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.
Robert Ellis Dudgeon practiced at the London Homeopathic Hospital and specialised in Optics.
Robert Ellis Dudgeon wrote Pathogenetic Cyclopaedia 1839, Cure of Pannus by Innoculation, London and Edinburgh Journal of Medical Science 1844, Hahnemann’s Organon, 1849, Lectures on the Theory & Practice of Homeopathy, 1853, Homeopathic Treatment and Prevention of Asiatic Cholera 1847, Hahnemann’s Therapeutic Hints 1847, On Subaqueous Vision, Philosophical Magazine, 1871, The Influence of Homeopathy on General Medical Practice Since the Death of Hahnemann 1874, Repertory of the Homeopathic Materia Medica, 2 vols 1878-81, The Human Eye Its Optical Construction, 1878, Hahnemann’s Materia Medica Pura, 1880, The Sphygmograph, 1882, Materia Medica: Physiological and Applied 1884, Hahnemann the Founder of Scientific Therapeutics 1882, Hahnemann’s Organon 1893 5th Edition, Prolongation of Life 1900, Hahnemann’s Lesser Writing.