A historical and analytical review of Bell’s diarrhoea

Dr Rushali Singh Tomar

Abstract: This article provides a comprehensive review of The Homeopathic Therapeutics of Diarrhoea, Dysentery, Cholera, Cholera Morbus, Cholera Infantum, and All Other Loose Evacuations of the Bowels by James B. Bell. First published in 1869, this work is a seminal reference in homeopathic management of gastrointestinal disorders. The review explores Bell’s classification system, therapeutic strategies, and detailed repertory structure, which categorizes remedies by pathology, stool character, aggravations, ameliorations, and general accompaniments. It also examines the historical context, Bell’s clinical experiences, and the subsequent editions’ contributions, including new remedies and editorial annotations. While Bell’s repertory is praised for its comprehensive symptomatology and clinical utility, limitations include a restricted number of remedies and inconsistencies in rubric definitions. This review highlights Bell’s influence on homeopathic gastroenterology and underscores the continued relevance of his therapeutic approach in modern clinical practice.

Keywords: Bell’s Diarrhoea, Homoeopathy, Repertory, Clinical Repertory, Book review

THE HOMEOPATHIC THERAPEUTICS OF DIARRHOEA Dysentery, Cholera, Cholera Morbus, Cholera Infantum and All Other Loose Evacuations of The Bowels

ABOUT THE AUTHOR
JAMES BACHELDER BELL, M. D., of Augusta, Maine, was born in Monson, Piscataquis County, Maine, February 21st, 1838. His father, a graduate of Amherst College, a lawyer, from Berkshire, Massachusetts, was of English-Irish descent.

Ill health prevented his entrance upon a college course, for which he was prepared in the Monson Academy; but began the study of medicine with his uncle Dr. William C. Bell, of Middletown, Connecticut.

He completed his course of study in the Homœopathic Medical College of Pennsylvania, graduating in 1859. In June following, he sailed for Bremen, Germany, and thence to Vienna, where he spent a year in diligent study at the Allgemeines Krankenhaus (Vienna General Hospital), with occasional visits to the Homœopathic Hospitals. After travelling somewhat, and visiting various hospitals, he returned and practiced ten months in Skowhegan, Maine, his father’s home, and then selected Augusta, Maine, as his place of residence, where he continued in successful practice.

In 1862, he passed an examination before the allopathic board, preparatory to his entering the service as a surgeon, and was accepted, although circumstances hindered his engagement in that capacity.

In 1863 he married Miss Pauline Robinson of Skowhegan, by whom he had three children.

Dr. Bell engaged actively in the practice of medicine, giving the preference to surgery. He was examining surgeon for the pension office from 1863 to 1866; and city physician from 1867 to 1868.

During this time, he examined several thousand discharged soldiers, and was obliged to resign his office on account of his private practice. He published a work on the “Homœopathic Treatment of Diarrhœa,” in 1869; and has written for the various medical journals.

He was a member of several medical societies. In medicine he is Hahnemannian; in religion, Evangelical; and in politics, Republican.

ABOUT THE BOOK:

CLASSIFICATION TYPE

• Book form
• Clinical
• Regional
• Disease condition

FIRST EDITION: 

• Published in 1869; a work of 10 years; Bell calls it a work of reference.
• By Boericke & Tafel
• Gradations used: 4 Types of gradations are used.

• • Roman bold. — First grade. —- 4 Marks.

• • Italics. — Second grade —- 3 Marks.

• • Simple roman. — Third grade —- 2 Marks.

• • (Roman in parentheses). — Fourth grade —- 1 Mark.

• Sources: 

• • Own clinical experience of about 10 years; From various journals; Hahnemann. Chronic diseases.; Jahr. New manual. Repertory; Lippe. Materia Medica; Hale. Materia Medica; Boenninghausen’s Therapeutic Pocket book; Hartmann; Wells Diarrhoea etc.

PREFACE: (Augusta, Feb 21, 1869)

• Prepared for own personal use; as a receptacle for clinical observations and for learnings from others and from the periodicals. This work was printed because the colleagues who had seen it wanted to possess a copy.
• Tafel saw it and desired to print it.
• It was the difficulty of treating frequently occurring and obstinate diarrhoeas of infants that first awakened the desire to possess in one little work all that was known of our Materia medica as applied to loose evacuations of the bowels.
• Not every remedy which has been known to purge has been included in this work; only those of which enough is known, either of its stool, conditions, concomitants to distinguish it from any other remedy.

SECOND EDITION:

• Published in 1881 by Boericke and Tafel.
• Bell felt the 1^st edition was quite defective. Additions, revisions and annotations in 2^nd edition made by Dr W. T. Laird, Bell’s former partner, Dr T. M. Dillingham, and Dr Adolf Lippe
• EDITOR’S PREFACE:

• Augusta, Maine, March, 1881
• Many new remedies and divided into 4 classes:
  1. Remedies which have been thoroughly proved and repeatedly verified in practice.
  2. Well proved but whose symptoms as yet, lack clinical confirmation.
  3. Medicines of which we only possess fragmentary and imperfect pathogeneses. Can be called “suggestive remedies”, include drugs like- Coto Bark, Gentiana lut., Geranium, Gnaphalium, Hura, Oenothera, Paullinia, etc.
  4. Remedies whose indications are derived solely ab us in morbis. (Knowledge obtained from the use of medicine in disease.) – basis of EMPIRICISM– must be viewed with distrust and given with caution.

• Though it is not very clear as to what typography represents which grade but it may be considered that the four classes described in this preface correspond to these typographies.

• The general plan is same in both the editions.

DIFFERENCES BETWEEN 1^ST AND 2^ND EDITION:

• Important symptoms are italicized, while those which are especially characteristic are printed in black type.
• The term “cholera infantum” has been retained in many cases, which according to pathology, should be termed, entero-colitis and gastro-enteric catarrh. This is so due to the extremely common usage of this term.
• The 2^nd edition contains over 100 pages more than the 1^st.
• 32 new remedies have been added.
• Old remedies have been revised or rewritten.
• Numerous clinical symptoms have been added to the text.
• Acknowledgment:

• • Dr W. P. Wesselhoeft and Dr Adolf Lippe for notes and suggestions
  • Prof. E. A. Farrington for important information and for his permission to make free use of very complete notes of his lectures on Materia Medica
  • Dr F. F. Laird for assistance in preparing the manuscript.

THIRD EDITION 

• Published in 1888 by F. E.  Boericke at Philadelphia.
• Written in Boston, June, 1888.
• 4 remedies of little importance have been omitted – Cactus, Euphorbium, Opuntia and Castoreum
• 5 remedies of much value have been added – Acetic acid, Crotalus, Angustura, Carbolic acid, Valeriana
• We are able to use new as well as old remedies by proving and observation and the knowledge thus acquired will be just as valuable centuries later as now.
• Acknowledgments: Dr Samuel A. Kimball, Dr J. G. Allen and Dr W. Jefferson Guernsey for annotated copies of previous edition.

FOURTH EDITION 

• Published in 1896 by Boericke and Tafel.
• No remedies have been added or omitted. Number of remedies = 141
• Only few changes to make.
• This work has fewer remedies compared to Allen’s register which has 425 or Knerr’s repertory but this is so because this work is more specific and contains no remedies whose provings are inadequate or where diarrhoea is only accompaniment to another characteristic symptom.
• E.g. Diadema in Intermittent fever, Asteria rubens in Epilepsy, Arum triphyllum in Typhoid or Scarlet Fever.
• By James B. Bell at 178, Commonwealth Avenue, Boston, Oct, 1896.

INTRODUCTION 

CHARACTER AND OBJECT OF THE WORK

• This work applies to all loose evacuations of the bowels, their descriptions, aggravations and ameliorations, and their accompaniments – immediate and general. Headings-
• Pathological Names
• Character of the stool is used as an adjective. The semicolon (;) stands for it.
• Aggravations and ameliorations
• Concomitants – before, during and after stool
• General accompaniments [Mind and Mood – General symptoms (23 headings)]
• Italicized symptoms – most frequently observed, serve to most sharply distinguish that remedy from others.
• Remarks following each remedy – only the personal opinions of the writer.

SELECTION OF THE REMEDY  

• Selection of the remedy requires two similars:

• • One corresponding to the general symptoms, which bring it into relation to the pathological state to be treated

• • One corresponding to the special and characteristic symptoms which bring it into relation to the individual case to be treated.

• These distinguishing symptoms are all kinds and qualities; from the most pathological and objective to the most subjective and delicate.
• Examples of the former –                               Examples of the latter –

Mag-c: green frothy stools                             Hydroph.: <hearing water run

Benz-ac: dark acid urine                                 Gels.: < sudden depressing emotions

Mur-ac: blue varices                                       Phos.: > cold food and drink

• Suppose we find the only remedy for a given case, corresponding to the peculiar and individualizing symptoms but it has never been known to cause the pathological state from which our patient suffers.
• Here, we may safely infer that the remedy does possess also the general and organic symptoms of the case, and that it will remove them, together with distinguishing indications.
• This has led to almost one fourth of the most valuable pathological symptoms of our Materia Medica:

• • Bry., Ars., Rhus., Bapt. – ulceration of Peyer’s glands

• • Hep., Lach., Lyc., – pseudo-membranous exudation

• • Spong. – plastic endocarditis

• • Puls., Sepia – trachoma or granular conjunctivitis

• • Podophyllum Bell – true pneumonia

THE ADMINISTRATION OF THE REMEDY

• “Each can only contribute the fruits of his own observation.”
• The author began with a preconceived notion that the 30^th potency is best for chronic and nervous affections; the lower and even crude preparations is more satisfactory for acute affections and particularly for diseases of the bowels.
• Hard experience has taught him the contrary.
• Personally, the author’s experience has been most satisfactory with 12^th, 15^th, 30^th, 200^th and often higher potencies, administered in water, repeated every 1 – 6 hours, according to the urgency of the symptoms.
• If the same remedy was needed to be resumed again, it has seemed to do better in a higher potency, but on this point, we cannot yet speak with entire assurance.
• The author has not been able to perceive that age or sex or habits, colour, race or order in natural history form any element in choice of the dose.

All classes have been found to respond favourably to the high potencies.

CHAPTER ARRANGEMENT  

• The general arrangement of repertory is as Pathology/location, character/sensation, modality & concomitants of particular & general state.
• Has 5 sections & certain section had subsection under it
• Chapter names are given in capital bold
• Subsections are given as a) or b) & in capital ordinary small font. Except in General accompaniment it is given in 1, 2, 3, etc.

RUBRIC ARRANGEMENT

• Rubrics are arranged alphabetically under sections & subsections.
• Rubric words are given in bold roman after a comma ‘,’ next word is given finally after colon ‘:’ the drugs are arranged alphabetically with their typography.
• Sub rubrics are given with indentations (—). One indentation means first word of the previous rubric. 2 indentation means 2 words of the previous rubric even in, of etc.

PART I: REMEDIES AND THEIR INDICATIONS  

Total Remedies: 141

First:  Acetic acid

Last: Zingiber

• PART II: REPERTORY
  1. PATHOLOGICAL NAMES

            CHOLERA

            —, asphyctica s. sicca: Camph., Carbo v., Laur., Tabac.

(Cholera sicca is an unusual form of the disease in which fluid accumulates in the intestinal lumen, and circulatory collapse and even death, can occur before the passage of the first loose stool)

             —, infantum

—, morbus

DIARRHOEA

DIARRHOEA, chronic

—, infantile

DYSENTERY

             —, periodical in every part of summer, every year on same month and day

2. CHARACTER OF THE STOOLS

Contains cross-references too.

3. CONDITIONS OF THE STOOLS AND OF THE ACCOMPANYING SYMPTOMS
   1. AGGRAVATIONS
   2. AMELIORATIONS
4. ACCOMPANIMENTS OF THE EVACUATIONS
   1. BEFORE STOOL
   2. DURING STOOL
   3. AFTER STOOL
5. GENERAL ACCOMPANIMENTS

1 Mind and Mood 2 Head 3 Eyes and Ears. 4 Nose 5 Face 6 Mouth 7 Throat 8 Esophagus

9 Appetite. 10 Eructations II Nausea and Vomiting 12 Stomach. 13 Abdomen 14 Anus 15 Urine 16 Sexual Organs 17 Chest 18 Back and Neck

19 Extremities 20 Sleep 21 Fever a. Chill b. Heat c. Sweat d Pulse 22 Skin. 23 General Symptoms

LIST OF AUTHORS: 

CONSULTED IN THE PREPARATION OF THIS WORK.

• HAHNEMANN. Chronic Diseases.
• JAHR New Manual. Repertory
• LIPPE. Materia Medica
• HALE. Materia Medica
• MURE. Materia Medica
• METCALF. Homœopathic Provings
• GROSS. Comparative Materia Medic
• POSSART. Arzneimittellehre
• BOENNINGHAUSEN. Repertorium. Keuchhusten. Pocket Book
• RAUE. Pathology and Therapeutics
• GUERNSEY. Obstetrics and Diseases of Females and Children.
• HARTMANN. Specielle Therapie Acuter und Chron- ischer Krankheiten. Spec. Therap. Kinderkrank- heiten
• TESTE. Diseases of Children.
• WILLIAMSON. Diseases of Women and Children
• CROSERIO. Obstetrics
• WELLS. Diarrhea
• WOLF. Hom. Erfahrungen, Erstes bis fünftes Heft.
• JOURNALS. Am. Hom. Review, Vol. I. to VI. Hahn. Monthly, Vol. I. to III.

ADDITIONAL WORKS: 

CONSULTED IN THE PREPARATION OF THE SECOND EDITION.

• ALLEN. Encyclopædia of Pure Materia Medica.
• HERING. Condensed Materia Medica.
• HERING. Guiding Symptoms.
• HUGHES. Pharmacodynamics.
• DUNHAM. Lectures on Materia Medica.
• DUNHAM. Homœopathy the Science of Therapeutics.
• BEHR. Science of Therapeutics
• RAUE. Annual Record
• LILIENTHAL. Homœopathic Therapeutics.
• HOVNE. Clinical Therapeutics.
• FARRINGTON. Supplement to Gross’ Comparative Mat. Med.
• BURT. Characteristic Materia Medica
• LIPPE. Repertory.
• JOURNALS. Hahn. Monthly, Vol. I. to XV. North Am. Jour. of Hom., Vol. XX. to XXVIII. Med. Investigator, Vol. IX. to XI. U. S. Med. Investigator, Vol. I. to X. N. Y. Jour. of Hom., Vol. I. to II., Amer. Jour. of Hom. Mat. Med., Vol. VI. to IX. Amer. Observer, Vol. IX. The Clinique, Vol. I. to II. Medical Counselor, Vol. I. to IV. Hahn. Hospital Reports. Trans. N. Y. Hom. Med. Soc. Trans. Penna. Hom. Med. Soc. Proceedings of Am. Inst. of Hom.

ADDITIONAL WORKS CONSULTED IN THE PREPARATION OF THE FOURTH EDITION

• ALLEN, General Symptom Register.
• KNERR. Repertory of Hering’s Guiding Symptoms.

INDEX: Indexing the contents of book first to last. 

UTILITY:

• This repertory is a complete work as it has expressed not only the symptoms of the bowel but the general state of the patient too. The section on General Accompaniments justifies this.
• Accompanying symptoms before, during and after is well elaborated in separate sub-sections
• Handy and easy for reference as the sections in the repertory can be referred quickly and the medicine can be selected accurately without much hassle
• Desires and Aversions related to food items are mentioned in Appetite sub-section.
• This book also mentions the guidelines regarding the selection of the remedy and also its potency selection.

LIMITATIONS:

• Number of remedies mentioned is less. Remedies in each rubric are very less
• Moreover the author has not included medicines-Whose proving is indefinite. This the author has said in context to a much larger number of diarrhoea medicines given in Allen’s Symptom Register (425) and Knerr’s Repertory of the Guiding Symptom
• Where Diarrhea is simply accessory to a larger and more important group of symptoms E.g. Diadema in Intermittent fever, Asterias rubens in Epilepsy or Arum triphyllum in Typhoid or Scarlet fever and not well defined in itself
• While describing under the heading ‘Character of the stools’ many sub rubrics are found which do not actually correspond with the meaning of the main rubric. E.g. Involuntary, Expulsion difficult, Alternating with constipation.

BIBLIOGRAPHY:

1. Bell JB. The Homoeopathic Therapeutics of Diarrhoea, Dysentery, Cholera, Cholera Morbus, Cholera Infantum. 1869.
2. The Homoeopathic Therapeutics of Diarrhoea, Dysentery, Cholera, Cholera Morbus, Cholera Infantum [Internet]. Google Books. 2025 [cited 2025 Feb 18]. Available from: https://books.google.co.in/books?id=NRk4AAAAMAAJ&source=gbs_navlinks_s
3. The homoeopathic therapeutics of diarrhoea, dysentery, cholera, cholera morbus, cholera infantum, and all other loose evacuations of the bowels : Bell, James B. (James Bachelder), 1838-1914 : Free Download, Borrow, and Streaming : Internet Archive [Internet]. Internet Archive. 2025 [cited 2025 Feb 18]. Available from: https://archive.org/details/65641080R.nlm.nih.gov/page/n5/mode/2up
4. Bell JB. The Homoeopathic Therapeutics of Diarrhoea, Dysentery, Cholera, Cholera Morbus, Cholera Infantum. 1896.

‌Dr Rushali Singh Tomar
MD Scholar, Department of Homoeopathic Repertory and Case Taking,
Government Homoeopathic Medical College and Hospital, Bhopal,
Madhya Pradesh, India
Email : drrushali12@gmail.com