Arsenicum album

Sudden, intense effects. Restless, anxious and very weak. Maddening pains; BURNING LIKE FIRE, hot neddles or wires, > heat, felt, even during sleep; exciting shortness of breath (Nat- s.) or chilliness. Inveterate neuralgias. Multiple neuritis. VERY RESTLESS, < affected part. Increasingly irritable (Cimi.) or SUDDEN GREAT WEAKNESS, from trivial causes. Rapid emaciation. ACRID, SCANTY, THIN SECRETIONS; coryza, saliva, sweat, etc. PUTRID, CADAVERIC ODORS. Destructive processes. Malignancy. Sepsis. Low vitality. Pale, puffy, baggy SWELLING. Dropsy. Anæmia. .................... Anxious. Oversensitive. Fastidious. EXACTING. Fault-finding. ANGUISH; despairs of recovery (Aco.). AGONIZING FEAR OF DEATH; nightly; yet tired of living. VIOLENCE; self-torture; pulls her hair; bites her nails. Suicidal impulses. Restless and suspicious. Congestion to head, > cold, but neuralgia, > heat. Pain alternates between head and stomach or body. Pain over l. eye. Restless head. Early grayness. Falling hair. Spasm of eyelids. Burning tears. Scrophulous ophthalmia. Takes colds. Nose colds descend to chest. Cold sores; in nose. Sneezing, with biting, watery coryza; but stopped nose. Hay fever. Sensitive smell; loathes odor, sight or thought of food. PALE, anxious, sunken, haggard or distorted countenance; with cold sweat. Black lips. Bluish white tongue. Nightly toothache. INSATIABLE BURNING THIRST; CRAVES ICE COLD WATER, BUT IT DISTRESSES STOMACH (Nux-v.) AND IS VOMITED AT ONCE; with anorexia; during heat. DRINKS LITTLE AND OFTEN. Gastritis. Swelled spleen. Vomiting, with purging, from ptomaine poisoning. Foul, rice water or small, acrid, burning, black, mucous or lienteric stools; < cold drinks. Scanty urine. Uræmia (Pip-m.). Profuse acrid leucorrhœa. As of a vapor in larynx. SHORT BREATH; felt in nose; must sit up; < odors, receding eruptions or ascending. Whistling inspiration. Wheezing breathing. Cough alternately dry and loose; must sit up. Frothy expectoration. Acute pain through upper third of r. lung. Asthma. Pulmonary œdema. Cough; dry, nightly; < drinking. Heart; weak; trembles; palpitates; < slight causes. Stiffness, ascends from coccyx to nape. Alternate internal and skin symptoms. SKIN; LOOKS SEARED; dry, rough, dirty or shrivelled (Op.). Free desquamation. Eczema. Acuminate eruptions. Hives after eating fish. Ulcerative tendency; chronic; with burning. Phagedena. Gangrene. Shocks on dropping to sleep. Restless sleep. Dreams of death. COLD, externally, with internal, burning heat; in spots; sensitive to, yet > in open air (Aur.). Chills; irregular; shaking; craves hot drinks; and can't get his breath. Heat, as of hot water in veins or they burn like lines of fire; burning or coldness in chest (Bry. Lach. Nat-m. Sul.). Hectic. Sweat; with insatiable thirst, dyspnœa or exhaustion; cold. Atypical or larval malaria. Old case of malarias. Waves of icy coldness in blood-vessels or intense boiling heat. Yellow fever (prophylactic).

COLD: ICES, DRINKS. FOODS. Air. PERIODICALLY: MIDNIGHT; after. AFTER 2 A.M. 14 days. Yearly. VEGETABLES. DRINKING. TIPPLING. Infections. Bad meat. Eruptions: Undeveloped. Suppressed. Quinine. Lying on part. Tobacco. EXERTION.

HOT: APPLICATIONS (dry). FOOD. Drinks. Wraps. Motion. Walking about. ELEVATING HEAD. Sitting erect. Company. Sweating.

MUCOUS MEMBRANES. MIND. RESPIRATION. Lungs; R apex. Blood. Heart. Nerves. SPLEEN. Lymphatics. Muscles. SKIN. Serous cavities. Organs.

Complementary: Nat-s. Pul. Thu. Related: Sul-ac. Ver-a.

Arsenicum album

White Oxide of Arsenic. AS2O3.

Great prostration, with rapid sinking of the vitalforces; fainting.

The disposition is :

a. Depressing, melancholic, despairing, indifferent.

b. Anxious, fearful, restless, full of anguish.

c. Irritable, sensitive, peevish, easily vexed.

The greater the suffering the greater the anguish, restlessness and fear of death.

Mentally restless, but physically too weak to move; cannot rest in any place ; changing places continually ; wants to be moved from one bed to another, and lies now here now there.

Anxious fear of death ; thinks it useless to take medicine, is incurable, is surely going to die; dread of death, when alone, or, going to bed.

Attacks of anxiety at night, driving out of bed, < after midnight.

Burning pains; the affected parts burn like fire, as if hot coals were applied to parts (Anthr.), > by heat, hot drinks, hot applications.

Burning thirst without special desire to drink; the stomach does not seem to tolerate, because it cannot assimilate, cold water ; lies like a stone in the stomach. It is wanted, but he cannot or dare not drink it.

Cannot hear the smell or sight of food (Colch., Sep.).

Great thirst for cold water; drinks often, but little at a time; eats seldom, but much.

Gastric derangements; after cold fruits; ice cream; ice water; sour beer; bad sausage; alcoholic drinks; strong cheese.

Teething children are pale, weak, fretful, and want to be carried rapidly.

Diarrhoea, after eating or drinking; stool scanty, dark-colored, offensive, and, whether small or large, followed hy great prostration.

Haemorrhoids : with stitching pain when walking or sitting, not at stool; preventing sitting or sleep; htirning pain < hy heat; fissures make voiding urine difficult.

Breathing: asthmatic; must sit or bend forward; springs out of bed at night, especially after twelve o’clock; unable to lie down for fear of suffocation; attacks like croup instead of the usual urticaria.

Rapid emaciation : with cold sweat and great debility (Tub., Ver.) ; of affected parts; marasmus.

Anasarca, skin pale, waxy, earth-colored (Acet.ac.).

Excessive exhaustion from least exertion.

Exhaustion is not felt by the patient while lying still; when he moves he is surprised to find himself so weak.

Symptoms general!}^ worse from 1-2 p.m.^ 12-2 a.m.

Skin : dry and scaly ; cold, blue and wrinkled ; with cold, clammy perspiration; dike parchment; white

• and pasty; black vesicles and burning pain.

Bad effects from decayed food or animal matter, whether by inoculation, olfaction or ingestion.

Complaints return annually (Carbo v.. Each., Sulph., Thuja).

Phos., Pyr.

Ars. should be thought of in ailments from: chewing tobacco; alcoholism; sea bathing; sausage poison-

• ing; dissecting wounds and anthrax poison; stings of venomous insects.

Aggravation. — After midnight ( i to 2 a. m. or p.

M.) ; from cold; cold drinks or food; when lying on affected side or with the head low.

Amelioration. — From heat in general (reverse of Sec. ) except headache, which is temporarily > by cold bathing (Spig.) ; burning pain > by heat.

Lecture LIII — Arsenicum album

Arsenicum.

V Phosphorus.

Aconite, Sulphur.

Phosphorus, Rhus, Lachesis.

Ipecac, China, Veratr. alb., Colchicum, Ferrum.

Baptisia, Muriatic acid, Phosphoric acid, Nitric acid.

Antimonium crud., Antimonium tart., Nux v., Pulsatilla.

Secale, Camphor, Carbo v.

Apis.

Ailanthus.

v Anthracinum.

>Sesquioxide of iron.

>China.

> Ipecac.

>Ferrum.

>Graphites.

>Camphor.

>Veratr. alb.

Irritability.

Inflammations: stomach, uterus, etc.

Fevers: continued, typhoid, intermittent.

Skin: exanthemata, indurations, gangrene, carbuncle, Arsenicum. <j cancer, ulcer.

Nerves: neuralgia, convulsions, stupor, exhaustion, fainting.

Catarrhs: eyes, nose, throat, lungs, etc.

Dropsy: anasarca, hydrothorax.

To-day we take up for study the last of the acid remedies. I refer to Arsenious acid or Arsenicum album. It has quite a number of concordant remedies, and quite a list of antidotes. Its complementary remedies are Phosphorus and Allium saliva.

Arsenicum has long been known as a speedy means of destroying life, hence it has been frequently used for suicidal and homicidal purposes. It has the property of uniting with animal tissues, probably with the albuminous portions, hardening them and causing them to resist the usual process of decay. This fact is taken advantage of by taxidermists in stuffing birds and animals. Cases of accidental poisoning with Arsenic are quite common, and this is all the more so because of the use of Arsenic in the arts. In the form of Scheele's green, or arsenite of copper, it enters into the composition of certain paints. It is used frequently in the manufacture of certain green wall-papers, and also in artificial flowers. It is also introduced into pastes to be used in sealing packages, which are to protect goods from insects. All these uses of Arsenic render poisoning, especially chronic poisoning, by it not at all uncommon.

In certain districts Arsenicum is indulged in as an article of diet. The women take it for the purpose of beautifying the complexion, and the men indulge in it because it enables them to work hard with little or no fatigue. The drug acts on muscular tissue so as to increase its power of endurance. We may make use of this fact when some disease has resulted, from climbing mountains or a long journey, as a provoking or modifying cause. The "Arsenic" vice is very objectionable, and certainly very injurious. After awhile these persons will suffer from Arsenic poisoning; especially if they move away from the region where they are living. The symptoms of slow arsenical poisoning are these : the eyelids are oedematous and the patient suffers from slight conjunctivitis; the eyes are always red and injected, and smart and burn. Associated with these symptoms is dim sight. Whether this comes from the inflammation externally, or from any internal ocular trouble, I am unable to say. The mucous membrane of the mouth, nose and throat is unnaturally red and dry. The sufferer complains of almost constant thirst. Digestion is most certainly deranged. The patient will tell you that he is dyspeptic. The skin assumes rather a dry, dirty look; it is only exceptionally clear and transparent. The patient suffers frequently from nettle-rash. Long wheals appear, and these itch and burn intolerably. Still later, eczema makes its appearance. The patient also suffers from stubborn neuralgia in different parts of the body. These are the most common; and the most certain symptoms indicating arsenical poisoning. In addition to these there will be some acute symptoms. For instance, there will be times when he has attacks of vomiting, with deathly nausea. He will vomit everything he drinks. At other times he has symptoms indicating cholera morbus, e.g., vomiting and purging, and coldness of the surface of the body.

You may frequently be called upon to antidote arsenical poisoning. If it is an acute case you should excite vomiting and administer the sesquioxide of iron as an antidote. Dialyzed iron has also been recommended. It has the advantage of being more stable than the sesquioxide. For the nausea occuring during chronic poisoning, Ipecac acts very nicely. In the acute attacks simulating those of cholera morbus, Veratrum album relieves.

Cinchona also suits many of the symptoms; particularly the debility, dropsy and neuralgia.

Graphites is one of the best remedies to cure the skin symptoms of chronic arsenical poisoning.

Now we will consider the symptoms of Arsenicum in their totality. Quite a universal symptom of the drug, and that, too, whether the result of poisoning or of proving, is what I have already mentioned as an irritability of fibre. This is prominent in the worst cases in which Arsenicum may be used. Death may be almost certain, and yet there is this irritability of fibre showing the universal characteristic of the drug. Even when the patient lies unconscious, his stupor is broken by anxious moans and restlessness. Consistently with this quality of the drug, we find Arsenic indicated in patients who are anxious and restless, frequently changing their position, full of fear of death; hence they do not wish to be left alone for fear they will die. Delirium is violent, more violent than in any other of the acids except Nitric acid. It is worse at night, particularly after midnight. The patient has visions of ghosts and other fanciful figures, with trembling of the whole body. You cannot here fail to recognize the similarity to delirium tremens or mania-a-potu. Arsenicum here is of great use, particularly in old offenders who are seriously diseased by the use of alcohol, and who, from some cause or other, cannot get their usual drink.

The pains which the Arsenicu?n patient experiences, whether neuralgic or otherwise, make him desperate and angry, and at times almost furious. When falling asleep, he jerks and starts. During sleep his dreams are frightful and fantastic. Before going any further, I want to introduce a caution in regard to Arsenic. Arsenic is not a remedy usually called for in the beginning of diseases. The tendency of the symptoms is deathward. If you give the drug too soon, in a disease which in itself tends deathward, you may precipitate the result which you are anxious to avoid. I have myself several times made the mistake despite great caution. Do not give Arsenicum early in typhoid fever unless the symptoms call for it unmistakably. Here it is especially dangerous to give it too soon. Often Rhus tox. precedes its use. I will say the same thing in regard to tuberculosis. In the last stages of this disease this restless tossing about is not an Arsenic symptom, and Arsenicum will not relieve it. That is only a precursor of death. You must be certain that the mental state is undisputably that of Arsenic, or you will do harm instead of good to your patient. There is one exception to this word of caution, and that is in inflammations of the gastro-enteric system. I may say that Arsenicum may here be given quite early in the case without doing any harm, on the contrary with much benefit.

Now for the inflammations and fevers of Arsenicum. Arsenicum alters the blood. It is useful, as we shall learn, in low types of disease, when the blood-changes are serious. The inflammations of this remedy are characterized by their intensity, and by their tendency to the destruction of the tissue which is inflamed. In these local inflammations of Arsenic you will find burning lancinating pains the characteristic sensations. This is described by the patient as though hot coals were burning the part. It is often accompanied by throbbing. Now this burning when Arsenicum is the remedy indicates destruction of tissue, hence it calls for this remedy in gangrene, in sloughing, in carbuncles; and in that dreadful disease cancer. And it does not call for Arsenic when this burning is a mere sensation. Patients occasionally complain of burning pains, here and there, which arise from nervous causes only. Arsenicum does no good then. I have often seen physicians give Arsenic when women complained of burning pain in the ovaries. There was no evidence whatever of active inflammation ; the burning was purely an ovaralgia. Arsenicum could do no good here. If, however, there is ovaritis with the pain, Arsenic becomes an invaluable remedy. All these cases in which Arsenic is called for are relieved by hot applications, and greatly aggravated by cold. The most important sites for the Arsenicum inflammations are the stomach and bowels primarily, and next to these the heart. The inflammation in the stomach and bowels may vary from slight irritation to the most destructive gastritis and enteritis. The mouth is dry, the tongue white as if whitewashed, or, in some cases with irritable stomach, the tongue is red with raised papillae. Thirst is intense, but the patient drinks but little at a time because water molests the stomach. An ordinary amount of food causes a feeling of fulness or repletion. In this symptom it is similar to Lycopodium. The least food or drink is vomited as soon as taken. But we may have another group of symptoms : weak, sinking sensation at the pit of the stomach, relieved by eating, but so soon as he begins to eat, he has urging to stool with diarrhoea. Here the drug is similar to Cinchona and Ferrum.

There is very distressing heartburn. Sometimes burning in the stomach like coals of fire is associated with the diarrhoea. The stools are undigested, slimy and bloody, and are attended with violent tenesmus and burning in the rectum. If this goes on, the stools become brownish or blackish, and horribly offensive, showing that it is indicated in most serious cases of enteritis and dysentery. The exciting causes for these various sets of symptoms are sudden chilling of the stomach with ice-water or ice-cream, alcoholic drinks in excess, certain poisons, as the ptomaine of sausage meat that has spoiled, rancid fat, spoiled butter or fat that has undergone decomposition, and lobster salads at certain seasons of the year.

Arsenicum also excites intestinal disease which is almost identical with cholera Asiatica. Even the organic growths of cholera are found in the discharges from the Arsenic proving. Do not conclude from this that Arsenic must be the remedy for cholera Asiatica. It is only the remedy when we have the following symptoms : intense vomiting and purging, the stools being not so much like rice-water as they are brownish-yellow, profuse, and offensive. The vomited matters are green, yellow and bilious. There is burning thirst, with the intense agony which belongs to Arsenicum. The surface of the body is as cold as ice, but internally, the patient feels as if on fire. Arsenicum is also useful in cholera infantum, and in atrophy of infants. It is indicated by many of the symptoms that have already been enumerated. The symptoms of the bowels are, undigested stool, diarrhoea which is provoked just as soon as the child begins to eat or drink, aggravation after midnight (particularly the restlessness and the diarrhoea), and rapid emaciation. The child's skin is apt to be harsh and dry, and often yellowish and tawny. The little patient is restless, evidently being in constant distress. Here, too, we often have to give Arsenic quite early in the case, because here the symptoms have been going on before your arrival. It stands in close relation with Nux vomica and Sulphur m. atrophy of infants. For instance, early in the case of marasmus, you may give Arsenicum, providing diarrhoea is present, in a case which would call for Nux vomica or Sulphur were constipation present. The same dried-up mummy which you find in the Sulphur case, with the peculiar gastric symptoms of Arsenic, would call for Arsenic. In far-advanced cases, the resemblance is not to these remedies, but to Cinchona , or China, and to Argentum nitricum.

Now let us study some of the related remedies of Arsenicum in gastro-intestinal troubles.

Argentum nitricum has slimy, greenish stools, with excessive flatulence, worse at night. Although both remedies have restlessness, it is not the same in each case. Arsenicum has a restless desire to change place, now sitting, now standing. The restlessness of Nitrate of Silver is purely nervous. The patient has difficulty in breathing, with long sighs.

Much more frequently will you be called upon to differentiate between Arse?iicu?n and Carbo veg. Carbo veg. is somewhat similar to Arsenicum in abdominal affections arising from chilling the stomach, as with ice-water. It has, perhaps, less of the distinctive restless tossing about, but at the same time it may have a nervous, irritable, anxious state, without tossing about. Carbo veg. is also a similar remedy to Arsenicum when rancid fat has excited gastro-enteric symptoms.

Secale cornutum is very similar to Arsenicum in many of its symptoms. The two drugs are complementary. They agree well one with the other. In the abdominal symptoms both drugs meet in cholera Asiatica. Arsenicum may be distinguished from Secale by these few symptoms: the movements in Secale are copious and come in spurts; Secale has not the same restlessness that belongs to Arsenicum. Now, when there are any spasmodic symptoms present, as is often the case, you will find, under Secale, fingers spread asunder, with tingling in the hands and feet, intolerance of heat.

Veratrum album is somewhat similar to Arsenicum, in cholera morbus. The latter has not so copious a stool as the former, and cold sweat on the forhead is more marked in Veratrum.

Do not forget that Cadmium sidphiiricum is similar to Arsenicum in black vomit, whether that symptom occur in yellow fever or in any other disease.

We find Arsenicum often indicated in intermitting types of fever. We all know how often Arsenic succeeds Cinchona in the treatment of chills and fever. It has cured many cases, especially after the failure of Quinine, or after the abuse of that drug; or when the fever has been contracted in salt marshes along the seashore. The chill is not well defined; in fact, it is rather irregular, but the heat is unmistakable. It is intense, with burning thirst, especially for hot drinks; cold drinks make the patient feel chilly. Sweat does not always relieve. Sometimes it appears very tardily. The apyrexia is marked by severe symptoms, dropsy showing itself as the result of enlarged spleen or liver. The patient is scarcely able to sit up. He is often annoyed by neuralgia, which is typical in its recurrence. The pain usually affects one side of the face and seems to be almost maddening, driving the patient from place to place. At the height of the attack there are nausea and vomiting and buzzing in the ears. Arsenicum may be also used in intermittent, semilateral headache of malarial origin, especially after the abuse of quinine.

There are several drugs similar to Arsenicum in these malarial neuralgias. Cedron has neuralgia, returning at precisely the same hour each day.

Chininum sulphuricum is also suited to periodical attacks of neuralgia, relieved by hard pressure.

Valerian is to be thought of in hysterical patients.

Cactus grandiflorus has neuralgic and other forms of pain, which are sure to appear when the patient misses an accustomed meal. Kalmia and Kreosote are useful in neuralgia, especially when there are burning pains.

Magnesia phos. is called for in neuralgia which occurs regularly each night, and is relieved by heat and pressure.

Mezereum has neuralgia in the cheek-bone or over the left eye. The pains leave numbness. They are worse from warmth. It is especially useful when there have been herpetic eruptions after the abuse of mercury. It is one of the remedies we use for the neuralgia of zona.

Robinia has: jaw-bone feels as if disarticulated. With this there is intensely sour taste and waterbrash or sour vomiting.

Other remedies to be borne in mind are Cinchona, Spigelia, Platinum, Stannum and Ckelidonium.

In typhoid fever Arsenicum is indicated late in the disease, when the blood changes have so far progressed that you have a picture of complete exhaustion. The patient thinks himself still able to move about until he finds out how weak he is. He has fainting attacks, which are very alarming; he faints dead away, with cold sweat on the body. The delirium is worse after twelve p. m., and is attended with great restlessness. He is sleepless at three a. m. on account of the great heat. The mouth and tongue are covered with sordes, and with a dark brownish coating. Sometimes the tongue is very red. Around the dorsum and tip of the tongue you w T ill find the papillae red and raised, as under Belladonna, but the concomitant symptoms enable you to differentiate it from that remedy at once. The mouth is full of blisters and aphthous ulcers which bleed readily. In other cases, the tongue is bluish with ulcerated edges. Sometimes, in severe cases, water cannot be swallowed because of partial paralysis of the oesophagus. You do not often find much tympany in the Arsenic case. The bowels are very much disturbed. Diarrhoea is almost always present, and seems to be provoked by every attempt to eat or drink. Sometimes, stool and urine are involuntary. The stool is yellowish and watery in character, horribly offensive and worse after midnight. At other times the stools contain blood, slime and pus. In some cases the urine is retained from atony of the muscular fibers of the bladder. The fever is intense, being almost sufficient to consume the patient. Sometimes, you have the hemorrhagic diathesis to deal with, and there is oozing of blood from various parts of the body, from the eyes, nose, etc. This is a dangerous symptom.

Colchicum is a remedy which we are very apt to neglect in typhoid fever. It seems to stand in typhoid conditions between Arsenic and Cinchona, having the excessive weakness of the former remedy and the marked tympany of the latter. The chief symptoms of Colchicum are abdominal. They are, this great tympany, involuntary, forcible, watery stools, accompanied with nausea and frequent vomiting of bile. The body is hot and the limbs are cold, just as in Phosphorus. The nose is dry and blackish. The teeth and tongue are both brown. The mind is somewhat cloudy. He answers questions correctly, but otherwise says nothing. He seems not to know the danger he is in. The relations of Arsenic to other remedies in typhoid fever have been described to you elsewhere. I need not, therefore, repeat them here.

Arsenicum may also be useful in continuous fever, which, in its early stages, so closely resembles that of Aconite that you may not be able to distinguish between the two drugs. There are hot skin, full bounding pulse, restlessness and anxiety. Thus far, it is exactly like Aconite. But it does not end here. It goes on to a continuous type of fever without any intermissions, and with only slight remissions. The heat increases, the patient grows more restless and weaker, the tongue becomes brown and typhoid symptoms develop.

Now, the distinction between Arsenic and Sulphur is easily made. Sulphur is also useful in continuous fever. Arsenic is indicated when the great restlessness and burning show you that the case has gone beyond simple continuous fever.

Now, the action of Arsenicum on the mucous membranes. We find it an excellent remedy in winter colds. The nose discharges a thin, watery fluid, which excoriates the upper lip, and yet the nasal passages feel stuffed-up all the time. This is accompanied by dull throbbing frontal headache. Repeated attacks of this kind of catarrh or coryza result in the discharge of thick, yellowish, muco-purulent matter. Ulcers and scabs form in the nose. Sneezing is a prominent symptom. Now this sneezing in the Arsenic case is no joke. It does not give the relief which one usually gets from a good sneeze. It is a sneeze which starts from irritation in one spot in the nose as from tickling with a feather. After the sneeze, this irritation is just as annoying as it was before. As the cold creeps downwards, you find the case complicated with catarrhal asthma. Dyspnoea appears. The patient cannot lie down, particularly after midnight. He is greatly relieved by cough with expectoration of mucus.

Arse nictiin jodatum closely resembles the "album" in coryza, hayfever and influenza. It has the same thin, acrid discharge, and chilliness, but owing to the Iodine it contains there is a marked affinity for lymphatic glands.

You will at once recognize the similarity between the symptoms of Arsenic and those of hay-fever. Other remedies which you may remember for this condition are: Ailanthus, Silicea (which has itching or irritation in the posterior nares or at the orifices of the Eustachian tubes), Lobelia inflata, and a remedy introduced by the late Dr. Jeanes, Rosa Damascena.

This Rosa Damascena is useful in the beginning of rose-cold when the Eustachian tube is involved and there is some little hardness of hearing and tinnitus aurium.

Sinapis nigra is indicated when the mucous membrane of the nose is dry and hot. There is no discharge. The symptoms are worse in the afternoon and evening. Either nostril may be affected alone or alternately with the other.

Wyethia is specific when with the usual symptoms of hay-fever there is itching of the soft palate.

Arsenic is one of our prime remedies in asthma, whether acute or chronic, with aggravation after midnight and from lying down. The patient is beside himself with anguish. The case may be complicated with emphjrsema, expiration being very much prolonged as in that disease. It follows Ipecac well.

In emphysema you should compare Lac/zesis, Sulphur, Ipecac, Antimonium tartaricum, Naphthalin, Carbo veg, and above all the Arsenite of Antimony.

In diphtheria, Arsenicum comes into use as a most valuable drug. Arsenic crude kills the microscopic growths which produce the disease. In its potentized state it cures when there is foetid breath, adynamic fever and a great deal of somnolence, which is broken by starts, crying out and by jerking of the limbs. The membrane looks dark and is gangrenous. The pulse is rapid and weak. I would advise you to substitute Arsenicum iodatum, if, in addition to the usual Arsenicum symptoms, there is marked enlargement of the lymphatic glands.

I have stated that Arsenic acts on the heart. It gives us a list of cardiac symptoms which are, in brief, these: the heart-beat is too strong, it is visible to the person standing by and is audible to the patient himself. It is worse at night and is particularly aggravated when the patient is lying on his back. There maybe palpitation with great irregularity of the heart's action. Or the pulse may be accelerated and weak. In cardiac inflammations, endocarditis or pericarditis, we find Arsenic indicated after the suppression of measles or scarlatina. You then find present the characteristic restlessness and agony of the drug, tingling in the fingers, especially those of the left hand. (Edema is more or less general, beginning with puffiness of the eyes and swelling of the feet and ending with general anasarca. There is great dyspnoea. Now there are two varieties of dyspnoea which belong to heart disease, one which depends upon the defective carrying of the blood through the lungs and the system generally, and the other which is due to accumulation of water in the chest, hydrothorax and hydropericardium. There are spells of suffocation, worse at night, particularly after midnight and on lying down. The skin is cool and clammy, while internally, the patient is burning hot. Now if this condition calling for Arsenic goes on uncured, Bright' s disease of the kidneys develops. The urine is highly albuminous and contains waxy and fatty casts. Dropsy appears. Little blisters form in the cedematous limbs on the legs, and these burst, and serum oozes forth. The skin itself is rather tense and has a pale waxen hue. Exhausting diarrhoea usually accompanies these symptoms. There is very apt to be also a burning thirst with intolerance of water.

I wish you now to recall the comparison that I have already given you between Arsejiicum and Apocy?iam, and Acetic acid, which stands midway between Arsenicum and Apis. I would also have you recall the similarity between Arsenicum and Mercurius sidphuricus in hydrothorax.

In kidney affections you may compare Arsenicum with Apis, Helleborus, Phosphorus, Aurum, Terebinthina and Digitalis.

Now the Digitalis symptoms are these: there is venous hypersemia of the kidneys. You are to study it, therefore, in renal affections when there are present dropsy, feeble or slow pulse, scanty dark turbid urine, which will, of course, be albuminous. It is exactly like Arsenic, without the restlessness and irritability of that remedy. Again, we find Arsenicum indicated in that dreadful disease, angina pectoris. The patient is obliged to sit upright; he cannot move a muscle of his body without great suffering. He holds his breath, so painful is it for him to breathe. The pain seems to radiate from the heart all over the chest and down the left arm. In extreme cases there is cold sweat on the forehead, the pulse becomes scarcely perceptible, and, with all this, there is apt to be burning around the heart.

I would now like to refer to the action of Arsenic on the skin. You have already seen that it tends to produce induration or hardening of the skin. This renders it a valuable remedy in eczema, in fact, in every variety of skin disease in which there is thickening of that structure, with copious scaling. Arsenicum is also useful in eczema proper, when vesicles appear which turn into pustules and form scabs. Arsenicum is specifically indicated for bran-colored scales on the head, coming down over the forehead. It may also be called for when there is a thick scabby eruption on the scalp, oozing pus, and very offensive. Arsenicum compares with Sepia, Rhus tox., and Graphites. Like Sepia there is a dry scaly desquamation, but in Sepia this " peeling " follows vesicles which were not surrounded by very red skin, or it follows a fine rash, worse about the joints, or a circular eruption like herpes circinatus.

Rhus tox. has vesicles on a red erysipelatous surface, chiefly about the genitals and on hairy parts.

Graphites looks very much like Arsenicum, but has oozing of a glutinous fluid.

Clematis is similar to Arsenicum, but has more rawness, aggravation from washing and moist, alternating with dry scabs.

Hydrocotyle has eczema with skin thick and scaly, but less burning than in Arsenic.

Under Kreosote the scales pile up into large masses; eruptions on the extensor surfaces of the limbs. Restlessness. Natrum mmiaticum on the other hand produces scaly eruptions on flexor surfaces and the bends of joints; dandruff alternating with catarrh and loss of smell. In the exanthematous diseases we find Arsenicum indicated first of all in urticaria. Here it is a valuable drug when the wheals are attended with burning, itching, and restlessness. Particularly may it be indicated for the bad effects of repercussion of hives. Even croup may be cured by Arsenic if it follows the retrocession of nettle-rash. In scarlatina Arsenic is to be used in some of the worst cases when the rash does not come out properly. The child is thrown into convulsions, and lies pale and in a sort of stupor, with restlessness and moaning. Suddenly it seems to arouse, and immediately goes into convulsions, and then relapses into stupor again. Arsenicum is also useful when, during the course of scarlatina, the parotid glands swell and suppurate, after the failure of Rhus.

Arsenicum is useful in gangrene, particularly in the dry gangrene of old people, with great soreness and burning in the affected part, with relief from warm or hot applications. This modality furnishes you with a sufficient distinction between Arsenic and another great gangrene remedy, Secale, which is useful in dry gangrene, with relief from cold applications. Lachesis is one of the best remedies for gangrene after injuries, as when the edges of a lacerated wound turn black.

Cinchojia suits in gangrene with haemorrhage or after great loss of blood.

We may use Arsenicum in carbuncles or in boils with pepper-box openings and dipping deeply into the cellular tissues. It is indicated by the character of the pains, which you know run all through the Arsenicum symptoms, cutting, lancinating, burning pains, with aggravation after midnight, and irritability of mind and body. Arsenicum sometimes fails in carbuncles. Then we have to resort to Anthracinum, chiefly in the thirtieth potency. It has precisely the same symptoms as Arsenicum, but to a more intense degree. Phytolacca is a remedy to be thought of in this affection when there are lancinating, jerking pains. It is said to promote suppuration. Carbo veg. and Lachesis are remedies that we neglect in this disease. If we use Carbo veg. it is well also to use a charcoal poultice over the carbuncle.

Arsenicum may be used in cancer. I am not going to propose that this drug will cure cancer. Epithelioma has been cured by Conium, Hydrastis, Arsenic, Clematis and a few other remedies. But in cases of genuine open cancer I have not seen any cases cured; but even if these cases cannot be cured, it is still possible to give them some relief. The pains of cancer you know to be torture. They are of a sharp lancinating character; a red hot knife thrust into the part could not be worse. Arsenic sometimes relieves these cases when indicated. In some cases Arsenicum iod. relieves when Arsenicum album fails. In others Belladonna brings relief.

The ulcers for which Arsenicum may be given are not usually very deep. They are rather superficial. The pains are of the character already described, burning and lancinating. The discharge is apt to be excoriating, dark and sanious and they are apt to bleed very readily. Lastly, we will consider Arsenicum as a remedy in nervous affections. It is indicated in hemicrania when the pains are worse over one eye, and are of a severe lancinating character. They often alternate with colic or affections of the liver. They are worse from any motion, and are temporarily relieved by cold applications.

It may also be used in epilepsy. The patient falls down unconscious, and then writhes in convulsions. Before the attack he has spells of vertigo and intense aching in the occiput. The convulsions are followed by stupor, which, however, is not complete, but is broken by the ever present restlessness.

Great anguish and restlessness. Changes place continually. Fears, of death, of being left alone. Great fear, with cold sweat. Thinks it useless to take medicine. Suicidal. Hallucinations of smell and sight. Despair drives him from place to place. Miserly, malicious, selfish, lacks courage. General sensibility increased (Hep). Sensitive to disorder and confusion.

Arsenious Acid Arsenic Trioxide A profoundly acting remedy on every organ and tissue. Its clear-cut characteristic symptoms and correspondence to many severe types of disease make its homeopathic employment constant and certain. Its general symptoms often alone lead to its successful application. Among these the all-prevailing debility, exhaustion, and restlessness, with nightly aggravation, are most important. Great exhaustion after the slightest exertion. This, with the peculiar irritability of fiber, gives the characteristic irritable weakness. Burning pains. Unquenchable thirst. Burning relieved by heat. Seaside complaints (Nat mur; Aqua Marina). Injurious effects of fruits, especially more watery ones. Gives quiet and ease to the last moments of life when given in high potency. Fear fright and worry. Green discharges. Infantile Kala-azar (Dr. Neatby). Ars should be thought of in ailments from alcoholism, ptomaine poisoning, stings, dissecting wounds, chewing tobacco; ill effects from decayed food or animal matter; odor of discharges is putrid; in complaints that return annually. Anæmia and chlorosis. Degenerative changes. Gradual loss of weight from impaired nutrition. Reduces the refractive index of blood serum (also China and Ferr phos). Maintains the system under the stress of malignancy regardless of location. Malarial cachexia. Septic infections and low vitality.

Worse, wet weather, after midnight; from cold, cold drinks, or food. Seashore. Right side. Better from heat; from head elevated; warm drinks. Complementary: Rhus; Carbo; Phos. Thuja; Secale. Antidotal to lead poison. Antidotes: Opium; Carbo; China; Hepar; Nux. Chemical Antidotes: Charcoal; Hydrated Peroxide of Iron; Lime Water. Compare: Arsenic stibatum 3x (Chest inflammations of children, restlessness with thirst and prostration, loose mucous cough, oppression, hurried respiration, crepitant rales). Cenchris contortrix; Iod; Phosph; China; Verat alb; Carbo; Kali phos. Epilobium (intractable diarrhœa of typhoid). Hoang Nan. Atoxyl. Sodium arseniate 3x, sleeping sickness; commencing optic atrophy. Levico Water–– (containing Ars, Iron and Copper of South Tyrol). Chronic and dyscratic skin diseases, chorea minor and spasms in scrofulous and anæmic children. Favors assimilation and increases nutrition. Debility and skin diseases, especially after the use of higher potencies where progress seems suspended. Dose. Ten drops in wine glass of warm water 3 times a day after meals (Burnett). Sarcolatic acid (influenza with violent vomiting).

Headaches relieves by cold, other symptoms worse. Periodical burning pains, with restlessness; with cold skin. Hemicrania, with icy feeling of scalp and great weakness. Sensitive head in open air. Delirium tremens; cursing and raving; vicious. Head is in constant motion. Scalp itches intolerably; circular patches of bare spots; rough, dirty, sensitive, and covered with dry scales; nightly burning and itching; dandruff. Scalp very sensitive; cannot brush hair.

Swollen, pale, yellow, cachectic, sunken, cold, and covered with sweat (Acetic acid). Expression of agony. Tearing needle-like pains; burning. Lips black, livid. Angry, circumscribed flush of cheeks.

Burning in eyes, with acrid lachrymation. Lids red, ulcerated, scabby, scaly, granulated. Œdema around eyes. External inflammation, with extreme painfulness; burning, hot, and excoriating lachrymation. Corneal ulceration. Intense photophobia; better external warmth. Ciliary neuralgia, with fine burning pain.

Skin within, raw and burning. Thin, excoriating, offensive otorrhœa. Roaring in ears, during a paroxysm of pain.

Thin, watery, excoriating discharge. Nose feels stopped up. Sneezing without relief. Hay-fever and coryza; worse in open air; better indoors. Burning and bleeding. Acne of nose. Lupus.

Unhealthy, easily-bleeding gums. Ulceration of mouth with dryness and burning heat. Epithelioma of lips. Tongue dry, clean, and red; stitching and burning pain in tongue, ulcerated with blue color. Bloody saliva. Neuralgia of teeth; feel long and very sore; worse after midnight; better warmth. Metallic taste. Gulping up of burning water.

Swollen, œdematous, constricted, burning, unable to swallow. Diphtheritic membrane, looks dry and wrinkled.

Cannot bear the sight or smell of food. Great thirst; drinks much, but little at a time. Nausea, retching, vomiting, after eating or drinking. Anxiety in pit of stomach. Burning pain. Craves acids and coffee. Heartburn; gulping up of acid and bitter substances which seem to excoriate the throat. Long-lasting eructations. Vomiting of blood, bile, green mucus, or brown-black mixed with blood. Stomach extremely irritable; seems raw, as if torn. Gastralgia from slightest food or drink. Dyspepsia from vinegar, acids, ice-cream, ice-water, tobacco. Terrible fear and dyspnœa, with gastralgia; also faintness, icy coldness, great exhaustion. Malignant symptoms. Everything swallowed seems to lodge in

the œsophagus, which seems as if closed and nothing would pass. Ill effects of vegetable diet, melons, and watery fruits generally. Craves milk.

Gnawing, burning pains like coals of fire; relieved by heat. Liver and spleen enlarged and painful. Ascites and anasarca. Abdomen swollen and painful. Pain as from a wound in abdomen on coughing.

Painful, spasmodic protrusion of rectum. Tenesmus. Burning pain and pressure in rectum and anus.

Small, offensive, dark, with much prostration. Worse at night, and after eating and drinking; from chilling stomach, alcoholic abuse, spoiled meat. Dysentery dark, bloody, very offensive. Cholera, with intense agony, prostration, and burning thirst. Body cold as ice (Verat). Hæmorrhoids burn like fire; relieved by heat. Skin excoriated about anus.

Scanty, burning, involuntary. Bladder as if paralyzed. Albuminous. Epithelial cells; cylindrical clots of fibrin and globules of pus and blood. After urinating, feeling of weakness in abdomen. Bright's disease. Diabetes.

Menses too profuse and too soon. Burning in ovarian region. Leucorrhœa, acrid, burning, offensive, thin. Pain as from red-hot wires; worse least exertion; causes great fatigue; better in warm room. Menorrhagia. Stitching pain in pelvis extending down the thigh.

Unable to lie down; fears suffocation. Air-passages constricted. Asthma worse midnight. Burning in chest. Suffocative catarrh. Cough worse after midnight; worse lying on back. Expectoration scanty, frothy. Darting pain through upper third of right lung. Wheezing respiration. Hæmoptysis with pain between shoulders; burning heat all over. Cough dry, as from sulphur fumes; after drinking.

Palpitation, pain, dyspnœa, faintness. Irritable heart in smokers and tobacco-chewers. Pulse more rapid in morning (Sulph). Dilatation. Cyanosis. Fatty degeneration. Angina pectoris, with pain in neck and occiput.

Weakness in small of back. Drawing in of shoulders. Pain and burning in back (Oxal ac).

Trembling, twitching, spasms, weakness, heaviness, uneasiness. Cramps in calves. Swelling of feet. Sciatica. Burning pains. Peripheral neuritis. Diabetic gangrene. Ulcers on heel (Cepa; Lamium). Paralysis of lower limbs with atrophy.

Itching, burning, swellings; œdema, eruption, papular, dry, rough, scaly; worse cold and scratching. Malignant pustules. Ulcers with offensive discharge. Anthrax. Poisoned wounds. Urticaria, with burning and restlessness. Psoriasis. Scirrhus. Icy coldness of body. Epithelioma of the skin. Gangrenous inflammations.

Disturbed, anxious, restless. Must have head raised by pillows.

Suffocative fits during sleep. Sleeps with hands over head. Dreams are full of care and fear. Drowsy, sleeping sickness.

High temperature. Periodicity marked with adynamia. Septic fevers. Intermittent. Paroxysms incomplete, with marked exhaustion. Hay-fever. Cold sweats. Typhoid, not too early; often after Rhus. Complete exhaustion. Delirium; worse after midnight. Great restlessness. Great heat about 3 am.

Third to thirtieth potency. The very highest potencies often yield brilliant results. Low attenuations in gastric, intestinal, and kidney diseases; higher in neuralgias, nervous diseases, and skin. But if only surface conditions call for it, give the lowest potencies, 2x to 3x trit. Repeated doses advisable.

Arsenicum Album

Generalities: From the time of Hahnemann to the present day Arsenicum has been one of the most frequently indicated medicines, and one of the most extensively used. In the Old School it is most extensively abused, in the form of Fowler's solution.

Arsenic affects every part of man; it seems to exaggerate or depress almost all his faculties, to excite or disturb all his functions. When all our medicines have been as well proved we will effect wonderful cures. It is a substance easily proved because of its active nature, and from its very abuse we have learned much of its general nature.

While Arsenic impresses the whole economy and disturbs all the functions and tissues of man, there are certain prevailing and striking features in it.

Striking features: Anxiety, restlessness, prostration, burning and cadaveric odors are prominent characteristics.

The surface of the body is pale, cold, clammy, and sweating, and the aspect is cadaveric. In chronic sickness with great debility, anaemia, from long exposure to malarial influence, in the poorly fed and from syphilis this remedy is of great service.

The anxiety that is found in Ars. is intermingled with fear, with impulses, with suicidal inclinations, with sudden freaks and with mania. It has delusions and various kinds of insanity; in the more active form, delirium and excitement. Sadness prevails to a great extreme. So sad that he is weary of life; he loathes life, and wants to die, and the Arsenic patient does commit suicide. It is a remedy full of suicidal tendencies. The anxiety takes form also in the restlessness, in which he constantly moves. If he is able to get up lie goes from chair to. chair; the child goes front nurse to mother, and from one person to another. When in bed, unable to sit up, the patient tosses and turns from side to side; if he is able, he climbs out of bed and sits in the chair, keeps moving from one place to another, and when thoroughly exhausted, he gets back into bed again.

The restlessness seems to be mostly in the mind; it is an anxious restlessness, or an anguish, with the idea that anguish is a deathly anxiety. That is an effort to express it in the extreme. It seems that he cannot live, and it is not pain that drives him to anguish, but it is an anxiety intermingled with restlessness and sadness.

This state prevails in all diseases intermingled with prostration. An uneasiness comes in the early stage of disease, and lasts but until the prostration becomes marked. While lying in bed, at first he moves his whole body, moves himself in bed and out of bed; but the prostration becomes so marked that he is able to move only his limbs until at last he becomes so weak that he is no longer able to move and he lies in perfect quiet in extreme prostration.

It seems that prostration takes the place of anxiety and restlessness, and he appears like a cadaver. So remember that these states of anxiety and restlessness go towards the cadaveric aspect, towards death. This is seen, for instance, in the typhoid, where Arsenicum is indicated. At first there is that anxious restlessness with fear, but the increasing weakness tends towards prostration.

Running all through the remedy there is the burning mentioned as one of its most marked generals. There is burning in the brain, which makes him want to wash his head in cold water. This sensation of heat in the inner head with pulsation is ameliorated by the cold bathing, but when there is a rheumatic state that affects the scalp and outward nerves, and there is burning, the burning then is ameliorated by heat. When the headache is of a congestive character, with the sensation of heat and burning inside the head, and there is a feeling as if the head, would burst, and the face is flushed and hot, that headache is better from cold applications and in the cool open air.

So marked is this that I have seen the patient sitting in the room with clothing piled on to keep the body warm and with the window open to relieve the congestion of the head.

Therefore, we say a striking feature belonging to this medicine is relief of all the complaints of the body from wrapping up and from warmth in general, and relief of the complaints of the head by cold, except the external complaints of the head, which are better from heat and from wrapping up. The neuralgias of the face and eyes, and above the eyes, are better from heat. The burning is felt in the stomach; there is burning in the bladder, in the vagina, in the lungs. It feels as if coals of fire were in the, lungs at times, when gangrenous inflammation is threatened, and in certain stages of pneumonia. There is burning in the throat and burning in all the mucous membranes. The skin burns with itching, and he scratches until the skin is raw, and then it burns, but the itching ceases; as soon as the smarting lets up a trifle the itching commences again. All night the itching and burning alternate, burning for a minute, when be scratches it until it is raw, but soon the itching begins again and it seems that he has no rest. The secretions and excretions of Arsenic are acrid; they excoriate the parts, causing burning. The discharge from the nose and eyes causes redness around the parts, and this is true of all the fluids from the various orifices.

In ulcers there is burning, and the thin, bloody fluid discharged excoriates the parts round about. The odor of the discharge is putrid. If you have ever discovered the odor of gangrene, of mortified flesh, you know the odor of the Arsenicum discharges.

The stool is putrid, like decomposed flesh, putrid blood. The discharges from the uterus, the menstrual flow, the leucorrhoea, the faeces, the urine, the expectoration, all the discharges are putrid. The ulcer is so putrid that it smells like decomposing flesh.

Arsenic produces a tendency to bleeding. The patient bleeds easily and may bleed from any place. There is vomiting of blood; bleeding from the lungs and throat. Bloody discharge from the mucous membrane, at times, when inflammation is running high; haemorrhage from the bowels, kidneys, bladder and uterus; anywhere that mucous membrane exists, there may be haemorrhage. Haemorrhage of black blood and discharges that are offensive.

Gangrene and sudden inflammatory conditions like gangrenous and erysipelatous inflammations are common in Arsenic. Parts suddenly take on erysipelas, or parts that are injured suddenly take on gangrene.

Gangrene in internal organs, malignant inflammations, erysipelatous inflammation. No matter how you look upon the condition, no matter what it is called, if it is a sudden inflammation that tends to produce malignancy in the part it belongs to Arsenicum. Inflammation will go on in the bowels for a few days attended with a horribly offensive discharge, vomiting of clots of blood, great burning in the bowels with tympanitic condition.

You may almost look upon this as a gangrenous inflammation, so violent, sudden and malignant is it, and it has the anxiety, prostration, fear of death, and chilliness, the patient wanting to be covered warmly.

When with this inflammation of the bowels the patient is relieved by heat, it means Arsenic. You should remember that Secale has a similar state; it has all the tympanitic condition, all the ulceration and prostration, all the offensive odor and expulsion of offensive clots, and all the burning, but the Secale patient wants to be uncovered, wants things cold, wants the windows open.

The only distinguishing feature between these two remedies in a case may be that Secale wants cold and Arsenicum wants heat, but this is the way we individualize in our homoeopathic prescribing.

When there is gangrenous inflammation in the lungs, we find the patient has been taken with a chill, there has been restlessness, prostration, anxiety and fear; as we enter the room we detect a horrible odor, and on looking into the pan we see the patient has been spitting up by the mouthful, black, foul expectoration. Look and see if the patient wants to be covered warmly; if he is easily chilled, and heat feels good; then it is a hard thing to cover that case outside of Arsenicum. The prostration, the vomiting, the anxiety, the restlessness the cadaveric aspect are present, and where will you find a remedy with that totality outside of Arsenic.

I have many times gone a long distance to detect, from the very aspect of things, these symptoms that could be gotten while walking from the door to the bedside. Every symptom is Arsenic; he looks like in acts like it and smells like it. You may go to a patient with high grade inflammation of the bladder, with frequent urging to urinate, straining to urinate, and there is bloody urine intermingled with clots.

It has been found by the attending physician when he introduces the catheter to draw off the urine that clots dam up the catheter, a little is drawn off and then it stops. We have a history of restlessness, anxiety, fear of death, amelioration from heat, great prostration.

You must give Arsenic, not because there is inflammation of the bladder, but because it is a rapidly progressing inflammation, and because it is gangrenous in character. The whole bladder will be involved in a short time, but Arsenic will stop that.

So it is with all the internal organs, the liver, lungs, etc.; any of them may take on violent and rapid inflammation. We are not now speaking of the particulars, but only illustrating the general state of Arsenic, in order to bring out what runs through the whole nature of it.

We shall find when we take up the remedy and go through it in a more particular way these features will stand out everywhere.

Mind: The mental symptoms show in the beginning anxious restlessness, and from this a continuation towards delirium and even insanity with all that it involves; disturbance of the intellect and will.

"He thinks he must die."

I went to the bedside of a typhoid patient once with all the general aspect I have described; he was able to talk, and he looked up at me and said:

"There is no use of your coming, I am going to die; you might as well go home; my whole insides are mortifying."

His friend was seated on one side of the bed, giving him a few drops of water, and just about as often as he could get there with it he wanted it again.

That was all he wanted; his mouth was black, parched and dry. He got Arsenic. One of the characteristic features of Arsenic is thirst for small quantities often, just enough to wet the mouth. It is commonly used as a distinguishing feature between Bryonia and Arsenic for the purpose of memorizing the Bryonia has thirst for large quantities far apart, but Arsenicum little and often, or violent unquenchable thirst. "Thoughts of death and of the incurability of his complaints."

"Thoughts crowd upon him; he is too weak to keep them off or to hold on to one idea." That is, he lies in bed tormented day and night by depressing ideas and distressing thoughts. This is one form of his anxiety; when tormented with thoughts, he is anxious. In the delirium he sees all kinds of vermin on his bed.

"Picks the bedclothes."

"Delirium during sleep, unconscious mania." "Whimpering and gnashing teeth."

"Loud moaning, groaning and weeping."

"Lamentations, despair of life."

"Screaming with pains."

"Fear drives him out of bed, he hides in a closet." These are instances of insanity that take on first a state of anxiety, restlessness, and fear. Religious insanity, with the delusion that she has sinned away her day of grace, the biblical promise of salvation do not apply to her, there is no hope for her, she is doomed to punishment. She has been thinking on religious matters until she is insane. Finally she enters into a more complete insane state, a state of tranquility; silent, and with aversion to talk. So we see one stage enters into another; we have to take the whole case together; we have to note the course that the case has run in order to see it clearly and note that in one stage there were certain symptoms and, in another stage, other symptoms.

For instance, we know that in the acute conditions of Arsenicum there is either thirst for ice cold water, and for only enough to moisten the mouth, or there is thirst for water in large quantities and yet it does not quench the thirst; but this thirsty stage goes on to another in which there is aversion to water, and hence we see that in chronic diseases.

Arsenicum is thirstless. So it is in a case of mania; in the chronic state he is tranquil, but in the earlier stages, in order to be an Arsenicum case, he must have gone through the Arsenicum restlessness, anxiety and fear.

Fear is a strong element in the mental state, fear to be alone; fears something is going to injure him when he is alone; full of horror; he dreads solitude and wants company, because in company he can talk and put off the fear; but as this insanity increases he fails to appreciate company and the fear comes in spite of it. He has a violent increase of his fear and horror in the dark and many complaints come on in the evening as darkness is coming on.

Many of the mental troubles, as well as the physical troubles, come on and are increased at certain times. While some complaints, pains and aches are worse in the morning, most of the sufferings of Arsenicum are worse from 1-2 P.M. and from 1-2 A.M. After midnight, very soon after midnight sometimes, his sufferings begin, and from 1-2 o'clock they are intensified. Extreme anxiety in the evening in bed. "Averse to meeting acquaintances, because he imagines he has formerly offended them." Great mental depression, great sadness, melancholy, despair, despair of recovery. He has dread of death when alone, or on going to bed with anxiety and restlessness. He thinks he is going to die and wants somebody with him. The attacks of anxiety at night drive him out of bed. This is an anxiety that affects the heart, and so the mental anxiety and cardiac anxiety almost seem to coincide. A sudden anxious fear comes over him at night; he jumps out of bed with fear that he is going to die, or that he is going to suffocate.

It is full of dyspnoea, cardiac dyspnoea, and varying forms of asthma. The spells come on in the evening in bed or after midnight; from 1-2 o'clock he is attacked with mental anxiety, dyspnoea, fear of death, coldness, and is covered with, cold sweat.

"Anxiety like one who has committed murder." This is one form of his anxiety; he finally works up to the idea that the officers are coming after him, and watches to see if they are coming in to arrest him. Some unusual evil is going to happen to him; always looking for something terrible to happen.

"Irritable, discouraged, restless."

"Restlessness, cannot rest anywhere."

"As a consequence of fright, inclination to, commit suicide."

The Arsenicum patient with this mental state is always freezing, hovers around the fire, cannot get clothing enough to keep warm, a great sufferer from the cold.

Chronic Arsenicum invalids cannot get warm; they are always chilly, pale and waxy, and in such invalids, after they have bad several unusual weak spells, dropsical conditions come on.

Arsenicum is full of puffiness and dropsy; oedematous condition of the extremities; dropsy of the shut sacs or of the cavities; swelling about the eyes; swelling of the face, so that it pits upon pressure. Arsenicum in these swellings is especially related to the lower eyelid rather than the upper, while in Kali carb. the swelling is more in the upper eyelid than the lower, between the lid and the brow.

There are times when Kali carb. looks very similar to Arsenic, and little features like that will be distinguishing points. If they run together in generals, then we must observe their particular peculiarities.

Periodicity: In the headaches we have a striking general feature of Arsenicum, brought out in their periodicity. Running all through this remedy there is periodicity, and for this reason it has been extensively useful in malarial affections which have, as a characteristic of their nature, periodicity.

The periodical complaints of Arsenic come on every other day, or every fourth day, or every seven days, or every two weeks. The headaches come on these cycles, every other, or third, or fourth, seventh or fourteenth day.

The more chronic the complaint is, the longer is its cycle, so that we will find the more acute and sharp troubles in which Arsenic is suitable will have every other day aggravations and every fourth day aggravations: but, as the trouble becomes chronic and deep-seated, it takes on the seventh day aggravation, and in the psoric manifestations of a long, lingering and deepseated kind there is a fourteenth day aggravation.

This appearing in cycles is common to a good many remedies, but is especially marked in China and Arsenic. These two remedies are similar to each other in many respects, and they are quite similar in their general nature to the manifestations that often occur in malaria. It is true, however, that Arsenic is more frequently indicated than China. In every epidemic of malarial fever that I have gone through I have found Arsenicum symptoms more common than those of China.

These headaches bring out the interesting point that we mentioned above. Arsenicum has in its nature an alternation of states, and this carries with it certain generals. Arsenicum in all of its bodily complaints is a cold remedy; the patient sits over the fire and shivers, wants plenty of clothing, and wants to be in a warm room. So long as the complaints are in the body this is so; but when the complaints are in the head, while he wants the body warm he wants the head washed in cold water, or wants the cold air upon it.

The complaints of the head must conform to the generals that apply to the head, and the complaints of the body must be associated with the generals that apply to the body. It is a difficult thing to say which one of these two circumstances is most general, and it is sometimes difficult to say which one is the general of the patient himself, because he confuses you by saying:

"I am worse in the cold," but when his headache is on he says:

"I am better in the cold, I want to be in the cold."

It is really only the head, and you have to single these out and study them by the parts affected. When things are so striking you must examine into it to see what it is that brings about modality.

You will see a similar state running through Phosphorus; the complaints of the stomach and head are better from cold, i. e., he wants cold applications upon the head with head sufferings, and wants cold things in the stomach with stomach complaints, but in all the complaints of the body be is ameliorated from heat.

If he steps out into the cool air, he will commence to cough, if he have a chest trouble. So we see that the modalities that belong to the part affected must always be taken into account. For instance, you have a patient suffering from neuralgia or rheumatic affections and these same pains, extend, to the head, then he wants the head wrapped up because they are ameliorated from heat.

But when it comes to cases of congestive conditions of the head, he then is better with his head very cold. Now, as I have said, there is an alternation of these states in Arsenicum. I will illustrate by mentioning a case. Once a patient had been dragging along with periodical sick headaches. The sick headaches were better from cold water, cold applications to the head, could hardly get them cold enough, and the colder the better. These headaches came every two weeks, and so long as they were present he desired cold to the head.

Then these periodical headaches would be better, for long periods; but when they were away he was suffering from rheumatism of the joints, which was also periodical, and also more or less tenacious, and when this rheumatism of the joints and extremities, with more or less swelling and oedema, was present he could not get warm enough; he was at the fire and wrapped up; he was relieved by heat, and wanted warm air and a warm room.

This would last for a period and then subside, and back would come his sick headaches and last for a while. That is what I meant by the alternation of states. Arsenicum cured that man, and he never had any of them afterwards. The alternation of states sometimes means that there are two diseases in the body, and sometimes the remedy covers the whole feature in alternation of states.

I remember another case, which will illustrate this peculiar nature of alternation of complaints, which is shared by other remedies besides Arsenic.

A patient suffered from a pressure in the top of the head, such as I recently described to you under Alumen.

She would suffer for weeks from that pressure on the top of the head, and the only relief she could get was from hard pressure; she tired herself out with hard pressure and would contrive all kinds of weights to put upon the head.

That would go away in the night and she would wake up the next morning with constant urging to urinate. The irritable bladder alternated with pain on top of the head.

Alumen cured. In many of these anti-psoric remedies we have an alternation of states. This illustrates the necessity for getting the symptoms of all the states that present themselves for cure, otherwise you will many times prescribe in a chronic case of psoric character and temporarily relieve it, when back comes another aspect of it.

You have only hastened the disease a little faster than it would go if let alone. But that is not homoeopathic prescribing. Be sure, when a remedy presents one state, that it is a clearly indicated in the other state, otherwise that remedy is not the similimum.

You must hunt until you find the remedy that has both states, or you will be disappointed. We sometimes do not discover this alternation of states until we have brought it back two or three times by incorrect prescribing.

Some people are so reticent and so difficult to get symptoms from that we do not always get these symptoms.

But you examine your record and you find where - you have made a foolish prescription, that you drove a new condition away and back came the first trouble, and you kept on with this see-saw business.

Now remember in doing this your patient is not improving, and that you must re-study the whole case, taking the alternating states into, account. In Arsenic, the head symptoms alternate with physical symptoms.

You will find running through certain remedies, as a part of their nature, that mental symptoms alternate with physical symptoms; when the physical symptoms are present, then mental symptoms are not trates the necessity for getting the symptoms of all the states that is determined it is a good point, but sometimes you do not find a remedy, because many of our remedies are not well recorded; they have not yet been observed in their alternations and marked as such. We find in Podophyllum the peculiar feature that the headaches alternate with diarrhea; he is subject to sick headaches and to diarrhea, and one or other will be present.

In Arnica the mental symptoms alternate with uterine symptoms. The uterine symptoms, when ob served, look like Arnica, but these go away in the night and mental symptoms come on, the mind being heavy, gloomy and cloudy.

When you have remedies that have these manifestations it requires a greater depth of vision to see the alternation of states, because these things are not always brought out in the proving, for the reason that one prover had one group of symptoms, and another.

Yet a remedy that is capable of bringing out the two groups of symptoms is sufficient to cure this alternation of states. The periodical headaches of Arsenic are found in all parts of the head. They are the congestive headaches with throbbing and burning, with anxiety and restlessness; hot head and relief from cold, There are headaches in the forehead, which are throbbing, worse from light, intensified from motion, often attended with great restlessness, forcing him to move, with great anxiety. Most of the headaches are attended with nausea and vomiting. The sick headaches are of the worst sort, especially those that come every two weeks. In some of these old, broken-down constitutions you will find he is cold, pallid, sickly; he is always chilly and freezing except when the headache is on, and it is better from cold; the face much wrinkled, great anxiety and no desire for water.

Remember that it was said in the acute state of Arsenic there is thirst, thirst for little and often, dry mouth and desire for water enough to moisten the lips, but in the chronic states of Arsenic he is generally thirstless.

Headaches: There are headaches on one side of the head involving the scalp, one-half of the head, worse from motion, better from cold washing, better from walking in the cold air, though very often the jar or stepping starts up a feeling as of a wave of pain, shaking, vibration or looseness in the brain; such are the sensations and these are conditions of pulsation. Then there are dreadful occipital headaches, so severe that the patient feels stunned or dazed. They come on after midnight, from excitement, from exertion; they come on from becoming heated in walking, which produces determination of blood to the head. Nat. mur. is a medicine. analogous to this in its periodicity and in many of its complaints. It has congestive headaches from walking and becoming heated; especially from walking in the sun.

The Arsenicum headaches are generally worse from light and noise, better from lying down in a dark room, lying with the head on two pillows. Many of the headaches commence in the afternoon from I to 3 o'clock, after the noon meal, grow worse into the afternoon, lasting all night.

They are often attended with great pallor, nausea, prostration, deathly weakness The pain is paroxysmal; violent head pain during the chill of an intermittent fever; headache as if the skull would burst during an intermittent fever. Arsenicum has this head pain of a congestive character in intermittent fever, as if the head would burst.

A peculiar feature of the thirst is that there is no thirst during the chill except for hot drinks; during the heat there is thirst little and often for water enough to moisten the mouth, which is almost no thirst, and during the sweat there is thirst for large drinks.

Thirst begins with the beginning of the heat and increases as the dryness of the mouth; he desires only to moisten the mouth until he breaks out in a sweat, and then the thirst becomes a desire for large quantities very often, and the more he sweats the more desire he has for water.

The headache is during the chill; it increases, so that it becomes a congestive, throbbing headache during the chill and heat; this grows better towards the end of the heat as the sweat breaks out, it is ameliorated by the sweat. In chronic headaches, congestive headaches and malarial complaints, a tendency to shrivel is observed upon the skin; a prematurely old, wrinkled appearance of the skin comes on. The mucous membrane of the lips and mouth often shrivels and becomes wrinkled.

This is also found in the diphtheritic membrane of the throat as a peculiar feature of Arsenic, and belongs, as far as I know, to no other remedy. The exudation in the throat is leathery looking and shriveled.

A shriveled membrane is not a sure indication for Arsenic, but when Arsenic is indicated you would be likely to find this kind of membrane; such cases as are very malignant in character, very offensive, putrid, those with a gangrenous odor. At times the head is in constant motion when there are complaints in the body, because parts of the body are too sore to be moved; then the motion of the head comes on because of restlessness and uneasiness, and he keeps it in motion even though it does not ameliorate. The face and head are subject to oedema; dropsy of the scalp and erysipelatous inflammation of the face and head.

The scalp pits upon pressure and there is a little crepitation under it from pressure. The scalp is subject to eruptions and is very sensitive. So sensitive is the scalp that the hair cannot be combed; it seems as if the touch of the comb or brush when rubbing over the scalp went into the brain.

Sensitiveness is a feature of Arsenic; sensitiveness to smell and touch; over sensitiveness of all the senses. A peculiar feature that perhaps I have not brought out is the over sensitiveness to the circumstances and surroundings of the room.

The Arsenicum patient is an extremely fastidious patient. Hering once described him as "the gold headed cane patient." If this is carried out in a woman who is sick in bed she is in great distress if every picture on the wall does not hang perfectly straight.

Those who are sensitive to disorder and confusion and the disturbed and made worse until everything is placed in order have a morbid fastidiousness which has its similimum in Arsenic.

Eyes: The eye symptoms of this remedy are very prominent. In old cases of suppressed malaria, in broken down constitutions, in pallid, sickly people who are subject to general catarrhal conditions, and such catarrhal conditions as localize more especially in the nose and eyes, the eye symptoms will be troublesome.

There are discharges from the eyes. It may be a conjunctivitis, in a general way involving the lids and the globe, going on sometimes to ulceration with thin, bloody discharge, increasing to thick, acrid discharge that excoriates the eye, making the canthi red and causing granulation with burning.

The burning is better from washing in cool water and also better from dry heat. Very often ulcers appear on the globe of the eye, often upon the cornea.

It has various kinds of hypertrophy beginning in patches that will form scars, and in old ulcerated patches little growth similar to a pterygium growing towards the centre of the eye and threatening blindness.

The inflammations are sometimes attended with swelling, burning and excoriating discharge; this swelling is bag-like in character, and so we find "baggy" lids and little bags forming under the eyes.

The face is waxy and pale, presenting the appearance of a broken down constitution or a dropsical condition.

The catarrhal state involves throat and nose, and it is sometimes difficult to separate the nose symptoms, from the throat symptoms.

The Arsenicum patient is always taking cold in the nose, always sneezing from every change in the weather. He is always chilly and suffers from drafts, and is worse in cold, damp weather; always freezing, chilled through.

These pale, waxy, broken down constitutions with catarrhal discharges from the nose on looking at a bright light become blind. Sneezing and coryza with inflammatory conditions through the whole nasal cavity, throat, larynx and chest.

The cold begins in the nose and goes down into the throat, very often causing hoarseness with dry, tickling, hard, rasping cough.

It is a difficult matter to find remedies for a coryza that begins in the nose and extends into the chest with bronchial troubles; very often you require a change of remedy, as the chest symptoms often run to a different remedy. It is difficult to find a remedy that covers the symptoms of both nose and chest.

Arsenicum is the remedy for old, chronic catarrhal troubles of die nose where the nose bleeds easily, and he is always sneezing and taking cold, always chilly and pallid, tired, restless, full of anxiety in the night and has troublesome dreams.

The mucous membrane is easily inflamed, producing patches of red and ulcers that bleed easily. Great crusts form in the back of the nose. There is a striking tendency too ulcerate in Arsenicum. If it is a sore throat it ulcerates; if colds settle in the eyes, they may end in ulceration; catarrhal troubles in the nose end in ulceration; and this ulceration tendency, no matter where the troubles locates, is a very strong feature of Arsenicum.

It is the remedy for catarrhal complaints of the nose and other places in broken down constitutions from syphilis or malaria, or a constitution that has gone through blood poisoning of some kind, either poisoning from a dissecting wound, or from erysipelas or typhoid fever or other zymotic states improperly treated, or poisoning with quinine and like substances that break down the blood and establish a state of anaemia. If an ulcer comes upon the leg, if a leucorrhea comes on, if any discharge is established the patient is relieved thereby. Now let some of these discharges slack up and you have a chronic state apparently from retained secretions, but it is a form of blood poisoning. So it is with suppressed ear discharges, suppressed throat discharges, suppressed leucorrhea and ulcerations. Arsenicum is one of the medicines that will conform to the anaemic state that follows each suppression. At the present day it is fashionable to use the cautery, to make local applications to stop leucorrhoea and other discharges and to heal up ulcers.

Now, when these external troubles go there is an anaemic state established in the economy, the patient becomes waxy and pallid, sickly looking, and these catarrhal discharges come on as a means of relief because of the suppression of some other condition.

For instance, since the suppression of a leucorrhoea the woman has had thick, bloody or watery discharge from the nose. It is frequently suitable to the constitution when an ulcer has been dried up by salves, or an old car discharge has been stopped by the outward application of powders. The doctor thinks he has done a clever thing in stopping such discharges, but he has only succeeded in damming up the secretions which are really a relief to the patient. Such medicines as Sulphur, Calcarea and Arsenicum are suitable for the catarrhal discharges that come from these suppressions, in broken down constitutions.

Arsenic is also like unto the condition that has been brought about from the absorption of animal poisons. It goes to the very root of the evil, as it is similar to the symptoms brought on from a dissecting wound. Arsenic and Lachesis are medicines that will go to the cause at once and antidote the poison, establishing harmony and turning things into order.

The nose symptoms, then, of Arsenic are very troublesome and furnish and extensive part of the symptom image of an Arsenicum patient. They always take cold easily, are always sensitive to cold and the catarrh is always roused up on the slightest provocation.

When an Arsenicum patient is at his best he has discharge more or less of a thick character, but when he takes a little cold it becomes thin; the thick discharge that is necessary to his comfort slacks up, and then he gets headache and on comes thirst, restlessness, anxiety and distress. This goes on to a catarrhal fever of two or three days duration, and then the thick discharge starts up again and he feels better; all his pains and aches disappear. It has been of great service in epithelioma of nose and lips.

Inflammation of the throat and tonsils with burning, increased by cold and better by warm drinks. There is redness and a shriveled condition of the mucous membrane.

When there is blood poisoning going on, as in diphtheria, and exudate appears upon the mucous membrane and it becomes gray and shriveled, ashy colored, and this sometimes covers the whole of the soft palate and the arches. It looks withered. He is prostrated, anxious, sinking, weak, not a great deal of fever, but much dryness of the mouth.

The catarrhal state goes down into the larynx with hoarseness, and into the trachea with burning, worse from coughing, and then comes constriction of the chest, asthmatic dyspnoea and dry, hacking cough with no expectoration. This testing cough is attended with anxiety, prostration, restlessness, exhaustion and sweat, and the cough does not seem to do any good. The cough is the early part of it and keeps on as a dry, rasping, harsh cough for several days without doing any good; and then asthmatic symptoms come on, when be expectorates great. quantities of thin, watery sputum.

There is constriction about the chest a great sense of tightness and wheezing, and he feels he will suffocate. Bloody mucus is expectorated at times, but the symptoms are more generally of a catarrhal character.

Symptoms of pneumonia sometimes appear with the rusty expectoration. The expectoration is excoriating. There is in the chest a sense of burning, as if coals of fire were in the chest, and it goes on to bleeding and liver-colored expectoration.

Arsenicum is a bleeding medicine, one that predisposes to haemorrhage, and bleeding takes place from all mucous membranes; commonly of bright red blood, but in this region the parts take on a gangrenous state and the hemorrhages become black and there are little clots like portions of liver.

The same are found in the vomited matter and in the stools. The expectoration is horribly offensive, so much so that you soon get the idea that there is a state of gangrene.

The patient is at this time going into a state that perhaps cannot be any better described than a gangrenous inflammation; there will be signs to indicate the inflammatory condition, and there will be the smell of the expectoration which you will detect as soon as you open the door, The expectoration is a thin, watery fluid intermingled with clots. In the pan you will find this watery expectoration looking like prune juice, and in the midst of it will be clots of blood; the offensiveness is horrible. He has gone through the period of restlessness and is now prostrated, sinking, pallid, and likely enough covered with a cold sweat.

Stomach and bowels: When we come to the stomach we find everything that may be called a gastritis, vomiting of everything taken, even a teaspoonful of water, extreme irritation of the stomach, great prostration, horrible anxiety; dry mouth; a very little hot water will sometimes comfort him for a minute, but soon it must come up; cold fluids are vomited immediately. The whole oesophagus is in a state of inflammation; everything burns that comes up or goes down. Vomiting of bile and blood.

Extreme sensitiveness of the stomach is present; he does not want to be touched. Heat applied externally relieves, and there is a temporary relief from warm drinks; the heat is grateful. In the bowels we have much trouble; this remedy has all the symptoms of peritonitis; distension of the abdomen, a tympanitic state; cannot be handled or touched, yet he will keep moving because he is so restless, he cannot keep still, but finally he becomes so weak that exhaustion takes the place of restlessness.

Dysentery is likely to come on, with involuntary passages of urine and faeces, one or both, with haemorrhage from the bowels and bloody urine. As the bowels move, we get the cadaveric odor to the stool, a smell like putrid flesh. The stool is bloody, watery, brown like prune juice, or black and horribly offensive.

Sometimes dysenteric in character with dreadful straining and burning of the anus; every stool burns as though there were coals of fire in the rectum; burning it! the bowels, burning all the way through. The pain in the abdomen is better from the application of hot things. The tympanitic condition is extreme.

Sometimes there is a gastro-enteritis that takes on a gangrenous character that in olden times used to be talked about as gangrene of the bowel, a mortification that always ended in death.

A thick, bloody discharge is passed with a horrible odor, all substances are vomited, the patient desires to be in a very warm room, wants to be well covered, wants hot applications and warm drinks, looks cadaveric and smells cadaveric, with a dry, pungent odor that penetrates everything, but if he wants the covers off, wants a cool room and windows open, wants to be sponged with cold water, and wants ice cold drinks then he must have Secale.

Bowels: I want to warn you against the too promiscuous use of Arsenic in the summer complaints of young babies, for dysentery and cholera infantum. It has so many little symptoms that are so common to these complaints. that if you do not look out and are not warned you will be likely to give your patient Arsenic, suppress some of the symptoms, changing the aspect of the case so that you cannot find a remedy for it and yet not cure the case with Arsenic. There is a strong tendency to be routine and give Arsenic without a sufficient number of generals being present; i.e., if you give it on particulars and not on the generals of the case.

This medicine is full of diarrhea and dysenteric symptoms; in these conditions there will be the pallor, the anxiety, the cadaveric aspect and the cadaveric odors.

In the dysentery there is most distressing and frequent urging to stool, scanty, slimy, black, fluid, inky stools with cadaveric smell, great prostration, restlessness and pallor. In the bowel troubles, in low forms of disease, the stool becomes involuntary.

This is a condition of the rectum, a relaxation of the rectum, great prostration. Involuntary stool generally indicates either local or general exhaustion, and in this remedy there is terrible exhaustion, so that there is involuntary diarrhea in typhoid and in low forms of zymotic disease; involuntary urine.

Purging is sometimes present in Arsenic, but generally be does not have much purging, such as we find in Podophyllum, Phos. ac. Usually there will be little, frequent gushes, little spurts with flatus and the great exhaustion that occurs in cholera, little spurts with mucus, slimy, whitish stools.

Arsenic is not so commonly indicated in cholera, i. e., during the gushing period, but sometimes after the gushing is over and the vomiting and purging have passed, leaving a state of extreme exhaustion, we have a state that appears like coma, the patient looks almost as if dead, except that he breathes. We find, then, that Arsenicum will establish reaction.

Cholera infantum with great prostration, sinking and cadaveric appearance, great coldness, covered with told sweat, cold extremities, cold as death; cadaveric, sickly, foul, pungent, penetrating odor in the room from the faeces and urine and even of what is vomited.

The passages from the bowels are acrid, excoriating, causing redness and burning. Very often the burning extends into the bowels. The rectum and anus burn, smarting all about the anus. It has tenesmus, painful, unbearable urging, great distress in the lower bowel, in rectum and anus, terrible state of anxiety of the patient and the pain is so violent and the suffering so intense, the anguish so intense, that he can think of nothing but death the fearfulness and frightful feelings are such as he has never experience in his life, and he feels confident these mean he is going to die.

This, like all other complaints, is attended with restlessness, and when not at stool he is walking the floor, going from bed to chair and from chair to bed. He will get on the stool and then back to bed, then he is hurried to stool again, sometimes he loses it.

Sometimes there is a chronic hoemorrhoidal state with burning, and the hemorrhoids protrude when at stool, he is much exhausted after getting back into bed after a stool, with these protruding lumps which are like grapes and feel like coals of fire. They are hot, dry and bleeding. Fissures of the rectum that bleed at every stool, with burning Itching and eczematous eruptions about the anus with burning.

This kind of pain may be felt anywhere in the body; burning is characteristic of Arsenic, stitching is characteristic of Arsenic. Now, put these together and the patient often describes it as being stuck with red hot needless all over him. This red hot sensation, which is a common feature all over, is felt at the anus, and especially when there are hemorrhoids, burning and sticking like hot needles in the hemorrhoids At times when a patent is coming down with the early stage of a violent attack he will have all the rigor and chill that it is possible to find in the Materia Medica and that can be found in disease. Rigors and chills of violent character, and at such times he describes a feeling as if the blood flowing through the vessels were ice water. He feels a rushing through the body of ice cold waves.

When the fever comes on, he is intensely hot from head to foot, before the sweat has appeared, he feels that boiling water is going through the blood vessels. Then comes on the sweat and dyspnoea and all complaints in which he is prostrated and becomes cold.

While the sweat some times relieves the fever and pains, yet it is prolonged and attended with great exhaustion and does not relieve his exhaustion.

Many of his complaints are increased with the sweat; for instance, thirst is increased, the drinking is copious and does not relieve, it seems he cannot get enough and patients will say: "I can drink the well dry," or "Give me a bucket of water."

Such things are indicative of the state of thirst. During the fever he wants little and often; during the chill he wants hot drinks.

Arsenicum is a very useful medicine in the eruptions of the genitals with burning. In little ulcers that burn, even when they are syphilitic; herpetic vesicles that appear upon the foreskin and upon the labia; chancre or cancroids with burning, smarting and stinging, but especially in those that are weak, that offer no willingness to heal, but that do the very opposite, that spread, those that we call phagedenic, those that eat from their outer margins, become larger and larger.

Ulcerations: Arsenic and Merc corr. are the two principal medicines for spreading ulcerations such as eat in every direction, very offensive. Such ulcerations as follow the opening of a bubo in the inguinal region where there is no tendency to heal.

A little, watery, offensive discharge keeps coming and extending, ulceration keeps spreading round about the opening, no tendency to heal. Or the patient has been in the hands of a surgeon who has passed his knife down the threatening suppurating bubo and it has been followed by red, angry, erysipelatous appearance and shows no tendency to heal.

The edges have been removed by ulceration, and now the surface has cleared off, leaving a surface the size of a dollar; sometimes becoming serpiginous. These ulcers are sensitive to touch and burn like fire.

Genitals: In the male and female sexual organs there are many symptoms of importance. In the male organs a dropsical condition, dropsy of the penis, oedematous appearance, so that the penis is enormously swollen and looks like a water bag; the scrotum, especially the skin of the scrotum, greatly swollen and humid round about, the parts.

In the female the labia are enormously swollen with burning, stinging pains, hard and swollen. Erysipelatous inflammation of these organs, ulcerations, of a syphilitic character; these when such symptoms burning, smarting and stinging are present.

In the female, violent, burning pains in the genitals with or without swelling, burning that extends up into the vagina, with great dryness and itching of the vagina.

The leucorrhoeal discharge excoriates the parts, causing itching and burning with great suffering. Whitish, watery, thin discharges that excoriate; so copious sometimes that it will run down the thighs.

The Arsenicum menstrual flow is very often excoriating in character. Copious leucorrhoeal flow intermixed with menstrual flow, very profuse and very acrid.

Suppressed menstruation going on for months; amenorrhoea in prostrated, nervous patients, wrinkled, careworn, haggard facet.

Of course, Arsenic has a wonderful reputation in the old school for anaemia, and it is said to be as good as Ferrum for anaemia.

Ferrum and Arsenic are the strong drugs for anaemia, so that it is not to be wondered at that these pallid mortals find benefit from Arsenic. "During menstruation, stitches in the rectum." "Leucorrhoea acrid, corroding, thick and yellow," etc.

After parturition the woman does not pass the urine; no urine in the bladder; suppression, or the bladder is full and it does not pass. In connection with this subject you will find Causticum the most frequently indicated remedy when you go back and the woman has not passed the urine and it is time that she should; you will frequently find it indicated when you have no other symptoms to go on. Aconite will be more frequently indicated than any other remedy if the infant has not passed the urine. This is keynote practice and is to be condemned when there are other symptoms to indicate a remedy.

If there are no other symptoms study Aconite and Causticum and see if there is any reason why they should not be given.

Cancer: Another feature in connection with the woman, Arsenic is a wonderful palliative in cancerous affections, such as occur in the uterus and mammary glands.

Burning, stinging pains have entirely disappeared, in incurable cases, of course. It becomes one of the palliatives.

Larynx and chest: Arsenic has loss of voice, laryngitis, with dry teasing cough; a cough that does not seem to do any good; hacking constantly, dry, hacking cough.

Study its relation to asthma and difficult breathing, dyspnoea. Arsenic has cured some long standing cases of asthma of a nervous character; asthma that comes on after midnight, in patients who suffer from the cold, those who are very pallid, dry wheezing cough, must sit up in bed and hold the chest, anxious restlessness with prostration.

The heart symptoms are troublesome to manage when they get to be like Arsenic; the symptoms correspond to a state of great weakness, great palpitation, palpitation from the least exertion or excitement, great anxiety, anguish, weakness; he cannot walk, he cannot go upstairs, he can hardly move without increasing the palpitation; every excitement brings on palpitation. "Severe paroxysms of palpitation or attacks of syncope during endocarditis."

Arsenicum corresponds to most serious complaints of the heart, corresponds to many of the incurable complaints of the heart; i. e., when you see Arsenic corresponding in all of the symptoms with these marked cardiac affections, dropsy of the pericardium, etc., you have a class of cases that are very serious, "Angina pectoris," etc.

"Rheumatism affecting the heart," etc. "Hydropericardium with great irritability," etc. "Pulse frequent, small, trembling."

"Pulsation through whole body," etc., etc. Again this goes on to another state when the heart becomes weak, pulse thread-like, patient pale and cold, covered with sweat, pulse very feeble. When this is not a state of the heart itself then Arsenic becomes a wonderful remedy; that is, it is capable of cure.

Fever: I want to say a few things concerning a few essentials, some few things most general to the Arsenicum type of intermittent.

You can read the general state of intermittent fever and fevers generally and apply what has been said.

Arsenic has all the violence of the chill that you can find in any remedy, with excitement, headache, prostration, dry mouth, desire for hot drinks and to be covered up warmly, with all the anxious restlessness and prostration that you can find in any medicine; but the time of the Arsenic case is an important thing.

A striking feature of the Arsenic time of chill is its irregularity, coming not twice alike, coming at any time. It has afternoon chill and after midnight chill, sometimes in the morning, sometimes at 3 or 4 P.M., sometimes at 1 P.M. It has a striking periodicity in its nature. Hence it has an intermittent nature. It has a striking feature of thirst.

During the chill, while there is sometimes great thirst, he has aversion to cold things, hence can take only hot drinks, hot teas, etc.

During the fever the thirst increases because he has dry mouth, and he drinks little and often, just a teaspoonful to wet his dry mouth. Water does not quench his thirst, for he wants but a tablespoonful, little and often. This runs on into the sweat with prostration, increased coldness, desire for copious drinks, unquenchable thirst for cold drinks.

The chill is attended with great aching in the bones, likely to commence in the extremities, and during the chill there is a great head congestion with purple fingers and toes. Put these things together and the prostration that occurs with the awful anxiety, and you can most always in a general way pick out the Arsenic case.

But it has so many details in its chill, fever and sweat that if you take the details of symptoms and leave these general features out you will be likely to be able to cover almost any case of chills, i.e., you may think you will, but unless some of these general nates are present that stamp it as Arsenic you will fail.

It is one thing to stamp the whole case as Arsenic and another thing to say that these are Arsenicum symptoms.

So it is with China and Quinine; they have numerous particular symptoms, and yet to make the case a China or Quinine case the striking general features must be present.