Further clinical observations in the therapy of nux vomica have afforded me an accumulation of evidence of its efficacy in certain and hitherto untried affections of neurotic origin.
Case I.—Was called, about one year ago, to Mrs. McG., age, 36. Found she had just miscarried at about four months pregnancy. The fetus and placenta had been expelled, but owing to inefficiency of uterine contraction, there was profuse hemorrhage; consequently soon after my arrival I found I had to contend with not only hemorrhage, but a grave case of syncope. Her extremities became cold, and the heart-beat was scarcely perceptible; and surely the case was rapidly becoming one of heart-failure. Quick action was necessary, and I at once concluded to test nux vomica, and proceeded immediately to administer one drop doses of the tincture every five minutes. When the sixth dose had been given the radial pulse-wave could be felt, and the heart-beat distinctly heard. After five more doses the pulse was nearly normal; warmth of body was restored and she was able to converse. Hayden’s viburnum compound brought on good uterine contraction, and I succeeded in controlling the hemorrhage. In a few hours after the first dose of nux vomica I found my patient in such a comfortable condition of reaction that I left for home.
About six months afterward I was called in the early part of the evening to Mrs. McG., who believed she was again pregnant and threatened with miscarriage. She had pain in the back and profuse hemorrhage. I was getting good control of the hemorrhage when syncope set in, and on finding it was becoming protracted and her condition very similar to that for which I had used the nux vomica so successfully, I at once resorted to the same treatment and with the same satisfactory result.—But I must state, she was mistaken as to pregnancy. In the course of that night she passed a very large blood-clot which was the cause of her trouble; it evidently had been accumulating in the uterus through several menstrual periods.
Case II.—In the fall of 1892, I was called to Rose L., (colored), age, 20. Her symptoms at first were of indigestion and sluggish liver, and congested portal circulation; but on further investigation of the case I discovered considerable tenderness over the left ovary. On the third day of my attendance, contrary to my advice to remain in bed and keep quiet, feeling quite comfortable in the afternoon, and getting permission of her mother, she left her bed to sit in an adjoining room. In the early evening of that day I was sent for in haste to see Rose. I found her in a prolonged state of syncope, and her mother was greatly alarmed, fearful she would die. The patient’s pulse was small, weak and frequent, and counted 112; extremities cold; she was in a semi-conscious state, and when aroused would reply in a whispering voice, but immediately relapse into indifference to her surroundings. It seemed to approach so nearly to a case of heart-failure that I administered nux vomica in my usual way as to dosage and intervals, resulting within an hour in complete restoration of pulse, warmth of body and consciousness, and my patient became quite cheerful and talkative.
Case III.—C. M., age, 28, had an attack, of acute inflammatory metastatic rheumatism. In the third week of the attack and while the disease was yielding to treatment, he was attacked with an exceedingly troublesome cough, but as he had been confined to his room, and in fact to the bed, by the rheumatism during this time, I was puzzled to account for the cough. Then I began to observe more closely the character of the cough and expectoration. A careful auscultation did not reveal any bronchial inflammation. By closely questioning the patient I found the cough was paroxysmal, and commenced with an annoying tickling in the throat; the cough steadily increased in violence with the return of every paroxysm until it became exhausting, and the patient would feel quite prostrated after each attack. I found also, his most severe paroxysms came on within ten minutes after his evening meal. I accordingly timed my evening visit for observation. I was now satisfied—having watched a paroxysm from beginning to end, which lasted over 30 minutes—that the cough was laryngeal and neurotic.
On examining the sputa it was found glairy and tenacious, and not such as we find in inflammatory conditions of mucous membrane of the air passages. I had given him a mixture which included compound tinct. benzoin and codeine without effect, but now being convinced the affection was of neurotic origin, it occurred to me to make a trial of tincture nux vomica in my one-drop-five-minutes-dosage. I timed my call the next evening so as to be present when the paroxysm of cough commenced. My patient had just finished his evening meal, and we had been conversing hardly ten minutes when the cough set in and rapidly increased in violence, and then came my opportunity for the crucial trial of nux vomica in this case. When I had given the seventh one drop dose the paroxysm began to yield, and by the time we had given the tenth dose it was almost over, the patient having an occasional cough. My patient was very happy over the sudden and unexpected relief afforded by the medicine I had just given him in such small doses, and of course was curious to know what it was. He then told me, these hard paroxysms sometimes lasted up to midnight, and on one occasion it had lasted almost until morning. I left him drops to take in the night in case he should have another paroxysm.
When I reached home that evening I do not think my patient was any happier than I was over my success with the nux vomica in a purely experimental case. The next morning Mr. M. informed me that he had slept through nearly the entire night, which, owing to the cough, he had not been able to do in a week. The patient from that night had no return of severe paroxysm of coughing. I furnished him with fresh drops every day, and he became so well posted in their dosage and use that in a few days the cure of the cough was complete. And I may here add that I have had several similar cases of cough since that, and the nux vomica has succeeded in all. If physicians would more closely diagnose their cases of cough, I will venture to say, there might be discovered more than one case of neurotic origin and laryngeal.
Case IV.—Mrs. L. S., age 40, is of nervous temperament and has occasionally attacks of a mild form of hysteria. About one month ago I was called to Mrs. S., who, I found, had the usual symptoms of “grippe.” I treated her accordingly, and she was convalescing nicely. I had made my morning call, and found her doing fairly well—excepting that she complained of a slight shortness of breath. I carefully examined her lungs, but there were no indications of pneumonia. In the afternoon, about 3 o’clock, I received a hurried message to come without delay to see Mrs. S. I found her in a very nervous, somewhat hysterical and desponding condition; her face was flushed, she had distressing dyspnea, cardiac palpitation, pulse 112, small, weak and frequent, which of course was due to the functional cardiac derangement—there being no indication of organic disease. She called my attention particularly to her difficult breathing so soon as I reached her bedside, and begged for relief. I took in the situation at a glance, and wasted no time in thinking of a remedy to meet the case. My previous experience, and knowledge of the efficacious therapeutic action of nux vomica in neurotic affections, prompted its immediate use in this case.
The fifth one drop-five-minute dose reduced the pulse to 100, and in a measure relieved the distressing dyspnea. When four more doses had been given the pulse dropped to 90, and the dyspnea was so nearly conquered that the patient expressed her thankfulness for such speedy relief after a steadily increasing suffering of over four hours. By the time four more doses had been taken respiration was normal and the pulse 84. My medical mission was accomplished, and I left my patient—who was now feeling very comfortable—with instructions to continue the one-drop doses every half hour for four more doses, and then every hour up to bedtime. Next morning she was sitting up in her bed feeling quite comfortable, with respiration normal and pulse 78, the palpitation having entirely subsided. She has had no further trouble up to date.
Case V.—About two weeks after the occurrence of this last, I was called to Mrs. E. C., age 31. I found her suffering from great dyspnea and palpitation. She was also greatly troubled with flatulent dyspepsia and frequent eructations. The difficulty of breathing and the palpitation of the heart had been increasing for several hours, and as it was a new experience in her life, she and her husband became greatly alarmed lest the attack should prove fatal. But I knew my patient, as she had been one of my clientele for many years. I knew she was of nervous temperament and slightly hysterical. I wasted no time, but administered tinct. nux vomica according to my usual plan; the particulars in this case would only be a repetition of others, and it is unnecessary to recite them. The result was an equally happy recovery.
No doubt some will smile at the above caption, and say: “The idea! Who ever heard of such a thing?” Others will read what follows and, perhaps, profit thereby.
Strangulated hernia is looked upon as, strictly, a surgical affair, only two ways of treatment being thought of, i. e., reduction by taxis or, in case of failure—and if the patient and family will consent, the knife. The former usually fails, and consent to the latter is frequently so long deferred that the result is anything but satisfactory; hence, any measure which is at the same time simple and helpful should be looked upon as a valuable acquisition.
The plan of treatment which I wish to present will best be understood if illustrated by the record of a case in hand. One morning, recently, I was summoned hurriedly to see an elderly German laborer, whose “breach was down,” so the messenger said, and it surely was. Such a scrotal display I never saw before; a mass larger than a child’s head, and as hard and tense as a foot-ball. I thought, at first, that part of it must be an old hydrocele, but was assured by the sufferer that “him all goes back.” This rupture was of some ten years standing. Formerly the hernia was retained with a truss, but of late years it had been allowed to go up and down according to circumstances, never having become strangulated before. Now, my experience has been that when an old man who has had years of practice reducing his hernia fails to put it back, the surgeon has a job on his hands.
In this particular case most of the mass was resonant, but there was a lump the size of a goose-egg, close to the ring, that was hard and gave a perfectly flat precussion note—the omentum—congested by strangulation, the very irritation from which caused a tighter spasm of the muscle-fibres between which the mass protruded. I tried taxis faithfully; so had the old man, and we both failed. I used hot fomentations to no avail; I placed him at an incline of 45° and sprayed the mass with cold water to stimulate contraction of the muscles of the cord. They contracted sharply, but had no effect except to increase his pain. I lowered him to the horizontal position, covered him up with a hot blanket, and sat down to rest.
Here was an old man, hernia strangulated for some two or three hours, a serious case. It was growing worse every moment, and nothing seemed likely to avail but the knife. The spasm was intense. How could I relax it?
I hesitated to try an anesthetic for various reasons, one of which was that I found a piece of candle burning in a beer mug at the feet of my patient. Knowing the great value of hyosciamine in spasm of the viscera, I took from my ever-present alkaloidal granule-case hyosciamine amorphous, gr. 1–134, and gave it hypodermatically with morphine sulphate, gr. ¼, and atropine, gr. 1–250. In a few moments my patient said, “that’s better”; and in less than ten minutes a gurgling of gas was heard through the mass indicating relaxation of spasm. Thus encouraged I gave a second dose, adding to hyosciamine, gr. 1–250, strychnine arseniate, gr. 1–48, the latter to induce forced peristalsis. In less than ten minutes more, I heard a loud gurgling sound, and my patient cried, “him’s gone,” and, sure enough, it had. The entire mass had disappeared through a hole the size of a nickel.
A retentive bandage for the time, and a well fitted truss a few days after, completed the treatment of, to me, an interesting case, which leads me to suggest a “therapeutics for strangulated hernia” for your consideration.
Recently I have had an opportunity of proving the efficacy of this new solvent, and am much pleased with the result obtained.
During the months of August and September I had five children under my care, suffering from diphtheria. As all the children belonged to one Institution, had the same nurse, and in every way the same surroundings, I had a good opportunity of testing the solvent powers of this drug, as compared with others. In the first child, age 4 years, I used acetic acid spray as a solvent, giving iron and potassium chlorate internally. Although the membranes in fauces visibly shrank, the disease extended downwards rapidly, almost choking the patient. Intubation was resorted to, which for a time relieved the choking symptoms, but the child gradually, sank.
Two more children were seized with the disease and the fauces were painted with sulpho-calcine, a remedy I have used successfully for some years, and corrosive sublimate was given internally. The children improved, but the patches were a long time in shrinking. I applied an aqueous solution of methylene blue (1:9) to the patches by means of a camel’s-hair brush, three times a day. The effect was remarkable. Not only did the patches, after the third application, shrink, but the feverishness and restlessness abated. Three days after the commencement of the treatment all the patches in both children had disappeared.
Two more children, aged 5 years and 3½ years, were attacked. As the patches covered the uvula, tonsils and back of the pharynx, and no further down, I thought that I would try local treatment only. After a few days the patches disappeared, the fever left, and the children were convalescent.
I have of late had ample opportunity to test both piperazin and piperazin hydrochlorate as solvents of uric acid. Hitherto I have used the salts of lithium and potassium in the uric acid diathesis, but will now certainly always use the new solvent in preference to either of these. I have taken particular pains to watch the action of the drug—so feel confident in stating that it is the best of known uric acid solvents.
I have never noticed any toxic effects from the use of either preparation, but prefer the hydrochlorate on account of being less hygroscopic, although I believe piperazin can now be procured in lozenge-form in glass tubes, which greatly lessens the hygroscopicity.
I will now briefly give particulars of three cases of uric-acid diathesis treated with the medicine.
The first, a man aged 36, weight, nearly three hundred pounds, suffered much renal pain, with occasional symptoms of small calculi passing along ureter. The urine had very acid reaction. The microscope revealed numerous crystals. The murexide test likewise proved that uric acid was present in abundance. This patient, wishing to become thin, was put on a beef diet, no potatoes, few vegetables, etc., just the diet to increase the uric acid. He was put on the solvent treatment, giving twelve grains, divided into three doses daily. Each dose was given in a tumblerful of vichy water. In a few days the urine became neutral in reaction; the loin-pains left; also the constant desire to micturate caused by the irritation of the uric acid. The beef-treatment was kept up for several weeks and the weight was reduced by 11 pounds. This case shows that, although no precautions were taken to diminish the formation of uric acid, but the contrary, piperazin was sufficient to dissolve the crystals.
The second case was that of a man aged 50, weight, 215 pounds. He complained of pain, described as “burning” in loins; also a dull ache in bladder, frequent desire to micturate; sometimes urine was mixed with blood. Without altering the diet at all, which was always a liberal one, including beer every day, all the disagreeable symptoms disappeared while taking piperazin hydrochlorate. On several occasions there was a return, in a modified form, of the symptoms, but after a few doses of the drug they always disappeared.
The third case was that of a man 60 years of age, who had for years felt pain in kidneys, along ureter and in bladder, and never got much relief. I prescribed for him 5 grains of piperazin to be taken three times daily in large quantities of water. After a week’s treatment the pains had left, and he was better than he had been for years.
Gruber has used it with good results in diabetes. He considers that the action of the drug in this disease is inhibitory to the transformation of glycogen into sugar.
Caird (Edin. Med. Journal, September, 1893) reports a case of extreme weakness and emaciation due to malignant stricture of the esophagus, which was improved by intra-muscular injections of sterilized olive oil. In the course of a week from three to four ounces of oil were injected into the gluteal region. There was no pain or inconvenience caused by the injection. Sugar was occasionally combined with the oil. None of the skin punctures inflamed. There seemed no limit to the amount of oil which a patient can tolerate.
Cold Due to Bacteria.—Bacteria are likely to be blamed for all the ills that flesh is heir to. Prof. Schenck now maintains that what we call a “cold” is really due to these invisible pests. When one enters a cold room after being heated the bacteria in it flock to the warm body and enter by the open pores of the skin. Whatever may be said of this hypothesis he seems to have proved by experiment that bacteria in the neighborhood of a warm body move toward it. The confirmed smoker may derive some comfort from the fact that tobacco is inimical to them.—London Globe.