2nd May, 1851: Sarah Ann T., aged 19, formerly a nursery-maid, of a nervous bilious temperament, with dark muddy complexion, came under my care as a clinical patient at the Hahnemann Hospital.
She states that she had the usual diseases of infancy, and enjoyed good health until about four years ago, when she was obliged to leave her situation on account of severe aching and shooting pains in the right side, which had gradually come on (as she believed) from carrying heavy children beyond her strength. The pains extended from the right shoulder downwards, occupying the upper and lower extremities) as well as the lateral and anterior portions of the chest and abdomen of that side. Leeches were applied to the side, and venesection was practised by her medical attendant ; when, after temporary relief, loss of the motor power of the extremities of the right side supervened, and the pains became so constant and severe, that she was forced to keep her bed for a whole year.
Blisters and frictions with iodine were now prescribed from time to time. At the end of rather more than a year, during which this treatment was pursued, the pains in the side suddenly subsided, and the motor power of the extremities returned ; but a metastasis to the brain seemed to have taken place. Intense splitting headaches, with alternations of flushes of heat, great sensitiveness to the light, and sensation of cold at the vertex, ensued, followed after several months by temporary loss of sight, which continued for three weeks. Leeches and blisters were applied to the temples, and bleeding again had recourse to. Mercurials, preparations of iodine, and a variety of other remedies, were likewise administered when the cerebral irritation subsided, and a return of the pains in the side, and of the paralytic weakness of the limbs, in rather a less degree than at first, took place, attended, however, with considerable derangement of the sexual and alimentary systems. At this period, she was admitted as an in-patient in one of the large metropolitan hospitals, where she underwent a course of fomentations and warm baths ; so that, with the exception of occasional blisters and the usual routine of aperients, the treatment was chiefly hygienic. At the time of her discharge from the hospital, after a three month’s residence, she was quite free from the pain in her side, and the motor power of the limbs had been restored; but the spine was becoming painful and sensitive, and there was an increase in the derangement of her general health.
She returned home, where she stayed for four months, at the end of which time, although her spine was still sensitive, she thought she would try a very light place. She was, however, soon forced to give up her situation from the aggravation of her spinal suffering, and again to return home. Here she continued, up to the time of her admission to the Hahnemann Hospital, without regular advice or medicine, being compelled at times to keep in bed for weeks together. During the whole period of her illness, there has been more or less irregularity and suspension of the catamenia for two or three months at a time, attended with thick, yellow, corrosive leucorrhcea ; and she has experienced considerable disorder of the digestive functions, with a disgust for animal food and dietetic stimulants, a craving for acids, and a marked preference for a milk and farinaceous diet, tea and bread and butter. She adds that her father has been insane for fifteen years, and that there is a hereditary tendency to mental disease on his side of the family. Her mother is healthy, and so are her maternal relations.
Her present condition is as follows : —
She is obliged to keep to her bed on account of the spinal suffering, which begins in the lower portion of the dorsal vertebral, and extends downwards to the sacrum. The neuralgia is ordinarily of a dull, aching, and gnawing character ; but, under the influence of the paroxysmal aggravation, which is of daily recurrence, the pain becomes shooting and rending, at times in so intense a degree that she cannot suppress her cries. The most violent paroxysms have, during the last few months, been usually associated with severe’, colic, as though the navel were “gathered up into knots” which comes on about an hour after every action of the bowels. The bowels are subject to alternations of inaction and looseness. The stools, which are either in small hard lumps or papescent, or else both one and the other, are voided with difliculty, and followed by painful tenesmus.
In addition to sensitiveness to pressure over the affected portion of the spine, she complains of a feeling of soreness and tightness in the epigastric and hypogastric regions; inflammatory irritation and heat in the genito-urinary passages, with weight and bearing down in the womb, thick yellow corrosive leucorrhcea, and painful micturition. The appetite is indifferent, and there is a prevalence of the same “likes and dislikes ” with regard to food and dietetic stimulants. She is very thirsty, and her tongue is dry and parched. She suffers from occasional returns of the frontal cephalalgia, attended with pain in the eyes (which are not inflamed) and intolerance of light, confusion of head, alternations of cold and heat at the vertex, purple suffusion or pallor of the face, and coldness of the extremities.
Great weakness is experienced in the lower limbs, so that she cannot get about without support. The feet are sore from suppuration under the toe-nails, which become detached from time to time. Sleep unrefreshing, disturbed by anxious and frightful dreams of fire, murders, etc.
Frequent twitching and jerking of the limbs is observed, more especially at night during sleep, accompanied with a general sensitiveness, which makes her dread the slightest touch. Pulse irritable, a little above the normal frequency. There is an aggravation of all her sufferings at the recurrence of the catamenia. The last appearance was about a week ago, after a suspension of some months; the blood was dark and clotted.
The moral equals the physical depression; for she is always weeping and despairing of recovery. From the extremely small quantity of solid food which she takes, she has become very thin, although the loss of flesh does not yet amount to actual emaciation.
Prescription — Ignatia, six globules, thirtieth dilution, in doses of a sixth part, morning and night.
A light farinaceous and milk diet, with cocoa or weak black tea, and an orange or a roasted apple, at her choice.
Clinical comment: From the observations which have already been made on a former prescription of Ignatia (vide Clin. com. on Case 4, page 28), and also from a comparison of the symptomatic groups more immediately connected with the nervous and reproductive systems with those of its pathogenesis, the remarkable appropriateness of this remedy in the treatment of the present case, will at once be apparent.
As it was with the greatest difficulty that the patient could be got to take nourishment, in anything like a sufficient quantity, it was thought advisable to follow nature’s instincts in the matter of diet. But for her insuperable repugnance to animal food and to dietetic stimulants, a more highly restorative dietary would have been enjoined.
May 4. With the exception that the paroxysmal aggravations have been less urgent, and that, last night, she had some refreshing sleep, her general state continues much the same.
Prescription: Platina, six globules, twelfth dilution, in doses of a sixth part morning and night.
Diet as before.
Clinical comment: As an antipsoric (more especially with Ignatia and Hyoscyamus as intermediate remedies), Platina is peculiarly suited to those cases of spinal irritation which are associated with painful hysterical erethism. The uterine symptoms, the nature of the colic and of the alvine dejections, and the neuralgic sufferings (which have been already detailed), as well as the sex and temperament of the patient, are characteristic of this remedy.
May 7. The paroxysms have recurred as usual in the daytime, with the exception of yesterday, when the attack was delayed until night. Upon the whole, the paroxysmal aggravations have been less urgent and of shorter duration ; the skin is moister, and there is a slight tendency to perspiration. Pulse 92, of better strength. The other symptoms are unchanged, and she still continues to lie in or outside the bed during the greater part of the day.
Prescription. — No medicine. The same diet to be continued.
Clinical comment: That the time of the paroxysmal accession should have been deferred till night, was a sign of good augury for the future. In fact, any decided change in periodical suffering, even though it should amount to severe temporary aggravation, is preferable to a stand-still.
Such a change will generally be the harbinger of steady and lasting improvement.
May 8. Yesterday she had two paroxysms in the daytime, which were rather more severe than the last. Today, she complains of great confusion in the head, accompanied with a feeling as though she would like to be left alone, and shut up in some dark place ; her spine is as sensitive as ever ; she has no appetite ; and her spirits are extremely depressed.
Prescription: Ignatia, six globules, thirtieth dilution, in doses of a sixth part morning and night.
The same diet.
May 12. She feels altogether better and stronger, and is able to sit up for some hours at a time. The paroxysms have continued to recur, generally once a day ; they are still severe, but of shorter duration and less urgent. The head is more comfortable, and the spine is less painful and sensitive than it has been for a great many months. The action of the bowels is preceded and with painful straining whether the dejections consist of small hard lumps or of loose fecal matter, and followed by still more painful umbilical colic, as though the navel were gathered into knots. Her appetite has improved, but the aversion to animal food still persists.
The attendant nurse has lately remarked that the paroxysm is aggravated and prolonged by the efforts of the patient to restrain (as long as she can) the action of the bowels, when they are about to be moved, on account of her dread of the pain which follows.
Prescription : Plumbum, three globules, thirtieth dilution, to be substituted for the morning dose of Ignatia for three days running. The evening dose of Ignatia to be given as before.
Clinical comment: A similar group of symptoms to that marked in italics will be found in the pathogenesis of Plumbum. Hence the peculiar suitableness of this, above other remedies having kindred spheres of action (such as Nux Vom. and Opium), to the treatment of an obscure paroxysmal colic of this kind. It is just in such cases that the great practical superiority of a purely therapeutic law in relation to the symptoms will be recognized ; for, notwithstanding the satisfactory progress which modern pathology has already made, we are unable, as yet, to see by its light why, in so many apparently identical (in so far as our limited means of diagnosis are concerned) affections of the same organs, there should be such a diversity in the accessory symptoms, objective and subjective alike, with regard to their extent and intensity, as well as to the periods of their accession and remission. )
May 15. The head-ache is not so constant; the spine continues less sensitive ; the action of the bowels has been less painful, and the subsequent paroxysm less urgent. The other symptoms remain as before, but are less intense. She sits up a great deal more. Pulse 84, of regular strength.
Prescription — Plumbum, three globules, two-hundredth dilution, instead of the morning dose of Ignatia, for three days running. The evening dose of Ignatia to be continued as before.
May 18. With the exception of feeling low and depressed in spirits since the morning, she is better generally. She has complained less of head-ache ; there has been less flushing of the face; and the extremities are now warm and comfortable. Pulse normal in frequency.
Prescription — No medicine. Diet as before.
May 19. Since last night she has been in a high fever; so that Dr. Kogers (the house-physician) prescribed Aconite. Today the skin is hot, thirst intense, and there is an entire loss of appetite; but the patient is comparatively free from acute pain. Pulse full and strong, about 120. She has kept her bed since yesterday.
Prescription — Aconite, two drops, third dilution, in doses of a sixth part every four hours.
Diet : water and toast
May 20. Numerous papules are coming out upon the face and neck, shoulders, and upper extremities. The head is confused, and the face flushed ; the eyes are sensitive to the light ; and the throat is sore and inflamed. Pulse 112, less full. The catamenia came on this morning.
Prescription — Belladonna, two drops, third dilution, in doses of a sixth part every three or four hours ; with an occasional alternating dose of Aconite, if feverish.
Diet as before.
May 21. The eruption is coming out all over the body, whilst the papules on the face are becoming vesicular, and fast assuming the characteristic appearance of small-pox ; the throat continues sore, and there is much dryness of the mouth : shooting pains with a feeling of weight in the occiput, and sensitiveness to the light are complained of.
Although she is still very thirsty, the fever has diminished, and there is a slight moisture on the skin of the chest. Pulse about 100, soft and regular. Has experienced some aching pain in the loins, which is rather urgent at times ; but there has been no recurrence of the paroxysmal attacks, or of the spinal irritation.
Prescription — Belladonna, two drops, third dilution, in doses of a sixth part every three hours.
Diet as before.
May 22. The eruption continues to come out about the trunk and extremities. The vesicles on the face and arms are beginning to fill. Pulse 92, soft and regular. The other symptoms remain much the same ; if anything, they are slightly improved. She thinks that she would like a little bread-and-milk.
Prescription — The same medicine every four hours.
Diet as before, with the addition of a little bread and milk or cocoa.
May 24. The eruption is becoming more confluent about the face and neck, and, in a slighter degree, about the arms also; whilst it continues distinct, although very copious, about the trunk and lower extremities. The lumbar pain is less urgent, and has, in a great measure, given place to a feeling of soreness. The throat is still rather sore ; but the inflammation is slight. Pulse 100, regular, but rather weak. The catamenia ceased yesterday.
Prescription — Belladonna, six globules, twelfth dilution, in doses of a sixth part every five or six hours.
Diet as before, with the addition of rice milk and an orange or two.
May 25 She had rather a restless night until half-past one o’clock a.m., from which time she slept tranquilly until seven this morning. Although there is not much eruption about the eyelids, there is still some intolerance of light and occasional headache. The vesicles are filling satisfactorily. Pulse 104, of better strength.
Prescription — Mercurius Sol., two drops, fifth dilution, in doses of a sixth part every four hours ; an occasional dose of Belladonna, third dilution, to be given if required.
Diet as before.
May 26. Had a very refreshing night, and is going on satisfactorily. Suppuration has commenced about the face, and the vesicles about the body are becoming opaque. Pulse 102, of regular strength.
Prescription — The same as yesterday.
May 27. Had a good night, and enjoyed her breakfast of bread and milk. She is beginning to open her eyes, which are more tolerant of light. Suppuration is going on about the face ; many of the vesicles are now much flattened. The soreness of the throat is no longer complained of. Pulse 96, of good strength.
Prescription — Mercurius Sol., two drops, fifth dilution, in doses of a sixth part three times a day.
May 28. The suppurative stage is steadily progressing, and scabs are already forming about the face. The appetite is much improved, and there is much less thirst, although she has passed a large quantity of urine during the last twenty four hours. She has not felt the slightest inconvenience from the inaction of the bowels since the 18th.
Prescription — Mercurius Sol., six globules, twelfth dilution, in doses of a sixth part three times a day.
May 31. Is going on satisfactorily in every respect. Some of the scabs of the face have already fallen off. Pulse 84, of good strength. Although the appetite is better than it has been for many months, she does not yet desire more nutritious food. Yesterday, the bowels acted without effort or pain. She now begins to get up, for an hour or two, during the day.
Prescription — The same as the last.
June 1. A considerable number of scabs continue to be detached from the face and neck, whilst the vesicles about the other parts are fast drying up. She is free from pain, and can now lie upon her back — a feat which she had not been able to perform for more than two years, on account of the sensitiveness of the spine. Tongue clearer ; mouth and throat comfortable. Pulse 76, of good strength. She gets up for a longer period every day.
Prescription — The same medicine to be continued.
Diet as before, with the addition of a tapioca-pudding.
June 5. Dessication is going on steadily, and the greater portion of the face is free from scabs. The bowels acted on the 2nd and 3rd, as well as this morning, as before, without the slightest effort ; dejections normal. Her appetite is improving, and she has now lost her disgust for animal food.
Prescription — No medicine.
Diet : an egg or a mutton-chop (at her choice), in addition to her other food.
June 7. In the course of yesterday, she complained of a return of aching and shooting pain in the right side, extending from the axilla to the hypochondrium, which reminded her, in a slight degree, of the old original pain. It did not, however, last long, nor was it very intense. Today, she is quite free from pain, and as comfortable as ever.
Prescription. — Nux Vom., three globules, twelfth dilution.
Diet as before.
June 9. There has been no recurrence of the pain, and she continues to progress favourably. Appetite better than it has been for years, and digestive functions normal ; the bowels act every other day. Since the last catamenial period, she has been free from leucorrhcea. At times there is great itching of the skin, just before the scabs become detached.
Prescription — Sulph., six globules, thirtieth dilution, in doses of a sixth part, morning and night.
Diet : to be placed upon the full diet of the hospital.
June 16. She has no pain of any kind, and can lie comfortably in any position. She is able to take exercise in the ward, and to amuse herself with any little work. She has an excellent appetite, and has quite recovered her taste for animal food. The scabs are falling from the extremities.
Prescription — Sulph., three globules, two-hundredth dilution, for three nights running.
June 26. She is quite convalescent. A large portion of the skin has resumed its former colour, and the maculae are gradually wearing away. There will be no permanent disfigurement.
Prescription — Sulph., three globules, thirtieth dilution, for three nights running.
June 30. Is quite well ; to be discharged cured.
This patient called upon me some three or four years afterwards ; she had continued in good health ever since her discharge from the hospital, and had been in service nearly all the time.
Clinical comment: This remarkable case will repay a careful analytical study ; seeing that it is replete with facts from which important conclusions may be arrived at, in the interest of practical pathology and therapeutics.
From the previous history of the patient, it will be seen that (along with a highly sensitive nervous organization) she had inherited a constitutional (psoric) taint, which had for many years continued in a latent form ; that this dyscrasic element being at length roused into activity by the withdrawal of that vital reserve force by which it had hitherto been held in check, fixed upon that portion of the nervous system, of which the constitutional sensitiveness had become morbidly intensified by long persistence in that kind of physical exertion which it was least fitted to bear; and lastly, that the aggravation and obstinacy of the complex disease thus induced, as well as the serious pathological additions which followed, were due to that reckless and unphilosophical employment of allopathic and antipathic measures, which, to this day, has so fatally militated against a right estimate of their therapeutic value.
The subsequent history of the case shows that in spite of the accumulation of adverse circumstances under which the homoeopathic method was substituted, so great and speedy a change for the better had already taken place in the patient’s condition as to have left no doubt as to the ultimately favourable result, when the attack of small-pox supervened. At this juncture, it will be seen that nature, sustained by dynamic medication in sympathy with the vital reaction which the variolous poison had provoked, took advantage of the eliminatory process to give simultaneous issue to the psoric miasm which had so long harassed the organism ; so that the period of time which otherwise would still have been requisite for the completion of the cure was thus very considerably abridged.