Lachesis mutus

MOVING FROM LEFT TO RIGHT. Sepsis. Disintegration. Gangrene; diabetic. Carbuncle. Erysipelas. Blueness; hands. FETOR; of acrid discharges; oris; stools, etc. HÆMORRHAGE, thin; dark particles; nose-bleed; vicarious; bloody urine, etc. Purpura. ASCENDING SENSATIONS, in throat; from eyes over vertex; from nape; from ovary to heart; chills; FLUSHES OF HEAT; rushes of blood. A LUMP; ascends throat and is swallowed back again; in liver, abdomen, rectum; rolls about in bladder, etc. EXCESSIVE PAINFULNESS; of throat; ulcers; spots over body. Constriction; of throat, > eating; as of a skull cap; of anus. Drawing; vertex to jaws; in rectum, etc. Tremor; of tongue; hands, etc. Hard throbbing or hammering (Fer.). Congestion. Apoplexy. Epilepsy. .................... Nervous, excitable. LOQUACITY; rambling; then sadness or repeats same thing. Compelling delusions. Persistent, erotic ideas, without ability. Depression; on awaking. Insane jealousy. Suspicion. Feels full of poison. Fears, going to sleep, lying down, or that heart will stop. Indolence. Vertigo, < turning to right. Headache; heavy; bursting; down nose; side (r) feels cut off. Eyes feel small. Nose; stopped coryza; discharges with every cough; bloody pus from; rum blossom (Agar. Led.). Face purple, mottled; netted veinlets; dusky during heat. Faceache. Lower jaw drops. Septic mumps. Aphthæ. Much thick, pasty saliva. Tongue catches on teeth. Thick, blundering speech. Peppery taste. Can't bear anything before mouth or nose. THROAT; PAINFUL, into ears; as of a soft body in; choking; MUST LOOSEN COLLAR; hot lump in; pit feels swelled or sore spot back of pit. SWALLOWING; the wrong way; painful; returns through nose. Diphtheria; laryngeal. Tonsilitis. Quinsy. Hawks foul pellets from throat. Thirsty, but fears to drink. Dipsomania. Soreness or cramp in epigastrium. Sore festering throb, deep in liver. Septic gall-bladder. Pain from anus to navel. Constipation of pregnancy. Piles; < coughing. Pain in l. ovary; must lift covers. Dark, scanty menses. Suffocates on dropping to sleep. Must take deep breaths. Air hunger. Tickling, choking cough, < touching neck or auditory canal, > retching out a little expectorate. Larynx, as of a skin hanging in, or a valve. Heart weak; turns over or too big, as if. Carditis; metastatic. Axilla; swelled glands. Numb, l. arm; finger-tips. Cracks in skin, at corner of nails. Cold knees, or cold, foul foot-sweat. Toes feel broken. Mottled or livid skin; dark marks. Eating ulcers, on legs; with dark areolæ; fungoid; varicose. Sleepless from cerebral irritation; tipplers. Frightful dreams; of snakes. Dilated capillaries. Chill, < drinking; with sweat. HEAT; on vertex; IN FLUSHES, on waking or falling to sleep. Sweat; about neck, during sleep; in axillæ; bloody; staining blackish; garlicky.

SLEEP; AFTER. MORNING. HEAT: SPRING. SUMMER SUN. ROOM. DRINKS. SWALLOWING; EMPTY; liquids. SENSITIVE TO: SLIGHT TOUCH OR PRESSURE OF CLOTHES; < NECK, Waist (Ap. Bro. Grap.); Noise. RETARDED DISCHARGES. Start and close of menses. CLIMAXIS. ALCOHOL. Cloudy weather.

OPEN AIR. FREE SECRETIONS. Hard pressure. Bathing part. COLD DRINKS. Rapid onset, intensity, prostration or malignancy. LEFT-SIDED COMPLAINTS, OR

Mind. Throat. NERVES: CUTANEOUS. VASO-MOTOR. Sympathetic. PNEUMO-GASTRIC. BLOOD; HEART. CIRCULATION. LEFT SIDE; then right: THROAT. OVARIES. FEMALES. Vertex.

Complementary: Lyc. Pho. Zin-io. Related: Caus. Sep. Zin.

Lachesis

Suriikiiku Snake Poison. Ophidia.

Persons of a melancholy temperament, dark eyes, and a disposition to low spirits and indolence.

Women of choleric temperament, with freckles and red hair (Phos.).

Better adapted to thin and emaciated than to fleshy persons; to those who have been changed, both mentally and physically, by their illness.

Climacteric ailments : haemorrhoids, haemorrhages ; hot flushes and hot perspiration ; burning vertex

I^ACHHSIS — (yCojitmued) .

headache, especially at or after the menopause (Sang., Sulph. ) .

Ailments from long lasting grief ; sorrow, fright, vexation, jealousy or disappointed love (Aur., Ign., Phos. ac.).

Women who have not recovered from the change of life, “have never felt well since that time.”

Left side principally diseases begin on the left and go to the right side — left ovary, testicle, chest.

Great sensitiveness to touch ; throat, stomach, abdomen ; cannot bear bed-clothes or night-dress to touch throat or abdomen, not because sore or tender, as in Apis or Bell., but clothes cause an uneasiness, make her nervous.

Intolerance of tight bands about neck or waist.

Extremes of heat and cold cause great debility.^

Drunkards with congestive headaches and haemorrhoids; prone to erysipelas or apoplexy.

Headache : pressing or bursting pain in temples < from motion, pressure, stooping, lying, after sleep; dreads to go to sleep because she wakens with such a headache.

Rush of blood to head : after alcohol ; mental emotions; suppressed or irregular menses; at climaxis; left-sided apoplexy.

Weight and pressure on vertex (Sep.) ; like lead, in occiput.

All symptoms, especially the mental, worse after sleep, or the aggravation wakes him from sleep; sleeps into the aggravation; unhappy, distressed, anxious, sad < in morning on waking.

Mental excitability; ecstacy, with almost prophetic perceptions ; with a vivid imagination ; great loquacity (Agar., Stram.) ; wants to talk all the time; jumps from one idea to another ; one word often leads into another story.

Constipation: inactivity, stool lies in rectum, without urging; sensation of constriction of sphincter (Caust., Nit. ac.).

Menses at regular time ; too short, scanty, feeble ; pains all relieved by the flow; always better during menses (Zinc.).

Piles : with scanty menses ; at climaxis ; strangulated; with stitches shooting upward (Nit. ac.).

The least thing coming near mouth or nose interferes with breathing; wants to be fanned, but slowly and at a distance (rapidly, Carbo v.).

As soon as he falls asleep the breathing stops (Am. c.. Grind., Lac c.. Op.).

Great physical and mental exhaustion; trembling in whole body, would constantly sink down from weakness; worse in the morning (Sulph., Tub.).

Epilepsy; comes on during sleep (Bufo) ; from loss of vital fluids, onanism, jealousy.

Haemorrhagic diathesis; small wounds bleed easily and profusely (Grot., Kreos., Phos.) ; blood dark,noncoagulable (Grot, Sec.).

Boils, carbuncles, ulcers with intense pain (Tar.) ; malignant pustules ; decubitus ; dark, bluish, purple appearance ; tend to malignancy.

Bad effects of poison wounds; post-mortem (Pyr.).

Sensation as of a ball rolling in the bladder.

Fever annually returning; paroxysm every spring (Carbo v., Sulph.), after suppression by quinine the previous autumn.

Fever: typhoid, typhus; stupor or muttering delirium, sunken countenance, falling of lower jaw; tongue dry, black, trembles, is protruded with difficulty or catches on the teeth when protruding; conjunctiva yellow or orange color ; perspiration cold, stains yellow, bloody (Lyc.).

Diphtheria and tonsillitis, beginning on the left and extending to right side (Lac c., Sabad.) ; dark purple appearance (Naja) ; < by hot drinks, after sleep; liquids more painfid than solids when swallowing (Bell., Bry., Ign.) ; prostration out of all proportion to appearance of throat.

Incompatible: Acet. ac., Carb. ac.

In intermittent fever Nat. m. follows Lach. well when type changes.

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

Lecture III — The Ophidia — Lachesis

In considering the remedies derived from the animal kingdom, first I shall speak, in extenso, of the large family, formally called Ophidians, or snakes proper. Of those we use in medicine, we have first the Lachesis trigonocephalies. This was proved by Dr. Hering, sixty years ago. Next we have the Crotalus horridus. There is also a South American species, proved by Dr. Muir, the Crotalus cascavella. This has a few symptoms which will not yield to the administration of the other species. Then there are the Naja tripadians, one variety of the cobra, and the Elaps corallinus, so called from the shape of the scales on the back, which have something the appearance of coral. Lastly, there is the Bothrops lanceolatus, a remedy which, for a year or more, I have vainly tried to procure. It causes symptoms similar to that peculiar condition known as aphasia. Of these poisons, the first four are commonly used in medicine.

The poison of the snake is generally held in a little sac behind the fangs. On the under surface of the fangs is a small groove, into which empties a little tube that conveys the poison from the gland. When they are not in use they lie back on the roof of the mouth. If the animal is excited, it opens its mouth, the fangs are pushed forward, and at the same time, by muscular action, a drop of the poison runs down the canal and into the punctured wound. Now, what follows? That depends on various causes. The poison is more potent at some times than at others. The more angry the serpent is, the more active is its venom. If, in inflicting the wound, the fang passes through the clothing, some of the poison may thus be absorbed. Again, the power of resistance of the individual has some effect.

Thus, you may divide the effects of the snake-poison into three sorts: First, that which may be compared to the action of a stroke of lightning or a dose of Prussic acid. Immediately after the bite the patient starts up with a look of anguish on his face and then drops dead. This represents the full, unmodified, lightning rapidity of the poison. In the second form, commonly, the part bitten swells and turns, not a bright red, but rapidly to a dark purplish color, the blood becomes fluid, and the patient exhibits symptoms like those characteristic of septicaemia. The heart-beat increases in rapidity, but lessens in tone and strength. The patient becomes prostrated and covered with a cold clammy sweat. Dark spots appear on the body where the blood settles into ecchymoses; the patient becomes depressed from weakness of the nervous system, and then sinks into a typhoid state and dies. Or there follow nervous phenomena. Vertigo; dark spots before the eyes; blindness; a peculiar tremor all over the body; face besotted; dyspnoea, or even stertor. Or the process may assume a slower form. After the vertigo or trembling the patient remains weak, and the wound turns dark or gangrenous. All the discharges, the sweat, the urine and the faeces, become offensive. Dysenteric symptoms of a typhoid character show themselves. The patient goes into a low state, and finally dies. These are all phases of the action of these powerful poisons on the blood and the nerves.

The Ophidia, as a group, are characterized by their paralyzing action upon the nerves. They directly weaken the brain and heart action. Then follow decomposition of the blood, changes in the muscular tissue and local death from gangrene. At first there is developed a condition of anxiety, mental excitability and oversensitiveness of the brain, with hallucinations, anxious fear, etc. Afterward arises nervous depression, varying from such a debility as is observed in severe or protracted disease and advancing old age to mental confusion, stupor, low delirium and paralysis. Constrictions are noticed, as in the throat, larynx and sphincters in general. Haemorrhages, which are usually dark, decomposed, oozing from every orifice of the body; thus, also, ecchymoses. They are most marked under Lachesis and Crotalus, less in Elaps, least in Naja. Face sickly, pale, anxious; bloated, dark red or bluish. Special senses altered; dim vision, excitability of brain and spinal cord, accounting for the mental restlessness and bodily sensitiveness. Predominant, even with the pains, are torpidity, numbness, twitchings, formication.

You already see in what class of diseases you will find these poisons curative: Inflammations and fevers of low, destructive type, such as gangrene, malignant ulcerations, diphtheria, typhoid, pyaemia, carbuncles, etc. With all there are tendency to faint, muscular prostration, trembling as in drunkards, irregularities in circulation, flushes of heat, apoplectic congestions, paralysis.

Nerves especially affected by the snake-poisons seem to be the pneumogastric and spinal accessory; consequently, you expect to find, as eminently characteristic, symptoms of the larynx, of the respiration and of the heart. All of the Ophidia cause choking, constrictive sensation coming from irritation of the pneumogastric. All of them have dyspnoea and heart symptoms.

Moreover, the Ophidia produce a yellow staining of the skin. This is not jaundice, and must not be confused with that affection. It comes from the blood, and is due to the decomposition of that fluid, just as we find in yellow fever, typhus or pyaemia, and not to the staining of the skin with bile. This is most marked in the Crotalus. Again, you may find that the skin is dry and harsh, as if there was no vitality in it, or it may be clammy, more characteristic of Lachesis. The discharges are foetid, even the formed faecal stools of Lachesis are horribly offensive. As the heart is weakened by all, we find as characteristic, running through them all, weak heart, cold feet and trembling—not the trembling of mere nervousness, but the trembling of weakness from blood-poisoning. The cold feet are not indicative of congestion, as you find under Belladonna; they are attendant upon a weakened heart.

The heart symptoms of Naja resemble greatly those of Lachesis, but its cardiac symptoms point more markedly to the remote effects of cardiac valvular lesions; those of Lachesis more to the incipiency of rheumatic disease of the heart. In Naja there is a well-marked frontal and temporal headache with the cardiac symptoms; the heart beats tumultuously. The patient awakes gasping for breath. Naja causes more nervous phenomena than any of the snake-poisons.

Under Belladonna the head is hot and the feet are cold, because the blood surges toward the head. Under the snake-poisons the feet are cold, because the heart is too weak to force the blood to the periphery. All of the snake-poisons cause inflammation of the cellular tissue. Accordingly, we find them valuable when cellulitis arises in the course of typhoid fever, diphtheria, etc. The color of the affected part is dark red, purple or black, like gangrene.

In diphtheria Crotalus has had more clinical confirmation in the persistent epistaxis.

Elaps claims attention in cases of haemoptysis, when the blood discharged is dark in color, especially when the right lung is affected. Antidotes for these poisons are numerous. There is no doubt that alcohol is a powerful antagonist to the snake-venom. It is remarkable how much alcohol can be swallowed by persons bitten by serpents, without the manifestation of the usual physiological effects. Dr. Hering recommends radiating heat as an antidote. The part bitten should be held close to a hot fire. Ammonia and permanganate of potash have been recommended as antidotes, and cures have been claimed for each.

IvACHESIS.

Now let us consider Lachesis. First of all, in order that you may comprehend the subject, I wish to refer to those symptoms which are universal. We notice that Lachesis is especially suitable to persons who have a peculiar sensitiveness of the surface of the body. Even if the patient is lying in a stupor and you touch him, as when you try to feel his pulse, he will show that he is disturbed thereby. Hard rubbing or pressure may cause no trouble at all. Dr. Hering, who first proved Lachesis, could never tolerate tight clothing about his neck. He always wore his collars loose. He noticed that, during the proving, this symptom annoyed him more than usual, so he faithfully made note of the occurrence, but did not place much value on it. Since then the symptom has been confirmed many times in practice, and has been found true, not only as a local symptom of the neck, but as a symptom of the body universally. The explanation seems to be that there is an irritation of the peripheral nerves; and because of this the patient cannot bear touch or slight pressure. It is no evidence of inflammation, and must not be confounded with the inflammatory soreness of Aconite, Arnica or Belladonna. The sensitiveness also differs from that of Apis, which has a bruised, sore feeling more acute than that of Arnica. It also differs from the sensitiveness of Nux vomica and Lycopodium which have it about the waist only after a meal.

Next we find that the drug is prone to affect the left side of the body. Homoeopaths have been criticised for attributing to drugs the power of acting upon one side of the body in preference to the other. The simple fact that disease chooses sides ought to be enough to lead one to believe that drugs may do the same. The left side of the body is more apt to be affected by drugs having a depressing action, because that side of the body is weaker.

Another peculiarity of Lachesis, arising, probably, from its action on the pneumogastric nerves, is its influence on sleep. This is a universal symptom, that the patient is worse from sleep; he sleeps into an aggravation. If it is true that Lachesis has an influence on the centres of respiration, and is a weakening drug, we can understand why sleep should aggravate. During our waking hours we have some control over respiration. During sleep this voluntary control is lost. It is when this change takes place that the weakening effect of Lachesis is asserted. Lachesis is a very valuable remedy at the climaxis, especially in the woman who has exhausted herself by frequent pregnancies and hard work. In this worn-out condition there occurs a sudden cessation of the menses. Suppression or non-appearance of discharges always makes the Lachesis patient worse. Perhaps previous to the climaxis she was worse before the flow than during it. The pulse is weak and tremulous. There are the peculiar headache, and the annoying symptoms of the mind, hot flashes, and nervous symptoms characteristic of the drug.

Now, let us consider some of the symptoms of Lachesis in detail. First, as to the mental symptoms. The patient is nervous, anxious, loquacious, jumping from subject to subject; sometimes with fear of being poisoned, which causes him to refuse the medicines you offer. Interesting stories excite immoderately and even intensify the bodily symptoms. Sometimes the anxiety assumes a peculiar type, and he imagines that he is dead, and preparations are being made for the funeral. The loquacity may be accompanied with sleepiness, and yet inability to sleep. Ideas chase each other so rapidly through the mind he cannot write them down. He sits up late at night, mental activity then being unusually increased. But this stage of excitement is commingled w rith another, which soon entirely supercedes it. The mind is weakened. The patient is able to think only with difficulty. He has to stop to think how words are spelled, like Sulphur, Lycopodium and Medorrhinuni. There is vertigo, w Torse on closing the eyes, or on sitting or lying down. Vertigo with deathly paleness; syncope. In this vertigo, fainting, etc.. you may compare Theridion, which has dizziness worse with the eyes closed; but, as a distinctive feature, you will find that under the latter remedy, vertigo, pains and nausea are intensely aggravated by noise. Both remedies are useful in sunstroke. Arsenic, Hydrocyanic acid, Digitalis, Veratrum album and Camphor, you should compare in vertigo and fainting from cardiac weakness.

Laurocerasus or Hydrocyanic acid may be needed in long-lasting faints; there seems to be no reactive power; the face is pale and blue, the surface cold. If fluids are forced down the throat, they roll audibly into the stomach. If the syncope is attendant upon some poison in the system, as scarlatina, the symptoms are similar, the eruption being livid, and, when pressed, regaining its color very slowly (cf. Ailanthus) . Digitalis also rivals the Ophidians in syncope, with the antecedent dim vision; the pulse is generally very slow, and the patient complains of nausea and deathly weakness in the epigastrium. Camphor and Veratrum album display coldness and cold sweaty skin; in the latter remedy, the forehead is cold and sweaty. The face may be red while lying, but if raised, it turns pale and the patient faints; the pulse is thready.

Camphor has icy surface, sudden sinking, as in Laurocerasus , and although so cold, he throws off the clothing as soon as he is strong enough to move, even though he be still unconscious.

Heaviness of the head on waking, with nausea and dizziness, as in sunstroke. In ill-effects of the heat of the sun, compare Glonoine, Belladonna y Natrum card, and Theriolion (see above). The first two, with bloated red face, paralytic weakness (Glon.), unconsciousness, etc., resemble Lachesis, but the latter displays the effects of heat upon one already exhausted. All the Ophidians are intolerant of warm, relaxing weather, and so we find many ailments returning in spring and summer. In the Lachesis case, the patient may be an inebriate or one prostrated by mental fatigue. The sun's heat makes him languid, dizzy, faint, or, if congestions ensue, the face is dark red, and looks at the same time sunken and cadaverous; the extremities are cold. Here Camphor may be demanded if vitality is ebbing away, the fainting spells growing worse, and the body icy cold and bathed in cold sweat. Both Lachesis and Natrum carb. are useful when hot weather fatigues, in which case you should compare, also, Selenium and Natrum mur. Returning now, after this digression, to the mental symptoms of Lachesis, we find that the delirium is of a low, muttering type. At other times the patient seems to be going deeper and deeper into a torpid state, with coolness of the extremities and trembling of the hands and body. When asked to protrude the tongue, it comes out tremblingly, or catches in the teeth, and is usually coated dark brown, sometimes with little blisters on the tip. The lips crack and ooze dark blood. Loquacity is commonly followed by depression, and by weakness which amounts to a typhoid state; then comes delirium, but not of the violent Belladonna type.

These symptoms show Lachesis to be an invaluable remedy in typhoid fever, and in fact in all diseases of a typhoid type. The loquacity just referred to is particularly characteristic. Another mental state which these typhoid patients may have is the delusion that they are under some superhuman power. Diarrhoea is usually present, and the stools are horribly offensive, a strong characteristic of Lachesis, which will also aid you in diphtheria, scarlatina and other diseases of this type. Even when the stools are formed, and in every way natural, they give forth this horrible odor. Lachesis may also be indicated late in the course of typhoid fever, when the patient lies in a stupor with dropping of the lower jaw, and other symptoms indicative of impending paralysis of the brain.

Let me now speak of some of the concordant remedies of Lachesis in these conditions. In the loquacity just mentioned Lachesis should be compared with Stramonium, Agaricus, Mephitis, Actea racemosa and Paris quadrifolia.

Stramonium you will distinguish from Lachesis by the red face and the other evidences of great sensorial excitement.

Agaricus exhibits great loquacity associated with convulsive movements of facial and cervical muscles; merry, incoherent talk. In Mephitis it is as if one were drunk.

Under Actea racemosa the loquacity is usually associated with menstrual suppression, with puerperal mania or as a part of delirium tremens, for which Lachesis also is a useful remedy. Actea cures wild imaginings of rats, etc., sleeplessness, wild crazed feeling about the head, incessant talking with continual change of subject; the patient must move about. Lachesis has more marked trembling of the hands, diarrhoea and greater exhaustion with the loquacity and hallucinations. Paris quadrifolia causes a garrulity which is much like that produced by tea, a sort of vivacity with love of prattling. In these typhoid types of fever you may compare Lachesis with Opium, Hyoscyamus, Arnica, Lycopodium, Apis, Muriatic acid, Baptisia and Rhus toxicodendron . Opium is indicated in typhoid fever with this threatening paralysis of the brain, but the sj Tmptoms under it refer to a very different condition from that of Lachesis. The symptoms which indicate Opium, in addition to this dropping of the lower jaw, are unconsciousness, stertorous breathing, and a dark or brownish-red hue of the face. The darker red the face the more is Opium indicated. With Lachesis the cerebral condition is due to the effect of the typhoid poison on the brain. With Opium it is a secondary effect of the intense congestion of that organ.

Hyoscyamus is perhaps more like Lachesis than is Opium. Here we find the lower jaw dropped; the patient is weak and trembling, and there is twitching of the muscles. This last is a necessary symptom of Hyoscyamus. Here, too, there is snoring breathing, as in Opium, with involuntary stool and great prostration.

Arnica is also indicated when there is great congestion of the brain. The patient lies in a stupor, with lower jaw dropped and eyes fixed, but, even in stupor, as if the bed was too hot and hard. The face is dark red, and stool and urine are passed involuntarily. In addition to these symptoms, we find under Arnica a symptom which differentiates it from the drugs just mentioned, namely, dark spots here and there on the body, irregular in outline and having a black and blue appearance—ecchymoses, as they are called.

Lycopodium is the complement of Lachesis, and is, therefore, more apt to be indicated after it than any remedy I have mentioned. The symptoms which indicate Lycopodium are these: The patient lies in a stupor, with lower jaw dropped and rattling breathing. There is a rattling of phlegm in the throat during both inspiration and expiration, and the eyes are fixed and set, and are filled with mucus. Lycopodium is the most important remedy we have in impending paralysis of the brain; by that I mean to say that it is the most frequently indicated.

Apis has not so markedly the dropping of the lower jaw, but resembles Lachesis in muttering delirium, trembling tongue, etc. The bee-poison, however, causes a nervous fidgetiness with sleepiness and inability to sleep; later, muttering delirium; happy, strange expression; abdomen swollen and extremely sensitive, hands and forearms cold, involuntary stools. This sensitiveness is a bruised feeling, differing from the hyperesthesia of Lachesis.

Muriatic acid displays a sunken face, tongue smooth as if deprived of papillae, or brown, shrunken and hard; sliding down in bed from muscular weakness.

Baptisia has dark, besotted face, drowsiness and stupor, goes to sleep while answering questions; discharges from the bowels dark, fluid and very offensive.

Rhus tox. may simulate Lachesis in one phase of its action, namely, when drowsiness appears and there are muttering; dry, cracked tongue, sordes and involuntary stool. In degree the snake poison is undoubtedly lower than Rhus, and, therefore, other things being equal, comes in later. Rhus has a well-marked restlessness with relief from motion; loquacity is not prominent; the tongue has a red, triangular tip, and the discharges are never so offensive as those of the former remedy. You must bear in mind that Rhus is an erethistic remedy, and must be very similar to existing symptoms if it is to be continued after torpidity sets in without erethism.

Leaving the mental symptoms of Lachesis and the indications of it and its analogues in typhoid fever, we will next consider its head symptoms. We find that it produces a pulsating headache usually in the left temple and over the eyes, with mental confusion before the development of a coryza, relieved as soon as the coryza appears. This is a universal characteristic—as soon as a discharge is established the patient feels better. I have relieved dysmenorrhea with Lachesis when there was a headache preceding the dysmenorrhea, but relieved as soon as the flow was established. At the menopause there is burning in the vertex.

In catarrhal and rheumatic headaches you may compare Mercurius, Cinchona, Pulsatilla, Bryonia and Gelsemzum.

Mercurius relieves headache from suppressed coryza when there is pulsating headache with pressure towards the nose, worse when warm in bed and from damp, windy weather. Cinchona, when the pain is worse from the least draught of air. Bryonia and Pulsatilla come into use when the checked catarrhal secretion is thick, and yellow and green, respectively. Gelsemium, when motility is lessened and the patient is drowsy, with neuralgic pains from occiput to forehead and face.

The headache may also arise from disordered stomach or bowels, or may be an accompaniment of fevers and of diseases of zymotic origin. The patient has an upward tendency of the blood, with throbbing in the head, dark redness of the face, puffed face, confusion of the mind, all the way from simple confusion to absolute stupor, often accompanied, too, by partial blindness, palpitation of the heart, and fainting. The pains about the head are briefly as follows: Sharp sticking, which seems to concentrate at the root of the nose; at other times the pains go from the zygoma to the ear. This direction of the pains is characteristic. As a parallel of this shooting pain from the zygoma to the ear we have pains from the head going down through and into the eyes. These are all characteristic pains of Lachesis. There is an additional one that I will now mention, which is probably of rheumatic origin; pains in the head, going down into the shoulders and neck of the affected side, and often accompanied by slight stiffness of the neck, either catarrhal or rheumatic.

You may have Lachesis indicated in severer forms of the head trouble; for instance, in inflammation of the membranes of the brain; sharp pains in the head, making the patient scream out; tongue showing papillae; strawberry tongue; patient rolls the head from side to side, and bores it into the pillow. Particularly useful is Lachesis when an exanthem, like scarlatina or erysipelas, has not developed or has been repercussed. The patient is at first very drowsy, but unable to sleep; there is trembling or palpitation of the heart. Soon stupor ensues, and he becomes heavy and sleepy, and you can rouse him only with difficulty.

In intense head pains, as in meningitis, you should remember the relation between Belladonna and Lachesis, the difference between these drugs being rather one of degree. Both are suited to meningitis from erysipelas, to scarlatina, to apoplexy, etc. ; but the former represents the initial stage of these diseases, or the state in which, even though there be stupor, there are still evidences of irritation and not wholly of depression. Thus, under Belladonna, the patient often starts from his heavy sleep, cries out, grinds the teeth, awakens frightened, etc. His pulse is usually strong and the surface congestions are bright red, or if more intense, deep red and livid. If there is an eruption, as in scarlatina, it is red, even if sparse, but vitality is not so low that the extremities are cold or the rash bluish, and the cellular tissue infiltrated and threatening an unhealthy suppuration, as in the snake-poison. Often, however, after the use of Belladonna we find evidence of cerebral exhaustion, or blood-poisoning, or impending paralysis, in which case Lachesis may be required. The patient still cries out in sleep or awakens frightened, the tongue still shows elevated papillae, the head is hot, and the face is red; but the pulse is quicker,and more feeble, the feet are cold, the surface heat is irregularly distributed; the mind is more befogged and drowsiness is stealthily creeping on, the inflamed part or the pseudomembrane or the eruption, as the case may be, is becoming more purplish—these indicate the change.

Considering the action of Lachesis on the special senses, we find the eyes to be affected by the drug. Dim vision, worse on awaking; dark spots appear before the eyes; sight suddenly seems to fade away; feeling of faintness and palpitation of the heart; with these, nervous trembling. Lachesis is one of the leading remedies for dim sight as an evidence of heart disease and vertigo. We may also use it with good effect for what we may term retinal apoplexy. There it acts very well in causing an absorption of the blood.

The nearest remedies to Lachesis in this condition of the retina are Crotalus, Phosphorus, Arnica, Belladonna and Hamamelis. Scrofulous ophthalmia calls for Lachesis when the symptoms are decidedly worse after sleep. There are gr:at photophobia and pains of a burning, stitching, shooting character, extending to the temples, top of the head and occiput. There are also itching and stinging in the eyes and lids, worse from touch. Vision is misty, with black flickering before the eyes.

Crotalus may also be called for in keratitis when there are cutting pains around the eyes, lids swollen in the morning, ciliary neuralgia with these cuttings, worse during menses.

In the diseases of the ear, Lachesis ma}' be remedial for roaring and singing in the ears, and other sorts of tinnitus aurium, which are relieved by putting the finger in the ear and working it. This shows that the tinnitus is not congestive, but of catarrhal origin, especially from occlusion of the Eustachian tube. The wax is altered in quality and becomes pasty and offensive. There is swelling between the ear and the mastoid process, with throbbing pain and stiffness. You can here compare Nitric acid, Capsicum, Auruni, Hepar, and Silicea. Elaps and Crotalus also have an action on the ears. Elaps, like Lachesis, produces a catarrh with black cerumen, buzzing in the ears, and otorrhcea. In Elaps, the discharge is yellowish-green, liquid and bloody. Only Lachesis seems to have the Eustachian stoppage, better from shaking the finger in the external meatus. Crotalus causes a stuffed feeling in the ears, worse on the right side, associated with a feeling as if hot ear-wax was trickling out. The face in the Lachesis patient varies, of course, with the condition that obtains in the system at the time. In many of the diseases in which the remedy is indicated the face has an earthy pallor. In exanthematic diseases it is apt to be bloated or puffed, and bluish-red; if the eruption comes out, it appears sparsely and is of a dark color. Anxious and painful expression with the stupor; face disfigured, puffy, hot, red and swollen, as after a debauch; blue circles around the eyes. With abdominal troubles, as in ague, the face is earthy gray.

Lachesis also has convulsions of the face; lockjaw; distortion of the face; stretching the body backward; screaming; feet cold and itching. Sudden swelling of the face.

For swollen face, you may compare: Apis, Belladonna, Arsenic, Lycopodium, Hyoscyamus, Rhus tox., Pulsatilla, Stramonium, Kali carb., and Phosphorus.

For sickly, pale, or earthy complexion: Arsenic, Bufo, Lycopodium, Carbo veg., Rhus tox., Cinchona, Phosphorus, and Phosphoric acid. Blue around the eyes: Arsenic, Cuprum, Phosphorus, Secale cornutum , and Veratrum album.

Debauched look: Baptisia, Hyoscyamus, Carbo veg., Nux vomica, Sulphur, Opium, Nux moschata.

In facial convulsions compare: Nux vomica, Hyoscyamus, Belladonna, Hydrocyanic acid, Lycopodhim, Cicuta, Camphor, Phytolacca, Arsenic.

Apis, Arse7iic, and Kali carb. agree in puffing of the face even without any redness. In the first, there are also smarting of the eyelids, and a sensation of stiffness. In the second, the swelling is noticed about the eyes, glabella and forehead (also Natrum ars.). Kali carb. has the well-known sacs of the upper lids, and also sudden swelling of the cheeks.

The expression, complexion, etc., of Arsenic are very similar to those of the snake-poisons. The anxiety and pain are marked by more restlessness, irritability, fear of death, etc., and the sunken face is more completely Hippocratic, with pointed features, sunken eyes and cold sweat. When yellow or earthy, it is cachectic. If trismic symptoms are present, the patient will be found lying pale, and as if dead, yet warm. Suddenly he arouses, and goes into severe convulsions, only again to relapse into this sort of cataleptic rigidity. The eyes are partly open, with gum on the conjunctiva.

Lycopodhim has pale or yellow face, deeply furrowed, looking elongated. The convulsive movements are unique. All through the provings of this remedy you will note an alternation of contraction and expansion. And in the face you note the tongue pushed out and withdrawn, spasmodic trembling of the facial muscles, angles of the mouth alternately drawn up and relaxed, alse nasi alternately expanded and contracted. The eyes may be partly open and covered with mucus — a bad symptom, generally being indicative of brain exhaustion. Phosphorus has a pale face, but it is distinguished by its ash}-, anaemic appearance. This should be remembered, since this remedy, like the Ophidia, has puffy face, sunken features, blueness around the eyes, and blue lips.

Hyoscyamns is very similar to Lachesis in facial expression and in the convulsive phenomena. It has a marked stupid, drunken look; the face is distorted and blue, or swollen and brownish red; starting; twitchings of single groups of muscles are noted. Hunger appears before the attacks.

Stramonium is readily distinguished by its swollen, turgid face, fright on awakening, renewal of spasms from light, and contracted gloomy expression, with wrinkles of the forehead.

Hydrocyanic acid closely agrees in convulsive symptoms and in the color of the face. As in Llaps, fluids roll audibly into the stomach; but in the latter it is more as a spasmodic contraction of the sphincters, followed by sudden relaxation. In convulsions, the surface, in the acid, is pale blue, and the muscles of the face, jaw, and back are affected. Suddenly a shock is felt, which passes like lightning from head to foot, and then comes the spasm. Here, the remedy is more like Cicuta and Helleborus than Lachesis. But Cicuta has, like the snake-poisons, great difficulty in breathing from spasm, and, more than any remedy, it produces staring; the spasm is followed by disproportionate^ severe weakness.

Camphor is readily distinguished from Lachesis by the coldness and by the withdrawing of the lip, showing the teeth.

Lachesis is indicated in erysipelas of the face. Characteristically, the disease will be most marked on the left side. The face at first may be bright red, but it soon takes on a dark bluish hue. There is considerable infiltration into the cellular tissue, so that we have puffiness of the eye of the affected side. Now the characteristic bluish face is due to the accompanying weakness. Kven in the beginning, while the skin is still red, the pulse, though accelerated, is weak, the feet are apt to be cool, and the head is affected sympathetically, so that the patient readify becomes drowsy, with muttering delirium; or the opposite condition of pseud o-excitement—the loquacity w Thich I have already mentioned—obtains.

You must now distinguish this erysipelas of Lachesis from that of the remedies which are akin to it; among these is Belladonna . In its early symptoms, Belladonna bears no resemblance to Lachesis. But in the course of the disease, when the inflammation is so intense that the bloated face grows bluish red, threatening gangrene, or when the brain becomes affected, differentiation is necessary. Here, both have hot head and cold feet, delirium, dry tongue, etc. But Lachesis suits when the cerebral symptoms fail to yield to Belladomia, and the excitement gives way to muttering stupor. The pulse is weak and rapid, and the cool surface of the limbs is plainly due to failing vitality rather than to the upward tendency of the blood. Crotalus holds the same relation to Belladonna.

Apis mellifica is indicated in erysipelas when the affected parts exhibit a tendency to become cedematous. If the face is involved, the eye-lids protrude like sacs of water. The face is usually of a pinkish hue, or it may be dark purplish, but it never has the deep bluish-black hue of Lachesis.

Although there may be a similar destructive tendency, the condition of nervous irritation produced by the bee-poison is very different from that of any of its congeners. It is a fidgety, nervous state, a fretted feeling, which deprives the patient of sleep, although he feels sleepy. Rhus toxicodendron is suited to the vesicular form of erysipelas. The patient is drowsy, as under Lachesis, little blisters form on and about the face, and the face is dingy red, not the bluish-black of Lachesis nor the purple of the intensified Apis case.

If vesicles form in the Lachesis case, they quickly fill with pus. Speaking relatively, Rhus produces more vesiculation and burning, stinging and itching, with more aching of the limbs and restlessness; Lachesis, more bluish-red inflammation, with gangrenous tendency. Euphorbium, since it causes gangrene with erysipelas, anxiety as from poison, apprehensiveness, dim vision, etc., deserves your notice. The right cheek is of a livid or dark red hue, vesicles form as large as peas, and are filled with a yellow liquid. The pains are boring, gnawing and digging in character, and extend from the gum into the ear, with itching and crawling when the pains are relieved.

Lachesis may be indicated in prosopalgia when the pain is worse on the left side, and when there are tearing pains above the orbit and digging and screwing pains around the malar bone. Delirium appears as soon as the eyes are closed.

The teeth decay and crumble. The gums are swollen and bluish, with throbbing pains. Lachesis may be successfully used in periodontitis and abscess at the root of a filled tooth (compare Mercurius, Hepar, Silicea, Lluoric acid and Petroleum.

Of the allied remedies in toothache none is so similar as Mercurius, which, like Lachesis, relieves when the gum is inflamed and the tooth decayed, with abscess at the root. It is said to have a direct action on the dentine. The pains are tearing and pulsating, and shoot into the face and ears. In Lachesis the gum is swollen, and at the same time dark red and livid, or it is tense and hot and looks as if it would crack. Mercurius is markedly worse from the warmth of the bed. Lachesis often follows the latter, or is needed at once if the patient has been previously salivated. Only Mercurius has dirty gums, with white edges.

In sore mouth, aphthae, etc., Lachesis should be compared with Baptisia, Nitric acid, Muriatic acid, Arsenic and Apis; while Mercurius compares more with Carbo veg., Staphisagria, Kali chlor., Iodine, Sulphuric acid, Nit} ic acid.

Baptisia has blood oozing from the gums, which look dark red or purple, salivation,foetororis, offensive stools, and thus far is precisely like Lachesis. Both, too, are indicated in the stomacace attending the last stages of phthisis. Decide by general differences and also by the tongue, which, in the former, is yellow or brown down the centre, with red, shining edges. In the latter, it is red, dry and glistening, especially at the tip, and has its sides and tip covered with blisters. Nitric acid causes an acrid saliva ; the pains in the mouth are pricking in character, as from a splinter; the aphthae and gums are usually whitish; there are raw places, with shooting pains.

Muriatic acid presents deep, bluish ulcers, with dark edges; the mucous membrane is denuded in places, the raw spots being dotted with aphthae.

Arsenic looks very much like Lachesis, with livid, bleeding gums, edges of tongue blistered, or ulcerating diarrhoea. The burning is more intense, and is associated with restlessness, compelling motion in spite of the weakness. In gangrena ofis it causes more acute pain and heat in the mouth; both have bluish or black sloughing ulcers. Arsenic has more mental irritability.

Apis has blisters marking the border of the tongue, or in clusters. The mouth is usually rosy-red, swollen, and there are marked stinging pains; the margin of the tongue feels scalded, as does the mouth generally.

Carbo veg. , Staphisagria and Sulphuric acid agree more with Mercurius; the gums are white, spongy, ulcerated, rather than livid. Staphisagria may cause sores, which look bluish-red or yellow; especially is it needed after abuse of Mercury, or in syphilitic cases when the general debility is marked with sunken face, blue around the eyes, etc. Sulphuric acid produces great debility, yellowish-white gums, yellow skin; the patient is nervous and hasty, and constantly complains of trembling, which, however, is not observed by others.

Salicylic acid causes the common canker sores, with burning soreness and foetid breath.

Lycopodium produces similar sores near the fraenum of the tongue, Lachesis at the tip, and Nitric acid, Phytolacca, Natrum hydrochlor. on the inner sides of the cheeks.

Phytolacca has some systematic resemblance to Lachesis here as well as in the throat (see next lecture). Both cause great weakness, dim vision, sunken face, blueness around the eyes, sore mouth, tongue blistered along the edges, tip of tongue red, roof of mouth sore, profuse saliva. The poke-root may be distinguished by the great pain at the root of the tongue when swallowing. These pains are a part of the tired aching and soreness which are general over the body. Helleboi'us produces canker in the mouth, but the sores are yellowish, with raised edges.

Returning to the subject of decayed teeth, it may be noted that Kreosote cures pains extending from teeth to left side of face; teeth decay rapidly, gums bleed, the blood being dark; but the accompanying facial pains are burning, and the patient is excitable, nervous, even, as in children, thrown into convulsions.

Thuja causes a decay just at the border of the gums, leaving the crown apparently sound. Gums dark-red in streaks. Teeth turn yellow and crumble.

Lecture IV (continued)

Lachesis (conti?iucd)

Next we take up the action of Lachesis on the nose, throat, and chest, so far as catarrhs are concerned. Lachesis produces watery discharge from the nose, which is often preceded by throbbing headache, worse in the left temple and forehead, and relieved as the coryza establishes itself. Accompanying this coryza sometimes are vesicles about the nose, redness, puffiness of the face and lids, creeping chills over the body, palpitation of the heart, and great relaxation of the whole system; hence it is suitable for a cold which occurs in relaxing weather, consequently in the spring of the year. Lachesis may also be used in ozsena of mercurial or syphilitic origin. Here you may compare Kali bichromicum, which follows Lachesis well; and also Aurum, Nit) ic acid, Mercmius, and Lac caninum. The last-named drug cures syphilitic ozsena and angina when the corners of the mouth and alsenasi are cracked.

The cold may extend to the throat, and then we will find that the tonsils are enlarged, particularly the left one, or the inflammation may tend to spread from the left to the right tonsil. The throat, when examined, exhibits a red hue, not bright or rosy-red, but bluish. The patient complains of a sense of constriction, as though the throat were suddenly closing up, or a sensation as though there were a lump in the throat which he must constantly swallow, but which as often returns. Pains in the left side of the throat extending to the tongue, jaw, ear. Rawness and burning. The throat externally is exceedingly sensitive to touch. Unless the tonsils are going on to suppuration , there is relief from swallowing solids, while swallowing of liquids and empty swallowing increase the pains. I except suppurating tonsils because, when they are large and stop up the fauces, nothing can be swallowed; then the attempt to take anything is followed by a violent ejection of the food, through either the mouth or the nose. But with the ordinary catarrhal sore throat, when the tonsils are not parenchymatously swollen, the swallowing of food often relieves the irritation for a time. The cold may travel farther down and involve the bronchial tubes, when a different class of s3 rmptoms develops. The patient may suffer from tickling, irritating cough, which is especially apt to come on as he drops off to sleep, arousing him as if he were choking. He can bear nothing to touch the larynx or throat, so that he loosens his neckband. These, briefly, are the catarrhal symptoms of Lachesis. But suppose, while we are considering this locality, we look to more serious affections which may manifest themselves in these parts, diphtheria, for example. Lachesis may be indicated in diphtheria of one or all of these parts. Symptoms for which you will be called upon to prescribe it are mostly those that I have already given you, with these points in addition: The discharge from the nose is thin, sanious, and excoriating; a really dangerous objective symptom. The throat is, if anything, a darker red than in the catarrhal state. The membrane is more marked on the left tonsil, or has an inclination to go from the left to the right. It early develops that gangrenous state which obtains in diphtheria, with the attendant foetid breath, and the increased danger of systemic infection. The tissues surrounding the throat are often infiltrated so that you have swelling of the glands about the neck, and also of the cellular tissue. The swelling may be so great that the neck becomes even with the chin and sternum. The lymphatic glands are swollen, too, and have a dark purplish hue, and threaten suppuration. When pus does form, it is not a laudable pus. The child is drowsy, even though feverish; the heart, though beating more rapidly than normal, is evidently greatly weakened, as is shown by the feebleness of the pulse and coolness of the extremities. This is the kind of diphtheria in which you can hope much from the use of Lachesis. The diphtheritic deposit may extend down into the larynx, and the remedy still be indicated. You must not infer from this that Lachesis is the remedy for laryngeal diphtheria; but when it has the characteristic symptoms which I mention, it may be needed; the patient arouses from sleep smothering, and has a diphtheritic, croupy cough. Crotalns and Naja, like Lachesis, have relieved in diphtheria. The former has been selected when the epistaxis is persistent; blood oozes from the mouth, not merely coming from the posterior nares but escaping from the mucous membranes of the buccal cavity.

Naja has helped in cases just like Lachesis, when the larynx is invaded; the patient grasps at the throat, with a sensation of choking, the fauces are dark-red; there is foetid breath, and short, hoarse cough, with raw feeling in larynx and upper part of the trachea. Lac caninum is very similar to Lachesis in diphtheria, but is readily distinguished by its peculiar habit of alternating sides. Starting on one side, frequently the left, the soreness and swelling, and even the membrane, suddenly shift to the opposite side, only to return, in a few hours, to the starting point. The membrane is grayish-yellow and curdy, and if ulcers form, they shine like silver-gloss. Lycopodium, which also resembles Lachesis, has aggravation of the symptoms from 4 to 8 p. m. The right side is mostly affected; the child awakes from sleep frightened or cross and angry.

Apis is to be distinguished by the oedema of the throat, the stinging pains, the blisters on the border of the tongue, etc.

Again, you may find Lachesis of great service in affections of the lungs. We ma)- use it in asthma when there are present one or more of these few symptoms. The patient arouses from sleep with the asthmatic paroxysm, and cannot bear the least pressure about the neck or chest; finally, he coughs up a quantity of water}- phlegm with great relief. This last is a neglected characteristic of Lachesis in asthma. I have succeeded with it in relieving an incurable asthmatic for months. In pneumonia Lachesis may be useful, but not in the early stages of the disease. There is nothing in the provings of Lachesis to suggest that it will be useful in pneumonia. It does not cause the engorgement of the lungs, the fever or the fibrinous deposit. But it ma)- be indicated in the later stages of the affection, when it assumes a typhoid form, especially when an abscess forms in the lungs. Brain symptoms, such as low muttering delirium and hallucinations, appear. The sputum is frothy, mixed with blood, and purulent, and the patient is bathed in a profuse sweat.

Sulphur is, perhaps, the better remedy to prevent suppuration when there are no typhoid symptoms, but be careful how you give Sulphur if tuberculosis has been developed by pneumonia. To do so is almost like giving a person running down hill another push. It will only hasten the end.

In chest affections Elaps is sometimes of great service. It affects the right more than the left lung, but both may be diseased. In the morning there is pain in the right side severe enough to prevent the patient's getting up. There is a feeling of coldness in the chest after drinking. The cough is accompanied by intense pains in the chest, worse in the right apex, as if it were torn out, and the sputum consists of black blood.

You may use Lachesis in phthisis, not necessarily to cure, but to relieve. Remember it when, in the course of typhoid fever or pneumonia, tubercles have been deposited in one or the other lung. You may use it in the advanced stages of tuberculosis of the lungs when the patient has a retching cough, which arouses him from sleep, and which ends in expectoration of tough, greenish muco-purulent matter, which causes gagging, and is vomited rather than clearly expectorated; when the patient sweats during every nap, the sweat being most copious about the neck, shoulders and chest, and when the strength is greatly reduced and the pulse indicates extreme prostration. Next we turn our attention to the alimentary canal from the mouth down. I referred to the tongue in speaking of the typhoid condition. Lachesis is useful for weakness of digestion in patients who, from some vicious habits, from abuse of Mercury, or of Quinine, or of alcohol, have so exhausted their stomachs that even the plainest food causes indigestion. Acids especially disagree, aggravating the stomach symptoms and causing diarrhoea. Sometimes a gnawing pain is relieved by eating or improves immediately after a meal, but soon a heavy pressure, as from a weight in the stomach, and other symptoms of indigestion show themselves. There may be a craving for coffee and oysters, which may not disagree.

The liver is affected by Lachesis. Like all the snake-poisons, it causes jaundice. Even when abscesses form it may be useful by reason of the tenderness on pressure, intolerance of clothing, and deep throbbing in the right hypochondrium.

The bowel symptoms are not numerous, though they are important. We find diarrhoea caused by the drug, with watery, horribly offensive stools; diarrhoea during the climaxis; diarrhoea of drunkards. Especially may Lachesis be used in chronic diarrhoea with great debility and aggravation in spring weather. The tongue is smooth, red and shining {Kali bi.). The abdomen is bloated; very sensitive to touch about the waist. Constant tormenting urging in the rectum, but not for stool. It is merely a spasmodic condition of the bowels with an unduly irritable sphincter. The rectum protrudes and is held by the constricted sphincter; after stool there is often a sensation in the rectum as from the beating of little hammers. These symptoms are common enough in dyspeptics, particularly in those who have, abused alcohol. They are not infrequently associated with large, protruding haemorrhoids, which are worse at the menopause, or with scanty menses, with stitches upward at each cough or sneeze. They occur also in connection with constipation. The patient attempts to strain at stool, but must desist on account of pain in the sphincter. Unsuccessful urging; the anus feels closed. Stool hard, like sheep's dung, and excessively offensive.

In dyspepsia Lachesis is very similar to Hepar. The latter remedy, however, has relief of the symptoms from the use of condiments. Under Hcpar the plainest food disagrees. The cravings are unique. As if knowing instinctively what will "tone up" the stomach, the patient longs for condiments or wine. Eating relieves the relaxed feeling, but food annoys as soon as the digestive process begins its slow and imperfect work. The bowels move very sluggishly, even when the stools are soft.

Cinchona, too, enfeebles digestion and induces great weakness and languor after meals. It also has a craving for coffee-beans. Fruits induce diarrhoea with intestinal fermentation. Both cause fulness after eating, but only in Cinchona is the fulness so severe as to cause pain, with little or no relief from belching. Bitter eructations and bitter taste belong to each; the latter has the altered taste after swallowing, food retaining its normal taste while being masticated. The discharges from the bowels and the flatus are offensive; yellow watery stools, undigested. But the marked aggravation at night, after a meal, and the resulting prostration, are not at all like Lachesis. In dysentery, etc , when putrid or gangrenous changes occur, the choice is more difficult. Both have cadaverous smelling discharges of a chocolate color, with coldness and great debility. And, although Cinchona is far preferable if the disease is of malarial origin, such a complication does not contra-indicate the snake-poison. The apparently close similarity is also enhanced by the nervous excitability in both. Light touch is distressing, the epigastrium is sensitive, and clothing annoys in each remedy. But this in Cinchona is an increased general sensibility, while in Lachesis there is general torpor, with hyperesthesia of the cutaneous nerves. The former is suitable when the offensive discharges follow a severe, rapidly exhausting inflammation, or when the frequency and quantity of the evacuations have greatly reduced the vitality, thus favoring retrogressive changes. If hectic symptoms are present, the choice is rendered more certain. In addition, we may also refer to the well-known anaemic symptoms of Cinchona, paleness, ringing in the ears, easy fainting, etc., which show at once how it affects the blood.

Mercurius presents many points of similarity with Lachesis. The latter frequently follows the former, and also antidotes its abuse. There are loss of appetite, coated tongue, nausea with oppression, and epigastric tenderness. Pressure in the pit of the stomach produces a deadly faintness. The stomach hangs heavily, even after a light meal of food of ordinary digestibility. The sensitiveness of the stomach to the clothing is a part of a symptom which is completed by a similar tenderness over both hypochondria, with fulness and upward pressure from the abdomen. The patient cannot lie on the right side. If hypochondriacal, he is suspicious, anxious and restless at night, with vascular erethism and sweat. In fact, this erethism is directly contrary to the torpid Lachesis.

In abdominal inflammations with suppuration, as in typhlitis, both remedies are useful and follow each other well. Mercurius has its ever-present perspiration without relief; stools slimy, or much straining, with or without stool. Lachesis follows when the symptoms threaten a typhoid condition. The patient can lie only on the back with the knees drawn up; if he turns to the left side, a ball seems to roll over in the abdomen.

In the rectum and anus, Mercurius has more persistent tenesmus; protrusion of the rectum, which looks inflamed and blackish; Lachesis \ more spasmodic tenesmus, with constriction of the anus, which tightly constricts the prolapsed rectum. Both have chronic constipation. The former induces much straining, with tenacious or crumbling stools; chilliness during defecation.

Arsenicum intensifies the gastric and systemic weakness to which we referred in the remedies just considered. While it is true that the patient does not fully realize his want of strength, and hence does not care so much to lie quietly, nevertheless the actual amount of his vitality is seriously reduced. In a word, he is excessively weak without feeling so fatigued. Any exertion produces fainting. Taste is lost, or is bitter, sour, and putrid. The stomach feels swollen as if full of water. Craving for acids and for coffee; the latter, as in Lachesis, agrees with the patient. There are burning feelings, red rough tongue, and anxiety and distress after eating, as in subacute gastritis, which no remedy pictures better. Nausea is frequent, and often periodical (12 p. m.) and is accompanied by great prostration. The vomiting is of manykinds, but is distinguished from the bilious, slimy, or bloody emesis of Lachesis by its irregular convulsive character, indicative of gastric irritability. Lachesis is adapted to the nervous weakness and trembling of drunkards; spasm of the stomach, spasmodic constrictions, relieved temporarily by eating; vomiting of bile or mucus; Arsenic is adapted to burning periodical pains, with sour acrid vomiting; violent thirst, but vomits the water.

Cadmium sulph. has nausea, } Tellowish or black vomit, saltish rancid belching, cold sweat of the face, burning, cutting in the stomach; cramps after beer, griping in the lower part of the bowels. Both this remedy and Lachesis induce marked sensitiveness to touch upon stomach or abdomen, spots of burning soreness here and there over the swollen abdomen (peritonitis); offensive, bloody, chocolate-colored discharges, as in dysentery, with constriction in the bowels; cutting pains in bowels. But in Arsenic there is more lamenting with agonized expression; restless moving despite the pains. The constriction of the intestines is torturing; the patient declares he cannot stand it, and rolls about in agony, despairing of his life. The extreme tenderness of the pit of the stomach denotes a more positive state of acute inflammation than Lachesis causes.

In the vomiting of yellow fever Lachesis has, in addition, brown coating on the teeth and abdominal tenderness.

Arsenic has also spasmodic protrusion of the rectum; very painful tenesmus with burning; haemorrhoids, especially in drunkards; they protrude at stool with burning. Alvine discharges are offensive, dark, sometimes involuntary, with great weakness and coldness. But Lachesis has less tenesmus recti, the distress there being attributable to a constriction of the anus not found in the other drug. Arsenic, moreover, causes more acridity of the stools, with rawness and excoriation of the anus.

All that I have here stated regarding the difference between these two drugs might be tersely stated thus: One causes intense irritability and acnte inflammation of tissue, mental anguish, and extreme prostration; the other, torpidity, with loss of vitality, but associated with nervous excitability, constrictions, and cutaneous hyperesthesia. Still, some minds require more attention to detail; and every one retains general mental impressions more accurately if they are formed with due attention to particulars.

When there is ulceration of the bowels, tendency to sloughing, with offensive, purulent, or bloody discharges, the two remedies are very nearly allied. Vitality is at a very low ebb; blood oozes from the cracked lips and tongue, and the extremities are cold. But even here the best distinctions are the mental irritability of Arsenic, and the intolerance of pressure of Lachesis.

Carbo vegetabilis resembles Lachesis in weak digestion, complaints of drunkards, flatulent asthma, constriction of the oesophagus, annoyance from clothing about the waist, offensive, bloody, decomposed, purulent stools, collapse, etc.

There is craving for coffee, but it does not relieve. Milk disagrees in both remedies, but only the snake-poison has craving for it. Carbo veg. has aggravation from fats, tainted meats, fish, oysters, foods causing flatulency, ices, vinegar, and sour cabbage—the latter principally on account of the flatulency it causes. Eructations are sour, rancid. Both drugs have relief of flatulent distension from belching, but Lachesis has an ill feeling in addition, which is relieved. Both drugs experience freer breathing after belching. In Carbo veg. this is expressed as the lessening of a tension and upward drawing which marks the costal attachments of the diaphragm; in Lachesis there is a relief after eructations which seem to suffocate him. They come rapidly, and induce the ever-present Lachesis constriction of the throat. The latter remedy also has empty eructations, which intensify the pains.

Carbo veg. has heaviness, fulness, sleepiness after eating, with fulness of the abdomen, almost to bursting. Burning in the stomach is also increased. This heaviness is very characteristic, and is noted likewise in the abdomen, which seems to hang heavily; also in the head, which feels as heavy as lead. The burning is attended with a creeping feeling up to the throat. In Lachesis, the fulness and pressure is as from a load, and the sense of repletion induces lowness of spirits. There is, also, a feeling as if a lump were forming in the stomach and also in the bowels; burning, with hard abdominal distension, and a feeling as if a stone was descending; he must stand still or step cautiously. This lump is presumably a part of the Lachesis constriction, which we have so often designated as highly characteristic. In Carbo veg. the flatus is more rancid, putrid, or, when passed per anum, burning, moist, offensive. Its incarceration with burning is a cause of many of the symptoms, and it is more in quantity than in the snake- poison. It also causes a bearing down upon the bladder and sacral region. Lachesis relieves a gnawing gastralgia, when eating lessens the pain; Carbo veg. cures when there is burning, with a constrictive cramp, bending him double; the pains are paroxysmal and take his breath. The burning spreads up to the chest and down into the abdomen, seemingly following the sympathetic.

Tenesmus recti is most prominent in Carbo veg., anal constriction in Lachesis It is this latter symptom which explains, as we have before observed, the ineffectual urging to stool; while in Carbo veg. the urging is fruitless on account of the pressure of flatus. Both have bluish, protruding piles, as after debauchery. This constriction distinguishes them, as do also the headache and diarrhoea In each there is throbbing headache, but Carbo veg. has more of the heaviness, and the diarrhoea is thin.

In typhoid conditions, whether the specific fever, or as a sequel to peritonitis, dysentery, etc., Carbo veg. causes the more perfect picture of collapse, while in Lachesis the cardiac debility, drowsiness, cool extremities, etc., indicate failing vitality, but the patient is not so near death as in the former drug. Inthe collapse of Carbo veg. there are tympany; cold legs, especially to the knees; filiform pulse; cool breath; absence of discharges from the bowels; or involuntary, putrid, bloody, purulent diarrhoea.

In hernia, Carbo veg. has anxiety, as in Arsenic, but with uneasiness rather than restless change of place; and it resembles Lachesis in the annoyance of the clothing, foulness of the parts, if strangulated, etc. There is, however, more meteorism and foetid flatus. Graphites has anxiety, melancholy; tip of the tongue blistered; feeling of a lump in the left side of the throat, over which the food seems to pass with difficulty; on empty deglutition, a constrictive retching from the oesophagus up to the larynx; must loosen the clothing after eating; gastralgia, relieved by eating; chronic gastritis, especially after abuse of alcoholic drinks. Sensation of a lump in the stomach; flatulent distension of the abdomen, with congestion to the head; foetid flatus. Suffocative spells arousing from sleep, must jump out of bed; compelled to eat something to relieve the pain. Offensive stools. But this remedy causes more flatulence than Lachesis. The gastralgic pains are burning and griping, and the feeling of a lump in the stomach is accompanied by a constant beating; the heartburn is rancid. The suffocative spells are usually worse after 12 p. m. instead of during or after a sleep at any time; and the constriction noticed on falling asleep is of the chest instead of the larynx. The offensive movements from the bowels are half-digested, dark and pappy, indicating the imperfect digestion which is so characteristic of this remedy.

There is some resemblance in the constitutional symptoms of Graphites and Lachesis, since both are needed at times in phlegmatic patients; but the former is related to a distinguishing type; fat, cold and costive; skin herpetic, rough and disposed to crack and ooze a glutinous fluid. Aside, then, from a few resemblances to the snake-poison, Graphites belongs more with Arsenic, Nux vomica and Lycopodium. It resembles the first two in gastritis and gastralgia; the latter in flatulency. Sulphuric acid resembles the snake-poisons somewhat, especially in the ailments of drunkards. Its corrosive effects, however, are distinctively prominent, as shown in the violent inflammation of the alimentary canal. But the nervous system is so involved that several symptoms look like those of Lachesis, as, for instance, epigastrium sensitive, constrictive feeling in the bowels, griping, cutting, twisting, with faint-like nausea; trembling, pale face, apprehensiveness; fluttering pulse; cramps in the pharynx; he cannot swallow; oesophageal stricture; great weakness, etc. Both, moreover, crave brandy. The acid acts well when the patient is weak, emaciated and complains of trembling, which, however, is more subjective than objective. He is anxious and restless; must do everything hurriedly. The face is pale, and sometimes presents dry, shrivelled spots, especially when the haemorrhoids are worse. Eructations are sour. The stomach feels relaxed and cold. Wine may palliate and distilled liquors aggravate, as in Lachesis; but the peculiarity of the acid is that the stomach rejects cold water unless it is mixed with brandy. The abdominal muscles are spasmodically retracted. Stools are yellow, like Lachesis, but present a chopped appearance, and are stringy; they are watery, diarrhoeic and very offensive. Piles are moist, burn, and may prevent defaecation.

As the acid causes croupous formations, it should be remembered with Lachesis when the stools indicate such a condition in the intestine. The acid also resembles Elaps; drinks feel like ice in the stomach; but only the former has the relief from the admixture of spirit. The Elaps diarrhoea resembles that of the rest of the order, but this remedy is particularly called for when the stools consist of black, frothy blood with twisting pains in the bowels.

Colchicum deserves mention here, especially since, like Lachesis, it causes coldness or cold feeling in the stomach {Elaps), intolerance of pressure of the clothing, burning in the stomach, vomiting and purging, spasms ofthe sphincter ani ', urging to stool, offensive flatus, offensive diarrhoea, sensitiveness to the least touch, very much exhausted, slow breathing, feeble pulse. But there is generally present nausea, worse from the smell of food; if the patient sits or lies very quietly, the vomiting is suppressed (like Veratrum) . Senses too acute; a bright light, touch or strong odors irritate him (like Nux vom.) . Vomiting and purging as in cholera morbus; the sphincter ani contracts after each stool, with fruitless urging. The similarity, then, exists chiefly in the sensitiveness to touch and the constrictions of sphincters with weakness, other symptoms being so different as to render a choice easy. (See also below.)

In cholera Lachesis has been employed when the vomiting was renewed by the least motion and the nausea was attended with a great flow of saliva. As Colchicnm has precisely the same symptoms other indications must decide.

In reflex irritation, as convulsions with variegated, slimy stools in teething children, and rolling of the head, Colchicum resembles Podophyllum.

Belladonna, Lachesis, Rhus tox. and Baptisia constitute a group serviceable in peritonitis, enteritis, etc.

Belladonna differs from all in the character of the inflammation. It is only when the affection becomes asthenic that the others are needed. Lachesis follows Belladonna when, especially in children with inflammatory diarrhoea, constipation suddenlj 7 sets in with abdominal swelling and tenderness, particularly at one spot, or if suppuration ensues and Mercurius fails, or, again, if gangrene threatens.

In peritonitis Lachesis is indicated late in the disease, when the fever still continues and is worse after i p. m. and at night. The slightest touch on the surface of the body is intolerable. Typhoid symptoms complicate the case. It may even be indicated when there is typhlitis after the formation of pus. It follows, particularly, Belladonna, Bryonia or Mercurius corrosivus. It is also similar to Rhus tox., but, having more typhoid symptoms, comes in later in the case.

Rhus tox. requires drowsiness, the fever remaining high or increasing; restlessness; tongue dry^, parched, brown, with red, triangular tip; diarrhoea slimy, watery or putrid, yellowish-brown and bloody, involuntary during sleep; generally it is accompanied by tearing down the thighs, while Lachesis has painful stiffness from the loins into the thighs. In typhlitis, in which affection either may follow Belladonna, Rhus tox. has relief from pressing the swelling gently from below upward; Lachesis, intolerance of touch.

In periproctitis Rhus tox. may be needed if the inflammation is of traumatic origin; Lachesis, if an abscess forms and fails to point, the surrounding tissues presenting a purplish hue.

Colchicum compares with Lachesis when the prostration is extreme, with coma, hot abdomen, cold extremities, and thready pulse; if raised, the head falls back and the jaw drops; the face is hippocratic, the tongue is protruded with difficulty, and the bowels move involuntarily. But the tympany is more marked in the former; and the stools contain white flakes or shreds; the tongue is either thickly coated brown or it is bright red, except at the root, where it is coated. According to provings and cases of poisoning, Colchicum does not cause sensitive abdomen below the epigastrium.

Aryiica develops a profound stupor, with blowing respiration, dry tongue, brown down the middle, distended abdomen, and involuntary faeces and urine. It may be distinguished by the ecchymoses and the bruised aching, inducing restlessness, which latter is relieved if the patient's clothing is smoothed down and his position changed. Among the remedies causing constriction of the anus, the following are worthy of notice: Bellad., Caustic, Nitric ac, Nat. mur., /gnat., Kalibi., Opium, Plumbum, Mezereum, Coccul.

The first has pressing and urging toward the anus and genitals, alternating with contractions of the anus; spasmodic constriction of the anus, as in dysentery.

The second, Causticum, causes fruitless urging to stool, with anxiety and red face.

Nitric acid causes sticking in the rectum, as from a splinter; the constriction occurs during stool and lasts for hours afterward; the rectum feels as if torn.

Natrum mur. has a sensation of contraction in the rectum during stool; the faeces tear the anus; frequent ineffectual urging; spasmodic constriction of the anus.

fgnatia induces a proctalgia; contraction, with cutting, shooting pains; contraction of the anus worse after stool. Symptoms are inconsistent, irregular, fitful, as in hysteria.

Kali bi. has a sensation of a plug, similar to Lachesis; diarrhoea of a brown, frothy water, spurting out in the early morning and followed by tenesmus ani.

In Opium the anus is spasmodically closed during the colic, with obstinate constipation. Plumbum is very similar.

But all these are readily distinguished from Lachesis by the characteristic symptoms of the latter: Tormenting urging in the rectum, but on account of constriction of the anus it becomes so painful he must desist; protruding piles, with constricted anus.

Much nearer, and indeed almost identical here, is Mezereum; after the stool, the anus is constricted around the protruded rectum. In other respects, however, the two remedies are widely different. Kali bichromicum must also be remembered as a relative of Lachesis in dysentery. Both have red, cracked, smooth tongue; blackish stools; hence both are useful in severe or typhoidal cases, and here they follow each other well. The offensive odor of the discharges distinguishes the latter; the jelly-like, sometimes stringy mucus, the former.

A peculiar feature of Cocculus is tenesmus recti after stool, with faintness, and yet peristalsis is lessened. (Compare Ignatia.~)

Lecture V (continued)

Lachesis {continued) .

Lachesis causes in the male an increased lasciviousuess with diminution of the physical powers. The mind is a prey to all sorts of allurements, but erections and emissions are imperfect. Upon the female organs, Lachesis acts very powerfully. It seems to have special affinity for the ovaries, particularly the left ovary; ovaritis, ovaralgia, and tumor, may be relieved when there are tenderness to pressure of the clothing and other characteristic symptoms of the drug. Menses scanty, feeble, blood lumpy, black, and very offensive; pains in the hips, bearing down in the region of the left ovary—all better when the flow is established. The uterus is also intolerant of the least pressure.

Lachesis may be used in puerperal metritis, especially when the lochial discharge is foetid. The face is purple and the patient unconscious.

It is indicated in ovarian tumors when the disease shows a tendency to extend from left to right, even when suppuration has taken place. It is especially called for after Hepar or Mercurius when there is great adynamia.

In syphilis, Lachesis is called for as an antidote to mercury or when the chancre becomes gangrenous. Its characteristics are found in its peculiar sore throat, the blue surroundings of the ulcers, nightly bonepains, violent headache, and the phagedenic chancre.

The syphilitic ulcers on the legs are flat and have blue surroundings; caries of the tibia; the parts are sensitive and livid; ulcers in the throat; bone-pains at night; all after abuse of mercury. The bluish ulcers ally it with: Hepar, Asafcetida, Lycopodium, Siticea, Arsenic; the pimples, blisters, or pustules surrounding the ulcers ally it with: Arsenic, Phosphorus, Lycopodium, Mercurius, Hepar, Siticea, etc.; the burning in the areola with: Arsenic, Lycopodium, Mercurius, Siticea; the offensive pus with: Arsenic, Asafcetida, Lycopodium, Silicea, Sulphur, Hepar; the ulcers, being flat, with: Arsenic, Asafcetida Lycopodium, Mercurius, Silicea, Phosphoric acid, etc.; if they become black or gangrenous, with: Arsenic, Secale. Silicea, Plumbum, Carbo veg., Euphorbium, Muriatic acid. But Lachesis has the burning most marked when the ulcer is touched. The surrounding skin is mottled. Ulcers on the legs tend to spread superficially (rather than deeply, as, for example, in Kali bi.), the discharge is scanty and the strength is failing. Dark blisters encircle the ulcers and the surrounding skin is dead. Sometimes the discharge ceases, the patient is stupid, cold, the leg becomes cedematous, and a bluishred swelling along the course of the veins shows that phlebitis exists. All this looks like Arsenic, Carbo veg., Bufo, Secale, Cinchona, etc. But Arsenic presents more vascular excitement and nervous irritability with the prostration. Carbo veg. induces still greater prostration than Lachesis, cold sweat, cool breath, collapse. The ulcer has a cadaverous odor. In mild cases there is no resemblance at all between the two, for Carbo veg. causes much burning, rawness in the folds of the skin; borders of the ulcer hard, but not oversensitive, as in Lachesis.

Hepar should be remembered as a concordant of Lachesis, especially because it is so useful after abuse of mercurials. The areola of the ulcer is very sensitive, but there is a sore, bruised feeling, together with hyperesthesia. And, although the suppurating part may turn bluish and the patient experience weakness, yet there are no evidences of loss of vitality and gangrene, such as suggest the later-indicated drug, Lachesis.

Lycopodium is here again a complement of the snake-poison. If syphilitic ulcers appear in the throat, they are dark grayish-yellow, worse on the right side. The forehead exhibits a coppery eruption and the face is sallow, often furrowed, but lacks the small red bloodvessels which shine through the yellow skin in Lachesis. Chancres are indolent. Condylomata are pediculated. Ulcers on the legs refuse to heal, with tearing burning, worse at night; they are made worse by poultices or by any attempt to dress them. The pus is often golden-yellow. There is flatulent dyspepsia.

Nitric acid, should it seem similar in phagedenic chancre, ulcers on the tibia, etc., may easily be distinguished by the irregular edges of the ulcer, which also presents exuberant, easily-bleeding granulations; and its mouth and throat symptoms may be differentiated by the cracks of the commissures of the lips, sensations of a splinter in the throat, etc.

Kali iodatum exhibits a very different train o£ symptoms from Lachesis. Gnawing, boring bone-pains; throbbing and burning in nasal and frontal bones; greenish-yellow, excoriating ozaena; papules ulcerating and leaving scars; rupia; chancres with hard edges and curdy pus; ulcers deep-eating; violent headache, much more severe than in the snake-poison, and causing hard lumps on the head. Tendency to interstitial infiltration of soft tissues and also of bones, thus more extended than with Lachesis, which infiltrates only the soft tissues. In the uterine and ovarian symptoms of Lachesis your attention is directed to the following comparisons.

Platina has profuse, dark menses instead of scanty flow, and the hauteur is much more pronounced. The nymphomania is accompanied by titillation and tingling of the genitals or with vaginismus. In ovarian affections this drug has relieved after Lachesis failed, as in suppuration of the ovary, the pus having been evacuated under the action of the latter. The pains are burning, with violent bearing down. Palladium has relieved induration and swelling of the right ovary, as has Lachesis. Mentally the two are widely different. The former develops an egotism which manifests itself in the patient's concern ior the good opinion of others, consequently her pride is often injured. Mental emotions aggravate the ovarian pains, as in the snake-poison, but in a different way. The Lachesis patient is ecstatic or at least excitable; the relating of stories moves her to tears. The Palladium patient is easily agitated in society; a lively conversation or some evening entertainment increases her pains and tries her mentally and bodily. In ovarian affections Apis stands closely allied to Lachesis, but it acts more on the right ovary than on the left. There is a bruised, sore feeling, or a stinging, burning. At other times the pains are described as lancinating.

In prolapsus uteri or during the menses the bearing down seems to be in the right ovary; pains followed by a scanty dark mucus. Both have pains from the left to the right ovary, but in Apis these are experienced while stretching. There is also a strained feeling in the ovarian region, very characteristic. The pains may ascend in either, but in Apis they are in the right ovaty, with pain also in the left pectoral region, and cough.

Mentally there is considerable similarity (see Mind). Both have jealousy, with talkativeness and increased sexual desire; restlessness, with bustling manners.

Arsenic affects the ovaries and uterus, and has metrorrhagia of dark blood, and increased sexual desire. But this powerful agent affects more the right ovary, with marked burning, tensive pains and restlessness, which is somewhat relieved by constantly moving the feet; menstrual colic, better from warm applications.

Lycopodium reverses the Lachesis direction of pains, shooting from right to left. Its gastro-enteric symptoms are also always present. Although Graphites more often affects the left ovary it will also relieve when pains in the right ovarian region are followed by a discharge from the vagina, but constitutionally- this drug and Lachesis differ. A marked symptom of Lachesis is the relief of pain when the blood flows. Compare Moschus, drawing, pulling at beginning of menses, ceasing with the menstrual flow; Ziricum, relief of boring in the left ovary (just like Lachesis).

Platina and Ammonium carb. have pains which continue with the flow, the former even with a profuse discharge, the latter with flow between pains. In Actea racemosa the more profuse the flow is the greater is the pain.

Now, the heart, circulation and fevers. Lachesis, as I have already intimated, affects the circulation markedly; it causes flushing of heat, as at the climaxis; rush of blood headward, with coldness of the feet; palpitation of the heart, with a feeling of constriction about the heart as if tightly held by cords. These latter symptoms, with the oppression of the chest, the dyspnoea on awaking, and the inability to lie down, have led to the use of Lachesis in hydrothorax and hydropericardium when dependent on organic disease of the heart.

Lachesis is indicated in general dropsy when the urine is dark, almost blackish, and contains albumen, and the skin over the cedematous parts is dark bluish-black. I remember a man, sixty years of age, who had just this sort of dropsy, and continued to live for six months under the action of Lachesis, and whose death, when it came, was painless. It is especially useful in the ascites following scarlatina and the ascites of drunkards, when the above symptoms are present. In renal and vesical affections Lachesis is to be selected more by the general than by the local symptoms. For instance, in albuminuria or morbus Brightii, the respiratory symptoms, aggravation after sleep, and blue surface are more characteristic than the urinary symptoms- In cystitis the drug is indicated when the offensive mucus introduces the universal characteristic of tendency to putrescence. And the more this offensiveness of the urine is disproportionately intense, when compared with the time of the vesical retention of the mucus, the more likely is Lachesis to be the remedy.

In haematuria the drug, like its powerful rival Crotalus, is called for when the symptoms occur as an evidence of blood degeneration, as in low fevers; hence there is the characteristic deposit of disintegrated blood-cells, of fibrin, etc., presenting the appearance of charred straw. In albuminuria after scarlatina there is dropsy from delayed desquamation, and the urine is black or contains black spots. This spotted appearance is precisely like Helleborus. Other remedies causing black urine are Colckicum, Natrum mur., Carbolic acid and Digitalis. Apis, Ammonium benz., Arsenicum, Benzoic acid, Arnica, Opium, Carbo veg., Kali carb. and Terebinthina produce dark turbid urine. Lachesis alone, however, has the foaming urine and the general characteristics already discussed.

Helleborus is to be distinguished by the sensorial apathy, muscular weakness, pale puffed face and jelly-like, mucous diarrhoea which accompany its dropsy. The patient may breathe better when lying down, which is the converse of Lachesis and Arsenicum.

Digitalis, with blackish, scanty, turbid urine, faintness from weak heart, with bluish face, looks very much like Lachesis here. In the latter there is more laryngeal constriction, as well as oppression and constriction of the chest; in the former the suffocative constriction is as if the internal parts of the chest had grown together. Digitalis has also sinking or faintness at the stomach, as if life was becoming extinct.

Terebinthina, has smoky and turbid urine, depositing a sediment like coffee-grounds. It is often.indicated in dropsy after scarlatina. The sediment contains disintegrated blood-corpuscles; haematuria. Dyspnoea; the patient must be propped up in bed. There is great drowsiness. The tongue is dry and glossy. Clinically, Terebinthina has proved useful in the early stages of renal disease, when congestion predominates, that is, before renal casts appear in any great quantity. It causes more intense burning and pain in the back than Lachesis, and the urine may have a violet odor. In typhoid fever both renal and alvine discharges resemble those of Lachesis. Foetid stools, haemorrhages from the bowels, caused by ulceration; the blood is dark, sooty and looks like coffee-grounds. Foetid urine; disintegrated blood in the urine. In addition, Terebinthina causes stupor, dry, smooth, glossy tongue and great weakness. But it is distinguished by a preponderance of tympanites, with burning, which is accompanied by a smooth tongue, as if it had lost its papillae.

Apis simulates Lachesis in post-scarlatinal dropsy, for both remedies have albuminuria, scanty urine, which is dark from decomposed blood, and dyspnoea. But Apis usually requires thirstlessness, pale waxen skin and an eruption here or there resembling nettle-rash, red pimples or an erysipelatous rosy appearance of the anasarcous limbs. Arsenicum is needed in cases of renal disease when the urine is scanty and albuminous without blood, the remedy being required on account of its well-defined heart symptoms or its mental restlessness, etc. Thus far it needs no differentiation here. But if the urine is dark, turbid, blood-mixed, depositing a coffee-like sediment, if there is orthopnea with cold legs, bronchial catarrh, great difficulty in breathing until phlegm is raised, spasmodic constriction of the larynx, the choice may demand further comparison. Arsenicum cures when the urine looks like dark dung-water, and renal casts are abundant. The dyspnoea is noticed more when the patient attempts to lie down in the evening, and again it arouses him after 12 p. m.; it is relieved by the expectoration of mucus. In Lachesis the dyspnoea is worse when, after lying down, he drops off to sleep, relief follows the hawking loose or coughing up of a small amount of thick adherent mucus, and there is far more annoyance from the contact of the clothing than there is with Arsenicum. In the latter the clothing is torn loose lest its pressure smother the patient; in the former there is added a cutaneous hyperesthesia.

Colchimin causes an intense congestion of the mucous membrane of the stomach and bowels, and also of the kidneys. The urine is dark, turbid, albuminous, bloody and as black as ink. There is dropsy. But Colchicum is readity distinguished from Lachesis by the prominence of irritation of the sphincter vesicae with tenesmus of the bladder after urination. It is especially indicated in gouty patients, who at the same time suffer from a nervous weakness, which is combined with hypersensitiveness. If this latter symptom seems to resemble Lachesis, we may readily distinguish by the general effects of Colchicum, namely, oversensitiveness to touch (except perhaps the tympanitic abdomen); senses too acute, especially over-affected by strong odors; gastric symptoms are prominent; mental labor fatigues, causing inability to fix the thoughts or to think connectedly; headache, the skin of the scalp feels tense; coated tongue; nausea; great weakness, yet easily irritated by external impressions. A peculiarity of Colchicum is that if there are copious salivation and urinary secretion, the stools are scanty and attended with tenesmus, and vice versa.

I need not dwell upon the fevers of Lackesis, because I mentioned them in speaking of the mental symptoms of the drug. I may, however, speak of the intermittent fever which recurs in the spring-time in spite of the use of quinine in the fall. The chill comes on at one or two o'clock in the afternoon. During the chill—and here is a symptom which is characteristic—the patient feels that he-must have clothing piled on him, not so much to keep him warm as to keep him still. He wants to be held down firmly to relieve the shaking and the pains in the chest and head. The fever is characterized by burning pungency, by the oppression of the chest and the heart, and by the associated drowsiness and loquacity. Desire to be held down during chill is also characteristic of Gelsemium.

Carbo veg., like Lackesis, has annual return of the paroxysms, loquacity during the hot stage, thirstlessness during the fever, oppressed breathing. The patient is very weak from protracted disease and abuse of quinine. But the thirst is greatest during the chill, not before it, and the chill is often accompanied by cold breath, coldness of the knees, even when wrapped up in bed. Flushes of burning heat in the evening attacks, without thirst. Flatulency. One-sided chills, left side generally. Collapse more marked.

Capsicum agrees in thirst before chill, desire for warmth, chill beginning in the back; irregular, intermittent pulse. But with the red pepper the chill commences in the back and spreads thence; the thirst continues into the chill, and drinking aggravates (see Elaps). The patient is relieved by hot applications, as by a hot water-bottle applied to the back.

Menyanthes is preferable when the disease manifests itself as a coldness of the tip of the nose, the ear-lobes, and the tips of the fingers and toes. Feet to knees icy cold. Hands and feet icy cold, rest of the body warm. When Lachesis is called for in such irregular cases, with cold nose, etc., the livid skin and great weakness, as shown by the filiform pulse, are sufficiently distinctive.

Agreeing more accurately are the following remedies, all of which produce weak or thready pulse, coldness orblueness of the skin, and, of course, great prostration: Carbo veg. (see above).

Veratrum album, but in this drug the chill is associated with thirst, and (if internal) runs downward, not upward. Skin blue, cold, inelastic; hands blue; face, mouth and tongue cold; breathing oppressed and labored; heart weak; cold, clammy sweat, worse on the forehead. Heat has no palliative effect.

Arsenic, external heat relieves; mouth and tongue cold; face blue; single parts of the surface blue. Anxious restlessness despite the great debility; cold, clammy sweat. Suffocative attacks of breathing. Camphor, icy-cold surface, but hot internally, so he throws off the clothing; face deathly pale; limbs blue; breath generally hot. Spasms, or, if conscious, voice altered. Sopor follows.

Hydrocyanic acid, marble-like coldness of the whole body. Pulse feeble or imperceptible. Long-lasting faints. Drinks roll audibly down the oesophagus. Clutches at the heart as if in distress. Spasms; especially muscles of back and jaw are stiff.

Helleborus, muscles relaxed; suddenly he falls, with coldness, cold sweat on the forehead; slow pulse. Horrible convulsions, with extreme coldness. Rheumatic pains in the knees.

Digitalis, like the snake-poison, weakens the heart. The skin is very cold. Copious sweat, but the heart symptoms are not relieved. Pulse intermits every third, fifth or seventh beat; very slow pulse. It will be remembered that Lachesis has oppression of the chest, with cold feet. As the latter become warmer the oppression lessens. Secale, cold surface; sunken, pale face and blue lips. Will not be covered. Tingling in the limbs; holds the hands with the fingers widely spread apart. Cold, clammy sweat. Speech feeble, stuttering. Hyoscyamus resembles Lachesis in the chill up the back, objective coldness of the body, convulsions, delirium. But the chill is worse at night, and spreads from the feet to the spine, and thence to the neck. The lowering of the temperature is accompanied hy slow arterial action, drowsiness, or by delirious and excited talk; picks at the bed-clothing, fears being poisoned, hallucinations, fibrillary twitchings, etc.

Lachnanthes, like Lachesis, causes glistening eyes during the chill, icy coldness of the body, relieved by warmth. But only the former has brilliant eyes and circumscribed red cheeks with the fever and delirium.

Lycopodium follows Lachesis. It is needed in fevers when the patient becomes drowsy or stupid; coldness, as if lying on ice. One foot warm, the other cold—an important symptom. Feels as if the blood ceased to circulate.

In intermittent fever the chill begins in the back, as in Lachesis. It is worse from 4 to 8 p. m., or at 7 p. m. ; hands and feet numb and icy cold. Sour eructations or vomit are almost invariably present, especially between chill and heat. Thirst mostly after the sweat. Desires hot drinks only.

Apis here, as in many other instances, favors the snake-poison. Both are suited to old or maltreated cases; afternoon chill, oppression of the chest, nose cold, pulse fluttering, skin of hands and arms blue, and general appearance of collapse. But the bee-poison has aggravation from heat, Lachesis has not; the former has much more marked oppression of the chest, with consequent smothering. The tongue is red, raw, and covered on tip and borders with vesicles. Thirst during and not before the chill. Urticaria.

Cuprum combines coldness with convulsive phenomena. Icy coldness of the whole body. Severe cramps in the extremities, with cold sweat, blue surface; also collapse. Urine suppressed. Employed successfully in the cold stage of cholera, after Camphor, but also useful in other forms of collapse. For instance, it has antidoted snake-bite, with cramps, delirium, and finally torpor.

L^achesis may also be indicated in scarlet fever, but not in the Sydenham variety of the disease, but in those forms which have a malignant tendency. The child is drowsy and falls readily into a heavy sleep. The rash comes out very imperfectly or very slowly, and has a dark purple hue. It may be interspersed with a miliary rash. It is apt to be complicated with a membranous deposit in the throat having the character I have already described to you when speaking of the remedy in diphtheria. The cellular tissue of the throat is inflamed and threatens suppuration. The cervical glands are swollen. On looking into the throat you find it to be dark red with a dirty white deposit on the tonsils, especially the left. The tongue is coated dirty yellow at the base, and the red papillae show prominently through this coating. The pulse is weak and the surface of the body cool. There is apt to be dark blood oozing from the mouth and nose.

The majority of physicians make a mistake in beginning their treatment of scarlatina. A mistake in the beginning means one of twothings, either a long, tedious illness, or a short one, ending with death. The mistake made is to give Belladonna in every case. Let us look for a moment at the differences between Belladonna and Lachesis. Both remedies have the strawberry tongue, the throbbing headache, the red face and the high fever. Belladonna is indicated only in the sthenic type when there is an active delirium, the throat is bright red in color, the pulse is full and bounding, the rash is bright red and smooth. Lachesis on the other hand, is suitable where asthenia predominates, with purplish, tardily-appearing rash, drowsiness, marked swelling of the cervical glands, and other symptoms of malignancy above enumerated .

In carbuncle and cancer we think of Lachesis when the surrounding area is swollen and purple or blackish, and pus forms very slowly. Lachesis given under these circumstances increases the quantity and improves the quality of the pus, and the patient's strength improves also.

When giving Lachesis for malignant pustule you should accompany the remedy with brandy. That is an experience of Dr. Dunham. I will next say a few words respecting the modalities of Lachesis- Modalities, as you know, express the mode or manner by which symptoms are qualified. They are therefore important in the study of drugs and especially in differentiating allied remedies. Two medicines, for instance, may induce supraorbital pains of a shooting character. But if one has the pains modified by pressure, the other by sleep, we are thus enabled to distinguish them in practice. Modalities, then, qualify symptoms and are as essential as adjectives to nouns. Care must be exercised, however, that they be not substituted for the symptoms they modify. Too often we see cases reported, the only homoeopathic resemblance between which and the remedy selected is a mere modality, as, for instance, worse after sleep.

The modalities of Lachesis, then, are as follows:

Worse.— During sleep, especially the throat symptoms, choking, which arouses him; worse after sleep, especially in the morning. Time of Day.—Generally worse from noon until 12 p. m. ; still there are some prominent symptoms aggravated in the morning and forenoon. This is partly owing to the bad effects of awaking, but, as some symptoms appear later in the morning, we may ascribe them to causes then at work. For instance, the patient has vertigo on awaking, yet this returns, on closing the eyes, at 11 a.m. Headache in the left frontal eminence in the morning. Weakness in the morning on rising. Finger tips numb. On sitting up quickly in the morning, breathing becomes slow, difficult and whistling.

In the evening and before 12 p. m., we find the following especial exacerbations: Throat sensitive; diarrhoea; dry, hacking cough. Chill beginning some time between noon and 2 p. m., but fever is marked in the evening and night; worse before 12 p. m. Temperature, Weather, etc.—Worse in the cold air, from change of temperature and from the warmth of the bed (see below under Motion, etc.); worse from getting wet, wet weather, windy weather; worse before a thunderstorm; worse from the sun; worse in the spring. Better often from warmth, wrapping up, near the stove, etc. Excessively cold or excessively warm weather causes debility.

Motion, Rest, Position, etc.—Worse on and after rising from bed; worse while sitting and better after rising from a seat; better lying in bed on the painless side, but worse from the warmth of the bed (see above under Temperature) and from lying on the painful side. Some symptoms are better from moving, but not if continued long. Touch, Pressure, Injuries, etc.—Almost invariably worse from touch, however slight. Useful for the bad effects of injuries, as penetrating wounds, with much haemorrhage or gangrene.

Great loquacity. Amative. Sad in the morning; no desire to mix with the world. Restless and uneasy; does not wish to attend to business; wants to be off somewhere all the time. Jealous (Hyos). Mental labor best performed at night. Euthanasia. Suspicious; nightly delusion of fire. Religious insanity (Verat; Stram). Derangement of the time sense.

Bushmaster or Surucucu Like all snake poisons, Lachesis decomposes the blood, rendering it more fluid; hence a hæmorrhagic tendency is marked. Purpura, septic states, diphtheria, and other low forms of disease, when the system is thoroughly poisoned and the prostration is profound. The modalities are most important in guiding to the remedy. Delirium tremens with much trembling and confusion. Very important during the climacteric and for patients of a melancholic disposition. Ill effects of suppressed discharges. Diphtheritic paralysis (Botulinum). Diphtheria carriers. Sensation of tension in various parts. Cannot bear anything tight anywhere.

Worse, after sleep, (Kali bich). Lachesis sleeps into aggravation; ailments that come on during sleep (Calc); left side, in the spring, warm bath, pressure or constriction, hot drinks. Closing eyes. Better, appearance of discharges, warm applications.

Pain through head on awaking. Pain at root of nose. Pressure and burning on vertex. Waves of pain; worse after moving. Sun headaches. With headache, flickerings, dim vision, very pale face. Vertigo. Relieved by onset of a discharge (menses or nasal catarrh).

Pale. Trifacial neuralgia, left side, heat running up into head (Phos). Tearing pain in jaw-bones (Amphisbæna; Phos). Purple, mottled, puffed; looks swollen, bloated, jaundiced, chlorotic.

Defective vision after diphtheria, extrinsic muscles too weak to maintain focus. Sensation as if eyes were drawn together by cords which were tied in a knot at root of nose.

Tearing pain from zygoma into ear; also with sore throat. Ear-wax hard, dry.

Bleeding, nostrils sensitive. Coryza, preceded by headache. Hay asthma; paroxysms of sneezing (Silica; Sabad).

Gums swollen, spongy, bleed. Tongue swollen, burns, trembles, red, dry and cracked at tip, catches on teeth. Aphthous and denuded spots with burning and rawness. Nauseous taste. Teeth ache, pain extends to ears. Pain in facial bones.

Sore, worse left side, swallowing liquids. Quinsy. Septic parotiditis. Dry, intensely swollen, externally and internally. Diphtheria; membrane dusky,

blackish; pain aggravated by hot drinks; chronic sore throat, with much hawking; mucus sticks, and cannot be forced up or down. Very painful; worse slightest pressure, touch is even more annoying. In diphtheria, etc, the trouble began on the left side. Tonsils purplish. Purple, livid color of throat. Feeling as if something was swollen which must be swallowed; worse, swallowing saliva or liquids. Pain into ear. Collar and neck-band must be very loose.

Craving for alcohol, oysters. Any food causes distress. Pit of stomach painful to touch. Hungry, cannot wait for food. Gnawing pressure made better by eating, but returning in a few hours. Perceptible trembling movement in the epigastric region. Empty swallowing more painful than swallowing solids.

Liver region sensitive, cannot bear anything around waist. Especially suitable to drunkards. Abdomen tympanitic, sensitive, painful (Bell).

Constipated, offensive stool. Anus feels tight, as if nothing could go through it. Pain darting up the rectum every time be sneezes or coughs. Hæmorrhage from bowels like charred straw, black particles. Hæmorrhoids protrude, become constricted, purplish. Stitches in them on sneezing or coughing. Constant urging in rectum, not for stool.

Intense excitement of sexual organs.

Climacteric troubles, palpitation, flashes of heat, hæmorrhages, vertex headache, fainting spells; worse, pressure of clothes. Menses too short, too feeble; pains all relieved by the flow (Eupion). Left ovary very painful and swollen, indurated. Mammæ inflamed, bluish. Coccyx and sacrum pain, especially on rising from sitting posture. Acts especially well at beginning and close of menstruation.

Upper part of windpipe very susceptible to touch. Sensation of suffocation and strangulation on lying down, particularly when anything is around throat; compels patient to spring from bed and rush for open window. Spasm of glottis; feels as if something ran from neck to larynx. Feels he must take a deep breath. Cramp-like distress in præcordial region. Cough; dry, suffocative fits, tickling. Little secretion and much sensitiveness; worse, pressure on larynx, after sleep, open air. Breathing almost stops on falling asleep (Grind). Larynx painful to touch. Sensation as of a plug (Anac) which moves up and down, with a short cough.

Palpitation, with fainting spells, especially during climacteric. Constricted feeling causing palpitation, with anxiety. Cyanosis. Irregular beats.

Neuralgia of coccyx, worse rising from sitting posture; must sit perfectly still. Pain in neck, worse cervical region. Sensation of threads stretched from back to arms, legs, eyes, etc.

Sciatica, right side, better lying down. Pain in tibia (may follow sore throat). Shortening of tendons.

Hot perspiration, bluish, purplish appearance. Boils, carbuncles, ulcers, with bluish, purple surroundings. Dark blisters. Bed-sores, with black edges. Blue-black swellings. Pyemia; dissecting wounds. Purpura, with intense prostration. Senile erysipelas. Wens. Cellulitis. Varicose ulcers.

Patient sleeps into an aggravation. Sudden starting when falling asleep. Sleepiness, yet cannot sleep (Bell; Op). Wide-awake in evening.

Chilly in back; feet icy cold; hot flushes and hot perspiration. Paroxysm returns after acids. Intermittent fever every spring.

Antidotes: Ars; Merc; Heat; Alcohol; Salt. Complementary: Crotalus cascavella often completes curative work of Lachesis (Mure; Lycop; Hep; Salamandra). Incompatible: Acet ac; Carb ac. Compare: Cotyledon (climacteric troubles); Nat m; Nit ac; Crotal; Amphisbœna -snake lizard––(right jaw swollen and painful, lancinating pains; headaches, lancinating pains. Eruption of vesicles and pimples); Naja; Lepidium.

Eighth to 200th potency. Doses ought not be repeated too frequently. If well indicated, a single dose should be allowed to exhaust its action.

Lachesis

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

Generals: We will first give a survey or the general symptoms, those which characterize the remedy and are of greatest importance, and the circumstances under which the symptoms appear, are brought out or are aggravated. One who is a constitutional Lachesis patient will find himself suffering from an aggravation of his symptoms in the Spring, when he goes out from the cold weather into the milder weather, and especially is that so if it mild and rainy, or cloudy weather. Or if he goes from a cold into a warmer climate the symptoms of Lachesis will come out. The warm south winds excite the Lachesis symptoms.

The symptoms of Lachesis are worse on entering sleep. He may have felt nothing of his symptoms when awake, but when sleep comes on they are aroused, and they gradually increase as the sleep is prolonged, so that a very long sleep will aggravate all the state and condition of a Lachesis patient, and when awakening from sleep he looks back on that sleep with sorrow. The sleep has been disturbed by attacks of suffocation and by awful dreams, and now, after having slept a long time, he arouses with dreadful headaches, with palpitation, with melancholy, with sorrows from head to foot. His body is full of suffering and his mind sees no brightness in anything.

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

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

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

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

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

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

The inflammation begins on the left side of the throat and gradually goes to the right. The left side of the head is commonly most affected. The left eye becomes painful and the pain extends to the right. The left side of the back of the head, in the occipital headache, will be more affected than the right. This does not always follow, and if the reverse is true it does not contra-indicate Lach., but such is the common feature of it. Left upper and right lower has been observed. In many symptoms of Lachesis, there is morning aggravation. This is the well-known Lachesis aggravation after sleep; the patient will sleep into the aggravation. In the milder symptoms this aggravation is mild and is not felt until after the patient wakes up from a long sleep, but if the aggravation is one that is of considerable violence, the patient may feel it immediately on going to sleep, and it arouses him; for instance, the heart symptoms. As soon as he goes into a sleep he rouses up with palpitation, with dyspnoea, with suffocation, with exhaustion, with vertigo, with pain in the back of the head, and many other circulatory disturbances.

Mind: The next most important thing to be studied is the mental state. Nothing stands out more boldly than the self-consciousness, the self conceit, the envy, the hatred, the revenge and the cruelty of the man. These things, of course, are matters of self-consciousness, an improper love of self. Confusion of the mind to insanity. All sorts of impulsive insanity. The mind is tired. The patient puts on an appearance like the maudlin of a drunkard, talks with thick lips and thick tongue, blunders and stumbles, only partly finishing words; the face is purple and the head is hot.

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

These symptoms are increased under the circumstances mentioned in the Spring; in the warm weather following a cold spell; in rainy weather; after a warm bath; after sleep. The mental state is large. Jealousy without any reason. Unwarranted jealousy and suspicion. Many times this medicine has cured suspicion in girls, when they were simply suspicious of their girl friends. She never sees a whispered conversation going on but they are talking about her, to her detriment.

Suspects that they are contriving to injure her, and she will resort to any scheme to see if they were not talking of her to her detriment. A woman imagines that her friends, husband, and children are trying to damage her; that her friends are going to put her in an insane asylum. Apprehension of the future. Thinks she is going to have heart disease, and is going insane; and that people are contriving to put her in an insane asylum. Imagine her relatives are trying to poison her and she refuses to eat. She thinks sometimes that it is only a dream and she can hardly say whether she dreamed it or whether she thinks it. She thinks she is dead, or dreams that she is dead, and in the dream preparations are being made to lay her out, or that she is about to die.

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

The torture is something violent until she confesses that which she has not done. Imagines she is pursued. Imagines that she has stolen something, or that somebody thinks she has stolen something, and fears the law. She hears voices and warnings, and in the night she dreams about it. The state of torture is something dreadful, and it then goes into a delirium with muttering. The delirium is carried on like one muttering when drunk. This state increases until unconsciousness comes on and the patient enters into a coma from which he cannot be aroused. The patient also goes through periods of violence and violent delirium. It is full of religious insanity. You will find a dear, sweet old lady who has always lived what would be called an upright and pious life, yet she is not able to apply the promises that are in the Word of God to herself; these things seem to apply to somebody else but not to her. She is full of wickedness and has committed the unpardonable sin. She is compelled to say these things; she is overwhelmed by these things and she is going to die and going to that awful hell that she reads about. The physician must listen to this with attention. The physician might make the mistake in this instance of making light of such feelings. If he does, the patient will not return, and he will be deprived of the chance of benefiting her. No matter what her whims are, no matter what her religious opinions are, her state of mind must be treated with respect. It must be treated as if it were so.

She must have sympathy and kindness. It is an unfortunate thing for a doctor to get a reputation of being an ungodly man, among pious people, as he will be deprived of doing these people an immense amount of good. He must be candid with all the whims and notions of the people that he visits in the world. He must be everybodyís friend and he can be such without any hypocrisy if he is simply an upright and just man. The state of religious melancholy, with religious insanity, is not uncommonly attended with much loquacity, with talkativeness, which Lachesis is full of. It is commonly among women, very seldom among men, that we find this religious melancholy. Now, this woman is impelled to tell it; she will annoy her intimate friends, day and night, with this story of the damnation of her soul and her wickedness and all, the awful things she has done. If you ask her what things she has committed she will say everything, but you cannot pin her down to the fact that she has killed anybody. If you allow her to go through with her story she will tell you all the crimes in the calendar that she has committed, although she has been a well-behaved and well-disposed woman.

There is another kind of loquacity belonging to Lachesis. The patient is impelled to talk continuously. It is found in another. state in which the patient is compelled to hurry in everything she does and wants everybody else to hurry, With that state of hurry is brought out the loquacity, and this is something far beyond comprehension, until you have once heard it. There is no use attempting to describe it, it is so rapid, changing from one subject to another. Sentences are sometimes only half finished; she takes it for granted that you understand the balance and she will hurry an. Day and night she is wide awake, and with such sensitiveness to her surroundings that you, would naturally think, from what things she hears and how she is disturbed, by noise, that she can hear the flies walk upon the walls and the clock striking upon the distant steeple.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Oversensitive to noise, oversensitive to motion in the room, to conversation and to others walking over the floor. By these circumstances the pains are increased. The patient becomes extremely sensitive throughout all the senses of the body. The oversensitiveness to touch is probably extensively in the skin, because of the fact that hard pressure often gives relief. In one who is suffering from peritonitis, front inflammation of the ovaries or uterus, or any of the abdominal viscera, the skin is so sensitive to. the clothing that contrivances are sometimes necessary to relieve the suffering from, the touch of the bed clothing. Something in the form of a hoop will be found in the bed, or the patient will have the knees drawn up, or with the hands will hold the clothing from touching the body. The ordinary weight of the hand may bring out the soreness that is in the abdomen, which is an entirely different soreness, whereas the clothing touching the abdomen only brings out the oversensitiveness of the skin. The mere touch of the skin with the finger or hand is unbearable.

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

The eye symptoms are worse after sleep, and the eyes are oversensitive to touch and light. With the eye symptoms we have headaches, because the brain and eyes are so closely associated. In the sore throats, when the spatula or tongue depressor happens to touch the wall of the throat, the tonsil, or the root of the tongue, there is a feeling as if the eyes would be pressed out. Violent pain in the eyes from touching the throat. Lachesis is a great jaundice medicine, because it produces much disturbance in the liver. Yellowness of the skin and whites of the eyes, and thickening of tissues about the eyes. "Fistula lachrymalis," which is accompanied by long standing eruptions about the face. Oversensitiveness of the meatus auditorus externus. Anything introduced into the canal of the ear will cause violent, spasmodic coughing and tickling in the throat. So sensitive is the mucous membrane of the ear that a violent cough, like whooping cough, will come on from touching the mucous membrane of the ear. This only shows the oversensitiveness of reflexes, and the oversensitiveness in general. With the hearing there is the same oversensitiveness that we have spoken of elsewhere. The Eustachian tube becomes closed with a catarrhal thickening, stricture of the Eustachian tube.

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

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

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

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

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

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

The nose is tumid, yet it will not remain pitted upon pressure. The lips feel as if inflamed, yet are not inflamed, simply sensitive to pressure. The face has also an oedematous appearance in which there is pitting upon pressure, in cardiac affections, in cases of Bright's disease. On the other hand the face becomes very pale, pale and cold; the skin covered with scaly eruptions. Eruptions that bleed easily, with crusty eruptions, with vesicular eruptions. Eruptions that fill with blood, bloody vesicles and large blood blisters, such as occur sometimes in burns, with burning. The face becomes jaundiced and very sallow. At times it takes on the appearance also of a chlorosis.

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

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

Mouth: In Lachesis there is oozing of blood around the teeth, the gums bleed easily. Dry crusts appear upon the teeth in zymotic diseases, often black formations, sordes, and the tongue takes part in the appearance of the mouth and becomes slick. This occurs in typhoid conditions when there is a total loss of assimilation, the appetite is entirely gone, the stomach will not take food, and when food is put into the stomach it is rejected. There is also paresis of the tongue. The tongue seems to be like leather in the mouth, it is moved with great difficulty. And the speech is like that of one half intoxicated; he is unable to articulate. The tongue swells and is protruded very slowly. It is dry and catches on the teeth and seems to have lost its stiffness. Seems like a rag, or as if the muscles did not act upon it so that it cannot be protruded, or if it is protruded it trembles and quivers and jerks and catches on the teeth. Again it is swollen, it is denuded of its papillae, and smooth, shiny and glassy as if varnished. In the mouth there is a soapy appearance of the saliva. The saliva runs into the mouth copiously and the patient will often lie with the head over the side of the bed, and the saliva dripping into a pan or commode. The saliva is stringy and can be pulled out of the mouth in strings; white mucus or saliva.

This is not an uncommon feature in diphtheria, in sore throat, in inflammation of the tongue and mouth and gums, and in inflammation of the salivary glands. When this mucus is thick, tough, yellow, stringy and ropy it is like Kali bichromicum. You will often find in severe sore throat that the patient will lie and gag; and cough, and attempt with difficulty to protrude the tongue to expel the saliva from the mouth. Very often the pain is so severe in the root of the tongue that he cannot expel the saliva by the tongue and he will lie with the open mouth over a commode, or with a cloth over the pillow, to receive the thick, ropy saliva. In such a state with sore throats, especially those that commence on the left side and go to the right, you hardly need to question longer, for it is the aspect of Lachesis.

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

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

I have a number of times seen it brought about by the physician, who has, instead of giving just enough Lachesis, high enough and similar enough to the disease to cure, given it as low as he could get it, the 8 th or 10 th, dissolved it in water and fed it all through the diphtheritic state. When you come across cases that have been treated in this way you need not be surprised if a post-diphtheritic paralysis comes on, because Lachesis will produce it. It may cure the diphtheria, but it will leave its poisonous effects which will last that patient a lifetime. Every spring the symptoms of Lachesis will crop out. In all the circumstances of aggravation described the symptoms of Lachesis will crop out if he has once been poisoned by it.

In the sore throat we have a combination of symptoms. Lachesis has produced this state, going from left to right; but with the sore throat there is a sensation of fullness in the neck and throat, difficult breathing, pallor or plethoric appearance of the face, choking when going into sleep, the peculiar kind of saliva and aggravation of the throat symptoms from warm drinks. There is not always an aggravation of the pain itself from warm drinks, but the patient is often unable to swallow warm fluids. The swallowing of warm fluids often causes choking, and after a swallow of warm tea is taken the patient will clutch at the throat and it seems as if he would suffocate. He says, "Oh I do not give me any more warm drinks." Something cold will relieve. The dyspnoea and the distress about the throat is increased by swallowing something warm. Now, in the sore throats of Lycopodium, warmth often benefits, but it is also true in some cases of Lycopodium sore throat, they want cold drinks and cold feels good to the throat.

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

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

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

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

The cough is a choking cough and produces a sensation of tickling. This is like the Bell. cough. Bell. antidotes a Lach. cough, it has a cough so much like Lach. that no one can tell them apart. Again the throat takes on extreme dryness in Lach., and this dryness is without thirst, dryness with aversion to water. Much inclination to swallow; the tendency is to continuously swallow, yet it is painful. Empty swallowing is more painful, than the swallowing of solids. Some Lach. patients suffering from cardiac affections are annoyed with constriction of the throat, choking in the throat when anything warm is swallowed, and sometimes when going into a warm room, choking and palpitation of the heart.

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

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

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

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

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

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

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

"Cannot endure any pressure about the hypochondria."

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

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

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

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

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

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

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

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

Catamenia flow but one hour every day; on stopping, violent pains follow in region of left ovary, alternating with gagging and vomiturition. It is especially useful at the menopause, because of the flushes of heat. Uterine hemorrhage, fainting spells, suffocation in a warm room; orgasm of blood most violent. Complaints during pregnancy.

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

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