A CASE OF PUERPERAL CONVULSIONS
MRS. — engaged me to attend her in confinement. She anticipated some trouble as she had not conceived before for fourteen years.
At the seventh month I was hurriedly summoned to her, the messenger informing me that she had a stroke of Apoplexy. I found her with suffused face, thick speech, heavy eye-lids, and considerable drowsiness. She evidently had had a convulsion and not Apoplexy. I gave her Gelsemium, and as she lived several miles from by office, left word to call in Dr. Chas. H. Smith, if she should be taken worse. I had it mind to leave a note for the doctor, suggesting Belladonna, if spasms should set in, as she was a stout lady, full-blooded and had previously complained of a throbbing headache over the right eye. But on second thought, I concluded to leave his mind unbiased.
My object in prescribing the Gelsemium was to endeavor to prevent spasms, rather than relieve them if they should occur. The immediate symptoms seemed to demand it. About midnight I was again called, and found my patient, in convulsions. Dr. Smith, who lives but two squares from the patient, had arrived before me and very properly gave belladonna 40m. The spasms began with flushing to the face, rolling up of the eye-balls, with biting of the tongue and violent jerkings of the whole body.
As the convulsive symptoms subsided, the face became purple and swollen, and she went off into deep, snoring sleep. The medicine was given every half-hour all night and until our visit the next fore-noon. We then found her in a continued deep sleep, from which aroused she would answer mechanically, but seemed not to recognize any one. The convulsions had ceased.
Three questions presented themselves to us. Shall we change the remedy, discontinue it, or repeat it? A change was absurd, for every symptom was still for Belladonna. Since her stupor was more profound, though the spasms had stopped, it was evident that either she was feeling the effects of her attacks or was going into a worse condition of coma. In either contingency, it would be best to suspend the remedy, so that the system might have opportunity to react in the one case, or that we might await developments, which would lead us to a new remedy if the case grew worse. She accordingly received Sac. Lac.
At my after-noon visit, I was met by the husband with the cheering words: “Doctor, she”s much better, that last medicine acted like a charm!” And better she certainly was. Her face was still swollen, but had lost much of its turgid appearance, she was conscious and had passed urine freely. Improvement continued for three days. Our immediate concern, now, was what was the condition of the foetus. No motions had been felt since the spasms. Camman’s stethoscope, however, enabled us to distinctly hear the foetal heart, which beat at the rate of about 140 per minute. Our next step was to examine into the condition of the mother’s kidneys. At my request Dr. Smith analyzed the urine and found it loaded with albumen. There was oedema of the face and slight swelling of both feet and ankles.
On the evening of the third day of relief, our patient became more restless, complained of feeling sore and tired, and of headache in the occipital region. Belladonna 40m was again resorted to. At about midnight she was seized with convulsions, which were not so intense as formerly, but lasted longer and caused a Paralysis of the right arm. Subsequent convulsive efforts were confined to the left side. No other remedy was indicated; even this Paralysis pointed to be Belladonna. So we pertinaciously continued, lengthening the intervals as the spasms diminished. Towards morning she became restless and though unconscious, complained and grunted, as if in labor.
The os externum was soft and dilatable, but the os internum was as firm as gristle. No attempt at artificial dilation was made, because the pains did not seem to threaten convulsions, and above all our trusty Belladonna was a better and safer dilator than clumsy instruments. A meddlesome doctor is an abomination. Daylight came and with it-not the baby, but an unwelcome cessation of all pains, while the patient sank into a stupid sort of sleep, from which she could not be aroused to consciousness. What was to be done?
I examined the symptoms carefully. Pulse regular, full; breathing snoring. but not stertorous; face red; pupils failed to react to light; right arm paralyzed; urine retained. Still Belladonna; but it was not needed so frequently as for the acute symptoms, so it was given for every two hours, and directions left to stop it entirely so soon as consciousness should return. The afternoon brought the desired relief; she recognized familiar faces, the pupils responded to light, the urine flowed freely and the patient became annoyingly aware of the condition of her right arm. In the evening she grew talkative, it was difficult to control her. Pains made her screw her face up; she said they were in her stomach and as they were followed by bleaching, I thought she was correct in her statement. But towards morning she began labor in earnest. Two or three vigorous pains were followed by the expulsion of a living, seven-month’s child.
The little fellow was as blue as indigo and cried with a faint voice, showing that its life had well-nigh been sacrificed by the terrible disturbances in the maternal circulation. It was wrapped in cotton batting, laid on its side, fed with milk in tea-spoons, hourly doses and treated with Laurocerasus 1m, as a corrective of its cyanotic condition.
The mother seemed to be in excellent spirits, talking so vociferously that threats were necessary to calm her. Her lame arm was still a mystery to her; for she had not been made acquainted with the character of the disease, she had passed through. She fancied she had had a chill with congestion to the head-an illusion I was very willing to leave undisputed.
The usual post-partum prescription of Arnica was omitted, because the labor had been too rapid and easy to need it and also because I desired the Belladonna impression to continue undisturbed.
The child died of cyanosis eight hours after birth.
The mother rallied steadily, regaining the use of her right arm in two days. Milk appeared in the usual time, but was unattended with any untoward symptoms. For several days the mother had occasional diarrhoeic stools composed of faeces and offensively-smelling bile; but as they seemed to relieve rather than aggravate the patient, it was deemed unnecessary if not meddlesome, to interfere.
The patient is now convalescing rapidly. She has regained the use of her arm and the symptoms of albuminuria are subsiding also.
AN AFFECTION OF THE SPINE – A CASE WITH COMMENTS
An intelligent patient came to me complaining of a singular heart trouble; several experts had pronounced him free from organic disease. There were various subjective symptoms, but the most marked was “a sensation after exercise, as if the heart were loose”. Physical examination showed no signs of hypertrophy or valvular lesion; but the heart muscle evidently lacked tonicity. When lying on the left side, the apex could be felt one inch to the right of a line drawn vertically from the axilla; and yet, the actual area was not over one inch and hence so far normal.
Most authorities state that the heart falls to the left when lying on that side, only sufficiently to bring the apex an inch or less to the left of a line through the nipple. But here was a variation of several inches, and yet no alteration in the size of the heart. Neither did there exist any disease of any neighboring viscus to displace the heart.
By turning on to the right side, the apex could be felt within or to the right of line through the nipple. I inferred a relaxed condition of the pericardium and of the connective tissues, producing great mobility, such as has been described in “movable kidney” (Flint’s Practice), and in other viscera. As confirmatory evidence, the patient related that often the muscles of the lumbar region and also the pectoral muscles would shake so on walking, that they would greatly inconvenience him.
If we trace the morbid tract still deeper, we shall find a weakened action of the motor nerve of the spine from central nervous exhaustion; and this in turn may arise from many sources. To determine the primal cause and so trace intelligently the disease from beginning to the present state, was the next step. I have often found that such a course of examination, unrolling as it were the panorama of the past, not only gives anamnesis of pathological importance, but, also exposes many long-forgotten characteristic symptoms of vital interest, in the selection of the curative remedy. Prescribing for the latest characteristics, is undoubtedly a positive key which unrolls the problem, until the cure is completed by eventually disclosing the whole picture.
This is the usual safest course, but if we can find a shorter way, we must follow it. And just here lies the advantage of Pathology, Physiology and the differential study of diseases. We know albumen in the urine points often to congestive kidney. We know excess of phosphates points to the nervous system. We know how Ague is indexed by a swollen spleen.
Thus far, we have no guide whatever as to the remedy, but we do know where to look for characteristic symptoms even though the present picture shows none of importance or of distinctive value. If we discover phosphatic urine may we not hope to find what we desire in the subjective phenomena of nervous exhaustion with its many causes, excesses, mental fatigue, emotions, etc.? If we discover a caked spleen may we not examine into suppressed Ague, abuse of Quinine, large doses of elixirs, not one tangible key-note?
If there are well-known indications of Psora, or Syphilis, or Sycosis, or with Grauvogl, if we suspect hydrogenoid constitution, etc., may we not review the medical and pathological histories of the case, and perhaps find therein key-notes, which unite with the latest (totality), confirm them or even supersede them in importance? Thus we find that medical research into the nature and course of diseases, unties the gordian knot, but here it stops. The error of the day is in searching here for the remedy and not in the symptoms which this process reveals.
Pathology recalls the past and points with approximate certainty to the future, but no more. Therapeutics picks out the characteristic from the revealed panorama and says, ‘these characterize the whole disease; find the remedy covering these and all inferior symptoms vanish.” Thus we find the basic remedy, so to speak, of the case; the remedy which is to be given long and carefully, under the strict rules of our practice. If troublesome symptoms appear, one of its analogues may act as an intercurrent remedy, as Hahnemann often employed Arnica, Chamomilla, Aconite, etc.
So in the case before us, my mind carried me analytically to some affection of the spine, so I inquired if his back troubled him now or ever had. His replay was that it was rather weak, for some years ago, he wrenched it trying to lift a heavy weight in a gymnasium. The present key-note was “weak, loose feeling about the heart from exertion”. the first was, “a strain from mechanical cause”, the latter symptom belonging to Arnica, Bryonia, Rhus, Lycopodium, Calcarea, etc. etc. the former only to Rhus, which is thus seen to cover the whole. It was given first in the 200th, raising the potency with each prolonged aggravation after a relief, until finally the 60,000th seems to have restored the patient.
Now, even though my explanation of the case proves erroneous, the result was correct, and we may say with Darwin, who though absurd in argument is excellent in observation; “False facts are highly injurious to the progress of science. but false views do little harm, as every one takes a salutary pleasure in proving their falseness” (The Descent of Man, P. 368, Vol.II).
A POINT IN ITS ETIOLOGY
Three years ago, we attended a lady in confinement whose new-born baby suffered terribly from purulent inflammation of the eyes. The cause was, we presumed, a purulent leucorrhoea with which the mother was affected, and the existence of which we were not informed of until after her labor.
A few weeks ago it again fell to our lot to attend the same patient in confinement. Labor followed so closely upon our engagement, that she had time to take only two of the daily injections we had ordered.
Always quick in parturition-and this was her fourth pregnancy we instantly obeyed the summons to visit her, and found labor well- advanced. The “waters” had not broken, and it occurred to us that if the child could be born with an entire amnion, it would necessarily escape direct contact with the maternal tissues, and so leucorrhoeal infection would be prevented. Our wish was gratified, and we lifted the caul from off the struggling child after its safe removal from the mother.
Upon the fourth day after delivery, the very same time that ushered in our trouble with the previous child, the little one’s eyes presented unmistakable signs of inflammation. We administered medicine, and cleaned the eyes frequently with Calendula and warm water, until the case was cured.
Now, the interesting point for consideration is, what caused this disease? That leucorrhoea is a common cause is undeniable. But in the case referred to, the child was protected and, moreover, was cared for by the most competent nurse we ever employed. Every effort was taken to shield the child from strong light, and to protect it during bathing. It has been suggested that some purulent matter may have been inadvertently transferred from the child’s legs to its eyes, and this is a possible elucidation of the case; but still the face was the first part bathed and dried.
Defective nutrition cannot be urged as a cause, for the child, from birth, was plump and well-nourished.
Probably, then there is a tendency in some to such inflammations, that light cool air, or some other slight cause, may arouse into active disease. That the eyes of the new-born are sensitive is well-known, and, according to Noyes, “a red and sticky condition of the eyes is common to many infants when they begin their extra-uterine adventures”.
It behoves us to watch with scrupulous care the eyes of our little charges, and endeavor to protect them from needless and perhaps fatal disease. Nurses should be taught to cleanse the eyes, not with a wash-rag or sponge, nor with a weak solution of Nitrate of Silver, now advised as universal preventive; but with an ordinary medicine-dropper and warm milk, milk, and water, or, if matter already exists, with warm calendulated water.
THE RUPTURE OF A VESSEL
AN INTERESTING POST-MORTEM
Mr. E., aged 50., came under treatment for Jaundice. The liver was found enlarged, the movements from the bowels were clay- coloured and the skin deeply dyed with the colouring matter of the bile. The most distressing symptom was the intense itching of the skin.
There were no evidences of malignant disease, yet the persistency of the Jaundice, in spite of medical treatment, proved that it arose from more than mere duodenal catarrh.
By and by Ascites developed, though it was at no time extensive. Appetite was good, and hearty meal of non-fatty food never caused any distress.
Mercurius, Nux Vom., Sul, Podophyllum, etc. gave little or no relief. Nux Juglans, selected by the nightly itching and burning of the skin, palliated more than any other remedy.
Suddenly one evening in December, he was seized with an agonizing pain in the left groin, followed by rapid swelling of the affected region, The temperature began at once to sink, and this together with a rapid but weak pulse and the suddenness of the onset, led to the conclusion that perforation had taken place. He sank rapidly and died in fourteen hours.
The post-mortem was performed for me by Dr. John E. James.
The liver was somewhat enlarged. The ductus choledochus was indurated and considerably narrowed by a scirrhous deposit. This, evidently, was the cause of Jaundice. As stated above, there was no external evidences of such an affection, as no cachectic symptoms had as yet developed.
The peritoneal sac was intact so there had been no perforation into its cavity, as was inferred. But in the left groin was seen a mass of dark coagulated blood, forming a tumour as large as a child ‘s head. Dr. James, proceeding with great caution, traced the swelling to the deep vessels. But none of them showed any rupture or any pathological changes, which could have resulted. The femoral vessels were also healthy. Some small vessel, probably one of the haemorrhoidal, was undoubtedly the source of the fatal haemorrhage. On careful enquiry we found that shortly before he felt the pain, he sat up in bed and indulged in “a good long scratch”, swaying to and fro and exclaiming; “I feel, as if I could scratch my legs off. It is quite probable that this effort ruptured some small blood- vessels, which were over distended by the abdominal congestion and which were unable to withstand pressure.
Judging from the condition of the various viscera, the muscular strength of the patient, and his digestive powers, it would have taken months for the Jaundice to destroy a life which so quickly ebbed away from the rupture of the vessel, too deep for a ligature.
Miss L.F., aged 15. Retention of urine; right kidney sensitive, no urging to urinate; no tenesmus; cutting, burning, crampy pains in the bladder, Cantharis 30, every two hours. Then followed twitchings, cough, hoarseness, Asthma; Drosera 2c. no relief. Restless, anxious, worse at night; Arsenicum 2c, relieved all except kidney symptoms. Urine contained albumen, but microscope discovered an abundance of triple phosphates without any lithates, casts, etc. She now reluctantly informed me that her menses, although over-due, had not appeared. A new symptom appeared; cramp in the bladder causing her to bend double; Coloc. 30, three doses gave speedy relief. The soreness in back lessened, urination increased from one to three times daily. The next month the menses returned, but the flow was scanty, with heaviness languor, drowsiness and the urine still albuminous; Helonias 6, three doses daily. The urine became normal.
This case illustrates a congested state of the kidneys from Amenorrhoea, the congestion being sufficient to cause Albuminuria.
The twitchings I regard as reflex symptoms from an irritated bladder and kidneys and not uraemia. The cough and hoarseness were very likely from the cause which suppressed the menses. But the chief feature is the complete relief following the use of Helonias. Whether it would be of use in genuine Bright’s Disease remains to be seen. It must be carefully distinguished from its analogue, Senecio. The latter is of service in nervous, restless, sleepless females, who always complain of nausea with usual symptoms. Helonias, on the other hand, gives us dullness, drowsiness, languor; kidneys heavy, sensitive; pains less intense than under Senecio.
ATONY OF THE UTERUS.
MRS.—- had long been troubled with retroflexion of the uterus. At about the third month of pregnancy, she was taken with symptom that indicated an impending abortion. Digital examination detected the uterus so retroflexed as to be almost inverted. Its replacement was followed by instantaneous relief of the threatening symptoms. By frequent replacements, danger was averted until the uterus had grown out of the pelvis. The labor, which ensued in full time, was tedious, the pains exciting but very imperfect contractions. Caulophyllum did no good; Pulsatilla also failed. The labor, however, terminated without other artificial interference than some manipulation of the fundus uteri to excite its contractions. Haemorrhage followed, which china controlled. The after-pains (this was her third pregnancy) was intense and seemed to call for caulophyllum. This relieved for two days; but on the third, they again became worse, and this time were accompanied by ineffectual urging to stool and entire suppression of the lochia. There were no head symptoms, no fever, nothing to explain the cessation of the flow except this persistent atony.
Nux Vom., repeated with each new paroxysm of pain, relieved and developed the lochia; but it would again cease and finally at the end of three days, stubbornly refused to reappear. The case had now reached its eighth day. The intermission of the lochia suggested Sulphur, but its use was followed by no relief; on the contrary, the symptoms grew more serious. There had been no lochial discharge for forty hours. The patient was weak and feverish. She complained of an agonizing headache. It felt as though the face was being drawn towards the root of the nose; and then backwards towards the occiput, as if by a string. The eye-balls were sore and pained on the slightest attempt at motion. The italicized symptom is found under Paris Quadrifolia (see Allen, Vol. vii, and also Allen & Norton, p.100). After the first dose of the 30th, the discharge returned. Two hours later following the second dose, the headache perceptibly diminished, ceasing entirely after the third dose. The remedy was then suspended. The lochial discharge, though somewhat fitful in its flow, continued the usual two weeks.
One cold, blustering day, a poor woman brought her child to my office to be treated for a “bad cold”. She had given it Magnesia and Rhubarb to “work the cold off”, The child, a well-nourished girl of, perhaps, three years, was lying in a semi-conscious state, skin pale; eyes half-open; an excoriating nasal discharge reddened the upper lip the cervical glands were swollen, and cellular tissue about the throat markedly infiltrated. The lips were covered with black scabs, and the mouth and throat internally so swollen, that an examination seemed impossible. I diagnosed the case as Scarlatina and gave Nux Vom. 2c, 3 doses, to prepare the way for Lycopodium 2m.