As the subject for a paper, this topic sounds large, for the majority of surgical procedures is based upon previous infection. For example: An infected appendix is followed by an appendectomy; an infected gall bladder, by a cholecystectomy; pus tubes, by a general sub-total hysterectomy. That this general removal of internal parts could be avoided many times, goes without saying, if the patients had heeded the first warnings which Nature gave, but humans are slow to place themselves under observation and treatment, until an operation is deemed imperative. Thus the internist has little chance to be of aid.
In addition to his inevitable major surgery, there is also that branch of surgery, dealing with infections of external parts, due to injuries which break the continuity of skin and allow infecting organisms to enter the tissues. These injuries may be as simple as the pulling out of a hair, the scratch from a pin, a hang nail or a silver in the finger, a bruise, a bled or a blister, the pricking of a pimple.
All of these are harmless and heal perfectly, if no infection occurs, or if the patient is in his usual perfect health, so that one pays little or no attention to them. But if the injured person is exhausted by long hours, is depleted through worry, or ill from any cause, the simple injury suddenly develops a virulent infection; there is redness and heat with red streaks going from the point of injury toward the heart.
These red lines show the channels of the lymphatic circulation which is seeking to localize the infection, by carrying the products of infection to the nearest node, before it becomes systemic, or develops into general septicaemia, a condition dreaded by both the laity and physician, because of its destructive action on life and limb. When these signs of sepsis manifest themselves there is no further delay and the doctor is asked for quick assistance.
Around the seat of the injury is swelling and heat, and throbbing pain is complained of by the patient. Upon examination some fluctuation may be felt, so under asepsis, a liberal incision is made.
If pus has already formed, it will come to the surface of the incision and the relief afforded, can be seen in the patients face.
If time will permit, (and it should be taken), the part of the body having the infection, is submerged in hot water, just as hot as the patient will stand. The part is kept submerged from one-half to one hour, constantly adding hot water to keep the temperature high. If no pus was found upon opening, some will appear by the end of the period of submersion, and the patients, sense of relief well repays the time spent.
Upon the removal from the water, a wick of gauze is pushed well down into the wound to prevent closure, the part is dressed in sterile gauze saturated with glycerine and creolin, 16 to 1, and the whole covered by a sterile bandage. If there was no fluctuations or severe pain no incision is made, but the patient is given the same treatment because it many be possible to abort the formation of pus, or if not, the treatment will show it up at the next visit.
As the patient leaves the office, he is given Hepar sulph. 6th if pus was found; if no pus, Hepar sulph. 30 th 200th to be taken every 2 to 4 hours. When first seen, if the condition shows symptoms of septicaemia, Silica, Hecla lava, or tincture of Echinacea is prescribed, or whatever remedy may be indicated. Also the patient is given some tablets of Chlorazene, made by the Abbott Laboratories, of Chicago. These are the Dakin solution used so much during the war, and as they release chlorine when put in the hot water, the patient gets (or is sure he gets) an antiseptic solution to bathe the part in, all of which has a useful mental effect.
He is instructed that two to four hours after the submersion in the office, he is to carefully remove the dressings, prepare his hot water as was done in the office, put in two Chlorazene tables, and submerge the part for one-half to one hour; then to re-dress in the same dressings in the same way as was done of the office. The procedure is repeated every two to four hours until his return to the office 24 hours later. It is very interesting to see how much more the patient is enthused about recovery by this work he does at home, than when the doctor does it all. The enthusiasm helps to build his morale, for a patient headed toward general septicaemia is a scared patient.
This line of therapy is followed, enlarging the incision if necessary, increasing or decreasing the frequency of the submersions, until at least 48 hours have elapsed with no pus found at a regular dressing. The wound is then dressed under sterile vasolene saturated gauze, until healing has occurred.
When the injury occurs upon the body, a submersion of the whole body in a bath tub may be ordered, or the placing of hot Turkish towels over the injury will do the work.
The success of the medical-surgical-hydro-thermic method depends upon the use of all the elements mentioned, but the heat of the water is especially important. A warm bath will accomplish nothing, and the application of dry heat is not beneficial. The water must be hot, the hottest the patient will stand. The doctor must test the water himself. Not until the patient gets the real relief from the very hot water of his first application can be trusted to regulate the temperature for himself, therefore, the benefit of the first treatment in the doctors office. In this connection, the story of little Joe will illustrate; Joe is a little five-year-old, who last winter, fell on the frozen ground in a vacant lot and cut his leg on a broken milk bottle.
He was brought to the hospital with a bruised, ragged wound, cut to the periosteum, dirty and not bleeding too well. Under gas anaesthesia the wound was cleaned as well as possible and sutured, with a faint hope that his youth might allow healing by first intention. At the end of two days, this hope faded and pus appeared, necessitating the removal of the sutures on the third day. There was nothing to do but treat the septic condition and prevent a general septicaemia.
Joe had been taken home on the same day that the accident had occurred, so it meant going to his home to do the work. The hot water was prepared, with Joe crying with pain. He was invited to put his foot in the water. He did, but removed it so quickly, accompanied with a howl, that we saw something was wrong. By dint of much cooling and persuasion, the leg slowly went back. Cautiously the temperature was raised, the pain began to subside and Joes tears changed to smiles, as he said, “More hot water, more”. Joe was all ready for each application and he insisted that the water be hot. He even used to get his parents up in the middle of the might to give him a hot bath, if his leg pained.
It required some weeks to clear the pus, and some time longer to granulate the would. Whenever the healing slowed, Joe called for his hot leg bath.
Water, being a solvent, softens the tense, infiltrated tissues; the heat is homoeopathic to the inflammation or heat in the part, the action of the hot water causes relaxation, pinched nerves are released, the increased blood supply in the part is allowed to flow out, which lessens the congestion, and a fresh blood supply can come in, bringing phagocytes and needed repair material. Between the periods of submersion, the excess water in the tissues is removed by the dehydrating action of the glycerine in the dressing.
The creolin prevents further infection, while the artificially speeded up circulation slows down to normal. Then, as the hot water is again applied, the increased circulatory action, removes products of waste and a new blood supply comes in. In the meantime the internal remedy is aiding in raising the resisting powers of the patient and thus the union of forces is at work all time, striving to restore the patients to normal, removing the general septicaemia.
The writers attention was first called to the action of creolin and glycerine during his college days in the dispensary. The value of a physician, whose left index finger showed infection two days after he had lanced a jaw abscess on a child. A brother physician was consulted, the finger was dressed and Hepar sulph. given internally. At the next dressing a free incision was made, followed by a good show of pus. At the fourth dressing a cross incision was made and Pyrogen prescribed.
However, the infection went merrily on with lots of pain. At the fifth dressing another confrere suggested the application of hot water. The patient went home, rigged up a small gas flat and with flame turned low furnishing a constant supply of hot water, in which he placed the whole hand and practically cooked the infection out. After the first application the pain ceased, but for ten days the treatment was continued with the result that the finger was restored to normal and the loss of a life, or at least an arm, was prevented.
Up to the beginning of the heat treatment there had not been the least response to treatment and the patient was growing steadily worse.
This, then, is the quartette form of treatment which has been used in a long series of infected cases through the years with no failures to date. The more submerged, the quicker the action, i.e., if an infection on the finger, submerge the whole hand; if an infected hand submerge the arm. Use as great heat as possible continuing till healing occurs. Reduce the protein, and increase the fruit and water in the diet, to increase resistance in the patient.
DR. WRIGHT: I would like to ask Dr.Farr about the creolin that he uses in local applications, whether it is really homoeopathic?.
DR. SKILES: Acute infection, like the dirty nail in the dirty alley, is something to combat, and how are we going to get a remedy that will meet this poison? Here is my treatment of such a case: A boy, eight years old, was playing in a dirty alley. He stepped on a dirty nail which ran up through his shoe into his foot. In a few hours the foot was swollen, and the swelling was running above his ankle.
The pain was very intense. How to meet and control this poison is, to my mind, quite a knack, unless we have some philosophy by which we can do it. In this case I took a piece of cotton cloth, two inches wide and a foot long, rolled it up and put it in the boys mouth, leaving it there until it was saturated. Then I hastened to my office and prepared a potency from it the electric machine, running it up from the 12th to the 30th. I gave him first the 12th potency, and then in six or eight hours the 30th. The swelling commenced to go down and the pain ceased. He was given one potency every day and every other day until he was well. That is the best homoeopathy that I know.
DR. ESMOND: I would substitute Calendula for the creolin in every case.
DR. FARR: The only query which has been raised is regarding the creolin. as far as I know, creolin is not homoeopathic; it is antiseptic. I have used glycerin along; I have used Calendula alone. I have used what we used to call in the dispensary C.G.& H., which is Calendula, Hamamelis and glycerin. I now turn to creolin and glycerin. My only reason is that I want the action of the glycerin. I havent quite as much faith in the Calendula and Hamamelis as I have in creolin and glycerin. My only reason is that I want the action of the glycerin. I havent quite as much faith in the Calendula and Hamamelis as I have in an ordinary wound. I use either plain Calendula, or with a combination, but where I have more, I dont want any cross infection.
Regarding the hot water, I only add the tablets to the hot water for psychological reasons. I have no faith the tablets in the water; it is the heat and the water with do the work, but so many people feel that they must have something, otherwise the water, to them, is not sterile, although it has been boiled.
DR. BOGER: Why dont you use Pyrogen?.
DR. FARR: Because i have found so little result therefrom. I have rather lost my faith in Pyrogen.
I am willing to try Pyrogen in connection with the other homoeopathic remedies which I have suggested.
DR. GRIMMER: How high have you used Pyrogen?.
DR. FARR: A 30th.
DR. GRIMMER: Try it higher and you will get better results.
DR. KRICHBAUM: How early is Pyrogen useful in aseptic cases?.
DR. BOGER: Just as soon as rose colored streaks run up the arm.
DR. KRICHBAUM: I havent found pyrogen of much use except where there is a true pus condition after a few hours.
DR. BOGER: We all see surgical cases, such as crushed fingers, and a thousand other things. Not long ago a young man came to my office and said, “Doctor, relieve me of this terrible pain. I dont want to have my finger cut off”. There were streaks running up his arm. I gave him some powders of Pyrogen, an said, “Let me see your finger tomorrow”. He came back the next day and pain was almost all gone. I gave him some more Pyrogen, and that was the end of it.
I have been in practice since 1888, and since Pyrogen was brought to my attention I have only lost one case of general sepsis. That case was not given Pyrogen.
When the demonstration is clear that the present remedy has done all it is capable of doing, and this demonstration can not be made until much higher potencies than usually made have been tried, then the time is present for the next prescription. To change to the next remedy becomes a ponderous problem, and what shall it be? The last appearing symptom shall be the guide to the next remedy. This is so whenever the image has been permitted to settle by watching and waiting for the shaping of the returning symptom-picture.
The fact cannot be too often called to mind, nor too strongly insisted upon, that our most characteristic indication for the use of a drug which presents well defined general symptoms, as Arsenic does, and indeed as every well proved drug does, are derived not from its local action upon any organ or system, not from a knowledge of the particular tissues it may affect, and how it affects them but upon the general constitutional symptoms and conditions and concomitants. If this were not so, in the presence of how many maladies, of the intimate nature of which we are wholly ignorant and which nevertheless we cure, should we be utterly powerless for good?- DUNHAM.