DR. DIWAN HARISH CHAND

Homoeopathy in Geriatrics by DR. DIWAN HARISH CHAND M.B.B5; L.R.C.P.(EDIN.); D.T.M. * H.(LPool); M.D. Horn.; F.F. Horn. (Loud); F.I.HA; D-HT. (USA.)

Hony. Physician to the President of India President, International Homoeopathic Medical League (Hq. Switzerland), 1979-82 Recipient, Dhanvantari Award-1979 Recipient, Ashwini Kumars Award-1981 Recipient, National Award in Homoeopathy-1984 Recipient, National Citizen's Award-1987 Recipient, Priyadarshini Award-1989 Recipient, Gold Medal of Academia Medico Homeopatica De Barcelona-1990 Chmn. Homoeo. Pharm. Com, G.O.I., 1980-85 Chmn. S. A. C. Research in Homoeo G. O. I., 1980-85 Hony. Adviser in Homoeopathy, Govt, of India, 1980-85.

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Homoeopathic Pharmacy 1, Hanuman Road, New Delhi-110001 (India)

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Published by: National Homoeopathic Pharmacy 1, Hanuman Road, New Delhi-110001 (India)

Dedicated to my parents: Dr. Diwan Jai Chand (1887-1961), my first teacher in Homoeopathy, and Smt. Thakur Devi (1889-1941); & The Senior Citizens of the world.

PREFACE The Organisers of the International Congress of the Liga Medicorum Homoeopathica Interaationalis held in Rome in May 1981 assigned to me the subject of 'Homoeopathy in Geriatrics", which was to be one of the Keynote papers of the Congress. In the process of Reflecting on the subject it exceeded the usual limits of an article and requests were received from many quarters to make it available in a book form and also in languages other than English. Because of numerous preoccupations and other reasons it has taken unduly long to do so. An extensive literature was scanned in the study of this subject from many angles as can be seen in the list appended. Anyone whishing to study some aspect in greater detail can refer to the corresponding sources. The presentation is not meant to be an exhaustive treatise on the subject. In any case according to Steiglitz, "There are no specific diseases of old age. Any illness may occur at any age. But, certain disorders increase in frequency after the peak of maturity". Besides certain illnesses associated with ageing as Cancers, Metabolic disorders (Diabetes mellitus, Gout), some Endocrinal disorders and some others have been completely omitted. Scanning the pages of the repertory would convince Anyone of the great role homoeopathy plays in geriatrics. A compilation from Kent's Final General Repertory has been appended for ready reference. In the different chapters of the book wherever any page number is mentioned it refers to this repertory. The reader will bear in mind that originally it was

PREFACE The Organisers of the International Congress of the Liga Medicorum Homoeopathica Internationalis held in Rome in May 1981 assigned to me the subject of "Homoeopathy in Geriatrics", which was to be one of the Keynote papers of the Congress. In the process of Reflecting on the subject it exceeded the usual limits of an article and requests were received from many quarters to make it available in a book form and also in languages other than English. Because of numerous preoccupations and other reasons it has taken unduly long to do so. An extensive literature was scanned in the study of this subject from many angles as can be seen in the list appended. Anyone whishing to study some aspect in greater detail can refer to the corresponding sources. The presentation is not meant to be an exhaustive treatise on the subject. In any case according to Steiglitz, 'There are no specific diseases of old age. Any illness may occur at any age. But, certain disorders increase in frequency after the peak of maturity". Besides certain illnesses associated with ageing as Cancers, Metabolic disorders (Diabetes mellitus, Gout), some Endocrinal disorders and some others have been completely omitted. Scanning the pages of the repertory would convince Anyone of the great role homoeopathy plays in geriatrics. A compilation from Kent's Final General Repertory has been appended for ready reference. In the different chapters of the book wherever any page number is mentioned it refers to this repertory. The reader will bear in mind that originally it was

written as a lecture supported with numerous slides (diapositives). I am grateful to Dr. Mohit Kundu for preparing part of the repertory study under my direction. I am also indebted to Vaid Bhagwan Das, then Dy. Adviser (Ayurveda) in Ministry of Health and Family Welfare for references on Ayurveda. The book is presented to the profession in the hope that it enables them to help the senior citizens through the benign system of homoeopathy, which is free from side effects or iatrogenesis, to which the aged are particularly prone. DIWANHARISHCHAND National Homoeopathic Centre 1, Hanuman Road New Delhi-110 001, India 3rd July 1991.

CONTENTS Chapter

Page No.

1. 2.

Introduction and Historical Physiological changes with Advancing years

3. 4. 5. 6.

Postponement of Ageing/Prolonging Life Problems of the aged Cardio-vascular system Senile Psychoses and Psycho-Geriatrics

13 16 23 33

7. 8. 9. 10. 11.

Sleep Neurological Disorders Ophthalmological Conditions Ears Respiratory System^

40 42 46 50 52

12. 13. 14. 15. 16. 17.

Digestive System Menopause Sexual problems Urinary problems Joints, Bones and Muscles Old Age Remedies

55 60 66 68 71 74

18. Epilogue Repertory Study References

1 6

76 80 101

CHAPTER I Introduction and Historical A healthy old fellow, Who is not a fool, is the happiest creature living — Sir Richard Steele If wrinkles must he written upon our brows, let them not be written upon the heart; The spirit should not grow old — James Abram Garfield "Vriddhtvam Jarasa Vina" Translation: Ageing Without Senescence — Kalidasa (Circa I cent.B.C.) These three words from the immortal Sanskrit poet, Kalidasa, who lived in the century before the beginning of the Christian era, sums up the aim of gerentology, a study of the Science of ageing.

HISTORICAL In orthodox medicine, Gerentology and Geriatrics, are subjects of comparitively recent study, even though now considerable attention is being given to them. However, in the ancient Ayurvedic system of medicine, developed and practised in India for centuries, great attention has been paid to the problem of the aged. The word "AYURVEDA" itself implies the science of life. In Indian mythology, Dtaanvantari, the God of Medicine, is shown holding a pot, Amrit Kumbha, that I

contains the 'Elixer of Life' which is supposed to prevent untimely death and till then maintain youth. In the daily prayer of the Hindus one of the mantrams (repetitive incantation) is as follows:-

"Jivemah Sharadh Shatam Shrunsiyamah Shasadah Shatam Pashyemah Sharadah Shatam Pravravamah Sharadah Shatam Bhuyashca Sharadah Satah" (Rig Veda) It says not only that one should live for a hundred years but also that one should be in the full possession of one's faculties of mind, of hearing, of sight and of speech. According to the Vedic concept, a full life was constituted of a hundred years and the function of each quarter was clearly mentioned. The latter half of life was to be devoted to increasing activity in spiritualism, a retirement from worldly activity and recluse. Medical historians find that matters connected with ageing were already a subject of special study in the Agnivesa Samhita dated to the 10th Century B.C. It is more elaborately mentioned as one of the eight specialities of Indian medicine in Sushruta Samhita and Charaka Samhita, both dated to the 6th century B.C. The study comprised not only in what is to be done for the medical problems of the aged, but, also gave detailed instructions as to how senility can be prevented as also measures for rejuvenation. One of the methods of Kaya Kalpa (rejuvenation) is Kuti Pravesika, which could be likened to a sort of 2

hibernation for a period of 3 months. The only diet in this period is Amla (Emblica officinalis) prepared in a special way. A double blind clinical study with an Indian medicine. Aswagandha (Withania somnifera) showed an effect of Rasayana (delaying the process of ageing) in a treatment period of one year (Newsletter No. 78 of Central Council of Research in Indian Medicine & Homoeopathy of Govt, of India). Many other medicines and measures are mentioned for this purpose and are under study. William Shakespeare with a deep insight described seven different ages of man thus: .... At first the Infant, Mewling and puking in the nurse's arms; Then the whining School-Boy, With his satchel and shining morning face, creeping Like snail unwillingly to school. And then the Lover, Sighing like furnace, with a woeful ballad made to his Mistress' eyebrow Then a Soldier, Full of strange oaths, and bearded like the pard, Jealous in honour, sudden and quick in quarrel, Seeking the bubble reputation Even in the cannon's mouth. And then the Justice, In fair round belly with good capon lin'd 3

With eyes severe and beard of formal cut, Full of wise saws and modern 'nstances; The sixth age shifts Into the lean and slipper'd pantaloon, With spectacles on nose and pouch on side, His youthful hose, well sav'd a world too wide For his shrunk shank; and his big manly voice, Turning again toward childish treble, pipes And whistles in his sound. Last scene of all, That ends this strange eventful hjstory Is second childishness and mere oblivion; Sans teeth, sans eyes, sans taste, sans everything. — William Shakespeare

the world population of people aged 60 years was 291 millions. This figure is expected to reach 585 millions in the year 2000 AD., i.e. doubling in 30 years." This.has led to the recognition that the aged have problems which are quite distinct from those of the others. When Does Old Age Begin? About a person growing old there's been a lot of chatter; But if a person doesn't mind, Age doesn't really matter. — Agnes W. Thomas

The increasing Importance of Geriatrics

Although ageing begins with conception itself, the first question that very naturally arises is "when does old age begin?" 65 years is an arbitrary demarcation between middle and old dge based on the social legislation of Bismarck, Chancellor of Germany in 1880s. But it is well known that the physiological and chronological period are not identical nor do they run parallel in all men and women. All do not reach their senescence point at a particular fixed age. Therefore, it has little relevance to functioning as general health, mental capacity, psychological or physical endurance or creativity. It is thus not a chronological but a physiological, biological process.

Improved health care, in recent decades, has directly enlarged the once insignificant group of the aged into a major subject of the population.

Some gerontologists further divide this period into Early old age from 65 to 74 years and Advanced Old age at 75 years and above.

"As you like it" Homoeopathy covers not only all the seven ages from the cradle to the grave, but, can cover the extra forty weeks from the moment of beginning of life with impregnation of the ovum. It is likely that it can help in the treatment of the chronic miasms and thus greatly improve or remove inherited tendencies. However, this monograph concerns the last two stages mentioned by Shakespeare.

The single factor that has put gerontology in the forefront is the number of aged in the society. "In 1970 4

5

Chapter II Physiological changes with Advancing years I would very briefly touch on the physiological changes which reflect on the medical problems that we are called upon to treat.

the body after the age of 30 years. It will be seen from the following chart that maximum oxygen uptake, heart rate and maximum pulmonary ventilation during maximal work on a treadmill or ergometer all decrease.

Fig.2 i

The average per cent of various human functional capacities or values remaining at different ages taking 30 years as 100%. Data from Shock N.W. el ai (1957) Geriatrics, 12,40.

Effects of exercise on maximum O2 uptake, heart rate and maximum pulmonary ventilation of men at various ages. All values obtained over a 5- or 6-min. period during maximal work on a treadmill or bicycle ergometer. From Asmussen E. (1958) Handbook of Respiration, ed. Dittmer, D. & Grebe R. Nat. Acad. Sciences, Nat. Research Council, p. 146.

As we see from the figures, there is a steady fall in functional capacity of most of the organs and systems in

It is also seen that progressively there is an increased accumulation of the pigment lipofucsin in the human

6

7

myocardium (Fig.3) This pigment and lysosomes may be related with ageing.

Relationship between age and pigment in the human myocardium from Strehler B.L. et al. (1959) J. Geront. 14,430.

activity.

Renal function decreases steadily with age from maturity onwards. It has been shown that glomerular filteration falls by 46% and renal blood flow by 53% between youth and old age. Because of these physiological changes it is said that likelihood of dying doubles every eight years after 30 (Benjamin Gompertz).

Liver decreases in mass by about 30% between young adulthood and old. There is a falling off in activity of the microsomal enzymes thus reducing the efficiency of metabolic 8

20 30 40 50 60 70 80 90 100 Age (years)

Fig. 4

Gompertz plot of cause-specific human mortality rates. From Strehler B.L. & Mildvam AS. (1960) Science, 132,14. Medawar has expressed succinctly by defining ageing as 'that change of the bodily faculties, sensibili9

ties and energies which renders the individual progressively more likely to die from accidental causes'. THEORIES OF AGEING The exact cause of ageing has been a matter of speculation. Natural ageing may be due to occurrence of gene mutations. According to some, "it is progressive masochism of somatic cells". Some harmful substances produced in course of time decrease the vitality of the organism or its certain organ systems.

nucleoprotein from aged cells inhibits the separation of the two strands in the DNA double helix, an essential step in transcription. A progressive, irreversible loss of genetic information for the cell results, leading to a loss in adaptive capacity and eventually to cell death. There appears some built in code that limits the capacity of the cell to divide only fifty times. (Fig. 5)

Probably no tissue ages completely independently of the rest of the body yet it may not be altogether an omnibus simultaneous cellular phenomenon. Ovary is an exception as mentioned under menopause. Tissues most likely to control ageing are those which have the greatest influence over other cells e.g. the vascular, nervous and endocrine systems. The body's ability to cope with stress, and to control deviations from homeostatic 'set-points' as also the body's ability to cope with infection decrease with age. The most popular theory of ageing is that it is due to mutations in DNA of somatic cells, random in time. Structural events leading to a blocking of the transcription step of protein synthesis in ageing cells are described. Using the methods of thermal denaturation, it is shown that in ageing cells, there are alterations in the bonds between the basic proteins and the DNA within the nucleoprotein. The increased stability of these bonds in 10

Life span of human cells determined by allowing a population to multiply until it has doubled in size. After a culture of cells from embryonic tissue has grown to a particular point, it is divided in two. Cell division ceases after about fifty such subcultivations. It is possible at any time (although it is rare) for a spontaneous change to occur after which the cells multiply indefinitely (broken line). From Hayflick L. (1968) ScL Amer., aig, 3, 32.

Fig. 5

11

In a rare disease, Progeria they divide only a few times and this child shows ageing when 1-2 years old, is an old man by 7-8 years and dies at 11 or 12 years. Therefore, it seems at present that life span of a normal human cell cannot be extended without making it either pathological like a cancer cell or truncated like a germ cell, the sperm or ovum. In 1976, at the Athens Congress I felt full of admiration for our nonagenarian, Dr. Franklin Cookinham, whom we affectionately called Cookie, attending not only the Congress but taking keen interest in the teaching seminar that followed. He being one of the senior-most Homoeopaths then living I asked him how did he keep himself so active and alert. His advice was No. (1) Be your age and No. (2) keep your genitals where they belong. You can draw your own conclusions as to what he meant! Yet it should be remembered that one of the most striking features of age changes is their great variation between individuals and in nature. Life patterns and longevity is dictated by our genes and it has been said that, "The best way to attain old age is to have old parents". Do we have a choice?

Chapter III Postponement of Ageing/Prolonging Life Based on knowledge of cell functioning attempts have been made to postpone the ageing process. Dr. Paul Niehans M.D. of Switzerland injected people with cells taken from lamb embryos, using cells from specific organs like the heart, kidney or liver to treat ailments of same organs in humans. He claimed excellent results and his clientele included Charles de Gaulle and W. Somerset Maugham. This has been called the CELL VITAL THERAPY. CELLULAR THERAPY practiced today is similar to Niehan's original method but more controlled and under better sterile conditions. More recently Dr. Benjamin S. Frank has developed a method of INJECTING RNA into the body of the patient through his diet. TRANSPLANT of organs is another new method to increase life. PLASTIC SURGERY can be used for cosmetic purposes but that cannot alter ageing process except possibly by giving a boost to the sagging spirits of the old! In recent times VITAMIN E and VITAMIN C and MINERAL SELENIUM have been mentioned as a help •in delaying the process of ageing. Of course, the Nobel Laureate Linus Pauling comes out with Vitamin Calmost

12

13

as a panacea for many conditions including Cancer. CHOLINE is known to improve brain function and stimulate memory. THYMOSIA improves body's immune system and thus ward off diseases that threaten life. BIO-ENGINEERING offers a possibility for the future by way of modifications in the genes. A bold attempt is made in a surgical technique called PARABIOSIS. This consists of joining blood circulation of ageing animals with the young. It nas been tried in rats, cockroaches etc. with remarkable regenerative changes in the old. It has been known since 1917 that HYPOTHERMIA can slow down the ageing process.

they can help in the making of Methuselahs. Therefore, all one can do is to ensure that it is a healthier period of life. It is said that death is the genes way of ensuring their own survival. A study of some areas of the globe where there is comparatively more longevity in the population brings out some common features. They are generally an agricultural society with much physical activity, worryfree lives, recreation, moderate eating habits and regular sleep. Fruits are consumed daily. Smoking and alcohol is rare. They continue to lead active sex lives.

The chemists have studied the enzyme systems and protein synthesis in ageing and come out with their contribution to retard it. An equimolecular combination of dihydroergocristine, dihydroergocornine and dihydroergoriptine put up as HYDERGINE is claimed to be useful. However, fantastic these measures may be and perhaps in the future yield positive results but for the moment, we have to agree with those researchers who say that warding off old age is in large part a matter of self image, positive thinking and staying active. EXERCISE is crucial, for exercising an organ presents a strategy for modifying the ageing process. The body is now felt to rust out rather than to wear out. It is certain that no advance in medicine will enable us to escape death through old age. It is even doubtful if 14

15

Chapter IV

Problems of the aged "While the ageing of the population is essentially a simple phenomenon, its consequences are multiple and not always well recognised." (WHO Report 548,1974). They pose many new problems. In the World Business Weekly (July 28, 1980) under the caption "Ageing World Raises Key Policy Issues" it is mentioned that "While it now seems unlikely that the agent of the earth's destruction will be the population explosion feared by Thomas Malthus and his successors, the declining birth rates and ageing population now foreseen will have far reaching political, social and economic consequences." The problems are social and medical. In a survey carried out in the West, the chief problems of the old have been worked out as follows: Financial 72% Boredom 30% Health 29% Social 19% Housing 13% A survey carried out in India found it to be as >llows: Financial 40.88% Lack of occupation 27.35% Health 10.29% Family & future worries 10.88% Dependence & Isolation 7.06% Accommodation 3-52% (Tata Inst. Soc. Sc. No. 27-1972) 16

Though as medical men, our direct concern is with the health problems but these are interlinked with the others and are of considerable significance to the homoeopath to enable him understand the life situation, build a complete psychosomatic picture and make a proper anamnesis. In this connection it is interesting to recall the emphasis by a WHO Committee in that "a decent level of income is a prerequisite for well being...." The financial condition affects social, health, nutrition and psychic state of man. Besides the ageing process itself does not remain merely confined to the biological field alone; it invades psychological, social, occupational and economic fields as well.

SOCIAL PROBLEMS OF THE AGED In addition to what is mentioned elsewhere in this paper I would refer tc a UN study. Its report around 1980 says that, "tr>day 200 million of the world's population are over 65, which is 24 million more than five years ago", and that their numbers in developed countries are growing twice as fast as total population. The philosophies of strongly work-centered and technology-oriented societies, the report says, are already seen by some as "dehumanizing and socially obsolete". In the developed countries, which mostly have a nuclear family, the old have become vulnerable. Their power and prestige is in decline undergoing a radical role-change in the economic, social and family 17

structures. Highly industrialised countries, says the report, are young-oriented, emphasising productivity, competitioi and self-sufficiency. The person whon can no longer work, produce and provide for his own basic needs tends to be relegated to the fringes of society. There comes a generational disequilibrium, a phenomenon called Ageism by Dr. Robert N. Butler. This is a negative or hostile attitude towards an age group different from one's own. In developing countries, which mostly have a joint family system, the report notes the aged still enjoy high esteem, support and power within both family and community. Old age is considered an advantage, bringing rewards of a full life of honour, respect, even reverence from younger generations. The elderly receive economic suppoit and emotional satisfaction from children and grandchildren; they usually assume leadership and hold real economic power. There is comparatively more hold of religion and all religions enjoin respect and honour to the parents and the aged. I have known families in India where all the earnings by the sons and grandsons are handed over to the head of the family who redistributes it according to his own wisdom and considering the needs of the different members. This bears no proportion to the earnings made by them. To give an idea of joint family system as it has been operating in most developing countries with an agricultural economy I will tell you an instance. At one of our Congresses, seeing that the wife of one of the 18

participants from an African country was in an advanced stage of pregnancy, I ventured to ask my colleagues "How many children have you got?" He paused for a moment and then replied, "Why ? I have some 40 or more!" Then looking at my surprise he added "in my country we do not distinguish between the children of all the brothers and we live together like one family". Undoubtedly there are strong kinship ties in rural areas. To highlight the contrast between these social systems, I relate two stories. There is an old story of an eagle which set out to cross the windy sea with his fledgling. The sea was so wide and the wind so strong that the father bird was forced to carry his young one in his claws. When he was half way across, and the wind had turned to a gale, he said, "Oh child, look how I am struggling and risking my life in your behalf. When you are grown up, will you do as much for me and provide for me?' 'Dear father' the eaglet replied, "it is true that you are struggling mightily and risking your life in my behalf, and I shall be wrong not to repay when you are grown old, but at this critical time I cannot bind myself. I can promise this; when I am grown up and have children of my own, I shall do as much for them as you have done for me." Love like water is said to flow downwards and there is an old Chinese proverb of Lin Yutang that says that though it is normal to love one's children, it is only in a cultured society where they care for the old. The above story contrasts with the epical story from India where they have traditionally had the joint family 19

Nervous

system. This story describes the devotion of a young man named Sharvan Kumar who carried his blind parents over his shoulders on a pilgrimage all over the country. It is held out as an example of good and devout progeny. Unfortunately in developing countries with the process of advancing technology, increasing industrialisation, with concomittent urbanisation, with increased migration of the young resulting in weakening of family and traditional ties, their economic struggles and overwhelming consideration for self, the joint family system is crumbling and with it the prestige and power of the older people is declining. What interests us are the impact such changes have in development of disease status. Homoeopathy is the one system of treatment that takes into cognisance, in fact gives it prime importance, the state of the mind. Stress from drastic changes of situation like sudden loss of income, loss of prestige and position in family and society, isolation, death of spouse etc. can all result in emotional, behavioural and physical disorders. MEDICAL PROBLEMS OF THE AGED The findings of a study, the only of its kind carried out in India, are given below. Briefly the incidence of disorders (Complaints and findings) system-wise shows the frequency % as follows: Cardiovascular Gastro-intestinal Urogenital

62.60% 45.25% 32:51% 20

19.77%

Respiratory Lymphatic & Blood Ears and Eyes Orthopaedic Surgical Gynaecological Misc. all systems

19.18% v 11.56% 11.21% 4.78% 5.66% 0.30% 37.29%

Most people get some disability in course of time Careful surveys have shown that even the so called healthy old have a few disorders. The Indian survey more or less corresponds with the results of a Munich (Germany) survey of a million people which are : Male % Hypertension (160/100) 60 Latent cardiac insufficiency 25 Manifest cardiac insufficiency 10 Cardiac infarction 8 Coronary arteriosclerosis 9 Vascular occlusion 8 Varices, thrombosis 10 Pulmonary emphysema 48 Bronchitis 18 Cholelithiasis 4 Cirrhosis of the liver 6 Nephrolithiasis 4 Cystitis, pyelitis 5 Prostatic hypertrophy 24 Prostatic carcinoma 3 Diabetes 10 21

Female% 72 27 13 2 9 6 21 23 11 9 6 3 11 0 11

Gout Osteoarthritis Diagnosis per patient

4 11 4.3

2 18 5.2

Multiplicity of disorders is noted in all such surveys. In the large scale Munich survey you would notice that 4.5 complaints per person above the age of 65 years were registered. This gives an impression that the elderly body is a museum of degenerated systems, some of which may breakdown any time. "Disorders in the aged is pharacterised by multiplicity, chronicity and duplicity." (Zeman). According to Stieglitz: There are no specific diseases of old age. "Any illness may occur at any age. But, certain disorders increase in frequency after the peak of maturity. These disorders, while not limited to senescents, are nevertheless characteristically geriatric." In these disorders are included several vascular problems such as arteriosclerosis (hardening or thickening of the vessels), high blood pressure and heart diseases, cerebral haemorrhage. Included also in the disorders of the later years are several metabolic disorders (chemical transformation), diabetes mellitus, the male and female climacteric (a critical crises occurring at a period of life when vital forces begin to decline), gout, anaemia, obesity, arthritis (inflammation of the joints), and many types of cancer. Also Pneumonia, tuberculosis, nutritional diseases and accidents.

22

Chapter V Cardio-vascular system "A Man is as old as his arteries". This old proverb has a lot of truth in it. In fact the idea has been mooted that the cardiovascular system may be the origin of ageing for the whole body. By starving cells of oxygen and nutrients and leaving them with accumulations of carbon dioxide and other waste products, the resulting environment might bring about ageing. Cardiac output begins to decrease after the third decade, and blood flow to all tissues falls as a consequence. The decrease in resting cardiac output is largely due to decline in stroke volume of about 0.7 per cent/year, but heart rate also falls. The microvascular changes in all parts of the body remain unnoticed for a long time. They are inevitable effects of ageing. Atherosclerosis may arise in part as a consequence of a normal age change in the form of intimal thickening. This might lead to ischaemia, causing loss of lipidmobilizing substances from the vessel wall, with consequent accumulation of lipids including cholesterol. Cholesterol is sclerogenic and the resulting atherosclerosis is a major factor in ischaemic heart disease and cerebro-vascular accident, two leading causes of death in old age. Such vascular changes of an atherosclerotic type now seem an important factor in ageing. Most individuals begin to develop atherosclerosis at an early age, e.g., in their twenties, but it is of minor degree and usually present as a few small plaques in the aorta. The condition increases in severity with age, and 23

affects other vessels e.g. the coronary and cerebral arteries. According to Dr. Paul White, the incidence of coronary and aortic sclerosis is 46 per cent in people in fifties and 84 per cent in the eighties.

Fig. 6 In the incidence of diseases of aged we notice that those of the cardio-vascular system are at the top and out of these the first one is Hypertension followed by Cardiac insufficiency and next is Coronary Thrombosis. (Fig- 6) Dr. Paul White has said, "Heart disease is the epidemic of the century". In the consideration of HYPERTENSION the first question arises as to who is hypertensive? Some of the well known authorities differ much regarding criteria for considering people as hypertensives. One finds Robinson and Brucer (1939) recommending for 120/80 mm Hg. as normal, Ayman (193^ for 140/80, Perera (1948) for 140/90, Bechgaard (i946) for 160/100, .

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Burgess (1948) for 180/100, while Evans (1956) puts the dividing line at 180/110. Arterial pressure is a quality which cannot be strictly either on a physiological or pathological side. There is a gradual transition from the low and safe side to a high and dangerous side of pressures. Pickering (1974) comments on the "absurdity" of classifying subjects into the two different camps, normotensive, and hypertensive by a sharp dividing line of very arbitrary value. The general consensus is that 170/100 is Hypertensive; 140-170/80-100 is Inter-mediate and below 140/80 Normotensive. It has been noticed that hypertension is more in the developed countries. Pickering (1974) puts this to a sociological reason and says, "By far the most likely answer to me would seem to lie between the security of life in the tribe and the insecurity in civilization—which causes arterial pressure to rise with age" Hypertension may be a common finding (in a large gerontology survey in Germany 60% of all males and 72% of all females above the age of 65 were reported to have high pressure (Stormer); in India under 20%) but, it is difficult to blame blood pressure alone for disorders of the old. In effect such rise may be considered physiological rather than pathological as many are led to believe. So diverse are the views regarding mere high systolic pressure that one is tempted to quote Anderson in this connection : "If hypertension is systolic in nature only and it can exist without impairment of function of other organs, it is possibly more conducive to good health in old age, than a low systolic blood pressure." Hypertension per/se is in my experience somewhat 25

difficult to treat, specially if one was looking for quick results only on the basis of lowering of blood pressure reading. Many hypertensives are without symptoms and as such Kent's Repertory does not help, there being no separate rubric for this condition. In the therapeutic index appended to Boericke's Materia Medica only remedies mentioned for Blood pressure—High, are BARYTA MUR., AURDM, VISCUM ALB., and GLONOINE. For Arteriosclerosis there are AM-IOD., PLUMBIOD., POLYG-AVIC, BARYTA, GLONOINE 2X., AURUM, CARDUUS, SUMBUL, and For arterial tension raised: VERAT-VIR.yiSCUM. Other authors group these remedies under Senile Sclerotic Group : ARS., AUR., BAR-CARB., BARMUR., PLUMB., SILICA. Dr. Hubbard mentions that "Plumbum-lead, the metal of Saturn, slows down and holds back the sclerosis." For ATHEROSCLEROSIS the IODIDES OF ARSENIC, AURUM and PLUMBUM, in addition to PLUMBUM MET. For atherosclerosis an American Homoeopath finds much benefit from additional use of VITAMIN E.

hypochondriacal (Comp. Bar-carb.) or suffering from chronic diseases, specially catarrhs. Cough with involuntary emission of urine in old withered looking people. I am sure, you will all agree that in your experience patients have been helped with many other remedies. I feel that the best result would come only by constitutional treatment by using the remedy indicated by the totality of symptoms of the individual patients. If I have been asked to make a pathological prescription on the basis of just high blood pressure I have used AURUM MURIATICUM NATRONATUM 6x, twice or thrice a day with considerable success. The remedies that need to be specially considered in such cases are SULPHUR, LACHESIS, NATRUM MUR., PHOSPHORUS, KALI-PHOS., CALC-CARB., THUJA, CACTUS, DYSENTERY CO. Please don't rush in with Hypotensives and diuretics, which weaken the subjects. And this advice applies especially in Geriatrics. In support of my views I quote from an article on the "Prescribing Problems in the Elderly." (Lancet, Vol. 220, pp. 749-755, May 1978). In regard to the Hypotensives, Dr. Williamson writes :

From a description in Hering's Guiding Symptoms (Vol. I, page 142) I find that ALUMINA should be a very good remedy for the old people. He mentions it for vertigo with atheromata or earthy deposits on the cerebral or cardiac arteries. Also for old people that are

"Every physician who is especially interested in old age will probably agree that he has seen more ill effects than benefits from hypotensives in this age group. The indications for lowering blood pressure in the over seventies are few and it must be realized that systolic pressures over 215 mm. Hg. and diastolic upto 115 mm. Hg. are in themselves not an indication.

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27

Hypotensives should be used : 1.

When congestive cardiac failure is thought to be due wholly or partially to raised pressure.

2.

When high pressures are accompanied by signs of left ventricular strain such as gallop rhythm or orthopnoea."

So eventually we can safely rely on the homoeopathic tenet 'Treat the patient and not the disease." In this case you can say *Treat the patient and not the sphygmomanometer." Before I close a consideration of this subject I must make a reference to YOGA . Some of the SADHANAS (practices) connected with relaxation have proved to be very helpful in lowering high blood pressure. The President of the Cardiology Association of India has found it very effective and uses it extensively. Next to Hypertension comes CARDIAC INSUFFICIENCY with symptoms of Angina, Breathlessness and Cardiac vascular failure. There is a rubric for Angina, in Kent's Repertory (see Appendix). I have used LATRODECTUS MACTANS, SPIGELIA, CACTUS, and NAJA TRIPUDIANS, the Indian Cobra more often. Naja has acted remarkably when the pain extended from praecordium up the neck to the jaw. BARYTA MUR. is another remedy useful for pain chest immediately after eating, with epigastric tenderness, in the aged with cardiovascular changes. The patients have been given ACONITE or ARSENIC ALBUM to keep with them and use during the attack when there is pain and much anxiety. 28

For CONGESTIVE CARDIAC FAILURE there would be a long list of remedies. ARSENIC ALB., CARBO VEG., KALI CARB., DIGITALIS, CRATAEGUS, LACHESIS, SPONGIA, LAURACERASUS, LYCOPUS VIRGINICUS are the ones I may have used more frequently. For the resultant oliguria and pedal oedema I have used ADONIS VERNALISw CONVALLARIA MAJALIS in mother tincture but with these I have not had any remarkable effect. SPARTIUM SCOPORIUM is another insufficiently proved drug used for the same purpose. Some books mention a list of remedies for the SENILE HEART. One such list is : CON., DIG., IOD., OR, PHOS., RHUS, SULPH, CRAT., but I suppose any of the remedies considered for the Cardiovascular system and others may be needed. Dr. Garth Boericke puts ARSENIC IOD. as a constitutional remedy for the senile heart, myocarditis and fatty degeneration. There may be a dilated aorta and irregular pulse is often present. Dr. Otto Leeser, whose scientific approach always commands respect, says, "in general BARYTA CARB. is said to be the best remedy in the senile heart where other remedies seem to act too little. The bradycardia which is present in heart block can furnish a very valuable heart indication for Barium preparations." This is not the occasion to talk about the prevention of cardiovascular disease or the regime of heart patients. The diet and cholesterol content, reduced calorie intake for the obese ("longer the waist line shorter the life line"), abstinence from smoking, regular mild exercise and a 29

regulated life style with adequate relaxation, physical and mental, are all very important and must be taken care of. Now let me get into the field and relate to you two very interesting cases. The first one shows the use of DIGITALIS, which has the outstanding symptom of a very slow pulse. In the symptomatology of Digitalis also appears thready and intermittent pulse, respiration difficult, stops in sleep and the sensation heart would stop beating if she moved (rev. Gels.). The date was 27th March, 1956, time just past 3.00 P.M. I was sent for by a patient 69 years old who had suffered his second major heart attack (coronary thrombosis) 4 days earlier. The reasons for the urgent summons was the fact that he was sinking so rapidly that he wanted to sign his will and some other papers. But this he could not do because the moment, he even slightly raised his head from the pillow, he would have severe vertigo and black-out and turn deathly white. The obvious reason for this was that the blood pressure had fallen to less than 90 systolic as against his usual of 134. The pulse was only 44 / per minute. It was irregular and there were some missed beats. On this basis, the remedy chosen was Digitalis, of which one dose of the thirtieth was administered at 3.15 P.M. The transformation in the condition was rapid and unbelievable and by evening he was more cheerful. The blood pressure started to rise and the pulse was better. A second dose was needed only about 9.00 P.M. This gave him a restful night. One more dose was administered next morning when he tended to slip back slightly. No further medication was needed and from then on, he started to feel quite normal. Two days 30

later, he took the courage to have a shower bath, of which I was informed only later. He said he felt so well that he wanted to be back at his table from which he was restrained only by much persuasion. However, ten days later, on the occasion of Hahnemann Birthday Celebration, he announced a handsome donation for Homoeopathy saying that it had given him a second life. He continued to be actively engaged in his work thereafter and the heart did not fail him again and he eventually died at the age of 74 years in May 1961 of Uraemia and not the heart. The patient I refer to was my father, Dr. Diwan Jai- Chand, who was the first qualified Homoeopath in Northern India. The second case shows the use of CRATAEGUS OXYCANTHA. This is a heart tonic that we have used in the mother tincture in material doses. It is to restore some strength to weak heart muscles. To the highbrow Homoeopath, this may seem a humble remedy but I have found it most useful and if I may say so, I have earned both money and name by its use in a patient I was called to see at Pondicherry (a place about 2500 kms from New Delhi, where I work). In April, 19781 was summoned by A.G., an Italian aged 74 years. In the two months prior to my visit, he had been hospitalised four times with lung infection. This he was getting frequently both because of a weak heart with symptoms of Congestive Cardiac Failure as also a history of Asthma, of which he had periodical attacks. On screening it was found that one lobe of his diaphragm was paralysed. This was considered a doubtful complication of Herpes that he had in 1975. On examination, he had basal crepitations, liver enlarged 31

two fingers, slightly tender, slight oedema on the ankles. This inspite of his being on Lasix (diuretic) and Digoxin. He had been confined to bed in the previous few months. In view of all the complications, I confess to nervousness in treating someone for whom, I had been called from all this distance. The prescription on 6th April, 1978 was Ars. alb. 30/nine powders t.i.d. and this was followed from the fourth day by Crataegus oxy.Q. 8 drops three times daily. The recovery was so rapid that it amazed me as much as the attendants. In 15 days, he was riding a moped and was thus a great advertisement for Homoeopathy. Crataegus oxy. is for hearts just tired out. It has been mentioned that "For that type of common senile myocarditis with a previous history of hypertension and beginning decompensation, Crataegus oxy. is an extremely valuable drug, suitable to cases complaining of extreme weakness, feebleness and often irregular heart action with runs of extra-systoles or slow fibrillation. Crataegus oxy. should be regarded as an intermediary cardiac remedy possessing no toxic effects. It can be given for long periods of time for such senile hearts."

Chapter VI Senile Psychoses and Psycho-geriatrics Mental changes in aged are most common, most certain and most difficult to deal. Very often difficulties and miseries of the old are due to tfreir mind rather than their bodies. "But worse than any loss of limb is the failing mind, which forgets the names of slaves, and cannot recognise the face of the old friend who dined with him last night, nor those of the children whom he has begotton and brought up." (Juvenal, n.d.) Such references to mental disturbances in the aged and to the more dramatic aspects of apoplexy are found in the earliest scientific and literary works. Shakespeare's King Lear has been considered an example of senile dementia, and in Gulliver's Travels there is a famous passage picturing the progressive physical and mental decline in senility. In the background is a complex interplay of social, psychological ?jid physical components. On the social side the probh ms have already been mentioned earlier. Deprived of dignity, responsibility and a feeling of importance in the scheme of things, there results selfdevaluation and self-deterioration. "Seeing themselves as unable, unacceptable, or useless they behave as though they were, though they may be enjoying perfectly good health." (Combs and Snygg—1959). In such instances, there are strong tendencies for the individual to turn inward, to reduce his involvement in the world around him, and to reminisce about and live increasingly in the past. Often his own lack of attention and interest 33

32

helps to account for his poor memory for recent events, and if he feels he is unwanted, it is a short step to becoming irritable and suspicious of others' motives and feelings. It also leads to a sense of hopelessness, apathy and depression. On the physical side the brain function can suffer considerably as a result of infections, malnutrition and poor circulation of blood. The cerebral vascular changes and cerebral senile changes can also account for the mind symptoms of the old. However, the relationship of these cerebral changes to the development of mental disorder and particularly of mental deterioration is still not clearly established. There is a gradual cerebral atrophy in which the brain tissue shrinks, the sulci open up, and the ventricles enlarge. Another change in the brain of these senile patients is the development of senile plaques in the cerebral cortex. This involves the loss of irreplaceable cells. These are seldom seen before the age of 65 but rapidly increase thereafter. Electron microscope studies suggest that senile plaques involve the destruction of dendrites, synapses, axons with the formation of an abnormal protein of an amyloid nature. There is also the appearance of Alzheimer's neurofibrillary changes.

rigid, often tortuous and appear yellow in severe atherosclerosis. Mental confusion in old age can often be accounted for by cerebral arterial changes with resultant cerebral ischaemia. The brain is known to decrease in weight as age advances. After age of 35 years our brain cells die off at the rate of roughly 100,000 a day from an initial total of 10,000 million or so. Brain cells once lost are never replaced. As a result there is decline in memory, reasoning, learning and problem solving. In addition to the defective cerebral cortex it has been shown that in these senile patients the adrenal cortex over-reacts to provocation, which includes that from many allopathic drugs, comparatively innocuous in younger years, with possibilities of seizures, symptoms of Parkinsonism and vascular symptoms of raised blood pressure. This last one by use of antidepressants (monoamine oxidase inhibitors) so frequently prescribed these days. The use of tranquillizers," anticoagulants, oral antidiabetic pills and heart medications can cause confusion.

In bringing about these changes the state of arteries may have a considerable role to play. These get thick,

On the basis of this background develop the mental symptoms of the old people. From mood changes, easy tears, easy laughter, temper tantrums and other behaviour problems; tendency to be resentful and suspicious; forgetful and childish; defective memory, especially for recent events and names and inability to find the right word; and depression to an advanced degree of senile dementia with gross forgetfulness; slow speech; restlessness and agitation; contrariness, malicious resentment, suspicion, dislike of being left

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35

The degenerative brain changes of old age are accompanied by a clinical picture of progressive mental deterioration.

alone, tendency to hoard and delirium and acute confusions. This last state is often associated with vascular pathology and other somatic illnesses. There can be a feeling of boredom and neglect and depression. A state of confusion and disorientation for time, place and persons. Then they may roam about and get lost. A list of remedies that may be more often indicated for SENILE DEMENTIA are:ANAC, AUR-IOD., BAR-AC, BAR-C, CALCPHOS., CALC-C, CON., CROT-H. HEPAR-S., PHOS-AC, PHOS,, SEC, LACH. BARYTA CARB., the classical remedy for many of the symptoms of the aged, has an important role here. It is for great mental and physical weakness in old age. For those that have always been intellectually dull. It has fear, especially of strangers, is suspicious; forgets what was just said, just done, or what he was going to do or get. Childish and foolish behaviour like King Lear. I might as well deal with the other features of Baryta carb. which would indicate as to why it is such an important remedy in old people. It has Cephalalgia of old people, especially old men; Amblyopia by age; Cataract; Asthma in old people; Apoplexy and paralysis. It is for those that catch cold easily and are addicted to excessive use of stimulating drinks. In such persons diminution of sexual desire and great weakness in genital organs and impotence. Jt is one of the remedies for impetigo in the old and it is also a remedy for tumours, more especially fatty tumours. Dysphagia for solids. Paresis of the tongue. 36

For those that are suffering from DEPRESSION the more useful remedy may be found among PLATINA, ARGENTUM NIT., NUX VOMICA, PSORTNUM, LYCOPODIUM, NATRUM MUR. When it is a reactive depression from loss of spouse they respond to the wellknown remedies IGNATTA and NATRUM MUR. and at times AURUM, CAUSTICUM, COCCULUS, especially when the bereavement has been preceded by a protracted period of nursing. NATRUM MUR., of course is for patients who cannot cry, hide their grief and are worse from consolation. LACHESIS is another remedy for depression. I have known of a remarkable recovery in an old man who asked for his breakfast in the evening as he was completely disoriented in time. He remained well thereafter for many years and died in his late eighties from a stroke. Lachesis is also for those that wake out of sleep in a delirious state, or those who undo the clothing or throw it off because they cannot tolerate any constriction round their body. The patient may refuse medicine because of fear of being poisoned. Some of its features have been considered under Menopause. There may be muttering dilirium, feeling of being under superhuman control or religious insanity. For the dilirium patients HYOSCYAMUS may be indicated. Hyoscyamus resembles Lachesis in the muttering delirium, the suspicion and confusion. But Hyoscyamus cases are more frankly maniacal, with a peculiar tendency to strip off their clothes; twitching and jerking; and stupor alternating with excitement. The mania is not as violent as when STRAMONIUM 37

is required but there is a good deal of swearing, singing and sexual talk, which is in distressing contrast with the patient's normal behaviour. LYCOPODIUM is of great value in conditions of mental torpor, with slowness of comprehension, for overworked brains where brain trouble threatens (Dunham), especially old people with forgetfulness of words and syllables. For the depression in old age remedies that may be most suitable would be AUR., KALI PHOS., SELENIUM.

A.M. are confirmatory symptoms. Old people who need CALC-CARB. sometimes become mentally very tired and feel unable to think. The mind revolves round trivialities which seem to compel the attention, and he loses his mental depth. He feels he must be going insane and imagines that others notice his strange behaviour. He talks to himself, and sees faces on closing the eyes to sleep. There is fear of the dark, of insanity, of something terrible going to happen and general timidity. The patient may drift into a state of quiet melancholia.

All these remedies according to indications would do great service in cases of depression where these old people find life not worth living. For the greedy, suspicious, malicious, exhausted, broken down old man you can use ANACARDIUM for all his physical and mental symptoms as they often have the indication of amelioration by eating. The great trio of polychrests SULPHUR, CALCCARB. and LYCO. of course, find a place here, as at any age. Lycopodium has been considered above. The old person needing SULPHUR shows it by a less restrained expression of tendencies which were always present, to untidiness, dirtiness, selfishness and sometimes mildly maniacal behaviour. They are often greedy, careless about table manners, and indifferent to the effect of their behaviour on others. It is a difficult business to get them to take baths. An itchy skin eruption, fibrositic pains, both worse from the warmth of the bed, frequent wakings at nights, and sleeplessness after 4 38

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Chapter VII Sleep For I am weary, and am overwrought. With too much toil, with too much care distraught. And with the iron crown of anguish crowned. Lay thy soft hand upon my brow and cheek, O peaceful sleep! —Henry Wadsworth Longfellow

sleep. Other than insomnia from such specific causes, which need treatment and are dealt with in other sections of this paper, remedies found useful in the sleeplessness of the aged are ACON., BAR-C, COFE, SYPH. Ruddock gives COFFEA CRUDA for the wakefulness of old people in 3rd or 6th potency and finds it the most effectual in producing calm sleep. S YPHILINUM has been lauded as a real bonanza in the sleeplessness of the aged as well as in their depression and rectal difficulties, haemorrhoids, fissures and obstinate constipation. BARYTA GARB, is the only remedy mentioned by Kent. It is also the remedy for those that are drowsy in day and at night and the remedy for those old people that talk in their sleep.

INSOMNIA is one of the most common complaints of the old. It is unfortunate that nature affords old people less and less sleep just at a time when boredom and loneliness lead many to crave more. Sleep is decreased especially in later part of night. It is important to investigate insomnia carefully and to uncover any underlying cause such as dyspnoea, pain, bladder or rectal discomfort, nocturia and anxiety. An important cause is also depression, with early waking and severe sleeplessness. A bedside commode or urine bottle may help in securing more restful nights. An attempt to provide the old person with physical and mental activity by day will help in producing better 40

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Chapter VHI

In\he neurological disorders the PARALYTIC GROUP is the largest. Though a problem of the nervous system it is essentially a result of the changes in the cerebral arteries, so now termed a Cerebro-Vascular Accident.

I have not had occasion to use these three remedies often because by the time the patients have reached me the initial phase is over and it is a problem of the subsequent paralysis. One case is very vivid in my memory because of the very remarkable and very rapid effect of medicine. I was called at mid-night in an emergency to this patient in the vicinity of my house. On arrival I found him completely unconscious, flushed face with considerable warm sweat, slight stertor in his breath and blowing of cheeks with each expiration and on examination I found additionally pinpoint pupils. In a case like that no further analysis was necessary and he was immediately given some doses of OPIUM 200. The attendants said he may have difficulty in swallowing so I told them to put a few tiny globules (of No. 10) on the tongue. I told them to report in the morning but they came only next evening because within a few hours the patient recovered consciousness and was feeling so well that the whole household had been resting after that sleepless night.

Unless the haemorrhage is massive these remedies can do much alongwith ACON., BELL, and NUX VOM.

For the paralysis subsequent to the stroke, homoeopathy has a lot to offer. The only treatment which the other school gives is vitamins. Physiotherapy, by way of passive and active movements, and in some cases electrical stimulation can, of course, be common to all systems. Even though I do not usually prescribe any vitamin but if the patient is already using it and feels somewhat concerned that there may not be any ill effects by stoppage I let them use it. Therefore, they have nothing to lose by the additional treatment that they get from a homoeopath. The most outstanding remedy, of

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The homoeopathic texts still use the word apoplexy in a loose way to describe this entire group though most of the cases, at least most of those cases that survive, are cases of paralyses as a result of cerebral thrombosis. At the time of occurrence of the stroke ARNICA is an extremely useful medicine. Another remedy at that time and sometimes even in cases of haemorrhage is OPIUM.

course, remains CAUSTICUM, although more specifically advised for right-sided paralysis. The remedies as they appear in Kent's Repertory both in the section of extremities and in generalities I need not repeat. Among the other remedies that are more often found useful are PHOSPHORUS, LACHESIS, PLUMBUM. Hughes has made a very pertinent point in recommending PHOSPHORUS "for the premonitory signs as it will not only control the determination of blood to the brain but also do something to retard the advance of brittleness and obstruction of the arteries" i.e., the atherosclerotic process. It is, however, equally useful in the resulting paralysis. Dr. R.N., a retired Civil Surgeon, in his 70s had a stroke and was lying in coma in the hospital for more than two weeks, when I was called to see him. There were not many symptoms to go by except that he was showing the signs of hemiplegia on the left side. He was given PHOSPHORUS 30/8 doses in an ounce of water, a teaspoonful to be administered every 4 hours. After the second dose he opened his eyes, looked around and finding that he was in an Allopathic Hospital called his daughter, who was attending on him, and requested that he be put under homoeopathic treatment and Dr. Harish Chand be sent for. She replied that this had already been done. This consciousness was for a very brief period of about 15 minutes and he lapsed into his former state thereafter. The doses were continued. After about 12 hours he completely regained consciousness and there was no relapse. The Allopathic doctors who were unaware of the Homoeopathic medicine that had been 44

given were jubilant and when he insisted that he must leave the hospital they wanted to persuade him saying that now he was responding to the treatment. However, as a medical man himself he knew that allopathy has nothing to offer in his condition. He had for many years been interested in and been studying homoeopathy. Thereafter he made a rapid and complete recovery from the paralysis and went back to his home town. He kept quite well and I would see him time to time when he would bring other patients for consultation. Some years later I learnt that he died at the age of 86 from some kind of Pneumonia. Dr. K.N.M. in his late fifties consulted me for BELL'S PALSY affecting the left side of his face. He had been a diabetic for some years. Looking in the Repertory the only remedy that appears both for left side facial paralysis and sugar in the urine is CURARE. This is rather unusual and I would not have thought of it unless I referred to the Repertory. Curare 200 single dose was administered with very speedy and complete recovery of the paralysis though no effect on the diabetes. Another neurological condition by ageing (mostly after 50 years) is PARKINSONISM. Remedies are mentioned for it in Kent's Repertory, under Paralysis Agitans (p. 1390), and other texts but I have in general failed to make much headway with these cases. The remedies I have tried most are PLUMBUM, MERCURIUS, ZINCUM and AGARICUS. Agaricus is not in Kent's list but it is a remedy for tremors and I have tried it on the indication of the tremors ceasing in sleep. 45

Chapter IX Ophthalmological Conditions Old men's eyes are like old men's memories: they are strongestior things a long way off. —George Eliot (Mary Ann Evans) There are changes in the lens as we grow so that from the age of forty years reading material has to be held at longer and longer distance because of decreasing accommodation (PRESBYOPIA). This is easily corrected with glasses. A problem that develops later in life is CATARACT and this is far more common in India than in western countries. Though only two remedies are mentioned under the rubric Cataract, senile viz., CARB-AN. and SEC. I feel the Cataract rubric in general (p.236) is to be referred to. In fact in Burnett's series of cases best results followed the use of such constitutional remedies as SULPHUR, SILICA, PHOSPHORUS, CALCAREA CARB. Other remedies found useful were CAUSTICUM, CONTUM and LYCOPODIUM. The Calcareas are the most popular and if I am consulted casually without the opportunity of meeting the patient and taking a proper history I prescribe CALCAREA FLUOR. 6x, a total of 8-9 tabs daily divided in 2-3 doses. This is in accord with recommendation of Dr. Anshutz based on experience of German physicians. Locally, the time honoured succus CINERARIA MARITIMA eye drops have a definite role though it is doubtful if it can reverse the process. It may retard or stop further deterioration in some cases. 46

However, I agree with Burnett that cataract is a constitutional complaint and it is essential to treat the patient and not the cataract. A case is recorded of bilateral cataract having cleared in an octogenerian by use of Silica 1M (Brit. Horn. Jour. 1924-p.63). PULSATILLA, the acute of silica, is mentioned as a remedy if cataract develops in a lady soon after the climacteric. An interesting study on the "Role of CONIUM MACULATUM in the prevention of immature cataract" was presented at the 66th session of the Indian Science Congress in 1979. The abstract of the paper is as follows:"The immature cataract of 43 patients was determined following the examination of lental opacity, defective vision, presence of iris shadow and fundal glow but interrupted by black spots and presence of all the purkinje images. All the patients were divided into different age groups. Conium maculatum (different homoeopathic potencies) was prescribed for different lengths of period and the condition of the immature cataract was reinvestigated following the abovementioned tests, at the interval of one month and continued upto four months. The results at the end of four months showed significant improvement in the condition of immature cataract and the fall of vision was improved remarkably." GLAUCOMA is another eye condition that may have to be tackled in the senior citizens. 47

Some cases of Glaucoma respond well to Homoeopathictreatment. The remedies particularly useful are SPIGELIA ANTHELMIA(specially if the trouble is in the left eye) and PHOSPHORUS. Such cases have, of course, to be kept under close observation and those that do not respond quickly have to be handed over to the surgeon.

of MAGNESIUM CHLORIDE solution gave an increase in the well being and general activity. This would make it almost a measure for rejuvenation of the old.

In my copy of Kent's Repertory I have added more remedies which I got from Dr. Pierre Schmidt, who extracted them from Hering. The complete rubric has : BELL., BRY., CEDR., COLCH., CQLOC, CROT-H., KALI-I, LAC-C, CAMPH., PHOS., PHYS., prun., rhus-t, SPIG., SULPH..

AURUM is for weakness of vision in old people that are corpulent and tired of life.

For DIMNESS OF VISION in old, presumably from senile changes in the retina, the remedy I have used is BARYTA CARB. (Kent's Repertory p.276), the well known remedy for degenerative changes by age.

ARCUS SENILIS : remedies in I & II grade in Kent's Repertory are COCC, COLOC, KALI BICH., MERC, PULS., SULPH. I have not prescribed for the Arcus nor do I think that tne remedies will clear it but may arrest the process. Recently it has been considered somewhat significant as an indication of state of arteries in the body and possibility of coronary thrombosis later. The iridologists call it, the Sodium Ring and I have known some that treat it with tablets of some Magnesium salts. This brings to my mind an interesting reference to Magnesium made by Dr. Otto Lesser. He mentions that according to observations of P. Delbet, a number of old age phenomena were favourably influenced when Magnesium was regularly introduced. Old people become more able to work. Sexual function is stimulated, muscle stiffness is lessened or removed, likewise senile tremor, and pruritus senilis. Studies on the healthy with the use 48

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Chapter X EARS HEARING IMPAIRMENTS increase with age. For this although BARYTA CARB. appears in third grade in the Repertory but I would think of that as the first remedy. The other two remedies in second grade are CICUf A and PETROLEUM. This may not be taken as the total list and other rubrics can be referred to depending on individual symptoms in a patient. Apart from diminished hearing PETROLEUM has dry catarrh and noises; ringing and cracking in ears; and noise unbearable especially when several people are talking together. It is for nerve deafness in old people and in arthritic subjects. Allied to this is TINNITUS AUREUM, an annoying symptom complained of by many old people. In fact if this is too bad it may account for the impairment in hearing. Kent's Repertory has a long list of remedies under Ear, Noises, with many subrubrics but none specifically mentioned for this condition in the aged. Remedies that may be indicated more often are BARYTAS (carb. and mur.) CHIN-SULPH., CHINA, CAUSTICUM, GRAPHITES, PETROLEUM, SULPHUR. If no other remedy is specifically indicated I would try CHININUM SULPH. It has violent ringing, buzzing, and roaring in ears, with deafness. Many of us from the tropics, who suffered with malaria, remember such symptoms being produced by Quinine sulph., widely used upto the forties of this century.

condition frequently found in old people is VERTIGO. This is mostly linked to the changes in the arteries and poorer circulation. If it is due to spondylitis then simple exercises of the neck muscles, and general instructions about the 'low or no pillow', and hard bed, and less bending of the neck.during work would greatly help. In fact, these measures would probably help all advancing in years. The Repertory list for Vertigo in old people (p. 102) is; AMBR., BAR-C, CALC-R, CUPR., RHUST., SIN-N. Here again though not specifically mentioned in the rubric, one of the most useful remedies is CONIUM. Apart from generally helping in the conditions incident to old age, it has very definite symptoms of giddiness in the act of lying down and turning over in bed, feels as if the bed were floating, whirling vertigo on rising; on looking around. The other remedy found very useful in positional vertigo where giddiness occurs for any change of position is BRYONIA. Blackwood mentions it as almost a specific for elderly women that have constipation alongwith much vertigo.

With or without the tinnitus, another troublesome 50

51

Chapter XI Respiratory System The conditions of respiratory system as we have seen account for more than 19% of the diseases of aged in India and if we consider the Munich Survey 66% of the males and 34% of the females had either emphysema or bronchitis. The relative incidence of different respiratory conditions in the Indian Survey are shown in the'following chart

In the weak state of the aged, ACUTE CHESTS (bronchitis and pneumonia) are naturally more serious than in the young. The remedies remain the same right from ACONITE, BELLADONNA and BRYONIA in the initial stages to CARBO VEG. and ANT-TART, in the more serious ones. I need not consider these in any detail or give the indications. The one remedy that J would like to highlight as specially useful here is ANT-TART. It is particularly useful for the old people with threatened paralysis of the lungs. There are sudden and alarming symptoms of suffocation, oppression and short breathing and orthopnoea. There is accumulation of mucus in the chest with coarse and loud rattling. There is much weakness and drowsiness and lack of reaction. The patient is covered with cold sweat. Another remedy that may be of special utility hi the respiratory conditions of the ageing is AMMONIUM CARB. I have helped with it cases of emphysema, as much help as can possibly be rendered considering the pathology in the lung. In the ASTHMA of the old people, there are the usual old age remedies as AMBRA, BARYTA CARB, CONTUM, CARBO VEG. and the remedy useful for it at any age—ARSENIC.

Fig. 8 In this sphere again Homoeopathy has a lot to offer, even though the irreversible changes that have occurred in emphysema may not get cured completely. 52

COUGH can be another troublesome sympu^n. In addition to the remedies mentioned, I may highlight another one and that is SENEGA. This is for Asthenic Bronchitis of old people with difficult raising of tough, profuse mucus and thus there is rattling in the chest (Anttart). A rarely thought of remedy in Bronchitis of old people is PROTEUS. This has been specially empha53

Chapter XII

sised by Dr. Farrington. CARBO VEG., the Homoeopathic corpse reviver, cannot be omitted from the fjeld of geriatrics. It could have been considered in connection with cardio-vascular failure. But whether air hunger is due to the failing heart and poor oxygen delivery system, or to an imperfect oxygenation in the lungs due to pulmonary causes the symptom is equally important. In acute chests there will be marked air hunger referred to above. The patient wants air moving briskly about him and therefore to be fanned. There is cold sweat, with cold bream, coolness of mouth and tongue. But with all the coldness, there may be burning of the chest as from glowing coals. The abdomen may be burning and considerable relief to breathlessness from passing of wind up or down for patients that are collapsed and almost gone. Carbo veg. may still save them and so justifiably carries the reputation: "corpse reviver". It is that indeed. In the early 1940s when I was a medical student, I remember my grandmother, then in her late 70s suffer a pulmonary infarction and being saved by my father with Carbo veg. prescribed on the above symptoms. She survived and lived a number of years thereafter

54

Digestive system

In the DIGESTIVE SYSTEM one of the most common and distressing symptom is CONSTIPATION. Many of the aged lead a sedentary life. This leads to weakened abdominal muscles. The reduced activity also results in reduced massaging of the intestine. Becuase of this reduced motorial activity with age the bowels do not drive the contents further with former efficiency. Therefore, in addition to the medicine some exercise is to be advised. Few extra glasses of water may help in ridding the patient of hard dry stools, The constipation is also made worse by frequent use of drugs, aspirin to tranquillisers, which weaken and interfere with the defaecation " reflex, leading to stagnation. Now the hard faecal masses refuse to move forward in absence of vigorous motorial activity. Such drugs are used by the old for the many other complaints, of aches and pains to insomnia and expression, that they have. 55

Use of laxatives is not the correct approach. Westropp and Williams put it that "many people lead an alternate life of constipation and drug induced diarrhoea." BRYONIA is already mentioned above (under Ears). Another remedy that is not so well proved and therefore not thought of as frequently is HYDRASTIS. Some of the other remedies like ALUMINA, OPIUM, BARYTA CARB., CONIUM, RUTA, etc. would be on the general indications. RUTA is of particular interest. Dr. R.M. le Hunte Cooper mentions it as an organ remedy for the rectum. I have verified his recommendation in cases of Cancer of the rectum with definite benefit and even a few cures. For these cases as suggested by him CARCINOSIN was given as an inter-current remedy (Trans. Int. Horn. Cong. 1927). For constipation alternating with diarrhoea, the most effective remedy can be ANT-CRUD. This remedy seems to suit many of the nutritional and digestive symptoms of the old and those patients would also have the tongue thickly coated white as if a layer of paint has been applied. It also has the rattly chest not uncommon in the aged with chronic bronchitis, whether as a result of smoking or otherwise, and no expulsive power in the lungs. In the Chronic Diarrhoea in o.d men, indicated by the stool and urinary symptoms and a tremulous weakness, CONIUM is to be considered first. For old people with morning diarrhoea, Allen, has 56

recommended PHOSPHORUS and for relaxation of bowels in the aged think of SULPHUR. The indigestion in the old is aggravated by poor mastication because of loss of teeth. The provision of proper dentures may rebeve the dyspepsia and much flatulence. I briefly mention to you about a case that not only had some digestive complaints but the case history would illustrate the multiplicity of disorders in the old and some of the connected social factors. Sir N.R.P. age 80 years, a resident of London, consulted me on January 29,1979. He started by saying that his wife had been ill and he had been nursing her through different ailments till her death in 1976. They had lived together for 49 years and her death was a great shock to him. He was prone to irregular bowel action earlier and would have 2 or 3 stools daily which were, however, not abnormal. In 1976 he suddenly developed constipation. This was the time he had the psychological trauma of his wife's death. Later he developed flatulence and still later pain abdomen off and on, which would be relieved by passing flatus. The skin was very dry and there was itching. A consultant in London had finally put it to emotional factors, that is, his wife's death. All investigations of Gastro-intestinal tract were negative. The stool was never satisfactory and due to much straining he developed a Hernia. 57

He was suffering from Diabetes from 1961 which was kept under control by Diabenese. He was prescribed NUX VOMICA 30/8 powders, one every night. His report on February 7, 1979— "Immediate effect was agreeably surprising and I was thrilled by it. Normal bowel action, normal colour and consistency and less effort as in old days. The flatulence in the afternoon is much better." Prescription S.L.* Report on February 20—"Distinct all round improvement, digestion is improving but could be better." March 2—"Has had to eat many farewell parties and digestion not as good; appetite reduced (because of overeating)". Repeated Nux vomica 30. This was again followed with improvement. On March 29, just before his return home he again complained of slight recurrence of symptoms and was given a single powder of Nux vomica 200 followed by the usual S.L.* This case history highlights a number of factors. Apart from the digestive complaints, he had the dryness of the skin and itching, hernia and diabetes. As already mentioned most of the old people have a multiplicity of complaints. Another significant fact is the change in social status and losing one's spouse and thus a break of companionship resulting in much loneliness and boredom. In fact, the statistics show that after losing one's spouse death occurs sooner than would otherwise be expected. This is particularly so for widowers as compared to widows. Dr. Ghosh has recommended that in ♦S.L. = Saccharum lactis given as placebo. 58

STRANGULATED HERNIA in old people with severe pain try PITUITARY 30 and it may obviate the need for surgery. I have not had such a patient. But, another case of Rai Bahadur B.B. age 72 years, I do remember. He came for some other complaints for which I prescribed NAT-MUR. 200. He also told me he had Bilateral Inguinal Hernia and Diabetes. When he called me again after one month he pointed to the wall where his truss was hung. The hernia had vanished much to his joy and my absolute surprise. Being an enthusiast for homoeopathy he insisted that I report this case in the journal for benefit of others. But that is a drawback in individualisation. No one else would benefit by receiving Nat-mur. for hernia. I had seen this patient some thirty years ago and surely he would have by now passed away. I am only belatedly fulfilling his wish to only highlight the fact that "nothing is impossible with homoeopathy" Spaking of hernias I may mention that I have had very good success in babies, the younger the baby the more successful I have been. The remedy has mostly been CALCAREA CARB. Though medicines are given in our texts the treatment of hernia in adults is quite frustrating.

59

Chapter XIII Menopause

It may be dangerous, or at least impolite, to call a woman old at any age and more so when she may not have completed even 50 years. However, the menopause does represent a "change of life" that occurs with advancing years and as such justifies at least a brief consideration here. Besides the ovary is somewhat of an exception in ageing to a large extent independently of the rest of the body. Although it is a normal physiological process but, like many other changes in the body, is accompanied by symptoms, that are for the most part functional and without organic disease. In fact only about 20% of women go through a symptom-free menopause. The list of symptoms put under post - menopausal syndrome is a long one. Some of these are : hot flushes and sweats; headaches; dizziness; lack of concentration; irritability; loss of libido; body or joint pains or backaches; insomnia; palpitation; and at times emotional turmoil, nervous depression etc. An undue increase in weight is common at this time with all the attendant problems of obesity. In the premenopausal phase, before the menses cease, in addition to some of the above symptoms there may be irregular menses, metrorrhagia or copious bleeding, at times even dangerous floodings. The other school treats these symptoms with some hormone preparations or sedatives but it is now being realised that this is fraught with many dangers. Prolonged use of oestrogens has been implicated as a risk 60

factor in cervical cancer, deep vein thrombosis, cholecystitis etc. The best treatment for the menopause is the deep constitutional remedy covering the totality of the patient's symptoms at that time. Among the more commonly indicated remedies are CALCAREA CARBONICA, LACHESIS, SEPIA, SULPHUR; less frequently APIS, GRAPHITES, PHOSPHORUS and PSORINUM. Dr Hubbard in her special style gives some graphic drug pictures. "LACHESIS is spectacular in the menopause where the neck becomes mottled, the patient has an endless spate of talk, neckbbeads are discarded and fans carried, and unreasoning jealousy and groundless suspicion combine with a powerful, energetic personality to make the home impossible." Hering says it was characteristic of his Lachesis patients that they had never been well since the menopause. Remember that Lachesis has amelioration from discharges and menopause represents the stoppage of a discharge, even though natural. It is the capital remedy for one of the very distressing and common symptom at this time and that is "hot flushes". Apart from the discomfort and nervousness and palpitation that may accompany it, it can at times be very embarrassing also. I recall the wife of a diplomat in India who said that she feels so ashamed when in the middle of a formal party she suddenly feels the flush and with it anxiety and palpitation and then breaks out into a sweat. Lachesis 200 61

in single dose helped her so tremendously that even when she moved to Gabon she sent a fried to fetch the remedy for a recurrence.

Sepia 200 was prescribed: Two powders, one to be taken in evening when she came for consultation, and one at bed time.

I would'go to the extent of saying that unless any other remedy was specifically called for I would use Lachesis. ACID SULPHURIC is the second most used remedy by me for this condition.

Next reported on September 2,1980. Vomiting had stopped. Prolapse continues. I suggested that if she was averse to an operation perhaps she could try out the "the ring pessary". She said that this had been suggested by a gynaecologist but she was hesitant. Sepia 200 was repeated : 3 powders to be taken every half hour.

"The woman needing SEPIA shares the honours, with Lachesis. She is cold, dowdy, indifferent in her house-keeping. Friends and family are too much effort. From passivity she flies into futile rages and makes biting or gross remarks without realizing it." Sepia is frigid and disliking sympathy, can have the yellow saddle across nose and cheeks, which is dependent on hormonal changes. Bearing down is a well known symptom of Sepia, with of without actual prolapse. In some cases stress incontinence. I may relate here a rather unusual recovery with Sepia in a case of procidentia, though not directly connected with menopause. Mrs. M.K.M., age 70 years, was seen on July 22,1980. She was of feeble constitution and had a number of vague complaints which I need not detail here. A distressing condition was procidentia, with some bleeding and discharge from mechanical irritation and not cancer. She had suffered from this for the previous six years. The uterus could not even be pushed in. She also suffered from a tendency to vomiting quite frequently and this could not be explained. Also quite frequently she would have low grade pyrexia. I did not think that much good would come out of treatment, particularly in the prolapse. 62

On October 13,1980, Temperature continues to be normal, digestion better, no vomiting. Prolapse the same but now no bleeding. In the report a month later (November 13, 1980) there was again bleeding. Sepia 200 was repeated. January 2,1981 she reported "50% relief in uterine prolapse." Cn February 3, 1981, "75% improvement" and on March 10, 1981 she said "prolapse completely gone and it does not come down any time." Last report received on April 13, 1981: No recurrence. It may be noted that the last dose of Sepia 200 was given on November 13, 1981 and thereafter she is continuing on placebo as improvement is maintained. "We must never forget that SULPHUR is an amazing remedy for the ageing. Their swollen ankles, varicose veins, spotted dresses and untidy hair, and increasing pre-occupation with themselves, and laziness encroach upon the natural personality." Hardly any remedy surpasses CALCAREA CARB. for the heavy and continuous haemorrhages 63

during the menopause. These women are pale, flabby, relaxed and cold, and reserved. The flow is hot, bright and gushing. At the time of the bleeding I have often used it's acute remedy BELLADONNA. For heavy bleeding, I have found SABINA of great use, especially if it is bright red flow with dark clots. If there is pain it is from the pubis backward to sacrum or vice versa. Protracted haemorrhages at the menopause. In view of its usefulness, I am afraid, I have prescribed it routinely in repeated doses of the 6th potency during the bleeding phase unless some other remedy be specifically indicated. Less often I have used MILLEFOLIUM, FICUS RELIGIOSA and THLASPI B.P. all in mother tincture. Or Belladonna as mentioned above, or IPECAC.

in the Repertory are CALCAREA CARB., PULSATILLA, RHUS TOX., CARBON-SULPH., ARGENTUM NIT. .CHINA, IGNATIA. There are also the depressions arising as a result of use of drugs e.g. remedies for hypertension that contain Reserpine. For a further study of the subject I refer you to an excellent article "Menopausal Depression" by the Psychiatrist Homoeopath, Dr. Frank Bodman (British Horn, Journal - VolXXI No.l; Jan. 1972).

A fairly usual practice with me is to give the indicated constitutional remedy in high potency in the interval between bleedings and one of the haemorrhagic remedies in low potency during the bleeding, to try and moderate it. The peak incidence of DEPRESSION in women is at the stage of the menopause (age 46-50 years) with an incidence of 17 per 1,000. The cases have been divided mto the ENDOGENOUS DEPRESSIONS, for the symptoms of which remedies like LYCOPODIUM, NATRUM MUR., PHOSPHORIC ACID, SEPIA, SILICA, SULPHUR, NUX-VOM., GRAPHITES, LACHESIS and MURIATIC ACID have been worked out from the Kent's Repertory. For the contrasting symptoms of the NEUROTIC or REACTIVE DEPRESSIONS the remedies coming through strongly 64

65

Chapter XIV Sexual problems PA condition that is a cause of considerable worry, especially to the ageing male, is the reducing virility and eventually IMPOTENCE. Although Kent's Repertory does not have a separate rubric for impotency in old age but this is definitely a problem which many old people would complain about. In fact many men, particularly the less educated, would consider old age only by the decline in the sexual prowess. Some of the remedies that may be particularly considered here are: AGN-C, ALUMINA, BAR-C. CON., LYCO., PHOS., PIC-AC, SEL., STRYCH-PHOS. SULPH., THUJ. (Strych-phos. I have included on the experience of Dr.George Royal).

and SELENIUM. For an increase in sexual desire in old women, the remedy is MOSCHUS. Some old men complain of frequent emissions. The remedy especially useful for this is NAT-C.

Dr. Pierce mentions that in sexual weakness and impotency in old age the symptom of involuntary emission, particularly when straining at stool, is a valuable indication for ALUMINA. AGNUS C, is especially useful in those advanced in years who in their youth have carried sexual indulgence to extreme, and who, while physically impotent are mentally as in early life. LYCOPODIUM is another useful and so popular remedy in this sphere. Dr. Nash says that happy results have been obtained by old men who on marrying young wives, have found themselves impotent, the result of age. For an increase in sexual desire in old men who are otherwise impotent the remedies are LYCOPODIUM 66

67

age in men. The residual urine can lead to infection and occurrence of cystitis. Malignancy of the prostate is another condition to be kept in mind.

Chapter XV Urinary problems UROGENITAL

Remedies that have shown particular utility in ENLARGED PROSTATE are CON., BAR-C, THUJA and sometimes DIG. A remedy not so well proved in the rest of its symptomatology but found of great benefit here is SAB AL SERR. I still vividly remember one patient in 68

UTERUS & CERVIX

Fig. 10 Urinary frequency, sudden urge, dribbling, incontinence, difficulty in passing, feeble stream, ineffectual urge and pain are some of the symptoms in the aged, especially in old men. Men far outnumber women in the incidence of urinary symptoms and Enlarged Prostate is the most common condition leading to urinary problems in old

paricular. He was in his seventies and had acute retention for which he had been catheterised once. The following day when he was again in great trouble, his son approached me. The patient received one dose of SAB AL SERR. and was then being driven to the hospital for catheterisation. Half way he asked his son to stop the car and found that he was able to pass urine though not freely. Not being happy with the hospital atmosphere, he asked his son to take him back home. A few more doses and the whole trouble passed and he died some ten years later of Pneumonia but never any recurrence of prostate. The fuller list of remedies useful in this condition appears on page 667 as also in some of the rubrics in the section of Bladder. Anshutz's remedy for enlarged prostate where catheter must be frequently used is SOLEDAGO VIRGAUREA. I ha^e used this with succes in the lower potencies but mostly I tried it only if I failed with Sabal serrulata. He mentions another little known remedy, OXYDENDRON ARBOREUM. The Biochemic prescribers rely on CALCFLUOR. 6x. I have not had any experience with HYDRANGEA ARBORESCENS. In fact I confess that I had not known much about it till I started to write this monograph. It is made out as 'the remedy' for "large prostate and very difficult urination" unless there were clear indications for some other medicine on basis of totality. 5 to 10 drops of the mother tincture given twice daily. These are some of the lesser known and used medicines for Hypertrophy of the Prostate and so 1 have 69

mentioned in some detail. Of course, as chronic remedies in thses cases CON., CAUST., BAR-CARB., PULS., SELEN ., and STAPH, are to be considered. For urging and pain after urinating in patients with enlarged prostate the remedies are STAPH, and SARS. For dribbling and enuresis in addition to the list of better known remedies mentioned in Kent's Repertory other authors have highlighted the use of some lesser known ones. Dr. Blackwood writes about PIPER METHYSTICUM for nocturnal enuresis of the aged and the feeble, dependent on muscular weakness. The same author also mentions about RHUS AROMATICA in urinary incotinence of the aged, in dribbling and nocturnal enuresis. COPAIVA is for ineffectual urging in old women.

Chapter XVI Joints, Bones and Muscles Rheumatism is a common cause of misery and disability in old people. However, I will not consider it here as it also occurs in younger people and the remedies are the same. Nor do I propose to consider the metabolic disorder Gout, which manifests in joint inflammation. OSTEO-ARTHRmS is a dengerative disease of the joints that results as a natural part of ageing and is a common disorder of the old. Although the bone changes may not be reversible but treatment can bring about clinical relief and make them more mobile, possibly by reducing some attendant inflammation. I am reminded of an anecdote: Patient : I've got a pain in my left foot. Doctor : Don't worry. It's just old age. Patient i In that case, why doesn't my right foot hurt-I've had it just as long. RHUS TOX and BRYONIA continue to have a role here as in rheumatism. CALCAREA FLU_OR. is another remedy I have often depended on. At times I have used it in 6x repeated doses and other times in 200c single dose. Indications are somewhat like Rhus tox. to which it is complementary. However, more often deeper acting medicines are needed.

70

CALC-CARB. comes in when the patient is very stiff and rather sluggish generally, with pain aggravated by cold and damp and exertion, like RHUS, which it 71

often complements as the deeper remedy. In such cases also remember TUBERCULINUM BOVINUM, especially when the patient feels every change of weather. CAUSTICUM has modalities opposite to CALC, relief in rain and aggravated from cold dry winds like NUX and KALI CARB. and SEPIA. Dr. Gordon Ross mentions that old age means a loss of elasticity with stiffness- in the joints and wandering pains and kali salts are excellent for this as they have an affinity for connective tissue. "CAUSTICUM and KALI CARB. are sheet anchors for the pains of ...OsteoarthriUs. I would add here two other remedies not often thought of as they do not appear in the books. One is OSTEO-ARTHRITIC NOSODE (O.A.N.) and the other is the bowel nosode SYCOTIC CO. In 1980 at the Mexico Congress I related the case of an Italian lady with much arthritis and osteoporosis so amazingly helped by THUJA prescribed on the basis of a recurrent dream of falling.

There are conditions that may primarily depend on the nervous system or are neuromuscular in their manifestation. Many people in advancing years have a TOTTERING GAIT, not being sure of their balance. CONIUM is an excellent remedy and has the symptoms of difficult gait, trembling, sudden loss of strength while walking, painful stiffness of legs, the well known ascending weakness etc. As age advances the hands do not remain as steady and the handwriting also gets shaky. For such trembling and SENILE TREMORS the remedies are AGARICUS, ALUMINA, AMBRA G., AVENA SAT. CANN-IND., LEDUM PAL., MERC, PHOS., ZINC.

A condition which occurs in the old people as a result of osteoporosis and brittleness of the bones is the frequent fractures. It is said where the young bones, like young twigs, bend the old ones break. For this if there be imperfect callus formation or slow union, then the usual remedies, SYMPHYTUM, CALCAREA CARBONICA and CALCAREA PHOS. wou. J be useful or the indicated constitutional. PHOSPHORUS is reputed to help the stiffness of the aged. 72

i

73

Chapter XVII Old Age Remedies Homoepathy depends on careful individualisation of each case, and almost any remedy in our vast Materia medica might be required on occasion. But, certain troubles are common in the old and I have tried to consider the more usual remedies for them. (See Kent's Final General Repertory p. 1376) If I may list the remedies that are in general more applicable in geriatrics, these are BARYTA CARB., CONILnVL AMBRA GRISEA, FLOURIC ACID, ALUMINA and to these for the frail condition Dr. E. Wright has additionally suggested ARNICA, CRATAEGUS, HYDRASTIS, LYCOPODIUM, OPIUM, SECALE, THUJA. The utility of most of these would be apparent from what has been mentioned in considering die different conditions. Baryta carb., Alumina, Lycopodium, Opium have mosdy been dealt with. Some additional points about CONIUM are inability to sustain any mental effort and a loss of memory. It is an important remedy for enlarged prostate and the symptoms that go with it. It has paralysis well known for its ascending character from the feet up. A problem that also occurs in advancing years is cancer and Conium is a remedy for cancer in various regions. Its use in vertigo has already been referred to. AMBRA GRISEA is a remedy which I have not seen being used as often in geriatrics as the symptoms would suggest. In fact, in compiling the Repertory study for the aged, I was surprised as to the large number of rubrics in which it was appearing. It is there in the sub74

rubrics of old people, in the rubrics of dullness, forgetful, vertigo, headache, asthma, cough, spasmodic cough, emaciation. It has also gouty pain in the joints, cancerous ulcers on the skin and premature old age. It is, therefore, not surprising that it appears in first grade in the rubric of remedies for old people in the section of Generalities. In the Materia Medica, we find loathing of life, despair, desire to be quiet, aversion to talking or laughing, even of others (naturally the youngsters in the family would consider him a 'joy killer'); inability to think or fix attention on what he reads; bad memory; great nervousness and mental weakness. It is for vertigo in old people that are restless, fidgety and nervous. It has nerve deafness where the hearing decreases very rapidly. Elderly emaciated people when abundant eructations accompany cough; it has been found useful for asthma in delicate old people. FLUORIC ACID is another remedy with a reputation for helping the old in some of their symptoms. The patient mistakes right and left, has weakness or loss of memory and depression. Old people that have vertigo on rising from lying, or when walking. It is an important remedy for alopoecia. In the younger age group, I have used it with much benefit for alopoecia areata

75

Chapter XVIII Epilogue

I may conclude by relating a story. It says diat in ancient times, some invaders in our country learnt that there was a spring, drinking the water of which gave immortality. After much search, they were guided by an old hermit to a hidden place. On reaching there, as they were going to drink the water, a feeble voice bade them stop. It came from a very oid man there and when asked the reason for his warning, he said, "look at me, I am infirm and suffering the effects of old age, but as I have drunk from this spring and have immortality, I cannot be relieved of my sufferings by merciful death." He guided them to another place where there was a plant which had the qualities of keeping one perpetually young. When they reached that place, they heard another voice warning them. This was from some people who had partaken of the plant and were now fed up with the turbulence and the struggles of youth. The moral is apparent that each phase of life has its own positive and negative aspects and it is a blessing that any one of them is not overlasting. A similar story is related about Alexander the Greas of having sought the well, the water of which was said to give immortality. On reaching there, he saw ? crow drinking the water and as it was flying off, someone shot an arrow into it. The crow was suffering terribly from the injury, but could not die. Seeing this, Alexander realised his folly. 76

Whether these stories are true or not, they effectively bring home a great moral teaching. Man must develop a philosophy which helps him to accept with grace the changes that occur with the passage of time, so that as he matures in years, he may also mature in his depths. In this way his life will be blessed with equilibirum and equanimity and be imbued with dynamic strength to achieve productive Harmony in his environment. In this way he can embody Hahnemann's idea that man's life be devoted to the "higher purposes of his existence" and also the spiritualistic concept that the aim of life is the realization, in its fullness, of the divine potential which lies within every being. I never had the wisdom of brevity and with increase in age my faculties may have further decreased. I am, therefore, encouraged by what Aldous Huxley writes: "However elegant and memorable, brevity can never, in the nature of things, do justice to all the facts of a complex situation. On such a theme one can be brief only by omission and simplification. Omission and simplification help us to understand but help us, in many cases, to understand the wrong thing; for our comprehension may be only of the abbreviator's neatly formulated notions, not of the vast, ramifying reality from which these notions have been so arbitrarily abstracted. But life is short and information endless; nobody has time for everything. In practice we are generally forced to choose between an unduly brief exposition and no exposition at all. Abbreviation is a necessary evil and the abbreviator's business is to make the best of a job, 77

which, though intrinsically bad, is still better than nothing. He must learn to simplify, but not to the point of falsification. He must learn to concentrate upon the essentials of a situation, but without ignoring too many of reality's qualifying side-issues." Ah, make the most of what we yet may spend, Before we too.into the Dust descend. Dust into Dust, and under Dust to lie, Sans Wine, sans Song, sans Singer, and sans End! — Omar Khayyam.

A REPERTORY STUDY ON SOME OF THE IMPORTANT CONDITIONS IN GERIATRICS A COMPILATION OF RUBRICS EXCLUSIVELY FROM KENT'S FINAL GENERAL REPERTORY EDITED BY DR. PIERRE SCHMIDT AND DR. DIWAN HARISH CHAND

78 79

MIND ABSENT MINDED, old age: Am-c. ANXIETY, health, about: especially during climacteric period: Sil. 38. DULLNESS, old people : Ambr., Bar-e. 49. FORGETFUL, old people, of: Ambr, am-c, bar-c, lye, ph-ac.. 56. INSANITY, climacteric period, during : Aster., lach., puis., sep., ther. 66. MISTAKES, speaking, old age : Am-c. 67. MISTAKES, writing, in, old age : Am-c. 67. MOANING, old age, in : Bar-c. 1. 7.

VERTIGO 102. OLD PEOPLE, in : Ambr, bar-c, calc-p., cupr., rhus-t., sin-n. HEAD 120. HAIR, baldness : Anac, apis, Bar-c, fl-ac graph., hep., lye,phos., sep., sil., zinc 120. HAIR, falling, menopause : Sep. gray, becomes : Ars., graph., hipp., ka//-j, ka'i-n., Lye, op., ph-ac, sec, sil., si 1-ac 137. PAIN, climaxis, during the : Carb-v., croc, glon.. Lach., sang., sep., ther., ust. 144. PAIN, old people, of: Ambr., am-c, iod. EYE 235. CANCER : Aur-m-n., Calc, lye, Phos., sep., sil., thuj. epithelioma: Cund., lach. 81

NOSE

EYE 324. 236.

CANCER, epithelioma, cornea, of: Hep. lids of: Hydr., lach., pliyt., thuj.

lower: Apis,cund.,.thuj. fungus : Bell., Calc, lye, Phos., sep., sil., thuj. medullaris:.Bell., Calc, lye, sil lachrymal glands: Carban. 236. CATARACT : Am-c, am-m, ant-t., apis., arn., bar-c., bell., Calc, Calc-f., calc-p., calc-s., cann-s., carb-an., Caust., chel., chim., chin., colch., con., dig., euph., euphr., hep., \iyos., jab., kali-■iC, kali-s., lac-c, lye, Mag-c, mere, nat-m., nit-ac, op., phos., plb., psor., puis., rhus-t., ruta., sec, seneg., sep., Sil., spig., Sulph., tell., zinc. senile: Carb-an., sec. , 240. GLAUCOMA : Phos., prun., spig., sulph. 247. OPACITY of cornea, arcus senilis : Aeon., ars,, cocc, coloc., kali-bi.,mere, mere-c, mosch., Puis., Sulph., zinc. 269. ULCERATION, lids, malignant: Phyt. VISION 276. DIM, old people : Bare EAR 292. NOISES, Not specifically mentioned for the old but Tinnitus is a frequent problem of the aged.

323.

HEARING IMPARIED, old people : Bar-c, cic, petr. 82

325. 326. 337.

CANCER: Alumn., ars., Aur., aur-m., calc, carb-ac, carb-an., cund., kreos., mere, phyt., sep., sulph. flat, on right side: Euphr. epithelioma; Ars., ars-i., carb-ac, cund., hydr., Kali-s., kreos. CATARRH, old age., of: Alum., am-c, bar-c, eup-per., kali-s., kreos., merc-i-f., pom. CORYZA, aged people: Am-C. EPISTAXIS, climaxis: Arg-n., Lach., sulph., sul-ac

337. old people: Agar., carb-v., ham., Sec, sul-ac. FACE 355.

CANCER: Ars ., aur, carb-an., con., kali-ar,; kalic, kali-i., lach., nit-ac, phos., sil., sulph., zinc, lips: Ars., aur. aur-m., camph., carb-an., caust., cie, cist., clem., Con., cund., kali-chl., kali-s., keros., lach., lye, phos., phyt., sep., sil., sulph. lower: Ant-chl., ars., cist., clem., con., lye, phos., sep., sil.

pressure of pipe: Con., sep., epithelioma: Ars., cic, con., hydr., kali-ar., Kali-s., lach., lap-a.,phos., sep., sil. lips: cic, con., hydr., lap-a., sep. lower: Ars., clem., merei-f., phos., sep., sil. near wing of nose: Aur, nolime tangere on nose: cist., jug-c, phyt., thuj. scirrhus: Carban., sil. 362. DISCOLORATION; red, climaxis, during: Graph, kali-bi., Lach.„lyc, Sul-ac, ter. 83

FACE 377. HEAT; flashes, climaxis. during : Amyl-n., graph., kali-bi., Lach., lye, psor., Sul-ac, ter. 96. ULCERS; lips, cancerous : Ars., aur-m., carb-an., clem., Con., kali-bi., lye., phos., phyt. 398.

415. All. 428.

MOUTH CANCER, Palate : Aur., hydr. Tongue : Alumn, apis., ars., aur., aur-m., benz-ac, calc, carh-an., caust., con., croth., cund., hydr., kali-chl., kali-cy., kali-i., lach., mur-ac, nit-ac, phos., phyt., sep., sil., sulph., thuj. PARALYSIS, tongue : old pebple : Bare. TUMORS malignant: Calc. ULCERS, malignant: Ars., lach., phos.

TEETH 432. 'LOOSENESS of: Alumn., am-c, arn., ars., aur., aur-m., aur-m-n., bar-c, bar-m., bufo, bry., ~alc, camph., Carb-an., carb-s., Carb-v., Caust., cham., chel., chin., cocc, com., con., crot-h., dros., elaps, gels., gran., hep., Hyos., ign., iod., cali-bi., kali-c, kali-n., kali-p., kali-c, lach., lye, mag-c, mag-s., Merc, Merc-c., mur-ac, naja., nat-a., nat-c, nat-h., nat-m., nat-p., nat-s., Nit-ac., mux-m., nux-v., olnd., op., ph-ac, phos., phyt., plan., plb., psor., puis., rhod., rhus-t., sang., sec, sep., Sil., spong., stann., staph., sulph., thuj., verat., Zinc. 84

433.

PAIN, toothache in general: Acet-ac, Aeon., agar., ail., all-c, alum., ambr., am-c, am-m., anac, anag., ang., ant-c, ant-t., apis, aran., argm., arg-n., arn., ars., ars-h., ars-i., asar., asc-t., aspar., aur., aur-m., bar-c, bar-m., Bell., berb., behz-ac, bism., bor., bov., Bry., bufo, calad., calc, calc-fl., calc-p., canth., carb-ac, carb-an., carb-s., carb-v., caust', Cham., chel., chen., Chin., chin-a., clem., cocc, coch., Coff., colch., coloc, con., cor-r., croc, cycl., dios., dros., dulc, echi, euph.,ferr., ferr-i., ferr-p.,yZ-ac, Glon., graph., grat., guaj., guare., hell., Hep., hyos., hyper., ign., iod., ip., kali-c, kali-i., kali-n., kalip., kali-s., kalm., kreos., Lach., laur., led., lob., lye, mag-c, mag-m., mag-p., mag-s., mag-arct., mag-aust., mang., Merc, merc-c, merl., mez., mur-ac, nat-a., Nat-c, nat-m., nat-p., nat-s., nice, nit-ac, nux-m., hux-v., olnd., par., petr., ph-ac, phos., phyt., plat., plan., plb., prun., puis., ran-s., raph., rat., rheum, Rhod., rhus-t., ruta, sabad., sars., sel., seneg., Sep., sil., spig., spong., squil., Staph., stront., stry., sulph., sulac, tab., tarax., tarent., teucr., ther., thuj., valer., verat., verb., vine, Zinc. Subrubrics of Toothache p. 433-446. THROAT-INTERNAL 448. CANCEROUS : Carb-an., led., tarent. 467. SPASMS, Oesophagus : old people.can only swallow liquids : Bar-c. 85

STOMACH 482. CANCER: Acet-ac, Ars., ars-i, bar-c, bell., Bism., cadm., caps., Carb-ac, Carb-an., carb-v., Con., crot-h., Cund., hydr., iris., krcos., lach., Lye, merc-c, mez., nux-v., Phos., plat:, sep., sil., staph., sulph. 488. EMPTINESS; climacteric period : Crot-h., lach., tab 503. INDIGESTION, old people : Chin-s. ABDOMEN 548. FLATULENCE, aged people : Carb-ac. phos.

606. 607.

RECTUM CANCER : Alum, nit-ac, rata, sep., CONSTIPATION; alternating with diarrhoea; aged people, in: Ant-c, bry., nux-v., op.,pJios.

608. CONSTIPATION, old people : Aloe, alum., alumn, ant-c, bar-c bry., calc-p., con., lach., nux-v., op., phos., phyt., rhus-t., rata, sulph., 610. DIARRHOEA, aged people : Ant-c, Ars., ars-i., carb-v., coil, con., fl-ac, Gamb., iod., kreos., rm-s., Nit-ac, nux-v., op., phos., sec, sulph. prematurely, with syphilitic mercurial dyscrasia: Fl-ac. women : Kreos., nat-s.,

86

RECTUM 611. DIARRHOEA, climaxis, during: Lach., sulph. URINARY ORGANS BLADDER 645. CATARRH, old people, in : Alumn., carb-v., sulph., tereb. 650.

PARALYSIS, old people, in : Ars., cann-s., cic, con., equis,, gels., kali-p., sec, thuj. 651. RETENTION, enlarged prostate, from: Apis, bell., benz-ac, cact., canth., chim., con., Dig., ferr., hyos., kali-i., merc-d., pareir., puis., sep., Staph., stram. 651. RETENTION, old men: Sol-v. 654. URGING, ineffectual, old women: Cop. 656. URINATION, dribbling; enlarged prostate, with: Aloe, arn., bar-c, bell., cop., dig., mur-ac, nux-v., pareir., petr., puis., sabad., sel., sep., staph. 658. URINATION, frequent; old people: Bar-c. 660. URINATION, involuntary; old people, in: All-c, aloe, apis, ars., aur-m., cann-s., cic, gels., iod., kali-p., phos., sec, thuj.

667.

668.

PROSTATE GLAND ENLARGEMENT, senile: Aloe, Bar-c, benz-ac, con., Dig., iod., nux-v., sabal., Sel., staph., sulph. % PAIN; cancer, in: Crot-h.

87

URETHRA 674. PAIN; burning in female urethra during climaxis: Berb. URINE 692. SUGAR : Acet-ac, all-s., alumn., am-c, amyl-n., arg-m., ars., benz-ac, Bov., calc, calc-p., camph., carb-ac, carb-v., chel., chin., chin-a., coff., colch., conv., cupr., cur., claps, ferr-m., Helon., hep,, iris., kali-chl., kali-n., kali-p., kreos., lac-d., lack., lac-ac, lee, lith., Lye, Lye, lycps., lyss., mag-s., med., mosch., morph., nat-s., nit-ac, op., petr., Ph-ac, Phos. pic-ac.„plb., podo., sil., sulph., sul-ac, Tarent., Ten, thuj., Uran., zinc. 693.

GENITALIA—MALE CANCER: Ars., bell., carb-an., Con., phos., phyt., sit, spong., thuj. Scrotum (epithelioma): Carb- an., ph-ac, scirrhus: Carb-an. Testes: Spong

695. ERECTIONS; frequent; old man, in an : Caust. incomplete : Agar., Agn., arg-n., ars., ars-i., bar-c, calad., calc, comph., caust., Qhin-a., cob., coc-c, Con., ferr-p., form., Graph., hep., ign., iod., kali-ar., kali-i., lach., lyss Lye, mang., mere, merc-cy., mur-ae, nat-a., nat-c, nat-m., nat-p., nuph., nux-m., nux-v., petr., ph-ac, phos., rhod., sars., sel., Sep., Sulph., tarent., ther. 88

GENITALIA - MALE 696. ERECTIONS wanting : (impotency): Agar., Agn., alum., am-c, ant-c, arg-m., arg-n., ars., ars-i., aur., aur-s., Bar-e, bor., bufo., Calad., Calc, Calc-s., camph., cann-s., caps., carbs., caust., Chin., chin-s., cob., coc-c, coch., coff., coloc, Con., Corn., crot-t., dig., dios., dulc, elaps., eug.,/err., ferr-i., fl-ac, gels., graph., ham., hell., helon., hyos., ign., iod., kali-br., kali-c, kali-p., kali-s., kreos., lach. lee., Lye, mag-c, Med., mere, mosch., mur-ac, nat-c, natm., nat-p., nit-ac, nuph., nux-m., Nux-v.,onos., op., ph-ac, Phos., phyt., plb., psor., puis., rhod., sabad., Sel., Sep., sil., spong., stann., staph., stram., Sulph., sumb., tab., teucr., ther., thuj., tus-p., uran., ust. 699.

INDURATION; penis ; in an old man : Berb.

710.

SEMINAL emissions; frequent; in an old man : Bar-c, caust., nat-c.

711.

SEXUAL PASSION increased ; old man, in an : Fl-ac, staph., sulph.

GENITALIA-FEMALE 715. ATROPHY, ovaries : Apis, bar-m., carb-s., con., helon., Iod., plb. 715.

CANCER of ovaries : Ars., con., graph., kreos., lach., psor. 89

715

717. 718. 724.

725.

GENITALIA-FEMALE CANCER; Uterus : Alum., alumn., anan., apis, arg-m., arg-n., Ars., Ars-i., aur., aur-m-n., brom., bufo., catc, carb-dn., carb-s., carb-v.,chin., cic, clem. Con., crot-h., cund., elaps., Graph., Hydr., iod., kaliar., Kreos., Lach., lap-a., Lye, mag-m., mere, merc-if., Murx., nat-c, nat-m., nit-ac, Phos., phyt., plat., rhus-t., sabin., sang., sec, Sep., Sil., staph., sulph., tarent., Thuj., zinc. Vagina: Kreos. DESIRE, increased, old women : Mosch. EXCORIATION , aged women : Merc. MENOPAUSE : Agar., aloe., apis., arg-n., bry., bar-c, calc, chin, cimic, cocc, coff., con., roc, Crot-c, crot-h., cycl, gels., glon., Graph., helon., hydr., ign., kali-bi., Lach., Mang., mosch., nit-ac, murx., phos., Psor., puis., sang., sei, Sep., Sulph., sul-ac, tab., ten, ther., ust., verat., xan. MENSES; copious; aged women : Lach., plat. menopause, durine : Bov., cimic, croc, helon., lach., laur.,
90

727. 728.

729.

GENITALIA-FEMALE MENSES; painful; climaxis, near : Psor MENSES; return after having ceased, the periods, old women, in an : Calc, lach. magc, mag-m., plat., sep., staph. METRORRHAGIA; aged women, in : Calc, cham., hydr., ign., lach., mang., mere, phos., sep. LARYNX AND TRACHEA

746 746

CANCER y larynx : Ars., nit-ac, phos., sang., thuj. CATARRH, old people, in : Ammc, ant-t., ars., Bar-c, hydr., Seneg. RESPIRATION

ASTHMATIC, old people, in : Ambr., Ars., bar-c, carb-v., con., phel., sulph. 771. DIFFICULT, old people : Bar-c, chin., seneg. 775. RATTLING old people : Ammc, bar-c, Hippoz., kali-bi., lye, seneg. 765

COUGH 798. OLD people : Alum., alumn., ambr., ammc, am-c, ant-c, ant-t., bar-c, camph., con., hydr., hyos., ip., kreos., psor., seneg. morning, chronic : Alumn. night: Hyos. winter: Kreos., psor 801. RATTLING, old people Ammc, Hippoz., kali-bi., seneg. .805. SPASMODIC, aged people :Ambr.,ip. 811. WINTER, old people.: Am-c, kreos. 91

EXPECTORATION 814 COPIOUS, old people : Ammc, ant-t. ars., Bar-c 815. DIFFICULT, aged people : Ammc. 817. MUCOUS, aged people : Ammc. CHEST 822. ANGINA pectoris : Acet-ac, aeon., Am-c, aml-m., anac, ang., Apis., Arg-n., Arn., Ars., Aur., Aurm., Cact., caust., cliel., Chin-a., chins, chr-ac, cimic., coca, cupr., cupr-ar., dig., dios., hep., ip., jug-c, kali-c, kali-p., kalm., lack, lact., Latm., laur., lye. mag-p., mosch., Naja., nwc-v.. Ox-ac, petr.; Phos., Phyt., Rhust-t., samb., sep., Spig., Spong., stram., tab., tarent., ther., verat. 824. CANCER, axilla : Aster. Clavicles, funges haematodes : Sep. Mammae : Alumn., apis., arg-n., arn., ars., ars-i., as-ter., aur-a., aur-m-n., bad., bell., bell-p., brom., bry., Bufo, calc, carb-ac, carb-an., carbs., carb-v., caust., cham., chim., cist., clem., coloc, Con., cund., feir-i., Graph., hep., hydr., kali-c, kreos., lach., lye, Merc, merc-i.f., nit-ac, ol-ar... ox-ac, phos., phyt., psor., puis., sang., sep., Sil, sulph., thuj., tub. nightly pains : Aster cicatrices, in old : Graph. contusion, from : Dell-p., con.

CHEST 824. CANCER; Mammas' epithelionla : Arg-n., ars., ars-i., brom., Bufo., calc, calc-p., clem., Con.fiydr., kreos., lach., mere, merc-i-f., phos., phyt., sep., sil., sulph., thuj. 824- CATARRH, alternating with diarrhoea, old people : Ammc, ant-t., Bar-c, chin., nat-s., phel., Seneg., tub. 825. CONGESTION, climaxis, at; Arg-n., Lach. 829. EMPHYSEMA : Am-c, Ant-a., Ant-t., ars., bell., brom., camph., carb-s,, carb-v., chlor., cupr., cur., dig., dros., Hep., ip., lac-d., Lach., Lob., mere., nat-m., nit-ac, op., phel., phos., sars. seneg., sep., sulph., ter. 835. INFLAMMATION Jbronchial tubes (bronchitis) aged people : Am-c, camph., ca^b-v, dros., Hippoz., hydr., lye, nux-v. 836. Lungs; aged persons : Bry., dig., ferr-., hyos., nat-s., nit-ac, nux-v., op., seneg. Pleura : old people : Nit-ac 846. PAIN ; mammae; under, left: climacteric, during : Cimic. 874. PALPITATION; heart; climacteric period: Crot-h. Lach., tab. 879. PHTHISIS pulmonalis; old people : Nat-s. BACK 949. TUMORS, malignant: Calc-p. 93

92

EXTREMITIES ARTHRITIC nodosities : Abrot, agn, ante, Apis, am., aur., Benz-ac, bry., Calc, Calc-f., calc-p., calc-s., carb-an., caust., cic, clem., colch., dig., elaps., fago., form., graph., guaj., hep., iod., kali-i, kali-s., Led., Lith., Lye, mang., meny., mere., nat-m., nux- v., p\b., puis., ran-b., rhod., rhus-t., sabin., 5/7., staph., sulph., sul-ac, urt-u. 959. COLDNESS; hand ; old people : Bar-c. 1009, GANGRENE ; Toes; senile : Carb-an., carb-v., cupr., ph-ac, Sec. 1047. PAIN; joints, gouty; Abrot., agar., Agn., alum., ambr., am-c, am-m., anac, anag., ant-c, apis., Arg-m,Arn., ars., ars-h., ars-L, asaf., asar., aur., bapt., bar-c.,,Bell benz-ac, bism., bor., bov., Bry., bufo., Calc, Calc-p., Calc-S., canth., carb-an., carb-s., carb-v., Caust, cham., chel., chim., chin., chin-a., cinnb., cocc, Colch., coloc, dros., dulc, eup-per., jerr., ferrar., ferr-i., krc-p.,form ., graph., guaj., hell., hep., hyos., ign., iod., kali-ar., Kali-c, kali-i., kali-n., kali-p., kalm., laur., Led., Lye, Mag-c, mag-m., mang., meny., Merc, mez. nat-a., natc, nat-m., nat-p., nat-s., nit-ac, nux-m., Nux-v., ol-j., petr., ph-ac, phos., phyt., plb., Psor., puis., ran-b., ran-s., rhod., Rhus-t. ruta. Sabin., sal-ac., samb., sang., sars., sec, Sep., 5/7., spig., Spong., squil., stann., Staph., strain., stront., Sulph., sul-ac, tarax., thuj., valler., verat., verb., viol-o., viol-t., zinc.

EXTREMITIES

952.

94

1097. PAIN; burning; foot; climacteric : Sang. 1176. PARALYSIS (also see p. 1390); apoplexy, after: Alum., anac, apis., bar-c, cadm., caust., cocc, crot-c, crot-h., cupr., gels., Lach., laur., nux-v., Op., phos., plb., sec, stann., stram., zinc. hemiplegia : Aeon., alum., anac, apis, arg-n., ars., bapt., bar-m., both., cadm., Caust., cocc, coc-c, cop., elaps, graph., hyos., kali-c kali-i., kali-p., lach., mur-ac, nat-c, ph-ac, phos., plb., Rhus-t., sars., stann., staph., stront., sul-ac, tab . thuj. old people : Bur-c, con., kali-c 1220. ULCERS ; varicose : Merc-c 1221. ULCERS; lower limbs; varicose : Aesc, carb-v., card-m., graph., ham., hydr-ac, kali-s., nat-m., syph. SLEEP 1254. SLEEPLESSNESS, old people : Bar-c FEVER 1288. INTERMITTMENT old people, with coma : Alum., nux-m. op. SKIN 1306. DISCOLORATION; dark spots in old people : Ars., aur., bar-c, carb-an, con., lach., lye, op., sec 1307. SPOTS; death spots in old people : Ars., aur., bar-c, con., lach., lye, op., sec 95

SKIN 1323. ERYSIPELAS , old people : Ani-c. 1325. GANGRENE, senile : Carb-v., Sec. 1328. ITCHING, old people : Mez. 1330. PURPURA haemorrhagica senilis : Ars., bar-C, bry., con., lack., op., rhus-t., Sec, sulac. 1334. ULCERS ; cancerous : Ambr., anthr., ant-c, apis., Ars., ars-i., aur., bell., Bufo., calc, calc-s., carb-ac, carbon., carb-s., carb-v., caust., chel., clem., con., crot-c, cund., dulc, graph., Hep., hippoz., hydr., kali-ar., kali-c, kali-i., kreos., lack., Lye, lyss., mang., mere, mur-ac, nitac, petr., ph-ac, phos., phyt., rhus-t., rumx., sars., sep., Sil., spong., squil., staph., Sulph., thuj. 1337. ULCERS; sarcomatous : Ant-c, apis., ars., Hep., kreos. mere, Nit-ac, phos., sabin., Sulph., thuj, GENERALITIES 1345. ATHEROMA (see TUMORS - p. 1409) 1346. CANCEROUS affections : Acet-ac, alum., alumn., apis., ambr., Ars., ars-i., aster., aur., aur-m., bism., Brom., bufo., cadm., calc, calc-s., carbac, Carb-an., carb-s., carb-v., caust., cist., clem., Con., cupr., dulc, graph., hep., hydr., kali-ar., kali-bi., kalis., kreos.. lack, lap-a., Lye, mere, merc-i-f., nat-m., Nit-ac, ph-ac, Phos., Phyt., sep., Sil., sulph., sul-ac, thuj., zinc. 96

GENERALITIES 1346 CANCEROUS affections: encephaloma : Acet-ac, ars.. ars-i.. calc, carbac, carb-an., caust., kali-i., keros, lach., nitac, Phos., sil., sulph., thuj. epithelioma : Acet-ac, arg-m., arg-n., ars., Ars-i., aur., bell., brom., calc, calc-p., clem., Con., hydr., kali-s., kreos., Lye, mere, phos., phyt., ran-b., sep., sil., sulph., thuj. glands : Aur-m., Carb-an., Con. melanotic; Arg-n., card-m., lach., ph-ac. scirrhus : Alum., arg-m., ars., aster., calc-s., Carb-an., carb-s., carb-v., Con., graph., hydr., lap-a., phos., phyt., sep., Sil, staph., sulph. 1352. CONVULSIONS; apoplectic : Bell., crot-h., cupr., lach., nux-v., stram. 1352. cerebral softening : Caust. 1358. EMACIATION; old people : Ambr., Bar-e, lod., Lye., sec, sel. 1376. OBESITY ; old people : Kali-c. 1376. OLD age, premature : Agn., ambr., bar-c, bufo., kali-c, lye, Sel. •people : Aeon., agar., aloe.,'alumn., Ambr., am-c, ammc, anac, ant-c, antWars., Aur., Bar-c., bry., catc-p., camph., carb-an., carb-v., caust., cic, Coca, colch., con.,fl-ac, iod., Kali-e, Lye, nat-m, nit-ac, Op., sabad., See, Sel., stneg., sulph., sul-ac, te.ucr.

97

GENERALITIES 1390. PARALYSIS agitans : Bar-c, bufo, gels., helo., hyos., kali-br., mag-p., Merc, phos., plb., Rhus-t., tab., tarent., Zinc. one-sided (also see p. 1176): Aeon., agar., alum., apis., am-m., anac, arg-m., arg-n., arn., asar., bapt., bar-c, bar-m., bell., bov., cadm., calc, carb-s., carb-v., caust., chel., chin., co'cc, coc-c, colch., cop., cycl., dig., dulc, elaps., graph., ,guaj., hell., hep., hyos., ign., kali-c, kali-i., kali-p., lach., laur., led., lye, mere, mez., mur-ac, nat-c, nat-m., nit-ac, nux-v., olnd., op., ox-ac., petr., ph-ac, phos., plb., podo., rhod., rhust., sabin., sars., sep., spig., stann., staph., stram., stront., sul-ac, syph., tarax., thuj., zinc. right: Apis, arn., bell., calc, canih., Caust. cotcn., crot-h., elaps., graph., kali-i., nat-c, op., rhus-t., sil., stront. left: Anac. apis., arg-n., am., ars., bapt., bar-m., bell., brom., cocc, elaps., gels., hydr-ac, Lach., nit-ac, Nuxv., ox-ac, petr., podo., Rhus-t.- stann.-, stram., sulph.

GENERALITIES 1402. SLOW repair of broken bones : Asaf, Calc, Calcp., ferr., lye, mere, mez., nit-ae, ph-ac, phos., puis., ruta., sep., sil., staph sulph., symph. 1409. TUMORS, atheroma : Bar-c 1410. ULCERS, cancerous : Arn., Ars., ars-i.,aur., bell., Bufo., calc, carb-an., carb-v., caust., clem., Con., cupr., dulc, hep., kali-c, kreos., lye, mere, merc-i-f., nitac, ph-ac, phos., rhus-t., sep., sil., squil., Sulph., sul-ac, zinc. 1410. VARICOSE veins: Alumn.Kambr., ant-t., Arn., arg-n., ars., asaf., bell., berb., Calc, calefy calc-p., carb-an., Carb-v., caust., clem., coloc, trot-h.,ferr., ferrar., Fl-ac, graph., Ham., hep., kreos., lach., lye, Lycps., mag-c, mill., nat-m., nux-v., peon., plb., Puis., sabin., sep., sil., spig., sulph., sul-ac, thuj., vip., zinc. 1418. WEAKNESS, old people : Ambr., aur., Bar-c, con., cur., nux-m., op., phos., sec, sel., sul-ac

apoplexy, after: Anac, arn., bar-c, bell., con., lach., laur., nux-v., Phos,, .tann.,stram., zinc.

98

99

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