WHEN a man comes forward with a proposition not generally received by his fellows in his own walk of life, it behoves him to proceed inductively and independently. If he does this he is proceeding scientifically, and trained minds, not being overladen with prejudice, soon know where they are in dealing with his proposition. Experience proves that a proposition may be demonstrably true, and that it may yet meet with only a very limited acceptance; especially is this the case with new truths, and truths that involve unpleasant consequences. And when a person has once committed himself, once taken sides, he is very apt to go on thenceforth for ever -for his ever-from the standpoint of a parti pris.
Most medical men are pretty well agreed that Diseases of the Veins are not amenable to drug treatment in any important degree. I refer more especially to general varicosis, haemorrhoids, varicocele, and varicose veins. There affections are therefore relegated to the domain of the surgeon; and, no doubt, the surgery of the veins -particularly of haemorrhoids-is now nearly perfect, being nearly bloodless and painless. That is very beautiful, and a matter of sincere congratulation for us all. It being pretty well perfect, the question may not unreasonably be raised . . . Is surgery, then, the ONLY crutch to rely upon; has medicine nothing to say to the behoof of healing affections of the veins? May not venous subjects fairly say to the physicians-What have you all been doing the past two thousand years; have you not, with all your learning, vivisections and mortisections, poisonings and drug-provings, and your never-ending ransacking of all creation for new remedies; have you not here withall been able to hit upon some gentle innocuous means of bringing back a few dilated veins to their normal calibre?
And would they be so very far wrong, if, individually, they were to continue in some such a strain as this … What use is it to me with my baggy veins, that you dub them with big names and learnedly talk about haemorrhoids with hypertrophy of surrounding connective hypertrophy of surrounding connective tissue varicocele, varicose veins, varicosis, and all that if I am merely an objective of study for you, and my miseries only so many classes and miseries only so many classes and sub-classes in your nosological natural history;and, having duly and scientifically classified my peccant parts you bow me out with a placebo, and show me thereafter the way to the amphitheatre?
But then this is not a thinking age for the many; only a few, in the present hurry and flurry, and race after riches can find time to go after “a more excellent way.”
Oddly enough the art of healing pure and simple, is not in great repute nowadays; indeed it is almost a reproach to fling one’s self body and soul into the business of healing and herein try to do better than one’s father did. Nay, it is even dangerous for a man of good repute to strike out a new path in therapeutics, and try to cure what the solid phalanx of and ancient trades union has ever held to be incurable; if he do he will infallibly be looked at askance and no one will thank him, while many will seek to deride and vilify him. The reason of this lies largely in the history of medicine and of mankind; bad ware has been so often brought forward as good that no one brought forward as good no one may be much blamed for looking with some suspicion on all new notions.
Now, I am coming forward with the thesis that atonic dilated veins may, in many instances be made to shrink to their original size by the proper use of medicines administered internally and aided by certain auxiliaries, – in other words varicosis haemorrhoids, varicocele and varices are amenable to drug- treatment, and therefore surgery, in this department of diseases of the veins is to be superseded by medicines. Surgeons will no doubt object to being thus ousted, and will probably not fail to vent their wrath upon me Good my ireful brethren you have done that before in another subject, “Curability of Cataract with Medicines.” and yet truth is gaining thereby, and a certain step in advance has been made.
Of course you will perceive that neither there, nor here am I originating anything I have merely been sitting at the feet of Hahnemann, and have come out to do battle for this great truth.
In the sincere hope that some truth-loving and truth-seeking brother may read this,and be desirous of seeking the path I have wondered I will give it step by step just as I have come. It is an honourable path wherein walk many good men and true who are striving to make the physician’s business one of healing the sick, cito, tuto, et jucunde; the path is not easy to travel, neither is it always daylight therein but it has just one safe and sure hand-railing running along it from end to end that is the LAW OF SIMILARS . There are other guides but they do not go all the way; they are only here and there, so we will, in the following pages, just hold on to LIKE CURES LIKE. We are the more constrained to do so as we know no other safe guide in therapeutics
The surgical treatment of diseases of the veins may be reduced to three fundamental parts, viz – Local astringents pressure, by way of support; an the so-called radical operations with the knife or its equivalent.
GENERAL VARICOSIS eludes the surgeon entirely for surgery must necessarily be only local. But when we have to deal with such local manifestations of varicosis or venosity, the scholastic physician forthwith hands over the case to the surgeon for operation or for surgical appliances. Thus with HAEMORRHOIDS: The physician gives his aperients, with perhaps a local astringent, and gradually the states of things gets worse, and then the patient learns that there is nothing for it but a surgical operation. What a terrible prospect even in these days of perfect anaesthetic and antiseptic surgery! Apart from the ultimate effects of shock a thing no one seems to take cognizance of cutting off the pulse cannot, as a rule reasonably be called curing . And this shock to the whole economy arising from an operation for piles, tells its tale for many a year afterwards – indeed, the sufferer often never recovers from it entirely. If we follow Hahnemann’s method of historical case-taking we see strange things, as to the really primitive causes of diseases. In my own practical experience I trace cases of diabetes and cataract to the surgical traumatism inflicted in operating for piles. But more of this anon.
Again with VARICOCELE: This is held to be entirely within the surgeon’s domain. I well remember the first case I ever saw was in one of the clinics in the Vienna General Hospital. It was an exquisite case, and the subject an individual of about 25 suffering really from general varicosis, but this condition was most pronounced in the spermatic veins from evident causes. Our genial and much-be-loved teacher said to us…
“There is nothing for it, gentlemen, but the radical cure” I inquired what the “radical cure” was, and learned, of course, that it meant a surgical operation. That is still the orthodox teaching but it is as false as it is cruel and as shallow as it is false. A merely surgical cure is no real cure at all, and in its very nature cannot be radical better than nothing no doubt and often nearly as good as a cure, but still not a healing in its true sense.
Finally with VARICOSE VEINS: The scholastic physician has here nothing whatever to say, beyond recommending his own favourite elastic stocking maker. The surgeon comes into treat any haemorrhage that may eventually occur from a ruptured vein, or to treat the varicose ulcers and bad legs. All mere patch-work and cobbling if nothing more be done.
But if we are to relegate the simple surgical treatment of vein diseases to the lumber-room, what is to take its place? The answer is . . . Scientific medicinal treatment, and in therapeutics that means specific constitutional (homoeopathic) treatment; for science in therapeutics and homoeopathy are synonymous terms.
The first time I became aware of the fact that veins could be specifically affected with medicines at all, was in reading a book by Dr. Richard Hughes, entitled “A Manual of Pharmacodynamics,” that was a new revelation to me in so many ways. It has been called “Homoeopathic Milk for Allopathic Babes ;” it would be a good thing for the world if the allopaths would but partake freely of this precious milk. However, there is one condition absolutely necessary to its digestibility, viz., the allopathic babe must have a clean tongue, and a stomach that calls loudly for healthy therapeutic food, or it will disagree with him. For, if his tongue be coated with crass prejudice, and his stomach gorged with medical conventionalism and scholasticism, he will be unable to take it up or assimilate it. And if he cannot bear the milk, how is he to partake of the more solid food of the Organon. Well, the special article I refer to is that on Acidum fluoricum, which to me, then, was an altogether new and unheard of remedy. The part that so impressed me runs thus :-
“Under its use whitlows have been blighted; fistulae- lachrymal and dental-have healed ; varicose veins have shrunk to half their size; fresh hair has grown on a bald head, and moist palms have regained their healthy dryness.”
This was good seed sowed, and it has borne much good therapeutic fruit in my subsequent professional life. An exquisite case of Alopecia areata recovered so completely, under the prolonged use of Acidum fluoricum, that a long-worn wig could be put off. This was observed by me while house-surgeon at the Hardman Street Homoeopathic Dispensary in Liverpool; and it was 4 there, too, that I first had an opportunity of testing this remarkably bold assertion of Dr Hughes, namely, that varicose veins would shrink to half their size under the influence of fluoric acid.
THE LAMP-LIGHTER’S CASE OF EXCESSIVE VARICOSITY OF THE LEFT INTERNAL SAPHENOUS VEIN.
A middle-aged man, by occupation a lamp-lighter, came under observation at the Dispensary for an enormously dilated vein of the left thigh. At its highest and largest end, just where it dips down to the femoral vein through the saphenous opening of the fascia lata, it was as large as a child’s wrist; and near the knee, about the size of a man’s little finger, so that there was no inconsiderable danger of its rupturing and causing dangerous hemorrhage. It was not the local expression of general varicosis, but arose from a mechanical obstruction in this wise : Patient had sowed his wild oats lang syne, and as part of the harvest had reaped a big bubo in the left groin. This had sloughed, and been burned with a strong acid, and there resulted as scar, a cicatricial surface of the size of a man’s palm, and this scar- tissue in contracting had very much narrowed the entrance of the long saphenous vein, through the opening of the fascia lata into the deeper lying crural vein. Then, in those days lamp-lighters used to do their work with the aid of light ladders and were in the habit of sliding down thus the vein,that had become dilated from the lateral pressure of the venous blood, coursing up the saphena, having such a contracted entrance, became still more disturbed in its function; hence the enormous dilatation.
patient received Acidum fluoricum 6 in pilules and was directed to take one four times a day, and till further orders. This he did for several months with the result that the enormously dilated vein shrank to about one-third of its original size, and this notwithstanding patients continuance at his usual occupation. No auxiliaries and no local applications or appliances were used, and the diet was not altered. When I saw him last the varicosis had ceased to be of any inconvenience; it was not longer dangerous in anything like the same degree, as the vein felt firm and strong. considering the irremediable mechanical hindrance at its inlet, the result seemed to me so striking that I have ever since gone in very strongly for the medicinal treatment of varicosis under all circumstances and the satisfaction one has in such medicinal treatment is truly great.
It is not medically orthodox to believe in the amenability of Diseases of the Veins to drug treatment and my own medical education having been ultra-orthodox, I thought it would be only fit that I should show what led me away from the generally received notions in this regard. This I have done in the foregoing, and the question may now be fairly put to any candid medical mind. If a greatly dilated, long saphenous vein, whose inlet was considerably narrowed, could be so materially modified in its physiological life by internal drug treatment alone the mechanical hindrance at the inlet still remaining is it not at least probable that many other forms of varicosis would likewise yield to properly chosen remedies? That such is the case I shall now proceed to shew, Before doing so, however, it might not be amiss to state that this notion has not originated with me or with Dr. Hughes; this genial writer was my immediate devencier and until I read his article on Acidum fluorum, I had never even I heard that any one ever attempted the medicinal cure of varices. Since then I have of course become fully aware that the thing dates back to Hahnemann and others, and that capable homoeopaths have herein followed in his wake for a good half- century; careless homoeopaths, however, often decline the bother and trouble consequent upon the acceptance of the dogma that vein diseases may be dogma that vein diseases may be cured with medicines more especially since the surgery has become almost painless by reason of the anaesthetics, and bloodless by means of the neat, elegant, and effective surgical proceedings at the operations; more particularly is this the case with piles. Yes even here, how much is a kindly, gentle, medicinal cure to be preferred! Far be it from me to detract from and honour due to my surgical brethren; may, I am free to admit that, had my hand possessed the chirurgical cunning that lies in theirs, I should no doubt have also suffered from the surgeon’s itch, and I may never have had the patience to try medicines as I have done, in the very worst I have in the very worst forms of piles and other varicoses, and thus finally triumphed, to my own intense satisfaction.
Necessitas non habet legem, and, moreover, she is the lawful mother of invention, as we have it in our own vernacular. While giving, therefore all due honour to surgery, I must call ver special attention to what maybe termed..
CHRONIC CHIRURGICAL TRAUMATISM
As far as I am aware, I have never and read anything about this very important subject in any books what I think I know thereon has been read in Natures ever-open has been read in Natures ever-open book, that come to us page by page, word by word and letter by letter, in the form of living human beings that are technically termed patients. I am not referring to ordinary traumatism, nor yet to surgical shock, but to the chronic traumatism that is caused by the surgical operation per se-here for piles more particularly-and which gives an impression to the organism that becomes chronic,and whose effects are seen years and years thereafter. And I do not think the traumatism is one whit the less for the anaesthetics so that whether a patient feels any pain at the operation or not, is, in the present sense, quite a matter of indifference.
I could offer a good many proofs of this proposition did space allow,but let us at least think over the matter a little. To begin with traumatism is admitted when it arises from contre- temps in obstetric practice and no one of experience will be disposed to deny it when ascribed to blows falls, railway accidents, and the like. This is so well recognised in homoeopathic practice that many successful cures have been wrought by falling back on the traumatic etiology of, may be twenty or more years ago.
What made me first think about it was the very frequent observation, in taking the cases of cataract *Operation for cataract has been known to be soon followed by complete loss of speech and memory. patients, that operations for piles were so often a part of their life history. It could not be accident or mere coincidence, I thought; If mere coincidence, it is ,to my mind very strange.
Thus I am at present treating patient for diabetes mellitus and the whole of her almost hopeless case-she is is a veritable sugar-maker engross-points unmistakably to the traumatic origin of her complaint, the trauma being an operation for piles.
Ophthalmologists are in to doubt about cataract being often due to blows and injuries; indeed, traumatic cataract is a recognised variety of that distressing affection. When we consider the exquisite sensitiveness of the rectum and its extreme tenderness and resentfulness of foreign interference; when we remember the hyperaesthesia of the parts in a bad case of piles – let sufferers from piles say whether the rectum is sensitive part! – there is to say the least nothing against the hypothesis that an operation for piles may, and does, make an abiding impression upon the organism the may years thereafter culminate in serious organic mischief. Still, I have not arrived at this conclusion from a priori reasoning but induce it from observation in actual it from observation in actual cases We need not enter into the matter any further here, as we are now concerned with medicinal treatment of diseases of the veins, and to follow out the subject of chronic chirurgical traumatism would be digressive; I merely mention it parenthetically, as it were, and commend it to the consideration of those whose refuge is the knife.
GENERAL CONSTITUTIONAL VENOSITY
There are certain subject whose venous systems are exceedingly prone to ail; if they have anything wrong with their hearts, it is pretty sure to be the venous side of it; if they get dyspepsia it arises from congestion of the portal system of veins if they suffer from headaches it is from venous stasis; if they get constipated piles develop at once; if they stand much, or wear a tight garter they get varices on the legs; if the uro- genetic system gets irritated or injured and fails to get tone- giving natural relief, they have varicocele, or menstrual troubles from dilated veins of the ovaries and broad ligaments, as the case maybe. They are constitutionally venous, and suffer from passive congestions at all turns. Such a one was the following:-
CASE OF GENERAL VARICOSIC VARICOCELE, AND VARICOSE VEINS.
A gentleman about thirty years of age, came under my observation on october 17, suffering from chronic prostatitis, varicocele, and varicose ulcers of the legs. At a glance one could see that he was a venous subject; as he was swarthy, pensive and melancholy, and had long slender limbs. Almost every region of his venous circulation showed signs of dilatation, having an enormous left-sided varicocele, and very pronounced baggy varices of the legs. His internal saphenous veins were like big robes. Around his left ankle were varicose ulcers, and the whole neighbourhood around was very dark,almost black in places. He stated that this left ankle had been in this state nearly all his life. General health fairly good except some lack of virility, but bandaging his legs was, of course, burdensome and the varicocele was very inconvenient, more especially in view of approaching marriage.
Rx Ferrum Phosphoricum, 6 trituration 3iv. To take four gains in water three times a day.
Nov. 12 The spermatic veins are not any smaller as far as he can perceive; the veins in his lower extremities are smaller; and the dark places under the left ankle are turning to a proper flesh colour.
Repeat the same flesh Remedy.
Dec. 8. The varicocele is much smaller – “At one time its existence was very inconvenient; now I hardly notice it,” said he. The varicose ulcers have healed up and the skin around is assuming a healthy hue.
Repeat jan. 8. Has had gatherings in the place where the black patch the place where the black patch was. All the varicose veins and varicocele much better.
Rx. Kali Chlorum, 6 trit 3iv. Four grins in water three times a day.
April 14. The veins are all getting smaller; the foot has completely healed (head had it nearly all his life!) The varicocele very much better, and also the varices of the lower extremities the venae saphenae longae having notably diminished in size. These few months of treatment have wrought a great change in the patient and in the man, and I accordingly gave him permission to get married. He is of course to get worried. He is of course not yet completely cured of his general varicosis, the time has been to short for that, – but the improvement is so great that all obvious unsightliness has disappeared, and this is no small boon to a man contemplating marriage.
This case has given me great satisfaction as a worse one has never come under my observation in man of that age. I made use of no local application whatever; neither was any change made either in his diet, mode of life (standing nearly all day) or place of abode, but he continued the bandage to his foot, to which he had been accustomed for more than twenty years.
He tells me his father suffered similarly. Practical men will agree with me that it is not very usual to have trouble from varicose veins at ten years of age, as this gentleman had, and that, as it went on without getting any better for twenty years, the present remarkable amelioration is, and can be, due to nothing else but the the medicines; and this being so – and considered in conjunction with the lamplighter’s case – my present thesis, that venous dilatation can be cured or ameliorated by medicines, is established. The basis on which it is established is narrow, perhaps, and therefore we will proceed to widen it by citing other evidence in its favour.
Before doing so, however let me be allowed to give what surgery has to say on varicocele. I will quote from a young promising surgeon, of the very latest date. In the Lancet of July 17, 1880, we read; PART OF A CLINICAL LECTURE ON THE RADICAL OF VARICOCELE BY THE GALVANIC ECRASEUR, DELIVERED AT THE WESTMINSTER HOSPITAL ON JULY 3RD, 1880, BY A. PEARCE GOULD, M.S., F.R.C.S., ASSISTANT-SURGEON TO THE HOSPITAL, AND LECTURER ON ANATOMY TO THE MEDICAL SCHOOL.
GENTLEMEN, Although there are very many cases of varicocele in which no treatment, or only palliative measures, are required, you will meet with others in which it will be your duty to undertake the permanent or radical cure of the varix. These cases are as follows :1. where the testicle is atrophying 2. Where the varicocele is double , especially if an examination of the semen shows an absence of spermatozoa, or the patient being married is sterile. 3 Where the opposite testicle is lost or useless from tumour orchitis, epididymitis, or injury. 4. Where the varix is large and increasing in spite of palliative treatment. 5. Where the varix causes much pain or interferes with proper exercise and necessary work. 6. Where it is occasion of marked mental depression. 7. Where the varicocele prevents acceptance for either of the Government services.
There are many plans for securing the radical cure of varicocele, including castration, excision of the veins the actual cautery, forcipressure, and ligature. The ligature is the method most commonly adopted and has been variously adopted and has been variously modified by Ricord, Vidal, Erichsen, Wood and H. Lee. (These methods of treatment were then described)
Of the efficacy of these treatment there can be no doubt but unfortunately they have no doubt but unfortunately they have two drawbacks the pain attending them, and a certain amount of danger. For a long time surgeons avoided as far as possible any interference with veins and although veins are now ligatured almost as freely as arteries there is no doubt that diffuse thrombosis, embolism,and septic poisoning are more liable to follow injuries of veins than of arteries. This being so, it is plainly the surgeon’s duty to avoid in every possible way any irritation or disturbance of an injured vein and it is because this principle is not sufficiently carried out that the usual modes of treating varicocele have been attended with serious and even disastrous results. The daily twist of Vidal’s pin, and constant traction of woods spring are not only painful but opposed to the great principle that demands perfect rest to all inflamed and injured tissues and veins in particular while in Lees operation, the presence of two hair-lip pins transfixing the scrotum is apt to set up oedema and inflammation and their removal is not without risk of embolism. That these are no imaginary fears is evident from the published results of these and analogous treatments. Gant says that the results of the operations are “variable,” and include diffuse inflammation and sloughing of the scrotum, suppuration of the testicle, phlebitis, pyaemia, and death Erichsen records two had deals from after ligature; Sir E. Hume had one nearly fatal case; Escallier mention two fatal cases of phlebitis, and curling speaks of three cases of serious years two of which were fatal. Some years ago the sensor of one of the chief London hospitals died from pyaemia after Lee’s operation. This list by no means includes all the accidents of these treatments it makes no mention of the pain suffered or of the inflammatory oedema and suppuration of the scrotum.
It was with the hope of avoiding these complications that I was led, now more than two years ago, to try the plan of subcutaneous division of the veins by means of a platinum wire heated to a red heat by electricity. The procedure is as you have seen very simple. First feel for the vas deferens and grasp the veins in front of it, and nip of the scrotum with the left thumb and forefinger; transfix the scrotum at this spot between the duct and the veins with a narrow bistoury and pass a needle armed with a platinum wire in the track of the knife; then return the needle through the same apertures, but this time in front of the veins between them and the skin. Of course if the vas happen to be in that of W. C.- shown to-day you modify the procedure a little. In this way you have the veins in a loop of the wire. It is better to make a puncture with a knife rather than merely to transfix with the needle for the veins are looped up cleaner there is not the same liability to include a portion of the skin in the noose as in the latter plan then attach the ends of th wire to the ecraseur, and connect with the battery, using sufficient cells to cause a faint hissing noise; one cell of Grove’s battery or at most two is sufficient. This step must be done deliberately; I have taken as long as five or six minutes over it. To protect the skin from burning let some cold water trickle over it while the wire is burning its way through the veins. The after-treatment consists in perfect rest in bed for a few days, with the scrotum supported on a broad strip of strapping fixed across the front of the thighs. I have three times operated without anaesthesia, but the pain may be severe, and I prefer to have the patient under the influence of either. After the influence recovery from the anaesthesia there is an entire absence of pain and this perfect freedom from spontaneous pain continues uninterrupted throughout the convalescence. A few hours after the operation the knobby feel of the varix is replaced by a soft even swelling which lessens and hardens and at the end of forty -eight hours is usually to be felt as a hard lump about the size of a big marble. This is tender on pressure. By the end of week it has lost its tenderness and has shrunk to three-quarters its original size. The veins below can still he full, but not compressible the blood in them has by that time coagulated, and they become smaller and firmer until ultimately a small pea-like induration in front of the vas is all that is left, and even this may disappear, and no trace of the varix or operation be left as in W.S —