8. Miss. M., aet. 54. Pains in hands and knees for years, getting worse. Worse before the rain comes. Better when it rains. Worse in bed at night. Worse after exertion, carrying bags e. g.
She likes the hear and feels the cold. Likes a warm room. Not much sweat at all.
Appetite is very good. Too good.
Most energetic person: always “on the go”. Quick, irritable. Flares up easily and takes offence. Rarely depressed. Smokes heavily and may take too much alcohol. B. O. M. P. ceased 4 years ago. B. P. 140-80. Weights 11 st. I lb.
Nux vomica 3 t.d.s. was prescribed. Four weeks later very much better except the hands.
Repeat Nux vom. 3. Four weeks later still improving.
Nine months later. Slight return before rain. Nux vom. 30. 1 dose.
The outstanding symptom in this case was of course the aggravation before rain and amelioration when the rain came, which is also marked in Hepar sulph, and Causticum.
The general make-up of the patient, however, the sensitiveness most marked in taking offence easily with outbursts of temper and the history of overmuch smoking and drinking, suggested Nux vom. but, since there was not a full picture, only a low potency was given in repeated doses. It is often found that this fails to hold for a long time but in this case it did for 9 months, but with a return of the symptoms a single dose of 30 was then given.
Nux vom. is, of course, usually the thin, spare, quick, active, nervous, irritable type with a lot of responsibility and worry, mostly engaged in a sedentary occupation with insufficient exercise. This type seeks stimulants to keep going, or the soothing effects of smoking. They eat well and drink too much. Keep late hours with the result that next day they are cross- grained and irritable; they then take a purgative and hope “to clear the system,: and so with over-indulgence in food and alcohol comes over indulgence in drugs.
Nux is more common in men, but there is a type of active business woman who also requires its aid.
The rheumatic pains are more of the numb semiparetic type pains and needles in the fingers and some loss of power. The knees crack, but the sensitiveness to wet weather and improvement from damp weather is the outstanding feature. The rheumatic pains are aggravated by the general tenseness of the individual which is also translated to his ligaments and muscles. Though the underlying changes may be unaffected, Nux, by decreasing the tension, eases the patients life considerably.
In Kent, amelioration from wet weather does not appear, but aggravation in dry weather, p. 1357, though not quite the same, has all the drugs usually listed as having amelioration wet weather, viz, Caust, Hepar sulph, Nux vom.
Here again a well-marked modality led to a consideration of the drugs having it in the Materia Medica. It would seem as if this is reversal of the usual advice that mentals and general come first in importance, but it is not really so. A well marked “peculiar” may on occasion “outvote” other symptoms or rather lead to a study of such drugs as have the peculiar symptom in order to ensure that the case is “covered”.
On the question of potency, it is good policy to keep “low” when there are only “locals” to prescribe or even to give the drug low in repeated doses, but experience frequently shows that if a result is obtained it may not “hold for very long and low “high potency such as a 12c or a 30c may.
Some experienced prescribers consider that even a 3x may be given as a “single” dose with a more prolonged effect than if repeated t.d.s. If the patient is at hand, then the law “that when improvement occurs stop the drug” still holds, even with a low potency.