April 2, 1890. Called to see Mr. F. A., aged to see Mr. F. A., aged seventy-six.

I was informed that he had been nearly ten weeks under the care of a prominent homoeopathic physician for rheumatic gout, asthma and irregularity of the action of the heart.

The treatment had comprised the use of strong drugs, mixed and in alternation; feet and legs had been painted with iodine, and various other scientific procedures had been adopted showing that everything for the patient’s good had been done; yet the patient was constantly getting worse. Sometimes there would be temporary relief from the suffering in the feet and legs; then the asthma, the breathing and the heart received special attention, the feet and legs, especially the great toes and r. knee, would be so much worse as to cause indescribable torture.

Between these diverse procedures the patient was in a most unenviable plight. Trying to avoid Scylla he fell into Charybdis; avoiding Charybdis was nearly wrecked on Scylla. Pulse including the cessations about 82. Twelve beats and would then stop during the time of one pulsation, then twelve jerky beats again, and so on. Tongue a thick, dirty brown coat, cracked, when protruded, trembles; it has a rough and stiff feeling after he has lain in bed all night; does not get much rest; after has been up awhile in the morning, it limbers up.

Anorexia: Coughs and chokes when eating.

Urine of a dark, rich brown color; as small quantity of whitish sediment.

The cough is < lying; raises a profuse quantity of thick yellow and white mucus; dryness and tickling in the throat which is very irritating. Patient says that he “could rest lying if it was not for that cough.” When is able to move at all, feels > when going about a little. A great deal of wheezing and mucus rales in l. lung.

Intense pains in toes of both feet, in the feet, ankles, legs and r. knee. Great toes are swollen to more than double their normal size; mottled, pale red and purple; sometimes one toe feels worse and sometimes the other.

The r. knee is even swollen to greater proportions than the great toes, as puffy, shining, causing almost as much agony as the toes.

The great toes, feet and ankles have been in this condition for about ten weeks; but the trouble was not so noticeable in the r. knee until after the treatment. Has had this trouble of the lower extremities, however, off and on for about six years. Rhus cm. in water, 2 hours, six doses.

April 3d. -Pulse about 102. Intermits irregularly.

R. Knee feels much worse; has suffered dreadfully; but the toes, feet and ankles feel better.

Cough has changed its character; is now short and dry; has not raised this A.M., which is very unusual.

“I must do something for that r. knee, because he can’t stand it.” sac. Lac.

April 4th. -Pulse is very difficult to count; intermits irregularly; a double beat, then stops; then three or four, and cases the time of one beat. It is about 90.

Tongue is partly clean and looks much better.

It is quite an effort to cough; expectorated a great deal of mucus during the night; some yellow, but mostly white.

R. Knee feels much better.

Stood for a short time on r. foot this A.M., which has not done for ten weeks.

The rales can scarcely be heard in l. lung, and the wheezing is decidedly relieved. Sac. lac.

April 5th. -Pulse 75. The intermissions are less marked.

Feels > in some respects, especially the gouty and rheumatic symptoms. The cough is, however much worse.

The expectoration comes up in strings of yellow and white mucus, and also like the white of an egg, beaten into froth.

Wheezing all over chest. I was told that he had taken cold from an open window yesterday.

Acute pain in l. elbow, can not bend or lift it. Kali bi. 200th, one dose.

April 6th.-Can not count the pulse. One pulsation, then stops; then two or three and stops; then will be four or five beats and ceases again for the time of one beat. I have frequently noticed irregular and intermittent pulsations but this is diverse from any in my experience.

Tongue coated white.

Not satisfied with one tumbler of water; will take two at once. Bry.

Coughs and coughs and coughs; expectoration bright yellow, white and thick.

There is much less wheezing.

Urine is clear and looks normal. Sac. lac.

April 7th. -Pulse from 85 to 90. Intermits so irregularly that it is impossible to count it accurately.

Tongue has a thick, yellowish-white coat.

Less expectoration; cough is dryer, tighter.

A very sore spot under r. patella, and soreness on inner aspect of r. ankle. Restless at night.

Always > when walks about a little, although very stiff at first.

Rhus cm. in water, 2 hourly, four doses.

April 9th.-Pulse about 87, including the intermissions which are less marked.

Feet feel bound up tightly, as though there was no elasticity in them.

Coughed and raised much less, all other conditions relieved. Sac. lac.

April 12th. -Pulse 80; does not intermit. The improvement is wonderful.

There is a sensation as of something screwing in l. heel, almost constantly, for the past two days. Sac. lac.

April 13th. -Pulse 80. Screwing sensation in l. heel only at night now; it goes away after has been up a short time.

Very little cough or expectoration; the cough is loose. Sac. lac.

April 15th. -Pulse 82. Still that screwing sensation in l. heel at night. Ball of r. great toe and the toe itself is very sore; but for that could walk very well. Led. 200, one dose.

April 17th. -Pulse regular, 78. Feels very much improved. The soreness and screwing sensations have departed. Dryness of the mouth in the A.M. on rising. Sac. lac.

April 20th. -Pulse 78. Dull ache in the ball and joint of r. great toe. walked about a little too much yesterday. Sac. lac.

April 23. -Pulse 92. Stiffness in both knees; I worse; > if goes round a bit, seems to get “limbered up.” Rhus 200, one dose.

April 26th. -Pulse 78. Feels very much >. The stiffness is confined to the l. knee, and that is not as bad as it has been. It is < when resting and at night. Sac. lac.

April 28th. -Pulse 93. Wheezing low down in centre of chest; < at night and when lying. Can hear it quite plainly when lying in bed at night. Raises white mucus. When asleep the breathing can be heard in the next room. Hepar 200, in water, 4 doses every two hours.

April 30th. -Pulse intermits, 90. short, dry, hacking cough; sometimes raises white and sometimes thick yellow mucus. Only raises in the night; the feeling is that it comes from very low down in the chest; there is a good deal of rattling therewith.

Feels > and that he is improving. Sac. lac.

May 2d. -Pulse 78. Very thirsty. Hacking cough, < lying on r. side.

Acute pain in r. great too; can not bear it touched, and to bend it gives much pain. Has been moving about for the past fortnight and going up and down stairs until yesterday; now must keep quiet. Bry. cm., one dose.

May 4th. -Pulse full, 90.

Took cold from sitting in a draught at an open window yesterday. Had a very restless night; thought that morning would never come; came near sending for me in the night. Acon. cm., I dose.

May 6th.-Pulse about 84; intermits.

Soreness and acute pain in r. knee, < on the slightest movement. Coughed is a short, dry hack. Sac. lac.

May 8th. -Pulse 94.

Pricking sensation posterior to and below sternum. Coughed nearly all night; it would case it to sit up for a short time and have it out, but the same trouble would soon return, requiring the same operation to be repeated; it is so tiresome. Raises a thick, dirty-looking, yellow mucus. Con. 200 in water, every 2 hours, 6 doses.

May 9th. -Pulse 84, intermits once in about 7 beats.

Cough mostly lying, very little during the day. It is much looser than it was yesterday, < after midnight.

Thought strongly of Hepar, but as there was decided improvement, more strongly of a placebo. Sac. lac.

Saw the patient again on the 13th and 16th inst. The pulse was even and regular. Had improved so rapidly that I discharged him. He said that he was better than he had been for many years.


DR. BELL: I Should like to know why Dr. Thomson takes so much account of the pulse in that case?.

DR. THOMSON: Simply on account of its very peculiar character.

DR. H. C. ALLEN: Did you not aggravate your pulse symptoms with Kali bich.? It never follows Rhus well.

DR. THOMSON: No; the remedy was indicated. At my next visit the patient was decidedly better.

DR. FARLEY: The trouble began in the feet and ascended to the knee. I noticed that after the administration of the Rhus the improvement began also in the feet and went up.

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