Manganum is pre-eminently a drug that causes a species of chlorosis, and it is suitable for chlorotic girls, in broken down constitutions, waxy, anemic, 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 waking. 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.

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 Am. 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.

Headaches as in anemia. Dreadful headaches; head feel heavy; sticking pains; pressing, boring pains. Stitches like needles. 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:

Agglutination of the eyelid. It is a suppurative and catarrhal remedy. The eye-lids 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.

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 are 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 center in the ears. That is strange. The ear is a center of much tribulation. “Catarrhal conditions, with increasing deafness.” From cold, damp weather. He is deaf whenever the cold rains come 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 taking, from swallowing, from laughing, or doing anything that brings the throat into operation. From talking, which is using the larynx. When the bolus passes 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.

A 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 are 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 routinists thinks of China, hut 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 anemia 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 anemic patients. Old “fever sores” can be cured with this remedy. Squamous eruptions.

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, anemic constitution, no appetite, diarrhea, pain in the bowels, and, as the patient emaciates, the glands are felt. Useful in women who have been anemic for some time from loss of blood, but it is not so great a remedy for anemia following hemorrhage as for that condition resulting from destruction of the blood corpuscles. Dreadful flushes of heat like Psor., Lach., Sulph. and Graph., coming on in women who have been anemic for some time.

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 form 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. Gallstone 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 diarrhea – 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.”

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 anemic conditions, unusual in chlorosis. In women past the turn of life, every little while there will come a little hemorrhage, a little watery flow. Anemic 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. 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 leucorrhoea. 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, sore 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 he 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 an infiltrated.

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