BY CARROLL DUNHAM, M. D., NEW YORK.

The very excellent and convincing article on Lachesis by Dr. Lippe in the last number of the Review, calls to mind the fact that this remedy, so highly prized by many practitioners — I might say by all who make any use of it whatever — is, by a large number of Homoeopathists, regarded as of no account at all.

Those who do not use Lachesis in their practice give various reasons for their course. Some express the views laid down by Dr. Hempel and satisfactorily controverted by Dr. Lippe. These are theoretical and a priori objections, and they cannot stand one moment against the testimony of experience and a posteriori demonstration.

Others hesitate to use Lachesis because they cannot procure it in the “mother tincture” or the “first decimal preparations,” or in any dilation below the sixth. Inasmuch as, by both faith and practice, they are committed against “infinitesimals,” they cannot employ Lachesis in any case, since they could not use it in any but an infinitesimal dose. No doubt many are sincere in this objection. A few, it must be feared, gladly avail themselves of so fair a pretext for avoiding the study of the long list of symptoms which Lach. presents. It is a pity that this whole class of objectors could. not bring themselves to the point of fairly testing, by clinical experiment, the virtues of Lach. The result would be happy in a double sense. It would enlighten them respecting a most valuable remedy, and at the same time it would be a satisfactory demonstration of the action of infinitesimal doses.

A third class of objectors throw discredit on the proving of Lachesis, and on very singular grounds. Because it is fragmentary? Scanty? Has but few symptoms? Is carelessly arranged? Criticisms like these have been made with more or less justice upon many provings in our Materia Medica. No! the objection made to the proving of Lachesis is that it is too rich; there are “too many symptoms;” it is too thoroughly elaborated! “What!” it is asked, “can one remedy produce so many symptoms?” The answer comes readily to hand — “No!” The inference is at its elbow — “Some symptoms, then, must be false.” Then come the conclusions — “Some are false — we cannot tell which they are — we will therefore reject all and the remedy-along with them!”

One of the oldest and most widely known homoeopathic practitioners in America said to the writer, “In the American Jahr's New Manual thirty pages are devoted to Lachesis. If all were reduced to a concise statement of verified, unquestionable Lachesis symptoms, even Dr. Hering would admit that there would not be matter for more than three such pages. I therefore reject the whole proving and I never give the remedy.”

To this objection I could not help replying, “In yonder wheat-field, I doubt not the proportion of chaff, straw and stubble to good wheat is as ten to one. And yet the farmer willingly submits to the labor of harvesting, threshing and winnowing for the sake of the ten percent. of wheat; he would not think of abandoning the grain in his field because of the tenfold preponderance of chaff.”

“And if there be as you admit in those thirty pages, the equivalent of three pages or even of one page of verified and trustworthy symptoms, how can you, as a conscientious prescriber, deliberately refuse to make yourself master of them, and to use in your practice the remedy which produced them?”

This question, which received at that time no conclusive answer, addresses itself to all who stand in the position of that practitioner.

If, of the three thousand and more symptoms ascribed to Lachesis there be thirty — if there be but three symptoms — that are trustworthy and that are peculiar to Lachesis — a case of disease may occur presenting those symptoms and no others and which therefore Lachesis, and no other remedy, will cure. How can those gentlemen, who determine Before-hand that they will have nothing to do with Lachesis because of the two thousand and seventy or the two thousand and ninety-seven symptoms which they discredit — how can these gentlemen with a clear conscience, ran the risk of meeting such a case and of losing it from the want of a knowledge of the characteristics of Lachesis?

The objection to the length and complexity of the treatise on Lachesis comes from those who have cursorily turned over the leaves of the Manual and not from those who have made an earnest study of the symptomatology. The latter class of students make no such complaints. They find, indeed, no great difficulty in getting a very clear idea of the relations of Lachesis to morbid conditions. And the facility with which they can do this, is due chiefly to the care with which Dr. Hering has elaborated the proving, to the immense labor he has devoted to the collation of the symptoms, to his caution in avoiding any sundering of pathogenetic groups and to his faithful repetition of each group under every rubric to which it has any pertinence. All these points of excellence, while they have made the original proving of Lachesis a model for fullness and clearness of arrangement, have made its length a bugbear to the timid reader.

But it is not to be supposed that either a priori doubts of the efficicacy of a remedy, or any practical difficulties in the mastery of its symptomatology, Would deter physicians from studying and using it, When the testimony of those who have employed it successfully shall have been placed before them.

With this conviction it has been proposed to collect in the Review the experience of the profession with Lachesis in the treatment of disease. The co-operation of all who have any definite experience on the subject is earnestly invited.

In 1850 while assisting in the autopsy of a woman who had died of puerperal peritonitis, the writer received a dissecting wound in the index finger of the left hand. Within a week, the finger had quadrupled in size, the hand and fore. arm were much swollen and edematous, a hard red line extended from the wrist to the axilla. The axillary glands were swollen. The arm and hand were intensely painful; the whole left side was partially paralysed. The constitutional symptoms were extreme prostration, causing the disease to be at first mistaken for a typhus, low muttering delirium at night, marked aggravation of Buffering and prostration on awaking from sleep. The general condition grew steadily worse — abscesses forming under the deep fibrous tissues of the finger and hand. No homoeopathic practitioner was in the neighborhood. The allopathic surgeons in attendance advised Calomel and Opium, but gave a very discouraging prognosis. The patient refused to take any drugs whatever determining to trust the issue of the case to Lachesis. The first dose (of the twelfth) was taken on the third day of the illness, and a dose was taken thrice daily for five days, at the end of which period the constitutional symptoms had substantially vanished. The recovery of the finger was slow bat complete. The effect of the Lachesis could not be mistaken by the patient.

FROM MY CLINICAL RECORD.

April 9th, 1860. Josephine Birmingham, aged nine years, well grown, had, last winter, scarlatina very severely. It left her delicate and deaf. Nine days ago she was exposed to measles. The rash appeared on the 6th inst., along with a copious discharge from the ears. Yesterday (8th) this discharge suddenly ceased and the rash disappeared. She immediately became very feeble and prostrate; was seized with wild, muttering delirium. She had great thirst, drinking however but little at a time. There was a singularly biting heat of the skin.

I saw her first at eleven, a.m., on the 9th inst. She had lain in alternate delirium and stupor for twenty-four hours; was irrational, had low muttering delirium; the pulse was soft, wavy, hardly to be counted; there was calor mordax; the respiration was attended by moaning; it was very rapid, whistling; there was an occasional single cough, with a moan following each cough, and a grasping at the throat, as if to tear away the clothing from it. The pupils were widely dilated; there had been no stool for two days; the urine was scanty and seldom passed — I could not secure any for analysis. The expression of countenance was cadaverous; the odor of the breath putrescent. I ordered Lachesis³⁰, six globules in water, a teaspoonful every two hours. Also strong beef tea every two hours.

At six, p.m., I found her sitting supported in an arm-chair, playing with some toys; rational; the skin of a pleasant temperature; the pulse eighty, regular and soft. The attendants reported that, after the second dose, she had slept quietly, had had no more delirium and no thirst I found the eyes normal, the cough infrequent and not painful. I ordered Sac. lactis.

The rash did not reappear. The patient convalesced from this point and I gave no other remedy, and did not repeat the Lachesis.

This change from apparent impending death to established convalescence within the space of seven hours was very impressive and even startling.

In the year 1853 there prevailed quite extensively in Brooklyn an epidemic of what was called “malignant pustule” A furuncular formation appeared, generally upon the lower lip, attended with severe pain and frequently surrounded by an erysipelatous areola. The most marked constitutional symptom was a very rapid and excessive loss of strength, the patient being reduced from vigor to absolute prostration within the space of twenty-four to thirty-six hours. Allopathic physicians at first resorted to the local application of Nitrate of silver to the pustule. In those cases, thus treated, which came under my personal observation, death followed cauterization within twenty-four hours.

In eight cases treated by myself, Lachesis was the only remedy used. It relieved the pain within a few hours after the first dose was given, and the patients all recovered very speedily.

I have three times been called to cases of chronic ulcers of the lower extremities (probably of syphilitic origin) in which the discharge had ceased, the extremity had become edematous and a hard, slightly red, swelling extending up along the course of the principal veins — together with a great and sudden prostration of strength, low muttering delirium and general typhoid symptoms — gave good reason for supposing that secondary phlebitis had occurred. In these cases a careful study of the symptoms induced me to give Lachesis. The effect was all that could be desired, the patients rallying promptly — all symptoms of phlebitis speedily disappearing.

During the prevalence of diphtheria on the banks of the Hudson in 1858-60, many cases occurred in which the severity of the constitutional symptoms was very much greater than the local manifestations of disease in the pharynx would have led one to anticipate. In some cases, in which the tumefaction in the throat was slight, and the redness of the mucous membrane hardly noticeable, and in which the diphtheritic deposits consisted merely of two or three little patches hardly larger than a pin's head, the prostration of strength was quite alarming, the pulse became, in a very short time, slow, feeble and compressed, a cold clammy sweat frequently covered the forehead and extremities, the breath was fetid, the appetite entirely destroyed — indeed the patient passed with alarming rapidity into a completely asthenic condition. Not unfrequently the prostration had become quite considerable even before any local evidences of disease could be detected.

In these cases — in all, in which the constitutional symptoms thus predominated over the local symptoms Lachesis produced prompt and lasting improvement, so much so that very rarely was any other remedy given subsequently.

Several cases of carbuncle have come under my notice, in which the progress of the inflammation was very slow, the skin over the dead cellular tissue showed but little disposition to ulcerate and when finally it became perforated in three or four places, there was but a scanty discharge of thin, sometimes bloody, sanies. Meanwhile, the constitutional symptoms denoted very great prostration, not preceded nor attended by the nervous and vascular erethism which are sometimes observed in similar cases. Lachesis is the remedy on which experience has taught me to rely in the treatment of such affections, provided the symptoms do not conclusively indicate some other remedy. In the cases to which I refer, the symptoms corresponded very closely to those of Lachesis.

About a year ago, I was called to take charge of a patient who had suffered for several years from a succession of carbuncles and indolent boils. During the four months preceding my visit to him, he had had four successive carbuncles, none of which ran a complete course. After the skin covering the dead cellular tissue had become perforated, a slight discharge of sanies had taken place and the perforations had closed again — without any discharge of slough — leaving an indurated mass, with a dull burning pain and considerable tenderness, but scarcely any discoloration. After each of these carbuncles, a marked deterioration in' the patient's health was observed, until, after the last, he was so much reduced as to be confined to his bed, with well marked hectic fever.

Pretty soon, a severe pain in and below the right groin and along the inner aspect of the femur gave indication of trouble in that region. An abscess was discovered to have formed, deep in the adductor muscles of the thigh. An opening was made by a distinguished professor of surgery in New York upon the anterior surface of the thigh, (as the patient was confined to the bed and lay on his back, this was the superior aspect of the thigh,) and nearly a quart of pus was discharged. The formation and discharge of pus continued to be profuse for fifteen days, the patient all the time becoming rapidly more feeble, with severe hectic, total loss of appetite and great local suffering, when the case was placed under my charge. I found that the evacuation of the pus was a very difficult matter, the aperture being at the highest point of the abscess. The attending surgeon had been compelled to withdraw the pus by means of an exhausting pump, attached to the free end of a gum catheter which he previously introduced into the abscess. I continued this, method until the abscess closed. The patient, his family and the physicians in attendance had abandoned all hope of the patient's recovery.

In view of the copious formation of pus, one's first thought would naturally be that Silicea would be the appropriate remedy. This remedy, however, had been given in every variety of potency. It had never failed to aggravate the whole condition of the patient, without any subsequent benefit.

Considering, now, the history of the patient — the long succession of boils and carbuncles — the four aborting carbuncles, each followed by a marked deterioration of health, and each leaving a painful induration, which might be supposed to be a portion of dead cellular membrane, retained in contact with the living tissues, and that the present abscess had followed immediately upon the last of this series of abortive carbuncles, very much as a secondary abscess follows the absorption of pus in pyaemia — I resolved to trust the case to the action of Lachesis. At the same time I informed the patient that, in my judgment, after the healing of the abscess, the indurated remnants of the four aborted carbuncles would inflame again and be discharged, and that this process must precede the re-establishment of his health.

I gave a dose of Lachesis²⁰⁰ every morning, noon and night. The progress of the case was tedious, but uniform and prosperous. In twelve days the hectic had ceased, the appetite was restored and the formation of pus had decidedly diminished. In six weeks the abscess had healed. In seven weeks the patient walked on crutches. But now, when he seemed almost well, fever came on again and he was prostrated. After twenty-four hours of fever, the indurated remnant of the last carbuncle became inflamed, an abscess formed and a slough was discharged. The same thing occurred in the locality of the three remaining indurations and, singularly enough, in the inverse order of their original appearance. After the last of these abscesses had healed, the patient rapidly gained health and strength and has since been perfectly well. In this case no remedy was given save Lachesis²⁰⁰. When the treatment was begun, the patient was in a most deplorable condition and his recovery was hardly hoped for by his attendants. Improvement began as soon as he began to take Lachesis, and continued with scarcely an interruption until he was completely restored.

Now, let us suppose that to a man in perfect health there be administered daily a dose of a drug, which, a person familiar for some years with its properties predicts, will cause the man to exhibit a definite series of symptoms and finally to die. As soon as the administration of the drug is begun, the man begins to exhibit the predicted symptoms and finally, as foretold, he dies. What jury, with these facts before it, would hesitate to say that the, man was deliberately poisoned and to convict the one who gave the drug of murder? Now, shall not such evidence as would convince a jury of citizens that a man has been poisoned by a drug, convince a body of physicians that a patient has been cured by Lachesis? Shall not testimony that would hang a male*. factor convert a sceptic?

The diseases which I have cited as those in which Lachesis, has been of unquestionable service in my hands, present, in name at least, a considerable variety. Pyaemia, repercussed measles, malignant pustule, diphtheria, phlebitis, carbuncle have not, necessarily, a great deal in common. A close examination, however, of the cases as I have described them, will show, notwithstanding the diversity in name, a considerable approach to identity in morbid condition. In all, there was great prostration, as manifested by loss of muscular power, slowness and softness of pulse, stupid delirium, etc., etc. In this respect the cases resembled those in, which Arsenicum is indicated and has so often proved curative. These cases, however, did not present that vascular and nervous erethism conjoined with prostration, which is so characteristic of Ars. Nor, on the other hand, was the asthenia so complete as to call for Carbo vegetabilis. Lachesis may perhaps be held, in so far as the symptoms of asthenia, are concerned, to occupy an intermediate position between Arsenicum and Carbo vegetabilis. This statement would at once suggest its usefulness in typhoid fevers, diseases, in certain forms of which, those who have made themselves familiar with Lach., have learned from clinical experience to place great dependence upon it.

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