The diagnosis of dilatation of the portal vein or of its tributaries is no easy matter, as the symptoms may be so varied. Many of those old chronic cases of “liver” are in reality portal congestion; the suffers therefrom have generally tried many physician and many medicines, and get a little relief, but soon are as bad as ever. It is clearly the liver, and yet the very best treatment has failed. They have often had the right remedies, but did not take them long enough; in vein affection we have to deal with a state that will only yield to well followed up coup sur coup treatment.
Rademacher’s remarks on the diagnosis of affection of the portal vein system (Erfahrungsheillehre, P. 290 et seq.) are very instructive He says “The symptoms and condition that I have seen arise from abdominal plethora are indeed manifold. In first line stands hypochondriasis, then follow giddiness, visual disturbances chronic inflammation of the tonsils and of the uvula cough, asthma haemoptysis, urinary troubles of various kinds: the so-called cold rheumatism or those chronic pains that many feel in the shoulder joints that pain in the heels (gallstones and hepatic obstruction cause these same pains in the heels), that does not prevent walking but makes it painful to do so, and renders the gait stiff. Then less frequently, colic; cramp in the stomach especially during digestion; sciatica; impotence or salacity, or both. All these I have myself seen. The question is: How can we differentiate between a primitive affection of the liver, pancreas spleen, bowels and mesentery and plethora of the portal system? This differentiation is not only difficult but in many cases simply impossibly.
And then the presently gives a very valuable clinical hint, viz.: the use of organ-remedies to aid the diagnosis. He says (P.292)
“At times we cannot get to the bottom of these obscure cases except with the aid of trial remedies (probemittel). For instance, in some cases abdominal plethora disturbs the functions of the liver; then we have pain and fulness in the right hypochondrium, the secretion of bile more or less disturbed, a yellow dirty colour of the face, yellow urine, difficulty of breathing and the like. Now if we act with reliable remedies on the organ that appears primarily affected, on the liver, we either do no good at all, or the symptoms disappear sooner or later gradually, but the amelioration is nevertheless, not felt by the patient. For before you can turn yourself round the spleen begins to cry out, or there is pressure on the umbilical region, or some other discomfort crops organ; then if we have the luck to get rid of this new affection the liver begins the old tune again. When we get this wonderful and thither condition you may safely bet that we have to do with abdominal plethora; provided always that no worse disease lies hidden behind all this such as scirrhus.”
This organ-testing I have found of great importance in practice, but it cannot be utilized unless one is well acquainted with the organ-remedies, – that is to say, with the local electivity of drugs, respectively the homoeopathic specificity of seat which is equivalent to the organopathy of Rademacher.
The periodic orgasmus humorum to which those subject to haemorrhoids are so liable is according to Rademacher, usually amenable to Sulphur; sometimes it is a mixed complaint and calls for sulphur and sodae nitras.
The ancient physicians maintained that Sulphur is a lungbalsam; this “Rademacher ridicules but maintains that bad coughs and even phthisis, may be cured with sulphur, when they arise secondarily from an affection of the portal system.
THE VENOUS ZIG-ZAG LINE
By the way, there is a pathognomic appearance of th chest in some cases of disturbances in the portal system and to which I desire to call attention viz: We find marked on the cutaneous surface of the chest about corresponding to be costal insertions of the diaphragm a zig-zag line of small veins. I have never read about this, as far as I remember but I often see it when examining patients with chest and abdominal complaints and in my case-takings I call it the venous zig-zag. No doubt other observe it as often as myself. When the patients get better this venous zig-zag becomes less and less visible.
Before going to what I have further to say on the amenability of piles to medicinal treatment, I will just give very short notes of a case of varicocele.
CASE OF VARICOCELE.
When practising in Chester I treated a patient at the Chester and North Wales Homoeopathic Dispensary for varicocele. The subject was an Irish workman of herculean stature, and who had syphilis; after getting rid of most of the manifestations of this vile malady, I set to work at the varicocele. In this case Fluoric acid was indicated, not only on account of the dilated spermatic veins, but because of the moist palms and loss of hair. Indeed Acidum fluoricum is no mean antisyphilitic remedy in the later manifestations, such as loss of hair, whitlows, and bone disease; so this was given for a number of weeks with very marked benefit the varicocele having considerably diminished. At this stage the man ceased attending having gone on a drinking bout, as I subsequently ascertained.
CASE OF CHRONIC PILES WITH PROLAPSE OF THE RECTUM
Some three or four years since a gouty gentleman of about 50 consulted me for this distressing malady. For many years he had suffered from haemorrhoids, with prolapse at each stool; he had been treated with various domestic remedies, and by several medical men, both allopathic and homoeopathic, and had obtained temporary relief at various times. Besides this he had a medicine chest of his own, and a Domestic Vade-Mecum, according to whose directions he was in the habit of taking Nux vomica, Sulphur and other such well known remedies. He was of spare habit very abstemious in all respects and careful liver. His bowels were inclined liver. His bowels were inclined to be costive but still they acted most days. All the organs seemed healthy and there was no evidence of any disturbance in the portal system but he used at times to pass fine sand like brick-dust. His pass fine sand, like brick-dust. His going to stool was very painful and the act lasted a considerable period owing to the state of the rectum the motion was very hard and usually more or less streaked with blood and it always brought down the bowel. After carefully washing the part he replaced it with more or less difficulty, and severe pain. On account of this unhappy state, he rarely left his home or family as it took him nearly three-quarters of an hour to get the matter over, and the bowel washed and replaced. He thought it came originally from lying in the trenches in the Crimea.
In this case there was considerable hypertrophy of the rectal mucous membrane, and also of the subjacent connective tissue which indeed is pretty always present in cases of old standing.
The indications to be fulfilled were: 1. To get this tumid mass dispersed.
2. To get the haemorrhoidal varices to contract and 3. To procure easy defecation.
Now it may be be affirmed that many physicians fail to treat such cases successfully with medicines; they look upon them as hopeless Granted, say they, that simple recent say they, that simple recent cases yield readily to homoeopathic treatment but these old standing cases do not and they must be either borne or the tumour cut away.
At first sight this seems evident but a little thought on the subject will shew that it is not necessarily so.
Let us remember that we have to deal with venous stasis for the most part hypostatic, and a resultant hyperplasia of circumjacent tissue this goes on till a tumour is there and this tumid mass lies practically without the organism to a large extent, and hence it is not reasonable to expect to affect it very radically from within alone. At least that is my view of the matter, and I have therefore in all very severe cases of piles, made use of remedies externally usually Hamamelis, sometimes Mikania guaco.
“Well,” some reader will say, “I too have made use of Hamamelis externally for years and yet bad cases for the most part will not yield to it; I have nevertheless to have recourse to the radical operation.
To that I have several things to say. First of all as to the the mode of applying it. A little reflection will shew that we want the thing applied for a considerable period, and my very successful plan is simply this:- Add to as much water as needful a few drops of Hamamelis Virginica 0 – I find the ordinary homoeopathic mother tincture acts better than pond’s Extract as a rule but when the tumour is very painful, and a active inflammation has been set up, pure Pond’s Extract of Hamamelis may be applied as they use it in America for hurts and sprains. Then take a piece of lint of convenient size and dip it into the Hamamelis solution and let it become thoroughly saturated therewith; then, on getting into bed the patient is directed to place it on the tumour or just within the anal orifice. AND LEAVE IT THERE ALL NIGHT. This leaving it there all night is of the greatest importance and has helped me to cure cases that had baffled some of our very best men, including low dilutionists and the very highest dilutionists. I have noticed that the rock on which the low-dilution men specially are apt to strike is the recoil action of their too big doses, while the Hahnemannians, in their laudable the consistency refuse to sanction the local treatment.
Burnett was one of the first to speak about vaccination triggering illness. This was discussed in his book, Vaccinosis, published in 1884. He introduced the remedy Bacillinum. He authored twenty books, including the much loved "Fifty Reason for Being a Homeopath." He was the editor of The Homoeopathic World.