My housekeeper, a robust brunette, temperament extremely neurotic, weight at the beginning of this attack, July, 15, 1924, 215 pounds; her usual weight had been 145 pounds; age forty-six. Patient had been for a long time subject to frequent attacks of acidity. The secretion vomited was intensely sour, also bitter of a greenish tinge. These attacks were often accompanied by a right-sided facial neuralgia–sometimes a left brachial neuritis.
These attacks usually subsided under the usual remedies in a reasonable length of time, but this attack proved an exception. The vomiting kept up persistently.
The urine now assumed a dark yellow color and was extremely offensive. Urinary analysis showed a specific gravity of 1012, hyper acid. Microscopical examination showed granular and hyaline casts, renal epithelium and blood discs. The amount of bile now constantly increasing until the color was becoming a dark greenish black.
The whole surface of the body now assumed a dark yellow, the characteristic jaundice color. The vomiting was almost continuous, with large quantities of bile passing the bowels, which were obstinately constipated.
The movements were a light clay color. The tongue was a dark coppery red–moist with no thirst. The pulse dropped down to forty per minute. Temperature subnormal, complained constantly of a strong saltish taste in the mouth, like a very strong brine. There was now a profuse cold perspiration, extending from just below the waist line down both legs to the toes. Now a general anasarca showed up, involving the whole body. The abdomen greatly distended, with marked dullness on percussion, both legs swollen almost to the bursting point. The question of tapping seemed almost imperative. The symptoms which were from the beginning bad, were now growing worse.
The patient was now flighty, soon becoming drowsy until it became a stupor. The urine which had been gradually decreasing for some time, now entirely stopped–anuria–nourishment from the beginning had been almost impossible. I had the bowels flushed out every three hours, with a hot normal salt solution; also washed out the stomach frequently and thoroughly with hot water, until it returned perfectly clear. I also had the surface of the body sponged once or twice daily with a warm solution of epsom salts, one ounce dissolved in one pint of warm water. The case was now becoming a very serious one.
The remedies at the onset were selected as indicated from the following: Nat. Phos., Ars., Ip., Robinia-Iris, Nux-V. As the jaundice followed Nat. Sul., Pod., Merc., Dulc., Chionan, Dig., apocy, Cann., and Apium. vir. In desperation I now went to Dr. R. M. Fields repertory index, which I had only recently procured. This was my first attempt at using it. In desperation I went over the case carefully again, selecting six cards from the cabinet and placing them together only one hole extended through the six cards–giving No. 300, which was Sepia; to me this was the “last shot in the locker.” My patients life was narrowing down frightfully fast.
I found I had Sepia 3x and 12x, I gave four tablets of the 12x dry on the tongue, once an hour and before the third dose, a great change for the better began to appear. The vomiting and salty taste in the mouth, which had been so troublesome, began to diminish. The kidneys after a suppression of nearly twenty-four hours, again began to act, the urine commenced to clear up, the bile diminished quite rapidly, but leaving the urine quite bloody. This condition lasted for a number of days, and the urine was still very offensive.
I now began to feed this famished patient; for the drain on her system had been a very severe one. I began giving her Fairchilds pancreatized milk, alternating this every two hours with thirty drops of Bovinine in a little water, but we were not quite out of the woods yet, for a large abscess formed in the left labium majora. This was quite painful, and I incised and drained this, giving Hepar and Echinacea. From now on, her recovery was prompt and uneventful. Dr. Richard M. Field has certainly given our school a magnificent work, as I believe that without its aid I would certainly have lost my case. The patient during this attack lost sixty-five pounds.
