charge with much burning; pain in frontal sinuses; headache over right eye.

Silica.-Begins with itching and tingling of nose; violent sneezing and excoriating discharge; tickling cough.

Sinapis nigra.--Hay fever, nose dry and hot, no discharge; or there is a thin, watery, excoriating discharge; eyes red, smarting, burning, itching, with lachrymation.

Sticta. Feeling of fulness and pressure at root of nose and forehead; severe dry racking cough from tickling in trachea; rattling wheezing in chest; feeling of malaise.

Tartar emetic.-Fluent coryza with chilliness; rattling of mucus in chest with oppression.

Tarus bacata.-Has been occasionally prescribed.

Teucrium marum verum.-Tingling in nose, frequent sneezing, followed by coryza; scraping in fauces; tickling in upper part of trachea.

Urtica urens. -When in addition to the nasal symptoms

there is urticaria.

Zincum met.-Asthma, with oppression of chest; shortness of breath and cough after eating, particularly sweet things; smarting, itching and burning, worse in inner canthus; (Graph. affects the outer canthi). Most symptoms worse towards evening.

It might be added that much relief has been given by the use of a weak solution of adrenalin chloride frequently applied to the inflamed mucous surfaces.

A careful examination of the nose and throat should always be made to ascertain whether they are any foreign growths or abnormalities that require attention, for the removal of such has often given relief.

There are other drugs undoubtedly, which may be required when called for by concomitant symptoms or complications.

In order to differentiate between the above-named remedies, one must, of course, refer to the materia medica in order to obtain the complete picture required to secure the accurate homœopathic similimum. Whenever we can grasp that we secure results most satisfactory.

THE Boston Journal is our authority for the following information concerning a mutual agreement entered into by the thirteen physicians of the town of Attleboro. On account of considerable friction recently, concerning the scale of prices charged for the various classes of visits, the doctors have combined, and it is stated, have all signed an agreement whereby the following prices will be followed:

Office call, without examination, 75 cents; office call, with examination, $1.00 to $5.00; house visit in the village, $1.50; house visit to nearby villages, $2.00; consultation, $3.00; night visit, $2.50.

HOMOEOPATHIC PRESCRIBING IN DIARRHEIC
CONDITIONS.*

BY GRACE STEVENS, M.D., NORTHAMPTON, MASS.

The proverb that "there is nothing new under the sun" most surely applies to all I can offer on the subject assigned me.

A prescription for any of the various diarrhoeic conditions must be made on the same principle as any other prescription. "Give the indicated remedy" sums up the whole matter. Perhaps, however, we cannot be too often reminded that, while the local condition always claims attention first, the physician must look beyond that to the condition of the whole system. He must remember that the human body is an organism, not a mechanism; that when one part is sick, the whole body suffers; and that all the symptoms of a case must be collected if an intelligent choice of remedies is to be made. In other words, it is the patient, not the disease, that is to be treated.

A correct diagnosis of the case is most valuable as an aid to prognosis and to the choice of adjuvant treatment, but it does not as a rule help much in the selection of the remedy. The pathognomonic symptoms may be found under twenty different drugs, but we shall benefit the patient very little if we are not able to select the one best fitted to the case in hand; and this choice must be made as a rule through the study of symptoms which have little or no connection with the diagnosis.

Again, some drugs have proved useful in all the several different forms of diarrhoea, so that here again something beside the intestinal symptoms must decide. For instance, suppose the case to be one of dysentery. If we turn to that heading in Dr. Bell's book on diarrhoea, we find forty-four remedies given, and we are quite as much at a loss for the right one as before. But, if, on considering the patient as an individual, we find, let us say, irritability of temper, great sensitiveness to external impressions, chilliness from any current of air, much flatulence, backache, pain in abdomen and much urging before stool, with relief of these last symptoms after stool, we can easily select nux vomica as our remedy.

And then, in the second place, the fact that arsenicum has sometimes proved curative in dysentery would not deter us from using it in cholera morbus, if the patient were restless in spite of great weakness; chilly, thirsty, and worse after midnight.

Thus, although it is essential in choosing the remedy that attention be paid to the character of the stool as regards color, odor, consistency, size and frequency, it is also necessary to note the accompanying symptoms before, during and after, as pain,

*Read before the Massachusetts Homeopathic Medical Society, April 1906.

tenesmus, chill, sweat, faintness, nausea, etc.; also the times at which, or conditions under which, the symptoms are aggravated or ameliorated. Besides all this, the general constitutional symptoms must be observed, thirst, appetite, desires or aversions, even the mental symptoms, and, last in order of mention, but often first in importance, the cause of the attack should be carefully sought.

All these details may become clear almost at a glance, so that the choice of the remedy is a very simple matter; or it may demand a good deal of time and very close attention to collect the symptoms and still more time and study to make a correct prescription. In the latter case, however, the time will have been well spent. There is no surer way to waste time with a case than to make a hasty and careless prescription, as any physician can testify who has been so unfortunate as to try it.

To give a list of the remedies which are at one time or another useful in diarrhoea and dysentery would mean repeating the names of nearly half our proven drugs. This I will not attempt to do, but will speak of only a few, which, although not those most commonly used, are extremely serviceable when they are indicated.

Dulcamara, the bitter-sweet, usually fits cases that are caused by exposure to cold and dampness after being overheated, or by sudden changes in the weather from hot to cold. Dr. Kent speaks of the remedy as especially useful in the diarrhoeas of children who have been at the mountains late in summer, when the days are very hot, and the evenings cold; also with people whose work compels them to go from one extreme of temperature to another, as those who handle ice or work in cellars.

The stools may be watery or mucous and bloody, and are apt to be preceded and accompanied by perspiration, colic and nausea. There is thirst after the stool, and the skin becomes hot and dry. When the exciting cause is present, Dr. Bell calls it "an indispensable and all-sufficient remedy," but says it must be given at the beginning of the attack in order to be useful.

Where the stool is preceded and accompanied by severe cutting pain in the abdomen, we are apt to think at once of Colocynth, and that is surely a most valuable remedy; but it is by no means the only drug that has that symptom, and one that needs to be carefully compared with it is Aloe.

The stool, like that of colocynth, may be yellow fecal or composed of mucus and blood, for both remedies are useful alike in diarrhoea and dysentery, but the aloe stool is apt to be discharged involuntarily when flatus or urine is expelled. Both remedies have an aggravation after eating, but colocynth more especially from eating cold food or fruit. Aloe has also an aggravation from standing and walking. Colocynth has re

lief of pain from hard pressure and bending double; with aloe this amelioration is less marked, but the passing of flatus brings relief. In aloe also, the rectal symptoms are more prominent than in colocynth:- the tenesmus is greater, there is heat, burning and feeling of weight, and, besides, there are often the characteristic aloe hemorrhoids which are relieved by cold water. Aloe has many times a craving for food, especially in children, while colocynth is apt to have nausea.

One writer tells of four cases of dysentery in one house, all of them characterized by excruciating abdominal pain and one also by prolapsus ani. The patients did not improve under the mercuries or colocynth, but recovered promptly on receiving aloe.

Another remedy which is interesting to compare and contrast with colocynth is dioscorea.

It has a violent colic occurring in paroxysms, but unlike colocynth it is worse lying down or bending double, better by standing straight and walking about, and also better by eating.

In a copy of the American Homeopathic Review for 1865 there is an account by Dr. Adolph Lippe of an epidemic of dysentery in Philadelphia. He says, in part, "The remedy most frequently indicated was mercurius corrosivus. The violent tenesmus, continuing after the evacuation, the discharges of blood and mucus, and the aggravation during the night were its indications. In former years nux vomica and colocynth were the remedies most called for."

In a protracted and desperate case the patient suffered much from tenesmus vesicæ; the desire to pass urine was urgent and continuous but unsuccessful, except during an evacuation from the bowels; also accompanied by violent tenesmus. Cantharides, camphor, aconite, mercurius corrosivus, capsicum and sulphur had been given without any good result. Alumina has the following symptoms [vide Hahnemann's Chronic Diseases]: Sympt. 567. While pressing to stool, which is passed with much difficulty, the urine escapes involuntarily. 792. Loose evacuations with tenesmus in the rectum.

Alumina relieved the patient at once and confirmed former observations when under similar circumstances alumina had been the curative remedy.

Thrombidium cured two cases. First, a consumptive old lady who was suddenly attacked with great tenesmus, straining to stool, prolapsus ani, with discharges of mucus and soft feces; was soon relieved.

Second. An old gentleman about seventy-five years old, much emaciated, but of nervous temperament, had dysentery for three weeks. The aggravation was from 4 P.M. to 4 A.M.; the straining and tenesmus violent, rectum and hemorrhoidal tumors protruded constantly when he was urged to evacuate;

discharges consisted principally of pus, blood and mucus, with occasional very small pieces of feces. The skin was dry, tongue coated, thirst moderate, pains in the bowels very moderate.

The most carefully selected remedies had but a very short effect in relieving. Mercurius corrosivus had been given in a single dose in various potencies and in water, but it did no permanent good.

Thrombidium 1000 [Dr. Fink's preparation] dissolved in water and a spoonful administered every few hours, at once removed all symptoms of dysentery. There was a profuse discharge of fecal matter without straining, tenesmus, or prolapsus ani.

These last two cases reported by Dr. Lippe suggest a comparison of thrombidium and podophyllum, on account of the symptom, prolapsus of the anus which occurs more frequently under those remedies than any others. Thrombidium has more pain before and during stool than podophyllum, and a pain in the left side of the abdomen before stool is especially characteristic. The thrombidium stool is frequent and scanty:- that of podophyllum very profuse and usually watery, with a meal-like sedi

ment.

Podophyllum has also marked exhaustion after stool, like nitric acid and sepia, but especially secale cornutum and veratrum album. With both of the last remedies we connect the cold, pale face, sunken eyes and general symptoms of collapse. The characteristic aversion of the secale patient to being covered or to any external heat, will help to distinguish the two;- also the fact that veratrum has more severe pain before and during stool, with vomiting and cold sweat on the forehead. Both drugs may be useful in the worst type of cholera morbus.

The cases which I have to offer from my own experience are in no way remarkable - they simply show the result of an attempt to prescribe according to the principles already stated.

Case 1. On shipboard. Miss E. H. called me to her stateroom one evening, and said that she had had diarrhoea for several days, but not knowing that there was a homoeopathic physician on board had been taking some "hot medicine" offered by a fellow passenger, but without any relief.

The stools were watery and nearly white, painless, and did not cause exhaustion. The patient had suffered from sleeplessness for several nights.

The only remedy in Dr. Bell's "Homoeopathic Therapeutics of Diarrhoea" which has absence of exhaustion is phosphoric acid, and this has also the white, watery, painless stool. Phosphoric acid was accordingly given, and the next morning my patient reported that she slept well all night, and she had no more diarrhoea.

Case 2.

Miss M. H. For several days has had diarrhoea