§ 149. Diaphragmitis, paraphrenitis.

This kind of inflammation is generally complicated with pneumonia, pleurisy, hepatitis or nephritis. It is known by a very violent pain in the lower portion of the thoracic cavity, which is more or less superficial or deep-seated, limited or extended, being felt lower down during a deep inspiration, with sensation of contrac-tion in the whole region of the diaphragm, from the sternum to the back and loins. If the whole diaphragm be inflamed, the pain is exceedingly distressing, extending from the lowest ribs to the dorsal vertebrae. The epigastric region, and particularly the pit of the stomach, is very hot, sensitive, drawn in, sometimes swollen, tight, beating, and burning internally. The inflammation is accompanied with a violent fever, with small, quick, sometimes intermittent pulse, violent and constant delirium soon sets in, with restlessness and excessive anguish, which the patient expresses by his looks and features; in many cases risus sardo-nicus, trembling, singultus, dry and distressing cough, vomiting, convulsions, attacks of paleness as if the patient would faint. The pain increases to a frightful extent from the least pressure or motion of the diaphragm. In higher degrees of inflammation, deglutition is impossible. Respiration is hurried, short, suffocative, anxious, or sighing and moaning. The pain is the same in any position of the body, and is somewhat relieved only by erect posture, with a slight inclination forwards.

§ 150. Diaphragmitis may be occasioned by inflammation of adjoining organs; by cooling the heated body suddenly, by uncovering it or by taking a cooling drink; by all sorts of organic injuries and atmospheric influences.

The prognosis depends greatly upon the violence and complication of the symptoms.

§ 151. If the fever have a true synochal character, Aconite is to be given first; but if the fever should have the erethic form, Bryonia is more specifically indicated. I consider Bryonia the most important remedy for diaphragmitis.

Chamomilla relieves the following symptoms: swelling of the pit of the stomach and subcostal region, with aggravation of the beating, burning pain extending from that region to the spine, by every pressure which moreover shortens the already oppressed breathing; the breathing is anxious and short, or intermittent in consequence of the pain; frequent, dry, harassing cough; vomiting, convulsions, great restlessness, tossing about, complaining, and the like. When these symptoms occur in liver-grown children, Chamomilla is likewise the best remedy.

If the lower part of the chest should feel constricted, as if surrounded with a band, with short, dry, distressing cough, anguish, retention of stool, great thirst, Nux vom. is a specific remedy, which gives place to Nux mosch., when the chest feels as if oppressed with a load, and when this feeling of oppression seems to come from the pit of the stomach, attended with a dry cough and arrest of breathing. The symptoms come on after taking cold by being in the water. Colchicum is likewise useful when the symptoms are occasioned by the same cause, and when the pain resembles a tensive pressure and is periodically worse.

Cannabis is suitable for anguish and oppression, Cocculus for a constrictive sensation, Pulsatilla for both conditions, provided they exhibit an inflammatory character. Ambra deserves a preference over any other remedy, when the painful oppression is accompanied with flushes of heat and anxiety in the region of the heart.

Other remedies are, Arsenic, Phosphor., Drosera, Sepia, Veratr. Spigel., Lauroc, etc.