In the case I shall now relate there will be less room for doubt as to the drug which worked the cure as the treatment was less complicated.
By a curious coincidence this patient also came to be treated for polypus.
CASE XII.-EXTENSIVE VALVULAR DISEASE. PRACTICAL CURE WITH Arsen. iod. POLYPUS OF THE NOSE.
Wm. B-, age.26, cabinet maker, rather below middle size, but well made and well nourished, pale, came under my care May 26th, 1883, for polypus of the nose. He was treated with Thuja internally and locally, and received much benefit, the polypus diminishing much in size and ceasing to give him trouble. He continued to attend at long intervals.
May 5th, 1884.-He complained that he felt ill in himself and was low-spirited, and suffered from giddiness. He attributed it to having three stumps taken out under gas about Christmas time.
no proper sounds, all being replaced by bruits, the heart itself being much hypertrophied. I gave him Arsenicum iod. 3x, two grains night and morning after food, and continued the application of Thuja.
May 17th.-He expressed himself as much better generally, and gave a like report on the 31st.
On the 28th of June the improvement was still maintained, though he had not had medicine all the time. Repeat.
On July 28th he was quite free from any symptoms relating to the heart.
The first (left) sphygmographic tracing shows the aortic collapse and rebound. The other tracings, taken the same day on the right side, show this peculiarity less marked. A further sphygmogram was taken on July 26th, and the tracing was much more like a normal one. The heart sounds remained the same.
In this case the steady improvement in the heart’s condition can only be attributed to the Iodide, as this was the only new element introduced into the treatment.
On the 26th of July the above tracing was taken.
CASE XIII.-DISEASE OF THE MITRAL VALVE. GREAT DEBILITY, EDEMA OF FEET. ACTION OF Iodide of arsenic.
A lady, age 58, tall, very dark, blue lips, nervous, consulted me in September, 1883. From six months old had been subject to ague. She had married rather late in life, had had no children, and had been a widow some years when she consulted me. Had never had rheumatic fever. Fifteen years before had had scarlet fever and inflammation of the lungs. Her breathing had never been quite as good since, but she only noticed distinct difficulty for six years. This had been much worse for two years. A few days before consulting me (September 17th, 1883) she had an attack of diarrhoea. This was stopped by brandy, and immediately a “cold” in the chest came on, cough hard and dry, unable to raise anything. She feels as if the windpipe were twisted and knotted, and crows with the difficulty she experiences as if she had whooping-cough. She feels very weak; is unable to walk more than a short distance, and not at all if there is a wind. The heart seems to stop and flutter. Sometimes she goes off into a kind of faint, but recovers very quickly. The feet swell about the ankles. Appetite poor; bowels confined. There is no tenderness about the larynx or trachea. The lung-sounds are feebler at left apex than right. There is a presystolic bruit.
She can sleep lying quite flat. Sleeps badly the fore part of the night, but well towards morning.
Treatment Digit. 0, one drop an hour before each meal and Arsen. iod. 1, gr. 1-20th, after food.
Three days after, she was very much better, lips less blue, expectoration easier. Much better generally. No alteration was made in the treatment. Her appetite improved, her walking powers returned, and on the 8th of October she considered herself quite well.
I will now give another case of Mitral Disease.
CASE XIV.-CONTRACTED MITRAL VALVE CLIMACTERIC SUFFERINGS. ACTION OF Arsen. iod. WITH OTHER REMEDIES.
Emma F-, age. 41, needlewoman, dark, sallow, nervous, consulted me on May 5th, 1883. She then complained of numbness and tingling in her right leg, and cramp in the right foot; numbness in arm. There was spasmodic action of the lower jaw, it closed with a jerk; (she never had had anything like this before). Had great pain in the right side of the head and burning at the vertex; the face flushed; she has pain in the back on waking. She had been ailing since the previous summer, when she had erysipelas and chronic rheumatism. The numbness had troubled her a fortnight.
The tongue was clean, bowels regular, appetite poor, sleep poor, catamenia not more than twice in the last twelve months. Pulse 102, small. She complained of her heart and breath.
On examination I found a thumping first sound, indicative of mitral stenosis, at apex. Lungs: right apex, exaggerated expiration; left apex, breathing feeble.
Treatment Arsen. iod. 3x, two grains night and morning; Ignatia3, one drop three times a day.
May 19th.-Her condition has varied; has now pains all about her, pressure at the top of the head; palpitation.
Treatment Arsen. iod., night and morning; Digitalis 1, one drop three times a day.
June 20th.-Better; no pain in left arm; has sparks before the eyes. Rheumatism; pain in the back. Tongue white, bowels much confined.
The eye symptom-“Sparks before the eyes”-is a strong indication for Spigelia. I have seen similar effects occur in patients taking Spigelia in a high potency.
Treatment Spigelia 3, one drop three times a day. Arsen. iod. as before.
July 4th.- Better. Bowels regular (I have again and again noticed this effect of Spigelia in relieving constipation in cardiac patients to whom I have been giving it). She has now no sparks before the eyes, but there is much numbness in right foot and leg. Repeat.
July 21st.-Yesterday had a bad attack; has felt giddy; breathing is difficult. Has much flatulence coming upwards, bowels confined.
Treatment Lycopod. 6, vice Spigelia.
September 25th.-Very giddy at times; flatulence very troublesome; catamenia have returned. Repeat. The following month she returned, complaining of pain through the left chest, for which she received Bryonia 3, one drop in water four times a day without any other medicine. The next fortnight this pain was better, but she complained of a choking cough rising in the throat, making her sick at times; the cough came suddenly whilst talking. She had numbness down the leg, and the bowels were rather confined.
Treatment Lachesis 6, Bryonia 3; every two hours alternately.
After this she continued in much better health till January of the following year.
January 16th, 1884.-For the last fortnight she has had pain round the sacrum, coming on between 4 and 5 a.m., and preventing her sleeping after that. She trembles all over, has low spirits; pain in the side of the head. Tongue white, lips parched.
Treatment Lachesis and Bryonia.
January 30th.-Pain round the back better, but the chest is giving much trouble-this comes on when she exerts herself.
She has a creeping sensation under the skin.
I now returned to the Iodide of arsenic, giving it night and morning and continuing the Lachesis three times a day. The next report was much more favourable, and the improvement was steady and rapid till she ceased to attend on the 15th of April.
There was a steady improvement both in the heart symptoms and the general condition whilst taking the Iodide of arsenic on the first occasion, though it was never given separately, and therefore the observation is not pure. On the second occasion the improvement was much more decided, and here, as the patient was already taking Lachesis when put on Iodide of arsenic, the increased rapidity of the improvement may fairly be attributed to the latter. The case was complicated by climacteric sufferings, but the signs and symptoms of heart disease were unmistakable.
CASE XV.-MITRAL CONSTRICTION WITH ANGINOUS PAIN. Arsen. iod., Naja.
Emily T,-age 43, dark, small, housewife, was first seen on May 31st, 1882, when she gave the following report. Has pain in left side and down left arm, has had it for three or four months; it came first eight years ago, then it took the whole side.
The pain is constant and does not depend on exertion. She has palpitation, but only when she exerts herself. She always has a little cough; much expectoration in the morning, none at night; coughing makes the pain worse. She cannot lift her left arm.
Her family history is as follows. Her father died of old age; her mother of consumption when the patient was born. Three of her children and her husband have died of consumption. Patient’s previous health has never been very good, but she has had no severe illnesses. A few months ago she had pain in the right side with retching, taking the strength out of her like labour pains.
The tongue was white, bowels regular, sleep restless. The catamenia had ceased three years. She suffered from flushes; had headache at vertex and across the eyes. The pain in the arms is relieved at times by motion; the arm swells at times. Examination of the heart showed the existence of stenosis of the mitral valve. Bryonia and subsequently Spigelia failed to give substantial relief.
June 28th.-Arm not any better.
