- Email: [email protected]
Iscador therapy of lymphogranulomatosis
Iscador therapy of lymphogranulomatosis D R . M~D. R I T A
LEROI
DESCRIPTION OF THE DISEASE Lymphogrannlomatosis (Hodgkin's disease) is a strange and inexplicable condition. Today, 140 years after the syndrome was first described b y Thomas Hodgkin, opinion as to its nature is still uncertain, with the following suggestions put forward: chronic inflammation due to infection, similar to TB systemic disease as in lenkaemia malignoma of the R E S following degeneration Lymphogrannlomatosis does in fact show some of the characteristics of all three conditions, both in its clinical progress and in the pathological changes to be seen on histological examination. Hodgkin's disease shows considerable variation from case to case. I t has only been observed in h u m a n beings so far, never in animals. The disease will often start at an early age (between the ages of 20 and 40), and tends to affect a certain type of patient: well proportioned in form, often fair-haired people with fine skin and a rosy complexion. A lively, active interest in the world around them combines with an unusual degree of sensitivity towards external and internal influences, physically expressed in a certain instability of the autonomic system. Too much under the impression of events, these patients often lack the power of resolution to carry through decisions. Patients will often develop the disease around the age of 21, when personality should develop and prove itself in the face of the world. Men contract the disease more frequently, and generally the prognosis is poorer for them. I n the f a m i l y history, a high incidence of tuberculosis (up to 50 %), malignant, tumours and diabetes is of interest. Frequently several members of a family develop Hodgkin's disease. The patient's history is not as uneventful as t h a t of a cancer patient tends to be, on the contrary, m a n y of the childhood diseases m a y be found, and frequent diseases of the upper respiratory tract. Often a small hyperthyroid, goitre is present. Usually the disease starts with enlargement of the cervical lymph nodes, apparently non-specific, with the patient still looking very well. Gradually the lymph nodes grow larger, forming conglomerations, moving on down to other lymph glands (mediastinai, axillary, abdominal, inguinal), and finally involving also the internal organs and bones. Only the nervous system remains Translation from the GelTnan of the material published in Mitteilungen aus der Behandlung maligner Tumoren mit Viscum album, Vol. 2, No. 2 (1970)by the Society for Cancer Research, Arlesheim, Switzerland. Translator: R. E. K. Meuss, F.I.L.
ISCADOR
THERAPY
OF
LYMPHOGI%AI~ULOI~IATOSIS
171
unaffected. This type of spread suggests lymphogenic invasion as well as primarily multicentric occurrence. Both are probably the case. With the local spread come the constitutional, systemic symptoms: pruritus tiredness and emaciation irregular febrile attacks of the Pel-Ebstein type night sweats An interesting symptom is a disturbance of the immunological system, with immunoglobulin abnormality, evident for example in that foreign skin transplants are not rejected. Blood tests often show anaemia and leukocytosis with eosinophilia. Lymphopenia is indicative of a poor prognosis, as is thrombopenia. Involvement of the cervical and thoracic nodes causes a sensation of constriction, cough and dyspnoea, and if the abdominal nodes are affected patients suffer nausea and retching. Neuralgia and herpes zoster develop through pressure exerted by lymph nodes on structures of the nervous system. The skin often shows persistent eczematous changes in the early stages, and later on areas and nodules of lymphogranulomatous infiltration. The course of the disease may be fulminant, with death in a few months, or it may occur in bouts, or show progressive deterioration. The disease ends in the depletion and sclerotic degeneration of the lymphatic system, with the consequences of lowered resistance and cachexia. HISTOLOGY
The clinical course of the disease is reflected in the histological findings which pass through the following stages: 4 Non-specific lymphadenitis with proliferation of reaction centres. The appearance of enlarged reticulum cells (Hodgkin cells) and disappearance of reaction centres. Tumorous proliferation of reticulum ceils, with regression of lymphatic parenchyma. Further deformation of Hodgkin cells leading to the grotesque structures known as giant cells (Reed-Sternberg). Chaotic development in the lymph node and polymorphism of cells, with reticulum, Hodgkin and Reed-Sternberg cells, large and small lymphocytes, lymphoblasts, eosinophils, neutrophils, myelocytes, stab cells, plasma cells, epitheloid cells, even Langhans' giant cells as in TB: granuloma stage. Polymorphism regressing. Hodgkin and Reed-Sternberg cells predominate:
r
stage.
Proliferation of fibroblasts and fibrocytes, fibrosis and cell depletion. Sclerotic degeneration of lymph nodes. Every lymph node involved first of all passes through the stage of inflammation; then the characteristics of malignancy predominate, and finally a unique feature appears, a gesture of spontaneous recovery in the form of sclerotic changes, but total exhaustion sets in and death ensues. Hodgkin's disease is officially classified as a malignant lymphoma nowadays. 1 Macrofollicular lymphoblastoma of Brill-Symmers 2 Hodgkin's disease: (a) paragranuloma ("benign" Hodgkin's disease) (b) typical lymphogranuloma (c) Hodgkin's sarcoma
172 3 4
THE
BRITISH
HO~CIEEOPATHIC
JOURNAL
Lymphosarcoma
(a) lymphocytic lymphosarcoma (b) lymphoblast lymphosarcoma Reticulum cell sarcoma
The above sequence is that of increasing malignancy of the conditions. Because of the sclerotic development already described, a typical lymphogranuloma does not fit into the sequence, however. Malignant lymphomata are divided into stages, and this is important in establishing the form of treatment to be given in each case.
Stages of malignant lymphoma 2 Stage I Involvement of one group of lymph nodes only, one organ only (e.g. spleen), no constitutional symptoms Stage II Involvement of 2 or 3 contiguous groups of lymph nodes above or below the diaphragm IIA = with no constitutional symptoms IIB ~ with constitutional symptoms Stage III Involvement of 2 or more groups of lymph nodes or organs which are not contiguous and above and below the diaphragm Stage IV Involvement of lymph nodes and/or visceral organs (spleen, liver, lung, etc.) or of skeleton. DIAGNOSIS
Apart from palpation of the lymph nodes, biopsy, chest X-rays, palpation of spleen and liver, and possibly lymphography, the following parameters are important: ESR blood count, including platelet and retieulocyte counts electrophoresis immuno-electrophoresis alcohol pain (immediate pain in the affected glandular regions upon drinking alcoholic beverages). CAUSES
With regard to its aetiology, Hodgkin's disease is nowadays thought to be an autoimmune disease due to virus-transformed, foreign-type lymphocytes.6 The whole lymphatic system may be regarded as a guardian of normal life. Like a sense organ, it reacts to various noxious influences, and when this happens the system, normally barely noticeable, becomes visible and palpable. As it circulates through the network of lymph vessels from the periphery to the centre, the lymph stream is something of a sensory organ, taking in the results of the digestion of food, often of denatured foods nowadays, and also the effects of infections of the upper respiratory tract and of dysbiosis in the gastrointestinal canal. On the other hand, the system may also be influenced by emotional fluctuations, very marked in these patients. The effect is above all a slowing-down of the lymph flow. Along the course of the lymph channels lie the lymph nodes, where organic and inorganic foreign substances are removed from the flow and phagocytized. In patients with Hodgkin's disease, the system of lymph nodes is constitutionally weak. If excessive demands are made upon it, a desperate fight to ward off invasion (inflammation) is followed by the
XSCADOR
THERAPY
OF
LYMPHOGRANULOMATOSIS
173
foreign development of the tumour and finally depletion of the system. Noxious influences from within or without which have not been overcome, can therefore evoke the disease we have described in hypersensitive, excitable patients who lack a certain strength of character, and usually also carry a hereditary taint. PROGNOSIS
With the usual form of treatment, the prognosis is as follows: Five-year-survival rates Stage Stage Stage Stage
I II III IV
71% 56% 15% 0%
I t should be noted t h a t 36% of cases diagnosed as Stage I are in fact Stage I I I , and 51% of cases diagnosed as Stage I I are in fact Stage I I I . CONVENTIONAL
TREATMENT
OF MALIGNANT
LYI~IPHONIA
Surgical intervention, is indicated for single, accessible loci in Stage I. I t is usually followed by irradiation. I n Stage I I , irradiation is the method of choice. I n Stages I I I and IV, the condition has become so general t h a t a cure is considered out of the question. The official opinion is t h a t treatment can only be palliative and to prolong life. Chemotherapy plays the main role in this, with drugs such as Endoxana, vinblastine and vineristine, and Natulan. Irradiation is used for individual local loci and as an adjuvant. I n the advanced stages, cortieosteroids given concurrently will sometimes give an improvement in the general condition. Through their lympholytic action they m a y cause regression of tumours in cases of lymphosareoma. Malignant l y m p h o m a t a are among the most satisfactory indications for irradiation therapy, and cobalt therapy is usually the method of choice nowadays. When the first treatment is given, the l y m p h o m a t a tend to melt away like "snow in the sun". Subsequent treatments are increasingly less effective. Most radiologists are in favour of high doses and complete "sterilization" of the tumours. There are a few who report good results with low dosages. 8 Treatment with antineoplastie drugs tends to show a similar pattern of initial success, but the side effects are much more damaging. All these measures do however result in depletion of the lymph nodes, i.e. in what in untreated cases is the terminal stage of the disease. TREATMENT
WITH
ISCADOR
AND
OTHER
REI~IEDIES
The aim of the t r e a t m e n t we give is to change the constitution, i.e. it is a causal therapy. The damaged lymphatic system is not to be depleted, but to be restored to normal function. Because of this, we always start the patient on our treatment, because we are dealing with systemic disease, and then, after very careful observation, determine whether and when surgery, irradiation or eytostatics shall be used in addition, in dosages causing as little damage as possible. The case histories given below demonstrate the mode of action of this approach.
~4
THE
BI~ITISH
HOI~(EOPATHIC
JOURI~AL
Iscador This stimulates the body's own defensive forces and at the same time has a direct effect on malignant cells. I t stabilizes the infrastructure of the members of being in the patient, right down to his conscious awareness of individuality. Treatment consists of injections of Iscador P c Hg St. 4 - 2 % (e.g. 4, 4, 3, 3, 2, 2, 2/3, 3, 2, 2, 2%, 2%, 2%) given subcutaneously in the region of the back of the neck, one every two or three days. I f there is a certain loss of effect after some time, a change may be made to Q c Hg for men, and M e Hg for women. Capsicum annuum The red pepper, one of the Solanaeceae, contains a pungent alkaloid, capsaicine. This plant with its fiery, warm nature, stimulates metabolism and may be used to get smouldering, long drawn-out inflammatory conditions into an acute, fighting phase. I t acts against sclerotic tendencies and supports the defensive function of Iscador. We give injections of Capsicum D5-D10 on days when no Iscador is given, in the morning, subcutaneously, in the epigastrie region. Colchicum autumnale The meadow saffron or autumn crocus, one of the Liliaceae, is a strange, somewhat uncanny plant. With regard to both time and space it steps outside the laws generally pertaining in the plant world--as the mistletoe does, too. I t flowers in damp autumn meadows, with the blossom arising directly from the ground. E v e r y part of the plant is poisonous. The alkaloid colchicine is the most powerful mitotic poison, attacking above all the lymphoeytes. This explains its action on proliferative conditions of the lymphatic system. I t supports the cytostatic aspect of the Iscador action. On the days when no Iscador is given, we inject Colehicum D5 in the evening, subcutaneously, in the region of the back of the neck. Epiphysis The suggestion to give injections of Epiphysis D2 and D3 as adjuvant therapy comes from Dr. Boie. 1 In this preparation made from the gland, the formgiving forces of the organism are condensed in physical form. Iron preparations in various forms are particularly indicated for fair-haired patients. Siderite 5% (spathie iron ore) Ferrum ustum comp. (Ferrum ustum D3/Nontronite D3/Pimpinella anisum, fruet./Urtiea dioica, herba D4 aa) Ferrum siderum D10 (meteoric iron) are among those available in the form of triturations, a knife-tip full three times daily after meals. They incarnate patients who often are not quite firmly embodied, i.e. they strengthen the body-soul structure and counteract anaemia.
ISCADOR
THERAPY
OF
LYMPHOGRA_NULOMATOSIS
175
Arsenic Arsenicum album dfl. D6, 7 drops t.d.s., or Scorodite D8 (Ferrum arsen, nat.), a knife-tip full t.d.s, calm down the hypersensitive susceptibilities of the patient. I n the same direction act baths with Levico Water (a natural water containing ferrous sulphate and arsenic), 89bottle of "full strength" Levieo W a t e r to a full bath, 10-15 minutes at 37-38 ~
Prunus spinosa The blackthorn, or sloe, given in the form of an elixir (a teaspoonful t.d.s.), stimulates the reduced vitality, an effect which m a y be increased further b y baths with the juice and rind of 2 or 3 lemons.
Liver remedies like Taraxacum D4 dil., Cichorium D4 dil., Cassiterite (Stannum oxid.) D4 trit., and Hepatodoron. all taken per os, are most important, particularly when irradiation and cytostatic agents have caused damage to the organism. The aim of treatment is to strengthen the defensive powers, to support the form-giving impulses in the organism, direct attack on the tumour. With this form of t r e a t m e n t it is not yet possible to do without surgery and irradiation, but it does already provide effective help. Where otherwise treatment is followed by helpless inactivity, waiting for recurrences to appear, we are now able to prolong the periods of remission by active therapy, and, cont r a r y to expectation, we even achieve freedom from recurrences for m a n y years in some relatively advanced cases. Above all, it is also necessary to use guidance, supported b y curative eurhythmy, art therapy, etc., to influence the patient's personality, for this, more than anything, needs to gain inner strength. Here the physician must give all he can to create a true relationship of trust, so t h a t there m a y be real collaboration, to bring about the salvation of the patient, to let the ego grow strong.
CASE HISTORIES The case histories given below are not m e a n t to be evidence of successful therapy, but rather to show how the battle has to be fought for each patient. CASE ~ISTORY NO. 1 Physician: Dr. R. Zech, Lukas Klinik Mr. H.W., born in 1941 Diagnosis: Lymphogranulomatosis, Stage I I I Family history: clear Previous history: measles, mumps, frequent sore throats as a child. 1964 and 1965, temperature, cough, headache: penicillin. November 1965, pruritus over the whole body. J a n u a r y 1966, glandular swellings in right subclavicu!ar , inguinal, hilar and mediastinal regions. Biopsy showed lymphogranuloma. L y m p h o g r a p h y provided evidence of hyperplasia of inguinal and lower iliac lymph nodes on both sides. Treatment: 30 million units penicillin and 125 mg UIt~'aeortenot daily for 12 days.
176
TItE
BRITISH
HOM(EOPATHIC
JOURNAL
Subsequent development of diabetes, with blood sugar levels of up to 500 mg%. Chest X-ray showed spread of lesions. Diabetes disappeared after discontinuation of the "heroic" treatment. February 1966 to August 1966, cobalt radiotherapy of all involved glands, resulting in good regression. The patient received a total of 43 180 R, cobalt-60. November 1967, recurrence in the area of the para-aortic nodes, discovered through weakness of the right leg. Irradiation with 3 570 1~ electrons Jr 940 R cobalt-60. Weakness of the leg improved. Patient made a good recovery. February 1968--0n examination: Asthenic, pale young man of 27, with light brown hair, structural engineer. General condition poor. Friendly, open, harmonious character. Marked dermographism. Local findings: L y m p h nodes the size of almonds i n right supraclavicular and axillary region, induration due to radiation therapy around the navel. Laboratory tests of 6 February 1968: ESR 38/76 ram, Hgb 82%, erythrocytes 4.3 mill., leukocytes 3 900, eosinophils 10%, stab cells 3%, segm. ceils 78%, lymphocytes 3~ monoeytes 6~ serum iron 102 7 % , serum copper 140 yO/0. Treatment: Iscador P c Hg St. 4-2, one every second day. On the other days, inj. of Capsicum D10 in the mornings, Colchieum D5 ~ Aurum/Meteoric iron in the evenings. Internally: Formica D4, Aurum D10, Archangelica D2, Meteoric iron D20, Cardiodoron A, and also Hepatodoron. Externally: irradiated skin areas massaged with Skin Tonic, compresses with Achillea millefolium over the liver region. Curative eurhythmy. J a n u a r y 1970: steady improvement in the general condition since 1968, with no signs of recurrences on searching examination. Lymphocytes were now 18%, ESI~ had gone down to 20/41. Hgb 88%, leukocytes 4 650, serum iron 97 y % , serum copper 205 y~ . Treatment: from May 1969, Iscador Qu St. 4-2~o, internally Phosphorus D5, also Prunus spinosa 5 ~o, otherwise continued as above. Summary: a young man of 27 with lymphogranulomatosis Stage I I I had been treated with huge doses of pencillin, cortisone and cobalt radiation. He obviously had a good constitution, to put up with this without complaint. Following a para-aortic recurrence, also treated with radiation, the patient came to the Lukas Klinik, and with our treatment has remained free from symptoms and in good general health for more than 2 years. CAS~. HISTORY No. 2
Physicians: Dr. D. Boie, Marburg Dr. R. Zech, Lukas Klinik
Miss U.G., born in 1946 Diagnosis: Lymphogranulomatosis, stage I I I - I V Family history: one grandfather died of carcinoma of the , stomach, otherwise clear Previous history: measles and chicken-pox as a child. Appendectomy at age 14. Fracture of the base of the skull at 16. Concussion through frontal collision in a car accident at 20. Dental inflammations and suppuration at 20 and 2l. In March 1967, when the patient was 21, supraclavicular gland on the left enlarged, with a group of nodes developing. A biopsy in July 1967 leads to the diagnosis of lymphogranuloma. August 1967. On examination: pink-complexioned young women of medium height, with light brown hair, a delicate skin, well proportioned build, gentle, slightly withdrawn in manner, intelligent and alert, but ~11 in all somewhat
ISCADOR
THERAI~u
OF
LYMI~HOGRA-NULOMATOSIS
177
lacking in definition. Occupation: trainee bank clerk. No constitutional systemic symptoms of Hodgkin's disease. Locally, groups of nodes were palpable in the subclavicular region and along the left sternocleidomastoideus muscle. Chest X-ray revealed enlarged lymph nodes in the left mediastinal region. The spleen was enlarged to a width of two fingers below the costal arch. Small goitre. Laboratory tests: serum iron reduced to 45 y % , thrombocytes to 177 000; reticulocytes normal, ESI~ and blood counts in normal range. Treatment: Iscador P c Hg St. 4-2 s.c. between the shoulder blades, one every third day. In between, Capsicum D10 in the mornings, with Arsenicum album D6 one evening and Colchicum D5 the other. E v e r y 7th day, Epiphysis D2 injected together with Phosphorus D10. Per os: Ferrum ustum comp., Vitis comp., Cardiodoron C, Digestodoron and Cichorium int. D3. Externally: Uraninite ointment-dressings 1% over the enlarged glands at night, lavender baths. Curative eurhythmy. September 1967: X-ray showed regression of mediastinal nodes. The glands in the neck varied, with marked enlargement before the period and regression afterwards; apart from that more or less stationary. The spleen was palpable at the costal arch. October 1968: good general condition had been maintained. The group of glands on the neck was, however, gradually getting larger. Mediastinal tumour on the left had grown to the size of a small first. Spleen no longer enlarged. Liver enlarged, width of one finger. Laboratory findings: ESR 12/30, hgb 78~ erythrocytes 4.1 mill. White cell count normal. Thrombocytes 165 000, serum copper 163 -/%, serum iron 37 4/0/0. I t was then decided to treat the neck and mediastinum with betatron irradiation. Between 14 October and 15 November 1968 the patient received 4 000 I~ each in the left side of the neck and one mediastinal field. This was palliative, not curative radiotherapy, for the latter would have covered adjacent lymph drainage areas as well, where involvement was not yet apparent. After the radiotherapy, the lymph nodes in both areas showed a definite tendency to regress, but new infiltrations were seen in the left upper lobe of the lung. Radiation was well tolerated. During it, the patient was given injections of Aurum D10/Meteoric iron D10 and Stibium prep. D10 in addition to her other treatment. November 1969: general condition very good, no palpable glandular swellings. Chest X-ray: involvement of left lung had completely regressed, as had the enlarged mediastinum. Patient was free from symptoms. April 1970. Treatment: (given b y Dr. Boie) from beginning of 1969: M c Hg St. 3-2%. In addition Mistletoe-Senker (haustorium) M D30 ~-MistletoeSenker M D 6 - ~ Epiphysis D2, all every second day. On the other days, Capsicum/Colchicum D10/D10 in the mornings, Argentum D 8 - ~ Thuja D2 in the evenings. Summary: a young woman of 21, in good general health, with lymphogranulomatosis Stages I I I - I V and poor prognosis, gradual progression of the disease during the first year of treatment. After palliative irradiation with incomplete regression of lesions, treatment with our remedies was extended and intensified. All the involved lymph nodes regressed, and the patient is now in very good general health. The therapeutic effect was also influenced by the decision to leave her work as a bank clerk and become a teacher. Period of observation since first symptoms appeared: 3 years.
178
THE
BI~ITISt:[
CASE HISTORY No. 3
HOM(EOPATIIIC
JOUI%NAL
Physician: Dr. H. Isbert, Berlin Dr. U. Delius, Lukas Klinik
Mr. G D , born in 1952 Diagnosis: Lymphogranulomatosis, Stage IV 2Family history: one aunt died of pelvic carcinoma, one cousin of leukaemia. Sister and nephew have TB. Previous history: measles, chicken-pox, whooping cough, German measles and mumps as a child. Pneumonia and appendectomy at age 7. Frequent sore throats. Habitual dislocation of right shoulder. Impact injury straining the spine at age 9, after that recurrent back pain. Specific history: from the summer of 1969, increasingly tired, without appetite, lost 9 kg in weight, back pains and headaches. From September 1968, swelling under the left jaw which grew bigger and bigger. October 1968: biopsy led to diagnosis of lymphogranuloma. Subfebrile temperatures, night sweats. October 1968. On examination: pale, fair-haired boy with delicate skin, tall and lank, poor posture, flaccid walk, and reduced general condition. Local findings: under the left mandible a solid tumour of 3 "8/6.8 cm semicircumference; in right submandibular region a node the size of a walnut. Above the left clavicle a node the size of a hazelnut, in both axillae nodes the size of cherries or hazelnuts; inguinal glands like pencils. Biopsy scars in the process of healing. ENT: large-nodular tumour in nasopharynx, almost filling the left half of it. Biopsy material taken from this confirmed the diagnosis. The tumour had blocked the right tube, causing the tympanic membrane to bulge inwards and hardness of hearing. Chest X-ray: nothing to indicate intrathoracic involvement. Lymphography: suspicion that retroperitonal lymph nodes had become involved. Laboratory tests: ESR 58/85 ram, Hgb 76%, erythrocytes 3-9 mill., leukocytes 13 100, eosinophils 1%, stab cells 2%, segm. cells 67%, lymphocytes 29%, monocytes 1~o , serum copper 146 ,/%, serum iron 18 y % , alkaline phosphatase 10.2 K.A. units. Treatment: Iscador P e Hg St. 5-3, every 3rd day, later Qu St. 3-2. On the other days, Capsicum D10 + Colehicum D5, and also Cetraria St. 3, later Cladonia St. 3. Patient felt better at first, nodes were regressing. Then, after a cold, lymph nodes increased in size again, bad headaches. November 1968. Sudden hypaesthesia of whole of left face. Raised temperature, vomiting. Neurological examination: tumour of the epipharynx had invaded the middle cranial fosse by the extradural route. This had to be regarded as the cause of the neurological disturbances. I t was certain that the
process also involved the base of the skull. Compression of the left internM carotid artery. December 1968. Cobalt radiotherapy given in addition to other treatment. January 1969. After a severe reaction to radiotherapy initially, there was a striking improvement and regression of the tumours. February 1969: the tumour in the nasopharynx had completely disappeared, as had the lymph nodes in the neck. Hearing was normal again, general condition very good, and the patient gained weight. Lymphography: still suspicion that retroperitoneal lymph nodes might be involved. Laboratory tests: ESR 9/22 mm, Hgb 88%, erythroeytes 4.6 mill, leukocytes 4 900, eosinophils 5%, stab cells 2%, scgm. cells 73%, lymphocytes 16%, monocytes 4%. Between 21 November and 20 February, a total of 6 00O 1~ cobalt-60 was given, distributed between both sides of the neck including the middle base of the skull and epipharynx.
ISCADOR
THERAPY
OF
LYMPItOGRAI~ULOMATOSIS
179
May 1969. Laboratory tests: Hgb 96%, erythrocytes 4.6 mill, leukocytes 3 100, stab cells 2%, segm. cells 66%, lymphocytes 29%, monocytcs 3%, ESR 6/16 ram, serum copper 135 y % , serum iron 80 ~/%. Alkaline phosphatase 17.7 K.A. units. Lymphography continued to indicate systemic involvement. Chest X-ray n.a.d. Induration in the site of biopsy, otolarynx n.a.d. October 1969. Condition as before. Weight gain of 13 kg in a year. February 1970. Had gained another 6 kg. All laboratory findings normal, except that alkaline phosphatase was raised to 17-3 K.A. units, though this might also have been due to growth of bones. Local examination, everything clear. Chest X-ray normal. The boy was in first-class general condition, robust, red-cheeked, and much more stable in outlook. Further treatment: Iscador P c Hg St. 4-2 twice a week in the region of the back of the neck. Capsicum D10 and Pyromorphite D8 alternating with Cerussite D8 twice weekly, Colehieum D5 twice weekly. Internally, Arsenicum album D6, Hepatodoron, Cardiodoron B, Ferrum silicium D10, Formica D4. Externally; Rosemary baths. Curative eurhythmy. Summary: a sensitive, alert boy at an advanced stage of lymphogranulomatosis with systemic symptoms and incipient cachexia reacted well to Iscador and supplementary therapy to begin with. Some weeks later, after a cold, his condition deteriorated. Cobalt radiotherapy, given concurrently with our treatment, resulted in complete regression of the irradiated lymph nodes, whilst abdominal glands suspected of involvement remained stationary. The rapid recovery of strength is most striking, and the weight gains. Period of observation: 18 months. CASE HISTORY NO. 4 Physician: Dr. R. Zech, Lukas Klinik Mrs. I~.C., born in 1906 Diagnosis: Malignant lymphoma, Stage I I Family history: mother died of carcinoma of the liver, brother of carcinoma of the liver, step-brother of carcinoma of the bladder. Previous history: measles, diphtheria, whooping cough. Frequent sore throats. Cholecystectomy because of gall stones at age 55. Persistent constipation. Present condition : since June 1967, several nodules in the area of the right neck, developing after short-wave therapy for dislocated jaw. October 1967. On examination: small, grey-haired lady, somewhat nervous, frightened of any intervention. General condition good, laboratory findings within normal range, except that the serum iron was reduced to 31 ~/~ Locally, a chain of lymph nodes were palpable in the region of the right neck. Chest X-ray showed definite enlargement and solidification at the right upper hihis; emphysema and arteriosclerosis of the aorta concomitant with patient's age. Heart n.a.d. Biopsy of a lymph node revealed malignant lymphoma, with no clear distiction possible between a lymphoreticular sarcoma and the lymphohistiocytic form of Hodgkin's malignant lymphoma. Treatment: started with Iscador U c Hg St. 4-2, because carcinoma of the bronchus was suspected at first. Once the histology was known, a change was made to Iscador P c Hg St. 4-2, one injection every 2nd day, and, on the other day, Cetraria prep. St. 3 -~ Capsicum D10 in the morning and Colchicum D5 in the evening. February 1968. Very slight increase in the size of the lymph nodes in the
180
THE
BRITISH
I-IOM(EOPATHIC
JOUI~NAL
neck. One small new node in the left cervical region. ESI~ and blood counts~ within normal range. Serum iron had gone up to 62 ~/~ May 1969. Treatment had been regular for the whole of 1968 until J a n u a l y 1969. I t was then discontinued until May. Report b y letter. The nodes in t h e right side of the neck had grown smaller. April 1970. Report b y letter: condition stationary. General health good. Summary: woman aged 64 with malignant lymphoma Stage II. Has been on our t r e a t m e n t only, for two and a half years, with the result t h a t the condition is stationary and patient is in good general health. The summaries of another eight case histories are given below. These are t a k e n from a paper recently published b y R. Leroi. 5 1 A woman of 66 presented with an acute lymphogranuloma of the axilla, confirmed by biopsy. After initiation of our thelapy, the nodes not removed by biopsy regressed completely within twelve weeks. The patient was free from symptoms for five years and seven months. At the end of that period, long pauses were made between courses of Iscador therapy. Now, after six years~ recurrence in the neck region. Period of observation: six years. 2 A woman of 43 with Hodgkin's disease Stage I I was maintained for six years on our therapy only, apart from surgical removal of some nodes. Then the condition deteriorated slightly. X - r a y therapy was followed b y rapid deterioration. Patient died eight years after starting on Iscador therapy. Most impressive was the change in the nature of the patient, from a somewhat rough personality to a sensitive, perceptive woman. 3 A red-haired young woman of 31, in good general condition, with lymphogranulomatosis Stage I I I survived for more than six years, with the condition gradually deteriorating at the end. Repeated X - r a y therapy was necessary. The impression was gained that the t r e a t m e n t given initially, with Iscador injections given at greater intervals and in high strengths, was not as effective as the more intensive therapy we are now using, with Capsicum and Colchicum also given more frequently. 4 A woman of 42, tall, slim, sandy-haired, light-skinned, the sister of the patient described in Case History No. 3. Lymphogranuloma Stage I I ; a life full of d r a m a - - t h i r d marriage, unhappy. For about 1189 years she was treated with Iscador and Capsicum/Colchicum only, with the condition progressing slowly. Finally X - r a y therapy became necessary. After that, deterioration was more rapid. Iscador discontinued. Died fourteen years after treatment started. 5 A young woman of 22 with lymphogranuloma Stage II. The type often seen: rosy with overflowing vitality, friendly, active nature and positive attitude to life. After conventional therapy of the Stage II, patient has continued free from symptoms for five years on our therapy, in spite of two pregnancies which so often are followed by recurrences of the condition. 6 A young woman of 27 with lymphogranuloma Stage I I I treated with cobalt radiotherapy has remained free from symptoms to date, i.e. for four years, on our therapy. 7
A man, now 61 years old, presenting with the rare phenomenon of three
HOM(EOPATHY IN GENERAL PRACTICE
181
malignant conditions at once: carcinoma of the rectum, lymphogranulomatosis and seminoma. The lymphogranulomatosis, at a fairly advanced stage (III), was treated with X-rays in moderate dosage, recurred three times, and was irradiated again each time. No further symptoms now for 589 years, nor are there any signs of secondaries developing from the other malignancies. Period of observation since starting on Iscador therapy: fifteen years. A woman of 31 who came for treatment when in Stage IV and was kept stationary and able to work for four years, taking our treatment only. Then increasing enlargement of the spleen, regressing after radiotherapy. Period of observation to date: 489 years. (Unless otherwise stated, the drugs mentioned in this paper are available from the Weleda Companies, and they will also supply copies of the new edition of Directions for the use of Iscador, on request. The German D potencies given in this paper are equivalent to the English x potencies.) REFERENCES
Bole, D. (1968). Das erste Auge. Stuttgart: Verlag Freies Geistesleben. Brunner, K., and Barandun, S. (1966). Die Therapie des malignant Lymphoms. Sehweizer Medizinische Woehenschrift, 96~ 263-7. Lehmarm, F. M. (1968). Kritische Betrachtung zur Krebsbehandlung. Tberapie der Gegenwart, 1173-83. 4 Leiber, B. (1961). Der menschliche Ly.mphknoten. Munich and Berlin. Leroi, R. (1969). Malignom-Behandlung nach geisteswissenschaftlichen Erkenntnissen. Die Lymphogranulornatose. Beitrffge zu einer Erwei~erung der Heilkunde, 22, 69-85 and 107-110. Smithers, D. W. (1967). Hodgkin's disease. British Medical Journal, 2, 263-8 and 337-41.
Homoeopathy in general practice KATHLEEN
G. P R I E S T M A N ,
M.R.c.S.,L.~.c.p.,M.F.r~OM.
When I was considering the title of this lecture, I wondered how I could present the difference between predominantly homceopathic prescribing in general practice, and ordinary orthodox prescribing, so that it could be most clearly understood - - after all, we all see the same kind of patients, to the third and occasionally the fourth generation when we have been in practice long enough - - w e all treat patients with acute illness, chronic disease, psychosomatic A paper read as part of the Post-Graduate Intensive Course of the Faculty of Homoeopathy on 23 February 1971
LEROI
DESCRIPTION OF THE DISEASE Lymphogrannlomatosis (Hodgkin's disease) is a strange and inexplicable condition. Today, 140 years after the syndrome was first described b y Thomas Hodgkin, opinion as to its nature is still uncertain, with the following suggestions put forward: chronic inflammation due to infection, similar to TB systemic disease as in lenkaemia malignoma of the R E S following degeneration Lymphogrannlomatosis does in fact show some of the characteristics of all three conditions, both in its clinical progress and in the pathological changes to be seen on histological examination. Hodgkin's disease shows considerable variation from case to case. I t has only been observed in h u m a n beings so far, never in animals. The disease will often start at an early age (between the ages of 20 and 40), and tends to affect a certain type of patient: well proportioned in form, often fair-haired people with fine skin and a rosy complexion. A lively, active interest in the world around them combines with an unusual degree of sensitivity towards external and internal influences, physically expressed in a certain instability of the autonomic system. Too much under the impression of events, these patients often lack the power of resolution to carry through decisions. Patients will often develop the disease around the age of 21, when personality should develop and prove itself in the face of the world. Men contract the disease more frequently, and generally the prognosis is poorer for them. I n the f a m i l y history, a high incidence of tuberculosis (up to 50 %), malignant, tumours and diabetes is of interest. Frequently several members of a family develop Hodgkin's disease. The patient's history is not as uneventful as t h a t of a cancer patient tends to be, on the contrary, m a n y of the childhood diseases m a y be found, and frequent diseases of the upper respiratory tract. Often a small hyperthyroid, goitre is present. Usually the disease starts with enlargement of the cervical lymph nodes, apparently non-specific, with the patient still looking very well. Gradually the lymph nodes grow larger, forming conglomerations, moving on down to other lymph glands (mediastinai, axillary, abdominal, inguinal), and finally involving also the internal organs and bones. Only the nervous system remains Translation from the GelTnan of the material published in Mitteilungen aus der Behandlung maligner Tumoren mit Viscum album, Vol. 2, No. 2 (1970)by the Society for Cancer Research, Arlesheim, Switzerland. Translator: R. E. K. Meuss, F.I.L.
ISCADOR
THERAPY
OF
LYMPHOGI%AI~ULOI~IATOSIS
171
unaffected. This type of spread suggests lymphogenic invasion as well as primarily multicentric occurrence. Both are probably the case. With the local spread come the constitutional, systemic symptoms: pruritus tiredness and emaciation irregular febrile attacks of the Pel-Ebstein type night sweats An interesting symptom is a disturbance of the immunological system, with immunoglobulin abnormality, evident for example in that foreign skin transplants are not rejected. Blood tests often show anaemia and leukocytosis with eosinophilia. Lymphopenia is indicative of a poor prognosis, as is thrombopenia. Involvement of the cervical and thoracic nodes causes a sensation of constriction, cough and dyspnoea, and if the abdominal nodes are affected patients suffer nausea and retching. Neuralgia and herpes zoster develop through pressure exerted by lymph nodes on structures of the nervous system. The skin often shows persistent eczematous changes in the early stages, and later on areas and nodules of lymphogranulomatous infiltration. The course of the disease may be fulminant, with death in a few months, or it may occur in bouts, or show progressive deterioration. The disease ends in the depletion and sclerotic degeneration of the lymphatic system, with the consequences of lowered resistance and cachexia. HISTOLOGY
The clinical course of the disease is reflected in the histological findings which pass through the following stages: 4 Non-specific lymphadenitis with proliferation of reaction centres. The appearance of enlarged reticulum cells (Hodgkin cells) and disappearance of reaction centres. Tumorous proliferation of reticulum ceils, with regression of lymphatic parenchyma. Further deformation of Hodgkin cells leading to the grotesque structures known as giant cells (Reed-Sternberg). Chaotic development in the lymph node and polymorphism of cells, with reticulum, Hodgkin and Reed-Sternberg cells, large and small lymphocytes, lymphoblasts, eosinophils, neutrophils, myelocytes, stab cells, plasma cells, epitheloid cells, even Langhans' giant cells as in TB: granuloma stage. Polymorphism regressing. Hodgkin and Reed-Sternberg cells predominate:
r
stage.
Proliferation of fibroblasts and fibrocytes, fibrosis and cell depletion. Sclerotic degeneration of lymph nodes. Every lymph node involved first of all passes through the stage of inflammation; then the characteristics of malignancy predominate, and finally a unique feature appears, a gesture of spontaneous recovery in the form of sclerotic changes, but total exhaustion sets in and death ensues. Hodgkin's disease is officially classified as a malignant lymphoma nowadays. 1 Macrofollicular lymphoblastoma of Brill-Symmers 2 Hodgkin's disease: (a) paragranuloma ("benign" Hodgkin's disease) (b) typical lymphogranuloma (c) Hodgkin's sarcoma
172 3 4
THE
BRITISH
HO~CIEEOPATHIC
JOURNAL
Lymphosarcoma
(a) lymphocytic lymphosarcoma (b) lymphoblast lymphosarcoma Reticulum cell sarcoma
The above sequence is that of increasing malignancy of the conditions. Because of the sclerotic development already described, a typical lymphogranuloma does not fit into the sequence, however. Malignant lymphomata are divided into stages, and this is important in establishing the form of treatment to be given in each case.
Stages of malignant lymphoma 2 Stage I Involvement of one group of lymph nodes only, one organ only (e.g. spleen), no constitutional symptoms Stage II Involvement of 2 or 3 contiguous groups of lymph nodes above or below the diaphragm IIA = with no constitutional symptoms IIB ~ with constitutional symptoms Stage III Involvement of 2 or more groups of lymph nodes or organs which are not contiguous and above and below the diaphragm Stage IV Involvement of lymph nodes and/or visceral organs (spleen, liver, lung, etc.) or of skeleton. DIAGNOSIS
Apart from palpation of the lymph nodes, biopsy, chest X-rays, palpation of spleen and liver, and possibly lymphography, the following parameters are important: ESR blood count, including platelet and retieulocyte counts electrophoresis immuno-electrophoresis alcohol pain (immediate pain in the affected glandular regions upon drinking alcoholic beverages). CAUSES
With regard to its aetiology, Hodgkin's disease is nowadays thought to be an autoimmune disease due to virus-transformed, foreign-type lymphocytes.6 The whole lymphatic system may be regarded as a guardian of normal life. Like a sense organ, it reacts to various noxious influences, and when this happens the system, normally barely noticeable, becomes visible and palpable. As it circulates through the network of lymph vessels from the periphery to the centre, the lymph stream is something of a sensory organ, taking in the results of the digestion of food, often of denatured foods nowadays, and also the effects of infections of the upper respiratory tract and of dysbiosis in the gastrointestinal canal. On the other hand, the system may also be influenced by emotional fluctuations, very marked in these patients. The effect is above all a slowing-down of the lymph flow. Along the course of the lymph channels lie the lymph nodes, where organic and inorganic foreign substances are removed from the flow and phagocytized. In patients with Hodgkin's disease, the system of lymph nodes is constitutionally weak. If excessive demands are made upon it, a desperate fight to ward off invasion (inflammation) is followed by the
XSCADOR
THERAPY
OF
LYMPHOGRANULOMATOSIS
173
foreign development of the tumour and finally depletion of the system. Noxious influences from within or without which have not been overcome, can therefore evoke the disease we have described in hypersensitive, excitable patients who lack a certain strength of character, and usually also carry a hereditary taint. PROGNOSIS
With the usual form of treatment, the prognosis is as follows: Five-year-survival rates Stage Stage Stage Stage
I II III IV
71% 56% 15% 0%
I t should be noted t h a t 36% of cases diagnosed as Stage I are in fact Stage I I I , and 51% of cases diagnosed as Stage I I are in fact Stage I I I . CONVENTIONAL
TREATMENT
OF MALIGNANT
LYI~IPHONIA
Surgical intervention, is indicated for single, accessible loci in Stage I. I t is usually followed by irradiation. I n Stage I I , irradiation is the method of choice. I n Stages I I I and IV, the condition has become so general t h a t a cure is considered out of the question. The official opinion is t h a t treatment can only be palliative and to prolong life. Chemotherapy plays the main role in this, with drugs such as Endoxana, vinblastine and vineristine, and Natulan. Irradiation is used for individual local loci and as an adjuvant. I n the advanced stages, cortieosteroids given concurrently will sometimes give an improvement in the general condition. Through their lympholytic action they m a y cause regression of tumours in cases of lymphosareoma. Malignant l y m p h o m a t a are among the most satisfactory indications for irradiation therapy, and cobalt therapy is usually the method of choice nowadays. When the first treatment is given, the l y m p h o m a t a tend to melt away like "snow in the sun". Subsequent treatments are increasingly less effective. Most radiologists are in favour of high doses and complete "sterilization" of the tumours. There are a few who report good results with low dosages. 8 Treatment with antineoplastie drugs tends to show a similar pattern of initial success, but the side effects are much more damaging. All these measures do however result in depletion of the lymph nodes, i.e. in what in untreated cases is the terminal stage of the disease. TREATMENT
WITH
ISCADOR
AND
OTHER
REI~IEDIES
The aim of the t r e a t m e n t we give is to change the constitution, i.e. it is a causal therapy. The damaged lymphatic system is not to be depleted, but to be restored to normal function. Because of this, we always start the patient on our treatment, because we are dealing with systemic disease, and then, after very careful observation, determine whether and when surgery, irradiation or eytostatics shall be used in addition, in dosages causing as little damage as possible. The case histories given below demonstrate the mode of action of this approach.
~4
THE
BI~ITISH
HOI~(EOPATHIC
JOURI~AL
Iscador This stimulates the body's own defensive forces and at the same time has a direct effect on malignant cells. I t stabilizes the infrastructure of the members of being in the patient, right down to his conscious awareness of individuality. Treatment consists of injections of Iscador P c Hg St. 4 - 2 % (e.g. 4, 4, 3, 3, 2, 2, 2/3, 3, 2, 2, 2%, 2%, 2%) given subcutaneously in the region of the back of the neck, one every two or three days. I f there is a certain loss of effect after some time, a change may be made to Q c Hg for men, and M e Hg for women. Capsicum annuum The red pepper, one of the Solanaeceae, contains a pungent alkaloid, capsaicine. This plant with its fiery, warm nature, stimulates metabolism and may be used to get smouldering, long drawn-out inflammatory conditions into an acute, fighting phase. I t acts against sclerotic tendencies and supports the defensive function of Iscador. We give injections of Capsicum D5-D10 on days when no Iscador is given, in the morning, subcutaneously, in the epigastrie region. Colchicum autumnale The meadow saffron or autumn crocus, one of the Liliaceae, is a strange, somewhat uncanny plant. With regard to both time and space it steps outside the laws generally pertaining in the plant world--as the mistletoe does, too. I t flowers in damp autumn meadows, with the blossom arising directly from the ground. E v e r y part of the plant is poisonous. The alkaloid colchicine is the most powerful mitotic poison, attacking above all the lymphoeytes. This explains its action on proliferative conditions of the lymphatic system. I t supports the cytostatic aspect of the Iscador action. On the days when no Iscador is given, we inject Colehicum D5 in the evening, subcutaneously, in the region of the back of the neck. Epiphysis The suggestion to give injections of Epiphysis D2 and D3 as adjuvant therapy comes from Dr. Boie. 1 In this preparation made from the gland, the formgiving forces of the organism are condensed in physical form. Iron preparations in various forms are particularly indicated for fair-haired patients. Siderite 5% (spathie iron ore) Ferrum ustum comp. (Ferrum ustum D3/Nontronite D3/Pimpinella anisum, fruet./Urtiea dioica, herba D4 aa) Ferrum siderum D10 (meteoric iron) are among those available in the form of triturations, a knife-tip full three times daily after meals. They incarnate patients who often are not quite firmly embodied, i.e. they strengthen the body-soul structure and counteract anaemia.
ISCADOR
THERAPY
OF
LYMPHOGRA_NULOMATOSIS
175
Arsenic Arsenicum album dfl. D6, 7 drops t.d.s., or Scorodite D8 (Ferrum arsen, nat.), a knife-tip full t.d.s, calm down the hypersensitive susceptibilities of the patient. I n the same direction act baths with Levico Water (a natural water containing ferrous sulphate and arsenic), 89bottle of "full strength" Levieo W a t e r to a full bath, 10-15 minutes at 37-38 ~
Prunus spinosa The blackthorn, or sloe, given in the form of an elixir (a teaspoonful t.d.s.), stimulates the reduced vitality, an effect which m a y be increased further b y baths with the juice and rind of 2 or 3 lemons.
Liver remedies like Taraxacum D4 dil., Cichorium D4 dil., Cassiterite (Stannum oxid.) D4 trit., and Hepatodoron. all taken per os, are most important, particularly when irradiation and cytostatic agents have caused damage to the organism. The aim of treatment is to strengthen the defensive powers, to support the form-giving impulses in the organism, direct attack on the tumour. With this form of t r e a t m e n t it is not yet possible to do without surgery and irradiation, but it does already provide effective help. Where otherwise treatment is followed by helpless inactivity, waiting for recurrences to appear, we are now able to prolong the periods of remission by active therapy, and, cont r a r y to expectation, we even achieve freedom from recurrences for m a n y years in some relatively advanced cases. Above all, it is also necessary to use guidance, supported b y curative eurhythmy, art therapy, etc., to influence the patient's personality, for this, more than anything, needs to gain inner strength. Here the physician must give all he can to create a true relationship of trust, so t h a t there m a y be real collaboration, to bring about the salvation of the patient, to let the ego grow strong.
CASE HISTORIES The case histories given below are not m e a n t to be evidence of successful therapy, but rather to show how the battle has to be fought for each patient. CASE ~ISTORY NO. 1 Physician: Dr. R. Zech, Lukas Klinik Mr. H.W., born in 1941 Diagnosis: Lymphogranulomatosis, Stage I I I Family history: clear Previous history: measles, mumps, frequent sore throats as a child. 1964 and 1965, temperature, cough, headache: penicillin. November 1965, pruritus over the whole body. J a n u a r y 1966, glandular swellings in right subclavicu!ar , inguinal, hilar and mediastinal regions. Biopsy showed lymphogranuloma. L y m p h o g r a p h y provided evidence of hyperplasia of inguinal and lower iliac lymph nodes on both sides. Treatment: 30 million units penicillin and 125 mg UIt~'aeortenot daily for 12 days.
176
TItE
BRITISH
HOM(EOPATHIC
JOURNAL
Subsequent development of diabetes, with blood sugar levels of up to 500 mg%. Chest X-ray showed spread of lesions. Diabetes disappeared after discontinuation of the "heroic" treatment. February 1966 to August 1966, cobalt radiotherapy of all involved glands, resulting in good regression. The patient received a total of 43 180 R, cobalt-60. November 1967, recurrence in the area of the para-aortic nodes, discovered through weakness of the right leg. Irradiation with 3 570 1~ electrons Jr 940 R cobalt-60. Weakness of the leg improved. Patient made a good recovery. February 1968--0n examination: Asthenic, pale young man of 27, with light brown hair, structural engineer. General condition poor. Friendly, open, harmonious character. Marked dermographism. Local findings: L y m p h nodes the size of almonds i n right supraclavicular and axillary region, induration due to radiation therapy around the navel. Laboratory tests of 6 February 1968: ESR 38/76 ram, Hgb 82%, erythrocytes 4.3 mill., leukocytes 3 900, eosinophils 10%, stab cells 3%, segm. ceils 78%, lymphocytes 3~ monoeytes 6~ serum iron 102 7 % , serum copper 140 yO/0. Treatment: Iscador P c Hg St. 4-2, one every second day. On the other days, inj. of Capsicum D10 in the mornings, Colchieum D5 ~ Aurum/Meteoric iron in the evenings. Internally: Formica D4, Aurum D10, Archangelica D2, Meteoric iron D20, Cardiodoron A, and also Hepatodoron. Externally: irradiated skin areas massaged with Skin Tonic, compresses with Achillea millefolium over the liver region. Curative eurhythmy. J a n u a r y 1970: steady improvement in the general condition since 1968, with no signs of recurrences on searching examination. Lymphocytes were now 18%, ESI~ had gone down to 20/41. Hgb 88%, leukocytes 4 650, serum iron 97 y % , serum copper 205 y~ . Treatment: from May 1969, Iscador Qu St. 4-2~o, internally Phosphorus D5, also Prunus spinosa 5 ~o, otherwise continued as above. Summary: a young man of 27 with lymphogranulomatosis Stage I I I had been treated with huge doses of pencillin, cortisone and cobalt radiation. He obviously had a good constitution, to put up with this without complaint. Following a para-aortic recurrence, also treated with radiation, the patient came to the Lukas Klinik, and with our treatment has remained free from symptoms and in good general health for more than 2 years. CAS~. HISTORY No. 2
Physicians: Dr. D. Boie, Marburg Dr. R. Zech, Lukas Klinik
Miss U.G., born in 1946 Diagnosis: Lymphogranulomatosis, stage I I I - I V Family history: one grandfather died of carcinoma of the , stomach, otherwise clear Previous history: measles and chicken-pox as a child. Appendectomy at age 14. Fracture of the base of the skull at 16. Concussion through frontal collision in a car accident at 20. Dental inflammations and suppuration at 20 and 2l. In March 1967, when the patient was 21, supraclavicular gland on the left enlarged, with a group of nodes developing. A biopsy in July 1967 leads to the diagnosis of lymphogranuloma. August 1967. On examination: pink-complexioned young women of medium height, with light brown hair, a delicate skin, well proportioned build, gentle, slightly withdrawn in manner, intelligent and alert, but ~11 in all somewhat
ISCADOR
THERAI~u
OF
LYMI~HOGRA-NULOMATOSIS
177
lacking in definition. Occupation: trainee bank clerk. No constitutional systemic symptoms of Hodgkin's disease. Locally, groups of nodes were palpable in the subclavicular region and along the left sternocleidomastoideus muscle. Chest X-ray revealed enlarged lymph nodes in the left mediastinal region. The spleen was enlarged to a width of two fingers below the costal arch. Small goitre. Laboratory tests: serum iron reduced to 45 y % , thrombocytes to 177 000; reticulocytes normal, ESI~ and blood counts in normal range. Treatment: Iscador P c Hg St. 4-2 s.c. between the shoulder blades, one every third day. In between, Capsicum D10 in the mornings, with Arsenicum album D6 one evening and Colchicum D5 the other. E v e r y 7th day, Epiphysis D2 injected together with Phosphorus D10. Per os: Ferrum ustum comp., Vitis comp., Cardiodoron C, Digestodoron and Cichorium int. D3. Externally: Uraninite ointment-dressings 1% over the enlarged glands at night, lavender baths. Curative eurhythmy. September 1967: X-ray showed regression of mediastinal nodes. The glands in the neck varied, with marked enlargement before the period and regression afterwards; apart from that more or less stationary. The spleen was palpable at the costal arch. October 1968: good general condition had been maintained. The group of glands on the neck was, however, gradually getting larger. Mediastinal tumour on the left had grown to the size of a small first. Spleen no longer enlarged. Liver enlarged, width of one finger. Laboratory findings: ESR 12/30, hgb 78~ erythrocytes 4.1 mill. White cell count normal. Thrombocytes 165 000, serum copper 163 -/%, serum iron 37 4/0/0. I t was then decided to treat the neck and mediastinum with betatron irradiation. Between 14 October and 15 November 1968 the patient received 4 000 I~ each in the left side of the neck and one mediastinal field. This was palliative, not curative radiotherapy, for the latter would have covered adjacent lymph drainage areas as well, where involvement was not yet apparent. After the radiotherapy, the lymph nodes in both areas showed a definite tendency to regress, but new infiltrations were seen in the left upper lobe of the lung. Radiation was well tolerated. During it, the patient was given injections of Aurum D10/Meteoric iron D10 and Stibium prep. D10 in addition to her other treatment. November 1969: general condition very good, no palpable glandular swellings. Chest X-ray: involvement of left lung had completely regressed, as had the enlarged mediastinum. Patient was free from symptoms. April 1970. Treatment: (given b y Dr. Boie) from beginning of 1969: M c Hg St. 3-2%. In addition Mistletoe-Senker (haustorium) M D30 ~-MistletoeSenker M D 6 - ~ Epiphysis D2, all every second day. On the other days, Capsicum/Colchicum D10/D10 in the mornings, Argentum D 8 - ~ Thuja D2 in the evenings. Summary: a young woman of 21, in good general health, with lymphogranulomatosis Stages I I I - I V and poor prognosis, gradual progression of the disease during the first year of treatment. After palliative irradiation with incomplete regression of lesions, treatment with our remedies was extended and intensified. All the involved lymph nodes regressed, and the patient is now in very good general health. The therapeutic effect was also influenced by the decision to leave her work as a bank clerk and become a teacher. Period of observation since first symptoms appeared: 3 years.
178
THE
BI~ITISt:[
CASE HISTORY No. 3
HOM(EOPATIIIC
JOUI%NAL
Physician: Dr. H. Isbert, Berlin Dr. U. Delius, Lukas Klinik
Mr. G D , born in 1952 Diagnosis: Lymphogranulomatosis, Stage IV 2Family history: one aunt died of pelvic carcinoma, one cousin of leukaemia. Sister and nephew have TB. Previous history: measles, chicken-pox, whooping cough, German measles and mumps as a child. Pneumonia and appendectomy at age 7. Frequent sore throats. Habitual dislocation of right shoulder. Impact injury straining the spine at age 9, after that recurrent back pain. Specific history: from the summer of 1969, increasingly tired, without appetite, lost 9 kg in weight, back pains and headaches. From September 1968, swelling under the left jaw which grew bigger and bigger. October 1968: biopsy led to diagnosis of lymphogranuloma. Subfebrile temperatures, night sweats. October 1968. On examination: pale, fair-haired boy with delicate skin, tall and lank, poor posture, flaccid walk, and reduced general condition. Local findings: under the left mandible a solid tumour of 3 "8/6.8 cm semicircumference; in right submandibular region a node the size of a walnut. Above the left clavicle a node the size of a hazelnut, in both axillae nodes the size of cherries or hazelnuts; inguinal glands like pencils. Biopsy scars in the process of healing. ENT: large-nodular tumour in nasopharynx, almost filling the left half of it. Biopsy material taken from this confirmed the diagnosis. The tumour had blocked the right tube, causing the tympanic membrane to bulge inwards and hardness of hearing. Chest X-ray: nothing to indicate intrathoracic involvement. Lymphography: suspicion that retroperitonal lymph nodes had become involved. Laboratory tests: ESR 58/85 ram, Hgb 76%, erythrocytes 3-9 mill., leukocytes 13 100, eosinophils 1%, stab cells 2%, segm. cells 67%, lymphocytes 29%, monocytes 1~o , serum copper 146 ,/%, serum iron 18 y % , alkaline phosphatase 10.2 K.A. units. Treatment: Iscador P e Hg St. 5-3, every 3rd day, later Qu St. 3-2. On the other days, Capsicum D10 + Colehicum D5, and also Cetraria St. 3, later Cladonia St. 3. Patient felt better at first, nodes were regressing. Then, after a cold, lymph nodes increased in size again, bad headaches. November 1968. Sudden hypaesthesia of whole of left face. Raised temperature, vomiting. Neurological examination: tumour of the epipharynx had invaded the middle cranial fosse by the extradural route. This had to be regarded as the cause of the neurological disturbances. I t was certain that the
process also involved the base of the skull. Compression of the left internM carotid artery. December 1968. Cobalt radiotherapy given in addition to other treatment. January 1969. After a severe reaction to radiotherapy initially, there was a striking improvement and regression of the tumours. February 1969: the tumour in the nasopharynx had completely disappeared, as had the lymph nodes in the neck. Hearing was normal again, general condition very good, and the patient gained weight. Lymphography: still suspicion that retroperitoneal lymph nodes might be involved. Laboratory tests: ESR 9/22 mm, Hgb 88%, erythroeytes 4.6 mill, leukocytes 4 900, eosinophils 5%, stab cells 2%, scgm. cells 73%, lymphocytes 16%, monocytes 4%. Between 21 November and 20 February, a total of 6 00O 1~ cobalt-60 was given, distributed between both sides of the neck including the middle base of the skull and epipharynx.
ISCADOR
THERAPY
OF
LYMPItOGRAI~ULOMATOSIS
179
May 1969. Laboratory tests: Hgb 96%, erythrocytes 4.6 mill, leukocytes 3 100, stab cells 2%, segm. cells 66%, lymphocytes 29%, monocytcs 3%, ESR 6/16 ram, serum copper 135 y % , serum iron 80 ~/%. Alkaline phosphatase 17.7 K.A. units. Lymphography continued to indicate systemic involvement. Chest X-ray n.a.d. Induration in the site of biopsy, otolarynx n.a.d. October 1969. Condition as before. Weight gain of 13 kg in a year. February 1970. Had gained another 6 kg. All laboratory findings normal, except that alkaline phosphatase was raised to 17-3 K.A. units, though this might also have been due to growth of bones. Local examination, everything clear. Chest X-ray normal. The boy was in first-class general condition, robust, red-cheeked, and much more stable in outlook. Further treatment: Iscador P c Hg St. 4-2 twice a week in the region of the back of the neck. Capsicum D10 and Pyromorphite D8 alternating with Cerussite D8 twice weekly, Colehieum D5 twice weekly. Internally, Arsenicum album D6, Hepatodoron, Cardiodoron B, Ferrum silicium D10, Formica D4. Externally; Rosemary baths. Curative eurhythmy. Summary: a sensitive, alert boy at an advanced stage of lymphogranulomatosis with systemic symptoms and incipient cachexia reacted well to Iscador and supplementary therapy to begin with. Some weeks later, after a cold, his condition deteriorated. Cobalt radiotherapy, given concurrently with our treatment, resulted in complete regression of the irradiated lymph nodes, whilst abdominal glands suspected of involvement remained stationary. The rapid recovery of strength is most striking, and the weight gains. Period of observation: 18 months. CASE HISTORY NO. 4 Physician: Dr. R. Zech, Lukas Klinik Mrs. I~.C., born in 1906 Diagnosis: Malignant lymphoma, Stage I I Family history: mother died of carcinoma of the liver, brother of carcinoma of the liver, step-brother of carcinoma of the bladder. Previous history: measles, diphtheria, whooping cough. Frequent sore throats. Cholecystectomy because of gall stones at age 55. Persistent constipation. Present condition : since June 1967, several nodules in the area of the right neck, developing after short-wave therapy for dislocated jaw. October 1967. On examination: small, grey-haired lady, somewhat nervous, frightened of any intervention. General condition good, laboratory findings within normal range, except that the serum iron was reduced to 31 ~/~ Locally, a chain of lymph nodes were palpable in the region of the right neck. Chest X-ray showed definite enlargement and solidification at the right upper hihis; emphysema and arteriosclerosis of the aorta concomitant with patient's age. Heart n.a.d. Biopsy of a lymph node revealed malignant lymphoma, with no clear distiction possible between a lymphoreticular sarcoma and the lymphohistiocytic form of Hodgkin's malignant lymphoma. Treatment: started with Iscador U c Hg St. 4-2, because carcinoma of the bronchus was suspected at first. Once the histology was known, a change was made to Iscador P c Hg St. 4-2, one injection every 2nd day, and, on the other day, Cetraria prep. St. 3 -~ Capsicum D10 in the morning and Colchicum D5 in the evening. February 1968. Very slight increase in the size of the lymph nodes in the
180
THE
BRITISH
I-IOM(EOPATHIC
JOUI~NAL
neck. One small new node in the left cervical region. ESI~ and blood counts~ within normal range. Serum iron had gone up to 62 ~/~ May 1969. Treatment had been regular for the whole of 1968 until J a n u a l y 1969. I t was then discontinued until May. Report b y letter. The nodes in t h e right side of the neck had grown smaller. April 1970. Report b y letter: condition stationary. General health good. Summary: woman aged 64 with malignant lymphoma Stage II. Has been on our t r e a t m e n t only, for two and a half years, with the result t h a t the condition is stationary and patient is in good general health. The summaries of another eight case histories are given below. These are t a k e n from a paper recently published b y R. Leroi. 5 1 A woman of 66 presented with an acute lymphogranuloma of the axilla, confirmed by biopsy. After initiation of our thelapy, the nodes not removed by biopsy regressed completely within twelve weeks. The patient was free from symptoms for five years and seven months. At the end of that period, long pauses were made between courses of Iscador therapy. Now, after six years~ recurrence in the neck region. Period of observation: six years. 2 A woman of 43 with Hodgkin's disease Stage I I was maintained for six years on our therapy only, apart from surgical removal of some nodes. Then the condition deteriorated slightly. X - r a y therapy was followed b y rapid deterioration. Patient died eight years after starting on Iscador therapy. Most impressive was the change in the nature of the patient, from a somewhat rough personality to a sensitive, perceptive woman. 3 A red-haired young woman of 31, in good general condition, with lymphogranulomatosis Stage I I I survived for more than six years, with the condition gradually deteriorating at the end. Repeated X - r a y therapy was necessary. The impression was gained that the t r e a t m e n t given initially, with Iscador injections given at greater intervals and in high strengths, was not as effective as the more intensive therapy we are now using, with Capsicum and Colchicum also given more frequently. 4 A woman of 42, tall, slim, sandy-haired, light-skinned, the sister of the patient described in Case History No. 3. Lymphogranuloma Stage I I ; a life full of d r a m a - - t h i r d marriage, unhappy. For about 1189 years she was treated with Iscador and Capsicum/Colchicum only, with the condition progressing slowly. Finally X - r a y therapy became necessary. After that, deterioration was more rapid. Iscador discontinued. Died fourteen years after treatment started. 5 A young woman of 22 with lymphogranuloma Stage II. The type often seen: rosy with overflowing vitality, friendly, active nature and positive attitude to life. After conventional therapy of the Stage II, patient has continued free from symptoms for five years on our therapy, in spite of two pregnancies which so often are followed by recurrences of the condition. 6 A young woman of 27 with lymphogranuloma Stage I I I treated with cobalt radiotherapy has remained free from symptoms to date, i.e. for four years, on our therapy. 7
A man, now 61 years old, presenting with the rare phenomenon of three
HOM(EOPATHY IN GENERAL PRACTICE
181
malignant conditions at once: carcinoma of the rectum, lymphogranulomatosis and seminoma. The lymphogranulomatosis, at a fairly advanced stage (III), was treated with X-rays in moderate dosage, recurred three times, and was irradiated again each time. No further symptoms now for 589 years, nor are there any signs of secondaries developing from the other malignancies. Period of observation since starting on Iscador therapy: fifteen years. A woman of 31 who came for treatment when in Stage IV and was kept stationary and able to work for four years, taking our treatment only. Then increasing enlargement of the spleen, regressing after radiotherapy. Period of observation to date: 489 years. (Unless otherwise stated, the drugs mentioned in this paper are available from the Weleda Companies, and they will also supply copies of the new edition of Directions for the use of Iscador, on request. The German D potencies given in this paper are equivalent to the English x potencies.) REFERENCES
Bole, D. (1968). Das erste Auge. Stuttgart: Verlag Freies Geistesleben. Brunner, K., and Barandun, S. (1966). Die Therapie des malignant Lymphoms. Sehweizer Medizinische Woehenschrift, 96~ 263-7. Lehmarm, F. M. (1968). Kritische Betrachtung zur Krebsbehandlung. Tberapie der Gegenwart, 1173-83. 4 Leiber, B. (1961). Der menschliche Ly.mphknoten. Munich and Berlin. Leroi, R. (1969). Malignom-Behandlung nach geisteswissenschaftlichen Erkenntnissen. Die Lymphogranulornatose. Beitrffge zu einer Erwei~erung der Heilkunde, 22, 69-85 and 107-110. Smithers, D. W. (1967). Hodgkin's disease. British Medical Journal, 2, 263-8 and 337-41.
Homoeopathy in general practice KATHLEEN
G. P R I E S T M A N ,
M.R.c.S.,L.~.c.p.,M.F.r~OM.
When I was considering the title of this lecture, I wondered how I could present the difference between predominantly homceopathic prescribing in general practice, and ordinary orthodox prescribing, so that it could be most clearly understood - - after all, we all see the same kind of patients, to the third and occasionally the fourth generation when we have been in practice long enough - - w e all treat patients with acute illness, chronic disease, psychosomatic A paper read as part of the Post-Graduate Intensive Course of the Faculty of Homoeopathy on 23 February 1971