November, 1937. On Thanksgiving Day this patient had a sudden shaking chill followed by hard aching all over and prostration. By evening her throat was sore on the right side. Next day when I was called there was a gray ulcer eating deeply into the right tonsil, pillars and edges of uvula. The pain was intense and prostration considerable.
From this day, November 26, to December 2 when she died, progress was almost steady. Sometimes it halted, even some clearing of the membrane, but soon it marched on again covering the entire throat from right to left and eating away the pillars, uvula and some of the posterior pharynx. The gray color gave way to a red, shiny or glazed appearance toward the end. The larynx was affected, almost taking the voice. A culture was negative for diphtheria. Dr. Custis, who was called, said it was a pneumococcic throat. Where it came from no one knows.
Remedies were Lyc., Kali bi., Merc., Phyt., Lac. c. and Pyrogen.
The day she died I learned what seems to me the key to the failure of remedies. She belonged to a highly nervous family, deeply miasmatic. She was always hard to treat for suppressed nervous conditions leading to hysterical spasms. She was a victim of migraine attacks which might keep her in bed two or three days. For the last two years or more she had secretly resorted to some sort of dope to stop these headaches and allow her to remain on duty.
It is often said that we learn most from our failures and I, for one, have no objection to reporting them, for we humans are frail and imperfect at best.
WASHINGTON, D.C.
DISCUSSION.
DR. HAYES: In the case of the abscess of the neck, I noticed the symptom “aggravated by cold,” and the rapid progress of the bluish discoloration, and I thought of Vipera, which is very much like Lachesis but very often in acute infections in five times faster.
DR. PANOS: This excellent paper is more appreciated because we should not hesitate to report our failures. We must remember when we operate that the large amount of fluid that is accumulated is beyond the power of the remedy. The vitality is of course already low. Even when we inject that much fluid in a perfectly healthy individual we dont expect a patient to go without a heavy disturbance, and when the patients vitality is already low we must not expect a remedy to absorb a tremendous amount of fluid, but we should give aid by surgical methods.
DR. GRIGGS: I see a great many cases of pleurisy, of empyemas, in the hospital, and I think one of the best remedies I have ever used in cases of inter-lobar empyemas, where there has been confined pus, where you have the erratic septic temperature and a harsh suppurative cough, has been Sulphur iodide. Sulphur iodide has really caused absorption and helped some of those cases, and I think I have cured two or three really severe cases of inter-lobar empyema, just taking a little through a Luers syringe. I have cleared those cases up perfectly with a negative x-ray with Sulphur iodide. It is a good remedy to think about.
