Page images



By Dr. Mackechnie.

The interest of the following group of cases is greatly increased by their pathological relationship.

The first case, one of "land-scurvy," was manifestly influenced by the medicine employed, for hygienic and dietetic measures alone would not have ensured recovery in so short a space of time. At the same time that medicine would not have obtained a cure without the hygienic means employed is evident enough.


E. J—, aet. 20, housemaid, was admitted on October 3rd, 1871, suffering from an eruption all over the body, but especially on the extremities, and accompanied by great languor and debility. The eruption is of a purplish colour in small spots or patches.

On admission we find that her illness has been coming on for some months. She has been living in a house where the kitchen is very dark and close. Has not cared much for her food and has been troubled with frequent heartburn after food. Has eaten little or no vegetable food, chiefly because she found that heartburn was sure to follow the use of potatoes, and there was seldom any other vegetable to be had.

On inquiry I find she has noticed her skin to be very liable to bruise from the slightest causes for some weeks past, and also that the gums bleed readily. Upon examination they look spongy and dark coloured. The patient is thin and delicate-looking, with dark marks under the eyes. She complains of dyspnoea in going up stairs. The catamenia have been occurring about every three weeks, and have been decidedly more profuse than usual, painless, lasting seven days, and followed by much prostration. The pulse is 96, but there is no suspicion of feverishness; hands and feet chilly. She has been troubled much with severe pains in various parts of the body, especially the face (apparently neuralgic in character). The blotches and patches on the skin are purple in colour, and tend to run together. They are accompanied by a good deal of itching after they have been out for a day or two. Sleep is good; rather heavy, but she does not wake refreshed. Sight has been very weak of late, and she is troubled with dizziness and vertigo after she has been exerting herself for a time. Palpitation of heart with any exertion, and frequently without. On examination I find some bruit at the cervical veins, not constant, however, most heard when standing. Bowels are very constipated, acting only every third or fourth day with much difficulty. She was ordered first diet with the juice of half a lemon a day. For medicine she had Sulphur <j>, a drop three times a day.

October 7th.—Reports the skin much the same, some fresh patches having come out, especially on the lower extremities. The bowels are acting once a day, but with difficulty; otherwise much the same.

11th.—Decidedly improving, the patches dying away, the itching ceased. Feels herself much more comfortable, though still rather weak. Bowels acting every day with moderate ease; spirits greatly improved.

14th.—The eruption almost entirely disappeared. There has not beeu any fresh appearance for a week. The bowels acting moderately well. She feels so much better that she was at her own request dismissed with strict directions as to her regimen and hygiene, and ordered a continuance of the Sulphur.

It seems to me that this case was sufficiently marked, and the recovery was sufficiently rapid, to say that the latter was due to something more than the hygienic and dietetic treatment, which are notoriously slow in their operation; and I am inclined to think that we may attribute it in a great


measure to the medicine, although this was selected in accordance only with the concomitant symptoms of the malady, viz., with the constipation and the itching of the skin.

Purpura hamorrhagica.

J. O—, engineer's assistant, aet. 30, admitted September 28th, 1869, suffering with hemorrhagic troubles. Has generally enjoyed good health, but seven years ago was laid up with acute rheumatism, from which he recovered without any ill consequences remaining perceptible to himself. Is on admission rather thin, and is very weak with an anxious, worn expression of countenance. Appetite generally very moderate, has been not so good of late. Has eaten a good deal of fish, especially fresh fish; does not ever eat much fresh vegetables, and has of late taken less than usual. Seven months ago had a severe attack of epistaxis, and at the same time coughed up a considerable quantity of darkcoloured clotted blood, followed in fourteen days by some red spots on the hands and wrists of the size of flea-bites; these gradually extended to the arms, and thence to the trunk, while he became very much out of health and very weak. Cannot give any account of the treatment which was then employed. He recovered, however, but has ever since been troubled with occasional attacks of epistaxis. Seven weeks ago had a severe attack of diarrhoea which lasted two days, and during which he passed a large quantity of (florid ?) blood with the stools. Has remained very weak ever since, and the present eruption began to make its appearance almost immediately after. There are a great number of purpuric spots over the legs and arms and a few on the trunk ; they vary from the size of a mere point to that of a split pea, and a few which are even larger appear to have arisen from the coalescence of some of the latter. He has also here and there some ecchymoses which seem to have occurred from very trivial causes. He complains of aching in the limbs and of being very easily fatigued. Sleep not good, being much broken, and not refreshing.

The gums show no signs of haemorrhage at present. Tongue clean; appetite moderately good ; complains of constant thirst; bowels regular, urine rather pale coloured. There is slight tenderness noticed on pressure over the lumbar regions. The hepatic dulness normal, splenic ditto. Respiratory sounds good; heart sounds normal. Complains of dyspnoea on ascending stairs or with a very moderate amount of exertion. Spirits are very much depressed.

On admission he was put under the influence of Arsenicum 3, a drop to be taken three times a day. He was put upon the first diet with two ounces of lemon juice and a pint of beer per diem.

On October 5th he complained of a good deal of heat and soreness about the principal seats of the purpuric spots, which latter, however, had been lessening slightly, and one of the legs looked much less intense in colour as a whole, but upon examining closely I found there was somewhat of a blush (erythematous) over the part where the eruption was thickest, and the patient was complaining of some headache, and had not slept so well the last night or two. Belladonna 3X, two drops three times a day.

7th.—The erythematous condition has subsided. The purpura is lessening. Complains of feeling very weak; takes and enjoys his food, but is troubled with flatulence shortly after, with much abdominal rumbling. Under these circumstances he was put upon China 3X, two drops three times a day.

From this time the case continued steadily to improve; there was no return of the erythematous condition, while the purpura gradually subsided, and he was dismissed on the 22nd October cured.

Erythema nodosum.

The next case, that of M. A. G—, a housemaid, aet. 25, is characteristic, though considerably different from either of the others. She is a fair, thin-skinned, rather delicatelooking girl. Has been getting out of health for some months, feeling easily fatigued, languid, and mentally depressed. Has lately, for some weeks, though she seems very uncertain as to its duration, noticed an eruption which affects her principally on the extremities, but has lately affected the trunk also. It occurs at first in the shape of patches of about the size of a split pea or bean. They are slightly elevated, red in colour, and raised a little above the surrounding surface, and itch and burn like the sting or bite of an insect; do not disappear but become purplish in colour and are very slow in subsiding, the irritation ceasing long before the spot disappears; fresh ones making their appearance here and there to keep up the supply. She is unable to give any account of the reasons of her present illness. Has lived well, and appears to have kept up the balance between animal and vegetable food well. Has very little out-door exercise. The countenance is pale, sallow, with dark marks under the eye3, and an anxious expression. The temperature is good. Pulse 74. Complains of general aching pains, which trouble her most when at rest, and especially at night. Has occasional headache affecting her in the morning, generally passing off after breakfast. The catamenia have not occurred for several months. Has palpitation of the heart, which she feels under any exertion. On auscultation the heart sounds are found to be natural, and the cardiac dulness within its natural limits. No cough, but is liable to colds, which generally eventuate in cough.

Was admitted on December 2nd, 1870, and had Arsenicum 3rd, drop three times a day. She was ordered first diet, to which was added in a day or two four ounces of port wine a day.

Under this treatment a certain amount of improvement occurred, though it was so slight that on December 14th I thought it well to try another dilution of Arsenicum, and ordered the 12th to be given three times a day. Under this the patient remained much the same, but on the 21st she was suffering much with headache, the head having a sense of fulness with heat, aggravated by movement. The catamenia occurring with pelvic pains and scanty discharge, &c., the house surgeon ordered Belladonna 1X to be taken

« PreviousContinue »