Bilious or sporadic cholera Or that which is attributable to casual causes only Symptoms The first-named variety, sometimes called

the Sporadic Cholera, generally commences with a sudden feeling of nausea and griping, followed by purging and vomiting; in severe cases, accompanied with coldness of the body, particularly of the extremities, anxious and hurried breathings, excessive thirst, a feeling of cramping in the legs, sometimes in the arms, with spasmodic contractions of the muscles of the belly, shrinking of the features, and a hollow expression about the eyes; pulse weak, sometimes scarcely perceptible; thin, watery, and fetid, or bilious evacuations, sometimes with dark, bilious vomiting, anxiety and straining. Causes The most frequent are worms, gall-stones, unwholesome - indigestible - food, fruits, or crude vegetables, alterations in temperature, moist of marshy situations, damp weather, wet feet, suppressed perspiration from sudden exposure to cold, over-fatigue and over-exhaustion, cold drinks when overheated, teething, or pregnancy. Treatment Ipecacuanha is very frequently the most appropriate remedy in the premonitory stage, but is often useful when the most urgent symptoms of cholera have been subdued by other remedies, such as Veratrum, and c. It is particularly indicated when there is nausea, with copious vomiting, and more or less griping, followed by diarrhoea, the stools still containing excremental matter mixed with slime, and presenting a greenish or brownish color; sensation of weakness (or of internal sinking); coldness of the face and limbs; sensation of shivering in the belly; slight cramps in the calves of the legs and in the fingers and toes. Dose: Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every hour (in cases in which the motions are very frequent), or every four hours (when the intermission is of longer duration), until the symptoms abate; and then every six hours, until positive amelioration or change. But if any of the subjoined symptoms should occur, consider the following medicines, - returning, however, to the administration of Ipecacuanha, as just directed, if the vomiting should become a prominent symptom. Chamomilla is, likewise, of great utility in the early stage, particularly when the complaint has been excited by a chill, and is associated with great dread of the disease, or when a fit of passion has given rise to it, in which latter case, indeed, this latter remedy is almost specific. The following are the symptoms which most especially indicate its employment: - acute, colic-like pains, or heavy pressure in the region of the navel, sometimes extending to the heart, with excessive anguish; bilious diarrhoea; cramps in the calves of the legs; tongue covered with a yellow coating; and sometimes vomiting of acid matter. Dose: Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful at each dose, as directed for Ipecacuanha, - substituting the last named medicine if the vomiting should become a prominent symptom. PAGE 275 Colocynthis is sometimes more appropriate than Chamomilla for the treatment of cases, the origin of which can be traced to a moral cause, particularly such as a fit of anger, or mortification attended with indignation. Dose: A solution of six globules, as directed for Chamomilla. Pulsatilla pratensis

is to be preferred to Chamomilla when the attack has been provoked by partaking of rich, indigestible food, and also when slime predominates in the evacuations. Dose: Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every two hours (when the motions are very frequent), or every four hours (when the intermissions are of longer duration), until the symptoms abate; and then every six hours, until positive amelioration or change. Nux vomica may be most advantageously employed after Ipecacuanha when the vomiting subsides under the influence of the latter, but symptoms of spasm of the stomach remain, such as - weight and tightness in the region of the stomach; or when anxiety, griping, frequent but insufficient evacuations and straining, severe headache seated in the forehead, accompanied with shuddering and with predominant internal chills still continue to prevail. Dose: Of a solution of six globules to three table-spoonfuls of water, give a tea-spoonful every three hours, until the symptoms abate; and then every six hours, until positive amelioration or change. Veratrum album is generally to be preferred for the treatment of patients of otherwise robust and healthy constitutions, and whose circumstances are such as to afford them all the comforts of life. This valuable remedy, which is equally well adapted to the malignant form of cholera, as it is to the milder variety now treated of, should at once be employed if the disease increases, notwithstanding the administration of the preceding remedy, or if, from the first, it assumes the following characteristics: violent vomiting with severe diarrhoea, excessive weakness and cramps in the calves of the legs, and c.; eyes hollow or sunken, countenance pale, and expressive of acute suffering and intense anguish; coldness of the breath and tongue; yellow or livid tongue; excruciating pain in the region of the navel; tenderness of the belly when touched; great thirst; dragging pains and cramps in the fingers, shrivelled appearance of the skin in the palms of the hands; extreme coldness of the extremities; cold, clammy sweat. Dose: Of a solution of twelve globules to two table-spoonfuls of water, give a tea-spoonful every half hour (or, in very urgent cases, even every ten or fifteen minutes), until the symptoms abate, the pains being more bearable, and the motions and vomiting less frequent or incessant, and c.; then every two hours (or even every four hours when that is found sufficient, and the improvement is progressive), until positive amelioration or change. Arsenicum album (which is to be preferred for patients of debilitated constitutions, or whose physical powers have been deteriorated by insufficient or unwholesome food, or, by living in squalid, unhealthy and ill-ventilated dwellings, or in districts in which ventilation and drainage are imperfect, and c.) is useful when this malady assumes a severe character from the beginning, but is more particularly indicated when the disease is attended with rapid prostration of strength, insatiable thirst, excessive anxiety, loss of articulation, with fear of approaching death, burning sensation in the region of the stomach, almost constant discharge from the bowels (the stools being usually very acid - creating a feeling of burning heat - and attended with straining) or renewal of the discharge, as often as the desire for drink is gratified; suppression of urine or scanty discharge of urine, followed by a burning sensation; violent and painful vomiting, tongue and lips dry, cracked and bluish, or black; hollow cheeks, pointed nose; pulse almost imperceptible, or small, weak, intermittent, and trembling; severe spasms in the fingers, toes, and c., clammy perspiration. PAGE 276 Dose: A solution of twelve globules, in every respect as directed for Veratrum.

China officinalis is chiefly useful against the weakness which remains after Cholera, but is also serviceable, occasionally, during the course of the disease, particularly when vomiting of food, and frequent watery and brownish evacuations, containing particles of undigested food, are present; also when there is oppression at the chest, with eructations, which afford temporary relief; pain in the pit of the stomach, especially after partaking of the smallest portion of food; great exhaustion, sometimes amounting to fainting. This remedy is sometimes required when the disease has been excited by undigestible substances, such as unripe fruit, and c., or by inhabiting a marshy situation; Arsenicum, however, is preferable in this instance when the attack is severe, and the symptoms as detailed under that remedy. Dose: Three globules in a tea-spoonful of water, repeated every four hours, until amelioration or change. Diet and regimen, and c. To avoid unnecessary recapitulation, all the directions on these important particulars have been concentrated at the close of the subjoined section on Asiatic Cholera. As regards the Diet, Regimen, and Accessory Measures, the patient who is afflicted with this less critical form of Cholera, should not, therefore, consider himself exempt from the strictest application of those rules which are afforded in the following article. These regulations apply equally to all forms of Cholera. Asiatic cholera - malignant cholera Epidemic cholera This virulent disease generally commences with giddiness, headache, singing in the ears, and general uneasiness, a sensation of flatulence in the stomach (rumbling of wind), or griping pains, rapid loss of strength, and a feeling of weight and oppression in the region of the heart. In the severest forms of the malady the patient suddenly falls senseless to the ground, as if struck by electric fluid. But in many instances, diarrhoea is the first symptom, which, if, neglected, soon becomes associated with vomiting, severe colic, cramps or convulsions, anxiety, and dread of dissolution which appears to be inevitable. In some, though not all, cases of Asiatic Cholera, we find the lips, nails, and sometimes the whole skin, of a blue color, but, in almost every instance, the frame loses its power of generating heat, the pulse and pulsation of the heart are almost unfelt, and the circulation of the blood becomes stagnant. PAGE 277 Patients who have outlived the second stage sometimes fall victims to a secondary typhoid fever in the third. Predisposing causes The predisposing influences are: intemperance in eating and drinking; insufficient or unwholesome food; the use of unripe, or of cold, indigestible fruit and crude vegetables; cold drinks when the body is overheated; exposure to exhalations from decayed vegetable or animal matter; residence in low, damp, dark, ill-ventilated dwellings; excessive fatigue; suddenly suppressed perspiration; sudden mental shocks, or moral emotions - as fright, fear, grief, and especially passion; - neglect of cleanliness, both personal and domestic; constitutional debility, serious derangement of the digestive organs, weakness of the bowels, and c. As any, or, at all events, several of these in conjunction, tend to favor the invasion of the disease, they ought, when practicable, to be carefully guarded against or removed. Exciting causes These are generally said to depend upon some peculiar atmospheric conditions. But it is to be remarked, that such atmospheric conditions (properly so called - in contradistinction to the many other immediate causes of diseases, with which the atmosphere may be impregnated), do not appear necessarily to involve whole regions or even extensive tracts of country. Cases are not wanting, especially in tropical climates,

in which this disease, in all its distinctive features, has occurred almost in isolated instances, or has been confined to particular spots. Treatment The success of treatment much depends upon the promptness with which remedial resources are exhibited, upon the earliest recognition of the attack. Tincture of camphor if administered upon the earliest premonitory indications of the attack, will often avail to prevent the further development of the disease, and will at all events, in the great majority of cases, avert fatal consequences; and if, moreover, the aggregate symptoms be such as are here subjoined, this medicine will, in most cases, suffice to effect a cure. The following are the particular indications in the early stage, which call for the administration of Camphor: - chilliness, shivering, giddiness, headache, singing in the ears, pain, weight, pressure, or a distressing sensation in the pit of the stomach, cramps with protracted rigidity in the calves of the legs, sensation of general uneasiness, sudden loss of strength; - or when, in addition to, or in the wake of the foregoing, the patient is seized with rigidity of the limbs or prolonged spasms in the fingers, arms, calves of the legs, and in the muscles of the belly; sunken, blue-encircled eyes; diminution of the senses; slow, or scarcely perceptible pulse; blueness and icy coldness of the face and hands, and greatly diminished temperature of the whole body; burning heat in the throat and region of the stomach; distended bowels; much flatulent rumbling; nausea and even vomiting, and diarrhoea; diminished or suppressed urine (an almost constant symptom in Cholera); hoarse voice; countenance expressive of excessive anguish; suffocating oppression. Camphor is sometimes, also, of service in a later stage, in cases such as those described as indicating Cuprum, when, however, symptoms of lock-jaw, and general spasms supervene. PAGE 278 Camphor should, moreover, be administered three times, (if very urgent symptoms do not transpire,) as below stated, before other treatment is adopted, when the patient has previously taken allopathic medicines. Dose: Take of the purest loaf-sugar, or of sugar-of-milk, finely pounded, just a sufficiency, upon which deposit one drop of the tincture, thus administering the dose, and repeating such dose, at first every five minutes, extending the intervals according to the duration of the intermissions between the spasmodic attacks, only repeating the administration as the attack returns, and continuing this course until positive amelioration or change. Decided improvement is readily distinguishable: first, by increased warmth, and, shortly, by diminution of anxiety, by comparatively healthy perspiration, and by an inclination to sleep. After sleeping an hour or two the patient awakes with a sensation of ease which he can scarcely believe. Veratrum, Arsenicum, Cuprum-a., Carbo vegetabilis These four medicines may be numbered amongst the most essential when Asiatic Cholera in its characteristic malignity has fairly set in and exhibits its worst aspect. One or more of these remedies either singly, in alternation, or in succession, may yet operate with astonishing effect in arresting the progress of the disease. The selection should depend upon the particular symptoms exhibited, and by comparing such symptoms with the indications subjoined in respect of each medicine now named. But it may not be superfluous to add, that the broad distinction which should generally determine the choice between Veratrum and Arsenicum, consists in the following difference of circumstances and conditions, namely: - 1. Veratrum is preferable whilst there is yet considerable reactive power (whereas Arsenicum is more appropriate when the vital energies seem feeble and as if disposed to sink rapidly). In the like manner, Veratrum is more appropriate for persons of habitually robust and vigorous health, and who are

not exposed to the depressing effects of insufficient or unwholesome food, or of squalid, uncleanly, illdrained or ill-ventilated dwellings, or to continual residence in unhealthy districts, and to the mischievous effects of deleterious exhalations. 2. Arsenicum, on the other hand, is usually more efficacious for those whose constitutions are either hereditarily defective or have been impaired by irregular habits, excesses, and intemperance, or who have been habitually exposed to any of the injurious circumstances just enumerated. The alternation of these two medicines, especially, is nevertheless of considerable advantage in some very desperate cases. Veratrum album (especially under the particular circumstances just enumerated) should be employed without a moment's delay, when Cholera sets in in its worst and characteristic form, with sudden and violent fits of VOMITING and PURGING, the evacuations resembling starch or rice-water, after several paroxysms; flatulent rumblings, excruciating gripes, severe cramps (either with protracted rigidity, or with rapid alternations of contraction - particularly the latter) in the calves of the legs, and c. (second stage), ice-like coldness of the entire body, even of the tongue, cold, clammy sweat, oppressed respiration, feeble pulse, great thirst - the patient, if permitted, drinking large quantities of water, - excessive weakness, terrified look, weak, hollow voice, groaning and yawning. PAGE 279 Dose: If singly, six globules in a tea-spoonful of water, every quarter of an hour (in extreme cases), or every half hour (in less urgent instances), or even in some very desperate cases, and when a fatal issue seems imminent, every five minutes, - until the extreme severity of the symptoms becomes somewhat abated; and, subsequently, every time the paroxysms return, and so on until the symptoms yield or change. But if no positive improvement should ensue within the first two hours, or even within the first half hour (in very desperate cases) consider the subjoined medicines, especially if alternation with another remedy may not be more effectual. If in alternation with Arsenicum, Cuprum, Carbo, or any other medicine, give the like dose of each in rotation, at intervals, regulated by the same considerations, continuing until decided amelioration or change. Arsenicum album is to be preferred to Veratrum (especially if the circumstances above enumerated should further qualify the case) when the symptoms hereafter mentioned occur. It may be premised, however, that this medicine is usually the most appropriate to be employed after the previous employment of Veratrum, or in alternation with that medicine, when relief has not promptly followed the previous treatment; - the indications for alternate administration of both these medicines consist in the combination of the indicative symptoms of each. The particular symptoms which more distinctly identify Arsenicum as the appropriate medicine are as follow: - scanty discharge by purging or vomiting, with severe urging or retching; external coldness or chilliness, accompanied with a burning sensation in the stomach and bowels; rapid loss of strength and extreme prostration, intense and insatiable thirst, with, however, inability to swallow more than a few drops (even of water) at a time without instantly or speedily adding to the intensity, or provoking a return or aggravation of all the sufferings; severe spasms (generally) or cramps in the fingers, toes, and c.; clammy sweat or extreme dryness of the skin; hollow, sunken, cadaverous appearance of the features and pointedness of the nose; livid spots on the skin; insuperable anxiety and intense restlessness; extreme oppression at the fore part of the chest and pit of the stomach; a pulse almost imperceptible, or small, weak, intermittent and trembling; violent and painful retching with scanty vomiting; tongue and lips dry, cracked and blueish, or black; suppression of urine, or scanty discharge of urine, followed by a burning sensation; loss of articulation; dread that recovery is hopeless,

and that dissolution is rapidly approaching. Dose: If singly, six globules in a tea-spoonful of water, every quarter of an hour (in urgent cases), or even every five minutes (when a fatal issue appears imminent), or only every half hour (in cases of a less desperate character), until the symptoms are modified, and the sufferings are not so incessant; then extending the intervals according to the duration of the periods of remission between the paroxysms, and so on, until positive amelioration or change. If in alternation, as directed for Veratrum. But if the patient be gradually sinking, and the pulse become less and less perceptible, or otherwise, if no good effect should appear to result from the third dose of Arsenicum, consider the other medicines herein-named, and Carbo-veg in particular, especially as regards the pulse. PAGE 280 Cuprum aceticum should be administered within a quarter of an hour after the last dose of Veratrum (especially), if notwithstanding the previous administration of the medicine last named, the cramps should continue to increase and should constitute a predominant feature in the case, or should be converted into general spasms, or into convulsions, particularly of the extremities, and especially of the fingers and toes, or convulsive twitching and jerking of the limbs, and attended with spasmodic constriction of the chest, which obstructs respiration and causes the patient to gasp for breath. The subjoined are additional indications for Cuprum: intense aching pains at the pit of the stomach, aggravated even by the slightest touch; noisy deglutition of liquids; vomiting and diarrhoea simultaneously, or in quick succession; sometimes intense, contractive, pinching pains in the bowels without vomiting, or vomiting preceded by a choking constriction of the chest, or again attended with an excruciating sensation of pressure in the region of the stomach; great restlessness; sometimes rolling of the eyeballs; coldness of the prominent parts of the face. Dose: If singly, six globules in a tea-spoonful of water, every quarter of an hour, until amelioration or change. But if partial relief only be observed to succeed the administration of Cuprum, resort to the alternate administration of Cuprum and Veratrum. If in alternation with Veratrum, the like dose of each medicine, the one fifteen minutes after the other in rotation, until positive amelioration or change; or, again, if partial good effect only ensue after the first hour, consider also Cicuta and Camphor. Carbo vegetabilis may often be advantageously employed after the previous administration of one or more of the preceding medicines, or even in alternation with Arsenicum (in some cases) when the patient is reduced to the last extremity, animation being all but completely suspended, and the pulse scarcely perceptible; or when on the cessation of vomiting, purging, and cramps or convulsions, determination of blood to the head and chest ensues, attended with oppressed breathing, coldness of the breath, redness or livid hue of the face (which is covered with clammy sweat) and lethargy - the patient seeming as if seized with an apoplectic fit. Dose: Six globules in a tea-spoonful of water, (or, - if there be difficulty in ensuring its being swallowed thus - dry on the tongue), at intervals of five, ten, and fifteen minutes successively, and then (if the pulse become stronger) every half hour until positive amelioration or change. But if, upon the development of stronger pulse, and the subsidence of the lethargic symptoms, the pain, vomiting, cramps, andc, should return, at once resume the administration of Veratrum as before Additional particulars Ipecacuanha, Nux vomica These remedies (the first either singly or followed by Nux-v.) have been found efficacious either before

or after the previous administration of the other medicines (generally when more urgent symptoms had been overcome), or at the onset of the attack (in milder cases), when such indications as the following could positively be identified. PAGE 281 Ipecacuanha may be administered under circumstances such as those just stated, either after previous treatment, when the vomiting becomes a prominent symptom, and the discharge attending it is more copious, or at the onset of the attack when the vomiting (being copious, and attended with much nausea) predominates, so as to characterize the case distinctly. Further indications for this remedy are such as the following: sensation of weakness (or of internal sinking), coldness of the face and limbs, sensation of shivering in the belly, slight cramps in the calves of the legs and in the fingers and toes; or sometimes again, vomiting, alternated with watery diarrhoea, accompanied with or preceded by griping, colicky pains; or even yellowish diarrhoea in some cases in which the vomiting does not occur; or loose evacuations of excremental matter mingled with slime (at the commencement of the attack), or evacuations of a greenish or brownish character. Dose: Of a solution of twelve globules to four table-spoonfuls of water, give a tea spoonful every hour, until amelioration or change. But if, after the more violent symptoms (the vomiting especially) have yielded in a degree to the action of Ipecacuanha, pause three hours, and proceed with the next medicine, if the subjoined symptoms remain. Nux vomica may be employed with great advantage three hours after the last dose of Ipecacuanha, when the vomiting has subsided under the influence of the last-named medicine, but symptoms of spasm of the stomach remain, such as weight and constriction in the region of the stomach; or again, when anxiety, great debility, griping, frequent, small evacuations with much straining, frontal headache, or aching pain at the back of the head, and shuddering, with predominant internal chills, continue to prevail. Dose: Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every hour, until the symptoms abate; and then every three hours, until positive amelioration or change. Cicuta virosa has proved an appropriate remedy, when there are spasms in the muscles of the chest, continuous vomiting, and little diarrhoea, when the eyes are turned upwards, and the patient is in a drowsy state. Dose: Six globules in a tea-spoonful of water, (or, if there be difficulty in this method, dry on the tongue), every ten minutes, until the symptoms abate, and then every half hour, until positive amelioration or change. Stramonium may be more appropriate to cases of a very analogous description, but when the distinctive indications for this remedy (as stated in the article on the "Characteristic Effects") are more prominently developed. Dose: In every respect as directed for Cicuta. Secale cornutum is very useful in cases of colorless diarrhoea, with pains in the extremities remaining on the cessation of the vomiting, but is also valuable alter Veratrum and Cuprum, when the cramps or convulsions do not yield to these remedies. The following have, however, been found the more immediate indications for this remedy; very copious, exhausting evacuations from the bowels, violent and painful spasms, particularly in the feet, toes, hands, and fingers, - the latter being often thereby spread asunder and drawn backwards, spasmodic pains in the stomach; wrinkled, shrivelled, cold, blue-colored skin. Spasms of the above-

described character, remaining or commencing after the subjugation of other symptoms by means of other remedies, almost invariably yield to a few doses of Secale. PAGE 282 Dose: Of a solution of twelve globules to two table-spoonfuls of water, give a tea-spoonful every ten minutes, until the purging, cramps, and other symptoms are subject to longer remissions; and then as often only as the return of the paroxysms renders the administration necessary, and so on until permanent amelioration or change. Treatment of the after-effects of cholera Carbo vegetabilis is of much service in the stage of convalescence when flatulent rumblings and colic with diarrhoea and excessive flatulence during stool remain. Dose: Three globules in a tea-spoonful of water every hour, or after every intestinal evacuation, until a degree of improvement becomes apparent, and then every twelve hours, until permanent amelioration or change. Cicuta virosa will be advantageously employed in cases which exhibit symptoms analogous to those engendered by its specific action, as stated in the article devoted to the consideration of the medicines at the end of this work. Dose: In every respect as directed for Carbo vegetabilis Phosphorus is very useful when debilitating diarrhoea remains after the removal of the more urgent symptoms, and particularly when the stools are watery, and sometimes productive of an acrid, pungent sensation in the last intestine, and attended with belching, weight or oppression at the pit of the stomach and lateral regions (without the heat or burning which accompanies this symptom in the cases that call for the employment of Arsenicum), and pain in the region of the navel, rumbling noise in the bowels, either at other times or on pressing the hand against the belly, pricking or shooting pains in the left side of the chest, and c. Phosphorus is also useful when a tendency to vomit remains, but with the distinctive indication that it only occurs about a quarter of an hour or so after drinking, or when the cold fluid drunk has become warm in the stomach. Again, it is a remedy of much importance in the event of congestion in the chest, with oppressed and laborious breathing, in addition to the before-mentioned symptoms during the course of the disease. Dose: Three globules in a tea-spoonful of water, every three hours (or every hour in more urgent cases) until the symptoms abate, and then every six hours, until permanent amelioration or change. But if the subjoined symptoms ensue, proceed at once with the next medicine. Phosphoricum acidum should be administered either after the previous use of Phosphorus, or even before it in the event of the tongue becoming exceedingly clammy or slimy; or again, if colliquative diarrhoea should ensue with or without the typhoid or congestive symptoms hereafter described; or when the dullness of the head and pallor of the face occur; or the evacuations are watery or slimy; or exhibit a greenish-white hue, and there is inadequate discharge of urine. PAGE 283 Dose: Of a solution of six globules to two table-spoonfuls of water, give a tea spoonful every two hours, until positive amelioration or change. China officinalis

is usefully employed against the general debility resulting from Cholera. Dose: Four globules in a tea-spoonful of water, every six hours, until four doses have been given, and then every twelve hours, until permanent amelioration or change. Sulphur is a medicine of great importance in completing the cure in this, as in many other diseases, when occurring in persons subject to haemorrhoids or to cutaneous affections, or other signs of constitutional derangement, especially against the irritation or weakness in the alimentary canal characterized by frequent attacks or nearly constant continuance of looseness of the bowels. Dose: Three globules in a tea-spoonful of water, every six hours, until the evacuations become less frequent and relaxed; and then six globules, in a wine glassful of water, every morning, the first thing (fasting) for ten days, (unless distinct improvement or change should sooner occur), after which pause four days, resuming the course, as before, if still required, and so on, until positive and permanent amelioration or change. Cantharidinum may be advantageously administered when there is great irritation and pain in the bladder, with scanty, loose evacuations and straining. Dose: Three globules in a tea-spoonful of water, every two hours, until the symptoms abate, and then every four hours, with permanent amelioration or change. Bryonia alba And rhus toxicodendron, these two medicines given alternately prove of great service with typhoid symptoms and delirium ensue. Dose: Dissolve, separately, of each medicine, eight globules in two table-spoonfuls of water, and give a tea-spoonful, first of one solution and then of the other, in rotation, at intervals of two hours, until a degree of improvement becomes apparent, and then at intervals of three hours, until permanent amelioration or change. Rhus toxicodendron And bryonia, these two medicines given alternately prove of great service with typhoid symptoms and delirium ensue. Dose: Dissolve, separately, of each medicine, eight globules in two table-spoonfuls of water, and give a tea-spoonful, first of one solution and then of the other, in rotation, at intervals of two hours, until a degree of improvement becomes apparent, and then at intervals of three hours, until permanent amelioration or change. Hyoscyamus niger should be administered when the patient lies in a torpid state, or speaks confusedly, and exhibits a red and bloated face. Dose: Three globules in a tea-spoonful of water. (or dry on the tongue,) every three hours, until the symptoms diminish in intensity, and then every three hours, until permanent amelioration or change. But if no apparent effect ensue within an hour after the third dose proceed with the next medicine. Opium should be given an hour after the third dose of Hyoscyamus, if no apparent effect has resulted from the previous exhibition of that medicine, the patient still remaining in the same drowsy state. Dose: Three globules, as directed for Hyoscyamus. But if only partial improvement be perceptible within an hour after the third dose, proceed with the next medicine. Lachesis mutus

should be given an hour after the third dose of Opium, in the event of the continuance of the symptoms without material modification. PAGE 284 Dose: Three globules in a tea-spoonful of water (or dry on the tongue), every two hours, until the symptoms are modified, and then every three hours, until permanent amelioration - or change. Aconitum napellus is of service when the blue, cold stage, is succeeded by heat of the skin, quickness of pulse, headache, noise in the ears, dryness of the tongue (the tip and margins being red), and deep-colored urine. Dose: Three globules in a tea-spoonful of water every three hours, until amelioration or change. Belladonna becomes requisite when the symptoms which succeed the cold stage are - extreme tenderness of the belly, redness of the face, with fullness of the vessels of the head. Dose: Three globules as directed for Aconitum. Antimonium tartaricum And chamomilla, these two medicines respectively (according to the analogy between the symptoms present and their specific indications, as enumerated in the article devoted to the consideration of the medicines at the end of this work), are of considerable service when the evacuations become very bilious, as the more serious symptoms subside. Dose: Of either remedy as thus selected, give three globules in a tea-spoonful of water every six hours, until amelioration or change. Chamomilla And antimonium tartaricum, these two medicines respectively (according to the analogy between the symptoms present and their specific indications, as enumerated in the article devoted to the consideration of the medicines at the end of this work), are of considerable service when the evacuations become very bilious, as the more serious symptoms subside. Dose: Of either remedy as thus selected, give three globules in a tea-spoonful of water every six hours, until amelioration or change. Accessory treatment The patient should be kept in a room of a warm temperature, the bed should be heated by artificial means, - bottles of hot water applied to the feet, if necessary, and hot flannels to other parts of the body. The observance of this rule greatly facilitates the action of the medicine employed. Enveloping the patient in a damp sheet (one which has previously been soaked in warm water), and then wrapping him in blankets, is another useful auxiliary mode of treatment. Frictions with woollen cloths, and the act of rubbing and pinching, under the bedclothes, the parts affected with spasms, have also been recommended; but if these auxiliary measures prove distressing to the patient, he should be left quietly under the action of the medicine. Anything which might disturb the equanimity of the sufferer, such as noise or contradiction, should be carefully avoided, and his spirits should be sustained as much as possible. Food and Drink. Cold water is the best drink, but the patient should not be allowed to take too much at a time; the occasional administration of a small piece of ice, if possible, or of iced water in tea-spoonfuls, is often attended with benefit; and injections of iced water are sometimes serviceable in relieving the colic and cramps in the intestines, - or of starch-water in the case of straining. When cold water, in lieu of diminishing, increases the vomiting or other sufferings, and the patient expresses a wish for a little nourishment, tepid emulsion of sweet almonds, thin gruel, barley-water, toast-water, milk and water (all warm and given in tea-spoonfuls at a time), may be administered.

PAGE 285 During the convalescence following this disease, we must be careful not to indulge the patient to the full extent of his desires. It is therefore advisable, when the appetite returns, to commence with semolina, sago, arrow-root, and such-like, as also cocoa, chicken broth, or beef-tea; but great caution must be observed, in order to avoid the risk of a relapse from an undue amount of nutriment. This is best accomplished by the administration of a table-spoonful every hour, or only every two or three hours diminishing or gradually augmenting and varying the quantity and quality of the food, according to the effects produced. General accessory precautions Care ought to be taken to avoid excesses of all kinds, late hours, exposure to night air, melancholy thoughts, or fear, which are all predisposing causes to attacks of this malady. Pure air and thorough ventilation are indispensable, and the precaution of providing a free current of water through all drains, and c., is not to be neglected. If it be known that stagnant or obstructed drains, cesspools, and the like, are distributing noxious exhalations about a dwelling, the safest course is (if possible), to remove to another locality, the next, to endeavor to neutralize the poison which is given out by these decomposed deposits, by means of chloride of lime or peat charcoal, and c. It is, however, very hazardous to set about removing such nuisances during the prevalence of the Epidemy, this should have been done before, or should generally be left until afterwards, and when there is no longer reason to apprehend the distribution of additional causes of disease; a keen frost may render the cleansing of foul places comparatively safe. Regular exercise should be taken during the best part of the day (in fine weather) in the open air, but excessive fatigue should be avoided. Preservative measures during the prevalence of cholera Accurate observance of the Homoeopathic Preventive Regulations will in a very great number of cases avert the attack altogether. But even if this should not be the case, the disease will in general be developed in a very modified form, and such as will usually be readily subdued by the employment of Camphor (as heretofore directed at page 277). In some few cases further treatment may become necessary according to the directions and indications stated in the foregoing portions of this article, but there will rarely be reason to apprehend a serious issue. Preventive medicines Veratrum-alb., Cuprum-acet. These medicines, whose characteristic action combined, most closely corresponds with the aggregate symptoms which identify the true Asiatic Cholera, may therefore be mentioned as those which will usually act with the most positive and specific effect when employed as preservative medicines. PAGE 286 Dose: Begin by giving six globules of Veratrum in a tea-spoonful of water, twice, at intervals of twelve hours; then pause two days, after which administer two similar doses of Cuprum, in like manner; then pause three days, after which give two doses of Veratrum as before; then pause three more days, after which repeat the two former doses of Cuprum; then pause four days, after which repeat the two former doses of Veratrum; then pause four more days, after which repeat the two former doses of Cuprum; and so on, during the continuance of the epidemy, adding one day to the length of the pause, after every such course. But in the event of a degree of medicinal action (see the article on the "Characteristic Effects") being developed, which will be distinguishable by progressive subsidence, upon suspension of the course, suspend the administration of both until it has thoroughly subsided. The doses for children should consist

of three globules administered in like manner. Clothing It may also be remarked, that, during the prevalence of this disease, the clothing should be sufficient to preserve the body at an equable temperature, and care should be taken to avoid chills or checked perspiration, or cold and wet feet: those who are affected with considerable perspiration in their feet, should change their stockings at least once daily; a flannel bandage worn round the abdomen is also a useful precaution, and should not be hastily laid aside, even when the danger seems to have passed away. Diet Adherence to the homoeopathic rules is a sufficient dietetic guide, but too sudden a change of diet is not advisable raw vegetables, such as celery, salads, cucumbers, pickles, and cold fruits, - for example, melons, oranges, apples, pears, and c. - should be carefully abstained from; and even the more wholesome varieties, and all cooked vegetables should be used in extreme moderation; pure beer and non-acid wines are unobjectionable for individuals not attacked, and accustomed to their daily use, with the same limitation.