SOME CASES OF INVETERATE SCROFULA RESEMBLING. “HODGKIN’S DISEASE,” OR LYMPHADENOMA.
THERE is a disease of the lymphatic glands, called after the first accurate describer of it “Hodgkin’s disease,” which consists of an enlargement of the glands without much tendency to suppuration, but with much constitutional weakness, anaemia, enlargement of spleen, and an almost invariably fatal result. Though distinct in nature from scrofulous disease, the two affections are often so closely alike as to defy distinction, cases having occurred where the diagnosis was not even cleared up at the post-mortem examination.
It is possible to have the two combined. The cases I am now about to relate were really, I believe, scrofulous in their nature, but they presented many points of resemblance to Hodgkin’s disease. At the risk of being thought tedious, I shall give full length pictures of these cases, as it is only by watching them over a course of years that a complete view of the disease in all its phases can be obtained.
CASE XIII.-DISFIGURING ENLARGEMENT OF GLANDS OR NECK WITH VERY LITTLE TENDENCY TO SUPPURATION. CONSECUTIVE INFLAMMATION OF THE EYES. FREQUENT COLDS. CONSTITUTIONAL CURE.
Charles M., 16, brassworker, consulted me at the Hospital on March 26th, 1884. For six years he had had very large glands on the left side of the neck and under the chin. Last winter, blotches appeared on his legs, and since then they come and go. Last winter, for the first time, he had a cough; it was bad for three weeks, and since then has continued to be trouble some. It continues during the day, and also in the night till he goes to sleep. He has a little swelling under the instep of each foot, which pains him when he walks. He looks pale. Family history negative.
Rx Arsen. 3, Baryta c. 6, every two hours alternately.
April 16.-Feet and legs better. Swelling gone from feet. Cough gone. Has a contracting feeling in abdomen when he coughs; cannot get his breath for some time.
May 7.-Breath better. Legs all right, but blotches have appeared on his face. The glands go smaller in hot weather, but this year there are more of them. Repeat.
June 7.-A gland under the chin has softened and discharged. A lotion of Nitric ac. I x, 3i. to 3zvi. of water, was ordered, and healing took place rapidly.
July 2.-Great inflammation of conjunctiva. No photophobia; not much lachrymation. Matter; eyes red all round.
Rx Euphras. I every two hours; a lotion of 0 tincture.
July 5.-Pain in eyes less.
Rx Acon I every two hours. Boracic acid lotion.
July 19.-Eyes almost well. Lumps in neck smaller. Repeat.
Aug. 2.-Eyes well. Neck smaller. Repeat Aconite
Oct.10.-Has a cold. Glands smaller. Have been still smaller, but have become a little bigger since the weather became colder. Repeat. p73 Nov.12.-Neck smaller. Has another cold. Repeat. (Last year he had colds and cough alternately.)
Dec. 10.-Cold soon got better. Glands smaller (they are usually worse in winter).
Dec. 24.-Has had another cold the last ten days. Nose very much stopped. Glands much smaller than they usually are at this time of the year.
Rx Arsen.3 four times a day till the cold is better.
Jan 21, 1885.-Cold in nose still very bad. Glands smaller. To use Vaseline.
Feb. 4.-Eye has been inflamed. Nose less sore. Glands small. Has had sores on face.
Rx Sacch. Lact. Vaseline to nose.
Feb. 11.-Better. Nose getting better. Right eye sore still.
Rx Aconite 6 four times a day. Lotion of Acid Borac. for eye.
Feb. 21.-Eye a little better. There are two vesicles on upper margin of cornea. Nose better.
Mar. 5.-(Dr. Moir, who was then in charge of the eye department of the hospital, kindly examined the patient’s eyes for me, and prescribed Pulsatilla 3x, with the Borac. acid lotion.) Eyes better. Nose still very sore.
Mar. 18.-Eyes much better, but still mattery. No pain. Glands same. Nose better.
Rx Mercurius sol. 3, gr. ii. ter die. Lotion, Borac acid.
April I.-Nose much better.
April 15.-Better Nose nearly well but a few days ago gland on right side of neck became very large. Repeat.
May 13.-One gland on right side has been larger, others smaller. Has a cough in morning on rising; dry. Eyes and nose keep right.
Rx Bryonia 3. four times a day for a week, then Aconite 6.
June 3.-Cough gone. Face same. Two weeks ago had throbbing pains in feet and hands; now they are stiff.
Rx Caulophyllum Ix four times a day.
June 17.-Feet and hands all right now. Has had eye bad for a few days; better now. Lumps about the same. a “pimple” came on the side of the eye as at first.
Rx Aconite 6 four times a day.
July 22.-Glands smaller. Two days after beginning the Aconite had a cold which lasted a week. Upper lip became sore and swelled. Nose does not feel sore at all now. Has pimples on face, chest, and back. Repeat.
Aug. 19.-Much better. Neck smaller. Repeat.
Jan. 6, 1886.-Glands smaller than ever. Has had cough three days. Gets up phlegm. p73 Rx Calcarea c. 6, one pilule three times a day till cough is better, then Aconite
March 5.-Very much better.
Jan. 12, 1887.-Lumps very small. Has a cough that seems to tear the throat. Slight cold.
Rx Causticum 5, one drop every three hours.
Feb. 18, 1888.-Aconite6.
May 12.-Lumps rather bigger.
Rx Kali mur. 6x, gr. ii. ter die.
Jan. 19, 1889.-Has kept well in meantime. Now has a lump appearing under ear. Repeat Kali mur.
Mar.20.-Lumps is larger. Has cough for a week.
Rx Aconite 6 ter die.
April 10.-Lump smaller. Has pain in feet and ankles; aching in limbs. Lumps of erythema nodosum, which feel bruised when touched. Eyes well.
Rx Arnica 30 ter die.
May 8.-Very much better. Soon improved. One or two small glands have a re-appeared. Repeat if required.
July 13.-Aconite 6 ter die.
Sept. 15.-Lumps smaller than they have ever been. Repeat.
April 2, 1890.-Has had a cough three days. Chest sore. Irritability worse at night. Cough jars the head. Legs ache.
Rx Sulph. 30 four times a day.
April 16.-Cough gone. His chest is sore. Unable to lie on right side. Sleeps on left.
Rx Psorinum 30 three times a day for a week.
April 30.-Better. Can lie on either side at night. Glands seem larger. Pain on left side when he laughs.
Rx Aconite 6.
May 16.-Pain gone. Slight stiffness in right arm.
Conium 30 ter die.
May 28.-Feels well. Repeat.
l I saw him for the last time on July 16th, 1890, when he was well, except for slight cold.
During the progress of this case, the great power of Aconite over the glandular enlargement was very strikingly manifested. It was the inflammation of the eyes which led me to prescribe it first, when the action on the glands was very marked.
CASE XIV.-CHRONICALLY ENLARGED AND SUPPURATING GLANDS. CONSTITUTIONAL CURE.
The case I am now about to narrate was under treatment upwards of three years. It presented some points of resemblance to lymphadenoma, or Hodgkin’s disease. In this case suppuration had occurred again and again before the patient came to the hospital, and did so whilst he was under my treatment; but the gradual improvement in general health was most marked, and finally his constitution was able to get rid of the disease p73 altogether.
In this case a radical “cleaning out” of the diseased glands by a surgeon would have necessitated the removal of almost all the glands the patient possessed,-and then the disease would have remained in the blood. The case exemplifies the necessity of steadily working at a case, though the progress may appear slow. The susceptibility to colds and coughs of patients suffering from diseased glands is worthy of remark. The glands bear the brunt of this vulnerability.
If they are taken away, there is little wonder that vital organs are next attacked.
Fred. H., 26, polisher, consulted me at the L. H. Hospital on Nov.22, 1884. He had been ill seven years with enlarged and suppurating glands in the neck and armpits, and he had also had abscesses over the breast bone.
He had, on admission swollen glands on both sides of the neck, and one of them was discharging, having been opened ten months before. In the armpits enlarged glands could be felt. The spleen was rather large. The mitral valve of the heart was incompetent, but this was compensated, as the patient did not suffer from short breath. Tongue dirty at the back.
Bowels rather relaxed; open, as a rule. There was no history of anything of the kind in the family.
Barytac. 3x, one grain three times a day.
Dec.6.-Neck more painful. Repeat.
Jan. 1, 1885.-Glands in neck have broken. Glands under arm have enlarged.
Rx Aconite I, four times a day.
Jan.3.-Still discharging. Abscess on sternum breaking out.
Rx Calcarea phos.3x, two grains three times a day.
Feb. 28.-Gland on left side rather larger. One on right side discharges at times.
Rx Calcarea ars.3x, one grain three times a day.
April 4.-Not so well. Glands more painful and larger. Scarcely any discharge. Gets faint at times. Bowels rather relaxed.
Rx Aconite, 6, one drop four times a day.
June 6.-Glands larger and rather painful. General health pretty good.
Rx Conium 0, two pilules three times a day. Conium30, one pilule at bedtime.
July 4.-Glands have been larger till the last few days. Now they have decreased. General health very good.
Sept.12.-Has been at Yarmouth. There a gland broke, and discharged matter and blood. Other glands still very bad.
Rx Aconite Lycopodium 6, one pilule three times a day.
Oct. 10.-Lumps are bigger. p73
Have broken and began discharging. Since then easier. General health very good. Pulse rather frequent, but steady and strong. On listening over the heart I found the bruit had disappeared.
This showed that the competency of the mitral valve had been restored, and was a significant fact, taken in connection with the case of Mr. Teale’s, in which sudden death from heart disease followed operation, and the case of my own, in which disease of one of the heart valves developed after a tuberculous gland had been removed.
Rx Kali iod., gr. iii. three times a day. A lotion of the same in the strength of a drachm to the ounce.
Dec. 24.-The patient remarked to me, that before coming under my treatment he had always been better in winter than in summer.
The glands have been larger in winter, but have broken out more in the summer. Since coming to me he has been better than before; no new places have appeared-only the breaking out again of old ones. Repeat.
Jan. 9, 1886.-Rx Calcarea Fluor. 6x, two grains three times a day.
May 8.-Feels much stronger. Glands same.
Rx Aconite I, one pilule three times a day. Aconite 30 at bedtime.
Aug. 4.-No more abscesses. Lumps decreasing. General health very good. Repeat.
Nov. 27.-Has cold and cough.
Cough worse in morning with phlegm. Bowels confined for four days. Is stronger and stouter. Has a rather painful gland at the side of the larynx.
Rx Nat. mur. 30, one pilule three times a day.
Jan. 8, 1887.-Glands smaller; did not break. Cold got better.
June4.-Has had fresh cold and cough at night; cannot go to sleep for wheezing.
Rx Arsen. 3, one drop every three hours.
June 12.-Chest better, but still has cough on lying down at night. Aching all over. Has cold in head. Neck rather smaller.
Rx. Aconite I, one pilule three times a day. Hyoscy. 3, one pilule at bedtime if required.
June 24.-Cough soon left him. Still has cold in head. Aching gone.
Rx Aconite I three times a day. Aconite 30 at bedtime.
May 16.-Ex Aconite 6 three times a day.
Sept. 17.-Has been three weeks without medicine. Has had sharp attack of diarrhoea. Before this the right side of the neck p73 swelled up much and then went down. It is both puffy and soft, but no distinct sign of pus. Repeat.
Nov. 12.-The glands did not break. Has had a bad cold and cough. Coughs much on lying down.
Rx Rumex 6, one drop every two hours.
Nov. 26.-Got rid of his cough in a week.
Rx Baryta c. 30, three times a day. Rumex if required.
Jan. 4, 1888.-Has been well except for cold. Gland swelling again.
Rx Aconite 6, one pilule three times a day.
Jan. 28.-Very much better generally. The gland went down in three days. Cough less.
This was his last attendance, as he was practically well.
CASE XV.-ENLARGED GLANDS OF NECK. INVETERATE CASE.
Alice M., 25, servant, came to the Homoeopathic Hospital Feb. II, 1889. She had had enlarged glands on both sides of the neck for three years. The tonsils were not enlarged, and she could not account for their appearing. They were worse in cold weather and ached at times.
Rx Aconite 3, one drop four times a day.
Mar. 25.-There has been very cold weather. Up till then the neck was better. Not so well since. Repeat.
April 22.-Right side not so big left a little bigger. Has had severe cold, but is better now. Repeat.
July 22.-Neck much smaller than it has been for a very long time. It always does get smaller in summer, but not so small as now.
Sept. 2.-Better, but rather swollen since weather became so cold.
Rx Aconite Lycoc.3, one drop three times a day.
Dec.2.-Has been better. Now not quite so well. Repeat.
Jan.6, 1886.-Glands have been painful.
Rx. Calcarea Fluor. 6x, gr. ii. three times a day.
Feb. 3.-Better, less painful. Repeat.
Mar. 10.-Glands more painful in the cold weather.
Rx Aconite Lycoc. 3, gtt. ii. four times a day.
April 7.-Not so well.
Aconite nap. I, one pilule four times a day.
June 9.-Rx Kali mur. 6x, gr. ii. three times a day.
Oct. 27.-Kept improving under same medicine till now.
Has a very bad whitlow.
Rx Silicea 3, gr. ii. ter die.
The whitlow got better, and the Kali mur. was resumed. She continued under this for some months. On May 11th she developed a p73 pain in the lower part of the back and right leg, which gave her much trouble. Under Bryonia it became much better, but did not leave her. Finally Argent. nit. 12 removed it, but she unfortunately had a fall, which brought it back again for a time. The neck steadily improved, and none of the glands suppurated, though at times there was a threatening of this. She ceased attending in December 1888.
CASE XVI.-INVETERATE CASE OF SCROFULOUS GLANDS. INFLAMMATION OF THE EYE. ACTION OF KOCH’S TUBERCULIN AND BACILLIN.
Ethel T., 12, school-girl, pale, sallow, very unhealthy looking, with enlarged glands on each side of the neck, and the marks of old scars, was brought to me on April 29, 1891.
Four years before had ophthalmia. The present swelling of the neck glands came on six weeks ago in consequence of a chill, as it was supposed. The right eye is inflamed, there being a phlyctenula at the edge of the cornea.
During this time her health has been worse. She has frontal headaches, a slight cough, is very irritable, low spirited, and cries.
Is chilly, and likes much clothing in the night. The tongue is white; bowels regular; the appetite is abnormally good, she is hungry before her proper meal-times. Sleep is bad; she wakes with pains in the neck and throat. She has large lips; they have been so for two years.
Rx Aconite 6, gtt. i. every three hours.
May 6.-Eye got very bad for sometime; is much better the last three days. Much less pain in the glands. Is much better than she has been for many weeks. Repeat.
May 20.-Glands seem to be softening; no pain. The eye is bad. Many more phlyctenulae have appeared. Eye feels hot.
Rx Acid nitricum 30, gtt. i. every three hours.
May 27.-Eye better to-day, but has been very bad. Glands inflamed and suppurating.
Rx Hepar 30, gtt. i. every three hours.
June 3.-Eye not so well for last few days; painful. Shooting pains in head.
Rx Rhus t. 12, gtt. i. every two hours. silic. 30, one pilule every two hours if abscess opens.
June 10.-Abscess in neck opened spontaneously on 7th. Since then has better. Has an itching eruption all round the body, and some spots on the arms. Had some of it three weeks ago.
Repeat Silicea Calend ointment.
June 17.-Eye was better till last three days.
Rx Sul. 30, gtt. i. every four hours.
June 24.-Eye has been worse, but now is better. Is low and weak. Feet hot; stockings damp. p73
June 27.-Eye worse; burning Is low and weak. Worse in night; restless.
Rx Mercurius cor. 3, gtt. i, every two hours. Arsen. 30, one pilule every two hours if required.
July 1.-Very much better; was better the next day after commencing Mercurius cor. She can now bear the light and see a little. The rash is urticarious and leaves a scurf. Rx Mercurius cor. 6, gtt. i. every three hours. Boracic acid lotion (half a grain to the ounce). Calendula ointment.
July 8.-Eye better. Glands the same as before. Has had restless night.
It Mercurius cor. 3.
July 15.-Very much better; can see better. Has had neuralgia in teeth.
Rx Conium 30, one pilule three times a day.
July 22.-On 16th nose bled profusely. Pain in teeth has been bad; teeth carious. Neck better Eye better, but there is still some photophobia.
Rx Tuberculinum Kochii 200, two globules on the tongue at once. Kreas. 30, one pilule every two hours if toothache continues. July 29.-Toothache gone. Eye very much better. Neck better.
Rx Sacch. Lact.
Sept.2.-Has been pretty well, but the eye does not get quite well. Ulcer in centre of cornea. Has had toothache.
Rx Mercurius cor. 3, gtt. i. every two hours.
Boracic acid lotion. Kreas. 3, one pilule every two hours when toothache trouble-some.
Sept. 9.-Eye much better; photophobia less. Has had much pain in lumps of neck.
Repeat. Also another dose of Tuberc. Koch. given.
Sept. 23.-Much better. Eye better; can write now. Toothache has been bad. No medicine.
Dec. 2.-Has remained fairly well the last ten weeks. All inflammation gone from eye. Leucoma on cornea.
Rx T. Koch. 200, three globules on the tongue.
Dec. 16.-Two days ago had pain in the side of the head and face, first on the right side, then on the left. The neck has been very painful; worse in the evening; is now better.
Repeat the dose of T. Koch. 200. Rx Staphisagria 30, every hour if required for toothache.
Jan. 6, 1892.-Neck very much better. Repeat.
Jan. 26.-Has been better. Neck better. Toothache at times.
Rx Bacillinum 1m., one dose. Staphysagria if required.
March 2.-Neck better. Has a very bad cold and cough; worse at night.
Repeat Bacillinum I m. Rx Arsen 30, one pilule every three hours.
March 16.-Cough very much better. Neck better. Repeat.
March 30.-Has a suffocative feeling every evening. Glands externally less swollen. Medicine discontinued.
April 13.-Face much better. One gland painful. Teeth better.
Rx Bacillin 1m., 3 globules.
July 29.-After three months, she reported herself as feeling better, but a gland under the chin on the left side is becoming larger.
Rx Bacillin 100, three globules.
Aug. 10.-Throat rather bad.
Rx Bacillin 30, three globules. Calcarea phos. 30, two pilules three times a day.
Aug. 24.-Better. Repeat.
Sept. 28.-Abscess discharged inside mouth. Repeat.
In this case, one of the worst. I have ever seen, the action of Bacillin had a marked effect in shortening the duration of the disease.
The patient has recently reported herself for a slight relapse, but is much stronger than she used to be, has grown much, and in the interval has kept very well.