THE DISEASES OF THE LIVER
THE issue of a second edition of this treatise on Diseases of the Liver affords me an opportunity of adding somewhat to the clinical demonstrations already contained in Part II.
Particularly would I call attention to what is here related of the sphere of action of Chelone glabra of which no mention is made in the first edition, because I was, at the time of its issue, not clear on the subject. At this place I would also take the opportunity of pointing out the omission by Dr. Dudgeon of a very important point in regard to the clinical use of Carduus marioe. Some time since Dr. Dudgeon translated and published in one of our journals some very important cases of pulmonary disease and coughs as cured by Carduus. The impression conveyed by this eminent writer’s translation is that Carduus in these cases acted as a pulmonary remedy whereas the cases were really considered by their author as of hepatic origin: the pulmonary manifestations being consentaneous, or secondary to primary liver affections in all the cases narrated. This point is of the highest importance as Dr. Dudgeon’s translations give one the impression that Carduus is a lung medicine which I think is entirely erroneous: the lung affections that are curable by Carduus have their starting point in a primary affection of the liver. All the clinical writers on Carduus with whose works I am acquainted are of this opinion, and Rademacher, the greatest of them all, is very clear and positive on the subject. *I am very well aware that Dr. Dudgeon does not share in my organopathic views, but as translator he is bound to faithfully render the original. I will now relate a case of hepatic disease of great interest which had baffled some of the best physicians in London and which very clearly exemplifies the therapeutic range of Bellis perennis and again of Carduus marioe. It is one of:
ENLARGEMENT OF LIVER REMAINING FROM HEPATITIS AND PERITONITIS.
The wife of the Vicar of St.B. brought a young lady, about 24 years of age, to me on February 20th, 1893, for considerable swelling of the abdomen and such severe varicosis of lower extremities that the patient had been confined to her couch for nearly a year. Patient had had thrombosis of the veins of her lower extremities repeatedly and the swelling in the right side of the abdomen dates from a severe attack of peritonitis and hepatitis. All idea of a cure had been abandoned. Percussion and palpitation revealed an enlargement of the left lobe of the liver and a painful lump lying between the liver and the navel about the size of a small first. Glands in the groins feel like marbles, lower extremities large and unshapely, clearly the remains of the original thrombosis. In as much as the whole series of phenomena-thrombosis, peritonitis, hepatitis-began with getting a chill (cold, wet) six years ago, I ordered my old friend Bellis perennis ten drops in a tablespoonful of water night and morning.
March 20th.-Very greatly improved, indeed, lump nearly gone and the lower extremities are now shapely. The left lobe of the liver however remaining enlarged, I ordered Carduus marioe seven drops in water night and morning.
April 28th.-Patient at this date was walking about like other people, and the only thing that remained was a little transverse swelling of the liver and this was removed by a short course of Chelone glabra.
In the fall of the year 1893, a slight relapse occured which was quickly righted by Bellis perennis. The Vicar’s wife was with me on October 15th, on another matter and mentioned incidentally that Jessie’s cure had proved complete and lasting.
The common sunflower is an old horticultural as well as clinical friend of mine that has here and there helped me in splenic affections. Here I use it more as a liver remedy:-
Helianthus Annuus AS A LIVER MEDICINE.
Although I regard the sunflower as specially a spleen medicine still it has a distinct action across from the spleen toward the liver and possibly it influences the liver also.
I have lately cured a stubborn case of a throbbing swelling in the pit of the stomach involving the left side of the liver and the spleen and the tissues lying between the two organs.
No defined epigastric tumours could be satisfactorily distinguished but the whole epigastric region was very tender on pressure and patient could not bend down with out getting giddy and feeling much distress at the epigastrium. The particular interest in the case lay in the long duration of the ailment and the pulsating epigastric mass.
Patient took five drops of the matrix tincture of Helianthus, night and morning for some weeks when the only abnormal thing remaining was the very slight enlargement of the left lobe of the liver and for which he was put on Chelone glabra. The spleen was put right and also the epigastrium of which the pulsation ceased, together with the tenderness and distension and in view of the difficulties one encounters in dealing curatively with pulsating epigastric swellings I think this short narration worth penning and preserving.
I know of nothing in the way of diagnosis offering more difficulties and pit-falls than “pulsating tumours” in the abdomen, and indeed all abdominal tumours take a deal of diagnosing.
I will now invite my reader to a short yet closer consideration of an hepatic that is a comparatively new friend, viz. Chelone Glabra-AN IMPORTANT HEPATIC.
I think I have discovered an important differential point for the scientific use of Chelone glabra.
A Commander in the Royal Navy, about two years ago, came under my observation for an enormous varix in the right groin, just on Poupart’s ligament. The varix was about the size of a very small orange and the thing was certainly becoming alarming on account of the thinning of the wall of the dilated vein. And being in the bend of the groin it was almost impossible to apply mechanical support. The patient was thoroughly healthy fellow and though I diagnosed him up and down and questioned him unto very weariness, still there was absolutely nothing findable beyond a slight enlargement of the left lobe of the liver. I first used Chelidonium majus. with some advantage, and under Carduus marioe the varix certainly diminished somewhat, but under the remedy in question the varix disappeared and patient hastened off on active service. From this (and similar observations I have laid it down for my own future guidance that the seat of action of Chelone glabra is the left lobe of the liver and its line of action is in the direction of the navel, bladder and uterus. That this is really so the competent will have no difficulty in verifying whether Chelone acts upon the liver itself as a true hepatic I would not venture to affirm; perhaps it reduces the swellings of the left lobe of the liver by its action on the veins running up to the liver.
Many of the “New Remedies” have come and gone; Chelone has come to stay: its sphere of action is small, its action sharp and withal well defined.
CASE OF RIGHT-SIDED VARICOCELE FROM ENLARGED LIVER, MUCH AMELIORATED BY Chelone Glabra.
A gentleman, who had long been under me, consulted me again in the spring of 1894 for varicocele of the right side. Casting about to find the primary dam I found the left lobe of the liver notably swelled, patient himself being however in capital health. There was besides the varicocele a moderate degree of varicosis of the large veins of the whole of the right leg. I prescribed Chelone glabra, five drops in a tablespoonful of water night and morning.
I did not hear from him for eleven months when he called to see me telling me he had gone on with the remedy steadily all the time as it seemed to be doing him good.
On examining him I found the varicocele had gone down about one half and the varicosis of the leg had also notably diminished, so that he can now safely dispense with the elastic support. I was here led to prescribe Chelone because of its line of action from right to left and from above downwards.
The testimony afforded by this case is very high indeed because patient has been under me for years for his varicosis with but small benefit, and his being an officer in the Royal Navy rendered it very important that he should have his varicosis mended. He is not entirely cured now but the amelioration is such that in his own words “they (the authorities) will let me go now on any expedition.” I had before made use of a number of vein medicines and constitutional remedies, but Chelone alone did ten times more than they all.
Carduus Marioe AND Chelone Glabra.
There are cases of enlargement of the left lobe of the liver that are ameliorated by Carduus marioe, and by Chelone glabra also, though not radically cured by either and these cases beautifully exemplify the limitations of the curative spheres of organ-remedies as I have more particularly dwelt upon in my work on “Diseases of the Spleen” The subject is so important that I will go into the matter at this place somewhat more in detail. It is a great help in the drug treatment of disease to be able to get clean-out constant indications for our remedies; and so it is very helpful to see where the remedial action certainly leaves off Now the curative sphere of organ-remedies stops short of blood diseases; they do not reach the diathesis, and they therefore do not cure, e.g., Chronic Skin Diseases; skin diseases are commonly diathesic.
A gentleman of thirty years of age came under my observation for liver disease, skin disease, insomnia, depression of spirits and chronic diarrhoea tho’ only thirty years of age; he has lost all his teeth from shrinking of the gums; they just fell out. His skin disease consisted in what I have elsewhere called the Sternal Patch, the liver affection in an enlargement of the left lobe and for this I ordered Carduus marioe, six drops in water, three times a day. In a short time he reported himself as sleeping well and his spirits notably improved. Arsenicum and Thuja followed but no further improvement worth while mentioning, when, on June 13th, I prescribed Chelone glabra in the same manner in which I had formerly ordered Carduus.
July 13th.-“That medicine (Chelone) acted like a charm. Patient remained well for a year or so and then returned with the old symptoms again-I have now come to the point of my case. Carduus was ordered as before. Chelone followed, but neither acted as formerly, that which a year before acted like a charm now act not at all. The fact is in this case there exists a constitutional crasis quite away from the hepatic state, it is an organismic ailing and not merely one of the organ, and here I found it necessary to go in quest of the homoeopathic simillimum, the simple homoeopathic part elective drug affinity not sufficing. Clearly organ-remedies restore only tone and equable circulation in most instances but do not alter the organismic quality of the organ, nor do they cure any diathesic quality of the stroma of the organ.
In fine: Where the organ-ill comes from the organism and keeps on coming, the organ remedy is capable only of clearing the organ of its organismic soot, so to speak, for the time being; it is only while where the organ ailment is in and of the organ that the organ remedy is adequate. Also where the ailment is in and of the organ it is useless to attempt its cure with high dilutions affecting the whole organism: a localized organ disease calls for a localized organ remedy, just as a general diathesic organismic disease needs the homoeopathic simillimum in some potency sufficiently removed from its materiality. The degree of homoeopathicity conditions the degree of potency, the greater the degree of homoeopathicity the greater (higher) the potency and conversely. Hence it is that I use mother tinctures in the organopathic states and ailments. Thus even in the use of simple organ-remedies of but small pathogenetic powers, yet considerable local affinity, a few drops of the mother tincture may act very perturbingly. For instance the tincture of the common marigold may be used in 5 or 10 drop doses with very slight effect but let the homoeopathicity be a little greater than merely local affinity and we get nausea, vomiting and abdominal distress.
Calendula AS A LIVER MEDICINE.
We find under Calendula “chilly hand” “He is easily frightened” I have often used Calendula internally and gained the conviction that it has a certain beneficial influence upon scrofulous ulcers notably helping to make a nice scar. In liver affections I had not used it till Dr. Robert T. Cooper mentioned it to me in this regard, but he knew of no special indication for its use in preference to any other, and this is ever the great difficulty with organ-remedies, especially where the epidemic genius of the disease is unknown, and, as it so often is, unknowable; my greatest help is to find out the exact part of the organ or part, a given remedy affects and this is often quite sufficient.
The two symptoms, “chilly hands” and “easily frightened,” taken together and in conjunction with liver troubles, would seem to call for Calendula.
Case.-Mr. X., a singer of world wide fame, had been under me for some months with much advantage; under hepatics and renal remedies he greatly improved, but did not get rid of his “cold hands” and “I am so dreadfully nervous, I am frightened at everything, sometimes I dare not enter a cab or carriage, and feel it to be absolutely impossible to face the audience and my indigestion is pretty bad and I have a great deal of heartburn.”
At the left side of the liver, deep in, seemed the faulty part. Rx. Calendula off, p., five drops in water, night and morning, was ordered and after a month of this I heard “Oh, I am getting on splendidly; the heartburn is gone, my digestion is better, my hands have quite lost that nasty cold feeling and my nerve is so much better, I am quite a different man.”
I had formerly won this gentleman’s confidence by materially improving his grand voice.
Thuja occidentalis 30.
The number of people I have benefited by Thuja 30 is really almost beyond belief; one dose of six globules every week is my rule.
Chelone Glabra IN HEPATIC DROPSY.
In a case of severe dyspnoea from hepatic dropsy Chelone glabra rendered me good service; the case was very complicated in as much as in addition to bradycardia, cirrhosis of the liver and Bright’s disease of the kidneys there was seemingly a tumour lying between the liver and the navel: tense, tender and certainly of quite a different nature to the general ascitic swelling. By reason of its topographic position and in view of the line of action of Chelone as I have before pointed out, I gave five drops of Chelone p in a tablespoonful of water every four hours and in less than a fortnight the lump between liver and navel had quite disappeared, and simultaneously there with also the cardiac dyspnoea. I say cardiac dyspnoea as it lay in its origin between the liver and the heart, I could not trace any direct influence of Chelone on either the heart or kidneys though both were much influenced by the removal of the obstructive mass between liver and navel.
Quassia AS A LIVER MEDICINE.
It is difficult to conceive of anything outside of one’s own self and one’s own experience and hence it comes to pass that I have never been quite able to realize that Quassia has any action on the liver worth while. Und Doch.
Very early in 1895 a gentlemen sent me a young man from Hampstead who had been in vain operated on in University College Hospital and thence discharged as incurable. Incurable at twenty years of age.
This young man informed me that he left University College Hospital quite lately and showed me a long scar in the right axillary line where an incision would have enabled an exploration of the right kidney region, gall bladder and back of liver, which no doubt was the object of the operation. He himself stated that it was for stone in the right kidneys but on reaching the kidney no stone could be found and so the wound was stitched up, and as soon as it had healed-up patient was discharged as incurable.
Patient complained of attacks of severe pain at the back of the liver just where the fresh scar is seen coming on with vomiting at any time, any day and in any weather; these attacks average about one a week and the pain once on will last from one to three days. Has been subject to these attacks for five years and has had to give up all work for long and is now much reduced in health and strength. The vomiting comes on whenever he attempts to eat. As the attack comes on he swells and seems very tight in the girth. In the perpendicular the hepatic dulness goes right up to the nipple. I put patient at first on Hydrastis Canadensis, then on Urtica urens, then on Chelidonium majus with the sole difference that under the Chelidonium the dull percussion note of the liver in the mammary line was trifle less.
On April 9th I ordered Quassia tincture p five drops in water every four hours.
23rd. There is very great improvement and the young man has quite a different look, his low whining complaining tone having given way to much greater mental and physical alertness, only one attack of pain. Rep.
May 7th. There have been two attacks of pain, but very much less severe and he feels much stronger. To take the Quassia in five drop doses three times a day. May 21st. Attacks are much less in severity and less frequent.
Patient has put on flesh, the previous dirty colour of the skin of his face has gone and given place to a clean, healthy looking face. Rep.
Remains under treatment so I am not able to say whether the Quassia is the real remedy in the case; but, assuming that it does no more than it has already accomplished, at nay rate its record in the case is better than that of my allopathic friends at University College Hospital. So far as I see at present it is a case of neither liver nor kidney merely; but of the right supra-renal capsule, but into this dark continent we will now not penetrate.