Leaders in Typhoid Fever by Eugene Beauharnais Nash, M. D.

Leaders in Typhoid Fever.

by Eugene Beauharnais Nash, M.
D.
Presented by

CLINICAL CASES.

     Case. A boy 12 years of
age (in a family in which one had already died of hćmorrhage of the
bowels and another lay sick of the same disease in the abdominal form)
was taken with typhoid fever and grew steadily worse until the third
week, when the following symptoms were present :

     Complete stupor ;
entire unconsciousness ; pupils greatly dilated, with no reaction
to light ; and hearing gone. All this interrupted by occasional
piercing screams ; abdomen so sunken and empty that the vertebral
column could be felt through its walls ; no stool for two weeks and
for forty-eight hours at one time not a drop of urine. He would lie for
a day or so in this stupor, then would involuntarily begin to jerk his
head forward up from the pillow, and with a yell carry it around in a
sort of semi-circle and drop it back again, continually trying to talk,
which he could not do on account of the stiff or paralysed condition of
the tongue ; then again would lapse into the stupor with screams.

Apis
mellifica alone did not control the
whole condition, so I gave the Stramonium,
when, with the jerking of the head, and loquacious delirium was on, and
between the two remedies he began to improve the paroxysms becoming
shorter and more mild, then ceasing entirely. The urine became abundant,
and the boy began to notice his attendants. The first word he spoke ten
days after he became conscious was “maw !”
(calling his mother), the next “pawidge” (porridge). His diet
had been oat meal porridge all through the course.

     Two other cases
essentially the same, one a school teacher, the other the wife of the
professor of mathematics in our State Normal School, were treated the
same way and made perfect recoveries. The late lamented Dr. H. V.
Miller, one of the best prescribers I ever knew, saw the last one in
consultation with me and pronounced a decidedly unfavorable prognosis,
but was surprised and delighted at the outcome. I have also prescribed
it alone in cases which had the stupor with screaming without the
alternate condition described above with equally good results. In almost
all cases of the Apis kind look for an increase of urine before the
other symptoms improve.

APIS AND SULPHUR.

     One thing I wish to
mention here, viz., that if in such a case

Apis
mellifica did not act promptly an
intercurrent dose of Sulphur
often seemed to help it. There must have been psora in such a case, and
I know that the two remedies follow each other beautifully when
indicated by the symptoms. Now, for fear that some one may accuse me of
teaching alternation or rotation of remedies, as is the practice of too
many in our school, let me say that the cases which call for even such
alternation as was necessary here, are very rare, and you will
distinctly remember that this was not the hourly or two hourly rotation
practiced by such.

     Such alternation and
rotation is neither necessary nor scientific. No good prescriber will do
it.

A CLINICAL CASE ILLUSTRATING THE USE OF HELLEBORUS
NIGER.

     Helleborus
niger

is another remedy which, though
not often indicated in typhoid, is sometimes, and nothing can take its
place. To illustrate its sphere I will give another case from practice.

     This was another boy
about twelve or fourteen years of age. After two weeks of a very severe
run of the fever, the whole force of the disease seemed to concentrate
in the brain. The loose stools stopped, and the urine, too, and he lay
dead to all signs of consciousness ; the eyes remained wide open
and still ; shoving a bright lamp right up to them made no
impression upon the widely dilated pupils. He looked idiotic, and the
heart beat was weak and very slow, “only the brain seems to be the
invaded part of the body.”

     Under the action of

Helleborus
niger 1000th (B. and T.) he began to
pass more urine, until it became profuse, to move occasionally, and very
slowly gain consciousness. The first sign that he gave of really
comprehending anything was this. He was a boy that had always been
particularly fond of money, especially silver money (free silver). While
testing him with a lamp one evening to see if I could get his attention
to anything, the father said ;

     “Try him with a
piece of money.”

     I then held a silver
dollar in such a position that the lamp would reflect it strongly into
his eyes, and for a second he fixed his sight upon it and laugh aloud –
“Ha ! ha !”.

     We “ha !
ha !’d,” too, but it was several days after that before he
could see or know enough to indicate what he wanted, or that he wanted
anything. He went on improving slowly until perfect recovery under the

Helleborus.
This illustrates the sphere of this remedy anywhere, either in acute
meningitis or in typhus, where the affection centers in the head, and
with these symptoms.

CLINICAL CASE. ZINCUM METALLICUM.

     Zincum
mettallicum

is also a remedy which comes
to our help in the last stage of these desperate brain cases. Allow me
once more to quote a case from my own work, Leaders
in Homśopathic Therapeutics, which will
show its power here. (See page 145.)

     A young lady about
twenty years of age complained a week before I was called of weakness,
or feeling of general prostration ; headache and loss of appetite,
but the greatest complaint was of prostration.

     She was a student, and
her mother, who was an excellent nurse, attributed all her sickness to
overwork at school and tried to rest and “nurse her up.” But
she continued to grow worse. I prescribed for her

Gelsemium,
and followed it with Bryonia
according to indications, and she ran through a mild course of two weeks
longer, and seemed convalescing quite satisfactorily.

     Being left in a room
alone, while sleeping and perspiring, she threw off the clothes, caught
cold and relapsed. Of course the “last state of that patient was
worse than the first.” The bowels became enormously distended,
profuse hćmorrhage occurred, which was finally controlled by

Alumen.
A low form of delirium came on, the prostration became extreme
notwithstanding the hćmorrhage was checked, until the following picture
obtained :

     Staring eyes rolling
upward, head retracted ; complete unconsciousness ; lying on
back and sliding down in bed, twitching, or rather intense,

violent
trembling all over, so that she shook
the bed. I had nurses hold her hands night and day, she shook and
trembled so ; hippocratic face, extremities deathly cold to knees
and elbows, pulse so weak and quick I could not count it and
intermittent ; in short, all signs of impending paralysis of the
brain. The case seemed hopeless, but I put ten drops of Zincum
metallicum 200th (B. and T.) in two
drams of cold water and worked one half of it between her set teeth, a
little at a time, and an hour after the other half. In about an hour
after the second dose she turned her eyes down and faintly said, “Milk !”
Through a bent tube she swallowed a half glass of milk, the first
nourishment she had received in twenty-four hours. She got no more
medicine for four days, and improved steadily all the time. She
afterwards received a dose of Nux
vomica, and progressed rapidly to a
perfect recovery.”

     I
have now given three remedies that have,

prominently,
general trembling, Gelsemium, Apis mellifica
and Zincum met.
Several others have this symptom, but not so persistently or intensely
as these. Gelsemium
trembling occurs almost wholly in the first week, and the other two in
the third or fourth week.

     Having now discussed
the remedies most generally useful in the different varieties of fever,
it remains to notice those other remedies which are exceptionally useful
and which in some cases are indispensable. One very important one not
mentioned in Raue, Lilienthal, Johnson or Jahr is Cina.

CINA IN TYPHOID.

     I once had five cases
of typhoid fever in one family, all in bed at the same time. Two took on
the most violent form of the cerebral variety, and the other three were
of the abdominal type. The youngest, a little girl of about seven years
of age, was very sick, having the stupor, unconsciousness, tympany,
diarrhśa, dry dark tongue and such other symptoms as generally
characterise or make up the diagnosis of abdominal typhus. The ordinary
remedies did not seem to do any good. The only thing that the child
seemed to notice was a spoon put to her mouth with water, which she
would eagerly open her mouth for as often as it touched her lips. There
were two other symptoms that were prominent.

     Intense

circumscribed
redness of the cheeks, and frequent and violent
rubbing of the nose.

     I hesitated to give

Cina
because this was an undoubted case of typhoid, and no text-book ever
said give Cina.
But I finally gave it, and in the next twenty-four hours my little
patient became conscious, and general and rapid improvement set in and
continued to perfect recovery.

     One evening my
telephone rang and a brother physician, in a town sixteen miles away,
rehearsed a similar case, asking for advice. I answered “

Cina.”

     “Why, damn it,
this is typhoid fever, it isn’t worms !” said the doctor.

     I answered again,
“

Cina,
I don’t care what it is.”

     Two weeks later he came
into my office.

     “How is that case
of worms ?” said I.

     “Well,” said
he, “that patient improved from the hour she got the

Cina.
I guess the next time I’ll know enough to prescribe according to the
symptoms and not for the name of a disease, as you have always taught
me.”

     So it is. The next case
of any disease may call for a remedy that no one over prescribed in that
disease, because the symptoms call for it. This is Homśopathy according
to Hahnemann’s teaching, and the sooner we learn and profit by it the
better for us and our patients.

     Cina

is often neglected because it is generally considered in connection with
helminthiasis, not only in fevers, but in rheumatism, where it has
aggravation on motion similar to Bryonia,
and has cured cases where that remedy had failed.

     Arnica

suffers the same neglect on account of its reputation for effects of
bruises, and is given sometimes when Ledum
or Sulphuric acid
would be better.

     Let us stick to our
text,

Similia Similibus
Curentur.

ARUM TRIPHYLLUM IN TYPHOID.

     I have met a few cases
of typhus in which, during its course, the

mouth
would be very red, raw and even bloody. The patients would pick and bore
into the raw surfaces, tho doing so gave great pain, causing them to cry
out, but still would keep up the boring.
I lost one case of that kind, because I did not know what could be done
with Arum triphyllum.
I took one case of this kind, after it had run between two and three
weeks under another physician’s care, who was giving Aconite
tincture because she had
fever, and I cured it promptly with this
remedy. A few hours after the first visit I called again, and the mother
of the patient (a young lady) said :

     “Doctor, did you
give Clara morphine ?”

     I answered,
“No ! Why ?”

     “She fell asleep a
few minutes after you put the powder on her tongue, and has been
sleeping perfectly natural since, which she has not done for several
days and nights past.”

     These symptoms of the
mouth are oftener found in scarlet fever than in typhoid, but that makes
no difference, it is similia, etc., just the same and no remedy can be
substituted for Arum triphyllum here. The fever runs very high in such
cases, and a high grade of delirium with such a mouth is no counter
indication.

VERATRUM ALBUM, CAMPHORA AND SECALE CORNUTUM IN
TYPHOID.

     If during the course of
a typhoid case there occurs – “

Sudden
and rapid sinking of
vital force ; to complete prostration ; cold sweat,
especially upon the face
and forehead ; cold
breath ; face hippocratic ; nose pointed and cold,
a picture of general
collapse, no remedy can equal Veratrum
album.

     In such a case do not
give alcoholic stimulants, for this remedy can do much better. After it
has helped us out of this state of collapse, other remedies, according
to indications, will generally be needed to conduct the case along to
recovery.

     Camphor

comes the nearest to Veratrum
album as a remedy for this collapse, of rapid
onset, (unlike Carbo
vegetabilis which comes on gradually),
but the Camphor
while cold all over, with sweats, does not no characteristically present
the cold sweat upon the
forehead, and Camphor
has a very prominent symptom not found under Veratrum
album, viz., notwithstanding the
objective coldness the
patient cannot bear to be covered. This
latter symptom should also call to mind Secale
cornutum which has the same. Here are
three remedies which are liable to be indicated in collapse occurring in
typhoid. It may be objected that these are remedies that are generally
most useful in Asiatic cholera, when indicated by such symptoms. True
because oftener indicated there than elsewhere, but here let me repeat
and emphasize
that the name of the disease cannot decide the choice of the remedy, but
the symptoms must. So if in exceptional cases, even of typhoid, such
symptoms should appear, not to prescribe one of these remedies in
accordance with our law
of cure would not only be unscientific,
but criminal.

ANTI-PSORIC REMEDIES IN TYPHOID.

     There are four
anti-psoric remedies that should always be kept in mind when treating a
case of typhoid. They are

Sulphur,
Calcarea ostrearum, Lycopodium clavatum
and Silicea.

     We have already given
the remedying indications for

Sulphur.

Calcarea.

     Calcarea osrearum. -If
at, or about, the beginning of the third week of the fever the

exanthem,
or miliary rash, has not made its appearance, and the other symptoms are
not being controlled by other remedies, a few doses of Calcarea
ost. may develop the rash and stop the
diarrhśa, if present, and so modify the case that the rest of the
course is easily managed. Calcarea
may be given whether diarrhśa or constipation is present.

Lycopodium.

     Lycopodium
clavatum

has served me well when at or
about the same time in the course of the disease there was present –
great meteoristic
distension of the abdomen, with much
rumbling. Constipation, delayed exanthem, sopor, and, especially, when
awaking, exceedingly cross, irritable, kicking or jerking the limbs,
scolding or screaming. Urine scanty an
red, or clear with red
sandy sediment. Now, if in addition to
all this the symptoms are generally worse from four to eight P. M. no
remedy can act more beautifully than Lycopodium
clavatum. I have seen it clean up the
whole case, and in very short order, too.

Silicea.

     Silicea

.
-I have also had occasion to use this remedy in a very obstinate and
long running case of this disease, in which the patient was greatly
reduced and had very profuse
sweating. He also wished to be
constantly rubbed, or magnetised, and seemed greatly comforted thereby.
A few doses of Silicea 6m., Jenichen, changed the whole aspect of this
discouraging case, and all went well until complete recovery.

HĆMORRHAGES IN TYPHOID.

     As regards the
hćmorrhages which occur in this disease, I have found most useful the
following remedies :

     Alumina

.
-If the discharge of blood occurs in a coagulated mass, resembling
liver, with serum, without much pain, but great weakness.

     Alumen

serves equally well in such cases.

     Hamamelis
virginiana

has acted well when the blood
was very dark,
venous blood, and there was sensation of great soreness in the abdomen.
In addition to the internal use of the remedy I have laid cloths wet
with the tincture over the abdomen.

     Nitric
acid

. -When the hćmorrhages were mostly
bright red, not clotted blood, active hćmorrhage, and especially if the
patient had been subject to anal troubles before the fever.

     Arnica
montana

. -Blood bright red, also, but
clotted.

     Terebinthinia

.
-If there is with the hćmorrhage extreme
tympanitis and a bright red tongue, smooth
and glossy, as if deprived of its
papillć.

     China
officinalis

. -If the patient has lost a
large amount of blood already, and there is fainting, ringing in the
ears, loss of sight and especially if later on or during convalescence
the effects of the loss of blood are long lasting.

     After all, it must be
remembered that these remedies are only recommended here for this
particular feature of a typhoid case, and that hćmorrhage is

only
a symptom, and while it may be necessary
to interpolate a remedy for it were must place our main dependence upon
the generally indicated remedy for the cure of the patient. It will be
remembered that in our treatment of the general remedies hćmorrhages
occurs under several of them, and they will generally control this
symptom with the rest of the case. Indeed, if those remedies are
skilfully used it is very seldom that hćmorrhage will ever occur. No
one symptom, be it ever so prominent, should engross the attention of
the physician, to the degree of leading him away from a close scrutiny
of the whole case.

LIVER COMPLICATIONS IN TYPHOID.

     We may sometimes get
liver complications in a case that is decidedly typhoid in its
generality. If in such a case the tongue becomes

thickly
coated yellow with reds edges, the
stools are very yellow, yellow
as gold ; the urine also very
yellow, whites of eyes yellow, and especially if the patient complains
of pains in the region of liver, running across the abdomen, or under
the right shoulder blade, no good homśopath would hesitate to give Chelidonium
majus. There is another remedy having a tongue
coated yellow at the base and, in
connection, there is foul smelling breath, with tongue showing imprints
of the teeth ; it is Mercurius
protojodatus. It does well here and it
is the only preparation of Mercury
that I have known to do any good in cases of a typhoid nature.

     Of course in bilious
remittent fever it is different, and

Mercury
may be very useful, but, as a rule, the more typhoid, the less Mercury.

A LEPTANDRA VIRGINICA CASE.

     Leptandra
virginica

once rendered me very good
service in a case that I took from another physician, who had so far
failed to get very good results from his treatment, and the particular
indication leading me to select it was dark
fetid tarry stools, mixed with blood and
mucus. The patient was greatly prostrated and would have died, I think,
but for the timely use of this remedy.

A MELILOTUS CASE.

     I once had two cases in
one family, one of which taking on the pneumonic type was greatly
benefited by

Hyoscyamus
niger ; the other of the cerebral
form had attack after attack of the most profuse epistaxis I ever saw.
No remedy seemed in the least to control these attacks until after
observing that each attack was preceded by the most
intense redness of the face I gave Melilotus
officinalis 30th. This was followed by
complete relief, not only of the epistaxis, but a decided amelioration
of all the symptoms, and an easily managed case until recovery.

ANTIMONIUM TARTARICUM.

     Antimonium
tartaricum

ought to be mentioned as a
very useful remedy in pneumo-typhus, when the lungs or bronchi become so
loaded with mucus, that cannot be expectorated, that marked cyanosis
is present. There is coarse, rattling
breathing, and when coughing it seems as if a whole cupful of mucus must
come up, but none comes. The patient cannot raise it. Here a few doses
of this remedy does wonders by enabling the patient to expectorate,
thereby relieving the embarrassed respiration. There may have to be made
a choice between this remedy and Carbo
vegetabilis, Veratrum album or Lycopodium
clavatum.

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