ELIZABETH WRIGHT-HUBBARD, M.D.
It is said that more than half the battle in any cure is a well taken case. We all know that the cases with few outstanding or characteristic symptoms, except pathological changes, are difficult to treat and of bad prognosis and usually show a profound miasmatic disturbance. This case, as given, is so incomplete as to be impossible of a satisfactory solution. It may be that the individual actually shows no other symptoms and could give no more but we should like to have a check-up, especially on the following:.
Other mentals, such as suicidal tendencies in the past, fears, whether the cheerfulness was euphoric or grandiose or merely normal, whether the suspicion was paranoid in trend or only the result of unfortunate experiences with physicians, and so on.
The general type of the patient, which is not mentioned, and many other little objective points such as tongue, ears, warts, moles, condition of nails, color and character of discharges, if any, condition of the external glandular system, type of build, skin quality, warm blooded or cold blooded typed, sweat in general, and sweat of affected parts in particular, sleep, conditions of aggravation and amelioration, time of aggravation, such as after sleep, morning, night, etc. The case as given present no individual picture which makes the patient either a living entity or a drug entity to the physician. There is a conspicuous absence of GENERALS, no mention made to wet weather or dry, heat or cold, position or motion, or to any of the desires or aversions in food.
Even from a general medical point of view the case is incomplete. One would like to know whether the groin ulcers followed buboes, whether at any time there was a urethral discharge whose venereal character was either unknown or unknown or unadmitted. This might be gotten at by discovering what kind of treatment he had ever received. No mention is made of Wassermann or Neisserian smears. One would like to know the Wassermann or Neisserian smears. One would like to know the cause of the paralysis.
From the brief description given little hint can be gained, but it makes an enormous difference in the choice of the remedy whether the paralysis is from a blood clot in the brain due to cerebral haemorrhage, or to a possible lead poisoning with resulting degeneration of nerve tissue, or to a luetic lesion in the cerebro-spinal mechanism. Under the paralysis, is it progressive, as it would be if of syphilitic or lead origin, or is it stationary or retrogressive, as more likely in apoplexy?.
The only really characteristic symptom in the whole case is the sensation of heat in the paralyzed part, although, being a particular, this should not be placed first. A careful inquiry is needed as to whether other symptoms throughout the life have been right-sided. (We would call attention to the fact that the lesion in the brain, if any, is left-sided). Right-sided paralysis alone is not sufficient to give great weight to right-sidedness as a general symptom, although in so barren a case one clutches at straws.
The question of suppression of the ulcers, which may well have led to the paralysis, should be stressed. A check up of symptoms for lead poisoning, both in the gums, blood and paralyzed side, should be gone into. No mention is made of trembling, formication or numbness.
In any case where there is a paucity of symptoms available it is important to get as clear a picture as possible of the child- hood, whether fat or thin, rickety, amiable, with a tendency to glandular troubles, suppression of eruptions, foot sweat or discharges, subject to frequent colds, etc., in other words the type of the child prior to any possible venereal or medicamentous or suppressive complications.
CHOICE OF RUBRICS.
1. My first would be Generalities, syphilis, p. 1406. [ Kents Repertory, third edition]. “Generalities, gonorrhoea suppressed” is tempting in view of the history of ulcers in the groin but is not justified without further data.
2. Generalities, ulcers, glands, p. 1410, combined with.
3. Skin, ulcers, p. 1333. We must get a clear description of the ulcers to make this a valuable symptom. It is vital to the case. Bleeding, itching, burning, lardaceous, bad odor, color of discharge from, punched out edges, etc.? Without these particulars we must use the two rubrics above combined.
4. Suspicious, p. 85.
5. The only other mental given is Speech, slow, p.82, which we use, lacking others.
6. Paralysis, one-sided, p. 1390.
7. Paralysis, one-sided, right, p. 1095.
8. Skin, pain, burning, right thigh, p. 1095.
9. Skin burning, in general to cover other parts showing this symptom, p.1303.
10. Paralysis, heat in part, p. 1390.
11. Bone necrosis, p.1375, Caries, bone, p.1346. Combined.
On repertorizing these 11 symptoms in Kents Repertory, third editions, the following remedies come through, the numerator of the fraction indicating the numerical value of the remedy and the denominator the number of rubric in which it appears:.
phos 23/10 Bell. 18/8 Mez. 12/7.
Merc. 19/9 Phos.ac. 14/8 Nat.carb. 10/7.
Rhus tox. 16/9 Thuja 12/8 Plb. 9/7.
Ars. 22/8 Sil. 18/7 Caust 14/6.
Lach. 19/8 Sulph. 18/7 Op. 11/6.
Such remedies as Bell. and Rhus tox. should be thrown out as they are not deep enough for this case. Lach. can be thrown out because of the absence of the marked Lach. personality, characterized by loquacity, aggravation after sleep, sense of constriction, extreme sensitiveness, marked suspicion, etc. Phos. ac., Thuja, Mez. and Nat. carb. do not present a similar picture. plb. appears in low degree in a large number of rubrics. As this remedy rarely comes through in repertory work and as the patient chewed lead to cure his groin ulcers it should be kept in the back of the mind. plb. has marked trembling and is subject to gastro-intestinal disturbances. Sight unseen we should say it does not fit the case. Caust. and Op. should also be kept in the back of the mind. This reduces our list of remedies to five:.
Phos. 23/10 Ars. 22/8.
Merc. 19/9 Sil. 18/7.
The patient should be gone over again with these remedies in the foreground and plb. Caust. and op. in the background. Each of the five is a searching miasmatic remedy and careful observation should enable a fairly certain choice between the five. Without further data it is impossible to prescribed accurately.
I had a case very similar to this one recently, to which, owing to the paucity of symptoms, I gave Sulph. 30, one dose, as the opening remedy with the result of a return of a previous suppurating discharge and the slow but steady amelioration of the paralytic symptoms. It must never be forgotten that when in doubt and Sulph. stands among the first five it is a good opening remedy to develop symptoms and bring the case into order.