FOOTNOTES:

FOOTNOTES:[J]Virginia Medical Monthly, Vol. II., No. 9, pp. 633-38, 1875. "He was commissioned surgeon in the Confederate army, July 1, 1861; served until August 1st in the field on the peninsula; then placed in charge of hospital in Williamsburg; afterwards ordered to Richmond and placed in charge of an hospital, and remained until close of war." Failing to find any further trace of him I am led to believe that he has been mustered out of service by the Grand Commander.

[J]Virginia Medical Monthly, Vol. II., No. 9, pp. 633-38, 1875. "He was commissioned surgeon in the Confederate army, July 1, 1861; served until August 1st in the field on the peninsula; then placed in charge of hospital in Williamsburg; afterwards ordered to Richmond and placed in charge of an hospital, and remained until close of war." Failing to find any further trace of him I am led to believe that he has been mustered out of service by the Grand Commander.

II.

It may be well to offer a critical examination of the foregoing cases. If they are genuine effects of the poison ofLatrodectus mactans, they must afford arecurrence of corresponding symptoms. They may differ indegree, because the quality of the venom may vary; first, from the season in which the bite occurred (and judging from cases I, IV and V, the poison ofLatrodectus mactansis most virulent in the month of September), and, secondly, from the more thorough elaboration of the venom. It is known that the poison ofCrotalus horridusdiffers in intensity according to the frequency with which the snake has bitten in a given period of time; of four successive "strikes" in four different organisms, and at brief intervals, the intensity of the action will vary, so that while the first wound is lethal the last is not—on which fact depends the vaunted reputation of many an antidote to the bite of the rattlesnake. That this may be also true of the spider poison is the only explanation I can offer for the fact that many naturalists have allowed themselves to be bitten by spiders of reputed poisonous species, and with impunity.

Recurrence of Corresponding Symptoms.

(Arabic numerals refer to the Cases.)

I.Nausea12II.Abdominal pain12III.Countenance anxious14IV.Pain up arm to shoulder,thence to back of neck45V.Præcordial pain extending toleft axilla, and down arm tofinger ends14VI.Left arm almost paralyzed14VII.Pain up arm to shoulder,thence to præcordia345VIII.Apnæa145IX.Præcordial pain1345X.Pulse feeble, thready1245XI.Skin cold1245XII.Sense of impending dissolution145

While Dr. Semple's reports do not precisely state it, I think we may safely infer asense of impending dissolutionin casesI, IV and V. The girl exclaimed she "would lose her breath and die;" the man in case I "expressed in words" "the deep anxiety he felt;" the woman in case IV was found "apparently moribund" with "gasping respiration," and therefore incapable of speech, but who can doubt that she hada sense of impending dissolution?

Isolated Symptoms.

It must be admitted that many of our accepted provings cannot as well bear a similar test.

III.

There is another feature that the believer in the law of similars should find no insuperable difficulty in accepting as a criterion of the validity of a proving, namely:the similarity of the drug symptoms to certain disease symptoms. I am not ready to believe that drug symptoms are only the result of a "fortuitous concourse of atoms," nor can I for one moment imagine that they are the product of blind and aimless chance. I plainly discern in them the result of law, and I am wholly unable to conceive of existing law without the absolutely necessarypre-existing law maker. The consequent must have its antecedent. Therefore, in a drug symptom I see a purpose, and by the light of the law of similars I find the purpose of a drug symptom in an analogous disease symptom—they answer to each other as face unto face in the refiner's silver—and behind and beyond them both is another purpose, of wisdom inscrutable, of love unfathomable. In a word, my reader, the problem of the visible universe forces upon me the alternative that weighed upon Marcus Aurelius—"either gods, or atoms." With atoms only I cannot account for law;with God and in God both atoms and law find a meaning and a purpose.

If I were submitting these convictions, or, if you will, this "working hypothesis," to a Sir Thomas Browne, or a William Harvey, or a Thomas Sydenham I should feel no momentary hesitation; as it is, I can only hope that the spirit that filled these worthies is not extinct in days when the "spiritual colic" that disordered an imaginaryRobert Elsmereis thought to disturb the eternal Verities. I much doubt if they who mistake an eclipse for an annihilation will get any good from this poor pen of mine.

The resemblance between the symptoms of angina pectoris and the effects of the poison ofLatrodectus mactansare so striking as to justify the presentation of a comparison; and it is hoped that physicians of wide reading will pardon what may seem to them a piece of supererogation for the sake of many a humbler practitioner whose opportunities have not been so happy. At the same time, the widest reader must admit that he has not found any one authority who has given a complete picture of angina pectoris. Nor is it essential that such an all-including "composite" shall now be presented; on the contrary, we shall offer only salient points substantiated by observers of the highest order.

It will be well to start from an authority whose scholarship has never been excelled—Copland. Of all our medical writers he may be called theGreat Definer—his readers will know what that means.

"Acute constricting pain at the lower part of the sternum, inclining to the left side, and extending to the arm, accompanied with great anxiety, difficulty of breathing, tendency to syncope, and feeling of approaching dissolution."

Copland presents a group of constants, and, for a terse definition, has well covered the principal phenomena. As variants he has omitted the pulse and the surface temperature. He errs on the side of dogmatism in defining the character of the pain as "constricting;" "aching, burning, or indescribable,"and "generally attended with a sense of constriction" is more in accordance with the actual condition. Of Copland's seven constants, Case 4 presents an analogue for each in symptoms IX., V., III., VIII., XII., and the "tendency to syncope," which is not included in our table because Dr. Semple did not put the fact in express words. If to this group we add thethready pulseandcold skin, we shall have "covered" nine of the most prominent symptoms of angina pectoris; a pathological "composite" with a most striking pathogeneticsimilimum.

But all the elements of Copland's group are not of equal importance; two of them, at least, are pathognomonic. "The two constituent elements of the paroxysm," says Latham, are "the sense of dissolution and the pain." "Pain with one awful accompaniment may be everything." "This mixture of the sharpest pain with a feeling of instant death." According to Fothergill "the two prominent subjective phenomena are pain in the chest and a sense of impending death." Eulenburg and Guttmann include another element: "We regard the substernal pain, the feeling of anxiety, and the disturbance of the heart's action, as the essential symptoms of angina pectoris." Romberg notes the companionship of these two elements: "The patient attacked with angina pectoris is suddenly seized with a pain under the sternum in the neighborhood of the heart, accompanied by a sense of anxiety so intense as to induce a belief in the approach of death."

We have laid the emphasis of these various citations on the "essential symptoms" in order to assert, with equal emphasis, that their analogues occur in not only one case ofLatrodectus mactanspoisoning. The præcordial pain is noted in Cases 1, 3, 4 and 5, and the sense of impending dissolution in Cases 1, 4 and 5. And that disturbance of the heart's action which Eulenburg and Guttmann consider an essential element is found in Cases 1, 2, 4 and 5; so that thetout ensemblepresented by Case 4 is corroborated.

Another important element, though it is one subject tovariations, is the direction of the extension of the pain. It most generally extends to the left axilla, and down the arm to the fingers; as variations it sometimes affects the right axilla and the back of the head. In Cases 1 and 4 the spider poison followed the direction of the disease, and in Cases 4 and 5 it also affected the back of the head. In Case 1 it produced the numbness of the arm and hand that is sometimes observed in the diseases.

Copland includes "difficulty of breathing" amongst the elements of angina pectoris. Trousseau does not regard this difficulty as real. "Although patients think they are going to be suffocated during a paroxysm, the chest is normally resonant on percussion, and if it be auscultated as they draw in breath again vesicular breathing is heard everywhere." Watson says, "the patient is not necessarily out of breath. It is not dyspnœa that oppresses him; for he can, and generally does, breathe freely and easily." Stokes is decided: "Respiration issecondarilyaffected; there may be slight dyspnœa or orthopnœa, with lividity of the face, yet by an effort of the will (if the patient dares to encounter the pang this commonly produces) the chest may be pretty freely expanded, and the breathing relieved for a brief space; dyspnœa is not a primary symptom of angina." Eulenburg and Guttmann say, "Our own experience leads us to adopt Parry's conclusion, that the changes in the respiration are principally, perhaps even solely, due to the pain." Bristowe speaks of the sufferer as "fearing to breathe." We can readily see that the "apnæa" observed by Dr. Semple in Cases 1 and 5 had physical origin, but in Case 4 he says "apnæa was extreme; the respiration only occasional—gasping." This shows to what an extreme extent the action of the spider poison had gone—even to implicating the diaphragm; and it is noteworthy that Anstie records a case of angina pectoris (Neuralgia and its Counterfeits, p. 67, London, 1871), in which "there was so marked a catching of the breath as to make it almost certain that there was a diaphragmatic spasm."

Of the changes in respiration accompanying angina pectoris we have, then, both the general, and the rarest, form, produced pathogenetically by the poison ofLatrodectus mactans.

IV.

In its physiological action the poison ofLatrodectus mactansresembles angina pectoris vasomotoria—a purely functional derangement. The similitude of the physiological action to pure angina pectoris corroborates the accepted pathology of the latter condition, because the phenomena ofLatrodectuspoisoning were educed from previously healthy organisms, and in pure angina pectoris there is no pre-existent organic change occasioning the attack. According to the accepted pathology, we have in angina pectoris vasomotoria, sudden spasms of the arterioles; from this an increase of the arterial tension; to overcome this is more forcible and rapid action of the heart; as the arteriole spasm persists and doubtless deepens in intensity, distension of the left ventricle follows, and from overdistension the agonizing breast-pang, and even death from stoppage of the heart's diastole. But we must include another element—spasm of the coronary vessels. "When there is a sudden rise in the blood-pressure in the arteries, due to vasomotor spasm of the peripheral systemic arterioles, and the heart-walls are strong and well nourished, palpitation is evoked; when the coronary branches are involved in the vasomotor spasm then angina is produced, and the heart-walls, acutely distended with blood, can scarcely contract in the face of the opposition presented to their contraction by the high arterial tension. When this sudden systemic arteriole spasm extends to the coronary vessels in a heart whose walls are diseased, a fatal attack of angina with the heart full of blood may be induced. The danger increases with the extent of the structural degeneration of the heart-walls. Sudden rises of blood-pressure in the arteries will tax hearts in their textural integrity, and lead to painful distension; such sudden demands on decayed hearts lead to agonizing angina pectoris, and the sense of impending dissolution is frequently followed by sudden death."

Spasm of the arterioles and coronary vessels, rise of blood-pressure in the arteries, embarrassed action of the heart, and painful distension are just so many consecutive links in the phenomena produced by the poison ofLatrodectus mactans, as Cases I and IV amply testify.

The spider poisons are akin to the serpent poisons in their property of producing a disorganization of the blood. In Case I, thin and florid non-coagulable blood continued to ooze from the cut surface despite the application of tannin. It may be a question whether this condition of the blood is directly toxicological, or a pathological result of stasis in the peripheral vessels. I incline to regard it as due to the latter condition, and I believe this explanation also holds good in the case of serpent poisoning.

The hæmorrhage recorded in Case I was of gastric origin; splenic congestion existed, and the vasa brevia—branches of the splenic artery—gave way under the pressure. I once met a similar hæmorrhage in a case of intermittent fever in a child, and I recorded the fact as a possible hint for the applicability ofLatrodectus mactansin a similar condition.

In all the year that the stray copy of the old magazine was in my possession I felt it a duty to write up this remedy. I have done it lamely, but as well as I was able. Reader, where my duty ends yours begins. May you discharge it more worthily than I.

(There have been a number of cases reported in whichLatrodectus mac.acted as Dr. Jones predicted; from them we select the following by Dr. E. H. Linnell,North American Journal of Homœopathy, December, 1890):

S. L. G., a man fifty years old, of bilious temperament, a dentist by profession, had slight attacks of angina after severe exposure and overexertion during "the blizzard" in March, 1888. He did not consider them of sufficient importance to consult a physician about them, but some months later he had a suppurative prostatitis, which was followed by considerable prostration, and the attacks of angina became very severe. I never could get a satisfactory description of the character of the pain, and I never saw him during a paroxysm. The pain was brought on by exertion of any kind, and was especially frequent soon after dinner. The pain was sometimes felt in the left arm, but was usually confined to the cardiac region. I once or twice detected a slight aortic obstruction sound, but aside from this failed to find any evidence of organic disease. The usual remedies gave no relief, butLatrodectusʒc was of great benefit. Under its use the attacks gradually became less frequent and less severe. He has taken no medicine now for at least six months, and he tells me that although he occasionally has a little reminder of his former trouble, the attacks are so slight that he pays no attention to them. I have given the remedy in another similar case, with even more gratifying success. The attacks were very promptly arrested and have not returned, although nearly a year has elapsed. I think we have in this remedy, to which Dr. S. A. Jones directed attention in one of the issues of theHomœopathic Recorder, a very valuable remedy in this painful affection. It is probably, as Dr. Jones suggests, in angina pectoris vasomotoria that it will be found especially serviceable.

Nat. Ord., Lemnaccæ.Common Name, Duckweed.Preparation.The fresh plant is pounded to a pulp and macerated in two parts by weight of alcohol.

(The following is by Dr. Robert C. Cooper, of London, and appeared in theHahnemannian Monthly, 1894):

"The lowest form of phœnogamous vegetation. It consists," says Lindley, "of lenticular floating fronds, composedof stem and leaf together and bearing the flowers in slits in the edge." It forms the green scum found on stagnant ponds and dykes. It is found in two varieties, theLemna minorand theLemna gibba.

Before going any further I may as well at once make a bald as well as a bold statement, and say that the special province ofLemna minoris to pitch with vigor upon the nostrils; from the very moment I began prescribing it this was beyond question evident. I can think of no possible source of error except that this beneficial action may be due to the germs adhering to the fronds of theLemnarather than to the pure plant-force.

To guard against this I have carefully filtered my tincture, but this has not made the slightest change in its beneficial influence.

Case I.Woman aged seventy-four; admission date, September 24, 1892. Nose never clear; breath very unpleasant; for twelve hours nose bled continuously last Christmas; unable to smell properly; hearing for the past seven or eight weeks bad; watch not heard on contact. PrescribedLemna minorθA. October 1, 1892: Feeling of cold in nose is better; sense of obstruction nearly gone; can smell better; hears on contact on both sides; no medicine. October 22: Decided, though slight improvement in hearing; nose, throat and all parts around more comfortable. Last attendance.

In proceeding with the consideration of the action of this remedy, I must consider myself fortunate in having the following case to bring forward:

1. A boy of fourteen, whose nose was completely blocked up for the last two years, and whose nostrils were full of polypi, the nose itself being broadened, and in whom the nose had been cleared out by operation a year ago at St. Bartholomew's Hospital, was sent to me by my colleague, Dr. J. H. Clarke. The boy never remembers having smelt anything, and the polypi can easily be seen blocking up both nostrils.

From the 26th of November, 1892, to the 4th of March,1893, four doses ofLemna m.θA were given at regular intervals without much change, thenCalcarea carbonica200 was given, and two weeks after, as he had faceache,Mercurius3d dec., and on the 8th of April following the faceache was better but the nose in no way improved.

ThenLemnawas given again, and this time with the most pronounced relief; the nose became much clearer, and he went on taking it, and it alone with scarcely an exception, in fortnightly doses, till the 14th of March last, when his nose was quite clear, with none but a very small polypi visible; he could breathe freely and his sense of smell had completely returned.

The delay in the manifestation of remedial change from November to March arose from complete blockage of the nose, and until the space created by the subsidence in the size of the polypi sufficed for a passage of air the patient had no reason to acknowledge relief.

In the treatment, both of swollen tonsils and in that of nasal polypi, the prescriber will be led away at the onset who accepts the testimony of the patient alone; he should make careful inspection of the parts, and be guided by what is often but a slight local change, as well as by concomitant, and it may be remote, symptoms.

2. The next case I have to bring forward is one of ozœna in a girl of sixteen, who had been three years under the treatment of a colleague who kindly sent her on to me for treatment at the London Homœopathic Hospital. The girl, whose occupation was a teacher, has had ozœna since three or four years old. The odor complained of was horrid, and the discharge excessive; a most unpleasant smell in the nose and nasty taste in the mouth; she takes cold easily if out in the night air or damp, and her nose, at times, gets stuffed up; bowels irregular; catamenia only twice—once three months ago and two months before that.

On December 30, 1893, I prescribedLemna minor, and she returned to me from the country, where she was living, onthe 31st of the following March, imploring me for another powder, as she had been almost well for two weeks after the last and then had relapsed to her old state; breathing is short and is low spirited.

21st of April, very much better; odor not nearly so bad, discharge much less; unmedicated pilules, three times a day.

19th of May, 1894, kept better for a month; took cold two weeks ago, and since then throat has felt thick and nose has discharged with a horrid odor. Catamenia regular. Breathing is better; crusts coming from both, worse on the left side. To haveLemna minor.

This patient came from a distance which prevented frequent attendance, but the above is quite sufficient evidence of the power possessed byLemna m.in acting upon the nasal mucous membrane.

In both these cases relief was immediate after the administration of the dose, and in neither case could any reasonable doubt exist as to its being drug effect.

In some cases I have known a certain disturbance of the bowels to set in after a dose ofLemna, but this effect of the remedy is not sufficiently pronounced to be able to say much about it. Still it is interesting to narrate one or two experiences, especially as in the first of these, at all events, the concomitants were interesting.

3. In a married lady, aged about twenty-six, for whom I prescribedLemna m.θA on Saturday afternoon, November 12, 1892, and in whom there existed a good deal of catarrhal pharyngitis, due to high up post-nasal ulceration, and who suffered from a dry feeling at the top of the throat with flatulence, and some pain in the bowels toward the evening, described as "twisting" pain, and in whom the nose was blocked on the right side, but without any visible polypus, and in whom the heart was easily disturbed, causing dyspnœa, the bowels being slightly confined.

Two weeks subsequently she stated that after the dose ofLemnathe nose felt less blocked, and she felt better in everyrespect; but that on the Tuesday following diarrhœa set in, which began with twisting pains in the bowels and went on to sickness; continual watery stools. The least chill or nervousness, I must say, upsets her in this way; and she was subject to the same the last two catamenial periods. She still wakes with her throat dry and tongue coated.Borax2x was then (November 25) given without any noticeable effect, and on the 9th of DecemberLemna minorθA was again prescribed for the following symptoms:

Mouth sore after talking or singing, and dry in the morning; tongue coated.

On the 23d of December, reported herself much better; tongue not so coated; heart less disturbed; no indigestion or diarrhœa.

Nose not perfectly clear, but no unpleasant smell or taste as she used to have, and throat no longer dry or uncomfortable. Instead of waking up with a dirty mouth, it feels clean and her taste pure.

4. A man, aged forty-seven, who suffered from old-standing vascular deafness and who specially complained of snoring a great deal, was givenLemna minor, and next day a rumbling and disturbance in the bowels set in and he felt as if he had taken medicine of a searching character. This lasted for three days, bowels acting during this time freely with much heat in the passage (anus); but was not bilious, nor were the motions diarrhœic; the snoring went away, and he ceased to dream unpleasantly when asleep. Hearing, too, seemed somewhat improved.

5. In another case, after a similar dose, diarrhœa came on next day, with pains across the bowels as from flatus; worse after eating, and a very putrid taste with an improvement at the same time in a stuffiness of the nose from which he was suffering.

6. Crusts form in the right nostril and pain like a string extends from the right nostril to the ear of the same side and right ear is deaf. (In a woman, aged twenty-six, great relief.)

It is with great pleasure that I have now to bring forward, not my own observations, but those of two valued colleagues. Dr. J. H. Clarke sends me the following:

Lemna minor,Case I.A lady, aged forty-seven, two years previously met with an accident; a sign board fell on her head when out walking in the street. Seven days after that was taken with sneezing attacks, suffered from nasal catarrh with little intermission until March, 1893, when she came under my care.Psorinum30 soon put a different complexion on the case, and she became so far relieved of her trouble (which has made her life almost unbearable, as she never dared make an appointment for fear of an attack coming on) that she discontinued treatment. Last Christmas a sharp attack of influenza brought back the catarrh, and this time it proved less amenable to treatment.

Fears of polypus distressed the patient, though I could not discover any.

However, she again made progress, but scarcely as rapid as I could have wished, when I thought of giving herLemnaon indications given by Dr. Cooper.

On February 15, 1894, I gave it in the 3x, one tablet four times a day.

February 22, very much better; has felt freer in the head than at any time during the last ten years; has felt very much better generally; spirits braced up.

She steadily progressed to cure, and by March 15th could endure the smell of strong scented flowers, which before was impossible.

Case II.Captain B., aged forty-four, consulted me on February 29, 1894, for violent neuralgia on the right side of the neck, the part being exquisitely sensitive to touch. He had cough and cold for a month. On getting up in the morning he filled two pocket handkerchiefs with yellow deflusion before he got his nose clear. I gave himBell.12 to take till the neuralgia was better, and then told him to takeLemna3x gtt. j. three times a day.

On March 9th he reported that theBell.speedily took away the neuralgia, and that then theLemnacleared off the catarrh in a most astonishing fashion. He never had a medicine to act so magically before.

30 Clarges street, Piccadilly, W., April 21, 1894.

The next communication that I have to bring forward is one from Dr. J. C. Burnett:

Dr. Cooper told me that he had relieved a case of nasal polypus withLemna minor, and having several cases of the kind that had long been under my observation I thought it my duty to give them the benefit ofLemna.

Case I.A gentleman of sixty years of age, with nasal polypus only moderately developed, yet of many years' duration, was much troubled by the chronic nasal obstruction which was markedly worse in wet weather.

I gave himLemna3x, five drops in water, night and morning. Returning in a month, he exclaimed: "That is the best tonic I have ever taken; I have never taken any medicine in my life that has done me so much good. I feel quite comfortable in my nose and can breathe through it quite well."

Case II.A lady, about forty-five years of age, mother of a large family and whom I had formerly cured of an uterine tumor, was so troubled with nasal polypi that her life was very distressful; moreover, the polypi had swelled so much that they hung out of the nostrils and compelled the patient to remain within doors. This was notably the case in wet weather. Why not have them removed chirurgically?

"Oh, I have had them operated on over and over again, but it's no good; they only come again worse than ever."

I have tried many things to cure these polypi, but in vain; they would get temporarily better, but the first rainy weather brought them back worse than ever; hence Dr. Cooper's recommendation ofLemnais very welcome to me.

I ordered, as in the last case, with the result that the polypivery greatly diminished in size, and the patient could again take her place in society.

I have usedLemnain many other similar cases, and with the like result. In no case is the polypus really cured, but greatly diminished in size, and the patient rendered relatively comfortable. Clearly theLemnadoes not either kill, cure or otherwise get rid of the polypi, but it rids them of much of their succulence and thus reduces their volume, and also diminishes the influence of wet weather to which such patients are so prone. And this is no small boon; is itself in every way superior to any operative interference. The tincture I made use of was made by Dr. Alfred Heath. The first prescription only being of Dr. Cooper's own make. Both acted alike well.

86 Wimpole street, June 4, 1894.

From these remarks of Dr. J. H. Clarke and Dr. J. Compton Burnett, as well as from my own, I think there can be no doubt, whatever, that theLemnaexercises a powerful influence upon the Schneiderian mucous membrane. How far it is capable by its specific action of removing large groups of polypi remains, as yet, an open question.

My own experience of the treatment of nasal polypi is that we have very few remedies that can at all be depended upon for giving even temporary relief. Even fromCalcarea carbonicaandTeucrium marum verumI have not had the effects that some practitioners testify to their possessing.

Lemnahas so far given relief in my hands to cases of nasal polypi and to cases where the nostrils were plugged by swollen turbinates and other causes in a matter far surpassing the effect I have obtained from any other remedy.

In saying this I do not at all wish it to be understood that we have in it a specific for all such cases.

We must remember that the symptoms in all such obscure diseases must be our guide for the selection of our remedy, and that, therefore, the important point is to work out the specific indications for the drug as we learn them from clinical observation, in the hope that on some future occasion pathogenesis may render these still more certain.

The indications that I myself have noticed as belonging toLemnaare either a putrid smell in the nose or a loss of all sense of smell and a putrid taste in the mouth, especially on rising in the morning, with a general foulness of the mouth, due apparently to the dropping down of impure material from the post-nasal region. Along with this there sometimes seems to prevail a disposition to "noisy diarrhœa."

Dr. Burnett has noticed thatLemnapatients have their nasal symptoms aggravated in damp and rainy weather, and I have to some extent confirmed this observation.

I hope on some future occasion to return to the subject ofLemna; it is in every way well worthy of being prosecuted further.

Thus, for example, a lady patient, æt. fifty-eight, suffering from pains flitting about her head and legs, with pains in her eyes during heavy rain, and in whom drowsiness by day and restless sleep at night existed, had all these symptoms removed by a single dose ofLemna, and the pallid, dullish, sickly look in her face changed to a complexion that was natural and healthy.

The truth would seem to be thatLemna'ssymptoms are specially aggravated in heavy rains;Calendula's, when heavy clouds are about;Rhododendron's, in thunder storms, andDulcamara's, in damp surroundings and in foggy weather.

(In 1895 Dr. Thomas L. Shearer contributed the following concerning the remedy to theHomœopathic Eye, Ear and Throat Journal):

Lemna minorwhere the crusts and the muco-purulent discharge are very abundant with fetor (in rhinitis atrophics). Its action is wonderful, but it must not be administered in too low a dilution, as it then produces a sensation of intense dryness in the pharynx and the larynx. Possibly if it were exhibited in a much higher dilution it would be applicable to cases which have only a slight amount of discharge. It seemsbest to stop the remedy as soon as its action upon the secretions is marked, and then to wait a while before returning to its further employment. Dr. Cooper, of London, was, I believe, the first to investigate the action ofLemna minorupon the upper air passages, but I do not think that he had tried it in cases of atrophic rhinitis. There is a great future for this new addition to our therapeutic resources, and it certainly deserves further investigation. It modifies the secretions to such an extent that we can more readily improve the condition of the nasal chambers with the aid of local measures. Whether it has the power to prevent or even retard the actual process of atrophy remains to be seen.

Preparation.—Dilutions made from the mineral water or triturations from the residue obtained by evaporation of the water.

(Dr. Burnett has called the attention of the profession to this water in his books. The following concerning its constituents is fromThe Therapist, a London journal):

Of all mineral waters those of Levico are distinguished, not only by their contents of these three elements, arsenic, iron and copper, but they are remarkable for the state of combination in which they occur. Situated in South Tyrol, on the confines of Italy, Levico has for many years been a favorite sanitorium of the Italian medical profession for their nervous and skin patients. Of late years Levico water has also been increasingly recognized by the German and Austrian faculty, among whom Bamberger, Billroth, Hebra, Nussbaum, and others testify to the extraordinary remedial activity of the waters, favoring assimilation, increasing nutrition, and in chronic and dyscratic skin diseases functioning as antiseptic or astringent.

Merely as an internal medicationLevicowater has, however, proved so satisfactory that it is a recognized member of the pharmacopœia in many German and Austrian hospitals and clinics. Thus Professor Nussbaum, of Munich, writes that 'Levicowater is given in my orthopædic institute in doses of two or three ounces to scrofulous and anæmic children. The water is well tolerated, and in spite of the smallness of the dose the result is, in many cases, very evident.' Professor Eulenberg, of Berlin, findsLevicowater especially satisfactory in chorea minor in children and at the age of puberty, as well as for hysterical neuralgia and spasms. A very copious testimony of like nature has been borne respectingLevicowater.

Nat. Ord., Leguminosæ.Common Names, Wild Vetch. Chick pea.Preparation.—Trituration of the dried pea.

(Dr. W. A. Dewey contributed the following paper concerning this remedy to theMedical Century, 1899):

History and Description of Effects,

TheLathyrusis a vetch, and a member of the leguminosæ family growing in India.

This remedy, which produces a perfect picture of certain spinal affections, has been known for over a century. InChristison's Toxicologyit is stated that it causes paraplegia, dragging gait, turning-in of the toes, stiffness and semi-flexion of the knee-joints.

The attention of the homœopathic profession was directed to the drug as a possible remedy in paraplegia, in theBritish Journal of Homœopathy, Vol. III. Here is found an account of a wheat famine in India, where the peas of the plant were substituted for wheat and used as a food. Those who subsisted on it were taken, even during sleep, withsudden paralysis of the lower limbs; this occurred without warning, in young men more than in young women, and was never recovered from. Another observer records fifty cases who had eaten theLathyrusbread and all stated that they became paralytic during the wet season of the country, that they went to bed quite well and awoke with stiff legs, unsteady gait, and aching, but no severe pain. The upper extremities were free.

Another who saw the disease in Algeria and described the symptoms found in ten cases observed that they came on suddenly, in damp weather, with some pains in the loins, trembling, motor paralysis and exaggerated reflexes. He attributed these phenomena to an acute transverse myelitis with degenerative changes in the cord.

A German writer states that the drug produces disturbances of nutrition of the muscles of the lower extremities, paresis, and that the muscles of the trunk and neck and face remain unaffected. Sensation remains normal. It seems to produce a sclerosis of the pyramidal tracts of the cord.

In animals the same condition is found; namely, paralysis of the hind legs. Pigs drag their hind legs and horses give out.

AGGRAVATED SYMPTOMATOLOGY.

From all the sources which I have been able to find, the following seem to be the symptoms caused by the drug:

Sudden loss of power in the lower extremities, from the waist down.

Tremulous, tottering gait.

Great exaggeration of the reflexes.

Stiffness and lameness of the ankles and knees.

Excessive rigidity of the legs; flexion difficult; spastic gait, the legs becoming interlocked, and walking is difficult or impossible.

Sudden onset of the trouble, and apparent aggravation in cold and damp weather.

Emaciation of the gluteal muscles also observed.

Those having taken it walked on the metatarso-phalangeal articulation, the heel not touching the ground.

Impossible to stand steady; swayed from side to side, but closing the eyes had no effect. This with the exaggerated reflexes would exclude its use in locomotor ataxia.

Debility and tremors of the legs.

Rigidity of the adductors of the thighs.

Staggering gait, with eyes fixed on the floor.

Could not extend or cross the legs when sitting.

Sensibility unimpaired.

CORRESPONDENCE TO SPINAL DISORDERS.

From these symptoms it will be seen that the effects of the drug correspond to many spinal symptoms, but more especially to what is known as spastic paraplegia. Indeed, Struempel asserts that it produces a perfect picture of this disease.

It is not so often that such a perfect picture of a disease can be had as in this instance. The disease itself is easily recognized by the stiff, spastic gait; the spasm of the adductors, causing the knees to strike each other, or to become locked, causing the patient to fall; the shuffling of the feet; the excessive muscular rigidity and the other well-known symptoms of paraplegia.

Therefore, reasoning from our law we would expect the drug to be of service in such cases, and although our pathogenesis of it is coarse we may be permitted to apply it to a disease whose symptomatology is of the coarse order; for it is often difficult to elicit any fine and characteristic symptoms in diseases like ataxic and spastic paraplegia.

It has been recognized as a remedy by but few of our writers on nervous diseases. O'Connor finds that marked benefit follows its use in old cases of myelitis with marked spastic symptoms. Bartlett, inGoodno's Practice, recommends it in excessive knee-jerk and rigidity. Hart speaks of it as a remedy in locomotor ataxia, but the absence of sensory symptoms and the presence of exaggerated reflexes would seem to contra-indicate it in this disease. He also speaks of it in spinal anemia, giving as symptoms: "Numbness, followed by pain in the lower extremities; sensation of a band around the body; unable to step or distinguish one limb from another"—symptoms which I am unable to find that the remedy produced. Elliott also speaks of it.

CLINICAL RÉSUMÉ.

The clinical record ofLathyrus, though very meagre, gives great hope that it may prove useful in numerous cases of bed-ridden paraplegiacs and in infantile spinal paralysis, as well as in certain forms of myelitis.

The following is a résumé of all that I can find published:

I. Case of spinal paraplegia, relieved.

II. A case of multiple sclerosis in a young man of twenty-eight who had been ill seven years and unable to walk for six years was greatly benefited byLathyrusʒx.

III. Case of paraplegia, could walk after taking the remedy for some time.

IV. Case of paraplegia, no improvement.

V. Rheumatic paralysis, with stiff knees, could walk after use ofLathyrus. (ClarkHomœopathic World.)

VI. In a case of a clerk with loss of power of the lower limbs, reflexes exaggerated, knee-jerk violent, locomotion difficult and unsteady, probably a case of transverse myelitis,Lathyrusʒx, night and morning, gave most satisfactory results. The patient could walk a mile without assistance. (Simpson,Homœopathic Review.)

VII. In a man aged fifty-two who had been unable to walk for six years, the paraplegia coming on after a "stroke" from exposure to wet,Lathyrusʒx practically cured in eight months. He had been tied to a chair for six, and at the time he stopped treatment he was walking four miles daily. (Blake,Homœopathic Review.)

From the fact that theLathyrusdisease occurs frequently in certain mountainous regions of Asia it has been remarkedthat it is akin to Beri-Beri, which has been traced to eating theLathyrusbread.

Nat. Ord., Compositæ.Common Names, Dense Button-Snake-root. Gay Feather. Devil's Bit.Preparation.—The root is pounded to a pulp and macerated in two parts by weight of alcohol.

(The following, by Dr. T. C. Duncan, was called forth by the publication of an item inEclectic Medical Journal, stating that twice during the past yearLiatrishad given good results in dropsy; in one case, on the second day, the patient had passed a gallon and a half of urine. Dr. Duncan's paper was published in theHomœopathic Recorderfor 1898):

Any new remedy that promises relief in dropsy will be hailed with pleasure by the profession. Happening into a pharmacy soon after receiving the JanuaryRecorder, a physician rushed in and inquired for "that new remedy for dropsy—that got rid of 'a gallon and a half of urine in one day.' Have a bad case cardiac dropsy. Want to try it. How do you give it?" He could not get it. "Get me some," was his order. "There is the article, be sure to get the right thing,Liatris!"

Liatris spicatais the familiar "button-snake-root" that I used to dig every fall for our old family physician (who called himself a "botanic physician") and who gave it for indigestion. It is also called "colic root" and "devil's bit," because a piece is missing from each tuber as a rule, just as if bitten out.Kost's Medicine(my first medical work) describes it as follows: "Root perennial, tuberous, ovate, abrupt, beset around the base with many fine fibers; it is aromatic. Stem round, about three feet high, bearing a spike of scaly purple-colored blossoms, bearing in the aggregate a resemblance to an acorn. The leaves are linear or sword-shaped, somewhatresembling the leaves of young corn. It is found in prairies and open woods in the western States."

"TheLiatrisis an aromatic stimulant, diaphoretic, diuretic, anodyne and carminitive. It is particularly useful in colic, backache and flatulency."

It is interesting to know that it has had clinically a good effect in dropsy, (1) due to liver and splenic enlargement, also (2) where the kidneys were involved. In the second case referred to, "Apocynum can.,Aralia,Digitalis,et al." had been given, but the kidneys failed to respond until theLiatris"was given in infusion," then "on thesecondday the patient passeda gallon and a half of urine"—equal to 192 ounces of urine! In the first case theLiatriswas followed byFerrum carb.

Whether it will prove equally efficient in cardiac dropsy only time will tell. I hope that the readers of theRecorderwill report results, whether favorable or otherwise. The dose that Dr. Bradley gave was about a pint, drank during the course of the day, containing about half an ounce of the root. The tincture will be more convenient, and it is a question if the dilutions will not be equally efficient. Try the third, and then go up or down the scale as the case seems to demand. This drug should be proved. It is harmless. If any young physician will volunteer I will gladly direct him.

Infusion ofDigitalis(English leaves) is a favorite prescription with some physicians in cases of cardiac dropsy, but I have not found that form any more efficient than the dilution, except in cases where alcohol had been a cause, thenStrophanthusorArsenicumhad a better effect.

Nat. Ord., Gramineæ.Common Names, Darnel. (G.) Taumellolch.Preparation.—Trituration of the dried seeds.

(The following concerning this little used drug was reported by Dr. Bonino, an Italian physician, translated by Dr. Mossa and published in theAllgemeine Hom. Zeitung, July, 1898. The use of the drug by Dr. Bonino was truly homœopathic for the short proving of it. Allen'sEncyclopædiareports trembling of the limbs and hand so great that "he could not hold a glass of water.")

A carpenter, aged twenty-nine years, had been suffering ever since his eighteenth year of trembling in both hands, especially in the morning; of late also his legs began to tremble. It is remarkable that both his father and his brother were subject to the same ailment, while no definite cause could be indicated. He was first givenMercurius vivus, thenAgaricus, which brought a partial but only transitory improvement. Finally I prescribedLolium tem., which in a short time effected a cure.

(On this Dr. Mossa comments as follows):

The pathogenetic effects of this remedy which has not yet been proved at all are only known to some degree from its effects when it has been mixed with grain and baked into bread. It has caused chest troubles,vertigo(thence the name darnel-grass, in GermanTaumellolch),trembling, paralysis with anguish and distress, vomiting, failing of the memory, blindness, headache, epileptic attacks, deep sleep and insanity. The good success obtained by its use in the case given above shows what curative effects may be expected from it in severe affections of the brain or spinal marrow. An Italian physician, Fantoni, has tried it in cephalalgia, meningitis rheumatica and in ischias.

Nat. Ord., Labiatæ.Common Name, Bugle Weed.Preparation.—Tincture of the whole plant by macerating one part by weight of the fresh plant in two parts by weight of alcohol.

(Although a well-known remedy, the following concerning it may not be amiss here; it is from theHomœopathic World, 1889, by Dr. Proell):

Lycopus Virginicusseems to be a specific for bringing back an old (but long disappeared) hæmorrhoidal flux in persons with light eyes. I gave, a week ago, the first decimal dilution to a gentleman (sixty years) for noise and throbbing in the head during the night (which prevented the quietness of sleep); because neitherCactus(which helped quickly when he had blood-spitting) norKalmia, norGelsemiumhelped radically. The night after takingLycopus, he was a little better, and in the forenoon came a bleeding from the rectum (about three tablespoonfuls after defecation) with great general relief. There was chronic catarrhus bronchialis. Two days afterwards, I gave an elderly lady (sixty years), who had glycosuria, cataract of the left eye, and every third night was very restless,Lycopus Virginicus1 decimal dilution, one drop in the evening. The following night was excellent, and in the morning came an abundant bleeding from the rectum, with great relief. Both patients are tall, very irritable, have weak innervation of the heart, without decided organic disease of the heart; both are hypochondriacs; have light eyes; noise in the left ear. Both had, years ago, hæmorrhoidal flux, which stopped suddenly.

Preparation.—It is prepared in three degrees of strength:No. I. Is the water that stood on decomposed vegetable matter for one week at a temperature of 90° F.No. II. Is the water that decomposed vegetable matter for two weeks.No. III. Is the water that decomposed vegetable matter for three weeks.

(The following is an abstract of a paper on this peculiar remedy, by Dr. G. W. Bowen, that appeared in the Transactions of the Indiana Institute of Homœopathy, 1895):

In the summer of 1862 vegetable matter of different forms was decomposed in my office in glass jars, and malaria was freely generated. Persons were hired to inhale the gas evolved in its different stages of decomposition, and a careful observation of its effects on them was made that gave me a clue to its future use, and the only reliable guide for combatting its effect when acquired naturally.

Not only did the gaseous form demonstrate, but subsequent use of the liquid product proved it capable of producing not only the three leading types that the past years had made me conversant with, but also others of a minor grade yet of unsuspected parentage.

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