Cantharis

Rapid and intense action. Excitement during the pains. CUTTING-SMARTING or BURNING- BITING PAINS; as if raw. VIOLENTLY ACUTE INFLAMMATION, or rapidly destructive. Discharge of bloody, acrid water. Serous effusion. Gangrene. Weak attacks, that take the voice away. .................... Amorous frenzy. Rage. Yellow vision. Swelled, tremulous tongue; raw edges. Throat: full of blisters; painful swallowing. Throat and larynx painfully constricted, and as if afire. Burning thirst, but averse to liquids. Violent retching and vomiting. Sensitive over stomach and kidneys (Solid). Shreddy, burning stools, with tenesmus of rectum and bladder. BURNING, SCALDING URINE, WITH CUTTING, INTOLERABLE URGING AND FEARFUL TENESMUS OR DRIBBLING. Strangury. Dysuria. Bloody urine. Acute nephritis. Nephritic colic. Cystitis. Griping in bladder. Gonorrhœa. Dropsy. Painfully swelled genitals. Painful priapism. Pulls at penis. Sexual irritation. Pollutions. Many, short, dry coughing spells. Chest pains, > eructations. Pleurisy. Pericarditis. Vesicular erysipelas; turning dark (Ran-b.). Bullæ. Chill, during stool. Urinous sweat; on genitals.

URINATING. Drinking; cold. Bright objects. Sound of water. Touch; larynx.

Warmth. Rest.

MEMBRANES (Mucous and serous): URINARY ORGANS. Bladder. Pharynx. Brain. Pleura. Lower bowel. Pomum adami. Skin. Right side.

Complementary: Apis. Antidote: Aco. Cam. Related: Ap. Ars. Merc-c.

Cantharides

Spanish Flies. Cantharidece.

Oversensitiveness of all parts.

Haemorrhages from nose, mouth, intestines, genital and urinary organs.

Pain; raw, sore, burning in every part of body, internally and externally ; with extreme weakness.

Disgust for everything; drink, food, tobacco.

Drinking even small quantities of water increases pain in the bladder.

Constant urging to urinate, passing but a few drops at a time, which is mixed with blood (sudden desire to urinate and intense itching in urethra, Petros.).

Intolerable urging, before, during, and after urination; violent pains in bladder.

Burning, cutting pains in urethra during micturition ; violent tenesmus and strangury.

Stool : passage of white or pale, red, tough mucus, like scrapings from the intestines, with streaks of blood (Carb. an., Colch.).,

Bloody, nocturnal emissions (Led., Men, Petr.).

Sexual desire : increased both sexes ; preventing sleep; violent priapism, with excessive pain (Pic. ac.).

Tenacious mucus in the air passages (Bov., Kali bi.) ; compare Cantharisif vesical symptoms correspond.

8o

(CANTH .

Skin : vesicular er}^sipelas ; vesicles all over body which are sore and suppurating.

Erythema from exposure to sun’s rays (sunburn).

The burning pain and intolerable urging to urinate, is the red strand of Cantharis in all inflammatory affections.

Relations.— Similar : to, Apis, Ars., Ecpiis., Mer.

Burns before blisters form and when they have formed. If the skin be unbroken, apply an alcoholic solution of any potency and cover with cotton ; this will promptly relieve pain and often prevent vesication. If skin be broken, use in boiled or distilled water, and in each case give potency internally.

Lecture VII — Cantharis

The remedy which I propose to bring before you for study today is Cantharis, the so-called Spanish fly. It is my purpose to speak of the more important symptoms produced by the drug, comparing it superficially with a number of others having effects similar to it. First of all, for the sake of completeness, let me give you notes on two other drugs, the Lytta vittata and the Cantharis strygosa. The first of these is the potato-fly, not the potato-bug, the pharmacopceial name of which is Doryphora. The potato-fly acts much like Caiitharis when applied to the skin. It produces first a dermatitis, which is soon followed by the formation of vesicles. The affected parts become red, almost erysipelatous in appearance. The vesicles finally rupture, leaving an ulcerated surface. Finally, death of the part may ensue. The Cantharis strygosa is a species of Cantharis, which infests the cotton plant. This, too, has vesication for its characteristic. There are other varieties of this Cantharis among which are the C. cinerea, C. marginata, C. atrata, C. nutalli and Mycabis cichorii et Phalateria, these last two being imported from China.

Cantharis, or Spanish fly, has long been used by allopaths as a counter-irritant; when applied to any part of the surface of the body it excites a violent inflammation. This inflammation begins, of course, with erythema, rapidly advancing to vesication. The blisters thus formed are filled with a yellowish-white serum. As the inflammation progresses they enlarge, and their contents assume a purulent character. Finally, death of the part ensues, presuming, of course, that the application is continued long enough. At other times 4arge blisters, termed bullae, may form.. These are sometimes as large as a silver half-dollar. They are raised above the surface, and are filled with a fluid which is excoriating. This irritating property of Cantharis is the founalatio?i-stone of the whole proving . The pains incident to this kind of inflammation are, of course, very severe. They are of a burning character. At times, when the nerves seem to be implicated in the inflammatory process, there will be sharp lancinating pains along their course.

But Cantharis is not the only drug that has these highly irritating effects when applied to the skin or taken internally.

Thus, from external use the following will, sooner or later, cause vesicles to develop on the skin: Varieties of Cantharis, Formica; varieties of Rhus, Anacardium orientate et occidentale; Ranunculous plants, as Clematis, Ranunculus bulb., Ranunculus sceleratus , Pulsatilla, Aconite, Caltha, Helleborus, Actea spic ; Araceae, especially Arum mac, Arum tri., Palladium, Pix, Terebinthina, Thuja, Nux juglans, Chininum sulph.; several species of Plumbago, Allium sat.; Buphorbious plants, particularly Croton tig., Hura, Euphorbia corol., Euphorbium offic, Mancinella, Sinapis, Piper nigrum , Capsicum, Mezereum, Thapsia garganica, Chloral, Cotura matura, Drosera, Podophyllum, Chimaphila, Oleander, Chelidonium, Cochlearia arm., Veratrum album, Camphor, Picric acid, Ammonium causticum, Calcarea caustica, Sulphur, Sulphuric acid, Kali hydrosulphuricum , Nitric acid; Arsenic preparations, Carbolic acid, Mercury, Cuprum arsenicosum, Antimo?iiu?n tart., etc. Rhus tox. and Anacardium cause vesication, with much redness of the skin and infiltration. The latter adds loss of appetite and other gastric symptoms as essential concomitants. The former causes red skin and numerous vesicles, surrounded with a red rim from infiltration. A well-defined advance-line of inflammation marks the progress of the disease. The predominant sensations are itching or tingling, while in Caiitharis burning and smarting, as from salt, are leading sensations. The latter, in some cases, when topically employed, induces an eczematous eruption around the plaster, and in others the vesicated surface assumes a soft, pultaceous, almost gangrenous appearance; but the skin is not the reddish-brown of Rhus. Croton tiglium gives rise to myriads of small, terribly-itching vesicles on a red base. When the genitals are attacked there is pain on urinating, and some of the blisters become large, others break, leaving a red, moist surface. The vesicles may develop into pustules, which finally break and form grayish crusts.

Hura Brasiliensis, a near relative of the former, also produces red vesicles. Both of these remedies cause a tension of the skin, a hidebound feeling, which is best confirmed in Croton; but Hura carries this feature into its vesication, for the blisters become so tense that, on opening, their serous contents fairly burst forth. A characteristic of this remedy is a sensation as of a splinter under the thumb-nails. The eruption prefers projecting portions of bone, as the skin over the malar bones.

Formica, locally applied, sets up inflammatory redness, with itching and burning, slight exudation and desquamation. The urine is albuminous and bloody, and there is much urging to urinate. Clematis crispa is food for the Spanish fly. The Clematis ereda we know irritates the skin to the production of burning vesicles, which pustulate and discharge a yellowish corrosive ichor. The urine is discharged in drops, or intermittingly, from a narrowed urethra. Ranunculus bulbosus and Ranunculus sceleraius act similarly. In the former the vesicles may become blue-black, or they may discharge a secretion which becomes horny. The latter raises blisters, which leave a raw surface with acrid discharge, and resembles Cantharis in pemphigus. In blueness Ranunculus bulbosus rather resembles Lachesis; the latter causes deep-seated bluish blisters (which appear after scratching). In horny crusts it resembles Antimonium crudum. The several species of Spurge have caused vesication, and the variety called Euphorbium officinarum has been employed in vesicular erysipelas; red cheeks, covered with yellow vesicles as large as peas (from an application of the juice); violent fever. Like Hura, this plant and the Euphorbium cyparissias have an affinity for the malar region. Cantharis attacks the surface of the nose (like Graphites). Euphorbia peplus also attacks the nose, as well as the cheeks.

Mancinella is so irritating that even the water dropping on the skin from the leaves may raise blisters, but the accompanying erythema far exceeds that of Cantharis. It resembles the blush of scarlatina, and has been used in that disease.

Thapsia garganica, an umbelliferous plant, closely resembles Croton* It causes more pustules, however, and these fill rapidly with pus. Mezereum develops numerous small vesicles, with intolerable itching; but the secretion quickly forms into thick, high scabs, from beneath which an acrid pus oozes.

Capsicum, Camphor, Terebinthina, Fix and Piper nigriim vesicate very slowly. Several of them are used rather as rubefacients. The first may be distinguished by the fact that the blisters appear on surfaces which have been wet with sweat, and the sensation is a pungent burning, while in the fly it is a smarting burning, as from salt. Camphor, topically, causes an erysipelatous dermatitis, with bright redness, and, eventually, blisters (from concentrated solution). We generally think of it when there has been a retrocession of skin disease, with its well-known symptoms of collapse and convulsions. Pix and Terebinthiyia cause violent itching, especially the former. The skin becomes cracked under Pix, with sleeplessness and bleeding when scratched.

Potash preparations favor more a papular than a vesicular eruption, the latter form being intermediate between the papule and the pustule- Kali hydrosulphuricum and Kali nitricum develop papular vesicles when locally applied. Kali bromatum causes vesicles about the hair follicles (from internal use). Kali bichromicum induces an eruption, which presents vesicles with a depressed centre; they suppurate, and on healing leave a cicatrix. Kali hydriodicum causes papular vesicles (from internal use), the resulting vesico-pustules contain minute quantities of Iodine. None of these, therefore, resemble the superficial blister of the fly.

Chloral is capable of producing several forms of eruption. Its vesicles are surrounded with a marked capillary hyperaemia. Chininum sulphuricum has caused an erythematous appearance strongly resembling scarlet fever, but it also forms confluent vesicles, which ulcerate or dry into crusts. Pemphigus, also, may appear. In pemphigus Cantharis compares with Causticum, Rhus tox. , Ranunculus sceleratus , etc. The following have induced this form of eruption, and deserve a trial: Caltha, Nitric acid, Copaiva, Sulphuric acid, Chininum sulphuricum, Carboneum oxygenisatum.

In Caltha the bullae are surrounded by a ring and itch a great deal. On the third day they are transformed into crusts.

Copaiva affects mucous membranes, then the stomach and bowels, and later the skin. A red, miliary rash forms on a red base; urticaria, pemphigus, with excessive offensive discharge.

Carboneum oxygen. is prone to excite vesication along the course of nerves (sciatic, trigeminus, etc.), and hence resembles herpes zoster, a disease which Cantharis has occasionally cured. It also causes "large and small vesicles of pemphigus."

Cantharis has a most remarkable affinity for the urinary organs; in fact, experience has. demonstrated that nearly always when it is indicated Cystic or renal symptoms are present. Marked symptoms of the kidneys and bladder may result even from the use of the drug externally. The same is true when the drug is taken internally. Let us now look at some of its symptoms. We find dull pressive pains in the region of the kidneys. At other times violent cutting, burning pains extend from the kidneys down either ureter to the bladder. The parts externally over the region of the kidneys are very sensitive to touch. There is persistent and violent urging to urinate. Often, too, these cutting pains extend along the spermatic cords to the testicles and down the penis, attended by drawing up of the testicles. At other times there is pain in the glans penis, exhibited in children by frequent pulling at the organ. This pain in the glans penis may not be of an acute nature, but may be simply an uneasy, uncomfortable sensation. When in children you notice this symptom Cantharis is generally indicated; at other times you may think also of Mercurius solubilis; of course, the symptom may be a habit which the child has been allowed to practice. That, of course, does not call for these remedies.

Coming to the bladder itself, we find here, too, extreme superficial sensitiveness over the hypogastrium (especially when the bladder is distended with urine), and almost unbearable tenesmus vesicae. Sometimes the patient will have the desire to urinate every two or three minutes. The urine does not pass freely or copiously, but dribbles away in hot, scalding, sometimes bloody, drops, with burning, cutting pains which could not be worse if the urine were molten lead. This burning and urging continue after urination, so that the poor sufferer is really in constant torture. Exacerbations come on every few minutes as calls to urinate become too urgent to resist. The urine itself shows changes in its composition. Blood is more or less thoroughly mixed with it, according to the part of the urinary tract from which the haemorrhage proceeds. The urine, however, is of a deep red color, independently of its containing blood, and deposits a sediment of mucus. Fibrinous casts, epithelial cells, small rolled-up membranous pieces of the lining of the parts through which it passes—the tubules of the kidney, the ureters and the bladder—are observed under the microscope.

This is the picture of the effects of Cantharis as they attain their maximum. From these extreme symptoms you have all grades of severity down to the slightest irritation at the neck of the bladder, with aggravation after micturition.

Now these symptoms characterize Cantharis, and indicate it in a variety of affections. You would expect it to be of use in inflammation of the kidneys, particularly in acute inflammation of one or the other of these organs rather than in chronic Bright' s disease. We find, too, that Cantharis is a valuable remedy in the passage of renal calculi, especially when the pains are very violent. It has been stated in controversy that it was nonsense to talk about relieving the pains from the passage of renal calculi by homoeopathic medication. The ureter is a narrow tube and the stone is frequently large, and it is said that this cannot be passed without pain. This is a mistake. The indicated remedy maj r so lessen local irritabilit} 7 that the pain attendant on the passage of the renal calculi may be greatly modified. Often you find Cantharis indicated in gravel in children when they have this irritation extending down the penis, with almost constant pulling at that organ.

Cantharis you will find indicated in acute cystitis more frequently than all other remedies put together.

It is also indicated in hematuria of inflammatory origin. It also has a secondary action in producing retention of urine, an effect due to the severity of the preexisting symptoms. In gonorrhoea Cantharis is indicated when there is most intense irritation; not a simple discharge with the necessary burning and smarting, but with violent and painful chordee, marked sexual erethism and discharge that is purulent or bloody. It is also indicated in cases in which the disorder has been suppressed by the use of injections and the disease involves the neck of the bladder.

Now, a word as to related remedies.

Cannabis sativa is very similar to Cantharis in its urethral phenomena. It has the same yellow, purulent discharge from the urethra, but is more important when the discharge is thin, and there is smarting and burning on urination. There seems to be more burning and smarting under Cannabis, while there is more tenesmus and cutting under Cantharis. The glans penis is dark red and swollen. Chordee may be present Cannabis sativa may be indicated in simple acute nephritis, but it is not likely to be of much use in Bright' s disease of the kidneys. It has, however, drawing pain in the region of the kidneys, extending into the inguinal glands, with anxious nauseous sensation in the epigastrium.

Cannabis Indica is much used in Asiatic countries. It produces the most wonderful mental phenomena, far exceeding Opium in its effects. The two central points of the mental phenomena of this Cannabis Indica are delusions as to distance and as to time. Time and space seem to be greatly extended. For example, the patient tells you that he is hungry, that he has eaten nothing for six months, when the dishes from which he has just partaken are yet by his bedside; or, on looking out of the window he tells you that objects but a few feet off are maii}^ yards distant. But it is the urinary symptoms of Cannabis Indica that concern us more particularly just now. It is very similar to Cantharis, and is said to be even superior to that drug for gonorrhoea when the chordee is well marked. In renal disease Cannabis is indicated by burning, stitches, aching in the kidneys, pains when laughing; also when uraemia sets in attended by severe headache, with a sensation as if the vertex were opening and shutting. If delirium appears, it is associated with the delusions respecting time and space just mentioned.

Equisetum hyemale is a plant growing in water. It contains a large quantity of silicic acid. It acts very similarly to Cantharis on the kidneys and bladder. There are, however, less escape of blood and less tenesmus vesicae than may be found under Cantharis. The urine is less scalding and does not contain so many fibrinous flakes. Cantharis is not called for so often as Equisetum when there is an excess of mucus in the urine. The bladder is tender and sore, with severe dull pain, which is worse after urination. There is constant desire to urinate, sometimes with a feeling of distension in the bladder and with profuse urination. During urination a burning pain is felt in the urethra. Equisetum has won most favor in enuresis. It has proved curative in these cases even when vesical irritation is marked, especially in women, and the urine contains blood and albumen.

Linaria is another drug which has produced and cured enuresis with frequent painful urging to urinate, causing the patient to rise at night. Eupatorium purpureum is similar to Equisetu?n in vesical irritability of women, for which condition it was used by Dr. Richard Hughes, of England. It causes frequent and painful urging with either excessive or scanty flow of high-colored urine containing mucus.

Petroselinum, one variety of the parsley, is indicated by frequent sudden and irresistible urging to urinate. In the case of a child, he will be suddenly seized with the desire to urinate; if he cannot be gratified immediately, he will jump up and down with pain. You will find Petroselinum useful in gonorrhoea with this sudden urging and strangury. Camiabis, Cantharis and Mercurius all have the sudden urging to urinate, but it is strongest under Petroselinum. Clematis erecta is to be selected when there is mucus in the urine, but not pus; when the urine flows by fits and starts, or the patient has to wait a long time for the urine to come, and then passes only a few drops, with intense biting and burning along the urethra, followed by a full, painless stream. Clematis is to be thought of in "first cases'' of gonorrhoea when the inflammation develops stricture. Conium is useful in urethral and bladder diseases when there is pus in the urine; otherwise it is like Clematis. It has "passage of the urine by fits and starts," cutting in the urethra after micturition, urine flows more readily while standing ( Sarsaparilla) . Doryphora is indicated in urethritis in children under ten years of age when the trouble has been provoked b}' local irritation. In these cases think also of Hyoscyamus.

Capsicum is sometimes useful in gonorrhoea, especially in fat persons of lax fibre and of rather indolent disposition. The discharge is of a thick yellow character. The patient complains of fine stinging pains in the meatus urinarius and of stitches in the urethra between the acts of micturition.

Copaiva and Cubeba have been so abused by allopaths that I think we are too apt to neglect them. Copaiva causes a urethritis with burning at the neck of the bladder and in the urethra. The discharge is of a milky color and of corrosive character. The meatus urinarius is tumid and inflamed and sore as if wounded.

Cubeba causes cutting and constriction after micturition. The discharge is of a mucous nature. Both Copaiva and Cubeba are useful in the irritation attending thickening of the lining membrane of the bladder. Neither remedy has so violent. an action as has Cantharis. Thuja gives us symptoms of continued or oft-repeated gonorrhoea. The patient has continued desire to urinate. The urging is violent, ret he passes only a few drops of bloody urine at a time; or, if these do not pass, there is intense itching. The urethral discharge is thin and green. Warty excrescences appear on the genitals and about the anus. At night there are painful erections which drive away sleep. In Cantharis the erections prevent urination; this is not the case in Thuja.

Argentum nitricum follows Cannabis in gonorrhoea when the discharge becomes purulent and the urethra feels sore and swollen. Mercurius solu bills and corrosivus follow when the discharge becomes worse at night and is green and purulent. The corrosive mercur} T causes the more violent tenesmus, burning and swelling, hence it is very similar to Cantharis. The meatus urinarius is very red. Mercurius solubilis has more burning between micturition than has Cantharis.

Chimaphila has been found useful in catarrh of the bladder caused by stones. It produces frequent urination at night with increased debility and smarting pain extending from the neck of the bladder to the end of the urethra.

In irritation of the neck of the bladder you may use a number of remedies, some of which I shall mention:

Erigeron, with or without bloody urine.

Pulsatilla is indicated when micturition is followed by cutting pains and there are pressure and soreness over the pubes.

Under Ferrum phos. the symptoms are worse the longer the patient stands, and better after urination.

Epigea, Apis and Copaiva should also be studied in this connection, the latter especially in old women.

Capsicum has spasmodic contracting and cutting in the neck of the bladder; Mercurius aceliacs, cutting just at the close of urination, like Natrum mur.

The Digitalis patient finds relief on lying down, as that position relieves much of the pressure upon the neck of the bladder. Sulphur comes in to remove the remnants of a gonorrhoea. Ipomea nil^ which is one variety of the morning-glory, was a remedy used by the late Dr. Jacob Jeanes for the passage of stone from the kidney to the bladder when he had the following symptoms present: Severe cutting pain in either renal region, extending down the ureter on the corresponding side. The distinctive feature which separates it from other remedies is that these pains excite nausea.

Hydrangea has also been used for the intense pain attending gravel and calculus.

Sarsaparilla is useful for gravel in children when they scream or cry with pain after passing urine; then there is found a grayish sand in the diaper.

Ocimum may be employed in renal colic when there is considerable haemorrhage; when the urine not only has a brick-red sediment, as under Pareira brava, but contains considerable blood. It favors the right side.

Terebinthina , like Cantkaris, has marked action on the kidneys, but it differs from the latter remedy in that the urine is always dark, cloudy and smoky, from admixture of blood. This is due to congestion of the kidneys.

Cochlearia armoracea, or the horse-radish, is a valuable drug. It produces burning and cutting in the glans penis during and after urination, with a great deal of strangury. The urine becomes thick like jelly on standing.

Then we have the Uva ursi. This remedy finds no equal when cystic and urethral symptoms are referable to stone in the bladder. You have, as symptomatic of the drug, burning, scalding urination: the flow of urine stops suddenly as if a stone had rolled in front of the internal orifice of the urethra. When the urine passes it is ropy from the admixture of mucus and blood. The drug seems to diminish inflammatory thickening of the cystic walls, and relieves suffering until the stone can be removed by operation.

Similar to this is Pareira brava, which is an excellent drug in gravel and in cystic calculus, w Then the patient has to get down on all fours to urinate. The tenesmus is great; the urine passes in drops; pains shoot from the kidneys down the thighs, and even into the feet; the urine deposits a copious uric acid sediment and also blood. This brings to mind Berbe?'is vulgaris. This remedy suits when there is kidney affection, with sharp stitching pains radiating from the renal region in all directions, particularly downward and forward, filling the whole pelvis with pain. There are pains in the loins and in the hips. The urine when passed is more slimy than is the Pareira brava urine, and deposits copiously a loamy sediment having a yellowish turbid appearance. Berberis is an excellent remed3 T in case of stone in the pelvis of the kidney or in the ureter. Now, you see the difference between the two remedies. Pareira has pain going down the thighs, Berberis only in the hips and loins.

You may expect to be called upon to use Camphor when strangury, retention of urine, etc. , have resulted from the abuse of Cantharis. In some cases Kali nitricum may be substituted for Camphor when renal symptoms have been produced by Cantharis.

Apis, too, is said to have relieved the cystitis caused by the Spanish fly.

Aconite frequently suits the incipienc}^ of renal and cystic affections, which, unmodified, progress into a Cantharis condition. The urging to urinate, the dysuria and hematuria are accompanied by an anxious restlessness and high fever altogether different from the expression of Cantharis.

Just as Cantharis acts on the tissues, producing inflammation, so does it excite the brain. Thus we find the patient violent at times, with paroxysms of rage, tearing his clothing and biting at anyone who approaches him. He barks like a dog. The slightest touch aggravates the symptoms, as does also any dazzling object, as a lookingglass or glass of water. These symptoms greatly resemble those of hydrophobia.

They also point to Cantharis as a remedy useful in puerperal convulsions and in inflammation of the brain. The eyes are bright, the pupils widely dilated, and the face is pale or yellowish, and bears an expression of deep-seated suffering.

These symptoms, indicative of inflammatory action in and about the brain and meninges, find their nearest concordant in Belladonna, which has the majority of the symptoms above mentioned, if not all of them. Even the intolerance of water is present under Belladonna. The difference between the two remedies is found in the expression of the face, Belladonna having a bright-red face with throbbing carotids; Cantharis usually exhibiting a face that is pale, yellow and wrinkled, with a constant frown and an expression of extreme suffering. When Cantharis is the remedy dysuria is almost always present. Camphor and Arsenicum are also nearly related to Cantharis. In all three of these drugs the anxiety, the restlessness and the expression of suffering on the face indicate the severity of the disease and betoken a sinking of the vital forces.

Arsenicum closely resembles Cantharis in violent inflammations, with intense burning, agony, thirst and subsequent collapse. The two drugs may also meet in uraemia. Arsenicum, however, lacks the sexual erethism, and its delirium is associated with a tendency to selfmutilation or to suicide. The patient exhibits fear of death, and restlessness often alternates with the stupor.

Camphor, like Canthaiis, causes delirium, convulsions, sexual mania, priapism, strangury, internal burning with external coldness, hyperemia or inflammation of internal parts, as brain, stomach, bladder, etc. The coldness and the sinking of the vital forces in Camphor are usually regarded as its most characteristic effects, the symptoms of excitement being reactionary. In Cantharis, on the contrary, the principal effects are those of excitement, coldness expressing the result of its prolonged or continued action. Practical^, you may decide upon Camphor when delirium, mania or convulsions exist with coldness and extreme prostration, especially if caused by a suppressed eruption. On the mucous surfaces we find that Cantharis causes just as violent an inflammation as it does on the skin. It is indicated in inflammation of the throat of a diphtheritic character, accompanied by severe burning and raw feeling in the throat, great constriction of the throat and larynx, amounting almost to suffocation, on any attempt to swallow water. Even the bladder symptoms are aggravated b}' water. It seems as if the sight or sound of water brings about a constriction of the sphincter muscles. Cantharis has been used very successfully in diphtheria when these throat symptoms and the dysuria were present, and when the debility was very marked.

While Belladoyma has constriction of the throat, worse from swallowing liquids, and intense inflammation of the throat, it lacks the burning, vesication, etc., so characteristic of the Spanish fly. Much more nearly related to Cantharis in its throat symptoms are Mercui'ius co?'rosivus, Arsenicum, Arum triphyllum, Diffenbachia and Capsicum.

The first is all but identical in symptoms; the distinctive mercurial features must decide, although Mercurius cor. causes more swelling, especially of the tongue. Deep ulcers form, rather than the extensive vesication of Cantharis.

Arum triphyllum is distinguished by the sore, cracked corners of the mouth and tongue, the acrid coryza and the excoriating saliva. Diffenbachia has caused an intense stomatitis with blisters and burning.

Capsicum relieves burning vesicles; mouth and throat swollen and dark, constriction of the throat, flat ulcers; worse between the acts of swallowing.

Cinnabar is also used in scarlatina, but the mucus from the posterior nares is dirty yellow, ropy, and there is dryness of the throat, waking the patient at night.

Apis bears some resemblance to Cantharis in erysipelatous states of the mouth and throat, and in diphtheria; but the debility in the latter condition is early in Apis, while it is the sequel only in Cantharis. In the alimentary tract we find Cantharis producing inflammation of the stomach, of the same character as the symptoms already mentioned, rawness, great thirst with aversion to drinks, and vomiting. It is of use in dysentery. The discharges are bloody and slimy, and are mixed with flakes that look like scrapings of the intestines. These, I believe, are not really portions of the bowel or pieces of the mucous lining, but are fibrinous formations, resulting from the inflammation. Tenesmus is marked and is almost always associated with dysuria. The pains in the abdomen are colic-like, doubling the patient up; they are of a cutting, burning, griping, wandering character. In dysentery Cantharis has several concordant remedies. One of these is Colocynth, which has colicky pains, doubling the patient up. The stools are bloody and slimy, and are made worse by any attempt to eat or drink. They also contain the so-called scrapings of the intestines. Colocynth differs from Cantharis in that the colicky pains cease after stool, and the patient is relieved by bending double and by pressing firmly against the abdomen. Looking at the two remedies from a pathological standpoint, Cantharis has more inflammation and Colocynth more nervous symptoms.

Another remedy very similar to Cantharis is Colchicum. This remedy has tympanitic distension of the abdomen. The discharges from the bowels are composed of white jelly-like lumps, and are followed by violent tenesmus and constriction of the anus, tormenting the patient more than the urging during stool.

Another concordant remedy is Capsicum, which is good for dysentery occurring in moist weather. It is best indicated in stout flabby persons. The pains and other symptoms are increased by the slightest draft of either warm or cold air. The drinking of water causes^ shuddering and increases the pains.

Sulphur you will find best adapted to chronic or persistent cases, especially when the tenesmus continues from one evacuation to another, like Nux vom., or when the bleeding and tenesmus have abated but the stools are still slimy with frequent sudden urging. Zincum sidphuricum has several times cured subacute cases of dysentery. The pains are referred to the sides of the abdomen, probably in the colon.

Kali bichromicum follows Cantharis when, though the "scrapings" continue, the discharges become more jelly-like.

We have yet to speak of the action of Cantharis on the sexual organs. Cantharis inflames the sexual appetite, producing a violent, almost insatiable, desire for coitus, with erections so violent and so persistent as to amount to priapism; even sexual intercourse does not always reduce the erections. These symptoms call for the drug in chordee during the course of gonorrhoea. They also point to its use for uncontrollable passion, whether the result of mental disease or not. This priapism of Cantharis should not be confounded with that of Picric acid. Under this remedy the priapism is associated with some spinal disease, such as myelitis, meningitis or locomotor ataxia. Erections are violent and the penis is distended almost to bursting. Cantharis also acts on the female genital organs, producing nymphomania, for which condition it may be a useful remedy.

We may also make use of Cantharis in labor. The drug has the property of expelling moles and other foreign materials from the uterus. We may make use of this effect in cases of retained placenta, either after labor at full term or after a miscarriage. Cantharis is a useful remedy in erysipelas, especially of the vesicular form. The erysipelatous inflammation begins on the nose, either with or without vesicles. It then spreads to one or the other cheek, with the formation of vesicles which break and discharge an excoriating fluid.

Graphites also has erysipelas commencing on the nose, but it is better adapted to chronic cases.

Cantharis should be remembered as of use in burns. It is remarkable what this remedy will do in allaying the painful symptoms and accelerating the repair of affected surfaces. It may be given internally in potency and applied locally at the same time. If administered early enough in slight burns, the formation of blisters may sometimes be prevented.

In burns you may compare Cantharis lotion with Sapo soda, Soda bicarb., Arsenicum and Carbolic acid—the last named when the affected parts ulcerate.

Furious delirium. Anxious restlessness, ending in rage. Crying, barking; worse touching larynx or drinking water. Constantly attempts to do something, but accomplishes nothing. Acute mania, generally of a sexual type; amorous frenzy; fiery sexual desire. Paroxysms of rage, crying, barking. Sudden loss of consciousness with red face.

Spanish Fly This powerful drug produces a furious disturbance in the animal economy, attacking the urinary and sexual organs especially, perverting their function, and setting up violent inflammations, and causing a frenzied delirium, simulating hydrophobia symptoms (Anagallis). Puerperal convulsions. Produces most violent inflammation of the whole gastro-intestinal canal, especially lower bowel. Oversensitiveness of all parts. Irritation. Raw, burning pains. Hæmorrhages. Intolerable, constant urging to urinate is most characteristic. Gastric, hepatic and abdominal complaints that are aggravated by drinking coffee. Gastric

derangements of pregnancy. Dysuria, with other complaints. Increases secretion of mucous membranes, tenacious mucus. The inflammations cantharis produces (bladder, kidneys, ovaries, meninges, pleuritic and pericardial membranes)are usually associated with bladder irritation.

Worse, from touch, or approach, urinating, drinking cold water or coffee. Better, rubbing.

Burning in brain. Sensation as if boiling water in brain. Vertigo; worse in open air.

Pale, wretched, death-like appearance. Itching vesicles on face, burning when touched. Erysipelas of face, with burning, biting heat with urinary symptoms. Hot and red.

Yellow vision (Santon). Fiery, sparkling, staring look. Burning in eyes.

Sensation as if wind were coming from ear, or hot air. Bones about ear painful (Capsic).

Tongue covered with vesicles; deeply furred; edges red. Burning in mouth, pharynx, and throat; vesicles in mouth. Great difficulty in swallowing liquids. Very tenacious mucus (Kali bich). Violent spasms reproduced by touching larynx. Inflammation of throat; feels on fire. Constriction; aphthous ulceration (Hydr mur; Nit ac). Scalding feeling. Burnt after taking too hot food.

Burning sensation of œsophagus and stomach (Carb). Disgust for everything-drink, food, tobacco. Burning thirst, with aversion to all fluids. Very sensitive, violent burning. Vomiting of blood-streaked membrane and violent retching. Aggravation from drinking coffee; drinking the smallest quantity increases pain in bladder, and is vomited. Thirst unquenchable.

Shivering with burning. Dysentery; mucous stools, like scrapings of intestines. Bloody, with burning and tenesmus and shuddering after stool.

Intolerable urging and tenesmus. Nephritis with bloody urine. Violent paroxysms of cutting and burning in whole renal region, with painful urging to urinate; bloody urine, by drops. Intolerable tenesmus; cutting before, during, and after urine. Urine scalds him, and is passed drop by drop. Constant desire to urinate. Membranous scales looking like bran in water. Urine jelly-like, shreddy.

Strong desire; painful erections. Pain in glans (Prunus; Pareira). Priapism in gonorrhœa.

Retained placenta (Sep), with painful urination. Expels moles, dead

fœtuses, membranes, etc. Nymphomania (Plat; Hyos; Lach; Stram). Puerperal metritis, with inflammation of bladder. Menses too early and too profuse; black swelling of vulva with irritation. Constant discharge from uterus; worse false step. Burning pain in ovaries; extremely sensitive. Pain in os coccyx, lancinating and tearing.

Voice low; weak feeling. Stitches in chest (Bry; Kal c; Squilla). Pleurisy, with exudation.

Pleurisy, as soon as effusion has taken place. Intense dyspnœa; palpitation; frequent, dry cough. Tendency to syncope. Short, hacking cough, blood-streaked tenacious mucus. Burning pains.

Palpitation; pulse feeble, irregular; tendency to syncope. Pericarditis, with effusion.

Pain in loins, with incessant desire to urinate.

Tearing in limbs. Ulcerative pain in soles; cannot step.

Dermatitis venenata with bled formation. Secondary eczema about scrotum and genitals, following excessive perspiration. Tendency to gangrene. Eruption with mealy scales. Vesicular eruptions, with burning and itching. Sunburn. Burns, scalds, with rawness and smarting, relieved by cold applications, followed by undue inflammation. Erysipelas, vesicular type, with great restlessness. Burning in soles of feet at night.

Cold hands and feet; cold sweat. Soles burn. Chill, as if water were poured over him.

Antidotes: Acon; Camph; Puls. Compare: Cantharidin––(Glomerular nephritis). The immediate pharmacological action of Cantharidin is irritability of the capillaries, rendering the passage of nutritive fluids through them less difficult. This is most marked in the capillaries of the kidneys. The increase of blood sugar coincident with the glomerular nephritis appears to be a valuable observation. Vesicaria––(Urinary and kidney remedy. Smarting, burning sensation along urethra and in bladder with frequent desire to void urine often with strangury. Cystitis, irritable bladder. Tincture 5-10 drop doses). Fuschina coloring substance used in adulteration of wine (Cortical nephritis with albuminuria, 6th-30th potency. Redness of ears, mouth, swollen gums; deep, red urine; red, profuse diarrhœa, with severe abdominal pains). Androsace lactea (urinary troubles, diuretic; dropsy). Apis; Ars; Merc cor. Complementary: Camph.

Sixth to thirtieth potency. Bears repeated doses well. Locally, in burns and eczema, 1x and 2x, in water, or as cerate.

Cantharis

The most important feature of this medicine is the inflammatory condition, and the most important characteristic in the inflammation is the rapidity with which it develops into a gangrenous state. inflammation conditions usually follow a definite course for days, but when this medicine is put upon a part or taken internally the inflammatory state terminates in death of the part with great rapidity. When taken internally it proceeds almost immediately to attack the urinary tract and establish a uraemic state which brings about the mental symptoms; the local inflammatory condition comes on with great rapidity, and this brings the patient down violently sick in a great hurry.

From strong doses in the poisonous effect we get startling and alarming symptoms; the whole economy is in disorder; grievous symptoms commonly of the urinary tract. The parts become gangrenous at an early stage.

Mind: The mental symptoms are striking. Among those that are guiding are sudden loss of consciousness with red face. Suddenly goes into stupor. Confusion of mind. Overwhelmed with strange ideas. Thoughts run riot, and go whatever way they will, as if possessed by outside influence.

Head hot, frenzy, delirium, with great excitement and rage, paroxysms renewed by dazzling or bright objects, by touching the larynx or by trying to drink water as in rabies.Fear and confusion of ideas. The mind often runs towards subjects that the inflamed parts would suggest.

Bladder and genitals: The bladder and genitals are inflamed and the excitement and congestion of the parts often arouse the sexual instinct, so that there are sexual thoughts and sexual frenzy. Violent amorous frenzy, an excitement such as accompanies inflammation attended with thoughts that correspond. The sexual instinct has gone mad, the erections in the male are painful and violent.

The penis is inflamed and sore and it would be painful to have coitus, yet there is this frenzy. Insolence. Blasphemy. Restlessness ending in rage. Restlessness causing him to move constantly, a rage and delirium intermingled with amorous frenzy.

This kind of mental conduct in Cantharis is similar to what will take place in Hyos., Phos., and Secale; a violent delirious state intermingled with sexual ideas and talk. In some instances he deliriously sings lewd songs and prattles on the subject of human genitals, urine and feces, a wild raving on subjects not talked about in health except among the depraved.

But in disease, chaste and modest persons, virgins, will speak so that it is surprising where they have picked up such language. in such cases it is well to exclude everybody from the room except the nurse and doctor. I have seen a dear old mother weep and wring her hands and say:

"Where did my daughter learn such language?" The daughter is not to blame.

It is simply a condition of the urinary tract or the menstrual function, brought on from cold or exposure, or through the mother's neglect to tell her daughter what she should know in regard, to her menstrual function, and how there is inflammation of the ovaries or uterus, or outside parts, and the urine burns and causes an inflammatory condition of the outer parts, or the urine is retained and there is frenzy. Such in Cantharis.

Violent, bursting, lancinating headaches as if stabbed with a knife an inflammatory condition that takes hold of the mind violently. Running all through the remedy there is burning. In the head burning, throbbing and stabbing. Unconsciousness and delirium in the mental state. Burning in the side of the head. Stitches in the side of the head and occiput. Lancinating pains deep in the brain. Hair falls out. It is seldom indicated in eye troubles alone, except such as come with head and mind symptoms.

Erysipelas of the face with large blisters. Burning in the eyes and the whole atmosphere looks yellow. Burning and smarting in the eyes. Erysipelas of the eyes, with gangrenous tendency. Eyes hot, scalding tears. Erysipelas of the face, dorsum of the nose, involving the lids. Rhus is more commonly. used in this condition, but when it is violent Canth. will often be indicated and preferable to Rhus, Rhus has the blisters and the burning, but in Canth. between your two visits the erysipelas has grown black, it is dusky, a rapid change has taken place, and it looks as if gangrene would set in.

Burning in the erysipelatous area and the skin around burns from the touch. In Rhus this is not so. In Cantharis the little blisters even if touched burn like fire.

Eruptions burn when touched, ever so lightly, i.e., those eruptions such as the remedy could produce.

This patient enters into a state of prostration, is pallid, has Hippocratic countenance and dies. It corresponds to the lowest forms of disease, even gangrene and violent inflammation of the bowels, bladder, brain, spine and lungs; sinking and hippocratic countenance.

Inflammation of the lungs, gangrenous type, prostration and the lung that is affected burns like fire, and immediately he expectorates cadaverous smelling expectoration, thin, bloody, watery; it has come on in an astonishingly rapid manner, and in a little while he will die; the nose is contracted, there is the hippocratic countenance, and the urine is suppressed. I remember one patient who had just come out of a prolonged drunk. I left the patient in the evening in just such, a state as I have described. He was drooling a bloody saliva from his mouth and be was dying. He had had this condition come on in one night from being nearly frozen in a drunk.

It would be Cantharis or death before morning, but by morning he was expectorating a rusty sputum and went on to good recovery.

Arsenic has the burning in the lungs and he spits up black sputum, pneumonia signs are present, with the restlessness and anxiety, and other symptoms of Arsenic, and Arsenic will stop it at once. These violent remedies are needed in those cases that will die.

Burning in the throat. Great thirst, with burning in the throat and stomach. Thirst, with aversion to all fluids, that is, the craving of the mouth and throat are antagonized by the mental state. Thirst in the throat and an aversion to water in the mind. Violent, burning in the stomach, pylorus, abdomen.

The abdomen is swollen and tympanitic; lancinating pains cutting and stabbing. Wherever there is a rapid inflammation in the bowels there is diarrhoea of bloody mucus or serum, watery, bloody fluids from the bowels and stomach. The same watery bloody fluid from the eyes. And wherever this watery fluid comes in contact with the skin it burns and excoriates. Bloody urine. Desire for stool while urinating. The patient will sit on the commode with violent tenesmus to pass urine and stool, feels that if he could only pass a few more drops of urine or a little more bloody stool he would get relief, but no relief comes. All the parts are inflamed and on fire. Tenesmus and urging not only when the bladder is empty, but often when the bladder is full. Retention of urine. Passes none or only a drop or two. Violent tenesmus of the bladder. Cutting pains with tenesmus, lancinating, stabbing like knives, in neck of bladder.

Pains shoot off in different directions. Violent pains with frequent urging. Constant tenesmus. An anxious state and frenzy come on; most violent suffering and be has urging to pass urine and stool with sexual erethism tantalizing in the extreme.

The whole urinary organs and genitalia are in a state of inflammation and gangrene. Burning when urinating. This bloody urine burns like fire in the bladder and about the genitals. Retention or suppression of urine.

It is rare that one suffering from gonorrhea has this violent inflammation, with burning and tenesmus of the bladder and rectum, but in such a case this remedy is indicated. The intensity and rapidity are the features of this remedy. It brings on pain and excitement found in no other remedy. Next to it comes Merc. cor.

In the female there is oversensitiveness of all parts. Inflammation of the ovaries and uterus. Burning in the vagina. Membranous dysmenorrhoea. Menses too early, profuse, black.

Puerperal convulsions. Retained placenta. Burning pains. When there have been no expulsive pains present to expel the afterbirth, with the symptoms running all through this remedy, after it has been given, normal contractions of the uterus have come on with expulsion of the membranes.

Violent lancinating pains through the kidneys and back. Pains in the loins and abdomen. Pain on urinating so that he moaned and screamed on passing a drop.