[ Read before Southern Homoeopathic Medica Association, Oct. 12, 1939].
H.A. ROBERTS, M.D.
In the Foreign Letters section of the J.A.M.A., July 15, 1939, is excerpted a report from the Revue due rhumatisme which estimate the prevalence and cost of rheumatic conditions in different countries. According to this report, 10 per cent of the German workmen incapacitated by disease are from rheumatic conditions; in France in 1936 these conditions accounted for 36.8 per cent of the total days of illness; in one paris factory alone 21.26 per cent of the workers were unavailable for this reason.
In France rheumatic endocarditis tends to decrease in frequency and at the present time is about 10 per cent, while other rheumatic conditions are on the increase. In Paris hospitals alone the annual cost of treatment for these rheumatic conditions is more than 10 million francs. The estimated cost of these conditions in Sweden is 6 million crowns annually; in England 17 million pounds; in the United States 200,000,000 dollars.
The American Medical Dictionary gives us a wide range of definitions for arthritis, and includes rheumatism as one form of arthritis. In any case, however wide or narrow we consider the definition to be, we must be appalled at the prevalence of these conditions, and no physician, be he specialist or general practitioner, can escape the inclusion of such cases in his field.
In its broad sense, arthritis is an inflammation of the joints, which may be acute or chronic; it may be markedly deforming or only slowly be acute or chronic the pathology of certain tissues; it may be due or related to bacterial infections of various kinds; it may follow suppressions of venereal diseases by the use of arsenicals, mercurials, copaiva, or many other drugs; it may follow suppression of discharge or manifestations such as foot sweat, exanthemata, eruptions; it may appear after injuries, long lasting dietetic errors or after living in damp locations.
In other words, arthritis, like most conditions with which we have to deal, is an outgrowth of a constitutional tendency which has been influenced by other factors which may now be too late to correct; but we have a suffering patient who must receive help, and if possible, cure.
It is unnecessary to state that insofar as possible we must correct living conditions and diet so that the patient may approach normal health through these factors. To this end we must not neglect to unearth the factors which, now or in the past, have influenced the present condition to fasten itself upon the patient. To look with care upon these conditions, to undo suppressions if possible and to otherwise direct the patient to natural living, will be of the greatest possible help in the treatment of the patient, for while the indicated remedy is our greatest aid, we cannot expect it to work completely if the patient continues under wrong living conditions and diet and continues suppressive measures.
It is a self-evident truth that any remedy in the homoeopathic materia medica may be indicated in these cases, because of the constitutional states which underlie the present disease manifestation. It is also self-evident that any remedy, when indicated and homoeopathic to the case, will do good work. The crux of the matter is careful case taking and the willingness to study long enough to find the homoeopathic remedy-homoeopathic not because it is “good for arthritis” nor because it has been prepared by a homoeopathic pharmacy; but because it is homoeopathic to the case. i.e., the similimum.
Among our most important symptoms are the modalities and the concomitants. If the choice of the remedy lies between a remedy whose provings have an affinity for certain tissues and a remedy with like modalities, the weight of choice inevitably lies with the likeness of modalities. In these selections the repertory plays a most important part, for through its use we can usually find the remedy that has the closet likeness in locations, sensations, modalities and concomitants. In fact, we cannot pass this point without emphasizing that full consideration of each of these items-locations, sensations modalities and concomitants-is necessary to a well taken case, and without a well taken case we cannot hope to find the curative remedy.
There is little use in citing the frequently indicated remedies such as Bryonia, Calcarea, Kali carb., Lycopodium, Phosphorus, Pulsatilla, Rhus tox., Silica, and so on, for their indications are well known to us all. We may say in passing, however, that the Calcarea and Kali salts, other than the carbonicum, are often more valuable. Sulphur, that great major, is very frequently indicated, but its use must be carefully weighed for Sulphur, injudiciously administered, often disturbs these conditions irreparable, or its violent action on these states must be carefully antidoted and slowly overcome. Very often the indications for Sulphur may be as well and much more safely covered by Lycopodium, phosphorus, Psorinum or Pulsatilla, and these must be borne in mind when considering the prominence of Sulphur symptoms.
Probably no remedy outside the group of polychrests has more influence on arthritic states than Ledum. It has the swelling and stiffness of joints and arthritic deposits in the highest degree; and nowhere else in the materia medica is emphasized more strongly the value of modalities and concomitants. Arthritic states are usually> warmth, but where the contrary is true, the group of indicated remedies narrows abruptly.
The pains of Ledum and the purple mottling of the skin, which is concomitant, are almost entirely abated by putting the affected limb in cold water, even ice water. This amelioration from placing the affected part in cold water is common to Ledum, to Tarentula, to Syphilinum and sometimes to Pulsatilla. Tarentula is differentiated by its restless, cunning hysteria or delirium, and in Syphilinum the relief is but temporary and the subsequent aggravation is the greater.
Ledum conditions often follow injuries. In this relationship we compare Arnica, with conditions arising from bruised tissues or concomitant with bruised sensations or bruised discoloration of the skin, in relation to arthritis as anywhere else it may be indicated; Hamamelis following injuries with passive haemorrhages, or concomitant to passive haemorrhages or varicose veins; Hypericum with its pains out of all proportion to the severity of the arthritic state or the original injury, showing the nerves are affected; Rhus tox. with its well known indications; Conium and Glonoinum following contusions, especially of the spine and back and where the arthritic state is most manifest in the back, glonoinum being pointed by the characteristic generalized throbbing throughout; Ruta from bruising the bony tissue, with its peculiar adaptability to conditions arising from “clerks foot”, and the frequent concomitance of eye conditions and the tendency concomitance of eye conditions and the tendency to eye strain; Ammonium mur. or Strontium carb. or Natrum mur. in the arthritic results of sprains, even long afterward.
Ledum is doubly indicated in alternating symptoms of haemoptysis and the acute manifestations of chronic arthritis, especially when the coccyx is attacked; the whole spine is stiff. Hypericum and Ruta also attack the coccyx after injuries. Ledum has special affinity for the left eye and right ear, pains in these locations often being concomitant to the arthritic pains. Like Agaricus, Agnus castus, Cannabis ind., Fluoric acid, Nux vomica and Staphisagria, Ledum is a remedy for “old sinners”, especially alcoholics.
Rhododendron is very frequently indicated in these conditions, and this remedy, too, has its well marked modalities and concomitants which differentiate it from a similar remedy, Rhus tox. Both have the < during storm, but Rhod. has its most marked aggravation before a storm or rough weather; and Rhod, is never comfortable sleeping unless the feet rare crossed.
Cyclamen closely resembles closely resembles Pulsatilla, but differs in that the best provers were dark and snappish rather than fair and tearful. It has a marked saltish taste in the mouth; and all the pains cease while standing. Menses are early rather than late; the patient is thirstless during the day but thirsty at night.
Another remedy which resembles Pulsatilla, and which is thought of rarely, is Magnesium sulph. The patient is tearful, restless, sensitive to touch and > walking about.
Recurrent attacks of arthritis which may or may not carry a slight rise in temperature, which recover quickly only to light up again in a short time, may require Carboneum sulph. The nape and dorsal spine are stiff, and there is the sensation of a heavy load hanging between the shoulders. The pains fly from part to part and recur at regular intervals; they are markedly > by every change of weather. Enlarged lymphatics, violent headache, neuralgic toothache and flatulence are valuable concomitants.
Carbo veg. also is < every change in the weather, especially to warm damp, and we should not fail to consider it when its indications are present. This is a valuable remedy, all too often overlooked, but it is marked by great depression of the vital force it is marked by great depression of the vital force in the arthritic state as in all others when this remedy is indicated. Remember its desire for highly spiced is indicated. Remember its desire for highly spiced foods; it is the “mince pie” remedy. Consider it when you may think first of Kali carb.; the remedies are complementary.
Carbo animalis, like Natrum mur., may be required when the patient has suffered previously from the abuse of quinine. CArbo an. is complementary to Calc. phos.
Calcarea phos., a most useful double salt, is very chronic in its manifestations. The patient is practically well in summer but the pains return when cold weather comes on. Lachesis symptoms may return annually, also usually in the spring. Colchicum symptoms return spring and fall. Dulcamara attacks annually in the autumn, or when the hot days and cold nights bring their variation in temperatures and consequent atmospheric changes.
Calcarea fluorica resembles Rhus tox., showing once more the relationship between Rhus tox. and the Calcareas; but too often Rhus tox. is used when Calcarea fluorica is indicated. The difference in the two is marked by the bony deposits of Calc. fl.
Colchicum is useful in recurring attacks, particularly with eye involvement; but when Colchicum, although seemingly well indicated, fails to reach down far enough, consider Benzoic acid, especially where there are concretions in the joints.
Eye troubles are very frequent concomitants of these arthritic troubles, and we may find any of the following remedies useful: Ant. t., Apis, Bell., Bry., Cact., Chel., Chin.m., Chin.off., Colch., Coloc., Como., Euphr., Form., Graph., Ign., Kali bi., Kalm., Lac c., Led., Lyc., Merc., Merl.p., Mez., Phyt., Psor., Puls., Rhus t., Sal.ac., Spig., Staph., Sulph., Tereb.
Heart symptoms may be induced by mismanagement of arthritic cases in any stage, or they may be concomitant to such conditions. Certain remedies have developed, through their provings, definite progression of symptoms to included those of the heart. In such cases we may find the following remedies valuable: Anac., Ant. t., Apoc., Arn., Ars., ARt., Aspar., Aur., Benz. ac., Ant. t., Apoc., Arn., Ars., ARt., Aspar., Aur. Benz. ac., Cact., Calc. c., Cham., Chel., Cimic., Cocc., Colch., Cupr., Dig., Dios., Glon., Iod., Kali c., Kali n., Kalm., Lac c., Lach., Laur., Lith., Lob. i., Lyc., Lycopus, Mag.m., Mag. p., Med., Merl. p., Merc., Merc. i.f., Naja, Nat.m., Nat.p., Nit.a., Nux v., Ox. ac., phos., Psor., Ran. s., Rhus t., Rumx., Spig., Stict., Sumb., Tarent., Verat. c., Zinc.
The spine is the point of attack in many arthritic conditions; of the many remedies having this relationship, Agaricus, Daphne, Dioscorea, Formica and Nux v. are among the few is which the spinal cord itself is involved. In Nux v. this is usually the result of alcoholism.
Perhaps symptoms related to the coccyx are among the most difficult with which we have to deal, because of the balance and pressure which changes continually as the patient changes position. Graphites has much pain in the coccyx while urinating. Hypericum is often required for pain in the coccyx after confinement. Other remedies having special affinity for the coccyx in arthritic conditions, whether the coccyx itself or its attachments are involved, are: Agar., Agn., Aloes, Am.c., Am.m., Ant.c., Apis, Arg.n., Ars., Bell., Calc.c., Calc.p., Cann.s., Canth., Carb.an., Carb.v., Cic., Cist., Coloc., Dros., Fl. ac., Gamb., Iod., Kali bi., Kali c., LAch., Ruta, Syph.
In the concomitance of gastric symptoms with arthritis, we find: Ant. c., Ant. t., Colch., Dros., Euphorb., Ipecac, Iris v., Kreos. Alternation of gastric symptoms and acute attacks of arthritis is a strong indication for Kali bi.
We seldom think of haemorrhoids as a concomitant of arthritic conditions, but the provings have demonstrated that Aesculus and Aloes have this peculiar relationship.
With chronic liver conditions consider Aesc., Chel., Hydr., Meph.
Arthritis induced by eating sweets often calls for Medorrhinum or Osmium.
These conditions coming on from washing: Lachn., Phos., Sep.; from scrubbing floors, Merc. i.r.
If your patient has the concomitant of a wry neck and is exceedingly loquacious, remember Lachnanthes. Lachesis has an equal loquacity, but the peculiar characteristics of LAchesis mark the differentiation.
In acute arthritic conditions with exanthemata consider Apis and Apocyanum, and perhaps Juglans cinerea. Also consider them after erythematous or exanthematous conditions, and also Elaterium, Lycopodium and Zinc. Eruptions occurring with the arthritis, especially over the affected parts, indicate consideration of Viola tricolor. After suppressed eruptions we have a number of remedies; consider among them Pulsatilla, perhaps Sulphur, surely Psorinum, and if there are nervous manifestations, Zinc.
Arthritic conditions with chorea may require Cuprum; there may be spinal ankylosis; touching the spinous processes is intolerable and causes severe pains in the limbs.
Caulophyllum or Cimicifuga are rarely indicated in men; they are the feminine counterparts of Actea spicata. Whenever any of these remedies are indicated there is apt to be sexual derangement. Arthritic conditions developing at the climacteric often calls for Graphites. In pregnant women, Cocculus or Dioscorea may be needed. When a patient has a diarrhoea only with the menstrual flow, consider Bovista, although it is not often indicated in arthritic conditions otherwise.
Among the remedies indicated in arthritis deformans we find: Am. phos., Benz. acid, Calc.c., f., Caust., Graph., Laur., Lith. carb., Ledum, Thuja.
If your patient has wandering pains, consider: Camph., Carb.s., Chin.s., Jambos eug., Kali c., Lac. c., Lycopus, Mang., Natrum ars., Palladium, plectranthus, puls., Sal. acid.
If the arthritic conditions developed after living in damp cold locations, your patient any need: Colch., Lyc., Natrum s., Oleum j.as.
If the arthritic attacks alternate with urticaria, never occurring simultaneously, consider Urtica urens. If the arthritic pains alternate with pains which change from throat to ear, to trachea or bronchi to teeth, and if the pains are markedly < from sunset to sunrise, Syphilinum is probably indicated, especially if the patient dreads the night because of the suffering and the subsequent weakness.
If the arthritic condition alternates with or follows tonsil affections, consider Guaiacum, Merc. i.f., Lac c. If the pains in the legs and toes alternate with heart pains, Natrum phos. Where the pains alternate between the shoulder and neck and the heel, where they are most severe, Rhus v. Arthritic pains moving from joint to joint: Kali s., Kreos. From side to side: Lac. From upper to lower parts: Kalm. From lower to upper parts: Lac.c.
In anaemic young girls with too early and scanty menses, or in boys during puberty, consider Manganum.
Kali bi. and Oxalic acid pains may be exceedingly severe, but they occur in small areas only. If arthritic pains are < as the moon waxes, it is wise to consider Silica; if as the moon wanes, Daphne. If arthritic conditions appear concomitantly with palsy, consider Crotalus hor.
The value of concomitance in finding the similimum for the patient with arthritic manifestations has been stressed here by mentioning a few such relationships. There is hardly a remedy in our materia medica which does not have its peculiar indications delineated through the provings if we will take the time to study them out.
The title selected for this paper by those whom compiled the program was Remedies Used in Treating Arthritis and Why. The answer of any homoeopathic veteran must be because they are indicated.
However, to put it clearly, let us state that the remedies mentioned here, and too many more to mention here, are clearly indicated, first, because they have been proven, through their administration to a sufficient number of healthy persons, to develop symptoms of artificial disease so closely simulating the arthritic conditions under consideration that only the most delicate instruments of precision could detect the difference; secondly, that the data derived from such provings has been compared with the clinical findings of such remedies in cases of true disease as like as possible (although more chronic and with more pathology) to the original provings; and thirdly, that experience having justified the confidence we place upon the Law of Similars as the only true and uniform law of healing, we have justified the confidence we place upon the Law of Similars as the only true and uniform law of healing, we have justified by our results the continued use of the homoeopathic remedy in potency, for these conditions.
This means that there has been a careful case taking and careful comparison of the symptoms to those developed by careful experimentation or provings and long usage, so that we may be sure that the remedy was truly and closely indicated, that is, homoeopathic to the case.