Some Interesting Clinics.

F. A. PINELES-MONTAGU, M. D., DRURY, NEW ZEALAND

PANCREATITIS:—In October, 1900, a gentleman, W. N—, aet. 52, called on me for treatment. He stated that for the past three years he had been in bad health, had spent much money, and had taken gallons of physic, having had a great many doctors. One treated him for dropsy, another for gout, another for rheumatism, and another for heart disease, each one finding a different disease. I found the temperature and pulse normal; heart fair, but weak; lungs normal. Slight swelling and great pain on pressure in the region of the pancreas, intensified by coughing. He stated that there was a feeling of nausea after food. The bowels constipated, tongue clean, skin jaundiced, general anemia, emaciation and debility, and both legs slightly swollen from knee to ankle. There was great despondency.

I prescribed:

Sig: One dram four times each day.

He came to me the following week and stated that he felt better, but that the medicine caused constipation. The swelling in the legs had disappeared. His skin was of a more natural color; depression gone; appetite and sleep good; no pain or swelling in pancreatic region. He also stated that the day after taking the medicine he passed a large clot of coagulated blood about the size of his fist, and after passing it, he felt greatly relieved. I saw him every week for two months and kept him on the same mixture. He gradually recovered his usual health and put on flesh and at the end of the two months I discharged him as cured. The same week that he came down for the last time he stated that he had walked 25 miles, which he had not been able to do for some years.

For the constipation I prescribed: Pil. veg. cathartic (U. S. P.), one pill pro re nata.

LEUCOCYTHEMIA:—On one Sunday evening in Aug., 1901, I was hurriedly called out to attend Mrs. B— aet. 40. Her husband stated that for the past few days his wife had an attack of indigestion. Could not keep anything on the stomach and sometimes vomited blood. She felt very weak and exhausted and was daily becoming paler in the face, and yet she was getting stouter at a certain part, but he did not think that she was pregnant as her youngest child was aet. 19. I found my patient in bed and vomiting. I immediately administered tr. nux vom. 5 drops, water 4 drams, which immediately checked it. On examination, I found temperature 100, pulse 99, small and weak, first sound of heart weak, palpitation. The liver was greatly enlarged, the spleen was also slightly enlarged. There was excessive perspiration. The urine had a strongly acid reaction and of high specific gravity, uric acid in excess. There was amenorrhea, slight diarrhea, thirst, asthenopia and nervousness. I prescribed

Sig: One dram every four hours.

I attended her for ten days and the mixture had good effect from the first. My patient so far improved under my treatment that she was able to leave her bed and take short walks especially to the railway station, where one day she left by train and at the same time left her doctor in the lurch, for I have never seen her since or my fee either. Such is life. This is one of our incurable diseases and lasts from six months to seven years. It is a very rare disease, except perhaps in malarial districts. In this disease, death may take place gradually from asthenia and exhaustion and frequently is preceded by delirium, stupor and coma, or by syncope; or more speedily as the result of hemorrhage, diarrhea or complications. The most frequent fatal form is epistaxis. Internal hemorrhage may also cause death, especially cerebral. The most important complications are: Pleural or pericardial effusions, pneumonia or bronchitis, and venous thrombosis, which in the male may take place in the penis and cause persistent erections.

ECHINACEA:—On July 16th, 1901, about 9:30 p. m. I was called out to see a Mrs. M—, aet. 30, married. Her little boy stated that his mother had run a sharp fish bone into her hand, and her arm was very much swollen, and she was in great pain. When I arrived I found the lady in great agony. She stated that she had accidentally run a fish bone into her hand just below the fleshy part of thumb, but had taken it out and washed the part, thinking that it would be all right. This was at dinner-time, noon. I found the hand and arm, to the shoulder, greatly swollen, almost purple; there was also a large tumor under the armpit. I wrapped the whole in cotton wool and saturated it with echinacea 1 part, aq. 4 parts, and covered it with oiled silk, and told her to keep the part wet. I also gave her echinacea 10 drops, water 1 dram, every 20 minutes until the pain was relieved. After the first dose, she experienced a tingling and pricking sensation all over her arm. After the second, a warm sensation with the pain slightly lessened, and after the third dose the pain had almost disappeared.

I called the next day and I found that she had slept fairly well. The pain had not returned, the swelling in hand and arm and tumor had also disappeared, there was a slight swelling at the base of the thumb which also disappeared in a day or two. Being a delicate woman her nerves were unstrung, so I gave her

Sig: One dram every three hours.

I saw her a week or two afterwards and she declared she was in perfect health. I heard that she had previously called in another physician who had advised operation, but she declined, and as a last resource sent for me. I always like to keep a supply of echinacea by me, as I have found that is it a splendid drug and does its work every time, both locally and internally.

SYPHILIS IN INFANCY:—This disease in infants is usually due to heredity, an instance in short of the children suffering for the sins of the parent. Occasionally, the disease is inoculated by sucking the mammae of a diseased woman, or by vaccination from a diseased child. A child born of syphilitic parents, and in whom the disease therefore exists congenitally, shows symptoms of coryza, snuffles, especially when asleep; has various forms of skin eruptions, especially around the mouth. It may be born well nourished and healthy, but gradually begins to show the above symptoms. The voice becomes hoarse, suffers with nasal catarrh, with herpes on the lips caused by the catarrhal mucus, the skin of the lips becomes fissured, the streaks radiating from the corners of the mouth. The gluteal regions become the seat of eruption. The child suffers with asthenopia and conjunctivitis or blepharitis; there is gradual emaciation and atrophy. The skin peels off and becomes thickened on the palms of the hands and soles of the feet. The child has a pale and pasty complexion, is peevish and cries if moved. Pyrexia occurs occasionally, also profuse nocturnal perspiration. The urine is thick and deposits phosphates on standing. As a rule the child is constipated and digestion is impaired. As the child grows older the wrists, ankles and other joints become deformed; it is knock-kneed or bow-legged. The chest assumes the so-called pigeon-breast. The nose becomes misshapen. The cranial bones do not close for some time; this disease is very often associated with hydrocephalus. The abdomen is usually distended with flatulence. Diarrhea and bronchitis are common, also pneumonia. The teeth become irregular. These deformities are seen when the child has reached adult life, if it is not carried off before that period. If the mother is unhealthy the child should either be suckled by a healthy wet nurse or hand-fed and should be given small quantities of corn-flour, arrow-root, and other farinacious foods, but I should advise that plenty of milk mixed with a small amount of liq. calcis should also be given with the food. When the child is about eight months old, it may have small quantities of beef tea, mutton and chicken broths in addition to the first diet. The gluteal and axillary regions should be rubbed once a day with unguent hydrastis (fl. ext. hydrast, dr. 1, adeps lana hydros. oz. 1. Mix) and the entire body should be rubbed once a day, preferably after a warm bath with ol. morrhuae. The bowels should be opened with pulv. rhei comp. or if it has diarrhea, with pulv. gray comp., bismuth subnit. and salol combined. The following mixture should also be given at the same time for a lengthened period:

Sig: One dram three times each day up to 2 years old and two drams over that age.

If the child is still weak and emaciated after it is two years of age give this emulsion; especially if it is subject to phthisis, bronchitis or any weakness of the chest.

Sig: One dram three times each day.

Other symptoms must be treated as they arise.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.