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The nasal passages afford ingress and egress of air to and from the lungs, at once sifting the air from impurities by means of the hairs that thickly stud the lower fossa, and to a certain extent, analyzing it by means of the special sense of smell. The olfactory nerve showers down from the cribriform plate of the ethmoid bone and is distributed to the convolutions of the superior and inferior turbinated bones and upper portion of the septum, in which region the lining mucous membrane of the nose (the pituitary or Schneiderian) is most developed, and productive of nearly the whole of the nasal discharges.
This special sense is only special, distinguishing only odors; perception of warmth and cold, itching, tickling, pain, etc., as well as the reflex action of sneezing, is given by the nervous trigeminus, or, to speak strictly, the nasal branch of the ophthalmic division of the fifth pair. The presence of a moist surface is essential to a perception of odor; in other words it has been proven beyond a question that a substance must be first gaseous (volatile), and secondly brought into solution, to affect the delicate papillae in which the ultimate filaments of the olfactory nerve terminate. Even aqueous solutions of gaseous odors will not affect the sense of smell if injected as such into the nostrils, the substance must enter the nostrils as a gas. Dark colors are capable of absorbing odors more readily than light. The same we know is true in regard to light and heat; the order as regards absorption of odor is black, blue, red, green, yellow and white. It has come to find its practical application in the use of white sheets and coverlids, white walls in hospitals, etc.; also warmth and moisture facilitate this absorption; so warm, damp atmospheres hold more odors in solution or suspension than cold dry ones.
Odors have been variously classified by Linnaeus as aromatici, fragrantes, ambrosiaci, alliacei, hircini, tetri and nauseasi; by Larry, as alkaline, acid, camphoric, aetheritic and narcotic; by Laller, very sensibly as pleasant, unpleasant, and indifferent. Our appreciation of odors and, hence to a certain extent, of the chemical composition of substances, often far excels any chemical tests, and rivals, if not surpasses in delicacy that beautiful test - the spectral analysis. In animals it is often developed to a far higher degree, owing to the special nerve development and the greater surface exposed to action. I must forbear to pursue this subject to a great length, nor can I now speak of the relation of the Eustachian tube to the sense of hearing; the arguments pro and con and the experiments are numerous and very interesting.
As bearing upon our pathology, there are, opening into the nose in the middle fossa, the ethmoidal cells (possibly also sphenoidal), frontal sinuses and Antrum Highmori, into the lower fossa the lachrymal canal, that sewer of the eye.
We must pass now to our principal subject, the pathology of the nasal passages, and I am constrained to remark that two weeks, in an exceedingly busy season of the year, when two consecutive hours are nearly unattainable, has given me hardly time to layout my work. I need not apologize therefore, for its hasty composition and lack of interest.
Any of these conditions may be a condition or accompaniment of disease; the depression or loss may be an affection of the special sense or be brought about by mechanical obstruction of the nostrils; so also perversion may only be a normal exercise of the special sense in recognizing offensive secretions or the sense itself may he perverted. This latter point could not be settled with any certainty; we may recognize offensive discharges from a patient's nose, and the patient himself, be unconscious thereof, or the reverse may be true; the fact alone concerns us in the treatment of nasal catarrh, and is of great importance; as much so, as the character of the discharge, whether acrid or not, yet in this connection the reason for this perversion is of no more practical value than the chemical composition of the acrid discharge.
In one connection this abnormity of smell will be of great importance, as showing a general pathological condition, viz: in paralysis; as conditions of general nervous depression in which the special senses are in abeyance, as in Hyoscyamus, where the loss of smell has no connection with any organic change in the nose, but is in consonance with general loss of sense and vitality. We find special pathological or pathognomonic conditions of exaltation of smell under Aurum, Belladonna, Lycopodium, Nux vomica, Phosphorus; also Aconite, China, Coffea, Graphites, and Plumbum .
Aurum in connection with extensive organic destruction; so also, Kali bichrom., smell diminished with frequent sneezing, blunted smell even of strong scents followed by frequent sneezing and incipient coryza, then loss of smell with great dryness and insensibility or numbness of the nose.
Under Perversions of smell, I include those bad smells, resulting, not only from change of the function of the special sense· but from offensive discharges; it is impossible to draw the dividing line. I may remark here, that these different smells are not to be viewed as mere curiosities of disease or drug action, but are to be noted as practical indications in the choice of the remedy. They will often decide when we may be in doubt, between two or more drugs.
Kali bichrom. Sensation as if she drew in sulphuretted hydrogen with each breath. Bad smell preceded by stuffing and increased secretion. Smell of rotten eggs. Putrid smell with a watery discharge and redness of the nose, smell of rotten eggs. Imaginary putrid smell. Sensation of fetid smell.
It may seem superfluous and even foolish to pay attention to these little smells, but I, for one, am as much interested in these peculiarities, as in the question of the microscopical character of tubercle whether it is hardened pus or undeveloped blastema; indeed more so, for the former, these smells, are practical, the latter theoretical.
We pass from the anomalies of the special sense of smell to the abnormities of structure in the nasal passages. I will pass over all congenital malformations, multiplicities, hypertrophies, deficiencies of development, etc., to acquired anomalies.
Severe inflammation of the lachrymal sac tends to produce imperforation; a pustule forms on the side of the nose near the inner angle of the eye; it may become a running sore, the tears constantly overflow the cheek causing excoriation. Lachrymal fistula, confirmed, has not been considered subject to medication, but the pathogenesis of Pulsatilla, guarantees to us that in very many, the majority of cases, it will arrest this formation, nip it in the bud; it is applicable in the first stage. So also Silicea and Natr. mur. ought to cure and have cured confirmed fistula.
Dr. Dunham related to me a case, in which there was no doubt of the diagnosis of a fistula of long standing, and the cure was complete and without mistake after the use of Natr. mur. This fistula does not cure itself.
There came to me to the Central Dispensary in this city, a German girl of eighteen, for menstrual troubles, especially menstrual headache and delaying menstruation of such characters that Silicea seemed to me to be the appropriate remedy. After deciding upon my remedy. I noticed on the side of the nose near the eye a small pustule somewhat inflamed. I asked her about it and she said it was of no consequence, it had been there three or four years, and came on after a severe cold in the head. On inquiry I found that the tears continually ran over the cheek of that side, the right, that there was no mistake about a lachrymal fistula on that side. I remembered that Hahnemann in his introduction to the proving of Silicea, recommends it for the cure of lachrymal fistula, and though somewhat skeptical about this case did not change the prescription; Silicea was taken twice a week. In less than three months the tears no longer overflowed the cheek, in less than one month the pustule entirely disappeared leaving smooth skin, red, but without tenderness. I made sure that tears were normally secreted by holding the lids apart and pressing on the caruncula lachrymalis.
The eustachian tube is liable to become occluded by extension of inflammation from the nostrils or pharynx, and here as in occlusion of the lachrymal canal I do not believe in the necessity of operation and, in anticipation, shall not believe it a sign of progress when people come to wear tubes from the posterior nares to the internal ear. I am unable to give an analysis of the drug pathogenesis on this canal; we infer their action from various correlative symptoms; there may be many, we must be careful however in our estimate of symptoms, for example, Lachesis has pain on swallowing going up into the ear, but the course of the pain is along the parotid gland, it is more external than internal. In Gelsemium the reverse is true, it is internal not external. To illustrate the action of Gelsemium I have a very striking and apt case which much astonished me and the patient.
A young lady of 22, in affluent circumstances, felt compelled to apply for relief from the terrible sick headache which preceded every menstrual period, appearing from twenty-four to thirty-six hours before the flow, and attended by profuse vomiting with bearing down pains in the abdomen; no pain in the back, the symptoms relieved., on appearance of the flow. Cocculus was prescribed which certainly relieved her somewhat and in time, I think, would have gradually cured her but after two months I was requested to take her throat in hand. For several years she had been having with increasing frequency, a sore throat coming on with a little fever and leaving her a little deaf. Lately every change of weather affected her throat and she was becoming more and more deaf and constantly so, when her throat was inflamed and sore, (confined to the upper part of the pharynx) pain on swallowing would shoot up into the ear. The family were becoming alarmed as one member, an old lady, formerly subject to like attacks of sore throat, became exceedingly deaf. I took down all the symptoms, was confident I did not have the right remedy with me (at least not in my head) and promised to send it up. I studied but could not make it out, at last Gelsemium was suggested to me and I sent it. It astonished us all; she had not a sick day with her menstrual periods nor has she had a sore throat since; and no difficulty of hearing in the slightest degree, from the time she began the Gelsemium. She took but little and it is now over a year; and a few weeks ago told me in great glee that she could go out in all weathers with impunity. I consider it a bona fide cure. You will of course ask the dose. I gave the only potency in the office then (I should have given lower if I had had it) the 1,000th, prepared by Dr. Fincke, of Brooklyn, which potency of Gelsemium I will swear to.
In passing to the consideration of the drug pathology of the nasal passages proper, I will refer to the abnormal growths within the nose, particularly warts or polypi; they may be hypertrophied states of certain portions of the mucous membrane and the submucous tissue or may be true adventitious growths, fibroid most commonly, in either case they may occur singly or in great numbers and produce more or less stoppage of the nasal passages. Teucrium mar. ver. Has been and is considered almost a specific for the removal of these polypi and many authentic cases are reported.
A remarkable case was reported in the Allg. Hom. Zeit, by Dr. Bojanus of Moscow in which the nostrils were entirely filled with large and small polypi, surgical removal had only increased the difficulty; after the use of Natr. mur. they all came away spontaneously, and the nostrils remained clear. [In this connection it is an interesting fact that several cases of distressing nasal polypus, so situated that extirpation was impracticable, have been cured by a long sea-voyage.]
In the American Homoeopathic Review for January 1864, in an article on “The Question of the Dose,” by Dr. Dunham is quoted a case of a lady of 55, who suffered from a large polypus in the left nostril; various remedies had been given without effect, an operation was proposed, but one physician consulted, thought that a cure by internal remedies would be much more permanent, and having seen striking effects from Calcarea carb. wished to try it. The second trituration was given for four weeks with an intermission of four weeks, with no result. The first trituration was then prescribed, after fourteen days the polypus seemed to be a trifle smaller but an intermission of four weeks was followed by return of the tumor to its former size; at last the officinal lime water was given in milk, a teaspoonful twice daily, amelioration followed the first dose, in four weeks there was no trace of the polypus and the patient remained well.
We come now to the consideration of the pathological conditions of the nasal passages, commonly induced by inflammation acute or chronic, and characterized by the terms coryza, catarrh, ozaena, etc. The inflammation may be: 1st, croupous,, witness ordinary coryzas; 2nd, diphtheritic, extension from the pharynx; 3rd, scrofulous, hereditary and other catarrhs complicated with or showing a tendency to the production of Tuberculosis pulmonalis, and 4th, syphilitic. I shall not stop here to treat of these separately but pass on to the second division, drug pathology - and first the aconite pathology.
The action of Aconite is ephemeral. It produces locally, congestion of the Schneiderian membrane with heat and dryness of the nostrils; but curative as it is in this stage it is still more so, in the inceptive period, when, especially, if the coryza is to be a severe one, there will be great chilliness with other Aconite symptoms. The greatest results from Aconite are always obtained in the chilly stage, but we are seldom called upon to prescribe for this incipient coryza outside of our own families where we often have the opportunity to ward off severe coryza by the timely dose of Aconite. This Aconite congestion may resolve itself by hemorrhage, or pass on into one or more forms of stopped or fluent coryza.
We find epistaxis from Ant. crud., Bell., Brom., Calc. carb., Croc., Dulc., Graph., Hyos., Kali bi., Merc. Millefolium, Nit. acid, Puls., Rhus. and Sabina especially. Epistaxis, of bright blood, Millefolium, Bell, Sab., Dulc., Hyos. and Bry especially. Of dark blood, particularly Croc. and Nux vom. Of clotted blood, particularly Plat., Rhus, and Cham.
Millefolium, deserves to take the lead as a remedy for a vast number of nose-bleeds, the blood is light colored and thin, copious, and the absence of concomitant symptoms serves to lead us to its selection for this as well other hemorrhages from mucous surface, (e. g. menorrhagia) instead of.
Bryonia, has epistaxis for several successive days, especially in the morning after rising. Now this is significant and in connection with other symptoms proves it to be of great value in vicarious menstruation; fully confirmed by experience.
Kali bichrom. Epistaxis preceded by burning in the right nostril and sneezing; also preceded by a sense of obstruction and heat of the expired air. Epistaxis followed suddenly by coryza. Epistaxis after eating; after exercise.
In presenting you the drug pathology of the nasal passages I shall follow a certain system according to the relations of the drug actions to each other, and to head the list present that potent drug Lycopodium; it produces much sneezing through the day, at night the nose is completely stopped with dryness of the nose and burning headache. The nose is swollen, the patient cannot breathe through it, he has to keep his mouth open; the burning headache becomes so severe that he must keep the eyes shut. After a day or two or more, the inflammation may extend down into the bronchi where the Lycopodium cough is developed loose with much expectoration, the coryza may then become somewhat fluent. I am inclined to think that the closure of the nostrils by Lycopodium is not at first, if at all, owing to the presence of lymph, I think the mucous membrane is enormously congested and dry, that only a scanty thick secretion is at first the result. It will be often found in practice to be of the greatest value, and in frequency of prescription only equaled by Nux vom. and Pulsatilla. On the one hand allied to Aconite on the other to Nux vom., but before Nux vom. comes Dulcamara producing a stuffed coryza which is exceedingly aggravated in the open air and followed by a loose cough.
Nux vom. produces a catarrh, which is at times stuffed, then fluent, then stuffed again; the nose will be completely closed by thick tenacious mucus, it will seem dry, but in a little time it will suddenly loosen and discharge copiously a moment or two and then close up again; all this accompanied by a dull confused headache in the forehead just over the nose; it feels as if a mass of cotton were there, the discharge may cause some redness of the nose and this condition is very likely to pass into the coryza of
Mercurius, which is characterized by a profuse discharge of thin or watery matter; the edges of the nose and the upper lip become very red and sore, but without excoriation. This form of coryza comes on with much sneezing the nose is red and swollen especially the left side, the patients are using the handkerchief constantly to which they attribute the redness of the upper lip and edges of the nose. In mercurial affections of long standing the bones of the nose become sore to the touch, the nose is swollen, bad looking pimples break out on the nose. It is allied to Aurum, Kali bichrom., and Nit. acid in connection with which group it will be again noticed.
Arsenicum, which produces a slimy discharge that seems to burn its way over the skin of the upper lip; the discharge is very biting and burning. This coryza commences with great dryness in the nostrils with excessive burning, which burning continues after the discharge appears and is quite characteristic of Arsenic. closely allied to this is
Senega, whose action on the nasal passages is quite characteristic; the coryza commences with the feeling as if red pepper were throughout the nostrils and even throat, with excessive dryness and sneezing; this condition extends itself into the bronchi producing a most distressing and obstinate cough. A lady was subject to attacks very like this, coming on with the feeling of red pepper in the air passages and followed in twenty-four hours by a distressing cough, which proved to many allopathic as well as homoeopathic physicians very obstinate. Senega not only arrested the course of this catarrh at once but from its repeated use the attacks became less and less frequent and severe, and finally ceased altogether. Another member of this group, closely allied to Arsenicum, and which will be called for in nearly as many cases in
Allium cepa, (the onion). It produces a most violent catarrh with profuse discharge of water from the nose and eyes. Singularly enough that from the nose is burning and excoriating, that from the eyes not so; in direct contrast is Euphrasia (that wonderful eye-brightener) which has very acrid lachrymation but bland nasal discharge. These discharges of Allium cepa are accompanied by a terrible laryngeal cough, which compels the patient to grasp the larynx with his hand, for it seems to him that the cough would tear it as if a hook were in there which pulled and dragged every time he coughed. He shrinks and dreads the cough. These are not rare cases and demand prompt action; instead, then of applying chloroform liniment, or giving laudanum and squills, or wrapping the neck up in an onion poultice, give a proper preparation of the onion and the work is done. It will not fail. (It may not be improper to say that the publication of the proving of Allium cepa in English, will immediately follow Aloes in the Review.)
Pulsatilla. Constant tickling irritation to sneeze especially at evening in sleep or in the morning while in bed; stoppage of the nose at night on going to sleep; in the morning discharge of thick yellow opaque mucus; coryza with loss of smell and taste; stopped coryza with ulcerated nostrils; chronic coryza, with discharges of yellowish-green, offensive mucus; discharge of green, offensive matter from the nose; an ulcerated condition of the nostrils.
The acute coryza of Pulsatilla follows the Aconite stage immediately, (as indeed Nux vomica or Mercurius coryzas may) it is marked by frequent sneezing and profuse discharge of thickish matter which is perfectly bland and only annoying by its great quantity; it may become dried on the nostrils and give rise to stoppage of the nose; this coryza is of daily occurrence, especially among children.
The Chamomilla, coryza has some distinctive points, though Pulsatilla and Chamomilla are given indiscriminately for snuffles; the coryza of Chamomilla is not so marked by profuseness, nor has it the excessive· sneezing of Pulsatilla. The nose is stopped, and as a result, prominently calling Chamomilla to mind, is the great uneasiness and fretfulness of the child; then the child is also apt to have the hoarseness and catarrhal Chamomilla cough. Pulsatilla seems to have a chronic coryza; of course it may have; but the same Pulsatilla condition may exist in the nose that exists in the vears, eyes, etc., a superficial inflammation attended by profuse bland discharges; Mercurius discharges excoriate. Arsenicum corrode.
Rational: Distressing sensation of enlargement of the caliber of the pharynx and esophagus from the choanae to the epigastrium. This symptom much aggravated by exposure to damp winds. It then begins at the choanae, and in twelve hours extends to the epigastrium. On reaching this point it provokes a cough, paroxysmal, extremely distressing, and attended by very profuse and exhausting expectoration of thick, starch-like mucus. The whole chest then feels like a big, empty cask; as if its calibre were enlarged tenfold. Great constitutional debility along with these attacks. The patient, who is intolerant of stimulants, can take whisky to any extent and with great temporary relief.
I would now call attention to other drugs whose action seems more profound and lasting, so to speak the chronic drugs, which, nevertheless, are as suitable for the cure or certain acute forms of disease as Lycopodium, Mercurius, Arsen., and no more applicable in chronic forms than these or others; indeed the line is nowhere to be drawn. Silicea may cure an acute form of disease as well as Belladonna a chronic form. Nor further can we any where draw the line through the Materia Medica, and say that, on this side of it, remedies may be used for the cure of catarrhs (or any local manifestations of disease), on that side no drug will cure them. In presenting the action of certain selected drugs on the nasal passages, I have selected those only whose nasal symptoms were strongest marked.
To attempt to detail the symptoms of all the drugs that cure catarrhs, I should have to read the Materia Medica from beginning to end; not only read the nasal symptoms of each drug, but detail the peculiarities of each, noting all accessory symptoms: for if a patient presents himself to us asking to be cured of the catarrh, he makes a great mistake; he wants to be cured as a patient, and we are bound to cure him as such. If he speedily dies of consumption, the catarrh disappearing, we have lost the patient even though the catarrh be cured.
Further, the local catarrhal manifestations are of the least importance in finding our remedies. Six patients may, any day, come to us with organic changes in the nasal passages; the extent of change may be equally great and yet six different remedies will have to be given. The treatment must, in the highest sense of the word, be constitutional. The treatment in the old school today for catarrh, acknowledged best, is general constitutional treatment.
There is another point in this connection. How should we treat catarrh with a Materia Medica constructed on a pathological basis? This and that, and a hundred drugs are called “good” for nasal catarrh, and its subdivisions into ozaenas, syphilitic catarrhs; very applicable in scrofulous subjects; we should be at sea, we could only make a guess; further, a proving may have been made, giving no catarrhal symptoms, and six others may prove the same drug with more sensitive noses and give us a host of catarrhal symptoms. So as I have said, a drug without a symptom under the rubric nose may yet cure a catarrh; and to enlarge our knowledge let everyone keep an accurate record of all his cases, and if any drug removes certain groups of symptoms not down in the Materia Medica, by virtue of its general fitness to the case, let the world have the record, and what an advantage when we do such a thing, to know that this or that remedy did do it, and not go home wondering which, of the half a dozen, it was. Let our young practitioners begin with a broad liberal field, be careful, look on all sides, and, striking, hit the point. It is hardly safe for even an old man to generalize.
There is quite a large group of remedies that show a marked tendency to affect the deep tissues of the nose, the cartilages and bones. In some the action is unmistakable, in others only inferred from the proving, but confirmed by experience; these I propose to consider first, and as a type take
Aurum which may also be called for in catarrhs not yet involving the bones. We find the nose swollen, red, inflamed, sore to the touch, especially the right nasal bone and adjoining parts of the upper jaw are sore to the touch; there is a discharge of greenish yellow, offensive matter. The stinging biting pains in the bones are aggravated at night; jerking pains in the septum from above downwards; pains in the nose in the sunlight; pains accompanied by flow of tears; the nostrils are ulcerated, crusty, agglutinated, so as to impede respiration. Ulcers in the right nostril, covered with dry yellow crusts without pain.
Asafetida has intermitting tearing pains from within outward in the bones of the nose, with a greenish offensive discharge. Experience has fully shown the utility of Asafetida in promptly alleviating such pains in the bones, also aggravated at night; it is an exceedingly useful remedy in all affections of the bones. Nearly allied is
Belladonna which has pressive pain in the nasal bones, worse at night and on touch; pain as if beaten from external pressure in the nose above the alae the left nostrils very painful and agglutinated, mornings; the upper lip is swollen, the nostrils and corners of the mouth are ulcerated, but neither itch nor pain; offensive smell in the nose as of herring brine on blowing it.
Hepar sulph. has sore pain in the dorsum, bones are sore to the touch; heat and burning in the nose; ulcerative pain in the nostrils; drawing pain in the nose passing into the eyes, becoming a smarting there; pain lasts far into the night; pains are drawing or burning.
Natrum mur. Burning pains in the nasal bones, especially at the root of the nose and in the region of the malar bones. Redness, heat and swelling of the left side of the nose, with sore pain especially on blowing the nose; burning in the nose; internal soreness; soreness and swelling of the inside of the nasal wings; many pimples thereon; loss of sensibility with a feeling of deadness of the inner parts of the nose; many small burning pimples under the septum, with the sensation as if acrid matter flowed from the nose; severe fluent coryza, with complete loss of smell and taste. The symptoms of this valuable drug in relation to lachrymal fistula were previously stated.
Natrum carb. Peeling of dorsum and tip which is painful to the touch; pains in the bones of the face, worse in the open air; sensation in the left nostril as if a hard body stuck there, which is not brought away by blowing the nose; ulceration of the upper portion of the nostrils.
Silicea. Stitches, tearings and crawlings in the nose, drawing into the right malar bone; itching; sore pain in the forehead, back of the bridge; throbbing in the nasal fossae, as if festering, radiating into the brain and causing frontal headache; the tip of the nose sensitive to pressure; sore spots on the septum; sore scurfy spots deep in the nostrils and under the alae, which are sore to the touch; much discharge of acrid water from the nose, which makes the inner nose sore and bleeding, with a smell of blood as of recently killed animals. Great dryness in the choanae, the food goes into the choanae; the patient is never free from catarrh, with an acute attack there will be swelling of the submaxillary glands; pain in the throat on swallowing; great chilliness; he must lie down, but when in bed a burning heat over the whole body; the pains are shooting, tearing or drawing.
Sulphur. Boring in the root of the nose; pressure on the right nasal bone, dryness of the inner nose; nostrils red and burning; nose inflamed and swollen, internally ulcerated and painful; cartilages inflamed and swollen; sense of congestion in the nose in the open air; yellow sticky strong smelling fluid drops from the nose; offensive smell of nasal discharge.
Zincum. Pressure on the root of the nose as if it would be pressed into the head; almost intolerable beating at the root of the nose with confusion of the head, with stitches in the jaw and drawing into the eye. Drawing and tearing in the right nostril; sore feeling high up in the nostril; tearing in the right side of the nose.
Nitric acid. The malar bones become sore and painful; stitches in the nose as of a splinter on touching it; soreness and bleeding of the inner nose; nostrils are ulcerated, blood and bloody matter is blown out of them; unpleasant smell, evenings on lying down. On eating, pieces of food get into the choanae, producing a sickening sensation; they are afterwards drawn out covered with mucus; nasal mucus goes down into the throat with inflamed and swollen alae; acrid matter from the nose at night; blows yellow matter from the nose of a sickening smell; discharge of thick nasal mucus corroding the nostrils; severe catarrh with swelling of the upper lips and, especially, night cough; stuffed catarrh with dryness in the throat on empty swallowing. This is a very potent remedy for syphilitic catarrhs of the nose and throat. I have derived more real satisfaction in seeing the prompt and lasting effects of this drug, not only in syphilitic catarrhs but lichen, ulcers, glandular affections, falling of hair, etc., etc., than from any other remedy. I think it is oftener indicated than any other, especially before the bones become much affected. I have occasion to use it every day in dispensary practice and invariably the report is great improvement. Next comes
Argentum nit. Pain and swelling of right alae; the left nasal bones are painful; bleeding pimples on the septum; violent itching in the nose, compelling rubbing till it looked raw; ulcers in the nose with yellow scabs; scurfs in the nose becoming exceedingly painful, if detached they bleed; bloody and purulent discharge in the open air; stopped in the house and at night smell of pus at night; catarrh with constant chilliness, sickly look, lachrymation, sneezing and such a violent stupefying headache that she must lie down. Aching pain in the forehead going into the eyes. It seems to me to be nearly allied to Thuja and Phosphorus, they all have swelling and painfulness of the alae. Thuja states swelling and hardness of the left ala. Argentum nit. of the right. Argent. nit. sore pains, bruised pain of one side of the bridge of the nose; pressure like a stone on the dorsum; stiffness and clawing in the fossae. Phosphorus has severe pains in the forenoon. Thuja the peculiar pain drawing between the nose and mouth as it the periosteum were tightly stretched; the pain then spreads over the nasal bones as if a saddle were across it. The catarrh of Phosphorus, like that of Argentum nit., is attended with much headache and general sick feeling, there is a dry feeling in the nose as if it would be stuck together. I do not think the action of Phosphorus so extensive, organically speaking, as the Nitrate of silver, it does not affect the bones as Phosphoric acid does, though the action of Phosphoric acid on the nasal bones must be inferred to a certain extent. We all know its extent on the superior maxillary bone, it probably would involve those of the nose by extension.
The number of Nitrate of silver catarrhs is not large, and the employment of it as a caustic, so much in vogue in the old school, is pernicious in the extreme; destroying the tissues of the nose that they cannot be inflamed or diseased, is as sensible as amputation for rheumatism or circumcision for syphilis. I have no doubt it sometimes cures and generally suppresses catarrh. Only a few weeks ago a gentlemen called for medicine for his wife. Knowing he had been under homoeopathic treatment for a catarrh of long standing, I asked him how he got along. “Oh, finely, but your little doses won't do, they are to slow for my case; they are the thing for my wife, but they didn't do up my catarrh. I went to an allopathic doctor and have had two injections of Nitrate of silver, pretty severe, but my catarrh is most well.” I congratulated him and thought that if that old catarrh was being so suddenly stopped, such speedy cures are impossible, he would have trouble. Not long after, he returned to the slow method; he had become frightened, for after three or four applications he began to grow deaf. There is not one here but has noted the production of tubercles in the lungs following the suppression of nasal or laryngeal catarrh, the treatment drives it down out of reach as well as the patient. Intelligent persons are learning that it is dangerous to suppress hemorrhoids, scrofulous glandular swellings, etc., etc. They are finding out the same thing as regards catarrhs and, in fact, all local manifestations. We must keep in advance of our patients.
Aching pain at the root of the nose with an acrid discharge, pain across the bridge with stuffed nostrils; pain especially at the junction of the cartilage and bone; ulceration of the cartilage quite through, with great soreness; ulceration of the frontal sinuses with violent headache at the root of the nose and in the frontal prominences, if the discharge stops. On blowing the nose, sensation as if two bones rubbed together; sensation as if the nostrils were made of parchment; a spot in the right lachrymal bone is swollen and inflamed; internal ulceration with thin watery discharge, or collection of elastic plugs, which cause great pain in removal and leave the nose very sore. Watery discharge with redness of the nose and putrid smell; nose often painful and dry or a watery discharge, excoriating the nose and upper lip with sore and swollen alae; fetid smell and complete loss of smell, etc. It produces deep and extensive ulceration; the process carried on mostly in the cartilages, hardly producing caries of the bones. It is almost a specific for perforating ulcers of the septum and many cases of cures are on record. This deep ulcerative process seems to extend throughout the whole mucous tract. Similar to this is
Kali hydrodicum. Ulceration of internal nose, involving the frontal sinuses and antrum highmori; the nose is red and swollen with constant discharge of acrid watery colorless liquid, with violent lachrymation; anxious expression and restlessness; discharge of burning corroding matter from the nose; the inflammation extends into the eyes; there is much conjunctivitis; painful hammering in the frontal region with compressed feeling of both sides of the brain. The action of the hydriodate is more intense, more superficial, not so deep as the bichromate; more applicable, I should judge, in the acute manifestations of scrofulous catarrhs or indeed any catarrh.
There are many other drugs that more or less affect the deeper tissues of the nose, especially the bones and very many that may be called for in practice from the relation of their symptoms to forms of this disease. It is impossible to draw a line, but following close unto this is a group which I will commence with.
Sepia. Pressive pains in the root or the nose; sore feeling in the nose on drawing the air through; nose swollen and inflamed; the nostrils angry and ulcerated; small ulcers in the nostrils; scurfy nostrils; a piece of yellowish green slime with bloody edges is blown out of the nose; discharge of yellow water from the nose, with cutting pains in the forehead; dryness in the nose and throat; dryness in the choanae (though there is much mucus in the mouth) with involuntary urging to swallow; a severe fluent coryza with severe pains in the occiput and painful drawings in the hips and thighs. It may be said in a general way that Sepia is often applicable for catarrhs arising from retrocession of an eruption. I note a few cases.
A severe catarrh came on after the disappearance of an eruption from the crown of the head, it lasted over a year. Phosphorus began the cure, but it required Sepia to complete it (what a pity more definite symptoms were not given). After washing the head in cold water (after having been heated), a throbbing pain in the forehead; then thin offensive discharge from the left nostril; scabs like small pox formed in the nostrils which were very offensive. Patient relieved by Belladonna but cured by Sepia. A case was reported with this which, though having no connection with Sepia, I will relate. Inflammation and suppuration of frontal sinuses and antrum highmori, with throbbing splitting pains in the nose and forehead; was not relieved by Iodide of potash nor Aurum, somewhat relieved or modified by Arsen., leaving a thick citron yellow discharge. Speedily cured by Lycopodium, which produced a red sandy deposit in the urine .
Ammonium mur. Ulcerative pain in the left nostril, with sensitiveness to external touch, frequently recurring; external swelling of the left side of the nose, with discharge of bloody crusts from the nose; persistent itching in the nose with irritation to snuffling, and feeling as if a raw large body stuck in the upper part of the nose; stoppage of the nose, with pain in the right nostril, at night and disappearing in the morning. Stoppage of only one nostril, from which much thick yellow matter comes, with tearing in the cheek bones and teeth of the left side; clear acrid matter runs from the nose; pains worse at night .
Alumina. Nostrils are sore and scurfy, with profuse discharge of much thick mucus; ulceration of the mucous membrane with pain in the alae and frontal sinuses; nose is red, swollen and painful to the touch; the nose is stopped at night, with dryness of the mouth; disposes to frequent coryzas, found very serviceable in scrofulous subjects. The pains are burning, stinging and biting, occurring mostly in the evening and on one side.
Antimonium crud. The nose is sore and painful, especially on drawing in the cold air, and on the right side dryness of the nose on going into the open air, so severe that he can scarce speak; must continually draw thick yellow mucus back into the throat and spit it out; the nostrils are angry, sore, puffy, crusty and painful
Borax ver. Dry crusts continually form within the nose, a discharge of thick green mucus; ulceration of the left nostril, with soreness and swelling of the tip; epistaxis in the morning, and at night throbbing headache.
Graphites, a very valuable remedy. Nose feels sore on blowing; blowing bloody mucus out of the nose; catarrh, with obstruction of the nose; heat in the forehead and face; oppression of the chest; numbness of the head and heat in the nose, with loss of smell; severe stuffed catarrh, with much nausea and headache, without vomiting; must lie down; fluent coryza, with frequent catarrh and frequent sneezing, with oppressive pains in the submaxillary glands; the exposed parts are sensitive to the air as if he would easily take cold; severe fluent coryza, with catarrh; much oppression of the chest; dull and hot head .
Magnesia mur. Burning of both nostrils, as if sore; nose is sore internally and sore to the touch; scurf in both nostrils, which is very painful to touch, with loss of smell; an oppressive stuffed feeling of the nose; severe coryza, now stopped, now fluent, with confusion of the head and complete loss of smell and taste. Discharge of offensive purulent yellow matter; must sit up in bed a long time; evenings cannot lie down for want of air.
Calcarea carb. The fore-part of the nose is red, inflamed and swollen; the nose is dry, very offensive; the nostrils are scurfy and ulcerated; catarrh, with internal heat of the head and with headache and oppression of the chest. Allied to Graphites, also,
Conium. Boring in the nostrils; smell of animals in back part of the nose; heat of face; congestion to the head, with catarrhal sensation; severe catarrhal fever, with inflammation of throat and loss of appetite.
Stannum has a catarrh, with a sweet taste to the discharge; its clinical record is quite large. I believe its pathogenesis not satisfactory in its local manifestations, though marked in general peculiarities.
Lachesis. With running from the nose and eyes; discharge of blood, with violent headache; dryness of nose and throat; secretion of mucus increased in the nose and fauces, but diminished in the larynx; complaints from retrocession of catarrhs; a fluent coryza relieves a headache of long standing, with lachrymation and stoppage of the ears, in many respects similar to Hydriodate of potash.
In giving you these analyses, I know I am giving but little of practical value. There are many drugs whose local manifestations are not essentially different. Taking these symptoms alone, one will be often puzzled to know where to refer any case of catarrh. For the choice of the drug we must, as I said before, look outside of the local trouble in the patient as well as in the drug; the concomitant symptoms, the conditions of appearance, aggravation and amelioration, in fact everything that is peculiar to our case in hand; and the peculiar drug must be found, it exists somewhere, it may be in Japan, or in the Rocky Mountains, it is very likely in our pocket case.
I am aware that there are many remedies used by professing Homoeopathicians in an empirical manner, of which no proving on the healthy subject exist. Some are fashionable this year, some were last. Undoubtedly they have their sphere of action - therein are they valuable - now we wish to know how a physician can know when to use them; those who are In the habit of doing so must have some guide, something in the phase of the disease that leads them to prescribe this or that drug in place of any proven drugs. They have found, by experience, that this new drug will cure certain specific conditions. Now I would urge it as a duty upon everyone who relates a case, or notices this or that drug, to tell what the indications are, why to give it in preference to other drugs. Of what avail is it to hear the relation of fifty catarrhs cured by fifty remedies, unless we shall know why they were cured. I must say that, as a young man searching after knowledge, I have found it very unsatisfactory to hear anyone say that he has found this drug or that combination very serviceable in this or that disease. Is it to be supposed that if, the next day, I am called to prescribe for that disease I am going to give that remedy because he found it useful,
A certain drug has been known to cure catarrhs, let us, therefore, find out what kind of catarrhs it does cure and then we can use it. If we give it for a catarrh now to try it, make a note of the patient's state before giving it, and we may arrive at it perhaps, approximately, remembering that change in a disease is not always to be ascribed to the medicine - to reason from diseased conditions we need hundreds of cases - absolute knowledge of a drug from the healthy needs but comparatively few provers.
|Source:||The American Homoeopathic Review Vol. 04 No. 09, 1865, pages 385-398, pages 453-465|
|Description:||The Physiology and Pathology of The Nasal Passages.|
|Editing:||errors only; interlinks; formatting|