This disease is reported, in the bill of mortality for the city of New York for the week ending March 21st, 1863, to have caused about ten percent of the deaths from all diseases in that city during that week. The prevalence of pneumonia and the consequent mortality, at this season of the year, are considerably above the annual average. The mortality from the same cause, during the same week, in the city of Brooklyn, was but a fraction of one percent less. It is probable that the loss of life from this disease, in the other large cities of our country does not vary much from that in the cities named. Hence the importance of a knowledge of the best method of its treatment is not a matter admitting of question. Any method for which, after a proper trial, it is claimed that it has reduced this mortality, is worthy of respectful attention from all right minded persons; and that method which comes to us fortifying its claim with unchallenged tables of statistics, which show that it has reduced this mortality more than one-half, is certainly worthy of something more. Such a claim was asserted on behalf of Homoeopathy many years since, and sustained by tables of statistics, showing the results of this treatment of pneumonia in a number of hospitals devoted exclusively to its practice, and at the same time, giving from the published reports of the principal European hospitals for exclusive allopathic practice, the results of the current methods of treatment in those establishments, each for a series of ten years or more. The contrast of these results was not a little extraordinary. They were gathered, on both sides, from official reports, published by the authorities of the respective institutions, without reference to such a comparison by either, and so far as is now known, the accuracy of these reports, on either side, has never been questioned. The one showed a loss of about five percent. of the cases treated, the other a considerable difference in the different hospitals, varying from fifteen to about forty-eight percent., this last and prodigious mortality being the result of the treatment of pneumonia in 1837, and for several subsequent years, at the “Charite” of Berlin.*[Dr. Genzke, Hygea, Vol. XVI, p. 200.] Exclusive of the reports of this hospital the average loss, under allopathic treatment, was about twenty percent.
If any rule of practice could be said to have been “settled” in the old school of medicine, twenty-five years ago, by its observations and works, it was certainly that which required the loss of the patient's blood as a curative resort, in the treatment of acute inflammations of important organs, and more than others, in acute inflammations of the lungs. Whatever else was true or false, the value of this means, in such cases, was not to be questioned by a sane man, so at least spoke a late President of the New York Academy of Medicine. It was in the exercise of a full reliance on and practice of this rule in the Berlin Charite, that about forty-eight percent of the patients treated according to its requirements died. This had been a fact for a number of years when the President of the Academy pronounced the insanity of the man who should question the indispensable necessity of this long unchallenged and trusted resort. That it should have been confided in and practiced for near three thousand years with almost entire unanimity by the medical profession, and that then, after this long confidence in its value, it should at last have been discovered, in the second quarter of the nineteenth century, by members of that school who had bled so undoubtingly, that to bleed in such inflammations was not only useless, but positively mischievous,*[In the Bezirkskrankenhaus the mortality from pneumonia from 1842 to 1846 inclusive, was, of the cases treated by blood-letting, 20.4 per cent; by Tart. Ant. and Potassa 20.7 percent; by diet only, i.e., the expectant method, 7.4 percent; Dietl, s. 105.106.] is one of the facts adapted to temper down somewhat the enthusiasm with which the young and inexperienced are prone to receive the dicta of the schools; and also to abate our accustomed reverence for that which presents itself to our confidence on a chief claim of antique acceptance and usage. If there be a greater marvel in human experience than this long confidence in this long practiced and trusted mischief, believed, in not only as a good, but an indispensable good, where shall it be found? So great was still the remaining confidence in blood-letting as a curative of acute inflammations, with those who were already converted to the doctrines of Hahnemann, even so late as the early experience of the writer in the practice of his school, that when they had often seen these affections promptly removed by the internal use of Aconite, according to his teachings, they at once and with general accord christened that drug the “homoeopathic lancet.“This, of course, could only have sprung from a misconception of the nature of the effects of loss of blood and of the drug, which regarded the one as a good for which the other was somehow a substitute. There can be no greater illustration of that facility with which acts are repeated which have become habits, and of that easy compliance with the demands of habit and authority, which never examines the right of the one or the proper foundation of the other, than is afforded by this prolonged practice of blood-letting now so generally acknowledged to be unnecessary, and more than this, now fully proved to be hurtful by the experiments of Dietl and his compeers. There is a better method of dealing with this enemy, and to this we propose to give our attention in the remainder of this paper.
The homoeopathic treatment of pneumonia does not consist in giving a few of the remedies oftenest called for, in succession, through the progress of the disease, to its termination. So far from this is it, that it can only be initiated after a careful individualization of each case, and adaptation of the remedy to its demands, according to the law of similars. This is no less true of this disease than of all others. This remark is made with the more earnestness, because it is believed that the practice of routine prescriptions is more common in this than in most other diseases, Acon., Bry. and Phos. being the first and most common resorts. To give either of these drugs in a case of pneumonia, without such a comparison of the symptoms of the case with the known effects of the drug on the healthy organism, and before the required similarity of these symptoms and effects is ascertained, is as far from Homoeopathy as the use of the lancet, blister, or massive doses of Ant. tart., be the drug given in minutest pellets or in drops of strong tinctures. The public believe, too generally, that Homoeopathy is a question of quantity; the profession should know it is only one of principle. To give Aconite in small doses to the sick because he has pneumonia, and because some of the symptoms of this disease, in some of its forms and stages, are known to be like some of the effects of this drug on the healthy, without reference to this similarity, in this particular case, is no more within the scope of homoeopathic practice than is the giving of massive doses of Tart, ant., Ipecac. or Squilla with a similar disregard of the law. To give this or any other drug because it is known to have cured ten thousand cases called by the same name (no matter in what doses), is so far from Homoeopathy, that it is merely falling back on the only pretended foundation of the practice of the old school, and to abandon utterly that of the new. It is to substitute empiricism for law which the old school ever does, and the new ever condemn. The progress of the treatment is only a repetition of analysis and comparison, each prescription requiring the same care as the first, nothing being left to routine, or taken for granted. The remedy first chosen is to be continued in use so long as the case improves under its action, and no longer. So of the second, third, fourth, etc., if the case require so many. It is not often, when the process of inflammation of the lungs is once set up, that it is removed in the shortest time, with the best results, with one remedy. It is sometimes. The more common experience is, that under the action of a right remedy the case improves for a time and to a certain degree, when it ceases to progress favorably, and another remedy is required, the first not being similar to all the elements of the case. As a rule, this occurs oftener in the treatment of pneumonia than in most other acute diseases. But this is never to encourage or excuse that frequent and hasty changing from one medicine to another, to which an honest desire to do better sometimes impels the practitioner, but which always ends in doing worse. This may be safely avoided by constant reference to the above rule. Is the patient improving? Have new symptoms appeared since the selection of the remedy now in use, and which call for a new one? These are the first two questions at every visit of the patient. If the first be answered in the affirmative and the second in the negative, this is all we need to know to decide a continuance of present treatment.
The choice of a first remedy is materially affected by the question — What is the present stage of the inflammation we are to deal with? Is it the initiatory, that of the simple congestion which immediately precedes the deposit of the inflammatory product, or has the process of deposition already begun? Is this deposit partial or complete? The differences of condition implied in these questions are easy of comprehension, and it would be quite natural to suppose that these would require a corresponding difference in the remedies by which they are to be met and cured, and this supposition simply anticipates the fact. There is nothing more certain than this, that the remedies which remove promptly the initiatory congestion, or arrest the progress of deposition, are no longer of the least value when this process is once completed, and so of those which procure the absorption of the deposited product; they are not of the slightest value in the stage of congestion or partial deposition. A recognition of this fact is indispensable to that success which is unmixed with disappointment.
Though it is easy to comprehend the differences of condition and the consequent difference of remedies here referred to, it is not always easy to determine in practice the exact state of the inflamed organs at any given point of a given case. For a correct judgment of this fact we have to rely on time, the symptoms, and the physical exploration of the condition of the thoracic organs. It is hardly necessary to say of time that alone, it must ever be a most uncertain foundation for a judgment as to the present actual state of the lung, the progress of cases from the point of attack, in a given period, being very different. Some are rapid in their course, passing in a few hours from congestion into deposit of inflammatory product, while in other cases this is more tardily accomplished, and even days pass, and this is not farther advanced, than in the other class of cases it is found after hours. Between these extremes there are all degrees of difference. Hence the necessity of recourse to other helps to our judgment, the first and most obvious of which are the symptoms of the case with which we are dealing, including its history, i. e., an account of the symptoms from the beginning to the time of the examination. If these have been violent from the start, and the febrile reaction excessive, the inference is a correspondingly rapid progress in the development of the subsequent stages of the disease, and of course the reverse of this, where the symptoms and fever have been more moderate in severity. It is not overlooked that this rule is one of comparison only, and that all such rules of practice involve in their nature uncertainties growing out of the different powers of perception of practitioners, the different standards of average violence and progress each may set up for himself, and the difference in the soundness of the judgments by which conclusions are reached. This is all true, and yet the rule has its value and should be received at its true worth, subject of course to whatever deductions these considerations impose. The nature of the symptoms, if carefully studied, will lead to definite conclusions, and this study is a first great duty.
The value of the results obtained by auscultation and percussion have by some been much overestimated and by others as much undervalued. This has in part grown out of the difference in the skill and tact of different practitioners in the use of these means, and in part from a misunderstanding of the nature and relations of the knowledge obtained by these resorts to the practice of our art. The most that can be gained by them, by those who are most practiced and skilful, is a knowledge of condition, while those who are less expert may fail of this entirely or partially, and hence their low estimate of the value of these helps in practice. Those who have erred by placing their value too high, have made them decisive as to the choice of remedial means, while those of the opposite opinion have given them little or no weight in this most important decision, an error certainly of less practical importance than the other, though still an error. They may be made helps, to some extent, in the choice of a remedy, but can never be an authority. This is the extent of their value, to the prescriber, if he be expert in their practice, and the degree of help to be derived from them is somewhat in the ratio of the skill employed in their use. In these remarks it has not been forgotten that the great value of these modern additions to practice is in other spheres of practical duty than that which finds and applies the remedy for the state discovered by their use, viz.: diagnosis and prognosis. Still, a knowledge of the condition of organs has something to do with the selection of the best remedy for the cure of their diseases, if we can get at it, and in none is this more important than in that under consideration. By auscultation and percussion, skillfully practiced (no easy matter), the state of the lung may be ascertained with a tolerable degree of certainty, and this is of value, because on this turns the question as to the class of remedies from which we are to draw the chosen one, and this is about all these means can do for the prescriber. In the individualization of the remedy they have no place. This can only result from the analysis and comparison of the symptoms of the disease and the drug. If the practitioner be not skilled in the practice of these helps to diagnosis, etc., let him study to become so, and by a proper diligence he will soon acquire so much as will enable him to use them to the extent above stated, and beyond this, any attempt to give them place or authority in the process of prescribing, is, in the opinion of the writer, to mistake their nature and uses.
It is the misfortune of physicians and patients that the initiatory stage of pneumonia is too frequently allowed to pass before the case is subjected to treatment. When first called to the patient, the disease has reached or completed the stage of deposit, when it is no longer possible to cut it short at a stroke, as might have been done at an earlier period. Wurmb, for the more convenient consideration and treatment of his subject, divides pneumonia into two stages, characterizing the first by the deposit, and the second the absorption of the inflammatory product. Practically, we believe his first stage is susceptible of a further division into two, with advantage to the treatment; the first consisting of that period of initiation between the first impression of the morbid cause and the beginning of the process of deposit; the second of that in which the process of deposit of the inflammatory product is accomplished. It is not a sufficient argument against the first stage as thus divided, that it is of brief duration or of difficult diagnosis. The question is only whether there be an initiatory stage of such fixed characteristics as to be entitled to distinct consideration in the selection of a remedy for the cure. That it may be brief is true. That, in this respect, cases differ, is not doubtful. The difficulty of diagnosis is believed not to be insuperable.
What are the characteristics of the initiation of the inflammatory process in the lungs? With the first signs are chill of more or less severity; general feeling of malaise; sense of oppression of the chest; more or less difficulty of breathing which is shortened and accelerated; fine sticking pains in the chest; sense of fullness in the chest.; short, dry cough; soreness in the chest, like excoriation; heat in the chest; cutaneous congestion; heat of skin either dry or moist; hot perspiration; pulse full, hard and quick. The resonance on percussion is not so clear as in the healthy lung, nor has it the dullness of the hepatized. The crepitant rale is slight or even not present at all. The patient is weak and must constantly lie down, he is disinclined to all movements. The morale is disturbed — he is impatient of all interferences and annoyance, and wishes to be left in quiet. These are some of the most common symptoms of the attacking stage of this disease. They are seldom absent. With the exception of those disclosed by auscultation and percussion the whole group is found in the pathogenesis of Aconite, most clearly expressed, [See Noack and Trinks Arzneimittellehre, Bd. II, s. 1287] and not with the same completeness in that of any other drug. Each of the individual symptoms may be met in the records of one or several other drugs, but not the entire group, and hence we should be warranted in the conclusion, a priori, that this is the curative, par excellence, in this stage of pneumonia, and this conclusion is fully confirmed by practical experience. The writer has no hesitation in the belief that if rightly used in this early stage of attack, there will be very little left for any other drug to do for the entire restoration of the patient; and none in saying that while Aconite is merely less than supreme in this stage, its sphere of beneficial action is strictly limited to this and the next, the two answering to the first stage of Wurmb, that of deposit. While its great strength is in the initiatory of the attack, it still has a place in the stage of deposit, though it is much less frequently beneficial here. In very many cases, indeed, during the deposit, it is not in place, and if given merely because the lungs are inflamed, it will be followed by no good result. After the stage of deposit is completed no drug is less called for than Aconite, and if given during the stage of absorption, it must be from a misapprehension of the nature of its action, and of the conditions to which this has made it a curative.
In the second stage, in which the process of infiltration and deposit is completed, the above group of symptoms is continued and aggravated unless arrested by the administration of the appropriate curative, and to these may be added the following symptoms which when present are valid reasons for the continued use of Aconite. (See Noack and Trinks, 1oc. cit.)
Cough after drinking; cough excites pain in the larynx; the cough is relieved by lying on the back, and aggravated by lying on either side; cough with stitching pains in the chest; with thin frothy expectoration; expectoration streaked with blood, (see Bryonia and Phosphorus); the oppression and acceleration of the respiration are increased; with these there is pressure under the sternum, with flashing heat and hot perspiration on the forehead; the pressure on the chest is like that of a great weight; frequent deep inspiration; sense of weariness and exhaustion in the chest; even speaking in low tones requires great effort; hoarseness and fullness in the chest; the chest feels as if it would not be expanded; the chest affections are accompanied by internal restlessness, anxiety and heart beating; painful pressure from the sternum to the spine; the seat of the pressing pains in the chest is painful to external pressure; the pains, in the chest, are burning shooting, or burning pressing. It will be noticed that these are symptoms which belong to the early stage of the disease, so that we are directed to the use of Aconite in this stage as well as the demands of the great law of similars, as by the lessons of enlightened experience. If these symptoms are continued to a later stage when Aconite is no longer in place, they are accompanied by others, which are characteristic of other remedies, and which clearly point to their use.
The study of the character of the expectorations is worthy of the careful attention of those who would avoid the misuse of Aconite in this class of pulmonary affections. The first fact which impresses itself on the mind of the student in this investigation is, that the various coughs which it excites are, for the most part, without expectoration. They are irritative, dry, hard, and painful. To this general feature of absence of expectoration there are five exceptions; two of which are quite characteristic of the earliest stage of inflammatory invasion, viz.: gelatinous mucous, and thin frothy, both of which are scanty and difficulty, two of which may find their counterpart in this and the next later stage, viz.: bloody streaked, and dear bright blood; the first is scanty like the other varieties,
while the second may be scanty or profuse, and may also be met where the lungs are not inflamed and yet Aconite be a remedy; the other, the rust colored, is characteristic of this stage of deposit. The second fact, the complement of the first, is, that Aconite has no place in the treatment of pulmonary affections with a free loose expectoration; and to these may be added a third, that it is seldom useful where the morale of the patient is tranquil, passive and uncomplaining.
These remarks on the use of this drug are made because of the conviction that it is very frequently used with no definite view of its exact relationship to the disease, and consequently, often without benefit, with loss of most important time and even with worse results, all of which an understanding of the true sphere of its application would so easily avoid. It will also be seen at once, that if a compliance with the law of cure is a sufficient treatment of disease, the exact similarity of the action of Aconite on the healthy to the symptoms of the disease, in this early stage must make that too frequent resort of giving it in alternation with some other drug, entirely superfluous if not worse. Indeed, the probability is rather, where the similarity is so great, that the action of this second drug will become an element of complication in the case, resulting in embarrassment and mischief. Its use is a violation of the law of cure equally with the administration of drugs without reference to a knowledge of their specific actions on the living organism, or the relations of these to the symptoms of the disease treated. It is also a violation of the law which ought to control the alternation of drugs in the treatment of the sick, and to which the practice should be strictly limited, viz.: to cases where the characteristic symptoms can be found in the pathogenesis of two drugs and cannot be in that of any one. The fact that the characteristics of the early stage of pneumonia are found in the pathogenesis of Aconite has been shown and this of itself is sufficient to exclude the use of all other drugs in this stage, unless there may be exceptional cases, with other symptoms, which for these reasons call for other drugs, and this state of things it will be seen, at once, excludes Aconite.
Bryonia resembles Aconite much in many of the symptoms by which both are related to the disease under consideration. If we were to decide its applicability to a case by sequence of remedies scarcely, its place would be next to Aconite in the series. But this rule is too uncertain to admit of its reception as a general authority. To nothing but the similarity of symptoms to the pathogenesis of the drug can be conceded the control of practice. Still it is true Bryonia is frequently required, by the demands of the law, next after Aconite in the treatment, and the question will have to be met and answered, — how, between two remedies so similar in their symptoms, are we to decide where Aconite ceases to be, and Bryonia becomes, the best of all remedies? The difficulty to the young practitioner, there is none to the mature, will be much diminished by the recollection of the general principle that it is the differences which decide between the choice of two similar remedies, and that the prescribe has, in the selection of the right, nothing to do with the similar symptoms, except to get as entirely rid of them as possible, it being evident, that being equivalents, they mutually neutralize each other, and are thus extinguished as grounds of this decision. On the other hand, the difficulty of avoiding mistakes will be increased by the fact, that many of the differences on which the decision depends are quantitative, and the line is not yet drawn that it can be said of it, all above this is decisive for Aconite and below for Bryonia, and the reverse. And yet these differences are appreciable, and not to be discarded because they require study and careful observation for their ready recognition; for if difficult they are still a very important part of the foundation of all exact prescribing.
In passing from the domain of Aconite to that of Bryonia, the case will have lost some of its symptoms. The perspiration is no longer hot; the morale is no longer restless and complaining but passive; the cetaceous congestion, if it have not disappeared, has been much diminished; the chills have ceased; anxiety, if present, is based on oppressed respiration and not on restlessness of both body and mind. Other symptoms have changed. The difficulty of breathing is referred to pressure on the middle or lower part of the sternum, like a weight; the soreness of excoriation has become that of a bruise; the fine stickings may have disappeared or become broader stabbings; the fullness of the chest has become a sense of pressure from without; the short dry cough is something looser; the expectoration is more copious though not free; it is now yellow and thick, or of copious mucus, or mixed with blood, or (continued from the Aconite state) streaked, or rust colored, and all somewhat difficult, though less so than the expectorations of Aconite. The patient desires constant and, as near as possible, absolute repose, all the sufferings being increased by motion. The nervous system is now more invaded and symptoms of its disturbed functions begin to prevail and perhaps to predominate the vascular symptoms, the reverse of which was true in the earlier stage; at least the case presents more of a mixture of these than before.
If the case be complicated with inflammation of the pleura, as most oases are to a greater or less extent, there will be a point in its progress where Bryonia will be called for, and will not be likely to disappoint our hopes, especially if the attack be of the left side. Wurmb, in his ”Studien,” gives to Bryonia a high place in the treatment of pneumonia with this complication, and also of cases with marked affection of the bronchial mucus surfaces, while, he says, its power to arrest the inflammatory deposit in the parenchyma of the lungs has not been determined by such observations, by auscultation and percussion, as to establish the fact on unquestionable grounds. It may be added to this, that its efficacy in procuring the absorption of this deposit, after the process of hepatization is complete, may well be questioned, while its power to arrest the progress of the earlier stage, of serous infiltration, and remove its product, if given at the right time, and with symptoms appropriate to its use, does not admit of a doubt. The strong ground of Bryonia then is just that which follows the condition in which Aconite has shown its great power. This may not be true of every case and is not. Oases are frequent in practice which do not call for this remedy at all, and it is to be borne in mind, that it is only to be given in cases with symptoms similar to its pathogenesis. Why then these remarks on stages and conditions. Because symptoms are met in later stages which to the inexperienced observer or hasty practitioner seem like those which require this drug, but which a more careful and intelligent examination will show to be a mere seeming, and that other remedies are indicated more or less clearly, by other symptoms associated with these. To give Bryonia in such cases is only to insure the disappointment of the physician and patient. To the truth of this we have all been too often witnesses, and to avoid this mistake and disappointment, by fixing as definitely as possible its true sphere of application, is the object of the above remarks. The idea of this sphere is presented as a help to the prescriber only, not as a sufficient, independent rule of practice. With this explanatory remark we shall proceed somewhat in the same manner to consider Phosphorus.
There are few cases of pneumonia treated by practitioners of Homoeopathy, in which this remedy is not introduced at some period of its progress. With the Homoeopathists of this country its use is very common, and yet it is believed its employment is oftener suggested by a general impression of its usefulness than by a discovery of its Homoeopathicity in individual cases, after a careful comparison of its pathogenesis with the symptoms of the case under treatment Indeed it may be safely received, that few drugs are oftener misapplied, and none in this disease, so generally treated by the suggestions of routine and habit. In this respect, in the new school, Phosphorus stands somewhat as blood-letting has in the old, the unquestioned instrument of an unquestioning confidence. But for the history of blood-letting in this inflammation, and its now acknowledged mischievous results, it might be but reasonable to suppose that the very general use of, and confidence in, Phosphorus, could only have resulted from an experience of its benefits, confirmed by repeated observations. But after the practice of a now known mischievous error, for three thousand years, with a similar universal confidence in its value, the argument from this general use and belief will hardly pass without a challenge. And it ought not. For besides the general duty of careful examination and analysis of cases on which alone a prescription can rightly rest, and never on the common reputation of a drug for power as a curative in a given disease, it is true of the drug under consideration that its success is as certain in pneumonia as its use is universal. We have all had disappointments from its use when our expectations have been confident, and then, perhaps, have consoled ourselves with the hope that it has in some way contributed something towards the general result of a cure, though we could not exactly see at the time how it did it, because a remedy of such universal reputation must have done something. Indeed these disappointments have been far from infrequent, and the continued, unvarying prescription of the drug is only another illustration of the force of habit in the direction and control of professional duties.
If the use of Phosphorus and the practice of blood-letting stand together as illustrating this principle, they are wide apart in the ascertained results of their employment. This is shown by the fact that in the Hospital of the “Barmherzigen Schwestern,” Vienna, under the administration of Dr. Fleischmann, from January, 1835, to December, 1843, the percentage of loss from pneumonia was 6 1/3 per cent., while the average loss from cases treated by blood-letting in different institutions, for a series of years, was over twenty per cent. Fleischmann, at this time, regarded Phosphorus as “the specific “for this inflammation.* [In the Oestreiche Zeitschrift fur Homoeopathic, Band I, Heft. 1, s. 198, after having detailed the treatment of half a dozen cases of pneumonia by Phos. alone, Dr. F. says, “It is not to be doubted that inflammation of the lungs can be cured by different homoeopathic medicines, still the experience of many years has given me the strongest conviction that it can be cured by no other so safely and speedily as by Phosphorus, without the help of any other remedy. And I firmly believe the pneumonia which Phosphorus will not cure, is incurable by the homoeopathic method.” In reading the contrary opinion of Dr. Franz Wurmb, about to be given, it will be recollected that Dr. F. examined his cases and watched the progress of their cure by the helps of auscultation and percussion, in the practice of which he has the reputation of being skilful.] Subsequently from 1844 to 1848 he reduced his loss to 3 5/7 7/1 percent In his earlier cases his faith in his “specific “led him to give it from the beginning of the attack and through the whole course of the disease, and his result was, as compared with that of the expectant method, which Dietl declares the homoeopathic simply to be, 6 1/3 to 7 4/10 The difference is certainly not great, but is in favor of Phosphorus. It is barely possible that this comparison led Dr. Fleischmann to modify his views and practice, and to the realization of a better result. As compared with the success of Reiss, at Liuz, that with Phosphorus as the “specific “is not flattering, and the conclusion is inevitable, whatever our views of “specifics,” that the sole use of this drug in inflammation of the lungs is not the best which the resources of Homoeopathy presents to our confidence.
It is worthy of remark that while this was the opinion and practice of Dr. Fleischmann, Dr. Wurmb, a man certainly of not less practical acumen, in the administration of his hospital in the Leopoldstadt, a suburb in the same city, came to a very different conclusion as to the value of this drug in the treatment of pneumonia. Ho says, “If when speaking of the remedies indicated in fibrinous inflammation of the lungs, we bring Phos. within the circle of our discussion, it is not because we regard it as a homoion against this disease, but rather to apologize for having brought it into use, as its selection, according to the requirements of Homoeopathy, cannot be approved.” That Phosphorus acts upon the lungs he regards as certain; that it produces deposits in these organs, he says, is proved by the experiments of Orfila, Majendie, Bibra and Geist, but these are not similar to the deposit of this form of inflammation; that the similarity of the symptoms and groups of symptoms of the disease to the effects of the drug are only apparent and not real. The proof of this he finds in the fact that “the Phosphorus pneumonia produces no plastic deposit, but rather a decomposition of the lung tissue, or a deposit which favors this destruction; and as shown by Liedbek and Arnold it renders the blood fluid dark, and mottle colored (missfarbig); it diminishes or destroys its coagulability; dissolves or reduces the size and consistency of the blood globules; these assume the most varied forms and lose all traces of their investing membrane. It produces a direct change in the blood and can therefore never be a homoeopathic remedy for fibrinous inflammation of the lungs.” It is quite clear in this statement of Wurmb's that in rejecting Phosphorus in the treatment of pneumonia he is governed wholly by one class of facts, and farther that it is more than possible that that class is only partially presented in the results of the experiments by Liedbek and Arnold. It is well known that most of our polychrests produce effects the opposites of each other, in different individuals and circumstances. The instances of this are too numerous and well known to make the giving of examples at all necessary, yet, as illustrations, it will be permitted to refer to the coma vigil and somnolentum of Opium; constipation and diarrhea of Nux vomica; the excessive and anticipating menstruation of Sulphur, and its entire suppression of that function. Wurmb has given no one reason for denying to Phosphorus, this power of doable action, so common with other drugs, in the class of facts he presents, and we are left to the conviction that he has only given us one side of the picture, the other of which is proved to exist by the clinical success of the drug in the class of cases from which it has been excluded by this partial view. For these reasons it is often the simillimum in pneumonia from change in the blood crasis, or from the tubercular or typhoid state.” He further says, “while we deny to Phosphorus all power over fibrinous pneumonia, other Homoeopathists not only employ it in this, but in all other varieties of the disease, as a polychrest, indeed some of our colleagues see in it the universal specific.”*[Studien, pp. 65, 76.]
Among those who have expressed a different judgment of Phosphorus from the above, is Hartmann. He gives the following as indications for its use: “If all the symptoms of the pneumonia are very severe; if the stabbing pains in the chest, excited or increased by the cough, are extended over a large space (Squilla); if a large portion of the lung is inflamed, and the respiration is consequently much embarrassed (dyspnea); if the cough be very dry, and the expectoration is rust colored †[Where does Hartmann find this symptom accredited to Phosphorus?] (a characteristic symptom), we shall often find Phosphorus the only curative medicine.” The following symptoms are also regarded by this writer as indications for the use of this drug: “Depressed mental activity; slight, bland delirium, with carphalogia and subsultus; rapid sinking of the forces; cold sticky sweat; small, weak, frequent pulse; dull eyes; sunken face; dry lips and tongue; short and difficult respiration; oppression and anxiety; heavy cough; with difficult expectoration.”
In regard to reasons given by Wurmb why Phosphorus cannot be a remedy for true pneumonia, it may be remarked that he has not shown that the law of cure requires similarity in the elements he adduces in his argument. That the similarity which cures is to be sought and found in the similarity of the product of the inflammation and the pathogenesis of the drag, rather than in those subjective symptoms belonging to the case, which have principally heretofore controlled prescriptions in other diseases, is what should have been shown before he claimed authority for his argument. This he has failed to do. That the curing similarity resides in this element may well be doubted. Indeed the analogy, and experience of the treatment of other diseases, are believed to be decidedly against this. The most that can be safely claimed for a knowledge of the character of the product is, that like the condition disclosed by physical exploration, it may be a help, but never a sufficient rule for the choice or rejection of a remedy.
What, then, is the true position of Phosphorus in the treatment of the disease before us? The experience of many practitioners, if not of all who have had much to do with its treatment, will be quite sufficient to show the error of those who would exalt the drug into a general specific; and we hardly need go beyond this for evidence that its entire exclusion from the treatment, on the grounds given by Wurmb, or on any other, is equally a mistake. It is easy to remember cases promptly relieved by its use, and others which have resisted its action and passed on unbenefited. How is this to be accounted for? By the fact that diseases which we call by one name are not indentities to the degree required to bring them into the same relations to curative agents. They may be the same as to identity of morbid products, as these appear to ordinary inspection, or as to the disclosures of physical exploration, and yet be far from that physiological identity which is even similarly impressed by the same agent, and it is this alone which demands the same remedy or the want of this a change. This identity is disclosed by the character of the subjective symptoms of the case, mainly, and that in these is the true home of “the like which cures,” is the experience of those who have trusted these phenomena most, and have submitted their practice chiefly to their control. After a careful study of this class of symptoms in the provings of Phosphorus, it will be very difficult to admit that it is to be discarded from the list of successful remedies in the treatment of pneumonia.
In Hahnemann's Chronische Krankheiten, B. v., we have, in the register of the symptoms of Phosphorus, sensation of dryness in the chest (bronchial?); cough with sticking pains in the hypochondria; cough with shooting pains in the epigastrium, so that she must hold on to the chest; with each concussion of the cough, a sharp pressure in the epigastrium; cough on taking warm or cold drinks; dry and violent cough which excites pain in the front of the chest, which wakes from sleep; cough which excites pain in the abdomen, and compels the holding on to this part because of the pain; loose cough, without expectoration, with pain and sensation of rawness in the chest, so that she fears to cough; cough with white expectoration, difficult to detach; frequent cough with copious expectoration, also at night; continued mucous cough, with painful tightness of the chest (spann-schmerz); cough day and night, with copious mucous expectoration, and after some days severe stitch in the chest while coughing; fine bloody streaks (Blut-Aederchen) in the mucus expectoration; expectoration of blood and mucus, with short, slight cough; the breath is very short after each cough; the breathing is only with a lond rattling; great tightness of the chest and breath very short; short breath with vertigo; anxiety and heaviness on the chest, as if it were pressed together, with obstructed respiration; tightness of the lower part of the chest as if a weight were laid on it; the chest is tight, as if a hand were drawn around it; tension and dryness in the chest; sense of contraction in the whole lung; stitch in the left side of the chest, while breathing; severe stitches in the right and left sides of the chest, in movement and repose; stitches in the left side, under the ribs; pains in the chest, especially while breathing; pressure on the lower part of the chest; bruised pain in the upper part of the chest: when stooping, moving, or while pressed on; weakness in the chest; pain as of excoriation about the clavicles, also to the touch. Any of these symptoms may be met in any case of inflammation of the lungs. All of them have been. And yet there is no one of them that may not be present in cases of less importance.
Wurmb, in his exclusion of Phosphorus from the treatment of pneumonia, lays stress on the inflammation being of the lung parenchyma. He might therefore object to these symptoms as a whole, or individually, that they do not of necessity represent that condition. This is true, and yet they often do belong to it. If he means to limit the term to cases of inflammation of the parenchyma only, he reduces the discussion to narrow limits. The cases, at least in this country, uncomplicated with pleuritis or bronchial affection are quite rare, and there is no doubt, in the present state of our knowledge of the relations of subjective symptoms to pathological conditions, this very uncommon pathological phenomenon cannot be decided to be the exact condition of any case, by the help of these alone. The parenchyma of the lungs is not of the most sensitive nature, even when inflamed, and consequently it manifests in this state but few symptoms, and these not of the most positive character. It is quite different in cases which involve the investing membranes of the serous and mucous surfaces of these organs, and it is with cases involving these that practically we have chiefly to do. If, for science's sake, the disease is to be classified in divisions according as either or neither of these surfaces are involved along with the substance of the lung, practically the classification can only take its place with the helps, which designate the class of remedies from which we are to draw our curative in a given case.
This prepares the way for the answer to the question just put — What is the true position of Phosphorus in the treatment of the disease before us? the answer to this being the object of these remarks. It would seem that there need be no great difficulty in the reply if the symptoms here given are carefully studied, and all the better if the tracheal and bronchial symptoms, which are numerous, be added. The dryness of the air passages, the sense of excoriation in the upper part of the chest, the dry hard cough, cough after drinks, and sense of pressure like a weight on the upper part of the chest, point to bronchial irritation; while the sticking pains when coughing, moving, and breathing; the bruised soreness, especially to the touch, are sufficiently significant of pleuritic affection to make a mistake altogether unlikely. The short, rapid, oppressed respiration, weight in the chest, pressure like a weight on the chest, painful respiration, anxiety, and the characters of some of the varieties of the expectoration are symptoms of the invasion of the lung tissue itself, not easily overlooked. Taking these as our guide, and we can receive no others, we are led naturally and obviously to the judgment that Phosphorus belongs to the treatment of cases of pneumonia when the lung tissue proper only is involved, as well as to those where the membranous surfaces are included. The symptoms compel the conviction that in these cases it must be one of our very best remedies, and we have no hesitation in saying, that this conviction is justified by practice. In the treatment of cases with pre- dominant bronchial symptoms the part which properly be- longs to this remedy can be given to no other without loss. If the pleuritic element be very prominent it will most likely be preceded by other remedies, and only be found most appropriate in the later stage of the case, when the question is the absorption of the inflammatory product. In the treatment of these two varieties the place of Phosphorus as to the period of the attack, is in nearly the opposite extremes. The stronger the prevalence of the bronchial element, the earlier its administration may be called for, while just the reverse is true in the pleuritic variety. In the cases where the hepatization of the affected lung is extensive, which, for convenience, may be called the pulmonary variety, it must be a remedy of the first importance, if the similarity of pathological and pathogenetic symptoms is to be trusted as the exponent of curative relationship. In these cases, being governed by this rule, and also by a somewhat extended experience, we shall put the drug into the treatment after the sharpness of the incipient attack has been somewhat moderated by Aconite and, perhaps, Bryonia, which would bring it into the latter part of the period of the deposit, and the early part of that of absorption. And this is confidently believed to be the true place of this drug, in the treatment of pneumonia, except in the bronchial variety, as already stated. To give Phosphorus in the early stage of the other varieties is to insure ourselves a disappointment. It may be well and interesting to note, that in the published history of Fleischmann's cases, treated exclusively with Phos. (Est. Zeit., Bd. I, Heft. 1, s. 7, 5, 193, et seq.), the improvement was not realized in any of them till after the lapse of some days, though the cases were all recoveries. The persistence and severity of the early symptoms of these cases can hardly fail to suggest that the relief might have been more speedy by the more timely use of some other drug before the Phos. When so given it has been common to alternate it with another drug, for what good reason it is not easy to say. If the other drug were appropriate in this stage, what is to be gained to it or the case by adding Phosphorus, which is not? If Phosphorus be the right remedy it needs no helps from other drugs. The assignment of this drug to the treatment of pneumonia of the typhoid and tubercular states, by Wurmb, is no doubt eminently just, and the results of its judicious use in these cases will hardly fail to be satisfactory.
Sulphur. There is reason for believing that the value of this remedy in the treatment of acute inflammations is far from being duly appreciated. This may have been in part the result of the habit of its use in diseases of chronic inveteracy, and the impression that it may somehow benefit cases of this description which nothing else can; and in part from the classification of remedies which seemed to appropriate an important division, at the head of which is Sulphur, exclusively to the treatment of psoric, or chronic, diseases. The effect of this last consideration has been very considerable in turning away attention from the relations of this class of remedies to important acute diseases, which are not less real than those which are recognized as belonging to the chronic. If the classification of drugs which assigns a division to psoric diseases be understood as limiting the relationship of the class to these affections only, or if it lead to the overlooking or neglect of the other and no less important relations of the class to acute attacks, then, to say the least, the classification is unfortunate. It was the remark of one of our ablest colleagues, to the writer, “you do not know what you have to give to a case till you have studied it; it may be Silicea to the most acute attack.” The experience of years has abundantly proved the truth of this remark, and its value is in no danger of being over-estimated. The similarity of the symptoms, the great law, in all its simplicity, is the controller of the ultimate appeal, in all cases, both acute and chronic.
As in typhoid fever, so here, Sulphur sustains a two-fold relation. First to a class of latent chronic miasms which may become active during the attack, and with which the acute attack is liable to become complicated, and by this association to be rendered less amenable to curative impressions; and second to certain conditions of the acute attack itself. The complication of the attack with the chronic element, (psora,) is to be recognized where, after the proper administration of the true homoeopathic remedy, the symptoms of the case remain unabated, and the disease progresses, without interruption, to an increased extent of inflammation and deposit. In such cases a single dose of Sulphur will often of itself work a great change for the better; or it may be followed, after a suitable time, by the true homoeopathic remedy with success. In these cases the suitable time is not a matter of indifference. What that will be, in a given case, cannot be told beforehand. In this respect cases differ greatly. The safe rule for the inexperienced, is, not to be in a hurry, after giving the Sulphur, to repeat the dose or to follow it with any other remedy. Haste in these cases may do great harm, and is rarely called for. A delay of six, twelve, twenty-four hours, or even longer, may be required to realize the best results. In all cases, and at all times, it is to be borne in mind that that fundamental rule of successful practice, to repeat no dose, and give no additional remedy, while improvement is progressing from that already given, is, if possible, more imperative here than any where else. It is on no account, nor for any reason, to be disregarded. It is also to be remembered, if the object of giving Sulphur be to clear the case of its psoric embarrassment, and so to open the way to the free action of the remedy homoeopathic to the acute attack, no repetition of the dose of the drug, will be called for and that such repetitions will only of themselves become causes of embarrassment which will greatly retard the best progress of the case.
The relation of Sulphur to uncomplicated pneumonia, is to the stage of absorption of the inflammatory product, in which it occupies a place of the first importance. In this stage, when Phosphorus has done good, but has not been equal to the perfect cure, or when the case, at this stage, has failed to respond to Phosphorus, Sulphur is often sufficient to complete the convalescence. This relation is indicated by the symptoms of the drug, and confirmed by practice. In the Chronische Krankheiten, Bd. v. s. 570, et seq., we have — sudden dry cough, as if the lung would be torn out, with increased pain in the head; loose cough with sensation of excoriation or pressure on the chest, and thick mucous expectoration, also with rattling in the trachea and hoarseness; dry, short, severe cough, with pain in the sternum or shootings in the chest; expectoration of greenish masses of sweet taste. With the cough there are — pain in the head as if bruised or torn; from short cough, shaking pain in the top of the head, and pain in the right ribs; painful shock in the head; the throat and chest as if cut; shootings in the region of ensiform cartilage; offensive breath; shooting in the right side; pain in the right side, the spot is painful to pressure; pain in the shoulder-blades: with dry cough, sensation of emptiness in the chest. The greatest dyspnea; shortness of breath from much speaking; obstructed breathing from pressure on the chest; rattling and slight snoring sound ( schnarcheln) in the chest, relieved by expectoration; oppressed breathing when speaking; obstructed breathing in sleep, The must be waked to prevent suffocation; when attempting a deep inspiration, the chest is as if contracted; tightness of the chest as if from adhesions; the breathing is accelerated by rising up in bed; weakness of the chest, she can scarcely breathe; weakness of the chest while speaking; anxiety in the chest; the whole chest as if bound (gespannt); tightness in the right breast and shoulder; pressure upon the chest with anxiety; sensation of heaviness on the chest many days with dry cough; contracting pain in the chest; shootings in the chest as far as to the back; shooting in the left breast while breathing, for some days; shootings in the region of the heart, or in the right side of the chest, nights, when lying on the back, or on the slightest motion; severe shooting from the right side of the chest through the epigastrium and stomach; shooting from the right side of the chest to the shoulder-blade; frightfully painful shooting into the right side of the chest; terrific (erschreckendes) cuttings in the middle of the chest, downwards as far as the epigastrium. Burning in the chest with great heat of the face; burning in the right side of the chest, which comes and goes suddenly. Copious sweating from the least exertion; disposition to sweat from the slightest movement; drops of sweat on the face from the least movement.
It will not be difficult to recognize in this group of symptoms resemblance to those of the last stage of the inflammation before us. Those of the cough, pains, respiration and fever are such as are quite characteristic of it; and when such are met in practice, there needs but a single caution before proceeding to its use, and that is found in the fact that there is a class of cases in which, if carelessly given, it may do great harm, viz.: cases in constitutions with tubercular taint. In such patients, in the stage of hepatization, with symptoms at all threatening suppuration, the inadvertent use of a single dose of this potent drug may precipitate the development of this process, and ensure the destruction of the patient. But these are just the cases where other remedies are in place and Sulphur is not. The relation of Phosphorus to these cases has already been shown, and an equal or greater value is believed to belong to Lachesis in the same state of things. In patients free from this taint, the above-named condition is just that where Sulphur is likely to work the greatest good. “In cases free from complications with other diseases, the violence of the fever, pains and difficult breathing usually subsides, as soon as the infiltration is wholly or mostly accomplished. Art has no other indication before it than to aid nature in its endeavors to remove the exudation, by increasing the activity of the process of absorption; or to oppose it when this product is threatening to pass into purulent degeneration. These indications, according to my experience, are fulfilled by no proved remedy so exactly as by Sulphur” (Wurmb, Studien, 3, 66). This experience of this acute observer and excellent physician, is confirmed „ by the practical observations of many witnesses, whose testimony sufficiently confirms the accuracy of the recorded provings of the drug, and establishes its claim to attention and confidence in the treatment of this stage of the inflammation. But this confidence, if blind and universal, is sure to meet disappointments. Cases are not unfrequently met where Sulphur fails to procure the absorption of the inflammatory product, even where there is no tubercular taint. How can this be true, if the above judgment of Wurmb is well founded? It is in just the way that this class of generalizations are constantly meeting exceptions in practice. The generalization is a truth because the proportion of cases, in which the class of symptoms by which the law of cure brings cases into curative relation to drugs, is greater where these symptoms are more like those of Sulphur than of any other drug. The generalization is true for this reason and no other; and to just this extent and no further. The cases where Sulphur fails are those where this relationship of similarity does not exist. And all attempts at similar practical generalizations, made regardless of this relationship of law, will be very likely to meet quite as many failures as successes. The endeavor to save the necessity for hard study and accurate observation by this practical short cut, can only be at the expense of safety to the patient, and ultimately of the reputation of the prescriber. The appeal, then, in all cases of doubt as to which of the individuals of the class of remedies appropriate to this stage of pneumonia is the remedy for the given case, is to be decided by the greater resemblance of the pathogenesis of any one of them to the symptoms of the case.
The three individuals of this class, oftenest called for, and which in past experience have been followed by the best results, are Phosphorus, Sulphur and Lachesis. Of the two first we have already spoken. Lachesis, in these cases, has received less attention than its merits deserve. One object of bringing it before the reader here is to enter a protest against the unwarranted prejudice, so often met in intercourse with physicians, against this remedy. We feel fully justified, after an experience of its use, extending over a period of more than twenty years, in pronouncing this prejudice without foundation. Its existence is, to the writer, wholly unaccountable. Where the prejudice has been found the strongest it has not been uncommon to hear the objector acknowledge, after declaring he had “not the slightest confidence in Lach.,” that he had never used it; and a very short conversation has been quite sufficient to show that such persons were wholly ignorant of the drug, as represented in its record on the pages of our Materia Medica. How, in the name of all that is rational, could such persons have “confidence” in the drug? Certainly there could be no value in any measure of confidence they might have given it, in these circumstances, and that the converse of this is equally true, is self-evident. It has seemed, on the part of some who have been free to express this reserve of their trust, that they somehow felt the scepticism to reflect upon themselves an honor. In the circumstances stated, it is certain it can only reflect a disgrace. We have not the slightest hesitation in saying, that the record of the pathogenesis of no remedy in the Materia Medica has been more completely vindicated by clinical success; and further, that few drugs have a wider range of application in the treatment of severe diseases. It has been, in the hands of the writer, more than once or twice, the happy means of saving the lives of his best friends, and he is free to confess that this has been repeated so many times, that it is barely possible a portion of the love he bears his friends may have passed to the agent to which they owe it that they still live. And further, we may say, if these happy results have enhanced admiration for the great zeal and industry of that untiring worker to whom we are indebted for this priceless drug, and if they have inspired a high sense of obligation to him for this great gift, it is not strange. We protest, therefore, most earnestly, against this prejudice, and commend the drug to the careful study and confidence of all such as are desirous of discharging their whole duty to the sick who put their trust in them.
In relation to special signs which might enable us to discriminate, in this stage of absorption, the remedy most certain to be followed by success in a given case, we are not yet in possession of observations which have disclosed them, if indeed such signs exist, other than those found in the differential elements of those symptoms of each drug which are similar to symptoms of the others, and to those of the disease. Neither has it been yet established by observation what are the special physical conditions of cases, or what their special complications, or causations which give to either of these remedies a preference over the others in a given case. We have endeavored to point out, in relation to Phosphorus and Sulphur, some of the conditions in which they are found to be especially efficacious; and some in which their use should be avoided, while by giving their symptoms we have endeavored further to elucidate their clinical relations. By the same course as to Lachesis, we may remark that it has been found especially successful in removing deposits resulting from inflammations in lungs already invaded by tubercles, and also from those inflammations of low grade which are not unfrequently developed in the progress of other diseases, for example, in whooping cough. The following case illustrates this:
J. N., aged 7 years, was attacked by whooping cough in the summer of 1858. In infancy, and up to the age of four years, he had been subject to frequent attacks of croup, for which he had had repeated large doses of Ant. tart. This practice had been so frequent and heroic that the child's constitution was much, affected by the drug. He became thin and puny, had deficient appetite, diminished power of digestion, he took cold on the slightest exposures, and then was likely to get symptoms of croup, and always got cough. It was for one of these attacks of croup the writer first saw him. The attack was successfully relieved, and he afterwards had a few doses of Phosphorus200, at seven and fourteen days intervals, and he has since had no more croup. For a long time, however, he gave signs of the injury ho had sustained in the lungs from the druggings he had endured. There was constantly to be heard over a greater or less extent of the lungs a catarrhal rattle, and this was always increased when he took cold. It was in this weakened condition of the lungs that, during the temporary absence of the writer from the country, he contracted his whooping cough. The treatment he received was not successful in abridging the duration of the specific disease, and after he ceased to be subject to the spasmodic symptoms peculiar to whooping cough, he suffered from a teasing dry cough, which was much worse on waking from sleep and during the morning hours. He was a good deal emaciated, appetite and digestion poor, fever every afternoon. There was an absence of respiratory murmur in the upper posterior portion of the right lung, and this region gave a dull resonance on percussion. The other portions of the lungs yielded a clear resonance on percussion, and a dry wheezing murmur throughout their whole extent. It was in this state that the writer found the patient on his return. Lachesis200, two globules in six table-spoonfuls of water, a tea-spoonful night and morning, removed the entire symptoms, including the dullness on percussion, absence of respiratory murmur, and the wheeze, in the short space of fourteen days.
The symptoms of Lachesis similar to those met in this stage of pneumonia, are a tickling cough,*[Noack and Trinks, Arzneim, Band II, s, 1547, et seq.] the tickling being in the larynx, chest, or epigastrium; the expectorated mucus is round and grey, or sticky and yellow, or watery, almost never at night, and is accompanied by coryza. The open air excites severe tickling cough with mucous expectoration, which lasts from five minutes to one honr. The cough seemed to be caused by increased secretion of fluid in the larynx. During the severe cough water runs from the mouth. Cough after every sleep. Cough during sleep of which the patient is unconscious. Short cough. Dry, hacking cough. Suffocation and shortness of breath from the cough. Expectoration frothy, mixed with blood. Pressing pain in the sternum. Difficult breathing the whole day. Breathing impeded by stickings in the chest. Pressure in the chest as if full of wind. Short breath with depression of spirits. Pain in the left side under the breast. The pains in the chest are so severe he does not dare to touch it. Heavy dull pressure in the whole chest. Pressing pain in the chest and between the shoulder blades in the bones of the chest — Throbbing in the chest. Burning in the chest at night, with pain in the sternum. Burning deep in the left side of the chest, much increased by breathing. Shooting in the left side. Shooting in the fore-part of the chest from without inwards. Copious perspiration easily excited. Perspiration during the heat (fever). Cold perspiration with tightness of the chest. Sweating, which relieves. Unpleasant dryness of the hands. Pulse small and rapid with hot skin. Frequent pulse with pains in the chest.
Cannabis. This remedy is in curative relation to the third stage of pneumonia, that of absorption, in that class of cases where the deposit is limited to the lower portion of either or both lungs. It is not to be replaced by any other drug in cases of this kind, especially if there be a difficult, greenish expectoration, with delirium during the fever, and vomiting of greenish bilious matter. In the experience of the writer, in this last stage of the inflammation, the cough, (which in cases appropriate to Cannabis is always frequent, teasing, hard, sometimes dry, sometimes even incessant), oppressed breathing, fever, and dullness on percussion, have all disappeared, in many instances in a short time after its administration, a few hours only sufficing for the relief of the trouble-some cough and oppressed respiration. Its true place in the treatment is late in the third stage.
It would extend this paper beyond the proposed limits to give in detail the special signs which indicate the use of those remedies which are occasionally of value in the treatment of this inflammation. It may, however, be confidently expected, if the disease has been subjected to accurate homoeopathic treatment in its early stage, and its progress carefully watched and met by appropriate remedies according to the suggestions we have endeavored to present to the reader, the number of remedies required for its satisfactory cure, beyond those already considered, will not often be much increased. At the same time it is not forgotten that other remedies may be required in some circumstances or complications. That Tart, ant., Ipec, Nux v., and Senega frequently do great good in the class of cases with marked bronchial character; and Bell., Nit., Sabad. and Squilla with some others, in the variety with pleuritic complication. For the proper selection of either of these, in cases to which they belong, we can here only refer the prescriber to their pathogenesis, In doing this, however, we feel that we cannot too earnestly warn against the desire to give numbers of drugs to a case, in the hope of thereby multiplying curative impressions, and securing a greater good to the patient. If the prescriptions are accurate numerous drugs are not needed; if otherwise, then we only experience drug complications which are often troublesome, or protract the sufferings and danger of the case by refusing to a remedy the time required for the development of its curative action, or this is neutralized or destroyed by the active presence of some other drug, which in its turn is no better managed, and consequently not more efficacious than its predecessor. This series of desultory attempts may be, and often is, continued through a considerable number of drags, till the patient finally recovers by the action of his own inherent powers, or succumbs because these have not been sustained and supplemented by a judicious use of the proper means. In either case, by whatever name his attendant has been called, significant of the school of medicine to which he professes to belong, it is certain the patient has not been treated homoeopathically.
|The American Homoeopathic Review Vol. 04 No. 01-03, 1863, pages 01-08, pages 55-70, pages 100-110
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