Opinions relative to the psora theory since the recognition of the itch-insect-Russell’s historical paper on itch-Abenzohr knew of the insects- The German peasants were acquainted with them- Moufet described them-Hauptmann gave a drawn of them-Bonomo wrote about them- Waehmann alluded to them-Afterwards they were lost sight of and disbelieved in -Rayer gets them pointed out to him- Adams describes them, and gives himself the itch-Since then they are generally believed in-Hebra’s account of scabies-His description of the acarus and its tracks-Hebra’s account of scabies-His description of the acarus and its tracks-Habitat of the vermin-Eruption dependent on its presence-The acarus the sole infecting agents-His treatment of the disease-Puffer defends the psora theory against Hebra-Denies itch to be a parasitic disease- The itch-insect the product of the disease-He allows that itch requires external treatment-Hebra reply to Puffer-He contends that the acarus is the sole essential feature of itch-He denies that any danger attends the suppression of itch- Griesselich’s views on the psora-theory-Hahnemann cured chronic diseases before he had a single antipsoric-The psora theory supplies a defect in Hahnemann’s previous doctrines-Influence of the theory on Hahnemann’s pathology of acute diseases-Hahnemann’s psora equivalent to dyscrasia, cachexia, and humours of others- Hahnemann wrong in his diagnosis of itch-Doubtful if itch can be cured by internal medicines-Influence of the ordinary treatment of itch in producing serious disease-Benefits conferred on practice by the psora theory-Absurdity of the division of medicines into antipsorics and apsorics-Weber’s definition of an antipsoric-Arnold’s views on the psora-theory-How can a parasitic disease give rise to other diseases?- The psora theory must include other skin-diseases besides itch-Hahnemann’s psora theory was a concession to the humoral pathologists- Henderson’s defence of the psora theory-Russell denies the repercussion of itch-Explains how its suppression may cause disease-Simon contends for more than three chronic miasms -Leboucher misapprehend’s Hahnemann’s cures of psoric diseases without antipsorics-Before he had any antipsorics he proposed to cure chronic diseases only by homoeopathy-Hahnemann fails to prove the origin of chronic diseases from itch-His diagnosis of itch incorrect-He confounds it with other diseases-Secondary diseases are sometimes produced by suppressing itch-How this happens- Danger of suppressing extensive exanthemata-Hahnemann erred in overlooking hereditary disease- They have been recognised in all ages-Aristotle-Piorry-Linz-Many causes of latent disease- Probability of certain eruptive diseases being connected with certain internal diseases-Nunez-Reasons for Hahnemann’s adoption of the psora-theory-Good done by the psora theory-Treatment of itch-Want of success of the internal treatment-Importance of destroying the acarus. Modes of doing so-Syphilis-Sycosis-After diseases of sycosis-Antisycotic medicines.
I NOW come to a consideration of the opinions of the more recent homoeopathic writers and others on the subject of Hahnemann’s psora-theory, expressed subsequent to the pretty general recognition of the presence of the acarus as essential to the disease with Hahnemann held to be the source of so many chronic diseases, viz., the scabies or itch.
In the sixth volume of the British Journal of Homoeopathy you will find a paper on the subject of psora or itch, written by Dr. Russell, in which the history of the knowledge of the existence of an animal inhabiting the skin in the disease we term scabies is traced from remote times.
It appears that about 640 years ago Abenzohr spoke of the existence of small vermin accompanying a skin disease, in such terms as must lead us to acknowledge their identity with the itch-insects of our days. His words are-“Syrones (called by the Arabs assoalat and assoab) are lice which creep under the skin of the hands, legs, and feet, and there excite vesicles full of water. So small are the animalculae that they can hardly be distinctly seen.” Magnifying-glasses had not yet been invented.
Abenzohr gives this as a popular brief, and it is curious, that in almost all countries a belief obtained that itch depended on the existence of a small vermin in the skin, and in many, certain old women and others were in the habit of driving a lucrative trade by extracting these small insects with a needle or other sharp-pointed instrument, and thus curing the disease. The peasants of Germany had a particular name for this operation. They termed it Sauren-graben, Sauren being probably a corruption of the more ancient syrones. In Moufet’s Theatrum Insectorum, published in the year 1634, this insect is introduced upon the stage as the chief actor in the drama of itch. Hauptmann of Leipzic gave a drawing of it in 1650; likewise an Italian of the name of Bonomo published an account of these creatures in 1683; and again, Wichmann in 1786 makes mention of their existence. Later pathologists and authors upon skin diseases, however, were either ignorant of the fact that it had ever been said that the itch had anything to do with an insect, or they noticed the report only to discredit it. Even Rayer and Biett, the celebrated dermatologists, continued as late as 1812 to disbelieve in the existence of the acarus; and a student from Corsica first convinced Rayer of their presence in the skin, and instructed him in the art of extracting them, as he had often seen the operation performed by the peasants of his native country.”
Before this time, Dr. Adams, in his works on Morbid Poisons, described the method of extracting the itch-insect, called in Portuguese oucoes, as he had seen it practised in the island of Madeira, and gives what he may call a pathogenetic proving of the insect; not, however, by means of swallowing a trituration or dilution of the vermin in the orthodox Hahnemannian manner, but by allowing two of the acari to burrow under his own skin, whereby he got in due time a severe attack of itch all over his person, from which the was only cured by means of an ointment of white precipitate.
Since that time all dermatologists coincide in the opinion that the little insect called acarus scabiei or sarcoptes hominis is essential to the itch-disease; that this well-known disease is never without it, though the difficulty of finding it is sometimes considerable, but that with a little patience and skill, and knowledge of the exact spot where it may be expected to be met with, it may always be discovered and drawn from its crypt in the epidermis.
In 1844, Dr. Ferdinand Hebra of Vienna, professor of skin diseases and physician-in-chief to what is called the Kratz- abtheilung, literally Itch Department, but more properly Cutaneous Disease Department of the Vienna General Hospital, wrote an essay in the Austrian Jahr-bucher, or medical journal, upon scabies. I may give you a brief abstract of his description of the disease. He says, is characteristic feature is the presence in the epidermis of certain tracks or passages, termed canaliculi, containing the itch-insect or acarus scabiei. Without the insect, he observe, there is no itch, and wherever the insect exists, there will be found the tracks or canaliculi just mentioned. These tracks differ in appearance under different circumstances. In young cleanly individuals, with fine soft skins, they appear as delicate white lines, slightly tortuous and somewhat elevated above the surface of the epidermis, varying in length from one line to as much as several inches.
At one end is generally a vesicle, pimple, or pustule, but this is not the seat of residence of the acarus, but represents the point of his entrance; the little animal will be found at the farther end of the track, and his presence is indicated by a very small, roundish elevation, somewhat darker in colour than the rest of the track. The vesicle stands in the same relation to the acarus that the mole-hill does to the mole, and this circumstances will account for the want of success of many searchers for the acarus, as they have generally thought that the animal was to be found close to or in the vesicle or itch-pustule, which is far from being the case. In cases of long standing, and in patients who are older or dirty, or who have a thicker epidermis, the track of the insect is no longer white, but often scarcely to be distinguished from the surrounding skin except by its elevated appearance or by its greater dirtiness.
As a rule, Dr. Hebra says, the acarus is confined to certain parts of the body, viz., the hands, wrists, and fore-arms, the feet and ankles, occasionally the penis and scrotum, and more rarely the anterior surface of the thorax and the knees. The general eruption over the whole body is produced by the scratching of the patient, owing to the sympathetic itching over the whole skin that accompanies the presence of this little vermin. As a proof of this, he alleges that paralytic patients infected with itch present none of the scabious eruptions on the limbs destitute of sensibility, excepting the itch-vesicles and canaliculi, the immediate effect of the acarus.
Several such cases I witnessed in Hebra’s wards. According to Hebra, the acarus alone possesses the power of propagating the disease. No inoculation of the fluid contained in the vesicle will suffice. This he convinced himself of by experiment. The deduction Hebra draws in this essay from the facts he relates is, that in order to cure the itch we only require to kill or remove the acarus, and this he does by rubbing an ointment consisting of chalk, sulphur, pitch, soap, and lard, upon the parts infected with the acarus, whereby the vermin is destroyed, and the sympathetic eruptions dependent on its presence, together with those produced by the patient’s scratching, gradually die away. An immense experience of this mode of treatment convinces Dr. Hebra of its efficacy and its perfect safety, and the non-liability of the patient to relapse after the disease has been thus removed. Various secondary eruptions do, it is true, appear after the itch-disease is removed, but these, he alleges, readily yield to the application of caustic potash in solution.
Such, then are Hebra’s notions on the subject of itch, as expressed in the essay I have just given you an abstract of, and such may be considered as the notions of most modern pathologists and dermatologists respecting the natural and treatment of this disease. Against these ideas a homoeopathic physicians, Dr. Puffer, felt himself impelled to write, fearing probably that homoeopathists might be disposed to adopt the apparently simple and effectual method described by Hebra, and thus, as he thinks, do much harm to patients by the treatment, and sap the foundations of Hahnemann’s doctrines by the adoption of Hebra’s most heretical pathological views. Dr. Puffer records the results of his observations and reflections in the second volume of the Austrian Homoeopathic Journal, and I shall now endeavour to give you a brief abstract of his essay.
He premises, by condemning the practice so common among allopathic practitioners of treating itch and other skin diseases by means of ointments and other external appliances. He asserts that Hahnemann’s psora-theory is founded on a great a and important truth. He refers to the reciprocal relations of the skin and the rest of the organism, and from his own and others’ experience gives numerous cases of the disappearance of cutaneous diseases being followed by hydrocephalus, apoplexy, and other serious diseases. One case in particular he relates, that of girl namely, who being affected with itch had the disease removed by means of an ointment containing lead; after the disappearance of the eruption there occurred heat disease, to wit, insufficiency of the mitral valve, together with ascites and anasarca. After the administration of sulphur a papular eruption appeared on the skin, but the disease went on increasing in intensity, and finally carried off the patient. It is remarkable that Dr. Griesselich, in his Sachenspiegel, relates an almost precisely similar case.
As regards the aetiology of itch, Puffer declares himself to be opposed to those who do not admit the existence of what are called metastased of itch, and especially to the view expressed by Hebra in the paper I have just referred to, viz., that where no acarus exists there can be no itch. In opposition of Hebra, Puffer is a defender of the real contagiousness of itch, and will not allow that it is of a parasitic nature. In like manner, contrary to Hebra’s opinion, he contends that the eruptions accompanying itch are essential parts of the disease. He will not admit the conclusiveness of the observations and experiments of those who allege that it is only the acarus that convey the infection, and that the fluid from the pustules has no power to do so. He cites a Dr. Schubert as an authority for the contrary; said Dr. Schubert having, it is said, succeeded in producing itch by inoculation with matter taken from an itch-pustule a year before.
Puffer holds the contagium of itch to be an animated substances, for whose production an internal itch-disease must be presupposed; the insect is not to be viewed in the light of causes, but in that of phenomenon or symptom: he considers it highly probably that the acarus is a product of the organism itself, a generatio oequivoca or spontanea, just as intestinal worms are said to be produced from the intestinal mucous membranes, and lice to be generated by some kinds of tinea. Thus, for the production of the acarus scabiei itself, the pre- existence of the internal itch-disease is required. For the production of the itch-disease, as for that of every other contagious disease, two conditions are requisite, an external and an internal; viz., the exciting and the predisposing cause.
Dr. Puffer admits that the acarus is capable of propagating the itch, but alleges that it cannot do so except the itch-disposition be present; just as the silkworm cannot live on cabbage-leaves, but requires the mulberry-leaf for its support. Puffer accordingly is against that method of treatment that only consists in killing the acarus. He accounts for the fact that so many practitioners have never seen any secondary diseases after the suppression of the itch, by the period of the incubation of these secondary disease, though at the same time he admits that it is going too far to ascribe every disease to an itch that has been suppressed by external agents. Hospital medical men, he remarks are not in a position to observe what becomes of those patients whose itch they have cured.
As regards the treatment of itch, Puffer says that the rapidity of its disappearance from the skin is no test of the excellence of the remedial means employed. The safety of the patient, his exemption from after-affections, must also be taken into consideration. Hence he condemns the treatment of Vezin, Hebra, and many others, who seek only to destroy the acarus, and thus procure the disappearance of the rash in a few days. On the other had, he vaunts the efficacy and safety of the homoeopathic treatment of itch by its specific, sulphur. He believes, however, that Hahnemann was mistaken when he said that itch can be cured in from two to four weeks by a globule or two of the 30th dilution of sulphur, and thinks that Hahnemann’s diagnosis of the disease he so cured must have been erroneous, more especially as he makes no mention of the characteristic signs of itch, namely, the presence of the acarus and its tracks or canaliculi. Hahnemann’s followers, he asserts, have also generally made wrong diagnoses regarding this disease. He states that the disease must be treated with sulphur, not only internally but also externally, but he does not tell us with preparation of sulphur he advises to be used externally.
This essay of Dr. Puffer’s incited Dr. Hebra to write another article (Ztsch, der Ges. d. Aerzte, v.) upon skin disease, and especially upon itch, which is well worthy of a perusal, containing as it does some excellent remarks upon the pathology of skin diseases. Hebra of course defends his views formerly expressed in the Jahrbucher, and attacks systematically all the opinions advanced by Dr. Puffer. From his position as chief medical officer in the skin-disease department of the General Hospital, he had an excellent opportunity of observing all manner of skin diseases, and of putting to the test his method of treatment.
His experience extends over an immense number of patients, 15,000, he says, is not too large a figure to express the numbers he has actually treated; and the opinions of one who has enjoyed such advantages, and who possesses besides a fair talent for observing and great industry, are entitled to our best attention. Whilst he allows that every dyscrasia (meaning every morbid condition of the blood) is, under certain circumstances, connected with the formation of an exanthema, he states that each of these dyscrasia may also occur without any appearance on the skin. He treats the doctrine of itch-metastasis and psoric humours as a myth, and will not allow that there are any such things as herpetic, impetiginous, leprous, or psoric dyscrasias. The acarus, with its canaliculi, is the sole essential feature of the itch-disease, and the object of the practitioner should be to get rid of the insect by its destruction as quickly as possible.
Not only has he never seen anything like a metastasis from this treatment of the itch, but he denies that anything of the kind ever occurs from the suppression, or cure as he terms it, by external means, of any skin disease whatever. As regards the itch, he says he has had ample opportunities of convincing himself of the accuracy of this assertion, for his experiments, is not confined to the patients that come and go in his hospital, and whom it is possible he might altogether lose sight of, but he has, by means of placing acari on the skin, produced itch on himself, his students, and nurses, and cured it by means of sulphur ointment, and not the slightest bed or unpleasant effects have ever resulted. He says that erroneous ideas prevail respecting local and general treatment; thus the treatment is called external or local when the remedy is applied to the skin, but if it be applied to the mouth or stomach it is called internal or general. This distinction, he asserts, is not tenable and is quiet arbitrary, for a medicine may exercise a general action as well when applied to the skin as to the stomach; an opinion indeed which was expressed and acted on by Hahnemann himself, as we shall hereafter find, in as far as the sound is concerned, and one which is corroborated by the daily experience of allopathists, more especially in their mercurial inunctions for the cure of syphilis or other disorders.
The motion advanced by Dr. Puffer and others that the general disease is relieved or silenced by a skin eruption is in many cases not true, for patients die of typhus or of inflammation though a skin disease may appear in the course of the disease, and some febrile diseases, such as small-pox, measles, scarlatina, etc., are severe in the direct proportion of the extent of skin-disease they present. That impetiginous diseases disappear on the occurrence of typhus is not a sign that the intensity of the typhus has anything to do with such disappearance, for it is rather in consequence of the general disease that the skin-disease disappears. In syphilis the occurrence of the syphilitic skin-disease does not suppress the other effects of this malady, for such syphilitic exanthemata often co-exist with iritis, sore throat ozaena, and nodes.
Notwithstanding all this and many other assertions and facts, Dr. Hebra is far from denying the reciprocal relation of the skin and other parts of the organism. He again repeats his assertion that the general eruption on the skin of scabious patients is caused by their own scratching, and refers to cases of itchy persons paralysed in the upper extremities who presented no general eruption, but only the scabious vesicles and canaliculi on the parts inhabited by the acarus. Hebra asserts that it is always his endeavour in all cases of skin diseases and ulcers to heal them as quickly as possible by external remedies, and he invites all those who dream of the bad effects of such treatment to watch his practice as carefully as they like. He laughs at the motion of a secondary disease from a suppressed cutaneous eruption requiring an incubation period of several years.
Dr. Griesselich, in the work to which I have frequently referred in these lectures, pays great attention to Hahnemann’s psora- theory, and enters at length into all the different points of a practical and theoretical nature involved in it.
The truths contained in Hahnemann’s psora-theory, he says, go to supply many wants in the Hahnemannic homoeopathy, as it had previously existed. When Hahnemann talks of the utter inefficacy of the treatment of chronic diseases he is guilty of great exaggeration, a fault which he very frequently commits; for there is no doubt that chronic diseases were cured by Hahnemann himself, as we learn from many cases detailed in his Lesser Writings, before the discovery of the psoric origin of diseases, and before he know a single so-called anti-psoric medicine. Griesselich regards the psora-doctrine as supplying a defect in the otherwise hyperdynamic doctrines of Hahnemann, and an acknowledgment that what is called the complex or totality of the symptoms is not the sole indication for the choice of the drug. By the psora-theory the material organism and the relation of the disease to its exciting cause are restored to a portion of their rights, and the choice of the remedy is made to depend, not only on the morbid symptoms actually present, but also on those that have been and are the cause of the disease.