A DIFFICULT CASE


A change had been made. The ever-troublesome new symptoms have arisen, and because of the stinging pain, the persistent dropsy of the lower limbs, I now gave apis the 30th in water every six hours. From this time on until August following, I kept her on apis mellifica in ascending potencies, with marked general improvement, though the growths on the legs and the accompanying pains persisted.


Read before the Annual Meeting of The International Hahnemannian Association,

In April, 1922, there came into my office in Chicago a medium-sized woman, aged fifty-nine years, and unusually gray for her age. She was very reticent in giving symptoms and answering questions. I learned that she was related to some of the best families of Chicago and was once accustomed to considerable wealth, The only history I could get of her case was “always well and active until two years previous”.

At this time it seems she was ironing with an electric iron, when suddenly something went wrong and she received an electric burn over the right shoulder and the biceps of the right arm. This occasioned very severe pain, for which she applied a certain liniment, which seemed to aggravate the pain and caused the appearance of red spots on the back and chest. Some time in 1921 she had an attack of lumbago and I noticed that the joints of her fingers were quite swollen. This was all I could elicit on this first examination.

On her return in May, 1922, she complained that the spots on the arm, chest, and back pained excruciatingly. In addition to this, she complained of severe formication over the burnt area. There was nothing visible other than these red spots to indicate any trouble. She also complains of violent twitching and jerking of the right elbow. She reports having slept better after the dose of causticum 10 m., and that the pain in the shoulder and arm was relieved by hard pressure. No remedy.

In June she reports that the injured area felt as if hot water was poured over it, and that the skin was very sensitive to touch. I knew that the leading remedies for effects of burns are arsenic and canth. But before prescribing either of these remedies, I preferred to wait for further data. In July, 1922, she reported feeling better, with the exception of the skin of the burnt area being very sensitive to touch. I now gave canth. the 30th, six powders, one every other day. I heard no more from her until September 5, 1922, when she complained of the right hand being very stiff. The shoulder and upper arm pained when out in the wind.

She sleeps well and her appetite is fair. The pains have now assumed a definite type, and are characterized as a violent stinging when heated. For this I gave a dose of apis cm. On September 22d she reported her arm as feeling full of splinters, with a slight improvement in the swelling of the right hand. This changing of the nature of pains confused me, and I frankly confess I could not understand these changes. I took her case under advisement, looked it over carefully, and sent her a dose of benzoic acid 10 m. I heard nothing from her until late in October, when she reported that the generals were good, and that the stinging and burning pains have now changed to what she calls smarting. I repeated my causticum in the cm. potency, then heard nothing from her until in December, when she reported feeling about the same.

Now, the thought arose that there might be an incipient cancer developing somewhere, and to prevent this I gave radium 200th, one powder. In January, 1923, she reports gaining ten pounds, arm is much better, and her vitality much stronger. Not knowing how long radium will act, I repeated it in the same potency. Matters went on in this way until March 2, 1923, when she complained of great difficulty of respiration in lying, and that she felt very uncomfortable pulsations in the stomach. I now awoke to the fact that there are changes going on here that threaten her life, and that a number of remedies are found in this symptom.

As kali carb. seemed to fit it better than the others, I prescribed it in the 1 m. potency, one powder daily for four days. On the 21st of March she reported no improvement. I now discovered that there was considerable cardiac hypertrophy. But why should this condition appear now? I then learned that she had passed through a very severe mental shock, which brought on cardiac dilatation, which she refused to tell me. I then gave her aurum metallicum the 200th, six powders, one daily. This was done because of her inability to lie down and sleep. On April 17, 1923, she reported a very slight improvement. Thinking that my potency was not on the plane of her trouble, I repeated the remedy in the 1 m. potency. One powder.

May 8th she reports feeling better. She can now lie down to sleep. She rests better lying on the right side and back. She has a fair appetite, and on a physical examination, I find the heart very rapid and greatly dilated. The legs are swelling and look as if glazed. Serious trouble is ahead of us and feeling that she still needed aurum, I gave here a dose of the 10 m. On May 30th she reports feeling some better with fair eliminations. I now discover that she is growing very irritable, that she is hard to please, and that there is marked dropsy of the limbs and feet. I now gave her a dose of arsenic 10 m., one powder.

June 28th I find the heart slightly improved, the general condition is better, but the limbs still very oedemic. I now gave arsenic the 50 m. On July 11th I find conditions the same, except that the face was becoming oedematous. I heard nothing more from her until November 16th, 1923, when I found the pathology about as I left it in July. She is now troubled with hideous dreams. Her nightmares are so severe that even the neighbors can hear her scream. Formication on the arm is slightly improved.

In the past she wanted heat applied, now feels better when in cool air and the application of cool cloths on burnt area. She is now annoyed with an occasional cough, and the legs are beginning to be inflamed and burn severely.

On December 8th she reports the swelling almost gone and general conditions fair. No medicine. January 11, 1924, she reports the limbs swelling again, and there is a large sore spot on the left tibia, threatening to become gangrenous. I now returned to aurum metallicum 1 m., four powders, one daily. On January 18th, 1924, the swelling has increased and is now extending into the abdomen and over the hips. Arsenic 10 m. February 18th I find the legs some better but the face very pale, swollen and oedematous. Realizing that my patient was not improving under what appeared to be well-selected remedies, I now gave for temporary relief solanum niger, the 30th, five powders, one daily.

On March 6th I found my patient with the right side of the face, right mamma, arm and leg badly swollen and the tendency to gangrene on the left tibia was very marked. I now called counsel, who decided that my patient was suffering from sarcoma, but while this may be true, the general conditions as well as the pathology now point to kali carb. as the only remedy helpful. For after waiting two weeks, I found her so oedematous that I thought the limbs and abdomen would burst. Her face was swollen beyond recognition, the upper eyelids protruded over the eyes, the mammae were swollen to the full extent, both legs highly inflamed and very sore.

I gave my patient two weeks time to live, and yet I worked as if she was to live a thousand years. I put her on kali carb. the 30th, in repeated doses, increasing the potency occasionally, until late in the fall I had conditions almost normal as far as the swelling was concerned. The sores on the legs were very angry, water dripping from the legs from the knees down, toenails discolored yellow, and my patient unable to lie down in any way. When I found that the condition of oedema was better, and that her respirations were very laborious, and that the nightmares were appalling, I gave her peony the 30th in water, 10 doses. This closed the nightmare scenes.

In November, 1924, feeling that the remedies given had exhausted their power, I gave her a dose of sulphur 10 m. This remedy stimulated her vitality, increased her appetite, and made her feel stronger; but produced no change in the limbs, neither in the general dropsical condition, except that the larger spot on the left tibia showed signs of marked improvement.

There now appeared on both limbs large cauliflower excrescences. I became considerably confused. As I sat and watched her, saw those angry growths, highly colored and dripping, her tremendous nervous irritability, I saw away back of all of this what seemed to be a sycotic condition implanted upon a deeply seated psoric condition. This led me to prescribe thuja 200th, daily for ten days. Late in January, 1925, I found her right arm extremely painful, and a sensation as if the skin were torn from the flesh, with a very unpleasant formication over right arm and shoulder accompanied with a stinging pain aggravated from heat.

A change had been made. The ever-troublesome new symptoms have arisen, and because of the stinging pain, the persistent dropsy of the lower limbs, I now gave apis the 30th in water every six hours. From this time on until August following, I kept her on apis mellifica in ascending potencies, with marked general improvement, though the growths on the legs and the accompanying pains persisted. Though there was general improvement, it was not sufficiently marked to make a favorable prognosis.

Late in the autumn of 1925 she had a marked return of the oedema, until the abdomen and both arms and both mammae were so filled with water that I thought her days were numbered.

Her greatest agony was from pains in the right shoulder and arm. These pains were so severe that they nearly drove her insane. The thought came that she would soon pass away, and I would turn to something for immediate relief. I gave strontium carb. the 200th, four powders, daily. I kept her on this remedy in ascending potencies through the winter and early spring with some improvement in oedema and pain. While the large spot on the left tibia had practically healed, the growths from the knees down seemed to multiply.

The toenails turned a golden yellow in color and looked as if they were ready to drop off. So on April 25, 1926, I returned to thuja the 200th in water, one dram every six hours. On May 8, 1926, I found the limbs greatly reduced in size, the arms practically normal, also the body, and my patient much quieter mentally. For previous to this she had shown symptoms of mania. The marked discoloration of the limbs was growing paler and the growths deeply red were turning white. This looked very encouraging.

I continued the thuja every eight hours and early in June found my patient very much better. The dropsical condition had practically all disappeared. The excrescences were growing less in size, the respiration, which was very difficult during all of these years, was very much better. She was now able, with the assistance of the nurse, to walk from the living room and her bedroom to the bathroom.

She felt so vigorous that she also walked into the dining room and took one meal a day there. On the 15th of June I found the conditions rapidly improving. My patient could talk with vigor, enjoyed company, and could lie down to sleep for six hours at a time, the first in three years. The mental and physical condition was so markedly improved that I now gave thuja the 500th, one dram every twelve hours, and am watching results.

George E. Dienst