Homeopathic Materia Medica

Lectures on Homoeopathic Materia Medica, James Tyler Kent

Lachesis is a frequently indicated remedy, and one that you will need to study much in order to know how to use. Lachesis seems to fit the whole human race, for the race is pretty well filled up with snake as to disposition and character and this venom only causes to appear that which is in man.

Generals: We will first give a survey or the general symptoms, those which characterize the remedy and are of greatest importance, and the circumstances under which the symptoms appear, are brought out or are aggravated.

One who is a constitutional Lachesis patient will find himself suffering from an aggravation of his symptoms in the Spring, when he goes out from the cold weather into the milder weather, and especially is that so if it mild and rainy, or cloudy weather. Or if he goes from a cold into a warmer climate the symptoms of Lachesis will come out. The warm south winds excite the Lachesis symptoms.

The symptoms of Lachesis are worse on entering sleep. He may have felt nothing of his symptoms when awake, but when sleep comes on they are aroused, and they gradually increase as the sleep is prolonged, so that a very long sleep will aggravate all the state and condition of a Lachesis patient, and when awakening from sleep he looks back on that sleep with sorrow.

The sleep has been disturbed by attacks of suffocation and by awful dreams, and now, after having slept a long time, he arouses with dreadful headaches, with palpitation, with melancholy, with sorrows from head to foot. His body is full of suffering and his mind sees no brightness in anything.

There is a cloudy state, sadness, melancholy, insane notions, whims, jealousy and suspicion. When taking a warm bath, or applying warm water to places that are inflamed, his mental symptoms are aggravated. After a warm bath or after getting warmed up, or, if he becomes chilled from being out on a cold day and then goes into a warm room, the symptoms come on. After going into a warm bath, palpitation comes on; it seems as if his head would burst, his feet become cold, and he is shocked all over, pulsation all over, or feeble heart. Fainting in a warm bath. Girls sometimes faint when going into a warm bath. The patient may be cold and chilly yet the warm room increases or brings out the symptoms.

The general aspect of the patient and the localities will point some times to Lachesis. Upon the face there is an appearance of anxiety, of unrest and distress. The face is spotted or purple and the eyes are engorged. The eyes look suspicious. If there is an inflamed spot, it is purple. If there is an inflamed gland, and Lachesis is full of inflammation of the glands and cellular tissues, there is a purple or mottled appearance.

If there is an ulceration the ulceration bleeds black blood, which soon coagulates and looks like charred straw. From the wounds there is much bleeding. Small wounds bleed much like Phosphorus and Kreosote. A prick of a pin will ooze great drops of blood. Ulcers eat in, have false granulations, are putrid, bleed easily, and the blood is black, and all round the ulceration there is a purple, mottled appearance, looking as if about to become gangrenous.

Often gangrene does come; gangrene of parts that have been injured. Sloughing with great offensiveness. The parts turn black and slough. The veins become varicose. These are found upon the limbs, having the appearance of the varicose veins that come after gestation. Enlargement of the veins is a prominent condition of Lachesis.

From the slightest exertion of the mind or from the slightest emotion the extremities become cold, the heart becomes very feeble, the skin is covered with sweat and the head is hot. Warmth does not seem to relieve the coldness of the feet and hands; they are so cold. They may be wrapped up in flannels and still they remain cold, but suffocation is brought on. He cannot breathe and wants the windows open. It is weakness of the heart; sometimes so weak that it can hardly be heard or felt, and the pulse is feeble and intermittent. At other times there is audible palpitation of the heart.

As we go over the symptoms of the text we will notice something singular about the complaints, that is, their tendency to affect the left side, or to, begin on the left and extend to the right. The paralysis begins by gradually appearing weakness upon the left side. Which extends to the right side. It has a strong affinity for the ovaries, and in this it will be found that the left ovary is affected first. So, in inflammation of the ovaries, the left will be affected first, and later the right.

The inflammation begins on the left side of the throat and gradually goes to the right. The left side of the head is commonly most affected. The left eye becomes painful and the pain extends to the right. The left side of the back of the head, in the occipital headache, will be more affected than the right. This does not always follow, and if the reverse is true it does not contra-indicate Lach., but such is the common feature of it. Left upper and right lower has been observed.

In many symptoms of Lachesis, there is morning aggravation. This is the well-known Lachesis aggravation after sleep; the patient will sleep into the aggravation. In the milder symptoms this aggravation is mild and is not felt until after the patient wakes up from a long sleep, but if the aggravation is one that is of considerable violence, the patient may feel it immediately on going to sleep, and it arouses him; for instance, the heart symptoms. As soon as he goes into a sleep he rouses up with palpitation, with dyspnoea, with suffocation, with exhaustion, with vertigo, with pain in the back of the head, and many other circulatory disturbances.

Mind: The next most important thing to be studied is the mental state. Nothing stands out more boldly than the self-consciousness, the self conceit, the envy, the hatred, the revenge and the cruelty of the man. These things, of course, are matters of self-consciousness, an improper love of self. Confusion of the mind to insanity.

All sorts of impulsive insanity. The mind is tired. The patient puts on an appearance like the maudlin of a drunkard, talks with thick lips and thick tongue, blunders and stumbles, only partly finishing words; the face is purple and the head is hot.

There is choking and the collar is uneasy about the neck; and the more uneasiness about the neck, the more choking, the more confusion of mind and the more appearance of intoxication. You will see if you talk with one who is intoxicated with whiskey symptoms like Lachesis, he stumbles through, hardly realizing what he says, half finishing his sentences and his words, leaving his "g's" off, all the present participles; he stumbles and blunders, he mutters, and tells you first one thing and then another.

These symptoms are increased under the circumstances mentioned in the Spring; in the warm weather following a cold spell; in rainy weather; after a warm bath; after sleep.

The mental state is large. Jealousy without any reason. Unwarranted jealousy and suspicion. Many times this medicine has cured suspicion in girls, when they were simply suspicious of their girl friends. She never sees a whispered conversation going on but they are talking about her, to her detriment.

Suspects that they are contriving to injure her, and she will resort to any scheme to see if they were not talking of her to her detriment. A woman imagines that her friends, husband, and children are trying to damage her; that her friends are going to put her in an insane asylum.

Apprehension of the future. Thinks she is going to have heart disease, and is going insane; and that people are contriving to put her in an insane asylum. Imagine her relatives are trying to poison her and she refuses to eat. She thinks sometimes that it is only a dream and she can hardly say whether she dreamed it or whether she thinks it. She thinks she is dead, or dreams that she is dead, and in the dream preparations are being made to lay her out, or that she is about to die.

Thinks she is somebody else, and in the hands of a stronger power. She thinks she is under superhuman control. She is compelled to do things by spirits. She hears a command, partly in her dream, that she must carry out. Sometimes it takes the form of voices in which she is commanded to steal, to murder, or to confess things she never did, and she has no peace of mind until she makes a confession of something she has never done.

The torture is something violent until she confesses that which she has not done. Imagines she is pursued. Imagines that she has stolen something, or that somebody thinks she has stolen something, and fears the law. She hears voices and warnings, and in the night she dreams about it. The state of torture is something dreadful, and it then goes into a delirium with muttering. The delirium is carried on like one muttering when drunk. This state increases until unconsciousness comes on and the patient enters into a coma from which he cannot be aroused. The patient also goes through periods of violence and violent delirium.

It is full of religious insanity. You will find a dear, sweet old lady who has always lived what would be called an upright and pious life, yet she is not able to apply the promises that are in the Word of God to herself; these things seem to apply to somebody else but not to her. She is full of wickedness and has committed the unpardonable sin. She is compelled to say these things; she is overwhelmed by these things and she is going to die and going to that awful hell that she reads about. The physician must listen to this with attention. The physician might make the mistake in this instance of making light of such feelings. If he does, the patient will not return, and he will be deprived of the chance of benefiting her.

No matter what her whims are, no matter what her religious opinions are, her state of mind must be treated with respect. It must be treated as if it were so.

She must have sympathy and kindness. It is an unfortunate thing for a doctor to get a reputation of being an ungodly man, among pious people, as he will be deprived of doing these people an immense amount of good. He must be candid with all the whims and notions of the people that he visits in the world. He must be everybody's friend and he can be such without any hypocrisy if he is simply an upright and just man.

The state of religious melancholy, with religious insanity, is not uncommonly attended with much loquacity, with talkativeness, which Lachesis is full of. It is commonly among women, very seldom among men, that we find this religious melancholy. Now, this woman is impelled to tell it; she will annoy her intimate friends, day and night, with this story of the damnation of her soul and her wickedness and all, the awful things she has done. If you ask her what things she has committed she will say everything, but you cannot pin her down to the fact that she has killed anybody. If you allow her to go through with her story she will tell you all the crimes in the calendar that she has committed, although she has been a well-behaved and well-disposed woman.

There is another kind of loquacity belonging to Lachesis. The patient is impelled to talk continuously. It is found in another. state in which the patient is compelled to hurry in everything she does and wants everybody else to hurry, With that state of hurry is brought out the loquacity, and this is something far beyond comprehension, until you have once heard it.

There is no use attempting to describe it, it is so rapid, changing from one subject to another. Sentences are sometimes only half finished; she takes it for granted that you understand the balance and she will hurry an. Day and night she is wide awake, and with such sensitiveness to her surroundings that you, would naturally think, from what things she hears and how she is disturbed, by noise, that she can hear the flies walk upon the walls and the clock striking upon the distant steeple.

You do not get all these things in the text, you have to see them applied. But the things I give you that are brought out clinically are those things that have come from applying the symptoms of the remedy at the bedside to sick folks.

"Most extraordinary loquacity, making speeches in very select phrases but jumping off to most heterogeneous subjects."

"One word often leads into the midst of another story."

These states may come on in acute diseases like typhoid, when it will take the usual typhoid delirium, or they may come on in conditions like diphtheria, or in any of the diseases that are characterized by blood poisoning; they may come on in the puerperal state, or may take the form of insanity. It is a long acting remedy, and if it has been abused its effects will last a life time.

In many cases a close connection between the mental symptoms and the heart symptoms will be noticed, especially in young women and girls who have met with disappointment, who have been lying awake nights because of disturbance of the affections, or from disappointment, or from shattered hopes, or from grief.

Prolonged melancholy, mental depression, hysterical symptoms, weeping, mental prostration and despair, with pain in the heart, with a gone sensation or sensation of weakness in the heart, with difficult breathing. She meditates upon suicide, and finally settles back into an apathetic state, in which there is an aversion to, everything, to work, and even to thinking.

I might impress upon your mind the head symptoms if I related the case of a patient who described her symptoms probably more typically than you can find in the books. She was sitting up in bed and unable to lie down; she was worse from lying down, her face was purple, her eyes were engorged, the face puffed and tumid and the eyelids bloated. She sat there perfectly quiet in bed and described the pain as a surging sensation, which came up the back of the neck and head and then over the head.

That is a typical feature of Lachesis. A surging in waves. Waves of Pain that are not always synchronous with the pulse. They may not relate to the flow of blood at all. The surging is aggravated by motion, not so much in the act of motion, but after moving. It is sometimes felt after walking or changing to another place, and sitting down again; that is, a few seconds after the motion is completed the pain begins, and it comes to its height instantly and then gradually subsides into a very steady surging or a more steady ache.

Head: In the head there is a continuous steady ache, which may be aggravated or aroused into a surging which is so violent that it seems as if it would take the life of the patient.

The headache begins in the morning on waking. The milder Lachesis headaches begin in the morning on awaking and wear off after moving about a while. With the headaches and complaints in general there is a momentary vanishing of thought; all sorts of vertigo. Vertigo, with nausea and vomiting. The vertigo inclines the patient to turn to the left.

Lachesis has bursting pains in the head congestive pains with a feeling as if all the blood in the body must be in the head, because, the extremities are so cold and the head pulsates and hammers. This pulsating headache is part of a general pulsation from head to foot. In all arteries and inflammed parts, there is pulsation. The inflamed ovary pulsates, and it feels at times as if a little hammer were hammering upon the inflammed part with every pulsation of the artery. Lachesis has a number of times cured fistula in ano when associated with this feeling as if a hammer continually hammered the little fistulous pipe.

It has cured fissure of long standing when it felt as if the inflamed part were being hammered. Haemorrhoids have been cured when this sensation of hammering was present. So that we see this pulsation in the head is not a special symptom, but is a general symptom, brought out in relation to the head.

Some symptoms are valuable because of the frequency of their association, and when such is the case their concomitant relation. becomes important. The cardiac symptoms are frequently connected with the headache symptoms in Lachesis. It is seldom that you will see Lachesis headaches without cardiac difficulty. A weak pulse or the pulsation felt all over the body, is more or less associated with violent Lachesis headaches.

In the text we find weight and pressure as a strong feature of the Lachesis head symptoms. With almost any complaint of the body, with typhoids, at the menstrual period, during the congestive chill, it seems that the body becomes cold, the extremities become cold, the knees are cold, the feet are cold, and it is impossible to keep them warm, while the face is purple and mottled, the eyes are protruding and engorged, and this awful pain in the head, with a tendency to become unconscious, incoherent speech, difficulty of articulation, and finally actual unconsciousness.

In relation to the head symptoms and mind symptoms and the sensorium in general, the oversensitiveness that is found in Lachesis ought to be mentioned. His symptoms become very intense. The vision becomes very intense; the hearing becomes intense; the sense of touch especially is overwrought. The touch of the clothing becomes very painful, while hard pressure may be agreeable. The scalp becomes so sensitive to the touch of the hand that it is painful, while the pressure from a bandage is agreeable.

Oversensitive to noise, oversensitive to motion in the room, to conversation and to others walking over the floor. By these circumstances the pains are increased. The patient becomes extremely sensitive throughout all the senses of the body.

The oversensitiveness to touch is probably extensively in the skin, because of the fact that hard pressure often gives relief. In one who is suffering from peritonitis, front inflammation of the ovaries or uterus, or any of the abdominal viscera, the skin is so sensitive to. the clothing that contrivances are sometimes necessary to relieve the suffering from, the touch of the bed clothing. Something in the form of a hoop will be found in the bed, or the patient will have the knees drawn up, or with the hands will hold the clothing from touching the body. The ordinary weight of the hand may bring out the soreness that is in the abdomen, which is an entirely different soreness, whereas the clothing touching the abdomen only brings out the oversensitiveness of the skin. The mere touch of the skin with the finger or hand is unbearable.

Eyes: There are many inflammatory and congestive conditions of the eyes.

The eye symptoms are worse after sleep, and the eyes are oversensitive to touch and light. With the eye symptoms we have headaches, because the brain and eyes are so closely associated. In the sore throats, when the spatula or tongue depressor happens to touch the wall of the throat, the tonsil, or the root of the tongue, there is a feeling as if the eyes would be pressed out. Violent pain in the eyes from touching the throat.

Lachesis is a great jaundice medicine, because it produces much disturbance in the liver. Yellowness of the skin and whites of the eyes, and thickening of tissues about the eyes.

"Fistula lachrymalis," which is accompanied by long standing eruptions about the face.

Oversensitiveness of the meatus auditorus externus. Anything introduced into the canal of the ear will cause violent, spasmodic coughing and tickling in the throat. So sensitive is the mucous membrane of the ear that a violent cough, like whooping cough, will come on from touching the mucous membrane of the ear. This only shows the oversensitiveness of reflexes, and the oversensitiveness in general. With the hearing there is the same oversensitiveness that we have spoken of elsewhere. The Eustachian tube becomes closed with a catarrhal thickening, stricture of the Eustachian tube.

Nose: The catarrhal symptoms of the nose are prominent. Frequent bleeding of the nose and body, watery discharge from the nose. Always taking cold in the nose. Stuffing up of the nose, with disturbance of smell. Oversensitiveness to smell, and oversensitiveness to odors, finally loss of smell.

Lachesis has inflammatory conditions, very chronic in character, with crusty formations in the nose, sneezing, watery discharges from the nose and catarrhal headaches. Sometimes the headache goes off when the catarrhal discharge comes, and when the catarrhal discharge stops the headache comes on. Violent headache with discharge, with sneezing and coryza. Congestive headaches with coryza.

This catarrhal condition has led to the use of Lachesis in syphilis. It is sufficiently similar to cope with the severe forms of nasal syphilis; syphilis where it has affected the nasal mucous membrane, producing crusts and finally affecting the bones. Fetid oezena; very offensive discharges from the nose. Bleeding from the nose need not surprise you, because Lachesis is a hemorrhagic remedy.

The blood from the nose or any part, when it dries or clots, looks like charred straw or becomes black. Parts bleed easily. Copious and prolonged uterine hemorrhage, copious and prolonged menstruation, bleeding front the nose, vomiting of blood, hemorrhage from the bowels in typhoids.

"Great sensitiveness of the nostrils and lips, swelling of the lips, great swelling and tumefaction of the nose in old cases of syphilis."

The nose swells up and becomes purple. The nasal bones are very sore, soreness upon sides of the nose. Lachesis is an especially useful medicine in old drunkards who have red nose, and in heart affections with red nose. A red knob on the end of the nose, a strawberry nose.

Face: The face is purple and mottled, the eyelids are tumid, very much puffed; not bloated as in oedematous subjects, but puffed. There is not the pitting upon pressure that we find in oedema, although Lachesis has that, but there is a puffiness peculiar to Lachesis, the face looks swollen and inflamed, due to a venous stasis, so that the face is purple and mottled.

The nose is tumid, yet it will not remain pitted upon pressure. The lips feel as if inflamed, yet are not inflamed, simply sensitive to pressure. The face has also an oedematous appearance in which there is pitting upon pressure, in cardiac affections, in cases of Bright’s disease. On the other hand the face becomes very pale, pale and cold; the skin covered with scaly eruptions.

Eruptions that bleed easily, with crusty eruptions, with vesicular eruptions. Eruptions that fill with blood, bloody vesicles and large blood blisters, such as occur sometimes in burns, with burning. The face becomes jaundiced and very sallow. At times it takes on the appearance also of a chlorosis.

If you have once seen the chlorotic color, it need not be described. It is a condition of anemia, with yellowish pallor, ash colored or grey, intermingled with a sort of greenish color, so that the ancients often referred to it as green sickness. Again the face becomes livid and puffed like the bloated aspect of drunkards, the mottled purple appearance of drunkards who have been drinking for years, until they are bloated and broken down and have a besotted aspect. You see that in Lachesis.

In Lachesis we have a remedy for erysipelas and gangrenous affections, and about the affected part there is the Lachesis appearance, that is the mottled, purplish appearance. Lachesis has become clinically a marked remedy for erysipelas and for gangrene. As provers do not follow up remedies until they produce these things, we have to gather them from the poisonous effects and clinical observation.

Mouth: In Lachesis there is oozing of blood around the teeth, the gums bleed easily. Dry crusts appear upon the teeth in zymotic diseases, often black formations, sordes, and the tongue takes part in the appearance of the mouth and becomes slick. This occurs in typhoid conditions when there is a total loss of assimilation, the appetite is entirely gone, the stomach will not take food, and when food is put into the stomach it is rejected. There is also paresis of the tongue. The tongue seems to be like leather in the mouth, it is moved with great difficulty. And the speech is like that of one half intoxicated; he is unable to articulate.

The tongue swells and is protruded very slowly. It is dry and catches on the teeth and seems to have lost its stiffness. Seems like a rag, or as if the muscles did not act upon it so that it cannot be protruded, or if it is protruded it trembles and quivers and jerks and catches on the teeth. Again it is swollen, it is denuded of its papillae, and smooth, shiny and glassy as if varnished.

In the mouth there is a soapy appearance of the saliva. The saliva runs into the mouth copiously and the patient will often lie with the head over the side of the bed, and the saliva dripping into a pan or commode. The saliva is stringy and can be pulled out of the mouth in strings; white mucus or saliva.

This is not an uncommon feature in diphtheria, in sore throat, in inflammation of the tongue and mouth and gums, and in inflammation of the salivary glands. When this mucus is thick, tough, yellow, stringy and ropy it is like Kali bichromicum. You will often find in severe sore throat that the patient will lie and gag; and cough, and attempt with difficulty to protrude the tongue to expel the saliva from the mouth.

Very often the pain is so severe in the root of the tongue that he cannot expel the saliva by the tongue and he will lie with the open mouth over a commode, or with a cloth over the pillow, to receive the thick, ropy saliva. In such a state with sore throats, especially those that commence on the left side and go to the right, you hardly need to question longer, for it is the aspect of Lachesis.

This state of affairs would lead to Lachesis in ordinary inflammatory conditions of the tongue and in cancerous affections of the tongue. Lach. has in its nature the tendency to formation of malignant scabs and malignant ulcers, such as we find in epithelioma. It has cured a number of cases of epithelioma. It has been a very useful remedy in lupus. It is an important remedy in syphilitic sore throat, in syphilitic ulceration of the throat, tongue and roof of the mouth with this copious, stingy saliva.

Pharynx: The muscles of the pharynx become paralyzed and will not act, and hence the food will collect in the pharynx, that is, the bolus to be swallowed goes to the pharynx and stops, and then a tremendous effort at swallowing, with gagging and coughing and spasmodic action of the chest, takes place in order to carry on respiration, and he will not again attempt it. This state often occurs with diphtheria.

I have a number of times seen it brought about by the physician, who has, instead of giving just enough Lachesis, high enough and similar enough to the disease to cure, given it as low as he could get it, the 8 th or 10 th, dissolved it in water and fed it all through the diphtheritic state.

When you come across cases that have been treated in this way you need not be surprised if a post-diphtheritic paralysis comes on, because Lachesis will produce it. It may cure the diphtheria, but it will leave its poisonous effects which will last that patient a lifetime. Every spring the symptoms of Lachesis will crop out. In all the circumstances of aggravation described the symptoms of Lachesis will crop out if he has once been poisoned by it.

In the sore throat we have a combination of symptoms. Lachesis has produced this state, going from left to right; but with the sore throat there is a sensation of fullness in the neck and throat, difficult breathing, pallor or plethoric appearance of the face, choking when going into sleep, the peculiar kind of saliva and aggravation of the throat symptoms from warm drinks.

There is not always an aggravation of the pain itself from warm drinks, but the patient is often unable to swallow warm fluids. The swallowing of warm fluids often causes choking, and after a swallow of warm tea is taken the patient will clutch at the throat and it seems as if he would suffocate. He says,

"Oh I do not give me any more warm drinks."

Something cold will relieve. The dyspnoea and the distress about the throat is increased by swallowing something warm. Now, in the sore throats of Lycopodium, warmth often benefits, but it is also true in some cases of Lycopodium sore throat, they want cold drinks and cold feels good to the throat.

Very often in the more acute symptoms of Lachesis a warm drink in the stomach is hurtful and causes nausea and suffocation and increases the choking and palpitation and the fullness in the head, whereas in the chronic cases of Lachesis, those that have been poisoned years before, there will be a sensation of nausea and tendency to vomit from taking a drink of cold water and then lying down.

The nausea comes on after lying down, that is, let the patient take a drink of ice cold water and go to bed and nausea will come on. Such a state is peculiar to Lachesis. It has been a later observation of those who have long before proved Lachesis. The symptoms of Lachesis have sometimes to be taken years after.

Lachesis has ulcers in the throat. It has aphthous patches, it has red and grey ulceration, it has deep ulceration. The tendency to ulceration upon the margins of mucous membranes is peculiar to Lachesis.

Also ulceration upon the skin, where the circulation is feeble. It seems that the pain in the throat is particularly marked between the acts of swallowing, and the pressure of the bolus going over the inflamed tonsils relieves the pain.

Always choking when swallowing, choking and gagging in the throat.

The cough is a choking cough and produces a sensation of tickling. This is like the Bell. cough. Bell. antidotes a Lach. cough, it has a cough so much like Lach. that no one can tell them apart.

Again the throat takes on extreme dryness in Lach., and this dryness is without thirst, dryness with aversion to water. Much inclination to swallow; the tendency is to continuously swallow, yet it is painful. Empty swallowing is more painful, than the swallowing of solids. Some Lach. patients suffering from cardiac affections are annoyed with constriction of the throat, choking in the throat when anything warm is swallowed, and sometimes when going into a warm room, choking and palpitation of the heart.

Tendency to chronic sore throat or recurrent sore throat and ulceration with every recurring sore throat. Liquids, of course, you will see, are analogous to empty swallowing, and empty swallowing causes more pain than the bolus which presses upon the sore throat, because it is of the nature of a slight touch. The slight touch increases the soreness and pain in the throat. Slight pressure of the collar increases the pain in the throat.

With the sore throat the muscles and glands about the neck become painful, inflamed and swollen, and very tender to the touch. With the sore throat, very commonly, there is pain in the base of the brain or in the back of the head, and soreness of the muscles of the back of the neck, which is often relieved by lying on the back and aggravated by lying on either side.

If you look into the throat it has a mottled, purplish appearance. Put all these things together, with the copious flow of tenacious saliva, and you will be able to manage cases of diphtheria that commence on the left side and spread to the right, whether the membrane is scanty or copious.

Tonsilitis with suppuration of the tonsils, when the left tonsil becomes inflamed and after a day or two the right one becomes inflamed and swollen, and they both finally go on to suppuration, or when one swells and suppurates and the other swells and suppurates. Diphtheritic appearances of the throat, spreading from left to right. The pharynx is full of thick, white, ropy mucus in the morning; must hawk out a mouthful of mucus in the morning.

Abdomen: The abdomen is distended with flatus. The abdomen is tympanitic in typhoid condition, much rumbling in the distended abdomen. The clothing cannot be tolerated, not even the slightest touch of the clothing, and yet it may require hard pressure to bring out soreness that is deep in the abdomen. This state is as it is in inflammation of bowels, ovaries and uterus, the patient lies on the back with the clothing lifted from the abdomen.

Violent labor-like pains, menstrual colic, present in typhoid, in puerperal fever, in malignant scarlet fever, in the more malignant affections of zymotic forms of the continued fever.

Lach. has a series of liver troubles with jaundice; congestion of the liver, inflammation of the liver, enlarged liver and the nutmeg liver. Cutting like a knife in the region of the liver. Vomiting of bile; vomiting of everything taken into the stomach. Extreme nausea; continuous nausea with jaundice. White stool. It has cured cases with gall stone.

"Cannot endure any pressure about the hypochondria."

In the chronic state the sensitiveness of the skin is so great over the abdomen, and about the waist and hips, that the wearing of the clothing creates pain, great restlessness and uneasiness, the patient grows increasingly nervous and finally goes into hysterics. Sensitiveness over the lower abdomen; can scarcely allow her clothes to touch her.

Female: It seems strange at first reading that Lachesis can be such a common remedy at the menstrual period.

It is also laid down as a remedy for the climacteric period. Now if you will study the cases of many women at the climacteric period you will find that many of them have the flushes of heat and the surgings in the head and the great circulatory disturbances that are found under Lachesis. This is also true of the complaints, the headaches, etc., that come in women at the climacteric period and at the menstrual period.

The Lachesis symptoms are strong in women during menstruation. There is violent headache, boring pain in the vertex, nausea and vomiting during menses.

The discharge in the female, either as a menstrual flow or as a hemorrhage, is black blood. Pain in the left ovarian region, or going from left to right. Induration of one or both ovaries. It has cured suppuration of the ovaries. The uterine region is very sensitive to touch, to the slightest contact of the clothing; in inflammation of the ovaries, pains in the ovaries and uterus going from left to right. Pains in the pelvis going upwards to the chest, sometimes a surging of pain going upwards, grasping the throat. Labor pains surge up, with clutching at the throat, or the labor pains cease suddenly, with clutching at the throat.

The menstrual pains increase violently until relieved by the flow. The menstrual sufferings are before and after the flow, with amelioration during the flow. The menstrual flow intermits one day and then goes on for one day, and during the intermission there is likely to be pain or headache.

Menorrhagia with chills at night and flushes of heat in the daytime. During the menstrual period violent headache, especially at such times as the flow slackens up.

It is a general feature of Lachesis to be relieved by discharges.

Catamenia flow but one hour every day; on stopping, violent pains follow in region of left ovary, alternating with gagging and vomiturition.

It is especially useful at the menopause, because of the flushes of heat. Uterine hemorrhage, fainting spells, suffocation in a warm room; orgasm of blood most violent. Complaints during pregnancy.

Inflammation of the veins of the leg. Varicose veins, blue or purple, extreme sensitiveness along the veins; sensitive to the slightest touch, though relieved by pressure.

The study of Lachesis is only a commentary on some of its important parts.

A Dictionary of Practical Materia Medica, John Henry Clarke

Trigonocephalus lachesis. The Surukuku Snake of South America. N. O. Ophidia. Trituration. Dilution.

Clinical.─Albuminuria. Alcoholism. Amblyopia. Aneurism. Apoplexy. Appendicitis. Asthenopia. Asthma. Atheroma. Bedsores. Boils. Bubo. Caecum, inflammation of. Carbuncle. Catalepsy. Chancre. Change of life. Chilblains. Ciliary neuralgia. Cough. Cyanosis. Delirium tremens. Diphtheria. Dog-bite. Dropsy. Dyspepsia. Ears, polypus of; wax in; noises in. Enteric fever. Epilepsy. Erysipelas. Eyes, affections of; haemorrhage into. Fainting. Fistula lachrymalis. Flatulence. Fungus haematodes. Gall-stones. Gangrene. Glanders. Gums, bleeding of. Haemorrhages. Haemorrhoids. Hay fever. Headache. Heart, affections of. Heartburn. Hemiplegia. Hernia. Herpes facialis. Hoarseness. Hydrophobia. Hysteria. Injuries. Intermittent fever. Jaundice. Labour, pains after. Laryngismus. Laryngitis. Leprosy. Liver, affections of. Locomotor ataxy. Malignant pustule. Measles. Ménière's disease. Mercury, effects of. Mind, affections of. Morvan's disease. Mouth, sore. Mumps. Neuralgia. Neurasthenia. Noises in ears. Nymphomania. Oedema of lungs. Otorrhoea. Ovaries, affections of. Paralysis. Paraphimosis. Perityphilitis. Perspiration, bloody; absent. Phlegmasia alba dolens. Plague. Pneumonia. Puerperal fever and convulsions. Purpura. Pyaemia. Quinsy. Rabies. Scarlatina. Sciatica. Scurvy. Small-pox. Stings. Strangury. Syphilis. Throat, sore. Trachea, affections of. Traumatic fever. Tumours. Ulcers. Veins, varicose. Vertigo. Vicarious menstruation (nosebleed). Warts. Whitlow. Wounds.

Characteristics.─"The first trituration and first dilution in alcohol of the snake-poison Trigonocephalus lachesis was made by Hering on July 28, 1828. The first cases were published in the Archives in 1835. In 1837 this remedy was introduced into our materia medica." I quote from Hering's Guiding Symptoms, vol. vi., of which Lach. occupies nearly one hundred pages, and comprises the substance of a monograph he was compiling at the time of his death to celebrate the fiftieth anniversary of the introduction of the remedy into the materia medica. To the genius and the heroism of Hering the world owes this remedy and many another of which this has been the forerunner. When Hering's first experiments were made he was botanising and zoologising on the Upper Amazon for the German Government. Except his wife, all those about him were natives, who told him so much about the dreaded Surukuku that he offered a good reward for a live specimen. At last one was brought in a bamboo box, and those who brought it immediately fled, and all his native servants with them. Hering stunned the snake with a blow on the head as the box opened, then, holding its head in a forked stick, he pressed its venom out of the poison bag upon sugar of milk. The effect of handling the virus and preparing the lower attenuations was to throw Hering into a fever with tossing delirium and mania─much to his wife's dismay. Towards morning he slept, and on waking his mind was clear. He drank a little water to moisten his throat, and the first question this indomitable prover asked was: "What did I do and say?" His wife remembered vividly enough. The symptoms were written down, and this was the first instalment of the proving of Lachesis. The natives crept back one by one next day, and were astonished to find Hering and his wife alive. The snake grows to seven feet and upwards in length, has fangs nearly an inch long, a reddish brown skin marked along the back with blackish brown rhomboidal spots. Nearly all the provings of Lachesis were made with the 30th and higher attenuations.─The four grand characteristics of Lach. are: (1) < By sleep. (2) Excessive sensitiveness of the surface with intolerance of touch or constriction. (3) Left-sidedness, and the direction left to right: symptoms begin on the left side and either remain there or proceed to the right. (4) > From the onset of a discharge. There is headache > as soon as nasal catarrh comes on. Uterine pains > as soon as menses appear. The other side of this is < from non-appearance of an expected discharge, and it is this which is the foundation of the appropriateness of Lach. to the climacteric state. Wherever one or more of these features is prominent in any case Lach. will most likely prove the remedy. Homoeopathic literature abounds with illustrations of the first named─< from sleep. I will take an illustration from Nash: An old syphilitic suffered from obstinate constipation, and was taken with severe attacks of colic. The pains seemed to extend all through the abdomen, and always came on at night. The man was not making any progress, when one day he remarked to Nash, "Doctor, if I could only keep awake I would never have another attack." And in response to an inquiring look from the doctor, he added, "I mean that I sleep into the attack and waken in it." He never had another. One dose of Lach. 200 cured the colic and the constipation too. "Sleeps into an aggravation;" "< after sleep whether by day or by night;" "as soon as he falls asleep the breathing stops "─there are endless varieties of forms in which this peculiarity may be met with. < By closing the eyes (vertigo) is allied to this. But the presence of the opposite condition > after sleep) does not necessarily contraindicate Lach. Rushmore (H. P., xii. 64) cured with Lach. c.m. a married woman who had been a great sufferer from headache, which always began with dim and aching eyes. The pain was of sharp, neuralgic character, in temples and eyes, < right side. If she could not be still with it she had nausea and very bitter vomiting. Sometimes unable to be still a minute, at others could not stir. Brought on by least fatigue. Keeps her in bed all day, and one attack is scarcely over before another comes on. Mental excitement, as receiving a call; induces it. With the headaches she is very cold; and with and after them has a very bitter mouth. Wants to close the eyes with the headache, which is > by sleep. Smarting in eyeballs and dim vision for several days after headache. During the headache much heart trouble; after the headache "skipping beats," soreness about head, pain in side. Loss of appetite after headache. Menses regular, painless, too free. Leucorrhoea many ears. A single dose of Lach. was given at the time, and the severe headache left on the way home. A constant light headache, with heaviness of head in morning, remained some days; but, without repetition, the remedy completely cured the headaches and the heart trouble as well. The haemorrhages of Lach. have this peculiarity─they contain flakes of decomposed blood looking like charred wheat straw. Uterine haemorrhage and haemorrhages in typhoid fever presenting these characters will find their remedy in Lach. The sensitiveness to contact of Lach. is not so much on account of pain or aggravation of pain as on account of the uneasiness it causes. In uterine affections the patient wants to lift the clothes up to prevent contact with lower abdomen. Touching the throat in laryngeal affections causes suffocative spasms. A minor characteristic of Lach. is pain in the shin bones. "Much pain in shin bones of an aching kind only." This has been frequently verified, but W. J. Guernsey (H. P., x. 476) has pointed out Rat when such pains occur concomitantly with throat affections, Lach. is specific. This I have confirmed. Guernsey remarks that in such cases it will always be found that the throat affection is < on left side or commenced on left side. According to Hering, Lach. is particularly suitable to those of melancholic disposition (Such provers showed most symptoms); next, to choleric individuals. Phlegmatic and lymphatic persons are also suitable, but principally when their dispositions border on the melancholic, with dark eyes and tendency to laziness and sadness. Lach. does not suit sanguine persons with high colour, fine, delicate skins, and impressible natures, unless the disease should have imparted to their disposition a choleric or melancholy tinge. Lach. especially suits choleric women with freckles and red hair. To this list must be added: Persons who have peculiar sensitiveness of the surface of the body. Women who "have never been well since the change of life." Debilitated, weakened persons. Thin rather than fat persons; persons who have been changed both mentally and physically by their illness. Drunkards. Sufferers from effect of masturbation. Persons who have been overdosed with Mercury; and to syphilitic, mercurial affections. Children and old people. Persons who cannot stand the sun and who are < in summer weather. A patient of mine, a tall, broad-shouldered, very nervous man of forty-seven, who had fled from the Cape as he could not bear the summer there, sent for me to see him at his hotel because he did not dare venture out in the middle of the day for fear of being caught in the sun. Lach. 200 soon enabled him to attend garden parties. The delirium of Lach. is of the low, muttering type; at times the patient sinks into a torpid state, with cold extremities, tremor of body and hands, tremor of tongue. Tremor of tongue is a leading feature of many Lach. states. It not only trembles, but it catches in the teeth or lower lip when the patient attempts to put it out. The mind is profoundly disturbed. There are rapidly alternating states: exalted powers, rapid succession of ideas; and again there is weak memory; frequent mistakes in writing; confusion. "Frantic loquacity, jumps from one subject to another," is a strong characteristic; "talks, sings, or whistles constantly; makes odd motions with arms"; "insane jealousy"; "intense sadness and anxiety"; "irritable, irascible, peevish, malicious." A curious symptom in the mental sphere is a derangement of the time sense. It occurs also in Merc. (to which Lach. is an antidote); but is more prominent in Lach., when a patient is always making mistakes in the time of day, and confounds the morning hours with the evening hours, Lach. will generally put this right, if it does no more. Fainting fits and vertigo on closing eyes; on looking intently at any object; in morning on waking. Rush of blood to head. Sun-headaches. Headache with very pale face. Throbbing headaches in temple, with heat of head. Headache extending into nose; > when nasal catarrh comes on. A woman, forty-four, to whom I gave Lach. 12 for a poisoned finger, experienced after each dose a sensation "as if a hand were in her head, moving and squeezing," an eruption of spots came out, and she felt as if she had no energy. The finger healed, but when she left off the medicine on account of the head pains, the finger became worse with cramping pains and a feeling of pins and needles. There is intense nervous irritability, restless, tossing, moving; nervous exaltation, hysteria. Trembling in whole body, thinks she will faint or sink down from weakness. Convulsions, spasms. Cases of hydrophobia have been cured with Lach., the thirst, spasms, sensitiveness and nervous prostration closely corresponding to the symptoms of rabies. Fainting accompanying other complaints is an indication for Lach.: with pain at heart; with nausea; with vertigo and pale face. Catalepsy. Awkward gait; left side weak. Gressus gallinaceus. Disturbances of sight and hearing are numerous. I have frequently cured with it noises in the ears when < after sleep. In hay fever it is the remedy when there is headache extending into nose < on suppression of the discharge, which may occur in sleep; or when the paroxysms are < after sleep. Sore nostrils and lips. Pus and blood from nose. Red nose of drunkards. Dark red eruptions; purplish swellings; black and blue spots are characteristic of Lach. Ulcer sensitive to least touch. Small ulcers surrounding larger. The throat is in an especial degree the seat of the Lach. action. Sore throats of almost all descriptions come within its range, provided some of the characteristics are present: < after sleep; by touch; symptoms < left side or proceeding from left to right; cannot bear any pressure about neck; empty swallowing is agonising, liquids are swallowed with less pain and solids with least pain. Diphtheria, mercurial and syphilitic sore throat. Fetid breath. The prostration is out of all proportion to the appearance of the throat.─Lach. has sinking at the stomach, and cannot go long without food. Unquenchable thirst. Desires: oysters, wine, coffee (coffee agrees). Symptoms are > after eating, especially after fruit. The throat symptoms are < by hot drinks. Nausea always after drinking. Everything sours; heartburn. Alcoholic drinks < (except the immediate effects of the bite). Although Lach. is a left-side medicine, it has a powerful action on the liver as well as the spleen. "Acute pain in liver extending towards stomach," though contrary to the general "left to right" direction, is characteristic, as I can testify. Lach. is also one of the most prominent remedies in appendicitis. The general characteristics will guide here. Bubos. Lach. and Naja have had the greatest success of all homoeopathic remedies in the recent epidemics of Plague in India. The bladder and rectum are most painfully affected. There is a very characteristic symptom in the bladder: Sensation as if a ball were rolling loose in the bladder or abdomen on turning over. The urine is almost black; frequent; foaming; dark. ("The patient always has to urinate after lying down, day or night, especially after sleep; more frequent in the night. Urine has little black spots or flakes like soot floating in it."─H. N. Martin.) Stitches in kidneys. The ball sensation occurs elsewhere: as if a ball, or lump, or button in throat; as if two balls threatened to close the throat; as if a ball rose from abdomen to throat; as if a plug were in anus. Many severe and characteristic symptoms appear in rectum and anus. Diarrhoea of fetid, cadaverous kind and also constipation. Atony of rectum. Painful haemorrhoids. Visible spasmodic tenesmus in paroxysms, from two to five minutes, extorting cries; passes blood and mucus. Painful constriction of anus followed by collapse. Haemorrhoids with scanty menses. Burning in rectum. Stitch in rectum (upwards) when coughing or sneezing. Full feeling in rectum, and sensation as of little hammers beating. Tugging upward sensation as from a mouse. Both ovaries are affected, but principally the left; swelling, induration, tumours. Menses regular but scanty; pains > when flow is established. In a case of mine, Lach. 12 postponed menses for a week. Many symptoms occur in connection with menses. The breasts are affected. I have seen most obstinate and distressing eruptions appear on the nipples and areolae of a middle-aged woman after a dose of Lach. in high potency. Cancer of the breast when assuming a bluish appearance will be helped by Lach. Lochia are thin, ichorous, insufficient. Milk thin, blue, nipples extremely sensitive to touch. In the respiratory sphere the sensitiveness of the parts to touch, constriction, and < by anything tight round neck, are the ruling conditions. Tickling, irritating cough. The least thing coming near mouth or nose interferes with breathing. Sleeps into an attack of asthma. Threatened paralysis of lungs. The heart feels too large─cramp-like pain in precordia. Constriction. Palpitation with numbness down arm. Cyanosis. Varicosis. Peculiar sensations of Lach. (in addition to those already mentioned) are: As if frightened by visions behind him; as if knives were being thrust into brow; as if tongue bound or tied up; as if a part of right-side of head cut away; as if a thread was drawn from behind to eye; stitches as from knives in eyes; eyes as if they had been taken out, squeezed and put back; ears as if closed from within; as if stuffed up as if insects whizzing in ears; as if he had a moustache of ice as if a small crumb lodged in throat; as if he had had a blow on neck; as if a stricture in rectum. As if heart hanging by a thread and every beat would tear it off; as though heart turned over and ceased beating for a moment; as if heart hadn't room to beat. As if neck constricted with a cord. (Lach. is one of the remedies for "gridle pain") as if burnt or scalded in different parts (tongue, tibia, hypogastrium). Burning sensation and pains are a leading feature throughout this remedy. Lach. is called for in many kinds of fever, particularly intermittents after abuse of Quinine. The symptoms of Lach. are < in spring or summer; from extremes of temperature; from sun's rays; change of weather, especially in a warm spell. Must have open air, which >; but draughts of air < External warmth > (wants head closely wrapped up); hot drinks < thirst; = toothache and bleeding of gums. Cold weather, cold washing <. Most symptoms appear or are < at night and in early morning after sleep. Lying down > pain in head; < vertigo, throat, cough, breathing. Lying right side > earache in right ear; palpitation. Lying left side = pain in heart. > Sitting bent. < Standing or stooping. < Motion generally. < Contact. < Constriction. Swallowing = stitches into ears. > By discharges.

Relations.─Antidote: Radiate heat outwardly, Alcohol inwardly, Salt,-effects of bite. Antidotes to dilutions: Alum., Bell., Coccul., Coff., Hep., Merc., Nit. ac., Nux, Pho. ac.; to the visible spasmodic tenesmus of rectum, Sep. According to Teste the chief antidote is Cedron. It antidotes: Bufo, Crotal., Rhus. Compatible: Aco., Ars., Bell., Bro., Carb. v., Chi., Hep., Hyo., Kali bi., Lac. can., Lyc., Merc., Nit. ac., Nux, Olean., Pho., Pul., Sil., Sul. (pneumonia), Tarent., (Plat. follows well when Hep. and Lach. fail to evacuate pus from ovarian abscess). Incompatible: Acet. ac. (Am. c.). Complementary Hep., Lyc., Nit. ac. [Lyc. is the chief complement; it is the opposite of Lach. in many respects (right to left, right upper, left lower; > warm drinks); Iod. and Kali iod., which are complementary to Lyc., are probably complementary to Lach. K. iod. has the diffused sensitiveness of Lach.] Compare: Crotal., Naja, Bothrops., Helod., Apis, Sul. and Lyc. (aphasia); Therid. and Mosch. (vertigo < closing eyes and sun-headache); Ars., Hydr. ac., Lauroc., Dig. and Ver. (fainting from cardiac weakness); K. carb. (heart hanging by a thread); Glon., Bell., Camph., Nat. c., Therid. (< from heat of sun); Stram., Agar., Mephit., Act. r., and Paris. (loquacity); Op., Hyo., Arn., Alum., Lyc., and Rhus (typhoid); Merc., Chi., Pul., Bry. and Gels. (catarrhal and rheumatic headaches); Sil. (> wrapping up head; aversion to touch); Crot., Pho., and Arn. (retinal apoplexy); Crotal. and Elaps. (otorrhoea); Apis, Ars. and K. ca. (oedema of face); Cic. (dyspnoea from spasm); Grind. (stops breathing on falling asleep); Apis, Rhus and Euphorb. (erysipelas, herpes, etc.); Phyt. (sore throat); Chi., Carb. v., Hep., Kre., K. bi., Nux and Lyc. (dyspepsias and abdominal diseases); Colch. and Elaps. (cold feeling in stomach); Bell., Caust., Nat. m., Nit. ac., Ign., K. bi., Op., Pb., Mez. and Coccul. (constriction of anus, anal tenesmus, and dysentery); Anac. (sensation of plug in rectum); Hep., Asaf., Lyc., Mur. ac., Silic., Sulph. ac., and Ars. (ulceration); Apis, Arg. m., Plat., Murex, Pall., Lyc. and Graph. (ovarian and uterine diseases); Crotal., Helleb., Dig., Tereb., Apis and Colch. (vesical and rectal affections, with haematuria); Calc. (gall-stones); Pho. and Thu. (fungus haematodes); Nat. m. and Led. (effects of bee-stings) Lact. ac. (fulness of throat and constriction); Lac. can. (diphtheria changing sides; sees snakes); Tarent. cub. (carbuncles); Colch. and Carb. ac. (black urine); Sel., Nat. c. and Nat. m. (< in warm, relaxing weather); Carb. v. (craves coffee─it > Lach. but not Carb. v.); Ant. t. (threatened paralysis of lungs); Merc. (Lach. occasionally antidotes Merc., when pus degenerates and becomes dark, thin, offensive); Chi. sul. (intermittents after abuse of Quinine, when chills return in spring); Am. c. (blueness, somnolence, engorgement of neck; but Am. c. right-sided and without sensitiveness); Hep. (any kind of food = indigestion); Nat. m. (opp. Lach., has > from tight clothing); Apis (jealousy); Ar. t. (diphtheria); Anac. (has two wills; thinks he is under control of superhuman power); Arn. (sensitiveness of chest─Lach., of peripheral nerves; Arn., soreness of over-full blood-vessels); Bry. (headache from suppressed coryza); Act. r. (puerperal mania); Bapt. (offensive discharges; typhoid); Bell. (head symptoms; throat; scarlatina); Hyo. (talks of things of daily life, jumps from one subject to another); Spi. (larynx sensitive; Lach., hyperaesthesia; Spi., inflammation of cartilages, turning head = suffocative spell): Sul. (left side; inflammation of liver, going on to abscess; < after sleep─also Nat. m.; Pho. > after sleep); Staph. (on swallowing pain runs externally along parotid gland to ears; perspiration impossible); Pho. (sensation as if anus open; Lach., as if uterus); Sil., Caul., Sul., Ustil. and Vib. o. (left ovarian and left inframammary pain). Nux m. (cough of pregnancy; Lach., cough at menstrual period when it is going off. Patient must swallow what loosens); Puls. (menstrual cough; menses scanty; but pain < as flow increases); Con., Graph. (scanty menses); Anthracin. (carbuncles; boils); Tereb., K. bi. (tongue glazed;─and shining, Apis, Lach.); Pul., Pho., Sul. and Mur. ac. (piles during menses) Solania, Bell. and Dulc. (paralysis of lungs); Iris t. (appendicitis) Pho. ac. (disappointed love); Hydrophobin.; Sabad. (throat affected left to right─Sabad., more chronic).

Causation.─Injuries. Punctured wounds. Poisoned wounds. Grief. Vexation. Anger. Fright. Jealousy. Disappointed love. Alcohol. Masturbation. Sprain (bluish swelling of joints). Sun. Warm weather. Draught of air.

SYMPTOMS.

1. Mind.─Great anguish, insupportable anxiety, and uneasiness, from which patient seeks relief in open air.─Fear, and presentiment of death.─Discouragement; distrust; easily affected to tears.─Mental dejection and melancholy, with apprehension, uneasiness about one's malady, great tendency to give way to sorrow, to look upon the dark side of everything, and to think oneself persecuted, hated and despised by acquaintances.─Dread of death; fears to go to bed; fear of being poisoned.─Thinks she is some one else; in the hands of a stronger power; that she is dead and preparations are being made for her funeral; that she is nearly dead and wishes some one would help her off.─Sadness when awaking in the morning or night (particularly in the morning); no desire at all to mix with the world.─Restless and uneasy; does not wish to attend to business, but wants to be off somewhere all the time.─Sadness, and disgust to life.─Mistrust, suspicion, and a strong tendency to take everything amiss, to contradict and to criticise.─Frantic jealousy.─Indolence, with dislike and unfitness for any labour whatever, either mental or bodily.─Timidity of character, with variableness and indecision.─Great apathy and extraordinary weakness of memory, everything that is heard is, as it were, effaced, even orthography is no longer remembered, and there is forgetfulness even of things on the point of utterance.─Confusion as to time.─Mistakes are made in speaking and writing, as well as in the hours of the day and the days of the week.─Imbecility and loss of every mental faculty.─Over-excitement and excessive nervous irritability, with a tendency to be frightened.─Perfect happiness and cheerfulness followed by gradual fading of spirituality, want of self-control and lasciviousness; felt as if she was somebody else and in the hands of a stronger power.─Amativeness.─Affections of the intellect in general.─State of ecstasy and exaltation which even induces tears, desire to meditate, and to compose intellectual works, with a sort of pride.─Frantic loquacity with elevated language, nicely chosen words, and rapid and continual change of subject-matter.─Loquaciousness, with mocking jealousy, with frightful images, great tendency to mock, satire and ridiculous ideas.─Nocturnal delirium with much talking, or with murmuring.─Dementia and loss of consciousness.

2. Head.─Head fatigued from intellectual labour.─Momentary vertigo on closing eyes.─Giddiness after resting.─Vertigo chiefly on waking in morning, as well as after lying down in evening, on going into open air, on raising arms, and often with fainting, paleness of face, nausea, vomitings, congestion in head, bleeding of nose, and lassitude of limbs.─Intoxication, stupor, and loss of consciousness.─Apoplectic fits, with blue face, convulsive, movements of limbs, and extravasation of blood in brain.─Softening of brain and its membranes.─Violent pain in head, with yellow face and flushed cheeks.─Headache, with congestion of blood, sparkling before the eyes, drowsiness, shiverings and inclination to lie down, or with nausea and vomiting.─Headache preceding coryza.─Cephalalgia from heat of sun.─Pains deeply seated in brain; or in the sockets of the eyes; or above the eyes; or in occiput; with stiffness in nape of neck.─Pain as from a bruise in crown of head, or sensation of boring, with jerks and throbbings on moving the head.─Heaviness and pressure in head, as if it were going to burst, or tension, as from threads drawn from occiput towards the eyes, or shootings, as from knives, in different parts of the head, and as far as the eyes.─Pressing headache in temples as if the brain were pressing out, in the morning after rising, from motion, from stooping; < from pressure and while ascending; > from lying down after eating.─Cutting headache as if a part of the r. side of the head were cut off, < after rising or ascending; > from heat and after belching up wind.─Pains which spread from the interior of head to ears, nose, and neck.─Headache extending into root of nose.─Headache with flickering before the eyes.─Headache every morning on awaking, or after dinner; or else on every change of weather.─Pulsating, beating headache with heat in head, esp. on vertex, or on r. side, or over eyes, preceding a cold in the head, with stiffness of neck.─Swelling of head, muscular throbbings in temples, tension in occiput extending to nape of the neck, painful sensibility of scalp, with troublesome itching, excessive desquamation, and falling off of the hair.─Falling off of the hair, esp. during pregnancy, with great aversion to rays of sun.─Sensitiveness of scalp in l. vertex down, and l. side of face on touch or moving muscles, a sensation as if sunburnt.─Cannot bear to have hair touched.

3. Eyes.─Yellow colour of the white of eyes.─Eyes yellow or turbid, dull and dejected, or bright and convulsed, with fixed look.─Pupils strongly dilated.─Ecchymosis and haemorrhage of the eyes.─Haemorrhages into interior chamber.─Dryness of eyes, as if full of dust; or lachrymation with tears, which sometimes seem to be cold.─Photophobia.─Over-sensitive to light.─Itching and burning of the eyes.─Itching, and shootings as from knives, in eyes, or violent aching, as if the ball were going to start from the socket, < by moving eyes.─Eyes red and inflamed, with redness of conjunctiva and sclerotica, burning heat and lachrymation.─Eyes water with headache from a cold.─Sensation as if the eyes were too large or the sockets too small.─Feels when throat is pressed as if eyes were forced out.─Swelling and inflammation of the eyelids or of the edges.─Convulsions, heaviness, and paralysis of eyelids.─Weakness of sight and presbyopia.─When reading the letters appear to be confused.─Clouded vision as when looking through a veil.─Obscuration and loss of sight.─Dimness of vision; black flickering before the eyes; often makes reading difficult.─Bright blue rings, filled with fiery rays, about the light; zigzag figures.─Flames and sparks appear before the eyes, or a blue veil or blue circles round the candle.─Eyes appear small and inexpressive.─Fistula lachrymalis accompanied by long-standing eruption on face.

4. Ears.─Ears cold, sensitive to the wind.─Painful swelling of interior of ear.─Dryness of ears.─Cerumen scanty, too hard and too pale, or like pap, and white, with diminution of the power of hearing.─Very disagreeable throbbing, tinkling, roaring, cracking, buzzing and rolling, or a resounding noise, as if a drum were beaten, in ears.─Whizzing, as from insects in ear.─Ears as if stopped.─Excessive sensibility, or hardness of hearing.─Haemorrhage from the ears.─Pain in ears with sore throat.─Tearing extending from zygoma into ear.─Swelling of parotids.─Excoriation and scabs behind ears.

5. Nose.─Nocturnal pains at bridge of nose.─Stoppage of nose, as from an internal swelling, principally in morning, or with coryza.─Swelling, redness and excoriation of edges of nose, with scabs in nostrils.─The nose bleeds when it is blown (blood dark), and blowing of blood from the nose, esp. in the morning.─Nose-bleed in amenorrhoea, typhus, etc.─Copious bleeding from nose, of a bright-red, or thick and black.─Flow of (blood and) pus from the nose.─Paroxysms of sneezing in hay fever.─Dry, chronic coryza, with stoppage of nose, or fluent coryza, with abundant discharge of serous mucus, lachrymation, frequent sneezing, and inflammation and excoriation of nostrils.─Imperfect coryza, with many sufferings of head and mind, all of which disappear as soon as the catarrhal flux commences.─Red, chronic pimples on nose.─Redness of the point of the nose.─Many symptoms end with catarrh.

6. Face.─Face pale, wan, wasted, and cadaverous; leaden, or earthy, discoloured, yellowish complexion.─Red spot on cheeks with yellowness of rest of face.─Dark bluish-red patch on l. side of nose and cheek, coming on when flushed, generally at noon or after wine; never in evening or night (Cooper).─Blue circle round eyes.─Small red veins in cheeks.─Bloatedness, sometimes to a frightful extent, tension and red swelling of face.─Heat and redness of the otherwise pale face.─L. side of face and lower jaw swollen and sensitive to touch.─Tri-facial neuralgia, l. side, orbital; heat running up into the head.─Heat and redness of face (during delirium).─Erysipelas in face, sometimes with itching, pimples or vesicles, cracks and corrosive oozing, burning pains and swelling.─Miliary eruption and pimples on face.─Tetter with thick scabs in region of whiskers.─Tensive and crawling pains in face, pains in bones of face, prosopalgia, with vomiting of food.─Feeling of stiffness of the malar bone coming from the cervical glands.─Lips dry and swollen, pimples on lips, trembling of the lips.─Weakness and paralysis of lower jaw, with distortion of features.─Trismus, with clenching and grinding of the teeth; chattering of the teeth.

7. Teeth.─Boring pains in the teeth which are carious, principally after dinner, and sometimes with swelling of the cheeks, and a sensation as if the teeth were too long.─Toothache every morning after waking, or after dinner every day, with tearing, drawing, and shooting pains in roots of teeth (of lower jaw); from warm and cold drinks.─Toothache with pains in head, shiverings, heat and heaviness of the legs.─The toothache affects the ears.─Brittleness and looseness of the teeth; the carious teeth become soft, and pieces of them are broken off.─Swelling and painful sensibility of the gums.─Gums bleeding; swollen, spongy.─Hot and cold drinks renew the pains.

8. Mouth.─Inflammatory swelling of the buccal cavity.─The mouth and palate are excoriated and very painful.─Dryness of the mouth and tongue, or accumulation of water in the mouth and salivation.─Tongue shining, dry, red and cracked; or inflamed, swollen (covered with blisters), brownish or blackish.─Stiffness, immovableness, and paralysis of the tongue.─Aphonia, or confused, indistinct speech, nasal tone of voice, difficulty in pronouncing certain letters or particular words; the speech is louder and more precipitate than the speaker wishes.─Tongue heavy; cannot open mouth.─Tongue trembles when protruded, or catches behind the teeth.─Stammering.

9. Throat.─Constant tickling in throat, as if a crumb of bread, or something similar, were stopping in it.─Partial or general dryness of throat, often extending to ears, nose, and chest.─Burning and pain as of excoriation in throat, principally on swallowing.─Painful excoriation and inflammatory swelling of throat, with redness of parts affected, as if they were coloured with vermilion.─Swelling of the tonsils (mostly l.).─Large and small tumours in throat, which impede deglutition.─Cannot swallow the food after masticating it, because it rests on the back part of the tongue, and produces a thrilling pain there.─Constant desire to swallow, and a sensation on swallowing as if there were a tumour, or a piece of something, or a plug in the throat.─Sensation of contraction, of strangulation, and of constriction in throat.─The throat as it were stiff and paralysed.─Convulsions and spasms in throat.─Impeded deglutition, with dread of drinks, which often pass through nostrils.─Hydrophobia.─Much slimy saliva, esp. in back of mouth.─The pains in the throat are < by slightest contact, and by least pressure on neck, as well as after sleeping, and while swallowing the saliva; the pains are > by eating.─When swallowing the pain extends to the l. ear.─Sore throat, which affects only a small part, or which, on the contrary, affects the ears, larynx, tongue, and gums; frequently with dyspnoea and danger of suffocation, salivation and hawking up of mucus.─Much hawking up of mucus, which is exceedingly painful.─Empty swallowing < the pain in throat more than swallowing food; or fluids are swallowed with less pain than solids.─Copious accumulation of tenacious mucus in throat.─In old chronic sore throats: throat may not be very sore, but a great quantity of mucus will stick there, and occasions much hawking and spitting to no purpose; the mucus will stick and can't be forced up or down.─Sore throat alternately with stoppage of nose, or with sufferings, while speaking.─Ulcers on palate, on back, of mouth (on the inflamed tonsils), and in throat, with fetid odour, abundant suppuration, and sharp pains on swallowing food.─The inflammation and ulceration of throat begin on l. side and extend later to r. side.─The external throat is very sensitive to touch (not painful, but an uneasy sensation); on lying down, with suffocative sensation; even to touch of linen.

10. Appetite.─Disagreeable, or saccharine, acid, rough, astringent, or metallic taste.─Want of appetite; complete indifference to food and drink.─Repugnance to bread, which it is impossible to swallow.─Irregular appetite, at one time anorexia, at another bulimy.─Sickly craving, with nausea, convulsive yawnings and fainting fits, if food is not eaten instantly, or with gnawing and aching in stomach, which is renewed shortly after eating.─Insatiable thirst.─Thirst, with dry tongue and skin.─Desire for wine or for milk, both of which, however, disagree; desire for oysters.─After a meal: pressure on stomach, risings, vertigo, flatulency, inclination to vomit, or vomiting of food, weakness in knees, indolence, and heaviness of body, mental fatigue, uneasiness, regurgitation, diarrhoea, difficult respiration, pain in head and teeth, and aggravation of all the sufferings.

11. Stomach.─Hiccough after having drunk; or after smoking tobacco.─Violent empty risings, with danger of suffocation.─Risings, which > the sufferings.─Acid risings, with taste of the food.─Pyrosis from the throat, as if the whole of the oesophagus were filled with rancid substances.─Nausea and inclination to vomit, principally in morning, or after a meal; as well as in consequence of many other sufferings.─Violent and convulsive vomiting of everything taken, or of bilious, bitter, greenish matter.─Vomiting of pure blood, or of bloody mucus.─Vomiting, with diarrhoea, obscuration of sight, pains in stomach, and diuresis.─Excessive sensibility of precordial region to slightest touch; tight garments are insupportable, and the least pressure is very painful.─Great weakness of stomach; it can bear neither food nor drink.─Stitches extending into the chest.─Gnawing in stomach; > after eating, but returns when stomach gets empty.─Painless gnawing.─Pressure in stomach; after eating; with weakness in knees.─Sensation as if something encumbered the cardia and impeded deglutition.─Aching in stomach, extending to chest, and a sensation as if a worm were moving about in it and gnawing it.─(Every evening) cramps and violent pains in stomach, with risings, retching, and vomiting of slimy matter.

12. Abdomen.─Burning, drawing, or cutting pains in liver.─Acute pain in liver, extending towards stomach.─Inflammation and softening of liver.─Hepatic abscess.─Gall-stones.─Pains and stitches in region of spleen, sometimes on riding in a carriage or walking.─Enlargement of abdomen in young girls.─Painful distension, flatulence; can bear no pressure, surface nerves sensitive.─Sensation of emptiness in abdomen.─Pains in abdomen, in consequence of a strain in the loins.─Pains, generally pressive, in umbilical region, sometimes with difficult respiration, < an hour after a meal, and > by eructations.─Tearing and cutting pains in r. side of abdomen.─Cutting pains, so violent as to drive patient distracted; or acute pullings, with contraction of abdomen.─Burning in abdomen, with pressure on bladder.─Abdomen hot, sensitive; painfully stiff from loins down thighs; peritonitis; pus formed.─Inflammation of intestines.─Extravasation of blood in peritoneum.─Swelling in caecal region; must lie on back, with limbs drawn up (typhilitis).─Abdomen hard and distended, with flatulent colic, pain in back, vomiting, diarrhoea, and diuresis.─Frequent emission of flatus; the flatus sometimes penetrates into inguinal ring.─Pain, as if a hernia were going to protrude.

13. Stool and Anus.─Slow evacuation.─Obstinate constipation with hard and difficult evacuation.─Constipation, anus feels tight as if nothing could go through.─Faeces small, scanty, and tenacious.─Constipation alternately with diarrhoea.─Diarrhoea, with violent colic, nausea, vomiting, anguish, pains in rectum during passage of faeces, tenesmus and excoriation of anus.─Stool lies close to anus without passing and without urging.─Loose evacuations, principally at night, or after a meal, or in warm (and damp) weather, or from having taken fruits and acids.─Diarrhoea after food, with occasional pain across navel, loins, and back.─Involuntary and unperceived evacuations.─Stools excessively offensive.─Evacuation of fetid matter, or of soft faeces, of the consistence of pap, or liquid, or slimy, like pitch, or sanguineous and purulent, or of undigested substances, or of pure blood, or of sanguineous mucus.─Stools watery, offensive, dark; watery, frequent, sudden, about midnight, offensive, ammoniacal; soft, bright yellow; pasty, putrid.─During the evacuations: pain, tenesmus, and burning in anus.─After the stool: congestion of blood to head, vertigo, debility, pains and throbbings in anus.─Painful constriction of anus and rectum.─Anus feels closed: sensation of a plug.─Prolapsus recti during evacuation.─Discharge of mucus and blood from rectum, sometimes with violent colic.─Haemorrhoids with colic, or with burning and cuttings in rectum, or with congestion of blood in anus, and diarrhoea.─Stitch in rectum when laughing or sneezing.─Sensation in anus as of several little hammers beating there.─Piles irritable, with painful drawing upward like a mouse tugging at one side and drawing it up.─Bleeding haemorrhoids.─Haemorrhoidal tumours protrude after stool, with constriction of sphincter.─Large haemorrhoidal tumours (in persons addicted to spirituous drinks).─Haemorrhoidal tumours protruding with stitches at each cough or sneeze.

14. Urinary Organs.─Pressure on bladder, with urgency to urinate, or with cuttings and burnings in abdomen.─Frequent want to urinate, with copious emission even in night.─Violent pain, as if a ball were rolling about in bladder, and thence into urethra.─Violent tenesmus, with scanty emission of urine.─Paralysis of bladder.─Continual incisive shootings in urethra.─Small tumour in urethra, with retention of urine.─Urine turbid and brown, or red, or deep yellow, and sometimes with frequent but scanty emission, or with brown and sandy or red or brick-coloured sediment.─Frothy urine.─Urine frequent, foaming, black.─Involuntary and unnoticed emission of urine.─Pains in back and loins during the want to make water.─Sensation of burning in urethra on making water, and many other sufferings, all of which are renewed by motion of a carriage, and return after drinking wine.─Pain, as from excoriation, in urethra and in glans.─Flow of urine after evacuating and after urinating.

15. Male Sexual Organs.─Pressure in testes, as if a hernia were going to protrude, when making an effort to urinate.─Pimples on the hairy parts.─Strong sexual desire without physical power, and with flaccidity of the penis.─Erections without sexual desire.─Pollutions night and day, sometimes with debility and sweat.─Flow of prostatic fluid when urinating, or after having urinated.─Semen of a pungent smell.─During coition the emission is tardy or does not occur at all.─Abundant secretion behind the glans.─Spots and red pimples on the glans and on the corona.─Mercurio-syphilitic ulcers.─Attenuation of scrotum and hardness of testes.─Thickening of prepuce.

16. Female Sexual Organs.─In females who never get well from the change of life -"have never felt well since that time"; may have unnatural unwell periods.─During change of life, where she has flashes of heat all day, and cold flashes on retiring at night.─Sensation in the abdomen as if a ball were ascending from thence to chest, as in hysteria.─Pains from ovaries to uterus, with discharge of pus while at stool.─The uterus feels as if os were constantly open.─Redness and swelling of external parts (with discharge of mucus).─Swelling of the parts, with itching and sexual desire.─Catamenia feeble, tardy, and of too short duration, often accompanied by haemorrhoidal and, other sufferings.─Menstruation suppressed.─Menstruation too scanty (blood black).─Abdominal spasms during catamenia.─Before menses: pains and throbbing in the head, vertigo, epistaxis, aching in stomach, risings, cuttings in hypogastrium, flow of mucus from urethra, and cramps in chest.─Before and after menses, diarrhoea with violent colic.─Menstrual colic, beginning in l. ovary.─Swelling, induration, pain and other anomalies of l. ovary.─On the appearance of the catamenia, sacral pains, with pain as of a fracture in hips and chest.─During the catamenia, pains in the loins like those of labour, throbbings in the head, and cuttings.─Miscarriage.─(The milk of females bitten by the serpent becomes venomous and curdles.).─Mammae swollen.─Intolerably itching tetters on and around nipples.─Nipples swollen, erect, painful to the touch.─Sexual desire excited: nymphomania.

17. Respiratory Organs.─Catarrh, with cough, coryza, shooting pains in head, stiffness of nape of neck, and affection of chest.─Continual hoarseness, with a sensation as if there were something in the throat which impeded speech, and which cannot be detached.─Oppressed breathing, < when talking and eating.─Contraction and constriction of the larynx, with a sensation of swelling and of tension.─Painful sensitiveness of larynx and neck to touch, and on slightest pressure, with danger of suffocation on feeling the gullet, and on holding back the head.─Sensation of pulsation and of choking between larynx and chest.─Dryness, burning, and pain as of excoriation in larynx.─Sensation as if there were a ball in the larynx.─Voice weak, hollow, nasal.─Cough, often fatiguing, and by which nothing is detached, excited mostly by a tickling in larynx, chest, and pit of stomach, or by pressure on the gullet, as well as by conversation, walking, and everything which increases the dryness of the throat.─Cough caused by pressure on the larynx, or by any covering of the throat; by a tickling in pit of throat and sternum; when falling asleep; from ulcers in the throat.─Constant irritating cough, with or without expectoration.─Very chronic coughs.─Cough with rawness of chest, difficult expectoration and pains in throat, head, and eyes.─Frequent attacks of short cough from tickling in pit of stomach, dry during the night; difficult, sometimes watery, salty mucus, which has to be swallowed again, is raised.─The cough is < during the day; after sleeping; from changes in the temperature; from alcoholic drinks; from acids and sour drinks.─Cough with hoarseness.─Diphtheria.─Cough always after sleeping, or at night, when sleeping, or in evening after lying down, as well as on rising from a recumbent posture.─Dry, short, suffocating and croaking cough, sometimes with vomiting.─Spittle mucous, tenacious, or acid, and of a disagreeable taste, or sanguineous.─Haemoptysis.─On coughing, accumulation of water in the mouth, sharp pains in pit of stomach, shocks in head, and tension of eyes.

18. Chest.─Respiration short, frequent, or convulsive or rattling, stertorous, and croaking, or wheezing, moaning, and deep.─Frequent want to draw a long breath.─Dyspnoea and oppression of the chest, with effort to breathe.─Shortness of breath, principally after a meal, on walking, after making an effort with the arms, and sometimes with sadness, or with an asthmatic cough.─Attacks of asthma, and difficulty of respiration, principally after eating, or in the evening on lying down, or at night, during sleep, and sometimes with anguish, thirst, nausea, vomiting, fainting, and cold sweat.─Fits of suffocation, esp. on lying down in evening or in bed at night, and principally when anything is placed before nose or mouth.─Paralytic orthopnoea.─Offensive breath.─Pressure on chest, as from a weight, or as if it were filled with wind, and principally at night.─Contraction of the chest wakens him after midnight, with slow, heavy, wheezing breathing, compelling him to sit up with his chest bent forward.─Violent pains with great anguish and constant movements in the chest.─Burning and pain of excoriation in chest, as if it were raw, principally after a meal.─Oppressive pain in the chest as if full of wind, > by eructations.─Stitches in side and in chest, < by breathing, and sometimes with cough and sanguineous-expectoration.─Stitches in (l. side of) chest, with difficult breathing.─Extravasation of blood in lungs.─Pneumonia (hepatisation of the inflamed lungs).─Gangrene of lungs.─Swelling and bloatedness of integuments of chest.─Itching, red places, and miliary eruption on chest.

19. Heart.─Palpitation of heart, with (fainting and) anxiety, sometimes excited by cramp-like pains, with cough, and fit of suffocation.─Palpitation of heart and choking from slightest anxiety.─Feels as if heart hanging by a thread and every beat would tear it off.─Irregularity of beats.─Constrictive sensation in region of heart.─Spasms in heart (with aneurism of r. carotid) and disagreeable pulsation in ears.─As if heart too large for containing cavity.─Stitches in region of heart, with shortness of breath, fainting fits and cold sweat.─Faint feeling about heart, with heats up spine and flushings of face.─Faintings, giddiness, and palpitation constantly recurring.

20. Neck and Back.─Nape of neck and neck excessively sensitive to least pressure.─Rheumatic stiffness of nape of neck and neck.─Stitches in back and between shoulders.─A small tumour is formed near the spine.─Burning in back.─Spasms in muscles of back.─Painful stiffness from loins to hip, as if muscles were too short.─Insupportable nocturnal pains in back, in loins, hip and knee.─Pain in the small of back, with constipation, intermittent fever, palpitation of the heart or dyspnoea.─Pain in the os coccygis, when sitting down one feels as if sitting on something sharp.─Want of strength in back and knees, which forces patient to stoop when walking.─Pain, as from dislocation, in loins, as after great exertion.─Papulae, vesicles, tetters, pimples, and scarlet spots on back and shoulder-blades.

22. Upper Limbs.─Lameness in l. shoulder.─Pain in r. shoulder-joint with headache.─Perspiration in axillae of strong smell (like garlic).─Rheumatic and arthritic pains, and aching pains in bones of arms, in hands, fingers, and wrists.─Malignant ulcer on upper part of arm.─Tension, as from contraction of tendons, from the elbow to fingers.─Erysipelatous inflammation in elbow.─Pimples on arms after scratching.─Sensation of fatigue or of paralysis, and pain, as from dislocation, in arms.─Paralysis of hands.─Trembling of hands (in drunkards).─The hands are dry and burning.─Extremities of the fingers numbed and painful.─Tingling and pricking in l. hand.─Prickings in extremities of fingers.─Numbness in tips of fingers (morning).─Itching, psoric eruptions, red spots with vesicles, furunculi, excrescences, and warts on hands and fingers.─Hard and cold swelling of a bluish black colour, on the back of hand and fingers.─The hands are cold, as if dead.─Hard swelling from hand to elbow, with excessive pain.─Panaris.

23. Lower Limbs.─Sensation of contraction, and contractions of the tendons of the ham.─Nocturnal pains in hip and thigh.─Caries of the tibia.─Burning spots on tibia.─Agonising pains in tibia (with throat affections).─Sharp and drawing pains in legs, when there is change of weather, and in windy weather.─Furunculi on thighs.─Sensation of heaviness, paralysis, of numbness and trembling in thighs and knees.─The knees are, as it were, dislocated, stiff and weak.─Stinging in knees.─Sensation as if hot air were going through knee-joints, which were shaky.─The l. knee feels as if sprained.─Swelling of knees.─Swelling of feet, < after walking (during pregnancy).─Flat ulcers on lower extremities, with blue or purple surroundings.─Gangrenous ulcers on legs (toes).─Cramps and pains in calves of legs.─Red pimples on the thighs and on the legs, after scratching.─Excoriated places, and superficial ulcers with foul bases, on the legs.─Red or bluish, and painful swelling of feet and legs.─Heaviness, numbness, icy coldness, sweating of the feet.─Itching, psoric eruptions, papulae and spots as from a burn, in feet and legs.─Cracks and rhagades between the toes.─Abscess in the heels.

24. Generalities.─Sensation of pain accompanied by voluptuous feelings; dreadful or strongly pressive pains in various parts of body.─Sensation of dislocation and of paralysis in the joints.─Stiffness and tension of the muscles, as if they were too short.─Pains in the bones.─Sharp and drawing rheumatic pains in the limbs (first in l. side then in r.), or gnawing pains, with sensations as if bruised on moving.─Nocturnal pains, which appear insupportable, and which do not permit patient to remain in bed.─The pains affect the sides of the body alternately, or at one time the limbs, at another the body, and often manifest themselves transversely.─Intermittent and periodical pains; sufferings, accompanied by danger of suffocation; and sufferings, with want to lie down, and aversion to move.─Aggravation or renewal of the sufferings after sleep or at night, and principally before midnight, or some hours after a meal, or during damp hot weather, as well as when there is a change of wind and weather (excessively cold and excessively warm weather cause great debility); many of the symptoms are > in open air.─Mental emotions, such as disappointment, fear, fright, etc., frequently renew all the sufferings.─Slight touch intolerable.─Obliged to wear clothes loose; cannot bear the contact.─Paralysis, with heaviness and stiffness of the limbs; semi-lateral paralysis.─The l. side is principally or first affected (throat, ovaries).─Affections in general of r. chest; r. lower extremity; r. abdominal ring; symptoms generally appear on l. side; symptoms beginning on l. side with great tendency to spread to the r. side.─Extreme feebleness of body and mind; exhaustion, like that caused by loss of blood; rapid failure of strength; relaxation of muscular force.─Weakness of whole body in morning on rising.─Nervous hyperaesthesia, with external flushings.─Fainting fits, with dyspnoea, nausea, cold sweat, vertigo, pallid face, vomiting, dizziness, obscuration of the eyes, pains and prickings in region of heart, convulsions and epistaxis.─Tearing, pricking, and pulsating pains.─Attacks of asphyxia and of syncope, with loss of sense and motion, insensibility like death, clenching of teeth, stiffness and swelling of body, pulse tremulous or imperceptible.─Trembling of limbs, muscular palpitations, and jerking in several parts of body.─Contractions of the muscles.─Convulsive and epileptic fits, with screaming, movements of the limbs, falling down without consciousness, eyes convulsed, foaming at mouth, fists clenched; before the attack, cold feet, eructations, paleness of the face, vertigo, head heavy and painful, palpitation of heart, inflation of abdomen; after the attack, sleep.─Attacks of tetanus, with distortion of limbs.─Haemorrhage and extravasation of blood in different organs.─Affected parts look bluish (cyanosis).

25. Skin.─Ecchymosis; wounds and ulcers bleed readily and copiously (small wounds bleed a good deal; ulcers bleed readily; cicatrices bleed readily; pain in old cicatrices), wounds bleeding a great while; skin very hard to heal, masses of blood pass through the pores.─Varicose swellings.─Dropsical swelling over whole body.─Hard and pale tumefaction.─Skin yellow, green, lead-coloured, or bluish-red or blackish, chiefly round the wounds and ulcers.─Yellow, red, copper-coloured spots.─Pale, livid spots, with fainting fits.─Dry, miliary itch, with eruption of large vesicles of a yellow or of a bluish-black colour, with swelling of parts affected, and pains which drive to despair.─Miliary eruption, which subsequently resembles nettle-rash, scarlatina, or morbilli.─Erysipelas and vesicular eruptions with a red crown.─Excoriated places, on touching which a burning pain is felt.─Rupia and other skin affections, with angioleucitis (Cooper).─Ulcers, surrounded by pimples, vesicles, and other small ulcers (on a purple skin).─Ulcers with great sensitiveness to touch, uneven bottom, ichorous, offensive discharge when touched, esp. around the lower extremities.─Gangrenous ulcers.─Gangrenous blisters.─Superficial ulcers, foul at bottom, with a red crown.─Cancerous ulceration (of wounds), or putrefaction of the flesh, which becomes detached from the bones, and falls off piecemeal.─Gangrenous wounds, with inflammatory fever, weak, quick, and intermittent pulse, fainting nausea, spasmodic and bilious vomiting, convulsions, and cold sweats.─Papulae, warts, hard swellings.─Panaris.─Red and itching lumps and tuberosities.─Carbuncles, with copper-coloured surroundings and many smaller boils around them.─Flat exanthemata which do not fill up; pustulous exanthemata; spongy excrescences.

26. Sleep.─Great drowsiness by day, and principally after a meal.─Sleeplessness, chiefly before midnight, with excessive nervous excitement.─Lively and wide awake in evening.─The patient sleeps into an aggravation, as (e.g.) in croup; is very well while awake, but as soon as goes to sleep the croup symptoms appear in great violence; child almost suffocates, and the mother or nurse is consequently really afraid to let him go to sleep.─Also in convulsions; patient has none while he is awake, but as soon as he is asleep they appear.─Drowsiness and sleeplessness alternately every two days.─When falling asleep he is awakened by a tickling cough.─Restless sleep, with many dreams.─Sleeplessness in the evening with talkativeness.─Light sleep, with frequent and easy waking, agitation and tossing, groans and sighs, starts and fright.─Dreams connected and frequent, poetical and meditative or voluptuous; dreams of quarrels, of horrible things, of spectres, and of death.─At night, heat, agitation, burning in palms and soles, pains in the bones or rheumatic pains, diarrhoea, emission of urine, mental excitement, and many other sufferings.─After sleep, sensation of stiffness, and pain as from fatigue in the limbs, erections with sexual desire, pains in the back and loins, congestion of blood, heaviness and pain in head, pressure in stomach, sore throat, nervous yawnings, and aggravation of all the sufferings.

27. Fever.─Icy coldness of the skin or of the limbs, or only of the feet, with great desire to be near a fire, and sometimes with loss of sensation, clammy sweat, weakness and great quickness of the pulse.─Shiverings, sometimes only partial, often with pains in the limbs, sacral pains, agitation and tossing, colic, trismus and convulsive movements of the limbs, pain in chest, thirst, chattering of teeth.─Chill ascending the back, often on alternate days.─Shuddering while the heat continues, and principally on lifting the bed-clothes.─Shivering, chiefly after a meal, or in afternoon.─Dry heat, principally at night, or in evening, and esp. in feet and hands, often accompanied by agitation and tossing, headache, delirium, insatiable thirst, eructations, bilious vomitings, cries, groans, dryness of mouth and throat, and frequent stools.─Heat, alternately with cold (alternating and changing localities), shivering of shuddering.─Fever at night or in evening, quotidian, tertian, or quartan, and often accompanied by headache, rapid prostration of strength, and debility which obliges the patient to lie down; want of appetite, hiccough, vomiting, sensibility of the neck to the touch, palpitation of the heart, anguish, yellow urine, diarrhoea, pains in the limbs, back, and loins, nervous and spasmodic yawnings, stretchings, swelling of the body, spots and ulcers.─Internal sensation of heat, with cold feet.─Chronic fevers; slow fevers; typhoid fevers.─The fevers are renewed by acid food.─Dry, burning skin.─Sweat >.─Perspiration colouring linen yellow red.─Febrile sweat, principally after hot stage, towards morning; copious sweat; fetid sweat; cold sweat; sanguineous sweat.─Pulse intermittent, or feeble and quick (but accelerated), or irregular, or scarcely perceptible, or tremulous, or alternately full and small.─Intermittent fever, the paroxysms come on every spring, or after suppression of the fever in the previous fall by quinine; face red; feet cold; during hot stage continuous talking; face yellow or ashy.─Typhus fever, esp. when the tongue is red or black, dry or in fissures, esp. at the tip, or when tongue trembles when put out, or if while endeavouring to put it out, the tip remains under the lower teeth or lip and cannot be put out.

Keynotes and Characteristics with Comparisons of Some of the Leading Remedies of the Materia Medica (Allen's Keynotes), Henry Clay Allen

Surukuku Snake Poison (Ophidia)

Persons of a melancholy temperament, dark eyes, and a disposition to low spirits and indolence. Women of choleric temperament, with freckles and red hair (Phos.). Better adapted to think and emaciated than to fleshy persons; to those who have been changed, both mentally and physically, by their illness. Climacteric ailments: haemorrhoids haemorrhages; hot flushes and hot perspiration; burning vertex headache, especially at or after the menopause (Sang., Sulph.). Ailments from long lasting grief; sorrow, fright, vexation, jealousy or disappointed love (Aur., Ign., Phos. ac.). Women who have not recovered from the change of life, "have never felt well since that time.". Left side principally affected; diseases begin on the left and go the right side - left ovary, testicle, chest. Great sensitiveness to touch; throat, stomach, abdomen; cannot bear bed-clothes or night-dress to touch throat or abdomen, no because sore or tender, as in Apis or Bell., but clothes cause an uneasiness, make her nervous. Intolerance of tight bands about neck or waist. Extremes of heat and cold cause great debility. Drunkards with congestive headaches and haemorrhoids; prone to erysipelas or apoplexy. Headache: pressing or bursting pain in temples < from motion, pressure, stooping, lying, after sleep; dreads to go to sleep because she awakens with such a headache. Rush of blood to head; after alcohol; mental emotions; suppressed or irregular menses; at climaxis; left-sided apoplexy. Weight and pressure on vertex (Sep.); like lead, in occiput. All symptoms, especially the mental, worse after sleep, or the aggravation wakes him from sleep; sleeps into the aggravation; unhappy, distressed, anxious, sad < in morning on waking. Mental excitability; ecstacy, with almost prophetic perceptions; with a vivid imagination; great loquacity; (Agar., Stram.); want to talk all the time; jumps from one idea to another; one word often leads into another story. Constipation: inactivity, stools lies in rectum, without urging; sensation of constriction of sphincter (Caust., Nit. ac.). Menses at regular time; too short, scanty, feeble; pains all relieved by the flow; always better during menses (Zinc.). Menses at regular time; too short, scanty, feeble; pains all relieved by the flow; always better during menses (Zinc.). Piles: with scanty menses; at climaxis; strangulated; with stitches shooting upward (Nit. ac.). The least thing coming near mouth or nose interferes with breathing; wants to be fanned, but slowly and at a distance (rapidly, Carbo v.). As soon as he falls asleep the breathing stops (Am. c., Grind., Lac c., Op.). Great physical and mental exhaustion; trembling in whole body, would constantly sink down from weakness; worse in the morning (Sulph., Tub.). Epilepsy; comes during sleep (Bufo); from loss of vital fluids; onanism, jealousy. Haemorrhagic diathesis; small wounds bleed easily and profusely (Crot., Kreos., Phos.); blood dark, non-coagulable (Crot., Sec.). Boils, carbuncles, ulcers and intense pain (Tar.); malignant pustules; decubitus; dark, bluish, purple appearance; tend to malignancy. Bad effects of poison wounds; post-mortem (Pyr.). Sensation as of a ball rolling in the bladder. Fever annually returning; paroxysm every spring (Carbo v., Sulph.), after suppression by quinine the previous autumn. Fever: typhoid, typhus; stupor or muttering delirium, sunken countenance, falling of lower jaw; tongue dry, black, trembles, is protruded with difficulty or catches on the teeth when protruding; conjunctiva yellow or orange color; perspiration cold, stains yellow, bloody (Lyc.). Diphtheria and tonsillitis, beginning on the left and extending to right side (Lac. c., Sabad.); dark purple appearance (Naja); < by hot drinks, after sleep; liquids more painful than solids when swallowing (Bell., Bry., Ign.); prostration out of all proportion to appearance of throat.

Relations. - Complementary: Hep., Lyc., Nit. ac. Incompatible: Acet. ac., Carb. ac. [Psor.]. In intermittent fever Nat. m. follows Lach. well when type changes.

Aggravation. - After sleep; contact; extremes of temperature; acids; alcohol; cinchona; mercury; pressure or constriction; sun's rays; spring. summer.

Leaders In Homoeopathic Therapeutics, Eugene Beauharnais Nash

Feels very sad and despondent, < after sleeping, or in the morning.

Enemy of all constriction; must loosen everything (neck, chest, throat, abdomen, etc.)

Left-sided affections generally, especially throat, chest, ovaries.

Inflamed parts very tender to touch and of bluish or dark color.

Great weakness and trembling; tongue trembles when protruding it; catches under the teeth (lower).

Blood decomposes, breaks down, haemorrhages; blood uncoagulable; ulcers and even slight wounds bleed profusely.

Modalities: < at climacteric; touch, constriction or pressure, sun-heat, after sleeping; > after discharges (suppressed or delayed discharges).

Many complains connected with the menopause: hot flushes, hot sweats, burning vertex headaches, haemorrhoids, haemorrhages.

Great physical and mental exhaustion; trembling in whole body; would constantly sink from weakness.

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To Dr. Constantine Hering belongs the honor of introducing and developing the wonderful medicinal properties of this snake poison. If he had never done anything beside this for medicine, the world would owe him an everlasting debt of gratitude. It alone would immortalize him. All this, and more; notwithstanding, Chas. Hempel wrote in his first volume of Materia Medica: "In spite of every effort to the contrary, the conviction has gradually forced itself upon my mind that the pretended pathogenesis of Lachesis, which has emanated from Dr. Hering's otherwise meritorius and highly praiseworthy efforts, is a great delusion, and that with the exception of the poisonous effects with which this publication is abundantly mingled the balance of the symptoms are unreliable." Hempel modified his views somewhat, I think, in later editions.

Now, it is interesting to note that in Allen's Encyclopaedia of Pure Materia Medica, the verified, and especially the black-typed symptoms, almost all of them, are verifications of provings made with the 30th potency. It is also significant that the provings of Hahnemann's polycrest remedies, mostly made with the potencies, are among the most useful and reliable we have to-day. Some have sought to destroy confidence in the provings of all remedies which are made with the 30th potencies and upwards; not only that, but in their power to cure even when the provings were made with cruder preparations. With us, who know the value of these potencies, all such efforts only excite pity. But many who do not know are misled and prejudiced so as to never dare to test for themselves. To all such we say take no man's ipse dixit, but prove all things, "hold fast that which is true."

Lachesis is a remedy of wide range of action. It has an alternate action on the mind and sensorium, that of excitation and depression. Illustrative of the former are the following symptoms: "Quick comprehension, mental activity with almost prophetic perception, ecstasy, a kind of trance. Exceptional loquacity, with rapid change of subjects; jumps abruptly from one idea to another." This kind of excitation may be found in acute chronic complaints; in the delirium of fevers, or in mania of a settled form. On the side of depression occur: "Weakness of memory; makes mistakes in writing; confusion as to time. Delirium at night; muttering; drowsy; red face; slow, difficult speech and dropped jaw. Feels extremely sad, depressed, unhappy and distressed in mind", and this condition is very apt to be worse on awaking in the morning, or indeed after any sleep, day or night. "Chronic complaints from depressing cause, like long-lasting grief or sorrow." This depressed side of the remedy may also be found in both acute and chronic complaints. Again these opposite conditions may be found alternating in the same person, and a notable fact is that the alternations are extreme. Of course the causes of these conditions of mind and sensorium are varied, but we will often find them in old topers, subjects of broken-down constitution, and in the troubles incident to the climacteric age. Such cases are subject to sudden attacks of giving away of strength, fainting, vertigo from rush of blood to the head causing apoplectic seizure, or opposite symptoms arising from sudden anaemia of the brain. In short, the circulation in Lachesis subjects is very uncertain. This is what makes it so valuable in sudden flushes during the climacteric period.

Lachesis has some prominent head symptoms where no other remedy can take its place. It is one of our best remedies for sun headaches; of course it does not compare with Glonoine for the immediate effects of sunstroke, but does come in well after the first effects are overcome by that remedy. The patient is troubled with headache every time he is exposed to the sun's heat, and the trouble has become chronic (Nat. carb.).

This is another characteristic symptom, namely weight or pressure on the vertex. (Cactus, Glonoine, Menyanthes). This is found mostly in women suffering at the menopause, and coupled with it in such cases there is sometimes burning on the vertex. Sulphur has this symptom, but if it occurred at the menopause the remedy would oftener be found in Lachesis, unless, indeed, there were some marked psoric complications. Lachesis has a variety of headaches, but I know of only two characteristics that have been of very much value to me in prescribing for them, namely, with then headache very pale face, and the patient sleeps into the headache; dreads to go to sleep because she awakens with such a distressing headache. These two are very valuable indications, otherwise I would expect to get my indications outside of the headache itself. "Headache extending into the nose, comes mostly in acute catarrh, especially when the discharge has been suppressed or stops after sleep. This kind of headache is often found in hay fever, with frequent and violent paroxysms of sneezing. Now if the hay fever paroxysms of sneezing are decidedly worse after sleeping, even in the daytime, Lachesis 2000th may stop the whole business for the season." Being an old hay fever subject myself, I am authority on that statement.

We now come to the action of Lachesis on the alimentary tract; first the gums are often swollen and spongy, easily bleeding; when this is found Lachesis often follows Mercury well. If the gums turn purple the indication is strengthened for Lachesis. One of the most characteristic symptoms of Lachesis is found in the tongue, especially in diseases of a typhoid type; namely, puts the tongue out with great difficulty; it is very dry; trembles and catches under lower teeth. The tongue trembles and is protruded with difficulty under Gelsemium, but it is not so dry as in Lachesis. This is a sign of great weakness, but in Gelsemium it occurs in the very beginning of the fever, while in Lachesis it comes later. There is bad odor from the mouth in Lachesis, and it may be very dry throughout; or there may be an abundant accumulation of tenacious mucus. Here it again resembles Mercury. Lachesis is one of our best remedies for sore mouth in the last stage of consumption. This is sometimes a very distressing symptom, and relief for it is often very difficult to find. If Lachesis should relieve it, my experience has been that the patients are also greatly relieved in other ways; so much so, indeed, that they think that they are, after all, going to get well. This brings me to notice what I believe I have not spoken of before, that where a cure is no longer possible, and temporary relief is the only thing left, we have the best means of giving it in the homoeopathically indicated remedy. Narcotics, counter irritants, so-called tonics, stimulants, etc., do not and cannot compare with the simillimum (if properly administered) in smoothing the pathway to the inevitable termination. Lachesis has won its chiefest laurels in affections of the throat.

"Throat and neck sensitive to slightest touch, or external pressure (Sepia); everything about throat distresses, even the weight of the bed covers." This is very characteristic. Another peculiarity is that empty swallowing, or swallowing of saliva or liquids, aggravates a great deal more than swallowing of solids. The pains in the throat run up into the ears. There is much mucus in fauces, with painful hawking. In tonsillitis and diphtheria, swelling of tonsils begins on left side and extends to the right (Sabadilla). The pains are aggravated by hot drinks (reverse, Sabadilla). All these symptoms are peculiar to Lachesis, and are all apt to be very much worse after sleep. In old quinsy subjects, where the trouble always began on the left side, I have often not only aborted the attack, but cured the predisposition thereto.

Sometimes the throat assumes a gangrenous appearance, but if the other indications are present it is an additional indication for its use. Lachesis is always one of the first remedies to be thought of in any disease, when it seems inclined to spend its main force in the throat, such as typhoid fever, pneumonia, scarlatina, etc.

If the skin turns purple or bluish, as if mortification were impending, there is no remedy like it. Not only is Lachesis an unusually efficacious remedy for these acute throat troubles, but for those of a chronic form, and the same symptoms are present, even in syphilitic throat troubles. We have placed great stress upon the great sensitiveness of the throat to all touch or pressure; but this does not end it, for, as Lilienthal expresses it, Lachesis is the great enemy of all constriction. "The pit of stomach sore to the touch, or even to pressure of clothes." "Cannot bear any pressure about the hypochondria." In the abdomen there is "Painful distention, flatulence, which is very annoying, can bear no pressure; the surface nerves are sensitive". "Is obliged to wear clothes, especially about stomach, very loose; they cause uneasiness; even in bed, obliged to loosen and pull up night dress to avoid pressure; dare not lay the arm across the abdomen on account of pressure." "Uterus does not bear contact; has to be relieved of all pressure; frequently lifts the clothes; they cause an uneasiness in the abdomen, even with no tenderness." "Larynx sensitive to least touch, which causes suffocation and feeling of lump in the throat." "During heat, as of an orgasm of blood, he is obliged to loosen clothes about the neck; sensation as though they hindered the circulation of blood, with a kind of suffocative feeling. "Intolerance of tight neck bands." I could no better express the value of this symptom, or great modality of Lachesis, aggravation from pressure or constrictions, than by quoting entire from Guiding Symptoms the above. It does nor seem, after such an array of oft-verified symptoms, that more need be said to impress this upon the memory and confidence of any physician. Now, the why of this almost invariable aggravation from pressure of Lachesis and almost as invariable amelioration from the same of Bryonia I leave for those to explain who pretend to be able to do so. It is, however, another proof of the value of modalities.

Lachesis has some peculiar symptoms of stool and anus. There is an urging, or rather a pressing down, in the rectum, but it is worse when he attempts a stool; hurts so that he must desist. It feels as if the anus were closed. This is somewhat like the constant or rather frequent, though ineffectual, urging to stool of Nux vomica; or like the painful constriction of Lycopodium, which either prevents stool, or follows after an incomplete and unsatisfactory one. Another marked symptom is that the stools are often very offensive, whether formed or not. Then, under Lachesis, we have haemorrhages from the bowels, of decomposed blood, which occur mostly during the course of exhausting, acute diseases, like typhoid. Guernsey gave this: "Flakes of decomposed blood, having form and appearance of perfectly charred wheat straw, in larger or shorter flat pieces; portions more or less ground up." I have met such cases and Lachesis was very efficacious, not only in changing the character of the stool, but bringing about general improvement, ultimating in perfect recovery.

This remedy is often of great use in that very common malady, haemorrhoids; and here you have the constricted feeling, whether the piles are external or blind, and sometime a beating or throbbing, or as the patient will perhaps express it, a sensation of "little hammers" beating in the rectum. All these symptoms and many more show the affinity of this remedy for the anus and rectum, as they do also its power over disease of the whole alimentary tract.

This is also one of our best remedies in diseases of the female generative organs. In the first place it is eminently an ovarian remedy, and seems to choose by preference the left ovary. It is of use in simple ovarian neuralgia, and from that to actual tumors or every cancer of the left ovary; or the trouble begins in the left and goes to right ovary. (Reverse, Lycopodium). But we may have neuralgia, swelling, induration, suppuration, tumors or cancer of one or both ovaries. Its action in uterine troubles is also very marked. Here is a condition, as expressed in Guiding Symptoms, that I have often verified during climaxis: "Pains in uterine region increase at times more and more till relieved by flow of blood from vagina; after a few hours or days, the same again, and so on".

In these cases you almost always have the intolerance of least contact or pressure over the uterine region so characteristic of this drug. The womb prolapses, is at times persistently congested, and obstinate uterine haemorrhages repeatedly occur. There are hot flashes, hot vertex, pale face and fainting, uterine displacements of various kinds, and deranged capillary circulation, all so common in females at the menopause and especially haemorrhages. (See also Crotalus and Kreosote). Probably there are not three remedies in the whole Materia Medica so often indicated in troubles connected with this period, as Lachesis. (Kreosote, post-climacteric diseases). It is often of great use in cancer of either the breasts or uterus. In either case the cancer puts on a bluish or purplish appearance, and if open or fungoid bleeds easily, a dark, decomposed blood. In case of bleeding, the pains and suffering, as in the case of uterine haemorrhage, are temporarily relieved by it. We would be greatly crippled in the treatment of these various ovarian and uterine troubles without Lachesis.

The respiratory organs and chest also come under the influence of this drug. Paralysis of the vocal chords, causing loss of voice; larynx is sensitive to least touch; it causes suffocation; it is one of our best remedies in desperate cases of croup, where the child gets worse in sleep; seems to sleep into it. Spasm of the glottis; sensation of something running from neck to larynx, stopping the breath. It has great shortness of breath when walking, especially in old topers and in heart affections, when this condition is always the guide to its use. "The least thing coming near the mouth or nose interferes with breathing; tears off the collar or everything about the neck, throat or chest, because it suffocates." Asthma with the same symptoms, has sudden flushes of heat or orgasm of blood; must loosen clothes to prevent suffocation; threatened paralysis of the heart or lungs; dry hacking cough, aggravated by touching throat or larynx, also cough during sleep, without awakening or being conscious of it. Here it often cures very obstinate cases of cough after Chamomilla has failed, which also has this symptom. For the short dry cough sympathetic with heart troubles, Lachesis is often useful. Cough with pain in anus, or stitches in pile tumors. One of our best remedies in typhoid pneumonia or typhoid fever with lung complications.

Now look out for the Lachesis tongue in these cases. Lachesis is also one of our most useful remedies in heart troubles, acute or chronic, the peculiar suffocation, cough and aggravation from constrictions being the guiding symptoms.

No remedy more profoundly impresses the nervous system than this. In the first place it causes trembling, not from fright or excitement, but from extreme weakness. In this it resembles Gelsemium; both have great trembling of the tongue on trying to protrude it. With both remedies the whole body trembles; but with Lachesis she feels faint, as if she must sink right down. This great prostration is both mental and physical, and she does not improve from rest or sleep, but on the contrary is worse in the morning after sleeping. With this prostration there are often pain or other troubles with the heart; nausea, pale face and vertigo. Now if this thing goes on the next stage supervenes and paralysis is the end of it. The paralysis is generally left-sided, as are the majority of complaints of Lachesis, which is pre-eminently a left-sided remedy. This paralysis may come on as a result of apoplexy or cerebral exhaustion; if the latter, there is still great hope of a perfect cure by a judicious use of Lachesis. Of course if the lesion is too extensive in apoplexy, and the extravasation of blood too great, there is little hope; but some apparently most desperate cases do recover even then. It is recommended in epilepsy and locomotor ataxia, but I have never seen good effects from it.

There is, however, another place in which I have seen it accomplish much and that is in the languor, weariness and prostration from hot weather. The heat not only aches, but the whole body seems prostrated by sun heat. (Antim. crud., Gelsemium, Glonoine, Natrum Carb., Natrum m.)

Worse after sleep, or rather the patient sleeps into an aggravation, is a genuine characteristic of this remedy, no matter what the enemies of Lachesis say of it. On this line there is one particular symptom to which I wish to call attention, i. e., "As soon as the patient falls asleep, the breathing stops." This is as Hering expresses it. I have oftener found it this way; the patient cannot go clear off into sleep, because just on the verge of it the breath stops and he wakens catching for breath. This is often found in heart troubles, functional or organic, and is very distressing. Grindelia robusta has a similar symptom. (Also Digitalis).

I once had a case of very obstinate constipation in an old syphilitic case. He was at last taken with very severe attacks of colic. The pains seemed to extend all through the abdomen, and always came on at night. After trying various remedies until I was discouraged, for he "got no better fast", he let drop this expression, "Doctor, if I could only keep awake all the time, I would never have another attack." I looked askance at him. "I mean", said he, "that I sleep into the attack, and waken in it." I left a dose of Lachesis 200. He never had another attack of the pain, and his bowels became perfectly regular from that day and remained so. I could give more cases where this symptom has led me to the cure of ailments of different kinds. It is enough to say that I have no hesitation in adding my testimony to that of others as to the value of this symptom. I think I have said enough about the different symptoms of Lachesis to indicate that it is one of the most useful remedies in typhoid fever. I will only add here that it is generally in the second or third week of the disease that it is found indicated. This is one of the differences between it and Gelsemium. For the trembling and weakness of Gelsemium come early, and if recognized then Gelsemium can abort the disease at once. Of course the sensorium, tongue, mouth, throat, abdominal and stool symptoms already spoken of, especially the sleep symptom, help to decide the choice between Lachesis and other remedies.

Now upon the tissues. We have swelling on all parts of the body, and one of the most characteristic conditions is the color of them. They are bluish verging onto black. (Tarantula Cub., Anthracinum). I never see a swelling of that color but Lachesis immediately comes to my mind, and then if I find that they cannot bear to have them touched, they are so sensitive, even a poultice is unbearable, because it is so heavy, that settles it. I give Lachesis and am seldom disappointed. The blood decomposes, or, as is sometimes said, "breaks down", becomes uncoagulable. This often occurs in typhoid fever, and is of course very serious. The bleeding is easily started, and is very persistent. There seems to be a tendency to haemorrhagic trouble, so we find Lachesis one of our best remedies in purpura haemorrhagica. Ulcers and wounds bleed profusely; even "small wounds bleed much;" wounds easily become gangrenous. Here Lachesis is capable of doing great good. Cancers turned bluish or black, bleed much and often, and burn; blood appears in the urine in many affections, indicating its broken down condition.

We find ourselves drawn out to a greater length on this truly

remedy than we had anticipated when we began writing we have also found it a much more useful remedy than we had anticipated from our impressions of it when reading Charles Hempel (for whom we have great respect) in our studenthood. It wears well for those who use it in the 30th potency and upwards. Don't forget that Lachesis is preeminently a left-sided remedy, as Lycopodium is a right-sided one. Left-sided paralysis, ovarian affections, throat troubles, lung troubles, headaches, etc., all make us think of this remedy first because of its positiveness in this respect. Of course, if the other symptoms were present in right-sided affections we would not hesitate to use it. Lachesis is often a remedy of great value in skin affections; in scarlatina maligna, black measles, erysipelas, smallpox, malignant boils, furuncles, carbuncles, chronic ulcers, bed sores; fungus haematodes, etc. In all these and many other affections appearing upon the surface, the characteristic dark blue color is present, or we need not expect much from this remedy. So far as stages of life and constitution are concerned, I have found it efficacious in all ages and temperaments. But Perhaps oftener indicated in thin than in fat people.

Now we bid our old and tried friend an affectionate good-by for a time, and heartily recommend all who have not done so to seek his acquaintance.