Inasmuch as we do not know of any remedy which might be used with anything like certainty in the last stage of hydrocephalus, I may be permitted to suggest Indigo among the physiological effects, of which we remark the following: Sensation as if the head were enlarged and more prominent; undulating motions; warmth and sensation as of boiling water in the occiput, etc.

§ 271. I shall conclude with a few remarks which seem to me of some importance.

It is frequently difficult, even for experienced physicians, to diagnose the disease in its first stages, more especially for this reason, that the disease seldom exists among children as an idiopathic disease, characterized by peculiar symptoms, and that it generally comes on slowly, in consequence of dentition, acute cutaneous eruptions, or diseased condition of the reproductive organs. It is easily confounded with worm-fever, though such symptoms of the latter affection as resemble hydrocephalus never last with anything like permanence, but exhibit long intermissions.

The most dangerous kinds of hydrocephalus are those which arise from acute diseases, particularly eruptive diseases by metastasis. Goelis terms such cases of hydrocephalus "hydrocephalic apoplexy." In chronic hydrocephalus the interference of art is most available, especially in the first stages, which last longer and exhibit even, at times, a decrease of the symptoms. If the physician be sent for in time, he will generally be able to save the patient. This variety of hydrocephalus arises most frequently from external injuries, blows, or a fall on the head. The treatment differs from the course which has been described in the preceding chapter, even from the commencement. The specific remedy for such cases is Arnica, internally and externally. For the external application, I use one portion of the tincture of Arnica to one, two, or three portions of pure water, and continue the application as long as any pain or other morbid symptoms remain.

§ 272. Spinitis, meningitis spinosa, myelitis, inflammation of the spinal marrow.

In myelitis, as well as in encephalitis, the membranes and substance of the marrow generally suffer simultaneously, and we therefore prefer describing the symptoms in one group, as we did in encephalitis. The disease is characterized by a more or less violent burning-stinging, tearing pain, along the course of the spinal marrow, frequently resembling a rheumatic pain. The patient feels the pain deep-seated, not in the muscles or bones, which can be pressed upon without increasing the pain; it is most violent on bending or moving the spinal marrow, and is sometimes intolerable in a recumbent posture, particularly in bed. The patient is able to lie on either side, but on turning has to keep the spinal marrow straight and rigid, on account of the pain. In some cases the pain remits at first, but soon becomes permanent. The pain not only extends over a large portion of the spinal marrow, but spreads also to the chest, shoulders, abdomen, thighs, according as one or the other portion of the spinal marrow is inflamed, and frequently occasions a troublesome drawing in those parts. In the later stages of the disease, clonic spasms are experienced in the extremities which are nearest the seat of the inflammation, not in the face; these spasms are apt to come on or to get worse in consequence of pressing on the spinal marrow, or of quickly moving the trunk. The same remark applies to painful paraplegia.

The patient complains, moreover, of chilliness, anguish, unnatural, unpleasant warmth, or, in the more violent cases, of excessive heat in the spinal marrow, particularly in the most painful part of it; the pulse is accelerated, the skin hot, profuse sweats set in. The head is free, without pain or heaviness, (except when the inflammation extends to the brain, in which case delirium, dysphagia, etc., set in.) the eye is bright, open, moves freely, consciousness is undisturbed, even during the convulsions.

The nearer the inflammation reaches the head, the more difficult it is to move the latter, or to swallow. The nearer the chest, the more the chest, shoulders, and hypochondria are affected. In myelitis lumbalis, the pain extends to the bowels, thighs, and pelvis.

§ 273. Myelitis occurs most frequently among young subjects and persons of robust constitutions. It frequently arises from mechanical causes, blows on the back, contusion of the back, concussion by a fall, dislocation and fractures of the vertebra; from cold, exposure to wet, rheumatism, etc.

Myelitis generally runs a rapid course, particularly when the disease arose by metastasis from exanthe-matic diseases, or from dysmenorrhoea. The disease terminates: (1.) In recovery, with gradual disappearance of the symptoms, and the development of the critical phenomena generally attendant on fevers. (2.) In exudation, suppuration, and softening, with increase of the paralytic symptoms. (3.) In death, which generally ensues in consequence of the last-named conditions. Paralytic conditions frequently remain, which disappear either gradually or not at all.

The prognosis is generally unfavourable; it is most favourable when the disease arises from some mechanical cause. Copious sweat, hardness of the pulse, and delirium, are said to be fatal symptoms.

§ 274. The treatment should generally commence with Aconite, even if the fever were not a true syno-cha; but if the pulse be quick and bounding, Aconite is the first remedy to be administered, no matter where the inflammation may be seated.

Although Bryonia is supposed to be indicated in all affections which get worse by motion, yet it is only indicated in myelitis when the disease is seated in the lumbar and sacral regions, when the adjoining abdominal organs are likewise affected, and the alvine evacuations are difficult.

Nux vomica is more suitable in chronic myelitis without scarcely any fever. The inflammation in this case holds a middle rank between acute and chronic rheumatism, the interior of the vertebral column being principally affected, and the abdomen remaining more or less free.

I have seen some cases of myelitis arise from imperfectly developed acute exanthems, particularly scarlatina and measles, the symptoms setting in with so much violence that every motion occasioned the most horrid pains. The joints of the extremities were likewise affected, their motion being impeded in consequence. There was considerable fever, but not acute, and there seemed to be a tendency to exudation. Dulcamara proved the best remedy, even if exudation had threatened to set in, or had actually taken place.

Belladonna is a principal remedy in this disease, particularly when arising by metastasis from the above-named acute eruptions, or when the disease is seated in the upper part of the spinal marrow.

I am unable, for want of experience, to point out more specifically the symptoms to which the above-mentioned remedies correspond. There are other remedies, which may likewise prove available, such as Pulsatilla, Arsenic, Digitalis, etc., when the chest is involved, with paroxysms of anguish, palpitations of the heart, etc.; or Veratrum, Ignatia, Cocculus, etc., when spasmodic conditions of the abdomen, a feeling of coldness, etc., are present.

§ 275. Otitis externa et interna, inflammation of the outer and inner ear.

These two kinds of inflammation, if arising from an internal cause, are generally found united. They are generally accompanied with cerebral suffering, particularly if the inflammation of the inner ear be very prominent.

These inflammations are characterized by the following symptoms: Heat, redness, and swelling, which frequently closes the meatus auditorius externus, particularly when the outer ear is inflamed, and spreads even over the adjoining parts. In internal otitis the pain in the inner ear is extremely violent, burning, stinging, tearing, boring, throbbing; it is aggravated by the least motion, extends frequently over the whole, head, and affects even the brain; this is the cause why otitis is apt to be accompanied with symptoms of cerebral inflammation. The meatus is exceedingly sensitive, a humming and roaring are perceived in the ears. There is violent fever, with furious delirium, vomiting, coldness of the extremities, great anguish, convulsions, fainting turns, throbbing of the carotids and temporal arteries, etc.

Under alloeopathic treatment, this kind of otitis is very apt to terminate in suppuration. Such a result has never occurred to me in my practice.

The disease generally sets in in consequence of a cold; but it may likewise occur in consequence of inflammation of some adjoining organ extending to the ear, or in consequence of the suppression of acute and chronic cutaneous eruptions, particularly the itch. I have likewise observed otitis in conjunction with secondary syphilis.

§ 276. The treatment of otitis is pretty much the same in all cases, no matter by what cause the disease may have been originated. If the symptoms of cerebral disturbance should be most prominent, the remedies will have to be chosen with especial reference to that state of things.

Experience has induced me to consider Pulsatilla as the true specific for otitis with delirium, horrid pain, swelling of the internal meatus, ear, and adjoining parts. According to Hahnemann's provings, Pulsatilla should not be given when there is much thirst and costiveness; although these symptoms are constantly present in otitis, yet I have always given Puls, with success.

Although Puls, is the specific remedy for otitis when the inflammation attacks simultaneously the inner and outer ear, and is equally violent in either part, yet there are cases where Belladonna is the best specific, especially when symptoms of cerebral inflammation, a painful tightness in the head, delirium and rage, convulsions and fainting turns, aphony, and the like, are prominent symptoms. For the latter symptom, Rhus tax. might likewise be used with success. Other remedies are: Bryonia, Aconite, Mercurius, Hepar sulphuris, Cantharides, Calcar., etc.*