The usual treatment gave no relief. The only benefit she got was from Quinine, but latterly she had been compelled to take such large doses that they caused a feeling of apprehension and giddiness. Bojanus found the general condition on the whole discouraging: appetite poor, cannot take milk which causes diarrhoea, nor fish, which causes pain in the stomach and nausea; she does not care for uncooked fruit and has an aversion to meat, so that, as she expressed it, eating is a matter of indifference. She was emaciated, often compelled to resort to wine, spoke slowly and in measured tones, always felt weak and exhausted. The tongue was slightly coated, no constipation, sleep generally light, disinclination to motion and work which she ascribed to her weakness.
In March, 1876, an examination, Bojanus writes, showed the following: “Liver normal, spleen slightly sensitive to pressure. Percussion gave negative results, while auscultation showed, with normal respiration, at the sixth intercostal space on the left and backwards a distinctly audible friction sound, so distinct, indeed, that I was not certain of its cause. This much was certain, that we had to deal with a quartan type of intermittent fever. Nux 3x and Ipecac. 3x, three drops of each were given in hourly alternation together with a wine diet and rubbing of the whole body with alcohol three times daily. At the next attack all the symptoms returned and I heard during the fever paroxysm the friction sound under the before-mentioned painful spot. For this I ordered a compress to be applied during the fever, removing it when the sweating stage came on. After four successive lessening attacks the fifth failed to appear and the patient began to improve. The appetite increased, also the general strength and she became more active and in better spirits. Auscultation showed steady vesicular respiration and complete absence of the friction sound. A few weeks later the patient went to the country with instructions to continue the medicine and closely follow the diet.
“During the following winter she enjoyed good health but in the early part of April I was again called to see her, and learnt that the attacks had returned, but in a tertian form, although she could not remember any error of diet and the attacks were somewhat different; she has now constant chilliness, the fever and pain in the side were less and the paroxysms did not last as long. I again examined during the paroxysm, percussion gave no results and I heard on auscultation, distinct normal respiration and very slight friction sound. She now received Ipecac. 3x and Aranea 3x in hourly doses, together with the same diet and rubbing with spirit. The second attack was so slight that she had no desire to remain in bed, and there was no other. In 1880 I saw the patient for the last time, and she had had no sickness up to that time.
[The remaining cases are given in Bojanus’ own words.]
CASE IX.
Intermittent in the form of Pleurisy. Nux and Ipecac.
This case, very similar to the last, says Bojanus. came to me in 1872.
The five-year-old son of General R. had been treated for two weeks by an old-school physician but without benefit. When I saw the child for the first time, a plaster, leaving a blister, had been removed from the affected side so that percussion and auscultation were not to be thought of in this capricious, spoiled and feared-inspired boy, who at the approach of every stranger uttered a terrified cry. I learned from the mother that two weeks before, without any apparent cause, he was attacked by a chill, not long in duration, followed by fever. With the chill he began to cough and with each coughing spell distorted the face and cried. He also complained of pain in the left side, more towards the back. The physician was called and said that the trouble was pleurisy, which was evident enough, and ordered a mixture which was given at once. Soon after this, sweating began and he rested easier, and towards evening of the same day the disease had apparently disappeared, which was naturally ascribed to the mixture. On the next day the boy seemed relatively well and was running round the room since it was impossible to keep him in bed. On the following day the same scene was repeated and so continued until the boy refused to take the medicine and it was not possible to use force. The mixture contained Quinine. Up to the time of consulting me the attacks had been of the tertian type. I could not examine nor question the boy, but from his well-nourished and vigorous appearance, and from my own experience, the scrofulous basis was plainly manifest. I gave Nux 3x and Ipecac. 3x in hourly doses, and ordered a wine diet, to which the mother at first objected. During the following week there were three paroxysms of which the third and last was very light, and the boy was soon well. He now permitted a careful examination, but it was without result. For three or four years after this I have seen the boy and during that time there has been no relapse.
CASE X.
Long-continued Intermittent Fever, simulating Tuberculosis. Phosphorus, Kali. nit., Nux and Arsen.
A young man, 20, of whose family I had been physician for many years, had suffered greatly from intermittent fever the last two years while residing in Dorpat, where he was attending the gymnasium and, as his parents would not employ old school treatment, he was prescribed for by letter, and each time relieved, but from want of perseverance with the diet, and on account of the climatic influence, he was constantly subject to relapses.
In February,1882, this tall, but reasonably strong young man, of good constitution, again fell sick. When a child he had scarlatina of rather severe form with albuminuria. Later he had measles but no other diseases, except the above-mentioned intermittent fever which frequently relapsed notwithstanding the use of Nux vomica, Arsen., Chinin. arsenicosum and Natrum mur. As he was preparing for his graduation examination he could not return home but was compelled to remain at Dorpat until the end of May. His elder brother was at the same time a student of medicine in Dorpat and could do nothing but call upon Professor V—, who proceeded to treat him, secundum artem, with large doses of Quinine and stopped the paroxysm, but as it persisted in returning, larger doses of the drug were used. So matters went on until h had passed the examination and was about to attempt the matriculant’s examination for the university.
At this time he was seized with a general feeling of exhaustion and an irritating dry cough which alarmed his brother, and Professor V—- was again called. He made a careful examination and found dullness with abnormal respiration at the left apex and ordered the patient to seek a warm southern climate.
Daily towards evening there was fever with copious night- sweats, and in the face of Professor V—‘s opinion already expressed, the brother asked him what he feared. ” Dear friend,” said the Professor, “here is a serious matter; do you not see that tuberculosis and hectic are in union? I have seen a mass such patients; I am not mistaken.”
The young man was startled and could not believe the words, although they were those of a master, and so called in Dr. S—, who after seeing the patient, gave, if not in the same word’s at least the same sentiment, and thus the correctness of the diagnosis was established.
The brother now wrote home describing in extenso the condition of the patient, as also the result of the physical examination, whereby it became apparent that the fever recurred every evening with slight chill, general heat, and a copious sweating, thus simulating hectic fever. I wrote to Dorpat inquiring if the professors thought the condition of the lungs to be a result or cause of the fever, since, if they determined that this was the cause of the fever, then the changes in the lungs must have preceded and not followed the fever, and this the more since it was known to me that these same gentlemen had examined this patient at other times and pronounced the lungs to be in good condition. I was also anxious to have this question answered since they had decided not only in this but in other similar cases, that a rational therapeutic treatment was not possible. The answer returned was that the fever was a hectic fever and was dependent on a commencing disease in the lung. I saw that my question had not been understood and urged the patient to come to Moscow, which he did on his arrival I examined him most carefully but could discover no dullness although the abnormal breathing was noticeable. I also learned that for the past three years, in each succeeding Spring, he had suffered from intermittent fever, and during the present season the same, and as it did not seem to yield to the medicines which I had sent, large doses of Quinine had been taken up to ten-grain doses. Still the fever returned until finally the attack came on each evening with chill, heat, headache, weakness, despondency, ill- humour, restlessness and dry cough. These conditions were also present, in a lessened degree, during the apyrexia. The young man had grown thin, there was loss of appetite, the sleep was disturbed on account of the fever and night sweats, and was only an unrefreshing slumber, while the normal condition was very much disturbed. I ordered Phosphorus 3x and Kali nit. 3x hourly in alternation with the wine diet and rubbing the body with spirits. At the end of three weeks, under the continuous use of these two remedies, the fever and abnormal breathing had entirely disappeared, while the appetite had improved and the patient was cheerful and bright.
