: This medicine is especially suitable in the low zymotic forms of sickness, such as we find in diphtheria and scarlet fever, in blood poisoning and in symptomatic typhoids, especially those cases that are characterized by capillary congestion in spots, red mottled spots.

: Perhaps the most striking manifestation of such a low type of sickness is malignant scarlet fever. The regular rash does not come out, but in its place red spots, roseola-like, make their appearance; the usual uniform spread of the eruption has failed, or has been suppressed, and there is bleeding from the gums and nose, and dreadful tumefaction in the throat.

The countenance is purple and besotted, the eyes are congested and there is even bleeding from the eyes. There is an appearance of great prostration, but it is really stupefaction; he seems stupid and benumbed.

If you look at the throat you see it is covered with little purple patches, intermingled with an oedematous appearance similar to that found in Baptisia. It is a low depressed type of sickness.

De composition of the blood is going on rapidly. The blood that oozes is black. The child is going into a state of stupor and it is with difficulty that he can be aroused. Sometimes blisters are formed on the ends of fingers, or here and there over the body. From the mouth and nose come foetid odors. The child is going as rapidly as possible into a form of malignant disease.

Sometimes the disease comes on as a light febrile attack, but from taking cold and suppressing some of the natural manifestations the case takes on a low typhoid form and whereas you had at first only a simple remittent, the case has now assumed a state of prostration with a very rapid heart, foetor, purpleness or blueness, a passive congestion with purple blotches of the skin, causing a mottled appearance.

When a disease turns so suddenly blood poisoning is going on and a symptomatic typhoid state appears. A remittent that turns into a sharp zymotic state in the course of twenty-four hours, a diphtheria that takes on this form with stupidity and mottled skin are examples of such a type of sickness.

: The mental symptoms accompanying this state are interesting. I read from some nows I have made. A continued dreamy state of mind though awake. Child cries all the time. Sees little animals like rats running around.

Feels a rat or something small crawling up the limb and over the body. There seems to be constant loss of memory, even the things spoken of a moment ago go right out of the mind. Constant forgetfulness. All past events are forgotten. Past events are forgotten or remembered as belonging to someone else, or as matters read.

That is in keeping with the dreamy state, it seems as though those things that are past appear as in a dream, as if he had dreamed them. Cannot concentrate the mind in any mental effort; cannot answer questions correctly; is as if in a semi-conscious state, and finally he goes into complete unconsciousness.

There is in the earlier stages of this zymotic state great anxiety and restlessness, later there is stupor and indifference to everything. Continual sighing with depression of spirits; extremely irritable, semi-conscious, finally unconsciousness, stupor, delirium and insensibility; muttering delirium with sleeplessness and restlessness.

This mental state is such as occurs in zymotic sickness; the chronic illness has not been well brought out. Dr. Wells used this remedy in a number of cases, as it was at that time an epidemic remedy for scarlet fever, in Brooklyn, and many patients were saved by it. It seemed to be able to change the character of the malignant forms of scarlet fever into a mild type.

: In addition to the symptoms of the text it has been observed that the hair falls out and flashes of light play before the eyes on closing the lids at night.

"Pupils widely dilated; copious, thin, ichorous and bloody, discharge from the nose."

That is in the zymotic states in scarlet fever.

"Nostrils congested. Great prostration and a countenance indicating much distress. Face dark as mahogany."

That is in suppressed scarlet fever. Purple, bloated and puffed, besotted face. This remedy is one not very much used, and it is not very often indicated, but it is very useful when indicated. You will not very often see this particular type even in malignant scarlet fever. You will often see such a scarlet fever running to a number of other remedies, but this remedy corresponds to one of the most malignant types, and its commonest use will be in an epidemic in which the cases largely run to the malignant type.

There are three common types of scarlet fever. In one season you find the cases are mild and simple, the typical eruption is present and comes on speedily without any great amount of fever. Such cases will often run their course with good nursing, a warm room and plenty of clothing without much medicine.

: The skin is bright red, smooth and shiny. The case is not serious. In other epidemics you will find only an isolated case of this kind, while the majority of cases present marked trouble in the throat; the rash is scanty when present, and congestion of the head and spinal symptoms come on with pain in the back of the neck.

: The throat is dreadfully swollen and inflamed, bright red and very painful. Then there is a third type in which the throat is severely swollen, all the mucous membranes are swollen, and the whole tendency is toward ad poisoning or zymosis with enlargement of the glands, puffiness of the skin and a great deal of fetor; the skin is dusky and the eruption is scanty, sometimes hardly visible from beginning to end.

These cases will almost all die if let alone; they are very serious. The old authors call these three forms "scarlatina simplex, scarlatina anginosa," and "scarlatin. maligna."

In some epidemics you will see all three of the appearances; in some families you will see two forms.

One child will have a mild in type, and another will have it more severely with zymotic blisters here and there, on the ends of the fingers, and these will be attended with foetor; as soon as the blisters break ulceration will take place if the child live long enough; but these are the deadly cases, the malignant type.

Even when the rash does not come out in the low forms of scarlet fever, the impression of the finger makes a white mark which will be slow to fill up. The more marked that is, the lower the type. The more zymotic the type the more sluggish the circulation, and in this remedy especially is this state present.

The congested condition of the skin is present even when there is no rash, a passive congestion of the veins.

Quite a number of medicines have that, but Veratrum viride produces such a vaso-motor paralysis that a line upon the skin made by pressure will remain a long time. In all these zymotic complaints there is a foetid odor that is sometimes cadaveric, sometimes like stinking meat; this will be found in the low types of disease where this remedy is indicated.

"Throat much swollen, dark red, almost purple in color. Diphtheria with extreme prostration. Throat livid, swollen; tonsils prominent and studded with deep ulcers."

The throat and tonsils very often appear as if they would pit upon pressure like a dropsical state. In some of these zymotic cases where a reaction ought to take place a diarrhea sets in that is horribly offensive; a critical diarrhea. With these zymotic states there is pain in the back of the neck and head no matter what the name of the disease is.

"Breathing hurried, irregular, heavy. Burning in the palms and soles, hunts to find a cool place to put them. Feels a rat running up the leg. Feeling as if a snake crawled up the leg."

These mental symptoms occurred in one of my provers. In low, adynamic forms of disease characterized by sudden and extreme prostration,

"Vomiting, pulse small and rapid purplish appearance of skin."

"Electric thrill from brain to extremities."

"Chill at 8 A.M. with chill, heat and sweat."

During the chill vomiting of food and piercing pain over the hip. Chill is preceded by malignant eruption, especially on the face and forehead.

"During chill hunger, empty feeling, intolerable pain in back of neck, upper part of back and hip joint."

That pain in the back of the neck is a common forerunner of low types of fever. It generally precedes a congestive attack of great violence characterized by fullness of the head with heat.

: This miliary rash spoken of in the text, looking like measles, is when the scarlet fever rash or the measles rash does not come out in its uniform fashion, but in patches, little circles here and there and is dark.

"Irregular, patchy, livid eruption, disappearing on pressure and return ing very slowly; interspersed with small vesicles, worse on forehead, head, neck and chest. Eruption appeared scantily for two days with sore throat and mild fever" .

This eruption is like the petechiae that we see, in typhoid forms of disease. The record of this remedy in scarlet fever makes it worthy of further study; it ought to be reproved that we may have a fuller understanding of it.

"Eruption plentiful, of a bluish tint. Typhoid scarlatina."

"Eruption is slow to make its appearance, remains livid."

"Body and limbs covered with an irregular patchy eruption of a very livid color."

Here you see but one type of scarlet fever. This low type of fever sometimes needs Sulphuror Phosphorus, or Belladonna, or Baptisia, or Lachesis. That you may be able to distinguish one from the other and keep the picture of each remedy clearly in mind requires a prolonged study of the Materia Medica.

It is an easy matter to compare remedies for yourself after you have first studied each one separately.

You can then bring out many comparisons, and especially in this case at the bed side. If you go to the bedside with a good knowledge of the generals of Materia Medica you will be surprised at the number of symptom pictures which will come into your mind, called up by the signs of the sickness.

When you go to the bedside of scarlet fever you should not call to mind the names of these medicines you may have heard recommended for scarlet fever; let the appearance of the patient bring to mind such remedies as appear like this patient, regardless of whether they have been associated with scarlet fever or not.

When you see the rash perhaps you will say that looks like an Aconiterash but there is such scanty zymosis in the nature of Aconite that it is no longer thought of.

Belladonna is not suitable, for in that remedy the rash is shiny and smooth, the typical Sydenham rash.

On the other hand, you will say Pulsatillahas a measly rash, and often associated with a low form of fever, but not so low as the typhoid type, so Pulsatillagoes out of your mind.

You now think of the remedies that are typical of all zymotic states; the prostration, the aggravation after sleep, general stupor and delirium, and almost at a glance you see Lachesis, the type of such forms of disease.

Its picture comes into your mind speedily. You see another case of scarlet fever where there is a scanty rash, the child before you keeps on picking the skin from the lips and nose, lies in a state of pallor and exhaustion, no rash to speak of, urine nearly suppressed; almost in a moment you think of Arum triph.

It is the aspect of things that will call the remedy to the mind. In another case you have all the purple appearance I have spoken of in this remedy; horrible foetor a good deal of sore throat, and the child cannot get water cold enough, wants a stream of water running down the throat all the time; you may safely trust to Phosphorus.

In these low types of sickness there is always something to tell the story if you will only listen, study and wait long enough.