It may be that the pons varolii (so called convulsive centre) was influenced. Most certainly were the vaso-motor nerves affected. We know this because Sulphur 100,000th has repeatedly produced such a stale when given to the healthy. More than this, repeated experiments have demonstrated to the writer that Sulphur 1,000,000th will frequently given, cause congestions of nervous centres. And if this occurs in different seasons, on different constitutions, and in both sexes, where is the unpardonable sin in accrediting these “moonshine” potencies.?
We have no doubt but that the Hemiplegia was not cerebral but spinal; that the pressure was on the left half of the anterior column (motor) and the right of the posterior (sensory). This decision finds some confirmation in the subsequent change to Paraplegia (congestion across the spine). The objective probability is enhanced by the fact that the deltoid, upper half of the trapezius all the cervical and facial parts preserved their sensibility and motility. Hence, after the removal of the dysphagia, that is, after the medulla and parts above were relieved, the Hemiplegia was sustained by spinal, not cerebral, pressure. It was a mistake to treat the first stage with such a succession of nearly allied narcotics. No more forcible example than this could be found to prove Hering’s law of Conjunctive and Disjunctive Relationship. The lemon seemed to mitigate the symptoms, but on the disease went; slipping from sensorium to medulla and spine, leaving blindness, dysphagia and Hemiplegia; yet the oft-recurring spasms showed that the causes were still at work.
PERICARDITIS
In the spring of 1881, Mr.–, aged seventy-two, was attacked with Pericarditis. Under the skilful care of Dr. O.S.Griggs, the disease rapidly subsided. But the patient, who had always been rheumatic, and who had probably suffered in former times from similar inflammation of the pericardium, began now to manifest serious symptoms, indicatives of disturbed heart action. The pulse ranged from 130 to 150 per minute; there was short breathing, and the feet and ankles became oedematous.
Dr. Griggs, in June, called me in consultation, the case by this time having developed into general Anasarca, with Hydrothorax.
Physical examination showed that the pleural cavities contained water, which, on the left side, was as high as the third rib, and on the right side, as high as the fifth rib. There was no evidence of Hydropericardium. And although the abdomen was very large, the increase in size was considered to be due to Ascites, for the physical signs of the latter were obscure or absent.
The legs were enormously swollen, presenting the scaling and oozing, with other alterations of the skin, incidental to such cases.
The points of interest in this case are the ready response to medicines, offering thus excellent opportunities to study drug- action; and the remarkable fact that the pulse, for more than ten months, never sank below 130 beats per minute, while it often arose as high as 160 to 170.
The medicine employed were principally; Antim tart., Digitalis, Laurocerasus, Sulphur and Bryonia.
The first was selected for the following group; Cough, drowsiness, nausea and white-coated tongue; cough always followed by gaping and yawning; urine scanty. The well-known Ant.Tart., symptoms would rapidly disappear after a few doses of the 30th potency. And not only this, the general improvement would be striking. The heart, which being bound down by adhesions, was visibly pulsating in the epigastrium, would beat less perceptibly, the pulse would fall 20 to 30 beats and the water entirely disappear from the serous cavities. Even the legs would lessen in size, leaving great folds of stretched tissue, which, but a few days before were tense with serous effusion. Frequently such a respite as this would last fro a week to two or three, when the embarrassed heart, unable to work as it should, again permitted blood stasis, with a renewal of Dropsy.
It should have been mentioned before, that painstaking and oft- repeated examinations of the heart, failed to acquaint us with the exact changes which the interior of the heart had undergone. That some valvular defect existed was evident from the murmurs which we heard. They were apparent over the mitral valve and also over the aortic. There was no regurgitation detectable.
As the symptoms returned after a more or less lengthy period of remission, they rarely yielded to the medicine which last relieved. Thus, after Antim tart., the returning symptoms were as follows : Dyspnoea, on falling off to sleep he would be aroused with gasping or a sense of falling. Terrible, distressed, nauseated feeling at the epigastrium, lips livid, face anxious. Lachesis would not help, but Digitalis, which plainly suits the entire group, would again institute a period of relief and comfort, effecting an almost complete removal of the Dropsy and decided increase of the urine. Then, perhaps, the following phase would call for Sulphur 200: Cat-naps, flushed of heat, must have air; feet burn, so he must have them cooled. Relief was certain, and certain, too, was a diminution of the attendant Dropsy.
On one occasion it seemed as though the poor sufferer would suffocated. None of the remedies hitherto successfully employed were now indicated. His face was livid, the eyes protruding, as with one being throttled; the breathing was gasping, and he was continually clutching at the heart. The picture pointed unmistakably to Laurocerasus;;which, given in the 30the relieved promptly. This particular set of symptoms never returned.
Towards the close of the year, however, evidences of decreasing power of reaction were more and more manifest. We still had opportunity of witnessing over and over again the favorable effects of drugs. They would eliminate their respective symptoms with almost mathematical precision, so that we had numerous confirmations of the relation of drugs to the groups of symptoms already detailed. But the patient was weaker; the legs ulcerated, discharging more or less, and were always offensive, despite Platt’s chlorides and other disinfectants.
As with many old men, an enlarged prostate interfered with free micturition. From some cause or other the urine now failed to pass. The attempt to introduce a catheter provoked urethral bleeding, though Dr. Griggs used no undue force. Even after the catheter had been introduced and retained, the patients suffering were not over. An urethral inflammation was set up, with thick purulent discharge. The disease travelled stubbornly along the cords until both testicles were inflamed and swollen, and the scrotum was purple and oedematous. Medicines began to fail; or, we were unskilful in their selection.
One night, however, Dr. Griggs was hastily summoned to prescribe for sharp stitching pains about the heart which prevented a deep breath, and were aggravated by respiration or motion. Of course, he very properly gave Bryonia. At our consultation we found the pains better. There was purple spots on the skin; the pulse was rapid and thready; skin blue. We thought of Lachesis; but before giving it, we bethought ourselves of the wholesome advice, “Let well enough alone. So we awaited the reaction from Bryonia; and we were not disappointed. Within a few hours the scrotum and the testicles began to grow smaller, the purulent discharge stopped, the urine doubled in quantity, and no more medicine was needed for three weeks! Not even the catheter was required.!
But relapse followed; the urine failed to pass; there was much straining, but it was ineffectual. Dr. Griggs gave Causticum 30 with prompt and permanent relief. Still the trend of the disease was slowly and surely deathward. Finally the patient became restless, anxious; the skin, if pinched, remained in a fold; the legs were more offensive than ever; his strength failed rapidly, death coming at last quite suddenly.
The autopsy was performed by Prof. A.R. Thomas. The heart was found intimately adherent to the pericardium. The valves were intact, excepting some roughening of the mitral, and a calcareous mass embedded in one of the cusps of the aortic. The other viscera were nearly normal, although the prostatic gland was considerably enlarged and a mulberry calculus was embedded in the posterior wall of the bladder. Aside from the difficult urination, there were no ante-mortem evidences of the existence of stone.
SANGUINEOUS TUMOR
Mrs. H,— had an easy labor four hours. Boy, weighed ten pounds, and seemed “all right”. But on the third day a tumor as large as a black walnut appeared on the right of the occipital bones. Examination showed it to be a sanguineous tumor. The anterior fontanelle was nearly closed, but the posterior was open and the tumor connected with it, showing a venous connection with the sinuses within. This condition of the fontanelles led me to prescribe Calcarea Phos 2c. The tumor lessened and then came to a standstill. The anterior fontanelle opened more, and connection between the posterior and the tumor disappeared. No further advance was noticed until Sul. 2c one dose, completed the cure. But now the occipital bone showed a depression of the size of a silver quarter, previously concealed by the tumor. It looked as though a knuckle had indented the bone. CalcareaPhosphorus, 2c three doses, brought the bone to its proper rotundity.
