ALCOHOL AND TOBACCO.
AMONG the cases recorded in other chapters of this work are several in the causation of which the use of alcohol was one of the factors. There are three cases, however, which occurred in the earlier years of my practice, in which the history of alcoholism and nicotism was so clear, that I think it may be well to give them a chapter to themselves.
CASE XXVIII.-HEART-PAIN WITH NERVOUS SYMPTOMS ARISING FROM ALCOHOLISM. ACTION OF Spigelia.
On the 24th of July, 1880, I was consulted by a young man, S.P., aged 27, for a pain at the heart, dizziness, noises in the head, excessive nervousness and inability to sleep. The contrast between the physique of the patient and the character of the symptoms he complained of was very striking. He was a ballast- quay labourer, considerably over six feet in height, powerfully built, well nourished, muscular, dark. That a man of his build should be complaining of nervousness, sleeplessness and dread of being alone in the dark showed plainly that there must be some cause at work, external to himself, giving rise to the disorder.
He told me he had been suffering in this way for two or three months. His tongue was dirty at the back; his bowels confined. His appetite was good, and he had no pain after food, though he had been troubled with it formerly. He had always been very strong.
On inquiring about his social habits I found that his occupation required him to go on board many vessels, and wherever he went liquor was offered to him, which he did not like to refuse, though, as he told me, he did not want it, and knew he was taking more than he ought. Besides this, he was a smoker, but not to excess.
This was quite sufficient to explain to me the anomaly of his case. Alcohol is a most powerful cardiac stimulant, and its free and persistent use in this case had brought on the natural result of all over-stimulation-weakness and perversion of function. The nervousness and other symptoms I considered were secondary to the state of the heart.
I explained to the patient the nature of his case. I told him that it was possible for medicines to relieve him, but whether they would cure him or not depended on himself. If he had the courage to refuse to take what he knew was not good for him, even when he got it “for nothing,” he would soon be quite well.
If he went on as he had been doing of late be would soon be beyond the reach of cure. He was so thoroughly alarmed about himself that he did not hesitate about his choice, and I believe left off the use of alcoholic drinks altogether. I gave him Spigelia 3, three times a day.
He returned a week later looking quite a different man. He had slept well, was less nervous, less giddy, his tongue was clean, and his bowels regular. (Here as in other cases Spigelia relieved constipation, as well as the symptoms which more particularly indicated it.)
I repeated his medicine, and the following week he reported still further improvement, though there was still a little giddiness and some gnawing pain at the heart. Pilules of Spigelia I were now given in the same way, and continued till September 8th. He had giddiness occasionally during this time, and slight palpitation at times, but was well able to carry on his work. His bowels were again a little confined, and he received Nux vomica I, three times a day, and this completed the cure. He returned in another week to say he was very much better. I gave him a fresh supply of Nux vomica, and told him he need not return unless he became worse. He was so exceedingly pleased with the favourable change that had come over him that I had little fear of his returning to his old habits.
CASE XXIX.-ANGINA, DYSPNOEA. HISTORY OF ALCOHOLISM. ACTION OF Spigelia
J.B.,37, single,lath-render, middle size, fair, florid, with shiny, weather-beaten-looking complexion, consulted me August 13th, 1879, complaining of a choking sensation in the throat and a smarting pain at the heart, worse some days than others; a constant gnawing pain in the left side of the chest, weakness of the left shoulder and arm, giddiness, headache, noises in the ears, palpitation and shortness of breath.
His health had been good till seventeen months previously, when he was taken suddenly ill,”like a corpse,” as he described it. He was then exceedingly nervous, and afraid above everything of going to sleep.
His present illness he dated from twelve months back. It came on gradually. For eighteen weeks previously to his consulting me he had been attending an allopathic hospital, but had received no benefit. He was discharged, and on his discharge- paper was written the word “relieved.” As he was not conscious of the smallest relief, this statement so angered him that it brought on an attack of palpitation and breathlessness which compelled him to sit down for a quarter of an hour before he was able to proceed on his way home.
His father and a brother were asthmatical. Of late he had been a total abstainer from alcohol, but previously had been a hard drinker.
Tongue clean; bowels confined; appetite poor; pulse feebler right side than left; pupils equal; sight same in both eyes.
I suspected aneurism, and gave Bary.-carb. 6, three times a day, with no beneficial result. I examined him then very carefully on two occasions, and found only a slightly jerking inspiration on the right side of the chest, and a muffling of the first sound of the heart. There was no bruit . The right inter- scapular region was a shade duller than the left. There was slight inequality of the pupils and pulses, the left pulse being stronger and the left pupil larger than the right. He had numbness of the left arm.
The bowels were confined. As Nux vomica is useful in alcoholism and its sequelae, and as it corresponded fairly accurately to the general condition of the patient, I gave it to him in the first centesimal potency three times a day, but this had no more effect than the Baryta.
August 27th.-I now directed my attention to the heart itself, as being the organ most injured, and the probable source of the rest of the patient’s symptoms. I gave Spigelia 3, three times a day.
September 3rd.-Improvement was soon manifest; he has been a good deal better. Bowels regular. Appetite better. To-day the breathing is short, and he feels choked; this he thinks is due to his having taken milk for supper the night before.
With the exception of one week during which he took China I for an attack of diarrhoea he continued to take Spigelia to the end of the year (1879), steadily improving in every way, able to work his full time, and enjoy life. He went away for a holiday at Christmas-time, and returned none the better for it. The fogs tried him a good deal, and any mental excitement was sure to throw him back. I again gave him Spigelia, and soon afterwards lost sight of him, so how he fared subsequently I cannot say. The wonderful improvement Spigelia wrought in his whole condition whilst under my care I can, however, answer for.
February 14th, 1880.-J. T., 21, a clerk, dark, middle-size, well nourished, well made, consulted me about a pain he had at the left side, below the nipple,”as if there was something too big under the ribs.” This was especially bad after a breakfast of porridge. He fainted at times, and was very nervous, and greatly alarmed about himself, fearing he had heart-disease, his father having died of it, and one of his sisters being a sufferer from it. He had a little cough in the morning, with pains in the chest.
Tongue clean, appetite good, bowels regular, sleep bad-it had been good until a short time previous to his consulting me.
I asked him about his former health, and if he could assign any cause for his malady. He told me he had been always healthy. For the last three years he had done much bicycling. Before that he had felt nothing of this trouble. For three weeks he had been working in a close office lighted nearly all day with gas. He had been worse during the last fortnight, having taken a chill at the seaside.
He had no palpitation. I examined the heart and found all the signs normal. The pulse was steady and full.
Treatment Actaea rac. I, three times a day.
February 21st.-The following week he returned, and reported that the pain had been easier, but he had still felt a little of it. He had not fainted, and had had no discomfort after food. Sleep still poor, but he was not quite so nervous. The medicine was repeated, and the following week, as he was in much the same condition as regarded the heart and nervousness, but his appetite was bad and his tongue dirty at the back.
Treatment Nux vomica I, in place of Actaea r.
March 6th.-Numb sensation over the front of the chest; fullness all round; perspiration at night and sleeplessness; is very nervous; has a bad cold. Treatment Ignatia.
March 10th.-The numbness has gone from the chest. There is less perspiration, but he is not so well generally. There is continually a dull pressing pain at the chest. He feels faint; hands and feet cold; pulse full; sleep still bad.
Treatment Spigelia 3, three times a day.
March 13th.-Decidedly better. Has slept well, no perspirations. Appetite better; spirits better. Repeat.
March 20th.-Faintness came on on the 18th. Since then he has felt ill; has slept badly; perspired much. Has had no pain in the side. Repeat.
March 24th.-Has felt worse. The pain has been bad, leaving him faint and ill. Retches with breakfast and tea. Sleep good; has perspired slightly.
I now for the first time discovered the real cause of his illness. Patients have a way of telling their doctors all kinds of causes for their diseases except the right one, which in most cases is perfectly well known to them all the time. In many cases it is difficult, sometimes all but impossible, for them to disclose it. Sometimes it becomes possible after a time, when the confidence of the patient has been completely won by the medical attendant. In many cases, as in the one before us, the patient, partly ashamed to confess some indulgence, and partly desirous of having his sufferings relieved without being compelled to exercise self-denial, purposely keeps his medical adviser in the dark.
It is always necessary to bear this in mind, or we shall often be wasting our time and energies in fighting shadows, when with a little trouble we might find the substance and at once put an end to our difficulties.
This patient had told me of his bicycling, of his close office, of his cold, and of the history of heart-disease in his family, and this he considered enough for me to work on. It was only when the partial success of the remedies I administered suggested to me that there was some other cause at work that I inquired more closely, and found out what it was.
The patient was a smoker, and when he smoked he could not smoke moderately. At times he abstained from it altogether- generally in the summer time. From October, 1879, to January, 1880, he had indulged to excess; but had been more moderate since then. For a week previous to my finding it out he had again been smoking, and this coincided with the return of many of his symptoms, in spite of his endeavour to counteract the effects of the tobacco with stout and port wine!
In repeating his medicine I told him that what benefit he had received from medicines was as much as he might expect until he abandoned the habit entirely.
If he did that he might hope to get perfectly well, and need not let the fact of there being heart-disease in the family cause him any concern.
He returned three days later, saying he had been very much better till the day before his visit, when he nearly fainted in the evening. I gave him Cactus I. He did not return again, so whether he made up his mind to abandon his habit or not I cannot say.
I am inclined to call these three cases instances of semi- functional disease of the heart. In all of them the heart was the seat and centre of the suffering. In none of them was any heart- lesion detected by physical examination, unless the slight muffling of the first sound in Case XXIX. may be counted such. And yet they were not purely functional cases. They differed from the cases of palpitation and breathlessness met with in hypochondriacal, hysterical and anaemic subjects, where the symptoms arise from no discoverable cause beyond the general condition of the patient. In each of them the heart-weakness was traced to the operation of a drug on the cardiac nerves or tissues or both.
Case XXVIII. and XXIX. present a striking likeness to each other. The same gnawing pain at the heart was complained of, the same kind of nervousness, the same giddiness and noises in the head, the same sleeplessness and constipation.
The same agent, alcohol, was at the root of each, and the same medicine-Spigelia-was in both strikingly beneficial. Case XXVIII. may be considered as an early stage of Case XXIX. S.P. was a younger man, and his indulgence had not lasted so long, consequently he was more speedily restored to health. J.B. was an older man, and an older toper, and his symptoms were, though the same in kind as S.P.’s, much more severe and long lasting. Palpitation, scarcely complained of by the one, was a very distressing feature in the case of the other. I am inclined to regard this, combined with the muffling of the first cardiac sound, as an indication that the structure of the heart had become somewhat degenerated in J.B.’s case. In Case XXVIII., if the disorder had passed beyond the limits of purely functional disease, the organic lesion was not so severe as to be beyond repair. In case XXIX. the tissue of the heart and probably the nerves as well, were degenerated, but the tissue that remained was still susceptible of being strengthened by proper remedies.
In the latter case I at first suspected an aneurism, and my failure to find any definite physical indication of one did not altogether allay my suspicions. I do not now, however, think that there was one present. The absence of any signs of hypertrophy or dilatation of the heart militates against the idea.
It is more than probable that the arteries were affected with atheroma in the early stage, but that cannot with certainty be diagnosed.
Case XXX., though closely resembling the other two cases, presented points of difference, as we should naturally except, arising as the disorder did from a different cause. All three patients, it is true, were addicted to the use both of alcohol and tobacco, but in two of them the former greatly preponderated, and in Case XXX. the latter. The characteristic features of this case were the continual faintness, sickness, and the dull pressure on the left side as if a substance were there-well known symptoms of tobacco poisoning.
When we meet with cases of this kind in young subjects without any history of previous carditis, we may be sure there is some cause at work. Simple fatty degeneration of the heart does not come on in early life without some definite cause. When we meet with symptoms that suggest it, as in the three cases related above, and find no traces of valvular mischief, or previous disease of the organ, we may at once set to work to find out the origin of the suffering. In the majority of cases we shall find it in the abuse of alcohol, or tobacco, or both. Sexual abuses of all kinds may cause it.
Occasionally I have seen it induced by Arsenic.
With regard to treatment, the first indication is, of course, to get rid of the cause. When this can be accomplished in time, a complete cure may be looked for. And even when the injurious habit has gone on for many years, much benefit may be hoped for from its discontinuance, and the administration of homoeopathically indicated remedies. It may be urged that the discontinuance of the habit alone would be sufficient for the cure. Such objection may be brought plausibly enough against the part played by medicine in Case XXVIII., but Case XXIX. effectually answers its general applicability. Here the habit had long been given up, and various remedies tried, none of which was of any service until the specific one had been found. And as regards Case XXVIII., I do not at all believe that the recovery would have been anything like so rapid without the aid of specific medication. The chronically induced effects of continued over-use of alcohol are not wont to disappear so rapidly of themselves. We should naturally have looked for a period of great depression following the giving up of the stimulant had nothing been given to counteract it, but under the use of Spigelia no such depression occurred. For this reason I assign to Spigelia the lion’s share of the cure in that case.
Case XXX. was not so satisfactory in the matter of treatment from the fact that the use of the toxic agent was not given up. But in spite of this, benefit was received from Actaea racemosa, and marked benefit from Spigelia. It is a remarkable fact, which I have repeatedly observed, that when two drugs are capable of producing a very similar effect on the body, that is to say, are homoeopathic to each other, the one will often in infinitesimal doses hold in check the action of the other when it is still present, and has been taken in injurious quantities for a long time. I can give no explanation of the fact, but the beneficial action of Spigelia in this case is an instance of it. The patient was still smoking, though not to such an extensive degree as he had done formerly. Here, as in the majority of cases, the antagonistic action of the remedy failed, after a time, to counterbalance the action of the poison.
Spigelia is the remedy I have found most useful in cases of the kind, though the serpent poisons also correspond closely to a considerable number of them. Cactus would be called for should its characteristic constricting pain be present.
The homoeopathicity of Spigelia to the condition it removed is evident from a glance at its pathogenesis. The following are some of the symptoms from Allen :-“Anxiety and apprehensive solicitude for the future;” “great weakness of the body after walking;” “when walking he becomes dizzy;” “sleeplessness;” “tearing constriction in the lower part of the chest, above the pit of the stomach, with oppression; afterwards, also, beneath the pit of the throat, with palpitation;” “palpitation and anxious oppression of the chest.