Dr. Bahr having been applied to, to superintend the publication of a revised and corrected fourth edition of Hartmann's well-known Therapeutic Manual, preferred, instead thereof, to lay before the profession this, which is an original work. Instead of preserving Hartmann's arbitrary nosological arrangement of diseases, Bahr treats of diseases in the same order in which Hahnemann arranged symptoms in the Materia Medica, that is to say, he follows the anatomical schema. By so doing he considers that the use of the Materia Medica Pura in conjunction with the study of his treatise is made easier and more practicable Particular attention is paid to the pathology and pathological anatomy of diseases, in which respects the author has aimed to bring his book fully in accord with the most recent authorities.
In a long introduction written with singular clearness and candor, and designed chiefly for beginners in the study and practice of Homoeopathy, Dr. B. presents his views on the following subjects: 1st. The proving of drugs; 2d. The law of similarities; 3d. Diagnosis; 4th. The simplicity of the remedy; 5th. The dose; 6th. The preparation and the repetition of the remedy; 7th. The diet.
“The dose used in proving a remedy must,” he says, “be very various; he should always begin with the smallest doses; we may even begin with the thirtieth potency and gradually ascend to larger and more substantial doses. The single doses should never be taken in rapid succession; it is better to allow all the morbid phenomena produced by one dose to pass away before a second dose is taken. If no effects result, the dose may be increased and may be repeated more frequently. These cautions respecting the dose are extremely important, because the susceptibility to medicinal action is extremely different in different individuals, and it can never be determined beforehand, how small the dose must be, in order to produce the feeblest appreciable action. Yet these feeble beginnings of action of remedies arc often of the greatest importance, because they afford data for the explanation of later appearing and more potent effects of the action of the drug”
On the subject of the diagnosis after stating the objections made against Homoeopathy for its alleged neglect and disparagement of this element of medical science, and after stating and deprecating certain alleged deficiencies and self-contradictions contained in the Organon, Dr. Bahr expresses his views in the following proposition:
“Investigate with the aid of all possible auxiliary means, every change in condition which has been brought about by the disease — investigate it with reference to its cause, kind, origin, course, connections and sequences; investigate in like manner the artificial disease produced by the drugs; you will have then fulfilled the two necessary conditions on which an artistic cure must be based. This proposition includes the covering of the symptoms, but it also requires something more.”
The subject of the dose is very candidly treated. “The question of the dose,” says Dr. Bahr, “is an entirely practical one, which can be solved only through an accumulation of a vast number of experiments, for the action of a remedial substance upon the human organism does not follow one uniform law, but depends upon many contingent circumstances. We can never expect either in the healthy or in the sick to obtain always the same effect from same dose. The conditioning circumstances are of three kinds: variety in individual susceptibility; variety in the morbid condition; and variety in the drug itself. The great variety of individual susceptibility to drug action is shown in every proving instituted upon a variety of persons and in every collection of practical observations upon the sick. We are not in a position to form an opinion beforehand in any given case respecting the degree of susceptibility, although it is true that experience has seemed to establish certain points. — Thus, for example, we know that children of very nervous and irritable temperaments, and persons who have led a regular and temperate life, are much more sensitive than others to drugs, that the susceptibility diminishes with the general decline of the reactive power and is diminished by the use of large quantities of drugs. Moreover experience daily teaches us the influence Of certain forms of pathological processes upon this susceptibility. We see the diseases of the nervous system do not tolerate such strong doses as diseases the organs of circulation, that contagious or miasmatic diseases tolerate, na even require larger doses.”
In passing we must protest against this last statement. We think that no one who has witnessed a comparative treatment of a series of cases of Scarlatina with low potencies on the one hand and with the two hundredth on the other, or of Intermittent Fever with low potencies of Ars., Nux vom., or Nat. mur., and with the two hundredth of the same drugs could hesitate for a moment to prefer the high potencies for quickness and pleasantness of action and for durability of result, or to say, that in these cases at least, a contagious and a miasmatic malady require the smallest rather than the largest doses, or, since we prefer to discard qualifying terms which involve the mechanical ideas of material quantity — the higher rather than the lower potencies.
“It is likewise clear that different remedies in the same dose do not always develop the same intensity of action. A grain of Arsenic acts much more strongly than a grain of Saltpetre or of Mercury; a drop of Belladonna than a drop of Chamomilla”
Regarded from these three points of view any standard dose that may be assumed, however large or small it may be, is an unwarrantable assumption which can never be justified by the results of practice; and although many Homoeopathis hold to a standard dose, we cannot but regard this as a lamentable error and as a direct contravention of the spirit of Homoeopathy For, just as Homoeopathy demands in the investigation of the morbid condition the strictest individualization, as it likewise requires that the remedy should be regarded in its strictly individual aspect, it is fair to assume as a necessary consequence that every dose should be made to correspond to the particular conditions of the case for which it is prescribed, and that in this respect also strict individualization should be observed.“
“The following general law applies to every endeavor to cure: tuto cito et jucunde curare. That is, in other words, every conscientious physician should, without impairing the certainty and rapidity of the cure, take most especial care that the patient do not receive from the remedy which he administers morbid symptoms in addition to those which he already has. But if we administer a remedy according to the law of similarities in a relatively large dose, we shall almost always produce a more or less considerable aggravation of the existing sickness; this is the so-called homoeopathic aggravation. That this is no imagination, no vague theory, any one may easily convince himself by experiment; but it is certainly the effect of imagination when many affirm that they have seen an aggravation after all possible doses below the ominous thirtieth potency; and thereby claim to be the true followers of Hahnemann. Hahnemann, indeed, through his dread of the homoeopathic aggravation came to commit the great error of fixing upon the thirtieth potency as the normal dose. * Inasmuch, however, as the homoeopathic aggravation, although sometimes when not too strong, a desirable phenomenon as justifying the choice of the remedy — nevertheless offends against the “jucunde curare” it is unquestionably our duly to avoid it by a diminution of the dose, to carry this diminution so far as that we attain a curative action undisturbed by any increase of the morbid phenomena already present; and this we should do even though in this manner we should carry the diminution as far as the thirtieth potency and still further”
“Besides the homoeopathic aggravation we observe also where large doses are given a pure medicinal aggravation, that is, effects which are produced by the drug outside of the circle of the previously existing morbid symptoms. — This medicinal aggravation, however, seldom occurs except after relatively large doses, whereas the homoeopathic aggravation may follow small doses. That a peculiar susceptibility to medicinal influence may cause it to appear even after very small doses is a welcome evidence of the activity of the latter. We have treated, for example, a very irritable lady, in whom a few drops of the sixth dilution of Mercury always produced a copious through brief salivation, with a distinct metallic taste. Of course the patient knew not what remedy she had taken. It is obvious that the medicinal aggravation stands in direct opposition to the “jucunde curare,” and that we must carefully seek to avoid it”
“From what has been said, it follows that the law for the determination of the dose, must be somewhat as follows: the dose must be of such magnitude as to produce along with an undisturbed curative action, no medicinal, and as far as possible, no homoeopathic aggravation. We say, as far as possible, for it is not always easy to avoid a homoeopathic aggravation, and indeed this is important only when it is severe.
“It is clear, however, that the law thus stated, is not, so easily applicable, without farther conditions, in every case of disease, for both the homoeopathic and the medicinal aggravation depend on the above-mentioned individual relations of the patient, the disease and the remedy. Practice, however, has taught us several more or less determined and valid rules on the add these we shall proceed to state”
“But, previously, it might not be inappropriate to state how it is possible that so small doses as Homoeopathy prescribes, can produce any effect whatever. The attempts to explain this phenomenon have, in truth, been numerous enough, so that a more minute treatment of the subject would lead us too far; we abstain from this, the more readily from a conviction that no attempts at explanation can ever lead to an absolute determination of the question”
We have already pointed out the fact that it was the purest empiricism which led to the idea of the homoeopathic small doses, and we must repeat that experiment alone can furnish evidence of their efficacy. Whoever, therefore, can and will not believe it then — and nobody should be blamed for such a priori unbelief — let him make the experiment for himself, and let him satisfy himself.
“In view of the investigations of modern times upon the course which diseases run without medical treatment, we hold it be to much more natural and more conscientious to ascertain with how small quantities of medicine cures may be effected, rather than to experiment how much medicine a patient can endure without a fatal result or very formidable injury. If the old school of medicine stands in such direct opposition to Homoeopathy respecting the scale of doses, no unprejudiced person can doubt to which of the two schools the need of prudence and conscientiousness should be awarded. We know that the majesty of diseases terminate in recovery without our assistance; is it not presumptuous to experiment with large doses of strong drugs. We Homoeopathist a have the right to adduce in support of our administration of remedies the results of many thousand experiments, but who could have the arrogance without valid experiment to pronounce a judgment simply because with his imperfect human understanding he is not able to comprehend the matter? Seeing is a better and more frequent formation for believing than comprehending is. For, are the little doses of Homoeopathy the only thing in nature that we do not comprehend? Must we deny, the result simply because the way by which it was achieved seems to us wonderful?
“As already said, it is useless to meet with arguments those who are unwilling to believe; we may better address them in the words of Hahnemann, “repeat the experiment, but repeat it with exactness and precision.” Whoever, from preconceived notions, refuses to make the experiment, him we can only pity for his self-will. He harms only himself and the patients who confide in him; not Homoeopathy.”
Further, more general propositions we may state better under one or other of the following maxims which practice alone has taught us: 1. Every remedy which is prescribed according to the law of similarities must be administered in a relatively small dose.
“That this proposition may be understood, it is necessary first to determine what doses shall be called small and what large. Smallness, we think, cm only be understood as relative to the doses administered by medical men in general, and we might, therefore, express ourselves as follows: that we should never give the same remedy in prescribing according to the law of similarity in the same dose in which it is given when prescribing according to any other law. If however, we wish to determine the smallness solely with reference to Homoeopathy, we should say, the dose of the drug should never be so large as to produce a medicinal aggravation, if possible not so large as to produce a homoeopathic aggravation. The relative smallness of the doses is determined, however, by means of the entirely different object we have in view in using medicines. We desire by the drug simply to kindle the reaction, not to give it an entirely different direction, and inasmuch as we desire to do this only within the circle of that portion of the body which is affected by the disease, we should not administer the remedy in so large a quantity that it can produce its peculiar effects along-side of the sickness already present; for in that case, additional organs or systems would become involved in the circle of the disease that, however, only small doses are necessary to kindle the reaction we are not alone taught by practical experience, but we must assume it a priori, since a diseased organ is infinitely more sensitive to a stimulus than a healthy organ is”
“2. The limits up to which the dose of a remedy chosen according to the law of similarity may be diminished without impairing its curative power, has not been settled. Hahnemann finally fixed upon the thirtieth potency as the suitable dose for all cases; nay, he even regarded this as. under certain circumstances, too strong a dose and thus he came to the famous olfaction. The greater part of his followers have preferred the lower potencies and administer the thirtieth as the highest, and this only occasionally. Another, certainly not insignificant part, has carried the potentization much higher than Hahnemann. If now these adherents of the high potencies claim to have seen brilliant results even from the 2000th potency, those of another way of thinking have certainly no right to express, without further investigation, a depreciatory judgment on the subject. And it is as imprudent in them to declare that all such experiments at curing are nonsense, as we on our side should regard it as unjust in those who, in their turn differ from us in their way of thinking, to brand as nonsense our use of doses which approach nearer to the material in quantity.'
“We will assume that the “high potencies” do manifest a curative power; this must be admitted. But yet there is no evidence that they act better than the lower potencies — for example, up to the thirtieth. It is certain that a malady which will not yield to a remedy in the lower potencies, will not yield to the highest. Now then, since no one can affirm that he has seen a homoeopathic, not to speak of a medicinal aggravation, from the thirtieth potency, and since this must necessarily determine the degree of attenuation, we can comprehend, why we should impose upon ourselves the labor of further potentizing remedies, which indeed is no trifling labor. If no one can point to any important advantages resulting from it, we may surely lay aside this method, those who employ only the higher potencies in condemning the lower on the ground that the latter produce toxological effects. The former of these classes commonly decide without baring experimented sufficiently; the latter impelled by a pitiable one-sidedness. It is therefore a piece of good fortune that this strife about doses, formerly so zealously and often so violently waged, has now given place to an armistic. May the parties thereto first accumulate a good stock of material and then commence the war of annihilation!”
Among so much that is excellent and judicious, one cannot fail to notice certain inconsistencies and one very grave omission in the treatment of this important question of the dose. Dr. Bahr states that the question is entirely a practical one to be settled by experiment alone; he says that those who use exclusively the low potencies have no right to denounce the use of the higher potencies without having carefully experimented with them; and in reference to this question he quotes Hahnemann's famous exclamation: “repeat the experiment, but repeat it with careful exactness!” Nevertheless, in speaking of the higher potencies he discourages experiment; he ventures to affirm in direct contradiction to the testimony of many of his colleagues, testimony claimed to be based on experiment, that the thirtieth and potencies near that degree never produce a homoeopathic aggravation; that the higher potencies are not curative save in rare instances, that where a lower potency has failed to cure there, as a matter of course, a higher potency of the same drug can never cure. On all these questions, which are the very questions at issue in the present discussions of the dose, he discourages experiment. He omits, moreover, all reference to the potentiation theory. He refers the diminution of the quantity which is involved in the potentization of remedies, solely to the necessity of avoiding the homoeopathic aggravation; implying, therefore, that the limit of potentization should be, attained in that potency which will produce no homoeopathic aggravation. He ignores the opinion entertained by many Homoeopathist that the potentizing process does not merely diminish the quantity of the drug but does, also, so modify its form as to develop in it, in the higher potencies, a curative power, which was altogether latent or but slightly manifest in the crude form or in the lower potencies. Now there are facts familiar to almost every Homoeopathist which controvert Dr. Bahr's position, a and which are not susceptible of explanation by his theory of the nature, uses and necessary limits of potentization.
Natrum muriaticum, known in its crude form as table-salt, when proved in massive doses, produces no medicinal symptoms and exerts no curative power. The Vienna proving showed that not until it was potentized up to the thirtieth potency, did it develop that pathogenetic power which was capable of producing the symptoms of a periodic fever. And practical experience shows that only in the higher potencies is it capable of curing periodic fevers of miasmatic origin. This curative power is latent in the crude substance and in the lower potencies. The potentization of this substance is made not at all for the purpose of avoiding a homoeopathic aggravation, for nobody has ever spoken of, or imagined, a homoeopathic or a medicinal aggravation from common salt. Tac limit of potentization then, for this and other analogous remedies, cannot be found by a consideration of the homoeopathic aggravation. Far from it being of acute and chronic diseases Such a distinction is always a difficult matter, for there are always transition forms, the classification of which would always be a matter of embarrassment, and the more so because on this classification the important question of the dose would depend. Moreover there are acute affections which require higher potencies and chronic ones on the other band which are better subdued with lower potencies. Among the former one reckon, for example, all diseases with a definite course, such as typhus or the contagious exanthemata. Among the latter such chronic affections as have frequent acute ascerbations. We think, then, that we may properly be guided in the choice of the remedy according to the urgency of the required reaction, and we prefer this general indication to all more special indications, because it is impossible to particularize the above proposition so as to meet all cases; we should be sure to make more or less numerous omissions.
This proposition is easily explained by what we have said above in explanation of the law of similarities. It also explains a phenomenon which we meet with almost universally among homoeopathic physicians, viz.: that the longer they have busied themselves with the Materia Medica, the more exact, therefore, their knowledge of the remedies, the more commonly do they prescribe the smallest doses. This shows that the similarity is the first and most important condition in the choice of the remedy, and that the quantity plays only a very subordinate part.
We have already shown that this point is tolerably important. We have many medicinal substances which do not manifest an effect until they are subdivided. Such are all inorganic substances which are insoluble in water or alcohol. These must first be rendered drugs by the process of trituration. They cannot therefore possibly exert a curative action in a large dose. Moreover among soluble, inorganic and among vegetable substances we must pay attention to the intensity of the action and we should never, for example, venture to give Corrosive Sublimate or Phosphorus, Nux vomica or Ignatia in so large doses as we might without injury give Chamomilla, Sambucus, etc.
This point was treated above; we add only a word. It is always difficult, in the case of a patient hitherto unknown, to get a clear notion how he will react under a medicinal stimulus. In such a case one should always be very prudent and more careful the younger the patient. Only very long observation of the peculiarities of individuals can afford us any reasonable degree of certainty.
In the above propositions we believe we have exhausted the question of the dose so far as that is possible in the present condition of things. We have intentionally omitted every thing which could pertain to a partisan view. We hold it to be just as wrong to Join with those who use chiefly the lower potencies in denying that the higher have any action, as on the other hand to jointution; and hence the importance of combining a constitutional with a local treatment. That when vegetable fungi cause disease by coming in contact with the mucous membrane of the head and chest, we have now fixed data for the administration of emetic.”
We find also interesting articles on the Sarracenia purpurea in small pox, it seeming to have a most powerful or special effect in arresting that disease, it is well worth attention by provers. We find unequivocal signs of progress in an article on epilepsy cured by Belladonna, reported by Dr. Ramskill, physician to the hospital for epilepsy and paralysis. He reports that twenty cures were effected out of one hundred cases treated by it. He says that it aggravates the disease for two or three weeks, especially in appropriate cases where amendment follows. He remarks, “a most important question now arises — Do we know anything of the nature of the action of Belladonna beyond the empirical results obtained in treatment?” and then goes on to theorize about its action on the blood-vessels of the frog, about its action on the iris, etc., etc. Proving thus that it should cure appropriate cases of epilepsy.
An article on delirium, giving statistics, proves that the best results are obtained by the pure expectant plan, no cases proving fatal; whereas in cases treated by Opium and stimulants, twenty-five percent are lost (somewhat significant).
The prevention of pitting in small-pox is said to be accomplished by painting with a solution of rubber and chloroform (naptha is a better solvent), it allowing the motion of facial muscles without cracking, off; it would seem to be much preferable to Collodion.
An interesting case of poisoning by Veratrum vir, is given, it is thus stated: “On the evening of December 18th, I was summoned to see a gentleman, a scientific chemist, who had taken experimentally one drachm of tincture of Veratrum viride I found him sitting in the water closet vomiting into the pan. His features were sunken, skin cold, and covered with a profuse clammy sweat; his pulse quite imperceptible. He complained of intense pain about the epigastrium. The vomited matter appeared to consist at first of the food and contents of the stomach, afterwards of glairy mucus.” Brandy was given which checked the vomiting. The pulse at this time was indistinct, feeble and irregular, 44 in a minute. Warm brandy and mustard were applied until the patient was out of danger. He afterwards gave the following account of it:
“A drachm of the tincture at about 4:30 p.m., and my stomach soon afterward whispered that I had admitted a troublesome guest. I went up-stairs and sat down thinking a cup of tea would set all right; but the uneasy constriction of the stomach continuing, with a tendency to sickness made me retire to the water closet. The sickness once commencing soon became alarmingly violent with the most excruciating pain in the lower part of the stomach, the pain extending to about the size of the hand, the feeling at the seat of the pain was that all the warm tea, water, etc., that I took to provoke the vomiting, went under the pain, making the constriction more and more violent. Finding the case getting desperate, I sent off for medical aid. The pain continued to increase, and the ejection from the stomach was now glaring mucus with Mood, with running from the nose and eyes. The most painful and profuse cold sweating now came on, and the difficulty of breathing became more and more labored. I could not help wondering at any thing like the presence of heat or constriction of the throat; my mind was perfectly calm and although I thought it more than probable that I should die, I did not feel alarmed. — Hearing and recognizing the voice of one of my medical friends is all I recollected for some time afterwards. Immense circles of green color appeared around the candle, which, as vertigo came on and I closed my eyes, turned to red. The pain continued excruciatingly at the pit of the stomach and a slight tendency to cramp existed when my legs touched, It was an hour or more afterwards when I woke and felt quite well. The sting of the mustard I can well recollect and the horror of being forced to swallow brandy is even now with me” ALLEN.
Having noticed in extenso the theoretical introduction of this work, we turn now to the practical part, from winch we extract, first, the section on Inflammation of the spinal marrow and its membranes:
“This disease belongs to the number of those that are rarely encountered, perhaps for this reason among others, that often it is not recognized as such, but is mistaken for some other malady. The inflammation may have its seat in the meninges alone; but if the spinal marrow itself is inflamed, a meningitis never fails to accompany it The disease may run an acute or a chronic course. Acute meningitis generally extends over a considerable surface and causes an exudation in the sub-arachnoid space, but seldom attacks the spinal marrow itself. The chronic form leads to thickening of the membranes, and to a more or less copious serous accumulation in the spinal canal. The inflammation of the substance, as in the case of the brain, leads very soon to softening and destruction of the fibres of the spinal marrow, also to the formation of abscesses; it is not generally very extensive but always induces an inflammatory condition of the meninges.
“The causes of this malady are very manifold if we are to believe all that has been alleged on the subject. As the most certain we may regard mechanical injuries, such as a blow and fall, fracture of the vertebrae; diseases of the bones, especially spondy larthrocace; apoplectic extravasation, prolongation of inflammatory affections of the brain. As doubtful causes: acute exanthemata, suppressed hemorrhages, sexual excesses. In many cases however the inflammation appears to arise altogether spontaneously.
”Symptoms. Those of meningitis are almost absolutely the same as those of myelitis; we will mention slight distinguishing marks. In most cases the disease begins with a chill, as all inflammations of important organs do, and the chill is easily repeated in frequent attacks of shivering. At the same time local pain is experienced in a clearly defined spot in the vertebral column; the pain is increased by pressure, but becomes most violent and even intolerable on motion of the vertebral column, especially rotatory motion At the same time there is considerable fever. There are commonly also at the very beginning of the attack pains in the extremities, indeed these arc often the first signs of the disease. Very soon the first symptoms of commencing paralysis are manifested, which consist first in painful contractions or twitchings of the muscles involved, often taking the form of tetanus, and then, more or less quickly, pass over into paraplegia. There almost never fails along with these symptoms a certain degree of anesthesia which often begins with a sensation as if the part were covered with fur and gradually increases.
“The complex of the symptoms presents important differences according to the seat of the inflammation. If the latter is high up, then naturally all those parts of the body which are controlled by that portion of the spinal marrow which is inferior to the seat of the inflammation, are paralyzed. The paralysis of the respiratory muscles is particularly grave and dangerous and quickly proves fatal. When the inflammation is seated in the lumbar portion, violent colics are observed. The bladder and rectum are almost always more or less paralyzed. A most peculiar feature, if it be not a constant one, is the convulsive shocks in the paralyzed parts which have a great resemblance to the reflex movements after strychnine poisoning.
“All these symptoms, in cases which do not run too rapid a course, present distinct remissions and exacerbations. When the spinal column alone is affected, consciousness remains unimpaired; yet the patients generally manifest unwonted excitement and sleep either fails or is very unquiet.
“The disease may prove very rapidly fatal, especially when its seat is near the brain, but it may also last for weeks before it proves fatal through exhaustion. If it terminates in recovery this is hardly ever complete, especially after inflammation of the substance itself, but there remain as sequelae, various paralytic phenomena. It may finally pass over into the chronic form. Before we treat of this we will cite The symptoms which are given as marks of distinction between meningitis and myelitis. In the former the pain is more diffused and is much increased by motion, whereas in myelitis it involves a small spot and is materially aggravated only by pressure. The febrile symptoms are more violent in meningitis. In myelitis the paralysis sets in very quickly and is complete, in meningitis it comes on gradually.
“The chronic form may, as has been said, be developed from the acute. Where however, it arises independently, it begins with less violent pains and without any febrile symptoms. These pains are seldom so severe in the locality of the inflammation as in peripheral parts, particularly in the lower extremities, and in the beginning they bear a complete resemblance to rheumatic pains. The paralysis is established very gradually and almost without being noticed and increases likewise very slowly indeed. Nevertheless, in this form, as well as in the acute, anesthesia is always present to some extent. In the further progress of the disease paralysis of the bladder sets in, and this, together with gangrenous destruction of the skin of the back, is the most frequent cause of death.
“Chronic inflammation of the spinal marrow itself differs somewhat, especially when, as most frequently happens, the meninges are not involved. The local pain, as well as the peripheral, is not so violent, is often vague and dull, not much aggravated by pressure and motion. The patient has a characteristic sensation, as if there were a hoop placed tight around his body. Anesthesia in a greater or less degree is a constant concomitant of this morbid process. Convulsive twitchings may fail entirely.
“Paralysis of the motor sphere begins as an undefined sensation of heaviness in the limbs, which makes it difficult to walk. Then the gait of the patients becomes uncertain in a peculiar way. They lift the feet very high, throw them far forwards, and then set them down in such a fashion that it has rather the appearance as if the foot fell and, moreover, the foot reaches the earth much farther back than it seemed as though it would at the beginning of the step, sometimes also more outward. The point of the foot is almost always strongly abducted. Another peculiarity is that the patients cannot walk at all with the eyes closed.
“A complete recovery is a rare occurrence; we must for the most part be content with ever so slight an improvement, even with on arrest of the progress of the disease. The duration of the disease may be very long; the fatal termination is often put off for years.
“The prognosis of the acute form depends with reference to its mortality chiefly upon the seat of the affection; the nearer to the head the paralytic symptoms extend, the more quickly does an unfavorable termination ensue. In any case we must be very cautious about promising a complete recovery for a partial paralysis almost always remains. Often enough indeed we must consider that we have gained a great deal when we have effected simply the transition from an acute to a chronic course. Meningitis when it exists alone always justifies a better prognosis than myelitis.
”Treatment. We still grope very much in the dark, not less as regards the correct diagnosis of the remedy than as concerns the exact diagnosis of the pathological process. Our literature contains but very scanty material in the way of histories of cases, as Ruckert's collection shows where only one case on chronic myelitis is to be found. The reason of this phenomenon does not surely lie in the fact that the malady is so seldom observed — else has the author had a remarkable fortune in that way — but rather that the therapeutic results have been almost always unfavorable and, unluckily, unsuccessful cases are very seldom published, although they would give us the means of learning very much.
“So much the more for this reason do we feel constrained to allude here to a special case that came under our own observation during the last summer, and the course of which was characteristic enough to prevent any mistake, notwithstanding the distance of the patient.
“A patient 60 years old, until now strong and healthy, had, in the last days of August, an attack of dysentery. Of this there could be no doubt, inasmuch as the patient had preserved fragments of the intestinal mucous membrane which he had passed at the time. He took remedies for this from a domestic medicine case; after four days the diarrhea stopped and gave place to obstinate constipation. I first visited the patient on the fourth day after the diarrhea ceased. At the first glance it must be confessed he did not appear to be very ill. And in fact he complained of nothing but severe pains, altogether resembling sciatica in the left limb from the tuber ischii as far as the knee, aggravated in paroxysms, increased by the warmth of the bed At the same time restlessness and sleeplessness, but a normal pulse. There was no febrile symptoms. He received Colocynth.
After two days, however, the reports from him told of aggravation of the pain and of the entire condition, and on this written report, I prescribed Belladonna. This, again, wrought no improvement, so that, five days after my first visit, I had to visit the patient again. I found a great change in the morbid picture. The patient lay half turned upon the left side. The pains in the legs are on both sides, yet not so violent, except in single paroxysms; twitchings of single groups of muscles or of the whole limb; very severe, but remitting pains in the lumbar region, the vertebra of which, however, are but slightly sensitive to pressure. These pains become furious at night. Creeping, formication, in the skin from the pelvis to the feet; the feet extraordinarily cold, according to the patient's own sensations. Paralysis of the bladder; the sphincter of the rectum is not in condition to retain flatus. Paralysis of the lower extremities for the last thirty-six hours, so that he cannot even stand, without supporting himself; if he wishes to put on his slippers, he stretches out the foot beyond the place where the slippers stand: walking is only possible when he literally hangs upon two men. Some fever. Stool normal, appetite trifling, almost complete sleeplessness, with regard to which a singular phenomenon obtained. If, namely, the patient did not, late in the evening, drink some not very strong coffee, he did not go to sleep at all. If, having gone to sleep, he waked again after a few hours, he could not go to sleep again at all without drinking some more coffee which for the moment acted like Opium. He had several nights tried to sleep without coffee but had remained altogether without sleep until he took some.
“Mercurius viv. third trituration was prescribed, and since the experiment with the coffee was so interesting and its hypnotic effect so beneficial to the patient, I allowed him to continue its use with the caution, however, to try whether he could not obtain sleep without it.
“Nine days later I saw the patient again, who, during the interval, had continued to take the same remedy. He could now lift his limbs alone and quickly from the bed, could put on his slippers quickly and walk without support, save with a stick as a precaution, six times the length of his room. The pains had very considerably diminished, the anesthesia had almost vanished, the bladder and rectum were no longer paralysed. The coffee had, during this whole period, produced its effect unchanged, but for the last two days it had no longer been necessary to take it. Veratrum was prescribed. The improvement continued steadily and the recovery was complete.
“A second no less clearly pronounced case, though of the chronic form, came under my treatment almost at the same time, and in which the locality of the disease was between the scapulae. Here, up to this time, treatment has been of no service, yet there has been no increase of the symptom for nearly five months * * * *
”Mercurius. So far as we know, this remedy has been hitherto but seldom employed in this disease. But we should think that a single result like that above related in a disease so difficult to cure, would alone be sufficient evidence to give to this remedy the first choice, and so much the more that similar experiences with other remedies are wanting. That Mercury has a special affinity to the spinal marrow, we might learn if the Materia Medica Pura taught us nothing upon the subject, from the too frequent contemplation of such persons as have been overfed with it But we find all the characteristic symptoms detailed in the Materia Medica, and those which are wanting or incomplete there, are supplemented by the manifold records of mercurial cachexey, a host of which lie before me. According to these we find, in the action of Mercury, all the phases of incipient paraplegia of the extremities, of paralysis of the bladder, of the rectum, with a tendency to the peculiar twitchings and shocks; violent pains in the spine increased by motion; the restlessness and sleeplessness as characteristic of Mercury as of myelitis; finally the anesthesia of the skin. In the particular case, above related, moreover the constant and very considerable aggravation at night, while lying down, was a very strong indication for Mercury” D.
Our provings, especially the fragmentary, are scattered through various periodicals, pamphlets, monographs, etc., and there are probably few of us who have not at times wished for some index to aid us in finding them.
In 1858, Dr. Henry Thomas, of Chester, Eng., gave us his “Additions to the Homoeopathic Materia Medica,” a very valuable little work of reference, excluding however those medicines mentioned in Jahr's Symptomen Codex. Dr. Klemert's book is an improvement on this, as he endeavors to give the source of all the medicines amounting to four hundred and sixty-five. He however omits a few that are mentioned by Dr. Thomas.
This book will be of great assistance in referring to German works. But few allusions are made to English periodicals, the provings, etc., which have appeared in the latter having been generally translated and republished in the former. It is to be regretted that the references to the journals are not always correct, a typographical inaccuracy probably which the indefatigable author will remedy in another edition. S.
”Secale cornetum. — There is perhaps scarcely any remedy which produces so characteristic symptoms of inflammation of the spinal marrow with respect to the impairment of its functions. We find here again the convulsive twitchings and shocks, painful contractions, tetanic symptoms, complete paralysis with persistent, often even exaggerated action, of tho reflex function, the most violent pains in the back, particularly in the sacral region; the most complete anesthesia, paralysis of the bladder and of the rectum, finally the peculiar disposition to gangrenous sloughing, which in Myelitis is represented by the bed-sores (decubitus). Unfortunately we have no records of microscopic examinations of the spinal marrow in persons who have died of ergotism.
”Iodium has been recommended as a remedy in affections of the spinal marrow, perhaps for this sole reason, that it is an antidote of Mercury which so often produces maladies of that character. Its action appears to be concentrated rather upon the brain alone, and hence the symptoms of paralysis in the extremities seem also to be derived. Anesthesia induced by Iodine has probably not yet been observed.
”Nux vomica. — Many of the symptoms of this remedy correspond so closely to the malady in question, that one would think it must be the most suitable of all remedies. And in fact it has been earnestly recommended on many occasions in Myelitis. But we doubt very much whether such a recommendation will be corroborated by the results of practice. We possess of few remedies more physiologico — toxicological experiments than of Nux vomica, in the form of strychnine, but in not one of these is there any mention of inflammation of the spinal marrow, although there is of decided venous hyperemia of the meninges. That is certainly very striking, but moreover we find as the effect of Nux vomica less a paralyzed condition in the peripheral portions than on the other hand violent tetanic contractions, less anesthesia than on the contrary hyperesthesia with unusually increased activity of the reflex function, which latter condition is in myelitis rather the exception than the rule.
“We believe accordingly, that Nux vomica is suitable rather for the nonmaterial affections of the spinal marrow, and, of inflammatory processes, at the most for meningitis of the spinal cord before it has advanced to the stage of exudation
”Rhus toxicodendron is always a remedy very deserving of consideration in Myelitis. Even supposing that all the symptoms which bear a resemblance to paralysis result from the decomposition of the blood-mass which is peculiar to Rhus, we cannot possibly from this point of view come to a one-sided conclusion as to a therapeutic application of it. In the first stages of Myelitis the slight degree of fever is a contra-indication of Rhus, except indeed where the malady was caused by an acute exanthem. On the other hand the stage of complete paraplegia appears to correspond much more closely, and this as well in chronic as in acute cases.
“Hartmann recommends Dulcamara emphatically against Myelitis as a sequela of exanthemata, but he seems from the symptoms which he adduces of the disease treated by him, not to describe an unquestionable inflammation of the spinal marrow.
”Veratrum album belongs to the remedies that are most similar, and exhibits especially the symptoms of the second stage of acute Myelitis. In this stage too, in the case above related, it very happily continued the cure after Mercury. Whether it will be suitable also for chronic cases is a question that can be determined only by practical testimony.
”Plumb, has evidently an equally important action upon the spinal marrow as we have already shown above in treating of encephalitis. It is very much to be lamented that we have no reports of the results of autopsy in relation to the medulla, for these, if we had them, would so certainly determine what part of the spinal marrow is effected. But even the analogy of the action upon the brain justifies the conclusion that the substance of the medulla is attacked and destroyed, since otherwise the symptoms of paralysis would not be so completely pronounced. From the fact of its slow action this remedy is not suitable for acute cases; it presents, in addition, the particularly characteristic phenomena, that the paralyzed parts early emaciate and are found in a state of violent contraction, which is generally at the same time painful. Colic. proceeding from the spinal marrow, would, moreover, if present, be a special indication for Plumbum.
”Cuprum. — If in a general view the difference in the action of Cuprum and of Plumbum is difficult to define, this is the case to a much greater extent when we regard them with especial reference to the spinal marrow. This is certain; that in Cuprum the symptoms of paralysis are not so fully pronounced and the spastic phenomena predominate, whereas in Plumbum the reverse is the case. Both remedies act decidedly in the same direction, but Cuprum more in the beginning of the affection and Plumbum at the end. The latter will therefore, be a safe remedy to follow the former, while the reverse would not be likely to occur.
“Another remedy which should receive great consideration, especially in the beginning of myelitis, is Cocculus If we wish to choose the remedy according to the locality of the disease, Cocculus would correspond rather to inflammation of the lumbar portion of the medulla, not to a disease located higher; it remains, nevertheless a difficult matter to determine whether Cocculus, like Nux vomica, does not simply modify the function of the medulla without producing material changes.
“We may not omit to mention a few other remedies which either have been strongly recommended or which seem to be appropriate. And first as regards Belladonna and Aconite, we believe that their administration will result in only a loss of time and no curative effect. Furthermore, the reaction in Myelitis is never so violent that we are compelled to give one of these remedies merely for the sake of calming the storm of the febrile movement. Neither of the remedies has any decided local relations to the medulla.
”Ignatia occupies in this malady pretty touch the same position as Nux vomica. Phosphorus should be an excellent remedy where the inflammation of the spinal marrow has been induced by sexual excess. Sulphur will come under consideration when the disease has come to a stand, and where we desire to act upon the chronic exudation in the spinal canal in order in this way to benefit fit the paralysis.
”Sulphur is here a very important remedy as is shown by the action of sulphur baths upou spinal paralysis. I myself know a lady between fifty and sixty years old, who suffered for more than ten years from chronic spinal meningitis which exhibited every year one or two exacerbations, had its seat in the lower thoracic portion of the medulla but could not have seriously affected the substance of the medulla, inasmuch as the paralysis were not strongly pronounced except in the arms; moreover there was observed in her case, as often after spinal hemiplegiae, a general increase of corpulence except in those parts which are decidedly paralyzed. This lady has for years taken, every summer, weak sulphur baths — artificial at that — with the most decided advantage; even the paralyzed arms are every time perceptibly improved.
“I likewise treated in the same place a man who lay for two years completely paralyzed in the limbs from Myelitis of the lumbar region; he had for a long time tried various remedies (among them Sulphur internally) without any farther result than that he was able to move slowly on two crutches. He was sent by his employers to the weak sulphur bath of Eilsen and when, at the end of about three months, I went to visit him again he came to meet me walking with a cane. Entirely cured, however, he is not.
“Finally, Calcarea carb, is worthy of notice where diseases of the vertebrae) were the cause of the inflammation, less, it is true, because this remedy has a direct influence upon the medulla, than, because it acts upon the exciting causes.
“Finally, a few more general remarks upon the treatment. It does not so often happen that we are called from the beginning to the treatment of the Myelitis. More frequently the patients have been first plagued to their heart's content with blood-letting, and other forms of depletion before they resolved to to place themselves under homoeopathic treatment. In such cases it is always a question what we may venture to promise the patient as the result of the treatment; we believe that we cannot in this be too cautious. Often, indeed, we succeed in producing an amelioration even in quite old cases, but often all remedial expedients utterly fail; complete recovery in paralysis of long standing is, perhaps, quite impossible. The former case certainly depends upon this condition, that in connection with the injury of the spinal marrow, there still exists a meningeal exudation, and that the gradual disappearance of this exudation be effected. Thereby assuredly an important improvement is often wrought. Then there is formed; even in chronic meningitis generally, a more or less copious serous accumulation in the meningitis space, upon the absorption of which many paralytic symptoms may vanish. In every case, therefore, it is our duty to attempt the cure, only we should take care not to promise a cure of such paralyses as depend upon destruction of the medulla itself.
“The question whether one who suffers from inflammation of the spinal marrow should observe absolute repose in the horizontal position, may we believe be best left to the patient for solution; he can always tell best by his feelings whether motion be hurtful to him or not. Unconditional harm it surely never does, whereas enforced recumbency may easily produce great mischiefs. Indeed, in chronic cases a good part of the hope of recovery is based upon a cautious methodical use of the paralyzed parts, such as the movement cure has introduced into medical practice.
“We wish finally to mention a mode of treatment, the injurious effect of which we have but recently observed on a lady; we mean the cold-water cure. This may, under some circumstances, be applicable in Myelitis but assuredly very seldom. The reason of this is found in the fact that in Myelitis the anesthetic skin is not competent to furnish the reaction, which is always necessary for the beneficent operation of cold-water; therefore the result is one sided, an excess of warmth is withdrawn for which loss no compensation is made. Thus, in the patient above-mentioned since her trial of the water-cure, the anaesthesia is decidedly aggravated.” D.
|The American Homoeopathic Review Vol. 04 No. 05-09, 1863, pages 227-237, pages 281-285, pages 423-426
|Book Notices; Die Therapie; Nach den Grundsetzen der Homoeopathic - Bearbeitet von Dr. Bernard Bahr; Therapeutics; Treated according to the Principles of Homoeopathy, by Dr. Bernard Bahr; Quellen-nachweis Der Arzneiprufungen Physiologischen von Dr. phil., Georg Otto Kleinert
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