Read by title before I.H.A.. Bureau of Clinical Medicine, June 17, 1940.
K. A. MCLAREN, M.D.
When I first began to practice, acute rheumatic fever was one disease that I rather disliked. This was probably due to the fact that my student and interne days were spent mostly in “Old School” institutions, and nothing I there encountered filled me with enthusiasm for the speed or effectiveness of their standard treatment of this tedious and dangerous ailment. So thoroughly were we taught concerning the ravages upon the heart caused by this disease that the tendency was to centre ones investigations upon how this important organ was withstanding the combined onslaughts of the disease and of the treatment rather than upon the patient in general.
For the homoeopathic physician, such a narrow point of view is disastrous. It is true the heart is a very important organ, and is frequently attacked and damaged by the rheumatic infection, but no good prescriber would think of basing his prescription on the fact that there is a heart murmur developing, or that the heart rate is increased, or that it is irregular. It is the whole patient for whom we must prescribe, and as he or she improves, so will the heart, and to a very remarkable degree. I always remember when treating one of these obstinate and serious cases that the “Old School” has nothing better to offer, and we think they have nothing as good.
Our philosophy tells us that psora causes its victims endless annoyance, but does not deprive them of life. It is not then psora as an underlying miasm that we are battling, but sycosis, and in some cases sycosis mixed with syphilis. There miasms are able to deprive the patient of his very existence. They are destructive agents and our remedies to successfully combat this disease, will be drawn largely from the antisycotic and antisyphilitic group. It can be readily seen that the “Old School” treatment must be suppressive, or else that a new drug disease which is stronger or more acute than the disease being treated has been thrust upon the patient.
He now has the original miasm or constitutional defect, sycosis, plus the latent rheumatic infection, plus the depression and poisonous effects of the coal tar products used in his so-called cure. Is it any wonder that these cases drag on for weeks, that they undergo long periods of convalescence and that so many are left with damaged hearts?.
Now I am not going to give you a long list of remedies, some of which I have never used, because that is not helpful, and they can all be found in our extensive literature. But I am going to remind you that according to the locality different acute remedies may be more frequently indicated than others. Thus in Ottawa and Montreal where the weather changes are severe and sudden, Aconite and Belladonna are frequently indicated. Farther south and in Toronto, Bryonia is more often needed. The choice of a remedy can only be arrived at by careful study of the patients symptoms and the generals are of primary importance.
For several years I gave Rhus tox. to many of these cases without any result, and finally felt that it was useful only where the muscles and fasciae were involved, and was relatively useless in articular cases. However, since I have been seeking for the general symptoms in these cases I have revised my opinion. Rhus tox. is quite frequently indicated, and will cure a case as quickly as any other remedy when that patient is restless, < at night, and is > moving and changing position. These cases usually come in damp wet weather or from exposure to wet and cold.
Now another remedy that is very restless in Arsenicum. It is really surprising how many cases of acute rheumatic fever are restless and need Arsenicum. It is quite easy to differentiate from the Rhus tox. cases, because the restlessness is more vehement. The pains are more acute or violent, and are burning in character. Then too, the Arsenicum patient usually has the blankets tucked in right around his neck. He looks cold yet feels hot to your touch and his rheumatic joints are relieved by outward heat. He can stand a hot water bottle so hot on the affected part that it would cause a burn anywhere else on his body, and it makes him feel better.
Then we have cases which are so sensitive to pain that you must not approach the bed, and the least movement causes the most frightful agony. They will be still, sweat profusely, and are harder to prescribe for. However, by observation and questioning, much can be learned. By the direction of the pains, by the mental state, by the aggravation time, we decide upon a remedy which is as nearly homoeopathic in its provings as can be discovered. If your choice is not homoeopathic you get no improvement unless you are using frequent doses of a low potency, in which case you may cause a suppression.
When your patient is < from any motion, is quite irritable, and the condition has come on slowly, especially if he has brown hair and eyes, you may reasonably expect rapid improvement from Bryonia. Your Belladonna patient is easily distinguished, and so is Pulsatilla because of the mental state and the tendency for the pains to move or wander about. It is probably easier to recognize the male Pulsatilla patient than the female because a tendency to weep in men is more striking than in women.
Nearly all these acute rheumatic fever cases sweat so profusely that this symptom does not constitute a strange, rare and peculiar one which may guide to the selection of the remedy. When this sweating is very marked, and when the tongue is swollen and indented showing teeth marks, we must study and frequently prescribe Mercurius.
Lachesis is frequently indicated in very severe cases which are extremely sensitive to pain, < following sleep and where the disease is beginning to affect the heart. We have then a little tendency to cyanosis of the lips and finger tips, and < after sleep, and the patient keeps the bed clothes away from the neck and face as this causes an uncomfortable sense of suffocation.
Where we have an every other day aggravation with palpitation, or morning headache, and the patient wants to be left alone, we think of the Natrum group. Head noises, pallor, distended abdomen, gas pains, and every other day aggravation, and where there have been exhausting sweats or the fluid losses, point to China.
To me it is strange that to date in my practice I have never met with a gouty or rheumatic case in which I could see any indication for Colchicum. It is also true that I cannot recall ever having made any very startling or rapid cure from any of the lesser remedies.
This is because of the miasm, and it is to Hahnemanns great polychrests that we are forced to turn when searching for the similimum. Medorrhinum at some time during or after every case of rheumatic fever should not be forgotten. Spigelia and Kalmia, when the disease appears to be centering about the heart, Lycopodium, often where the throat was first involved; in convalescence Medorrhinum, Sulphur, Calcium, Silica, and the Natrums are very frequently indicated,