On nasal catarrh: its symptoms, causes, complications, prevention, treatment, etc., with illustrative cases. By Lucius D. Morse.
Morse, Lucius D.

Page  A Notes on Nasal Catarrh BY E. A. FARRINGTON, M. D. NASAL catarrh, discharge yellowish green, bland. Five cases cured with pulsatilla. If the nasal discharge is non-irritatin, this remedy seldom fails, whether the case is recent or chronic. In one case of ten years standing, pulsalilla 30, 200, 29m successively, cured in three months. It should be repeated every four or six hours until the secretions lose their purulent character and become white or colorless mucus. Dropping of mucus through the posterior nares, causing constant hawking. Two cases cured with co-rallium rubrunzm. The inspired air feels cold. Two cases relieved promptly by corallium rubrum. The symptom in the provings is: I)uring deep inspiration, it seems as though icy-cold air was streaming through the air passages, etc. Allen, vol. iii,, p. 563. By "reading between the lines," this was transferred to the nasal mucous membrane. In a case of "snuffles," nux., ipec., and sanbucus failed. The nostrils were exceedingly dry. This symptom suggested sticta _pulmon., which quickly relieved. When the nasal discharge is a clear albuminous mucus, natrum mur., almost always aids. In deeper seated forms where ulcers exist, among such well-known remedies as kali-bich., thuja, sepia, lycopod, and nitric acid, kaolin must be inserted. It becomes of great use when the nostrils feel sore to the patient, slabs form in the nose and the secretion is scanty and blood-streaked.

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Page  I ON NASAL CATARRH: ITS SYMPTOMS, CAUSES, COMPLICATIONS, PREVENTION, TREATMENT, ETC., WITH ILLUSTRATIVE CASES. LUCIUS D. MORSE, M. D. MEMPHIS: A. F. DOD & COMPANY, PUBLISHERS, 1876.

Page  II Printed by THE SOUTHERN BAPTIST PUBLICATION SOCIETY, 361 Main Street, Memphis, Tenn.

Page  III PREFACE. This little treatise is offered to the Profession and the general reader, with the hope that it may prove practically useful Nasal Catarrh, in its various forms, afflicts a large number of people, and it cannot be denied that the results of medical treatment are, often, far from satisfactory, both to physician and patient. Anything positive, on the score.of its Therapeutics, we feel certain, will not come amiss. While no pretensions are made, as elsewhere stated, to anl exhaustive consideration of the subject, the clinical department of this little work will be found tolerably full, The writer has drawn freely from his case book in dicussing the application of remedies. He trusts that the results of his investigations, detailed in the following pages, Will not prove valueless to the practitioner, and believes that the information imparted regarding the Causes, Prevention and rational Treatment of a frequent and distressing complaint will not be unacceptable to many sufferers. MEMPHIS, 1876.

Page  IV CONTENTS. Pago Preface........................................................................ Introductory................................................................. 5 PART I. Internal Structure of the Nose................................... 9 Symptoms of Catarrh....................................................... 11 Complications of Catarrh.................................................................... 13 Causes of.................................................................... 15 Prevention of................... 17 Treatm ent of "................................................................. 2 PART II. CASES FROM PRACTICE AND OBSERVATIONS ON THE USE OF REMEDIES. Case I-Treatment with Nux Vomica, Hydrastis and Lycopodium........................................................................... 24 Case II-Treatment with Nux Vomica, Aurum Sepia............. 27 " III-Treatment with Sepia........................................................ 29 " IV- " " Calcarea Carb............................................ 30 " V — " " Calcarea Carb., observations upon theuse of Sulphur, Silicea, Kali Bichrormicumrn and Mercurius.................................................. 31 Case VI-Treatment with Calcarea Carb., Mercurius and Arseni- 32 VII — " " cum Mercurius and Sanguinaria............ 34 " VIII- " " Iodide of Arsenic............................... 35 IX- " " Iodide of Arsenic.................................... 38 " X " " Ozsena from Disease of the Antrum........ 37 XI- " " Nux Vom., Mercurius Jod.,Kali Bichromicum and Sulphur........................................... 38 " X[I-Treatment with Alumina.......................4............... 41 " XIII — " " Phosphorus and Silicea......................... 42 " XIV- " " Nitric Acid............................................ 43 XV- " " Pulsatilla and Sulphur........................... 44 " XVI — " Graphites..................................................46 G:,neraI Observations............................................................................. 47 PART III. Actte Catarrh-Coryza.................................. 49-53 PART IV. RE EEDIES.-Alunmina-Argentumn Nit.,-Arsenicunr-Aiseniculn Jod,-Asafoetida -Auru in-Calcarea Carb,-Chamomilla-Euphrasia-Gelsemi num-Graphites - Hepar Sulph., - Hydrastis -Ipecac - Kali BichromicumKali lodicun1 - Laclesis - Lycopodium - Mercurus Jod.,-Mercurius Viv.,-Natrum Carb.-Natrum Mur, -Nitric Ac.,-Nux Vomica-Phosphorus-Pulsatilla -Sanguinaria-Sepia-Silicea-Sticta-Sulph ur...... 54-72

Page  V NASAL CATARRH. INTRODUCTORY. The harrassing and annoying complaint of which we purpose briefly to treat in the succeeding pages, is one of the most common in our changeable climate. In its chronic form it has, too, the reputation of being one of the most obstinate and refractory to medical treatment. This may be ascribed, in part, to the very nature of the trouble itself, often dependent upon obscure causes, which are frequently overlooked, even when diligently sought after, and, in part to the prevalence of mistaken notions regarding topical applications. The still popular system of local treatment with douche, syringe, atomizer, inhaler, etc., is well calculated, by its aggres

Page  VI vi. NASAL CATARRII: ITS CAUSES, sive character, to excite in the patient's mind hopes of speedy relief-hopes which, it must be confessed, are but too seldom realized. The indiscriminate employment of local medication in these troubles is greatly to be deplored. The Douche. The nasal douche, in particular, is responsible for a great deal of harm. PRoosa, Knapp, Pardee and other well-known specialists have clearly indicated the evil effects it is apt to produce. The cleansing of the nasal passages, for which this instrument was so highly lauded at its first introduction, is accomplished but indifferently by its use, so far as the disease is concerned, and quite too well, so fiar as the bland mucous covering is concerned, which nature provides for the protection of an inflamed or highly irritable tract of membrane; while the danoger of producing serious trouble with the organs of hearing, through irritation of the Eustachian tubes, has proven so great that experienced and careful practitioners have mostly abandoned it. The irritating, lnedicated solutions, which, by its assistance, are forced with such facility into one nostril and out at the other, have a directly pernicious influence upon the delicate mucous membrane of the nose, coming in contact, as they do, not only with the diseased portions, but with those parts which are still in a normal condition.

Page  VII COMPLICATIONS, PREVENTION, TREATMENT, &C. Vii. Loss of Smell. It is not to be wondered at that the olfactory nerve, subjected to the corroding influence of acrid solutions, pungent snuffs and penetrating vapors, which are so constantly recommended in the treatment of Catarrh, should speedily become so benumbed and deadened as to destroy almost entirely the sense of smell. Frequently, patients apply to us, after having submitted to this sort of heroic treatment, unable to distinguish the strongest odors. In very few of these cases, which have come under our notice, has the extent and severity of the disease itself, justified such a condition. We have been compelled to ascribe it, in no small part, to the mistaken remedial measures to which these patients had been subjected. Loppcatons Very rare are the cases of Nasal Catarrh which can be benefitted by the usual local applications, while the harm which such medication has produced, and is liable to produce, furnishes a warning to both physician and patient against, at least, its routine employment. The theory which pronounced the nose, in all instances, the dire offender, over-looking the frequency of remote causes, held such applications to be indispensible, but these erroneous popular ideas are giving place to more intelligent views.

Page  VIII viii. NASAL CATARRH: ITS CAUSES, Object of It will be the aim of the writer to present in the succeeding pages some plain, practical observations, regarding the complaint under consideration, together with brief details of clinical experience and indications for the use of remedies. An exhaustive consideration of the subject, under any of its. several heads, does not fall within the scope of this little work. If the suggestions, here offered, are found of practical utility, by those under whose notice they may fall, the great object of the writer will be attained,

Page  9 COMPLICATIONS, PREVENTION, TREATMENT, &C. 9 PART I. INTERNAL STRUCTURE OF THE NOSE. Before proceeding to a consideration of the causes, the symptoms and morbid conditions which arise in Nasal Catarrh, let us glance, for a moment, at the structure or anatomy of the parts involved. As we address ourselves to non-professional, as well.as to professional readers, this short digression will tend to a clearer urderstanding of the subject, on the part of the one class, at least. The anterior nares or nostrils communicate directly with the nasal fosspe, which are two irregular cavities, situated in the middle line of the face, extending from the base of the cranium to the roof of the mouth, and separated from each other by a thin vertical septum. They communicate with the ipharynx, or upper part of the throat, by two large apertures-the posterior nares. The internal structure of the nose is exceedingly delicate. Each fossa is supplied with:three lamella of bone, curved and.twisted, known technically as the turbinated bones.'These twisted plates, with their two sides free, and

Page  10 10 NASAL CATARRH: ITS CAUSES, covered with delicate mucous membrane, add vastly to the area of surface contained in each of the two nasal cavities. At the upper part of the nasal fosse the membrane is very thick, soft, spongy and vascular, and is supplied with numerous mucous follicles which exude a secretion by which the surface is protected and kept in a moist and sensitive condition. It is only this portion of the mucous membrane which is supplied with filaments of the olfactory nerve, and which is capable of receiving the impressions of smell. It is called the olfactory membrane. Elsewhere the nasal passages are lined with a mucous membrane which is less vascular and spongy in structure, and which is called the Schneiderian membrane. These tissues and the sub-adjacent structures, to. a greater or less extent, are involved in Nasal Catarrh. It is well to remember that only a thin plate of bone, pierced by numerous openings for the passage of the olfactory nerve, separates the brain from the upper part of the nasal fossae. This fact of close proximity may have much to do with those distressing mental symptoms which often exist in connection with chronic Nasal Catarrh. The okiler pathologists erroneously believed that the brain itself was frequently involved in these delug-6 ing fluctions, and with this conviction they actually gave to a gland-like body, at the base of the brain, the name " pituitary,"-which it still bears-supposing it to be the firequent source of catarrhal discharge.

Page  11 COMIPLICATIONS, PREVENTION, TREATMENT, &C. 11 SYMPTOMS. CATARRH is a term applied to any abnormal discharge from a mucous membrane. In a condition of health these membranes are constantly moist. When they become inflamed from cold or any other cause, the character of the secretion is changed. First, the membranes involved become dry, tumifled and more sensitive, then follow sensations of increased heat, fullness and itching, with perhaps, frequent sneezing. The second stage is characterized by the free discharge of a thin, serous, acrid fluid, which irritates the nostrils and lip as it flows over them. In the third stage, the fluid becomes thicker, less irritating, more viscid, usually opaque and yellowish. Frequently, headache and a general feeling of discomfort accompany these symptoms. If, from any cause, the system fails to re-act from the noxious influence which produced this condition, and the discharge does not cease after a week or two, chronic Catarrh is the result. Chronic Catarrh. Here the symptoms are as diversified as the different cases. The existing state of affairs may be quite overlooked by the sufferer, under the supposition.that he is simply the victim of a " cold in the head," until the increase of the discharge changes in its character and, perhaps, the appearanee of painful subjective symnptoms force the matter upon his attention. The discharge is more or

Page  12 12 NASAL CATARRH: ITS CAUSES, less copious, and frequently escapes from the nasal cavities through the posterior nares instead of from the nostrils. Sometimes, there is a constant dropping back into the throat of a yellowish or grayish opaque matter, which causes frequent hawking and spitting. In other cases, large plugs form in the nose and are expelled with considerable difficulty. The discharge then, be it remembered, varies widely as to color, consistency and quality. The elements of which it is composed are serum with corpuscles of epithelium mucus and pus. Pathology. What is the pathological condition which attends these symptoms? By the hydrostatic pressure in the congested parts, the dilated capillaries are unable to perform their functions; the serum of the blood transudes through the capillary walls and contributes to the swelling of the surrounding parts; the epithelial cells become infiltrated and undergo a series of modifications; they take on a distended globular form, entangling granulations of mucin; they are then shed, and constitute, with mucous globules and nascent epithelium, the semi-transparent, gelatinous, bluish-gray discharge. Corpuscles of pus are usually mixed with this mucus, and give it, according to their number, a more or less opaque, yellowish color. Ozna. When the Catarrhal irritation progresses to ulceration, true ozcena is the result. The discharge becomes of a much more disagreeable character. It usually has a greenish yellow color, a salty taste

Page  13 COMIPLICATIONS, PREVENTION, TREATMENT, &C. 13 and is often expelled from the nose and throat in scabs and lumps streaked with blood and haviing a fetid odor. In the morning the throat and nose are often filled with the filthy secretion, and the efforts to expel it frequently result in nausea and vomiting. The patient becomes morbidly sensitive and is tortured with the belief that all who approach him can discover his complaint by the offensive odor. There is usually present severe frontal headache and dull, heavy pains, referred to the bridge ofthe nose. The sense ofsmell is impaired, occasionally to the point of complete extinction, and the mind of the sufferer is harrassed with gloomy and melancholy forebodings. The general health suffers as the morbid condition of the system, which feeds the Catarrh, intensifies. Sometimes a destructive process is set up in the cartilages and bones of the nose, but, happily, this last mentioned condition is comparatively rare, and is usually of a specific origin. COMPLICATION S. The Ears. The mucous membrane lining the Eustachian tubes, being continuous with that of the nose and throat, inflammation in tile nasal fosspe or upper portion of the pharynx readily extends in that direction. Implication of the organs of

Page  14 14 NASAL CATARRH: ITS CAUSES, hearing is the complication most to be dreaded in Nasal Catarrh. A recent writer, discussing this subject, says: "Chronic pharyngeal and nasal troubles are the starting point for most affections of the ear, which makes throat deafness a common form of defective hearing." It may be remarked, that disease of the external ear is comparatively rare, and much injury has frequently resulted from local treatment directed to that part, when the real fault lay in the passage to the internal ear. A slight amount of irritation at the point where the Eustachian tubes open into the post-nasal cavity will interfere with the free passage of air and cause first, a sense of stoppage, accompanied with crackling sounds and ringing in the ears, soon followed by deafness, more or less severe. Curing the catarrh restores the mucous membrane to its normal condition, and the hearing is regained, unless the trouble has existed for so long a time a.s to produce structural changes, with more or less occlusion of thie tubes. The Throat. Many cases of laryngitis with chronic cough and hoarseness may be traced directly to the extension of a naso-pharyngeal catarrh. Singularly enough, in some instances, when the inflammation has traveled downwards and fastened itself upon the speaking apparatus, the nasal symptoms will suddenly and completely disappear. The Eyes. Not infrequently, the inflammation extends from the nose along the lachrymal ducts to the

Page  15 COMPLICATIONS, PREVENTION, TREATMENT, &C. 15 eyes, causing severe irritation of the conjunctiva, with increased secretion, enlargement of the AMeibomian glands, and general weakness of sight. CAUSES. The mucous membrane of the nose being more exposed to external influences than any other similar tissue of the body, is correspondingly more liable to disease. Sudden changes of temperature, checking of the perspiration, getting the feet wet, inhalation of dust, soot, acrid vapors, etc., producing mechanical irritation, may be cited as prolific causes of the ordinary acute catarrh. Where a predisposition to this complaint exists, repeated attacks so weaken the mucous membrane of the nose that it finally becomes chronically congested, and is seldom free from an abnormaldischarge. We have found Catarrh hereditary in some families, grafted upon a scrofulous or psoric diathesis. Repelled Eruptions. Chronic itch-like eruptions which have been repelled by external applications, such as salves, washes, etc., not infrequently attack the mucous membranes of the body and sometimes produce very troublesome catarrhal affections. Usually a re-appearance of the former erruption during the progress of treatment is attended with a cessation of the catarrhal symptoms.

Page  16 16 NASAL CATARRH: ITS CAUSES, Derangements. Many times, an abnormal discharge, from a mucous membrane seems to depend entirely upon waste matter which should have been thrown off by the skin, lungs or kidneys. A restoration of these organs to their healthy functions is followed in these cases by a complete subsidence of the nasal, pharyngeal or laryngeal symptoms. The folly of local treatment, directed to the nose, in these instances, and they make up probably the more numerous class, is sufficiently apparent. A certain proportion of cases is due also to constitutional taint of syphilis, the nasal trouble being but a symptom belonging to a general condition. letastasis. The writer has treated a few cases where metastasis could be clearly traced of a catarrhal condition of the mucous membrane in some other portion of the body to the nose. Eruptive diseases, such as Scarlet Fever and Measles, by metastasis, often inflame the mucous membranes, and so produce aggravated catarrhal affections in the throat, nose and ear. Malaria. That mysterious and peculiar influence, known as malaria, is responsible as a powerfully predisposing cause of catarrhal troubles. The profound impressions, even to organic changes, which it is capable of producing secondarily in some of the great organs of the body, lead, not infrequently, to sympathetic disturbance in remote parts. The mucous membranes are often involved, and hence arise multitudinous catarrhal affections, confined by no& means to the nose.

Page  17 COMPLICATIONS, PREVENTION, TREATMENT, &C. 17 Drug Strong medication with Mercury, ArPoisoning. senic, Potassium, and other powerful drugs, frequently gives rise to serious and Long lasting throat and nasal symptoms. Many a catarrhal discharge dates back its origin to an illness, during which the system was saturated with Mercury in some of its many forms. Fortunately for this class of sufferers, such cases are amenable to an enlightened treatnient, which antidotes the effects arising from drug poisoning, and brings back the tissues to a normal condition. PREVENTION. A deep interest attaches to this branch of the subject, from the fact that the belief is gaining ground, among those best able to judge, that persistent Catarrh of the nasal passages is but too often the forerunner of more serious disturbances in the respiratory organs. It is certain that persons who are predisposed to this complaint, by attention to hygienic rules, may greatly lessen the liability, and perhaps overcome it entirely. The writer ventures the following brief suggestions Clothing. Dress warmly in cold weather and wear woolen under-clothing, but do not sleep in flannel; such a habit is highly objectionable. Keep. the extremities warm to obviate congestion to the

Page  18 18 NASAL CATARRH: ITS CAUSES, head and chest. Do not muffle up the throat; this practice is very pernicious, as it induces perspiration in the parts, and the least exposure results in cold. Bathing. A mornillg sponge bath of the entire body in tepid or cold water, three or four times a week, aids greatly to maintain a vigorous cutaneous circulation and to toughen the cuticle, preventing the tendency to excessive perspiration, so frecquently a prominent symptom with catarrhal sufferers. After the bath, the body should be rubbed briskly with a coarse towel or flesh brush until reaction is produced. A little salt may be added to the water occasionally, with benefit. W'here bathing the entire body is found to be too trying upon the powers of reaction, a cold sponge half-bath, with vigorous dry rubbing from the face down to the waist, is a ready, and generally effective mode of putting the body in a condition to resist the chilling influence of the cold air throughout the day. Bathing the throat and neck in cold water, once oi' twice a day, is also efficacious in warding off cold. It is well, however, to abstain from wetting the hair on these occasions. Exercise. Take plenty of out-door exercise. Walking, horse-back riding, use of dumb-bells, clubs, -cross-bar and similar appliances, may all be recomm:ended in moderation. Persons of sedentary hab

Page  19 COMPLICATIONS, PREVENTION, TREATMIENT, &C. 19 its, especially those living in cities, cannot pay too much attention to this branch of hygiene. Diet, Etc. In respect to diet, all stimulating food should be carefully avoided. Under this head are included all those dishes which are prepared with strong peppers and spices. Rich pastry of all kinds should be abstained from. Good, nourishing, wellcooked food, of any sort whichthe patient's digestion will tolerate, can be eaten in moderate quantity. Fresh vegetables and fruits may be recommended. Strong coffee is not allowable. Regularity in respect to meals is important, and between meals nothing should be eaten. Sleep in a well-ventilated and cool room. Finally, live temperately in all thin gs. As a comment upon the above, we may remark that catarrhal affections involving the organs of speech, as in the case.of clergymen and literary men, often arise from, or are greatly aggravated by a dyspeptic state of the stomach. Such may be prevented and sometimes remedied by proper exercise and diet. There is no complaint which requires closer attention to hygienic meansto insure its complete eradication, when it is thoroughly established, than chronic Catarrh. Its prevention, in those predisposed, demands equal-vigilance. Immunity, however, purchased at the expense of the slight trouble involved in adhering to a few simple, hygienic rules, is cheap, indeed.

Page  20 20 NASAL CATARRH: ITS CAUSES, TREATMENT. We have no panacea or cure-all to recommend. Each case must be individualized. As there are no two faces exactly alike, so there are no two cases of disease precisely similar. A remedy, which would afford relief in one instance, might have no. perceptible curative effect in another. It should be borne in mind, as already intimated, that " Catarrh " itself is, in many cases, merely a symptom of a morbid condition of the system, more or less pronoanced, dependant, perhaps, upon the derangement of some remote organ or organs; that derangement removed and the Catarrh ceases. Remedies. The Materia Medica is rich in drugs which have a specific influence upon the mucous membranes of the nose and throat, either directly or by reflex action. Such are the remedies upon which reliance must be placed in the treatment of the complaint under consideration. When administered according to the law, similia similibus curantur, they may be made to meet all the varied curative indications, and by removing the causes which produce deranged action, secure permanent relief. It must be distinctly understood, however, that neglect of hygienic measures can hardly be atoned for by medical treatment, no matter how skilfully applied. Right living is, at last, the basis of good health. The physician, as well as patient, must not be

Page  21 COMPLICATIONS, PREVENTION, TREATMENT, &C. 21 discouraged, while using the properly indicated remedies, if the progress be slow and often interrupted, as every cold taken, however slight, is sure to be felt early, if not at first, in the nasal fosspe and neighboring parts. Idvcartile Improvement in the general health is often, noticeable under proper treatment, for some time, before there is any marked abatement in the nasal symptoms proper. When the patient says he feels better every way, except as to the nose, the physician may be confident that he is upon the right course, and should hesitate and carefully consider before deciding to change the treatment. A good rule is to administer the remedy at longer and still longer intervals, after improvement has set in. ofChlgate, We must not omit to mention the fact that, in the treatment of some cases, a change of air and scenery is productive of the most beneficial results. Numerous illustrative instances might be cited, were it necessary, to prove the influence of climate in modifying the symptoms of catarrhal affections. Those who reside in low, malarial regions will experience the most benefit from a sojourn among the hills and mountains in a dry, bracing atmosphere; while those who already inhabit elevated sections of country, might try, with fair prospect of betterment, a visit to the low-lands or seashore. In obstinate cases, where circumstances permit, such aids to treatment as are offered by brief change of residence should not be neglected.

Page  22 22 NASAL CATARRH: ITS CAUSES, Diagnosis. of No one who is not expert in diagnosis,. in the widest signification of that term, can treat chronic Nasal Catarrh successfully. The common acute attacks, arising from cold, will usually run a course and the symptoms disappear, even if medical treatment is entirely neglected. But the chronic forms of this complaint arise from such a variety of causes, being often kept up by functional or struc — tural derangement of some remote organ, and again frequently depending upon hidden constitutional taint or hereditary bias, that the keen faculties of' the practiced and experienced observer are demanded for their proper understanding and treatment. This is an important fact, and one well worthy of careful consideration, for it shows how utterly unsuited bad cases of " catarrh " are to self or empirical treatment. The physician who is applied to for relief in these often obscure and deeply-seated troubles, should spare no time nor pains in his efforts to elicit a clear picture of the general and special conditions in each individual case. Treatment based upon a hasty and superficial examination will result in little good to the patient and less satisfaction to the prescriber. The problem presented for solution, in many instances, is a profound one-how to restore to their normal action the long perverted vital forces. The task which the physician sets out to accomplish is not the work of a day or a week, but must often be prolonged through months, and sometimes, even,

Page  23 COMPLICATIONS, PREVENTION, TREATMENT, &C. 23 through years. VWhat care, what patience, what judgement, what discrimination must he not exercise. PART II. CASES FROM PRAOTICE AND OBSERVATIONS ON THE USE OF REMEDIES. The writer believes there is no more ready or effective method of conveying information regarding the treatment of any complaint than the citation of characteristic cases, with detail of symptoms and application of remedies. There is, it seems to him, a positiveness and reality about the knowledge thus attained, which can be imparted in no other way. Acting upon this conviction, he presents here a number of carefully selected cases, taken from his record book, and trusts that the accompanying therapeutic observations and compari

Page  24 24 NASAL CATARRH: ITS CAUSES, son of symptoms and remedies may not prove valueless to the inquirer. They are, at all events, -the fruit of the writer's practical experience.'TREATMENT WITH NUX VOMICA, HYDRASTIS AND LYCOPODIUM. CASE I.-Mr. C., book-keeper, Pet. 29; Nasal Catarrh for two years. Had used, in that time, a great many domestic cure-alls and patent nostrums, as well as gone through the cauterizing and disinfecting treatment with douche and syringe. Symptoms were as follows: Frequent, severe, frontal headache, affecting the eyes, the conjunctiva being reddened and irritated; worse from cold; frequent stoppage of the nose, with dropping of mucus into the throat, from the posterior nares; patient not able to sleep on his back, on account of the choking produced by the discharge; large lumps of yellowish and whitish mucus blown from the nostrils every morning, four or five minutes being required to clean out the nose; bowels constipated. Prescrip.-Nux vomica 3, gtt. iii, inmorning,Nux -30, gtt. iii, at night, for one week. As expected, the severe frontal headache almost ceased, after a few days, but the other symptoms remained about the..same. Prescrip. —Hydrastis 3, trit. gr. ii, morning and night for two weeks, then, only at night for another vweek.

Page  25 COMPLICATIONS, PREVENTION, TREATMENT, &C. 25 At the end of the three weeks, the dropping of mucus into the throat, from the posterior nares,-a prominent symptom of the drug administered, which, together with the condition of the bowels, led to its selection,-had ceased, and the patient could sleep on the back undisturbed. There remained, however, an obstruction of the nose high up, with frequent forcing out of plugs of partially dried mucus; the patient's urine was dark and scanty, and, though there was good appetite, a small quantity of food seemed to fill him up. Prescrip.-Lycopodium 200th. dose at bed time for three nights-no more medicine. The cure was complete, at the end of three months, when the patient had gained in flesh to the extent often pounds, and expressed himself as never having felt better. Ilydrastis. The Hydrastis is a remedy which the writer has found, very frequently, of striking benefit in the treatment of catarrhal troubles. Not without good reason have the Eclectics pronounced it to. be one of the very Lest of the so-called tonics. In cases where the stomach lacks vigor, where the bowels are inactive and the nose dripping, as if fiom simple hydrostatic. pressure, its administration in two or three grain doses, of the 1st. or 2d. dec. trit., three or four times a day, will produce strikingly beneficial results. It is useful in those cases where ulceration exists with free muco-purulent discharge, but its range of action stops far short of

Page  26 26 NASAL CATARRH: ITS CAUSES, those virulent cases which call for Aurum, Nitric Acid and Mercurius. It is the rival of Kali bichromicum in those cases where the discharge is tenacious and stringy, but has not the same intensity or persistence of action manifested by the latter remedy. It acts vigorously upon tL-e posterior nares and postnasal cavity, and should be considered in'those cases, where the catarrhal inflammation has involved the Eustachian tubes, and even affected the middle ear. Where there is induration or chronic enlargement of the glands, the Hydrastis will seldom claim attention; here, recourse must be had to the various preparations of Mercury, Calcarea, Iodine.and Sulphur. In many cases where Nasal Catarrh in the female is attended with uterine troubles, notably leucorrhceal discharges, it ranks with Sepia and Pulsatilla. It should not be forgotten, where the eyes are involved in a general catarrhal condition of the mucous.membranes of the head. In acute attacks it is valueless, during the first stages and so long as febrile symptoms are nmanifested, but, when the active inflammation subsides, it comes in splendidly. In chronic catarrhal cases, where torpidity of the liver and a general atonic condition of the digestive organs obtains, this remedy may be administered with great confidence. For that exceedingly characteristic symptom: "Dropping down of mucus from the posterior nares into the throat," I am indebted to Dr. IH. Noah Martin, of Philadelphia.

Page  27 COMPLICATIONS, PREVENTION, TREATMENT, &C. 27 NUX VOMICA, AUBUM AND SEPIA. CASE II. —Mrs. D., et., 29, dark hair, light complexion, angular form, illy nourished, applied to me for treatment of a chronic Catarrh, of the ozoena variety, which had existed for six years. She had tried every method of treatment of which she could hear; had visited different cities, and consulted practitioners of every kind; had submitted to the douche for months at a stretch, and taken large quantities of Iron, Cinchona and other tonics. Appetite and digestion were impaired; bowels severely constipated; terrible frontal headache. The mind was in a constant state of the most horrible gloom and depression, and altogether, the patient presented a forlorn appearance. The nasal discharge was copious, green and yellow as to color, terribly fetid and often streaked with blood. There were severe constrictive pains in the bones of the nose. The sense of smell had been apparently obliterated and there was partial deafness. An inspection of the throat made it apparent that the morbid process after spreading.from the posterior nares to the post-nasal cavity, had traveled downward, so as to involve the entire pharynx, the mucous membrane of which was of a dull purplish color, and highly congested. This patient came to me from a. distance, and could only remain for a day or two. I prescribed Nux vom. 3, gtt. vi, in half a tumbler of water, a teaspoonful to be taken every two hours

Page  28 28 NASAL CATARRH: ITS CAUSES, during the paroxysms of headache.. Also Aurum metalicum 3d, trit. gr. ii, morning and night for two weeks. At the, expiration of that time my patient wrote me that she was much better. Appetite had improved, bowels were regular, firontal headache had almost vanished, and the discharge was much less troublesome. I continued the Aururn, one dose a day, for another fortnight, when my patient called to see me again. I found the hearing improved, sense of smell returning, while the nasal discharge had greatly decreased. The mind was cheerful and free from the former gloom and melancholy. I told her to return home and write me again in a fortnight, meanwhile, taking a dose of the same medicine (Aurum) every other day. Improvement still continuing, I suspended the medicine for a month, when the patient reporting that there was an occasional discharge of greenish scabs, I prescribed Sepia 6, gtt. vi, in half a tumbler of water, a teaspoonful of the mixture night and morning for one week. Three months elapsed before I saw this patient again. She had fully recovered, save an obtuseness of smell. The writer has found Nux vomica to be almost a specific, as an intercurrent remedy, in those severe frontal headaches, accompanied by constipation and derangement of the digestive organs, with which catarrhal patients so frequently suffer. If the patient feels worse when out in the wind, and is subject to neuralgic pains about the head

Page  29 COMPLICATIONS, PREVENTION, TREATMENT, &C. 29 and face, Phosphorus or Arsenic will usually afford relief, if the Nux fails; the two former, however, seem to possess none of the antidotal powers which render the latter so useful in beginning treatment after strong medication has been employed. Aurum. The above case, very strikingly, illustrates the happy effects of. the Aurum in those deeply seated symptoms, where the mlind has become noticeably affected. The settled, melancholy, hopelessness, and loathing of life, are very characteristic indications for the use of this remedy. The mental symptoms of Nitric acid are somewhat similar to those of Aurum, but fall short of the intensity possessed by the latter. In syphilitic ozaena, these two remedies are oftener indicated than any others save Mercurius, and are especially useful where thislatter remedy has been excessively employed. Sepia, the last remedy used in the foregoing case, is one of the most prominent to be thought of in case of greenish discharge from the nose, especially in women, though it is sometimes indicated in the other sex. What is said of Sepia may be applied equally to Asafcetida and Pulsatilla; they seem to be pre-eminently female remedies. Of Sepia, it may be remarked, further, that no drug acts with more promptitude and efficacy when clearly indicated, as the following case illustrates; TREATMENT WITH SEPIA. CASE III. —Mr. B., machinist, 2et. 27; Nasal Catarrh

Page  30 30 NASAL CATARRH: ITS CAUSES, for three years. Patient dark-haired and pale, with a strikingly feminine appearance; discharge of large quantities of greenish, offensive mucus; dropping down of mucus from the posterior nares; (same symptom as Hydrastis, but the color is whitish or yellowish in the latter,) greenish plugs in the nostrils, blown out with much difficulty. Prescrip.-Sepia 6,,gtt. ii, every morning; Sepia, 200, gtt. ii, every night for a week, after which no medicine was taken. Hygienic rules as to diet, bathing, etc. were recommended and followed. The discharge from the nose decreased somewhat, the first week, the green color almost disappearing.by the close of the second week. During the third week there was a marked aggravation and a stirring up, as it seemed, of the whole system, manifested in urine almost the color of blood, ill occasional hemorrhages from the nose, and in great weariness and lassitude. All.these symptoms disappeared gradually, and the nasal discharge had( almost ceased when the patient passed from my observation. TREATMENT WITH CALCAREA CAiLBONICA. CASE IV.-Mr. T., banker, set. 36, gradually increasing catarrhal affection of the nose for several years. The discharge, much of which was hawked out-from the posterior nares, was sometimes thick and jelly-like, sometimes thin and watery, and againr tough and lumpy. The patient felt that his general

Page  31 COMPLICATIONS, PREVENTION, TREATMENT, &C. 31 health was impaired; appetite bad; great disinclination to exertion; feet constantly cold; stockings felt as though they were continually wet. He was melancholy, anxious, and afraid he was going into consumption. Prescrip.-Calcarea carbonica, 30th. and 200th. in alternation, dose every night for four or five nights, and then at intervals of two or three weeks, for several months. The general health began at once to improve under the influence of the remedy and the customary hygienic regulations. The discharge fronl the nose became less and less, and in six months' time he was, to use his own words, " a new man." TREATMENT WITH CALCAREA CARB. - OBSERVATIONS UPON THE USE OF SULPHUR, S1LICEA, KALI BICHROMICUM AND MERCURIUS. CASE V.-Was a fourteen-year-old son of the above, who had suffered for nearly a year with symptoms much the same as those of the father. Coldness and dampness of feet were prominent symptoms, and the leuco-phlegmatic temperament was more marked. There was also some laryngeal irritation, with morning covgh. Calcarea carb., 200, four or five doses, in as many days, cured the Catarrh in a fortnight, the other symptoms disappearing more slowly. Calcarea Carb. Calcarea is a great corrector of malnutrition, manifested either by emaciation or ex

Page  32 32 NASAL CATARRH: ITS CAUSES, *cessive obesity. The pale, wrinkled face in the one case, and the colorless, bloated visage in the other, are equally characteristic of this remedy. The leuco-phlegmatic temperament, as Dr. Guernsey is wont to call it, is, however, the touchstone of its applicability. Where this temperament is pronounced, long lasting catarrhal troubles of nearly every species fall within its province. Children with chronic discharges, either from the nose or the.ear, present evidence of a constitutional, hereditary taint which must be combatted; here the Calcarea, becomes the foremost remedy, but Sulphur, Silicea, iKali-bichromicumn and Mercurius will come in frequent play. If there is enlargement or induration of the glands, especially about the head and neck, -discharge copious, light straw color, or even yellow, lffercu)rius will often prove of great benefit. Where there is periodical ejection of plugs of yellow, sticky mucus, Kali-bichromicum generally becomes most effective. In treating children who are subject to,boils and eruptions, with skin of a dirty, unhealthy appearance, the writer has invariably prescribed Su1phur to begin with, regardless of other symptoms. The following case is evidently one of hereditary taint. TREATMENT WITH CALCAREA CARB., MERCURIUS AND ARSENICUM. CASE VI.-Little girl, five years of age, dark hair, noticeably light complexion; very bright and sprightly. Catarrh of the nasal passages, for two

Page  33 COMPLICATIONS, PREVENTION, TREATMENT, &C,. 33 years; came on after the cessation of an aural discharge of some months' duration. The nose at one time had been intensely inflamed; one of the lachrymal ducts had ulcerated, and after healing, had occluded. The tonsils were enlarged and indurated, and there were evidences of glandular swelling about the neck. The child had been subjected to the use of the nasal douche and various strongly medicated solutions, for more than a year without benefit.. The discharge was copious, whitish or yellowish-green; sometimes lumpy and streaked with blood. The feet were nearly always damp and cold. Appetite was very good, but child was subject to frequent attacks of indigestion, and the sleep was habitually restless and disturbed. Prescrip. —Calcarea carb. 3, gr. i, morning and night, continued for a week, afterwards once a day for a fortnight. Improvement was speedily manifested in bettered digestion, quieter sleep and a decrease of nasal discharge. The same remedy was continued for two weeks longer, a dose every other night. As the tonsils still remained swollen and indurated, recourse was now had to the Proto-iodide of Mercury, 2, gr. i, every night for a week, then every other night for a fortnight. Under this course, there was great improvement, and all medication was omitted for a month. At the end of that time a severe, scalding coryza came on, which yielded in a few days to Arsenicum 3, gr. i, lmorn

Page  34 34 NASAL CATARRH: ITS CAUSES, ing and night. With it passed away the last vestige of the former chronic discharge. Mercurius I have used the Mercurius jodatus with great benefit, in many cases where inflammation of the nasal mucous membrane has extended into the lachrymal duct and sac. It seems peculiarly adapted to such cases in children. I have occasionally used it as low as the 1st. dec. trit., with prompt relief, in cases where the catarrhal inflammation of the posterior nares ran high, extending, somretimes, so as to involve the entire pharynx. In marked contrast to the foregoing case is the following, in which the catarrhal discharge evidently depended upon derangement of the great emunctories: TREATMENT WITII MERCURIUS VIVUS AND SANGUINARIA. CAE VII. —Little boy, five years of age, dark hair and eyes, fleshy, compactly built, had suffered with a copious, yellowish and watery discharge from the nose, for more than a year. Occasionally, large plugs, dry upon one side, would be ejected from the nose. There was great complaint'of stinging and raw feeling in the nose. Examination with the speculum showed the nasal cavities to be in a state of chronic hypermenia, and secreting briskly. The throat appeared normal, tonsils, however, larger than the average size. The little fellow suffered terribly from constipation, and a certain yellowness of the skin pointed to defective hepatic action.

Page  35 COMPLICATIONS, PREVENTION, TREATMENT, &C. 35 Prescrip.-Mercurius Vivus, 3, gr. i, morning and night, for the first week, then once a day for another week. There was slight improvement under this course, but not satisfied with the action of the remedy, and finding that the little fellow suffered with periodical headache like the so-called "sick-headache," I gave Sanguinaria 3, trit. gr. ii, morning and night for a week, then every other day for a fortnight, and at last once or twice a week for a month. A complete cure was the result. The constipation was overcome, the headache ceased, the secretions became normal, and the Catarrh vanished. Sanguinaria. The Sanguinaria is not a remedy widely applicable, in the complaint under consideration, but the writer has found it efficient in a number of cases where periodical headaches were complained of, and there existed an impaired condition of the stomach, with torpidity of the liver. The Eustachian tubes and inner ear fall within its sphere of action, and where deafness has been caused by catarrhal troubles of the throat, it deserves consideration. In some points it resembles Phosphorus and Arsenicurn, and, remotely, Hydrastis. TREATMENT WITH IODIDE OF ARSENIC. CASE VIII.-H. B., boy, wet. 16, dark hair and dark complexion; fleshy, but small for his age, had suffered with Catarrh almost constantly for four years. Sometimes both nostrils were closed, and he was compelled to breathe through his

Page  36 36 NASAL CATARRH: ITS CAUSES, mouth; eyes were weak and watery; eyelids puffy; had always lived in a malarial region, and suffered more or less from the usual chills and fever, every year. The nasal discharge was nearly always jellylike, but sometimes watery; very copious in the morning and after meals, but at other times, much less; color, grayish-white. A glance at the throat showed the tonsils very much enlarged, and the fauces in a state of sub-acute inflammation. Prescrip.-Iodide of Arsenic 3, gr. ii, three times a cay for a week, then, once a day for another week, then every other day for a fortnight, and finally one dose a week for three months cured the whole trouble. Arsenicum The Iodide of Arsenic possesses a very considerable range of action and is a precious remedy in many cases where there is enlargement of the tonsils, and a tendency to induration of the glands. I have also found it, as in the above case, of wonderful efficiency in catarrhal affections, grafted upon a phlegmatic temperament, where the constitution has received a profound malarial imlpression. It will be found, I think, far more useful in chronic cases of Catarrh than the simple Arsenic. The following case is quite characteristic: CASE IX.-Mr. F., set. 30; dark hair and eyes, light complexion, phlegmatic temperament; Nasal Catarrh for two years; constant hawking of tough,

Page  37 COMPLICATIONS, PREVENTION, TREATMENT, &C. 37 yellowish and whitish mucus from the throat and posterior nares; frequent coryza; glandular indurations about the neck; tonslils enlarged. Prescrijp.-Arsenici Iodd(4(m, 2d. aqueous dilution, gtt. iii, four t;mes a clay. An amelioration of the symptoms commenced at once, much to the delight of the patient, who had previously tried all the nostrums he could hear of, but without avail. After a fortnight, one or two doses a week sufficed to remove the whole trouble in about three months. OZENA FROM DISEASE OF THE ANTRUM. In all discharges from the nose, of a fetid, puslike character, the physician should make sure that the trouble does not originate from disease of the antrum, caused, in most cases, by carious teeth. The following case is in point: CASE X.-Mrs. HI. had been troubled, for about a year, with occasional fetid discharges from the left nostril, the discharge increasing in quantity and fiequency. She sought medical advice, thinking it was a simple "catarrh;" but an examination showed that she was suffering with diseased antrum, caused by a dead eye tooth, at the root of which a sac had formed, and discharged repeatedly, the contents finding its way out through the sinus opening by the middle meatus, into the nose. The chronic inflammation had crept out from the antrum so as to affect the membrane of the adjacent

Page  38 38 NASAL CATARRH: ITS CAUSES, nostril. The offending tooth was extracted, and the antrum washed out occasionally with warm water. Nux vom. was given for a persistent frontal headache and constipation. The discharge ceased in about a week. TREATMENT WITH NUX VOMICA, PROTO-IODIDE OF MERCURY, KALI B1CHROMICUM AND SULPHUR. CASE XI.-W. H., young man, 20 years of age; tall and well built; dark hair and dark complexion; face covered with pimples; nose large and prominent, the entire surface a purplish-red, and furnishing the soil for repeated crops of small boils. It was a Bardolphian nose in its frequently fiery intensity of color. Never, except in one other instance, have I seen its equal. An examination with the speculurn. showed the interior of the organ to rival in intensity of congestion the exterior. The mucous membrane, as far as the eye could penetrate, was thickened and in a state of chronic hypermriia, denuded of its epithelium, and secreting a thick, glutinous, opaque matter. A glance at the throat showed the fauces and pharynx, as far as could be seen, in a state of sub-acute inflammation, and secreting a whitish, tenacious mucus. The tonsils were also much enlarged. Nearly all the discharge from the nose was ejected through the nostrils, though sometimes, especially in the morning, masses were hawked from the posterior nares and upper part of the throat. The eyes were weak and watery, and often felt as if full of sand. There

Page  39 COMPLICATIONS, PREVENTION, TREATMENT, &C. 39 was also frequent severe frontal headache, and digestion was impaired-bowels constipated. This case dated its commencement two years and a half, anterior to the time of my seeing the patient, and was attributed to a " cold in the head." The sufferer had tried every species of treatment — all the douches, snuffs, etc.,but these had only made matters worse. I recommended, on commencing to treat the case, all the hygienic measures mentioned on a preceding page, and prescribed Nux Voi. 3, gtt. ii four times a day for a week, then, morning and night, for a fortnight. At the end of that time, the frontal headache had entirely disappeared, the appetite was normal, dyspeptic symptoms relieved and bowels freer. The discharge had slightly diminished, and was thicker. Prescrip.-Proto-iodide of Mercury 3, gr. ii, morning and night, for a week, then, only once a day for another week. Discharge much less in quantity, lighter in color; throat much improved; feeling better generally. Same remedy in 6th. trit. gr. i, every night for a fortnight, was now exhibited, but the discharge still remaining gluey and tenacious, Kali bichromi-,cum 3, gr. i, every other night was prescribed, for another fortnight, when the discharge had greatly decreased and had changed to a greyish-white. Treatment was now suspended for a month, save occasional doses of NYux to combat recurring spells

Page  40 40 NASAL CATARRH: ITS CAUSES, of constipation. At the end of that time, thle appearance of things had greatly changed for the better. The external nose had nearly lost its abnormal redness, acnd the organ had even been reduced ill size, through return of the hypertrophied tissues to their normal condition. The skin being still unhealthy and covered with frequent crops of pimples, a dose of Scilph]r 6th. was administered, every other night, for a week or more, when the patient was discharged, the symuptoms detailed above being relieved. Comments. This case is, on many accounts, a most interesting and instructive one. Very rarely, indeed, are instances met with where the entire nose is so completely involved in the morbid processes. In the only two similar cases which have fallen under my notice, where the external infalla-nmmation, even remotely, approached that of the one detailed above, I received marked aid from the Iodide of Arsenic, followed by Nitric Acid. The congestion and redness yielded tardily in all these cases, but was finally conquered. Diet is a very essential point to be considered in the treatment, when such symptoms are present. Nitrogenous food may be recommended, to the exclusion of those articles which are rich in carbonaceous material. It need hardly be added that abstinence from spirituous drinks is imperatively necessary. ULTnder an abstemious regimllen these local inflamniations are much more readily subdued.

Page  41 COMIPIIC~ATIONS, PI'IEVENTION, TREATMIENT, &C. 41 Il several instances, where there was a sensation of great external heat and burnling of the lose, I lhave reconmmendled the organ to be freqluently batlled iln dilute alcohol. This has provell of preat coi foirt to thle patient. TREATTMENT WITH ALUMINA. CASE XII-M. B., printer, mt. 20, chronic Catarrh for five years. IIas tried various nostrumns alnd domrestic remedies without relief. The trouble canme on gradually, the dischalrge being offensive and consisting, at last, of' thick, yellowish mucus, o' greenish-yellow scabs. IRoot of inose sore and p)ainful to touch, ar,d sometimes, severe f-rontal headache witllh darting pains over the eyes. Patient was also sulbject to vertigo and rushes of blood to the heead. There was ip-resenot obstinate constipation, soft stools even being passed with dlifficult y. Thle sy l-ptoll)s seelned to p)oilt to Aluinliua, and tlhis rleRCed(y s prescribed in attelnuationlls from the 8d. to tle 12th1., a d(ose o l1ce a dclay, and fially, once a wceek all (llce in twCo weeks. A cure was efcted-l ill Il)olout six FOolntihs. A-uii. Tiis erem ue(ly1s a pov.:eli i'll ad 1 lotn lastinll ipr)l)ession 111-)0l tlhe mulcouls nmc ilbranes of' tlte enltile boldy. Its efltet is vervy 1nlarked upon tle ftlenale, eemci'lly iill ntell ( llerl;gllellts and leucholl acl'all12l ldischarcgles( l Wlie(ll alternate withl Catar.11 of tlie )lose al(ld tflraIt. r'le dcisposition to

Page  42 42 NASAL CATARRII: ITS CAUSES, cld, uponl the sliglitest exposure, iwith inlllallnation of' the linlin lmeC lbralles of thle air palssages, is ficquel.tly removed by its adlninllistrntion. In1 the case above detailed, it is a question whllether or not the patient's peculiar conditionl couldl be ascril)ed to the constant handlilig of type ili lis business as a prititer. In prescribingg for the case, the filct iwas considered that Alumina is, perlhaps, tile m-ost plrolliient remledy fob tle ccnistitutional efiects of lead poisoning. TREAT'AIENrT wIT'rt PIoC)SpLoR1'IUS AND SSILICEA. CASE XIII.-J. C., at. 40, darkll.S hallir alld dark eyes, tall land slim, a teacher by ptrofessionl, Ullmarried, and a thorough lbaclelor in all ljhis way', applied to me in 187-2 for relief fr1om a troublesome hoarseness and irritatillt coug1h with hcllh hle lhad suffered for a considerable period. An exanniation of the case revealed the fact t-hat, for sevNleral -years lie had been a great sufferer fromr Nasal C,(atarrh*1. The discharge was thick anid yellow, andl offteii (discolored with blood, and inl )1lowingic tlie nlose tlheri was frequently slight hemlorlrhage. 1 wa-s always worse fiom walking in the open air, particnlarly it the weather were winldy, and was sure to coille ill after such exercise with distressing frontal lieadc(ltcell and a feelin(g of swellilng, about the nose. TIhe coug'i Was excited by reading aloud, laull iill, o() singinfg, and seemed to be llo(luced by a ticklilng ill the throat-pit. The lu10ngs were evidettly iweak, digestion none of thle best, )ut the patient wais chleer

Page  43 COMPLICATIONS, PREVENTION, TREATMENT, &C. 43 ful and hopeful. I requested him to abandon the use of tile douclhe, while I treated the case as a whole. Prescerip.-Striet hygielic rules. Phosphorus 3, gtt. ii, morning anid nigllt for a week, tlhen same remedy 6th. attenuation tt. i, every night for a fortinigiht. Inmprovemeilt began at once; the hoar'senless and cough were amleliorated, by the close of tile first week, and the discharge from the nose had considerably lessened, by the end of a fortnight. The Plhos. was conltinued f'or six weeks, a dose once or twice a week, the patielit constantly imnproviIng in general ]healtll, and the couigh finally ceasing. The discharge from tile nose had a1ssunmed the character of elastic plugs, often streaked nwith blood, and there was a troublesome roaring anld crackling and stopplage in olle, land, somletinles, both ears.'Prescrip.-Silicea, 6th. gr. i, every nilght for a fortnight, then, no more e(licille, cured tle patient in a month. TEATSIMENrT WIT11 NITKIIIC ACID. CASE XIV. —Mr. L., ret. 30, dark lhair, ligh1t coImplexion, strong, hardy constitution, applied to me in 1873, for the treatment of' a most troublesome and annoving Catarrh. A yvcar before, he had contracted a specific ulcer, which, after a time healed, but was followed b)y coLlstitutional symptoms —

Page  44 44 NASAL CATARREI: ITS C~AUSES, painless swellilng and indurlation of thle glaCnds, ulceration of the tonsils, etc. The lischarge from the nose was fetid, salty in taste, and filequently very copious, a true oztna. Thle upper portion of the nasal fossie and the post-nasal cavity seemed to be the parts most affected. Thle mouth was full of aphthous ulcers. Patient had takein large quantities of Mercury antd Iodide of lotassium. The mind was gloomy anld deslpon(lent. Presc-rip.-Nitric Acid 2, gtt. iii, four tinmes a day, for a week, thlen twice a lay, and finally, on;ly ocee every other day. This treatment sufliced to mnake a promplt anti satisfactory cure. The nasal discharge ceased, the glandularl.s~wellinl, al(d the ulcers in the moutll disappeared. Remarks. I11 this case, the chloice lyV betweell Anrumn and Nitrlic Acid. The cla-tracter of the glandular swelling's-painless —and thle condition of the mouth, decided in favor of thle latter remedy. Both Aurum and Niitric Acid antidote tile eftfects of Mercury, but the first menitioned has a more limlited range than the others. TREATMENT WITII PULSATILLA AND SULPHU'IiR. CASE.. —E. C., Ayo(1111g girl, -it. 13?, ligllt hair and light complexion, XNasal Catarrh for nearly two years, dating back to a severe attack of Measles. The dischargle was copious, and yellow or greenishl as to co]lor. There was also loose coughli, aldl after every ('olli, slight d(isclairce froml olle of the ears.

Page  45 COMPLICATIONS, PREVENTION, TREAT'MENT, &C. 45 Diigestion was weak, and the stomaclh grumbled at all fatty food. The child was exceedingcly mild and gentle-a regular I' ulsatilla temnlperament. This fact, together witlh the history and symptoms of the case, led to the selection of that remledy. Prescrip.-Pulsatilla 3, gtt. i, morningl and nigllt, continued for a week. At tle end of tlat time, slight improvement h)eilig manifest, tile salie remedy was coltinued —dose only at night for another week, and thlen, only once or twice a week. Tlle 1results, at tlhe elld of six weeks,, we0re encoulragilng. Thle conulh and aural di.elharl e had ceased, but the (lischarge fromn the nose, tlhougnmuch improved, was not enltirely removed. I waitedl a fortniglt longer, and thlen administered a few doses of Sulplhur 6tl. Two or tllree iweelks sufficed to effect a complete cure. PulsatiIa. So far as the experience of tlle writer extends, Pulsatilla is not very frequently of utility in the treatment of chronic discharges from the nose, however applicable it may be to acute cases. lie has been frequently disappointed, where it seemed quite clearly indicated. The general condition, mlental symptoms, gastric symptoms, temperanleit, etc., nmust call for this rermedy, otherwise, its administration will be followed by trifling benefit. The general indications are of far more importance than the nasal symptoms proper. Even when these have been followed, it will seldom complete the cure.

Page  46 46 NASAL CATARRH: ITS CAUSES, TREATMENT WITH GRAPHITES. CASE XVI.-J. D., aet. 32, literary gentleman, light hair,and dark complexion; constantly increasing catarrhal trouble of the nose, for nearly three years. Symptoms: Ears prominently affectted-often feel as though they were filled with water; conitant desire to clear the throat and nose; great dryness of the nose, alternating with fluent coryza; discharge very copious, and almost watery,. after mleals; fauces and pharynx in a state of subacute iflaammation; the Eustachian tube, of one or both ears, often becomes obstructed, producing roaring, in the head, followed by detonation, after which thlere is iprovemient in hearing. There is tendency to gummy, oozy eruptions, attended with general unhealthiness of the skin, every injury, no nmatter how slight, producing suppuration. Prescrip.-Graphites 6, gtt. i, morning and night, for one week. Patient repnorted the closirng of the ears as much less troublesolme; catarrhal symptoms unchanged. The same remedy was continued for another week —dose only at night, afterwards powders of Sac. Lac., morniving and night, for a fortnight. A very marked change for the better had taken place in the patient's condition at the end of that tinme. The tendency to suppuration at every trifling lhurt had been removed; the ears were, clear and unobstructed, and the frequent painful dryness ofthe nose, as well as the troublesome discharge, had been almost entirely relieved.

Page  47 COMPLICATIONS, PREVENTION, TREATMENT, &C. 47 A dose of Graphites, once a week, for a month, completed the cure, the skin, mealwhile, becoming perfectly clear and healthy. Graphites. The remedy administered in the above case is frequently indicated iq the treatment of that class of catarrhal sufferers who exhibit an unhealthy condition of the skin. Its curative action is prompt ill individuals, subject to any sort of eruption exuding a thin, glutilnous, transparent, watery fluid from its raw surface. Graphites has many symptonis in common wlith Calcarea carb., Hepar, Lycopodiunm, Silicea and Sulphur, alld should be carefully studied in thbse cases where the organism fails to respond to these remedies. GENERAL OBSERVATIONS. Even a superficial examiniation of the cases already detailed, wvill make it apparent that the treatment adopted was b)ased(, in each instance, upon the patierit's general colndition, as well as upon the character of the nasal symnptonls proper. As a mledical writer of note has well remarked: "A single symptom is rarely characteristic. It is the presence of oiie s.nymptom (or more) siirrultaneouslv with other mrnaiifestations which characterizes (lisease, anl(d indicates the treatment. It is, therefore, essential to tie right use of iemedies, that the conditions and accompaniments should be closely marked, and that tile syrmptonls should be studied i;n groups."

Page  48 48 NASAL CATARRII: ITS CAUSES, For instance, there are a very considerable number of drugs, which exhibit in their symptonlatology green, yellow, thick, thin, mucous, puriformn, acrid, bland or waterx discharoges from the nose. Were attention confined, alone, to these mlanifestationls, the choice of a remedy would.be involved in the greatest doubt and uncertainty, but, by considering the concomitants, in connection with the peculiar symptoms of the organ at fault, the treatment is ilndicated with precision. Herein, lies the secret of the success or failure of the physician's efforts. The remedy selecte(d must be suited to the ilndividual case. No amount of zeal or persistence in the direction of medication can atone for errors in the choice of Lemedies. As to potencies, the writer is neither a partizan of the low nor of the high dilutioi-ists. Ite has witnessed very gratifying results froml the admlinistration of all the different attenuations, and is disposed both to exercise andl to concede the greatest fireedom in respect to them. But, in reporting clinical cases, he considers it due to those who may read his reports as well as to the cause of medical truth, to state honestly and faithfully, not only what remedies he has employed, but also the particular form and quantity of each.

Page  49 COMPLICATIONS, PREVENTION, TREATMENT, C. 49 PART III. AOUTE CATABRL- OORYZ. The cases detailed in PART II, it will be observed, all belong to that class, Nwhichli, by way of distinction, may be termed "chronic." Coryza or acute Catarrhal affections of the nasal passages, arising from transient causes, seldom prove very troublesome to the practitioner. The symptoms are, generally, well marked and the remedies correspondingly easy of selection. Nevertheless, we shall devote, here, sonme space to the brief consideration of this branch:of the subject. In the incipient stages of Catarrh, Coryza or Influenza, while the chilliness and depression, which with many people are, the precursors of ai cold, are still present, a few doses of Camphor will often dissipate the whole trouble. If no more convenient preparation is at hand, a drop of the tincture on a little sugar, every half hour, until re-action sets in, will answer every purpose. When fever has already set in, but the cold has not localized itself, Aconite is the remedy. Rarely,

Page  50 50 NASAL CATARRH: ITS CAUSES, however, is the Physician called upon to prescribe in the early stages of such complaints. When the cold has become established, a different class of remedies is denmanded. The chief remedies for Coryza, where the trouble appears to be epidemic and many persons are affected at the same time, as is often the case in the Spring and Fall, are Mercurius Viv. Arsenicum Alb., Iodide of Arsenic, Hepar Sulphur, Nux Vomica, Sticta Pul., Gelsemninum, Kali Iodicum and Kali Bichromicunm. If much water drops from the nose and the discharge is offensive, the patient being worse at night and experiencing no relief from perspiration, give Mercurius. This remedy is also proper, where there is feverish heat with sensitiveness to cold, great thirst and Dailfll heaviness of the forehead, or where there are glandular swellings. Arsenicum Alhb. is applicable where there is almost constanlt chilliness and desire to be close to the fire; great restlessnoess at night, without apparent cause; stoppage of the nose, with a copious discharge of acrid, watery mlucus, accompanied by burning of the nose, internlally and externally. If the discharge is very profuse and excoriating and there are alternate chills and heat, give the Iodide of' Arsenic. lMy friend, Dr. J. P. Dake, informs rre that he has employed the Kali lodicum with fine results, in cases, where from recent cold,there is excessive flu

Page  51 COMPLICATIONS, PREVENTION, TREATMENT, &C. 51 cnt coryza, pain in forehead, above root of nose, much heat and burning in nasal ducts, and some irritation of the pharynx. He considers it much better than Arsenicum in cases where that remedy is usually prescribed, especially when there is a copious watery flow, literally dripping from the end of the nose. When the Catarrhal headache is increased by every motion and the slightest exposure causes a fresh cold, or when there is stoppage of only one nostril and the nose is painful and:exceedingly sensitive, Hepar Sul., will be found curative. This remedy is also useful, when Mercurius has afforded partial relief. Should the Catarrh be fluent during the day, but cease in the evening, with obstruction of the nose, attended by headache with great weight in the forehead and a constipated condition of the bowels give Nux Vomica. Sticta Pul. is applicable where the premonlitory symptoms are strongly pron ounced —dryness of the nasat membranes and of the throat, followed by severe coryza, attended frequently by racking cough and violent sneezing. ]Kali Bichromicum, is sometimes required when, beside the nasal symptoms, there are present, hoarseness and cough with yellowish and thick expectoration. Where discharge is bland and watery, with either chilliness or heat; fever without thirst or restless

Page  52 52 NASAL CATARRH: ITS CAUSES, ness, Gelserlinumll will prove useful. Should it fail to remove tile trouble, and tLere is great irritability, one cheek red and the other pale, especially in case of children. Chamomilla should be administered. Chcanzom.illais also useful where the nostrils are ulcerated, lips chapped, perspiration suppressed and there is great dullness and heaviness of the head. In case of profuse coryza, with irritation of the eyes, copious flow of tears, Eaphrasica will usually effect the best results. Where there is lack of appetite, and loss of smell, and the nose discharges a thick, yellow, sometimes greenish, mucus, Pulsatilla should be given. This remedy is also appropriate where the watery discharge becomes thicker and there is alternate running and obstruction of the nose. Should there be frequent discharge of blood fron the nose when blowing it, Arsen., Phosph., Gelsem., and Pulsatil., will generally prove sufficient. Ipecac and Arsenicurn are the best remedies where the Catarrh is coimplicated with asthmatic dyspncea or this condition follows a suppression. When there is much pain or soreness in the limbs or body, Mlercuris' will usually relieve. \Where there is very profuse watery cobryza-the nose constantly dripping, attended by sensations of painful rawness and excoriation in the nasal passages and throat, Sanguinaria is the remedy; it is especially useful,where there is stinging in the nose and much sneezing. If this remedy fail to give

Page  53 COMPLICATIONS, PREVENTION, TREATMENT, &C. 53 speedy relief, in the condition described, and there is a free discharge of watery mucus from the posterior nares into the throat, give Hydrastis. When the parts are all swollen and sore and there is a pI-lentiful escape of water, Lachesis will sotnetinmes affird relief, where the remedies already mentioned fail. Should there be severe stupefying headache with Ophthalmia and discharge of serum from- the nose, or bloody and purulent nmucus, especially if' there is chilliness, Argentum Nit. is the remedy. WThen there is runninog of the nose during the day, becoming dry at night, Euphrasia or Nux Vomica will generally suffice. If there is obstruction of the nose, only at night, Nux Vomica, Lycopodiuni and Pulsatilla are the remedies. Heat of the head and face, with creeping chills, even when seatedl by a warm fire, calls for Nux Vomica. For the coryza of infants, Calcarea Carb., Chailomilla, IKali Bichromicum, Mercurius, Pulsatilla and Sarnbucus Niigra are the most appropriate remedies. Chamomilla is appropriate vwhen the child cries unuch and is only quieted by being carried up and down the room; KIali Bichromicum when the discharge is tough and stringy and seems to extend into the throat; Mercurius when the discharge is profuse and the nostrils raw and ulcerated; Pulsatilla, when the coryza is better in the morning, worse in the evening; Calcarea in children who exhibit

Page  54 854 NASAL CATARRH: ITS CAUSES, the characteristic leuco-phlegmatic temperament. Sambucus is appropriate, where the nose is obstructed by a thick mucus with sudden suffocative attacks and starting from sleep. PART IV. REMEDIES. Some brief indications are here presented for the (employment of a number of the more prominent remedies useful in the treatment of Nasal Catarrh. ALUMINA. This remedy ranks with those which have proven efficacious in combatting scrofulous taint, coupled with chronic nasal or aural discharges. It also counteracts the tendency to Catarrh in those who are predisposed, and may be classed with those drugs which are first to be considered in cases of ozaeua.

Page  55 COMPLICATIONS, PREVENTION, TREATMENT, &C. 55 Its prominent symptoms are ulceration of the Schneiderian menmbrane, with discharge of thick yellowish macus or expulsion of yellowish-green scabs, stoppage of the nose, snapping in the ears, when chewing or swallowing, caused by partial occlusion of the Eustachian tubes. Pain in the root of the nose, chronic inflammi-ation of the fauces with accumulalion of tenacious mucus in the throat. Alumina is a prominent remedy for old people and to be thought of in all cases of Catarrh when there is obstinate constipation from atony of the bowels, so that even soft stools are passed with difficulty; useful in Catarrhal affections occurring among painters and workers in lead. Alumnia patients are generally better in the open air, but take cold from the slightest exposure. ARqENTUM NITRICUM. Violent itching in the nose-ulcers in the nose which become covered with yellow crusts. Scurfs in the nose which excite pain and are followed by slight bleeding when detached. Stoppage of the nose at night with much itching. Bloody and purulent mucus discharged from the nose. Dullness of the sense of smell. Coryza with constant chilliness, lachrymation, sneezing and violent stupefying headache. Argentum is a good remedy in both acute and chronic Catarrh of the nasal passages. The pharynx, larynx and eyes will nearly always be found

Page  56 56 NASAL CATARRH: ITS CAUSES, mnore or less affectedhby catarrhal inflammation when this remedy is indicated. Wlien Catarrh is complicated with Ophthalmia, this is among the foremost renmedies. ARSENICU rM. The discllharge for which this remedy is indicated is of a burning, acrid character, occasioning a biting and soreness in the nose. There is frequent stoppage of the nasal passages, accompanied by a stinging(, burning sensation and succeed'ed by fluent coryza. There is usually great restlessness and chilliness even, in the chronic cases; the sufferer clings close to the fire, and is better in a warm room and worse in the open air and at night. Sleeplessness with beating in the forehead and sometimes nausea; no thirst or desire to dcrinllk often but little at a time; the ears are sometimes affected, anrl one or both become closed during deglutition. The catarrhal symptoms often affect the eyes, producincg a discharce of excoriating tears. This drug is to be thought of prominently in cases of thin anld illy nourished subjects and in those who l]ave been long subjected to malarial influences. IARSENICUM JODATUM, The Iodide of Arsenic is applicable in persons with pale, delicate skin, enlarged tonsils, defective assimilation; tendency to passive cedema, shown by puffiness of the eyelids. It is also strongly indica

Page  57 COMPLICATIONS, PREVENTION, TREATMENT, &C. 57 ted in the tuberculous diathesis, upon0 which has been grafted a Nasal or laryngeal Catarrh. The discharge in thiese cases is generally copious and thini, but sometimes scantv and thick, now and then teinacious and frothy. Discharge of very irritating and corrosive, watery mucus, which burns thle nostrils and lips, attended, often, with alternate chills and 1heat. Epideimiic influenza; otorrhcea, complicated with Catarrh, where the discharge is fetid and corrossive. Summer Catarrh or HIay Fever. A burning sensation inl the l1ose allcl throat is quite characteristic. Like the simple Arsenic, this combination is often useful in cases complicated by effects of malaria. ASA(FJTIDA. This drug, has proven useful in offensive nasal discharges in nervous, hysterical females. The writer has, however, seldom found it of advantage save as an intercurrent remedT. AURUM. This remedy affects the nose as prominently, ierhaps, as any other known to the JlIateria Jedica. It is indicated in caries of the bones of the nose; fetid discharge of greenish or yellow pus. Salty tasting, watery discharge through the posterior nares. Nostrils closed with ulcers. Loss of smell and frequent discharge of blood fiomn the nose. Swelling of the nose after walking ill the open air; nasal bones

Page  58 58 NASAL CATARRIl: ITS CAUSES, painful to the touch; fetid otorrl-ca with Catarrh; coryza, sometimes violent and profuse; habitual iasal tone of voice; drinks flow back again through the nose. It is one of the first remedies to be thought of after abuse of Mercury; in syphilitic ozoena, and in Catarrhs which appear only in winter. The mental symptoms are characteristic. There is great depression of mind; patient constantly bemoans his condition and thinks everybody knows his complaint —shuns society on account of the disagreeable odor from the nose. YWhen tihe scrofulous diathesis is marked, the Aurum mnuriaticurn is preferable to the Auruml metalicu in. CALCARE.A CARBONICA. This is armong the most prominent of the remnedies which are useful in conibatting profoundly seated constitutional taints. It should always be carefully considered in cases of children of scrofulous diathes;s and phlegmatic temperament, with affections of the glands, and having a chronic discharge either from the ears or the nose. The symptoms in such subjects are usually of a sub-acute character. Dampness, coldness of the feet and a feeling as though the stockings were always wet are prolinent symptoms under this drug. The nasal discharge for which the Calcarea is applicable is usually thick and pus-like, but sometimes thin and watery. There is frequently dryness of the nose at

Page  59 COMPLICATIONS, PREVENTION, TREATMENT, &C. 59 night, with moisture during the day. Often, the catarrhal symptoms are not confined to the nose, but the pharnyx and larnyx are also involved and there is present, sometimes, a peculiar raw feeling in the vocal organs, accompanied, not infrequently by chronic hoarseness. Inflammation, swelling and redness of the anterior portion of the nose; eruption on the nose; sore ulcerated nostrils; very bad smell in the nose; itching of the eyes with lachrymation. Calcarea is exceedingly useful in females of leucophlegmatic temperament where Catarrh existsin coiinection wlth leucorrhcea or menstrual irregularities. The constitutional symptoms and characteristic temperament are most reliable indications for the employment of this remedy. CILAMOMILLA. Adapted to children, where there is great irritability, with feverishness; one cheek red, the other pale; acrid mucus from the nostrils, which are frequently ulcerated; obstruction of the nose with fluent coryza; chills with thirst. EUPHRASIA. Very profuse, fluent coryza, with inflammation and redness of the eyes and discharge of excoriating tears; photophobia with dimness of sight; painfulness of the nasal passages, with sneezing and discharge of watery mucus. This remedy will be found frequently adapted to acute eases, but seldom useful in those of a chronic character.

Page  60 60 NASAL CATARRH: ITS CAUSES, GELSEMINUM. Bland, watery discharge from the nose, with frequent tingling ill the nasal passages; great chilliness with dread of leaving the fire; fever without thirst or restlessness; soreness in the throat and chest. This remedy affects prominently the mucous membranes of the nose, ears and eyes, and is frequently applicable in those severe epidemic influenzas which prevail at certain seasons of the year. It is often useful in suppressed Catarrh, but is rarely applicable in chronic cases. GRAPHIITES. Catarrh, accompanied with inflammnation of the fauces and stoppage of the Eustachian tubes, producing constant desire to clear the nose and throat. Roaring in the ears and crackling when swallowing. Catarrh of the middle ear. Bloody mucus from the nose, alternating with expulsion of dry scurfs, also discharge of thick fetid mucus. The aural symptoms are quite characteristic in this remedy and are nearly always produced by stoppage of the Eustachian tubes. There is frequently present in some part of the body, a tetterlike or humid eruption in cases where it is applicable. It often follows admirably after Mercurins and should be carefully considered in cases of women with tendency to unhealthy corpulance, and in those suffering with menstrual troubles.

Page  61 COMPLICATIONS, PREVENTION, TREATMENT, &C. 61 HEPAR SULPHUR. Swelling of the nose, which is painful like a boil, accompanied by Catarrh and smarting Ioughness in the fauces. The bones of the nose are painful to the touch. Nasal discharge thick and pus-like; sometimes tinged with blood. Headache worse from motion; Catarrh coufined to one nostril; every exposure to cold causes a new attack; cases of ordinary Catarrh where Mercurius has afforded partial relief and improvement has ceased. Especially useful where the patient has, at some period in life, had the itch, or other cutaneous disease which was repelled by external applications, such as ointments and washes. Also applicable where there is great sensitiveness; patient is chilled by the slightest draft of air; the least injury causes ulceration; swollen, indurated tonsils and hard, glandular swellings about the neck. Useful antidote to abuse of mercury where characteristic symptoms are present. ITYDRASTIS CANADENSIS. )ropping down of mucus from the posterior nares into the thloat. Raw, excoriating feeling in both nares. Constant inclination to blow the nose. The fauces feel raw and inflamed. Hawking up of tough yellow or whitish mucus. Tenacious stringy discharge. Ulceration of the membranes of the nose. Scrofulous ozena; aplhthous sore mouth; excessive secretion of tenacious mucus from the mouth; profuse lachrymation. The dropping down of mucus from the posterior

Page  62 62 NASAL CATARRH: ITS CAUSES, nares into the throat is exceedingly characteristic of this remedy, If constipation of the bowels and general atony of the system accompany the above symptoms, it will seldom fail to effect a cure, or, at least, produce a favorable change and pave the way for the successful employment of some other remedy. IPECAC. Coryza, with obstruction of the nose; loss of smell, and bleeding from the nose; Catarrh with asthmatic dyspncea; debility and loss of appetite, with nausea and vomiting; frequently useful in acute cases where Arsenic and Nux Vom. fail to relieve; rarely applicable in chronic Catarrh. KALI BICHROMICUM. This, in the writer's experience, is one of the most frequently indicated remedies in Nasal Catarrh. It exercises a very marked influence upon the nose, pharynx and larynx and is exceedingly useful in cases where all these parts seem involved. It is one of the few drugs beneficial in caries of the bones of the nose, and useful in combatting the constitutional effects of Syphilis, when complicated with Catarrhal affections of the nose and throat. It is especially suitable for fat, light haired people. The symptoms calling for its administration are: yellow discharge from the nose: internal ulceration; severe pain across the bridge of the nose; periodical discharge of tough plugs from the nose, tinged sometimes with blood; discharge of tough,

Page  63 COMPLICATIONS, PREVENTION, TREATMENT, &C. 63 stringy mucus; destruction of nasal septum; chronic "cold in the head," and Catarrhal inflammation of the fauces, with chronic hoarseness; loss of smell; fetid smell before the nose; headache from suppressed ozoena; Catarrh which is worse in warm weather; or which involves the mucous membrane of the stomach; loss of appetite, with nausea on moving about, relieved by lying down. KALI HYDRIODICUM. The Iodide of Potassium is applicable in fluent coryza, with copious discharge from the nose, at first very thin, watery, scalding, then thicker; frontal pressure and headache, with lachrymation, more or less profuse, and sometimes irritation of the throat. It resembles Arsenicum, in its nasal symptoms, more closely, perhaps, than any other remedy and is exceedingly useful in acute cases,"cold in the head" -where the characteristic symptoms are present. It will be found applicable, in some instances, in chronic Catarrhal troubles where the discharge is very copious and watery. L ACHEss. Extreriely copious discharge of watery mucus; swelling of and soreness of the nares and lips; scnrfs in the nose; vesicular eruption in the nostrils; discharge of pus and blood from the nose, with violent headache. Fluent coryza, with profuse se

Page  64 64 NASAL CATARRH: ITS CAUSES, cretion of mucus, running of the eyes, and cough; or when the coryza does not fully form itself, with stoppage of the nose. This remedy is especially useful in acute cases, where Nux Vorm., Mercurius or Hepar seem indicated, but do no good. In chronic cases, where the nose is very sore and greatly inflamed, the patient irritable, mind confused, with inability to think, this remedy is espepecially useful. LYCOPODIUM. This remedy is useful in cases where there is a persistent dryness of the nose, high up, with periodical expulsion of elastic plugs. The writer has seldom foulld it indicated in the commencement of treatment, but frequently indispensible towards the close. The symptomn-" Patient feels hungry, but a little food fills him up," the writer has frequently verified in treatment of Catarrhal troubles, as also a feeling of excessive accumulation of flatus in stomach and bowels; and stoppage of the nose only at night, with burning or dull heavy feeling in the forehead. This remnedy will be found useful in some cases where there is great aptness to take cold. Each attack being attended at the out-start by fluent coryza —corroding the upper lip. MERCURIUS JODATUS. This drug is frequently called for in Catarrhal

Page  65 COMPLICATIONS, PREVENTION, TREATMENT, &C. 65 affections of the nose and throat. It has a precious range of action. The nasal discharge for which it is indicated is a tough white or yellowish mucus, which forms chiefly about the posterior nares and in the post-nasal cavity. It is also useful in those profuse, acrid, long-lasting discharges which excoriate the nostrils and upper lip. The constitutional symptoms are most characteristic, viz Tonsils subject to inflammation and ulceration; induration and swelling of the glands; torpidity of liver and enlargement of the spleen. In syphilitic ulcerations of the nose, it should receive careful attention, unless Mlercury has been, previously, used to excess. MERCURIUS VIVUS. Nasal discllarge profuse and watery, also discharge of greenish, fetid pus from the ~nose. Liquids swallowed often pass back into the posterior nares. Chronic inflammation of the throat and tonsils. In acute attacks, copious discharge of watery saliva; -swelling redness and soreness of the nose; night sweats and feverish heat; symptoms aggravated by warmth or cold; pains in the limbs; bleeding fromn the nose during sleep or on coughing; aphlthe; fetid odor from the mouth; ptyalisrnm; Catarrh with cough and salty tasting expectoration or with Inucous diarrhcea. The roof of the mouth is often dry and there is constant inclination to swallowv. Catarrh of the Eustachian tubes. Hardness of hearing. Crackling

Page  66 66 NASAL CATARRH: ITS CAUSES, and roaring in the ears with periodical stoppage of one or both ears. Swelling and induration of the liver; torpidity of the liver and heavy sluggish feeling of the entire body. Patient worse at night, and in a warm room; experiences little relief from perspiration. INATRIUM CARBONICUM. Ulcerated nostrils, high up; hard, fetid clots expelled from the nose; also thick, yellow. and green discharge from the nose; roaring in the ears; great sensitiveness to noise; rough, acrid sensation in the throat; large quantities of mnucus in the posterior nares; extreme sensitiveness to cold; glandular swelling of the neck. In cases where the larynx is much affected by a general Catarrhal condition of the nose and throat, accompanied by haldness of hearing, this drug has. proven usefutl. NAT RUM MURIATICUM. In those cases where there is excessive liability to take cold. Also where the patient has taken a great deal of Quinine and there is weakness and languor. Dry)ness of the nose with sudden, thin coryza; hiardness of hearing with roaring and buzzing in the ears; yellowish complexion, chilliness and wlant of animal heat. This remedy has been very useful in cases where the patient has resided in a malarial distriet and taken a gleat deal of strong medicine.

Page  67 COMPLICATIONS, PREVENTION, TREATMENT, &C. 67' NITRIC ACID. Useful in persons who have taken a great deal of Mercury, and in Syphilitic Ozena. The discharge is yellow and fetid;. often accompanied by swelling of the nose and violent itching in the parts. Sometimes ichorous discharge is present. Violent coryza with lacerating in all the limbs; redness of the tip of the nose; great sensitiveness to the open air; excessive thinness; emaciation of the whole body. It is also important in cases where there is much heart-burn, acid eructations and other symptoms of dyspepsia: especially in persons subject to aphthous ulcers in the mouth. Nux VOMICA. Heat in the head and face with creeping chills even when seated by a warm fire. Fluent coryza in the daytime with stoppage of the nose at night; premonitory symptoms of Catarrh; inflammation in the frontal cavities with severe headache; expulsion of bloody mucus from the nose; excessive itching of the nose; severe pains in the face; frequently useful where Arsenicum fails to relieve. Dry coryza of infants. The writer has found this druog almost specific in many of those distressing frontal headaches, which frequently accompany Nasal Catarrh. If the bowels are.constipated and the patient feels worse ill the morning, it is still more strongly indicated. It acts also to a certain extent as an antidote to the injuri — ous effects of the douche and strong medications..

Page  68 68 NASAL CATARRH: ITS CAUSES, It prepares the system for the successful employment of other remedies. In dyspeptic persons of sedentery and studious habits, it is especially useful. PHOsPIIOR US. This remedy is especially suitable to persons of phthisical constitutions, who are subject to Catarrhal affections. The particular symptoms indicating its use are: Swelling of the inose, frequent discharcge of blood from the lose (very characteristic). Green-yellow discharge from the nose, with great dullness of the head. Catarrh with inflammation of the throat and hoarseness. The discharge from the nose is nearly always tough or thick and unaccompanied by coryza; weakness of the lungs; frequent hoarseness; tickling cough brought on by reading aloud, laughing or singing. Cough with salty expectoration; loss of the sense of smell; fetid smell from the nose; discharge of burning and smarting fluid from the eyes, especially in the open air; bleeding from the nose. Patient nearly always feels worse in the morning and especially worse when abroad on windyl days, and is al.so very sensitive to cold weather. This remedy is particularly useful in- cases where there is neuralgia of the head and face; headache worse from stooping. PULSATILLA. Loss of appetite; loss of taste and smell; photo

Page  69 COMPLICATIONS, PREVENTION, TREATMENT, &C. 69( phobia; feeling of dullness and heaviness in the head, especially in warm room, with obstruction of the nose; patient better in the__ o92en air; chilliness with absence of thirst; alternate stoppage and running of the nose. Applicable in cases of green, fetid discharge froml the nose, accompanied with hardness of hearing, as though the ears were stopped up; affection of the frontal sinuses. Bad smell fromr the nose. Pressure at the root of the nose. This renledv is oftener indicated in females thanml. ales. The mental symptoms are characteristic-patient gentle and melancholy and easily moved to tears. In Catarrhal cases of this class, there will always be found derangement of the stomachusually dyspepsia and, very likely, obstinate constipation. There is also frequently present a peculiar huskiness of voice, early in the morning, which passes away after slighlt cough and expectoration. Best suited to flabby subjects, of light complexion, irritable eye-lids, troubled often with aphthous ulcers in the mouth, and such as have an aversion to meats or greasy food. Useful in Catarrhal troubles following measles or other acute diseases. SANGUINARIA. Severe, burning heat and redness of the face; much sneezing; fluent coryza; watery, acrid coryza; Catarrhal Ophthalmia, with copious watering of the

Page  70 70 NASAL CATARRH: iTS CAUSES, eyes; beating and humrnin(r in the ears; feeling of dryness in the chest nlot diminished by drinking; sensation as if the throat were swollen up; pain in the breast, cough and finally diarrhce:; cold and languid circulation, with great sensitiveness to attrospheric changes. This powerful drug has a marked effect upon the mucous membranes of the body —particularly of the respiratory tract. It has been used most successfully in affections of the nose and throat, when there has been present a sensation of stinging and tickling accompanied by irritative swelling of the parts either with or without free discharge. It is exceedingly useful in cases of torpidity of the liver accompanied by Catarrh, especially in persollns subject to violent sick head-ache or vertigo. SEPIA. Swollen, inflamed nose, with sore and ulcerated nostrils; painful eruption on the tip of the nose; feeling of dryness in the nose and fauces; obstruction of the nose; violent, dry coryza with roaring in the head and ears. This remedy is prominently indicated in cases where there is a discharge of green, bloody mucus from the nose, especially when accompanied by external inflammation of the nose. It is curative, too, in cases where there is ulceration high up in the nasal fossie, accompanied by loss of smell. It acts well in dark-haired, pale-faced women. In such,patients there is, sometimes, ayellow discoloration of

Page  71 COMPLICATIONS, PREVENTION, TREATMENT, &C. 71 the skin across the nose, resembling very much a saddle. In womren with uterinle weakness and menstrual derangements the Sepia is often highly useful. SILICEA. Tlhis remedy is often indicated where there is painful chronic dryness of the nose. or inveterate ulceratiQon of the Schneiderian membrane, produci ug an acrid,corroding discharge. In these cases, if there is a tetter-like eruption about the nostrils or on the lips, these indication s for its use are strengtlhened. Silicea acts slowly but profoundly, and is adapted to the scrofulous diathesis, especially where the.re is induration alld suppuration of the glands or lympbhatics in any part of the system. Like Atrurtn, it reaches those deep-seated morbid processes vwhich sometinies attack, destructively, the bones of the nose. STICTA PULMONARIA. Severe corvza, violent sneezing, intense headache and conjunctivitis with burning in the eyes and fullness at the root of the nose. The primary discharge is a hot, irritating, watery mucus which frequently changes to a thick, greenish or bloody matter. Frequently the discharge dries up in the nose, forming scabs which are difficult of expulsion; there is also great dryness of the throat, with painful deglutition; aggravation at night; and often incessant sneezing.

Page  72 72 NASAL CATARRHI: ITS CAUSES, ETC. This renledy is frequent applicable in acute Catarrhal affectiois a1nd sonmetimes in chronic cases, especially where there is painful dryness of the nose. Summller Catarrh, or Hay Fever falls witlin its raI'ge of actionl. SUTEPIJUR. -Useful in chlronlic obstruction of the nose, attended by formation, in the passages, of hard dry scabs, also where there is frequent bleeding of the nose and external inflammation; illusions of smnell; Catarrh mrith itching eruptions on the skin; excoriation and ulceration of the nostrils; profuse secretion of thick, yellowish and puriform mT'ucus; boils and eruptions on the nose; stoppage of the nose, sonetimes only one-sided; aphtlie; ptyalism; great susceptibility to taking cold; great heat of the feet at night with burnilg and itching. One of the prominent indications for this remedy is an unhealthy condition of the skin, where every little injury suppurates and heals slowly. When Catarrh accompanies this condition,Sulphur will act most satisfactorily. This, like Hepar Sulphur, is to be considered in obstinate cases, where there may be suspicion of a psoric taint, from repelled itch, or where the person has been subject to out-breaks of nettle rash; or' when there has been excessive use of MIercury.

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