Book review by Dr Jubin BHMS,MD(Hom)
Full name of the book : The Therapeutics of fevers
Continued, Bilious, Intermittent, Malarial, Remittent, Pernicious, Typhoid, Typhus, Septic, Yellow, Zymotic etc
Author : H.C.Allen.M.D
First Edition : 1879
Publishers : Kuldeep Jain For B.Jain Publishers Private Limited, New Delhi.
Printed at Unisons Techno Financial Consultants Private Limited, New Delhi.
Price : 90
Reprint Edition : 2001.
About the Author : H.C.Allen.M.D, Author of Keynotes and Characteristics of the Materia Medica and Materia Medica of the Nosodes
Note from the Publishers : Any information given in this book is not intended to be taken as a replacement for medical advice. Any person with a condition requiring medical attention should consult a qualified practitioner or therapist.
H.C.Allen is grateful to his professional collegues of India where every type of fevers are endemic. As per the teachings of Hahnemann it has been verified in chronic intermittents the most obstinate and intractable cases are of psoric or tubercular type, the more deep the dyscrasia, the more protracted the fever. Massive doses of Peruvian bark or any of its alkaloids suppresses the symptoms and thus increase the sufferings of the patient.
In the Organon Hahnemann affirms that acute diseases “are generally only a transitory outbreak, an explosion of a latent psoric affection”, the symptomatic expression of this or any other dyscrasia must be included in the anamnesis and the remedy must be selected based on the totality thus obtained.
This volume includes all types of fevers as described earlier and irrespective of the type of fevers the same law of cure applies to each patient. It is the individual patient with his peculiar idiosyncrasies and constitutional inheritances, not the fever that is chiefly to be considered. Family history is much more suggestive of the curative remedy than the rapid pulse and high temperature and must be carefully studied. The constitutional miasm – psora, sycosis, syphilis and tubercular miasm must be specially noted and they are the key with which to unlock the secret of the severity of the attack of the relapsing tendency of the fever. If the patient is treated according to the objective, subjective and miasmatic symptoms the patient may be cured in any stage of fever.
Therapeutics of fevers
After he has found all the existing and appreciable symptoms of the disease, the physician has found the disease itself- He has a complete idea of it, and knows all he need how to cure it “ –Hahnemann’s Medicine of Experience
Homoeopathy gives importance to the objective and subjective symptoms not to the theory of the cause or name of disease. No theories are to be put forward about the cause that bears the test of scientific investigation and Hahnemann’s therapeutic facts are more at the bedside than all the theories that have been advocated.
Many theories : 1. Lord : Intermittent fever is a neurosis. Its phenomena like chill and fever are distinct and its origin is distinct. The heat is due to action on the sympathetic system and chill on the spinal system
2. Wurmb and Casper : It is a neurosis. Its seat is on the ganglionic system and so nerve remedies and such as which act on the vasomotor system can cure
3. Burt’s characteristics : Acute cases can be treated with cerebrospinal remedies and chronic with organic remedies.
4. Hale’s Therapeutics : The remedies can be divided into 2 classes –
a. Destroy germs, protozoa, infusoria and cryptogamic fungi eg : Gelsemium, Nux vomica, Cedron.
b. Those which have no power as above but corresponds to the periodicity of the paroxysm eg : Eupatorium, Cornus, Salicine
5. Barlett, Salisberry and others with cryptogamic theory have many followers in our school and they use Carbolic acid, Salicylic acid and Sulphite of soda to destroy the germs.
6. Gravuvogl concept of splenic congestion and constitutional divisions.
THE MALARIAL THEORY (MARSH MIASM)
This is most generally accepted and evidence in this support is due to prevailing occurrence of epidemics where this poison exists. It is as a result of decaying substances and it is confined near to the earth, seems to spread in a horizontal direction and its progress is cut off by walls, hedges, high banks and dense forests. It is not infectious or contagious and by each attack the system more liable to more subsequent attack.
On the other hand, fever exists on dry or even on a sandy soil, and in rocky, mountain region where it is more extensive and severe than the adjoining low country. Those people in a valley if moved to a mountain area will be attacked with this fever. Microscopist, chemical and spectral analysis are unable to find the internal cause ie the miasm and we can’t antidote it without finding the cause. Homoeopathy never advocates in such antidotal treatment and internal miasma must be found and treated.
THE PSORIC DIATHESIS
Another cause for intermittents, and especially of the most obstinate types – a cause most universally neglected or overlooked by the Homoeopathic physicians is found in the inherited dyscrasia of the patient, the psoric or tubercular diathesis This is clearly stated in Hahnemann’s Chronic Diseases (Page 75) and more deeply psoric the more malignant the attack.
SIMILIA IS A NEVER FAILING GUIDE
If we stick on it the case will never fail. Hale comments that if the attack is due to miasmatic poisoning he must wait till the disease shows its true character and miasmatic disease cannot be understood. The physician must distinguish between sure and certain. He is sure that the patient is with symptoms and is not certain that he has been poisoned with miasma, or uncertain that cerebrospinal or sympathetic system is affected and which remedy to select and patient needs only one remedy. The objective and subjective symptoms are in every respect similar to those produced on the healthy subject by Cinchona.
EXAMINATION OF THE PATIENT
The first step in individualization begins with the examination of the patient. Taking the case is a difficult task and it requires knowledge of human nature, histry of disease and knowledge of Materia Medica. The symptoms occurring before and during the chill, heat, sweat and apyrexia, the time of occurrence of paroxysm, the parts of the body in which the chill makes its appearance, the regularity of the stages, the degree or absence of thirst and time of its appearance as well as the constitutional ailments aroused by the fever are to be carefully noted.
Individualising peculiarities must be carefully noted and prescription must be based on them and mere treatment by Quinine will only suppress the case and is not cured and the character of the disease is destroyed and is till indisposed and is incurable and old school physicians say it as a cure.(Note to Aphorism 233). Old school gives importance to the type of fever but it is a single symptom and is of not much value in remedy selection.
Allopaths searches for general conditions and mere diagnose of the type is enough for them but in our way of treatment the remedy which is suitable is to be found out and which corresponds to particular case and is therefore indicated in it. (Vol II P201 Dunham)
THE GENUS EPIDEMICUS
A cough during the epidemic of whooping cough is relieved by the genus of the epidemic. In sea-side intermittents Arsenicum, Gelsemium, Natrum muriaticum are to be used. In epidemic after an outflow of a river Baptistia, Bryonia, Capsicum and Rhus toxicodendron are to be used. Epidemic dysentery at autumn Colchicum is used Cinchona, Eucalyptus, Ipecacuanham, Malaria officinalis are drugs often used.
Hahnemann says this as epidemic in places where such are not epidemic partake of the nature of chronic diseases and composed of a series of acute attacks. Each possess uniform characters common to the individuals attacked with this disease. By observing the symptoms peculiar to all patients, this common character is found out which points out the Homoeopathic specific remedy for cases in general. This also relieves the cases of the patients who previous to this epidemic enjoyed good health and who were free from developed psora.
WHEN TO ADMINISTER THE REMEDY
This is a question of much controversy and Hahnemann had given the instructions about what to be done in his Organon. In Aphorism 236 he says about administration of the remedy after the termination of the paroxysm. There are proofs that when the medicine given during the cold stage of fever quickly deprived him of life. In aphorism 237 he says about if the interval is too short give the medicine when perspiration diminishes or when the subsequent stages of the paroxysm decline. In aphorism 238 he says that one dose of the properly indicated remedy may prevent several attacks but if there is threatening indication of anew attack the same medicine must be repeated provided the complex of symptoms is the same. If after remedy given if the paroxysm is earlier and more severe or later and milder than preceding one the action of the remedy must not be interfered with then wait for the next paroxysm and it may be lighter or not come at all. In aphorism 245 during improvement never repeat the medicine as the beneficial effects of the medicine is rapidly approaching perfection.
The more perfect the similimum, the quicker and surer the cure. Hahnemann teaches from the first to last pages of Organon that it is quality and not the quantity that cures; that the proper selection of the remedy is of much moment than the quantity to be given. Disease is an entity and it is expelled from the system in terms of quantity.
Dunham says that we seek a parallelism between symptoms of drug and those of the patient. Life, a physiological process is concerned with series of oscillations within physiological limits. Morbid phenomena or symptoms requires oscillations and shifting between series of phenomena. The symptoms of the case and of a drug may appear to be very similar; but if we compare the succession and order 0of symptoms, for the space of a day or two, with the succession and order of the drug symptoms we notice a marked difference.
Our school does not give remedy to each and every stage of the patient as the Allopathic school and for prescribing a single remedy a vast and comprehensive knowledge of Materia Medica is necessary especially the connection and succession of symptoms. Alternation of remedies can be tried as Hahnemann advocated it and here many remedies have to be given and so it is not a good practice. A mere repertory study for the case in hand will not suffice.
“To cure an intermittent fever we must
1.Study the patient during the apyrexia, to form an exact idea of the functional action, regular or otherwise of all the organs.
2. Observe all the symptoms in the three stages of heat, sweat and heat.
3. Particularly if the stage is absent which among them is most marked.
4. Expressly depend upon the bizarre, singular, exceptional phenomena as they are characteristic and first grade symptoms in order of cure “ A.CHARGE, M.D
The more time and care devoted to a careful and thoughtful examination of the patient , the less guessing and alternating and changing remedies afterwards; A case well taken is already half cured.
Routinism on potency selection must be avoided. Faith can have no place in science where a fact can be demonstrated by experiment. The question of potency can only be settled by the experimental test and every practitioneer can make the test for himself. We must use all potencies and failures must be published to the world as Hahnemann did. Hahnemann decreased the dose as he increased the knowledge of the Materia Medica.
Every case of Intemittent fever, can and must be cured with the potentised remedies, under the law of similars homoeopathically – Lippe. Many pioneer Homoeopaths supports this view. If cure takes place for the patient he will have faith equally in the physician and his methods. A Homoeopathic cure is as beneficial to our patients as Allopathic one and if it is quicker, surer, safer and more pleasant why not cure him Homoepathically.
General symptoms and constitutional action of the remedy are to be given importance than local manifestations of the disease and the drug. Thus the totality of the symptoms both subjective and objective are apt to be in treating the patient rather than his disease. In treating the large class of chronic intermittent the psora of Hanemann – The constitutional dyscrasia of the German pathologists becomes an important factor.
In masked intermittents our only guide is the constitutional symptoms of the a patient. In aphorism 153 Hahnemann describes about the characteristic symptom. Our most characteristic indications for the drug are based on the general constitutional symptoms and their conditions and their concomitants.
TYPHOID, TYPHUS AND CONTINUED FEVERS
This is the disease which the Homoeopathic physician has done more careful investigation and more patient research than any other diseases. The law of similars points to a better way and unequaled success for those who follow it and not for those who believe in it, but to those who obey its every mandate. Allopathy has got certain results but the highest success and low mortality are obtained by the accurate selection of the similar remedy and strict compliance with the requirements of law.
In aphorism 83-104 Hahnemann describes about how to take a case as life depends upon the first prescription. S o this is the first step and the key to success in Homoeopathic practice. A strict individualization is necessary and without it remedy selected is largely empirical. Another most important thing the case taken must be well recorded. If the first remedy only palliates though simillimum the constitutional miasm and family history must be included in the anamnesis. At the close of Hahnemann’s masterly instruction of how to examine the sick he says that the most difficult part is done. This has been well expressed by Dr. P. P. Wells in his valuable work on Typhoid fever and endorsed by Dr. Carroll Dunham. The exactly similar remedy once found must not be changed till the change of symptoms form a new picture of the disease. Typhoid alike all other ailments is developed from exposure to any depressing or exhausting morbid influence either mental or physical when the vital force is least able to resist the onset. For example in puberty when rapid growths occur and in climacteric when severe mental stresses occur.
THE NAME: ITS — USE AND AB– USE
Typhoid (low, stupor) fever is designated by groups of symptoms which appear sporadically, endemically and epidemically and sometimes annually. Typhus, amore severe form more contagious and more malignant due to bad sanitation where persons already exhausted by exposure, ill-treatment or live in crowded atmosphere or when chronic febrile diseases assumes a more febrile type. These are diagnostic terms and we select a remedy on therapeutic terms. The diagnostic is based on pathology and therapeutics on the basis of characteristics of the patient. Hahnemann in note to Aphorism 73 says that the names are irrelevant. No specifics in Homoeopathy and only importance to the individuality of the patient. Genus epidemicus may be called for in epidemics. Pathology is needed for prognosis, sanitation, dietitics and quarantine. So Allen suggests to give importance to the constitutional miasms as all diseases have their own miasmatic expression.
THE TRUE CA– USE OF TYPHOID
From the first edition on “ intermittent fever “ he has devoted much to find out the true cause of typhoid. The cause lies in the psoric or tubercular miasm and the more pronounce the psoric miasm the more severe and fatal the disease. The more the vial force is weakened is weakened by the psoric or tubercular diathesis the more susceptible the patient becomes to all external dynamic influences and less the vitasl resistance to the onset of typhoid or other fevers. Hahnemann about acute diseases in aphorism 73 as a transient explosion of latent psora. 3 miasms under psora we include the tubercular diathesis is an aggravated form of psora and sporadic influenza or La Grippe is generally an outburst of latent tubercular diathesis. In aphorism 80 psora as the fundamental miasm. Outburst of latent psora may produce acute diseases. So a well taken anamnesis—personal or family history can be traced having marked susceptibility to this miasm. A person under psoric influence is handicapped by and susceptible to psychic impressions.
THE TENDENCY TO RELAPSE
This is found in all acute diseases and in most fevers this “ outburst of latent psora” assumes a periodicity and attributed to the patient and not the fever. In typhoid, typhus and some malarial fevers the relapse assumes a weekly or monthly aggravation.
The first prescription selected for the totality of the symptoms of the febrile attack removes the symptoms and restores the patient to health but the original cause remains and produces fever again. Hahnemann says in aphorism 80 foot note as after twelve years of investigation he found out antipsoric remedies. During the second prescription, the miasm and the inherited tendency and the family history are to be found out and they are the key to unlock this tendency. SULPHUR is the remedy in which “ complaints that continually relapse”. When Sulphur or the best selected remedy fails to relieve or permanently improve then Psorinum or Tubeculinum selected upon the symptom an peculiarities of the family history and inherited diathesis will cut short the attack and prevent a future relapse. H.C.Allen was called to attention on an antipsoric remedy in typhoid by a case in the American Homoeopathic Review by Dr.P.P.Wells in 1863.
SANITATION –THE SICK ROOM
The sanitary surroundings of the fever patient must be carefully guarded. The temperature must be adapted to that of the comfort of the sick, the room freely ventilated in the day time especially when the sun shines and abundance of fresh pure air maintained. To disinfect the room flood it with fresh air, protecting him from undue drafts and exposure. Disinfectants should be avoided and other than pure air the similar dynamic remedy meets every requirement of science. Bathing is essential in every stage of typhoid especially during the fever exacerbation. The warm or tepid bath is most beneficial. The bath cloth or wet towel should be used .Never use the cold or ice bath to educe the temperature as it is harmful. Bedding should be well aired and frequently changed as quietly and gently as possible. Never waken as sleeping patient and never forget that the stupor of delirium is not sleep. Hering says to use tubs or pans under the bed and it will prevent decubitus. The wet compress – cold or warm a the patient prefers should be given and it gives good sleep to a nervous patient.
THE DIET OF THE TYPHOID
Absolute rest to the digestive organs is necessary for safe and speedy recovery in continued fevers. Pure water ad libitum is the best and safest diet for the fever aptient till the tongue is clean, appetite returns and pulse and temperature are nearly normal. The best results are with hot water, luke warm water nauseates. Cracked ice or melted ice is often injurious and cold water given after cooling on the outside of the vessel. Ice water is not used internally or externally in typhoid, typhus or yellow fever.
Diet if monotonous can be varied by adding fruit juices but not lemon or vinegar. As the tongue cleans and appetite returns rice water, unseasoned dried apple water or toast water is allowed. Stale bread well toasted is put in boiling water while hot and allowed to cool in an earthern vessel. Barley, cracked wheat or oatmeal gruel well cooked may be allowed later. Dr.Woodruff of Detriot fed his fever patients on codfish water. Extract or Essence of Beef contains no nourishment to the typhoid patient is injurious and in typhus and yellow fever is fatal. Alcoholic stimulants are rarely advisable though Hering recommends American or Hungarian wine during convalescence but prohibits port. Correction of abnormal hunger or a total want of hunger by the indicated medicine than by diet or by stimulants. The abnormal cravings noted down and suitable remedy selected than by the indulgence in it.
THERAPEUTICS OF FEVERS
In this section remedies are given in alphabetical order like in Allen’s Keynotes. The remedies other than those in keynotes are Angustura vera, Aranea diadema, Benzinum, Cadmium sulphuricum, Canchalagua, Cascarilla, Cedron, Cimex, Clematis erecta, Curare, Elaps corallinus, Elaterium, Eucalyptus, Eupatorium purpureum, Euphorbinum, Gambogia, Lachnanthes, Laurocerasus, Malaria officinalis, Mercurialis, Paris quadrifolia, Phellandrinum, Plantago major, Polyporus officinalis, Robinia, Sarracenia, Tarentula, Tuberculinum and Valeriana
Arrangement of sections
2. Aggravation and amelioration.
First 3 sections as in Allen’s Key notes. All sections are remedy comparisons in brackets.
Prodrome and cause together in Cinchona and Lachesis. In others either prodrome or cause occurs.
After Apyrexia comparison between remedies are given eg: Antimoum crudum.
1. Comparison with Pulsatilla is given. As prodrome, chill and tongue.
2. In some cases given as CLINICAL. Eg : Aranea diadema –case by Grauvogl
3. Arsenicum long section with detailed description about paroxysms of intermittent fevers with comparison between Cinchona and Arsenicum album.
4. Benzinum in the last section a letter to Dr.Allen from St.Clara Smith.
5. Bryonia – last section with clinical cases
6. Camphora – Apyrexia with cases
7. Cascrilla – After sweat section a symptom Can’t drink anything but hot drinks during fever by A.O. Hardenstein though Cedron has similar symptom the above remedy has got wonderful results.
8. Chininum sulphuricum after apyrexia section comparison between Cinchona and this remedy with discussion and clinical cases.
9. Colchicum after all sections case is given.
10. Malaria officinalis – About its prover and hiow it was conducted then provings by Dr.Yingling with 30 potency in weeks then Type, Time Cause, Prodrome, Chill, Analysis then Clinical cases.
3 Gradations as Kent –Bold, Italics and Roman. Rubrics are in alphabetical order.
1. Type eg; Anticipating, Day at precisely same hour, Pernicious.
2. Time eg : Autumn, Bed in Morning, Forenoon with times from 1 am to
12 pm under paroxysm returning at, Anticipates, Yearly then fever without chill returning at different times.
3. Cause – Attack brought on by eg: Air in open, Exposure to bathing, drafyt when heated.
4. Prodrome – Conditions occurring during eg: Abdomen diatension of, Excitement mental, lip upper excoriated, Nausea
5. Commencement of Chill – Chill begins in eg : Different parts of the body.
6. Chill Location of — Chill; Part affected, Location of
7. Chill Aggravated. Eg : Air, in adraft of, Thinking of it.
8. Chill Ameliorated. Eg: Covering by, Rising on.
9. Symptoms During the Chill.—Chill absent, Predominates, in general.
10. Chill, character of : Alternating with heat or sudden cold sweat, Fright from.
11. Chill, Symptoms during eg : Abdomen bloated, air sensation of being too hot, ankles swollen, Hair bristling of.
12. Chill Followed by – Anxiety internal, breathing oppressed, eyes redness of
13. Heat Aggravated by – Air in open, Carriage when riding in, Warmth by.
14. Heat Ameliorated by : Air in open, Walking when.
15. Heat Absent.
16. Heat in General
17. Heat, Symptoms During – Abdomen symptoms, Carotids throbbing, Limbs cold, Lips burning, dryness of, Prostration marked.
18. Heat, Followed by – Chill, Colic, chilliness, Sleep .
19. Heat; characteristics of : — Burning, Aversion to uncovering.
20. Sweat Aggravated.
21. Sweat Ameliorated.
22. Sweat, Followed by.
23. Aggravation while sweating.
24. Amelioration while sweating.
25. Sweat absent.
26. Sweat in General
27. Sweat Predominates.
28. Sweat, Produced by.
29. Sweat, Character of.
30. Sweat; Time of
31. Sweat, Location of
32. Sweat, Symptoms during
33. Sweat Suppressed.
34. Aggravation After Sweat.
35. Amelioration After Sweat.
36. Appetite, Taste, Tongue etc.—Symptoms of
37. Apyrexia; Symptoms During
38. Typhoid, Typhus, Prodromic Stage.
39. Symptoms of the Mind.
41. Head Internal.
42. Head External.
43. Eye and Sight.
44. Hearing and Ears.
45. Smell and Nose.—Bleeding – with salivation – Hyos (in Starred as Don’t give Mercury in typhoid salivation.)
46. Face – Teeth, Speech, Throat, Appetite, Thirst, Desire, Eating ,Drinking.
47. Gastric – Belching, Hiccough, Nausea and retching, Vomiting, Epigastrium, Stomach, Liver, Spleen, Abdomen, Flatulence, Rumbling, 5Tympanitis, Eruptions, Diarrhoea, Involuntary, Haemorrhage, Constipation, Urine involuntary, Bladder, Voice, Sighing, Breathing, Cough, Heart, Pulse, Back, Hands, Fingers, Lower limbs, Feet, Sleepy, Sleep, Sleepless, Nervous Restless, Convulsive motions, aParalytic Symtoms, Weakness, PositIon, Skin, Decubitus, Sweat of typhoid and typhus, Tissues, Constitution and general.
Lastly Index with remedies is given in alphabetical order.
Then Index to the repertory is given
Chill Heat Sweat Apyrexia
Appetite, Tate etc NIL NIL NIL
Chill, cause of ; brought on by NIL NIL
Chill, commencement of NIL NIL NIL
Character of NIL
During, symptoms of
Followed by NIL
Location of NIL NIL
Predominates NIL NIL
Prodrome NIL NIL NIL
Stages in general NIL
Sweat aggravation after NIL NIL NIL
Sweat amelioration after NIL NIL NIL
Sweat, suppressed NIL NIL NIL
NIL indicates absent Those left blank are marked in the index section to repertory with page numbers