BY CARROLL DUNHAM, M.D., NEWBURGH, N. Y.

“Charles C — , aged 10 years, has had diarrhea ever since he was 4 years old — has been subjected to various modes of treatment, including the Homoeopathic, but without any material benefit. He is of good height for his age, but is emaciated to an extraordinary degree, not only are his tissues utterly devoid of fat, but the muscles are wonderfully attenuated; my thumb and finger meet with case around the middle of his arm. Nevertheless he is active and full of fun. His appetite is prodigious — thirst very great — he complains of distress in the epigastric region, which is much greater just before a stool, compelling him to press his hand upon that region and bend forward, this is relieved to some extent by a movement of the bowels. The epigastrium is sensitive when touched. The abdomen is greatly distended: this is habitual; it is hard, and tympanitic; by forcible manipulation, one can detect hard ovoid bodies, deep in the abdomen, as large as a pigeon's egg. The number of stools in twenty four hours varies from five to twenty. They are copious, pappy, of a dark greenish brown color, quite offensive. They occur chiefly during a period from 4 a.m. to noon — seldom after noon or before midnight. Though so. copious they do not produce faintness or a sense of weakness, nor does the boy complain of debility although aware that he is not so strong as other boys of his age. On the contrary he is lively, and lull of mischief, his chief complaint being of the very frequent pain in the upper part of the abdomen, which he describes as a “grumbling pain,” and sometimes a “very sharp squeeze.”

Of the particulars of his previous treatment, I could learn but little. During the summer preceding my first visit to him he had been under homoeopathic treatment, (not in this village) and I was told that he had taken a good deal of Arsenicum which, however, to the great surprise of his physician had done him no good.

And, indeed, on a hasty review of the symptoms, it might seem extraordinary that Arsenicum should have failed to cure the case. The dark, pappy, offensive stools, preceded by tolerably acute pain in the abdomen, with great and excessive emaciation, comprehend, to speak with the pathologists of our school, the essential features of this present disease of the alimentary canal and moreover present a fair simile to the Arsenicum-disease. A careful examination, however, will show that some even of these symptoms vary in important aspects from the corresponding symptoms of Arsenicum, while other symptoms which betray the diathesis of the patient are quite at variance with those of Arsenicum. For example, in the first place, the thirst although very great, is not satisfied by a small quantity of water, as in the Arsenicum-disease; the stool though similar in color, consistency, and odor to that of Arsenicum is copious, that of Arsenicum being, like all the secretions under that drug,scanty. It is not attended by as great a sense of exhaustion as one would expect to find. Indeed the debility and muscular weakness are much less than one would suppose must result from a diarrhea so copious and of so long duration, whereas in the Arsenicum. disease, the general prostration is much greater that can be accounted for by the actual drain upon the system. In the second place, the aggravations occur in the mornings, while in the Arsenicum disease they occur almost exclusively in the evenings. The abdomen is distended and hard, making the child quite pot-bellied, whereas Arsenicum produces retraction of the abdominal walls and concavity of the abdomen. The appetite is very great, a symptom which is not characteristic of Arsenicum.

Then it appears although the symptoms, to which my attention was first called, as being the symptom of chief importance, seemed to point to Arsenicum as its remedy, yet the conditions and concomitants of that symptom and the general symptoms of the patient did not at all demand but decidedly contra-indicated that remedy.

But with what propriety can the diarrhea, the frequent liquid stool, be regarded as the symptom of chief importance, the primary symptom, so to speak? It is that symptom which would first strike the observation of the patient's friends because so decidedly objective in its character; but it is obviously a secondary phenomenon, depending on the diseased state of the alimentary canal and of the Mesenteric Glands; and this diseased state depended unquestionably upon a general depressed state of the vascular and nervous systems, or upon a modified vital action, which is manifested in those general symptoms, upon which we predicate distinctions of dyscrasia and diathesis. Taking this view of the case, it is evident that to assign the chief place in our scheme of symptoms to the diarrhea, would be to prescribe for symptoms (and secondary ones at that) rather than for the whole morbid state of the patient. But if in accordance with the view I have indicated we give but a secondary place to the diarrhea, it becomes easy to find a remedy for our case. The distended, prominent abdomen, the indurated and enlarged glands, the excessive appetite, the great thirst demanding large draughts of water, the pain in the upper part of the abdomen just before the stool, the tender epigastrium, the copious and long continued diarrhea, without corresponding exhaustion, all these symptoms combine to exhibit a condition which finds its exact simile in Calcarea carbonica. Moreover, although Calcarea does not produce stools of the color met with in this case, yet the conditions of stool produced by Calcarea correspond to those of the case in hand. The aggravations of Calcarea are frequently in the morning, and the pain in the abdomen is relieved by warmth as in this case. Calcarea carbonica therefore was selected as the appropriate remedy, and the propriety of giving it being so obvious that I could not suppose it had been overlooked by the physicians who had previously attended the lad, and there being every probability that if they gave it at all, they gave it in low potencies; I concluded to give the 200. Two globules were according dissolved in four ounces of water, and a teaspoonful of the solution ordered to be given every four hours. For the week preceding this prescription the boy had had twenty stools daily, and very great pain.

On the third day after the remedy was administered, I called again. The lad had had but one stool daily, since the day after my visit, and during the ten months which have since elapsed his bowels have moved regularly, but once daily, the stool being in all respects normal. In the space of one month, the lad became so ruddy and plump, having gained twenty-two pounds in weight. that I should not have known him. As he gained flesh and strength, the rotundity of the abdomen disappeared and at the end of the third month, the indurated abdominal glands were no longer to be felt. He received no medicine besides the the single dose of Calc. carb.²⁰⁰, above mentioned.

It may seem incredible, and I confess I cannot explain it, that a drain so long established and so copious could be instantaneously checked without producing at least temporary disturbance of some other character. The fact, however, does not admit of dispute.

In a review of this case, two points seem worthy of notice.

1. The prompt and enduring action of the high potency. I would not venture to say that a low potency would not have acted as promptly — certainly, however, nothing better could be imagined or desired.

2. The great importance of paying careful regard in the selection of a remedy to the general symptoms of the patient, as denoting the dyscrasia, and to the conditions (time and character of aggravation, &c.) of every symptom.