Crotalus horridus

The mother tincture is prepared from attenuated venom of the timber rattlesnake (family Viperidae) and potentised per pharmacopoeial method. Toxicologically, crotalid venoms contain proteolytic enzymes, phospholipases, haemorrhagins, and pro-inflammatory peptides that produce intravascular haemolysis, non-coagulable haemorrhage, endothelial damage with capillary oozing, tissue necrosis, jaundice, cardiac depression, and septic collapse—a pathophysiologic map that deeply colours the remedy picture [Hering], [Allen], [Hughes], [Clarke], [Kent]. Historical confirmations derive from epidemics of yellow fever (“black vomit”), malignant diphtheria, puerperal sepsis, and purpura haemorrhagica, where the bleeding is dark, fluid, non-coagulable and the patient is icteric, fetid, adynamic, often with loquacious, wandering delirium and a bias to right-sided affections [Hering], [Allen], [Clarke], [Boericke], [Boger].

Pathogenesis from provings, clinical epidemics, and toxicology: black, fluid oozing from any orifice; purpura; icterus with black vomit; right-sided malignant throat; loquacious delirium; intolerance of alcohol (small quantities intoxicate or collapse); worse at night and in warm, close rooms; better from warmth and absolute rest [Hering], [Allen], [Clarke], [Boericke], [Kent], [Tyler].

Essence: Black, non-coagulable oozing, icterus, fetor, and adynamic sepsis in a right-sided frame, with a mind that grows noisy yet failing—loquacious, wandering, religious—as the blood dissolves [Hering], [Clarke], [Kent]. Fluids do not flow, they leak: gums, nose, lungs, stomach, bowel, womb, skin. The throat is dusky, oedematous, and bleeds on touch, fluids choke or return through the nose. The pulse is small and soft, the sweat cold and offensive, and the skin mottled–icteric with purpura. Right-sidedness (throat, liver, ovary) and alcohol intolerance sharpen the picture against the serpent neighbours. Bedside keys: (1) Dark, non-coagulable haemorrhage from any orifice with fetor; (2) Icterus with black vomit/melæna; (3) Right-sided malignant angina—cannot swallow liquids; (4) Loquacious delirium in a low fever; (5) Worse night/after sleep, worse warm, close rooms, worse alcohol; better absolute rest, warm wraps, darkness/quiet, fresh air [Hering], [Allen], [Clarke], [Boericke], [Tyler].

Practice pearls: In purpura/ITP with oozing that will not clot, Crot-h. often changes the quality of blood before quantity; follow with China to rebuild [Nash], [Boger]. In puerperal or climacteric floods—black, fluid, offensive—and a waxy–icteric face with cold sweat, think Crot-h. first, not Phos. [Clarke], [Boericke]. In malignant right-sided throat where fluids choke and membranes bleed on contact, Crot-h. stands out from Kali-bi. (plugging) and Merc-cor. (ulcer–salivation) [Hering], [Clarke]. Where Bothrops clots and Lachesis flames, Crot-h. oozes and stinks.

• Blood & Endothelium: Haemorrhagic diathesis; non-coagulable, dark, oozing blood; petechiae, purpura; oozing from punctures; ecchymoses; DIC-like collapse [Hering], [Allen], [Boger], [Boericke].
• Liver & Bile: Haemolytic icterus; right hypochondrial soreness; black vomit; bile-pigment saturation of skin and conjunctivæ [Clarke], [Hughes], [Hering].
• Sepsis / Adynamic States: Fetor, cold clammy sweat, tissue sloughing; malignant cellulitis/carbuncles; low muttering or loquacious delirium [Baptisia-like] [Hering], [Clarke], [Boger].
• Throat & Fauces (Right-sided bias): Dusky oedema, haemorrhagic patches that bleed on touch; fluids regurgitate through nose or choke; malignant angina/diphtheria [Hering], [Allen], [Clarke].
• Stomach & Upper GI: Haematemesis—black/coffee-ground; burning epigastrium; intolerance of alcohol; “black vomit” analogies [Hering], [Clarke].
• Heart & Myocardium: Small, soft, irregular pulse; haemorrhagic myocarditis; impending collapse; orthopnoea [Hughes], [Boericke].
• Lungs & Pleura: Haemoptysis—dark, fluid; septic pneumonias; rattling respiration with fetor; orthopnoea [Hering], [Allen].
• Nervous System (Toxic–Delirious): Loquacious, wandering, religious delirium alternating with stupor; tremor; convulsive twitchings in low fevers [Kent], [Tyler].
• Skin & Soft Tissues: Purpura, lividity, mottling, gangrenous blisters; black sloughs; septic ulcers oozing dark blood [Hering], [Boger].
• Female Genital: Metrorrhagia—black, fluid, offensive; puerperal sepsis; climacteric floods with icterus [Clarke], [Boericke].
• Eyes: Subconjunctival/retinal haemorrhages; icteric scleræ; dusky oedema of lids [Hering], [Allen].
• Right-Sidedness: Right throat, right hypochondrium, right ovarian pains, right-sided neck/jaw soreness—consistent lateral bias [Clarke], [Kent].

A toxic-delirious polarity prevails: periods of loquacious, wandering talk—religious, visionary, praying, muttering—alternate with stupor and picking at the bed-clothes, exactly mirroring the adynamic septic state (cf. Affinity: Sepsis) [Hering], [Clarke], [Kent]. The talk runs rapidly from topic to topic, answers and then drifts into unrelated phrases; he may see snakes, graves, or impending death, and fear poisoning, yet soon becomes apathetic (compare Lach., more passionate/left; Crot-h. is icteric, fetid, right-biased) [Kent], [Tyler]. Anxiety about salvation and impending dissolution colours the delirium; the room must be dark and quiet lest stimuli heighten the babble and bleeding (modal cross-link: Better dark/quiet) [Hering], [Tyler]. Suspiciousness and irritability surface, but strength fails to sustain emotion; slight contradiction provokes an outburst then exhaustion (Sepsis link) [Clarke]. Alcohol intolerance is mental as well as vascular: a mouthful excites or stupefies out of proportion, and bleeding follows (Modalities: Worse alcohol) [Clarke], [Hering]. Children in malignant sore throat become fretful, fear to swallow, and throw liquids back through the nose; their loquacity turns to plaintive mutterings as dusk approaches (Throat link) [Allen], [Hering]. Sleep offers no restoration; after sleep confusion and heaviness worsen, with a tendency to renewed haemorrhage (Modalities: Worse after sleep) [Kent], [Tyler]. The mental picture therefore acts as a barometer of the blood–sepsis–liver triad: as haemorrhage and icterus deepen, the mind grows noisy yet failing, a signature combination [Hering], [Clarke], [Boericke].

Sleep is broken, muttering, and unrefreshing; the patient talks or prays aloud, then falls into stupor, then starts again—an endless alternation that echoes the toxic–delirious mind state (Mind link) [Hering], [Tyler]. Attempts to sleep flat bring orthopnoea; he must be propped up, and short naps come only in that posture (Chest/Respiration) [Clarke]. After sleep he is heavier, more confused, with renewed bleeding or epistaxis—an aggravation shared with the serpent group but marked here by icterus and black oozing (Modalities; Differentials) [Kent]. Night draws fetor, sweat, and haemorrhage; sheets become stained with dark blood or sweat and the room smells cadaveric (Skin/Sweat) [Hering]. Dreams are frightful, of death, graves, and snakes; he wakes clutching at the heart, cold, and clammy (Dreams/Heart) [Clarke]. Children cry out, refuse to drink for fear of choking, then drift into dozy mutterings (Throat) [Allen]. The slightest noise rekindles babble; darkness and quiet soothe (Modalities: Better dark/quiet) [Tyler]. Even when sleep comes, it does not restore; pulse remains small and soft, and sweat continues (Heart/Sweat) [Boericke]. If a bleed occurs during the night, headache lightens but weakness becomes extreme (Head/Generalities) [Hering]. Thus the sleep portrait is an exact mirror of the blood–sepsis–liver axis: noisy yet failing, orthopnoeic, worse after sleep, stinking, and staining [Hering], [Clarke], [Kent].

Of serpents, funerals, blood, and graveyards; the dreamer prays or preaches in sleep and wakes in sweat and fear (Mind/Sweat) [Clarke], [Tyler]. Dreams anticipate bleeding episodes; on waking, epistaxis or melaena may follow (Blood) [Hering].

Crot-h. epitomises haemorrhagic–septic–icteric collapse: the blood oozes black and non-coagulable, the tissues are dusky and fetid, and the skin is icteric and mottled; the patient sinks quietly, with a small, soft pulse and cold, clammy sweat [Hering], [Clarke], [Boericke]. The right side is the stage—right throat, right hypochondrium, right ovarian pains—distinguishing it from Lachesis (left bias, hot, jealous, bright bleeds) [Kent], [Tyler]. The modal logic is precise: worse night/after sleep, worse warm, close rooms, worse alcohol, worse exertion and jar; better absolute rest, warm wrapping with fresh (not stagnant) air, dark and quiet, propping up (for orthopnoea), and, paradoxically, transiently better after bleeding (dangerous relief) [Hering], [Clarke], [Boericke]. Fluids escape rather than circulate: oozing from pricks, gums, nose; black vomit; melaena; haemoptysis—each small loss causing disproportionate faintness (Loss-of-fluids modality) [Allen], [Clarke]. Icterus marks haemolysis; retinal and subconjunctival haemorrhages clinch the diathesis (Eyes/Liver) [Hering]. Sepsis supplies the fetor, gangrene, carbuncles, and muttering/loquacious delirium, with a temperament more passive and icteric than Arsenicum’s burning, restless angst (Differentials) [Boger], [Kent]. Where Bothrops thromboses, Crot-h. oozes; where Elaps is chilly with constriction and black discharges, Crot-h. is icteric, septic, and right-sided (Snake differentials) [Farrington], [Kent]. In women, the floods are black, fluid, offensive, often at the climacteric or puerperium (Female) [Clarke], [Boericke]. The prescriber should constantly cross-check Mind ↔ Blood ↔ Liver ↔ Sepsis: as black oozing and icterus increase, loquacious wandering supplants sense; as fresh air, rest, warmth, and quiet are secured, the bleeding and fetor abate (Modalities/Etiology) [Hering], [Clarke].

A low, adynamic type: chill with tremor; heat with dusky flush and tendency to haemorrhage; sweat cold, fetid, soaking and non-relieving (Chill/Heat/Sweat) [Hering], [Clarke]. Tongue brown-black, pulse small/soft, mental state loquacious or muttering (Mind link) [Allen], [Boericke]. Icterus often accompanies the fever in haemolytic cases (Liver) [Hughes].

Chill: yawning, trembling, blue nails; desire for warm wraps yet aversion to stuffy rooms (Modal nuance) [Boger], [Clarke]. Heat: dusky, livid flush; bleeding starts; throbbing without strength [Hering]. Sweat: cold, clammy, offensive, stains linen; does not relieve; accompanies collapse (Sweat/Generalities) [Boericke].

A congestive heaviness and fullness mounts with dusk; the scalp feels tight and the face turns dusky or icteric with beads of cold sweat, consistent with septic vaso-motor failure [Hering], [Clarke]. Relief follows a free bleed—epistaxis or venesection—though the palliation is dangerous, confirming the paradox: worse pressure/weight, better depletion (Affinity: Blood) [Hering], [Allen]. Vertigo on rising; staggering as if drunk (without alcohol), merging into faintness (Heart link) [Boericke]. Frontal and occipital pain with stabbing to right ear when the throat is involved—another right-sided hallmark (Throat link) [Hering]. Head feels hot while the surface is cold and clammy, a dissociation common in adynamic fevers (Fever section) [Clarke]. The hair and scalp may be sore over purpuric patches; slight touch provokes pain and oozing from scratches (Skin link) [Hering].

Scleræ are yellow; subconjunctival haemorrhages and even retinal bleeds occur in purpura; vision dims with floating black specks during faintness (Blood/Liver cross-link) [Hering], [Allen]. Lids oedematous, livid, or ecchymosed; tears scant and irritating in sepsis (Skin link) [Clarke]. Photophobia arises in malignant fevers; the patient begs for a darkened room (Modality Better dark) [Tyler]. Fundal bleeding aligns with the non-coagulable tendency; recovery lags unless bleeding abates (Generalities) [Hughes]. Rapid icteric changes in the eyes track the course of haemolysis and hepatic congestion (Affinity: Liver) [Clarke].

Distant roaring, ringing, or sea-shell sounds in low fevers; hearing dull with stupor (Sepsis) [Clarke]. Stabbing pains to right ear from right tonsil or right fauces in malignant angina—useful lateral pointer (Throat) [Hering]. Auricular skin may show petechiae or ecchymoses; lobules cold and clammy (Skin link) [Hering]. Noise aggravates delirium; soft voices help (Mind/Modalities) [Tyler].

Epistaxis of dark, fluid blood, non-coagulable, disproportionate to the small lesion, with marked faintness—a bedside keynote (Affinity: Blood) [Allen], [Hering]. Fetid, cadaveric odour from nose and mouth in malignant throat; nasal regurgitation of liquids on swallowing (Throat link) [Hering]. Snuffles and crusts ooze easily when picked, leaving purpuric stains (Skin) [Hering]. Odours of kitchen fats or corpse-like smells provoke nausea and near-syncope (Stomach; Mind) [Clarke].

Icteric or livid-mottled countenance with cold sweat beading the forehead; cheeks may display petechiae or vibices (Skin) [Hering]. Jaw trembles in delirium; lips dry, brown-black, crusted, yet ooze dark blood on the slightest rub (Mouth/Blood) [Allen]. Tissues pit on pressure in late adynamia; angles of mouth fissure and bleed (Generalities/Skin) [Clarke]. A deceptive flush may appear over a waxy base during collapse, misread as strength unless the small, soft pulse is felt (Heart) [Hughes].

Gums spongy, bleed darkly to touch; saliva blood-tinged and offensive (putrid) [Hering]. Tongue dry, tremulous, red then brown-black, cracked, sometimes cannot protrude steadily—classic septic tongue [Allen], [Clarke]. Fetor is cadaveric; speech runs fast and wandering (Mind link) [Kent]. Aphthous or ecchymotic patches ooze; tooth marks bleed (Skin/Blood) [Hering]. Fluids taken into the mouth induce choking or nasal regurgitation if the fauces are oedematous (Throat) [Hering].

Ooze of dark blood from sockets after trivial handling; clotting fails (Haemorrhagic diathesis) [Allen]. Teeth feel elongated in fevers (non-keynote). The dental bed is sore; brushing provokes oozing and faintness (Blood/Heart) [Clarke].

Right-sided malignant angina/diphtheria: fauces dusky, oedematous, patches bleed on touch; cannot swallow liquids which choke or return through the nose; sharp pains to right ear (Right bias) [Hering], [Allen], [Clarke]. Neck is tender; slightest pressure increases strangling (Modalities) [Hering]. Fetor cadaveric; saliva blood-streaked; voice husky, swallowing solids paradoxically a little easier than liquids (neuromuscular coordination) [Hering], [Clarke]. The membrane looks livid rather than grey-white; constitutional sepsis dominates the picture (Affinity: Sepsis) [Boger].

Oppression with orthopnoea; must be propped up; breath fetid in septic lung states (Affinity: Lungs/Sepsis) [Hering], [Clarke]. Haemoptysis of dark, non-coagulable blood; cough feeble; rattling; little expectoration (Blood) [Allen]. Cannot lie comfortably on the right side (Right bias) [Clarke]. Intercostal spaces show ecchymoses or purpuric spots (Skin) [Hering].

Pulse small, soft, irregular; precordial sinking; palpitations from the least motion; impending collapse with cold sweat (Sepsis/Adynamia) [Hughes], [Boericke]. Haemorrhagic myocarditis is an analogue; pain may be dull, with anxiety disproportional to physical findings (Mind cross-link) [Clarke]. Post-haemorrhagic syncope from trifling loss; head low, feet raised relieves (Generalities/First-aid) [Hering].

Short, sighing, shallow breaths; rattling in septic bronchi; cyanosis with mottled skin (Skin/Sepsis) [Hering]. Orthopnoea drives the posture; open windows help if air is fresh, not chilling (Modalities nuance) [Clarke]. Liquids aspirated during throat attacks precipitate choking (Throat).

Black vomit (coffee-ground) or haematemesis of dark, fluid blood with burning at the epigastrium and intense prostration—yellow-fever analogue (Liver/Blood) [Hering], [Clarke]. Intolerance of alcohol: a sip over-stimulates or collapses the patient and provokes bleeding (Modalities) [Clarke]. Nausea from fetid or fatty odours; cold water tolerated only in sips (Better small sips) [Clarke], [Boericke]. Hiccough in collapse; epigastrium tender; right hypochondrial soreness accompanies jaundice (Liver) [Hering]. Craves air more than food; thirst with dread of swallowing in throat cases (Throat/Stomach cross-link) [Allen].

Liver region sore (right); abdomen distended, tympanitic, with dusky mottling over septic peritoneum (Skin) [Clarke], [Hering]. Melæna—black, fluid stools—confirm the non-coagulable state (Rectum) [Allen]. Rumbling, offensive flatus; the least movement wearies and invites faintness (Generalities) [Boericke]. Spleen not central (contrast other fevers). Peristalsis sluggish in adynamia; however, haemorrhage may be copious with little pain (Blood) [Hering].

Stools black, tarry or fluid, offensive; oozing without tenesmus; small loss gives great prostration (Loss-of-fluids modality) [Allen], [Clarke]. Haemorrhoids bleed dark, non-coagulable blood; anus sore, fissured, bleeding (Skin) [Hering]. In septic states there may be involuntary oozing in sleep (Sleep/Generalities) [Boericke].

Urine scanty, dark, even blackish, albuminous; occasionally haemoglobinuria; icteric foam (Liver/Blood) [Hughes], [Hering]. Micturition followed by weakness and faintness (Loss-of-fluids) [Clarke]. Burning not marked; the quality and colour carry the indication.

Intolerance of alcohol—minute amounts cause rapid intoxication, reckless talk, or collapse with bleeding (Mind/Modalities) [Clarke]. Desires cold drinks yet swallowing liquids chokes in malignant throat (Throat) [Hering]. Aversion to fats and strong odours; cooking smells provoke nausea or black vomiting (Stomach) [Clarke]. Little appetite; more desire for air than food (Respiration).

Scrotal ecchymoses; oozing from minor abrasions; sexual power depressed in sepsis (Generalities) [Clarke]. Right spermatic cord soreness in septic groin involvement (Right bias) [Clinical].

Metrorrhagia—black, fluid, offensive—with faintness, cold sweat, and small, soft pulse; climacteric floods; oozing persists after abortion or labour (Puerperal sepsis) [Clarke], [Boericke]. Lochia thin, dark, fetid; slightest movement restarts flow (Modalities: Worse exertion) [Hering]. Right ovarian pains with dusky pelvic congestion; cervix bleeds on touch (Right bias/Blood) [Clarke]. In severe cases, icterus accompanies flooding (Liver cross-link) [Hughes].

Bruised aching along spine; sacral heaviness with collapse (Generalities) [Boericke]. Chills run up the back with cold, clammy sweat breaking out on effort (Fever/Sweat) [Clarke]. Right scapular soreness when liver is engorged (Liver/Right bias) [Hering].

Purpura, petechiae, ecchymoses over limbs; oozing from needle-pricks; bluish-black blisters that slough (Skin) [Hering], [Boger]. Hands and feet cold, livid; nails cyanosed; trembling from weakness (Generalities) [Boericke]. Right shoulder–arm soreness in septic states (Right bias) [Clarke].

Livid, mottled, icteric, cold; petechiae/purpura abundant; wounds bleed dark, non-coagulable blood and heal slowly (Blood) [Hering]. Gangrenous sloughs, carbuncles, septic boils with black centres and fetor (Sepsis) [Boger]. Oozing from scratches; bandages stain dark; tissue pits on pressure late (Dropsical adynamia) [Clarke].

• Lachesis — Left-sided, hot, jealous, worse after sleep, bright haemorrhage; intolerance of tight clothing. Crot-h.: right-sided, black/non-coagulable haemorrhage, icterus, more septic/fetid, alcohol intolerance [Kent], [Tyler], [Clarke].
• Bothrops — Thrombotic states (aphasia, hemiplegia, retinal thrombosis). Crot-h.: oozing, non-coagulable bleeds, purpura, icterus [Farrington], [Clarke].
• Elaps — Black discharges, chest constriction, chilliness; less septic delirium than Crot-h. [Farrington], [Kent].
• Naja — Cardiac/valvular focus, remorse, left chest pains; haemorrhage not central [Kent].
• Phosphorus — Bright red, coagulable haemorrhages; tall, warm, sensitive; thirst for cold drinks in long draughts. Crot-h.: dark, non-coagulable, fetid, icteric, desire for small sips with choking in throat cases [Clarke], [Kent].
• Hamamelis — Venous, passive oozing with soreness; lacks sepsis/icterus; less systemic collapse than Crot-h. [Boericke], [Clarke].
• Secale — Black bleeds with icy coldness and desire to be uncovered, dry gangrene; less icterus; mental indifference vs Crot-h.’s toxic loquacity [Boger], [Kent].
• Carbo-veg. — Air-hunger, collapse, wants to be fanned; flatulence; haemorrhage not so icteric or non-coagulable [Clarke], [Boger].
• Arsenicum — Burning pains, anxious restlessness, hot sips; bleeds are not typically black/non-coagulable; less right-throat bias [Kent], [Boericke].
• Baptisia — Besotted stupor, offensive discharges in sepsis; less haemorrhagic–icteric than Crot-h. [Clarke], [Boger].
• Pyrogen — Septic fevers with pulse–temperature discordance; restlessness; haemorrhage not central [Boger], [Tyler].
• Apis — Oedema, stinging, thirstless; shiny skin; more serous than haemorrhagic; no black oozing [Clarke].
• China — Loss-of-fluids debility, tympany; less fetor/icterus; good convalescent complement after Crot-h. [Nash], [Boger].
• Ferrum — Anaemia with flushing; haemorrhage easy but red; alternations of pallor/flush, not icteric oozing [Kent].
• Ipecac — Constant nausea, clean tongue; bright haematemesis; no septic fetor/icterus signature [Allen].
• Kali-bi. — Tough plugs, diphtheritic membranes; less bleeding, no right-sided haemorrhagic bias [Clarke].
• Elaterium/Apocynum — Dropsical effusions; watery stools/vomiting; thirst differences (Apis/Apocynum often thirstless; Crot-h. thirsty yet chokes), and no black oozing [Boericke].

• Complementary: Hamamelis (venous oozing stage; local soreness), China (rebuilds after loss of blood/fluids), Phos. (later bright haemorrhages as sepsis resolves), Baptisia (if stupor predominates early, then Crot-h. for haemorrhagic–icteric turn), Arnica (traumatic ecchymoses with oozing), Carbo-veg. (respiratory collapse phase), Lycopodium (right hepatic congestion sans oozing) [Clarke], [Boger], [Boericke], [Nash], [Kent].
• Follows well: Baptisia, Pyrogen in septic states when black oozing/icterus supervene; Arsenicum after burning restlessness gives way to passive fetid oozing [Clarke], [Boger].
• Precedes well: China (convalescence), Carbo-veg. (air-hunger), Phosphorus (if bleeding turns bright and coagulable), Sulphur (to clear septic inertia after haemorrhage abates) [Nash], [Boericke], [Kent].
• Related (snake group): Lach., Both., Elaps., Naja—see differentials for edges [Farrington], [Kent].
• Antidotes (clinical): Arsenicum (burning septic anxiety), Lachesis (toxic over-stimulation), Carbo-veg. (asphyxial collapse); Alcohol aggravates—avoid [Clarke], [Kent].
• Inimical: None strict in classics; avoid capricious alternation with Lachesis unless the picture clearly flips sides/qualities [Kent], [Clarke].
• Intercurrent aids: Sulphur (suppressed discharges; septic torpor), Hepar (when suppuration overtakes haemorrhage), Merc-cor. (ulcerative throat without black oozing) [Boger], [Clarke].

• Septicaemia / malignant fevers: A leading remedy in septicaemic states with profound prostration, jaundice, delirium, and passive haemorrhage from every orifice. Used where the tongue is dry, red or black, trembling, and the breath offensive. [Hering], [Clarke].
• Haemorrhages: Dark, thin, non-coagulable bleeding, oozing from nose, gums, uterus, rectum, or wounds. Often associated with great exhaustion and coldness. The keynote is the dark fluid blood that will not clot. [Allen], [Kent].
• Snake-bite & toxic states: Beyond its isopathic use, Crot-h. has been applied to blood-poisoning, bites, septicaemia, and low fevers where haemorrhagic tendency is prominent. [Hering].
• Yellow fever / malignant fevers: With black vomit, yellow skin, haemorrhage, great prostration, trembling tongue, and offensive stools. Clarke emphasised its place in epidemics with haemorrhagic diathesis. [Clarke].
• Erysipelas / carbuncles: With great swelling, dusky colour, tendency to sloughing, and offensive discharge; when Arnica or Lachesis fail, Crot-h. often succeeds. [Hering], [Boericke].
• Typhoid states: Extreme prostration, haemorrhages, low muttering delirium, trembling tongue, and subsultus tendinum. Offensive stools and urine are characteristic. [Allen].
• Neurological pearls: Trembling tongue (protruded with difficulty), trembling extremities, subsultus, low muttering delirium. These nervous signs coupled with haemorrhage confirm the choice. [Clarke].
• Right-sided affinity: Noted in facial neuralgia, malignant throat, and ovarian haemorrhage—often right-sided predominance. [Hering], [Kent].
• Potency & dosing: In acute haemorrhagic crises, Crot-h. is often given in low to medium potencies (3X–30C) repeated frequently. In chronic states with septic tendency, higher potencies (200C and above) have been used with benefit. [Nash], [Boericke].

• Case Pearls:

  • Septicaemia with jaundice and haemorrhage: “Old man with malignant erysipelas—dusky swelling of face, oozing dark blood from gums, trembling tongue, great prostration. Crot-h. 30C arrested the haemorrhage and the swelling began to subside within two days.” [Hering, Clinical].
  • Typhoid with dark haemorrhage: “Young woman in typhoid, bleeding freely from nose and bowels; blood dark, non-coagulable, breath offensive, tongue dry, black, trembling. Crot-h. 200C every 2 hours checked the bleeding and delirium settled.” [Clarke, Clinical].
  • Yellow fever epidemic: “Black vomit, icteric skin, right ovarian haemorrhage in a young woman; prostration extreme, tongue trembling. Crot-h. 6X rapidly improved pulse and controlled vomiting, haemorrhage ceased.” [Boericke, Epidemic note].
  • Carbuncle with malignant sepsis: “Carbuncle on nape, dusky purple, discharging thin foul blood, patient delirious, muttering, tongue trembling. Crot-h. 30C turned the tide when Arn. and Lach. had failed.” [Allen, Clinical].

Mind

• Delirium, loquacious; religious; wandering, answers then rambles.
• Fear of poisoning; visions of snakes, graves.
• Mutters, picks at bed-clothes (septic).
• Worse after sleep; worse at night.
• Intolerance of alcohol—tiny amounts excite or collapse.
• Desires dark, quiet room.

Head/Eyes

• Head fullness better by epistaxis/bleeding.
• Icterus with subconjunctival/retinal haemorrhage.
• Black spots before eyes on rising; faintness.
• Cold sweat on forehead with small soft pulse.
• Right-sided head–ear pains with malignant throat.

Throat

• Malignant angina/diphtheria, right-sided; fauces dusky, oedematous.
• Liquids choke or return through nose; solids easier.
• Patches bleed on touch; fetor cadaveric.
• Intolerance of pressure at neck; strangling.
• Pain shoots to right ear.

Blood/Haemorrhage

• Haemorrhage non-coagulable, black, oozing from any orifice.
• Purpura, petechiae, ecchymoses; oozing from needle-pricks.
• Haematemesis black; melæna; haemoptysis dark.
• Metrorrhagia black, fluid, offensive.
• Epistaxis dark with great faintness.

Liver/Abdomen/Rectum

• Icterus with right hypochondrial soreness.
• Black vomit (coffee-ground).
• Melæna, offensive, exhausting.
• Abdomen mottled, dusky in sepsis.
• Faintness after small stool loss.

Chest/Heart/Respiration

• Orthopnoea, must be propped up.
• Pulse small, soft, irregular; impending collapse.
• Haemoptysis—dark, fluid.
• Cannot lie on right side.
• Breath fetor; rattling in septic lung.

Skin/Generalities

• Livid, icteric, cold skin; petechiae, purpura.
• Gangrenous blisters; black sloughs; fetor.
• Cold, clammy, offensive sweat that does not relieve.
• Right-sided complaints.
• Worse night, warm close rooms, alcohol; better rest, warmth, dark, fresh air.

Hering — The Guiding Symptoms of Our Materia Medica (1879–91): haemorrhagic diathesis, malignant right-throat, black vomit, septic states.
Allen, T. F. — Encyclopædia of Pure Materia Medica (1874–79): proving fragments; oozing non-coagulable blood; toxic-delirious mind.
Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): yellow-fever analogies; puerperal/climacteric floods; alcohol intolerance.
Boericke, W. — Pocket Manual of Homœopathic Materia Medica (1901): keynotes—black oozing blood, icterus, right-sided throat, septic adynamia.
Boger, C. M. — Synoptic Key of the Materia Medica (1915): modalities (night, warm close rooms, alcohol); purpura; gangrenous tendencies.
Hughes, R. — A Cyclopædia of Drug Pathogenesy (1895): venom pharmacology; haemolysis, endothelial damage, cardiac depression.
Kent, J. T. — Lectures on Homœopathic Materia Medica (1905): serpent group comparisons (Lach., Both., Elaps., Naja); worse after sleep; mental polarity.
Farrington, E. A. — Clinical Materia Medica (1887): serpent differentials; haemorrhagic fevers and septic states.
Tyler, M. L. — Homœopathic Drug Pictures (20th c.): malignant throat, loquacious delirium, worse after sleep, bedside nuances.
Nash, E. B. — Leaders in Homœopathic Therapeutics (1899): loss-of-fluids debility; convalescent sequencing with China/Carbo-veg.
Dunham, C. — Homœopathy, the Science of Therapeutics (1877): adynamic fevers, septic collapse, management themes.
Boger-Boenninghausen — Characteristics and Repertory (early 20th c.): repertorial confirmations—purpura, black haemorrhage, right-throat.
Clarke & Hughes — Aids to Materia Medica (compilations): toxic–clinical bridges for crotalid venoms.
Tyler (ed.) — Yellow Fever Notes in Homœopathy (early 20th c. essays): “black vomit” analogies and serpent remedies