The corresponding part on the left side gives also a rather flat note. There is still pulsation in the episternal notch. The apex beat is not felt. No pulsation felt in scrobiculus cordis. Mitral area: first sound not quite pure, followed by a loud diastolic bruit. Tricuspid area : first sound, followed by a marked diastolic bruit. Pulmonary area: systolic and diastolic bruits.
Posteriorly.- The right side about the upper and inner angle of the scapula is slightly duller than the left. The breath sounds are not quite so loud as on the left side, and the cardiac bruit is more audible. Otherwise the two sides are alike.
The bruits are audible over the dull area above the right clavicle, and above the dull part; not so loud in the corresponding part of the left chest. The systolic bruit is heard in the carotids.
July 30th.-Still some pain in the right side, low down in the lumbar region, worse when sitting; not felt at all when walking.
The patient went home on the 31st, and subsequently saw me as out-patient. The improvement had gone on steadily. He continued taking the Bary.-carb.
When he visited me on the 2nd of August I took the following sphygmogram :-
On February 20th, 1888, the patient again presented himself at the hospital. He had been at labouring work on the railway ever since June, 1887, and he managed it as well as ever, lifting and carrying heavy weights as this kind of work entailed. The physical signs showed still further improvement, though the cardiac bruits still remained and there was still a little difference in the pupils.
This case I call a practical cure; the patient was restored to his usual health and usefulness. The aneurism had consolidated and contracted, having become firm enough to resist the pressure of the blood stream even under great exertion. The crippled heart valves remained unaltered but the strength of the heart was so far improved that these defects gave rise to no symptoms.
The Baryta carbonica accomplished, tuto et jucunde, the end aimed at by the heroic and dangerous measures of allopathy which generally seriously damage the patient, even when successful. Among them is the insertion of an electric wire within the sac of the aneurism to promote clotting. This has often proved fatal. Another remedy is Iodide of potassium in massive doses. This drug acts specifically on the heart and is used in the homoeopathic form according to its indications by homoeopathists; but even as used by the allopaths it has met with some measure of success. But at what a price! The patient is lowered by the powerful drug to such a degree that very frequently he never recovers the drugging. Another method is reducing the blood-pressure to a minimum degree by means of starvation. The patient is put on “absolute diet”-that is to say just given enough food to keep him in life and no more.
That there is no possibility of routine practice in medicine is shown by the following case in which the medicine which acted so splendidly in the last narrated completely failed. Homoeopathy has no specifics for diseases-only for patients; and the art of it consists in fitting each case with its own remedy.
Another point of comparison between the two will be found in the symptoms of the voice. In the case of Jesse F., as we know, there was hoarseness and loss of voice. As the aneurism improved this symptom disappeared. In the next case it was the alternation in the voice which first attracted attention. The explanation of this is that the increasing aneurismal tumour presses on one or other of the recurrent laryngeal nerves, paralysing its function to a greater or less degree, and so preventing the proper action of the vocal cords.
CASE XXXV.-THORACIC ANEURISM, CAUSING LOSS OF VOICE. ACTION OF Carbo animalis.
George P., aged 51, a traveller, came to my clinic at the hospital on May 9th, 1888. He complained of his throat, which he said had been bad for six months. Before that he was quite well. Suddenly one night in November, 1887, he was taken with a sharp pain in his chest and two days later he lost his voice. The pains then gradually subsided and he had little inconvenience till the middle of January, 1888, when he began to suffer from pain again- a dull aching “like indigestion.” He has been unable to do any work. On the date of his attendance the voice was thin and reedy- almost falsetto.
He had been having treatment for his “voice” before he came, but, naturally enough, got no better. I suspected the cause and asked him to uncover his chest. At the spot where he had complained of pain was an abnormal amount of dullness in the percussion sound, a very slight bulging was apparent, much throbbing could be felt on palpation. Over the tumour a loud blowing murmur was heard. The valvular sounds of the heart were normal.
There remained no doubt as to the nature of the case-it was one of thoracic aneurism.
He seemed fairly well nourished, but had lost much strength since this came on. He could not walk without bringing on pain on pain. His previous health had been very good. For months he had been a total abstainer, but previously he had indulged too freely in alcohol. The minute blood-vessels of the face were marked and prominent, giving the complexion a dark appearance. Tongue whitish; appetite fair; bowels regular and sleep good. He had a very little cough.
Treatment Baryta carb. 3x, gr. ij. three times a day.
He got no better, but rather worse, so I made him an in- patient.
On admission, June 11th, 1888, the following particulars were ascertained. In his family history the points of importance were that his mother had died of consumption, and one sister had died suddenly from some cause which he did not know.
Other brothers and sisters were alive and healthy. Thirty years before the patient had had some kind of specific disease but had had no secondary symptoms.
The pulse was 60, fairly full, collapsing; there was no difference between right and left. Urine acid, specific gravity 1012, contains no albumen or sugar.
Under Lycopod. 6, and afterwards Ferrum phos. 6x, and still later Calcarea fluor. 6x, he made some progress, and after leaving the hospital on August 18th, he was able to undertake some light employment. Later on he left London and I treated him by correspondence.
On October 24th he sent me the following report. “The pain is severe at times. It is a sharp burning pain, relieved after lying down for an hour. On getting up in the morning it is comparatively well but it comes on again in half-an-hour or so after moving about.”
On comparing the symptoms of various medicines, Carbo animalis seemed to me to come nearest with “sharp, burning stitches in chest, and straining and over-lifting easily produce great pulsation of the heart.” I gave this medicine in the 500th attenuation (Boericke & Tafel) and there was immediate improvement, both in cessation of pain and in the condition of the voice. On rarely repeated doses of this medicine he kept in wonderfully good health till the following April, a period of nearly six months.
His occupation entailed a good deal of walking which he was able to accomplish without inconvenience.
After that date he began to be troubled with sleeplessness, the pains returned and his voice was not so well. He felt a great strain on his neck when attempting conversation. His voice was very bad and he felt tired and had occasional headache. This state of things continued with fluctuations till the beginning of the following winter when Thuja in high attenuation temporarily checked the downward progress. The winter tried him much and he was laid up with colds. A cough set in which was relieved by Nitric acid; but the lung symptoms again became worse, necessitating medical attendance on the spot and he passed out of my hands. I heard that he died quite quietly not long after. There was no sudden collapse, Death occurred from general failure of strength and not from sudden rupture.
The following case, though incomplete, may be mentioned in this connection.
CASE XXXVI.-THORACIC ANEURISM. GREAT IMPROVEMENT FROM Lycopodium AND Baryta carb.
In September, 1894, a gentleman was advised to come from the country to consult me, his allopathic doctors having pronounced him to be suffering from aneurism, and having given him no encouragement as to the future. I was able to confirm their diagnosis, there being a very evident pulsating tumour in the second left interspace, the tumour being the seat of a stitching pain felt up into the left shoulder at times. He also suffered a good deal from difficulty of breathing. But I did not take such a gloomy view of his prospects as his former advisers. I was able to promise him that homoeopathy would, in all probability, give him great relief, and might eventually cure him. The general symptoms pointed to Lycopodium-Loss of flesh, soreness at commissures of lips, tendency to flatulence and constipation, with a little eczema about the anus; urine thick at times; and Lycopodium, given in the 30th potency, promptly relieved him of pain, and did him great good generally. In November last, there being a check in the improvement, he was put on Baryta carb. 3x. Since then I have not seen him, as he lives in the country, and having had a severe cold and an attack of bronchitis, he had been compelled to call in local medical aid. He was, however, able to report in January of this year (1895) that in spite of these trying circumstances his heart had troubled him very little,”in fact, it is better than it has been for some time.
