CHAPTER VI. – EXAMPLES OF THE HYDROGENOID SYCOTIC
CONSTITUTION FROM THE PRACTICE OF DR. BOJANUS.The
North American
Journal of Homśopathy of
August and following months, 1888, published a series of case treated by
Dr. Bojanus of Moscow, and published in a German journal. The articles
were translated from the German by Dr. T. M. Strong.The first eight of Dr.
Bojanus’ cases I have somewhat condensed from his narrative. The rest
are given in his own words and are written in the first person. The
opening of his article runs as follows :“If in reference
to the various constitutions I give preference to the Hydrogenoid, which
I shall endeavour to illustrate by examples, I do this chiefly, first,
since this constitutions for many years past is the predominant one and
affords me more material for illustration, and secondly, because it
gives practical proof of what Grauvogl says in his posthumous work
concerning the subject. May it encourage the study of the works of this
eminent and well-deserving enquirer !“Ever since I
began to apply the study of the doctrine of constitutions to practice,
and with eminent success – twenty years ago – only one single case of
perfect Oxygenoid Constitution has come to my observation.“The
Carbo-nitrogenoid indeed often appears together with the Hydrogenoid,
but seldom alone, and presents in this fashion an extremely difficult,
often enigmatically mixed up, therapeutic subject. Almost all of the
cases mentioned here belong to the period of time previous to my
acquaintance with the posthumous work of Grauvogl ; the practical
results, of which but a small portion is communicated here, are based
chiefly on the study of Grauvogl’sText-book
and familiar remarks which I have gathered during my acquaintance and
conversation with him.”Dr. Bojanus’ remarks on
the frequent combination and complication of the Hydrogenoid and
Carbo-nitrogenoid Constitutions I can fully corroborate, but for all
that, the three-fold division can be of great assistance in the
selection of remedies. Bojanus endorses what Grauvogl says about the
accessory circumstances characterising the constitutions, but the
“Constitution” itself is not sufficiently clearly
characterised in its exterior manifestations to admit of an exact
description of it ; “But in reference to the various materials
constituting the diet it will be found invariably that aquatic plants
and animals, fruits and vegetables largely containing aqueous material –
cucumbers, melons, mushrooms, moreover, milk in every form, eggs even
cooked soft ; as also a moist atmosphere, humidity in dwelling
apartments, even accidental and transitory baths, warm or cold, drinks
of water or of liquids containing much water ; rain cold, storms,
whose approach many persons of this sort feel and foretell in advance,
not only may aggravate the disease (in a Nitrogenoid the reverse takes
place – at the approach of and during the tempest they feel better), but
may also cause a relapse after a disappearance of several months.“After a complete
cure even, the diet restriction should be followed for a further year at
least. Among patients of this class some will be able to digest some of
the forbidden articles and not others without detriment to their health.
Some can take salt-water fish and not fresh-water fish. Some can take
eggs and milk but no fish. Most are decidedly avers to flesh meat.”Bojanus gives a very
graphic description of the terribly unhygienic condition of Moscow and
its two rivers in his day, which mightily fostered the hydrogenoid state
in the inhabitants. Filth and ice in winter, dust in summer, floods in
spring, and smells al the year round are about the sum of his
description. It is not to be wondered at that intermittents are among
the endemic diseases he had to treat, and “intermittent fever”
and “hydrogenoid constitution” are frequently more or less
identical.I will now give a brief
account of Bojanus’ cases :
Case I.
Insanity
with Intermittent Fever.
Veratrum and
Arsenicum.O. K., 23, a young lady
of an impoverished noble family, whose mother was and energetic lady of
strong will, scrofulous in childhood and often subject to neuralgia,
dying after her tenth confinement of typhus. The daughter, who was an
exact likeness of her mother and very lean and pale, had recently filled
a position in Moscow to which she had to make a long journey every day
to her office, and lodged in a cold, damp, unwholesome house, where even
the bedclothes were hardly ever dry. In childhood she had scrofulous
inflammation of the eyes, at thirteen prolonged tinea capitis with large
swelling of the neck and its glands. In her fifteenth year the menses
appeared for the first time, scanty and always with pains in the
abdomen. Three years later leucorrhśa appeared with continual
chilliness.In July, 1875, she left
Moscow and went to her father’s house twelve miles in the country. At
the time Bojanus was called in, August 6th, symptoms of insanity
appeared and soon intermittent fever, two paroxysms a day, 10 a. m. to
12 noon, and 8 p. m. to 12 midnight. She walking up and down the room.
There was short interruption of the mania on August 10th ; but the
fever continued to return twice a day, and for eight days there was
complete sleeplessness, and the singing went on continuously for
twenty-four hours on eight occasions, followed by complete aphonia.
Pains in the left hypochondrium with enlargement of the spleen were
added.Verat.
3 was given night and morning and Arsen.
3 every three hours during the day. Under these there was steady
improvement. By the middle of October the insanity had disappeared, and
by November 14th she was well and the remedies were discontinued.Then followed a relapse
brought on by the use of water. During this day, November 14th, she
ordered the floor of her room to be scrubbed and as it was not oiled it
retained water enough to keep it moist for a long while. Without any
apprehension of evil she spent a part of the day and the whole night in
that room. At 11 p. m. on the following day she began to complain of
headache and pains in the left hypochondrium. There returned also
chilliness, weeping, outbursts of temper with terrible excitement and
despair about her condition with desire for a speedy death. Verat. and
Arsen. were immediately given in hourly alternation. The next paroxysm
appeared at the same hour but was very light, with some sensation of
chilliness but without any other inconvenience, and after the 18th all
trouble had ceased.
Case II.
Intermittent
fever in the form of Congestion of the Brain.
Atropine and
Nat. sulph., later
Nux and
Ipec.Z.
B., 6, of cheerful disposition, having had no severe illness, was taken
ill 7 a. m. one morning in January, 1871. She awoke screaming, tossing
wildly in bed, vacant, glassy stare, pupils dilated, face flushed, pulse
slow. Talked absently, imagined strange things, could not be quieted.
This lasted an hour and a half, when she fell asleep. Slept till
morning, when she awoke and remembered all that had happened. Gentle
perspiration set in and she became bright and cheerful. The following
day and night there was no complaint, but the second night the same
symptoms re-appeared.Atropine
6x, and Nat.
Sulph. 2x, hourly in
alternation. Paroxysms recurred but with less intensity. She always
remembered what had happened on awaking. After the third night there was
no return.The following year she
had scarlet fever in a mild form. All went well till during the
desquamation period fever set in. She did not complain of her head or
stomach. Thirst increased, sleepless, and when she did sleep muttered
and seemed restless. Was constipated and feverish.Acon.
alone and later Bellad.
were without effect. Then careful observations showed that there were
intermissions and Bojanus concluded that it was the old intermittent
that he had to deal with. Arsen.
every three hours was given, water was forbidden as drink unless mixed
with wine. From this time the fever diminished and in ten days she as
well, but Arsen.
was continued at increased intervals until the twenty-first day.After this Z. B. had
good health for several months when it was noticed that she had a short
but continual cough while sleeping. It lasted several nights but ceased
between 4 and 5 a. m.Cham.,
Nux, Hyos. and several other
remedies were given without effect before Bojanus was called in. He then
recognised that it was merely another form of the original complaint.
There was rough bronchial breathing in the left side and posteriorly. Nux
and Ipecac.
were given every three hours alternately with the anti-hydrogenous diet
and in a week she was free from cough. At fourteen she had measles
lightly, she menstruated for the first time and since then was in
perfect health. She was twenty-two when Bojanus wrote.
Case III.
Intermittent
in the form of Meningitis.
Atropine 6x and
Nat. sulph.Adele W., 10, tall,
slender, pale, hollow-chested, delicate, was out walking one clear day
in March, 1881, and on returning home suddenly complained of being sick.
Her symptoms were : raging headache, severe chill followed by
intense heat, intolerance of light, very nervous, nausea, vomiting first
food then bile. The following night very restless, dozed a little but on
awaking always had headache, at times slightly delirious.Next morning she was
very feverish, high temperature, raging headache, loud singing noise in
ears, convulsive twitching of muscles of face, especially about mouth
and cheeks, very sensitive to touch and irritated by the least noise.
Bellad
.
3x was given every hour. Next day no change. The day after, March 4th,
much better. Bellad.
was continued and hydrogenous diet ordered. On March 7th she was taken
with severe chills which lasted fully three days ; It was now clear
that it was a question of an intermittent. Atrop.
sul. 3x and Nat.
sul. 2x, of each three drops
was given on wafers, the body to be rubbed with spirits, and water only
to be drunk mixed with wine. On March 14th she had another paroxysm in a
light form and on the 21st another still lighter. From that time she
began to recover her health and appetite and grew stout.In March, 1882, one
night she went to bed well and woke up in a few hours screaming with
pain in right ear, cheeks flushed, more on right side.Atrop.
6x Next two days she was free from pain but on the fourth day she had
another attack but less severe. Atrop.
6x, and Nat.
sul. 2x every hour. There were
four more attacks, all quartan and each time shorter and lighter. She
was seen last in the winter of 1884 when she was well and had been so
since the last attack.
Case IV.
Intermittent
Fever in the form of Lepto-meningitis.
Nux and
Belladonna, Nat. sul. and Nux (I give this case in Bojanus’ own words.
J. H. C.)In January, 1870, a
distinguished gentleman called on me and invited me to visit his sick
child, who, he said, had been under the care of three physicians, one of
them being Professor F., of Moscow University, whose speciality was
children’s diseases.I learned from the
father that his daughter was three years old, had been ill six weeks,
and the doctors had told him his daughter was suffering from
inflammatory hydrocephalus. I remember having then made the remark that
there must be an error somewhere, for from my experience, and from what
I had read, I had never heard of so protracted a case of
lepto-meningitis. When I arrived at midnight I found the child lying on
her right side, her face turned to the wall and her right hand resting
under her cheek ; her legs were crossed ; she was asleep but
eyes partly open ; she was very thin and pale ; her skin not
warm, but normal ; she was breathing easily ; pulse, 80-90,
not hard ; would cry at the least touch. I found between the two
shoulder-blades a blister the size of the hand due to a vesicant. This I
immediately opened and applied a cerate dressing.While I was going this
she cried, but showed no other abnormal signs. She was very much
constipated. With the best of good will I could not find out how those
physicians made such a diagnosis. The intelligent nurse said it was but
natural I should think so as I had not seen her when she had her spells,
but if I would take the trouble to call the next morning about eight
o’clock I should probably agree with them. On further questioning the
nurse she told me that the child’s mother, who was till a young woman
and nursing her youngest child, through sorrow and trouble had nearly
lost her mind.At first the child’s
sickness attacked her in spells, but each day she became worse ;
to-day she had a quiet one, but to-morrow, at the same time, would
become worse ; her sickness would begin with cold hands and feet
and headache, vomiting of bilious matter, squinting and rolling her
eyes, with convulsive motions of the face and occasionally of the
extremities. This would last for three hours, then she would become more
quiet, and by the afternoon and during the next day would be in her
usual health.I now examined the
liver and spleen, and found the left lobe of the liver enlarged to the
extent of one and a half finger-breadths, and the spleen to an equal if
not greater extent ; chalk-white stool (similar to what might occur
form an exclusive milk diet) without any icteric taint. Urine dark and
without sediment ; appetite poor and only on the well days ;
lived almost exclusively on milk which she also took to satisfy her
thirst.I informed the parents
that under the circumstances I might not be able to group properly all
the conditions, but no time should be lost on this account, since
everything pointed to one conclusion, that we were not dealing with an
acute hydrocephalus. On the next morning at 7 o’clock I went to see the
child in order to see the symptoms reported by the parents. A few
minutes before eight o’clock the hands and feet became cold, followed by
pale face, headache and weeping, the latter occasionally interrupted by
a shrill cry. Twice there was a slight vomiting of bilious matter. After
this condition had lasted over one hour the cheeks began to redden, the
temperature increased to 39.3 c, pulse 100 to 120, occasionally
intermittent, generally full, eyes distorted, twitching in the face with
drawing of the mouth as if in laughter, pupils contracted, respiration
quickened, intelligence lessened, slight convulsive movement of the left
side. Half an hour later the child began to bore the head into the
pillow, while there was at the same time a convergent squint. There was
no more vomiting, but at intervals a shrill cry. The paroxysm lasted
until 11.30 a. m., when amelioration began, so that by 1 p. m. the
condition was nearly normal. Nux 3x and Bellad. 3x, two drops every two
hours in alternation were given ; milk and water were forbidden and
only wine and water with a little sugar were allowed as drink. The body
to be rubbed with 90° spirits.To compel obedience to
these rules was very difficult, since there was but one opinion under
the circumstances, namely, that the case was a most desperate if not
hopeless one. After many unsuccessful remonstrances I finally said that
since the child had been given up by the physicians we could only try,
and that I could not permit any other treatment than the one ordered and
if no permitted to carry it out unrestricted I would cease attendance.This had the desired
effect, the nurse obeyed my orders accurately. I gave the child an
injection of warm water to relieve the constipation.I called about eight
o’clock the next morning, thinking she would have another spell, which
attacked her at nine o’clock, but in the same way, namely, with cold
hands and feet, and she begged to have more covering over her (which she
had not asked for before).She also had a severe
headache, but did not scream. Soon after she became feverish, with a
temperature of 38.5°C, pulse 80 to 85. She was not delirious and had no
convulsive movements of face or extremities. She then fell asleep until
10 o’clock, and perspired freely which she had not done before. she
awakened about one o’clock, was very weak and indifferent. Soon followed
a pale, grass-green stool. The three following paroxysms, still of the
tertian type, did not differ in intensity or duration, except that the
perspiration was decidedly less. Apparently there was a change in the
condition. Since improvement went on slowly, and the lessened
perspiration seemed to threaten a relapse, in place of theBelladonna
I gave Natrum
sulphuricum 2x in alternation
with the Nux
3x, every two hours. After this she had two paroxysms accompanied by
profuse perspiration. The second, however, was light, and after this the
child began to recover ; appetite and sleep improved and by
continuing the use of the remedies, but not so often, until the
twenty-eighth day after having the last paroxysm, and with a strict
diet, in three weeks she was able to leave her bed and walk about.In 1876 I saw her for
the last time. She was then in good health and I have not heard from her
since.An interesting part of
this case is that when the child was able to go about the father met
Prof. F. in the street, when the Professor inquired after the child. On
being told that she was well, he threw up his hands above his head and
exclaimed, “That is impossible !” “Come and see her
and satisfy yourself”, replied the father. But he did not come.
Case V.
Neuralgia,
Chill, Night-cough. Nux and
Arsenicum, Nux and
Ipecac.Frau E. von E., a
slender delicate woman of good constitution, who celebrated her
eightieth birthday during her illness, complained in December, 1863, of
pain in the left side of the face, especially in the zygoma, the pain
being of a tearing, drawing nature. The corner of the mouth was slightly
drawn to the left, and there was twitching of the lower eyelid. There
were marked remissions and occasional intermissions which were very
irregular. There was no periodicity noticed. The pain was markedly agg.
at night. In other respects the patient was perfectly well and actively
busy with her usual duties.Spigelia
12, three drops every two hours, was prescribed, and the pain gradually
disappeared, only the twitching of the lower eyelid remaining. Causticum
was now given night and morning, and a few days later the twitching was
gone.But this was succeeded
by a severe chill lasting the entire day and followed in the evening by
high fever which continued the whole night. This produced complete loss
of appetite, but did not affect the general health and she continued at
work as before.Causticum
was continued, but as there was no change at the end of a week, a wine
diet and rubbing the body with brandy were ordered and Nux
3x and Arsen.
3x were given every two hours alternately.At the end of a week
the feverish condition had lessened, but a night cough, entirely
relieved by day, now came on. Otherwise her condition remained the same
except that her appetite was better. The loss of sleep weakened her and
although she got some sleep in the day it did not make up for that lost
in the night.Nux
3x and Ipec.
3x were now given every two hours alternately. In a few days the cough
disappeared, the sleep returned and the patient seemed well. Several
weeks later when Bojanus again called she told him that after the cough
left she had been weak and then noticed a swelling in the back of the
feet which had increased slowly till it reached the knees. She
complained only of difficulty in walking and itching of the swollen
extremities and was otherwise well. There was a trace of albumen in the
urine but no casts, and liver and spleen were normal. Bojanus ordered a
half lemon to be taken night and morning with plenty of sugar but no
water. at the end of a week the śdema was gone and the patient was not
again ill till she died of old age at 88.
Case VI.
Intermittent
Fever under the form of Prosopalgia.
Nux
and
Ipec., later
Aranea.D. B., wife of a
Russian clergyman, 36, small of stature, emaciated and badly nourished,
mother of several children, consulted Bojanus on March 6th, 1878,
complaining of pain in the left side of the face, which as of long
duration and came on every day at 2 p. m. It followed the three branches
of the trigeminus, and she also complained of a persistent chilliness
not relieved by the heat of the sun or a warm room. This had lasted two
years, the pain in the face having first appeared in March, 1877, and
had proved intractable to all kinds of household remedies and was only
removed by Quinine given under medical advice. But the general health
was not improved, and in the beginning of autumn the pain returned and
though again relieved byQuinine
the relief was slower in coming than at first. She now gave this
history :With the onset of
chilliness, with cold hands and feet, there appears a burning pain deep
in behind the joint of the lower jaw. The pain radiates into the eye
causing weeping, into the eyelids, the left side of the nose, the cheek
and all the teeth, upper and lower and even to the chin and lips. To
this pain there is added a particularly painful, intermittent tearing
sensation from within outwards. The only relief was by the application
of very hot dry cloths. After the attack had lasted about two hours the
pains began to slowly lessen, the entire attack lasting from three to
three and a half hours, after which she felt very weak and faint. Fever
and sweating were absent during the attack. She complained of want of
appetite, the tongue was coated white with insipid taste, and there was
aversion to meat ; long continued sensations of coldness or
chilliness over the whole body and constant coldness of the hands and
feet. The liver and spleen were normal, menses regular and scanty but
without pain, no constipation or thirst.Nux
3x and Ipec.
3x were given every hour in alternation during the pains. The usual diet
and wine were ordered and no water except mixed with wine. On March 17th
she reported that after three days the pains began to disappear
gradually and for three days there had not been any, but the chilliness
and cold hands and feet remained. On April 26th, the pain had not
returned and the chilliness and cold hands were better, as also the
general health.The Medicines were
continued at longer intervals with strict instructions that the diet
should be continued for at least one year. On March 28th, 1879, the
patient reported that the pains had returned one week before. Since
April 1878, she had taken the medicines as ordered, for two weeks four
times daily, in alternation, for two weeks twice and for a further two
weeks once a day. But she had not been strict with the diet, especially
in the latter part of the time. Nevertheless, she had been in good
health until the beginning of the great fast (Lent). (According to the
laws of the Russian Church the seven weeks of the fast are very strictly
kept. Nothing but vegetable food is allowed ; only on two days of
this long fast can fish be eaten, namely, at the feast of the
Annunciation and Palm Sunday. The diet consists of cabbages, turnips,
potatoes, mushrooms and farinaceous foods, everything being prepared
with oil ; animal food is strictly excluded). Believing that she
was quite well she began to fast and at first suffered no inconvenience,
but on March 25th she could not resist the desire for fish and on the
26th the neuralgia returned, together with the coldness of the hands and
feet. It also transpired that since the winter she had been living in a
very damp house.Aranea
3x and Spigelia
3x were given in hourly alternation.On April 12th the pains
had been entirely absent for three days and the patient felt decidedly
better. The remedies were continued and it was directed that for
twenty-eight days after the least attack the diet should be strictly
observed and a drier dwelling found. Seen by Bojanus when attending her
children during 1882 to 1884 there had been no return of the trouble.
Case VII.
Intermittent
Fever under the form of Pneumonia.
Ipecac.
and
Nux.B. T., 4, a
well-nourished, strong, active boy, was taken ill on January 10th, 1875.
The previous day he had given a few coughs, which had passed unnoticed,
but about 2 a. m. he was suddenly seized with a severe shaking chill,
followed in an hour with high fever and reddened cheeks. He was
restless, continually tossing about, coughed frequently and cried
continually from pain in the chest, but was unable to locate the seat.
After this had lasted two and a half hours sweating began and the cough
lessened, crying ceased and the boy soon fell asleep. The sweating
continued, though not copious, till 9 a. m., when he awoke without any
distress and after eating his breakfast, went to his accustomed playing.
So passed twenty-four hours and again a slight cough occurred, almost
unnoticed by the parents and not attended to. Soon after midnight of the
12th occurred the same scene, and in the morning of the 13th Bojanus saw
the child. As soon as he entered the dwelling he noticed that it was
damp, which the parents admitted and said that they were determined to
leave it in the spring. The boy was then up and busy with his
playthings, without any special appearance of sickness.Examination showed that
there was no fever. The tongue was slightly coated and there had been no
stool since the day before. Percussion gave negative results. There were
fine bubbling rales under the left scapula ; when quiet there was
no cough, but it at once appeared when moving about. Bojanus diagnosed
bronchitis or catarrhal pneumonia with a malarial complication and
warned the parents that they might expect another paroxysm.Ipec.
3x, in two-drop doses, was given every hour.The next paroxysm came
on at 10 p. m., and was ushered in with a severe chill, which lasted one
hour, and great thirst ; the cough quickly followed and was
accompanied with headache an general pain, together with restless
tossing about the bed. A few minutes after eleven the fever began with
reddened cheeks, increased heart-action and a temperature of 39.3 to
39.9°C. There was quicker respiration, violent action of the nostrils,
drawing in of the lower ribs, aggravation of the cough, increased
restlessness, crying and tossing around, all continuing until half-past
twelve. The thirst was not so great during the fever. The child became
easier as the sweating stage began, which was this time more copious and
of shorter duration than in the previous attacks, the whole paroxysm
being lighter, as the mother said, than the former ones.
Nux
3x and Ipec.
3x were given in hourly alternations during the interval, together with
wine diet and rubbing morning and evening with brandy. The three
following paroxysms were each lighter in character and after the last
the child began to improve rapidly. During the Spring and early Summer
he was well and before the hot weather was removed to a drier dwelling
and then into the country, so that he suffered neither a relapse nor a
new attack. Seen in 1884, then fourteen years old, he was in rugged
health and had had no other sickness.
Case VIII.
Intermittent
Fever under the form of Pleurisy.
Nux
and
Ipec. ; Ipec. and
Aranea.M. D., 46, mother of a
grown-up daughter, had suffered for many years on each recurring spring
with the following conditions :Early in March, without
any visible cause, she would be attacked with a severe sticking pain in
the left side of the chest which interfered with the respiration and
with this there was a chilly feeling lasting and hour, followed by fever
lasting three hours, during which the pains were aggravated, the
breathing more difficult, and accompanied with a cough, generally
without expectoration, but sometimes there was a frothy, slimy sputum.
There was also intense thirst, dryness of the mouth, headache and
internal chilliness but with hot skin with desire to be covered during
this period and sometimes longer, sometimes shorter but never of over
three hours duration. This was followed by profuse sweating lasting
generally from two to two and a half hours, during which the pains
lessened, the breathing became freer and the cough looser. On the
following day the patient was able to be up for a few hours, but this
only lasted two days when the attack recurred. This state of things
lasted till May, when every symptom disappeared and she gradually
recovered her health.The usual treatment
gave no relief. The only benefit she got was fromQuinine,
but latterly she had been compelled to take such large doses that they
caused a feeling of apprehension and giddiness. Bojanus found the
general condition on the whole discouraging ; appetite poor, cannot
take milk which causes diarrhśa, nor fish, which causes pain in the
stomach and nausea ; she does not care for uncooked fruit and has
an aversion to meat, so that, as she expressed it, eating is a matter of
indifference. She was emaciated, often compelled to resort to wine,
spoke slowly and in measured tones, always felt weak and exhausted. The
tongue was slightly coated, no constipation, sleep generally light,
disinclination to motion and work which she ascribed to her weakness.In March, 1876, and
examination, Bojanus writes, showed the following : “Liver
normal, spleen slightly sensitive to pressure. Percussion gave negative
results, while auscultation showed, with normal respiration, at the
sixth inter-costal space on the left and backwards a distinctly audible
friction sound, so distinct, indeed, that I was not certain of its
cause. This much was certain, that we had to deal with a quartan type of
intermittent fever.Nux
3x and Ipec.
3x, three drops of each were given in hourly alternation together with a
wine diet and rubbing of the whole body with alcohol three times daily.
At the next attack all the symptoms returned and I heard during the
fever paroxysm the friction sound under the before-mentioned painful
spot. For this I ordered a compress to be applied during the fever,
removing it when the sweating stage came on. After four successive
lessening attacks the fifth failed to appear and the patient began to
improve. The appetite increased, also the general strength and she
became more active and in better spirits. Auscultation showed steady
vesicular respiration and complete absence of the friction sound. A few
weeks later the patient went to the country with instructions to
continue the medicine and closely follow the diet.“During the
following winter she enjoyed good health but in the early part of April
I was again called to see her, and learnt that the attacks had returned,
but in a tertian form, although she could not remember any error of diet
and the attacks were somewhat different ; she has now constant
chilliness, the fever and pain in the side were less and the paroxysms
did not last as long. I again examined during the paroxysm, percussion
gave no results and I heard on auscultation, distinct normal respiration
and a very slight friction sound. She now received Ipec. 3x and Aranea
3x in hourly doses, together with the same diet and rubbing with spirit.
The second attack was so slight that she had no desire to remain in bed,
and there was no other. In 1880 I saw the patient for the last time, and
she had had no sickness up to that time.[The remaining cases are given in Bojanus’ own
words.]
Cases IX.
Intermittent
in the form of Pleurisy. Nux and
Ipec.This cases, very
similar to the last, says Bojanus, came to me in 1872.The five-year-old son
of General R. had been treated for two weeks by an old-school physician
but without benefit. When I saw the child for the first time, a plaster,
leaving a blister, had been removed from the affected side so that
percussion and auscultation were not to be thought of in this
capricious, spoiled and fear-inspired boy, who at the approach of every
stranger uttered a terrified cry. I learned from the mother that two
weeks before, without any apparent cause, he as attacked by a chill, not
long in duration, followed by fever. With the chill he began to cough
and with each coughing spell distorted the face and cried. He also
complained of pain in the left side, more towards the back. The
physician was called and said that the trouble was pleurisy, which was
evident enough, and ordered a mixture which was given at once. Soon
after this, sweating began and he rested easier, and towards evening of
the same day the disease had apparently disappeared, which was naturally
ascribed to the mixture. On the next day the boy seemed relatively well
and was running round the room since it was impossible to keep him in
bed. On the following day the same scene was repeated and so continued
until the boy refused to take the medicine and it was not possible to
use force. The mixture containedQuinine.
Up to the time of consulting me the attacks had been of the tertian
type. I could not examine nor question the boy, but from his
well-nourished and vigorous appearance, and from my own experience, the
scrofulous basis was plainly manifest. I gave Nux
3x and Ipec.
3x in hourly doses, and ordered a wine diet, to which the other at first
objected. During the following week there were paroxysms of which the
third and last was very light, and the boy was soon well. He now
permitted a careful examination, but it was without result. For three or
four years after this I have seen the boy and during that time there has
been no relapse.
Case X.
Long-continued
Intermittent Fever, simulating Tuberculosis.
Phos., Kali nit., Nux and
Arsen.A young man, 20, of
whose family I had been physician for many years, had suffered greatly
from intermittent fever the last two years while residing in Dorpat,
where he was attending the gymnasium and, as his parents would not
employ old school treatment, he was prescribed for by letter, and each
time relieved, but from want of perseverance with the diet, and on
account of the climatic influence, he was constantly subject to
relapses.In February, 1882, this
tall, but reasonably strong young man, of good constitution, again fell
sick. When a child he had had scarlatina of rather severe form with
albuminuria. Later he had measles but no other diseases, except the
above-mentioned intermittent fever which frequently relapsed
notwithstanding the use ofNux,
Arsen., Chinin. arsenicosum
and Natrum mur.
As he was preparing for his graduation examination he could not return
home but as compelled to remain at Dorpat until the end of May. His
elder brother was at the same time a student of medicine in Dorpat and
could do nothing but call upon Professor V—, who proceeded to treat
him, secundum
artem, with large doses of Quinine
and stopped the paroxysm, but as it persisted in returning, larger doses
of the drug were used. So matters went on until he had passed the
examination and was about to attempt the matriculant’s examination for
the university.At this time he was
seized with a general feeling of exhaustion and an irritating dry cough
which alarmed his brother, and Professor V— was again called. He made
a careful examination and found dullness with abnormal respiration at
the left apex and ordered the patient to seek a warm southern climate.Daily towards evening
there was fever with copious night-sweats, and in the face of Professor
V—‘s opinion already expressed, the brother asked him what he feared.
“Dear friend”, said the Professor, “here is a serious
matter ; do you not see tat tuberculosis and hectic are in
union ? I have seen a mass of such patients ; I am not
mistaken.”The young man was
startled and could not believe the words, although they were those of a
master, and so called in Dr. S—, who, after seeing the patient, gave,
if not in the same words, at least the same sentiment, and thus the
correctness of the diagnosis was established.The brother now wrote
home describingin
extenso the condition of
patient, as also the result of the physical examination, whereby it
became apparent that the fever recurred every evening with slight chill,
general heat, and a copious sweating, thus simulating hectic fever. I
wrote to Dorpat inquiring if the professors thought the condition of the
lungs to be a result or cause of the fever, since, if they determined
that this was the cause of the fever, then the changes in the lungs must
have preceded and not followed the fever, and this the more since it was
known to me that these same gentleman had examined this patient at other
times and pronounced the lungs to be in good condition. I was also
anxious to have this question answered since they had decided not only
in this but in other similar cases, that a rational therapeutic
treatment was not possible.The answer returned was
that the fever was a hectic fever and was dependent on a commencing
disease in the lung. I saw that my question had not been understood and
urged the patient to come to Moscow, which he did. On his arrival I
examined him most carefully but could discover no dullness although the
abnormal breathing was noticeable. I also learned that for the past
three years, in each succeeding Spring, he head suffered from
intermittent fever, and during the present season the same, and as it
did not seem to yield to the medicines which I had sent, large doses of
Quinine had been taken up to ten-grain doses. Still the fever returned
until finally the attack came on each evening with chill, heat,
headache, weakness, despondency, ill-humour, restlessness and dry cough.
These conditions were also present, in a lessened degree, during the
apyrexia. The young man had grown thin, there was loss of appetite, the
sleep was disturbed on account of the fever and night sweats, and was
only and unrefreshing slumber, while the normal condition was very much
disturbed. I orderedPhos.
3x and Kali nit.
3x hourly in alternation with the wine diet and rubbing the body with
spirits. At the end of three weeks, under the continuous use of these
two remedies, the fever and abnormal breathing had entirely disappeared,
while the appetite had improved and the patient was cheerful and bright.In order to quiet the
family, and also on hygienic considerations, I advised the young man to
seek another climate, and, in order to lose no time, to begin his
studies in South Germany, which was done. In the meantime, his brother
who had attained his degree, travelled through Austria in October of the
same year and was a witness of his good health and activity in his
studies.In the Spring of 1883
the former wrote me that his brother had had a threatening of a return
of the fever but thatNux
and Arsen.
promptly relieved it. After spending a year in Austria my patient
returned to Dorpat to complete his studies in natural science and
philosophy and then travelled. So far as I know, he had not been sick
since the occasion noted above.
Case XI.
Sycosis
.
Nux and
Ipec. ; Thuja, Nat. sul.Mr. K— worker in a
glove factory, 28, tall and strong, of pale countenance and spare build
complained that for one year, especially in the autumn and winter
months, he had suffered from a cough, which was accompanied by a
constant, generally copious, thick, yellowish or greyish expectoration,
which in the last attack was also mingled with blood and this led him to
seek advice. According to his report the cough had not come on any
single occasion from catching cold. He was not able to give any
particulars of his condition except that for year, or about the time
that the cough began, he had gonorrhśa, which had been treated
according to the old-school method and had only been cured about a
month.On examination of the
genitals I found over twenty narrow-pedicle condylomata about he glans
and especially around the corona. Percussion showed marked dullness in
the upper part of the left lung extending down into the third
inter-costal space, while auscultation demonstrated harsh bronchial
breathing, which, in every case, points to extensive infiltration. A
distant weak vesicular murmur could also be heard in the same side The
third and seventh dorsal vertebrć were sensitive to pressure The cough,
which was agg. in the morning, was not debilitating. It was caused by a
persistent tickling in the throat which at night interfered with sleep,
at which time the cough was drier. His strength was lessened and also
his appetite. Cold water, cucumber and water-melon caused a watery,
painless diarrhśa, so that only boiled water could be taken and this in
the smallest quantity. The stool was sluggish. There was no fever but
lately constant chilliness not amel. in a warm room.On November 10th, 1868,
he received Nux 3x and Ipec. 3x, three drops in hourly alternation, and
anti-hydrogenoid diet. On December 1st he reported that he was feeling
better and that within a week the cough had nearly disappeared. The
medicines were continued at intervals of two hours. On December 10th the
cough had not returned, the chilliness was better and some of the warts
had fallen off the glans ; there was an insignificant thin
discharge from the urethra ; he felt stronger on the whole, his
appetite was better and the stool regular. Physical examination of the
thorax showed a clearer percussion sound over the affected area, and a
somewhat rough, prolonged, but not bronchial breathing ; the
tenderness over the spine was better.Thuja
30 and Nat. sul.
2x were now ordered morning and evening.On January 12th only
two of the condylomata remained, the discharge from the urethra had
ceased, as also the chilliness, while the appetite, stool and general
health were very satisfactory. The remedies were repeated and on
February 2nd all the condylomata had gone. The chest showed everywhere
normal percussion sound and strong vesicular murmur. The tenderness over
the spine was gone, the colour of the skin was good and the patient’s
former strength, through good appetite and regular digestion, had again
returned. No further medicine was given but he was directed to report
later. This he did on March 20th and I satisfied myself by a thorough
examination of his restoration to health.
Case XII.
Intermittent
Fever and Perihepatitis. Nux
3x and
Arsen. 3x.A wealthy lady, 30,
mother of two children, who had as a young girl taken for anćmia or
chlorosis large quantities ofIron
in the form of Vallet’s pills, and had lost nearly all her teeth in
consequence, was taken ill in February, 1868, with a severe chill,
accompanied with sever pains in the right hypochondrium and pressure in
the stomach which was greatly aggravated by free respiration. This was
followed by fever, not intense, lasting several hours and followed by
sweating. By this time it was evening, and alter spending a bad night
with frequently interrupted sleep, she as alarmed to see her skin as
well as her eyes had a strong icteric coloration.From this time these
attacks began to manifest themselves in regular tertian type, during
which the icterus persisted in its intensity, but the pains in the
hypochondrium lessened during the apyrexia ; no other symptoms
manifested themselves.The patient was treated
up to the beginning of May with old-school measures – soda water, soda
baths and many other remedies unknown to me – also with homśopathic
remedies, whilst all possible diagnoses were given even to the presence
of micrococci, but all without relief. She then went to Carlsbad. There
she drank of the Markt and Muhlbrunnen, and bathed in Sprudelwasser, but
the only relief obtained was that the paroxysm changed from a tertian to
an eight-day attack. During this long interval the icterus almost
disappeared, although the urine still contained a large quantity of bile
pigment and the fćces retained a white, bile-deficient colour. After
the patient had remained six weeks at Carlsbad without any benefit she
became impatient and losing hope of any results returned to her home.I was consulted the end
of July and found the following conditions : Very weak and
emaciated, marked icteric colour of the skin, with intensely yellow
sclerć. The left lobe of the liver was at least three inches below the
borders of the ribs, extending to the scrobiculus cordis ; it could
also be traced backwards to the middle of the last rib and was very
sensitive. The gall-bladder could be felt as a round elastic body. The
spleen seemed to be normal.Over the whole body
were scratched and bleeding spots due to the itching from the icterus.
The appetite was poor, the tongue coated, a bitter taste in the mouth,
the urine was filled with gall pigment, the fćces chalk white, and the
menses had not appeared since February last. The paroxysm came on
regularly every eight days at the same hour, but on the seventh day the
patient felt an oppressed feeling about the heart, accompanied with
difficult breathing and an indescribable discomfort, due to the
approaching paroxysm. The latter came on in the morning lasting till
evening and began with a light chill, followed immediately with a severe
pain of a pressing sticking character in the region of the liver,
extending also to the cardiac region causing there an unendurable
distress with difficult breathing. The fever was rather severe in
character, lasting about one hour, with little thirst but with intense
aggravation of the pains about the liver. During this time the liver was
so sensitive that the slightest touch could not be endured ; the
swelling of the liver and distension of the gall bladder were also
increased, whilst the sufferings could not be borne without hot
applications which afforded manifest relief. This continued until
towards evening, when the pains began to abate at the outset of a slight
perspiration, so that by ten o’clock the patient was again in a
comfortable condition and was only troubled by the increased icterus and
persistent itching of the skin, During the seven days’ apyrexia the
swelling of the liver and gall-bladder and the jaundice of the skin
disappeared and the patient was able to move about and take short walks
in the garden. No headache or other disturbances were present.She received
Nux
3x and Arsen.
3x, three drops of each in hourly doses, was ordered wine diet and to
have the body rubbed night and morning with alcohol. Th next paroxysm,
also after an interval of a week, showed itself only by a feeling of
weakness and discomfort, and the pains, swelling of the liver, chills
and fever were wanting so that the patient was not compelled to lie down
nor to apply the hot compresses. On the following day there was a sudden
urging to stool, the movement consisting of a partly formed white partly
coloured pappy fćcal mass mixed with a partially thick, grass-green,
watery fluid of fetid odour. From this time the decrease of the swollen
liver was daily evident. The gall-bladder could not be felt on the day
following the stool. The icterus slowly disappeared and with it the
itching of the skin, while the appetite at the end of two weeks was
voracious, and as the restoration of the whole organism went on the
patient began to pain flesh, to recover her strength. By the end of
August, up to which time the medicines had been continued, but at longer
intervals, one would hardly know her. The medicines were given once a
day in alternation to the end of September, when they were discontinued.
There has been no relapse up to the time of writing.
Case XIII.
Sycosis
.
Thuja and
Nat. sul.Herr von Z—, a feeble
young man, 29, of delicate constitution, an officer of artillery, had,
in October, 1862, all the symptoms of gonorrhśa, having been exposed to
infection, and in addition an ulcer on the glans, which the attending
physician at once announced to be syphilitic.A thorough use of
Mercury
(the preparation unknown to the patient) both internally and externally,
healed the ulcer and reduced the acute gonorrhśa to a chronic,
painless, insignificant discharge. He was an invalid nearly a month and
was discharged near the end of November. During this treatment the
health of the patient was much impaired ; he was pale and anćmic,
with little appetite, and could not recuperate. In December there was a
pustulous eruption on the head, to which he gave no heed. Soon after
this he noticed a moist, sometimes painful swelling in the anus, and
finally also white spots in the mouth and throat. For all these he
treated himself, but without result. He then consulted a physician, who
took all these symptoms for secondary syphilis, and in consideration of
his anćmic condition gave him Iodides ;
but as these gave no result, the Protoiodide
of Mercury as prescribed, with
the sole result of producing a profuse salivation. So the Iodides
were again resorted to. So went the treatment around without any visible
improvement until April, 1863. This led him to leave Kasan, where he had
lived, and come to Moscow. Here a so-called specialist in secret
diseases assured him of an ointment which was a sure cure and would
remove all the complaints after a
very small quantity of the
remedy had been used. He made only forty applications and some of these
to several insignificant mucous plaques on the lips, which nevertheless
the specialist affirmed were the after-effects of the ointment already
applied. In consideration of his weak condition and the anćmia, as also
from wise and secret reasons, the apparently cured one was sent into a
warmer climate. On the journey to Italy he was seized in Turin with an
angina, and consulting a physician, received large doses of Sulphate
of Soda, and later Kali
chloricum internally and Iodine
externally. He as treated a long time without the slightest improvement
in his condition. Tartar
emetic was then given, but in
what doses the patient does not know. A few days after taking this
remedy the angina disappeared, as also the mucous plaques with which it
was complicated. After this, the now apparently convalescent man spent
some time in Italy waiting in vain for the favourable action of the warm
climate upon his strength, and then journeyed into Switzerland, where he
had another attack of angina. He was treated at a water-cure, with the
result of bringing back the mucous patches without relieving the angina.
This complete over-powering of the favourable action of Tartar
emetic, as shown in the cure
at Turin, an account of which having been given by the patient,
surprised the doctor of the water-cure and made him prove untrue to his
principles, so that he prescribed Tartar
emetic with the same result as
before. The again convalescing patient spent the winter of 1863 and the
summer of 1864, vainly waiting for returning strength and the
disappearance of the anćmia, part of the time being spent in
Switzerland and part in Southern France, until September, 1864, when he
arrived in Paris. He then suffered from a headache, which he thus
described : The pain came in different parts of the head, moved
from one side to the other, and as for the most part of a drawing and
boring character and seemed to lie deep in the brain.As the termination of
his furlough was drawing near he was prevented, perhaps fortunately,
from calling upon a Parisian corypheus and so travelled with his
headache.In the beginning of
October, 1864, he came to Moscow and put himself again under the care of
the specialist who had formerly treated him. Here he remained until
December, being treated with Russian baths andIodide,
but without any improvement, but on the contrary with a progressive
increase of his distress. On the 9th of December I was called to attend
him, and found the following conditions :Pale, anćmic, wasted
almost to a skeleton, he lay in bed being only free from headache during
the morning hours. When the headache is on he can neither move, think or
collect his thoughts. He answered in a very low tone, loud speaking
resounding in the head, so that he presented an appearance of
imbecility. He described the headache as deep in the brain, but not
located on any one spot, the pain being boring, gnawing, tearing, and so
severe as to cause him to rave and wish himself dead. The headache
generally begins between 5 and 7 p. m., reaching its height at 12
midnight, and then declining with morning, so that between 7 and 8 a. m.
he has the greatest relief. The appetite was poor, the stool torpid,
urine normal, the old gonorrhśa still existed in a mild form, with
slight discharge and no pain. He slept very little either in the night
or during the morning remission. The head pains were greatly agg. by
noise and light. If he was spoken to he answered in a monosyllabic,
depressed, weeping manner, hesitating long on his answer, and not always
comprehending the question, and when alone he lay as if in a stupor. He
was agg. in damp weather. The only thing which gave him comfort was a
temperature of 38 to 40 R. (118-120°F.). This he sought daily in the
special room of the Russian baths, nor could he admit any moisture into
this room, and the heat gave no relief to the headache.It should be noted that
the above facts were not obtained at my first visit, but later on when
he was able to put them in order, since on my first visit his mind could
bear only the slightest strain. I gave himThuja
200 in four ounces of water, a teaspoonful morning and evening ;
whilst during the day he received Nat.
sulph. 2x, two drops three or
four times a day.The result was so
surprising that at the end of one week the headache had improved to such
a degree that he was already more active and could now spend the day in
comparative comfort. The sleep also returned except just before and
after midnight, when he had headache ; but it was easily endured,
and this disappeared at the end of the second week, the same remedies
being continued. After this the appetite returned, and by the 30th
December his strength had wonderfully increased. By this time the
urethral discharge, which has lasted from the beginning of the illness,
was completely removed. The patient remained in Moscow until January,
1865, continuing the use of the remedies, without any return of the
symptoms, and once more he appeared in social life, attending parties,
balls and the theatre. At the latter date he went to Kiew, and soon
after this he was married. Two years later I heard that he was a father,
and had never had a return of his former conditions.
Case XV.
Sycosis
.
– Arsen. and
Nux ; Thuja and
Nat. sul.N. N., 38, and
old-school physician in Taroslaw, presented, on February 25th, 1869, the
following conditions : A small man, spare, wan, of weak
constitution, had noticed for nearly a year a swelling near the right
sacral bone which measured near its base 11 c. m. broad and 14 c. m.
long, and 1 c. m. high. It was surrounded by a hard, immovable, not
everywhere equally thick margin, with distinct fluctuation, so that by
touch its form could be determined and the presence of fluid
ascertained. The margin had the consistency of a hardened gland and
simulated the latter in not having the same thickness everywhere. The
skin over and around the swelling was normal, except where the frequent
application of vesicants produced a livid redness. Of the origin of the
swelling the afflicted could give no other cause than that he had for a
so-called rheumatic pain and that the swelling had grown very slowly to
its present size. Of this previous history we learned that while he had
never enjoyed good health, he was liable to “catching cold”,
and had noticed that al his ailments were accompanied by chilliness,
which was also true at the present time. All his lesser indispositions
presented an irregular intermittent character.Many years before he
had had gonorrhśa, which had continued for an entire year and had been
treated in the usual manner, and even now from time to time it appeared,
but was of short duration. From this gonorrhśa had come a swelling of
the epididymis.The physical
examination of the chest, abdomen and spinal column gave only negative
results, while the closest examination by pressure and percussion failed
either to produce pain or any condition which might render clearer the
puzzling cause of the swelling. It had the appearance of an abscess due
to congestion, an opinion which had been given by one of the professors
of the faculty. This professor had also advised an exploratory puncture
and the opening of the abscess ; but this advice the patient had
not followed and was led to consult me.In examining the
history and constitution of the patient it appeared to me very
reasonable to consider the swelling as a result of a sycotic rheumatoid
dyscrasia, and with this view I orderedThuja
30 and Nat. Sul.
2x, the former morning and evening and the latter every two hours during
the day, and to follow the diet of this constitution. On March 23rd the
abscess was smaller, the overlying skin relaxed, the muscular system was
in firmer condition, the patient felt much better and the colour of the
face was improved. Remedies continued.On March 31st the
abscess had lessened one-half in size and the chronic epididymitis was
smaller while the general health of the patient was still improving.
Remedies continued. On April 8th the abscess was reduced to a minimum
and the epididymitis gone entirely. He was now compelled to return home
to resume his duties, but in August I heard from him that he was then in
excellent health, all traces of the abscess having disappeared.
Case XVI.
Intermittent
with Skin Conditions. Nux 3x and
Arsen. 3x, Thuja 30 and
Nat. sul. 2x, then
Silic. 3.M. L., 32, whose sister
had been a servant in my house for eleven years, of large size and good
constitution, now in her thirteenth year of married life ;
childless ; had when a child and also since her marriage, a
scrofulous, oozing eruption on the head and face. She had had only
measles out of the list of children’s diseases. The menses appeared when
she was fifteen. The eruptions on the head were finally removed after
the long use of salves ointments. Soon after this she noticed a small
painful induration at the angle of the right lower jaw, which slowly
increased in size. In the autumn of the same year, 1867, she was seized
with a severe tertian fever with a hard and long-lasting chill, the
attack persisting for three months in spite of the use of Quinine and
other remedies. Immediately after the disappearance of the fever the
above-mentioned induration began to enlarge rapidly, became inflamed and
suppurated ; the latter continued for several weeks with
considerable destruction of tissue, leaving an unsightly wound. In the
Spring of 1868 she had another attack of tertian fever, which again
lasted three months, reappearing again in the Summer for a short time
and again in the beginning of July, this attack lasting for one week.Towards the end of July
an eruption of tubercles appeared on the forehead, continually spreading
and covered with a thick crust, underneath which was a copious, pus-like
secretion. This continued for a long time and left behind a red,
irregular, hard, puffy-looking sore. The eruption slowly, spread over
the forehead and temporal regions and upwards into the hair, and was
accompanied by an intolerable itching. At the same time, with this
eruption, there began a violent, at times sleep preventing, dull tearing
pain in the right upper jaw, which was agg. ; in damp weather and
accompanied with swelling which extended up to the eye. This swelling
rapidly increased so that by the end of September the right eye could be
only partially opened.The anxiety due to the
trouble whit the eyes sent her from the country where she had been up to
this time, into the next government town, Nishny Novgorod. After a trial
of remedies, resection was advised, but to this she would not consent
without my opinion. This was in the end of September, 1868. Her
condition was now as follows :Long continued
chilliness with flashes of heat ; weak, feeble, emaciated, sallow
complexion ; on the forehead the above-described eruption. The
swelling of the right jaw was very prominent, almost the size of my fist
and reached to a level with the cornea, covering nearly the whole cheek.
It felt as hard as a bone, the skin over it was unaltered, moveable and
of natural colour and structure. Pressure on the swelling caused no
pain. Examination within the mouth showed no alteration of the hard
palate. The teeth were in normal position and firmness, but many were
carious and nearly all of them blackened, which was due, as the patient
said, to severe toothache, which came on like an intermittent, was long
continued and suddenly ceased. The space between the eyelids was greatly
lessened, and the eye continually watering, a trouble which had affected
both eyes since childhood. The vision was distorted ; the pain was
described as dull, tearing and greatly agg. at night and in stormy
weather ; no headache, menses regular, no leucorrhśa.The appetite is fair,
stool regular, lungs normal ; no trouble with digestion ;aversion
to fish, which she cannot look
at, to say nothing of eating, nor
can she bear warm or cold baths
since these produce either fever or toothache or pains in the limbs or
headache, so that she very seldom, or only for the sake of cleanliness,
uses the bath-tub.Whatever the diagnosis,
the eruptions could not be definitely defined, since the spot was
covered with a thick crust from beneath which could be pressed in large
quantities a purulent watery discharge. The previous attack had left no
scarring. In consideration of the papules, the profuse suppuration and
the existing bone-swelling I could only conclude there was tuberculous
infection with lepra characteristics. The swelling of the upper jaw was
diagnosed as an enchondroma. The ground on which this affection grew
must, according to all examples, be due undoubtedly to the
sycotic-hydrogenoid constitution, and this was confirmed when we knew
that the patient had always lived near the Volga, and that in the Spring
the high water reaches to the windows, and the land itself was low and
boggy. On account of the frequent returns of the intermittent fever,
which was not cured, as shown by the still long-continued chilliness,
and seeing that it had probably been suppressed by the large doses of
Quinine, I gaveNux
3x and Arsen.
3x. in hourly alternation of three to four drops each ; also the
wine diet and strict avoidance of articles forbidden by the hydrogenoid
constitution.By the middle of
October there was general improvement. As I did not expect these
remedies to have any marked effect on the eruptions and bone swelling, I
gaveThuja
30 and Nat.
sulph. 2x in the same manner
as before.In the beginning of
November the eruptions had almost disappeared, there was no discharge,
and the itching and reddish discoloration had lessened, while the
swelling, at least, had not increased and the pain was very much
reduced. At the end of November the tumour has softened and lessened. On
December 12th there was a further change in the tumour but the eruption
had entirely disappeared. At this time she was called home and receivedSilica
3, a powder morning and evening. In the beginning of May the patient
wrote that all her troubles had disappeared. Anyone who has studied the
constitution and has learned to apply the results in practice will be
convinced that Silica would not have performed so prompt a cure had not
its relationship to the diseased constitution been so marked.
Case XVII.
Hydrogenoid
Menorrhagia. Nux and
Arsen. ; Nat. mur.Madame A. L—, mother
of two children, of robust constitution, fleshy, never had a severe
illness, menstruation regular and copious until the autumn of 1867, when
her menses came on in an unusually severe form. At first she thought
little of it, but as it continued beyond the accustomed time she became
worried and consulted me. Careful examination failed to discover any
cause for this menorrhagia. The appearance of the flow was about
natural, but the quantity had increased to a hćmorrhage. There was no
pain, functions of the body normal, and before the onset of the
menorrhagia there had been nothing to complain of. Under these
circumstance it was not easy to apply a remedy, and one after the other
of those prominently indicated for hćmorrhage for one week failed.Salina
afforded a passing improvement for one week only. She was nursing her
youngest boy and thinking this might be a possible cause it was
forbidden. With the onset of Winter, which was a dry and unusually
severe one, the menorrhagia ceased. She was neither emaciated nor weak,
although the hćmorrhage, with brief interruptions, has lasted two
months. During the winter the menses appeared several times in normal
quality and quantity. In the early Spring, which was a very damp one,
the hćmorrhage returned, and as the patient had lost confidence in homśopathy
and myself, another physician was consulted. He ordered injections of Ferrum
sesquichlor, and gave
internally Iron,
Secale cornutum and acids,
but without the slightest relief.In October, 1868, on my
return home after an absence of several months, I was again called to
see the patient and learned that thehćmorrhage
ceased on the outset of warm and pleasant weather,
but that at the
beginning of the rains and cold weather
– which was in the early Autumn – the hćmorrhage had again returned and
with the same conditions. A most thorough examination failed as before
to show the slightest cause for the condition. Noticing now that the
attacks ceased
in Summer and came
on in the Autumn I asked
concerning damp weather or baths, and whether fish, milk and fruit
agreed, but to these questions no definite or satisfactory answers were
obtained. However, Nux
3x and Arsen.
3x were given in hourly doses, and the wine and hydrogenoid diet
ordered. On the next day the hćmorrhage ceased and remained away two
weeks, but returned again after the patient had been out on a very wet
day. I strictly forbade going out in similar weather, gave the same
remedies and ordered the whole body to be rubbed every morning with
brandy. The next day the hćmorrhage ceased and did not return until
July, 1869, after she had remained for a long time during rainy weather
in a building which was not perfectly dry. During this time the menses
appeared in normal quality and quantity and without pain.The remedies were given
at longer intervals and in higher dilutions while the diet remained
unchanged. When the hćmorrhage again returned I gaveNatrum
mur. 9, two drops every two
hours and after a few days the hćmorrhage was again controlled. A few
months later I was informed that she was pregnant.
Case XVIII.
Sycotic
Tumour. Hepar 3x, Thuja 30 and
Nat. sulph. 3x.Johann v. T., 37, of
strong, robust constitution, a cavalry officer, consulted me in August,
1869, concerning a swelling on the thigh which had existed since 1859,
and for the past seven years he had been unable to walk except with the
help of a cane, and even then not without limping. The swelling was on
the left thigh, almost at the middle, in the rectus femoris muscle,
having an elliptical shape and measuring 6 1/2 inches long, 3 1/2 inches
broad and 3 inches high. It was slightly moveable, lay embedded between
the muscles, was hard and even, feeling like a convolution of a hardened
gland and only slightly painful on handling. A portion of the skin
covering it was of normal hue ; on the other portion was seated
superficial, livid-bluish ulcerations, with a watery, serous,
transparent, but at times reddish discharge. A few of the ulcers, of
irregular size and varying shape, were cicatrised and had formed dark,
dirty blue and livid spots, while others were only apparently covered
over, and underneath suppuration was active, discharging through a small
fistula. On the side of the swelling towards the knee the ulcers are
close together, a few of them in long sinuses extending into the
swelling itself, pressure upon which caused a profuse discharge similar
to the above. On the lower leg and over the body were numerous livid,
blue superficial spots, the results of former furunculi. The pain is not
sever but is agg. by motion and disappears almost entirely by rest. The
face had a dirty yellowish colour, but not marked ; the patient was
not emaciated, and digestion, appetite and sleep were not disturbed. The
limited motion in the limb, especially at the knee-joint, rendered it
difficult to bring the joint into more than a very obtuse angle, so that
the limping gait was very similar to that caused by disease of the
knee-joint. There was pain in the swelling, knee-joint and leg on
attempting to bend forwards. Physical examination of the chest and
abdomen revealed nothing abnormal ; the left testicle was somewhat
larger than the right and felt harder but pain was not present.The general condition,
although satisfactory, had, in comparison with his former state, greatly
declined. The mind was weakened, spirits depressed, he was easily
excited to anger, especially over trifles, which was not the case
formerly.The previous history
was as follows : He had never suffered from an acute affection but,
on the contrary, had always enjoyed unusually good health. In February,
1855, he had, after an illicit intercourse, a small, slimy, itching sore
on the inner surface of the foreskin which healed of itself in a short
time. In October, on account of a similar cause, the same sore appeared,
was pronounced syphilitic, was treated in the usual manner and healed in
a month.In the Spring of 1856
he was attacked with intermittent fever which continued for several
months, showing first a tertian and then a quotidian type. After the
fever had been cured with large doses ofQuinine
there again appeared an ulcer following as before an exposure, which was
treated with Mercury
but was slow in healing. The intermittent fever appearing during the
period, the Mercury
was alternated with Quinine,
and now the ulcer and the intermittent promptly disappeared. A few
months later balanitis appeared but was promptly relieved with a lead
wash.In the winter of 1857,
the sore which was supposed to have been healed in the previous year
again opened, and was healed as before with the sublimate. The ulcer
again healed, and in the Summer the patient took on his own
responsibility, to cleanse the blood, a so-called
“Spring-cure”, orSarsaparilla
decoction. But in order to secure a sure result he mixed Colbert’s
essence with the decoction. In the winter of 1858 the ulcer again
appeared without apparent cause in spite of the previous
prophylaxis ; probably the blood-cleansing liquid had not washed it
sufficiently. Colbert’s essence was given and the ulcer again
disappeared to be followed by a balanitis, which was also cured.Now the patient began
to feel and exhausted, with falling out of the hair and an uncomfortable
feeling of weight in the left thigh, with difficulty in bending the
limb, especially at the knee-joint. Later there was an increase in the
circumference of the limb. In 1859 he had a left-sided orchitis without
apparent cause, and nowKali
iodatum and leeches joined the
series. These benefited the orchitis, but it was followed by a furuncle
on the lower leg with long-continued suppuration which was healed with Muriate
of Soda. To these conditions
was added a dry cough, accompanied with retching an continuing
throughout the day accompanied each evening with chilliness. This was
treated with Rhubarb
and Quinine pills. The
swelling in the high now increased rapidly and had in 1863 reached quite
a size. In 1865 the trouble had increased still more, notwithstanding
the use of Merc.
iod. and Sublimate
and other remedies, including baths and ointments, with the result only
of producing numerous furunculi over the whole body. Finally, losing all
hope of relief, since several consultations of professors had been held
over his case, he came to me.On account of the
often-reported, falsely considered syphilitic and mercury mis-treated
ulcer, the balanitis, orchitis, furunculi, the characteristic scarrings,
the appearance of the same general affections in different organs as
well as the intermittents and the characteristic cough, due to the
long-continued use ofQuinine,
it was only possible to arrive at one diagnosis, namely, a blood
infection on a sycotic or hydrogenoid basis. The swelling on the thigh
was also considered a neoplasmus due to the same cause.There could be no doubt
about the preliminary treatment. All salves and ointments were laid
aside and dry charpie applied to the suppurating sores, and a wine and
hydrogenoid diet ordered. In order to antidote the effects of theMercury,
although no salivation had been produced, I gave in August, 1869, three
drops, three times daily of Hepar
sulph. 3x. In September there
was a general improvement and now Thuja
30 and Nat.
sulph., 3x was given. IN the
latter part of October the pains in the leg had disappeared, the
swelling had greatly lessened and he was able to move so well that at an
evening company he had been able to dance a polka. In December, 1869,
the swelling measured exactly 1 1/2 c. m. long and about the same width.
All ulceration as well as the hard scars or spots had disappeared. He
walked freely without a cane and could move the limb without difficulty
in any direction.The remedies were
repeated at longer intervals. I often saw this patient during the
following ten years ; he had married, was a father and was not
again sick.
Concluding remarks by Dr. Bojanus.
Whoever will take the
trouble to compare what is here written upon the causes and character of
the disease-relation with what Grauvogl has stated in his writings on
“Intermittents” will see that very much of what is there
written is here fully confirmed. At the same time he will also see the
necessity of asking himself this question – Whether it is possible,
without the knowledge and recognition of these constitutions, to cure
such cases as safely and in as comparatively a short time with such
moderate therapeutic measures ?I am well aware that
the history of special cases of sickness is convincing only to those
under whose eyes they take place, and who themselves are interested in
them in their professional character. This is also to be regretted
because of an inviolable law that man never becomes wise by the
experience of others but only by his own, if he becomes so at all. We
should think an hope, therefore, that in a science like ours, in which
three of four lifetimes, if they were allotted to one human being, would
not suffice to learn more than a small part of it by personal
experience, that the experience of others should at least stimulate
examination especially by the more highly educated classes to which
physicians belong as well as by those who are advanced in mental
culture. And this the more as they put off prejudices and reject them,
and when men who on the field of research have made their mark point out
doctrines that differ from ordinarily accepted views it by no means
follows that they are incorrect or false.Thus, for example, B.
H. Gross, who in matters of science must have more than one voice if his
achievements are appreciated, says concerning the doctrines of the
constitutions of Grauvogl :“Grauvogl’s
fundamental laws have been declared impracticable by men of opposite
views, by some out of mere dogmatic habit, by others because they found
it too inconvenient to bind their accustomed arbitrary proceeding to
study laws. Grauvogl’s works they would study them for their own
interest ; for the fundamental characters of constitution alone
render it possible, to a certain degree, to generalise without becoming
unfaithful to homśopathy. As epidemic constitutions they must be very
important for the diagnosis and treatment of climactic diseases in all
countries of the world. They make it possible to cure with one single
remedy a complicated constitutional ailment.”Dr. B. H. Gross quotes
the following pertinent Motto. “A physician is he who lays open the
wonder-works of God to each and every one. For what is n the sea that
may be hidden from the physician ? Nothing ! What is in the
earth that he should not open ? Nothing ! He shall bring it
forth and not alone in the sea, in the earth, in the air, in the
firmament !Requirimus
in medico non solum microcosmi sed etram universć naturalis
philosophić cognitionnem, non ex phantasmibus ac speculatoribus sed
sensuum et experimentić judicio exortam.”Paracelsus.
“The doctrine of
Constitutions as Grauvogl teaches it in hisText-book
had found very little favour in Europe, but somewhat more in
America ; whether justly must be evident by good will to anyone
that is free from prejudice.”
A Recent Case.
To the above record and
remarks of Dr. Bojanus I may add a recent case of my own.A man of 60 who had
long been subject to nasal and bronchial catarrh with asthmatic
complications, though otherwise well, after some years’ residence on
high ground, returned to a former residence close to the river. All his
old troubles returned in great intensity. On January 1st, 1926, he was
put on the double salt ofMercurius
biniodatus and Kali
iod. 3x, gr. viii., night and
morning. Under this he made great progress for a time, but had a bad
relapse in which it ceased to help. An “awful running, sneezing
head-cold” came on, leaving congested nose, cough with whitish
expectoration, difficult breathing and depression.I prescribed on January
20thIpec.
3x, discs half and ounce. Two discs to be taken every three hours ;
and Nat. sulph.
3x, ten grains night and morning. I told him also to confine his baths
to one a week, and on the other days to be content with a brisk rub with
a rough towel in the morning on rising.March 4th. Very much
better. Still discharge from nose but not so bad.Repeat.
March 22nd. He
reports : “I am pleased to tell you that I am very fit and
that all my old troubles are very trifling.”So he is not thinking
of changing his residence again for the present ! The medicines
were continued.
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