the pain suddenly ceases, as if it were suddenly arrested, and the patient feels as if commencing a new life. Occasionally the vomiting is preceded by a violent rigor, with chattering of the teeth, goose-skin &c. The intervals between the attacks are usually very long, perhaps weeks or months. The patient can take any sort of food without injury until again unexpectedly the paroxysm makes its unwelcome ap pearance. Predisposing Causes.-Eating too many sweets, mental emotions, especially vexation, before, during, or after a meal. Bryonia.-Not generally successful in pure gastralgia. Meyer only succeeded with it when the case embraced also hepatic affections. In the case of a man aged twenty-seven, with hypertrophy of the liver, it succeeded. "There was violent pain in the stomach and scrobiculus cordis always soon after eating; eructations with the taste of the food; flow of water into the mouth; headache and vertigo. On examination nothing was found abnormal in the region of the stomach; but the liver was much enlarged below the last ribs, the abdomen tense, with dull (hepatic) sound on percussion. After the violence of the pains, and especially the excessive tenderness of the scrobiculus, had been d. minished by Atropine, the hypertrophy of the liver diminished gradually under the use of Bryonia; and in proportion as the size of this organ diminished, the pains in the stomach decreased, and were at length. completely removed by China." Some irritability of the stomach remained. 10. GASTRODYNIA NEURALGICA. Dr. Kissel says he cured eleven cases of this disease with Cuprum. They all occurred in women whose menstruation was sometimes normal, sometimes deficient, sometimes excessive. In some metrorrhagia preceded; several had already exhibited symptoms of gastric catarrh, after the removal of which the gastrodynia remained unaltered. This gave very severe pains in the præcordium, which extended from thence as far as the spine, and lasted one or more hours. Then the intermission was complete, till the fits returned after some hours. In most cases, the third and fourth dorsal vertebræ were painful on pressure. Scarcely any pains arose from pressure on the gastric region, which was neither hard nor tumid, but rather drawn in. Stool, urine, appetite, &c., presented nothing abnormal. All the patients had pale complexion. Cuprum-aceticum, as well as Sulphurica-ammoniatum soon brought relief, and, by persevering in their administration, complete cure. Lembke reports (in the Allg. Hcm. Zeitung, B. 45. No. 6), of a case of gastrodynia which had lasted four months, and was associated with nausea, oppression of the chest, trembling of the hands and feet. and feebleness. This case was treated by Cuprum-metallicum, second trituration, as much as would lie on the point of a knife, four times a day Other remedies, see page 516. 11. NERVOUS DISEASES OF WOMEN. SYMPTOMS.-Low spirits, nervous feelings; on feeling the pulse there is perceived a tremor of the hand with acceleration and sharpness of the pulse, arising chiefly from mental agitation. When the attempt is made to encourage her she burst into a flood of tears. She says she has gradually lost health and spirits, is easily fatigued; her heart beats irregularly, flutters and palpitates; impressions are made on her mind disproportioned to their cause. She is prone to weep, has transitory feelings of alarm or dread. Both mind and body are in a morbidly sensitive condition; and general distress is depicted in her pale and dejected countenance. In these cases there is usually some irregularity, some pain, or other difficulty of menstruation and leucorrhoea in the intervals. This con dition has perhaps long existed without its influence being suspected and the patient has already taken a load of tonics without benefit, though they were expected to give strength and cure dyspepsia, which has been in many cases the head and front of the case. The dyspeptic symptoms are: flatulency, lasting for weeks or months; repeated vomitings, irregular or inverted action of the oesophagus; ascent of flatus obstructed in the throat (globus hystericus), almost threatening suffocation. Other nervous sensations: an inverted action attended with rumbling noise in the stomach or abdomen. An inverted action passing from the stomach up the oesophagus and pharynx, ending in a hysteric paroxysm, involving the brain and entire nervous system. This mysterious communication so closely allied to the aura epileptica may result from some irritation in the alimentary canal through the pneumogastric nerve. The breathing is also affected in a remarkable manner. In short, in these complicated nervous cases every nervous symptom may meet in an individual case, the whole uniting to compose the true hysteric paroxysm; and blended with all we may have various neuralgic sensations, varying from the slightest irritation to the most exquisite torture. These neuralgic pains are often treated as inflammation; and always without success. The prominent of the local pains manifesting themselves in the ganglionic system of nerves distributed on the abdominal viscera are: 1. A pain seated under the left mammæ; 2. A pain under the margin of the ribs on the left side; 3. In the course of the descending colon; 4. In the course of the ascending colon toward the right hypo chondrium, 5. In the abdomen generally; 6. Pain in the stomach; 7 Pain in the region of the kidneys extending down to the bladder. It is not always easy to locate the pain so as to know precisely what organ is the exact seat of the pain. The site it most frequently occupies is under the left breast; it may last for weeks or months, often of doubtful location. In one aggravated case the patient died suddenly; the post-mortem revealed only a very delicate ring of enlarged bloodvessels around the cardiac orifice of the stomach, such as might be caused by a spasm. 2.. The pain under the margin of the ribs of the right side is perhaps seated in the duodenum, as it is always aggravated by mercurial purgatives, and it is often attended by a jaundiced appearance of the skin. Though it is increased by pressure, and often treated as hepatitis, it is not inflammatory. The rest of these obstinate local affections are all neuralgic in character. 3. The pain in the stomach is a true gastralgia. The suffering it causes is the most extreme that can be imagined. It sometimes comes on suddenly, and the patient screams in agony, is sometimes drawn forward almost double, then intermits, returning in spasms. Though tender on pressure there is no inflammation. Treatment.-1. Correct the morbid condition of the uterine system. 2. Remove or mitigate violent symptoms. 3. Restore tone and vigor to the general system. Homœopathic Remedies, see pages 485, 508, 511. It has been common to treat these debilitated subjects with tonics, in the vain hope of restoring strength. The results have been disgraceful to practical medicine. Dr. Gooch selected all the cases in which there was tenderness of the os-uteri, and prescribed, with much timidity and distrust," general bleeding, cupping from the loins, leeches from the pubic region, purgatives, anodynes, warm baths, and the recumbent posture even for months at a time." No satisfactory results followed these depressing measures. Dr. Addison, of Gray's Hospital, attributed the nervous symptoms to a sympathetic irritation of the uterus reflected to the remote points where the pain is felt. On this idea he treated them all by local astringent lotions applied directly to the uterus itself. The lotion used must be one capable of producing a similar degree of irritation; and then in a proper degree of dilution it will be found homoeopathic to the local irritation and the sympathetic nervous affections arising from it. The solution of Sulphate of Zinc just strong enough to excite a slight sensation of pain, is one of the best applications. If the pain be unpleasant, let the strength be diminished. In many cases cool water alone is the best application. All lotions should be frequently repeated, perhaps two or three times per day, ceasing to use them shortly before the menstrual period. 12. INJURIES OF THE SPINE. Spinal Disease from Traumatic Lesion.-The spinal cord is as liable as the brain to derangements of nutrition, as well as to concussion or compression; while its intimate connection with every part of the organism, through nerves arising from, or communicating directly with it, will render any injury to its delicate structure almost certain to originate a serious train of morbid and anomalous symptoms. Thus: Mechanical injury of the spinal column may cause either excess or deficiency of the cerebro-spinal fluid; and thus give rise on the one hand to dropsical effusion, and on the other to a partial atrophy or wasting away of the tissue. This latter form of spinal disease may run a latent course for months or years, the obscure cause of the infirmity dating back to some trivial injury sustained by the spine or skull, and which has passed by unnoticed, or has been entirely forgotten. 1. Concussion of the Spinal Marrow.-A common case is thus described:-A gentleman falls, without violence, with his back upon the hard ground or soft turf. There is no mental confusion, no cerebral disturbance-he feels a transient, peculiar sensation, called pins and needles, in his hands and feet; he gets up, walks or rides home; feels little or no inconvenience, makes arrangements for the morrow; but in the morning is unable to get up, because, he says, he is in pain all over, he feels sore and stiff, just as if he had been bruised, making it painful for him to move his limbs. Now, what is the pathology of this case? It is possible that the spinal marrow, obeying the law of gravitation, may, as the body falls, precipitate itself in that direction-may fall backwards towards the arches of the vertebræ, and be itself concussed in this way; or the little filaments of the sensitive and motor nerves, which are delicately attached to the spinal marrow, may for the moment be put in a state of extreme tension; because, as they pass through the inter-vertebral foramina, they are fixed there by the dura mater, and if the spinal marrow be dragged from them, the intermediate parts must necessarily be put upon the stretch, producing at the same time the "pins and needles sensation." This patient has not caught cold, has no rheumatism; nor has he been bruised, or received any blow where the pain is felt. The stiffness he feels is not the result of local injury. The sensitiveness of the surface which creates pain on being touched, and the stiffness which he experienced are the result of some structural disturbance of the motor, as well as of the sensitive nerves, or of some mischief in the interior of the spinal marrow; but the precise nature of this mischief is not always ascertainable. When the spinal marrow has been impaired by a blow, or direct force, or by a shake, or by a to-and-fro movement, as occurs in railway collisions, the spinal marrow is protected by the long and substantial textures around it, but there is still some immediate deterioration of function, and this is to be attributed to the shock; and the appropriate treatment will be directed according to this idea. The first point in the treatment is the enforcement of perfect rest. It has been supposed that the best way to get rid of the effects of a con• cussion of the brain or spinal marrow is "to walk it off." A gentleman at Epsom had a fall upon his back from the giving way of a scaffold. When he fell he experienced a sensation of pins-and-needles in his legs. He was a most energetic man, he immediately set off and ran six miles, as he said he had been before told to do. In a short time he began to have spinal marrow symptoms, which resulted in complete paraplegia, which was never cured. If he had given nature a fair opportunity by immediate and complete rest, he would no doubt have recovered. The opposite course, exercise immediately after the shock to the spinal marrow, leads to inflammation and softening of the spinal marrow, which remains incurable. See Vol. I. p. 689. Soldiers who have suffered some spinal concussion, have continued active exercise, without necessary rest, have experienced, on resuming ordinary duties, some little difficulty in walking. In a few days, or a week or two, the legs become feeble; there is a little jumping of the legs at night on going to sleep, some sense of coldness in the limbs, slight dullness of sensation on the surface of one or both limbs. Perhaps he is thought to be a malingerer, and is ordered by the surgeon to increase his exercise. This adds to the exhaustion of the spinal marrow, and the plan, if persevered in, leads to paraplegia, which might have been avoided by continued rest for a sufficient length of time. Some patients only recover from spinal injuries after many months, or a year or two of perfect rest. In other cases the recovery is rendered incomplete by persistent loss of sensation, or wasting of some part; and this persistent loss is supposed to be connected with some distinct defect of structure in some minute filaments, either of the spinal marrow or the nerves themselves. Hypericum-perfoliatum.-Dr. Ludlam says this plant is reputed to be as appropriate to traumatic lesions of the nervous tissue as Arnica is to those of the muscular or vascular systems. He gives two cases which illustrate the efficacy of this remedy,* and also the morbid results of cerebro-spinal injury developing themselves after considerable time had elapsed. Dr. Müller has given a proving of this remedy, which shows it to, possess considerable power to induce an irritation of the nervous centres, with vascular erethism and congestion. He says it acts partially upon the head, causing heaviness therein, with a sensation as if Transactions of the Chicago Homop. Med. Society, No. I., p. 9.-Brit. Journal Homop., No. XVII., p. 523. |