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).
OPHTHALMIA NEONATORUM
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.
ALBUMINURIA
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.
