ALCOHOL AND TOBACCO.
AMONG the cases recorded in other chapters of this work are several in the causation of which the use of alcohol was one of the factors. There are three cases, however, which occurred in the earlier years of my practice, in which the history of alcoholism and nicotism was so clear, that I think it may be well to give them a chapter to themselves.
CASE XXVIII.-HEART-PAIN WITH NERVOUS SYMPTOMS ARISING FROM ALCOHOLISM. ACTION OF Spigelia.
On the 24th of July, 1880, I was consulted by a young man, S.P., aged 27, for a pain at the heart, dizziness, noises in the head, excessive nervousness and inability to sleep. The contrast between the physique of the patient and the character of the symptoms he complained of was very striking. He was a ballast- quay labourer, considerably over six feet in height, powerfully built, well nourished, muscular, dark. That a man of his build should be complaining of nervousness, sleeplessness and dread of being alone in the dark showed plainly that there must be some cause at work, external to himself, giving rise to the disorder.
He told me he had been suffering in this way for two or three months. His tongue was dirty at the back; his bowels confined. His appetite was good, and he had no pain after food, though he had been troubled with it formerly. He had always been very strong.
On inquiring about his social habits I found that his occupation required him to go on board many vessels, and wherever he went liquor was offered to him, which he did not like to refuse, though, as he told me, he did not want it, and knew he was taking more than he ought. Besides this, he was a smoker, but not to excess.
This was quite sufficient to explain to me the anomaly of his case. Alcohol is a most powerful cardiac stimulant, and its free and persistent use in this case had brought on the natural result of all over-stimulation-weakness and perversion of function. The nervousness and other symptoms I considered were secondary to the state of the heart.
I explained to the patient the nature of his case. I told him that it was possible for medicines to relieve him, but whether they would cure him or not depended on himself. If he had the courage to refuse to take what he knew was not good for him, even when he got it “for nothing,” he would soon be quite well.
If he went on as he had been doing of late be would soon be beyond the reach of cure. He was so thoroughly alarmed about himself that he did not hesitate about his choice, and I believe left off the use of alcoholic drinks altogether. I gave him Spigelia 3, three times a day.
He returned a week later looking quite a different man. He had slept well, was less nervous, less giddy, his tongue was clean, and his bowels regular. (Here as in other cases Spigelia relieved constipation, as well as the symptoms which more particularly indicated it.)
I repeated his medicine, and the following week he reported still further improvement, though there was still a little giddiness and some gnawing pain at the heart. Pilules of Spigelia I were now given in the same way, and continued till September 8th. He had giddiness occasionally during this time, and slight palpitation at times, but was well able to carry on his work. His bowels were again a little confined, and he received Nux vomica I, three times a day, and this completed the cure. He returned in another week to say he was very much better. I gave him a fresh supply of Nux vomica, and told him he need not return unless he became worse. He was so exceedingly pleased with the favourable change that had come over him that I had little fear of his returning to his old habits.
CASE XXIX.-ANGINA, DYSPNOEA. HISTORY OF ALCOHOLISM. ACTION OF Spigelia
J.B.,37, single, lath-render, middle size, fair, florid, with shiny, weather-beaten-looking complexion, consulted me August 13th, 1879, complaining of a choking sensation in the throat and a smarting pain at the heart, worse some days than others; a constant gnawing pain in the left side of the chest, weakness of the left shoulder and arm, giddiness, headache, noises in the ears, palpitation and shortness of breath.
His health had been good till seventeen months previously, when he was taken suddenly ill,”like a corpse,” as he described it. He was then exceedingly nervous, and afraid above everything of going to sleep.
His present illness he dated from twelve months back. It came on gradually. For eighteen weeks previously to his consulting me he had been attending an allopathic hospital, but had received no benefit. He was discharged, and on his discharge- paper was written the word “relieved.” As he was not conscious of the smallest relief, this statement so angered him that it brought on an attack of palpitation and breathlessness which compelled him to sit down for a quarter of an hour before he was able to proceed on his way home.
His father and a brother were asthmatical. Of late he had been a total abstainer from alcohol, but previously had been a hard drinker.
Tongue clean; bowels confined; appetite poor; pulse feebler right side than left; pupils equal; sight same in both eyes.
I suspected aneurism, and gave Bary.-carb. 6, three times a day, with no beneficial result. I examined him then very carefully on two occasions, and found only a slightly jerking inspiration on the right side of the chest, and a muffling of the first sound of the heart. There was no bruit. The right inter- scapular region was a shade duller than the left. There was slight inequality of the pupils and pulses, the left pulse being stronger and the left pupil larger than the right. He had numbness of the left arm.
The bowels were confined. As Nux vomica is useful in alcoholism and its sequelae, and as it corresponded fairly accurately to the general condition of the patient, I gave it to him in the first centesimal potency three times a day, but this had no more effect than the Baryta.
August 27th.-I now directed my attention to the heart itself, as being the organ most injured, and the probable source of the rest of the patient’s symptoms. I gave Spigelia 3, three times a day.
September 3rd.-Improvement was soon manifest; he has been a good deal better. Bowels regular. Appetite better. To-day the breathing is short, and he feels choked; this he thinks is due to his having taken milk for supper the night before.
With the exception of one week during which he took China I for an attack of diarrhoea he continued to take Spigelia to the end of the year (1879), steadily improving in every way, able to work his full time, and enjoy life. He went away for a holiday at Christmas-time, and returned none the better for it. The fogs tried him a good deal, and any mental excitement was sure to throw him back. I again gave him Spigelia, and soon afterwards lost sight of him, so how he fared subsequently I cannot say. The wonderful improvement Spigelia wrought in his whole condition whilst under my care I can, however, answer for.
February 14th, 1880.-J. T., 21, a clerk, dark, middle-size, well nourished, well made, consulted me about a pain he had at the left side, below the nipple,”as if there was something too big under the ribs.” This was especially bad after a breakfast of porridge. He fainted at times, and was very nervous, and greatly alarmed about himself, fearing he had heart-disease, his father having died of it, and one of his sisters being a sufferer from it. He had a little cough in the morning, with pains in the chest.
Tongue clean, appetite good, bowels regular, sleep bad-it had been good until a short time previous to his consulting me.
I asked him about his former health, and if he could assign any cause for his malady. He told me he had been always healthy. For the last three years he had done much bicycling. Before that he had felt nothing of this trouble. For three weeks he had been working in a close office lighted nearly all day with gas. He had been worse during the last fortnight, having taken a chill at the seaside.
He had no palpitation. I examined the heart and found all the signs normal. The pulse was steady and full.
Treatment Actaea rac. I, three times a day.
February 21st.-The following week he returned, and reported that the pain had been easier, but he had still felt a little of it. He had not fainted, and had had no discomfort after food. Sleep still poor, but he was not quite so nervous. The medicine was repeated, and the following week, as he was in much the same condition as regarded the heart and nervousness, but his appetite was bad and his tongue dirty at the back.
Treatment Nux vomica I, in place of Actaea r.
March 6th.-Numb sensation over the front of the chest; fullness all round; perspiration at night and sleeplessness; is very nervous; has a bad cold. Treatment Ignatia.
March 10th.-The numbness has gone from the chest. There is less perspiration, but he is not so well generally. There is continually a dull pressing pain at the chest. He feels faint; hands and feet cold; pulse full; sleep still bad.