At the end of a week the feverish condition had lessened, but a night cough, entirely relieved by day, now came on. Otherwise her condition remained the same except that her appetite was better. The loss of sleep weakened her and although she got some sleep weakened her and although she got some sleep in a day it did not make up for that lost in the night. Nux 3x and Ipec 3x were now given every two hours alternately. In a few days the cough disappeared, the sleep returned and the patient seemed well. Several weeks later when Bojanus again called she told him after the cough left she had been weak and then noticed a swelling in the back of the feet which had increased slowly till it reached the knees. She complained only of difficulty in walking and itching of the swollen extremities and was otherwise well. There was a trace of albumen in the urine but no casts, and liver and spleen were normal. Bojanus ordered a half lemon to be taken night and morning with plenty of sugar but no water. At the end of a week the oedema was gone and the patient was not again ill till she died of old age at 88.
CONSTITUTIONAL MEDICINE
CASE VI.
Intermittent Fever under the form of Prosopalgia. Nux and Ipecac., later Aranea.
D.B., wife of a Russian clergyman, 36, small of stature, emaciated and badly nourished, mother of several children, consulted Bojanus on March 6th, 1878, complaining of pain in the left side of the face, which was of long duration and came on every day at 2 p.m. It followed the three branches of the trigeminus, and she also complained of a persistent chilliness not relieved by the heat of the sun or a warm room. This had lasted two years, the pain in the face having first appeared in March, 1877, and had proved intractable to all kinds of household remedies and was only removed by Quinine given under medical advice. But the general health was not improved, and in the beginning of autumn the pain returned and though again relieved by Quinine the relief was slower in coming than at first. She now gave this history:
With the onset of chilliness, with cold hands and feet, there appears a burning pain deep in behind the joint of the lower jaw. The pain radiates into the eye causing weeping, into the eyelids, the left side of the nose, the cheek and all the teeth, upper and lower and even to the chin and lips. To this pain there is added a particularly painful, intermittent tearing sensation from within outwards. The only relief was by the application of very hot dry cloths. After began to slowly lessen, the entire attack lasting from three to three and a half hours, after which she felt very weak and faint. Fever and sweating were absent during the attack. She complained of want of appetite, the tongue was coated white with insipid taste, and there was aversion to meat; long continued sensations of coldness or chilliness over the whole body and constant coldness of the hands and feet. The liver and spleen were normal, menses regular and scanty but without pain, no constipation or thirst. Nux 3x and Ipecac. 3x were given every hour in alternation during the pains. The usual diet and wine were ordered and no water except mixed with wine. On March 17th she reported that after three days the pains began to disappear gradually and for three days there had not been any, but the chilliness and cold hands were better, as also the general health.
The medicines were continued at longer intervals with strict instructions that the diet should be continued for a least one year. On March 28th, 1879, the patient reported that the pains had returned one week before. Since April 1878, she had taken the medicines as ordered, for two weeks four times daily, in a alternation, for two weeks twice and for a further two weeks once a day. But she had not been strict with the diet, especially in the latter part of the time. Nevertheless, she had been in good health until the beginning of the great fast (Lent). (According to the laws of the Russian Church the seven weeks of the fast are very strictly kept. Nothing but vegetable food is allowed; only on two days of this long fast can fish be eaten, namely, at the feast of the Annunciation and Palm Sunday. The diet consists of cabbages, turnips, potatoes, mushroom and farinaceous foods, everything being prepared with oil; animal food is strictly excluded.) Believing that she was quite well she began to fast and at first suffered no inconvenience, but on March 25th she could not resist the desire for fish and on the 26th the neuralgia returned, together with the coldness of the hands and feet. It also transpired that since the winter she had been living in a very damp house. Aranea 3x and spigelia 3x were given in hourly alternation.
On April 12th the pains had been entirely absent for three days and the patient felt decidedly better. The remedies were continued and it was directed that for twenty-eight days after the last attack the diet should be strictly observed and a drier dwelling found. Seen by Bojanus when attending her children during 1882 to 1884 there had been no return of the trouble.
CASE VII.
Intermittent Fever under the form of Pneumonia. Ipecac. and Nux.
B.T., 4, a well-nourished, strong, active boy, was taken ill on January 10th, 1875. The previous day he had given a few coughs, which had passed unnoticed, but about 2 a.m. he was suddenly seized with a severe shaking chill, followed in an hour with high fever and reddened cheeks. He was restless, continually tossing about, coughed frequently and cried continually from pain in the chest, but was unable to locate the seat. After this had lasted two and a half hours sweating began and the cough lessened, crying ceased and the boy soon fell asleep. The sweating continued, though not copious, till 9 a.m., when he awoke without any distress and after eating his breakfast, went to his accustomed playing. So passed twenty-four hours and again a slight cough occurred, almost unnoticed by the parents and not attended to. Soon after midnight of the 12th occurred the same scene, and in the morning of the 13th Bojanus saw the child. As soon as he entered the dwelling he noticed that it was damp, which the parents admitted and said that they were determined to leave it in the spring. The boy was then up and busy with his playthings, without any special appearance of sickness.
Examination showed that there was no fever. The tongue was slightly coated and there had been no stool since the day before. Percussion gave negative results. There were fine bubbling rales under the left scapula; when quiet there was no cough, but it at once appeared when moving about. Bojanus diagnosed bronchitis or catarrhal pneumonia with a malarial complication and warned the parents that they might expect another paroxysm. Ipecac. 3x, in tow drops doses, was given every hour.
The next paroxysm came on at 10 p.m., and was ushered in with a severe chill, which lasted one hour, and great thirst; the cough quickly followed and was accompanied with headache and general pain, together with restless tossing about the bed. A few minutes after eleven the fever began with reddened cheeks, increased heart-action and a temperature of 39.3 to 39.9C. There was quicker respiration, violent action of the nostrils, drawing in of the lower ribs, aggravation of the cough, increased restlessness, crying and tossing around, all continuing until half-past twelve. The child became so great during the fever. The child became easier as the seating stage began, which was this time more copious and of shorter duration than in the previous attacks, the whole paroxysm being lighter, as the mother said, than the former ones.
Nux. and Ipecac. 3x were given in hourly alternations during the interval, together with wine diet and rubbing morning and evening with brandy. The three following paroxysms were each lighter in character and after the last the child began to improve rapidly. During the Spring and early Summer he was well and before the hot weather was removed to a drier dwelling and then into the country, so that he suffered neither a relapse nor a new attack. Seen in 1884, then fourteen years old, he was in rugged health and had no other sickness.
CASE VIII.
Intermittent Fever under the form of Pleurisy. Nux. and Ipecac.; Ipecac. and Aranea.
M.D., 46, mother of a grown-up daughter, had suffered for many years on each recurring spring with the following conditions:
Early in March, without any visible cause, she would be attacked with a severe sticking pain in the left side of the chest which interfered with the respiration and with this there was a chilly feeling lasting an hour, followed by fever lasting three hours, followed by fever lasting three hours, during which the pains were aggravated, the breathing more difficult, and accompanied with a cough, generally without expectoration, but sometimes there was a frothy, slimy sputum. There was also intense thirst, dryness of the mouth, headache and internal chilliness but with hot skin with desire to be covered during this period and sometimes shorter but never of over three hours duration. This was followed by profuse sweating lasting generally from two to two and a half hours, during which the pains lessened, the breathing became freer and the cough looser. On the following day the patient was able to be up for few hours, but this only lasted two days when the attack recurred. This state of things lasted till May, when every symptom disappeared and she gradually recovered her health.
