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MISS
A 575021
LECTURES
ON
ACUTE AND CHRONIC
DISEASES OF THE CHEST, ETC
Y
R. D. HALE, M. D.
SECOND EDITION.
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EIGHT LECTURES
ON THE

HOMEOPATHIC TREATMENT
BA Lawson, M. D.
ACUTE AND CHRONIC BRONCHITIS,
OF
LARYNGITIS, PLEURITIS, PNEUMONIA, PHTHISIS
PULMONALIS, AND PERICARDITIS,
DELIVERED AT THE LONDON HOMEOPATHIC HOSPITAL,
BY
R. DOUGLAS HALE, M.D., &c., &c.,
LATE PHYSICIAN TO THE LONDON HOMEOPATHIC HOSPITAL.
SIMILIA
SECOND EDITION.

SIMILI
LIBUS
OMOLO
CURANTUR
ΠΑΘΟΣ
HENRY TURNER AND CO.,
OF LONDON,
77, FLEET STREET, E.C.
NEW YORK: BOERICKE & TAFEL.
1877.
INTRODUCTION TO SECOND EDITION.
THE first edition of my lectures on acute affections of
the respiratory organs having proved acceptable to the
profession I have been induced to publish a second
edition, adding to it a course of lectures on some chronic
affections of the same organs. In the second course
of lectures I pursued the same plan as that contem-
plated in the first course, namely, by endeavouring to
describe and explain the mode of procedure which we
follow in the application of the therapeutic law of similia
similibus without entering minutely into the symptoms
or pathology of the diseases treated of. The audience to
whom these lectures were addressed being educated
medical men or advanced students of medicine, I assumed
that they possessed a knowledge of the diseases whose
treatment it was my province to discuss from a point of
view which differed essentially from that teaching to
which they had previously been accustomed in the various
medical schools of so-called orthodox medicine.
In addressing my medical brethren of another school, I
expressed a regret, which I still deeply deplore, that the
rival schools are still separated by a needless gulf which
could easily be bridged over were the love of scientific
truth for its own sake, as well as for the advance of
scientific medicine, the only rivalry between the now
hostile camps. I am bound to claim for our side an
b
978176
iv
PREFACE.
▼
honest desire to accept all the light that orthodox
medicine can afford us bearing upon therapeutics. All we
demand from our opponents is a fair field and no favour,
and a just recognition of our status as legally qualified,
educated medical men, honestly holding to our convictions,
which we maintain are based upon scientific facts; and if
with this they would accept the light that the law of
similars offers them, and would reflect it in their practice,
the advance of the art of medicine would be vastly
accelerated. That it has not advanced is abundantly
proved by the most recent utterances from their ranks.
From Dr. Lauder Brunton, Lecturer on Materia Medica
and Therapeutics at St. Bartholomew's Hospital, we
have the following candid admission, proving the almost
stationary condition of therapeutics from the time of
Hippocrates and Galen to the present hour. In the
first of his Gulstonian Lectures, delivered this year at
the London College of Physicians, he commenced with
these words: 66
Although few persons possessing any
knowledge of the history of medicine will deny that
therapeutics have made some progress during the last
thousand years, yet it is impossible to read the writings of
the ancients without feeling that, not to mention Hippo-
crates and Galen, if some of the old Egyptian physicians
were to arise from their graves and commence practice,
we would have but little cause to sneer at their treatment,
although we have the medical knowledge accumulated
during the two or three thousand years which have.
elapsed since they flourished," and further on he says,
after enumerating the empirical use of the same remedies
the ancients employed by physicians in the present day,
he concludes his exordium thus: "As to the modus
operandi of these remedies, or why they should succeed in
one case and fail in another, the ancient and the modern
would be equally in the dark? for medicine would be an
art and not a science." The aspiration of every physician
should therefore be to examine and test every fact which
1
PREFACE.
}
Oh!
Choppỏ sást e
has been arrived at by experiment and fair induction, from
whatever source it comes, in order to lay the foundation of
a science of medicine.
That a science of medicine is possible may be fairly
predicated when we are enabled to interpret phenomena
by the law which rules them. It is surely fair to assume
that there is a law of nature in every healthy organization
which regulates the various parts and their functions; the
term normal recognises the fact, and if the term abnormal
means without law, it can only be applied to diseased
conditions until it can be proved that in disease there is
no law which accounts for the departure from, or none
which guides to the restoration of, health. It would be
as difficult to believe that if a planet were to be set free
from the attraction which keeps it in its orbit it would
wander into space, free from any other attracting force or
regulating law.
Hahnemann formulated a law of therapeutics (similia
similibus curantur) which, although answering all practical
purposes for the selection of the proper drug in the
majority of cases, does not explain the rationale
of drug action, either in its pathogenetic or curative.
aspects. There is, no doubt, a deeper meaning and a
more profound causation influencing the phenomena of
diseases than can be expressed in any mere formula. The
feeling after, if happily we may find the true explanation
of so much that is obscure, will be the duty and privilege
of future investigators, but even now we get glimpses into
regions of marvellous and hitherto unsuspected realities;
microscopic examination has revealed, this, among other
facts, namely, that each cell or bioplast, each monad,
or leucocyst, has an independent life, and
a life
history consisting of mutations and transformations
which the most fertile imagination could never have
conceived, but which are now seen and registered
with scientific accuracy by many observers amongst the
foremost of whom may be mentioned Dr. Drysdale, of
vi
PREFACE.
Liverpool, and his fellow-worker, Mr. Dollinger. Micro-
scopic discoveries have led to the protoplasmic theory of
life, which may now, I think, cease to be a theory and take
its place as an established fact.
The problem which waits for solution, and can only be
solved by a more intimate knowledge regarding the
changes produced, on the one hand, by those influences
which act upon and derange the healthy metamorphosis.
of cells, or on the other hand, the effect of dynamically
acting drugs in restoring to a healthy condition the
abnormal cell-life which constitutes disease.
The phenomena of inflammation, when viewed in the
light of modern microscopic discovery, comes suggestively
to our aid by enabling us in some measure to anticipate
what future research will, I have reason to believe, more.
fully demonstrate. The dilatation of arteries, veins, and
capillaries, and accelerations of the circulation are the first
of a series of changes, to be followed sooner or later by
retardation of the blood current, until, in a more advanced
stage, stagnation or stasis, occurs, and then migration of
red and white corpuscles and the important changes
which these undergo in the extra vascular connective
tissues. Now, although these phenomena have been
observed and studied with great accuracy, the initiatory
process remains at present undiscovered. We know it is
true that the application of cold or exposure to the air of
any living tissue will soon be followed by the very com-
plex changes which constitute inflammation, but we do
not know as yet the why and the how these changes are
brought about. It may be that cell-life is either paralysed
or destroyed by the agent employed, whether it be
chemical or mechanical, when locally applied, or that, as
in the case of fever, the poison germs have either altered
the condition, deranged the metamorphosis, or destroyed
the vitality of the protoplasmic cells which constitute the
chief elements in the blood; or it may be that the first
factor initiating the change of the physiological into the
PREFACE.
vii
pathological state is to be traced to an arrest of the
energising influence of some nervous centre, from which is
derived the activity of the cells of each individual organ,
thereby causing the disturbance which we call functional.
Upon the same principle nutrition is probably arrested or
prevented by a failure in the trophic cells of the nervous
system to effect those normal changes in the protoplasm
upon which healthy nutrition depends, and I think if
this view of the matter is in accordance with the latest
discovery in the physiology of the nervous system, we are
approaching the solution of a confessedly difficult pro-
blem in relation to the law of similia, &c.
The most recent discoveries in the physiology of the
nervous system, namely, those of Professor Ferrier, prove
the localisation of the centres of nerve force in relation
to muscular motion, and further experiment is leading to
the conclusion, that not only in the case of muscular
motion, but also in connection with the organs of secre-
tion, there are nervous tracts arising in nervous centres,
from which the functional activity of remote organs
proceeds. The first injury from without which causes
the primary morbid change sometimes acts directly upon
the nervous centres, at other times the peripheral nerves
suffer first, and then, by reflex action, the morbid changes
are set up which constitute disorder or disease. It is
not difficult to conceive that a drug, having an elective
affinity for a nervous centre which energises the diseased
organ, should have the power of restoring the arrested
or enfeebled force of that nervous centre to which it
has an undoubted specific relation.
As examples of direct action upon the nervous centres
I may instance the action of the poison of the cobra de
capello, which slays sometimes with the rapidity of
lightening, or the poison of asiatic cholera, which destroys
life in some cases so quickly that there is no time left for
the development of the symptoms which characterise the
disease, and several drugs have the same direct and
•
viii
PREFACE.
rapidly fatal action, e. g. strychnia, hydrocyanic acid,
&c. Examples of indirect or reflex action are more
numerous, and include those drugs which act primarily
upon the periphiræ of the nerves inducing local mani-
festations by reflex action, e. g. tartar emetic, ipecacuanha,
colocynth, &c., but whether the primary action be direct
or otherwise, it is excited in every case upon nervous
matter, and conveyed by nervous tracts to the organs or
structures implicated. There is, most probably, an inter-
mediate class of diseases between those which are the
result of injuries of a non-specific kind, such as most
inflammatory affections, and those of a specific nature,
such as the various forms of fever.
In the latter, the morbid poison would appear to act
directly upon the blood, altering or destroying the normal
condition of its constituents, blighting, as it were, the
nascent blood corpuscles, or arresting the metamorphosis
of the matured protoplasmic cells constituting both kinds
of blood corpuscles.
If these suggestions have any value they at least show
what a complex series of phenomena are involved in
the causation, development, and progress of diseased
action. It is the complexity of the phenomena, and our
ignorance as to the nature of the forces acting within the
living organism, which renders all the attempts hitherto
made to explain the modus operandi of drugs unsatis-
factory.
Dr. R. Hughes, in a lecture lately delivered, examined
and, I think, refuted the various theories of drug action
in vogue up to the present time, but it is the latest of
these I wish to discuss, because I heard it promulgated,
ex cathedra, in a lecture inaugurating a course of lectures
on homœopathic practice of medicine, and not only do I
think the explanation unsound, and not acknowledged or
received by homoeopathists generally, but I hold such a
doctrine opposed to all analogy, reason, or common
sense.
PREFACE.
ix
The propounder of the doctrine of "antipraxy" is our
esteemed colleague Dr. Sharp, of Rugby, from whose
conclusions I am most reluctantly obliged to differ, while
thankfully acknowledging his former most valuable con-
tributions to the literature of homoeopathy, but believing,
as I do, that those conclusions are erroneous, and are
based upon inductions arrived at by experiments which
have the fatal error of being performed upon himself,
without guarding against the influence of "unconscious
cerebration," although made in most perfect good faith.
Dr. Sharp arrives at the following conclusions:
(1) The kind of action varies with the dose."
Now, if Dr. Sharp had stated that the intensity of the
pathogenetic action varied with the magnitude of the dose,
that would be a self-evident proposition which all experi-
ence goes to prove, but that the kind of action varies with
the dose is, I think, contrary to experiment and to fact.
The kind of action, or, in other words, the essential or
specific property of a drug, remains unchanged, irrespec- osir
KEITSE
tively of the magnitude of the dose. The essential property
of aconite is the same from first to last, although its patho-
genetic force, on the one hand, and its curative power on
the other, does vary with the dose. To maintain that the
essential properties of a drug depend upon the dose is to
establish a doctrine subversive of all the previous induc-
tions which homœopathy has accumulated, and is con-
trary to the facts upon which it rests. Dr. Sharp's
second" conclusion" is as follows:

(2.) This variation in a certain range of large doses.
amounts to opposition to the kind of action of another
range of small doses."
Dr. Sharp's usual perspicuity is absent in this axiom,
which being interpreted means, I take it, a certain range
of large doses have an opposite action to a certain range of
small doses. If the opposition here meant is that a small
dose of medicine will act in opposition to a larger dose of
a different medicine, which would be another way of
X
PREFACE.
!
saying that one medicine will antidote another, no one
doubts such a fact; but if the statement means that a
small dose of the same medicine acts in opposition to the
large dose of the same medicine, that is a statement which
from the nature of things, is repugnant to common sense,
is contrary to all experience, and has no possible relation
to the law of similia similibus, &c. Let us, however, look
this doctrine fairly in the face. We give, let us say, a
large dose of a drug capable of causing abnormal condi-
tions in the organism after its kind, and having noted the
amount and direction of the injury we have inflicted we,
at some given time during the progress of the patho-
genesis, administer a small dose of the same medicine, and
that after a time the symptoms subside, the probable and
rational explanation of this supposed reversing action of
small upon the effects of the large dose is, that the large
dose having exhausted its action nature has righted herself.
The only effect, I can conceive, that the smaller dose
could have, would be to retard recovery by an incre-
ment, small though it be, to the same kind of action
originally set up. We come now to Dr. Sharp's third
axiom.
(3) "The direction of this range of large doses is the
same as that of the diseases for which they are remedies."
To this doctrine there can be no objection; it is only
another way of saying that large doses acting as the morbid
process is acting will aggravate the disease. To that
statement I give unqualified assent.
Dr. Sharp's proposition No. 4, namely, "The direction
of the range of small doses is in opposition to that of the
diseases which they cure," which being interpreted simply
means that small doses are curative. That they effect
cure by "opposition" is another matter open to grave
doubt. It may be that small doses, although administered
according to the law of likes curing likes, do really act
antipathically, but how they do so act still remains the un-
solved problem.
2
PREFACE.
xi
C
Dr. Sharp's 5th "conclusion" requires especial ex-
amination. It is thus stated-" This opposite tendency is
shown in health. Its cause, therefore, is not a difference
in the state of the organ arising from disease, but in the
quantity of the drug." If I understand this proposition
correctly, it is intended as proof that inasmuch as this
supposed opposite action of small doses, which has been
proved by experiments upon the healthy organism, is not
the result of any difference in the state of an organ induced
by disease; but whether or not, as we have to do with
organs in a state of disease, we want to know how
drugs affect diseased organs. We do know-what is of
prime importance to remember-that organs altered from
their healthy condition possess a receptivity to the
action of small doses of those drugs which have a specific
relation to them, and it is just because of that specific
relation and intensified receptivity that minute doses,
from the very nature of things, become a necessity. The
conclusion of the whole matter, according to Dr. Sharp,
is this "That the law of Hahnemann, similiar similibus
curantur, remains true when limited to large doses, and
the law of Galen, contraria contrarius curantur, is true
when limited to the action of small doses."
To this con-
clusion we may possibly come, but certainly not for the
reasons adduced in Dr. Sharp's thesis, which concludes
with an aphorism and an hypothesis. Aphorism—“ For
a drug to be a medicine it must have two actions in different
doses: the action of the small dose must be contrary to the
action of the large dose." The hypothesis is more astound-
ing than the popular cure for hydrophobia-" a hair of the
dog that bit you," and if suggested by the cogency of Dr.
Sharp's induction, a reductio ad absurdum. The thera-
peutic law in relation to the dose just quoted as the ultima
ratio of the whole argument, Dr. Sharp "suggests the
idea that for the virulent poisons, such as snake venom,
arsenic, opium, &c., for which no antidotes are known,
the best antidote may be very small doses of itself" (!).
→
xii
PREFACE.
This, even were it true, may be isopathy or "antipraxy,"
but it is not homoeopathy.
In the early part of this preface I have ventured to
suggest, when a more intimate knowledge of the behaviour
of living protoplasm, both in health and disease, is ob-
tained, when the molecular changes occurring in cells
and their nuclei when abnormally disturbed are studied
more intimately, when, in short, cellular pathology in the
hands of a present or some future Virchow has advanced
a stage further, materials will be forthcoming for the
construction of a truly scientific practice of medicine
which will be neither homeopathic, nor allopathic, nor
antipathic, but will be a science having a law of cure
which the law of homoeopathy only at present fore-
shadows, but which will be a higher law because founded
upon knowledge which will then be absolute and not
relative, a knowledge of things which we now only know
in part, but which will then be to the physician not as
now, what they seem to be, but what they are. In the
meantime let us be for ever grateful to Hahnemann and
reverence his memory for the boon we possess in the law
he has discovered for us; let us value it and guide our
practice by it until the advent of a higher law.
Ar
As to the questio vexata of dose, it seems to me to be
irrational for any physician who has ever looked through
a microscope to despise "the day of small things" when
he reflects upon the fact, that we are built up by increments
of very small things indeed, and that vital processes are
carried on by extremely minute cells. Virchow writes:-
“The chief point of the application of histology and patho-
logy is to obtain a recognition of the fact that the cell is
really the ultimate morphological element in which there is
any manifestation of life, and that we must not transfer the
seat of real action to any point beyond the cell." This
being so, the minute dose of the homeopathists, instead of
being a stumbling-block to the reception of their doctrine
and practice, ought, one would think, be a legitimate
•
PREFACE.
xiii
corollary to the facts which histology teaches; for surely
if, as Virchow says, the cell is really the ultimate
element in which there is any manifestation of life, the
agent employed to act potentially upon cell-life ought to
be equally minute. I would fain close these prefatory
remarks here, were I not anxious to call the attention of
my brother practitioners to the fact, that there is a
growing tendency amongst some of us to ignore such
considerations as are here suggested, and to view the
human organism more as a piece of rough machinery, to
be hammered into order by equally rough and crude
materials, than what it really is, a complex arrangement
of vibrating atoms and molecules of infinite minuteness,
and yet of stupendous energy and force; and therefore
this very condition of its ultimate elements upon which
all the phenomena of life, whether normal or abnormal,
depends, renders the attenuation of medicinal substances
a logical necessity, and entirely in harmony with the
known facts of histology. It would extend these remarks
too far to discuss the question of the dynamization of
medicinal substances; I would only venture to remark,
that there are proofs to be offered from many facts well
known to physicists to support the theory.
It is well known that the molecular and electrical con-
dition of many substances undergo remarkable changes,
by which their potential properties become intensified,
and if so, it is, reasoning from analogy, reasonable to pre-
dicate that substances so potentialised would have their
specific properties increased by such processes as the
pharmaceutist employs; and, moreover, it is difficult to
conceive how inert insoluble substances can possess
dynamic force by simply minute subdivision, unless in
the process there is an augmentation of their specific
action.
In conclusion, I offer the matters treated of in this
preface in no dogmatic spirit, and to those who may
be
induced to read this second edition of my lectures I have
xiv
PREFACE.
1
only to repeat what was written in the concluding sen-
tence of the introduction to the first edition.
1
58, HARLEY STREET,
June, 1877.
}
I
R. D. H.
INTRODUCTION TO FIRST EDITION.
WITH the many guide-books, domestic and quasi-pro-
fessional, which are sown broadcast for the edification of
homœopathic amateurs, lay and medical, and which pro-
fess to give information about the symptoms and treat-
ment of every disease under the sun, what necessity, it
may be asked, is there for so small a contribution to the
literature of homoeopathy as that now presented in these
pages? To reply to this question, it will be only neces-
sary to state that the object of the lectures inaugurated
by the British Homœopathic Society was to afford the
medical profession generally an opportunity of obtaining
that kind of information about homoeopathy which it was
thought could not be so readily acquired from other
sources. These lectures appeared first in the Monthly
Homeopathic Review, and at the suggestion of some
friends, I venture to present them to the profession, in a
separate form, claiming for them neither originality nor
novelty.
The object which the Society had in view was (1) to
explain the principles upon which medicines are adminis→
tered homœopathically, which was most ably done by
Dr. Dudgeon in his second lecture. (2) To examine the
properties and pathogenesis of drugs in relation to the
therapeutic law of homoeopathy-a duty fulfilled admir-
ably by Dr. Richard Hughes. (3) To point out how the
therapeutic law is applied in the treatment of acute
inflammatory disease, by a few lectures of a practical
character. This duty fell to my lot, and, in fulfilling it,
xvi
INTRODUCTION.
I shrank from attempting anything in an educational
sense, as if I were presuming to instruct an already
educated audience; but my aim was to try to point out.
the rationale of the homeopathic treatment, and to show
that it is essentially a system of medicine, neither based
upon any theory of the nature of the disease, nor the
modus operandi of the remedy on the one hand, nor upon
empirical experience on the other, but upon a study of
the symptoms by which the disease manifests itself, the
co-relation they bear to the pathological seat when dis-
coverable, and the relation these hold to the remedy which
bears the closest resemblance in its pathogenesis to the
totality of the subjective and objective phenomena of the
disease. This I sought to do by selecting the most salient
symptoms of each disease, and then by pointing out the
practical application of the therapeutical law, similia
similibus, &c., I hoped to render this mode of practice at
least intelligible to an audience, who, by their presence,
seemed to wish for information.
The affections chosen were such as I thought would
interest enquirers, and such as I could discuss more
advantageously than many other forms of disease met
with in practice.
I am fully aware of the many shortcomings these
lectures exhibit, and how very imperfectly they represent
anything approaching a systematic plan. They are
merely tentative and suggestive, and therefore cannot
pretend to a completeness which was neither contem-
plated nor attempted; but if they have in any measure
succeeded in removing ignorant prejudice, or have stimu-
lated any desires to examine further into the claims of
homœopathy, or to put them fairly to the test in practice,
their object has been accomplished.
58, HARLEY STREET,
August, 1875.
H
R. D. H.
LECTURE I.-ACUTE BRONCHITIS
""
""
"
در
""
در
در
CONTENTS.
II. LARYNGITIS
III.-PLEURISY
IV.-PNEUMONIA
V.-CHRONIC BRONCHITIS
VI.—
93
""
VIII. PERICARDITIS.
(continued)
VII.-PHTHISIS PULMONALIS .
·
4
PAGE
1
16
29
40
50
. 61
71
86
•
•
LECTURE I.—Acute Bronchitis.
GENTLEMEN,-In the lectures lately delivered in this
place, the principles of homoeopathy were so ably pre-
sented to you, that it will not be necessary for me to
occupy your time by doing more than recalling to your
minds the facts then dwelt upon; yet, as those principles
will be applied to practice in the observations I shall have
the honour to address to you in this and my subsequent
lectures, a few words of caution become necessary, lest
those principles should suffer at my hands by the way in
which they may be presented to you, or that, while
endeavouring to explain to you in the simplest language
I can use, the practical application of our therapeutic law,
I should mislead you into any erroneous conceptions, by
attempting to lay down with precision definite rules for
the treatment of any disease. In the present state of our
knowledge, it would be vain to attempt to do so, and it
would be moreover mischievous. Let me explain: we are
often asked, what medicine do you give in such and such
a disease? All we can say in reply is, that as a general
rule we find such and such a remedy or remedies gene-
rally successful in the particular disease named; but as,
in point of fact, we do not treat a name but a morbid
condition of one or more deranged functions or organic
changes, made known to us by phenomena which we term
symptoms and signs, our province is to note these col-
lectively as a whole, and for the cure of this morbid con-
dition find the pathogenetic analogue. Now, as these
phenomena are neither constant in any given disease abso-
lutely, nor exactly similar in any, two individuals, it is
evident that it is impossible, and would be irrational, to
administer the same drug to every case which we diagnose
as any particular disease or disorder to which we attach a
name. We cannot, however, dispense with nomenclature,
which is a useful help in directing us to the medicines
which are placed under the heading of the disease we
diagnose, and thus shortening the time spent in finding
1
2
LECTURE 1.
the drug or drugs whose pathogenesis we are to study in
relation to the case in hand. All that I can attempt in
these lectures is to select types of the acute affections of
the organs of respiration, and by taking the most salient
symptoms and physical signs by which these affections
manifest themselves, endeavour to point out the co-relation
which a few of the most frequently indicated remedies
bear to the morbid conditions homœopathically. Allow
me to say, there is no royal road to the practice of homœo-
pathy patient and careful study of the Materia Medica
on the one hand, and an intelligent individualization of
every case on the other, are essential elements in suc-
cessful practice.
A few words more, relative to another point, will detain
us, by way of explanation, before entering upon the sub-
ject I have selected for my first lecture. In addressing
myself to the task of lecturing on acute diseases of the
organs of respiration and their homœopathic treatment, I
shall take it for granted that those gentlemen who have
done me the honour of being present to-day are con-
versant with the etiology and pathology of those diseases,
and that therefore it would be superfluous for me to dwell
at any length on those subjects, except as bearing more
or less directly upon the elucidation of our mode of treat-
ment, and, if in doing so I shall be able to prove that the
charge of neglecting pathology, which is often preferred
against homoeopathy, is groundless and contrary to the
fact, I trust I shall succeed in removing some of the
prejudices which are stumbling-blocks to many of our
brethren of a different school-stumbling-blocks which
are hindrances to that candid and fair examination of the
system of medicine called homœopathy, and that practical
trial of its claims, which alone will convince enquirers of
its value in the cure or alleviation of disease.
To my colleagues of the homoeopathic school, I beg to
say that I do not pretend that I have anything to teach
them, and trust that they will bear with me while discuss-
ing the treatment of the diseases I have elected to lecture
upon, as I shall have to dwell upon or enter into details
with which they are perfectly familiar; and in connexion
with such details, I wish, as far as possible, and entirely,
if possible, to avoid all controversy with regard to the
vexed question of dose, by simply stating the doses which
I myself have found most successful in practice. To those
Z
ACUTE BRONCHITIS.
3
gentlemen of an opposite faith to my own, I beg to give
the assurance that, in discussing the treatment of disease,
I shall endeavour to avoid a single expression that could
be misinterpreted into anything savouring of offence,
ridicule, or injustice. I will limit myself to a profound
expression of regret that any barrier should exist pre-
venting that free and candid interchange of thought or
experience between the two schools of medicine which
would, in my opinion, be of mutual benefit and help in
the search after truth in therapeutics. With these few
introductory remarks, I come to the consideration of the
subject immediately before us. And first, I have to
observe that I have chosen to explain the principles of
our treatment of acute disease because they admit of
more simple elucidation, and because the phenomena of
diseased action in its acute forms are less complicated
than in chronic diseases, the subjective symptoms are less
numerous, and the selection of the appropriate remedy less
difficult, and the results of treatment are more quickly
manifest.
Now a few words as to our mode of selection. To
explain this, I must just contrast this mode with that of
the ordinary practice. In the latter, the language usually
adopted is pretty much the following, as heard in lectures
on the practice of physic: "Gentlemen,-In the treat-
ment of this disease (let us suppose pneumonia) your first
duty is to place the patient in the most favourable hygienic
conditions, as to complete rest in bed, where warmth,
suitable diet, and other adjuvantia are such as the case
requires; and with regard to the administration of medi-
cine, the indications of treatment will be best carried out
by prescribing those remedies which will subdue the
symptomatic fever, quiet the circulation and determine to
the skin; and if you find that any of the secretions are in
an unhealthy condition, you will add to your prescription
those medicines which are likely to restore healthy secre-
tions." Then will follow directions for the administration
of the medicines which are supposed to fulfil the indi-
cations for the choice of the drug or drugs, depending
either upon some theory about the disease or the modus
operandi of the medicine, or (which is, no doubt, a safer
rule of practice) the method based upon experience ab
usu in morbis.
Now the homoeopathic method differs essentially from
4
LECTURE I.
-
this. It is based on no theory of disease, or of the modus
operandi of medicines, although there is nothing to pre-
vent homœopathists indulging in theories or scientific
speculations; but if true to the principles inculcated by
Hahnemann, they must discard speculation, and base
their treatment on the selection of a remedy, the sum total
of whose pathogenetic symptoms bears the closest resem-
blance to the sum total of the symptoms, both subjective
and objective, which form the features of the natural or
idiopathic disease. "Look upon this picture and upon
this," is Hamlet's appeal to his mother, when he presents
to her in violent contrast the portraiture of two brothers;
the one is "Hyperion to a satyr." But the homeopathist
seeks to trace the closest resemblance, the reflection; as it
were, and the analogue between the disease and the cura-
tive agent when he has found this, he has found the
similimum which, in not a few cases, may, without ex-
aggeration, claim to possess a specific action. Let me,
however, not be misunderstood when I speak of finding
the medicine. This might lead you to suppose that every
acute disease was to be forthwith cured by one well-
chosen drug such a brilliant result is possible, and I have
in course of my experience often witnessed such a result ;
but it is certainly not the rule, nor should we on scientific
grounds expect it to be such. No, the simplest acute
inflammatory affection passes through well-recognised
stages, with their accompanying and changing conditions
of circulation, secretion, exudation, &c.; and to meet
these changing conditions demands a change of remedy-
the features of the picture have changed. It may so
happen that we are called in to an acute case in its very
earliest stage; here one medicine will often suffice to cut
short the inflammation. This I have seen over and over
again, and the effect of a few rapidly administered doses
of aconite in cutting short an attack of simple catarrh
every tyro in homeopathy knows full well. As we shall
have frequently to refer to the action of this drug as we
go on, I will not dwell upon it now, further than to say
that it is our sheet-anchor in the early stages of almost all
acute inflammations.
The more or less acute affection which is termed BRON-
CHITIS, having its anatomical seat in the mucous membrane
of the bronchial tubes, is the first disease which claims.
our attention, because it is really what might be called
ACUTE BRONCHITIS.
50
2
the key to the correct understanding of many of the other
inflammatory conditions of the organs contained in the
cavity of the thorax; it frequently accompanies pleuritis,
pericarditis, and pneumonia, the last-named disease being
in many cases, especially in children, an extension of
inflammation into the air-cells, when it constitutes pneu-
monic inflammation proper; where it seems to be chiefly
in the finer ramifications of the bronchial tubes, it receives
the name of capillary bronchitis; and when it involves
the vesicular structure as well, the term broncho-pneu-
monia expresses its anatomical seat. We thus see that
there is, as it were, a shading off of one pathological con-
dition into the other. The first link in the chain of these
phenomena may be and often is, in the first instance,
simple nasal catarrh, which, passing down, extends to the
larger bronchi, from them to the finer ramifications, and
from these, if not arrested, the diseased action travels into
the deeper-seated structures, and its rate of progress, as
you all know, is in young children so exceedingly rapid,
that we are often not called in until the secretive stage is
far advanced, oxygenation of the blood arrested, the brain
supplied with impure blood; asphyxia and death closes
the mortal life of many a child which a day or two before
the attack appeared to be in perfect health. I may just
observe, parenthetically, that the tendency of the disease
under consideration in the young child is certainly not to
spontaneous recovery, but, on the contrary, demands the
promptest treatment, in order to prevent its running a
rapidly fatal course. I need scarcely say that we seldom
meet with this form of acute bronchitis in the adult, in
which it more commonly assumes the subacute form, and
therefore less frequently endangers life. Allow me to
take a typical case of this disease of infancy, to illustrate
our treatment.
The child of Mrs. K., six months old, a girl, had, about
a month before the present attack, symptoms of croup,
which were promptly subdued by treatment. The sym-
ptoms now present are, greatly accelerated respiration and
pulse-the latter almost uncountable; the alæ nasi are
in rapid motion; the face pallid with a distressed expres-
sion; sucking at the breast for more than a few seconds at
a time impossible, owing to the hurried breathing and a
short hacking cough. Upon auscultation sibilant råles of
considerable intensity are heard all over the chest, an-
6
LECTURE I.
teriorly and posteriorly, but no amount of appreciable
dulness on percussion can be detected. The skin is hot,
the lips are red and parched, and the urine is high
coloured. The temperature was not taken; but, judging
by the hand, it could not have been under 102 or 103.
There were no symptoms of gastro-enteric irritation, and
the irritation of dentition had not yet begun. We have
here then an uncomplicated case of acute bronchitis in the
infant. The treatment was simple and the choice of the
medicine easily made; and 99 out of every 100 prac-
titioners would have, without any hesitation, chosen
aconite.
Let us pause for a moment to compare salient patho-
genetic symptoms of aconite with the symptoms of the
natural disease. These are of course entirely objective in
the case of infants and dumb animals, and from these alone
can we make our diagnosis, or upon an understanding of
their import base our treatment; and here, in passing, I
would remark that in the provings of drugs by Hahnemann
and most of his followers, the objective symptoms of some.
of our most important medicines, if noticed at all, were
very insufficiently observed; and, in so far as they were
not registered, homœopathy labours under the disadvantage
of having, by accumulating clinical experience, to sup-
plement this want at a time when physical diagnosis is of
so much importance. The truth is, that Hahnemann and
his immediate followers had carried on their experimental
trials of drugs upon the healthy organism years before
physical diagnosis (as far, at least, as regards thoracic
disease) was thought of, except in the roughest possible
way. Hahnemann published his Organon in 1810; and
not until six years later did Laennec publish his work on
Auscultation, a work which revolutionized the old methods
of diagnosis as much in Laennec's day as Hahnemann's
discovery is revolutionising therapeutics in our day.
After this digression I will return to the case before-
mentioned; and before coming to the treatment, allow me
to compare the objective symptoms of aconite with those
of acute bronchitis roughly, without going into the nicer
shades of the pathogenesis: we have rigors, followed by
heat of skin, flushed face, these symptoms sometimes
alternating; and, in some provers, burning heat of the
skin was produced, and this is a very characteristic sym-
ptom of aconite; the heat of skin becoming excessive with
ACUTE BRONCHITIS.
7
L
thirst-acceleration of pulse and hurried breathing: here
we have all the symptoms of symptomatic fever; and, as a
rule, when symptomatic fever is present in the early stage
of any acute local inflammation, the indication for aconite
is so strong that, in my opinion, it is good practice to ad-
minister this drug whatever the local inflammation may be.
This as a general rule, which of course has its exceptions;
and I beg you to remember that I limit its use chiefly to
the early stages of the inflammatory process, and for this
reason, that in later stages of inflammation of any organ
you will have structural changes which, though accom-
panied by symptomatic fever, require a remedy having a
specific relation not only to the affected organ, but to the
particular lesion causing the symptomatic fever. Aconite
may often be specific to the local inflammation, in which,
case the inflammation is cut short, and no other medicine
is needed; but in the great majority of cases aconite plays
the part which venesection plays in subduing the increased
general circulation, but without robbing the system of the
vital fluid, which subsequently is needed for the restorative
efforts of nature. The recognition of this fact has, no
doubt, operated in bringing about the almost general
disuse of the lancet, because on no other ground could
the success of the expectant treatment be explained or
justified.
Aconite, then, takes the place of blood-letting; it lowers
the action of the heart, quiets the pulse, reduces the tem-
perature, and restores cutaneous action; and thus, if it be
not the specific agent in arresting diseased action in the
affected organ, it operates in a very striking manner in
paving the way, so to speak, for the action of the drug
which has the closest elective affinity to the morbid process.
taking place in the organ affected. Those gentlemen pre-
sent who have heard Dr. Hughes lecture on Aconite, will
have learnt the main facts about it from his lucid descrip-
tion; but, were further evidence wanted as to the thera-
peutic value of this drug, I would refer them to the 4th
edition of Dr. Ringer's Handbook of Therapeutics, an ex-
tract or two from which I will read-just, however,
remarking that the effects upon acute inflammation, which
are new facts to him, and which he describes as mar-
vellous," have been known to homeopathists by almost
daily experience for the last half-century. For the sake
of suffering humanity we are glad that a Professor of
66
8
LECTURE I.
1
Therapeutics is educating his brethren of so-called or-
thodox medicine to receive and even applaud discoveries
which do not come to them stamped with the reviled name
of homœopathy.
To return to the treatment of acute bronchitis in the
child. During the first few hours of the attack, aconite
is the chief and generally the only medicine demanded:
I give half-drop doses of the 3x tincture every two, three
or four hours, according to the urgency of the symptoms,
in some cases the severity of the symptoms may be such.
as to require the administration of aconite every half-hour
or hour. The rule of practice which I myself adopt, and
which I believe to be a good one, is to direct the doses to
be given at longer intervals, as the symptoms abate in
severity, and if, on my next visit, I find the pulse less
frequent, the respirations less hurried and distressed and
the skin moist, I discontinue the aconite for a few hours,
thus allowing the drug to exhaust its action before giving
any other medicine which the conditions of the case may
demand. What are usually those conditions? 1st, you
may have the satisfaction of finding the inflammation
entirely arrested, and, with the exception of a loose cough,
which in a few hours almost ceases, the child assuming its
usual aspect and sucking at ease, in which case there will
be no indication for further medication. 2ndly, we may
find that, although the systematic fever has abated, instead
of a return of the normal respiratory murmur, you may
have sibilant râles, mixed with muco-crepitating râles-
and, on coughing, the child appears to have soreness of
the chest; the cough is concussive, sometimes ending in
retching or actual vomiting; there is a gasping for air pre-
ceding the cough, which often causes momentary deter-
mination of blood to the head. The medicine indicated is
bryonia alba, which I generally give in the same dilution
and dose as aconite, repeating the dose every two or three
hours until there is a decided change in the symptoms and
physical signs. 3rdly, we may have a much graver state
of things. Auscultation may now indicate that the finer
ramifications of the bronchial tubes and even the air-cells
are implicated. Fine crepitating râles are heard in
detached lobules, there is some amount of dulness on per-
cussion, the temperature rises, the cough becomes more
hacking and constant, and appears to cause pain of a more
acute character than the soreness which accompanies the
ACUTE BRONCHITIS.
9
inflammation of the larger bronchi; the cheeks are more
flushed and the flush is circumscribed, and, as a matter of
course, the respiration and pulse are accelerated. We
now have catarrhal pneumonia, complicating a case which
began with simple bronchitis. I have frequently noticed
that in addition to general increase of temperature over
the body, there is a still higher temperature over the
inflamed portion of lung in a pneumonic condition; and
the circumscribed flush on the cheeks is more intense on
the affected side. As, however, I shall have to recur to
these symptoms when speaking of the form of pneumonia
most frequently met with in adults, I will not dwell
further upon these phenomena of the disease under con-
sideration, neither will I dwell upon the pathogenesis of
the medicine which, in nine cases out of ten, we find truly
homœopathic to this assemblage of symptoms and patho-
logical condition-namely phosphorus.
It may here perhaps be asked, does not aconite seem
more indicated, because of the acceleration of pulse and
respiration and increase of temperature? Not so. Aconite
does not produce the pathological condition called pneu-
monia, but phosphorus does; its action is, therefore, more
specific, and we select it on that account. In this form of
catarrhal pneumonia in young children, I usually give the
6th dilution of phosphorus, in quarter or half-drop doses,
every two, three or four hours.
of
4thly, we may have to treat a still more serious array
symptoms, for, although the before-mentioned pneumonia
complication may not supervene in the case, a still more
dangerous change in the condition of the bronchial tubes.
more frequently occurs,-supersecretion of mucus, which,
when accompanied, as it so frequently is, with paralysis of
the bronchial muscles, is the fatal conclusion of the large
number of deaths from infantile bronchitis, which the
Registrar-General's reports contain every quarter. The
symptoms are so familiar to you, that I need only just
roughly mention the most salient. The child breathes
with increasing difficulty and distress-cough often almost
absent a symptom of most serious import, indicating a
partially paralysed state of the bronchial muscles, and, as
a consequence, increased blocking up of the bronchial
tubes; the face is pale and has a most distressed expression,
and there is more or less lividity of the lips and finger
nails. These latter symptoms, if accompanied with cold-
!
10
LECTURE I.
ness of the cheeks and nose, and cold, clammy perspiration,
too plainly indicate a speedily fatal termination.
The stethoscopic signs are not so much changed in
character, as they are intensified, save that the sibilant
râles are, as it were, drowned by the loudness of the
muco-crepitating. If called in for the first time to a case
presenting symptoms of such extreme gravity, there is not
much to be done under any system of medicine; but
having seen cases snatched almost from the jaws of death,
I feel justified in recommending every effort we can make
to save life, even when all seems hopeless. Arsenicum
holds the first place as a remedy in this state of things,
given in frequently repeated doses every hour, or oftener,
and with it, brandy in doses suitable to the age of the
child.
(
In the earlier stage of supersecretion, before the oc-
currence of symptoms showing failing vitality, I have, in
my own experience, derived the most signal help from
tartar emetic in the 3x dilution, given in half-drop doses
every two or three hours. To those who would wish to
compare the symptoms I have but roughly indicated with
the pathogenesis of tartarized antimony, I cannot do
better than advise them to read the pathogenesis of the
drug in Allen's Encyclopædia just published, also a paper
on tartar emetic by Drs. Madden and Hughes, in the
25th vol., and a review of a thesis by Dr. Molin in the
6th vol. of the British Journal of Homeopathy, and in a
recent lecture in this room by Dr. Hughes, the subject
was treated almost exhaustively, affording almost all the
information we possess about the drug.
But let me now trace the similarity to the secretive
stage of the disease before us in a few of the more salient
chest symptoms. In my introductory remarks, you will
remember, I stated that it was impossible to lay down any
general plan of treatment absolutely, because every case
ought to be studied by itself, and as completely indivi-
dualised as time will permit. It is quite impossible, in
lecturing upon any disease or its treatment, to dwell upon
the finer shades of symptoms by which we are often
obliged to differentiate one medicine from another.
only broadly indicate the relation tartar emetic bears to
the kind of bronchitis under consideration, and also, which
is most important, to the stage of the disease, the few
symptoms I shall enumerate are sufficient to show the
I can
>
ACUTE BRONCHITIS,
11
gravity of the bronchial lesions tartar emetic is capable of
producing.
The respirations are short, heavy, anxious, and difficult,
amounting in some provers to a sense of suffocation, the
result of supersecretion, for if there is sufficient power
retained to cough and expectorate, relief is obtained; and
here I would again remark that in the provings of tartar
emetic there is the same poverty of observation with
regard to physical diagnosis-with the exception of one
symptom noticed in the proving, namely, "the mucous
rattles in the chest "there is no other auscultatory sign
mentioned; but here come in to our help all the aids
which auscultation gives us, and by it are compensated for
the omissions in the provings, detecting and measuring
the anatomical seat, the intensity and extent of the lesion;
by it we correct any wrong impressions which might be
produced, were we to form a diagnosis from subjective
symptoms only. These are, of course, absent in very
young children, and when they are the subjects of any
acute disease we are solely guided by what the eye can
see, the ear hear, or the hand feel.
One symptom more, and a symptom of great import-
ance, will complete the picture, which will, I hope, suffi-
ciently prove the homeopathic relation to this form and
stage of bronchitis. This symptom is lividity of the face,
showing imperfect arterialization of the blood. This is a
very marked symptom, indicating tartar emetic.
I repeat again, then, that tartar emetic is our sheet-
anchor in the advanced stage of infantile bronchitis, as
well as in cases where the inflammation extends into the
air-cells, constituting what is termed broncho-pneumonia;
and as this has more immediate connection with the patho-
logical condition we have been dwelling upon, I think it
will be well to speak here of the treatment of the pneu-
monic complication in children, instead of deferring it
until I have to speak upon pneumonia occurring in the
adult subject.
The pneumonic inflammation which supervenes upon
acute bronchitis in the young subject is usually catarrhal
pneumonia, occupying isolated lobules, and differing in
that respect from croupous pneumonia as well as from the
absence of the plastic exudation which characterises the
latter disease. The physical signs of catarrhal pneumonia
do not enable us, when taken alone, to diagnose it from
12
LECTURE I.
the croupous form, but the history of the attack will, in
most cases, enable us to do so. If the first symptoms were
distinctly those of ordinary bronchial catarrh or if they
have supervened upon measles or hooping-cough, and if
the physical signs are those common to both forms of
pneumonia, we are pretty safe in diagnosing the catarrhal
form.
Niemeyer's remarks on this point are of great practical
value in assisting to form a correct diagnosis, upon which
the selection of the remedy will greatly depend; for ex-
ample, if the history of the case, the totality of the sym-
ptoms, lead to the diagnosis of catarrhal pneumonia, the
drug which will probably be found to bear the closest
homœopathic relation to the morbid process is tartar
emetic; if, on the other hand, the history, symptoms, and
physical signs indicate a condition of the lung more re-
sembling croupous pneumonia, I believe the medicine
having the closest specific relation to croupous pneu-
monia is phosphorus, which I usually prescribe in the
3rd or 6th dilution in half-drop doses to very young
children.
I do not wish it to be understood from what I have
just said that every case of catarrhal pneumonia will
demand tartar emetic, and every case of croupous pneu-
monia will call for the administration of phosphorus.
That would indeed be misleading; for cases are met with
in practice in which neither tartar emetic or phosphorus
would either of them have proved most curative. My
introductory remarks, have, I trust, sufficiently explained
why we cannot indulge in such sweeping generalizations.
I now beg to direct your attention to the subject of
acute bronchitis in the adult and its treatment. The
difference between the affection in the child and adult is
one more of degree than a difference in kind, and yet
there is a very essential difference in many respects. In
the child, unless as a sequel of measles or hooping-cough,
capillary bronchitis and broncho-pneumonia may occur,
without the existence of any antecedent unhealthy condi-
tion of the bronchial tubes or pulmonary tissue; in the
adult, in the great majority of cases, an acute inflamma-
tion of the bronchial mucous membrane usually attacks
that membrane which has been suffering from a sub-acute
condition, or supervenes upon chronic bronchitis; and
this again, in many cases, is complicated with gastro-
+
ACUTE BRONCHITIS.
13
hepatic derangement-a very common complication; or
there may be cardiac disease or asthma, and all three may
coexist with renal mischief. It is, therefore, evident that
the treatment of this disease is much more difficult,
although happily it does not pursue its destructive course
with the same rapidity that characterises the acute affec-
tion in the child. We are also aided in finding the
proper medicines by the subjective symptoms, as well as
by the objective, and also we are enabled to examine the
character of the sputa, which is next to impossible with
young children, and the character of the sputa becomes in
many cases a most important guide to the remedy, with
regard to which I can only venture very curiously to offer
some practical hints as to the choice of one medicine in
preference to another.
If the symptoms are ushered in with rigors, followed by
dry heat of skin, frequent tickling cough, constriction of
the chest with sensation of rawness in throat, extending
down behind the sternum, with acceleration of pulse and
arterial tension, headache, and general malaise, I need
scarcely say that aconite, given in drop doses of the 3x
dilution, frequently repeated, will be, in 99 cases out of
100, the proper remedy; and this remedy alone, if given
early in such an attack, has, over and over again, in my
experience, and in that of most practitioners, arrested all
further symptoms of a serious character.
Let us suppose, however, that although the pyrexial
symptoms, the incessant cough, the constriction of the
chest and rawness, with other of the most urgent conges-
tive symptoms have moderated, the pulse is quieter, the
respiration less hurried, the temperature lowered, yet
there is concussive cough, which causes headache, the
walls of the chest feel sore, there is scanty and difficult
expectoration, the tongue is white, or has a frothy saliva
adhering to it, the skin inclined to perspire instead of
being hot and dry, the urine high-coloured, throwing
down lithates, the medicine indicated will be bryonia
alba 3x in drop doses every three or four hours. I do
not here enumerate the physical signs in the adult, which
differ but little from those of the child, the difference
being that they are of less intense loudness. There is
one point of practical importance, according to my own
opinion, with regard to bryonia, namely, that, supposing
aconite had not preceded it in the treatment of bronchitis,
14
LECTURE 1.
and also in the treatment of acute rheumatism, I have
almost invariably found that bryonia does not begin to
produce its curative action until a few doses of aconite
have been first administered.
In the adult, notwithstanding that bronchitis does not
often occur in so very acute a form as in childhood, the
secretive stage is one of great danger, especially in elderly
people, or in those broken down by long-contiuued
chronic bronchitis, especially if there be in addition heart
disease.
Here again, as in the child, tart. emetic is of signal
service. I usually prescribe it in the 3x dilution, or if
the reactive powers of the system are at a low ebb, in
grain doses of the 1st trituration. If vitality is very
feeble, the temperature falling, with increasing dyspnoea
and great restlessness, arsenicum 3 or 3x every hour or
two, or according to the urgency of the symptoms, will be
the medicine upon which to rely for supporting vitality.
If the circulation be failing, and venous congestion, indi-
cated by lividity of the surface, exists with icy coldness,
then the medicine I have seen act, sometimes with extra-
ordinary restorative power, is carbo vegetabilis. I find a
good plan, in these cases of great prostration, is to give
arsenicum every hour or two for four or five hours, and
then to give carbo vegetabilis in the same way for some
hours. I consider this a more satisfactory way of admin-
istering medicine than alternating one medicine after
another in quick succession. I know that many good
homœopathists do so alternate remedies, but I cannot
think it scientific, and if the action of either medicine is
antidotal to the other, I do think the practice is more
honoured in the breach than in the observance.
I do not
presume to give this opinion ex cathedra, but only as my
own individual conviction, and without the slightest wish.
to disparage or doubt the success which follows a different
mode of prescribing. Let every man do what seemeth
best to win.
I wish now to say a few words upon another form of
bronchitis, which we meet with mostly in the sub-acute
condition. The following are its most characteristic
symptoms:-The cough seems to proceed from a spot in
the epigastric region, which is tender to the touch; there
is a sense of weight and soreness in the chest, which feels
oppressed; there is often wheezing; there are sometimes
ACUTE BRONCHITIS.
15
•
stitches felt under the sternum when coughing, and there
is inability to take a deep breath, and some of the sym-
ptoms are excited by taking food, or during the first stage
of the digestive process; the tongue is coated sometimes
thickly with brown or yellowish fur at the root, often
morbidly red, with raised papillæ. The sputa are espe-
cially characteristic-a tough, plastic mucus, which can
be drawn into long strings. This group of symptoms
points to a gastro-hepatic complication, or at least to a
very irritable and hyperæmic condition, not only of the
bronchial mucous membrane, but also of the mucous
membrane of the fauces, the pharynx and gastric mucous
membrane, and, in some well-marked cases of this plastic
bronchitis, the sputa are sometimes expectorated, retain-
ing moulds of the bronchial tubes even to some of the
finer ramifications.
The drug which is the truest similimum to this form of
bronchitis is bichromate of potash, which I have found
most curative in the dilutions ranging from 3x to 6 cent.,
and there are few remedies from which are obtained more
brilliant results. I give drop doses of one of the dilu-
tions I have named every four or five hours, and very few
cases of uncomplicated bronchitis, having the symptoms
before described, fail to yield to this invaluable drug.
T
Before concluding the subject which has engaged our
attention, I would beg to say a few words upon the treat-
ment of secondary bronchitis, which will differ chiefly in
this respect, that, having to treat the sequelae of an ante-
cedent morbid process, the consequence of a specific cause,
we must not attack the symptoms vi et armis, because we
have to deal with a state of things where the general
strength of the system is reduced by the previous attack.
of measles, scarlatina, typhoid, or typhus, so that our anti-
phlogistic aconite will be seldom required; and remem-
bering this important difference, we must be, as in the
primary affection, guided by the totality of the sym-
ptoms, and here, more than ever, observe the physical signs
by which alone even the existence of local inflammation
can be detected.
Where my subject not limited to the consideration of
acute affections of these important organs, I might have
been led on to the nature and treatment of sub-acute
affections, but the time at my disposal will not permit of
this. On some future occasion I may have the pleasure
16
LECTURE II.
of lecturing on these and some other diseases of the chest
which we meet with in everyday practice.
In conclusion, I wish to say that although the medi-
cines mentioned in the course of my remarks are those
chiefly demanded in the treatment of catarrhal bronchitis,
capillary bronchitis, and broncho-pneumonia in the child,
and in the forms in which the disease occurs in the adult,
there are several other drugs of signal service in those
affections where the symptoms correspond with the patho-
genesis of those other remedies, among which I would
mention the following:-belladonna, ipecacuanha, hepar
sulphuris, squills, mercury, senega, and sulphur.
LECTURE II.-Acute Inflammation of the Larynx and
Trachea.
GENTLEMEN,-
I have now to speak about acute inflammation of the
inlet, the janua vite to the respiratory apparatus. If we
compare the size of the larynx with the thorax and the
organs it contains, it appears a very small organ; but
when we consider the complexity of its structure, the
delicacy of its organization, and how richly it is supplied
with nerves and blood-vessels, and if, in addition, we
think of the various functions it performs, we shall the
better understand how important becomes a right under-
standing of the morbid changes to which it is subject.
When, moreover, we consider its exposed position, its
mobility, and the strain to which it is hourly subjected in
the production of human speech and vocalisation, and, in
addition, the sympathetic connection which exists between
it and the stomach-an organ itself exposed to such rough
treatment by its omnivorous owner-the wonder is that
the larynx is not more frequently attacked with acute
disease than it is.
Having only to speak about acute inflammatory affec-
tions of the larynx and trachea, I will not occupy your
$
ACUTE INFLAMMATION OF THE LARYNX AND TRACHEA.
17
time by mentioning the various sub-acute and chronic
affections and structural changes to which the organs of
voice are subject. An entire course of lectures might be
well employed in discussing these affections and their
homœopathic treatment.
With regard to the diagnosis of chronic affections of the
larynx, the laryngoscope has become of late years a valu-
able aid in enabling us to see various morbid appearances
in the organ. I doubt very much whether it enables us,
as homœopathists, to prescribe with greater accuracy or
success than we are enabled to do guided by symptoms
and an external physical examination. To those practi-
tioners who treat laryngeal affections by topical applica-
tions, examination by the laryngoscope enables them not
only to see the diseased surface, but also to apply their
local remedy.
A very striking instance, showing the value of the in-
strument, occurred not very long ago in Dublin. A
patient, who had consulted several medical men
account of complete aphonia, which had lasted for, I
think, three or four years, and which nothing that they
prescribed had in the least removed, at last consulted a
gentleman who had been well trained in the use of the
laryngoscope. This aphonia was cured almost instanta-
neously by the removal, with a forceps, of a polypoid
growth, which was attached to the mucous membrane in
close proximity to the vocal chords. If, for no other
reason, one such example as this of the value of the laryn-
goscope, would prevent any man in his senses from under-
valuing it as a valuable aid to diagnosis; but I wish to point.
out this consideration-that, inasmuch as our more specific
application of drugs having an elective affinity for the
morbid process, whatever it may be (with the exception of
incurable malignant diseases), and administered in obe-
dience to the law of similars, we do not, as a rule, require
the aid of topical applications. The character of the
cough, pain, tenderness on pressure, nature of the expec-
toration, and a study of all the symptoms which, com-
bined, form a true picture of the case, enable us to select.
the medicine which, in its pathogenesis, reflects with the
greatest clearness the symptoms of the natural disease.
Excuse this reiteration of a fundamental axiom, which
is so strangely misinterpreted by those who have not, or
will not, put it to the test in practice.
2
18
LECTURE IÌ.
I would fain, in these lectures, avoid every approach to
a controversial argument; but I must be permitted, in
justice to homœopathy, emphatically to deny the state-
ment which is constantly made, namely, that we ignore or
neglect pathology.
So far from this being the case, there is no fact in phy-
siology, histology, pathology, or morbid anatomy, that is
not of as great value to us as to any other school of medi-
cine. As diagnostic helps we employ the microscope, the
test tube, the ophthalmoscope, the laryngoscope.
Our
hygienic rules are precisely the same as those of all intelli-
gent medical men; and the diet we prescribe, excepting
the prohibition of coffee and medicinal condiments,
differs very little from that prescribed by our allopathic
brethren.
I now come to speak upon the immediate subject of
this lecture-acute inflammation of the larynx and trachea,
and, as in the case of bronchitis, I drew your attention
to the disease occurring in childhood and infancy, so
here I think it well to select the same period of life,
because, during it, acute affections of the windpipe pre-
sent their most striking manifestations.
Now, as touching the pathology of laryngeal inflamma-
tion in the child, we are met on the very threshold of the
enquiry with the remarkable divergence of opinion among
pathologists as to the true definition of that most serious
form of disease called croup. The question to be solved
is this: Ought the inflammation of the windpipe in the
young child, having a catarrhal origin, manifesting all the
symptoms, local and constitutional, of inflammation of the
mucous membrane of the larynx and trachea, which
becomes vascular and swollen, and sometimes oedematous,
narrowing the inlet to the lungs, and, when accompanied
by an exudation of plastic nature, ends in apnoea and
death, be designated croup; or should that name be re-
stricted to a morbid condition of the larynx, which is
diphtheritic, and nothing else?
Very eminent authorities are at issue about the etiology
of croup. Trousseau, Sir Thomas Watson, and others,
draw a broad line of distinction between catarrhal laryn-
gitis and true croup, restricting the name to a complica-
tion of diphtheria; whereas Niemeyer and Sir William
Jenner adhere to, what I venture to think, the sounder
view-that acute laryngitis in the child does not essen-
ACUTE INFLAMMATION OF THE LARYNX AND TRACHEA.
tially differ from true croup, but that, under certain con-
ditions, the morbid process may become diphtheritic.
19
Niemeyer's lucid definition is of such great practical
value that, I think, I need not apologise for transcribing
it here. Niemeyer writes thus upon the etiology of
croup:
66
Croupous inflammations are inflammatory disorders,
in which a fibrous exudation, which rapidly coagulates,
is thrown out upon the free surface of a mucous mem-
brane, but which involves the epithelium only. If the
croup membrane thus formed be detached, it is quickly
reproduced. No loss of substance occurs in the mucous
membrane itself, and no scar remains.'
99
Now, please to observe, comes the important distinction
which Niemeyer so clearly points out. "The diphtheritic
process is also characterised by the production of a fibrin-
ous, rapidly-coagulable exudation, but differs from croup,
the exudation forming not merely upon the surface of the
membrane, but also within its substance. The pressure
upon the blood-vessels excited by this interstitial exuda-
tion, as well as by the swollen elements of the tissues.
results in sloughing of a portion of the influenced mucous.
membrane, and in the formation of a so-called diphtheritic
eschar, which, upon separating, occasions a loss of sub-
stance, and consequent cicatrix.
"Of these two forms of inflammation (the essential
quality of which has of late been much in dispute) it is
almost exclusively the croupous form which appears in the
mucous membrane of the respiratory passages; and it is
only in rare and solitary instances of secondary croup,
when that malady forms part of some general acute infec-
tious disorder-as measles, scarlatina, smallpox, typhus,
or epidemic diphtheria-that a transition from croupous
to diphtheritic inflammation is observable. Even here,
too, though the pharynx may be the seat of a most exqui-
site diphtheria, it is far more common-and it is, in fact,
the rule-for the laryngeal inflammation to retain the
characteristics of true croup.'
In confirmation of this view of the disease I will quote
Sir William Jenner's most pertinent questions:-" Are
diphtheria and croup essentially the same disease?"
And he answers in these words: "I think not; because
there is no evidence to show that croup is anything but a
local disease, or that it is contagious, or occurs as a wide-
,"
1
20
བྷ
LECTURE II.
2.
spread epidemic, affecting a large proportion of adults, or
that albumen is in the urine, or that symptoms of dis-
ordered innervation follow recovery from the primary
affection."
This was the opinion of Sir William Jenner in 1861,
and I do not know whether he has changed his views
since.
The late Dr. Hillier was the first to propound the doc-
trine to which Sir T. Watson gives his adhesion; and
yet Sir Thomas, in his lecture on diphtheria, says: "I
had been for more than a quarter of a century in practice
in London before I ever met with a case of diphtheria.
دو
It was not until after the year 1855 that the disease
appeared in this country and became an epidemic. Now,
what were all the fatal cases of croup which Sir Thomas
Watson must have seen in those twenty-five years? Can
we imagine that a disease unknown to the profession until
1855, which must have attacked hundreds upon hundreds
of children, could have been a form of diphtheria, or, if
diphtheria, should have been unaccompanied by the other
well-marked symptoms of that terrible disease?
Were further arguments necessary to prove that true
croup is not necessarily diphtheritic, I would ask: Is
there a tittle of evidence to show that croup, except in its
diphtheritic form, is infectious?
I think I am justified in saying that all experience is
against such a conclusion; and experience, I think, proves
that, in the great majority of cases, the exciting cause is
suddenly checked cutaneous action, and not the poison
of sewer-gas or any other kind of malaria.
That a terribly fatal form of croup is often met with
during an epidemic diphtheria, and that even when there
is no such epidemic prevalent, isolated cases of diphthe-
ritic croup often occur, no one will deny; but that is a
very different thing to saying that all cases of true croup
are essentially diphtheritic.
What, then, it may be asked, is false croup? There
are two kinds—one an entirely different disease, which,
though manifesting itself often with a fatal suddenness, is
not a disease of the larynx at all, but one of the neuroses,
and has its cause in the nervous centres, and the pheno-
mena of the disease are the result of reflex action.
The exciting causes are various. The irritation of
teething, gastric irritation, or the pressure of tumours, or
ACUTE INFLAMMATION OF THE LARYNX AND TRACHEA. 21
an unabsorbed thymus gland upon the recurrent branch of
the vagus nerve; and I have seen cases where the excit-
ing cause was distinctly in the brain itself, or its mem-
branes.
**
The diagnosis of this spurious croup is most important,
because the treatment is totally different from that neces-
sary in inflammatory croup. Into this I will not enter, as
this affection does not belong to the class of inflammatory
diseases we are considering.
There is another and comparatively harmless affection
often met with in children who are the victims of a mor-
bidly sensitive organisation. They are often not decidedly
strumous or rickety, but they have a very excitable and
irritable condition of the nerve tissue. An ordinary cold,
accompanied by a cough, which in other children differ-
ently organised would be an honest barking cough, or a
cough occurring in paroxysms, or even during sleep, will
in these children produce a spasm of the glottis, produc-
ing a cough and stridor closely resembling croup, and
sometimes like hooping-cough, but there is neither hoarse-
ness, nor fever, nor quickened pulse, and the spasm occurs
capriciously, mostly occurring during or in the act of
waking out of sleep. There is a certain amount usually
of congestion of the mucous membrane of the fauces and
larynx, but short of inflammation.
Now, although the inexperienced practitioner may
think he has got a case of true croup to treat, and may be
led to boast of the rapid success of his treatment, he has
not really had a genuine inflammatory croup to contend.
with. Nevertheless, this spasm, although only an accom-
paniment of simple catarrh, should not lead us to treat
lightly such a symptom, because the case may develope
into true inflammatory croup if neglected, or if the child
be exposed to a fresh chill.
Should any amount of hoarseness accompany the spasm
of the glottis, there would be an additional reason for
caution and watchfulness, because hoarseness in a young
child is a symptom of more serious import than it is in the
adult. So that, should the temperature rise, the spasm
become more frequent, the pulse accelerated, and the
voice more husky, inflammation is impending, or has
commenced.
The symptoms I have just mentioned are indeed the
symptoms of croup in its first stage, and, if not promptly
22
LECTURE II.
.
subdued, the mucous membrane becomes at first dry,
turgid, and more congested, the cough assumes its charac-
teristic brazen sound, the short-lived spasm becomes
stridor, the child grasps at the throat as if to remove some
obstructing substance, the breathing is quickened and
laboured, the child sometimes sleeps for a short time, and,
while sleeping, may breathe with somewhat less difficulty,
but cough and spasm wake the little patient, and the
struggle for breath comes on with increased severity.
During the cough portions of the exuded false mem-
brane sometimes comes away, with partial and temporary
relief; but if the process of exudation be not arrested, the
larynx and trachea become so narrowed that respiration
becomes impossible, the surface becomes livid, cold per-
spiration breaks out, coma supervenes, and sometimes
convulsions and complete apnoea closes the scene.
That tracheotomy has succeeded in saving life before
the last fatal symptoms have come on, the records of medi-
cine no doubt prove; but the number of cases where life
has been saved by the operation, compared with those
where it has failed, presents, alas! an enormous majority
of the latter, and for the following reasons:-
In children under two years of age the trachea is too
small for the operation to have much chance of success;
and even in older children, although the calibre of the
tube is greater, and, in consequence, the operation less
difficult, the cause of the exudation is not removed by the
operation, the false membrane continues to be formed
below the artificial opening, or, if that hopeless result do
not follow, acute inflammatory action continues to extend
deeper into the pulmonary mucous membrane, and even
into the finer tubes, and the child succumbs to capillary
bronchitis, because its vis vitæ has become exhausted by
the antecedent struggle through which it has passed. It
becomes, therefore, a point of supreme importance to
decide at what stage of croup we are justified in resorting
to tracheotomy. If we operate too early in the case we
have not given time for general treatment to have its
curative effect; and, if too late, we have wasted the time
during which there was a chance of the operation suc-
ceeding.
In homœopathic practice, happily, we are not so fre-
quently placed in this painful dilemma; for in the great
majority of cases, where our treatment has been applied
ACUTE INFLAMMATION OF THE LARYNX AND TRACHEA. 23
before any great amount of exudation has taken place, the
specific medication we employ arrests the inflammation of
which the exudation is the product.
As the result of my own experience of the thirty years
I have practised homeopathy, I can say that I don't
remember having lost a single case of croup where I have
been called in within the first six or eight hours, or before
any fatal amount of exudation had formed.
Were it possible to select the acute inflammation of any
organ as a crucial test of the great superiority of homœo-
pathic treatment over any other, I should be inclined to
choose non-diphtheritic croup. The difficulty of such a
test, I need scarcely say, consists in the impossibility of
meeting with two cases of this or any other disease exactly
alike in the conditions present.
The treatment of this formidable disease upon the prin-
eiple of like curing like will now engage our attention.
In the early stage, when fever, quickened pulse, flushed
face, characteristic cough as if through a brass trumpet,
increasing hoarseness, restlessness, all indicating impend-
ing danger (and quite a different state of things to that
before described, where there is only occasionally recur-
ring spasm, and no exaltation of temperature or accelera-
tion of pulse), we know that there is a congestive vascu-
larity and dryness of the inflamed mucous membrane.
The increased redness can be seen in the fauces, and the
epiglottis can sometimes be seen swollen. As in the
earlier stages of acute bronchitis, so in this of croup,
aconite takes precedence of every other drug; and it
ought to be given in frequently-repeated doses. Half-
drop or drop of tr. of aconite, from the 1x to 3x, are the
doses I have found most efficacious. Except in a few
rare cases, I have found the 3x dilution effect all the good
I could have desired. Guided by the urgency of the
symptoms, I give aconite every hour, half-hour, or quarter-
of-an-hour. If the air be very dry, an important aid to
the purely medicinal treatment is to keep it moist by the
steam from a common kettle; but a kettle made for the
purpose, with a long tube for conveying the steam into
the room, and close to the patient, if necessary, is a most
useful article to have in every house. If this plan of
treatment be steadily pursued for some hours, you will,
in the great majority of cases, have the satisfaction of
finding your little patient upon your next visit safe
•
24
LECTURE II.
from further mischief, the cough will have lost much of
its harsh tone, the skin will be perspiring freely, the spas-
modic closing of the glottis will occur less frequently, and,
instead of a plastic exudation, the cough, by its character,
indicates that there is merely an easily-detached mucus
secreted-an infallible sign of resolution.
We must, however, be on our guard against relapse;
and now, laying aside our aconite, the symptoms requiring
it having subsided, we give the remedy which this stage
and kind of secretion demand—namely, hepar sulphuris,
the antiquated name for sulphide of calcium.
This medicine I generally give in the 5th cent. dilu-
tion, in half-drop doses, every two or three hours, and,
with these two remedies-aconite and hepar sulphuris—I
have seen scores of cases make most satisfactory recoveries
from impending mischief.
All cases, however, will not thus promptly yield to
aconite, followed by hepar sulphuris; and then more
alarming symptoms occur-the inspirations are more pro-
longed, the rasping sound, the stridor becomes louder, you
see the child cough, but the thickened mucous membrane
covering the vocal chords, prevents them vibrating, and
no cough is heard. For this condition of things two
medicines, and I think I may say only two, claim our
attention. These are spongia and iodine.
In Vol. X of the British Journal of Homœopathy
there is a very learned essay on this disease by Dr. Elb,
who gives to iodine the first place, as having the closest
specific relation to membranous croup; and he goes so
far as to advise that even in the very earliest stage it
should be given instead of aconite. But I have never had
the courage to dispense with our great antiphlogistic
remedy in combating the incipient symptoms of this affec-
tion, or in substituting iodine for spongia in the exudative
condition we are now considering; and having followed
the example of the late Professor Henderson and other
physicians, now no more, in the successful administration
of aconite, hepar, and spongia, I do not see sufficient
reason for adopting Dr. Elb's suggestion.
If we study the pathogenesis of iodine alone, it certainly
bears a closer resemblance to the symptoms of croup than
spongia; but a suggestion thrown out by the author of a
thesis on croup, in the fifth vol. of the British Journal, is
worth considering, and it is this: bromine as well as
"
ACUTE LARYNGITIS IN THE ADULT.
25
iodine has also croup-producing symptoms, and as spongia
contains both iodine and bromine, may not the generally
acknowledged efficacy of spongia be due to the fact that
it is a compound of these two elementary substances, and
on that account has been so signally successful with the
great majority of practitioners? In common, then, with
most practitioners, I have chiefly relied upon burnt sponge
when the symptoms I have just mentioned are present in
croup, and the most satisfactory results have attended its
administration.
I cannot recall any cases in which I have required any
medicines in this disease but the three I have named—
aconite, hepar s., and spongia. Croup, as you know, has
a great tendency to recur in children who have once had
it. One of my own children has had three attacks; and
it is stated that children living on the sea coast, or in the
vicinity of large sheets of water, are more liable to the
disease than those living inland, or where there is no ex-
panse of water in the neighbourhood.
Phosphorus has the reputation of removing the suscepti-
bility to this local inflammation; but I cannot verify this
from my own experience, although, from the well-known
specific action of that substance upon the organs of respi-
ration, there is good ground for the belief.
Acute Laryngitis in the Adult.
Acute laryngitis in the adult differs, in many important
particulars, from croupy inflammation in the child. First
and foremost, it is rarely, or never, accompanied by the
exudation of plastic lymph.
2ndly. It differs from croup in the inflammation being
more local, often occupying little more than a square inch
of mucous membrane.
3rdly. Owing to the wider calibre of the organ, there
is less imminent danger than in the case of younger sub-
jects. It is, however, often a very formidable disease in
grown-up persons; for, although every common cold,
accompanied by hoarseness and cough, is, strictly speak-
ing, a hyperæmic and somewhat inflamed state of the
organ of voice, it is only when the inflammation runs
high, and that thickening, greatly increased vascularity,
and sometimes oedema of the glottis and epiglottis, follow
upon what was at first simple catarrh, that dangerous
symptoms occur.
26
LECTURE II.
In this disease a correct diagnosis is of the utmost
importance, for, if it be mistaken for tonsillitis and treated
accordingly, I need scarcely say the mistake is likely to
prove fatal.
A case which occurred in my practice will illustrate the
ordinary symptoms of this disease in its acute form. I
was summoned to see a gentleman, over 60, who had
taken a severe chill while going about London in a
Hansom cab on a very raw, cold day in February. He
was attacked the following morning with pain and sore-
ness in the larynx, with a throttling sensation and painful
deglutition; there was a hoarse muffled cough and stridu-
lous breathing, the countenance had an anxious expres-
sion, and the eyeballs protruded unnaturally with the
efforts in making slow inspirations, the pulse was fre-
quent, the skin hot and the face flushed. On examining
the fauces, instead of injected dry and swollen tonsils,
there was a good deal of mucus thrown out upon the
lining membrane of the fauces, the uvula was oedema-
tous, and, if it could be seen, I have no doubt the epi-
glottis would have been the same; the voice was nearly
extinct, and the larynx was tender on pressure. The
case was one of considerable gravity.
The treatment consisted in giving aconite 3x in drop
doses every two hours through the afternoon of the day
when I first saw the patient, and during the night. On
the following day, most of the urgent symptoms having
subsided, I gave hepar sulphuris, the cough becoming
loose and the expectoration free, the voice regaining some
amount of resonance, and the whole aspect of the patient
so far improved as to be pronounced out of danger. I
left him with directions to continue the hepar s. at longer
intervals, and on my next visit he was convalescent.
You will observe that in this case the only medicines
given were aconite and hepar s. Spongia was not indi-
cated, because, although there was stridulous breathing,
owing to the narrowing of the glottis by the swollen and
œdematous condition of the membrane, the dryness of
the organ which characterises the laryngeal symptoms of
burnt sponge was absent. Tartar emetic, indeed, was
probably more indicated than spongia, but I am led to
think that when tartar emetic is found to be curative in
laryngeal inflammation, there has been an extension of it
into the larger bronchi, or that it has spread upwards
ACUTE LARYNGITIS IN THE ADULT.
27
from the latter into the trachea and larynx. My opinion
on this point is based upon the fact that, in the pathoge-
nesis of tartarized antimony, the laryngeal symptoms are
evidently closely associated with, or are concomitants of
bronchial inflammation; but in the pathogenesis of spongia,
it is evident that the morbid action is concentrated in the
larynx and trachea, while those of the bronchi or pulmo-
nary tissue are comparatively insignificant, and those re-
ferable to the lungs seem to be caused by obstruction to
the ingress of air through the vocal organs.
In conclusion, a few remarks on tracheotomy in the
adult will not be out of place. The operation is easier in
the full-grown organ; that is an important element favour-
ing its success, and a still more important fact is that, as I
have said, the inflammation is generally limited to the
larynx in the adult, whereas in croup all experience goes
to prove that, in the great majority of cases, there is bron-
chial inflammation complicating the laryngeal affection;
and lastly, exudation of the plastic products of inflamma-
tion, as far as the larynx and trachea are concerned, ist
rarely met with. Tracheotomy is, therefore, not only jus-
tifiable, but becomes imperatively necessary in the adult
when general treatment has failed, and life is endangered
by the closing up of this important and delicate organ.
I have yet to speak of secondary croup, the diagnosis of
which ought not to be a matter of difficulty, if the history
of the case is enquired into. It will then be found that
the child has had some form of specific fever, diphtheria,
or blood poisoning, in some shape or other. It is not
unfrequently met with during the subsidence of one of
the exanthemata; nevertheless, the diagnosis is of so much
importance as influencing treatment, that I will make no
apology for directing your attention to it during the few
minutes left to me; and I cannot do better than read you
the lucid comparison which Dr. Stokes, of Dublin, draws
in his work on Diseases of the Chest-a work which, I
think, few modern treatises equal, and which none sur-
pass for perspicuity of diction and practical knowledge
of disease. More minute pathological discoveries have
been made since the earlier editions of Dr. Stokes' work
were published, but the principles of diagnosis he has
laid down with such philosophical insight are for all time,
be the pathology of the present day never so complete.
The following, in tabular form, are the diagnostic symp-
28
LECTURE II.
3
toms, in opposite columns, of primary and secondary
croup :—
Secondary Croup.
1. The laryngeal affection
secondary to disease of
pharynx.
2. The fever symptomatic of 2. The local disease arising
the local disease.
in the course of another
affection.
3. The fever typhoid.
4. Incapability of bearing an-
tiphlogistic treatment.
5. The disease constantly
epidemic and contagious.
Primary Croup.
1. The air passages primarily
engaged.
3. The fever inflammatory.
4. Necessity for antiphlogis
tic treatment.
5. The disease sporadic, and,
in certain situations, en-
demic, but never con-
tagious.
6. The exudation of lymph
spreading from below
upwards.
7. The pharynx healthy.
8. Dysphagia absent or slight.
9. Catarrhal symptoms often
precursory to the laryn-
geal.
10. Complication, with acute
pulmonary inflamma-
tion, common.
11. Absence of
any character-
istic odour of the breath.
6. The exudation spreading
to the glottis from above
downwards.
7. The pharynx diseased.
8. Dysphagia common and
severe.
9. Laryngeal symptoms su-
pervening without the
pre-existence of catarrh.
10. Complication, with such
inflammation, rare.
11. Breath often characteris-
tically flœtid.
We have then, it is clear, in secondary croup, to deal
with an asthenic condition, the result of an antecedent
disease, arising from a specific poison, and upon the
nature of the antecedent disease must our specific treat-
ment depend, be that disease scarlatina, measles, small-
pox, typhoid, typhus, or diphtheria. Such being the
case it is obviously impossible to lay down any rules for
the treatment of secondary croup without entering upon a
very large question concerning each of these diseases.
ACUTE PLEURISY.
29
LECTURE III.-Acute Pleurisy.
GENTLEMEN,-
I have to-day to speak to you about acute inflamma-
tion occurring in a very different structure to that we
have been considering in my two former lectures.
Although the serous membrane investing the lungs
and lining the cavity of the chest is not richly endowed
with blood-vessels and nerves, it nevertheless is subject to
inflammation in its acutest form, and the pain which
accompanies the inflammation is, in point of fact, more
acute than the pain which is present in either of the
diseases we have been speaking of. The reason of this
does not, I think, afford a very easy explanation from a
merely anatomical point of view. The same fact holds.
good in inflammation of the arachnoid, which is accom-
panied by more acute pain than when the substance of
the brain is inflamed. I suppose the nature of the
function which all serous membranes perform, namely,
that of lessening or preventing friction, is the most simple
way of explaining the cause of pain. Now, wherever
there is motion, there must necessarily be friction, and ast
long as the membrane retains its healthy condition, and
performs its function of secreting the halitus which lubri-
cates opposing surfaces, there is absence of all pain, but
let the halitus cease to be formed, as the consequence of
inflammation, and the friction of morbidly dry surfaces
to take place, you then have pain of a peculiarly acute
character. When the function of an organ is accom-
panied by motion, whether in serous or mucous mem-
branes, pain is an invariable concomitant of inflammation.
The conjunctiva is a mucous membrane; how intense
is the pain when it is inflamed; the mucous lining of the
pharynx and rectum, when in a state of inflammation,
are notably painful affections. I dwell upon the symptom
pain in connection with the inflammation, which will
form the subject of my remarks to-day, because it is as a
rule a constant symptom of pleuritic inflammation, and it
is the symptom which usually first calls the attention of
the patient to the fact, that there is something the matter
30
LECTURE III.
with his chest, for which he is mostly very anxious to
seek for medical advice. It very often happens that
patients, although the subjects of very serious organic
disease, do not feel anxious about their symptoms, and
do not seek advice unless pain be present. A remark-
able case occurred in my own practice about five or six
years ago. A gentleman, advanced in life, and who
was able to within a month or six weeks of his death
to walk his sixteen miles, was totally unconscious of
anything being the matter with him, until a pain which
he had never felt before induced him to seek my advice.
Upon examining his abdomen, I discovered an enormous
tumour, occupying the entire right side of the abdomen,
extending from Poupart's ligament to the ensiform carti-
lage. A tumour could also be felt during life, which
pressed upon the larynx and oesophagus. Upon a post-
mortem examination an encephaloid mass was discovered,
occupying the omentum and mesentery, extending into
the posterior mediastrum, which must have been forming
for a year or more, and yet perfectly painless until
within a very short time before the disease terminated
fatally. It is fortunate therefore-I would rather say,
providential—that pain in pleurisy and in other diseases
becomes a danger signal, drawing attention to the seat
of the disease, but this it does especially in inflamma-
tion of the pleura, so that we are enabled to put our
fingers and stethoscopes upon the very spot inflamed.
Pleurisy is generally ushered in with rigors, then follows
the painful stitch in the side, catching the breath, which
is short, not owing to hurried respiration, as in bron-
chitis or pneumonia, but owing to an instinctive dread
of deep inspiration. Heat of skin soon follows the
rigors, the pulse is frequent and hard, and sometimes
wiry. Decubitus varies with different people; some lie
on the affected side in the early stage, others prefer to
lie on the unaffected side, and some partly on the side
and partly on the back. I don't believe there is any
invariable rule upon this point. If effusion takes place,
then the patient most commonly lies on the affected side,
because the lung on the sound side can expand with
greater freedom. There is some cough, but this is of
a suppressed character, and for the same reason that the
respirations are shortened instinctively, to avoid the sharp
stitching pain. The physical signs require the closest
ACUTE PLEURISY.
31
observation in this disease, for by them can we alone.
measure the extent, the complications, if any exist, the
pathological changes which take place, or indeed rightly
interpret the import of the other symptoms. Upon the
physical signs it will therefore be necessary that I should
dwell for a few minutes. When the stethoscope is applied
over the seat of the painful stitch, which in most cases
is situated in the lateral or infra-mammary regions of
the chest, if the inflammation be in its very earliest stage,
a sound will be heard which can be imitated by rubbing
a smooth piece of paper with the fingers, it only conveys
to the ear the idea of two smooth dry surfaces, and I
believe the very first abnormal condition of an inflamed
serous membrane is simply dryness, owing to arrest of
secretion; this stage does not last long, for if not removed
by treatment, is soon followed by exudation of lymph,
more or less adhesive in character; then is heard, not
the friction sound of dry and smooth surfaces, but that of
roughened membranes-the frottement or rubbing sound
of pleuritic inflammation. This friction sound does not,
as à rule, extend over a large extent of surface, but we
must not, on that account, conclude that the inflammation
only exists under the spot where we hear the frottement,
for it generally extends further than we can detect merely
by the stethoscopic sign. I believe it is only where the
motion of the parietes of the chest is greatest that there
is sufficient motion to produce the friction sound. The
disappearance of friction indicates one of three very dif-
ferent conditions: 1st, Resolution; 2ndly, Agglutination
of the surfaces by exuded lymph; 3rdly, Effusion of
serum.
In the two former there will be absence of dulness
on percussion; in the case of serous effusion there will
be more or less dulness on percussion. The fact of
resolution taking place will be rendered certain by the
subsidence of the general symptoms, namely, the sympto-
matic fever, the quickened pulse, thirst, hacking cough,
&c.
An important fact to recollect in connection with this
local inflammation is, that the cessation of pain, instead
of being a sign of amelioration, may be a very significant
sign of increasing mischief, especially if a rapidly in-
creasing effusion of serum, by separating the
opposed
surfaces of the membrane, has caused the absence of pain.
Gi
4'
32
LECTURE IIÌ.
So that cessation of pain and frottement become negative
signs of a positive increase of inflammation and its pro-
ducts. It is also an important fact to remember, that
occasionally there is entire absence of pain. A case
which occurred in my own practice some years ago was a
remarkable verification of this. I was requested to pre-
scribe for a lady about 40, who with the exception of
feeling and looking ill was free from pain, cough, or
shortness of breath, the only symptom being a pulse over
120. Upon listening to the chest there was entire ab-
sence of respiratory murmur, and upon percussion there
was complete and absolute dulness over the whole of the
left side, anteriorly and posteriorly. If anything were
wanting to prove to me the value of physical diagnosis,
this case alone would have been sufficient. If feverish
symptoms had preceded the effusion, there were none,
-if we except the frequent pulse-when I first saw the
patient, but the absence of bronchophony and crepitating
râles excluded the diagnosis of pneumonia, or pleuro-
pneumonia, and the only disease which could cause entire
absence of stethoscopic signs and absolute dulness, would
have been an interthoracic tumour, occupying the whole
of one side of the chest, but as this could not have
occurred during the few days she complained of feeling
ill, the diagnosis of rapidly effused serum became easy;
I cannot now remember whether there was dislocation of
the heart to the right of the sternum or not, but the
probability is, there was; I think the case is mentioned
in a paper I read some years ago at a meeting of the
British Homœopathic Society, but I have not had time
to search through the annals for more details than I am
able to mention now. The case interested me very
much at the time, the more so as this lady made a
most satisfactory recovery. The effusion was completely
absorbed, and she lived for many years afterwards. The
treatment employed in this case will be referred to when
I come to the question of treatment. I need scarcely
say that serous effusion, so extensive and rapidly formed,
is not very frequently met with in simple pleurisy, though
it does occur in Bright's disease, and as a passive effu-
sion in broken-down cachectic subjects, and in blood
poisoning. I need not, I think, do more than mention a
few other signs of pleuritic effusion, such as obliteration
of the intercostal spaces, the absence of the vibration of
ACUTE PLEURISY.
33
the walls of the chest, accompanying the voice, the curious
stethoscopic sound called gophany, and the means we
have of diagnosing effusion, by altering the position of
the patient, by which we can change the situation of the
fluid, provided there are no adhesions to prevent it. I
will only dwell upon one symptom, which has a physio-
logical bearing of some interest: it is the yielding of the
intercostal muscles to the pressure of effused fluid, pro-
ducing the obliteration of the spaces between the ribs.
This is by no means a constant symptom, and I don't
know of any pathologist who has explained the reason
why pressure alone is not sufficient to produce the ap-
pearance, except Dr. Stokes, who has shown that the true
cause of the yielding of the muscular fibre to the out-
ward pressure is, the paralysis of nervous fibrillæ, con-
sequent upon the inflammation of the contiguous struc-
ture. In vesicular emphysema, in hydrothorax, and in
the first stage of pleurisy, you have no protrusion of
the intercostals, because their innervation has not been
destroyed by previous inflammation. I have thus broadly
described the usual symptoms and physical signs by
which we recognise the simple uncomplicated form of
inflammation of a serous membrane, whose relation and
contiguity to other important organs renders it most liable.
to be complicated.
1. With inflammation of the substance of the organ it
envelopes.
2. With inflammation of the investing membrane of the
heart.
3. Pleurisy may be accompanied by bronchitis.
4. It is a very common concomitant of tubercle.
The diagnosis of these complications is of supreme
importance in relation to the prognosis and treatment,
and as a matter of practical medicine, especially as regards
its homœopathic treatment. I hope I may be excused if
I dwell for a few minutes upon some of the chief points
of interest, the value of which every practical physician
will at once acknowledge. If in a patient, in addition to
the local stitch-like pain, there is with the cough rusty
expectoration, and that you hear on listening to the chest,
either crepitating rales or bronchophony, or both, and if
upon percussion you have incomplete dulness, there is
not much difficulty in diagnosing pleuro-pneumonia, but
with a small amount of effusion, or only exudation of
$
3
34
LECTURE IÍI.
lymph, and consequent adhesion; but if in the progress of
the case, the crepitating râles recede from the ear, and
the percussion sound becomes completely dull, serous
effusion is increasing, and the extent of its increase will,
of course, be measured by extending dulness upwards,
and if the dulness ends in a well-marked line, it is caused
by the pleuritic effusion, and not by the solidified lung;
if the latter extends above the level of the effused fluid,
there will be no well-marked line of dulness, but a
shading off of complete dulness into that which is less
complete. A solidified lung, except in the case of pul-
monary cancer, does not sound absolutely, but only
relatively dull. Bronchitic complication declares itself
by the various stethoscopic sounds which accompany it,
and its presence does not appreciately effect the sonoriety
of the chest, unless there is dilatation of the air-cells.
The presence of tubercle will cause more numerous and
varied phenomena, especially if in an advanced stage, and
with the formation of vomica of large size; so varied,
indeed, and requiring such a detailed examination, that
they will be more fitly postponed to another occasion,
should I, or one of my colleagues, lecture on the subject.
of pulmonary tubercle.
I should like, however, to mention a case not irrelevant
to our present subject, as showing the fatal effects of the
entrance of air into the pleural sac. I was in attendance
upon a young lady in a somewhat advanced stage of
phthisis. In the apex of the right lung there was a large
vomica, and, considering the nature of the case, she was
enabled to enjoy out-of-door exercise, and go to afternoon
concerts, &c. I was hastily summoned one afternoon,
upon her return from a walk, on account of a sudden
and intense pain in the affected lung, and most distress-
ing dyspnoea, which increased every hour; on percussion
of the chest, which the day before was dull some distance
from the apex anteriorly, and posteriorly it was now
tympanitic from apex to base, the tympanitis increasing
every moment, and with it the most distressing dyspnoea
it was possible to witness; in just four hours from the
attack of sudden pain, this poor girl ceased to breathe.
You will have anticipated what a post-mortem examina-
tion revealed. The fibrous capsule and serous membrane
of the lung had become so thin by the ulcerative process,
in the cavity which was close to the surface, that these
ACUTE PLEURISY.
35
attenuated membranes gave way suddenly, the contents
of the cavity escaped into the pleural sac; a direct com-
munication was thus formed with one of the larger bron-
chi, the air escaped into the pleural sac, compressing the
lung into the size of a thin cake. Such a frightfully
sudden and distressing termination to phthisis is happily
rare, owing to the fact that in the majority of cases
adhesions form between the pulmonary and costal sur-
faces. It was the suddenness of this compression which
destroyed life, because when pressure from serous effusion
occurs, there is generally time enough for the opposite.
lung to take on compensatory action, sufficient to sustain
life, notwithstanding that the collapse of lung is as great
as in the case of pneumonia-thorax I have described.
We
e see, then, that pressure from an effused fluid is one of
the most important results of pleuritic inflammation, and
operates not only upon the lung and intercostal spaces,
but also upon the diaphragm, forcing it down and upon
the heart, dislocating it to one side or the other; if the
effusion is into the left pleura, the heart will be pressed
over to the right of the sternum, and one of the signs of
a diminishing effusion consists in observing that the heart.
is regaining its normal position.
I cannot enter into the other symptoms and signs of
pneumothorax and emphysema, without occupying more
time than I have at my disposal, or delaying to speak to
you about the treatment of pleurisy, which I will now
venture to describe as briefly as possible. Much that I
before explained in regard to the administration of our
chief anti-inflammatory remedies will equally apply here,
for as in the early stage of bronchitis and laryngitis,
where our great polycrest aconite, is our all-important
drug with which to combat the febrile symptoms, the
frequent resisting pulse, hot skin, stitching pain in side,
increased by cough and deep inspiration. A glance at
the pathogenesis of aconite will show how strictly ho-
mœopathic it is to this first stage in which dryness,
and increased vascularity of the pleura are the pathological
condition to be first dealt with, and again, quoting Dr.
Ringer, it is no exaggeration to describe its action as
truly marvellous, and I have (over and over again had
the satisfaction of witnessing the complete subsidence of
pain, during inspiration and cough, reduction of tempera-
36
LECTURE III.
ture and pulse, and prevention either of exudation of
lymph or effusion of serum to any extent in a few hours,
by the exhibition of the 3x dil. of aconite every three or
four hours. With regard to the exudation of lymph, I
think there are very few cases of inflammation of this
membrane in which some lymph is not thrown out, even
when the extent of the inflamed surface is comparatively
trifling; hence the frequency of the adhesions which we
see in autopsies, made after death from other diseases.
The next medicine we generally employ when aconite
has effected its salutary work is bryonia, the drug upon
which my colleague, Dr. Richard Hughes, lectured on
Thursday last, and I wish I could quote word for word
his graphic account of its range of action; suffice it to
say, that bryonia has a most marked elective affinity for
fibro-serous membranes generally, producing all the phe-
nomena of hyperæmia and inflammation, and especially for
the production of serous effusion. You will at once see,
therefore, its perfect homoeopathic relation to the stage of
pleurisy which is either threatening to be followed by
effusion, or when effusion has taken place. Under these
circumstances bryonia in the 1, 2x, and 3x, given in drop
doses every three or four hours, is followed by the most
satisfactory, and, I might say, brilliant results, checking
the advance of the inflammation which aconite had arrested,
and causing the absorption of its fluid products.
Although bryonia has not the direct action upon mucous
membranes which it has upon fibro-serous, it nevertheless
is a valuable remedy when both the substance of the lung
and its investing membrane are inflamed; and in peri-
carditis and endocarditis it is our sheet-anchor.
Although the specific relation bryonia holds to the vesi-
cular structure of the lungs does not appear to be so inti-
mate as that of phosphorus, yet there is no doubt as to its
curative action in pneumonic inflammation, I hazard the
conjecture that bryonia is homoeopathic to the form of in-
flammation which spreads from the minuter ramifications.
of the bronchial tubes; and when we remember that these
tubes in their minuter ramifications possess a distinctly
muscular structure, and as we know that bryonia has a
special action upon muscular fibre, its curative power upon
broncho-pneumonia is easily explained, and, moreover, the
delicate lining membrane of the air-cells has some analogy
ACUTE PLEURISY.
37
to the structure of sero-fibrous membrane. We see, there-
fore, how it comes that this drug is curative in broncho-
pneumonia and in pleuro-pneumonia.
Although it is not my intention to discuss the subject of
pneumonia, I could not avoid mentioning these facts in
connection with the treatment of pleurisy. The fact is—
as every practical physician knows-that, although it may
be
very well in lectures and in text-books to draw fine,
but too often false, lines of distinction, when contiguous
structures are involved in disease, we do not in actual
practice, as a rule, meet with this isolation of morbid
action. On the contrary, I believe that whenever you
have pleuritic inflammation, there is probably some amount
of pneumonic inflammation, and in the latter some degree
of pleuritic hyperæmia. Happily in the matter of treat-
ment, as regards such complications, bryonia fulfils all the
indications we require.
In the conditions before stated-that is, after aconite
has reduced the vascular excitement, subdued the febrile.
symptoms, we administer bryonia in the 1st, 2nd, or 3rd
dec. dilutions every three or four hours in drop doses.
Some practitioners, and those not among our high dilu-
tionists, have witnessed most excellent effects from dilu-
tions ranging from 12th to 30th. I have seldom found it
necessary to go higher than the 3rd cent. or lower than
1x. This drug is especially indicated when the patient's
diathesis is the rheumatic, or where there are rheumatic
pains in the muscles, or where there is a disposition to
sweat which is more than usually acid, and again in cases
where gastro-hepatic symptoms accompany or have pre-
ceded the local inflammation.
I now come to the consideration of a more advanced
and serious train of symptoms which we meet with in cases
where the patient has not sought for advice early enough,
or where the existence of disease within the chest has not
been detected or even suspected: and this is not a very
uncommon occurrence even in the present day; but in
times before physical diagnosis was understood or prac-
tised, I have no doubt many and many a patient suc-
cumbed to this disease who seemed to be suffering simply
from debility and from the convenient complaint called
し
​"weakness," which ignorant patients and some ignorant
doctors try to cure by stimulants and tonics.
Such patients look pale and anæmic, feel very ill and
38
LECTURE III.
,
feeble, but, strange to say, have no pain, very little cough
or expectoration, and, although they are short of breath,
are not aware of it, and go about their usual avocations
perfectly unsuspicious that there is anything seriously the
matter with them.
The case mentioned in the early part of this lecture
illustrates these facts very forcibly. Suppose, then, we
are called into such a case, the previous history is of great
importance. There may be absence of pain, but, if there
have been pain, and fever, and cough, however slight, if
in addition auscultation reveals more or less effusion, you
may depend upon it you have to deal with the products
of an antecedent inflammation of the pleural sac. And
here other evils may be lurking behind: you may have
to contend with tubercle; amphoric breathing will point
either to secretion of air into the upper portion of the sac,
or to a tubercular cavity and pneumothorax. Into the
various lesions possible, and their diagnosis, it would be
impossible to enter in the time allotted me. I can only
say it requires no small amount of diagnostic skill to in-
terpret complications like these.
But suppose the case to be less complicated, and that
you have to consider what remedy is most effectual in
producing the absorption of serous effusion, two medi-
cines before all others that I know of will require to
be studied in connection with the case, and these are,
sulphur and arsenic, provided there be no signs of sub-
acute inflammation lurking behind, in which case I should
be inclined to give bryonia for two or three days, and
unless there is great debility I should trust most hopefully
to the action of sulphur. It is not possible with anything
like accuracy to localise the action of this drug, the range
of which is more extensive, I think, than any of the drugs
in our Materia Medica.
I can only describe it as appearing to hold the same
relation to chronic inflammatory disease that aconite holds
to acute inflammation, and, to employ the phraseology of
the present day, I would say that it acts by altering
perverted nutrition, and changing caco-plastic processes.
into healthy cell growth and metamorphosis, and thus it
comes to be applied in homoeopathic medication, not only
as the chief remedial agent in many chronic affections,
but also as an intercurrent remedy, its effect being to
energise dynamically whatever other drug we may be
ACUTE PLEURISY.
39
administering on account of its local action upon the
affected organ-thus, while we are giving, say, bryonia, or
some other medicine, in frequently repeated doses, if such
drug seem to hang fire, so to speak, we find as a matter
of experience that a single dose of sulphur given once or
twice in the 24 hours will materially assist in the cure.
Next to sulphur, and in no respect inferior to it, where
the totality of the symptoms agree with its pathogenesis,
comes arsenic.
What are the chief symptoms, and what is the general
condition of the patient which demand this powerful
agent? Essentially symptoms of great debility and a
condition of asthenia, which word will include the
typhoid, the condition of nervous prostration, and a
characteristic state of the general system, such as we
see in toxæmia, and in the various forms of malignant
disease. If, therefore, with the prostration, dyspnoea,
from rapidly increasing effusion, thirst, restlessness,
colliquative sweats, or diarrhoea, palor of countenance,
arsenicum, in 2x or 3x dilution is imperatively demanded,
and only those who have put it to the test, and have
witnessed its miraculously restorative powers, will
acknowledge that in this, which I feel is a very inade-
quate description of its value, I have not been using
exaggerated language if I add that we are daily witnesses
of the most brilliant results derived from this invaluable
drug.
I can only very briefly mention, in conclusion, that as
in the case of larygeal affections we had to describe false
croup, so in the case of pleuritic inflammation, we have
false pleurisy, or pleurodynia, a purely muscular affection,
rheumatic in character, often very painful, but usually
yielding pretty quickly to arnica, bryonia, actæa, or
ranunculus bulbosus, according to the character of the
subjective symptoms. I would fain have made this lec-
ture more complete, and have dwelt on many points of
interest which the subject really demands, but I found it
impossible owing to the interruptions and distractions of
our everyday London life.
Pneumonia will form the subject of my next lecture,
40
LECTURE IV.
LECTURE IV.-Pneumonia.
GENTLEMEN,-
It is not my intention in this lecture to occupy your
time by enumerating the symptoms or physical signs of
pneumonia, which, I assume, are perfectly familiar to
most of those I am addressing. I will content myself by
quoting from Dr. Wilson Fox a general definition of the
disease, which more clearly and succinctly expresses the
general character of the disease than any description I
have met with.
Definition.
"A disease whose essential anatomical feature consists
in the inflammation of the vesicular structure of the lungs,
which is thereby rendered impervious to air through the
accumulation in the interior of the alveoli of the products
of such inflammation.
"Clinically it is characterised by pyrexia, which, in the
majority of cases, when the disease is primary, commences
with rigors; it is also commonly attended by pain in the
side, dyspnoea, cough, sanguinolent sputa, great physical
prostration, and by the physical signs of pulmonary con-
solidation.
"Its course, when primary, is usually acute, and tends to
end favourably by a crisis occurring from the third to the
tenth day; but it may prove fatal from the first to the
fourteenth day, or at later periods. When secondary to
other diseases, the termination by crisis is uncommon, and
its duration is also more protracted, and under all circum-
stances of its origin it may in some instances lapse into
the chronic state.
"Its immediate cause is uncertain, and it appears in the
majority of instances to depend either upon an unknown
but suddenly produced dyscrasia, or on an alteration in the
composition of the blood induced by various diseases. In
other cases it is produced through the extension to the
pulmonary tissue of bronchial inflammation, or it origi-
nates through local disturbances of the pulmonary cir-
culation occasioned by congestion or collapse, or by
obstruction through emboli of the pulmonary artery, or it
may be caused by mechanical injury to the tissue of the
lung."
PNEUMONIA.
41
From this general definition we must conclude that.
pneumonia presents some features which distinguish it
from most other acute inflammations occurring in internal
organs. Inflammation of the vesicular structure of the
lungs seems to possess somewhat of a specific character, as
shown in its tendency to terminate in a crisis and on
certain critical days, the symptomatic fever, cough, &c.,
abating on the 7th, 8th, or 9th day from the invasion of
the attack.
Another feature of great importance to bear in mind in
relation to treatment is the occurrence of early prostra-
tion. Now, although, as I have said, the symptoms show
a decided abatement on certain critical days, resolution of
the local structural changes is much more variable as to
time, in some cases taking place in from 24 to 48 hours
after hepatization. An important point to remember,
which I shall refer to more particularly when I come to
the subject of treatment, is that in many cases of pneu-
monia the subsidence of the constitutional symptoms does
not bear the same relation to, and is not the measure of, a
corresponding amount of resolution of the local inflamma-
tion. In other words, the pathological condition does not
improve in the same ratio as the constitutional symptoms.
These characteristics of the disease, in the opinion of some
pathologists, point to a morbid and morbific condition of
the blood, which gives to pneumonic inflammation a cha-
racter somewhat resembling essential fevers. However
this may be, pneumonic inflammation in its essence does
without doubt differ in its manifestations and sequences.
from other forms of acute local inflammation, such as
bronchitis, pleurisy, and inflammation of the organs of
voice. No disease has been more accurately studied, its
natural history is well known, the diagnosis of uncompli-
cated pneumonia is comparatively easy, its stages well
marked, its physical phenomena well understood, and yet,
notwithstanding, it forms the battle-ground for the cham-
pions of active treatment and expectancy. It has taxed
the ingenuity of accomplished pathologists to account for
the extraordinary success of homoeopathy in reducing the
mortality of the disease from 24 or 25 per cent. to 6 per
cent., by an ingenious but not ingenuous theory that the
type of acute diseases has entirely changed within the last
half century—a theory which is now happily blown to the
winds by the leading pathologists of the day, who, fully
42
LECTURE IV.
admitting the adynamic character of pneumonia, do not
limit that character to the disease of the present day, but
with better reason believe it to have possessed the same
essential quality through all time, but which time and a
more intimate study of the disease have revealed, and I
maintain that homoeopathy has to be credited not only
with the triumphant proof it afforded of its success in the
treatment of this and other acute diseases, but in directly
leading to the trials of the expectant treatment by Dietl,
Skoda, and others.
We shall see anon the comparative value of expectancy
as contrasted with homeopathic treatment, and with the
almost homœopathic plan of Prof. Hughes Bennett. Let
us not, however, ignore or undervalue expectancy, but
rather join our allopathic brethren in acknowledging the
great value which those experiments possessed, and the
light they threw upon the natural history of pneumonia
and on the terrible mortality of its antiquated treatment.
Happily this discovery by the expectant method has led
to the adoption of a more rational medication in other
forms of acute disease, revolutionising the modern practice
of medicine over the whole of Europe and America.
Differing as it does from other acute inflammations in
its nature and in its tendency to manifest an asthenic cha-
racter, not only accounts for the high rate of mortality of
pneumonia under the former antiphlogistic treatment by
bleeding, large doses of tartar emetic, &c., but proves
the value of the restorative mode of practice which is
happily followed by all judicious physicians of the present
day. It is only within the last few years that the neces-
sity for husbanding the strength of the patient during this
and kindred acute diseases has been recognised. In
Fleischmann's and Prof. Henderson's day the value of such
restorative treatment was not fully appreciated, because
the adynamic tendency of pneumonia was not then so well
known as it is now; and my conviction is that had a more
supporting and nutritive diet been employed, the rate of
mortality would have been still more remarkably reduced.
In point of fact, the notion was prevalent among physi-
cians of both schools that an antiphlogistic diet was de-
manded in order to subdue the inflammatory process.
The physician's mind was too much occupied in knocking
the inflammation on the head, and too little careful to
support vitality. To Prof. Hughes Bennett and others.
PNEUMONIA.
43
we are indebted for affording practical proof of the value
of restorative treatment. The stimulating plan of the late
Dr. Todd, though carried to excess by him, and even
more so by his followers, was nevertheless, I venture to
say, infinitely superior to the reducing antiphlogosis of
by-gone years; and it is a question worth considering
whether the judicious exhibition of alcoholic stimulants
in small doses is not a kind of rough homoeopathy viewed
in relation to elevation of temperature when accom-
panied by subsequent symptoms of exhaustion, not only
in cases of essential fever, but also in the disease we are
considering to-day.
we
A very interesting case, under the care of the late Dr.
Anstie, at St. Thomas's Hospital, which you will find in a
number of the Lancet, illustrates the value of stimula-
tion in pneumonia. I do not advise or follow that
treatment, because with our specific remedies
quickly remove the cause of all the other phenomena
by directly reaching the local manifestation of the disease.
Without advocating the use of stimulants as a rule, what
I want to impress upon you is this-that, in addition to
the administration of specifically acting drugs, the exhibi-
tion of nutrients in pneumonia is a matter of supreme im-
portance, and I have no hesitation in saying that if in
future any trial on a large scale be made between the
rival systems, the superiority of specific medicine over any
other will be abundantly proved, if the nutrient plan be
judiciously followed out.
I now come to the important subject, that of examining
into the various modes of treatment in pneumonia, and I
wish to place them fairly before you. Those which are
obsolete I might have omitted altogether, but that they
show by such a remarkable contrast the superiority of the
mode we practise.
Mortality of Pneumonia under various modes of
treatment.
Rasori, large doses of tart. ant.
Grisolle, expectant treatment
Von Wahl, do. do.
Dietl, tart. ant. in large doses
diet alone
""
Todd, stimulants
1 in 4
1 in 5+
1 in 43
1 in 5
1 in 10.9
1 in 9
44
LECTURE IV.
By this survey you will observe that the treatment by
diet alone is superior to every other, but only very little
above that of Dr. Todd's stimulating plan. So that for
all practical purposes we may put all these modes of prac-
tice out of court, i. e. the treatment by large doses of tartar
emetic, the stimulating plan, and, lastly, the purely expec-
tant plan, and direct our attention to a system of medica-
tion which at first sight appears to excel all others in the
results obtained.
I refer again to Prof. Bennett's cases, published in a
work entitled The Restorative Treatment of Pneumonia,
in which he claims to have arrived at a success so great
that in 125 cases of uncomplicated pneumonia the mor-
tality was nil! Of these there were 26 cases of double
pneumonia. The average ages were-
Males
Females
"J
Average duration of disease....
20 of the cases were convalescent in
74
""
314
28/1/
144 days.
10 days.
in .... 15 days.
Nothing, judging by prima facie evidence, can excel
this; but Dr. Bennett does not afford us the very impor-
tant information as to the actual condition of the lung
when convalescence was considered to have commenced ;
and this is much to be regretted, because we know, as I
have before stated, the constitutional disturbance in pneu-
monia will often disappear long before the resolution of
the pulmonary inflammation has commenced. I beg to
quote on this point the authority of one of the most accu-
rate observers of disease-namely, Trousseau-who in his
lectures refers to an article by Dr. Bourgeois, of Etampes,
in the Union Médical for Jan. 3, 1860, who had for 25
years abstained from all active treatment in pneumonia.
Dr. Bourgeois writes thus:-
"On the 9th day there is almost always improve-
ment; though there is more cough it is looser; the
sputa, albuminous rather than gelatinous, are nearly
always colourless; the stitch in the side has quite ceased;
unless it be that it returns during severe coughing fits or
on taking a deep breath; the tongue has become clean;
there is a decided appetite for food; the urine, which was
PNEUMONIA.
45
¡
of a scalding character and scanty during the acute stage
of the pneumonia, becomes abundant, nearly normal in
character, having no deposit, and being devoid of tur-
bidity,-appearances which rarely show themselves except
during convalescence; in a word, the symptoms of the
disease disappear, while its physical signs remain in their
plenitude;" and ends by remarking "that several weeks
will often be required for the complete disappearance of
the signs of engorgement of the lung."
Trousseau's remarks on the expectant treatment are
well worthy of attention. He says:
He says: "Are we obliged to
conclude that the treatment of pneumonia ought to be
expectant, because recovery takes place spontaneously in
a certain number of cases? I think not; and moreover,
when I find myself confronted with this disease, I cannot
remain an inactive spectator whenever I am called in to a
patient suffering from pure and absolute uncomplicated
pneumonia, I lose no time in intervening by antiphlo-
gistic treatment."
Now, although I should be sorry to suggest the sup-
pressio veri as to the actual state of the lung, the
evidence upon which Dr. Bennett's success is built is
wanting in the absence of the facts as to the condition of
the lung pathologically considered when the cases were
reported as convalescent. In Professor Henderson's cases
-treated more than 20 years ago, when he was almost a
tyro in homœopathy-to be referred to presently, the
physical signs proving the resolution of the inflammation
were carefully recorded, and he lays down in forcible
language the absolute necessity of such a record in order
consistently to pronounce any case convalescent. In these
observations I do not wish to detract one iota from the
value of Prof. Bennett's treatment, I would wish to
magnify it. What can be better than a mortality of nil?
Above all I for one feel indebted to him for having proved
the value of attending to the nutrition of the patients
suffering from this disease. But now let us enquire-
What is Prof. Bennett's treatment therapeutically con-
sidered? I have no hesitation in defining it an empirical
application of one truly homoeopathic medicine in frac-
tional doses. Let us examine it in detail. Up to his 45th
case in men, and after the 22nd case in women, the doses
of tartar emetic, in a strikingly diminuendo scale, were as
follows: 4,,,,, andth of a grain. In all sub-
•
-
46
LECTURE IV.
sequent cases in both sexes the doses were reduced to the
ath of a grain (!) with nutrients and occasionally wine.
This reduction of the dose is very significant, and ought
to be instructive to our brethren of the old school, for
does it not show that successful results followed diminu-
tion of dose? Homœopathists considered the question to
be still sub judice as to where subdivision ought to stop.
Many of us constantly prescribe more than the 14th of a
grain of tartarised antimony for a dose, and are yet loyal
to our therapeutic principles, for the principle is not
involved in the dose, although our opponents will have it
so, notwithstanding all reason and fact are against such a
notion. In estimating the value of Prof. Bennett's treat-
ment, the comparison does not hold good between it and
homoeopathic treatment, for, as I have shown, Prof.
Bennett's is a rough kind of homœopathy, and the success
which followed his treatment is due to his obeying
(unconsciously) the law of similars, aided greatly no doubt
by his judicious administration of nutrients. If we com-
pare the cases he reports with those treated by the late Prof.
Henderson, it will be seen that the latter had a greater
number of complications of the disease to combat, whereas
Prof. Bennett's cases were all uncomplicated. In Prof.
Henderson's first case two thirds of the right lung were
involved, and the patient had delirium tremens; he was
notwithstanding convalescent in 11 days. His third case,
æt. 60, was complicated with spasmodic asthma, chronic
bronchitis and emaciation, both lungs inflamed and
pleurisy in addition, was convalescent in 12 days.
7th case, æt. 60. Pleuro-pneumonia, three fourths of
right lung inflamed, arrested in first stage. Convalescent
in 8 days.
"
the
11th case was complicated with delirium tremens;
three fourths of lung affected. Convalescent in 11 days.
I have selected a few of Prof. Henderson's cases,
majority of which were women in whom the disease is
always more fatal in order to show that he had to treat a
more formidable class of cases than his colleague, which
would account for the homoeopathic mortality reaching to
6 per cent., a death rate not to be wondered at when the
unfavourable complications are taken into account-yet
the mortality was only 6 per cent.
Prof. Henderson's remarks in relation to the treatment
of pneumonia are as follows:---
PNEUMONIA.
47
1
"I proceed next to prove that though, owing to the
peculiarity referred to in the anatomy and consequences
of hepatization, pneumonia is a much less fatal disease
when left to nature than was generally supposed; the
success of the expectant method does not account for the
small mortality under the homoeopathic treatment. That
it does is the conclusion of Dietl. . . . A comparison of
details would, however, have satisfied him that he greatly
erred in his denial of active and positive virtues to the
homœopathic method, and that its success is due to some
other cause than that which favours the expectant method.
This truth is illustrated by the duration of the disease
under different plans of treatment. The duration of the
disease ought to be computed from the first symptoms of
the inflammatory fever to the cessation of the local physical
signs, or complete resolution of the hepatization. When
the resolution of the hepatization is not made the final
particulars in the estimate of duration, the physician is
left to an arbitrary and uncertain criterion in fixing the
period of cure, and is exposed to the temptation of under-
estimating the length of time his remedies have taken to
effect recovery."
Prof. Henderson then adverts to Dietl's averages, and
compares the homoeopathic data with them. Dietl found
the average duration of cases
Treated by Venesection to be
Tartar emetic
Expectant method
19
>>
35 days.
28.9
28
رو
در
The whole duration of the disease from the commencement
of the fever to the complete resolution of the hepatization
is ascertainable in 43 of the 50 homœopathic cases.
The average duration of the disease in these 43 cases
amounts to only 11 days.
Having thus passed in review before you the results of the
several modes of treatment of pneumonia which have been
adopted since the old and destructive treatment by vene-
section was abandoned; having submitted to you evidence
that the mortality under the expectant plan sufficiently
proves the necessity of employing remedies for subduing
the inflammation; and lastly, having dwelt somewhat in
detail upon the successful, though purely empirical, ap-
plication of the law of similars by an eminent Professor of
so-called orthodox medicine in Edinburgh, I come to the
48
LECTURE IV.
consideration of the treatment of pneumonia by homoeo-
pathy properly so called. In this form of acute inflamma-
tion, as in those we have been considering, when the
symtomatic fever is high, aconite is the remedy which
will be required in the early stage of the disease, especially
if checked perspiration has been the proximate cause of
the attack, and if the pulse is not compressible, and that
the pleura is involved: unless these conditions are present
a few doses only of aconite will in most cases be required.
The sooner one or other of the drugs having a specific
action are administered, the sooner will the inflammation
be controlled. There are five medicines holding a more
or less specific relation to inflammation of the pulmonary
tissue, namely, bryonia alba, tartar emetic, phosphorus,
lycopodium, and bromine. I will endeavour as far as it is
possible to point out the various conditions of the lung,
and the accompanying symptoms, which indicate one or
other of the remedies I have named.
Of these phosphorus undoubtedly holds first rank; it is
especially curative in the true croupous pneumonia, where
you have all the subjective symptoms and the stethoscopic
signs which are present in this the typical form of the
disease, whether occurring in the child or in the adult.
The more the inflammation involves the vesicular struc-
ture, and the more the sputa assume the plastic character,
the greater will be the necessity for the administration of
phosphorus. If, however, the attack has had a catarrhal
origin-the morbid process extending from the bronchial
mucous membrane into the air-cells-the remedy which
best fulfils the indication is tartar emetic; the choice of
this remedy will depend, as in all other cases, upon its
corresponding to the totality of the symptoms.
In lecturing upon Practical Medicine in relation to
homœopathy, all that it is possible to do is to give a few
leading symptoms as guides. In actual practice at the
bedside each man must, by his own observation and judg-
ment, aided by his knowledge of the Materia Medica,
apply the remedy which best fulfils the guiding principles
of the homoeopathic law. Without these practice degene-
rates either into a miserable empiricism, or into slavish
routine.
I cannot pass over tartar emetic without mentioning
some other symptoms which point to its use: these are
more copious and less viscid sputa, difficult to expectorate,
PNEUMONIA.
49
and if there be much gastric irritation, nausea, and a
thickly coated tongue, and if the case occur either in
early life or advanced age, then tartar emetic becomes an
invaluable remedy. When pleuritic inflammation com-
plicates pneumonia, especially if it predominates, and if
the concomitant symptoms point to bryonia, which-as I
have in a former lecture mentioned-holds a specific rela-
tion to inflammation of sero-fibrous membranes, upon that
drug ought our choice to fall. But if pleuro-pneumonia
has followed upon an external injury, such as a blow or a
fractured rib, or some other traumatic cause, we should
choose arnica in preference to bryony.
I have now to notice a drug, namely, lycopodium, about
which there has been a good deal of controversy, chiefly
caused by the rather dogmatic statement that whenever,
in cases of pneumonia, flapping or forcible dilatation of
the alæ nasi is observed, this cryptogamic plant is par
excellence the remedy. Inasmuch, however, as in all
acute inflammation of the respiratory organs in the young
child this symptom invariably is present, it has little.
diagnostic or therapeutic value. Not so, however, when.
it is noticed in the adult subject. I have, over and over
again, verified its value as a guide to this medicine in
certain forms of inflammation of the lungs.
In thus giving you the result of my own experience, I
would wish to express my strong condemnation of such
an unscientific proceeding as selecting a medicine solely
from the presence of one symptom. Other important
features of the case will generally be found to coexist
with this symptom of the alæ nasi which will lead the
physician to prescribe lycopodium. In secondary pneu-
monia, for instance, following measles, scarlatina, small-
pox, or typhoid; in pneumonia accompanying advanced
phthisis; in cases which do not yield to the action of
phosphorus; in others, where there are hepatic or renal
complications; and in some of the exceptional cases met
with in practice. Lycopodium seems to me to hold a
relation to conditions of the organism where there is a
tendency to disintegration of tissue and proliferation of
pus-globules. A low state of vital resistance, easily low-
ered vital heat, and, in short, that state of the whole
system which demands the most careful feeding by suit-
able nutrients as well as the administration of specifically
acting drugs.
S
4
50
LECTURE V.
One medicine, said to cause as well as cure inflammation
of the right lung especially, I will only just mention—
namely, bromine, being unable to give you any informa-
tion derived from my own experience.
The only case in which I was induced to give bromine,
was in a case of this disease which resisted the action of
phosphorus 3x; but after a fair trial of bromine, without
any good result, yielded promptly to phosphorus 6.
I cannot conclude without again repeating that of all
the drugs I have named phosphorus is the chief, and will
be found the curative agent in the great majority of cases
of the disease we have been considering.
It only remains for me shortly to mention the doses of
the medicines I have been in the habit of giving in the
treatment of pneumonia. Aconite I generally give in
drop doses of the 3x tincture; bryony in the same dose
and dilution. The doses of tartar emetic I vary more,
ranging from the 1st cent. to the 6th cent. Lycopodium
I rarely give below the 5th, but more frequently I give
the 12th cent., from which, and the 30th cent., I have
derived the most satisfactory results.
In the course of lectures which this concludes I have
endeavoured to present the subject in the simplest possi-
ble form consistently with the importance of the subject.
If I have succeeded in showing those who have honoured
me with their presence that homoeopathy is based upon a
law of nature, and can justly claim to be a rational and
scientific system of medicine, I shall feel amply repaid for
any trouble these lectures have imposed upon me.
LECTURE V.-Chronic Bronchitis.
GENTLEMEN,-Acute inflammation occurring in the
organs of respiration was the subject I chose to lecture upon
last session in this place. This year I propose, with your
permission, to bring to your notice the same organs when
the subjects of sub-acute or chronic inflammation; but
CHRONIC BRONCHITIS.
51
before entering into any details respecting the local mani-
festations of inflammation whether chronic or acute, I have
thought that I might profitably dwell for a short time on
the general phenomena of inflammation; for I think a
correct understanding of this morbid condition is essential
to rightly comprehending what inflammatory action in any
organ really is.
The process we call inflammation meets us in all the
stages and phases of morbid action taking place in the
various tissues of the body, presenting phenomena not
only of the deepest interest as matters of scientific obser-
vation, but possessing, especially for us of the homœo-
pathic school, most important issues as bearing upon our
special therapeutics.
In John Hunter's day, and even up to comparatively
recent times, increased arterial action in a part, a plus
quantity of the circulating fluid, dilatation of the arteries,
disturbance of the vaso-motor innervation, and a more or
less correct acquaintance with the products of inflamma-
tion, were all that was known. But how is it now? The
microscope and experiments upon living tissues have re-
vealed most important facts. In the capillaries and veins
not only is dilatation observed, but their coats are seen to
undergo remarkable changes, and the blood-globules cir-
culating in them are not only seen in greater quantity, but
are observed to possess an independent life and action.
The white corpuscles and their movements and behaviour
are of special interest; amabæ-like prolongations of their
protoplasm which first fix them to the sides of the capillary
tubes, and then by a force which seems to be a vital
action the corpuscles pass through the vascular mem-
brane, and emerge into the connective tissue. Here still
more curious changes occur; the corpuscles divide and
subdivide and proliferate. These actions of the white
corpuscles in inflammation become a study of the deepest
interest; and I venture to predict that, when the time
comes, these phenomena of tissue-changes and the mole-
cular motions which are at the bottom of all cell muta-
tions, will be found to have an intimate relation to the
toxic influences which operate within the organism, or to
those which act upon it from without.
Strictly speaking, it might be contended that the causa-
tion of all morbid changes comes from without, and that
"injury to tissue," which is the new expression that most
52
LECTURE V.
fitly describes the essence of inflammation, is the result of
influences acting ab extra, either by impressions upon the
nervous system primarily, as in the case of non-specific
inflammations, or from the introduction into the system of
contagia operating primarily upon the blood, as in the
case of specific fevers; but in either case the phenomena
will be found to be under the reign of law.
If this be so, and that further knowledge of the relation
which cause and consequence hold to each other prove the
existence of a law of pathogenesis in the case of natural
disease, is it not rational to suppose that there is a rela-
tion, also governed by law, in the case of those agents
which have the power of exciting a rectifying influence
upon the morbid processes which constitute disease? In
other words, that a law exists in relation to therapeutics
as fixed and determinate as that which rules over diseased
conditions of the organism.
Then, with respect to the action of certain substances
upon the organism, it is found that these actions are not
uncertain or fortuitous, but produce effects more or less
constant. For example, in the case of inflammation a
weak solution of caustic soda, dilute sulphuric acid, &c.,
produce dilatation, first of the arteries, and subsequently
of the capillaries, with marked acceleration of the circula-
tion-conditions followed by arterial contraction and capil-
lary anæmia. But liquor ammonia and carbonate of
ammonia appear always to occasion a certain degree of
primary arterial contraction, lasting for an hour or two,
but followed by dilatation and acceleration. In other
words, ammonia and its carbonate produce results which
are the opposites of other stimuli.
This cannot be explained upon any theory of chemical
composition, for you will observe that the alkali caustic
soda and the sulphuric acid, although of different com-
position, produce similar effects upon the arteries, so that
the action must be dynamic and specific, and not che-
mical.
m
Did time permit, this specific action of toxic agents
acting according to a governing law might be further
illustrated, by describing a number of interesting experi-
ments which you will find in Dr. Brunton's Experi-
mental Investigation of the Action of Medicines.' He
found, for instance, that solutions of corrosive sublimate
and veratria in very minute quantities stop the movements
(
CHRONIC BRONCHITIS.
53
of the white corpuscles of the blood, but that quinine is
more powerful still.
Now, if these substances produce these disturbing
effects upon the capillary circulation, and upon the proto-
plasm of the white blood-corpuscles, according to certain
fixed laws, we should reasonably expect to find that the
agents which have a rectifying effect obey an equally
determinate law. Homœopathists hold that such a law
exists in nature, believing that the relation between the
disturbing or pathogenetic force and the restorative or
curative force is best expressed by the formula, similia
similibus curantur.
It may be asked why I have occupied your time in
dwelling, even for these few minutes, upon minutiæ of
this kind, when the more immediate subject of this lecture.
is upon bronchitis in its chronic form. My answer is that
it will no longer be possible to discuss any disease, whether
acute or chronic, without entering upon the question as to
what are the actual tissue changes which constitute dis-
ease, what are the phenomena accompanying such and
such alterations of the minute structures under examina-
tion, and what are the curative agents which have the
closest specific relation to the morbid conditions the phy-
sician has to observe, interpret, and, if possible, restore to
healthy action. If the practice of medicine is ever to
attain to anything like a science, it must be based upon a
foundation not of the wood, hay, and stubble of ever-
changing theories, but upon carefully observed facts con-
cerning the various tissue-changes constituting disease,
and a knowledge of the physiological properties of medi-
cinal agents.
W
With regard to treatment, one thing is quite certain, that
whether it be conducted upon allopathic, antipathic, or
homoeopathic principles, the idea that inflammation is in-
creased vascular action and a vital effort characterised by
vital strength, must be for ever abandoned. It is, in fact,
the very reverse; it is in its lowest degree and mildest
form incipient death of tissue, in its most advanced stage
it is absolutely death of tissue. Let me revert to the
phenomena of the circulation which are observed in in-
flammation :-
(1.) Acceleration of the blood current with dilatation of
the arteries, followed by retardation of the current, which
if complete ends in stasis,
54
LECTURE V.
(2.) Exudation of liquor sanguinis and migration of
blood-corpuscles.
(3.) Alteration in the nutrition of the inflamed tissue.
Let me as shortly as possible recall to your mind what
takes place in each of these stages of the inflammatory
process. In the first of these stages the minute arteries,
capillaries, and veins, which in health permit only the
liquor sanguinis to exude for the purposes of nutrition,
now by some change of function or structure, the nature
of which has not yet been made out, arrest the blood-
corpuscles which adhere to their inner surfaces, and then
either by some breach of continuity or some other pro-
perty of their walls, allow the corpuscles of the blood to
pass through their coats and escape into the extra-vascular
tissue. The first stage of this process causes the hyper-
æmia of the tissue.
The second stage-exudation of liquor sanguinis and
escape of the corpuscles--produces the swelling of the
inflamed tissue, and constitutes the various kinds of inflam-
matory effusions.
We shall have more to say about these latter when we
come to the subject of chronic inflammation of the mucous
membrane of the bronchial tubes.
I might have contented myself with a conventional defi-
nition of inflammation as consisting of increased heat, red-
ness, and swelling of inflamed parts, without going deeper
into the matter; but whether I should have, in any mea-
sure, satisfied those whom I have the honour of addressing
or not, I certainly should not have satisfied myself, for I
am convinced that in all future attempts to interpret dis-
ease the recent discoveries to which I have directed your
attention cannot be lost sight of. Any system of thera-
peutics deserving to be called scientific or rational must
be based upon a knowledge of the histological discoveries
of the last five or six years.
With reference to these there is a point connected with
the phenomena of cell life which has for myself surpassing
interest, and it is this, namely, the vital endowments of
the blood-corpuscles, which enable them in their extra-
vascular life to manifest new functions, by which they
either become instrumental in forming new and permanent.
tissue, or, if that do not take place, they become, by a pro-
cess of degradation, pus-cells, causing rapid disintegration
of tissue and abscess. This latter is no doubt a destruc-
CHRONIC BRONCHITIS.
55
tive process, and if the inflammation be intense, and ex-
tends over a large area, gangrene may be the result; short
of this, cell proliferation and suppuration are nevertheless
conservative and vital actions by which the products of
inflammation are removed, which if retained would lead.
not only to the death of the tissues involved, but also to
the adjacent healthy structures, and as a consequence to
the death of the individual.
How interesting, then, become the facts connected
with the form, motions, and mutations of these elements
of the blood, and what a captivating problem awaits solu-
tion as to the relation curative agents bear to these minute
elements of organic life, when the tissues which they build
up and energise become the subjects of disease.
Before entering upon an examination of the structural
changes which the bronchial mucous membrane under-
goes in bronchitis, it will be well to say a few words upon
the relative proneness to undergo transformation which
characterises the cells of the different tissues in the body.
Cells possess more or less stability according to the nature
of the tissue in which they exist, and it is a curious fact
that the cells of the highest and lowest organisations have
this property of stability in common. For example, in
those tissues where there is least cell activity, movement,
and multiplication, as in bone and cartilage, there is sta-
bility of cells, and, on the other hand, in the most highly
organised tissues, as in the nerve-cells, stability is one of
their special characteristics; whereas in mucous and
serous membranes, where the epithelial cells maintain.
themselves by constant multiplication, inflammation sets
up very active movement and cell proliferation. The rule
seems to be that where there are free surfaces, there cell
changes are most active.
This brings me to the consideration of the immediate
subject of this lecture-sub-acute and chronic inflamma-
tion of the bronchial mucous membrane, which differ in
their histological elements from the acute inflammation in
this, that whereas in the acute form the morbid process
takes place chiefly in the epithelial cells, in chronic in-
flammation the sub-mucous and connective tissues under-
go changes of nutrition whereby either a more or less
permanent tissue is formed, resulting in thickening, or in
degeneration and death of the newly formed elements.
It must not be supposed that there is a well-marked
56
LECTURE V.
boundary line between acute, sub-acute, and chronic
bronchitis; there is no such thing in nature, but one
passes into the other by insensible gradations, from the
simple bronchial catarrh, which when it ceases leaves no
trace of any structural change, to the confirmed and per-
manent thickening and interstitial condensation of the
membrane, or to the absorption or dilatation of the
vesicular structure which obtains in chronic bronchitis
with emphysema.
-
With respect to the physical signs of sub-acute and
chronic bronchitis, without entering minutely into these,
I may state that the resonance of the chest is not gene-
rally so materially altered as might be imagined from the
extent of thickening of the mucous membrane, or from
the presence of the copious secretion of mucus or muco-
pus which takes place. Where these two conditions, or
either of them exist, there must of necessity be dimin-
ished resonance, but this being general and not local the
dulness on percussion is not so manifest as in phthisis,
where it generally exists in the apices of the lung, or, as
in pneumonia, where it is in the lower lobes. On the
other hand, where there is increased resonance, this sign
is not local, but more or less general, as in emphysema,
caused by dilatation of the bronchi or of the air cells. If
therefore local dulness or local increased resonance is
detected, something more than bronchitis exists, caused
either by condensation from the presence of tubercle or
pneumonia where the percussion sound is dull and from
pneumothorax where it is morbidly clear.
To the value of these signs I shall have to refer when I
come to the diagnosis of the early stage of tubercle in a
future lecture.
The stethoscopic signs of sub-acute and chronic bron-
chitis are very various in character, depending chiefly
upon the intensity of the inflammation or upon the quan-
tity and character of the secretion, varying from a scarcely
perceptible roughness of the respiratory murmur to the
most intense sibilant or muco-crepitating râles. I may
state as a general axiom, in the words of one of the most
accomplished stethoscopists of the present day, “That
there is no such thing as a perfectly pathognomonic
symptom or sign of any thoracic disease. We must com-
bine the lights drawn from the careful study of symptoms,
both past and present, with the observation of physical
CHRONIC BRONCHITIS.
57
signs, for by this mode alone can we hope to arrive at a
practical result."
Now the practical question presents itself-does a know-
ledge of these histological facts, however minute, help us
in the diagnosis or treatment of the various forms of
chronic bronchitis, or does a physical examination enable
us to detect the structural changes which I have endea-
voured broadly to describe, with that amount of accuracy
which will enable us to select the appropriate remedy
without the aid of a more or less minute study of sym-
ptoms? I am sure they will not, and therefore sym-
ptomatology must come largely to our aid.
And here I claim for homoeopathy its great superiority
over other methods of treatment, for valuing as it does all
knowledge derived from an intimate acquaintance with
the etiology and pathology of bronchitis, such know-
ledge must be supplemented by the most careful study of
symptoms in each individual case, so that by a combina-
tion such as this, utilising all that is known and discard-
ing nothing, we possess all the aids to treatment possible
at the present time.
In few affections is the minute study of symptoms more
essential than in the treatment of chronic bronchitis, and
the reason is that the character of the symptoms is so
variously modified by the temperament, constitution, and
sometimes by the idiosyncrasy of the patient. Take, for
example, one symptom alone-namely, cough, which will
in one patient be a most incessant, harassing, and often
obstinate symptom, yet the amount of actual bronchial
irritation will be insignificant; whereas although in
another patient other symptoms will reveal a profound
obstruction to the due oxygenation of the blood from
actual structural change, the cough will be a compara-
tively insignificant symptom.
Then, again, how varied are the exciting causes of this
one symptom-such as position of the body, the act of
speaking, the ingestion of food, the temperature of the air,
the period of the day, &c. &c.
It may be objected that these exciting causes, some of
them appearing at first sight trivial, if taken as guides to
the choice of a medicine, are very unscientific. They may
be so, and we should be truly grateful to any pathologist
who will give us any more satisfactory rule which we can
follow, and by which we shall be able to differentiate one
58
LECTURE V.
I
kind of cough from another with more scientific accuracy,
when a knowledge of the pathological condition of the
organ fails to be the guide to the remedy. In the majo-
rity of the cases we meet with, this knowledge, combined
with a knowledge of the totality of the symptoms, is suffi-
cient, and we do not fail. An objective symptom of great
value is the character of the sputa when such are secreted
and expectorated. These are to be observed as to colour,
form and consistence, and as to the facility or difficulty
in expectorating.
-
From what has been said in reference to the necessity
of observing nice shades of difference in these particulars,
it will be at once manifest how difficult it becomes for a
lecturer to lay down rules of treatment with that precision
which enquirers naturally look for.
If he attempts to give general rules, they would be
vague, and unsatisfactory; if he, on the other hand, ven-
tures into details such as the treatment of individual cases
really requires, he would weary the most patient audience
in the world, and would have to devote not one or two,
but an extended course of lectures to the elucidation of
the subject. I will try to adopt a middle course by classify-
ing some of the most common forms of chronic bronchitis,
and by combining with the description of each, the chief
remedy or remedies for that particular form which ex-
perience has proved to be curative.
First then, there is the very common form of chronic
bronchitis of the elderly patient; you have cough, wheezing
respiration hurried upon exertion, with various kinds of
expectoration, but with little impairment of the general
health, except that in winter the patient feels less well,
has more cough and expectoration, and is liable from a
slight cause, to have an attack of acute bronchitis.
The following may be considered a typical case. Mr.
M., æt. 60. Subject to a winter cough for years; a
tolerably free liver with the exception of stimulants,
which he cannot take without causing increase of cough.
The cough is concussive, causing headache; the voice is
husky, expectoration alternately scanty and loose; the
cough is caused by a titillation in the epiglottis, and is
most violent on first getting up, and produces a bruised
sensation in the epigastrium which is somewhat tender on
pressure. The velum, uvula and fauces are somewhat
swollen and congested, and the tongue is red at the tip
CHRONIC BRONCHITIS.
59
and edges. There is constipation, and the urine is high
coloured and loaded. There is no fever or acceleration
of pulse, and but for the unusual frequency of the cough
and some tightness of the chest, his condition is not very
different to what it is during the winter months.
A chill seems to have been the exciting cause of the
sub-acute condition which these symptoms indicate, that
there is gastro-hepatic derangement complicating the
bronchial symptoms, and this, conjoined to the chest
symptoms, indicates, without any hesitation, the selection
of nux v. as the truly homoeopathic remedy. It would
occupy too much time to describe the wide sphere of
action of this medicine; suffice it to say, that in addition
to its well-known action upon the cerebro-spinal system
generally, it has most certainly a direct action on that
important compound nerve whose origin is in the medulla
oblongata, namely the pneumogastric.
With this knowledge, aided by a comparison of the
symptoms with the well-proved pathogenesis of nux v.,
this drug given in the 3x or 3rd centesimal dilution in
one or two-drop doses every four hours, produced in a
very few hours a very marked change for the better, not
only in the bronchial symptoms, but also pari passu in
the gastro-hepatic, and subsequently, under the action of
varying dilutions of sulphur, the chronic bronchitis.
yielded kindly in a few weeks to the action of these two
medicines.
Friedlander's experiments upon the par vagum, de-
scribed in the number of the Lancet of Jan. 8th, by
Dreschfeld, are most interesting in showing that section
of the vagi in rabbits invariably produces a condition of the
lung identical with that of catarrhal pneumonia in man.
The conclusions to be drawn from these researches are
as follows:-
(1) That by section of the vagi an irritative inflam-
mation is produced in animals comparable to the acute
catarrhal pneumonia in man.
(2) That the first stage in this process consists in an
active proliferation of the epithelial cells lining the alveoli,
which become detached from the walls of the cells, increase
in size, become more granular and show multiplication of
their nuclei, and thus give rise to new cells.
(3) That the capillaries in the neighbourhood of the
alveoli undergo active hypnomia; the white blood-cor-
60
LECTURE V.
puscles accumulate in them, and eventually (where the
alveolar epithelium is detached) emigrate into the alveoli.
Now, although we are not now considering the pathology
of pneumonia, which I dwelt upon at some length in
my lectures last year, I mention these researches of
Friedlander's in order to suggest, that not only in the
form of bronchitis having a gastro-hepatic complication,
but that in other forms of bronchial inflammation, we may
reasonably infer that lesions of the par vagum form an
essential element in the pathogenesis of the various forms
of inflammation involving the structure of the lungs. In
the gastro-hepatic form of bronchitis, it is more than
probable that irritation of the gastric mucous membrane
is the primary cause of the bronchial irritation which,
acting upon the peripheral nerves, induces a reflex action
(the precise nature of which we cannot yet determine),
producing the morbid changes of nutrition similar in kind
to though less in degree than those produced by section of
the vagi.
The practical conclusions to which I am led from these
considerations are this, that inasmuch as we know that nux
vomica in pathogenetic doses produces symptoms which
point to a pathological condition similar to the catarrhal
hyperemia which lesions of the vagi induce, and is cura-
tive of such arising idiopathically, we are justified in
saying that its modus operandi is in accordance with the
law of similia. I venture to go still further, and to affirm
that all recent histological research is leading irresistibly
to the conclusion that in the majority of diseases, whether
functional or structural, the morbific cause, whatever it
may be, produces its first impression either on the nervous
centres or their peripheral expansions. Physiologically,
we now know that whether it be muscular motion, vas-
cular contraction or dilatation, glandular secretion, or cell
growth, all these are energised or controlled through the
instrumentality of nerve force; and pathologically, we are
by analogy led to infer that disturbance of the vis nervosa
is the prime factor in most diseased conditions, whether
functional or structural. We employ these terms as if
they were essentially different; further research, how-
ever, will probably show that all functional diseases are
really structural, but that from our present limited powers
instrumentally, we are unable to detect the first departure
from health in any tissue. Now, although, we cannot see
*
CHRONIC BRONCHITIS.
61
with our eyes the earliest changes taking place in nerve-
cell or capillary vessel in the living human body, micro-
scopic research is revealing facts of inestimable value, and
we homœopathists are as deeply interested in every dis-
covery achieved, for we feel sure that the results will
harmonise not only with our therapeutic formula, but also
will be found to hold a consistent relation to the minute
doses which experience has taught us to administer in
disease. These observations will not be considered irre-
levant, if you agree with me that the researches to which
I have referred will enter largely into the medicine of the
future, and they will not be unfruitful if they tend to
mould the future practice of the healing art into more
rational and scientific methods than at present prevail.
LECTURE VI.-Chronic Bronchitis (continued).
GENTLEMEN,
Having thus dwelt at some length upon matters that
seemed to me to demand attention in connection with the
form of bronchitis I have described, I will now attempt
some sort of classification of a few of the different forms
of sub-acute and chronic bronchitis we meet with in prac-
tice, and will try to point out the different actions of a
few of the drugs which are found by experience to be
curative in those forms.
The first form I shall notice is the common catarrhal
sub-acute bronchitis supervening upon a chronic condi-
tion having remissions during the summer months, but
invariably returning with the cold or damp of winter.
CASE NO. 1.
W. M., æt. 25, a brassfounder, was admitted into this
hospital under the care of Dr. Hale, April 6, 1875. For
four or five years he has suffered from "winter cough,"
which usually disappears during the summer. During
№3
62
LECTURE VI.
the last winter it has been much worse than usual. It is
most troublesome during the night, when it is paroxysmal,
and occasionally followed by retching, though rarely
accompanied by any expectoration. There has never
been any hæmoptysis. He has not become thinner,
though much weaker, and unable to follow his trade.
Resonance over the whole chest is good, though a little
less clear on the left side anteriorly than on the right.
Occasional dry and moist râles, though not numerous, are
heard over both sides of the chest.
Prescription-Tinct. ipecac. 1x, mj. qq. 4tâ. h. He was
put on full diet, and allowed half a pint of porter daily.
April 19th. The cough is much less, appetite improved,
and he is feeling stronger.
Med. cont.
April 27th. The cough has nearly ceased. He con-
tinued to gain strength, and was discharged perfectly
well on the 15th of May.
C
Ipecacuanha 1x was the drug prescribed for this case,
and was the only drug indicated from first to last during
his three weeks' stay in the hospital, until he was dis-
charged cured. The symptoms which specially indicated
this drug were, 1st, the spasmodic character of the cough
and the reflex gastric irritation as shown by the retching.
Auscultation only revealed a moderate amount of bron-
chial irritation by the moist râles heard over the entire
chest, which, however, were not numerous, and the reso-
nance was good.
Tartar emetic, the analogue to ipecacuanha, might at
first sight seem as homœopathic to the symptoms as ipeca-
cuanha, if the retchings alone had been taken into account,
but inasmuch as spasm is not a characteristic symptom of
tartar emetic, and is a marked symptom in the pathoge-
nesis of ipecacuanha, the choice of the latter was truly
homœopathic, and was therefore truly curative.
This symptom of spasm differentiates ipecac. from ant.
tart., and if you will study the pathogenesis of the drug
you will see what a prominent part it plays in many of
the organs of the body. In the throat it produces a spas-
modic contractive sensation; it causes spasmodic vomiting
in the stomach, pinching colic in the hypochondria,
convulsive cough and asthmatic breathing in the lungs.
Opisthotonos and emprosthotonos in the spine and con-
vulsive twitchings and cramps in the lower extremities.
·
CHRONIC BRONCHITIS.
63
Tartar emetic, it is true, causes spasmodic vomiting and
colic, and jerking of the limbs during sleep, but spasm
cannot be said to be its characteristic symptom.
The neurotic character of ipecacuanha is more promi-
nent than its power of producing any great amount of
tissue-change. It causes some amount, no doubt; for
the epithelial cells of the bronchial mucous membrane
play an important part in the secretion of mucus which
ipecacuanha produces; but, I take it, its action does not
produce any deeper tissue-change, whereas tartar emetic
affects often very profoundly not only the bronchial
mucous membrane of the larger bronchi, but extends its
toxic effects into the minute ramifications of the bronchial
tubes and into the air-cells.
CASE NO. 2.
W. Y., æt. 32, a confectioner, was admitted into hos-
pital March 20, 1875, under Dr. Hale. Three years
since he had a violent attack of dyspnoea, which he
ascribes to his having inhaled sulphurous acid gas.
After a short time he recovered, and remained well for
two or three weeks. It then returned, and his breathing
has since been always more or less defective. Two years
back he had an attack of bronchial catarrh, which con-
tinued for a considerable time, and greatly embarrassed
his breathing. Relapses have occurred from time to
time.
On his admission the dyspnoea is very distressing,
cough violent and paroxysmal, and the expectoration
muco-purulent. The normal respiratory sounds are very
feeble, and mucous râles abound throughout the chest.
His appetite is poor, nausea is frequent; he gets but
little sleep at night.
Prescription-Tinct. ant. tart., 3x gtt. j. qq. 4tâ. h.
April 13. Since his admission he has steadily im-
proved. The cough is much less violent, breathing
comparatively easy, expectoration diminished, and its
muco-purulent character less marked. His appetite is
now good, tongue clean and moist; bowels rather in-
active. Some muscular pains along the base of the chest
of which he complained on admission are much relieved.
Cont. med.
April 20th. Improvement continues.
...
wil
64
LECTURE VI:
Prescription-Tinct. ant. tart. 6 gtt. j. ter in die.
27th. Has now comparatively little cough or expecto-
ration, and has greatly increased in strength.
The same medicine was continued, and he was dis-
charged greatly improved on the 9th of May.
You will observe that in this case, although the sym-
ptoms were paroxysmal in character, and that dyspnoea
was one of the chief symptoms, spasm was only incidental
to the more serious impediment in breathing caused by
the imperfect aëration of the blood, owing to the amount
of secretion in the bronchial tubes, which secretion being
muco-purulent was sufficient proof that the injury to
tissue was greater, and, for the reasons before stated, the
case demanded tartar emetic in preference to ipecacuanha,
notwithstanding the suspicion that asthma to some extent
complicated the symptoms.
In the next case I have to bring to your [notice asthma
greatly aggravated the condition of the patient and was
combined with functional disorder of the chylopoietic
viscera, menstrual irregularity, and with an array of
symptoms which proved the case to be a complicated one,
but deserving your attention as illustrating the manage-
ment of such a one under homoeopathic treatment.
W
CASE NO. 3.
E. M., æt. 32, domestic servant, was admitted under
Dr. Hale, March 13, 1875.
For five or six years she had suffered from a cough
during the winter, but more so than usual during the last
few months. Has had occasional hæmoptysis, and the
sputum is still now and again streaked with blood.
Cough is worse during the night than in the daytime.
Expectoration stringy, and is somewhat difficult. There
is no dulness on percussion in any part of her chest; but
both anteriorly and posteriorly sonorous and sibilant râles.
are numerous. Her appetite is poor. Tongue coated in
the centre with brownish fur; bowels confined.
Prescription-Tinct. kali bichrom. 3x, mj. qq. 4tâ. h.
March 22nd. Cough is somewhat less. Otherwise
she is much the same.
Prescription-Tinct. ipecac. 3x, mj. qq. 4tâ. h.
29th. Much the same.
Prescription-Tinct. nucis vom. 6 mj. ter in die.
CHRONIC BRONCHITIS.
65
April 21st. The cough has improved. The expecto-
ration is looser, and though the cough is still somewhat
troublesome at night, she sleeps better. She complains
now of pain in the left side, and of flatulence.
Prescription-Tinct. lycopod. 3x, mj. qq. 4tâ horâ.
She continued to improve slowly, and on the 13th May
lobelia 3x was ordered.
On the 12th June she was discharged much improved.
It will be noticed that in this case we had not only
extensively diffused bronchitis, the sputa having that
plastic character which always accompanies a considerable
amount of inflammation involving tissue change, but we
had in addition a neurotic complication in the accompany-
ing asthma, and besides this we had the reflex action of
the pneumogastric, arising from the irritable and con-
gested state of the mucous membrane of the stomach.
Ševeral medicines in succession were therefore necessary;
for example, when the more urgent bronchial symptoms
had subsided, and which were treated by bichromate of
potass and ipecac. from March the 14th to the 29th, nua
vomica carried on the improvement for nearly three weeks,
and this, followed by lycopodium (whose sphere of action
extends not only over the functions of the abdominal
organs, but also has a specific action upon the organs of
respiration), was of effectual service at this stage of the
patient's recovery.
The catamenia not having appeared during this patient's
stay in the hospital, and her circulation being evidently
embarrassed from this cause, I prescribed pulsatilla on
May the 4th, and on the 6th the menstrual secretion
appeared.
The catamenia were always irregular in this woman, a
circumstance which accounts for the hæmorrhage from the
lung which no doubt was vicarious, and for the reflex
spasm producing asthma.
The treatment of the latter part of this case consisted
in the administration of lobelia inflata 3x.
The next case to which I beg to call your attention,
one of those by which professional capital is often made
by charlatans who profess to cure pulmonary consump-
tion, was a case of chronic bronchitis and nothing more;
it is, however, instructive, and of considerable value in
relation to the diagnosis of phthisis.
5
66
LECTURE VI.
CASE No. 4.
J. W., æt. 55, traveller. Was admitted under Dr.
Hale on the 9th April, 1874. About two years and a
half since had an attack of bronchitis which lasted several
months and left him rather weak. He has since had
several similar attacks; latterly he has never been entirely
free from cough, while dyspnoea has supervened and has
been gradually increasing in intensity.
The
On admission he complains of debility and a distress-
ing cough, coming on in paroxysms and frequently giving
rise to a feeling of nausea. The expectoration, which at
one time was profuse, is now much diminished, and
muco-purulent in character. He has had several attacks
of hæmoptysis. Dyspnoea is very distressing.
respiratory and cardiac sounds are feeble, and mucous
râles abound over the chest. He has pain at the upper
part of the thyroid body. There is profuse perspiration
over the right side of the head, which is constantly damp
although the opposite side may be quite dry. He is
weak, and has lost flesh considerably during the last
twelve months.
Prescription-Tinct. ipecac. 3x, gtt. ij. qq. 3tià h.
April 13th. Considerably improved. Cough much
less; breathing easier; expectoration diminished some-
what; appetite good; bowels act regularly; sleeps pretty
well.
Continue medicine.
19th. All the symptoms are improved. Perspires a
great deal on the right side of the head on the least
exertion.
Prescription-Acid. nitric. 1x, qq. 4tâ h.
30th. Cough better; expectoration diminished; while
out yesterday had an attack of faintness. Perspires
freely, especially on the right side of the head; saliva is
in excess.
Continue medicine.
May 7th. Breathing is easier; cough the same; per-
spires less; appetite improves.
Continue medicine.
21st. Is improving in all respects. The perspiration
had rather increased until within the last few days, but is
now diminished in amount.
2
CHRONIC BRONCHITIS.
67
Prescription-Ac. nitric. 3 ter in die.
He continued to get better until the 5th of June, when
he was discharged "much improved."
You will have observed how many of the symptoms of
consumption existed in this man's case. The frequent
bronchial attacks, the persistent cough, the hæmoptysis,
loss of flesh, debility, perspiration, the semilateral sweat
on head being a marked and peculiar symptom. There
were besides laryngeal tenderness and copious muco-
purulent expectoration. All these symptoms looked very
like a picture of phthisis, but the physical signs of that
disease were wanting, and the marked amelioration at the
end of a two months' treatment was in itself sufficient
proof that the case was not pulmonary consumption in an
advanced stage. Only two medicines were given, ipecac.
for the first few days, indicated by the paroxysmal cough
accompanied by nausea, and subsequently nitric acid in
various dilutions, the perfectly homoeopathic remedy
chosen among other reasons for its specific action upon
the skin as well as for its relation to laryngeal inflamma-
tion and ulceration. The muco-purulent expectoration, a
symptom among others which simulates the sputa of
phthisis, reminds me especially of two cases out of many
others I have met with in practice which are apropos to
this one.
One was a lady who consulted me some fifteen
years ago, and who presented all the symptoms of active
tubercular disease, with night perspirations, emaciation,
cough and purulent expectoration, causing the greatest
anxiety to her relatives and friends, but who made a rapid
and complete recovery in a very few weeks; and not very
long ago I saw a case, in consultation with an esteemed
colleague, where without exaggeration the sputa consisted
of pints and pints of pure pus, wholly and solely the
result of the rapid production and proliferation of pus-
cells in chronic bronchitis. There is only time to call
your attention to two or three other hospital cases, one a
case of bronchitis complicated with that mysterious con-
stitutional element gout. Where this dyscrasia is present
in the system, I need scarcely remind you it invariably
renders cases obstinate and often intractable in their
treatment, especially if latent, and deeply engrained in
the system; and, whether we have to deal with gouty
iritis, conjunctivitis, or any other inflammation having
Gain.
68
LECTURE Vi.
i
gout at the root of it, the treatment is often, and, indeed,
I may say always attended with difficulty and, in not a
few cases, with disappointment. I don't mean to say that
we fail to relieve urgent symptoms or to mitigate suffer-
ing; but to eradicate or cure gout, or remove the gouty
materies morbi, if there is a materies morbi, is not as yet,
in the majority of cases, in the power of homœopathy or
any other system of medicine to effect. The case, the
notes of which I am about to read, is a good example of
the prompt relief which follows the local development of
the disease and the speedy removal of the bronchial in-
flammation which it brought about.
CASE No. 5.
A
H. H., æt. 63, omnibus driver, was admitted under
Dr. Hale Jan. 28th, 1875. He states that he has always
suffered from winter cough, but more severely of late
than heretofore. The cough is worse in foggy, and less
in dry weather. It is aggravated at night, when he has
paroxysms of cough, accompanied by the expectoration of
clear frothy sputa, which gives him much relief.
paroxysm of cough is frequently followed by vomiting.
The resonance of the chest is pretty good except under
the left clavicle, where it is somewhat impaired. Sono-
rous and sibilant râles are heard over the chest in
abundance. The heart-sounds at the base are very in-
distinct, but normal at the apex. The appetite is pretty
good; occasionally there is some indigestion; sleeps mode-
rately well.
C
Prescription-Tinct. ipecac. 1x mj. qq. 3tiâ h.
Feb. 8th. An attack of gouty inflammation in the
right hand was followed by a rapid subsidence of all the
symptoms and signs of bronchitis.
Prescription-Tinct. colch. 1x mj. qq. 4tâ h.
He continued to improve, and was discharged cured on
the 4th March.
1
A case in my private practice was that of a Warwick-
shire squire, who came under my care for several winters
at St. Leonard's, is an example of the curious vicarious
action of gout. This gentleman, who was about 60 when
I first prescribed for him, could ride with the hounds
:
CHRONIC BRONCHITIS.
69
during the day without the slightest distress to his breath-
ing, but could never attempt to lie down in bed until he
had passed several hours of the night sitting in his arm-
chair, except when gouty inflammation showed itself in
one of his toes, and then he could lie down at once in bed
and breathe in comfort. He rarely, however, had a
thorough good fit of the gout, and the consequence was
that the immunity from this distressing dyspnoea was short
lived. In addition to this nightly difficulty of breathing
the senses of smell and taste were entirely absent, except
when gout attacked the feet, and then both smell and
taste were completely restored. The late Dr. Rutherford
Russell and myself tried various expedients to try and
develope a good attack of gout, but without success. I
did not attend this gentleman in his last illness, which
was at his seat in Warwickshire, and I do not know
whether it was his old enemy or not which caused his
death.
CASE No. 6.
A. B., æt. 60, a married woman, was admitted under
Dr. Hale October 17th, 1872.
Has suffered from dyspnoea for two years. Cough came
on about two months ago, somewhat suddenly attended
with dyspnoea and palpitation of the heart. Expecto-
ration difficult to detach. Moist râles are heard all over
the chest.
Prescription-Antim. tart. 3x gtt. j. qq. 4tâ h.
Oct. 21st. Is in much the same condition.
Prescription-Tinct. Phosp. 6 gtt. j. qq. 4tâ h.
24th. Cough better. Bowels slightly relieved last night,
but with great pain.
Prescription-Bryonia 3x gtt. j. qq. 4tâ h.
28th. Cough very much better; no dyspnoea; expecto-
ration still viscid.
Continue medicine.
31st. Some nausea; sour rising; dyspnoea; cough and
dyspnoea very much better.
Prescription-Tinct. Puls. 3 gtt. j. qq. 4tâ h.
Nov. 4th. Improving.
Prescription-Tinct. Bell. 3 gtt. j. qq. 4tâ h. Trit.
Lycop. 3 gr. j. omne nocte.
70
LECTURE VI.
11th. Has greatly improved; complains of pain and
bearing down in passing stool, and some pain in mic-
turition.
Prescription-Sepia 12 gtt. j. ter in die.
She was subsequently examined by Dr. Leadam, who
found a little prolapsus, very slight ovarian tenderness,
but no uterine flexion. She continued to improve, and
was discharged cured on the 21st November.
This kind of case is very common in oldish women of
phlegmatic temperament, lax fibre, and a tendency to
over-secretion from mucous membranes generally, as we
have seen in the symptoms of the expectoration.
Recapitulation of the points which I have dwelt upon
in this lecture will conclude what I have to say to-day:
1. I have endeavoured to maintain the doctrine which
is now that generally held-That inflammation is owing
to diminished vital force in the organism.
2. That modern microscopic research has given us a
more intimate knowledge of the tissue-changes involved
in inflammation, which changes obey certain fixed laws.
3. That we are justified in expecting that the agents
which have the power of rectifying abnormal tissue-changes
are equally under the reign of law.
4. That we of the homoeopathic school maintain the
existence of such a law, which is best expressed by the
formula Similia similibus curantur.
5. And, lastly, that we hold what we think ought to be
accepted as a self-evident truth, that if the abnormal
conditions which constitute disease exist in the minute
elements which make up the structure of animal bodies,
the physical condition of the curative agent must be
minuter still, must have an elective affinity for certain
tissues, and must act dynamically upon those elements.
which are abnormally changed by disease.
PHTHISIS PULMONALIS.
71
LECTURE 7.-Phthisis Pulmonalis.
GENTLEMEN,—It would be impossible to exaggerate
the importance of the subject which will occupy us to-day,
for I have to direct your attention to the diagnosis and
treatment of one of the most fatal diseases to which
suffering humanity is prone.
When we remember the
insidious character of phthisis, and how frequently its
earliest symptoms escape the observation of either the
patient or his friends; and when we know that unless the
very earliest warnings of the advance of the enemy are
noticed, and its onward march arrested, our measures of
defence against the destructive process in the great
majority of cases, consists in covering a retreat with as
little loss as possible, or by defending the citadel of life
until resistance is no longer in our power.
With regard to the pathology of phthisis, it is not my
intention in the present unsettled state of the question as
to the nature of pulmonary tubercle, to attempt any
positive definition of its essential character. I will content
myself by stating as concisely as possible, the most recent
views entertained about it. It is maintained that pul-
monary phthisis originates in a purely inflammatory pro-
cess in the tissues of lungs having a weak organic power
of resisting those changes which are brought about by an
accumulation of epithelial cells within the pulmonary
alveoli, resembling the changes which take place in true
catarrhal pneumonia by a thickening of the alveolar walls
as a result of the former, ending in an increase of the
interlobular connective tissue, in fact a process identical
with that of catarrhal pneumonia, but with this essential
difference, that in pneumonia the exudative products are
cast off, the lung tissue regaining its normal condition,
whereas in pulmonary phthisis the products of inflam-
mation are not cast off, but on the contrary cause destruc-
tive disintegration and death of the lung tissue, the result
in a great measure of a condition interfering with the pul-
monary circulation by which large portions of the
pulmonary consolidation are destroyed.
True tubercle, it is asserted, is the result of an infective
72
LECTURE VII.
process, originating in a focus of infection from which the
infective tubercular element is carried to distant organs,
and there deposited in the shape of grey granulations and
numerous nodular masses, which disseminated through the
substance of the lungs, constitute what is understood as
miliary tubercles. But even here it is asserted by some
that an antecedent inflammation seems to originate these
infective elements, so that to my mind there is no
absolutely clear line of demarcation between inflammatory
and non-inflammatory pathological conditions in relation
to the distinction between the lesions constituting pul-
monary phthisis and tuberculosis. In practice we meet.
with cases where it is not easy to say whether the lesion
in the lung has been antecedent or subsequent to inflam-
mation. Cases occur where infiltration of what I must
still call tubercle goes on slowly, unaccompanied by
symptoms or signs of inflammation, a gradual degeneracy
of tissue owing to feeble or perverted nutrition takes
place, followed sooner or later by local and constitutional
signs of irritation. Albuminoid and cacoplastic exudations
take place from the blood deficient in fibrine, followed by
condensation and subsequent softening of the infiltrated
substance. Such are cases of what is termed chronic
phthisis, which do not advance with an unvarying progress
towards a fatal termination, but have often long intervals
during which the local signs and constitutional symptoms
remain in statu quo, or become less pronounced under
judicious treatment. On the other hand you meet with
cases in which evidence of pre-existing inflammation,
either of frequently recurring attacks of bronchial irri-
tation, or of unresolved pneumonia is undoubtedly afforded
you. In either case, we frequently find, that there was
a constitutional proclivity to the disease; but what the
essence of that phthisical diathesis is, we are at present
unable to say. In the great majority of cases it is
hereditary, but it can also be induced, witness for example
the effects of climatic influences in natives of the tropics
(where phthisis is unknown), when they are exposed to
European cold and damp; it may also be induced in
natives of the temperate zone not otherwise prone to
tuberculization by hereditary descent, if they are subjected
to those influences which deteriorate the general health by
inducing imperfect assimilation of food, and at the same
time deficient oxygenation of an imperfetly elaborated
•
-
PHTHISIS PULMONALIS.
73
vital fluid.
Another cause of induced phthisis closely
allied to that just named is no uncommon one, namely, a
low state of health following undue lactation or exhausting
discharges or loss of blood. I saw lately in consultation
with an esteemed colleague, a case in which there is no
history of hereditary consumption, but in which frequent
miscarriages and domestic anxiety have been followed by
most suspicious general and local symptoms of pulmonary
tubercle. These may be thought such trite and well-
known facts, that it may seem unnecessary to occupy your
time by dwelling upon them; but I do so because I wish
to impress upon the younger portion of those I have the
honour to address, some cautions for which I should have
been most grateful when I commenced the practice of our
profession. I mean this, that in the absence of evidence
of hereditary predisposition, we should be alive to the fact
of the frequency of induced phthisis in forming our
diagnosis. A case which occurred some five-and-thirty years.
ago, made a very lasting and painful impression upon my
mind, illustrates both this form of the disease, as well as
its insidious character. I was living in the house of a
medical friend, a man of good average education in large.
practice, with quick perceptives in detecting disease, and
yet both he and myself were blind to the fact, that a
daughter of his, between 15 and 16 years of age, was day
by day and week by week, fading away before our eyes
in tubercular phthisis. The girl had been to school at
Brighton, and I am afraid had not been sufficiently
nourished, or had her general health attended to; on
coming home for the holidays, she simply looked pale,
languid, and thin, but then she was growing fast, the
symptoms of cough and shortness of breath were not
sufficient to arrest our attention, neither on the father or
mother's side was there consumption, and so both when
at school and at home the mischief escaped detection;
until one day to our horror, upon examining her chest, a
cavity was discovered in the apex of one lung, and in a
very few months she was carried to her grave. Now if
such blindness could exist in the family of a medical man,
is it to be wondered at that the same occurs over and over
again in other families, and most precious time is lost.
This insidious character of the disease being one of its
characteristics, is I believe the chief cause of the great
mortality which this disease produces, for I am convinced
L
74
LECTURE VII.
from considerable experience, that the prospect of cure is
much more hopeful than is generally believed, provided
those structural changes have not advanced beyond a
certain stage. When I come to the question of treatment,
I shall endeavour to point out the kind of cases in which
treatment in the early stages affords the most hopeful
prospect of cure, and happily such cases are by no means
uncommon. It is scarcely necessary to repeat what is so
perfectly well known and self-evident, that the early
detection of the disease is of supreme importance, and I
do not think that if the physician possesses the necessary
qualifications of ordinary diagnostic skill in interpreting
the value of symptoms, combined with an acute ear,
trained to the perception of those sounds which auscul-
tation yields, the diagnosis of phthisis in its very earliest.
stage is such a very difficult matter. Of course every one
knows that there are cases, where, in spite of the most
careful inquiry into the history of the case in relation to
hereditary transmission, or to the previous habits, mode
of life, and occupation of the patient; and even where a
most careful physical examination has been made, a doubt
still remains, and no positive opinion can be given to the
anxious relatives or friends, and time alone the resolver of
all doubts must decide the momentous question; such
cases, however, I venture to affirm form the exception and
not the rule. Permit me now to recall to your mind the
symptoms which lead to a suspicion of threatening con-
sumption, and the physical signs which ordinarily accom-
pany such symptoms.
Let me for example take an every-day case. A young
girl of 18 or 19, tall, slight, fair, and narrow chested, who
menstruated early, say at 13 or 14, and in whom the
catamenia are rather abundant than otherwise, occurring
every third week; the face is pallid, there is an unusual
languor about her, her respiration and pulse become
accelerated on slight exertion, but are but very slightly
hurried when she is at rest; the appetite is capricious,
extremities are cold and clammy. There is very little
cough, except on first getting up; but the character of
the voice is altered in speaking or reading aloud, it soon.
becomes husky, and in singing, her voice which used to
be as clear as a bell, now breaks, even on a low note, and
has no power of holding a note, whether high or low in
the scale. Although in the early and middle part of the
.
:
PHTHISIS PULMONALIS.
75
day her temperature is often below the standard of health,
towards evening it rises above 100°, and she is flushed.
Her hair, which used to be until lately glossy and inclined
to curl, now falls limp and springless, and is inclined to
fall off; she perspires but very slightly, and that only to-
wards morning. I need scarcely say that these symptoms,
however suspicious, may all exist, and yet may be the
result of other causes, and may not depend upon tuber-
cular development at all; but if combined with these
symptoms, the physical signs of condensation of the lung
tissue, however limited, exist, the diagnosis of pulmonary
phthisis becomes almost a matter of certainty.
Before drawing your attention to those signs which aid
in the diagnosis of the earliest stage of phthisis, I wish to
dwell for a few minutes upon those signs which generally
indicate the presence of tubercle, when there is no doubt
as to its existence. It is important to remember, that
there are no physical signs peculiar to phthisis, and it is
only by combination and comparison of the signs in
relation to the symptoms of the disease, that a correct
diagnosis can be arrived at. For instance, the existence of
tubercle in the upper portion of the lung is recognised
by the difference betwen its physical signs and that of
the lower lobe, in other words by applying comparison.
Where comparison cannot be employed, the diagnosis is
rendered more difficult; in those cases for example which,
however, are exceedingly rare and exceptional, and where
there is an extensive infiltration of tubercular matter
throughout the whole of both lungs, and accompanied
everywhere by the signs of irritation. It is important to
remember, that all the tissues of the lungs may be involved.
in the irritation which accompanies the development of
tubercule. We may find-
1. Signs of irritation:
Metadata
a. Of the mucous membrane.
b. Of the air-cells.
c. Of the serous membrane.
2. Of solidification.
Of ulceration.
Of atrophy.
It is scarcely necessary to say that the earliest signs are
not those of actual condensation of the pulmonary tissue,
nor are they signs of bronchial irritation to any appreciable
extent; but as I believe are caused by slight hyperæmia
76
LECTURE VII.
coming and going, a condition, so to speak, of preparedness
for the lesions which will sooner or later occur, if preven
tive treatment be not promptly adopted. During this
threatening stage there are two signs of supreme im-
portance:
1. Local dulness on percussion, often of the slightest
possible amount, and requiring the most delicate manipu-
lation to detect.
2. Slight feebleness of respiration of one infra-clavicular
region.
A caution becomes necessary with regard to this sign-
namely, that if we do not know that the respiratory
murmur on the left side is generally more pronounced
than on the right side, we may be led into the error of
confounding the slightly less pronounced vesicular expan-
sion of the right apex, which is normal, with capillary
congestion or consolidation, which would be the abnormal
cause of the feebler respiration, and thus be led to take an
unfavourable view of the case.
Let us now revert to what I propose to call, for the
purpose of illustration, a typical case-that of the young
girl referred to before.
Let us suppose that, having gone carefully into her
history and symptoms, we next make a physical examina-
tion of her chest, which on inspection we find seems to
expand equally on both sides; there is, however, a want
of the full development of the thoracic cavity, considering
her height; we percuss delicately both clavicles with the
tips of two fingers, and a practised ear detects slight com-
parative dulness on one side, but so slight that positive
dulness cannot be affirmed. If we now get our patient to
take a deep inspiration and then to hold her breath, if
any
dulness really exists this procedure will in most cases
reveal it. If in addition to this slight amount of dulness
we find, on applying the stethoscope, that there is feeble-
ness of respiration, as well as diminished sonoriety on the
affected side compared with the opposite side, especially if
the feebleness be on the left side, we should, I think, be
justified in concluding that at least the gravest suspicions
must be entertained that tubercular disease is impending.
If either or both of those signs are unequivocally present,
and that either on ordinary or deep inspiration signs of
bronchial irritation are heard in the shape of mucous or
muco-crepitating râles, or even only one or two bubbles,
• 1
PHTHISIS PULMONALIS.
77
the diagnosis of incipient phthisis becomes a matter of
certainty, when taken in conjunction with the symptoms
and history of the patient.
I would mention, in passing, one symptom, which is, I
know, often relied upon in diagnosing phthisis-namely,
prolongation of the expiratory murmur; but inasmuch as
I have frequently noticed this in thin, nervous patients,
in whom all other symptoms and signs of consumption
were wanting, I am not inclined to attach much import-
ance to that phenomenon; but if a prolonged expiratory
murmur is of an interrupted character, the "respiration
entrecoupée" of Laennec, it has an increased diagnostic
value.
My object in this lecture being to limit what I have to
say to the chief principles of the early diagnosis and to its
treatment, it is not my intention to go into the larger
question of the symptoms, physical signs, and the struct-
tural lesions of the fully developed disease. It would
require an entire course of lectures for such an undertak-
ing; but I beg it to be distinctly understood that when I
come to the subject of treatment, and confine my remarks
solely to the homoeopathic method of combating the inci-
pient stage of phthisis, it must not be inferred that homoeo-
pathy is powerless in the subsequent stages; on the con-
trary, I can affirm, from some thirty years' experience,
that our specifically acting remedies, when applied accord-
ing to the law of similars, are of inestimable value in
retarding the progress of phthisis, prolonging life, and in
the last stage of all palliating many of the distressing
symptoms which usher in the approach of the last
Y
J
enemy.
In the prognosis the physician may be called upon to
give, it is of the utmost importance to be able to diagnose.
between that form of phthisis which is more closely allied
to catarrhal pneumonia and has a pneumonic origin, and
where the lesion is limited and localized, to that form
which originates in the formation and general distribution
of what pathologists now-a-days call true tubercle, consist-
ing of grey semi-transparent nodules, which are often
deposited not only through the entire substances of both
lungs, but also in all the other organs of the body. In
such cases where such extensive deposits exist, I need
not say the prognosis must be most unfavourable, and
even the possibility of arresting the fatal issue hopeless.
1978
LECTURE VII.
In not a few cases the diagnosis is one of extreme diffi-
culty, for, owing to the general diffusion of tubercle
through the lung, comparison of one portion of the lung
with the other portions, cannot be made, even where
physical signs exist, and cases of acute tuberculosis are
now and then met with, in which no auscultatory signs
are discoverable, and such patients even die, retaining to
the last their usual embonpoint, and in whom there were
neither cough nor expectoration. Such cases are of course
comparatively rare, but the ordinary form of acute tuber-
culosis is well exemplified in a case at present under my
care in my private practice.
A little girl, æt. 11, whose family are intensely stru-
mous, and who has lost, I think, three or four grown-up
sisters in consumption, presents the following symptoms:
-When first seen there were short hacking cough,
extreme acceleration of pulse and respiration, pallid face,
with a crimson circumscribed flush during the evening
exacerbation, extreme variation of temperature-that of
the morning being normal, rising to 103° in the evening;
she perspires during the night, and has diarrhoea during
the day. There are moist crepitating râles from apex to
base in the right lung posteriorly, but of greater intensity
anteriorly. The same phenomena exist in the left lung,
but confined to the upper lobes. Now, although a week's
treatment has greatly diminished the severity of the
above-named symptoms and physical signs, I am obliged
to give a most unfavourable prognosis, for I fear nothing
can save this child.
I mention this case, not indeed in relation to the dia-
gnosis of the early stage of phthisis, but as an illustration.
and a contrast to cases in which we are justified in giving
a hopeful though guarded prognosis. And what are these
cases?
1. They are those having no strong hereditary predis-
position.
2. If the threatening manifestations of the disease are
limited and confined to the apex of one lung, especially if
it be the left lung.
3. If impaired nutrition, owing to feeble assimilation,
appears to be the proximate cause.
4. If the symptoms have followed an attack of catarrhal
pneumonia or hæmorrhagic congestion of the pulmonary
tissue.
PHTHISIS PULMONALIS.
79
-
Now, I am prepared to affirm that if we meet with cases
of this kind and in the incipient stage, there is every
reason to hope that, under homoeopathic treatment, aided
by judicious hygienic measures, health can be restored;
and I will go further in stating, as the result of no in-
considerable experience, that even in cases where there
is a considerable amount of disintegration of the lung-
tissue, life can be indefinitely prolonged. Many of my
colleagues whom I see before me can, from their own ex-
perience, verify this statement.
But now a few words as to the pneumonic origin of this
disease, in which the great Laennec did not believe, and
which some in the present day are slow to acknowledge.
Laennec's opposition to this theory I will take the liberty
to quote. He thus writes:-
"If we question any practitioner ignorant of morbid
anatomy, but who is a man of observation and free from
prejudice, I have no doubt that he will give it as his
opinion that it is very rare to see the symptoms of phthisis
supervene to acute pneumonia. Even in the cases where
this sequence is observed, it is impossible to say whether
the pneumonia has given rise to the tubercles, or whether
these, acting as irritating bodies, have not excited the
pneumonia. On the authority of morbid anatomy, the
solution of the question is much more simple, since it is
certain that we very rarely find tubercles in the lungs
of those who have died of pneumonia, and that the greater
number of consumptive subjects exhibit no symptom of
this disease during the progress of their fatal malady, nor
any trace of it after death. Many of these even have
never been affected with it during the whole course of
their life. If tubercles were merely a product or termina-
tion of acute peripneumony, we should be able to ascertain
the different steps of the transition of the one into the
other, in the same manner as we are able to describe all
the intermediate degrees between the simple inflammatory
engorgement and the pulmonary abscess; but this is far
from being the case.”
I was educated in this belief, and have held it until the
researches of the last few years have changed my views.
It is only within recent times that even the distinction
between catarrhal pneumonia and the croupous form of
the disease has been made clear. Laennec knew of no dis-
tinction between the two forms at all, and to histological
80.
LECTURE VII.
discoverers we are alone indebted for the proofs of such
distinction.
But the question may still be asked, as Laennec asked,
why are not tubercles more frequently found in the auto-
psies of pneumonia ?-and how comes it that the greater
number of phthisical patients exhibit no symptoms of the
disease?
The answer to Laennec's first question appears to me to
be this. In croupous pneumonia the fibrinoid exudations
into the alveoli and connective tissue, in the majority of
cases, after coagulating in the pulmonary tissue, liquefy,
and are absorbed or expectorated, and the same thing
takes place in catarrhal pneumonia; but if there be a low
state of general health or a predisposition to phthisis,
these exudations are not absorbed, and the following
structural changes ensue :—
1. An accumulation of epithelial cells within the
alveoli.
2. Fibrinous exudation and leucocytes remain within
the alveoli.
3. Thickening of the alveolar walls.
4. Increased growth of the interlobular connective
tissue.
This condition of things soon leads to still greater tissue
changes. The cells in the consolidated tissue pass
through various stages of retrogressive metamorphosis,
the alveolar walls are destroyed, and where this process is
most advanced all trace of structure is lost, and nothing
is seen but a granular débris.
To follow the destructive process any further would
lead me into the subject of phthisis in its still more
advanced stages, which is not my object in this lecture;
and if I have travelled thus far, it is only for the purpose
of showing to what the neglected incipient stage of
phthisis may very quickly lead. But these details have
also a most important bearing upon the practical question
of treatment, to which I now will address myself.
I endeavoured to impress upon you in my first lecture
that inflammation and the destructive changes, such as we
have just been considering, depend essentially upon
feebleness of the organism; how much more it is of this
nature when associated with the development of acute
tubercle, or with the more common form of pulmonary
PHTHISIS PULMONALIS.
81
phthisis. A recognition of this principle is of supreme
importance, for whether the low standard of health which
invariably exists in consumption depends primarily upon
defective assimilation, and as a consequence imperfect
sanguification, and as a result weak and unstable cell-life;
debility, whether in the nervous centres or in the tissues.
involved, is at the bottom of the diseased state; and to
rectify, and if possible improve this low standard of health,
forms one of the chief indications.
The treatment of this disease, in common with all dis-
ease, consists of two kinds-hygienic and medicinal. The
first or hygienic involves the question of climate, upon
which I will say a few words. With regard to any cli-
mate having a specifically curative effect upon phthisis,
I may state, as the result of my own experience, that I
don't believe any climate in the world possesses any such
specific power; but I do believe that whatever climate
has the effect of keeping up the general health to the
highest possible standard is the best, whether it be a
winter passed in the valley of the Engadine, with its
almost arctic temperature, or the Riviera, with its balmy
air and vitalising insolation, or the valley of the Nile,
where, from the purity and elasticity and perfect dry-
ness of the air, physical existence is a pleasure and
delight.
The treatment, then, of incipient phthisis must obviously
be a combination of hygienic measures and those more
directly medicinal. No sane physician would trust to
either exclusively. In the treatment of the poorer classes.
the former is, alas! always difficult and often utterly
impossible, and even the wards of an hospital, though
better for such patients than squalid homes, are not favour-
able places for the treatment of incipient phthisis.
Whatever the climate chosen as best suited to any par-
ticular case may be, the patient should live out of doors.
for as many hours of the day as possible; and I believe
the advantage gained at any of the usual winter places of
resort to which invalids are sent, arises from the fact of
their being able to be in the open air without taking cold.
The amount and kind of out-of-door exercise to be taken
must of course be regulated by the strength of the
patient, and the exercise should be of a kind that has the
least effect of hurrying the respiration; and of all kinds
G
6
82
LECTURE VII.
the
of exercise that taken on horseback is undoubtedly the
best.
With regard to diet, which I need scarcely say is a
matter of equal importance, but upon which only a general
rule can be laid down, namely, that it should be as nutri-
tious and as easily digested as possible, but as to what
diet is the best for each individual case, is a matter which
can only be determined by the requirements of each
patient and his power of digesting food, and by the
individual idiosyncrasies, where such exist. When cod-
liver oil can be digested it is an invaluable nutriment,
and checks the tendency to wasting. To eulogise its value
would be a waste of time, seeing how universally its
beneficial effect is acknowledged, but it is contra-indicated
in the following circumstances, according to my own expe-
rience :-*
1. If it causes nausea, lessens the appetite, or after a
fair trial continues to cause eructations tasting of the oil.
2. If there is irritative fever.
3. In cases where there is a marked tendency to
hæmorrhage.
The question as to the use of stimulants is a very
important one, for upon the choice of the most suitable
stimulant, or as to the advisability of withholding stimu-
lants altogether, much of the success of the dietetic
treatment depends; and as in the case of food, so
here, each case must be studied for itself, and the
effects of stimulants or their abstraction carefully
watched.
If an apparently well-chosen stimulant cause flushing,
headache, thirst, or fever, you may feel sure that either
the wrong stimulant has been chosen or that all stimulants
had better be avoided. These are such trite and common
sense observations, that I ought almost to apologise for
mentioning them. I may just say, as a general rule, I
have found Guinness's stout the best stimulant in the
majority of cases.
* In the course of lectures lately delivered at the Royal College of
Physicians, by Dr. Shepherd, 'On the Natural History of Pulmonary
Consumption,' this accomplished physician, having instituted very
careful investigations into the character of the alvine evacuations in
phthisical patients who were taking cod-liver oil, found that up to a
certain amount of oil exhibited, large quantities passed through unchanged,
causing fatty stools; the inference intended to be drawn was that only a
certain amount of oil was absorbed and the rest absolutely wasted. Dr.
Shepherd thinks that 3ij twice a day is the amount really absorbed.
PHTHISIS PULMONALIS.
83
The treatment of incipient phthisis by drugs is of two
kinds:
1. The exhibition of medicines which have a specific.
effect upon the constitutional diathesis, or which have the
power of rectifying that particular functional derangement
of any organ which appears to have induced the low con-
dition of health which invariably obtains in phthisis.
2. The administration of those remedies which have the
power of subduing the local inflammation which accom-
panies the tissue-changes involved in this disease, and
thereby have the effect of reducing the fever and high
temperature which usually exist, and are indeed an exact
measure, in most cases, of the amount of the pulmonary
irritation.
Those medicines of the first order will of course include
chiefly those which Hahnemann termed antipsorics, from
their well-proved pathogenetic effects upon the organism
in profoundly affecting the nutritive and assimilative
functions, which I have no doubt they do by their effects
either upon cell metamorphosis or upon the innervation
of organs. I can only broadly indicate the conditions
which we may have to alter by treatment, and the reme-
dies which a totality of the symptoms indicate; a study of
such totality, I beg again and again to impress upon you,
is before all things essential in the practice of homeo-
pathy. Let me then mention a few of the disordered
functions which may induce the phthisical condition, and
the medicines most likely to be curative of functional
derangement.
If the digestive functions are at fault, then such medi-
cines as pulsatilla, nux vomica, calcarea carbonica, bryonia,
carbo veg., &c., are of great value.
If feeble nutrition be the consequence of undue lacta-
tion, exhausting discharges, or mental anxiety, then china,
phosphoric acid, ignatia, calcarea, &c., are indicated.
Should menstrual irregularity or amenorrhoea in the
female be the proximate cause of suspicious pulmonary
symptoms, such medicines as pulsatilla and sepia will be
of essential service.
If in young girls in whom the catamenia have com-
menced very early, occur too frequently, and are too pro-
fuse, we have in calcarea carbonica an invaluable remedy.
Then there are the cases where a highly strumous
diathesis exists, and where the entire glandular system
84
LECTURE VII.
seems involved. In such cases iodine, biniodide of mer-
cury, and especially iodide of arsenic are all, according
to the symptoms, of undoubted value in arresting the
tissue changes and improving the quality of the blood.
Were I to single out one of these medicines as superior
to the other, I should, cæteris paribus, give the first place
to iodide of arsenic.
In what I have ventured to put before you, the prin-
ciple I desire to enunciate is this, the importance of dis-
covery, and when discovered, treating the cause, whatever
it may be, which has led to the pulmonary weakness and
irritation. If we only fix our attention upon the latter
and neglect the former, failure will be too often the
consequence, but treatment directed to the causation
of the disease, will, I believe, be crowned by the most
satisfactory results.
I now come to speak about the second, but equally
important remedies, those which we employ to meet the
local manifestations of pulmonary irritation; and when it
is remembered how largely inflammation enters into the
pathology of phthisis, and, if not arrested, is the chief
factor in breaking down the pulmonary structures, it
necessarily follows that, when there are increase in the
frequency of the pulse, rise of temperature, increase of
cough, and acceleration of the breathing, we must lose no
time in meeting those symptoms with remedies calculated
to subdue them, especially if, upon auscultation, we dis-
cover the signs of irritation mentioned in the early part of
this lecture; the chief of those remedies is aconite,
which must be given freely and frequently, or until the
hyperæmic state of the affected portion of lung ceases to
give evidence of increased irritation. And it is often very
interesting and satisfactory to observe how local dulness
of the clavicle or the sub-clavicular region will disappear
under this treatment with aconite, which, however, ought
not to be continued after the increased irritation has sub-
sided; when this takes place we should return to the con-
stitutional treatment, until again called upon to attack
any fresh irritation. Should aconite, however, fail to
remove the local signs, and that a sharp lancinating pain
in the lung accompanies the cough, if there be heat in the
palms of the hands coming on towards evening, and that
the pulse and respiration are still accelerated, phosphorus
will most likely be the proper medicine. I say most
PHTHISIS PULMONALIS.
85
likely, because I wish to guard myself against laying
down any fixed rule in this or any similar case; all I
venture to say is, that in the great majority of cases I
think phosphorus will be found to be the best medicine.
Two other drugs may be indicated in preference to
aconite in pulmonary congestion passing into pneumonic
inflammation, these are gelseminum, especially if the fever
have a very decided remittent character; and I have seen
veratrum viride subdue broncho-pneumonia, after aconite
and phosphorus had only produced partial amelioration.
Recapitulation.
I have endeavoured in this lecture to place the subject
of phthisis before you as clearly as the present state of
our knowledge allowed me. The following were the
points chiefly dwelt upon:
1. That the views of Laennec, and of most pathologists
from his day up to comparatively recent times, made no
distinction between two different pathological elements
constituting tubercle proper on the one hand and the
disease which modern pathologists consider pulmonary
phthisis on the other.
2. The more recent views of the pathology of phthisis
and the distinction between pulmonary consumption and
tubercle were dwelt upon.
3. It was shown that inflammation being a constant
element in all the stages of phthisis, rendered the early
recognition and treatment of the accompanying inflam-
matory process, especially in the incipient stage of the
disease, a matter of supreme importance.
4. The treatment of the early stage of pulmonary con-
sumption, it was shown, consisted both in hygienic mea-
sures and in those more strictly medicinal, and that the
latter, or the treatment by specifically acting drugs, was
of two kinds, the one calculated to remove local irritation
of lung-tissue, the other the administration of remedies
having control over the constitutional dyscrasia and ab-
normal nutrition; and that homeopathy laid claim to a
large measure of success in arresting the progress of inci-
pient phthisis, as well as in palliating the advanced stages.
of the disease.
86
LECTURE VIII,
LECTURE VIII.-Pericarditis.
GENTLEMEN,-The subject which will engage our
attention to-day is inflammation of the serous membrane,
investing the heart and lining the closed sac in which the
heart performs its rhythmical contractions. The study of
pericarditis, whether clinical or pathological, possesses
especial interest for the physician, clinically, because it
forms as a complication of acute articular rheumatism so
large a percentage of the cases of that disease, calculated
by some authors to amount to 30 per cent., but which fails
often to reveal itself by subjective symptoms, and probably
more than any other form of acute inflammation, illus-
trates in a remarkable manner the value of physical signs
as aids to its diagnosis and treatment. Before ausculta-
tion came to the aid of the physician, pericarditis could
only be diagnosed by eliminating two other forms of
thoracic disease, namely, pneumonia and pleurisy: if
neither of these could be discovered as the cause of the
symptoms of the patient, then pericarditis could be
approximately diagnosed. The diagnosis arrived at by a
process of negative reasoning, we now look back upon as
men regard the ignorance of the dark ages, for the veriest
tyro of the medical art is now able to detect the very
first manifestations of the disease, and will be able to
describe the pathological condition which his stethoscope
detects; and yet I think it behoves him as well as the
most experienced practitioner not to be arrogantly proud
or dogmatic, because he knows a few things more about
this or some other disease than did his forefathers. There
are many difficult questions about this very disease waiting
solution.
Why, for instance, is pericarditis so seldom met with
as an idiopathic uncomplicated affection? Why is this
fountain of the life blood the heart and its investment,
although composed of muscular fibre, nourished by blood-
vessels, energised by nerves derived both from the cerebro-
spinal and sympathetic systems, and, moreover, apparently
exposed to the same causes which produce inflammation
in other organs, so seldom the seat of ordinary idiopathic
PERICARDITIS.
87
inflammation such as attacks the pleura, or the peritoneum,
or muscular fibre? What is the relation, anatomical or
pathological, which it holds to Bright's disease or tuber-
culosis, but especially to rheumatism, which causes it to
be so frequent a complication in these diseases? and
lastly, how is its insidious latency to be explained? With
regard to these questions there is the temptation to pro-
pound very pretty theories, but believing as I do that
theories in medicine unsupported by inductive reasoning
from well-established facts have been the greatest impedi-
ments to the advance of medicine, especially in thera-
peutics, I am, I trust, discreet enough to avoid so unpro-
fitable an undertaking.
Now, although we may not be able to account for
the frequent latency of pericardial inflammation, or for
its so frequently complicating acute rheumatism, I need
scarcely say that a knowledge of these facts is of the
utmost practical importance. Knowing the former neces-
sitates the daily examination of the heart in rheumatism
in order to detect the very first signs of that diseased
action which would lead if not arrested to lesions en-
tailing the most serious consequences to the patient,
and a knowledge of the rheumatic origin of pericarditis
cautions the physician to avoid everything in the treat-
ment or management of the patient, which would en-
danger the occurrence of pericardial, and more especially
of endocardial mischief. There are other questions
of great interest connected with the etiology and patho-
logy of pericarditis and endocarditis, which I would
fain discuss were it possible to do so in the time allotted
for one lecture, but it would be impossible to do so
without omitting the more practical question of treat-
ment. It is not my intention to describe in anything like
detail the symptoms and physical signs of pericarditis, for
I take it for granted that all whom I address are perfectly
familiar with the phenomena of the disease, but I may,
perhaps, be permitted to summarise the more important
of these, and then to discuss shortly the relation which
pericarditis holds to the graver inflammation affecting the
lining membrane of the heart.
The first circumstance to be noticed in connection with
pericarditis complicating articular rheumatism is, as I
have just said, its frequent latency and the absence of
symptoms calling attention to the heart, such as pain,
88
LECTURE VIII.
palpitation, dyspnoea, and acceleration of pulse, or any
other indication of embarrassment of the heart's action;
of course, when the inflammation attains a certain height,
or is followed quickly by effusion into the pericardial
sac, such symptoms appear, and are often intensely dis-
tressing, yet it is a remarkable fact that the heart will
bear an amount of pressure from effusion into the peri-
cardium, without suffering that amount of distress which
one would suppose it ought to suffer, and even when
extensive adhesions occur the heart's action is less embar-
rassed than at first sight we should be led to expect.
When pericarditis complicates Bright's disease, tubercu-
losis, or chronic disease of the heart, its invasion is as
insidious as in acute rheumatism, and if it set in during
the course of grave blood disease, Niemeyer states there
are, as a rule, absolutely no subjective symptoms; but
even when there is no blood disease present, the sym-
ptoms sometimes simulate typhus and other forms of
asthenic fever. The tendency of the disease is to recovery
when it accompanies pleurisy, pneumonia, and articular
rheumatism, but it is otherwise when it complicates
Bright's disease, disease of the heart, tuberculosis, or sep-
ticæmia, but, of course, its fatality depends upon the
frequently fatal termination of those diseases, and not
upon any inherently fatal tendency in itself. When it
does terminate fatally it is from paralysis of the muscular
structure of the heart, causing syncope, and in such
cases myocarditis from extension of the inflammation into
the substance of the heart has taken place. With regard
to the stethoscopic signs of pericarditis, I cannot do better
than quote Dr. Stoke's summary from his work on Diseases
of the Heart and Aorta.
"1. That in cases of pericarditis with effusion of lymph,
the rubbing of the two roughened surfaces causes sounds.
perceptible to the car and vibrations communicable to the
hand by which the diseases can be easily and surely recog-
nised, even where all other indications are absent.
2. That the more rough the state of the membrane the
more distinct will those signs be.
3. That they accompany both sounds of the heart, but
are most distinct with the first sound.
4. That they are generally audible only over the region
of the heart.
5. That they present themselves with various modifica-
PERICARDITIS.
89
tions of character, and sometimes resemble the sounds
produced by extensive valvular disease.
6. That they are most distinct where the region of the
heart retains its natural sound on percussion, but that the
presence of fluid does not necessarily imply their com-
plete subsidence.
7. That they may reappear after the absorption of fluid
or the supervention of fresh inflammation.
8. That they are singularly and rapidly modified by
treatment.
9. That by observing the progress and mutations of
these signs, we can trace the process of organization, or
of obliteration of the pericardial cavity, judge of the
effect of treatment, and accurately ascertain the state of
the pericardium.
10. That the vital symptoms of acute pericarditis, with
the exception of pain, are caused more by irritation of
the muscular portions of the heart than to the state of its
external or internal membrane.
11. That cases of this disease may be divided into
three great classes.
a. Simple dry pericarditis with little or no muscular
excitement.
b. Acute pericarditis with liquid effusion, and with, in
many cases, a great amount of muscular excitement.
c. Acute pericarditis with effusion, and with severe
symptoms of muscular suffering, as indicated, first by
excitement, and secondly by paralysis."
The presence of liquid effusion, I need scarcely say,
is discovered by dulness on percussion over and above
that of the normal dulness of the cardiac region, and the
extent of the increased area of dulness is an exact mea-
sure of the amount of effused fluid.
It is now time that I describe the histological changes
which morbid anatomy reveals in this disease: they are
those which take place in serous membranes generally,
and are so lucidly described in Dr. Green's Introduction
to Pathology and Morbid Anatomy, that I will not apolo-
gise for transcribing his description.
"The process commences, as in mucous membranes,
with hyperæmia, exudation of liquor sanguinis and emi-
gration of blood-corpuscles, together with increased acti-
vity of the endothelial elements. The endothelial cells
enlarge and become more granular, their nuclei multiply,
90
LECTURE VIII.
and thus several new elements are formed within a single
cell from which they subsequently escape. Owing to
these changes, the membrane loses its natural smooth and
glistening appearance, and becomes opaque, roughened,
and exceedingly vascular. Its surface at the same time
becomes covered with a fibrinous layer, and more or less
liquid transudes into its cavity. The coagulable material
which exudes from the vessels, forms a soft, elastic, mem-
branous, or reticulated investment, enclosing in its meshes
numerous small cells. This either glues the two surfaces
of the membrane together, or, if they are separated by
liquid effusion, forms a slightly adherent layer. The
exuded liquid varies considerably in amount, and is
always turbid, thus differing from non-inflammatory
effusions."
This quotation gives us a concise view of the morbid
process which we have to arrest and subdue by treatment,
but before entering upon that subject, a question of some
moment arises as to the causation of endocarditis, for my
own experience, both in this Hospital and in private
practice, leads me to believe that in the great majority of
cases, where patients have suffered from previous attacks
of acute rheumatism, the consequences of antecedent
pericardial inflammation in the shape of an adherent
pericardium, are much less frequently found than the
effects of endocarditis, so that I cannot but come to the
conclusion that in most cases endocardial inflammation
accompanies pericarditis, but is difficult to diagnose owing
to the physical signs of pericarditis extinguishing the
murmurs which accompany endocarditis. Be this as it
may, there is no question but that endocardial murmurs,
as every one knows, are met with in a very large per-
centage of patients who have had previous attacks of
rheumatic inflammation, and that these murmurs are pro-
duced by roughening, shrivelling, or incompetency of
the valves, the results of antecedent endocardial inflam-
mation. I have not time to enter upon the still debatable
question, as to whether endocarditis occurs as an idiopa-
thic affection, or into the question of the origin of val-
vular disease, but must come at once to speak of the
treatment of pericarditis: but before entering into any
details of treatment, it will be well to dwell for a few
minutes upon the special circumstances which cause the
heart to differ from other organs of the body, in regard
PERICARDITIS.
91
to its movements and special function. In all the other
organs of the body motion accompanies function, whether
in brain, lung, intestinal canal, or secreting gland, but in
none, save the lungs, which functionally are closely
associated with the heart, is there incessant muscular
action, and even in the respiratory organs there may be
long intermissions more or less voluntary, but with the
exception of a pause of only the fraction of a second
between the systole and diastole, there is no cessation or
rest in the heart's contractions. In the matter of treat-
ment, therefore, we cannot obtain the advantage of rest
when the heart or its investing membrane is inflamed,
all we can do is to minimise its labour. Then consider its
intimate connexion with the brain and sensorium, and the
disturbing influences which this connection exposes it to.
Again, how profoundly are its movements influenced
by almost all the morbid disturbances taking place in
remote organs, and how soon are its contractions affected
by the condition of the blood itself, not to mention the
mechanical hindrances to the normal performance of its
functions if disease of its valves is added to all these.
When, therefore, the physician has to treat affections of
the heart, or its membranes, when in a state of inflamma-
tion, these circumstances should ever be remembered, and
the unique peculiarities of the organ taken into account
when applying his remedies. These may be divided into
four classes.
1. Those having special relation to inflammation and
its products.
2. Those influencing the innervation of the organ.
3. Remedies which have the power of energising the
heart when weakened by the antecedent inflammation.
4. Remedies which are homoeopathic to the disease,
which pericarditis, endocarditis or myocarditis complicate.
In the first of these classes of remedies aconite holds
first rank as long as frequency and tension of pulse, high
temperature, dyspnoea, &c., and the physical signs of the
earlier stages of inflammation are distinctly made out.
If any one doubts the perfect homœopathic relation
aconite holds to inflammation of the heart or its mem-
branes, let him study its pathogenesis either in Allen's
Encyclopædia of the Materia Medica Pura, or Dr.
Hugh's exhaustive article on Aconite, in his lectures
delivered in this place, and he will see how profoundly
92
LECTURE VIII.
that drug acts upon the heart, and how closely the sym-
ptoms resemble those which accompany pericarditis. If
the pyrexial symptoms have subsided, or if the case is
first seen after their subsidence, and that there are sym-
ptoms and signs of effusion, the second remedy of the first
class is bryonia alba, which will subdue the remaining
inflammation, and thus stop further effusion and cause
its absorption. But suppose the acute inflammatory and
pyrexial symptoms have been subdued, and yet there
remain palpitation and pain and distress in breathing, and
that although a roughened state of the pericardium pro-
ducing the friction sounds heard by the ear remains, but
that the palpitation seems to be owing more to irritability
than to the more acute state of things which has taken
place, then the chief remedy of the second class I have
mentioned will play an important part in relieving and
quieting the nervous irritability of the heart, if even it
have not a curative action upon the actual tissue change
involved in the disease-this remedy is spigelia, a drug
which I have over and over again given in pericar-
ditis and other organic affections of the heart, with most.
satisfactory results. Cactus grandiflorus is another medi-
cine which sometimes relieves palpitation depending upon
irritability of the muscular fibres of the heart, but vastly
inferior to aconite, in my opinion, in any condition bor-
dering on inflammation.
K
The third class of remedies afford signal assistance to
the heart enfeebled by the violence of the previous
inflammation, or embarrassed by the pressure of a large
collection of fluid in the pericardium, especially if the heart
is threatened with paralysis, or that anasarca is present.
Two medicines will claim our attention under such a
serious aspect of the case-digitalis and arsenic-the
former, when the action of the heart is intermittent and
feeble, and there is a tendency to syncope, and when the
kidneys are inactive. The latter (arsenic) when the vital
powers of the patient are failing, when frightful dyspnoea
and anguish, the cyanosed lips and finger-nails, cold
sweats, and other grave symptoms of what appears to be
the closing scene, combine to present an amount of human
suffering, which few other diseases exceed. It only now
remains to say a few words with regard to the remedies.
which the general disease may demand, be it rheumatism,
or Bright's disease, or blood poisoning, but to enter into
PERICARDITIS.
98
the treatment of any of these would, I need scarcely say,
be out of place on this occasion, but one remark I may
offer, which is this, that if in the course of any of those
diseases the heart or its membranes become involved in
the mischief, the proper course is to combat the intercur-
rent complication which most seriously threatens the life
of the patient.
As an illustration of the homoeopathic treatment of this
disease, I wish to submit to you the two following cases,
the symptoms and physical signs of which I am sorry to
say are not recorded in the Hospital notes with that pre-
cision and detail which is desirable. They nevertheless.
may in some measure indicate the homeopathic method
of procedure in the matter of treatment. The first case to
which I shall call your attention, although only one of
subacute rheumatism, was threatened with a recurrence
of the same cardiac complication which in several previous
attacks had caused structural injury to the valves; and
the treatment was chiefly directed to prevent further de-
structive effects, and consisted in the administration of two
medicines only.
CASE No. 1.
Jane N., æt. 19, maid servant, admitted Oct. 18th,
1875.
Suffering with acute rheumatism for some days. Has
had several attacks before. The joints of the lower
extremities most painful; perspires moderately. Pulse
104, full, soft. Systolic bruit at apex and base, but
loudest at apex. Acon. 1x, 2dis horis. Milk diet.
Oct. 21st. Pain principally in right leg; pulse 92;
slight perspiration; cannot sleep; tongue thickly furred;
constipation.
22nd. Pains quite gone; slept better. Cont. med.
26th. No pain; tongue clean; bowels act daily.
Temperature normal. Double bruit at apex still very
distinct. Cont.
29th. Slight return of pain in right leg. Pulse 94;
perspires moderately. Spigelia 1x, mj. 3tiis horis.
Nov. 11th. Pains in joints quite gone; bruits remain
the same. Pulse 96, regular.
94
LECTURE VIII.
20th. Discharged cured.
The second case I shall read to you was of a more
serious nature, the lining membrane of the heart as well
as the pericardium being involved in acute inflammation;
and here also we had to contend against the effects of two
previous attacks of endocarditis accompanying acute arti-
cular rheumatism.
CASE NO. 2.
}
Thomas B., admitted June 17th, 1875, æt. 19.
Has had rheumatic fever twice, on both occasions the
heart was affected.
Present symptoms: Dyspnoea; swelling and pain in
both knees; slight fever, with moderate perspirations;
systolic bruit, and marked accentuation of the sounds of
the pulmonic side of the heart. Bry. alb. 1x, mj. 3tiis
horis. Diet, milk.
June 21st. Temp. 102-8 (9 p.m.).
2dis horis.
Spigelia 1x, mj.
22nd. Temp. 102.2; pulse 110, soft. Less dyspnoea;
has passed a restless night. Friction sound heard dis-
tinctly at base of heart. Resp. 52 per minute, rather
laboured; skin moist. Temp. 100-4 (11 p.m.). Acon.
3x, gutt. j. 2dis horis nocte.
23rd. Slept well; breathing easier. Pulse 104, soft ;
temp. 101.4. Cont. acon.
24th. Breathing easier; slept very well. Pulse 92,
compressible; temp. 100. Constipation for eight days;
bruit at apex. Bry. alb. 3x, mj. 3tiis horis. Beef tea.
26th. Bowels have acted freely. Has been less free
from pain; no dyspnea; respiration still hurried, 33 per
minute; double endocardial bruit at apex, heart sounds
almost inaudible at base. Pulse 96, moderately full;
temp. 98.4. Steadily improving. Cont. bry. alb.
28th. Much
Much the same. Spigelia 1x, 4tis horis.
Ordered eggs and a chop.
29th. Breathing still somewhat laboured, but there is
no palpitation or dyspnoea, and the joints are quite free
from pain.
July 1st. No return of pain anywhere; dyspnea
entirely gone. Pulse 99; bruit the same.
Cont. med.
15th. Complete absence of pain or distress.
I
1
PERICARDITIS.
95
22nd. Cardiac murmurs softer; sleeps well. Cactus
grand. 1x, mj. 4tis horis.
26th. Gaining strength, but is slightly anæmic.
Aug. 11th. Symptoms have all disappeared but the
cardiac murmurs. Discharged cured.
In concluding the course of lectures which have fallen
to my lot, I beg to thank you for your attendance and
for the patience with which you have listened to what I
have had to say. I wish, however, again to impress upon
those of my audience who have not put homœopathy
practically to the test, that it cannot be practised upon
what are called general principles; the practice of homœo-
pathy essentially consists in individualization, which
means that every case of disease, whether acute or chronic,
must be studied by itself in relation to the remedy which
most vividly reflects in its pathogenesis the symptoms of
the patient in their entirety; but to fix upon one or two
of the most salient symptoms in any case and select the
remedy which seems most homoeopathic to them, without
regard to the other seemingly unimportant symptoms, is
bad and unscientific homœopathy. If in the course of
the lectures I have had the honour to deliver in this
place I may have unavoidably led you into such a narrow
and utterly wrong path, pray do not follow me; but if I
have so appeared to lead you in anything I have said
when trying to explain the rationale of the homœopathic
trreatment, such leading was not intentional, and has
arisen from the fact that it is next to impossible in lec-
turing upon the homoeopathic practice of medicine to
attempt that amount of detail and that individualization
which our practice demands.
PRINTED BY J. E. ADLARD, BARTHOLOMEW CLOSE.
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