Review and Analysis of Therapeutics of Diarrhoea by James Bell

 Review and Analysis of  ‘The Homoeopathic Therapeutics of Diarrhoea’ By James B. Bell¹
Dr. Shradha Kothari*, Dr. Abhijit Chakma**  

ABSTRACT
A brief glimpse on “THE HOMOEPATHIC THERAPEUTICS OF DIARRHOEA, DYSENTERY, CHOLERA MORBUS, CHOLERA INFANTUM,  AND All Other Loose Evacuations of the Bowels” by Dr. James B. Bell through this article to show its practical utility in prescribing on the basis of various peculiar and characteristic symptoms in the whole anamnesis of the case. An attempt has been made to put this repertory more into use through this bird’s eye view. 

Keywords: Homoeopathy; Bell’s Diarrhoea; James Bachelder Bell; Regional Repertory; Stool 

INTRODUCTION
Homoeopathy was born in 1796 and in spite of its spread and propagation all over the world with innumerable remarkable cures, we have to fight for its recognition and prove its scientificity. In 19^th century and later part of 20^th century, homoeopathy has proved its worth by checking, curing and preventing many of the epidemics of various fatal diseases. At one time cholera was one of such dreaded diseases. Hahnemann and later his disciples have been repeatedly successful to cure cholera and other diarrheal diseases. Diarrhea, cholera, dysentery and other such conditions of the bowels is one of the most common complain we encounter in our daily practice and sometimes most difficult to treat. Moreover the failure to treat such cases was not considered the failure of the physician but of the whole system. It was the difficulty of treating these that first awakened the desire to possess in one little work all that was known of our Materia Medica as applied to disturbed evacuations of the bowels. Hence emerged the work is as “THE HOMOEPATHIC THERAPEUTICS OF DIARRHOEA, DYSENTERY, CHOLERA MORBUS, CHOLERA INFANTUM, AND All Other Loose Evacuations of the Bowels” by Dr. James B. Bell. 

THE AUTHOR
James Bachelder Bell (1859- 1914) – Not much detail is known about James Bachelder Bell. He was born in the year 1838. He graduated from Homoeopathic Medical College of Philadelphia in 1859. He was the president of the International Hahnemannian Association in 1892. And he died in the year 1914. 

THE BOOK
According to the classification of repertories it is designated as a type of special clinical repertory.

Plan and construction: Following the traditional repertories, this book consists of 2 sections viz- therapeutics and repertory. This kind of typical arrangement by the Master multiplies the function of books. It is meant for study of Materia Medica and to be utilized at the bed-side at the same time.

Part I – The Remedies and their Indications

Part II – Repertory 

Part I contains the remedies and their indications. Each remedy is described under the following heads-

• Stool
• Aggravation
• Amelioration
• Before stool
• During stool
• After stool
• Accompaniments

The last paragraph under each medicine contains valuable information which is of immense clinical importance. 

Part II contains the Repertory, which has the following sections:

1. Pathological names

2. Character of the stools

3. Condition of the stools and of the accompanying symptoms

i. Aggravations; ii. Ameliorations

4. Accompaniments of the Evacuations

i.   Before stool; ii. During stool; iii. After stool

5. General Accompaniments

a) Mind and Mood                                          o) Urine

b) Head                                                                       p) Sexual organs

c) Eyes and ears                                                          q) Chest

d) Nose                                                                       r) Back and neck

e) Face                                                             s) Extremities

f) Mouth                                                          t) Sleep

g) Throat                                                         u) Fever

h) Oesophagus                                                                        – Chill

i) Appetite                                                                   – Heat

j) Eructation                                                                – Sweat

k) Nausea and Vomiting                                                         – Pulse

l) Stomach                                                       v) Skin

m) Abdomen                                                   w) General symptoms

n) Anus                                                          

YEAR OF PUBLICATION

• 1^ST EDITION- 1869
• 2^ND EDITION- 1881
• 3^RD EDITION- 1888
• 4^TH EDITION- 1896
• 11^TH EDITION- 1920

This book has undergone fifteen editions till now.

CLASSIFICATION OF MEDICINES

This is talked about in 2^nd edition by Dr. W.T. Liard and is divided into four classes-

• 1^st – remedies which have been thoroughly proved and repeatedly verified in practice
• 2^nd – remedies which have also been well proved, but whose symptoms, as yet, lack clinical information
• 3^rd – medicines which possess only fragmentary and imperfect pathogeneses. These may be styled “the suggestive remedies” and include such drugs as Coto Bark, Gent. Lut., Geran., Hura., Oenothera, Paullinia, etc.
• 4^th–remedies whose indications are derived solely ab us in morbis 

CHARACTER OF THE WORK
This work is intended to apply to all loose evacuations of the bowels, and to describe them, their aggravations and ameliorations, with their immediate accompaniments and general accompanying symptoms.

The 1^st heading comes as ‘Stool’ under which different character of the stool has been described

Under the head of ‘Aggravations’ and ‘Ameliorations’ those influences are given which affect the stool, and also those which act as excited causes of the attack. When referring to other symptoms, they will be found indicated in parentheses. The concomitants of the stool like ‘before stool’, ‘during stool’ and ‘after stool’ have been described thereafter. Then it follows the general accompaniments, which include all the symptoms that can occur during the attack.

Under each of the best known remedies some symptoms are found italicized. These are the symptoms which have been most frequently observed, and which also serve to most sharply distinguish that remedy from others. While there are some symptoms which are especially characteristic; they are printed in black type.

It is intended to include not just every remedy that has been known to purge, but only every remedy of which enough is known, either of its stools, or conditions, or concomitants, to distinguish it from any other remedy. 

TYPOGRAPHY : The remedies are seen in four typographies-

Bold Roman

• Italic
• Roman
• (Roman): The medicines written in bracket are doubtful remedies.

Though it is not very clear as to what typography represents which grade but it may be considered that the four classes described in the preface to 2^nd edition correspond to these typographies. 

NO. OF MEDICINES
141 medicines are used in the therapeutic section.

In 2^nd edition 32 remedies were added. In 3^rd edition 4 remedies of little importance have been omitted viz.: Cactus, Euphorb., Opuntia and Castoreum. 5 medicines considered to be of much value have been added, viz.: Acetic ac., Crotalus, Angustura, Carbolic ac. and Valeriana. In 4^th edition no addition or deletion of drugs is done.

PURPOSE OF THIS BOOK

• For author’s own use as a labor-saver
• As a receptacle for clinical observations
• For gleanings from others and from the periodicals 

ABOUT SELECTION OF REMEDY
The selection of remedy is done by seeking the remedy which possesses the physical and diagnostic symptoms of the case, and which corresponds also to the special, distinguishing and peculiar symptoms which mark the individual case. And further, if a remedy is found that possesses distinctly the latter symptoms, but not, so far as is known, the former, we may conclude safely that it does possess the former, and administer it with confidence.

ABOUT THE POTENCY SELECTION
One of the shortcomings of repertories is that they are silent regarding the potency selection. That has been overcome by use of the 12^th, 15^th, 30^th, 200^th, and often higher potencies, of our remedies, administered in water, and repeated every 1-6 hours according to the urgency of the symptoms, and suspended as soon as decided improvement appeared. 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. 

LIST OF AUTHORS CONSULTED IN THE PREPARATION OF WORK

• BOENNINGHA– USEN. Therapeutic Pocket Book (1846)
• CROSERIO. Obstretrics
• GROSS. Comparative Materia Medica
• GUERNSEY. The Application of the Principles and Practice of Homoeopathy to Obstetrics and Disorders Peculiar to Women and Young Children
• HAHNEMANN. Chronic Diseases Their Peculiar Nature and Their Homoeopathic Cure (1828)
• HALE. Special Symptomatology of the New Remedies Vol. I, II
• HARTMANN. Practical Observations on Some of the Chief Homoeopathic Remedies
• JAHR.  New Manual (1853) Symptom Repertory (1835)
• JOURNALS
• LIPPE. Materia Medica
• METCALF. Homoeopathic Provings
• MURE. Materia Medica (1849)
• POSSART.  A Repertory of Characteristic Homoeopathic Remedies (1853)
• RAUE. Special Pathology and Diagnostic with Therapeutic Hint
• TESTE. A Homoeopathic Treatise on the Diseases of Children
• WELLS.  Essays on “Diarrhoea and Dysentery” (1862)
• WILLIAMSON. Diseases of Females and Children and their Homoeopathic Treatment
• WOLF. Homoeopathic Works

 ADDITIONAL WORK CONSULTED IN THE PREPARATION OF THE 2^ndEDITION

• ALLEN. The Encyclopedia of Pure Materia Medica (1875-1880)
• BAEHR. The Science of Therapeutics, according to the Principle of Homoeopathy
• BURT. Characteristic Materia Medica
• DUNHAM. Homoeopathy the Science of Therapeutics (1877)
• FARRINGTON. Supplement to Gross’ Comparative Materia Medica
• HERING. Condensed Materia Medica
• HERING. Guiding Symptoms of our Materia Medica
• HOYNE. Clinical Therapeutics Vol. I, II
• HUGHES. A Manual of Pharmacodynamics
• Journals
• LILIENTHAL. Homoeopathic Therapeutics
• LIPPE. A Repertory of Comparative Materia Medica (1854)
• RAUE. Annual Records

 ADDITIONAL WORK CONSULTED IN THE PREPARATION OF THE 4^thEDITION

• ALLEN. The Symptom Register (1880)
• KNERR. The Repertory of Hering’s Guiding Symptoms (1896)

SOME DISCUSSION ON THERAPEUTICS
After going through all the medicines thoroughly few medicines deserved special attention. In these, some peculiar symptoms were found which can be thought of great therapeutic value.

• Aconite: Especially useful in the very beginning of acute diseases of the bowels, and is then often able to cut short dysentery and even cholera morbus without any other remedy.
• It is also a valuable intercurrent in dysentery, when Merc. cor., although indicated, fails to relieve. It closely resembles Dulc. and is followed well by that drug, also by Bell.
• Aloe: Loud gurgling in the abdomen as water running out of a bottle. Contrary to what might be expected, the peculiar gurgling in the abdomen is often found with the dysenteric stool, when Aloe is indicated. The good appetite is most frequently met with in children.
• Antimonium tart: Although not of frequent use in diarrhoea, Tartar emet. will repay careful study. Veratrum has doubtless been given many times where the choice should have fallen on this remedy, as the colic, desires and vomiting is quite similar. Tartar emet., however, has more drowsiness and itching of the muscles than Verat.
• Apis: In infantile diarrhoea and cholera infantum it is one of our most precious remedies, corresponding to a low and dangerous condition. Still more characteristic is the bruised soreness of the abdominal walls.
• Arsenic alb: The mucous stools are not usually offensive; the watery ones are very much so, and often painless.
• Borax: Before stool- peevish, lazy, dissatisfied. After stool- cheerful, contented mood.
• Camphor: is principally useful in the very commencement of diseases of the bowels; later stages, presenting similar symptoms, requiring Verat., Cuprum, etc. “In Camph. Collapse is most prominent; in Verat. Alb.  the evacuations and vomiting; in Cuprum the cramps.” – DUNHAM.
• Carbolic ac: “In an exhaustive diarrhea with very offensive stools, when Carbo veg. and Psorinum do not help, give Carbolic acid.”-C. PEARSON.
• Causticum: Fresh meat causes nausea and water brash; smoked meat agrees.
• Croton tig: The three highly characteristic symptoms- the yellow watery stool, sudden expulsion and aggravation from drink and food, form a trio whose presence will render success certain and brilliant.
• Lycopodium: The “chilliness in the rectum”, before stool, is a singular but genuine symptom, which further observation may prove to be characteristic.
• Mezereum: In cases of chronic diarrhea, with a psoric anamnesis, Mez. will sometimes prove to be the remedy for the whole condition.
• Pulsatilla: “These kinds of nightly diarrhoea are characteristic of Pul., and there is scarcely a drug which occasions them as often.” – HAHNEMANN.
• Phosphorus: The stools are hardly characteristic unless the little grains of tallow should prove to be so.
• It is often well to give a single dose of a high potency of Nux vom. few hours before beginning with Phos., particularly in cases coming from allopathic treatment.
• Podophyllum: There is no remedy so surely indicated by painless cholera morbus as Podoph. The stools are profuse and gushing, each seeming to drain the patient dry, but soon he is full again.  

SOME RUBRICS FROM REPERTORY
Character of stool

1. Colourless, increasingly and watery- Coloc.
2. Expulsion, sputtering, spattering all over the vessel- Natr. S.
3. Fecal, black and hard, first part, last part white as milk- Aescul.
4. Infrequent, long intervals between- Arn.
5. Soap-suds like- Benz. Ac.
6. Tomato sauce like- Apis
7. Undigested, food of previous day- Oleand.
8. White, shining particles like kernels of rice- Cub.
9. 9.      Whey-like- Iod.

Condition of the stool and of the accompanying symptoms
Aggravation

1. Acute diseases after- Carbo v, China., Psor.
2. Alone, when- Stram.
3. Chocolate, after- Bor. Lith c.
4. Cold, becoming when- Coccul.
5. Drastic medicines after- Nux v.
6. Drinks, alcoholic after- Lach.
7. Meat, fresh- Caust.
8. Nephritis during- tereb.
9. News, bad- Gels

Amelioration

1. Drinks cold- Phos
2. Drinks hot- Chel.
3. Milk, hot- Croton tig.
4. Smoking- Coloc.

Accompaniments of the evacuations
Before stool

1. Ill humour- bor., Calc. c
2. Mucous, white discharge of- Kali c.
3. Ptyalism- Fluor. Ac.

During stool

1. Back, chill in- Thromb.
2. Head, fore, cold sweat on- Verat.
3. Head, fore, warm sweat on- Merc.v.
4. Hunger- Aloe
5. Uterus, bearing down pain in- Bell

After stool

1. Chilliness- canth., Grat., Mez.
2. Hunger, canine- Lept., Petrol.
3. Irritation, ill humour- Nitr.ac.
4. Sleep as soon as tenesmus ceases- Colch., Sulp.
5. 5.      Water brash- Caust. 

COMPONENTS OF A TOTALITY

1. Pathological type is considered whether the symptoms correspond to diarrhea, dysentery or cholera.
2. Character of stool regarding colour, smell, consistency etc. is to be taken.
3. Modalities include ailments from, aggravation and ameliorations.
4. Accompanying symptoms before, during and after stool is considered.
5. General accompaniments which are actually the symptoms of the patient help for the final differentiation between the close running remedies. 

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 in this repertory. As the author has included only those remedies of which enough is known either in its stool, or conditions or concomitants to distinguish it from any other remedy.

Moreover the author has not included medicines-

• Whose proving is indefinite. This the author has said in context to a much larger number of medicines given in Allen’s Symptom Register (425) and Kneer’s Repertory of the Guiding Symptoms (159)
• 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. 

CONCLUSION
Though clinical repertories have not been put to their fullest utility, these can be very useful too if the scope and limitations are properly understood and implemented in practice. But while going through this special clinical repertory and its construction we see that the author has well justified its utility and at the same time not compromised with the Hahnemannian principle of totality and individualization. T.F. Allen says “A good clinical repertory is certainly a desideratum that is something always wanted and needed” 

BIBLIOGRAPHY

1. Bell JB. The Homoeopathic Therapeutics of Diarrhoea, Dysentery, Cholera, Cholera morbus, Cholera infantum. 11^th Edition. B. Jain Publishers Pvt. Ltd. New Delhi; 1997.
2. Dudgeon RE. The Lesser Writings of Samuel Hahnemann. 10^th Impression. B. Jain Publishers Pvt. Ltd. New Delhi; 2010.
3. Kent JT. Repertory of the Homoeopathic Materia Medica. Indian Edition. B. Jain Publishers Pvt. Ltd. New Delhi; 2006.
4. Kneer CB. Repertory of Hering’s Guiding Symptoms of our Materia Medica. Augmented and Revised Edition. B. Jain Publishers Pvt. Ltd. New Delhi; 2006.
5. Siju PV. A Reference to Repertories for Homoeopathic Students. 1^st Edition. B. Jain Publishers Pvt. Ltd. New Delhi; 2007.
6. Tiwari SK. Essentials of Repertorization. 4^th Edition. B. Jain Publishers Pvt. Ltd. New Delhi; 2010.
7. www.minimum.com  

Dr. Abhijit Chakma, MD (Hom.)
Senior Research Fellow (H), Clinical Research Unit for Homoeopathy,
¼ Main Road, Colonel Chowmuhani, Krishnanagar, Agartala-799001
E-mail- dr.abhijit24@gmail.com

*Medical Officer (H), Govt. of West Bengal.
**Senior Research Fellow (H), Clinical Research Unit for Homoeopathy, Agartala.
¹This article is originally published by the same authors in Bulletin of The National Institute of Homoeopathy (ISSN 0972-6276) Vol-15 No. 3 July 2012 (Page 106-110).