It is said that more than half the battle in any cure is a well taken case. We all know that the cases with few outstanding or characteristic symptoms, except pathological changes, are difficult to treat and of bad prognosis and usually show a profound miasmatic disturbance. This case, as given, is so incomplete as to be impossible of a satisfactory solution. It may be that the individual actually shows no other symptoms and could give no more but we should like to have a check-up, especially on the following:.
Other mentals, such as suicidal tendencies in the past, fears, whether the cheerfulness was euphoric or grandiose or merely normal, whether the suspicion was paranoid in trend or only the result of unfortunate experiences with physicians, and so on.
The general type of the patient, which is not mentioned, and many other little objective points such as tongue, ears, warts, moles, condition of nails, color and character of discharges, if any, condition of the external glandular system, type of build, skin quality, warm blooded or cold blooded typed, sweat in general, and sweat of affected parts in particular, sleep, conditions of aggravation and amelioration, time of aggravation, such as after sleep, morning, night, etc. The case as given present no individual picture which makes the patient either a living entity or a drug entity to the physician. There is a conspicuous absence of GENERALS, no mention made to wet weather or dry, heat or cold, position or motion, or to any of the desires or aversions in food.
Even from a general medical point of view the case is incomplete. One would like to know whether the groin ulcers followed buboes, whether at any time there was a urethral discharge whose venereal character was either unknown or unknown or unadmitted. This might be gotten at by discovering what kind of treatment he had ever received. No mention is made of Wassermann or Neisserian smears. One would like to know the Wassermann or Neisserian smears. One would like to know the cause of the paralysis.
From the brief description given little hint can be gained, but it makes an enormous difference in the choice of the remedy whether the paralysis is from a blood clot in the brain due to cerebral haemorrhage, or to a possible lead poisoning with resulting degeneration of nerve tissue, or to a luetic lesion in the cerebro-spinal mechanism. Under the paralysis, is it progressive, as it would be if of syphilitic or lead origin, or is it stationary or retrogressive, as more likely in apoplexy?.
The only really characteristic symptom in the whole case is the sensation of heat in the paralyzed part, although, being a particular, this should not be placed first. A careful inquiry is needed as to whether other symptoms throughout the life have been right-sided. (We would call attention to the fact that the lesion in the brain, if any, is left-sided). Right-sided paralysis alone is not sufficient to give great weight to right-sidedness as a general symptom, although in so barren a case one clutches at straws.
The question of suppression of the ulcers, which may well have led to the paralysis, should be stressed. A check up of symptoms for lead poisoning, both in the gums, blood and paralyzed side, should be gone into. No mention is made of trembling, formication or numbness.
In any case where there is a paucity of symptoms available it is important to get as clear a picture as possible of the child- hood, whether fat or thin, rickety, amiable, with a tendency to glandular troubles, suppression of eruptions, foot sweat or discharges, subject to frequent colds, etc., in other words the type of the child prior to any possible venereal or medicamentous or suppressive complications.
CHOICE OF RUBRICS.
1. My first would be Generalities, syphilis, p. 1406. [ Kents Repertory, third edition]. “Generalities, gonorrhoea suppressed” is tempting in view of the history of ulcers in the groin but is not justified without further data.
2. Generalities, ulcers, glands, p. 1410, combined with.
3. Skin, ulcers, p. 1333. We must get a clear description of the ulcers to make this a valuable symptom. It is vital to the case. Bleeding, itching, burning, lardaceous, bad odor, color of discharge from, punched out edges, etc.? Without these particulars we must use the two rubrics above combined.
4. Suspicious, p. 85.
5. The only other mental given is Speech, slow, p.82, which we use, lacking others.
6. Paralysis, one-sided, p. 1390.
7. Paralysis, one-sided, right, p. 1095.