Majumdar J N
I have been asked by our Secretary to speak this evening on Acute Polyomyelitis. I take it that this means the homoeopathic outlook in this epidemic condition. The news reached me rather late in Calcutta. I am afraid what I speak here today not be of the standard expected in this sort of meeting.
Firstly, the homoeopaths gets these cases in two stages:
1. During the febrile period of the disease, when except in an epidemic the diagnosis is never made as the diagnostic features of the disease during the pyrexial period is very common and there are no clinical peculiarities in the various aids to observation to put a label to the patient before the onset of the paralysis. Diagnosis is made only when paralysis has set in.
2. In the paralytic stage we can get the cases (a) during the course of the acute condition or (b) during the established paralytic stage with or without the deformities.
Therefore our outlook to the disease syndrome should also vary according to the stage of the disease that we get them. It is because our outlook is always from the point of view of treatment of the patients.
But as Kent has said to a homoeopath, nothing is of unimportance in diseases. The causative conditions, the ultimates, everything is of importance. So let us just have a look at these things so far as is known to us. As these give us valuable indications as physicians to fulfil our purposes according to sections 1 and 4 of the Organon, viz., from the curative and preventive aspects.
Etiology: It is supposed to be due to a filterable virus. But the associated features are better known. Unhealthy surroundings, unhygienic social conditions, war, inundations and famine conditions have been found to be associated with the epidemics.
Thus we find as usual it is not organism alone that is responsible for this conditions, the associated factors are equally responsible. The study of pathology of the disease shows us that along with a similar virus causing epidemic encephalitis this is one of the few organisms that directly affects the nerve tissue. This was not well understood some years ago. The route of the infection was supposed to be from the nasal cavity along the peri – neural lymphatics and there was distinct inflammatory reactions in the affected areas of nerve tissue, particularly in vascular and lymphatic structures.
The mode of infection also is a debatable point and modern trend of opinion is supporting an alimentary spread via the blood with special affinity for the nerve cells, the peri – neural lymphatic and vascular inflammations are supposed to be the secondary inflammatory reactions. The sites of predilection of poliomyelitis are the anterior horn cells, the cranial nerve nuclei and rarely the sub- thalamic and cortical nuclei. Immunity is very often quickly acquired and many cases are aborted in the febrile period. But this immunity is bound to be only effective while the organisms are in transit through the vascular channels.
The use of prophylactic and curative serum from convalescent patients have been found to be hopelessly inadequate in both spheres proving that the immunity is of a transient nature and cannot be used for the purposes with any reasonable amount of certainty. It does not somehow or other reach the nerve tissue through normal vascular channels, maintaining nutrition of the nerve. The symptomatology has nothing distinctive to make a diagnosis clinically clinching.
Symptoms varying from mild influenzal attack to a continued fever of the enteric type are found. Some of these febrile cases have to be differentiated from acute rheumatic fevers because of the aching muscles. Some resemble mild attacks of cerebro – spinal meningitis. But to a homoeopath the acute conditions are distinctive in matching pathogenetic remedies. The paralysis may be of a bulbar type affecting cranial nerves only, a spino – bulbar type affecting cranial nerves as also extremities or purely spinal type.
Fortunately the paralysis is maximal to start with, a recovery inspite of no treatment in a large group of muscle is the general rule. If not properly treated the residual paralysis may be invalidating and may also produce deformities which are painful both from the functional and aesthetic points of view. Prognostically the danger to life is not of so much importance as the chronic invalidism causing individual and national loss of manpower.
From the homoeopathic standpoint the disease may be classified as an epidemic disease coming under acute diseases. The paralytic symptoms being a sequelae due to flare up of latent psora existing in the patient. This is proved by the fact that majority of the patient who do not die recover without much sequelae even in big epidemics. As such, cases have to be treated keeping this nature of the condition in view.
It is also another interesting point that adults are not affected in large numbers and when so affected, 75 percent of the adults do not develop paralytic symptoms. This again shows that the damage to the vital resistance by the acute infection is not big enough to allow latent psora to take up its secondary form.
With regard to treatment, though statistics have not been collected, it is an interesting fact to know that even during epidemics febrile patients treated homoeopathically show much less incidence of paralysis. A homoeopath while thinking of treatment in epidemics has to remember Roberts definition that “an epidemic is a gigantic proving of a noxious principle”. A toxic or a disease producing principle which produces in different persons common symptomatology with individual variations and can always be matched with one individual remedy, viz. the genus epidemics is a sheet – anchor to the homoeopaths and when applied to contacts and also to all and sundry will definitely abort cases.
The co – incident measures of protection, viz. isolation, notification, quarantine and disinfection of the nasal discharges and other excreta are more stressed by homoeopaths than by modern medical practitioners or the state as it does now. In the curative sphere during the acute febrile phase, the symptomatic remedy can always be found because of the distinctive individualistic symptoms in lots of cases. Bryonia, Gelsemium, Rhus tox, are some of the common medicines that come up during different epidemics.
One peculiar individualising symptom noted in some epidemics has been a reversing of the sleep rhythm, that is the child is irritable or playful during whole night and sleeps during the days. It reminds one of the use of such medicines as cypripedium, Jalap, and Lycopodium. During the paralytic phase when seen during the latter part of the febrile onset remedies like Gelsemium, Rhus tox are useful in avoiding and controlling the paralysis. It is in the early paralytic conditions of the patients that such medicines as Causticum, Lachesis, Lathyrus come to the mind.
Needless to say that one depends on the symptomatology of these cases. Fortunately the homoeopath cures the acute cases whether they are sporadic or epidemic sticking to the law of similars. It is the late paralytic case with or without deformities that tackles the ingenuity of the homoeopath.
Here individual case taking, particularly with regard to the peculiarity of the constitution of the patient before the onset of the disease, his family history, his reactions to environmental stimuli (modalities) and lastly though not the least the location, viz. the groups of muscles paralysed are to be taken into account while matching a remedy for the patient which is generally a search for an anti- psoric.
Some of the case may be complex ones and symptoms particularly in the sphere of modalities are our pointers to the necessity of anti-sycotic and syphilitic drug. The nosodes come in very useful according to the symptomatology in the latter part of the disease.
Remarkable results are sometimes obtained even in the late periods because of the reversibility of the ultimates. One must mention that the mechanical effect of residual paralysis have to be treated mechanically by taking orthopedic measures, which includes training and development of the functions of the existing muscles, splinting the limbs to give rest during this training period, muscles transplantation operations and arthrodesis in suitable cases after the dynamic treatment has been given with removal of symptoms and the irreversible portions of the paralysis remains. The mental outlook of these young children have to be kept in view also, while treating them. Measures to make them happy and interested in life are absolutely indispensable.
Regarding the management of epidemics I would draw your attention to the necessity of reviewing the cases and having cross references amongst homoeopathic practitioners during the treatment of cases with a view to find out the genus epidemicus.
Gentlemen, I have taken much of your time and I do not know whether what I have tried to bring to your notice will be of any importance to you because I have not gone into the details of homoeopathic symptomatology which is so variable and which, I take for granted, all of you are past master in.