May 16, all symptoms better, except there is still some urethral soreness, with slight milky discharge; as the length of time the remedy usually acts had nearly expired, I repeated Cyclamen cm (S), one dose dry.
June 6, very much better, especially the last week; before that no improvement, but was worse. Urethral soreness and discharge less. No rectal spasms. Perineal soreness much less. No medicine.
June 21, received a letter from him saying: “I have not been feeling nearly as well for the past week, but am not so bad as I was before.” Cyclamen cm. two doses dry.
July 2, very much improved. Soreness not all gone, but can stand much better. Less bearing down. Urethral discharge and soreness much less. No medicine.
As he was going away for a month I gave him two powders of Cyclamen cm. to take in case there should be an aggravation. Aug. 22, reported that he was worse about Aug. 3rd and 4th and took the Cyclamen powders with relief so that now he is feeling well. Had a spasm of rectum. He noticed, he said, that he did now have a return of the trouble as often and when it did come back it did not last as long. Had an attack of cholera morbus two nights ago and a few loose stools since. I gave him two powders of Cyclamen cm, as on July 2d, to use when necessary.
Oct. 6 1898, reported that about ten days ago, Sept. 26th, was worse again and took the powders of Cyclamen. The soreness, discharge, bearing down, etc., all came back only much less than the time before. No rectal spasm. Is gaining right along now.
I have not heard from him personally since, but have seen the physician, who sent him to me that Mr.X. was perfectly well and that if the perineal trouble returned he would see me at once. This was over a year later.
The time that elapsed between the repetitions of the drug are interesting. Starting with Jan. 20th, 1898, he then went for 35 days then 21 days, then 41, then 21, then 36, next 43, and lastly 54 days, bringing it to Sept. 26th, 1898. The duration of action of Cyclamen is given as two or three weeks; in this case the effect never passed off in less than three weeks and between the last two prescriptions of Cyclamen was nearly eight weeks.
Case III is a chronic one. Mrs. L., 60 years old, who had passed the menopause without incident, thought she had always had “liver trouble” though the first attack of icterus occurred in the spring of 1896. The next fall she was again jaundiced for six to eight weeks. Through the the following winter her health was poor and in May 1897 chills began, first with intervals of seven days, later quotidian and finally irregular. In June considerable quinine was given to her which for a time controlled, apparently, the chills as only slight ones occurred in the summer, but in September she had two severe ones and two more at the beginning of November just prior to my seeing her in consultation.
The symptoms of the last paroxysms, the “latest symptoms to appear,” were:
Time-4 to 6 p.m. generally near 6 oclock, an afternoon and evening paroxysm.
Exciting cause-Any slight irregularity in diet.
Prodromes none.
Chill-Began “all over.”
Feet and hands very cold as if dead.
Wanted to be wrapped up, without relief, though if she uncovered was no chiller.
No thirst.
Chill lasted from twenty to sixty minutes.
Heat-Generally slight, though temperature rises from.
1* to 4* according to severity of paroxysm.
Moderate thirst.
Apathetic, very drowsy, lies, with eyes closed.
Face bluish.
Pulse full and slow.
Desire to uncover.
Sometimes wishes to be fanned.
Sweat -Generally begins by 8 or 9 p.m.
Cold sweat, general, not profuse.
She then goes to sleep, and usually does not wake till morning. Apyrexia-Clear, though slightly icteric.
Other symptoms-Has been constipated for years and takes laxatives, stools natural color.
Liver normal size.
Spleen can be felt.
Digestion easily upset, but clean tongue and no bad taste.
Has lost twenty-five pounds the past year, is emaciated, pale, sallow.
Remedies already given: Nat-m. 30 and 200; Ph-ac. 30; Sul. 200 (last spring); Gel 3x recently.
No quinine for two months.
The useful symptoms were:
1. Cause-(a) drugging with quinine, p, 295 (as it partly suppressed the chills and modified them.)
“Our antidotes to be most effective must be directed especially against those (drugs) last given.”
–Hering, Hahnemanns Three Rules.
(b) Exciting cause of paroxysm “aggravation disordered stomach,” p. 277.
And next the characteristics of the paroxysm complete picture,” including:
2. Time (a) “aggravation afternoon” (4 to 6). p. 269, and (b) “aggravation evening,”p. 270.
3. “Chill without thirst,”p. 255.
4. “Heat with thirst,” p. 259.
5. “Desire to uncover in heat,” p. 259.
6. “Sweat cold,” p. 263.
Taking the first two rubrics together, to shorten the work, we have:
Nineteen remedies Abuse Agg. Agg Chill Heat
result from first quinine after evening without with
two rubrics. Agg. dis noon. thirst. thirst.
ordered
stomach.
Ant-t 5 1 4 3 1
Ars 6 3 3 4 4
Bry 5 3 4 2 3
Calc-c 5 2 3 1 4
Caps 3 1 4 2 1
Carbo-v 7 1 2 1 1
Cham 3 1 3
Cyc. 2 1 4 3
Fer. 5 2 3
Ip. 8 2 3 2 1
Nat-m 5 2 3 1 3
Nux-v 5 3 1 3 1
Phos. 3 3 4 4 1
Puls 8 4 4 4 3
Sep 5 4 4 2 2
Stan 2 2 4
Sul. 5 4 4 3 4
Sul-ac. 3 1 4
Verat-a. 5 1 1 1 2
Desire to Sweat Totals.
uncover in cold.
heat.
Ant-t
Ars 1 4 25
Bry 1 3 21
Calc-c 3 1 19
Caps
Carbo-v 1 2 15
Cham
Cyc.
Fer.
Ip.
Nat-m
Nux-v 1 2 16
Phos. 2 1 18
Puls 4 4 31
Sep 1 2 20
Stan
Sul. 2 3 25
Sul-ac.
Verat-a. 3 4 17
Now the materia medica was consulted. In such cases assistance is obtained from Dr. H.C. Allens work “Therapeutics of Fevers,” and full confirmation of Pulsatilla for this case can be found either in that book or in Herings “Guiding Symptoms, Vol. VIII, pp. 634-8.
Nov. 9, 1897, she was given, during the apyrexia, Pulsatilla cm (F), five doses in water.
Nov. 17, slight chill at 6 p.m.
Nov. 18, severe chill, then heat, no sweat, between 2 and 3 p.m.
Nov. 20, Pulsatilla 1 mil. (F), three doses in water.
Two weeks elapsed and then a very slight chill, none after. Bowels regular, doses not have to use laxatives.
The last report, April 19, 1905, seven and one half years later, was that she had no return and was well.
Case IV. As an illustration of rapid work with the repertory at the bedside let me offer the following:
A man, forty years old, was taken suddenly in the afternoon with pain in the scrobiculus, a severe griping and also sticking pain which extended to the back. For relief he either bent backward or lay on his abdomen. The site of the pain was sensitive to touch, there was no flatus, and no history of dietetic or other indiscretion. When seen the attack had been going on some two hours.
On taking the symptoms in proper order the first who rubrics “pit of stomach,” p. 81, and “griping pain,” p. 161, together, using only the remedies in the two largest sizes of type occurring in both, gave six remedies, as follows: Bell. 6 Bry. 7, Calc-c.7 Cocc. 7, Lyc. 6, Puls.7.
Rubric No.3, “sticking inward,” p. 184, gave four remedies with the following totals: Bell.8. Bry. 10, Calc-c. 10, Cocc.8.
From the fourth rubric, “aggravation from touch,p. 304, there resulted: Bell. 12, Bry. 14. Calc-c.11, Cocc.10.
The fifth symptom part, “amelioration bending backward,” p. 311, cut out two, leaving only: Bell. 17 and Cocc. 13 and lastly the “relief lying on abdomen,” i.e., amelioration pressure, external,” p. 317: Bell. 17, Cocc. 16. The full working out of the case, the only safe way, and which I did at the bedside, gives the same result.
It required but a glance at the pathogeneses of the two remedies to confirm the choice of Belladonna, and one dose of the 200th relieved in fifteen minutes so he was free from pain; but in about an hour he tried to get up, when the pain returned, and as it persisted and grew in intensity another dose was given, with prompt and permanent relief.
Case V is one more instance of quick repertory work and results.
A pneumonia of the middle and lower lobes of the right lung, in a woman about seven months pregnant, yielded rapidly to Phosphorus, but after the crisis the cough developed much more severely, and premature labor seemed unavoidable. Phosphorus repeated did not act. There was no fever; pulse 90 to 100 and regular; cough short, hacking, almost constant, worse from 4 to 6 in the afternoon; expectoration whitish mucus, sometimes bloody; no thirst; short breath; most relief lying on the back; much abdominal flatus.
What medicine would help and how could it be found?
It was probable that a remedy which related to or followed well after Phosphorus should be selected, and I turned to the “Relationship” under that remedy on p. 437. Here the rubric “Other Remedies” seemed to give the desired list;l of these we will take the two highest types yielding twenty-five medicines, among which is doubtless the one needed.
The rubrics should be used in the following order:
1. Other remedies, p. 437.
2. Cough with expectoration, p. 115.
3. Expectoration white, p. 119.
4. Expectoration bloody, p. 117.
5. Aggravation afternoon, p. 269.
6. Amelioration lying on back, p. 316.
7. Respiration rapid, p. 113.
