Typhoid Fever complicated with Jaundice . - The case here presented is chiefly remarkable for its complication. It is one of those cases which do not always yield promptly to medical treatment, on which account they are often early given over to baseless experimentation; and while some, even then, will get well, the majority, it is believed, sooner or later succumb to the disease. If, in the treatment of any class of diseases it were desirable to adhere strictly to the principles of our science, this class is the one above all others, because, as it is more malignant and fatal, greater certainty of prescription is requisite to conduct it to a favorable issue. Yet, unhappily, it is too often the case that the Homoeopathician, finding the case stubborn, not readily yielding to his remedies, feels it his duty to ignore his most cherished principles and resort to any method, system or drug, that in the annals of medicine — or out of them - ever succeeded in the treatment of an analogous case.
G. H. S. is of a frail constitution, with a predisposition from youth to bilious and catarrhal difficulties. Temperament, nervo-bilious; scrofulous diseases appear to be hereditary in the family, as indicated by the early death of a brother with pulmonary tuberculosis. Age, twenty-four years.
August 27th, 1865. Has been suffering for the past two days with temporary swimming in the head and a disposition to chilliness. Had today, as the occasion for calling me, a decided chill. The following Mercurius symptoms were present, viz.: .swimming in the head when attempting to arise; vomiting of slimy mucus; the tongue and fauces are covered with white slime; ardent thirst for cold water; hot and dry skin; aching in the bones, particularly in the back and legs. Dissolved a few pellets of Mercurius sol.30 in half tumbler of water, and give a dissert spoonful once in two hours.
29th. Seems decidedly improved. The bowels however are constipated and pain him considerably; the abdominal pains seem of an obstructive character. There is frequent disposition to evacuate without the power to do so. Dissolved in half tumbler of water a few pellets of Nux vom. 30 and gave a dessert spoonful once in two hours.
30th. Much relieved; bowels have moved twice today; Skin feels natural; some return of appetite of which he has been entirely wanting of late; complexion sallow; and the conjunctival membrane of the eyes strongly indicate considerable hepatic torpor. Mercurius sol30 in water, once in three hours.
I pass over the brief period of five days in the history of my patient, during which time Mercurius sol.30 had been continued, with occasional intermissions of twelve hours. He was doing finely - had gotten along too well as the event proved-serious relapse now followed as a natural consequence, it is believed, of untimely exercise and fatigue. — Typhoid symptoms had now clearly set in, of which I give the following synopsis:
September 5th. Hot and dry skin; pulse 110, unsteady; mind confused; great thirst for cold drinks; mouth dry; tongue coated yellowish brown; extremely restless; throws his arms and legs wildly about; tosses himself from one side of the bed to the other; loathing of food; slumbers for a few minutes and then wakens to toss about; bowels feel natural although there has been no stool since 30th ult; all the nervous symptoms are worse at night. Gave Arsenicum alb.30 a few pellets dissolved in half tumbler of water, of which a dessert spoonful is ordered once in two hours.
10th Much as usual; increased feverishness and restlessness last night, against which Arsenicum30 was given in solution. Although he seems more comfortable this morning, I order the medicine continued.
11th. This morning the face, neck and chest are decidedly jaundiced; the urine is strongly impregnated with bile; it passes unnoticed, not unfrequently, imparting a deep yellow stain to the linen. The mind is clear in the morning, but toward evening becomes excessively dull; doses considerably, but is restless during waking intervals. Gave Mercurius sol.30 in solution as before, and ordered farina gruel to be given in four hours.
14th. The case grows more critical. There is a sluggishness about him, painful to both physician and nurse. Though greatly reduced in flesh and strength in the early part of the day, he answers questions correctly. He always feels “first rate” when his health is inquired after, but presently kicks off the bedclothes exposing his person to whoever may be present. Sleeps heavily; no inclination to stool; still the abdomen is not tympanitic, and auscultation discovers no fearful gurgling at the cecum; the breath emits an odor of putrid flesh; tongue brownish; the teeth are thickly crusted with offensive sordes; lips brown; corners of the mouth cracked; they bleed profusely at times. Percussion reveals great tenderness at the hypogastrium, and considerable hypertrophy of the liver. The urine is scanty, of a dark brown color, and deposits no urates.
As will be observed Mercurius sol.30 was continued, although I was not fully satisfied with it. It did not seem to do the patient any good, and yet what remedy in our Materia Medica covered the totality of the symptoms better? What remedy answered the long roll of symptoms so well?
Dr. Dunham, of New York, in consultation. He thought the case unhappily complicated. Recommended patience on the part of the attending physician, and perseverance in the use of Mercurius sol. to the patient. Spoke hopefully of the issue. If, however, after a further use of that remedy it be found inoperative, he would suggest Lycopodium.
The next day after our conference, the symptoms were favorably modified, and seemed every way to justify the confidence which had been reposed in Mercurius. On the day, following, however, we were doomed to disappointment. The worse features of the case were again presented. I quote from my notes as follows:
September 16th. Had quite a severe chill this afternoon; the skin is very hot; pulse 116 per minute; does not seem to notice anything; cannot get replies to questions; dull incoherent muttering. Lycopodium in solution, dessert spoonful once in two hours.
19th. Improving satisfactorily; pulse 84 per minute; no appetite; takes farina gruel and beaf-tea, because he is urged to do so; drinks lemonade for which he has had a fondness from the beginning; mouth very dry; tongue chapped and sore. Continued Lycopodium“.
The patient remained in this condition, comparatively comfortable, neither gaining nor becoming visibly worse, for several days. Lycopod. seemed no longer operative. The friends were losing faith of his recovery. I quote as follows from my note book:
28th. Pulse 72 per minute; skin cool and dry; the hepatic soreness seems to have passed away; colliquative sweat during sleep; great atony; the condition is clearly dyscrasic; bed sores appear on the ankles; the back and hips are chafed and sore. China30 in solution, a dessert spoonful once in two hours.
The case now looked discouraging enough. He was extremely emaciated. Thirty-one days had elapsed since the last passage from the bowels, and still no rumbling sound could be heard - nothing indeed to indicate that they were ever to move. All injection of warm water had been given, but only a few hardened feces had been discharged from the rectum. Dr. Dunham, in response to a note from me, advised Lachesis. A few pellets of the thirtieth potency of that remedy, therefore, were dissolved in half a tumbler of water and a teaspoonful given once in two hours. I quote from my note book:
4th. The swelling is subsiding without suppuration; had a natural passage from the bowels last evening, just thirty-three days from the date of the last one. His appetite is becoming absolutely voracious; the bed sores have commenced to heal; bile has disappeared from the urine. Sacch. lact.
12th. Gains strength daily. Dreams of rich viands and dainty dishes; talks or little else during waking moments. The parotid swelling has entirely disappeared; the urinary secretion is perfectly normal; the patient, however, is very weak; sits up but a few minutes, morning and evening; complains of numbness and prickings in the left leg; not removed by rubbing nor motion. Gave a few doses of Nux vom30 in solution.
21th. With slight and unimportant variations, the patient has steadily improved since last note; he now walks unaided down stairs; takes long drives; enjoys his dinner; sleeps soundly and long; has a clean mouth and a soft cool skin. Discharged.
|The American Homoeopathic Review Vol. 06 No. 07, 1866, pages 263-268
|Clinical Contribution; Typhoid Fever complicated with Jaundice.
|errors only; interlinks; formatting