Minutus

General features: Manganum is pre-eminently a drug that causes a
species of chlorosis, and it is suitable for chlorotic girls, in
broken down constitutions, waxy, anaemic, pallid, sickly,
threatening phthisis, with necrosis and caries of bone and organic
affections.

There is the history of a long period of scanty menstruation, or the
menses have been delayed until the patient was eighteen or twenty
years of age.

A strong feature is the great soreness of the periosteum, and
especially of the shin bone. Tendency to ulceration and eruptions,
and around these there is thickening and infiltration. Chronic
eruptions; inveterate like psoriasis.

Small ulcers suppurate and infiltrate with purple hardness. It has a
deep action, breaks down the blood corpuscles and lays the
foundation for tuberculosis, especially in the larynx. Repeated
attacks of laryngitis, each leaving the patient in a worse state
than before. Tuberculosis that begins in the larynx. Aversion to
food, no appetite, nothing will tempt him.

This, with great soreness over the body, lays the foundation for
some deep complaint. It is not an acute periostitis, but a passive
soreness all over. Inflammation of the joints and swellings go on to
suppuration and necrosis.

Ulcerations and suppurative processes take on a quality of semi-
malignancy and do not heal, presenting an erysipelatous appearance.
Everywhere there is soreness to touch and soreness from jarring.

The bones are sore from walking. Arnica relieves only a day or two;
but in this remedy it is deep-seated and prolonged, and we would not
think of Arnica or Baptisia, which would only give relief for a day
or so.

Vesicular eruptions, infiltrating, deep-seated, with tendency to
crack and bleed. Roughness of the skin and psoriasis. Complaints
worse in cold, damp weather and before a storm.

Mind: And now we will take up some, of the mental symptoms.
There are only a few of them, but they are striking, and these go
deeper into the nature of the man himself, even than those we have
been speaking about.

Anxiety and fear. Great apprehensiveness. Something awful is going
to happen. Restless and anxious. He walks the floor, and the more he
walks the floor the more anxious he becomes. He attempts mental
occupation; tries to occupy his mind, and the more he does this, the
more anxious he becomes.

He is tired and careworn. He cannot think; he cannot meditate. He
has difficulties in his business because he cannot do good thinking.
Anxious restlessness.

The queerest part of all is just how he gets relief. He lies down
and it all passes away. You cannot- find that in every medicine;
that is rare, strange and peculiar. And yet, see how general it is;
it defines the whole nature of the sick man. His very life is
excited, tired and anxious. Great sadness and distress.

He lies down and says,
"Why did I not think of that before?"
Perfectly comfortable now. He gets up, and the anxiety and
restlessness come over him again, and he is fairly driven to
distraction.

See how unlike Rhus that gets relief from motion. See how unlike
Ars. that is, the patient goes from one bed to another, from bed to
chair and back again; he cannot sit still, or lie still, for his
anxiety is worse keeping still.

See how striking these symptoms are, and see what a contrast we
have. The very innermost life, of the patient is talking to us and
asking for remedies. We must now read the signs and inner
expressions of the disordered economy.

Then, he has these tormenting fears. Anxiety in the day time while
moving about, better while lying. down. Sad, weeping and silent. Can
think of nothing to console him but to lie down and get peace. Is it
any wonder, then, that some of these patients are driven to a
bedridden state? And Manganum is a wonderful remedy for bedridden
women who love to keep still, and it is said of them that they love
to lie in bed.

As far as we have gone we see that everything brings out that very
idea and the nature of things that Hahnemann talks about in his
first paragraph, that the sole duty of the physician is to pay his
attention to the sick, to the patient himself; and who is this
patient himself?

This is what we have been talking about, this is what we have been
trying to bring out here; and all the particulars that I shall take
up corroborate these very things. These particulars are so linked
with, these generals talked about that they make a grand unity of
thought, and we cannot separate them.

Irritability and low-spirited, like Sulph., and Graph. It is similar
to Arg. met., Phos., Graph., and Sulph., in its underlying tendency
to tuberculosis. Fretfulness from small things.

Head: Headaches as in anaemia.
Dreadful headaches; head feels heavy sticking pains; pressing,
boring pains. Stitches, like needless. Aggravation from jarring on
stepping. Soreness in the brain and skull.
Skull sensitive to touch and pressure. Red, sore spots here and
there on the scalp (like Phos.), as if erysipelas would develop.
Drawing, stinging headache in the open air, ameliorated in the house.
Other headaches are ameliorated in the air. Aggravation from a jar,
motion, and change of temperature and in cold, damp weather.

Eyes: Agglutination of the eyelids.
It is a suppurative and catarrhal remedy. The eyelids are swollen.
Aching of the eyes on looking at near objects, especially a near
light. I have used this medicine often with that symptom and cured
when there was pain in the eyes from sewing, reading fine print and
doing anything that would concentrate vision.
Ruta in nervous, gouty constitutions, when there is pain in the eyes
and complaints from sewing and reading fine print for a long time.
Ruta is especially a remedy for artists who work with a magnifying
glass.

Ears: Offensive discharges from the ear.
Dullness of hearing ameliorated by blowing the nose. Stopped
sensation ameliorated by blowing the nose. Catarrh of the Eustachian
tube. The external ear is painful to touch.
The ear symptoms arc numerous. It seems to many patients that all
their troubles settle in the ears. All the pains and aches in the
upper part of the body settle in the ears. The pains in the throat
shoot to the ears.
There are pains in the throat, and pains in the teeth that go to the
ears. Pains in the eyes that centre in the ears. That is strange.
The ear is a centre of much tribulation.
"Catarrhal conditions, with increasing deafness." From cold, damp
weather.
He is deaf whenever the cold rains conic in the fall. Then there is
a soreness, rawness and burning in the auditory canal, with much
itching.

Silica and Kali carb. are the two principal remedies for the
paroxysmal cough that comes on from scratching the auditory canal. I
have seen them choke and gag and vomit when they needed Kali carb.
after scratching the auditory canal.
Spasmodic cough from scratching the auditory canal belongs
principally to Silica and Kali carb. but Manganum has cured it.
Itching in the ears from talking, from swallowing, from laughing, or
doing anything that brings the throat into operation.

From talking, which is using the larynx. When the bolus p asses down
behind the larynx is when it takes place. It is sometimes present in
laryngeal phthisis, in chronic ulceration of the larynx, with
burning, stinging pains in the larynx that shoot to the ears.

In the proving of Manganum it is astonishing how many ear symptoms
are recorded. And all these ear symptoms, like the others, are
brought on, or increased, in cold, damp weather.
"Catarrh of the Eustachian tube."
Obstruction. Feels as if the ears were obstructed.
"Feels as if there were a leaf before the ear."

In cold, rainy weather: it strong feature running through the remedy
is similar to Dulc., in that it is worse from cold, cold air, and
cold damp weather.
His catarrh rouses up in cold weather. Every cold, damp spell causes
hoarseness and the formation of mucus in the throat All of its
complaints respond to the weather.

Wherever there is irritation there is great soreness. The eyes are
red and sore. The throat is red and raw. Ear discharges are followed
by great tenderness. Soreness and tenderness run all through.
Chronic catarrh. Nose stopped up. Discharge yellow, lumpy and green
in the morning. Bloody discharge. The nose and cartilages sore. He
avoids handling the nose.

No medicine will give you a sicklier face. When persons have bled
out and have become waxy and pale the routinist thinks of China, but
when there has been no bleeding and this same state is present from,
breaking down of the blood corpuscles Manganum is to be thought of.
Chlorosis and pernicious anaemia would make one think of Manganum,
and also Picric acid and Ferrum. Small wounds suppurate; every
bruise remains sore for a long time. There is not much bleeding, for
there is not much blood.

Infiltration is in keeping with this remedy. I have seen it cure
inveterate ulcers, indurated and purple, in anaemic patients.
Old "fever sores" can be cured with this remedy. Squamous eruptions.
Stomach: All sorts of stomach disorders.

Indigestion. Want of appetite. Drawing in the region of the stomach.
Colic. All of these are worse from cold, damp weather. The pains are
ameliorated from bending double. It is a very useful remedy for
warding off tabes mesenterica, anaemic constitution, no appetite,
diarrhoea, pain in the bowels, and, as the patient emaciates, the
glands are felt.

Useful in women who have been anaemic for some time from loss of
blood, but it is not so great a remedy for anaemia following
haemorrhage as for that condition result ing from destruction of the
blood corpuscles.
Dreadful flushes of heat like Psor. Lach., Sulph. and Graph., coming
on in women who have been anaemic for some time.

Liver: it is also a great liver remedy.
There is congestion and tumefaction of the liver. It has cured a
tendency to fatty degeneration. It has cured jaundice; it has cured
many cases of gall stone; which means that the liver goes into such
a sluggish state that the bile is unhealthy, the flow is impeded,
and then little nodules form in it, and from gall stones.
It establishes a better working order of the stomach, a better
working basis of the liver, the bile becomes healthy, and gall
stones are dissolved in healthy bile. Gall stone colics are likely
to occur along with gall stones.

The abdomen: may be said to be full of rumblings, and there are
frequent griping pains and these come on in cold, damp weather.
They come on from eating cold food, like iced foods. Cold things
create much distress in the region of the liver. Distress in the
stomach, and distress through the bowels.
"Pain and contraction at the navel" something like Plumbum, although
it is not said to draw like a string at the navel, like Plumbum and
Platinum.
"Passes much flatus with the stool.
Irregular action of the bowels."
There may be periods of constipation, interrupted with every
indigestion, causing diarrhoea so that the bowels are always
irregular. He is never quite safe, he has constipation or diarrhea.
As we might suppose, the stomach is the faulty organ.
"Cramps in the anus while sitting.
Better lying down."

Females: It is a useful remedy for those flashes of heat that occur
at the climacteric period.
The chlorotic state mentioned is closely related to the menstrual
state. Disorders of the uterus, and of the stomach.

Very scanty menstrual flow. It lasts but a day or two, and it comes
too soon. This is unusual in anaemic conditions, unusual in
chlorosis. In women past the turn of life, every little while there
will come a little hemorrhage, a little watery flow.

Anaemic old ladies, with a little watery flow from the uterus. We
have had in the past to rely mostly on Calcarea for the old ladies
with hemorrhages of the uterus.

We are not surprised with all these weaknesses if we have muscular
relaxation, and it is true in Manganum with these tired, weakly,
anemic women; and also there is prolapsus of the uterus and
prolapsus of the rectum. A dragging down of the intestines, and the
whole abdomen feels heavy from a state of relaxation.

The region most threatened is the larynx, trachea and lungs.
Larynx: If this anemic girl does not improve and get up a better
reaction something serious will happen.

Menstruation is merely a pale fluid or a little leucorrhea. Rawness
of the larynx. Hoarseness and loss of voice in a chronic state. It
is suitable in recurrent cases coming with every spell of damp
weather until finally tuberculosis starts.
Every cold starts up additional trouble in the larynx, causing a
laryngitis. It is a wonderful remedy in speakers and singers, as
useful as Argentum met.

Constant accumulation of mucus, more forms as soon as he clears it.
Hemming all the time and annoying everybody. Arg. met., Sil.,
Sulph., Phos. and Manganum, all do that. Each hem brings up a
mouthful of mucus.

Tubercular laryngitis. Rawness in the larynx. Expectoration of green
mucus, great anemia. Every spell of cold, rouses up a bronchitis,
like Dulc. Cold, dry weather sometimes relieves, but the patient is
sensitive to cold; he is chilly and anemic,

The cough is ameliorated by lying down. Most coughs are worse from
lying down, and few remedies have amelioration from lying. In
Euphrasia there is a cough coming from coryza, especially acute
coryza in vigorous persons, and the cough is better while lying.
Again there is a nervous spinal cough in spinal subjects, nervous
girls, who have a cough as soon as they lie down, which is cured by
Hyos.

This remedy has a day cough, no cough at night because he is lying.
Arg. met. has a day cough; like Manganum it refers to the larynx,
and is ameliorated by lying down. Cough worse from talking,
laughing, walking, deep inspiration and cold, damp weather.

This remedy is most useful in recurrent complaints, and is hardly
ever seen in first attacks. It is of great use in patients who are
gradually declining. Ulceration and bleeding in the lungs. The
hemorrhage is watery, like bloody saliva or bloody mucus. The
patient grows nervous, tremulous and has palpitation.

The limbs are full of distress, even to gout. Sore bones, burning in
soles, arthritic enlargements, painful periosteum, some joints. It
has not rapid inflammatory rheumatism, like Puls. and Bell., but
tenderness of the joints, with not much swelling and aggravation
from damp weather, like Rhod., Rhus and Dulc.

This remedy does not usually come up in fevers, but in cases of low
typhoid, after the fever has somewhat abated, the bones are
sensitive, sore all over, the patient does not rally, there is
prolonged convalescence, especially in badly treated cases, who have
been drugged until the blood corpuscles are ruined.

You would think if he could only start up a big abscess he would be
better, but be has not vigor enough for that.

Some of these patients have "fever sores," and this acts as a seton
and relieves them; but this patient cannot develop one, only the
periosteum is sore and infiltrated.