My clinical experience of the last two years has given me a feeling of great gratitude to Dr. Joslin, for his introduction of Rumex Crispus to the profession by his excellent proving. The value of the published proving is much enhanced by the publication of the daily records of each prover, which enable the student to appreciate the consecutive action of the drug much more perfectly than the Hahnemannian scheme allows, while the latter, again, is indispensable to the prescriber.
I have used Rumex chiefly in acute catarrhal affections of the larynx, trachea and bronchi. In these cases it seems to me to present a close analogy in its action, to Belladonna, Lachesis, Phosphorus and Causticum. Without assuming to present an exhaustive analysis of the action of Rumex on the respiratory organs, I proceed to state the indications for its use to which my studies of it thus far have led me.
Rumex diminishes the secretions, and at the same time exalts in a very marked manner the sensibility of the mucous membrane of the larynx and trachea, exceeding in the extent of this exaltation any remedy known to us. The cough therefore is frequent and continuous to an extent quite out of proportion to the degree of organic affection of the mucous membrane. It is dry, occurs in long paroxysms, or, under certain circumstances, is almost uninterrupted. It is induced or greatly aggravated by any irregularity or respiration such as an inspiration a little deeper or more rapid than usual, by the inspiration of air a little colder than that previously inhaled, by irregularity of respiration and irregular motion of the larynx and trachea such as are involved in the act of speech and by external pressure upon the trachea, in the region of the supra- sternal fossa. These phenomena show a very great morbid irritability of the mucous membrane of the larynx and trachea.
The subjective symptoms are rawness and soreness in the trachea, extending a short distance below the supra-sternal fossa and laterally into the bronchi, chiefly to the left; and tickling in the supra-sternal fossa and behind the sternum, provoking the cough; this tickling is very annoying and very persistent, and is often but momentarily, and sometimes only partially, relieved by coughing. The cough occurs chiefly, or is much worse in the evening, after retiring, and at that time the membrane of the trachea is particularly sensitive to cold air and to any irregularity in the flow of air over its surface, so that the patient often covers the head with the bedclothes to avoid the cold air of the apartment, and refuses to speak or even to listen to conversation, lest his attention should be withdrawn from the supervision of his respiratory acts, which he performs with the most careful uniformity and deliberation, and all in the hope of preventing the distressing tickling and the harassing cough which would ensue from a neglect of these precautions. I have frequently witnessed this state of things during the last three years, and have invariably given prompt relief with Rumex.
In the group of remedies in which I have placed Rumex (along with Belladonna,
Lachesis, Phosphorus, Causticum), it stands pre-eminent in respect to the extreme sensibility of the tracheal mucus membrane. All of these remedies produce symptoms identical in kind. The characteristic of each is to be found in the relative degree in which each symptom is pronounced in the different remedies, quite as much as in the possession by any one of them of symptoms not produced by the others.
Thus Belladonna, Lachesis and Rumex, produce each, a dry cough, induced by tickling in the larynx or trachea and provoked by deep inspiration, by speaking, and by external pressure on the larynx or trachea. Each produce soreness or rawness of the larynx or trachea. The cough of each is spasmodic and long- continued, and is worse at night after retiring. But, apart from the fact that Belladonna and Lachesis act more upon the larynx, and Rumex more upon the lower part of the trachea, we observe that, in the case of Lachesis, the slightest external pressure on the larynx or trachea produces violent and long-continued spasmodic cough; the patient cannot endure the least constriction in that region, not even the ordinary contact of his clothing. There is, moreover, a sense of fullness in the trachea and a very painful aching in the whole extent of the os hyoides. In the case of Belladonna not only is cough produced to a moderate extent by pressing upon the larynx, but soreness and pain are experienced with a sense of internal fullness and soreness which at once suggest the presence of acute laryngitis submucosa. In Rumex, on the other hand, there is no sensibility, strictly speaking, of the trachea, but simply such an irritability of the mucous membrane that cough is produced by the change of position induced in that membrane by external pressure on the trachea. As regards the extent and intensity of this symptom, Rumex holds a lower rank than the other remedies named.
But the irritability of mucous membrane by virtue of which cough is induced by hurried or deep inspiration or by speaking, while it is common to Belladonna, Lachesis, Rumex and Phosphorus, is produced in the most exalted degree, as we have already seen, by Rumex, which, as regards this symptom, takes first rank. A sensation of rawness or roughness in the larynx, trachea and bronchi is produced by each of the four remedies above named, but the locality and the degree in which it is produced vary in such a manner as to serve in some measure as a characteristic of each. It is most marked on Phosphorus and Belladonna, less prominent in Rumex, and least of all in Lachesis. In Belladonna and Lachesis it is most marked in the larynx; indeed it is almost confined to that region. Rumex produces it in the trachea and upper part of the bronchi, while Phosphorus induces it in the whole mucous tract from the larynx to the smaller bronchi; and, moreover, in the Phosphorus proving this “rawness” of the air-passages is accompanied by a no less characteristic sense of weight and constriction across the upper part of the thorax, which indicates an affection of the finer air- tubes and of the air-vesicles of such a character as seriously to impede the function of respiration. In considering this last symptom we must mention Causticum also, which produces “rawness” extending the whole length of the sternum.
All five remedies, again, produces hoarseness; Phosphorus, Causticum and belladonna most eminently, Rumex less decidedly, and Lachesis in a still less degree. As regards complications, Belladonna and Lachesis apply especially to those which involve the fauces and pharynx, and are acute, the one of a sthenic, the other of an asthenic character; Phosphorus to those of the pulmonary tissues of a definite inflammatory character, and Rumex to certain affections of the lungs and their envelopes of which the nature is not clearly defined in the proving. They are indicated by pains, generally sub-acute, in the upper part of the lung near the clavicle and axilla, and more frequent in the left than in the right lung.
In addition to these obervations on the respiratory organs, I have noticed, in one case, the cessation of a brown watery diarrhoea after the administration of Rumex. A boy of five years had brown watery diarrhoea, chiefly in the morning, having five stools from five to nine A.M., attended with moderate griping pain in the lower part of the abdomen. This continued several days, notwithstanding two prescriptions which I made for it. Observing that the boy had a cough which presented the characteristic features of the Rumex cough, I gave that remedy, and both diarrhoea and cough were speedily cured. The symptom “brown watery diarrhoea” occurs once in the provings. In relating this case I cannot forbear remarking that had I been more careful to collect and consider the totality of the symptoms, embracing cough as well as diarrhoea, I should have given Rumex at first, instead of making two blundering prescriptions on the basis of a parital view of the symptoms which embraced the diarrhoea alone.
The following case from my clinical record will illustrate the character of the Rumex cough:
M., aged twenty-two, of feeble constitution, strumous, subject for several years to sub-acute rheumatism; has had a severe cold for several days, and is now confined to the bed. The pulse is quick, not hard, 110, skin moderately hot and dry, face somewhat flushed. Respiration embarrassed not so much by any constriction of the chest as by the violent and long-continued cough which follows any attempt to make a full inspiration. A physical examination of the chest reveals no abnormal condition. The patient complains of roughness and soreness in the lower part of the trachea and behind the upper third of the sternum, much more perceptible when she coughs. The cough is dry, slightly hoarse, very violent and fatiguing to the patient. It is provoked by a tickling in the supra-sternal fossa; is induced by pressure upon the trachea in that region, and especially by talking and by deep inspiration or by the inspiration of cool air. This irritability of the trachea increases very markedly after 7 P.M., so that the patient suffers exceedingly from the constant tickling and violent cough. She can prevent them only by respiring with very great caution and deliberation, by avoiding all distractions of speech and conversation, and finally she draws the bedclothes over the head in order to avoid inhaling the cool air of the chamber.
Dr. Dunham graduated from Columbia University with Honours in 1847. In 1850 he received M.D. degree at the College of Physicians and Surgeons of New York. While in Dublin, he received a dissecting wound that nearly killed him, but with the aid of homoeopathy he cured himself with Lachesis. He visited various homoeopathic hospitals in Europe and then went to Munster where he stayed with Dr. Boenninghausen and studied the methods of that great master. His works include 'Lectures on Materia Medica' and 'Homoeopathy - Science of Therapeutics'.