Hepar sulphur is an impure calcium sul-phid prepared by heating a mixture of calcined oyster shells and flowers of sulphur. Its physiological action is practically the same as that of the chemically pure salt, yet when fine therapeutic distinctions are made, the two medicines are not to be considered in identical action and should not, therefore, be used interchangeably.

Hepar sulphur disturbs the entire organism in a greater or less degree, but its more apparent and immediate points of action are confined to the skin, respiratory and intestinal tracts and the blood.

The skin presents an unhealthy condition; eruptions such as eczemas and ulcers make their appearance and they suppurate easily. Foul smelling excretions are discharged and the skin is sensitive to cold and touch. Practically every manifestation of the action of hepar sulphur is attended by this oversensitiveness to slight mechanical or thermal irritation.

Upon the respiratory tract, Hepar sulphur causes a catarrhal condition, mostly of a croupous character. Its action here is very pronounced. A cough is produced characterized by the ejection of thick, purulent sputum, which is easily expelled. The pathological conditions produced in animals are those of congestion and exudation in the bronchi and lungs, and the same, or similar conditions are produced in the human, as the symptoms therein found are those which can be caused by this kind of a pathology only. "There is produced (in the rabbit) great congestion around the bronchus; blood vessels large and small are distended and filled with blood elements. Some exudate covers the lining epithelium. There is round celled infiltration in some portions of the mucosa and muscular layer. Some congestion and exudation are apparent in the surrounding lung tissue. The following changes are seen in lung tissue: many lobules throughout the section are congested. This is especially true of those about the bronchi. Many of the bronchi contain an exudate, consisting largely of blood elements with some mucus and denuded epithelium. The bronchial epithelium shows an infiltration of leucocytes and some disintegration. Congestion is present in the large vessels of the section."

The exact changes in the blood that result from the influence of Hepar sulphur. cannot be stated except in clinical terms. Probably many of the skin effects result more from a disturbance in the functions and quality of the blood, than they do from a specific effect upon the integument itself. Suppuration is the result of prolonged treatment with the drug and it may assume the forms, in addition to those previously mentioned, of tonsilitis, hypopion, or furunculosis. Clinical evidence goes to show that, at first, lime salts decrease the phagocytic power of the leucocytes, which in part may explain the "suppurative" symptoms of the remedy, and that in another stage of their action, they specifically augment their motility and phagocytic effect.

In the bowel the sulphids act as irritants, producing increased peristalsis and purgation. This is the explanation, in part, for the diarrheic symptoms caused by Hepar sulphur; the discharges being sour smelling, owing to the presence of bacteria.

It was discovered by Dr. J. H. Wilms, of Cincinnati, Ohio, that calcium sulphid is the antidote for bichlorid of mercury poisoning. That the treatment is effective, the doctor has shown by numerous laboratory experiments, supported by clinical observations.

Therapeutics

Hepar sulphur. is an impure calcium sulphid and not to be confounded with cal-carea sulphurica or calcium sulphate, which, however, resembles it in respect of some of its clinical uses.

Hepar sulphur. as it is commonly spoken of, is first of all, to be thought of in relation to suppurative processes. When indicated and if given in time, it may avert pus formation, or if given after pus has commenced to form, it will hasten this formation and bring it to a focus. In the treatment of boils or abscesses for example, Hepar sulphur. is frequently indicated following Belladonna, where the latter has modified the initial violence of the process, but has failed to check it. Extreme sensitiveness to touch, as well as to cold air or draft, sharp sticking or splinter-like pains, throbbing and general chilliness of the patient, will be the indications.

This sensitiveness to touch or to pain, as well as sensitiveness to cold, are in fact, very characteristic indications of this remedy. Patients who faint readily from pain, may require Hepar sulphur.

In suppurative tonsilitis or quinsy this remedy is of great value, often relieving the entire condition within a very short time and obviating the necessity for the knife. Sharp sticking pains in the throat, extending to the ear on swallowing, yawning or on turning the head, but relieved by warm or hot drinks, are the guiding symptoms for its use.

•The patient requiring Hepar sulphur perspires easily on exertion, or has sour smelling sweats, especially at night. He likewise takes cold easily. In bronchitis, Hepar is useful when the cough is beginning to loosen and becomes rattling and choking in character, with copious sweat on coughing. In spasmodic croup or in simple catarrhal laryngitis, it will often be needed when these conditions have followed exposure to dry cold winds. The cough is barking and croupy, yet has, so to speak, a loose edge to it; is aggravated by any exposure to cold air or draft, by even uncovering a part of the body and in the early morning hours. In these conditions, the temperature is low or even absent altogether. Hepar frequently is useful after the exhibition of Aconite, Belladonna or Spongia, particularly in croup.

A curious fact regarding Hepar is, that many of the conditions calling for it are made worse by or during dry cold weather, whereas damp, particularly warm and damp weather, is agreeable to the patient needing Hepar.

Suppurative otitis media will demand this remedy when suppuration impends or has taken place, with exquisite sensitiveness of the ear to touch and to drafts. The pus is thick, yellow and creamy. External application of heat relieve somewhat.

Pneumonia and pleurisy may require Hepar at some time during their later stages, when the exudate has begun to soften and is purulent, thick and yellow in character In the surgical treatment of pyothorax or empyema, for example, the remedy will be of aid to the surgeon, in reducing suppuration and in increasing the vitality and resistance of the patient.

It has been shown by laboratory experiments that Hepar sulphur. is capable of raising the opsonic index in suppurative conditions and thus has been established, a firm scientific foundation for its clinical use.

In diseases in which mercury has been too freely given, with resultant toxic effects, Hepar sulphur. will be of service as an antidotal remedy. Hence, in mercurialized syphilitic patients, its exhibition is at times called for.

The oculist will find a friend in Hepar sulphur., in suppurative keratitis. Hypopyon will be absorbed by it and corneal ulceration may frequently require it. In all ocular diseases in which this remedy is indicated, there will be present sensitiveness to touch, cold and bright light, together with stitching pains and an aggravation of all the symptoms at night. Warm applications relieve.

Hepar sulphur. when symptomatically indicated, is said to hasten suppuration, if given in the lower potencies such as the 2x or 3x; but if given in the higher potencies, is said to have the power to prevent the same. Clinical experience would appear to verify this observation.

Characteristic Symptoms Of Hepar Sulphur

1. Sensation as if a fish bone or splinter were sticking in the throat.

2. Stomach inclined to be out of order; longing for sour or strong tasting things.

3. Green slimy diarrhea of a sour odor.

4. Croup after dry cold wind, with swelling below the larynx, and great sensitiveness to cold air or water.

5. Cannot bear to be uncovered; coughs when any part of the body is uncov-erved.

6. Unhealthy, suppurating skin; every cut or hurt suppurates.

7. Ulcers very sensitive, burning or stinging edges, discharges corroding, smelling like old cheese, little pimples surround the principal ulceration.

8. Ailments after west or northwest wind.

9. Affections from the abuse of mercury or iodin, particularly the iodid of potash.

10. To promote suppuration in boils, abscesses, etc.