— We republish with great pleasure the following detailed and lucid narrative of a very successful prescription, by Mr. D. Wilson, of London. It was based, as will be seen, on a single characteristic symptom of the remedy which was strongly marked in the patient. D.

CASE OF SEVERE AND COMPLICATED PNEUMONIA.
By Dr. CAPPER, Ipswich.

Concluded with Remarks on a Characteristic Indication for the Selection of Lycopodium. By Mr. D. WILSON.

“On the 13th April, 1863, I was sent for, fourteen miles, from home, to see a young lady, a patient of Mr. Wilson's, of London. She was spending the Easter holidays at the sea-side, when she became very unwell, and as Mr. Wilson was so far off, I was sent for to see her.

“She was 11 years of age, of Indian birth, very thin, pale complexion, strumous diathesis, and of a highly nervous temperant.

“On the evening of the 10th, up to which time she had appeared in her usual health, she was sick two or three times, and brought up some rice she had token for dinner. The following day she seemed out of sorts, and on the 12th complained of uneasiness down the right side of the chest and abdomen, and she had a slight hacking cough.

“When I saw her on the 13th, at three, p.m., I found her in bed, very hot, and feverish; pulse 120; tongue dry and coated white; dyspnea; extreme tenderness over the right side, from the clavicle to the crest of the ileum. — There was no dullness on percussion over the chest. The respiratory murmur was feeble on the right side posteriorly, but there was no crepitation.

“The cough was short and hacking, increased on the least movement, and she expectorated without difficulty a small quantity of clear frothy mucus tinged with bright arterial blood.

“Acon. 3, three ter. horis, for three doses, then Bryonia 3 in the same way.

“14th, 4: 30, p.m. She had a restless night. After taking each dose of Bryonia she appeared relieved, and perspired slightly. Cough and expectoration the same, but there is some dullness over the lower part of the right lung posteriorly, but no crepitation. She has taken a little arrow-root. The bowels have not been relieved for two or three days. Rep. Bryonia.

“15th, 4, a.m. Has been very restless; skin dry and hot; pulse 120; respiration 52; alae nasi in rapid motion; posteriorly, dullness over the whole of the right lung, with crepitation; crepitation also over the lower third of left lung; anteriorly, dullness and crepitation over the lower third of the right lung, the liver, and the abdominal cavity on that side; expectoration very tenacious, frothy, and rust-colored. The bowels were relieved this morning' Phosphorus 12, three horis.

“As I considered her now in great danger, Mr. Wilson was telegraphed for, and on his arrival at two, p.m., undertook the further treatment of the case, I continuing my attendance, in order to report to him of its progress.

“When we saw her together this afternoon, there had been but little change since the last report. The dullness on percussion, and the crepitation, had not extended. It gave her pain to lie on the right side. Mr. Wilson gave her Lycopod. 200, in solution, every two hours, and in the way of diet ordered her to have nothing but barley-water.”

“ADDITIONAL PARTICULARS BY MR. D. WILSON. — The foregoing case, succintly reported by Dr. Capper, forms one of many similar cases, some of great severity and danger, that I have treated by Lycopodium alone. I shall in the present case give the details just as they occurred, and point out what I believe to be a genuine characteristic of Lycopodium, hitherto overlooked, and by which I have been led to prescribe that remedy during the last twelve years, with great success. in the treatment of several affections occurring chiefly amongst children and young people.

“The patient of whom we write came on a visit to London from school at the Christmas holidays, in very indifferent health, the symptoms of which I was informed had been manifesting themselves before vacation, through the mucous membranes of the stomach and bowels. She had, I believe, taken recently under advice several doses of Calc. carb. When I saw her in town the symptoms then certainly corresponded with those of that remedy. Her condition passed on very speedily to an acute attack of dysentery, which yielded to one dose of Mercur. corros. 200 (Lehrmann's), which was allowed to act without interference, as Hahnemann recommends. Subsequent to this, her symptoms indicated Graphites, which she took, and finally returned to school quite convalescent. An occasional report informed me of her well doing until the present occasion.

“On the 13th of April, I was informed by letter in the morning that my patient, while spending her Easter holidays at a sea-coast rather exposed to the keen east wind, had been seized with an illness requiring the attendance of Dr. Capper. Before he had time to reach her, however, I received the following telegram: 'Fever came on in the night; cannot move in bed, or breathe deep without pain in the right breast, going down and round about the liver; loose cough and slightly streaked expectoration.'

“I prescribed Lycopod. by return of telegram, which reached just as Dr. Capper arrived. He wrote to inform me that he found the patient suffering from a pulmonary attack and congestion of the liver, and that he had not administered the Lycopod. His next letter gave me the details which he has already recorded. On the evening of the 14th I received, too late to catch the lost train, the following telegram: “Disease advancing; danger increasing; let nothing prevent your coming by mail train.” Dr. Capper remained all night with the patient.

“I saw her on the 15th, and noted the following condition: She was lying on the curve of her left ribs, midway between her spine and side, the legs drawn up and abdominal muscles relaxed. Her countenance was anxious, as also the breathing, which was very quick — 50 to 60 per minute; the skin burning hot; tongue coated brown, red at tip and margins; her nostrils were in rapid fan-like motion; her answers were quick, anxious and tremulous; there had been some wandering.

“There was great sensitiveness to the pressure over the right side of the chest, but most over the liver in particular, extending also over the abdomen. In the latter locality the sensitiveness manifested that acute kind which we have in peritonitis. The pulse was quick, and not very steady, ranging from 120 to 130 and more while I remained (about two hours). There was great thirst.

Auscultation revealed extensive bronchophony extending to under the right shoulder-blade. The crepitus was as yet but moderate, but the absence of vesicular breathing and the general heaving of the contained lung too clearly, independent of percussion, confirmed Dr. Capper's diagnosis and revealed the extent and serious nature of the active pulmonary congestion, complicated with an inflammatory condition of the liver and peritoneum. The cough was frequent and hacking in character, provoked by putting the tongue far out. — The expectoration was streaked with red blood and rusty to some extent, also very tenacious.

Upon this record I noted the following remedies for study: Acon., Arn., Bry., Con., Cup., Dulc., Euphras., Lyc., Mag. m., Nat. mur., Scill. It would be too tedious, and without any advantage, were I to detail the reasons that led me to single out these remedies for study. There is very little difficulty, however, in selecting from amongst them Lycop. as the only appropriate remedy, if that which I regarded as an unerring characteristic of it should be confirmed by future well-observed clinical experience.

“The symptom to which I allude, and which has never deceived me, is the fan-like motion of the alae nasi. When this is very marked, the expression of the patient is often much pinched, and the entire expression of the eyes and general features is most characteristic, and once clearly recognized is never to be overlooked. Hahnemann in his introductory remarks on Lycopodium has called our attention to this remedy in shortness of breathing in children (Kurzathmigkeit bei Kindern). The symptom, however, which has guided me to its selection in the diseases of children has been that of

“311. Nasen-Muskeln erst wie ausgedehnt, dann wieder zusammengezogen und verkurzt, wie aufgestulpt, i.e., the nasal muscles are first expanded then again contracted and shortened, as if turned up [but not turned over like the brim of a hat! as Hempel translates it in the Chronic Diseases].

This is the symptom, I presume, which has been translated in the British Repertory, at page 85, under 'movements,' as belonging to Ledum; but that drug, as far as I am aware, has no such symptom. The liberties that have been taken with this symptom by compilers and translators are a very fair specimen of what we frequently meet with, and bear us out in our structures as to the manner 'in which the magnificent works of Hahnemann and others have been so hacked and hewed and cobbled up again.'

“Jahr, for example, in his Symptomen-Kodex der Homoeopathischen Arzneimittellehre, changes Hahnemann's text (Symptom 311), which I have already quoted, into the following: 'Nasenkrampf, muskel erst wie ausgedehnt, dann Wieder zusammengezogen and Verkurzt wie ausgestulpt.' Here we have 'Krampf' manufactured, and interposed between Nasen and muskel, with an altered punctuation to which we might fairly take exception — and what is the result? The result is we find Hempel in his supposed translation of Jahr's aforesaid Symptomen-Kodex giving the English student of the Homoeopathic Materia Medica the following incorrect version of the symptom: 'Spasm of the muscles of the nose, which feels distended, then again contracted and shortened, forming a thick bundle.' By the unwarrantable use of the word 'feels,' the symptom, which is purely objective — symptoms for which there has been so much clamor — is converted into one that is subjective. Dr. Hempel probably considers his last translation in the American Jahr an improvement since he translated the same words in the Chronic Diseases accurately enough, with exception of the rather too impressive expression ”like the brim of a hat turned over”

“It has been well remarked in a translated article in the British Journal of Homoeopathy: 'Truly we ought to be ashamed to endure any longer such shameful specimens of book instruction And it is by means of such asses bridges that the Homoeopathic Materia Medica is to be studied and is actually practised by very many medical men! Shall this scandal last longer?' In the year 1848 a' Homoeopathic Publishing Society' was instituted by a few English Homoeopathists, but their promises have not yet been realized. Their undertakings have indeed been of a very desultory character. We should like to have some information in regard to the future intentions of this society, now called we believe 'THE HAHNEMANN SOCIETY.' Two of the most active members of that society are the journalists who, through the article to which I have referred, hare given their readers some insight as to what is thought of the existing state of our educational literature. Yet some foremost men have been so wanting in circumspection as to solicit help in the construction of a 'New Repertory,' compiled as it must necessarily be, when existing translations are used, from such 'hacked and hewed and cobbled up' rubbish! It would seem as if compilers and translators, whether they be English or Foreign, with a very few honorable exceptions, are nearly on a par when fairly tested by the rules of just and rigid criticism. Book-making and trade seem in most cases to have been hitherto the one grand object in view.

“To proceed with our case.

“This alternate contraction and dilatation of the nostrils, when it accompanies hurried and anxious respiration in cerebral and thoracic affections, constitutes a perfectly quick and fan-like motion.*[This symptom is one of no mean importance when we examine its anatomical and physiological relationships. It is not surprising that the nasal wings should be in a state of increased and peculiar action during difficult inspiration when the nervous centres belonging thereto are deeply involved.' We will do well to remember that the compressor muscles of the nose are supplied with nerves from the fifth pair, which arises from the crus cerebelli, by two roots (motor and sensitive), thus resembling the spinal system of nerves.] When clearly marked, no matter through what organ or tissue the symptoms of any attack of illness may manifest themselves, in children and young people, I venture to submit that the whole group of phenomena in such attacks will be found under Lycopodium. This has at least been my experience, which has been abundantly confirmed in my private practice as well as by my dispensary records. In hooping-cough I have also found it a valuable indication for the selection of Lycopodium. My experience of the value of the symptom as regards adults is as yet incomplete.

“I will not longer trespass on the patience of the reader, but proceed with details.

“For the treatment of the case in hand I selected, as Dr. Capper states, Lycopodium 200 (Lehrmann's), prepared by contact instead of saturation;†[On this question and dilutions generally, I shall offer some observations at a future time. My plan however merely carries into practice Hahnemann's statement of I drop being adequate to medicate 300 globules.] five globules were dissolved in an ordinary tumbler of water, and one tea-spoonful ordered to be repeated every two hours until the fan-like motion of the nostrils ceased, then to be repeated at longer intervals, until Dr. Capper pronounced the patient convalescent. Barley-water and milk and water were ordered for diet, but subject to his discretion. I need not say that we were aided in our attendance upon this most anxious case by the unfailing vigilance of a lady superintendent of acute perception and judgment, as the report will I think testify.

“Her first report to me was as follows: 'April 15th. First dose of Lyc caused a little more cough and sputa — decreasing in the second hour. Second dose of Lyc., followed by great quietness, very little cough, but the sputa purer blood, redder and clearer; breathing in the chest 46, as near as my unpractised fingers and watch can count; pulse 100; breathing in the chest, not from stomach; no change in the nostrils; wandering after dosing. Third dose — still greater quietness, until an attempt to lie on the left side, and to extend the limbs across the bed caused cough, producing a voluntary return to lying on the back. Then cough became quiet; deep sleep under this third dose, with quick loud breathing, and finally a turning on the right side, with a little cough, which passed off without change of posture.

”'The sleep continuing with knees drawn up, and the figure curled up thus across the bed; breathing very quick but not so loud; this at eleven o'clock at night. In about ten minutes the cough began again — she turned, threw off the bed clothes, and said she must get up. On being soothed, she settled down again on the back in the old attitude. Fourth dose at 11: 30, whilst making another effort to lie on the right side. This was accomplished without coughing, but she soon resumed her old posture again from evident discomfort.

”'Thursday morning, nine o'clock, April 16th. During this interregnum I have been dozing by her side, the coachman's wife watching. She has had a night of quiet alternating rest, coughing occasionally and raising the same sort of sputa, but so different from any previous night; proved by my venturing to lie down. I have again been watching her for some time; the nostrils are more quiet; but the same fan-like action is undoubted; the respiration seems to be 36 and the pulse 90 in the minute. The whole face looks relieved, and the darling says, 'So much better, I can lie on my side — could I not have some pictures to look at Half-past eleven, a.m., last report before noon-post. No action of the bowels since yesterday afternoon; tongue unchanged; coughs when putting it far out; lies on the back chiefly, but turns a little on either side occasionally; sputa whiter, more frothy, not so stringy and tenacious; breathing from 30 to 35; pulse 85: no breathing from the stomach, but the right lung heaves more than the left, the breathing varies.

”'Two o'clock, p.m. Steady improvement; now lying calmly asleep on the left side, knees drawn up, arm thrown naturally over the stomach; breathing quiet and easy, though far too quick; the cough slightly increasing, more power. and effort, and the sputa less and less tinged, whiter, freer and more frothy Has borne the changing of linen of the bed nicely. The day is balmy, warm summer and sunshine — a great help to us.'

”'At 4:30, p.m., Dr. Capper reports:

”'Our little patient is certainly better; pulse 92, respiration 42. The inflammation of lungs certainly not extending. Moist crepitation all over the right side posteriorly, also the lower part of the left. Ditto over the lower half of the right anteriorly. The sputa is less tenacious and much less bloody. There is less twitching of the alae nasi, and if anything less tenderness over the liver. She has much less pain all down the right side. I believe all the other symptoms have been already mentioned to you.'

“Dr. Capper was aware I believe of the copious notes of events made by our lady superintendent, just as they occurred; and which form a very interesting study, as it is seldom that practitioners have such a favorable opportunity of seeing the minute and elaborate workings of a remedy as we have in the present instance.

“Our lady assistant observer continues after Dr. Capper's visit: '7: 30, p.m., last time for post. Pulse and respiration still 92 and 42; both more than in the earlier morning, as has always been the case. A good deal of heat this afternoon, but the day has been oppressive.

“Surely such details of marked improvement, confirmed too by Dr. Capper, in a case of extreme gravity within the short space of twenty-four hours, ought to make men cautious before they venture lo express rash opinions ridiculing the healing influences of attenuated doses of appropriate selections. Those who differ from us will see the folly of their idle assertions when they write that the men who cure their patients with the 30th and 200th dilutions are myths nowhere to be found. Such sneering detractors must surely never have read their Master's Organon, when they say that practitioners who administer dilutions above the 30th have abandoned the Hahnemannian creed.

“In the Organon there is to be found upon the most undoubted testimony evidence that 'Hahnemann appeared in the latter years of his practice to employ his whole dexterity in diminishing the dose more and more.' Then again in answer to those who sneer at inhalation, Dr. Croserio writes: 'My own wife was cured by him in this manner of a violent pleurisy in the course of five hours.' And again with regard to the assertions implying that Hahnemann did not prescribe dilutions higher than the 30th, I beg to quote from Dr. Dudgeon's translation of the Organon, page 331: 'The higher we carry the attenuations…. with so much the more rapid and penetrating action does the preparation seem to effect the vital force and to alter the health, with but slight diminution of strength, even when this operation is carried very far, — in place, as is usual (and generally sufficient) to X, when it is carried up to XX, L, C, and higher; only that then the action always appears to last a shorter time.'

“Does this not give a satisfactory answer to all such foolish assertions with regard to Hahnemann never employing dilutions above the 30th? The statement made by Hahnemann, that the higher the attenuation the shorter its action is, in my opinion, perfectly correct as regards its action in acute disease, and herein lies one of the great advantages of attenuated doses, as I shall hereafter explain, should a wrong selection have been made. same time the high dilutions enable us to repeat the remedy at short intervals of even a few minutes, with perfect safety in acute attacks, and with the most marvelous success if the remedy be correctly chosen.

“To conclude with our case: the report of April 17th, 11: 30, a.m., says, 'Progress seems steady; a little heated and restless last evening, ending in a little fretful crying and sobbing [action of Lyc] After this she was comforted and seemed like herself; at one o'clock she began to sleep quietly, scarcely waking or coughing till seven, a.m. Then much better, though a little more cough, as if to raise the accumulation of the long sleep. The sputa white and frothy, with a little coloring inside the piece thrown up by each cough. This has passed off, and she is now beautifully quiet, happy and amusing herself with pictures. Pulse feels to me weak and low — scarcely 70; respiration 88. She is losing flesh fearfully. The tongue is as you saw it — only the red tip and sides extending, and the coat thinner — breaking up — and the edges getting greyer. She lies on both sides easily; breathes softly; puts out the tongue without coughing, and the fan-like movements of the nostrils are much diminished. The action of each dose is wonderful. Friday evening, Dr. Capper is astonished at the rapid progress, be said: pulse 72; respiration 88;

^” Dr. Capper's own report to me dispatched April 17th, Friday evening, says:

”'I am glad to find our little patient decidedly better today. The pulse only 72; steady, and respiration 38. Very little tenderness over the liver; less dullness over the right lung; moist crepitation as before.

“Expectoration frothy, with hardly a tinge of blood. Bowels relieved slightly once. Her tongue looks much as when you saw it, but moister. The twitching of the ale nasi has ceased. She is tired of the barley-water, and I gave her leave to have some gruel, and we spoke of chicken broth to-morrow. I have now ordered the Lyc. to be repeated only every three or four hours;

“April 20th. Dr. Capper continues: 'Steady improvement; she has no pain; hardly any cough or expectoration, and what there is of the latter looks purulent. Crepitation has almost disappeared all over the affected part of the lungs. She can now lie in any position, and sit up without pain; pulse 60; respiration 28. Her tongue is still coated, but clearing nicely from the tip. — There is slight tenderness in the liver on deep pressure. She had some pain after taking some thickened barley, so that she has taken nothing since but barley-water. She is very hungry and craved for a biscuit, which I have allowed with boiled skimmed milk. We have not ventured on chicken broth yet. She is taking a dose of Lyc. every four hours.'

“23d April. Dr. Capper says: 'There is no crepitation, and no pain any where. There is more dullness than there ought to be at the lower part of both lungs posteriorly, and the respiratory murmur there is feeble. Pulse 56; respiration 20. She feels faint at times. I have ordered more food frequently. There is no cough nor expectoration. The Lyc. is taken every five hours.' On the 24th, Dr. Capper allowed her to be dressed. She was taking beef-tea and chicken. On the 28th of April, Dr. Capper informed me that he had seen our patient, and that the lyc. was only repeated night and morning. She complained of a slight sensation of stiffness through the right lung on taking a deep breath (Lyc.) The appetite is good, and she can read, write, work, etc., without any difficulty. On that day she was removed back to her school, a distance of seventeen miles. Dr. Capper adds, 'she has certainly made a most excellent recovery.⁹ I recommended all medicine to be suspended for a week, and the report was a perfect recovery.

“I have since been informed that the patient looks better than she has done of years. Such improvement is the general result I have usually observed after a severe attack of illness, that has focussed, as it were, the entire morbid taint of constitutional dyscrasia, known amongst the disciples of Hahnemann as the psoric element, which has been met and overcome by its true homoeopathic analogue during the treatment of the patient”

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