In order to quiet the family, and also on hygienic considerations, I advised the young man to seek another climate, and, in order to lose on time, to begin his studies in South Germany, which was done. In the meantime, his brother, who had attained his degree, travelled through Austria in October of the same year and was a witness of his good health and activity in his studies.
In the Spring if 1883 the former wrote me that his brother had had a threatening of a return of the fever but that Nux and Arsen. promptly relieved it. After spending a year in Austria my patient returned to Dorpat to complete his studies in natural science and philosophy and then travelled. So far as I know, he has not been sick since the occasion noted above. CASE XI Sycosis. Nux and Ipec: Thuja, Nat. sul. Mr.K-, worker in a glove factory, 28, tall and strong, of pale countenance and spare build complained that for one year, especially in the autumn and winter months, he had suffered from a cough, which was accompanied by a constant, generally copious, thick, yellowish or greyish expectoration, which in the last attack was also mingled with blood and this led him to seek advice. According to his report the cough had not come on any single occasion from catching cold. He was not able to give any particulars of his condition except that for a year, or about the time that the cough began, he had gonorrhoea, which had been treated according to the old-school method and had only been cured about a month.
On examination of the genitals I found over twenty narrow- pedicle condylomata about the glans and especially around the corona. Percussion showed marked dullness in the upper part of the left lung extending down into the third intercostal space, while auscultation demonstrated harsh bronchial breathing, which, in every case, points to extensive infiltration. A distant weak vesicular murmur cold also be heard in the same side. The third and seventh dorsal vertebrae were sensitive to pressure. The cough, which was (<)in the morning, was not debilitating. It was caused by a persistent tickling in the throat, which at night interfered with sleep, at which time the cough was drier. His strength was lessened and also his appetite. Cold water, cucumber and water-melon caused a watery, painless diarrhoea, so that only boiled water cold be taken and this in the smallest quantity. The stool was sluggish. There was no fever but lately constant chilliness not (>) in a warm room.
On November 10th, 1868, he received Nux 3x and Ipecac. 3x, three drops in hourly alternation, and anti-hydrogenoid diet, On December 1st he reported that he was feeling better and that within a week the cough had nearly disappeared. The medicines were continued at5 intervals of two hours. On December 10th the cough had not returned, the chilliness was better and some of the warts had fallen off the glans; there was an insignificant thin discharge from the urethra; he felt stronger on the whole, his appetite was better and the stool regular. Physical examination of the thorax showed a clearer percussion sound over the affected area, and a somewhat rough, prolonged, but not bronchial breathing; the tenderness over the spine was better. Thuja 30 and Nat. sul 2x were now ordered morning and evening.
On january 12th only two of the condylomata remained, the discharge from the urethra had ceased, as also the chilliness, while the appetite, stool and general health were very satisfactory. The remedies were repeated and on February 2nd all the condylomata had gone. The chest showed everywhere normal percussion sound and strong vesicular murmur. The tenderness over the spine was gone, the colour of the skin was good and the patient’s former strength, through good appetite and regular digestion, had again returned. No further medicine was given but he was directed to report later. This be did on March 20th and I satisfied myself by a through examination of his restoration to health.
CASE XII Intermittent Fever and Perihepatitis. Nux 3x and Arsen ex.
A wealthy lady, 30, mother of two children, who had a s a young girl taken for anaemia or chlorosis large quantities of Iron in the form of Vallet’s pills, and had lost nearly all her teeth in consequence, was taken ill in February, 1868, with a severe chill, accompanied with severe pains in the right hypochondrium and pressure in the stomach which was greatly aggravated by free respiration. This was followed by fever, not intense, lasting several hours and followed by sweating. By this time it was evening, and after spending a bad night with frequently interrupted sleep, she was alarmed to see her skin as well as her eyes had a strong icteric colouration.
From this time these attacks began to manifest themselves in regular tertian type, during which the icterus persisted in its intensity, but the pains in the hypochondrium lessened during the apyrexia; no other symptoms manifested themselves.
The patient was treated up to the beginning of May with old-school measures–soda water, soda baths and many other remedies unknown to me–also with homoeopathic remedies, whilst all possible diagnosis were given even to the presence of micrococci, but all without relief. She then went to Carlsbad. There she drank of the Markt and Muhlbrunnen, and bathed in Sprudelwasser, but the only relief obtained was that the paroxysm changed from a tertian to an eight-day attack. During this long interval the icterus almost disappeared, although the urine still contained a large quantity of bile pigment and the faeces retained a white, bile-deficient colour. After the patient had remained six weeks at Carlsbad without any benefit she became impatient and losing hope of any result returned to her home.
I was consulted the end of July and found the following conditions: Very weak and emaciated, marked icteric colour of the skin, with intensely yellow sclerae. The left lobe of the liver was at least three inches below the borders of the ribs, extending to the scrobiculus cordis; it could also be traced backwards to the middle of the last rib and was very sensitive. The gall-bladder could be felt as a round elastic body. The spleen seemed to be normal. Over the whole body were scratched and bleeding spots due to the itching from the icterus. The appetite was poor, the tongue coated, a bitter taste in the mouth, the urine was filled with gall pigment, the faeces chalk- white, and the menses had not appeared since February last. The paroxysm came on regularly every eight days at the same hour, but on the seventh day the patient felt an oppressed feeling about the heart, accompanied with difficult breathing and an indescribable discomfort, due to the approaching paroxysms. The latter came on in the morning lasting till evening and began with a light chill, followed immediately with a severe pain of a pressing sticking character in the region of the liver, extending also to the cardiac region causing there an unendurable distress with difficult breathing. The fever was rather severe in character, lasting about one hour, with little thirst but with intense aggravation of the pains about the liver. During this time the liver was sensitive that the slightest touch could not be endured; the swelling of the liver and distension of the gall bladder were also increased, whilst the sufferings could not be borne without hot applications which afforded manifest relief. This continued until towards evening, when the pains began to abate at the outset of a slight perspiration, so that by ten o’clock the patient was again in a comfortable condition and was only troubled by the increased icterus and persistent itching of the skin. During the seven days’ apyrexia the swelling of the liver and gall-bladder and the jaundice of the skin disappeared and the patient was able to move about and take short walks in the garden. No headache or other disturbances were present.
She received Nux 3x and Arsen. 3x, three drops of each in hourly doses, was ordered wine diet and to have the body rubbed night and morning with alcohol. The next paroxysm, also after an interval of a week, showed itself only by a feeling of weakness and discomfort, and the pains, swelling of the liver, chills and fever were wanting so that the patient was not compelled to lie down not to apply the hot compresses. On the following day there was a sudden urging to stool, the movement consisting of a partly formed white partly colored pappy faecal mass mixed with a partially thick, grass-green, watery fluid of fetid odour. From this time the decrease of the swollen liver was daily evident. The gall-bladder could not be felt on the day following the stool. The icterus slowly disappeared and with it the itching of the skin, while the appetite at the end of the two weeks was voracious, and as the restoration of the whole organism went on to the patient began to gain flesh, to recover her strength. By the end of August, up to which time the medicines had been continued, but at longer intervals, one would hardly know her. The medicines were given once a day in alternation to the end of September, when they were discontinued. There has been no relapse up to the time of writing.
