BY W. KARO, M. D. (WURSBURG).
(Lecture delivered before the Richmond and District
Homoeopathic Group on November 25th, 1948).
Heal Thyself, April, 1949.
RHEUMATIC diseases are the most common and crippling ailments of our time. They constitute a serious economic and social problem. A few figures may illustrate this statement.
American statistics covering the years 1935-6 disclose the fact that 5 per cent. of the population suffer from some form of rheumatism. There are two cases of rheumatism to every one of heart diseases, seven to every one of cancer and ten to every one of tuberculosis.
Dr. Kemsleys figures for 1927 show that out of 1,000 insured people unfit for work for more than three months, over 14 per cent. were rheumatic cases. Moreover 16 per cent. of all rheumatic patients are gradually developing disease of the heart.
The annual death rate from heart diseases in England and Wales is 95,000 of which 40 per cent due to rheumatic fever.
Further statistics of Dr. Davidson and Dr. Duthrie prove that in Scotland the annual figure of rheumatic disease is more than 30,000. 75 per cent. of these patients suffer from fibrositis (rheumatism of the muscles, nerves of tendons).
Faced with this grave problem, Dr. Davidson quite rightly called rheumatism “Public Health Enemy No. 1” and for this reason the Governments of nearly all civilized countries have formed committees to enquire into the causes, nature and cure of rheumatism.
Many attempts have been made to classify the various rheumatic ailments according to their causes and clinical symptoms. All these groupings are, however, of no practical value to the homoeopathic physician, who prefers to consider the rheumatic patient as a single problem in spite of the many different symptoms.
I therefore restrict myself to mentioning the classification advocated by the English Rheumatism Committee, which differentiate between the following nine groups:.
1. Rheumatic fever or acute rheumatism.
2. Sub-acute rheumatism.
3. Muscular rheumatism.
6. Rheumatic arthritis.
9. Various chronic joint changes.
I should like to add a special kind of rheumatism in children which may easily be overlooked, namely “growing pains”, which are often associated with specific rheumatic nodules, varying in size from tiny peas to good sized beans. They most frequently occur on the head, the edges of the shoulder bone and on the forearm. They also collect round the elbows and knuckles. In some children they are painful and tender. These cases require our most careful attention, because all these children, if not properly and constitutionally treated, may develop, sooner or later, heart diseases.
In the limited time at my disposal, I can only deal with rheumatic fever (acute rheumatism of the joints) and even here I must restrict myself to a few more important points.
Acute rheumatic fever (rheumatic arthritis) is an inflammatory process, more frequently found among under-nourished, anaemic patients. As a rule, the disease starts suddenly with fever, profuse perspiration, swelling and pains in the affected joints, with more or less inflammation of the covering skin. Sometimes the pain is so severe that the patient is afraid to move.
He shrinks from being touched and even dreads the shaking of his bed or the slamming of the door. When several joints are affected, as they usually are, the patient lies with his hips slightly flexed, the knees and elbows bent, the fingers spread and extended.
Acute rheumatism often moved from one pair of joints to another, a symptom responsible for the name “Rheumatism”, which is derived from the Greek word “rheo”, meaning running. The simultaneous affection of corresponding joints differentiates rheumatic arthritis from other cases of acute arthritis.
Here I am referring to those frequent cases of acute arthritis associated with other infectious diseases, such as typhoid fever, pneumonia or blood poisoning etc. Also there are cases of acute arthritis secondary to diseases of the central nervous system, such as locomotor ataxy. All these and many other such cases, although they display the same clinical symptoms, have nothing to do with properly so called rheumatic diseases. They are never symmetrical.
Whilst rheumatic arthritis always starts in the synovial membrane, osteoarthritis begins in the cartilages. Osteoarthritis is a chronic degenerative process, more frequent among rather well-nourished fat people during or after middle age. The cartilage surfaces decay and wear away and there is a change in the bone-structure or formation.
Both types of arthritis develop progressively and eventually affect the surrounding tissues as well. An excessive amount of fluid may or may not be present. The capsule and ligaments of the joints as well as the over-laying wasting of the muscles, which is a common symptom of all forms of rheumatism.
All rheumatic patients, however different the clinical symptoms may be in the individual patient, have the following symptoms in common:.
1. The character of the pains; they are always of a drawing and tearing nature.
2. The pains are located where there are joints, ligaments or stronger nerves.
3. The clinical symptoms are rapidly moving; they afflict in a periodic way the various sensitive parts of the body.
4, The patients are very sensitive to wind and weather.
5. The affected joints and limbs are extremely stiff and painful.
6. All rheumatic patients suffer from disorders of perspiration. It might be increased or diminished.
7. All symptoms are relieved by dry heat. They are, on the whole, aggravated at night.
It is by these symptoms that we can differentiate between rheumatic and gouty patients. The rheumatic patient feels always better by dry heat, whilst the gouty patient feels easier in cold weather and by applying cold compresses. Moreover gout is more common with elderly people. The gouty attack is mostly complicated by digestive disorders and affects, as a rule, one joint only, especially the big toe or thumb. Gouty pains are more violent, even if the patient does not move; they diminish, on the whole, in the morning, whilst in rheumatic fever the pains are permanent.
The diagnostic difficulties, however, do not end here. The greatest difficulties arise from the fact, that the pains are often due to the involvement of a nerve and are felt at the end of the affected nerve rather than at the actual location of the disease. For instance in a case of rheumatism of the hip, the pain is felt at the knee. In cases of rheumatic arthritis of the spine and of the neck, the pains radiates along the spinal nerves to the arm and fingers. These so-called radiculitis pains lead to the most serious diagnostic failures.
Take the case of rheumatic arthritis of the dorsal part of the spine: in such a case the only symptom may be pains in the chest. These pains are identical with pains due to heart disease, or, when they are felt in the right side, they might be mistaken for the symptoms arising from gall-bladder diseases.
Again, in cases where the rheumatism affects the lower portion of the dorsal spine, the only symptom may be burning pains in the pit of the stomach, coupled with flatulency and all those symptoms which are characteristic of an ulcer of the stomach, whilst in cases of rheumatism of the lower lumbar of sacro-iliac joints the patient complains about sciatic pains.
The implications of a wrong diagnosis are self-evident. It the symptoms are wrongly attributed to gall-bladder disease or to an ulcer of the stomach, an unnecessary operation may be performed.
Only a thorough examination and taking into account the family history and all previous diseases of the patient will enable us to arrive at the right diagnosis and treatment. In quite a number of patients we find a tubercular inheritance. Here a few doses of Tuberculinum will in many cases achieve a cure. In other cases acute infectious diseases, such as scarlet fever or gonorrhoea preceded the rheumatic disease, or ill affects of vaccination may be responsible.
Again exposure to wet or injury may in some patients be the causing factor. Although all these and many other factors play an important part in the development of rheumatism, its real cause is not known yet. Many theories have been propounded. Professor Lichtwitz regards all rheumatic diseases as allergic conditions. This theory is strongly contradicted by Dr. Hay, whose theory will be explained in connection with the question of focal sepsis.
Septic spots are most frequently found in the tonsils, the nasal sinuses around the teeth and in the mucous membrane of the intestines. Less frequently in the prostate, the womb or the gall-bladder.
There is no general agreement among the physicians whether or not in all these cases an operation is necessary. Personally I should like to stress the point that indiscriminate removal of diseased tonsils or wholesale extraction of teeth is unjustified and does not in the least prevent the recurrence of rheumatism.
Certainly, there are cases in which an operation may be necessary, as every chronic focal sepsis lowers the general resistance of the patient. This is especially true of a closed abscess around a tooth or in a tonsillar cavity. Pyorrhoea, however, should never be an indication for extracting all the teeth. Many cases of pyorrhoea can be cured by constitutional and local treatment.
On the other hand, a dead tooth or an abscess in or around the apex or root of tooth calls for extraction.
We should, however, remember, that eradication of any septic spot, although it may improve at least for the time being, the patients general health, is no real cure for rheumatism, for the simple reason, as Dr. Hay points out, that the cause of rheumatism is something far deeper than a septic spot. “Really it is the condition that produces the spot and it is this condition which requires our utmost attention.”.
The clinical fact that colon bacilli are present in almost every septic spot, leads to the conclusion that the real cause of rheumatism, atleast in such cases, is a more or less serious disorder of the bowels, especially of the colon, where the colon bacilli come from. It was Dr. Hay who propounded the theory that rheumatism is nothing but the symptom of a disproportion in the chemistry of the body and that rheumatism never attacks a person whose bowels are sufficiently emptied every day and really cleared of the usual fermenting and putrefying wastes.
Whether we accept Dr. Hays theory or not, it is an undeniable fact, that almost every rheumatic patient suffers from a more or less marked insufficient action of the bowels, commonly known as constipation.
The carmine test discloses the fact, that even patients who have one or two stools daily may suffer from a delayed elimination of the waste products from the colon.
To restore the normal function of the colon, we should start the treatment with a fast cure, adapted to the constitution of the patient. The best known fast cures are the Guelpa cure and the Schroth cure. Both are drastic, but highly efficient cures, which, however, should never be prescribed for anaemic, under- nourished patients, who need a fattening diet.
It is better to start these patients off with 1-2 days fasting on a fruit diet and with high colonic irrigations at first for three days running, repeating once or twice a week, until the activity of the colon has been fully restored.
These biological measures are the best supplement to any medical treatment.
There are two different ways of approaching this task. The orthodox medical treatment and the homoeopathic way. The orthodox medical treatment, which is based on clinical diagnosis, believes in specific remedies for each disease without any consideration of the peculiar symptoms of the individual patient.
The homoeopath, on the other hand, although he is equally interested in the clinical diagnosis, prescribes the remedies in accordance with the so-called drug-diagnosis. This drug-diagnosis is based:.
1. On the exact knowledge of the symptoms of the patient.
2. On the exact knowledge of the Materia Medica.
You will easily understand the fundamental difference between these two schools, when discussing chronic rheumatic neuralgia, a condition where pain is the key symptom.
In such a case the homoeopath endeavours to get an exact knowledge of the course of the special neuralgia attack, of the circumstances which provoked it and influenced its development. In other words, he has to find out where the pain starts, how it moves, where it settles down, what site of the body it attacks, whether the pain is throbbing, boring, stitching or otherwise, whether or not it appears at certain hours of the day. Furthermore, whether or not the pain is aggravated or improved by rest, by heat or cold, whether or not the pain is coupled with disorders of vision or nausea.
We also have to ascertain whether there is any connection with the menstruation, or any influence of the weather, of spirits, tobacco and so on.
All these details from the symptom picture of the patient. It is this symptom picture which must be matched with the indicated drug picture.
Drug picture means the totality of symptoms, which develop in healthy people under the influence of a drug.
As you all know, the testing of remedies on healthy people is the basis of the homoeopathic Materia Medica. They are supplemented by our clinical experience with patients. Our generally accepted rule “Let like be cured by like” means; the patient should be given that drug which tested on healthy people, gives similar symptoms, as seen in the individual patient. For example, we prescribe Belladonna in a case of rheumatic neuralgia, because Belladonna has in some provers developed symptoms similar to the symptoms of our special patient.
Certainly we do not suppose that Belladonna administered homoeopathically will ever cause a real rheumatism in healthy people.
The following two cases will illustrate my statements and will at the same time show you the difficulties in finding the indicated remedy.
CASE 1.– Mrs. E. F., 29 years of age, had been suffering from rheumatic fibrositis for more than 12 years. All her symptoms were restricted to the left side of the head. The pains were always throbbing, going from forehead to the back of the head; neither heat nor cold had any influence on the pains, but sunlight was intolerable. The patient was very sensitive to the slightest pressure on the head, she could not even wear a hat. The pains came rather suddenly and disappeared likewise; they were coupled with the feeling of an enlargement of the head and of an intense heat. So far she had been treated by a great many allopathic as well as homoeopathic physicians without any improvement.
Considering thoroughly all symptoms and modalities of the patient I soon found the right remedy. Let us remember the symptoms:.
1. The pains were always on the left side of the body (indicating Spigelia, Argentum nitricum, Glonoin).
2. The pains were throbbing (indicating Belladonna, Coffea, Glonoin, Sanguinaria and Iris).
3. The pains start suddenly and disappear suddenly (indicating Belladonna, Glonoin).
4. Sensitiveness to sunlight (indicating Belladonna, Glonoin, Sanguinaria and Spigelia).
5. Feeling of enlargement of the head (indicating Glonoin and Argentum nitricum.).
Summarizing, we learn that Glonoin is the only drug, covering all symptoms of the patient. It was the real simile for the patient, and was therefore prescribed. Glonoin 6x, 5 drops to be taken twice a day, cured the patient, who had been suffering from rheumatic fibrositis for twelve years. The cure was permanent, there were no recurrences of the disease.
My second case represents quite another type of patient.
It concerns a young man, 29 years of age, who had been suffering from acute rheumatic arthritis for more than eight weeks. So far he had been treated by his allopathic physician with big doses of Salicylicum acidum. The disease did not yield to this remedy. The patient was still in a serious condition with a temperature, running up to 104 F. in the evening and chills in the morning. His knees and elbows were swollen and very painful. The skin covering the loins was reddened and dry.
You certainly know that Salicylicum acidum is a drug, which we prescribe in many cases of rheumatic diseases. What then was the reason for its failure in this individual patient ? Simply because it was not the simile — according to our principle of “Like cures like”. The symptoms of this patient were not similar to the drug picture of Acid salicylicum, which is characterized by neuralgia, buzzing in the ears, disorders of vision, profuse perspiration, palpitation of the heart, rapid weak pulse, greatly diminished quantity of urine.
Our patient had none of these symptoms. His symptoms were similar to quite another drug picture. It was characterized by aggravation of all symptoms at about 11 a.m., by burning pains, by diarrhoea almost every morning, by burning heat in his feet at night, inducing the patient to uncover and put them out into the air. Face and back of the patient were covered with pustules and small vesicles, the whole skin was dirty and dry. The patient had been suffering from skin troubles, especially from eczema all his life.
I have not the slightest doubt, that you all know this drug picture. It is familiar to every homoeopath and you will agree with me that Sulphur was the indicated remedy. Indeed, Sulphur 30, 5 drops to be taken twice a day, brought about a speedy recovery. In about three days the temperature went down to normal, all pains gone, the swelling of the joints diminished gradually and finally disappeared in about two weeks. So did all other complaints of the patient such as diarrhoea, eczema, the burnings in the feet, etc.
These two cases, as different as they are, will illustrate the same homoeopathic lesson to you. Treat always the patient, not the label of the disease. Trust our rule of similars, then you will understand that there are no specific drugs in Homoeopathy, but any of our thousand remedies may be called for in any rheumatic patient. This, however, does not in the least absolve the careful physician from his obligation to use all the means at his disposal for an exact diagnosis. This is especially true for chronic cases.
We should always remember that in spite of all progress medical knowledge has achieved, there will always be hundreds of hopelessly crippled patients with irreparable destructions, who will need something other than drugs or ointments. They have to be comforted, they need our whole-hearted reassurances. It is here that the practitioner has to show a keen sense of cheerful sympathy with all sincerity.