If names are not things, their protracted use, in some instances, comes ultimately to the imparting to them the importance and consideration which belong only to the things they are supposed to represent This, unfortunately, is only too true of the use of the names we have, for the convenient interchange of ideas, been compelled to apply to diseases, in the discharge of our practical duties in relation to them. To certain generic characteristics a name is given, and, by use, this comes to represent these in whatever combinations they may be met. They are accepted as expressing identity of condition, and therefore, of uniformity of curative relation to remedies, whatever other attendant phenomena may be present, and however these may really, on a thorough investigation, be found to disclose new characteristics and establish new relations. The misfortune is that the name, in so many cases, is taken as sufficient, and this investigation is neglected. The name is assumed to represent, what, when the generic elements of the case are thus complicated, it really does not. And proceeding, on this false assumption, in administering for the cure, of necessity, in many cases, wrong means are selected, and the result is only a partial success or utter failure.
If this be true of individual cases of disease, it is still worse of groups called by the same name, or of epidemics. It may be sufficient for the ordinary purposes of life to call a member of such a group “whooping cough,” the object being to convey to some friend of the patient an idea of the nature of his malady. Both he and the patient think they understand this, and they are satisfied. And so far the name is well enough. It is to this extent and for this purpose useful. But if to this name be attached the idea that that which it expresses is an identity, in all cases, which is to be met by a given curative, Drosera, for example, it is not only not useful, but positively mischievous. Such an idea in relation to this affection was once quite prevalent. It was believed by Hahnemann himself and many of the earliest and best Homoeopathists. But it was not true, notwithstanding. So far from it, that it is confidently believed that Drosera has cured but few cases of whooping cough in the practice of Homoeopathy in this country. In the practice of the writer, extended over more than twenty years, it has in a very few cases mitigated the severity or frequency of the paroxysms, but in no one, that he now recollects, has it effected a complete cure. It has not been for want of a trial. The great confidence in the drug expressed by Hahnemann and his early followers, and their great success with it in the treatment of this troublesome malady, led, in his early practice, to its frequent use, till frequent disappointments caused him first to question the genuineness of the specimen of the drug employed, and to resort to the use of different specimens; then, the result being still unsatisfactory, to its use in different potencies, from the lowest to the highest, and still the cures were not realized. The question was unavoidable, Why are not the same successes realized from the use of the drug here as are claimed for it in Germany? The fact had been abundantly proved that Drosera was not a specific for whooping cough in Brooklyn. It was declared to be so in Germany. Whence the difference? The honesty and capacity of the German witnesses were of the highest character. These could not be questioned. The drug used was obtained from the same source and therefore was presumed to be the same. There must then be a difference in the disease, arising from the difference of climate, or the modifying influences of different social and domestic life, in the two countries; or the morbid cause producing the different epidemics was not an identity. It was different in its nature in these different visitations, and therefore though it still produced the generic phenomena we are accustomed to recognize as whooping cough, these came in different epidemics, accompanied by other phenomena, by which each was characterized, and in which it differed from the other. Was not here the reason why Drosera cured in some instances and failed in others? A careful and prolonged observation has convinced him that this is not only true of whooping cough but of all epidemics. That in them all, that which we call by the same name when met in groups, in successive years, though exhibiting the same generic phenomena, are not the same in their intimate nature, and therefore not in their curative relations. This is shown in the case which we have used for our illustration. Why would not Drosera cure for us as well as others? A careful examination of the symptoms of the drug and the disease showed clearly enough the reason why. Though there was a marked similarity in the generic phenomena of the disease and some of the symptoms of the drug, there was none whatever between the accompanying symptoms of these generics, and the symptoms of the drug, and hence the failure.
This is the truth in relation to all epidemics. Though called by the same name, they are not, as met in successive visitations, identical. Indeed, in those elements by which they are related to curative agents, they are quite different in different years, and no fact is now better known than this, that the remedy which has been almost uniformly successful in a previous epidemic is without value in that which next follows it. This was not at first understood, and hence the hasty generalizations of the earlier Homoeopathists, one instance of which, we have found, led to a conclusion not sustained by subsequent experience. This is equally the case with other diseases for which they supposed they had found specifics for all time. They had not yet appreciated the extent of that strict individualization which constitutes the very soul of the homoeopathic system, and which is no less a necessity to success in the treatment of epidemic than in spasmodic diseases — in those from specific no less than in those from general causes.
More than this is true. Diseases which appear for the most part as epidemics, and proceed from specific causes, though retaining so much resemblance, of their generic phenomena, in their successive visitations, as to be still called by the same name, are nevertheless subjects of changes in these from epidemic to epidemic, till there is finally but small propriety in calling the recent disease by the same name as the ancient. It has ceased to be the same even in the general manifestations which were the foundations of its classification, and a fortiori has no longer the resemblance in its specific elements to those characteristic symptoms of drugs which once gave to these the relation of curatives to the disease, and which they sustained so long as this resemblance continued and no longer. Hence the necessity of carefully studying each epidemic in its elementary characters, just as we would if we were investigating a new disease, never before seen, named or prescribed for, if we would secure for our practice the best possible results. It is only after such a study that we can know what is the remedy for this individual case. For it is well to know that epidemics have their characteristics, by which they are related to their curatives, as individual cases of disease have. When these are discovered and understood, the key to the control of the epidemic is in our possession, and the cure of the members of the family group is almost a matter of no difficulty It is only to find the drug, the characteristics of which are like these of the epidemic, and the cases successively treated by it yield to its power with almost uniform certainty. This has been taught by some of our colleagues, and especially by Hering, and its truth demonstrated, in their practical successes, for many years. It is not stated here as a thing which is new, but as a truth, the practical knowledge of which is not so general as its importance merits.
We have made these observations on the nature, study, and treatment of epidemics generally, to prepare the way for the question which we now put — Why is the supposed homoeopathic treatment of what is called “Scarlet Fever” less successful now than it was in the early history of our school? That it is far less satisfactory now than it was even twenty years ago, needs no argument to prove. An appeal to the memory and candor of physicians who have an experience of so many years of practice is all that is necessary to establish this truth. Twenty years ago a fatal case of Scarlet Fever, that had been intelligently treated in accordance with the instructions of the early Homoeopathists, was a rarity. Now such cases are believed to be far more common, though the treatment has been but little varied. Why is this?
An intelligent answer to this question involves a consideration of the two powers which enter into and compose the elements of all practical attempts to cure the sick by drug agency, viz.: the disease, the facts which compose it, and the circumstances and conditions in which these are developed; and the drug, the powers by which it affects the actions of the living organism, and the resemblance of its effects on these actions to the phenomena of natural disease. Of these elements it will be seen at a glance, that one class is, in its nature, subject to modifications, and in practice is found to present constant changes, more or less important, resulting from impressions of circumstance or condition, either on the nature of the morbid cause, or on the vital forces and susceptibilities of the patient, while the other remains a fixed quantity, or is only subject to such differences of power as result from different degrees of excellence or purity in the samples of a given drug employed. If this be so, that while the disease is, in its nature, subject to constant change, and the drug at the same time remains ever the same, it is evident that to continue to treat a disease, because called by the same name, by the administration of the same drug, for a series of years, must of necessity often result in such violations of law as can only be followed by want of success. It does not avail that the drug was once homoeopathic to this disease, for this has so changed, in the elements by which it is related to curatives, that this relation no longer exists.
In the introduction to Belladonna (Reine Arzneimittellehre, b. 1, s.15), Hahnemann has clearly stated what he understood by the term Scharlachfieber (Scarlet Fever), for which he claimed to have found not only a specific curative, but a prophylactic as well. He says this is the “true erysipelatous, smooth (glatte) Scarlet Fever, as described by Sydenham, Plencitz, and others,” and remonstrates against the objections to the claims of his prophylactic, that it did not protect against attacks of Rothe Friesel (miliary rash), which appeared in Belgium in 1801, and which he says is quite a different affair, and requires to be treated with very different remedies. He complains that the distinction was not made by those who ridiculed and rejected his curative and protector. If it be now objected to the so-called homoeopathic treatment of what is now called Scarlet Fever, that it is sometimes unsuccessful, and this more frequent than formerly, the reply is not difficult. Indeed there are several, either of which is sufficient to meet this objection fully. It is quite enough to state the fact that there has been no method of treatment found which does not sometimes fail of curing this truly formidable malady, and that this, which is called homoeopathic (we shall by and bye try to show that, sometimes it is not), is as often or oftener successful than other methods.
But there is another. That this which is now often and generally called scarlet fever is not the disease which Sydenham described and Hahnemann cured and prevented. That which is now generally met in practice, and which passes under this name, is quite different in its nature, elements and curative relationships, from the smooth scarlatina of Sydenham. This difference has been increasing from year to year, till now it is one of the rare occurrences, that one meets a case of what Hahnemann calls “true Scarlet Fever“The disease has been assuming more and more each year the character of ”Purpurfriesel” (miliary rash), which he says Scarlet Fever is not, and that the remedies required by the one do not cure the other. Now while this is true in relation to the disease, what are the facts in relation to the treatment? Has this been changed to meet the changing requirements of the case? If not then however frequently this may have failed of success, Homoeopathy has not each time, then and there, failed in it. Homoeopathy is, in its treatment of this as of all other diseases, the applying of a remedy to a given case, the known pathogenesis of which is like the elements of this case, and never for a given name the administration of a supposed specific. Now the changes in the disease we are considering have been so gradual that the same name has been continued, and is still in use, which years ago was given to a group of phenomena now rarely met, at least, in this neighborhood. While this change has been progressing, the treatment has been dominated by the name, and has remained substantially the same in too many instances, and if, in these circumstances there have been failures to cure, they have been only what should have been expected from this, as well as from any other violation of the law of cure, which this treatment certainly is, whenever the remedies employed have not in their pathogenesis the likeness of the characteristics of the case treated. Whatever the treatment of such cases may have been called, certainly, homoeopathic it was not.
It is very common to hear from practitioners of both the old school and the new the declaration — “We do not treat names” — “we treat” — what? The old school claims to treat “diseases,” the new, sick men and women; guided in this by the elements of diseases — their symptoms. In too many instances the claims of both are equally false. The truth is, in the great majority of cases, both have been concerned, chiefly if not entirely, with the name, notwithstanding this disclaimer. The case is “Scarlet Fever,” has been the thought and this requires so and so, and in this way it is that names came to take the place of things. It may even be said with truth in our school, so gradual has been the change that has crept over this, which we still call “Scarlet Fever'' that it now presents no longer the simple elements of true scarlet fever, but a mixture of these with the ”Purpurfriesel“ or miliary rash. The case has been recognized as Scarlet Fever at the outset, and this has saved all trouble of observation and investigation. These were both troublesome, and useless, because from the beginning it has been known that this malady required for its treatment and cure Belladonna and little else; and Belladonna has not been wanting, whatever has been the success.
Now against all this style of practice we enter our solemn protest. It is wholly unwarranted by any authority, or by any success. It is unscientific, puerile, and hazardous. It can only proceed from carelessness, indolence, ignorance on general incompetency. That, in the case of the disease before us, it has become common, is explained, perhaps, by the impression, too general, though false, that such a thing as a general specific for a group of generic symptoms is possible, and that such a specific for the group called Scarlet fever has been found in Bellad. Or if this were not strictly true, it was so nearly true, that at any rate the best thing to do in the beginning was, to give it, and continue to give it, till it should cure or fail. And if it did fail, then there was the comforting assumption of the specific idea, and the easy conclusion, if the specific failed, then, of course, all else would have failed. Would it not have been as well instead of this to have investigated the case, and to have ascertained before giving the drug, whether it was appropriate to the treatment — whether it was required by the law of cure? If not, then it could not be specific for this case, though it had cured every other called by the same name, in all past time.
What has been, and is still, the most common prescription at the beginning of the treatment of Scarlet Fever? We hazard nothing in saying that in a great majority of cases treated by the practitioners of our school, if not in nearly all of them, the same prescription is repeated, and this with very little reference to the facts disclosed by a critical examination of the case and a reference of these to the requirements of the law of cure. The current method is to give at once, the once supposed specific, Belladonna. Or, if there be exceptions to this, oftener than otherwise, it will be found that Aconite has been given, either a few doses as a preliminary compliment to the high febrile reaction of the initiatory stage, or, more commonly, this is alternated with the specific. This is almost invariable in all cases where treatment has preceded the localization of the attack on either the throat or brain. And now who, in all the cases treated in the last twenty years, has, when so prescribing, given himself the trouble to inquire why Bellad. or Acon. was given rather than Amnion. carb., Stram., Rhus tox., or any other drug which may or may not have shown in its pathogenesis some form of efflorescence of the skin, or a red rash? Who of all these has given to himself a better reason for what he was doing than this — others have done it before? And how shall such a practice be defended from the charge of the grossest empiricism? In what, in those cases where the likeness of the symptoms of the disease and drug were wanting, is such a practice better than the grossest quackery?
Extreme cases are better illustrations of a truth than those composed of less striking elements. Let us take such a case. Suppose a child, while at its play, is suddenly seized with vomiting, and this is immediately followed by violent pains in the head, intolerance of light, desire to lie down, sudden and great prostration of strength, vertigo, comatose sleep, insensibility, convulsions, here and there on the skin may be found patches of redness with raised points, more or less prominent, while the intermediate spaces are of a dull opaque appearance, the whole having a marbled look; the redness is evanescent, it goes and comes again, or this may, from the outset, assume a purplish hue, and when the blood is forced from the skin, by the pressure of the finger, the color is slow in returning; and after an interval of from ten to thirty hours death closes the scene. The case has been treated by a Homoeopathist, and what have been the remedies he prescribed? Has not Belladonna been his chief reliance? If he has given any one medicine in such cases, before and oftener than any other, has not this been it? Why? Let him bring this question home to his conscience, and answer it, in the light of the law of cure, before he ever, in a case like this, pursues a similar practice again. We repeat — why did he give this drug? If he be a practitioner who, before prescribing for his patient, is accustomed to have some reference to the symptoms of his case, he has seen headache, intolerance of light, vertigo, sleep, insensibility, convulsions, redness of the skin — and has not Belladonna all these? To the careless observer, yes. To the careful student of the Materia Medica, no.
The whole condition of the patient, in the case imagined, and that of the brain in particular, through which the attack from the outset threatens life and so rapidly destroys it, is altogether unlike that produced by this drug. The pain, intolerance of light, vertigo, insensibility, sleep, convulsions, etc., which characterize the action of Belladonna on the cerebral apparatus find their counterpart in the symptoms of acute inflammations, for the most part of the membranes of the brain or, it may be, of its substance, though this is more rare. In the case before us the brain is not suffering, as is often thoughtlessly supposed, from inflammation, but from toxication. Not from excessive but deficient action. Indeed, in all its characteristics it discloses a state as nearly the opposite of that produced by the action of this drug as can well be imagined. It is not inflammation but paralysis. These symptoms, to be sure, are nearly all named in the pathogenesis of Belladonna, in nearly the same words we have used to state them. But when produced by the drug they are of a different quality. And they have been selected, in part, in addition to the illustration they afford of our present subject, to give opportunity for insisting on the duty of studying symptoms in their quality, because in this is often found the distinction between the symptoms of different drugs, which are recorded in nearly the same language. We insist on this because it is essential to an accurate and successful practice. This duty, if faithfully discharged, would have saved the long succession of false prescriptions in this class of cases, which have been so uniformly followed by fatal results. For, we believe we may safely affirm that this drug has never yet cured one of the hundreds of such cases in which it has been employed. And these symptoms have been given, in order further to say that the similarity in the symptoms of the drug and disease to be sought and found in the process of prescribing for the cure of the sick, is not a similarity of verbal expressions used by the patient and the drug provers, but of a physiological or pathological state to be discovered only in the resemblance of the characteristic symptoms of the drug and the disease. This verbal similarity has often imposed on the inexperienced, though it is really of little or no value as a guide to the selection of curatives, and we have no doubt that the success in practice, of any prescriber, will be found to have been in the inverse ratio of his reliance on it. For the cure of a case with symptoms like those we have given, it is not enough that a drug be found which has produced symptoms which have been recorded in words which may be used also to describe those of the case. This must be true in addition — it must have added to its record that these symptoms were characterized by torpor. In this class of cases, met too often in practice, a representative of which we have endeavored to present in its symptoms, this is the dominating feature, which, in the selection of a curative, if one can indeed be found for it, can in no wise be ignored. We say if a curative can be found, for it is but too notorious that these cases generally die. Are we therefore justified in the conclusion that this is a necessity inherent in such cases; and that we may therefore be satisfied in sitting down to a routine of practice which has little to present us but an almost unbroken list of failures? Certainly, till after our utmost endeavor, we have no right to be content with such successes, or rather want of successes, as our past history and treatment of such cases has put on the record.
Scarlet Fever, as it is still called, and as it is now met, stands in the list of those acute diseases most to be dreaded in practice, as well for the fatality which follows it, as for the power it possesses of bringing into activity whatever of latent miasms may exist in the patient attacked, the workings of which when so aroused we are called to meet under the garb and name of ”Sequelae of Scarlet Fever“ a proper treatise on which is still a desideratum in our literature. At present, however, we have to do with the fatality wrought more directly by the action of the scarlet fever poison itself. If observed with only a little care, it will be seen to be destructive of life, so far as its effects are localized, chiefly through the brain and throat. It may be doubted, indeed, whether those cases which fall so suddenly before the attack, that dissection reveals no changes in the appearance of these or other organs from the state regarded as healthy, are exceptions to this rule. In our attempt at a further consideration of the subject we propose to treat it with this view, and to consider those cases which prove fatal through assaults on the brain as presenting two classes: First, those which are characterized by symptoms of toxication of the brain; and, second, those which present more distinctly signs of inflammation of the brain or its membranes; third, those which are marked by the localization of the disease more especially upon the throat and parts adjacent.
This division is made solely with reference to convenience in treating of the disease in its relation to remedies. For though the problem before the prescriber is always one and the same thing — to find the curative for the given case — and though this problem is, on the one side, primarily composed of two elements only — the patient and the action of the morbid poison — the first of these elements is so subject to change from hereditary miasms or accidental causes, that the results of the action of the second, though it may or may not be an identity, are ever varying. Though in this, as in every other case of disease, we have to do with the sick man in our endeavors to cure, and not with a thing, the result of the action of this morbid poison on him, which we call Scarlet Fever, still the sick man, by his hereditary or accidental constitution, is liable to show almost an infinitude of variety of results from the action of this poison upon him. And hence, in this, as in all other diseases, the necessity still exists for that strict individualization which we ever insist on in the discharge of the duty of prescribing for the sick. It is in the peculiarity of these results, in an individual case, that we are to look for the phenomena, the counterpart of which is to be found in the pathogenesis of some drug, before the practical problem of a curative cap be solved. So that when, for convenience, we divide the consideration of our subject into classes according to the characters or the seat of the localization of the more important phenomena of the case, we are not to be understood as regarding these local phenomena as the disease, or in any way giving countenance to the silly idea that ”the disease has gone to the brain,“ as is often said, or ”to the throat;“ but, as cases modified by these changing elements, demand different remedies, it facilitates the finding of the true one in a given case, if we can properly narrow down the limits of the inquiry among drugs, by such a classification as is founded on the more important phenomena of cases to be prescribed for.
To this extent generalization is legitimate. But if the process of examination stops here, if it do not pass to the individualization of each member of the class to be prescribed for, then, for all the purposes of finding the true curative, the classification is not only useless but mischievous.
It must then be apparent we believe, if these views of the disease and its relations to remedies are correct, that the whole idea of finding a specific for the whole family of Scarlet Fever is a sheer absurdity, and the practice, so general, of treating almost all cases, at least in the outset, regardless of their individualities, with one drug, is wholly unworthy of a school of medicine, which claims to be a school of individualization, and that its practice is one of specifics based on this in each individual case. And more than this must be clear, that this practice, if persisted in by the members of our school, must be a fraud on the public and a crime of no less gravity than the persistence of practising on false pretences — a crime, in comparison with which, false pretences in trade are less reprehensible, in the ratio that property is less valuable than life.
In the first class, in the division we have made of our subject, we include those cases which suddenly sicken, and, generally, suddenly die, with marked symptoms of suspending, and at last, suspended, cerebral functions, early in the history of the case. We allude to these cases as a class, partly to bespeak for them a careful study by the members of our school, that if possible, a method of treatment, may be found which may diminish its present almost certain fatality. We have already shown the worthlessness of the current routine method. What we have said of this, if it has any truth, applies with especial force to the treatment of this class of cases. In making these remarks we have had this class especially in our mind. The following case is no fancy sketch, but a sad fact:
A child of seven years in school, in perfect health, was seized with a pain in the head so sudden and so violent that she gave a sharp outcry, soon vomited violently, which only increased the intenseness of the pain in the head; she was immediately removed to her home, in a few moments became drowsy, this soon passed into a deep sleep, and this deepened into a coma from which there was no rousing, and then came convulsions, paralysis, loud, difficult respiration with hissing-blowing. The skin suddenly became hot, with red patches here and there, and in these were slightly raised red points, so that these patches had a marked roughness to the feel; the intermediate spaces had an opaque, dull aspect, giving to the whole a mottled or marbled appearance. As the case progressed the red spots became dark, approaching to purple, and then livid; the extremities became cold; and the restlessness which had been extreme was only quieted by the profound coma and death, which followed in sixteen hours after the first attack.
This case is a tolerably fair picture of its class. It was treated allopathically. Similar cases treated according to routine Homoeopathy scarcely succeed better. Cases like this, subject to modifications of some of their symptoms, are met in all epidemics. One of these, not infrequent, is: the eruption in its early appearance is dark colored, and soon becomes livid, slowly regaining its color when this is expelled by the pressure of the end of the finger. This is quite significant, in any stage of the disease, and, if occurring early, with rapid and feeble pulse, threatens the worst results. Now what similarity have the recorded symptoms of Belladonna to this whole picture. None. Or if in some of the symptoms there be an apparent resemblance, this is certainly only apparent, and not in the least real. For example the pain in the head. This, with Belladonna, if it be violent, to the degree witnessed in this little patient, is accompanied by excess of activity in the arterial circulation, especially in that of the head; the pulse is not only quick and sharp in its beat, but is hard under the finger; the accompanying nervous phenomena are those significant of activity — the exact opposite of those in this case, where all were indicative of torpor. The drowsiness and coma of Bellad. are accompanied by, if not the result of, active cerebral congestion, and the same is true of the convulsions it produces. The opposite is true of such cases as this which we have given above — the congestions of such cases are passive — the result of a sluggish and not of an active circulation. Paralysis from the action of Belladonna is the result of pressure on the brain, either from the accumulation of a continuously increasing congestion of this organ or of its membranes, or of accumulated serum in its ventricles and between its membranes, in the effusion of which a previous congestion has terminated. Paralysis, in this class of cases of Scarlet Fever, is only one of the manifestations of that loss of brain power in general, the sum of which are at once expressed by the term “Paralysis of the Brain.” The loss of power in distant parts is the result of loss of power in the brain itself. Its functions are paralyzed, each perhaps in a different degree, and the loss in different functions appearing successively, partially, and progressively, till in the final sum are swallowed up the whole of the forces of life.
Now when called to treat a case like this of which we have presented the outlines from life, the first enquiry to be answered is, what remedy, now known, in the Materia Medica presents, in its recorded pathogenesis, symptoms most like to the group before the prescriber? What one of them all strikes at the central forces of life, paralyzing them, and extinguishing their functions progressively one after another, till all are lost, not by that great terror of the old school, inflammation, but by a palsy which knows no relenting, and yields to no check, till all living functions have ceased, as they do in the all but uniform history of these cases? If there be one remedy which has been found to act in this manner more than another, this is the one most likely to prove a curative in these cases. If there be a class, then from its members is the curative to be selected. With this view of the case it is quite natural the attention should be first directed to Hydrocyanic acid. This remedy attacks the living forces at their centre, and suddenly extinguishes their sum. In this respect there is a marked similarity between the action of the two poisons. There is a farther resemblance. The acid destroys life by paralyzing the nervous centres. It is true, so far as we know of the effects of the drug, that with this the process is sudden, and with the whole, simultaneous, while with the morbid poison the process is more gradual, and is accomplished by successive steps. In this the two poisons are dissimilar in their action. But it is to be remembered the sudden fatal effects of the drug, now known, are from massive doses. That it is but partially proved. That when this process has been carried farther, with potentized doses, there may be such results developed as will establish new curative relations. And where the general resemblance of the mode of attack of the two poisons is so striking, it may not be unreasonable to suppose that there may be in the undiscovered symptoms of this partially proved remedy, resemblances to the special symptoms of the disease which will bring it into a proved curative relationship to this most formidable malady. If it be objected that this is altogether hypothetical, and therefore unsafe as a practiced suggestion, the objection will be at once admitted as valid. The basis of our practice is to be law, at all times, and never hypothesis, however plausible. The suggestion of the drug, in relation to this variety of Scarlet Fever, and of the similarity of the general modes of attack and action of the two poisons is made rather to call attention to the drug, and to bespeak for it a farther proving, in the hope that that which can only be named now as hypothesis, may be proved to be fact. The apology for this reference to what is now only hypothetical, in this connection, if further apology be necessary, is in the fact that, in the class of cases under consideration the remedies hereto fore employed have been little better than useless. If we are to have any success in combating this constant companion of death, we have certainly to meet it with other remedies than those used in our past practice. This being so, let Hydrocyanic acid be studied, by all means. There seems to be a promise of good in it.
Tobacco, also, in massive doses, attacks and destroys life in a manner very similar to that of Hydrocyanic acid. The remarks as to its partial proving, and the possible development of farther, and at present unknown curative relationships when further investigations, which have been made of the acid are equally applicable to Tobacco. It is here named for the same reasons which have been given for the suggestion of the acid. Where we have almost no remedies on which we can rely, in dealing with a malady so formidable, even a suggestion of a possibility may perhaps be excused, if not received with respect.
There is another class of remedies which merit far more attention in the treatment of this variety of cases than they have hitherto received. The allusion is to the serpent poisons. Of these that of the Crotalus horridus is deserving of especial attention. Those who have read descriptions of the progress of cases to a fatal termination, after the bite of this serpent, will be struck with the similarity of the phenomena of those cases to those of the variety of the disease we are now considering. This poison, also, goes direct to the central forces of life, in its initial attack, and proceeds to gradually paralyze and extinguish the living functions, till all are lost, in a manner so like the action of the scarlet fever poison, that even the most unskilled observer cannot fail to perceive the resemblance. But unlike what is now known of the remedies already named, this shows a wonderful resemblance, in the details of its action, to the details of the symptoms of the disease. So great is this that there can hardly be a doubt of its value in such cases as are not struck so low, by the first impression of the morbid poison, as to preclude any vital response to curative impressions, from whatever agent, in accordance with the known law of cure.
A careful study of the symptomatology of this remedy is earnestly recommended, in reference to these resemblances and relationships, as a duty which can hardly fail to bring a reward for its proper discharge. In these cases remembrance should always be had of that most interesting and reliable cognate of the Crotalus — Lachesis. The whole picture of cases, in their progress to a fatal termination, after the bites of these serpents, is so strikingly like the fatal progress of this variety of Scarlet Fever, after the attack of the morbid cause, that the resemblance cannot but inspire, in those who have proved the verity that the law of cure is no other than the law of similars, a confident hope that in this class of poisons, and especially in the two members of the class above named, may be found the means of successfully overcoming these rapid cases of Scarlet Fever, heretofore so generally fatal. But if this, or any other class, of remedies are to be employed successfully, they must be given early and with no previous paltering with useless Aconite and Belladonna. This only wastes time and the vital forces where there are none of either to spare.
There is another agent which there is some reason for believing may be found valuable in the treatment of this variety of Scarlet Fever — the poison of the Ailanthus. The following case came under the observation of the writer:
A girl, fifteen years of age, rose in the morning, feeling slightly ill, dressed and went immediately to the breakfast table. She could take no food; the sight of it made her reel so much worse she immediately left the table, and went to her room. She was seized suddenly with violent vomiting; severe headache; intolerance of light; dizziness; hot, red face; inability to sit up; rapid small pulse; drowsy, at the same time very restless; great anxiety; two hours after. the first attack, the drowsiness had become insensibility, with. constant muttering delirium; did not recognize the members. of her family; she was now covered, in patches, with an eruption of miliary rash, with efflorescence between the points of the rash, all of a dark, almost a livid, color; the patches between the points of the eruption were of a dingy, dull opaque appearance; the eruption was more profuse on the fore-head and face than elsewhere, and especially on the fore-head The whole aspect of the eruption, and the whole condition of the patient, were so just like those so many times seen in cases of this variety of Scarlet Fever, that the case was unhesitatingly recognized as an example of it, and in its most violent and hopeless form. The pulse was now small, and so rapid as hardly to be counted; the surface had become cold and dry; the livid color of the skin, when pressed out by the finger, returned very slowly; the whole was a most complete picture of torpor, and seemingly a perfect instance of that manifestation of it which immediately precedes dissolution in these rapidly fatal cases of Scarlet Fever. There was apparently no prospect of the patient's living more than a few hours. Such cases in the practice of the writer had always gone to a fatal termination, and this had been more rapid in its progress than any he had seen. The patient being his own child, he had opportunity for most carefully watching the case. In about three hours from the first appearance of the eruption the livid color began to lose something of its dark hue; the restlessness and anxiety diminished; the pulse became more distinct and less frequent; consciousness partially returned; the eruption became a brighter red; and the whole train of symptoms so similar to this pernicious form of the fever gradually gave place to a train of phenomena scarcely less remarkable, but not at all like those of any variety of Scarlet Fever.
Of course this was not a case of Scarlet Fever at all; but for a short time it was a very great puzzle. What could it be? what could have produced it? were questions not to be put aside, and when consciousness had so far returned that questions could be intelligently answered, the nature and cause of the case were no longer a matter of doubt. As the eruption began to lose its dark hue and take on a brighter red, there was a repetition of a series of symptoms, then recently treated, in the case of a small lad who had been poisoned by eating the seeds of the Ailanthus. This resemblance was a surprise, and at once excited suspicion that this was also a case of similar poisoning. And so it proved to be. It was produced in this manner. This patient and one of her young associates had been amusing themselves, the evening before the attack, by stripping the outside bark from the young and tender shoots of the Ailanthus, and then, after writing letters on the stalks with the point of a pin, these were moistened with saliva which was rubbed on them by the end of the finger. This was many times repeated, and in this process the juice of the stalk was conveyed to the mouth in considerable quantities. Its taste was an intense bitter. Both the experimenters were made ill, with similar symptoms, but the symptoms were much less violent in the patient's friend. It is a singular fact that this patient has been attacked by a similar miliary rash each year since this poisoning, at the season of the blossoming of the Ailanthus, and is always now more or less ill each year from this cause. This case is here in part presented to the reader for what it is worth. That it was the result of the Ailanthus poison is sustained by the fact that the juice of the green stalks was introduced into the mouths of the two girls, that they both, soon after, sickened, suffering from similar symptoms, differing chiefly in degree of severity rather than in kind; and in the case of my patient showing subsequently a train of symptoms precisely like those witnessed in the case of a lad who was poisoned by eating the seeds of this tree. The case is also given here with the object of urging on the profession the importance of a thorough proving of this powerful poison. If the subsequent history of my patient can be received, as showing in her sufferings the continued workings of this poison, and if drug agents are indeed related to diseases as curatives by the law which we receive as the universal law of cure, then the relation of the Ailanthus to many important diseased conditions is clearly established, and the importance of a knowledge of this relationship, in its details, to both practitioner and patient, needs no argument to show. Let the Ailanthus be proved.
The second class of cases which we propose to treat of, that in which the attack of the poison is followed by symptoms resembling those of acute cerebral inflammation, is more commonly met in practice than that which has just been considered. It is less rapid in its progress and not so uniformly fatal in its results. The initiation is less sudden and violent. The patient, very likely, has slight chills (rarely severe), followed by a disproportionate severity of heat of the skin and frequency of the pulse; the pain in the head is violent, often accompanied by vomiting; intolerance of light and sounds; great redness, heat, and turgid appearance of the face; the eyes are injected, and perhaps suffused; the patient soon becomes drowsy; is very restless; intolerant of all disturbances; the skin is generally covered with the characteristic eruption, or this is in patches, as has been already described; the color is of a brighter red than is found in the torpid variety, and the eruption is less evanescent; if the eruption be in patches, the interspaces arc less of the opaque and dull, pearly aspect than in the torpid variety; delirium is early developed and becomes increasingly violent; or, if at the outset, only occasional, in the progress of the case it becomes more constant; it is. oftener demonstrative in its character than mild and muttering; amounting, in its later stage, to terrors and screamings; and these may be finally followed by coma, convulsions and death.
It requires no extraordinary powers or knowledge on the part of the practitioner to perceive at once, that a case showing symptoms like the group here presented is in a very different pathological condition from that of the class already considered. We may continue to call both by the same name, as long as it may please an ignorant clientage to demand names for their ailments, or as long as a profession affecting a knowledge which it does not possess may be disposed to gather under one denomination diseased states dissimilar or even antagonistic, as in the case before us; still they can never be the same thing, and can never stand in the same curative relationships to remedies, except in the case of those drugs of great value, which, in their provings, have been found capable of producing opposite morbid conditions on the healthy prover.
This class of cases is, in the general, characterized by excess of action, the other by torpor, deficient, or lost action. Hence it is most obvious that remedies which may be equal to the prompt and certain cure of the one class may have no relation whatever to the other, and it employed in the treatment of it, can give to either patient or physician no better result than disappointment, with increase of suffering and danger. As in the first class the curative was to be sought in that class of drugs-which produce torpor and paralysis, in the second it is to be found among those which exalt the action of the vital forces, and by increased violence exhaust the more rapidly their power to execute the functions on which life depends. Among this class of drugs we are now to look for individual members which, while they have the generic quality of the class, have also the specific characteristics of the disease before us. And in the outset we are met by the difficulty that diseases are not gotten up, as they occur in practice, in exact patterns to suit the pathogenesis of individual drugs or classes of drugs. This is true of all diseases in relation to drug symptoms. And hence, of necessity, what may be written as hints for their treatment can only be of the most general character. There can be no such thing as laying down an arbitrary treatment, for all cases, which could possess the least value. General principles which may stand as hints or guides are the most that can be given with any profit.
The first remedy of this class to be considered is Aconite. Its relation to the disease, judging from its recorded pathogenesis, and we can properly judge from nothing else, must be restricted to narrow limits. It has but few symptoms which resemble those of the disease, in any of its stages or phases, and of these the greater part are such as are found almost solely in the early, or earliest, stage of the strictly inflammatory varieties; and of these, it may find an important place in the treatment of such as chiefly localize these attacks on the brain. And it would seem, from the pathogenesis, that its usefulness must be realized almost entirely in the very beginning: of the attack. Of special symptoms resembling the generics of Scarlet Fever there are almost none. Of general symptoms, analogues of those which characterize the fevers accompanying acute inflammation, there is no lack. There are heat and sanguinary congestion of the surface of the body; thirst; rapid and hard pulse; general restlessness; pains in the head; peevish disposition, which revolts against all interference; perspiration, if present, is hot; heat and shootings in the throat, etc. But there is not in the pathogenesis of Aconite, in any of the provings at hand, the record of any eruption in the least resembling that of either the true scarlet rash, or of the miliary variety like that with which we have oftenest to deal at the present day. Aconite does not attack the living organism in the modes so characteristic of the scarlet fever poison. The effects of the two poisons on the brain are only similar in the beginning of some of the cases of our inflammatory type of the fever. Their effects, as developed in the throat symptoms, show little similarity, those of Aconite being but little like those of the cases of the fever which prove fatal through local destructions in the throat. If these views, then, are correct, Aconite can only be of use, in the treatment of this fever, as a general palliative of the violence of the inflammatory febrile action, and never as a curative of the local affections through which the disease is chiefly fatal. And for its right use we must depend on general principles and on the similarity of general symptoms of the drug and the disease.
Bryonia may have an important place in the treatment of this variety of fever. It will be well in deciding the selection of this remedy to bear in mind the analysis given in this REVIEW, Vol. IV, No. 2, p. 52, et seq., of its characteristics and the comparison of them with the effects of some other drugs, especially of Aconite. One fact, at least, should not be forgotten, viz.: that cases calling for Bryonia are likely to present nervous symptoms dominating the vascular, while with Aconite the reverse is the case. Bryonia has also in its pathogenesis repeated records of miliary rash. It shows itself especially on the arms, the front of the chest and knees; it becomes red and itches in the evening. This, to be sure, is only a repetition of one of the generic elements of the fever and its occurrence in the pathogenesis of the drug may give more importance to the remedy in the treatment of the fever than is warranted by the law of cure, properly understood. Still in the present state of our knowledge of the value of this class of phenomena to the prescriber it cannot well be overlooked.
Bryonia is often of great value in cases where the eruption has suddenly disappeared, and this disappearance has been followed by symptoms threatening great danger to the patient. The power of the drug to reproduce the eruption, in these circumstances, has been long recognized, but whether in a given case it is to be preferred to Ars., Bell., Caust, Hepar, Ipecac., Lyc., Rhus, Sepia, Stram. or Sulph., is to be decided by the greater resemblance of the general and characteristic symptoms of the given case to the similar symptoms of this or either of these drugs. The decision always depends on this resemblance and never on the fact that the eruption has disappeared, and hence the necessity of the most careful study of these symptoms before selecting the remedy on which we shall depend. Care here — before the first prescription — is in the highest degree important, for the case is likely to be rapidly fatal if not speedily relieved. There will probably be small opportunity for giving these drugs in succession if the selection of either has been hasty and wrong.
[With very sincere sorrow we are compelled to announce the suspension of this series of practical papers from the pen of our dear colleague Dr. Wells, which have given so great value to the pages of the REVIEW.
Being suddenly called away to a distant part of the country, he retires for a period of time, which we trust may be brief, from participation in the active management of the REVIEW, and leaves us to express to our readers his regrets at the temporary severance of a connection which, he assures us, has been to him a source of pleasurable toil, and to feel very keenly the loss we suffer by his absence.
We entertain the hope that before many months shall have elapsed, Dr. Wells will have resumed his active editorial labors, and will have given us the conclusion of his paper on “Scarlatina” Meanwhile, he requests us to sketch, in a few words, the plan on which the continuation and conclusion were to have been written.
Following Bryonia as discussed in the preceding pages, he proposed to treat of Belladonna much in the way in which that remedy was studied by him under the head of “Typhoid Fever,” in earlier numbers of the REVIEW; then, in the same way, of Lachesis, Rhus, Stramonium, Hyoscyamus, Ammonium carb. and Sulphur.
In connection with Sulphur, he proposed to call especial attention to the applicability of this remedy in cases of Scarlet Fever, of the variety treated in the present number of the REVIEW, when the delirium takes the form of screaming wildness, in which the child knows not where he is, and seeks to flee he knows not whither.
Passing from this form of Scarlet Fever to the other grand division, that in which a fatal issue is threatened or is brought about by destruction of tissues in the throat Dr. Wells proposed to show that, in these cases, Aconite, Belladonna and Mercurius have no application whatever, but produce only mischief. The remedies for this form of the disease are chiefly Rhus and Lachesis; Rhus for those milder cases in which the mucous membranes and the submucous cellular tissues are involved, and Lach. for those very serious cases in which the whole areolar tissue of the throat and neck seems to be infiltrated and hardened, and in which unless, by this remedy, the morbid process is arrested, suppuration and sloughing surely ensue and carry off the patient. In this connection the history of a case recorded in the February number of the REVIEW, by Dr. Wells, is pertinent.
This imperfect outline of the scope of the proposed papers will only quicken the regrets of our readers at Dr. Wells' absence, and will enlist their good wishes along with our own earnest longings for his health and prosperity, and for his speedy return to us. — Eds.]
|Source:||The American Homoeopathic Review Vol. 04 No. 07-09, 1863, pages 289-296, pages 346-356, pages 385-393|
|Editing:||errors only; interlinks; formatting|