Excerpted and annotated by H.A. Roberts from original mass. by Wells.
The prognosis of dysentery, when under intelligent and careful homoeopathic treatment and nursing, is generally favorable. This can hardly be questioned, after a careful experience in this treatment of the disease of more than thirty years without the loss of a single case. In this time the number of cases treated has been great, and there is no reason for regarding them as less severe, on the whole. than the average of cases as they occur in a general practice. There are considerations, however, which are of moment always, in making up our account of prognosis.
Sporadic cases, in good constitutions, are the least likely to be attended with danger, or to give much trouble in their cure. In different epidemics, differences in the character and severity of the disease are met, which may have an important bearing on the question of prognosis…Patients convalescing from attacks of severe acute disease, if attacked by dysentery, are, other things being equal, in more danger than those attacked in health. The degree of added danger is determined by the nature of the previous attacks, and the degree to which it has depressed the vital forces.
The surrounding circumstances of the patient may have an important influence circumstances of the patient may have an important influence in determining the issue of an attack. If the patient be…subjected to the privations of poverty, or to great mental anxiety or is from any cause wanting the comforts of proper diet and nursing, the prognosis will be so much more unfavorable as any of these causes may be operative. The disease is said to be more fatal in childhood and old age than in middle life…Temperate climates are more favorable than the tropical. Extreme heat in either is unfavorable.
A moderate intensity of the pain and tenesmus, and evacuations of moderate frequency and quantity, which are not very offensive and contain but little blood, are favorable, while the reverse of these are unfavorable, and in the ratio of the intensity in which this reverse condition is present.
Other unfavorable elements are: a long continuance of the disease, which is threatening to pass into a chronic form; relapses are more dangerous than – original attacks; symptoms of collapse; great prostration of the vital forces; symptoms of peritonitis, and of perforation of the intestine; chills; a falling in of the abdominal patients, with loss of their natural elasticity; involuntary eructations; erysipelas; pyaemia; violent vomiting; with choreic symptoms, rapid emaciation, dropsical affections, protracted hiccough, delirium, convulsions, and paralysis.
When we pass form the consideration of dysentery as a fact in medical science to treat of it as a fact to be cured, the first question we have to answer is how shall we able to grasp, with certainty, the means best adapted to the accomplishment of this end? And if, just here, the Law of Similars presents itself, and claims our confidence as a sure guide in the selection of the requisite means, we reply with the next question, What does this Law of Similars require? Or, in other words, what is the similimum which it requires us to discover, to be like?
What are the facts which it is to resemble, the likeness to which constitutes it the curative of the case, under the authority of law? To be able to answer this question with clearness and certainty when it arises as it must, at the outset of our practical consideration of our subject, we have already presented a somewhat extended statement if those facts, in two classes, viz., the generic and specific symptoms of the case.
Similarity to these alone answered the demand of the law…Cure…is a positive removal of an evil, by the interposition of an efficient appointed law. Recovery may be possible where no means are employed for the attainment of this end, or even where the means employed have been wholly wrong, and therefore, so far as they have been influential in the case, have been only hurtful. A cure results only from the right use of right means, according to the requirements of law, the whole tendency and influence of which, when so employed, is in the direction of health, and therefore only beneficial.
There is, sometimes, an experience in the treatment of this disease, when it is present as an epidemic, which at first glance would seem to negative the statement that it finds its cure in no one drug. There is such a repetition of the facts of each case in every other, in these circumstances, as to make it quite possible for a cure to be found in a single drug, for the epidemic. The reason for this is in the fact, that all the examples of the disease in the epidemic are the product of a common cause, the action of which on the organism is so little modified by local or individual circumstances, that the result in each case is virtually a representative of that in every other.
The resemblance of each case to each is so great that the similimum to one is a similimum to the whole. So that, though a single drug may be found which will cure most, or even all, the examples of an epidemic, it cures by virtue of the resemblance of its effects on the organism to the symptoms of each or all the cases of the epidemic, and not at all because the case in hand is a dysentery. The cure is general only because of the uniformity of the symptomatology of the cases, and the application of the drug in each succeeding case is as much as individual compliance with the demand of the law, for and individual likeness of the drug and the symptoms of the case, as if there had been but this one case to be treated. It will be apparent, them, at once, that this experience in epidemics of dysentery, or of any other disease, is only an apparent and not a real negation of our denial to any one drug of the right to be regarded the curative of the genus dysentery.
And then it is not to be forgotten that when the cure for the epidemic which now prevails has been found, and it has cured each of our hundred cases without a failure, we have done nothing towards finding cures for subsequent epidemics of the same disease beyond the discovery of the method of finding cures for the same disease beyond the discovery of the method of finding cures for epidemics in general, if indeed we have found this. It is certain that the drug which cured every case of the epidemic twelve years ago has not since sustained the same relation to any succeeding one, and has rarely cured even in a single case. It will be in place again only when epidemics or cases present a symptomatology like to its effects on the organism, as that did in which it was so uniformly curative.
In proceeding to treat a case of this disease, i.e., to find the specific remedy for it cure, the first caution we should regard is, not to allow ourselves to be too much occupied by the central or generic group of symptoms. There is no small difficulty in avoiding this, for here are present the chief sufferings of the patient. and these wholly occupy his attention and that of his friends, and it is these they will constantly thrust before the prescriber, all else to them being of comparatively small moment. For this, and other reasons, we are to look elsewhere for the controlling facts which decide the choice of the curative means.
We are to look elsewhere for these facts because, as we have already intimated, they are not to be found in the central group, and because if we do not find them elsewhere, no one else will find them for us. If others have knowledge of their existence, they have no suspicion of their importance, and they are sure to be passed by as of little consequence. If we do not seek them out, and give them their due place in practical decisions, we treat our case in darkness, and out patient is likely to escape a cure, and take his chances for a recovery, whatever these may happen to be.
We are no only to look outside of this central group for our guiding symptoms, but are to be satisfied with nothing short of gathering every fact, from every other quarter and of whatever kind, and bring them all into our view and hold them there till we have made our selection of our remedy. In this duty we shall not be embarrassed by the presence of all the many peripheral symptoms, we have named, in a single case. Probably there will be but few of them. Few or many, here are our guides when we have then once before us.
But the difficulty as to symptoms is not ended when we have progressed only thus far. However few or many of these are found in the case, they are not all of equal importance as indices of its true curative.
We are now to further examine all these, and make selection of those which are most authoritative in the decision of our choice of a remedy. In making this further elimination, we are to be guided by the same general principle which excludes so largely from the process of the prescribing, those symptoms which belong to all the members of the class. There are, in the peripheral group, those members which are oftener repeated in the progress of successive cases then others. As these are common to many cases, so analogues of them may be found in the pathogenesis of several or many drugs.
