Fevers and Blood poisoning


Some of the most effective remedies for treatment of fever with septicemia are Baptisia, Arsenicum, Lachesis, Crotalus, Vipera, Naja, Mercurius, Gelsemium, Aconite, Phosphorus….


FEVERS AND BLOOD-POISONING.

HAD the homoeopaths done nothing in practical medicine but fix and precisionize the use of Aconitum in inflammations and fevers of the inflammatory kind, they would have well merited the undying gratitude of the whole human race. That the use of Aconite is thus by them fixed with scientific precision is a matter of common knowledge, and needs no further insisting upon, for “we do not drink our Aconite out of a Wilksian mug.”

But while this is a fact, while we thus have inflammatory fever, as it were, under our thumbs, we have heretofore had to deal with typhoid and other continued fevers from blood-poisoning in quite a different manner.

Granted that Aconitum is no mean remedy even in these continued fevers, still it will not regulate them or shorten their course, though it will ease them, and will even do a good deal towards rendering a mild case milder, perhaps through the diaphoresis.

Granted also that Baptisia tinctoria will do much good in some cases of continued fevers, perhaps even regulate some gastro-catarrhal cases, still, from a good deal of experience, I can say that it is at best a long way from having a real control over the continued fevers I have met with.

The allopathic treatment of continued fevers is hopeless helplessness: the patients just live or die according to the ratio of the dose of fever-cause to their body-bulk, and (the dose not being of necessity lethal) in proportion to their powers of resistance, and modified by hygienic surroundings. Of course no system of therapeutics can be of any service where the causal quantity is necessarily fatal right off. “Nursing” is their sheet-anchor!

In modern modish medicine it has come to this state of despair in the treatment of continued fevers. This I have seen in the best hospitals in Europe, and under the best allopathic physicians modern times has produced. I will not deny but that judgment and care, and some clever clinician’s resourcefulness, will at times save a given case at a collateral crisis, but this is all that can be truthfully conceded.

Hydropathy does some good in continued fevers, but its help is not very certain.

Homoeopathy has hitherto won but few real laurels from its successes in continued fevers, though with the aid of Baptisia, Arsenicum, the serpent poisons, Mercurius, Gelsemium, Aconite, Phosphorus, and many other more or less symptomatically or hypothetically indicated remedies, the homoeopathic practitioners get the best results yet obtained, and bad they are. No one of the remedies used will, even theoretically, cover the whole case.

To conduct a case of typhoids to its termination, we often need the aid of a dozen different remedies for the different symptoms and syndromes as they arise, and then the patient will often die at the end, either of diarrhoea and haemorrhage, or otherwise. And I do not here refer merely to cases amongst the very poor, or under bad or indifferent hygienic surroundings, but to cases in the wealthy classes, with excellent hygienic surroundings, capital nurses, and clever physicians of the most advanced schools of medical thought, and all anxious to do their best.

The fact is, continued fevers are our masters, and we can, even with homoeopathy, good nurses, good hygiene, and “the best of everything,” only fight the enemy in detail symptomatically or hypothetically. And we thus mitigate the course of the bulk of the cases, and save the lives of a few who, but for our aid, might have succumbed. That homoeopathy may be proud even of these achievements I will not deny, but they are not good enough when all put together to make a nice pillow to sleep on. Rather should they fill us with humility and discontent, and stir us all up to find something better.

I was in this frame of mind when Dr. Drysdale in and just before the year 1880 brought forward a suggestion that Pyrexin might be a good remedy in typhoid and synochus generally. But the dose and mode of administration were stumbling-blocks to me: I did not feel I should like the treatment for my own person, and so I turned away from it not without some feeling of disgust. And, as it is an axiom with me never to give another person a remedy that I would not myself be both willing and anxious to take were I similarly, I thought no more of Pyrexin as a remedy.

Time passed, and occasional cases of continued fevers- typhoid-came under my sole care or in consultation with other physicians, but I did not cure them, nor could older and more experienced men whom I called to my help. The most experienced and most eminent homoeopathic physicians in London kindly saw two consecutive cases very frequently with me; their treatment and mine were practically the same, and also their results-both patients died after a number of weeks of detail treatment that time and again seemed to be curing the cases.

But we evidently only cured the symptoms and syndromes-the morbid process was going on within undisturbed in its essential course and progress; the various remedies only acted, as it were, at a tangent, none were adequate, so I made up my mind to go in quest of some better treatment for any future cases that might fall to my lot, and Dr. Drysdale’s Pyrexin seemed to stand in the way. Before going further afield, I thought it best to try the pyrexin: there are strong theoretical grounds for its use in Pyrexin quite apart from Dr. Drysdale’s results, which “have been favourable and give good promise” (p. 16).

Mr. Health, of Ebury Street, very kindly made a preparation of the remedy according to Dr. Drysdale’ direction (*”On Pyrexin or Pyrogen as a Therapeutic Agent,” London: Bailliere, Tindall, & Cox, 20 King, William Street, Strand, W.C., 1880.* by John Drysdale, M.D.*), and it was carried up to the sixth and twelfth centesimal dilutions and kept ready for my use.

Before I go in to my experience with pyrexin or pyrogen, I think it would be useful to quote from Dr. Drysdale’s paper; the style is so concise that I cannot advantageously condense the part I want, hence it shall follow in full. Drysdale says,-

“In studying the experimental evidence bearing on the germ theories of disease, I was greatly struck by a remark made by Dr. Burdon Sanderson in the British Medical Journal of 13th February 1875. It was as follows:- `Let me draw your attention to the remarkable fact that no therapeutical agent, no synthetical product of the laboratory, no poison, no drug is known which possesses the property of producing fever.

The only liquids which have this endowment are liquids which either contain bacteria, or have a marked proneness to their production.’ This last clause is qualifies by the statements elsewhere, and from other sources, that the fever producing agent is a chemical non-living substance formed by living bacteria, but acting independently of any further influence from them, and formed not only by bacteria but also by living pus-corpuscles, or the living blood- or tissue- protoplasm from which these corpuscles spring.

This substance when produced by bacteria is the Sepsin of Panum and others, but in view of its origin also from pus, and of its fever-producing power, Dr. B. Sanderson names it Pyrogen. If, however, it is to be also used therapeutically, I suggest the more neutral name of Pyrexin. I cannot admit without qualification the statement that no drug of poison can produce fever, for undoubtedly Aconite, Belladonna, Arsenic, Quinine, Baptisia, Gelsemium, and a host of other drugs, do produce more or less of the febrile state among other effects.

But they produce it only after repeated doses, and contingently on the predisposition of the subject of experiment, and thus uncertainly as regards any individual case or dose; or they produce it as a part of a variety of complex local and general morbid states, of which it may be a secondary phenomenon. It is therefore practically true that no other known substance induces idiopathic pyrexia certainly directly, and at will after a given dose. This directness and certainty of action ought to make it a remedy of the highest value if it ever can be used therapeutically; and if the law of similars is applicable here as it is in so many other instances, we ought to find it curative in certain states of pyrexia and certain blood-disorders to which its action corresponds pathologically.

In order to put this suggestion to the test practically, let us first shortly sum up the symptoms and pathological changes caused by Sepsin or Pyrogen freed from all bacterial, self-reproductive, or transmissible cause of disease. In a series of experiments by Dr. B. Sanderson on dogs after a non-fatal dose of Pyrogen (i.e. 1 I/4 cubic centimetre of the aqueous solution per kilogram of body weight, or I/2 grain of the solid extract for an ordinary sized dog), the animal shivers and begins to move about restlessly; the temperature rises from 2 degree to 3 degree C., the maximum being reached at the end of the third hour.

There is great muscular debility; thirst and vomiting come on, followed by feculent and thin mucous, and finally sanguinolent diarrhoea and tenesmus. These symptoms begin to subside in four or five hours, and the animal recovers its normal appetite and liveliness with wonderful rapidity. I mention this fact as proving that the septic poison has not the slightest tendency to multiply in the organism; and secondly, as rendering it extremely probable that when death occurs it is determined not so much by alvine disorders, which are so prominent, as by the loss of power of the voluntary muscles and of the heart. (*Brit. Medorrhinum Fourn., ii., p. 913.*).

Another proof that death when it occurs is from failure of the circulation is, that in non-fatal cases with well-marked gastro- enteric symptoms, the temperature rises gradually during the first four hours, and as gradually subsides; whereas in fatal cases it rises rapidly to 104 degree F., and then declines rapidly to below the normal before death, thus indicating failure of the heart. In fatal cases from larger doses, the above symptoms increase to intestinal haemorrhage, purging, collapse, and death.

Post-mortem.-There is found extravasation of blood in patches underneath the endocardium of the left ventricle, sometimes on the papillary muscles, sometimes on or in the neighbourhood of the valvular curtains. Similar though less marked appearances are seen in the right ventricle. There are similar points of ecchymosis on the pleura and pericardium. The spleen is enlarged and full of blood. The mucous membrane of the stomach and small intestine is intensely injected with detachment of the epithelium and exudation of sanguinolent fluid distends the lumen of the gut.

These appearances indicate a general tendency to congestion and capillary haemorrhage as well as locally, congestion and capillary stasis of the gastro-intestinal mucous membrane with shedding of the epithelium, as the nature of the disorder. The state of the blood plays a great part in the morbid process; it is darker in hue, and the corpuscles arrange themselves in clumps instead of rolls; many of the blood- corpuscles are partially dissolved in the liquor sanguinis, communicating to it a red colour: a large quantity of the haemoglobin is lost by evacuation of the bowels, and conversion into bilirubin; the partial disintegration of the white corpuscles, by liberating the fibrino-plastic ferment, is supposed to be one cause of the capillary stasis.

“The symptomatic and pathological effects are substantially the same in man, and indeed, the analogy between the symptoms and morbid appearance and state of the blood in septicaemia after wounds and the experimental poisoning with Sepsin is very close.

“Now, granting that the powerful agent producing these remarkable effects may be expected to act therapeutically as an alternative in morbid states which present the pathological simile to them, what are these morbid states, and how are they to be recognised in the complex phenomena of fever in the human subject? To answer this we must inquire what is the cardinal point in the proximate cause of pyrexia with which we have to deal in employing a directly acting remedy? To this question-at least as regards the chief phenomenon which determines the name pyrexia, viz., the increased heat-the critical review of the experiments of Senator, Leyden, and others by B. Sanderson, {* See Blue Book, 1876, No 1 Appendix.*) gives a reply.

“The temperature of the body being dependent on the production and discharge of heat. of which the former is a function of living protoplasm, the later a function of the organs of circulation, respiration, and secretion, the question arises, whether pyrexial increase of temperature depends upon the former or the later.

To this Dr. B. Sanderson thus replies (p. 45):- “Two possibilities are open to us. One is, that fever originates in disorder of the nervous centres, that by means of the influence of the nervous system on the systemic functions, the liberation of heat at the surface of the body is controlled or restrained, so that “by retention” the temperature rises, and finally, that the increased temperature so produced acts on the living substance of the body, so as to disorder its nutrition. The other alternative is that fever originates in the living tissues, that it is from first to last a disorder of the protoplasm, and that all the systemic disturbances are secondary.

The facts and considerations we have had before us are, I think, sufficient to justify the definitive rejection of the first hypothesis in all its forms; for, on the one hand, we have seen that no disorder of the systemic functions, or of the nervous centres which preside over them, is capable of inducing a state which can be identified with febrile pyrexia; and, on the other, that it is possible for such a state to originate and persist in the organism after the influence of the central nervous system has been withdrawn from the tissues by the severance of the spinal cord. We are, therefore, at liberty to adopt the tissue- origin of fever as the basis on which we hope eventually to construct an explanation of the process.’ It is elsewhere concluded that it is in the protoplasm of the blood and the muscles that take place those changes of activity and disintegration on which depend the changes of temperature, and no doubt the other essential phenomena which characterize fever.

“What, therefore, on these data are we to expect from an agent which shall act directly as curative of the pyrexial state? Not certainly any palpable disturbance of the nervous system which can in health lower temperature by promoting heat discharge, as is expected from large doses of Quinine, or from the merely physical action of cold baths; nor a general support of the vital powers till the specific disease runs its course, as is expected from alcohol, etc. But, on the contrary, a simple modification of the exalted and perverted protoplasmic action in which the proximate cause of pyrexia consists, which shall be of such a nature as to bring it back to health.

Let us assume (without any attempt to prove it, but merely to give an intelligible illustration in explanation) the hypothesis of Beale, that the essence of inflammation and fever consists in a degeneration in the scale of biological development of the bioplasts of the blood and tissues, which involves the production of a more rapidly growing and disintegrating kind of protoplasm; our most complete and perfect conception of a direct remedy would be that of an agent which would act as a specific stimulus to be affected protoplasm, and bring back its germinal development up to the normal plane. This has long been my view of the action of Aconite in inflammatory fever, or, at least, that it acted directly on the pyrexically affected protoplasm, and not on the vaso-motor nerves or centres of the heart, or of the spinal marrow; for reiterated experience has shown that its acts in far too small a dose to exert any directly effect on the heart or its nerves, or indeed, and perceptible effect on them at all.

Now, the living matter or protoplasm is capable of an almost infinite variety of kinds of morbid action according to the predisposing and exciting causes acting on it, and hence pyrexia may vary indefinitely in its character, even independently of the addition of the local lesion proper to the concrete specific fevers; so no directly curative remedy can be applicable to more than a few forms, or even to only one, e.g., Aconite suits inflammatory fevers, and Quinine malarious intermittents, while they would be powerless if interchanged. To what form, then, should we except pyrexin or pyrogen to be applicable?

The true clue to this is given, I think, by the state of the blood, for that is the most marked and important of the signs of septicaemia; the local congestions and extravasations not being so constant or so grave as respects the issue. If we contrast the characteristic hyperionotic state of the blood in inflammatory fever, displaying its bright colour, buffy coat, firm coagulum, and the adherence of the red corpuscles in rolls, with the septicaemic state of blood already described, showing its dark and dissolved state, loose coagulum, the red corpuscles adhering in clumps, and the increase of white corpuscles, we shall see well-marked grounds of distinction.

This latter state of the blood is very similar to, if not identical with, that which belongs to typhous or adynamic fevers, and, indeed, in describing fatal cases of septicaemia after wounds the analogy of the symptoms is so great with these fevers that the word `typhous’ is generally used in describing them. Hence the shortest discrimination of the indications for the use of Pyrexin or Pyrogen may be stated to be the typhous or typhoid character or quality of pyrexia, using these adjectives in their old fashioned sense.

For although the clinical discrimination of enteric fever from typhus is a great gain, it is unfortunate that the word `typhoid’ should have been appropriated to the former, as it either introduces confusion into our nomenclature or deprives us of a hitherto well- understood expression of the character of pyrexia from the name of a specific disease. We shall find it convenient to go back to the terms of Cullen, viz., synochal for inflammatory fever, the typhous or typhoid condition for the low adynamic or asthenic character or quality of fever, and synochus for the mixed kind, which is inflammatory at the beginning and typhous at the end.

I do not know that the more accurate discrimination of the typhous, enteric and relapsing fevers into distinct specific diseases gives any ground for denying the existence of the above distinctions of character in the pyrexial state in general, and therefore, we should still keep up the words inflammatory and typhous or typhoid, as expressive of different qualities or characters of fever, and not of distinct febrile diseases.

“As Aconite is well known to be the most important of the remedies for the synochal or inflammatory pyrexia, so the most summary indication for Pyrogen would be to term it the Aconite of the typhous or typhoid quality of pyrexia. This being a condition and not a distinct disease, it is to be looked for as occurring in a variety of diseases such as the typhous and enteric fevers themselves always, and more or less it may occur in intermittents, so-called bilious remittents, in certain varieties or stages of the exanthemata, especially scarlatina, measles, and smallpox, of dysentery, and of epidemic pneumonias, diphtheria, etc.

From the gastro-enteric symptoms Pyrogen may possibly also apply to some stage of cholera and to yellow fever. It is, of course, to be distinctly understood that this substance is only recommended. at certain stages and phases of these disease, and entirely as a remedy of a secondary or subordinate character, and not in any sense as a specific for the whole disease.

“Sepsin or Pyrogen, it must be remembered, is only a chemical poison, like Atropin or serpent venom, whose action is definite and limited by the dose, and it is incapable of inducing an indefinitely reproducible disease in minimal dose, after the manner of the special poisons of the specific fevers; its sphere, therefore, is by no means commensurate with that of these diseases, and if ever true specifics for them should be discovered, it is hardly probable that such would be merely chemical non-living agents.

At present there is no questions at all of such specifics. The only point is that we should be able to form an intelligible idea of the way in which a margin can be supposed to exist in individual cases, say of enteric fever, smallpox, or yellow fever, etc., in which a directly acting medicine can do good to the pyrexia without at the same time having any power to check, modify, or shorten the true specific disease.

Observation, I think, shows that such a margin exists, for we are all familiar with the immense variety in the degree of severity, especially as regards the pyrexia existing between cases of the same specific fever in different individuals, while at the same time the cardinal symptoms are pronounced sufficiently to leave no doubt of the diagnosis, and the completeness of the specific process is also shown by the protection against subsequent attacks being as complete after the sight cases as after the more severe. In scarlatina and small pox both these circumstances are notorious, and the astonishing mildness of the pyrexia in some cases of enteric fever, in which the local diseased process runs its full course, is well known.

James Compton Burnett
James Compton Burnett was born on July 10, 1840 and died April 2, 1901. Dr. Burnett attended medical school in Vienna, Austria in 1865. Alfred Hawkes converted him to homeopathy in 1872 (in Glasgow). In 1876 he took his MD degree.
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.