By “malaria fevers” I mean such as are mixed, and not distinctly intermittent, generally denominated typhomalaria; exclusive of the variety which has, as a class, a clear apyrexia; such as are especially met in this city. This paper is intended to apply to the class of mixed fevers confined to St. Louis, to the cases blending from the complicated intermittent to the complicated typhoid. It is known that some of them take on a predominance of typhoid symptoms, and some of them a predominance of symptoms found in complicated intermittents. It is this hybrid state that causes us so much vexation. I have undertaken the task of furnishing the best guide to remedies for our own circumscribed work. I have not mentioned many remedies generally thought of great importance, because I have not found the symptoms indicating them. Should I go into remedies so seldom indicated, this paper might extend beyond endurance. Hence the remedies are those most useful.
Antimonium crudum.-The gastric derangement, nausea, and vomiting, great exhaustion, white tongue, and thirstlessness, constipation, or diarrhoea, must guide to this remedy. The concomitants, few or many, can seldom do away with indications for this remedy.
Arnica. – This is a frequently used remedy. The sore bruised feeling all over the body; the patient complains of the “hard bed” and the aching, sore feeling in the whole body, the soreness compels him to move and he turns upon the other side, which in turn becomes sore and I bruised and compels him again to move. There is thirst and moaning; he cries for relief “or he will die.” There is great exhaustion and pain in the stomach and bowels, pressing and cutting pains in the stomach with nausea and vomiting; very often eructation, tasting like spoiled eggs, with bad taste in mouth, diarrhoea of a blackish water with bits of bloody, mucous stool; repugnance to food, milk, broth and meat; coldness in the stomach, and if there is a chill, it is preceded by great thirst.
Arsenicum alb.- Prostration, anxiety, and fear of death; extreme exhaustion, with thirst for water, little and often, for cold water, which causes nausea and vomiting; diarrhoea, stools scanty, dark, watery, offensive, with tenesmus, and the patient is covered with a cold sweat and blue spots. The tongue is dry and cracked, and the mouth and throat are parched and he wants only water enough to moisten the dry, mucous surface. In the beginning he goes from bed to bed, and is not relieved by the motion (unlike Rhus), yet his anxiety and restlessness compel him to move. The after midnight aggravation of fever and anxiety are especially guiding. The relief from warmth in general and warm drinks is also important. The burning in the stomach, bowels, mucous membranes, and skin, so common in many cases, is happily met by Arsenicum.
The involuntary stools generally point to Ars, but Arn, and Phos, have sometimes been indicated. The latter I have not often found indicated; occasionally the following symptoms have been present, indicating Phosphorus The dry, burning mouth and tongue, with constant thirst for large quantities of ice-cold water, which is vomited when becoming warm in the stomach, or gurgling from the stomach down through the abdomen, causing an involuntary stool from a relaxed ani; hot head, desire to be magnetized, with overpowering fears; thinks he will see some thing coming from the corner of the room; bleeding from the nose, and septic exudation about the teeth (sordes); the face is blue, bloated, and Hippocratic; the terrible dryness is not relieved from drinking, and he wants a stream of cold water poured down his throat, there are stupor and delirium, and he slides down toward the foot of the bed (like Phosphorus ac. and Rhus). He answers no questions or gives wrong answers to questions; great indifference.
Baptisia.- The peculiar sodden condition of the patient, with his besotted countenance, the face discolored and dusky, and the mental disquietude; his body he thinks is scattered over the bed and he is striving to arrange the scattered members; he thinks his limbs are talking to each other, his answers are irregular, as if he were intoxicated; he seems to comprehend the question and makes an effort to answer, but falls to sleep, or into a stupor in the midst of the sentence; the tongue is foul and the mouth fetid; the delirium is greatest during the night the functions are all sluggish, and the fever never runs very high; the pulse is often weak and compressible, sometimes the surface is cold.
In diphtheria the mucous membrane is dark and looks as if it might slough, and the exudation is dark; the surface is tumid and threatens to become gangrenous; finally dark, ragged, putrid and ulcers form and the patient is too stupid to complain of pain; the tongue may be coated white or yellowish, white at first, but soon becomes dirty and brown and feels as if burnt or scalded and cracks; dark blood exudes. There is seldom much thirst, although if water be presented he will drink a large quantity and relapse into stupor. The typhoid abdomen and stool can be found under this remedy yellow, mushy, and pasty, or bloody and very fetid, stools of pure blood or bloody mucus, exhausting and excoriating; involuntary stools. The tenderness and tympany of the abdomen are well marked, Baptisia is not a specific for typhoid fever, yet will cure promptly if given when the above symptoms are present. It is the remedy to begin as well as finish the case, Arnica, Hyoscyamus, Lachesis, Mur-ac., Opium, are especially related to it.
The Arnica patient forgets the word while speaking, but he does not begin his answer and fall into a profound sleep without finishing. Baptisia has the sore, bruised feeling of Arnica, but not the restlessness attending the soreness. The sensitiveness to pain is marked in Arnica and nearly lost in Baptisia. These remedies cannot be distinguished by the stools in many instances; both have dark, profuse, watery, fetid stools, and great soreness of the soft tissues as if bruised. The mental state and the besotted condition may be the only symptoms to base a choice upon.
A patient of mine was violently attacked with a chill; he moaned with pain and declared he would die; he purged almost involuntarily, a fetid dark, watery stool; he would not answer me civilly, but said he was sore as if bruised. Between the violent abdominal pains he was stupid, as if drunk; when aroused he was snappish and his words did not express his probable intention.
The stool made me think of Baptisia, but Arnica has the same, also the mental state, hence it must be the most appropriate remedy. It broke his chill. The violence of the attack led me to anticipate a congestive chill, but the remedy quieted him very speedily.
Baptisia is often given, I find, where Hyoscyamus would be a more appropriate remedy. In the latter the patient has a profound stupor, but when aroused he will answer correctly; the tongue is dry, black and stiff, but there is not the tumid appearance of mucous membrane as if sloughing would soon appear, or as if they would become gangrenous; Baptisia has involuntary stool, but not stools and urine like Hyoscyamus, nor does she attempt to expose the genitals in her delirium.
Arsenicum produces stools that cannot always be distinguished from those of Baptisia, but the thirst, so seldom in the latter, the extreme prostration and restlessness, will enable one to select the appropriate remedy. Arsenicum has the tendency to gangrene, but not the tumid, semi-transparent condition with the blueness. It has the bluish, or dusky aspect of the skin, but it is attended with a pinched condition of the countenance. Baptisia has a bluish, bloated condition of the face that is not so oedematous as that of Arsenicum. It is the result of venous stasis, not transudative, like that of the latter. Baptisia has not the heat of Arsenicum.; both have involuntary stools, but Arsenicum has involuntary stools and urine; both have burning pain in the stomach, but Arsenicum has marked nausea, not found in Baptisia. Baptisia causes vomiting but without much nausea or effort. Baptisia seldom has much thirst, but when it is present, it is for a large quantity of cold water. It is not the important factor of the Arsenicum thirst.
The Arsenicum delirium is a busy one; the Baptisia is passive. He will sometimes lie all day without moving if not disturbed; in the former, he is moving and is always in a hurry; the latter will do as advised, if he can; the former is irritable and wants his own way, and he is full of strange imaginations of vermin and burglars, and he has many fears.
Hyoscyamus corresponds to the most continued type in an advanced state; the tongue is dark or black, dry and stiff; he is unable to put it out, the lips are dry and bleeding, the urine is passed in bed unconsciously, and there is much delirium. The patient answers questions correctly and lapses into stupor, (Arnica has the same; Baptisia goes into stupor in the midst of his attempted answer) Hyoscyamus has cured cases when the patient has passed into the state where it was impossible to arouse him. The profound stupor, pinched countenance, involuntary urine and stool, sliding down in the bed, picking at the bed-covers, picking the finger, mark the case as a Hyoscyamus state when taken in connection with his having gone through the first symptoms mentioned.