Dyspnoea, Palpitations, Asthma, etc. Argentum nitricum [Symptoms in italics are found in the provings of Argent. nit.]
J -. L -., a police officer, 54, complained that for a year past he could no longer satisfy his desire for hunting because, when ascending a hill or on moderately rapid motion he loses his breath. He stated that he suffered from piles and had always taken many powders and pills which relieved him, at most, for a day or two, and that now his digestion is so much impaired by having taken them for years, that for many months he has suffered from loss of appetite. Previously corpulent, he was now emaciated and has to complain of a constant anxious feeling in the region of the heart, periodical pains in the abdomen, burning haemorrhoidal tumours and urgency to urinate. He was most alarmed by the frequent vertigo and the weakness of the whole of the left side of his body. He has a prematurely old look, ashy pale colour of the skin, the tongue was coated white, the taste unpleasant, the region of the liver sensitive to pressure though no enlargement of the liver could be discovered. No blood or mucus was passed with the stools. Respiration 26, pulse 108; palpitation of the heart; no cough, the respiratory murmur scarcely audible in several places; only on the upper part of left lung was it dry, vesicular and manifestly more acute. When requested to draw a deep breath he did it without pain but with so little elevation of the thorax, with so small a quantity of air being inspired, and without being able to hold his breath for any time, that it was clear that the capacity of the lungs was much diminished. The hands trembled; the sleep was short and he awoke frequently with attacks of suffocation. Discharge of wind upwards and downwards always brought relief. He had lived moderately ever since he could remember.
Soup, meat, vegetables, milk, coffee and two glasses of beer a day were his food. He walked two hours every day in the open air and never smoked.
The use of coffee was forbidden and Nux vomica 2 was prescribed provisionally once a day for eight days, then set aside for eight days, and so on.
For eight days he thought he was feeling better, that is, in general only, for all his complaints remained, though in a less degree.
Four weeks later at 2 a.m. he had a violent attack of asthma, more violent than ever; this was apparently according to his statement, cause by cold although it was in the middle of summer. Arsen. 10, two or three drops every two hours. was ordered. After three hours he was quiet again, but there was still violent palpitation and short respiration. Arsen. 10 once a day. After six days he returned to his occupation as his breathing had become easier. Sulph. 30, a single dose. Better sleep followed and better appetite, and he felt stronger. But after another four weeks he still had no real inclination to work, was also tormented with anxiety, and, although not so often with vertigo, yet with confusion of the head and constipation – the latter always aggravating all his complaints.
For the next six weeks everything remained much the same. But now he earnestly begged for something against the constipation; for after two or three days without an evacuation there regularly returned intense weariness and more trembling of the hands; then also more sleeplessness and disgust for all labour; heaviness and stupefaction of the head, especially the occiput; eructations and sense of constriction in the bowels, as if tightly girt by a band, which had chiefly set in after the last asthmatic attack. The urgency to urinate also the increased, while he suffered from obstruction; also the palpitation and difficulty of breathing, as well as the sense of weakness of the left side of the body, and the left arm became then as heavy as lead.