IT is a cause for extreme regret and deep disappointment that the one man in our school peculiarly fitted, by his long training, his patient study and observation, and his extensive clinical experience, Professor Henry C. Houghton, should have been prevented by illness from the preparation of the paper on this subject which had been originally assigned to him.
As his assistant, working at his side and under his supervision for years at the New York Ophthalmic Hospital, the writer knows, better than most men, his eminent qualifications for the task, and of what the profession are deprived by his inability to undertake it.
The brief notice of a few days in which to prepare and complete an article on so important a subject, for so profound an occasion, is but simple justice to the writer to plead in part extenuation for the crude and incomplete remarks he presents for your consideration.
It is nearly nineteen centuries since the divine lips uttered the words, “He that hath ears to hear, let him hear.” Spoken to the scornful and unbelieving Jews as a warning, the words have an application directly physical, and in these days may be construed as a direct command; for the neglect to guard and care for the most valuable of all the special senses, with the modern facilities available, is reprehensible in the highest degree where one is responsible to one’s self alone; but the responsibility becomes criminal when the neglect entails upon a child all the disastrous consequences and mental suffering that follow impairment of hearing.
Considering the limitations necessitated by the brief time for preparation, no opportunity for research was available, and it is evident nothing new or starting can be presented. Therefore is seemed that the most practical, and in fact the only possible way to meet the occasion, was by a short statement of the means at our command for the treatment of morbid conditions of the aural apparatus, and the relations they should bear to each other.
The specialist, as a specialist, will find little of interest, because to him it is well-known ground.
The main point to which I wish to call attention is this: that there are no therapeutics (taken in the strict medical sense) which as yet are sufficient in themselves to meet the conditions daily presenting.
I do not say that drugs internally administered have no place, for they are of exceeding value; but this I do say, that he who, in his ardent faith in the all-powerful for-good nature of medicine, and his confidence in his own ability to always administer them accurately, neglects the necessary means of local treatment, will find, in dealing with the ear, that there are many conditions in which the most scientifically prescribed will fail to meet the expectation of himself and his patient; while some judicious local measure will give both satisfaction and relief.
Illustratively, our Materia Medica is full of symptoms pertaining to the head and eyes, and a case presents itself of which the perfect similimum is found.
The drug is given, with no relief. Again and again is medicine administered, with the most careful study of the totality of symptoms, and from the tincture to the highest attenuation. Ultimately an oculist is consulted, who finds a refractive error, prescribes the proper glasses-when, lo! all discomfort disappears; all pain is appeased.
Such instances are of too common occurrence to admit of argument.
As the result of the prolonged strain, certain morbid conditions may have arisen, characterized by certain symptoms, which persist after the adjustment of the glasses. For these the proper remedy may be applied with brilliant results. Here the Homoeopathic remedy finds its true field.
Analogous to this is the proper sphere of Homoeopathic aural therapeutics.
Time and again have patients presented themselves, complaining of deafness and tinnitus, having been drugged for weeks with the “suitable Homoeopathic remedy,” that have gone from the office in ten minutes with completely restored function, simply by the removal of a mass of cerumen from the meatus. It is true that the ceruminous accumulation may be due to a morbid condition of the glands, arising from some perverted state of the system. For this, medicinal treatment is applicable; but the patient applied for relief from his discomfort, and be obtained it by a simple local measure-while all the medicine in the pharmacies would not have helped him. Afterwards is the time for administering such suitable remedies as may reach the underlying cause that resulted in filling his ears with the impacted mass.
In the one case, remedies are suitable to relieve the consequences, the cause being removed by local means; in the other, the consequences are relieved by local measures, the cause being treated constitutionally.
I have cited these two conditions purely as illustrations, and my remarks may seem trivial to you, but I am led to make them of these reasons:.
Upon the issuance of a small work relating to the ear (in 1885), I used the following words in the preface: “In regard to treatment, I am firmly convinced that we are not yet in a position to dispense with local measures; our therapeutics are yet too meagre in this department.”.
Certain critics assailed the statement as evidencing a lack of faith in the curative powers of Homoeopathy.
Another reason is, the fact that Homoeopathy suffers from the indiscreet fanaticism and ignorance of a class, of whom the aforesaid critics are a portion. This class, claiming that the Homoeopathic law of cure is sufficient for every morbid condition of the system, pursue with malignity and invective all who do not subscribe to the same views, calling them mongrels, hypocrites, false to the master’s teachings, etc. These are they who are responsible for much of the ridicule which Homoeopathy has been compelled to endure in spite of its onward march.
In 1876, at Philadelphia, Professor T.P. Wilson, on a similar subject said: “This point needs emphasis, became, we as a school have unfortunately been always handicapped by a class of professed leaders who have boastfully discarded these things, and taught us to rely upon symptomatology.”.
This ignorance and boastful assertion exists to-day, and it is in an effort to clear the ground, that the true place and value of our remedies in aural work may be seen that the foregoing remarks have been indulged in.
Coming, then, strictly to the matter in hand, we find ourselves in possession of two classes of resources for reaching and relieving the conditions that present themselves, general and specific. The general means includes all local measures, nutrition, hygiene, sanitation, etc.; the specific, our remedies.
Taking first, one of the most common affection, an earache, an acute aural catarrh, the otitis media catarrhalis acuta of the specialist, what can be done for it?.
Certainly, few conditions give rise to more intense pain, and in a certain class, with marked predispositions, repeated attacks lay the foundation for obstinate and intractable consequences. The local measures at command are protection, heat instillations, inflation, blood-letting, and paracentesis.
These are common property, and in any given case we resort to more or less them.
Now, in the matter of medicine, have we any advantage over our confreres of the Old School? Dr. Roosa says: “The proper treatment of acute aural catarrh is, predominantly, an antiphlogistic one. The disease is an inflammation of the severest form, and can only be successfully combated by such means as blood-letting and Opium.” Dr. Burnett says: “Anodynes should be given in doses sufficient to allay pain and produce sleep. Aconite….is of great value in acute otitis.
Many quotations from different authorities could be adduced to the same purport, but the consensus of most of them is the same, viz., reduce the inflammation by local measures, and allay the pain by anodynes.
To this uniform paucity of medicinal resources of the Old- School specialists, there is one notable exception. Dr. Sexton, in speaking of the treatment of acute otitis media, recommends quite an array of Homoeopathic remedies-Acon., Hepar., Merc., Puls., etc.,-but then, he is half a Homoeopath anyhow.
Let us look, now, at our side of the case. We find an acute local inflammation, with constitutional disturbances, fever, frequently sore throat, etc. Can you not readily picture to yourselves the Aconite type, with its flushed face, high temperature, bounding pulse, restless impatience, anxious tossing, pains sharp and tearing, extreme sensitiveness to noise, and all the concomitants that make up an Aconite case. So take your list of remedies, and in your imagination you can see the Belladonna case, the Ferrum phos., the Mercurius the Hepar. sulph., the Pulsatilla, and so on down the line.
I am not going into the details of symptomatology, but merely direct your attention to the contrast between the poverty of their resources, and the richness of our own if but used wisely and intelligently.
Supposing the morbid condition has passed beyond the line of the so-called catarrhal from and has eventuated in suppuration.
In many cases, as you well know, this point seems to mark the climax of the inflammatory action, and resolution follows.
But this by no means ends the difficulty in some instances, even where the membrane becomes repaired. Products of inflammation remain in the tympanum to organize and interfere with the delicate machinery therein.
You as specialists know the importance of the speculum and the air-bag, in preventing the development of adhesions and closure of the tube. But you have important aids in your remedies to assist in carrying on the process of resolution by absorption of the remains, and reduction of the swelling and infiltration. Our friends again here show their poverty, unless they trespass upon our bounty. Kali mur., Merc., Puls., the Calcareas, Hepar, Silica, all stand ready with a helping hand.
But in case resolution does not follow after the suppurative stage is reached and a chronic pyogenic condition is established you are confronted with a serious problem.
Now as a rule it is useless n aural suppuration to depend on internal medication alone, although there are perhaps few conditions more indicative of a perverted systemic state, and showing more need for constitutional treatment. The local conditions must be complied with, and unless this is done, your remedies are of little value.
But after cleaning and dressing the suppurative tract, such remedies as Aurum, Hepar, Mercurius, Silicia, Calcarea, Sulphur, Arsenicum, Lycopodium, come in as powerful levers to so modify the constitutional state that the local measures employed have far greater efficacy, and vice versa the local treatment being judiciously used, the medicinal treatment finds fewer obstacles in its way.
A block between two pieces of gearing, disarranges the machinery and limitless fuel and steam does not produce smooth running, but put the local conditions of the machinery in proper order and the motive power does its work.
It is this mutual dependence between local and systemic treatment that I wish to especially emphasize, and thus assign to our specific therapeutics their proper field of action. This argument holds good through all the varied forms of aural pathology that we meet.
Perhaps the most intractable form of treatment catarrhal condition. Taking the most advanced form of treatment of the present day, the air-bag, pneumatic speculum, vibrometer, telephonic attachment, surgery of the ossicles, naso-pharyngeal treatment, etc., one is simply removing the blocks in the machinery, and the more perfectly that is done, the clearer is the way for the more satisfactory action of constitutional remedies.
The ideas are not applicable to aural therapeutics only. Throughout the whole range of human pathology the same principle applies, and intelligent practitioners everywhere are recognizing the fact that there is more in treating human ailments, than the suitably selected Homoeopathic remedy.
Nutrition, climatic conditions, sanitation, hygiene, general and local, the elimination of mechanical obstacles by mechanical means, are indispensable to the best action of the remedy, and the more quickly this general fact is appreciated by us as a school, and the internecine warfare-as to the size of the dose, the degree of attenuation, who are true and who are false Homoeopaths-ceases, the sooner will be ushered in that wished for day, when the law of similia assigned to its proper relations and limitations, will be recognized by the world at large, as offering to suffering humanity its best medicinal aid.
HAYES C. FRENCH, M.D: In the discussion of Dr. Sterling’s admirable paper we are not unmindful of the paucity of remedies that have been found, even by our Homoeopathic brethren to have any definite or constant affinity for the tissues involved in painful and destructive aural troubles.
Under the classification of general and specific agencies for meeting ear diseases Dr. Sterling says: “They general means include all local measures, nutrition, hygiene, sanitation, etc.; the specifics, our remedies.” To my mind this classification seems indefinite and unphilosophical. I doubt if many disciples of Hahnemann will be found willing to admit that our remedies are specific in the sense herein implied, from the fact, that the symptomatology that leads to the selection of an efficient remedy for the ear, may be found to have no definite relation to the condition of the organ at the time, but to quite remote ones.
In selecting an ear remedy upon its clinical reputation the results seldom justify the appellation of “specific,” and if we chose it in response to the totality of the symptoms, whatever may be the result, it could not in harmony with the philosophy of our law of cure be said to be specific to the ear trouble. Again, in acute suppurative otitis, with incarcerated pus in the middle ear, what could be more specific than the relief obtained by the incisive offices of a lancet? And this certainly does not belong to the classification-“our remedies.”
In all curative ear troubles, due to mechanical causes, experience has taught most of us that the more specific results have usually been obtained by means of mechanical or surgical agencies, and in the domain of prophylaxis the same has been true, as in the example of impacted cerumen cited by the author in his paper. Even in the few remedies for which our Old-School colleagues claim the virtue of specifics, our use of the same agents in accordance with the law of similars has always shown the falsity of the claim and the narrow limitations of the specific action, as for example the demonstration that the action of quinine is after all limited in its antiperiodic efficacy to definite forms of tertian intermittents.
Would that there might be some solid ground on which to found our claims to specific remedies for the painful and often intractable diseases, especially of the middle ear and the labyrinth. It is astonishing what specific results sometimes attend the exercise of a little good “horse sense,” even against the general teachings of the books and the professors.
In one of our first cases of suppurative otitis media, after cleansing the meatus thoroughly twice a day for two weeks, following the dressing with pledgets of absorbent cotton in he outlet, with no appreciable diminution of the discharge, the mother of the patient blandly suggested that the ear might do better if stooping the canal with cotton were discontinued; and as soon as it could be done without sacrificing the dignity of the doctor, the advice was acted upon to the great benefit of the patient and subsequent advantage to the doctor-loose bandages, allowing free vent to the pus, being substituted.