Clothing should be adapted to the season, and should be warm without being oppressive. The extremities especially should be kept warm. As a general rule, flannel should be worn; in winter it affords direct warmth, and in summer it tends to neutralize the effects of sudden changes of temperature. The linen should be frequently changed, always observing that it is put on perfectly dry.
In certain cases operative interference may be advisable.
63. – Lupus. (Lupus.)
DEFINITION. – Tuberculous Inflammation and infiltration of the skin, usually of the nose or face, caused by the tubercle bacillus. It is very chronic.
Lupus occurs usually before puberty, and persists indefinitely unless properly treated. It is commonest on the face, especially on the nose and cheeks, and may spread to mucous membranes.
SYMPTOMS. – Nodules appear deep in the skin and then run together. Each nodule is red and raised and resembles apple jelly. The skin becomes infiltrated and ulcerated, fresh nodules appearing on the spreading margin. The Ulcer is constantly spreading in one direction, and healing in another; it may last for years, and wander over the whole face, completely destroying perhaps the alae of the nose, or the eyelids, but in other parts not penetrating the entire thickness of the true skin. The cicatrix is excessively irregular and shining, of a dense whiteness, causing perhaps eversion of the eyelids and distortion of the features; in some parts it feels soft and pulpy. This affection is generally conceded to be due to the bovine type of tubercle bacillus.
TREATMENT. – Arsenicum. – This is the chief remedy, and by its preserving use, both internally (in various dilutions) and externally, we have witnessed most unpromising cases cured or greatly benefited.
Tuberculosis. – Koch’s Tuberculin was claimed as a remedy for lupus, rather than for tuberculosis. IT has proved curative in the 30th and 200th homoeopathic potencies, in rarely repeated doses, as also has Bacillinum. These remedies should only be used by medical men.
Iodium, K-Hydriod., Hydras., Ferri Iodium, Sulphur and vaccine treatment, are also useful. All the remedies may be used locally as well as administered internally.
LOCAL TREATMENT. – Finsen light, and X-rays.
64. – Tuberculous Disease of Glands (Tuberculous adenitis).
DEFINITION. – This term includes all those affections of the lymphatic glands – enlargement, induration, and suppuration-which arise from infection of the glands by the tubercle bacillus. The tubercle bacillus is ubiquitous. All are exposed to infection, and upon the local conditions whether favourable or unfavourable, depend the fate of those micro-organisms which find lodgment in our bodies. Special predisposing factors in lymphatic tuberculosis is catarrhal inflammation of the mucous membranes, and decayed teeth, which in themselves excite slight adenitis of the neighbouring glands. In a child with constantly recurring naso-pharyngeal catarrh the bacilli which lodge on the mucous membranes find in all probability the gateways less strictly guarded, and are taken up by the lymphatics and passed to the nearest glands. The importance of chronically enlarged tonsils and decayed teeth as an infective atrium, cannot be too strongly urged. In conditions of health the local resistance, or as some would put it, the phagocytes, would be active enough to deal with the invaders, but the irritation of a chronic catarrh weakness the resistance of the lymph tissue, and the bacilli are enabled to develop and gradually to change a simple into a tubercular adenitis.
Tubercular adenitis is met with at all ages. It is, however, more common in children than adults.
SYMPTOMS. – The gland slowly enlarges, becomes hard, and is painless up to a certain point; afterwards Inflammation, pain, and suppuration occur, the pus being curdy. When the wound is healed, a marked and, frequently, protuberant cicatrix remains. In other cases, however, the gland remains enlarged, without proceeding to suppuration. The glands most commonly affected are those in the neck, under the jaw.
EPITOME OF TREATMENT. – Unless the abscess is opened, or the matter drawn off, it bursts and leaves a slowly healing sinus.
Chronic enlargement. – Iodium, MErc.-Iodium, K.-Hydriod., Ammon-Mur. (indurated), Phyto., Calcarea, Sulphur Nourishing diet, cod-liver oil (Secale 21), pure air, sunlight, with the general treatment prescribed for tuberculosis.
65. – Tuberculosis of the Lungs – Phthisis Pulmonalis – Pulmonary Consumption.
DEFINITION. – Phthisis is almost synonymous with Tuberculosis of the Lungs. Syphilis of the lung, and some chronic pneumococcal infections may give rise to a clinical picture difficult to distinguish from that of Tubercle, and therefore the term Phthisis and Consumption should be given up and the diseases named according to the agents that cause them. Tubercle is by far the most important of these.
The disease is due to the invasion of the lungs by the tubercle bacillus, with consequent inflammation. The inflammation may proceed to healing even after considerable breaking down of tissue with resulting scanty, or broken down tissue may be coughed up in pus and cavities may result or the process may gradually extend through the lungs, healing here and there, but always creeping on till a great deal of fibrous tissue is formed (fibroid phthisis). All these are varieties of Chronic Tuberculosis. Acute Tuberculosis is of two kinds. The first is of a similar nature to the first two varieties described above, only it sets in with great violence and acute symptoms; the second is called acute miliary tubercle. The lungs become filled with small tubercles, which do not break down. There is little expectoration, but marked fever and acute symptoms, and recovery from this form is almost unknown.
SYMPTOMS. – The early indications are often obscure, and may appear at any age, but most frequently between twenty and thirty. The chief symptoms are impaired digestion – loss of appetite, red or furred tongue, thirst, nausea, vomiting, and, in rare cases, gastralgia; more or less cough, chiefly in the morning; hoarseness or weakness of voice; irregular pains in the chest; dyspnoea on slight exertion; debility, languor, and palpitation; persistently accelerated pulse; heightened temperature; night sweats; and progressive emaciation.
As a tendency to tubercle is apt to be a hereditary, inquiry should also be made if any members of the patient’s family have died from this disease.
Cough is a prominent symptom. In the early stage it is dry, short, and irritative, and most troublesome in the morning, or after exertion; the expectoration is usually small in quantity, and consists of ropy or glairy mucus; the cough may continue for months without aggravation or the supervention of any other symptom. In a more advanced stage, cough recurs during the day, and especially after slight exertion, being caused by the necessity for getting rid of the inflammatory products and disintegrated lung tissue, with then begin to accumulate. The recognition of this different variety of cough is necessary in order to prescribe for its cure and relief, as remedies suited to one condition are inadmissible in the other. The mere existence of a cough, per se, by no means proves that tubercle is present, as it may arise from diseases of other organs than the lungs; neither does the absence of cough prove the non-existence of the disease. The discovery of tubercle bacilli in the expectoration puts the diagnosis beyond doubt.
Haemoptysis frequently, but not invariably, occurs; it is a suspicious symptom, and often gives the patient the first intimation of danger; its occurrence either before or soon after the commencement of a cough always renders the fact of tubercle probable, especially if the patient has received no injury of the chest, and has no disease of the heart.
In phthisical Haemoptysis the amount of blood discharged is sometimes very small in the early stage, merely streaking the sputa, or there may be a few teaspoonfuls, proceeding only from the small vessels that are congested in the neighbourhood of the tubercles; but in the later stages there is sometimes a copious and even fatal Haemoptysis, arising from some large vessel being opened by ulceration and rupture of an artery in a vomica; but this is comparatively rare, because the vessels usually become plugged with coagula before the ulceration opens them.
A persistent rapidity of the pulse, ranging from 90 to 110, or higher, is an invariable symptom of active Phthisis. The pulse is especially liable to become accelerated towards evening, and, as the disease advances, becomes more rapid and also feebler. Even more important is the temperature which often gives the first danger signal. A persistent rise of temperature in the evening to 99* or 100*, and particularly a marked rise of temperature after moderate exertion, is a very suspicious sign.
Shortness of breath or difficult breathing is a common symptom. In Phthisis the capacity of the lungs is diminished, and enough air is not inspired to aerate the blood sent there by the quickened action of the heart. An extensive growth of tubercle in the lungs gives rise to very great distress in breathing; this symptom becomes, therefore, a sign of the extent of the deposit. The number of respirations in healthy, tranquil breathing is 14 to 18 per minute, and bears a remarkable proportion to the pulsations of the heart, that is, one complete respiration to about every five beats of the heart. In Phthisis the number of respirations is from 24 to 28, the number increasing as the disease progresses. Inspiration is generally short, limited and speedily checked, causing uneasiness or inducing coughing, and is quickly succeeded by expiration. The patient complains of want of breath; exercise, especially going uphill or down stairs or walking fast, exhausts him, and he often requires to rest. The patient’s feelings cannot here be relied upon, for the sense of dyspnoea may be experienced when the function of respiration is unimpaired; and, on the other hand, one lung may have become useless by slow compression without nay such distress for breath. The rate of progress, and not the actual advance of the disease, therefore, determines the degree of the patient’s distress. A lowered respiratory power tends of itself to induce accumulations of mucus in the air-cells, and to excite inflammatory action.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."