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a patient have "tubercular dulaess" not knowing, indeed, wherein that dulness differs from any other kind of dulness, and, sad to say, our author has not divulged the secret.
For all practical purposes tubercular consumption may be divided into two kinds, acute and chronic. Chronic phthisis may be brought about in many different ways, but presents tolerably definite signs and symptoms in whatever way it may have been induced. This is now regarded pretty generally as admitting of great amelioration by treatment, and in many cases of cure. Acute tuberculosis is a general disease, extremely rapid in its course, and generally fatal. We say generally when we might be expected to say always. On this point we can only say that we have seen cases get well which were perfectly undistinguishable from cases of undoubted acute tuberculosis, where the diagnosis has been confirmed by autopsy, the latter being the only thing wanting to make the diagnosis absolute in the cases that recovered.
Dr. Brigham is not content with this simple classification. He gives us a chapter on catarrhal phthisis, another on phthisis due to amenorrhcea, &c., another on pneumonia, another on haemorrhage, a note on acute phthisis, and a chapter on chronic phthisis. In each of these chapters he gives medicines with their indications and illustrative cases. This necessitates much repetition, and introduces confusion, as the divisions are for the most part purely arbitrary.
It may be well here to indicate our author's position as regards therapeutics. Though not altogether despising the lower attenuations, his sympathies in the matter of dosage are clearly with the "Internationals." He is a believer in Fincke, and does not reject nosodes. But he is not a pure International. He is too liberal for that, and too fond of pathological theorising of a kind most un-International. The cases he cites are many of them of very great interest, though OBly about half of the 114 can be set down as genuine cases of phthisis. The rest are chest and throat disorders of other kinds.
The first cases related are some in which there is a marked connection between the chest affection and menstrual disorders. Dr. Brigham is strongly impressed with the idea that the latter act as causes of the former. The evidence he adduces is, however, quite insufficient to sustain his hypothesis.
The remedies he has most confidence in in cases of the kind are Alumina, Apis, Calc. Carb., Conium, Ferrum Met., Iodium, Lycop., Murex Purp., Puis., and Sepia. Here is what he says of Lycopod.
"The action of Lycopodium upon the ovaries, especially upon the right, has for a long time been well understood. It has been gaining clinical importance recently in the treatment of consumption. The two facts suggest that we are likely to find cases where it will be of great service when lung troubles seem to have arisen from menstrual derangements. The flatulency affecting the stomach and bowels; the urinary sediments; transverse character of pains or affections affecting the upper right and lower left sides, are often accompaniments pointing to Lycopodium. The leucorrhoea if present is usually excoriating, bowels constipated. Patients are subject to sharp cutting pains in the limbs, are sensitive to cold air, and are apt to emaciate, especially in the upper part of the body. The cough often seems to come from the stomach if one attempts to eat; pyrosis or burning at the pit frequently exist as a complication. Cough worse evenings, or night and morning.
"Case.—A woman of lymphatic temperament has for a long time suffered from a cough. Symptoms: cough getting worse, aggravations morning and night; expectoration copious, yellowish green, purulent, and of salty taste; occasional stitching pain in the chest; very weak; night sweats; looks more and more miserable every day; little appetite; burning at the stomach; bowels constipated, moving every three or four days; excoriating fluor albus; cannot bear a current of air; shifting rheumatic pains; had taken Natt Mur., and Calc. Gave Lycop.so every day then every two days; relief after the first dose, then improvement in the cough, disappearance of the night sweats, gradual lessening and eventual cure of leucorrhoea. Discharged cured in eight weeks."—Krussler, in Allg. Horn. Zeitung, xxix, 122;
"Dunham mentions the symptoms: 'menses too profuse, anticipate a little; preceded by flatulent distention of the abdomen; great weariness of the legs; chill and heat at night; ill-humour and disposition to weep. During the menses acid taste, headache, severe backache, swelling of the feet, nausea, and a kind of faintness. Leucorrhoea in spells of a blood-red colour.'
This is all very interesting, but it can hardly be accepted as doing anything towards proving the author's theory, and indeed we require to know a little of the physical signs before we can be quite certain that there was phthisis in the case. However, it is a good case any way.
The chief medicines Dr. Brigham relies on in pulmonary haemorrhage are Aconite, Veratrum viride and Elaps c. Arnica, Cactus, Phos., Ipec, Ham., China, and others are also recommended, and illustrated. Veratrum v. he confesses to have used somewhat empirically. As indications for Elaps he gives "taste of blood in the mouth and feeling of laceration in the region of the heart." Here is a case treated with China.
"A woman, set 40, has been nursing for sir months her tenth child. She had formerly been perfectly well; never had lung trouble. Has had cough with expectoration of blood for last two weeks. Symptoms: the woman seems strong but always looks thin and miserable; nearly constant dry hacking cough, with some pain in the chest every morning half an hour after rising, with constant tickling in the throat and some oppression of the chest; expectoration of bright red blood, about four ounces,with great exhaustion; cannot stir, pulse small, thread-like, rapid, 100; appetite poor; bowels constipated for three days; mind apprehensive. Prescribed immediate weaning of the child, and two doses each day of China12 After the third dose the cough ceased, and she was well after receiving twelve doses."—Hichelheim, in Hygeia, vii, 142.
It is interesting in this connection to note that Dr. Kuriazides (see New York Med. Times, Oct., 1882) has recorded two cases of haemorrhage from the use of Quinine, one from the kidneys, one from the nose, occurring in his own practice. Others have noted purpuric eruptions occuring from the use of the same drug.
In the cases that call for Aconite the blood is bright red, usually foamy. Arnica cases may have either black or bright red blood, frothy, mixed with mucus and coagula; there are periodical flushings accompanying the haemorrhage of Arnica.
In catarrhal phthisis and catarrhs which threaten to run into phthisis, the author thinks highly of Alumina. The chief indications for its use are, a dropping down of mucus from the posterior nares, a violent cough in the morning, raising of a little phlegm after coughing a long time, scurf about nose, swelling of septum. The Iodide of Arsenic appears to occupy but a subordinate place in Dr. Brigham's armoury. This is partly explained by his fondness for high dilutions, for we never hear of this drug doing much in the attenuations. It may be accepted as one of the best examples of the efficiency of what may be called the coarser homoeopathy, meaning by that the homoeopathy that does not confine itself to excessive refinements in fitting symptoms to symptoms, but dares to generalise, to endeavour to infer the genius of a disease from its manifestations, and the genius of a drug from its composition, as well as for its pathogenetic effects, and so adapt the one to the other. We are not aware of extensive provings of the Iodide of Arsenic, and yet it has earned a reputation in the treatment of consumption that is second to no other. From experience we can testify to its marvellous powers here, and could venture to match with any of the cases Dr. Brigham cites, cases in which the Iodide of Arsenic has performed the chief part of the cure. Do not let us be understood to disparage accurate homoeopathising, if we may be allowed the term. No remedy always answers expectations, and we are quite convinced that that medicine whose symptoms correspond most closely to the symptoms of the disease under treatment, is the most sure to cure. But in rapid prescribing that is not always possible, and next to it in value comes the power of grasping surely the genius of disease, and the genius of drugs, and so adapting likes to likes. This power is only gained by the most patient and intelligent study of disease and drug-action at the bedside, and in the study.
As an example of Dr. Brigham's method of presenting remedies and illustrative cases we may quote the following (italics the author's):
"Lung and thorax.—Sore pains in the lungs, felt more by deep inspirations and stitches when moving. Stitches in both sides of chest aggravated by leaning forward. Sharp slow stitches in left side of chest, in a line horizontal with the pit of the stomach. Stitches in the left chest from the left to the right side with sense of constriction. Stitches mostly begin on left side.
"Sharp stitches in right thorax, from within outward, not affected by breathing as most calcarea pains are.
"Cough.—The cough is dry, especially at night, often violent, and when expectoration follows, the feeling is as if something had been torn loose. Cough is provoked by air carried down by full inspirations; and by tickling in the throat as from feather down; also by eating, and playing on the piano.
"Aggravations.—Morning and evening.
"Accompaniments.—Morning exhaustion; dozing even after getting upon the feet. Intense melancholy. Very forgetful. If patient be a woman still menstruating, menses too early, too profuse, too fong lasting.
"Face chalky coloured, pale, may be bloated or may be thin; if thin skin inclines to shrivel.
"Flesh often flabby and soft. Lips swollen. Eyes surrounded with blue rings.
"Neck is slender and head seems too heavy for the small size of the muscles.
"Derangements of the stomach, such as a sense of weight soon after eating; pressure at the pit which is distended; eructations, which are tasteless or sour; spitting up of food or vomiting of ingesta; rapid loss of flesh (iodine). Abdomen bloated; mesenteric glands swollen, and various peculiarities in the excreta, such as, hard at first then thin^