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this came on she ate four figs on one occasion, and not being accustomed to eat figs she thought this might have caused the trouble; which is very probable.) T. little coated; B. reg. Sleep very good. She has not had much palpitation since the 1st. Hep.
Remarks.—This was a case of valvular disease of the heart, without rheumatic history, fairly well compensated. The compensation was giving way when she came under treatment but was rapidly and permanently restored—in her second illness the heart was not prominently affected—by Spiyclia. One remarkable feature in the action of this medicine, which I have noticed repeatedly, was the permanent relief of obstinate constipation. She had had no relief of the bowels without purgatives for long previously. I have never given Spigelia in simple cases of constipation, but I see no reason why it should not be tried.
Case 5. Gleet. Varicocele.—Oct. 25th, 1882. George L—, aet. 21, shopman, dark, small, spare. Five months ago had gonorrhoea; discharge never great but has continued. For two months testicles (which were always tender) have been painful. The left is especially so now. There is varicosis. There is scalding on passing water, which may be light or dark, clear or cloudy. He has used an injection of Condy's fluid. T. clean; B. reg.; app. very good. Sleep very good; has rarely emissions. Has been total abstainer five months. Has been under homoeopathic treatment. Thuja 1, pil. j, q. d., Ferr. phos. 3, gr. v, n. et m.
Nov. 1.—Less scalding. The swelling of testicle, if anything, is slightly less; pain and tenderness less. For three days there was less discharge, now it is the same as before. There is still some irritation in the urethra. T. clean; B. confined. Rep. The Condy injection to be used only every other night.
8tb.—Testes not quite so tender; discharge same; no scalding; B. fairly regular. Leaving off the injection made no difference. Ferr. phos. 3 gr. v, n. et m., Sep. 6, pil. j, qter. d.
15th.— Discharge better, no scalding; testes not so sore, swelling same. There is irritation of the pubes, has had this a month or two. Rep.
22nd.—Swelling decreased (it varies); slightly more discharge yesterday. A forcing pain in urethra, no scalding. Still has a little irritation at end of penis, and aching; urine natural. B. irreg. still, has passed streaks of blood with motion, has done this before. Rep.
29th.—Swelling same. Slight aching in pubes; skin of this region irritable. More discharge. Testes soft. Veins distinct. Emissions at times, but rarely. Has cold and rheumatic pains. B. reg. Merc. sol. 6, p. j, qter. d., Ferr. phos. 3, gr. v, n et m.
Dec. 13th.—About the same. Testes tender; veins very large. Discharge same. Ac.fluor. 5, pil. j, Ham. 1, pil. j, 2 h. alt.
He did not return.
Case 6. Psoriasis— October 30th, 1882. Kate W—, aet. 16, servant. Fair, dark blue eyes. Spots of psoriasis on both arms and one on upper lip; had them three weeks; they first came on the scar of vaccination performed a year previously. General health good. None of her family ever had anything of this kind. She never had before. Arsen. 5x, gtt. j, 3 h.
November 14th.—Has been without medicine, and few of the spots, which had all gone, have now returned. Ars. 5x, pil. j, q. d.
20th.—Better, but not quite well. Rep.
I heard soon after that she had got perfectly well, and I have since heard that she has remained so.
Case 7. Nervous symptoms consequent on old apoplexy from embolism; disease of aortic valves, stenosis of mitral) hypertrophy of heart and dilatation; syphilitic history.—■ November 9th, 1882. S. G—, set. 55, pensioner; large, well made, fair, nervous-sanguine, irritable. Complains of giddiness, noises in the head (China), and fixed pain in the nape of the neck (Helleb.).
Four years ago was taken suddenly one morning, whilst shaving, with shaking. He did not fall, and had no inclination to. The shaking soon passed, but left a numbness in the right leg. Went out about 9.30 a.m., and felt as if walking on sponge with the right leg. He was like a drunken man. This condition lasted four days. The strength came back, but he has always had numbness in right leg, below knee, since. Commencing the day after the seizure, there came on gradually giddiness and noises in the ears, ceasing only during sleep; and the pain in the nape of the neck. This is on the left of the middle line, and extends upwards as far as the occipital ridge; it is like a hard pressing; it affects the eye at times; it causes impairment of memory. Has always had good health. Is not a total abstainer, but never a great drinker. When in the army, thirty years ago, drank a little. For last twenty years has been subject to heartburn. Twenty years ago had syphilis followed by severe secondaries. Fifteen years ago had a rash, which disappeared under severe allopathic treatment. Has irritable spots on forehead now occasionally. He married, a few years ago, a wife many years younger than himself. Has children, all healthy, but subject occasionally to spots on the skin. T. rather dirty at back; B, regular; two or three times a day, but not loose. Sleep good as a rule. He has palpitation sometimes; P. soft, regular.
Examination of heart.—Dulness begins one inch to left of sternum, at lower border of second rib. At the level of the fourth rib it extends from a quarter inch on right of sternum to two inches and three quarters to the left. The apex beat cannot be felt. In mitral area a thumping first sound and reduplicated second. In tricuspid area normal sounds. In pulmonary area a slight systolic bruit, heard louder in aortic area, not heard at all to the left of pulmonary area. This bruit is prolonged into the carotid artery, where it becomes musical. Hell. n. 1, gtt. j, 2 h., for 3 days, Chin. 1, pil. j, 2 h., for 4 days.
20th.—Better generally. Pain in head and giddiness both better (the noises are worse when he is lying down than when up). T. dirty at back; B. regular; app. very good; sleep good first part of night. He has had a great upset through sudden illness in his family during the week (14th). Rep. Chi.
27th.—Hissing noises very bad; pains all over; bilious. T. dirty; B. regular; app. poor, no giddiness. Hell. n. 1, pil. j, q. d.
December 4th.—Pain in back of neck better; has had a few sharp turns of it; noises bad at times, but better on the whole. He suffers from irritation of the skin in cold weather. For years has been subject to rheumatic pains, in knees chiefly. He now has pain across the top of the sacrum. Rep.
11th.—Has had rheumatic pains about the neck, and the pain in the back of the head has been bad again. Noises in head troublesome, hissing. Sod. sal. 3x, pil. j,
18th.—Hissing noises same, perhaps a trifle less; pressure on the carotids stops the noise for the time. The first part of the week, after taking the Sod. sal., he was worse as regards the pains, now they are better. He still has the pain at the nape, worse at night. He thinks Hell. n. in the liquid form does him more good than in the form of pilules. Hell. n. 1, gtt. j, q. d.
28th.—The second day after getting the last medicine the pain in the nape disappeared, but he was seized with pain in teeth of right side—first upper, then lower—they seemed to rise up; the pain affects the ear. Has scarcely any toothache now, but teeth are still tender. T. coated at back. Has indigestion (Christmas fare ?). Spiyelia 1, pil. j, q. d.; Hell. n. 1, gtt. j, p. r. n.
January 6th, 1883.—The pain in the nape keeps better. The noises are very bad, hissing changing to a thumping; no deafness. The pain has gone from the side of the face to the top of the head. P. regular; T. little coated at back. Chi. i, pil. j, 3 h.; He-ll. n. 1, gtt. j, p. r. n.
17th.—Noises same; giddiness a little better; heartburn better (fish or eggs cause it if he takes them); has had slight touches of pain in nape. Dig. 1, pil. j, 3 h.; Hell. n. 1, gtt. j, p. r. n.
31st.—Giddiness better; noises better ; pains do not last so long. Helleb. gave relief. Has had pain in soles of feet, so great that he could not keep still; has had this before; when the feet are bad the head is worse. T. coated; B. little confined. Rep.
Remarks.—The heart in this case was very much damaged, and I have little doubt that his paralytic attack was due to the plugging of a small artery of the brain by a fibrinous plug carried from the heart. He improved much under treatment. Hellebor. n. seldom failed to relieve the aching located in the nape of the neck in this case, and I have found it most useful for pain similarly situated, in many other cases. The noises in the ears constituted the most obstinate symptom. This seems to have been due to transmission of the cardiac murmurs to the bones of the ears. Digitalis was most serviceable for this symptom, and also for the giddiness.
The patient, whose case forms the twentieth and last of this series, was the wife of this patient.
Case 8.—Chronic abscess over head of right fibula.— November 17th, 1882. Jenny R—, set. 7, dark eyes, florid, delicate. Swelling size of filbert over head of right fibula, four weeks. Had been taking Silica three weeks under my advice. Her general health improved, but the swelling has become larger. It is neither tender, sore, nor painful. She has a cough, troublesome night and day. Ac. benz. 1, Bry. 1, 3 h. alt.
24th.—Cough better, not quite gone, swelling not quite so well. Silic. 6, Bell. 3, 3 h. alt.
December 1.—Bandage put on with card-board splint. Iod. 3x pil. j, q. d.
7th.—She has lost app.; T. white; B. reg.; sleep restless. Ac. benz. 1, alt. Iod.
22nd.—Swelling rather softer; not any smaller. [Up to this time I had considered the swelling to be of the nature of a ganglion—synovial. I now began to suspect that it must be an abscess. I learned that the patient had been vaccinated as an infant with " bad matter; " that her arm