Usually it is the month of June when abdominal typhoid start as an epidemic in the Yang-tse valley. The peak of this epidemic is reached usually in July and after October there is hardly a case of typhoid to be found. The intensity of the symptoms changes with the genus epidemicus, appearing sometimes very mild, in other years in a dreadful array of severe toxic symptoms and a lot of complications.

I am going to describe a few observation made during the great epidemic of typhoid in 1943 in Nanking. It is sometimes difficult to differentiate typhoid from the many fevers occurring at this period of the year. Malaria and Dengue are easily excluded, but it is different with the so called Shanghai fever, a rheumatic fever of a low type, Banger fever and some cases of undulant fever. The widal in population treated every 2-3 years with a mixture of typhoid and paratyphoid vaccines, is not as reliable a test as it was considered in Europe.

Only in cases starting with an index as high as 300 is it taken for granted that the case represents an enteric fever. The following signs are considered necessary to classify an enteric fever: the relative bradycardia (starts usually from the third day of fever), dicrotic pulse (very characteristic in China) leucopenia (3000-4000) with a relative lymphocytosis, eosinophilia. This last symptom is met with in at least 80 percent of all enteric fevers in China. On top you come to smell the typhoid in China: a sweetish-mouldy smell mainly between the scapulae and over the abdomen. The ileocaecal gurgling and the constipation are considered as non-essential.

A close study of a great amount of patients in the 1943 epidemic treated homoeopathically revealed a reaction hitherto unknown to me. The incipient symptoms were manifold: there were cases of shivering fevers of the Nux vom. and Gels. type, Nux vom. especially characterised by profuse perspiration with continuing heat; the congestive fevers of Ferr. phosph. with nosebleeding and 4 a.m. aggravation; some Arnica (fear of being touched and there is nothing wrong with hi, with putrid phenomena) and Pyrogen cases;

very few Belladonna types (an interesting fact: the Aconite type of restlessness with presentiments of death is an extremely rare specimen in china); a few Baptisia (more efficient in dilutions between the 6x and 12x) stupors; some Pulsatilla and Rhus, rarely the dry burning fevers of Arsen. (mostly in paratyphoid B); Stramon. cases (worse when left alone, after a bit of sleep, constant trying to raise the body, delusions with loquacity, tendency to get way, constant perspiring on nose, upper lips) about 16 percent; Hyoscyam. (4 percent) with rage alternating with coma and carphologia and the delirious state reminding one of Bryonia with the low murmuring.

Among the patients mentioned above according to their correspondence with certain drugs, there were 11 cases treated with Bryonia. These showed typical Bryonia symptoms which I will not mention, but a fact which I noticed was that in 8 out of 11 patients one day of treatment with Bryonia, 30x, sufficed to produce an eosinophilia up to 4 percent in cases with aneosinophilia with considerable improvement, first alleviating the feeling of dry heat, and after about 36 hours producing a drop in temperature.

No other drug showed this reaction heralding in the blood a turn to recovery. I saw with Nux vom. a drop of temperature, even to normal, within 30 hours (taking temperature every 2 hours) in a fever 3 days old. I continued the treatment in all abortive cases for one week, giving a single dose per day, experience showing that relapses were common though patients remained in bed on a diet unchanged.

Another fact I noticed concerns the changed in the blood serum in malaria. In a 10-day period I examined 15 cases of malaria which were allopathically treated and 12 cases treated with different homoeopathic drugs according to their symptoms. They were all cases of chronic malaria (lots of stippled cells): 0tertian, subtertian and quotidian types. Blood tests were taken from all 27 patients every morning on an empty stomach for a period of 10 days. Allopathically were used Quinine, Atabrin, Plasmochin. Homoeopathically was administered: Natr. mur., 30x (4 cases) Ignatia, 30x (1), Nux vom. 30x (1), Ipec., 30x (1), Arsen., 200x (4), Lycopodium, 200x (1), the latter very interesting: quotidian, chill 4 p.m., followed by sweat but no heat, dread to be alone, symptoms with direction above downwards.

All orthodox treated case showed, two or three days after commencing treatment, no clinical symptoms and no signs of malaria in the blood. All the homoeopathically treated patients, except one Arsen. case, showed after two days no clinical symptoms whatsoever but no change in the blood for 3-4 days following the day of the improvement during which period gametocytes, schizonts could be found in a somewhat diminished quantity in patients who were absolutely free of fever, perspiration, chill, etc. After 4 days the blood test was normal again. The 200x was repeated once or twice a week; the 30x every third day, two doses.

The formidable task I had to face every day (a daily amount of 450-500 patients in 1940/42) prevented me from going into details. But it is worth while to continue research especially as malaria will tend to establish itself in countries which formerly, knew nothing about this dreadful disease.

The observations made in malaria indicate the nature of this disease. It represents a disequilibrium in our vegetative system, with a preponderance of the sympathicus-influence or action. As it happens, in cases of chronic malaria we might consider some cases as actual malaria and some as not, when studying only the blood picture. Stippled cells, RBC down to 2,500,000, monocytosis, HB 50-60 percent in a negative (plasmodium free) smear will be found in people with and without actual signs of malaria. Sternal puncture may reveal plasmodia in people free of any clinical sign of malaria.

It is the whole make-up of a personality which will decide whether or not the individual is bound to develop a clinical malaria. People under stress, mentally exhausted, constitutions run down by overwork of overeating and alcohol, women weakened after many a childbirth, etc. here we find the huge army of actual malaria, although, I am sure that there are hardly people free of plasmodia a malaria-stricken country, though not all of them suffering from malaria. [ I, myself, had a positive blood test once without having malaria].

On the other side I am sure that the malaria-syndrome we are dealing with in our patients is not a clean cut one. There are purely malarial semiologic picture. There is hardly a general oedema, severe anaemia, subicterus to be found among Chinese peasants where Rad. quillajae, Rad. saponariae, camphor wood bark, slough of all sorts of reptiles [+ This represents isopathic or signature ideas] living near marshes, is being used instead of quinine. there is a special diet being prescribed: fasting in short, congestive people for 1-2 days, and a dietetic regime which should avoid any food of cold and humid quality: fish, buffalo, domestic fowl, vegetable leaves, in some districts farinaceous food.

Malaria is a hot air disease (je-ch-ih), affecting the heat center, (Kan-cho=dry fire), i.e. the liver, the cooling center, spleen (pi), thus affecting profoundly the metabolism of the elements fire and air, the results being the prevalence of water, wood, and metal (there are five elements according to Chinese thought) with main affections of tendons, joints and skin. This is the explanation for the rheumatic malarial fever which I found in non-quinine cases in the Chinese country; urticaria in chill or fever or both, hot perspiration of the whole body (cold perspiration in quinine and atabrin- treated), fleeting swellings of joints, tendons even a kind of a Quincke-oedema in parts (I saw one case of left supra-and infra- orbital neuralgia with an oedema and slight redness, from 10 a.m. 6 p.m., every other day; Cedron brought no change, Verbascum 30. cleaned up the whole syndrome in two days.).

Extensive studies in suppressed, later homoeopathically treated, cases, and cases treated in other ways (as natives every-where are doing) should follow up the whole picture of the disease, not only smears and periodic blood-tests. It is possible to get a clearly defined semiology of this dreaded disease, but it should be born in mind that we have to deal with a sort of neurosis with symptoms of a much wider scope than a purely mechanical spoliation of our blood by the different plasmodia.

This experience of an 8-years work in the Yang-tse valley I consider most valuable for an homoeopathic outlook; dont treat the plasmodium but the human being entrusted to you.

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