I may here remark that I found repeatedly Arsenic in the urine of such patients. A case of obstinate intermittens larvata, characterized by vomiting of chyme, also yielded toArsen. brom.One case more must suffice. A young man went to America but failed in his trade, and became barkeeper on a Mississippi steamer, which place he had to give up on account of intermittent fever. We find him then as hostler in Chicago where he was laid up with an attack of cholera, and as he did not fully recover his strength he returned to the old home again. When I saw him for the first time the diagnosis seemed to be first stage of Bright's disease. Anamnesis, ætiology, and present state, albumen in the urine, justified the diagnosis. Patient is pale, bloated, œdema pedum, no appetite, white tongue, thin feverish pulse, swollen spleen, watery diarrhœa alternating with constipation. Every drug produced vomiting, and he perfectly abhorred the old Quinine powders. I ordered four dropsArsen. brom.and a full meat diet. Improvement followed with the continuance of the treatment. After three weeks the spleen was reduced in size, his face showed better color, hardly any œdema. To strengthen the skin he was advised to take pineneedle baths, and after three months' treatment he could be discharged, a well man. He was advised to take for a few months one drop daily of his solution, and to take often an airing in the pineries which abound around Frankfort. Though he returned to America the latest reports from himare that he feels again as well as ever, but he keeps his drops about him.
Arsen. brom.is also a powerful remedy in diabetes mellitus and insipidus, for I cured cases with it where the patient had already been reduced from 138 pounds to 98, and where the urine could be condensed, by boiling, into syrupy consistency. Mixed diet may be allowed, though I insist upon large quantities of fresh meat during treatment withBromide of arsenic. Let the patient take three drops thrice daily in a glass of water, and after a week the insatiable burning thirst will be quenched, and these doses must be continued till the quantity of sugar in the urine is reduced, when the drug might be taken twice a day and continued for a long time. A diabetic patient needs fresh pure air if he wishes to get well; confinement in a room or in the office prevents the action of any treatment, for it needs ozone to reduce the sugar of the blood into carbonic acid and water.
Preparation.—Trituration of the alkaloid.
(Dr. Edwin M. Hale communicated the following concerning this alkaloid to theHomœopathic Recorderfor 1889):
(Dr. Edwin M. Hale communicated the following concerning this alkaloid to theHomœopathic Recorderfor 1889):
Dyspnœa.—This alkaloid is from the South American tree—Quebracho. The maximum dose, according to Merck, is 1/10th grain. I use the 1/500th trituration, which I find most efficient in doses of 2 to 5 grains.
Case I.—A boy of ten. The attacks of spasmodic dyspnœa were a sequel of hay fever. The aggravation was at night, when lying down, or sleep was impossible. I triedIpecacandArsenic, but with no effect.Aralia, also. (I never had any curative or palliative effects fromAralia.)
PrescribedAspidospermine, 1/500th trituration, 2 grains every two hours, all day. The night was comfortable, could lie down and sleep. Continued the remedy for four days, when he was so much better that the medicine was suspended.
CaseII.—Cardiac dyspnœa in a man of 60. Valvular disease, hypertrophy with dilatation. Distressing difficulty of breathing from the slightest exertion; had to sit upright day and night. Face livid from venous stasis.Strophanthusregulated and strengthened the heart's action, but only slightly benefited the dyspnœa. Five grains ofAspidospermine, 1/500th trituration, every two hours effected a marvellous change. He could walk about the house and out to his carriage with but little discomfort. He has now continued it three weeks. Observes no unpleasant symptoms. Can lie on his back and right side and is very grateful for the relief. It seems to act as well as an aid toDigitalis, orStrophanthus, in cardiac dyspnœa.
FOOTNOTES:[B]AspidospermineorQuebrachineis derived from the Chilian "white Quebracho" (Aspidospermia Quebracho). At Santigo de Chile the bark is used as a substitute for Cinchona as a febrifuge. The alkaloid forms salts with Citric, Hydrochloric and Sulphuric acids.
[B]AspidospermineorQuebrachineis derived from the Chilian "white Quebracho" (Aspidospermia Quebracho). At Santigo de Chile the bark is used as a substitute for Cinchona as a febrifuge. The alkaloid forms salts with Citric, Hydrochloric and Sulphuric acids.
[B]AspidospermineorQuebrachineis derived from the Chilian "white Quebracho" (Aspidospermia Quebracho). At Santigo de Chile the bark is used as a substitute for Cinchona as a febrifuge. The alkaloid forms salts with Citric, Hydrochloric and Sulphuric acids.
Common Name.—Chloride of Gold and Sodium.Preparation.—A mixture composed of equal parts of dry chloride of Gold and chloride of Sodium, triturated in the usual way.
(The following is an extract from a paper by Dr. H. Goullon in theAllg. Hom. Zeit., bd. 114, No. 12, on the therapeutics of this remedy):
(The following is an extract from a paper by Dr. H. Goullon in theAllg. Hom. Zeit., bd. 114, No. 12, on the therapeutics of this remedy):
Never have I observed gold so startling in its action as in the following case: The patient is a type of the scrofulous habit; reddish hair, pasty complexion, thick nose, coarse features. About thirty years of age. He has had the misfortune of being infected by syphilis, and the still greater ill-luck of being treated by mercurial inunctions and iodine toexcess. All these circumstances conjoined helped to produce a complication of morbid conditions which would put medical art to a severe test. Let us recall the region in which gold makes such brilliant cures, and we find it especially suitable in an uncommon swelling of the left testicle. In this case I do not exaggerate, when I say that the scrotum was as large as a gourd of moderate size and the tumor was four or five times larger in circumference than the right testicle, which was also swollen. The entire mass simulated an oblong, heavy weight, like those one meets with in old-fashioned clocks, and could hardly find space in the capacious suspensory.
The skin was also involved. On the elbow was a wide-spread herpetic eruption; on different parts of the body were gummy indurations; the ear discharged; in short, the many characteristic manifestations of the syphilitic poison were to be seen throughout the cutaneous and mucous systems. There were also ulcerous formations in the oral cavity and on the sides of the tongue.
After about four weeks the patient again set foot upon the floor, saying: 'The drops have done wonders.' And indeed the influence upon the testicles was so striking that now the right, which was formerly the smaller, seemed the larger, without having actually at all increased in size. Not the less remarkable had been the action of gold on the general condition. The patient, formerly irritable and uneasy, is cheerful and comfortable; enjoys sound sleep, whereas before he was disturbed with morbid dreams; has lost his previous debility and disgust for everything; and says that his digestive power is quite a different thing. He assimilates articles of diet which he did not formerly dare to take, unless he wished to suffer with flatulence, gastric acidity and vomiting. Among other things punch, which he 'could not even smell,' agrees well.
But, evidently, the mode of administering gold in such cases is not a matter of indifference. And although I haveonly recently published a cure with high potencies (in which I subsequently corrected the mistake of the 100thDec.for theCentes., which was what I used of theNatrum muriaticum), I cannot commit myself to high potencies in syphilitic complications. Experience in these cases is always in favor of substantial doses. But, as we shall soon see, these proportionally massive and heavy doses are always quite out of the allopathic posological range, and even on this ground one must set boundaries, and seek for the conversion of the traditional school. By two or three clinical experiences of this sort many a Saul would become a Paul in spite of all former prejudices,vis inertia, and most tormenting skepticism. One-half grainAurum muriaticum natronatumwas dissolved in 6 grms. Spiritus vini, but of this first 6 drops are again put into a wineglass of water, of which the patient takes a teaspoonful thrice daily.
(Dr. Tritschler, of the Gynæcological Clinic of Tübingen, furnishes the following on the use of this remedy in diseases of women. FromAllg. Hom. Zeit., bd. 94. Nos. 17. 18, 19):
(Dr. Tritschler, of the Gynæcological Clinic of Tübingen, furnishes the following on the use of this remedy in diseases of women. FromAllg. Hom. Zeit., bd. 94. Nos. 17. 18, 19):
Permit me now to specify some practical instances of the curative powers ofAurum, and especially ofAurum muriaticum natronatum, in reference to gynæcology.
Chronic Metritis.
The first case is that of a woman with chronic metritis and prolapsus uteri. Hydrarg. chlorat. mit. was given at first, which acted favorably on the inflammation, but whose further use was prevented by its giving rise to salivation. The intumescence of the uterus continued about the same. Chloride of gold entirely reduced the chronic inflammation, and restored the uterus to its natural position without external means.
Induration of Uterus.
The second case was an unmarried woman at the climacteric, the vaginal portion of whose uterus showed an induration which disappeared during the administration of chloride of gold.
Hysterical Spasms.
The third case was a woman with periodical attacks of hysterical spasms, which involved the entire body, with unconsciousness lasting several hours, asthma, palpitation, etc., beginning with a sense of coldness, ascending from the abdomen, and perceptible even to the bystanders. Sometimes the attack began with pulsation through the occiput. Examination showed an inflamed uterus, filling not only the true pelvis, and interfering with urination and defecation, but the enlarged uterus perceptible through the thick abdominal walls above the pubes. At the end of seven months,Aur. mur. nat.had entirely reduced the swelling. The woman has enjoyed good health for several years, quite free from the so-called hysteria.
Induration of Cervix.
It happened that a woman presented an induration of the cervix, together with a remarkable softening in the posterior uterine wall. The result of treatment with chloride of gold was, that in proportion to the decrease of the induration there was an increase in the consistency of the softened posterior wall. The woman, who had been married for three years and childless, became pregnant for the first time and has since borne several children. With this experience, the Gold-chloride was also given for a softening of the atrophied cervical canal, in one case until it was curved at right angles to the body of the uterus; also in a diffused softening of the uterine tissues, with the result that the hitherto sterile woman, after toning up the uterine tissue, attained the joy of motherhood. * * * * *
Habitual abortion and premature labor recurring at about the same month of pregnancy generally depended upon induration in some portion of the uterus, which, preventing its natural expansion during gestation, gives rise to premature expulsion of the fœtus. By the use ofAur. mur. nat.beforeand during pregnancy, the absorption of this induration will conduce to the proper termination of parturition.
A swelling of the ovary, reaching as far as the umbilicus, I have cured withAur. mur. nat., and have improved others of considerable extent very decidedly. Martini has cured five cases of ovarian dropsy in the greatest possible degree with the same remedy.
Ulcers of the os and the vaginal portion, which had resulted from inflammation and induration, some as large as a dollar, and of a gangrenous character, were healed by the use of gold, without any topical applications.
The profession considers ulceration and induration of the uterus incurable. This dogma of theirs is based on the fact that the usual change, the disturbance of nutrition, can neither be remedied nor hindered in its advance. Now since ulcers are generally found only in an advanced stage of softening and induration, it is conceivable why the school—seeking a cure solely in the use of local means—turns away almost entirely from the employment of internal remedies. According to the opinions of the specialists the use of different remedies, partly insoluble, partly soluble, pure or in combination, permanent or transient, is indicated. Others apply ointments on sponges to the surface of the ulcers, keeping them in contact with it by tampons. Others again prescribe injections, and with these expect to attain the end. Finally, glowing-hot iron, the galvano-cautery, or the knife and scissors remove partially or entirely the vaginal portion.
Now, if the malady continues to thrive on the wounds made by these procedures, if old cicatrices break out again, if too a permanent cure is out of the question, there is ground for supposing that theproductof illness, the ulcer, may be cauterized, burnt and cut away, but that the cause, the diathesis, the tendency to it, can only be removed by internal medication. * * * * *
Chronic Metritis.
One day an official in Dresden brought his wife to me, who was 41 years of age. The couple, all of whose children had died soon after birth, longed once more for children. The woman had aborted several times, and both were intelligent enough to see that everything could not be right with the sexual organs, and even begged for a gynæcological examination. The result was in a few words: inflammation of both lips of the uterus, a thickening of the cervical canal with a swelling of the posterior uterine wall as hard as cartilage, and retroversio uteri. Menstruation too early, dysmenorrhœa, blood dark, tarry, passing in clots. Yellowish, fetid leucorrhœa. Stools retained, appetite changeable; pains in the broad ligaments on both sides during rest as well as on exertion. The so-called "facies uterina"—weeps much. Frequent exclamations on the distastefulness of life since the death of all her children, and on account of her present childlessness. Should I register in my journal in the beginning of a scirrhus? I wrote simply: metritis chronica; intumescentia labiorum orificii et colli uteri.
Prognosis, not unfavorable as far as regards the swelling, after my already well-tested experience withAur. mur. nat.But how about the removal of sterility acquired in her 41st year. I was more cautious about this. The cure took six months, and was not only accompanied by absorption of the affected parts, but the woman became pregnant in good time and gave birth to a boy with comparative comfort. Thus would the wishes of the worthy couple have been fulfilled, if their joy had not been banished once more by the death of the child in four weeks from an attack of eclampsia.
Anteversion With Prolapsus.
I now come in conclusion to a gratifying case, which I relate partly because we make ourselves guilty of sins of omission in certain instances through neglect of the needful investigation. A woman in her twentieth year, quite healthy,had been delivered with forceps for the first time two years before, nominally on account of deficient labor pains. There was nothing unusual about the confinement. Immediately after the first getting up, she began to have constant pain in the right side of the uterine region, and soon a feeling "as if something would fall out of the parts." The family physician paid no attention to these persistent complaints for a whole year, until finally a constantly increasing leucorrhœa demanded an examination. He now expressed himself as unable to make a diagnosis alone, and the lady was referred to a celebrated gynæcologist in Leipsic. Cauterizations were now undergone at the professor's house at short intervals, and further treatment of a similar character was to be carried out at the patient's own house, which was, however, discontinued when the patient was referred to me. Examination showed: metritis following upon sub-involution of the uterus, anteversion with prolapsus of the whole organ. Both uterine lips were swollen, and on examination with the speculum a greenish-yellow discharge was seen to flow from the uterus. All local treatment was discontinued, the woman received for the first time in April, 1876,Aur. mur. nat., and in June, 1876, again became pregnant; the treatment with gold was continued until the 8th month of pregnancy, in consequence of which the uterus was found in its normal position on examination twelve days after her safe confinement on March 30th. The menses, which up to this time had been very painful, returned for the first time on the 25th of April, and were quite free from suffering.
But now let us ask, whether we have in the salts of gold a simile for the diseases of the female sexual organs under the comprehensive name of chronic metritis. We find in the homœopathic proving, inflammatory affections of the internal organs; fainting depression and emaciation; great anxiety, sadness, dizziness, whimsical mood, weariness of life, morbid desires, and headache; nausea, vomiting; pressure in the gastric region; cardialgia, contractive, drawing pains in theabdomen.Stitches in the left hypochondrium, pinching and burning in the right, the abdomen sensitive to touch, with distension; dull pains in the abdomen; drawing and stinging in the whole abdomen; eruption of small papules above the pubes;decreased excretion of urine, pressure on urinating, burning on urinating; redness, burning, swelling and moisture of the labia,discharge of yellow mucus, menstruation too soon and lasts too long; amenorrhœa; labor-like pains, as if the menses would appear; symptoms which certainly correspond to the whole picture of chronic metritis and its results.
The mode of administration which I have used forAur. mur. nat.is in trituration. Generally I have had the patient herself divide into three parts a 10 gr. powder of the 3d trit., and take one of these dry just one hour after each meal. But I have also used the 1st and 2d trituration. The effect cannot be seen before four weeks, hence I seldom make a further examination before that time. Many women notice a remarkable increase of the appetite during the use of gold. After the administration of the 1st trit. I have observed frequent, dark stools. An increase in the urine with a thick, gray sediment is often seen. * * *
Uterine Diseases.
Uterine diseases, according to my experience of many years, make more marriages unfruitful than all the other known or fancied hindrances to child-bearing. They can exist many years even with a blooming appearance, without apparently disturbing the general health, and on that account are often overlooked and mistaken by physicians themselves, who are not concerned about gynæcological examinations, or else make only superficial investigations, not having their eyes at the ends of their fingers. I beg, therefore, if this communication should give rise to a more extensive use ofAur. mur. nat., above all things, a thorough gynæcological examination, not leaving this to the so-called surgeons and midwives. If women complain of gastric troubles, dizziness, pain in the loins and back, disturbances of urination or defecation, with a more or less pronounced hysterical appearance, and withal purposely or unwittingly deceive themselves and the physician; if, added to these, leucorrhœa and a sensation as if everything would drop out of the abdominal cavity, one may say of the patient that her uterus is diseased, and may base upon that his proposal for an examination, which will give the correct information of the nature of the malady. As a rule, every deep-seated, morbid alteration in the uterine tissues entails suffering upon the nervous system, which, being in such close relation with the uterus, not seldom apparently suffers the most.
Hysteria.
Because the uterus receives its nerves from the sympathetic system, which governs nutrition, circulation, respiration with distribution of animal heat, gestation, etc., these functions being out of sight, it is difficult to get at the root of the matter as regards the uterus in a suffering woman. Her sensations and fancies offer, according to her education, organization, etc., a wide field in which to make her a burden to herself and others. Her mind is generally out of order, she knows not why. In the more advanced stages of disease, the functions of the higher nervous system, the organs of sense, and even the mental activities are disordered. Then appears that chameleon of diseases, which goes by the name ofhysteria, suitable in so far as hysteria almost without exception takes root in the "hystera" or uterus. I shall certainly not deny the possibility of primary or purely nervous diseases of the uterus, hysteria sine materia; I am nevertheless convinced that in at least nine cases out of ten, hysteria depends upon objective, sensible, perceptible changes in the uterus. It is these whose existence I ascertain by a thorough examination, and according to these that I regulate my treatment; they give me in every case a more certain starting point than a lengthy account of true and imaginary suffering. If I find, however, no palpable abnormality in the tissue to remove, andprescribeAur. mur. nat.simply as an excellent nervine, following Niemeyer, it occasionally does good, but generally leaves me in the lurch.
Nat. Ord., Graminaceæ.Common Name, Oats.Preparation.—The fresh green plant, gathered in August, is pounded to a pulp and macerated with two parts by weight of alcohol.
(Comparatively little has been written concerning this remedy, the tincture of oats. It acquired a bad reputation somewhere in the "eighties" by being advertised as a proprietary remedy making wonderful cures, but analysis showed the advertised "avena" to contain opium. The following outline of the drug is by Dr. E. H. Russell, inNorth American Journal of Homœopathy):
(Comparatively little has been written concerning this remedy, the tincture of oats. It acquired a bad reputation somewhere in the "eighties" by being advertised as a proprietary remedy making wonderful cures, but analysis showed the advertised "avena" to contain opium. The following outline of the drug is by Dr. E. H. Russell, inNorth American Journal of Homœopathy):
Avena sativais pre-eminently an anti-neurotic, quieting the nervous system to a remarkable degree. Its special sphere of action seems to be upon the male sexual organs, regulating the functional irregularities of these parts perhaps as much as any drug can. It is a most useful remedy in all cases of nervous exhaustion, general debility, nervous palpitation of the heart, insomnia, inability to keep the mind fixed upon any one subject, etc., more especially when any or all of these troubles is apparently due to nocturnal emissions, masturbation, over sexual intercourse, and the like. For these disorders it is truly specific. It is one of the most valuable means for overcoming the bad effects of the morphine habit. In most cases in which the habitue has not used more than four grains daily the opiate may be abruptly discontinued, and even substituted, without any serious results. If a larger quantity than this amount has been taken for some time, it is better to gradually reduce the daily dose of morphine, in the usual manner, simply prescribing theAvenain addition. The latter should be given in the same dose, as a rule, regardless of the amount of morphine taken. In other words, it is not necessary to increase theAvenaas the opiate is withdrawn. When the quantity of morphine has not exceeded four grains daily it should be stopped at once, as stated above, andAvenagiven in its stead in fifteen-drop doses, four times a day, in a wineglassful of hot water. By this method the disagreeable after-effects will be much less than though the dose of morphine is gradually reduced, and the patient will find life quite bearable, as a rule, at the end of a week.
Avena sativashould always be given in appreciable doses of the tincture. Fifteen drops three or four times a day, well diluted, will usually meet the case. It may be given in doses of from five to sixty drops in rare instances. It should, however, never be given in larger quantities than twenty minims unless the patient is thoroughly accustomed to the remedy, and has found the usual dose insufficient. Otherwise there is danger of getting the physiological effect of the drug, which ispain at the base of the brain. When this symptom makes its appearance the medicine should be discontinued for a day or two, and then given in reduced doses. There seems to be no danger whatever of forming the habit of taking this drug, as it can be suddenly abandoned at any time without evil consequences, even when given in large quantities. In one case it was prescribed by the writer in sixty-drop doses, night and morning,for one year, and then abruptly stopped, nothing being substituted therefore, without bad effects.
Whenever a quick action is desired, and in all cases whereAvenais given to overcome the morphine habit, it should be prepared in hot water. It is also a good plan to prescribe it in this fashion wherever indigestion complicates the case.
The writer has employed this drug in his private practice for a number of years with the most gratifying results. He has very rarely found it to fail when indicated, and on accountof his high opinion of the remedy he has taken great pleasure in thus bringing it prominently to the attention of the medical profession.
Preparation.—The fresh bark is pounded to a pulp and macerated in two parts by weight of alcohol.
(The following synopsis ofAzadirachta Ind., is contributed by P. C. Majumdar, M. D., of Calcutta, India):
(The following synopsis ofAzadirachta Ind., is contributed by P. C. Majumdar, M. D., of Calcutta, India):
Azadirachta Indica.Syn.: Sanskrit, Nimba; Bengala and Hindi, Nim. Belongs to the natural order Meliaeæ. It is a large tree. Bark is used for making tinctures from which provings were instituted. The leaves, bark, wood, roots and fruits, in short, every part of this tree, is intensely bitter. According to Ayurveda (Hindu System of Medicine) the different parts of this tree possess different medicinal properties. Bhava Misra, Charak, Susratha and several other Sanskrit authors agree that its bark, though very disagreeable in taste, is generally used with success in cases of lassitude, thirst, cough, fever, loss of appetite, helmenthiasis, boils, bilious derangements, catarrh, vomiting, cutaneous diseases, hiccough, gonorrhœa, etc.; its leaves are used in some forms of ophthalmic disease, helmenthiasis and disorders brought on by deranged bile or use of poisonous things. A decoction of fresh leaves is used as a favorite wash to cure old ulcers of long standing. It removes within a short time the sloughs and promotes the healing. The fruit is purgative, demulcent, and is used in some forms of cutaneous affections. A kind of oil is produced from the seed of ripe fruits, and this oil is said to cure lepra, eczema and some other obstinate skin diseases.
Nim is also praised by some of the Allopathic physicians for its tonic, antiseptic, astringent and anti-periodic properties. Its febrifuge action is well-known in our country. Kanirages (native physicians) use Nim as the principal substance in theirfebrifuge medicines. The vast range of its action is chiefly due to azaderine, margocine and katechin, the three active principles found in this tree. Nim was proved by me and one of my students, U. C. Bagchi. A full report of the proving was published in theIndian Homœopathic Review, Vol. iii, No. 1. Here I give the most reliable and peculiar symptoms obtained in its proving.
Mind: Depressed and forgetful, mistakes in writing and spelling words, weak and dull, full of anxiety, inactive, could not think or remember names of persons very familiar, or what has been done in the previous day. No desire to go out or walk out. Loss of memory.
Head: Giddiness, as if the head were moving to and fro, especially when rising from a sitting posture; headache, pressure in the head, by moving it; headache, throbbing in the temporal arteries, especially of the right side, with a little vertigo; aching, drawing and throbbing in the whole head; headache, by wet compress, with much pain in the right eyeball; headache, on moving; headache on the right side with much pain. Frontal headache, especially on the right side, in the open air. Throbbing in the vertex, by stooping; scalp is painful and sensitive to touch, even the hair is painful. Vertigo at 10a.m.; intense headache, pain in the whole head; on walking pain is felt in the back part of the head.
Eyes: Burning in the eyes; burning of the eyes continued throughout even the next day; burning, dull and heavy. Pain in the eye, by slightest pressure; red, congested and burning with slight coryza; sense of pressure in the right eye; eyes red and sunken; pressive pain in the right eyeball.
Ears: Buzzing in the ears; a peculiar cracking sound is heard in the ear like tickling with a feather, which is increased on opening the mouth.
Nose: Running of watery fluid from the nose.
Face: Flushings of the face; flushing and heat in the face; face pale.
Mouth: No thirst but mouth is clammy, water has relish;taste good, but mouth is clammy and bitter. On the sides and surface of the tongue a painful burning sensation is felt as if scalded; papillæ seem to be enlarged and prominent. Putrid taste in the mouth. Saliva coming out which tastes salty. Slight difficulty in deglutition, especially water and meat.
Throat: Bitter taste in the throat; left-sided sore throat.
Stomach: No thirst; appetite very acute and keen; very great thirst for large quantity of cold water; very great thirst at long interval. Heart-burn and water-brash. Uneasy sensation in the thorax.
Abdomen: Great uneasiness in the abdomen with flatulent rumbling in the bowels; twisting pain in the epigastric region; no tenderness in the abdomen; clutching pain in the umbilical region, obliging to bend forwards, which affords some relief; abdomen a little distended, passing of offensive flatus; painful tension in the hypochondriac region.
Stools: Insufficient; bowels very much constipated; stools hard, small and knotty; stools hard, but natural; stools copious, soft, semi-solid. Diarrhœa, no satisfaction after stool.
Genito-urinary organs: Great excitement of sexual organ (in male); sexual desire a little diminished. Urine scanty and high-colored, and scalding; urine white, clear and copious; urine of strong odor (once with purple sediment).
Respiratory organs: Very troublesome cough after bathing at 1p.m.Sputa white in small lumps expelled with much difficulty. Sighing, breathing at intervals. Slight hoarseness. Cough with greyish expectoration; cough with thick sputa; short, dry cough in the afternoon; very troublesome cough with white sputa and tasteless. Deep breathing at long intervals; breathing very rapid and hot.
Chest and throat: Aching in the lower part of the right chest, below the nipple. Stitches in the chest. Crampy pains in the lower part of chest. Transitory stitches in the chest, especially in the right side.
Pulse, quick and hard, feeble.
Neck and back: Pain and debility in the nape of the neck.
Extremities: Numbness of the limbs, as if the limbs are paralyzed. Gnawing in the legs. Strength of the hand diminished. Burning of the hands and soles of the feet. Numbness of the hands only, especially the right hand. Rheumatic pains in the lower extremities.
Sleep and dreams: Sleeplessness and tossing in bed; dreamy and interrupted sleep at night. Dreams of quarrels and beating in the latter part of night.
Fever: Fever commences with very slight chill or without chill from 4:30p.m., and abates from 7:30p.m.; afternoon fever. Glowing heat and burning, especially in the face, eyes, palms of the hands and soles of the feet, in open air.
Copious sweat, especially on the forehead, neck and upper part of the body; sweating commences on the forehead, gradually extending towards the trunk; no sweat in the lower part of the body.
Skin: Itching of various parts of the body, without the appearance of any eruption; itching of the body. Sudamina on the back.
Preparation.—Triturate in the usual way.
(The literature on these several preparations is so extensive that we must confine ourselves to the paper read by Dr. Francois Cartier, Physician to the Hospital St. Jacques, Paris, at the International Homœopathic Congress, 1896, it covering the ground more completely than any other. For fuller information onBacillinumthe reader is referred to Dr. J. Compton Burnett's book, theNew Cure for Consumption.)
(The literature on these several preparations is so extensive that we must confine ourselves to the paper read by Dr. Francois Cartier, Physician to the Hospital St. Jacques, Paris, at the International Homœopathic Congress, 1896, it covering the ground more completely than any other. For fuller information onBacillinumthe reader is referred to Dr. J. Compton Burnett's book, theNew Cure for Consumption.)
I must disclaim any intention of traversing afresh the pathogenesy ofTuberculin, or of instituting an examination into the various treatises put forth on the subject of the virusof tuberculosis by the allopathic as well as by the homœopathic school.
The materia medica ofTuberculintakes its rise in the complex result of the use of Koch's lymph, in experiments upon animals, and in certain symptoms observed by those who have experimented upon themselves with different products of tuberculous nature. I shall therefore indicate the published sources, and I specially desire to place before the Homœopathic Congress of London the tuberculous virus under certain aspects which are perhaps new; and if my conclusions seem somewhat paradoxical I am content to accept, with a good grace, the criticisms of my colleagues.
Fourteen years anterior to the researches of Koch, Hering, Swan and Biegler availed themselves, as a homœopathic remedy, of the maceration of tuberculous lungs, and of the sputa of tuberculous subjects.
Dr. J. Compton Burnett in his book, "A Cure for Consumption," several years before Koch's experiments, noticed symptoms resulting from taking the preparation which he callsBacillinum.
Drs. de Keghel[C]and J. H. Clarke[D]instituted an inquiry into the symptoms produced by the employment of Koch's lymph in the case of tuberculous and non-tuberculous patients.
Dr. Mersch[E]published a pathogenesy, based to a large extent upon that of Dr. de Keghel; it is an excellent work.
Dr. d'Abzen,[F]of Lisbon, sent to the Tuberculosis Congress of 1895, at Coimbra, a study of the works of Koch and Pasteur, and an enumeration of the treatises published by homœopathists.
We must notice also an English translation of Dr. Mersch's pathogenesy, by Dr. Arnulphy, of Chicago, in which special attention is paid to the symptoms observed in healthy andnon-tuberculous persons, with some original remarks aboutTuberculin. It is published in theCliniquefor this year (February, 1896).
Nor must we overlook a series of writers who have published isolated observations of the cases of persons cured withTuberculin. Such are Drs. Lambreghts, Joussett, Zoppritz, Horace Holmes, Richardson, Young, Clarke, Pinart, Youman, U. H. Merson, Snow, Lamb, Clarke, Ebersole, W. James, Kunkel, A. Zoppritz, Steinhauf, Van den Berghe, &c.
Finally, for my own part, in my articles inL'Art Médical, published three years ago, and in theHahnemannian Monthly(July, 1894), I have insisted on homœopathic action of the viruses of tuberculosis.
In certain of the pathogenesies ofTuberculinwe find thrown pell-mell together symptoms appertaining to Koch's lymph, as well as others which belong to the product baptized by several names, such asBacillinumandTuberculin, in the recommendation of which Hering and Swan, and Dr. J. Compton Burnett, in England, have made themselves conspicuous.
Bacillinum—since it must be distinguished from Koch'sTuberculin—is a maceration of a typical tuberculous lung.[G]Koch's lymph is an extract in glycerine of dead tuberculous bacilli. The former is compound natural infection; the latter is a product of laboratory experiment. In the one, various bacteriological species are associated which give, clinically, an appearance of cachexia and of hectic fever; from the other we may sometimes observe vascular, cardiac, renal changes having no connection with the clinical "syndrome" of pulmonary tuberculosis. To place these products together in thesame pathogenesy gives an absolutely wrong sense, and the fact that both contain Koch's bacillus gives no excuse for confounding them. In my opinion there are, from a homœopathic point of view, distinct differences betweenBacillinumand the Koch's lymph.
Experimentally Koch's bacillus, like many other microbes, does not reproduce a clinical symptom-group; and we homœopaths must have an assemblage of clearly-defined symptoms before prescribing a poison on homœopathic principles. Such is unfortunately the case with many other microbes in pure culture. The experimental diphtheria does not resemble clinical diphtheria. The pneumococcus, pathogenetic of pneumonia, is met with in many other diseases, such as pleurisy, salpingitis, meningitis, etc. Koch's bacillus, too, sometimes remarkably mild in its effects, and seeming to meet with no reaction in the system, evolves aside as in the verrucous tuberculosis; while at other times nothing is able to arrest the action of this terrible microbe, and the world still waits in vain for the man who shall find the means of combatting it. The toxins of tuberculosis are far from reproducing clinical tuberculosis; yet even here we find a curious aspect sometimes assumed by certain poisons drawn from the pure cultivation of microbes. We cannot produce withTuberculinsymptoms analogous to those of real tuberculosis—as it is possible, for instance, to produce tetanus with the toxine alone,Tetanin.
As a general rule, in the case of a healthy man, Koch's lymph would not develop any reaction, its effects manifesting themselves in a febrile congestion, which betrays the presence of tubercles. In our pathogeneses (those of Mersch-Arnulphy), we note the following symptoms—"catarrhal pneumonia with soft hepatisation, and tendency to abscess formation; at post-mortems it is not a gelatinous or fibrinous exudation which oozes out from the alveoli, but an opaque and watery fluid; 'never,' so says Virchow, 'is there found the characteristic lesion of croupous pneumonia.'" A pneumonia from which issues an aqueous and opaque liquid! I confess I do not understand it.
Experimentally this same lymph of Koch gives symptoms of inflammation of the arteries which are not found in clinical tuberculosis.
Animals inoculated with progressive doses ofAvian tuberculin, or with serum of tuberculous animals, undergo wasting and loss of appetite, and other general symptoms. They may die of cachexia, or may develop an isolated abscess; but they do not present characteristic symptoms as they would under the action ofCantharis, ofPhosphorus, or ofLead.
Finally, inoculation with dead bacilli may produce real tuberculosis.
In the pathogenesy put forth by homœopathists, pulmonary symptoms do not occupy a prominent place. Dr. Burnett, who has experimented on himself withBacillinum, notes at the end of his symptoms, after the headache, a slight and almost insignificant cough.
In explaining the clinical forms of infectious complaints, we are frequently forced to admit the increasingly preponderant part played by association of microbes—as it is the frequent case in diphtheria—and especially the modifications which depend directly on the disposition of the organ attacked, and not upon the action of the microbe itself.
An examination of the above considerations leads me to the following conclusions:
1. That the importance of the materia medica of the tubercular virtues ought not to be exaggerated. There are few characteristic symptoms to take off; it is more wise to guide oneself in the homœopathic application of the therapeutics by the clinical symptoms of the evolution of the various tuberculosis, rather than by the intoxication produced by their active products, theTuberculins.
2. Koch's lymph,BacillinumandAvian tuberculinmust be studied separately, clinically as well as experimentally.Bacillinumpresents symptoms very different from those ofAvian tuberculin, and especially from those of Koch's lymph; and I intend to divide my remarks into three parts, corresponding to these three substances, which have actually become homœopathic remedies.
At the time of the introduction of the ever-memorable Koch's lymph, there were included under the head of poisonings by this drug vascular lesions, as I have mentioned above, acute arteritis, arterio-sclerosis, changes in the vessels of the heart and the kidneys, and acute nephritis. Apropos of acute nephritis, the supposition was that the kidney became congested because of the presence in that part of certain tubercular islets, and that the kidney responded, like the tuberculous lung, under the influence of theTuberculin, by acute congestion.
However this might be, these vascular lesions drew attention to the homœopathicity of Koch's lymph in nephritis. Dr. Jousset has experimented in it with encouraging results, using homœopathic dilutions, in Bright's disease; and at the meeting of the Société Homœopathique Francaise on April 18, 1895, Drs. Tessier, Silva and Jousset, father and son, mentioned the diminution of albumen in cases of chronic and incurable nephritis, and the appearance of that substance in acute cases.
Dr. Arnulphy, in a series of articles in the ChicagoClinique, which I have read attentively, speaks favorably of Koch's lymph in homœopathic dilutions in cases of tuberculosis. Personally I have not used it, and I am loth to pass judgment on observations recorded in every good faith. I would merely remark to my honorable colleague that Koch's lymph was used in our school in all the homœopathic dilutions possible at the moment of its far-resounding discovery—a fact which he should know as well as myself. To mention only one instance—Drs. Simon, V. L. Simon Boyer and Chancerel used the drug at the Hahnemann Hospital in Paris at the time of the arrival in France of the first consignmentof lymph from Germany; and I am nearly certain that there is not at this time a single country where homœopathists have not used this remedy in all the infinitesimal dilutions. Homœopaths and allopaths have actually taken pretty much the same side as regards the primitive formula put forward by Koch (I am not now speaking of trials of new tuberculins); and Dr. Arnulphy would be fortunate enough were he able to revive its credit after its several years' oblivion as a cure of tuberculosis.
Clinically this lymph of Koch has led to wonderful cures in lobular pneumonia, for it produces pneumonia, broncho pneumonia, and congestion of the lungs in the tuberculous patient. Its homœopathic action would thus appear more trustworthy than its isopathic, and Dr. Arnulphy makes this remark: "I make bold to state that no single remedy in our materia medica, not exceptingIpecac,Iodine,Tartar emetic, and evenPhosphorus, approaches the singular efficacy ofTuberculinin well-authenticated cases of that affection (broncho pneumonia, be it) in the child, the adult, or the aged. Its rapidity of action in some cases is little short of wonderful, and all who have used it in this line are unanimous in their unbounded praise of its working."
The four cases quoted by Dr. Mersch (Journal Belge d' Homéopathie, November, 1894, January and May, 1895) are very instructive:
The first is that of a member of the Dutch Parliament who had contracted a pneumonia which reached a chronic stage. While undergoing a relapse his expectoration assumed a rusty-red color, which color disappeared completely in three days on treatment withTuberculin30th.
The second case is that of a person who was seized, after an attack of measles, with broncho-pneumonia. On the fifth day Dr. Mersch prescribedTuberculin6th. In a day or two the condition of the chest was completely altered.
In the third case an old lady was likewise attacked with broncho-pneumonia, together with digestive troubles, and wasfor a long time in a serious state. After the lapse of a single night, which was a rather distressing one, under the action of the remedy the amelioration was great, and it was with difficulty that Dr. Mersch found a touch of bronchitis in the very place where the day before he had heard nothing but the tubularsouffle. The prescription ran:Tuberculin6th, eight packets of ten globules each, one to be taken every two hours.
Finally, in a fourth case, the patient was a lady of vigorous physique, and twenty-five years of age, who had capillary bronchitis, combined with the symptoms of angina pectoris. Dr. Mersch had once more had an opportunity of viewing with astonishment the rapidity with which the therapeutic action ofTuberculinmay be manifested in such cases.
Bacillinumdeserves study from two points of view, isopathically in the treatment of tuberculosis, homœopathically in the treatment of affections of the respiratory organs without tuberculosis. To fully understand its action it is necessary to know with exactness its composition. Dr. J. Compton Burnett has christened itBacillinum, because he recognized in its lower dilutions the presence of Koch's bacilli. As a matter of fact,Bacillinumcontains in its elements everything that a cavity of a tuberculous lung is capable of containing; that is to say, many other things besides Koch's bacillus. The bacillus of Koch is feebly pyogenetic, and the purulent contents of the cavities include pyogenetic staphylococci and streptococci, to say nothing of the organic products which play a large part in the production of the hectic fever of tuberculosis. It is a combination of toxins, then, which constitutesBacillinum, and especially of toxins of a purulent nature. I lay stress upon this last fact, as it goes to sustain the opinion that I hold on the action ofBacillinum.
The infinitesimal dose of Homœopathy is in no way inimical to the entrance of all the elements constituting a substance into its materia medica. The salts of potassium owetheir effect to their base as well as to their acid;Graphitesis analogous toCarboandFerrum, because it contains both carbon and iron;Hepar sulphuris calcareumacts by reason of its sulphur as well as of its lime.Bacillinum, then, combines in its action all its constituent products, owing its efficacy to its suppurative microbes as well as its inclusion of Koch's bacillus.
This method of viewing the matter, which is peculiar to myself, permits me to include in one and the same category the action ofBacillinumin consumption and its action in non-tuberculous bronchitis.
I have studied conscientiously the action ofBacillinumin tuberculosis, and I must confess that I am looking out still for an authentic case of cure by this remedy. Nevertheless, in the midst of the paucity of drugs for the treatment of tuberculosis, I am happy to state thatBacillinumhas produced in my hands considerable amelioration of the symptoms of this disease. Perhaps in certain cases it produces what Bernheim would call "la treve tuberculeuse." But sooner or later the drug, after ameliorating the symptoms, loses its effect, and the disease again gets the upper hand. I wish I could be as optimistic as Dr. J. Compton Burnett in his interesting book, "A New Cure for Consumption;" but that is impossible.
In looking over my observations I find that the symptom which has always undergone the greatest mitigation has been theexpectoration. WhenBacillinumacts on tuberculosis the sputum is less abundant, less purulent, less green, and more aērated. It is this which has always struck me most in the action ofBacillinum. It is rarely that a patient satisfied with the remedy fails to remark, "I expectorate less." In cases of dry cough at the beginning of tuberculosis I have noticed that the drug evidently arrests the tubercular process.
I would most severely criticise, as well for myself as for others, cases of so-called "cure of tuberculosis." There certainly are persons in whom the disease does not develop.These may have been accidentally infected, and their phagocytes may have struggled against their microbe foe. But in the case of an individual in whom the tubercle finds a suitable field for development, it is the merest chance that he entirely recovers without ulterior relapse; mostly it is a seeming cure, caused by a time of pause in the microbian pullulation.
Last year I had under my care, at the Hospital St. Jacques, a truly extraordinary case. It has been followed out by Dr. Jousset, by Dr. Cesar, head of the hospital laboratory, and by the house-physicians. It was that of a woman who entered the hospital suffering from influenza, and who, a few days after a slight amelioration of her symptoms, was attacked with a pulmonary congestion, clearly localized in the top of the left lung, and accompanied by all the clinical symptoms of tuberculosis—râles and moist crepitation, dulness, exaggeration of the thoracic vibration, nummular expectoration, fever, perspiration, spitting of blood—everything was there. Examination of the sputa showed distinctly the presence of Koch's bacilli. Everyone at the hospital diagnosed tuberculosis, myself the first. I gave herAvian tuberculinand in three weeks all the symptoms had disappeared. That woman left the hospital completely cured, anda year afterwardsher health was still perfect. In my opinion this patient never had consumption; she was attacked with pseudo-phymic bronchitis, a complication which is very often found with influenza, and which may very easily be mistaken for tuberculosis; and in spite of the presence in the sputa of Koch's bacillus I would not register it as a case of tuberculosis, because, in contradistinction to that single case, I could mention twenty cases of tuberculosis whose symptoms neitherAvian tuberculinnor any other such drug has cured.
There is absolutely no connection between the clinical evolution of real tuberculosis and observations based on the autopsies of old persons whose lungs contain cavities, but whose death was not due to tuberculosis. To admit, withProfessor Brouardel, that three-fourths of those who have died a violent death are possessed of tuberculous lesions, whose existence was not suspected while the subject was living, would be running absolutely counter to clinical experience. The time is probably at hand when the different kinds of tuberculosis will be distinguished and separated, as we distinguish and separate the varieties of serious pleurisy and purulent pleurisy, of broncho-pneumonia arising from the presence of pneumococci, of streptococci, or of staphylococci. Malassez has already described cases of pseudo-tuberculosis, or zoogleic-tuberculosis, whose existence has only been acknowledged of late years. Courmont has discovered a pseudo-bacillosis of a bovine origin. We have a pseudo-bacillosis of a strepto bacillar origin, not to mention the "professional" tuberculoses, such as that to which persons are exposed who have to breathe the fumes of charcoal.
To return toBacillinum, I consider this remedy as a powerful moderator of the muco-purulent secretion of consumption. While diminishing the secretion it modifies the auscultation; there is less thick sputum, the cavities are drier, the peri-tuberculosis congestion less intense. The clinical symptoms follow those of the auscultation; as the patient expectorates less he is less feeble, coughs less, gains strength, and regains his spirits; but the tubercle remains untouched. The peri-tuberculous congestion only is diminished, as one may observe with the naked eye when Koch's lymph is employed in the amelioration of lupus. The peri-tuberculous inflammation disappears; the skin seems healthy, but the yellow tubercle remains as it was, and the patient is still uncured. Such are the limits I assign toBacillinumin its action on consumption.
Far more potent is the part played byBacillinumin non-tuberculous pulmonary affections, for the simple reason that the struggle is with a less redoubtable opponent. Ebersole, Young, Zoppritz, Burnett, James, Holmes, Jousset, Steinhauf have published cases of the cure of acute bronchitis, influenzadiarrhœa, syphilitic eruptions, cystitis, ringworm of the scalp, nephritis, idiocy, retarded dentition, cretinism, gout, rheumatism, etc., withTuberculinorBacillinum.
If we wish to prescribeBacillinumsuccessfully in non-tuberculous affections, we must observe, on auscultation, symptoms analogous to those which are perceptible in tuberculosis. The peculiar characteristics which indicateBacillinumfor non-tuberculous maladies of the respiratory organs are, in my opinion, the two following: The first isoppression; the second,muco purulentexpectoration. These two phenomena show themselves always in the last stage of tuberculosis; that is to say, together with the products contained in the preparation ofBacillinum.Dyspnœa resulting from bronchial and pulmonary obstruction caused by a super-abundant secretion from the mucous membrane is marvellously relieved by Bacillinum.I put forward this fact, not on the evidence of a single isolated observation, but on that of several cases conscientiously studied. Such expectoration leads to the auscultation of sub-crepitant râles, sounding liquid and gurgling, having some analogy to the moist sounds of tuberculosis.
This power ofBacillinumto relieve oppression in pulmonary catarrh is in no way surprising from the point of view of the law of similars; for in the acute and infectious stage of tuberculosis the dyspnœa is a characteristic symptom, and is far more distressing than the cough. I have read with pleasure in the work of Dr. Mersch, of Brussels, onTuberculin, of a fact which corroborates my statement as to the influence ofBacillinumover catarrhal dyspnœa. After the sixth dose the patient, who was suffering from bronchial asthma, was seized with violent intercostal pains, with augmented cough; but the oppression entirely disappeared after the first day, and did not return even three months after the treatment had ceased.
InL' Art Médicalof January, 1894, and in theHahnemannian Monthlyof July, 1894, I published the case of an old man of eighty years of age, suffering from broncho-pneumonia, who, in the last stage of asphyxia, had been saved byBacillinum. Two years ago I was called upon to treat another octogenarian who, as the result of a cold, developed an obstruction in the bronchial tubes, and at the basis of the lungs. He passed sleepless nights in a sitting posture, striving to draw deep inspirations.Phosphorus,Arsenic, andStibiumproduced no relief. I gave himBacillinum30th, and he slept the whole night through. Doses of this remedy, administeredat longish intervals, always produced a remarkable amelioration. Last year I was called to the house of an upholsterer. He preferred not going to bed at all to passing the night in bed without closing his eyes. He had humid asthma with incessant cough, which ended by causing him to eject thick yellow and puriform mucus. For eight days he tookArsenicandBlatta, and for a whole week he passed the nights without sleeping. From the day he tookBacillinumhe was able to sleep. I saw him again this year in good health. Once or twice he was attacked with the same bronchorrhea, and had my prescription made up at the chemists, with the same success. This year, too, I have givenBacillinumto several patients at the Hôpital St. Jacques for the same symptoms, and it has never yet failed me.
When I am called upon to treat a patient suffering from an obstruction of the bronchial tubes occasioned by mucus, which is frequently thick and opaque and puriform—an obstruction extending to the delicate bronchial ramification, and causing oppression more frequently than cough, I turn my thoughts at once toBacillinum.Bacillinumis a drug for old people, or, at any rate, for those whose lungs are old; for those chronically catarrhal, or whose pulmonary circulation is enfeebled without regard to the age of the subject; for those who have dyspnœa, and who cough with difficulty from inaction of the respiratory ducts; for the humid asthmatic, the bronchorrheal, who feel suffocated at night; and, finally, for those who, after taking cold, are straightway attacked withpulmonary congestion. Here, I believe, is the exact sphere of action ofBacillinumas a homœopathic remedy.
Bacillinumhas been stigmatized as an unstable product. I consider this reproach ill-founded.Bacillinumis no more unstable thanPsorinum, which is an approved remedy in Homœopathy. Typical tuberculous lungs contain practically almost invariable elements. Do not the microbes produced by cultivation and the animal extracts show any variation in quality, and do they not change in the long run?
Like most homœopathists who have made use ofBacillinum, I think it is best given in the high dilutions and at long intervals. Dr. J. Compton Burnett and Van der Berghe recommended the higher potencies—the 1000th, 100,000, etc., whereas I content myself with the 30th, which satisfies every requirement. As regards the intervals which must elapse between the doses, certain writers recommend from one to two weeks. In acute cases I generally give six globules ofBacillinum30th every two or three days; and in chronic cases of tuberculosis, etc., one dose about twice a week.
We are no longer permitted to include in the same description the tuberculosis of birds and that of mammals. Although the two bacilli, as far as form and color are concerned, are absolutely identical, the evolution of the two forms of tuberculosis presents characteristics so different that we are forced to study them separately. At this day the debate is a question of words, and experts discuss whether there are two distinct genera or merely two different species.
It is this characteristic of non-transmissibility from mammals to birds, andvice versa, which forms the chief difference between the two kinds of tuberculosis. Strauss failed in his endeavor to inoculate a fowl with tuberculosis by injecting fifty kilogrammes of tuberculous human sputa, whereas the fowl, absolutely impervious to human tuberculosis, became infected when treated with a very slight quantity of the avian tuberculosis. The guinea-pig, so sensitive to the human microbe, presented encysted abscesses when treated with thevirus of birds; it dies of cachexia, but never, as far as the naked eye can discern, of generalized tuberculosis. Rabbits are more sensitive to the avian infection. Dogs are absolutely refractory. The monkey, so delicate in our climate, and which almost invariably perishes from tuberculosis, is uninjured by inoculation from avian virus. The parrot is a remarkable exception to the general rule; it is the only bird which resists avian tuberculosis, while, on the other hand, it is sensitive to that of man. Such facts as these irrefutably differentiate the two kinds of tuberculosis.