The face of Carbolic patient is a dusky red, white about nose and mouth, while Ailanthus is definitely cyanotic. Mercurius cyanatus has some cyanosis. However, its outstanding symptom is great exhaustion. It has gray membrane of the throat, and the necrotic areas of the soft palate; has the dark blood from the nose, which is also present under Ailanthus, but not under Carbolic acid.

This paper will present an actual case record, taken from one of the foremost university hospitals in the United States, with comparative therapeutics of the allopathic and homoeopathic methods of treatment.


A 33-year-old American factory hand was admitted complaining of abdominal pain and vomiting.

The patient had been perfectly well until five months before entry, when he suddenly became ill with “intestinal grippe”, characterized by nonradiating, colicky, lower abdominal pain which was sufficiently severe to require the use of hypodermic medication. At the onset of the illness the temperature was 101 F., but this rapidly subsided. The patient was confined to bed for ten days. There was no nausea, vomiting or diarrhoea. Subsequently the patient returned to work but continued to feel rundown and became fatigued more rapidly than usual. There was no recurrence of the abdominal pain. Three days before coming to the hospital the patient took a mild laxative before going to work.

During the morning he had repeated shaking chills, headache and severe pain in the back and loins. There were several loose bowel movements, the color of which was not noted. His appetite was poor, but he had a bowl of soup for lunch. Subsequently he felt very sick and returned to his home, where the soup previously ingested was vomited. He felt hot and restless, and his temperature was found to be 102.5 F. He slept fitfully, and on the following day felt quite fatigued. There were anorexia and nausea, but no vomiting. A mild laxative was again taken, and throughout the remainder of the day there were frequent loose bowel movements. He felt alternately hot and chilly, but there were no further chills.

His skin was livid or purplish with face dark as mahogany and hot; sordes. He was white about mouth and nose with a thin, copious, ichorous, bloody nasal discharge. His temperature at that time was 104 F., and a physician stated that he had a septic throat, although his throat was not sore. It was swollen, purple and livid. There were ulcerations of the mouth with a gray membrane. Also burning in the mouth.

Necrotic destruction of soft parts of the palate and fauces with dark blood from the nose. Fauces red and covered with exudation. The throat was inflamed and oedematous. There was an irregular, patchy, livid eruption. Patient was semiconscious and delirious with weak pulse, general torpor and great and rapid prostration. There was a tendency toward haemorrhages from different orifices, of dark fluid blood; cyanosis, rapid respiration and heart action. The symptoms continued unchanged during the day preceding admission, but at two oclock on the following morning he began to vomit repeatedly. The vomiting was non-projectile. The vomitus was variously brown, yellow and green in appearance. He felt feverish and again took a laxative which was followed by a series of loose bowel movements, the character of which was not noted. During the day he developed epigastric soreness, worse when moving about, which he attributed to straining when vomiting.

The patient had received typhoid vaccine thirteen years ago, while in the navy. During a one-year period, twelve years before his entry, four members of his family contracted typhoid fever. There were no related illness in his family since that time. He last visited his family four weeks before the onset of his illness. Four years preceding entry the patient had attacks of burning mid-epigastric pain. This was thought to be due to an ulcer, but x-ray studies were negative. Subsequently the symptoms subsided.

Physical examination showed a well developed and nourished, pale young man, who was obviously acutely ill. The lips and nail- beds were slightly cyanotic and the mucous membranes dry. The pharynx was moderately injected and there was a small amount of mucoid exudate. The cervical lymph nodes were slightly enlarged but not tender. Questionable dullness was elicited at the right base and right lower axilla. In this region tactile fremitus and vocal resonance were slightly diminished and questionable distant bronchial breathing was heard. There were also a few transient crackling inspiratory rales, which were dispelled by cough. The heart was not enlarged. A systolic murmur was heard in the apical region. The blood pressure was 120/75. There were tenderness and muscle spasm in the epigastrium, more evident to the right of the midline. Peristaltic sounds were normal.

Rectal examination elicited slight tenderness on the right side.

The temperature was 104 F., the pulse 75. The respirations were 30.

The urine showed a specific gravity of 1.028 to 1.042, with a slight trace of albumin. The sediment was negative. The blood showed a red cell count of 4,600,000 with a hemoglobin of 86 per cent. The white cell count was 7,000, with 78 per cent poly- morphonuclears. The non-protein nitrogen of the blood serum was 15 milligrams per cent and the serum protein was 3.8 grams per cent. A Widal test showed agglutination of bacillus typhosus up to a dilution of 1:320. Agglutination test for bacillus abortus was negative. Three blood cultures were done; one was negative; the second showed staphylococcus albus in one flask and hemolytic streptococcus in the other, and the third showed no growth in one flask and nonhemolytic streptococcus in the other.

A chest x-ray was negative. There was no free air beneath the diaphragm.

On the second hospital day the patient complained of severe upper abdominal pain. There was marked spasm in the right epigastrium, and peristaltic sounds were absent. On the following day he felt comfortable, peristalsis was again audible, and the abdomen was soft. Subsequently, similar episodes occurred and eventually the abdomen became distended, tense and tender, and peristaltic movement ceased.

Another x-ray film with the patient recumbent showed obliteration of both sides of the diaphragm by dullness in the lower lung fields. The dullness was hazy in outline and extended higher on the left than on the right side. The heart was transverse in position. Throughout the hospital course the temperature remained elevated between 102 F. and 106 F. and the pulse rose progressively to 160. The white cell count also rose to 17,000, with 96 per cent polymorphonuclears. The patients condition became progressively worse and he died on the seventh hospital day.


Dr. A.: I think that the findings in the chest were due solely to a high diaphragm in a man who was very distended. It is obvious from this history that in the final days of his hospital stay the mischief was in the abdomen. When it started in the abdomen and what it represents are our problems. The next question is whether this attack of so-called intestinal grippe that he had five months previously was intestinal grippe and whether by any chance it was related to his final illness.

There is only one suggestion that there might be any relation, and that is the fact that from that time on, up to the last illness, he was not up to scratch, did not have all the pep he would like, and, as he stated, he felt “a little run-down”. I am inclined to believe, however, that this attack of right lower quadrant abdominal pain was more likely something that might pass under the name of intestinal grippe, rather than something related to the present illness. Nevertheless, we must still consider the possibility of this being a manifestation of something related to the final illness. In this day and age we are all regional-ileitis-minded, and we might think of that as a possibility, but the subsequent course makes it seem unlikely.

A more reasonable thought would be some form of acute ulcerative colitis. We should think of either the idiopathic type or that due to one of the dysentery organisms. We can have fairly extensive colitis at times, with very little in the way of symptoms and signs to show for it. If this was the cause of his original illness, it had been silent for a period of some five months. Since he had right lower quadrant pain, one must entertain the possibility of appendicitis. It could be appendicitis, which may or may not have ruptured. I think it unlikely that he could walk around for five months with an appendiceal abscess without more in the way of signs, fever and the like.

I think that is quite remote. If he had had appendicitis one might wonder if he had an associated pylephlebitis; but, again, there is nothing to suggest it. I think it is reasonable to assume that the pathology was in the large bowel. One might think that we were dealing with an individual who had multiple diverticula, one of which had ruptured. I should think, again, that it subsided too rapidly for that. I would be inclined to say that the illness five months before was in no way related to the final illness.

Three days before coming into the hospital he had a shaking chill, with sudden, severe pain in the back and loins. To me this means nothing more than a man coming down with an acute infection. One might wonder, since he had so many chills, if he did not have an actual blood stream invasion at that time, and whether we are now dealing with a septicemia or bacteremia. Whether this diarrhoea that he had had for three days was any- thing more than that induced by catharsis, is again difficult to say.

Chairman, Bureau of Surgery