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Parents healthy. One brother has died. Patient is now only surviving child. Had whooping-cough when a small infant; bronchitis many times since; measles at four; chorea at six. Has swelling in glands of neck. Often has palpitation. No dyspnoea. P. quick. App. good.
Examination.—Area of cardiac dulness considerably increased. Apex felt beating strongly in fifth interspace, far to left. At extreme left of apex-beat a short bruit, following immediately the first sound, is heard at times; accentuated second sound heard all over, reduplicated at both bases, especially the left. Lungs.—Right apex slightly natter than left, and duller on percussion. Vocal resonance increased; bronchophony below clavicle; expiration prolonged; a few dry sounds, no moist sounds.
Diagnosis.—Bronchial irritation in tuberculous subject; healed cavity at right apex; hypertrophy of ventricles, and insufficient mitral. Arsen iod. 3x, gr. ^ in water, Digit. 1, pil. i, 2 h. alt., for about ten days.
Oct. 24th.—Heard that he got rapidly better; had no occasion to return; is now quite well, attending school.
Case 2. Abscess in neck; gastro-intestinal disorder; erythema.—Oct. 2nd, 1882. Jno. E. S—, aet. 18 months, fair, fairly nourished, rather small, seven-months' child: mother was only able to suckle him a fortnight. He is her first child. Never strong from birth; never had bronchitis; not subject to diarrhoea. His mother is very poor; the drainage of the house is bad. Seven days ago was taken with sickness and cough, followed by diarrhoea for two or three days. Has had no diarrhoea for three days, but his motions have a strong smell. He takes milk. T. has been coated, is better now. Wakes up screaming from sleep. Sweats a little. Head does not sweat in the night. Temp. 101-2°. Below the left ear, in the neck, is a gland the size of bantam's egg, hard and red, and increasing in size. His mother noticed this from the first. Legs and thighs largely covered with erythema, the epidermis scaling. Bel. 3, p. i; Mer. s. 6, p. i, 1 h. alt.
5th.—Had sleep last night for first time. Neck softening. Eruption on leg fading. T. white; b. reg.; no sickness; can swallow only milk. Pharynx congested; no patches. Bel. 3, Hep. s. 6, 1 h. alt.
7th.—Abscess matured. I opened it and let out about an ounce of creamy pus. Pharynx normal. Rep. medicine. Dressed abscess with calendula lotion.
8th.—Better night. Good deal of brawny swelling. B. loose, very offensive. Fever gone. Silic. 6, g. i, 2 h.
9th.—Better, but excessively fretful and bad-tempered. Cham. 6, p. i, Sil. 6, p. i, 2 h. alt.
14th.—Slept very well on night of 9th. Very much better since; abscess discharging much. Rep. His mother did not bring him again.
Remarks.—I was not a little suspicious of scarlatina in this case, but I came to the conclusion, which I still think is the right one, that it was a case of blood poisoning from bad drainage. The diarrhoea at the outset was against the supposition of scarlatina; as was also the limitation of the vivid red eruption to the lower extremities, and the scaling off of the epidermis whilst the eruption was at its height. In spite of very unfavourable surroundings there was good response to the remedies administered.
Case 3. Goitre; anemia; ascarides.—Oct. 11th, 1882. Jane R—, set. 18; shop; pale, but easily flushed; dark eyes. Complains of enlarged throat. It came on six months ago after staying for some considerale time at Swindon, where the water was very hard. Previous health good, except for irregularity of cat. As a child she had thread-worms, and fits with them. The ascarides have lately become troublesome again. T. clean; b. reg.; much irritation in rectum at night. Cat. come on before the time (Cal. c.); sleep good; app. good; has a frequent hacking cough, worse in evening, with a little phlegm. Headache over the eyes; aching in the eyes; mattery discharge in the eyes in the morning. P. 96. There is a loud venous hum in neck. The thyroid gland is much enlarged and soft. (In June she had for a week Acid, fluor. lx, gtt. ii, in 3iss of water ter die, and received benefit.) Cina 1 pil. j, Calc c. 6, pil. j, 2 h. alt.
18th.—Cold and cough rather better. Has been troubled with worm-symptoms, but has seen no worms. P. 100. Calc. c. 6, Ferr. mur. 5x, 2 h. alt.
Nov. 1st.—About the same; irritation from worms bad when at stool, and in the night. P. 92. Calc. c. 6, quater die. Teucr. lx, pil. iij, h. s. s.
8th.—Cat. came on at right time. She feels better. Worms no trouble, has seen none. She has a cold; is seldom free from one; much mucus from nose. Slight hacking cough. T. clean; B. reg.; app. good. Thirsty. Rep.
22nd.—Feels better generally. Worms no trouble. Less cough. Cold in head is worse. Thirst same. Calc. c. 6, Ac. fluor. 5, 3 h. alt.
Dec. 12th.—Has been about the same; neck same; cold rather troublesome. Last night worms became troublesome. B. reg.; app. good; cat. reg. Ac. fluor. 5, qtr. die. Teuc. lx iij, h. s. s.
Feb. 28th, 1883.—Returned after ten weeks' absence. Cough troublesome. Goitre apparently larger; still soft; throat internally normal. Loud bruit de diable in neck. Headache across eyes. T. rather white; app. very good; B. rather confined; worms very troublesome. Has bad dreams. Cat. have been too early. Calc. c. 6, p. j, qtr. die, Teuc. lx, pil. iij, h. s. 8.
March 14th.—Throat less by a quarter of an inch in girth. Less cough. B. still rather confined; worms have given no trouble. Headache nearly gone. Cat. have been on, nearer the right time—only two days before. Rep.
Remarks.—The attendance in this case was scarcely steady enough to warrant any definite conclusions being drawn as regards the goitre. Still it may be said to have diminished under the influence of the medicines—especially Calc. c.—and to have increased when medicines were left off. The leading indication for Calc. c. was the anticipation of the catamenial periods, as pointed out by Hahnemann. So far as my experience goes it tends to confirm the truth of
VOL. XXI, NO. CLXV.—JULY, 1883. P
his remark that Calc. c. is only useful when cat. are regular or the intervals are shorter than natural. When the periods come on after the normal time Graphites is more likely to be of benefit. The worm-symptoms rapidly improved under the nightly dose of Teucr. lx. In adults I have found this medicine, in this dilution, much more efficacious than Cina in temporarily and permanently removing troubles from ascarides.
Case 4. Disease of aortic and mitral valves.—Oct. 23, 1882, Mrs. B—, aet. 66, widow 16 years, cook, rather tall, spare, pale, fair. Complains of pain in chest and back going to elbows, stoppage at heart, fainting, pain in hypogastrium, sharp, extending to thighs, coming with flatulence. She has a catching of the breath. On the least excitement the heart seems to stand still. Last night lay two hours unable to rest for fluttering. She has had these symptoms a month. Has taken pills which have relieved the pain in the body but caused pain in the head. This is much better. The boivels are never moved without purgative medicine. There is no swelling of the feet. Up till twenty years ago she had had no severe illness but had suffered from spasms. She had suffered much trouble from an unsteady husband. Twenty years ago came under Dr. Andrew Clark's treatment for heart disease and remained three years under him. At that time she often reeled in the street like a drunken person. The first intimation she had was sudden seizure with violent pains like knives in the cardiac region, in the middle of the night. On one occasion she ran to catch an omnibus, and when she got inside was seized with violent pain in the back, like two balls beating together, so bad that she could not help screaming. Ever since then the sight of a train has been enough to bring on the same sensation in a slight degree. T. dirty at back; app. poor. Milk does not agree with her, takes beer for supper as a rule but has not for a fortnight. Has much wind, up and down, especially down, in the morning. Is slightly ruptured on the right side. Water clear and colourless. Feet do not swell. Pulse 96, steady, artery rather tortuous. Cardiac dulness begins lower border of second left costal cartilage, 1 in. to left of sternum; sternum dull from the top. Mitral area: impure first sound, musical accentuated second, accentuated second in aortic and pulmonary areas. Between the two fourth costal cartilages, where they join the sternum, the second sound is heard as a short musical bruit.
Diagnosis.—Aortic dilatation, slight incompetence of aortic valves, no obstruction, mitral stenosis. Spigel. 1, p. j, qter. d.
30th.—Very much better generally. Has had no feeling of stoppage; no reeling on rising, or giddiness on stooping— which have been troubling her—pain in arms and thighs better; app. better; b. reg. Has pain in hypogastrium like a gathering. Has been nervous this week in consequence of domestic worry. Rep.
Nov. 14th.—On 5th fell as she was getting out of a train, and hurt herself. The fall did not affect the heart, and, except for bruising and stiffness, she has kept much better. Am. 1, 2 h.
20th.—Much better generally. Still stiff but less so than she was.
Jan. 20th, 1883.—Has kept pretty well during last two months. Has had attacks of palpitation at times. Has had heavy work during the last week. This has brought on palpitation which is getting worse. P. quick; T. rather dirty; B. reg. Sleeps well till 1 a.m. but cannot sleep after. Spigel. 1, pil. j, qtr. d.
30th.—Has been very ill with headache and indigestion. Pain at chest after everything she takes; sharp pain, going through to the back after breakfast. Breath has been very short. T. dirty; B. reg. Headache on lying down; the pain is as if the top of the head were taken off, and the contents of skull stirred up. Bry. 3, pil. j, qtr. die.
Feb. 9th.—Was very much better all the week. Has been out of medicine for two days. On Tuesday (6th) had pain across the chest causing sick feeling; pain extended down into bowels and thighs. This has gone and the sickness is better. She now feels as if something were lying at the chest. Has pain in the hypogastrium. (Before