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CASES TREATED AT THE MASSACHUSETTS HOMEOPATHIC

HOSPITAL.

SERVICE OF J. P. SUTHERLAND, M.D.

[Reported by A. D. Hines, Medical Interne.]

This summary presents the medical cases treated at the Hospital from January 1st to April 1st, 1892. Several of the cases offering features of peculiar interest, are reported, somewhat in detail, in the pages that follow.

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TYPHOID FEVER, WITH RELAPSE.

No. 662. Male; aged, II.

Sickness was ushered in, November 20, 1891, with chilly sensations, nausea, and diarrhoea; some pain in abdomen, and hunger. At close of first week much thirst, lips parched, tongue heavily coated; sordes on teeth; mind wandering; two thin, greenish-yellow stools daily.

During second week he was restless, delirious, and tried to

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escape twice in one night. Near the close of the week rose-spots and sudamina appeared on the abdomen. He would sleep most of the time, making it difficult to give him nourishment by the mouth. Three fæcal evacuations daily, of a thin, mushy consistency

In the third week abdomen became tympanitic; small pustules appeared on the body, and he began to cough, with no expectoration. Very hungrycries for something to eat. Mind cloudy. Speech difficult.

During the fourth week his mental condition became better. Still some cough; pain in left iliac region; two stools dailymore nearly natural than previ ously; articulation better.

During fifth week had a relapse. Temperature became higher; diarrhoea increased; talks and cries a great deal; some delirium.

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All the symptoms became more grave during the sixth week. Dr. Sutherland began to treat the case at the close of the sixth week. During the seventh week there was gradual improvement. Became constipated during the eighth week, which condition was persistent till near the close of eleventh week. An enema of warm water was used every other day, until movements became natural. Swelling of feet during

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first week in February; but no renal or cardiac trouble was discovered. Improvement was gradual and continuous after January 4, 1892.

The accompanying chart shows the temperature variations up to the period of convalescence. The pulse chart presented corresponding curves. The peculiarities of the chart, for a case of enteric fever, need no pointing out (it should be borne in mind. that the patient entered the hospital at the end of the first week of his illness); but the symptoms, as recorded, establish the diagnosis.

The treatment after January I consisted of ars., hyos., and rhus tox., as called for, the ars. being almost constantly used. Sponge baths were given occasionally, and the diet consisted of milk. About four weeks after leaving the hospital he reported, and had gained so much in flesh as to be almost unrecognizable. Discharged February 10, cured.

ECZEMA, CHRONIC.

No. 713. Male; aged, 38; printer.

History. For five years has been troubled with periodical attacks of eczema, and with occasional attacks of facial erysipelas. The eczema begins in left leg, and spreads to entire body. There is a great deal of burning and itching; is constipated; has been in habit of smoking three or four cigars daily; has varicosis of legs.

Present Condition. Face, neck, chest, greater part of surface of arms and legs intensely red; skin dry, thickened and covered with minute vesicles and crusts; abundant desquamation of fine branny scales; fierce burning and itching, the latter being nearly intolerable, and interfering with sleep. Otherwise, his condition was that of health.

Use of meat prohibited. Eczematous lesions not to be moistened. A generous farinaceous diet and an abundance of water to drink was given.

Anacardium 3x was given during January. There was marked improvement after use of anacardium.

Discharged January 18, improved.

Reported several times; the last time showing quite a clean skin, and being practically cured. Anacardium was continued after leaving the hospital.

REMITTENT-INTERMITTENT FEVER.

No. 51. Female; aged, 48; widow. Admitted Jan. 2, 1892. Previous History. Has been suffering from headache, frequent spells of vomiting, pain in abdomen, and afternoon chills for nine weeks. Was taken sick while in Vicksburg, Miss.

Present Condition.

Skin dry and eczematous, and of a yellow

color-feels harsh, and never perspires; spleen not enlarged;

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teeth loose; flatulent; raises much wind; coppery taste in mouth, and desire for cold foods only; chill, morning and afternoon light and creeping, always accompanied by elevation of temperature, and sensation of great heat; vomits in the morning, about every third day. Nausea occurred daily, with marked prostration.

January 5. Urinalysis showed twenty-four hours' amount to be only twelve ounces (sp. gr. 1020), with phosphates in excess; no albumin. The quantity of urine increased gradually until thirtytwo ounces were passed daily. Vomiting occurred at intervals of two or three days, until February 27th, after which there was no return of vomiting, though there was still some nausea. Chills became less and less frequent, and ceased on the 24th.

Diarrhoea set in February 26, and was followed by constipation February 28th.

Fowler's solution, I gt., t. i. d., was given during the greater part of her stay in hospital, and nux v. 2x internally, for the gastric and intestinal disturbances.

Discharged March 7th, cured.

The accompanying chart shows the variations in temperature.

MERCURIAL STOMATITIS.

No. 71. Female; aged, 22; unmarried. Admitted January 16, 1892.

Previous History. An eruption began two weeks ago on the right arm, and extended over face and body. The eruption was attended by neither pain nor itching. She received medicine from the Bennett Street Dispensary (allopathic), and the eruption disappeared in four days. Swelling about inferior

maxilla began three days ago, and salivation followed rapidly. Present Condition. A few brownish, irregular spots here and there on surface of body; sordes on teeth, which cannot be brought in close contact; gums bleed easily; opens mouth with difficulty, on account of swelling about the face and neck; tongue large, flabby, indented by teeth, and coated; mouth has a very strong and most offensive odor; excessive and constant ptyalism, the saliva running in almost a stream from the partially open mouth; many small and superficial ulcers in mouth.

Peroxide of hydrogen was used as a mouth wash three times. daily, and a solution of hydrastis was used every one half-hour; nitric acid Ix internally.

January 22. Much improvement has been made, the general and special symptoms diminishing in severity; but the gums are still swollen, and bleed easily. The temperature, which was elevated for four days, is now normal. Kali iod. 5 gr. in twentyfour hours, with the idea of accelerating the excretion of mercury, and thus assisting in the recovery.

January 27. Great improvement; can open mouth easily ; slight fetor to breath; two small ulcers remaining; no swelling of face.

The question of diagnosis in this case was a somewhat puzzling one. The patient's social status, and her condition on admission, more than suggested the existence of syphilis. The ephemeral character of the eruption, according to the anamnesis, the fact that no signs of characteristic lesions could be found on careful physical examination, and the positive and apparently sincere denial of unchastity, in addition to the rapid and satisfactory recovery, would seem to offer convincing testimony that the disease was not venereal. Sectarian prejudices prohibited any attempt to find out what treatment the patient had received at the hands of her dispensary physician; but the very characteristic objective symptoms pointed to an accidently excessive, or unjustifiably rash use of some form of mercury. Discharged January 29th, cured.

No. 110.

PNEUMONIA.

Male; aged, 65; carpenter. Admitted February 2. History. Had la grippe last November. Thought he had recovered. Has been sick for ten days with pain in the right side, and cough. Now has pain in the hepatic region; cannot take a long breath, the pain is so severe. Feels weak; no appetite;

much thirst; coughs but little.

Physical examination shows marked dulness over lower lobe of right lung, crepitant râles, whispering bronchophony, increased vocal fremitus.

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