Clinical cases, sulphur

CLINICAL CASES: SULPHUR.

By E. W. BERRIDGE, M.D.

(Member and Corresponding Secretary of the International Hahnemannian Association.)

CAsE XX.-Sulphur. Mr. M. B., aged 16. Was telegraphed to visit him in the country on Dec. 21, 1891. On Dec. 15th, he was attacked with mumps, which was very prevalent at a seaside town from which he had just returned, as if a pin were running into it, and the right tonsil was swollen and red. His symptoms were all subsiding satisfactorily by keeping him in a warm room, without any medicine being given: when on Dec. 20th he remained some time in a cold_ water-closet, which resulted in the subsequent trouble. I saw him at 5 p.m. with a Pulse of 120, very full. Skin hot to the touch, though not excessively so; but the temperature was 1058. Since yesterday afternoon, he had been drowsy, with jerking of limbs. Vertigo, feels as if the bed were revolving. Extremely weak since yesterday. No stool for five days, with ineffectual desire. Yesterday evening, the left testis became painful to touch, and hung low, though he was lying in bed; today the right testis is similarly affected, and they are both swollen. Tongue is white and moist.

His history showed a decided psoric diathesis. He had been subject to catarrhal obstruction of the nostrils for many years. In 1885 an allopath burnt his nostrils with caustic, for supposed indications of polypus. In the spring of 1888, he had left-sided diphtheria, treated by a homeopath with two strong medicines in alternation and a gargle; later in the same year, he twice had a recurrence of sore throat. He had enteric fever at the age of 5 or 6. Since the attack of diphtheria, he has been myopic, and his teeth have decayed much, some of them close to the gums. Was re-vaccinated in 1887 and had rickets in infancy.

His mother had suffered from ague since childhood; also from severe headaches when at school; since the birth of this (her eldest) child, she has suffered much from gallstones, hepatitis, and hay fever; and has had three stillborn, decomposed children. Her parents and a maternal aunt all suffered from liver disease, and a cousin nearly died of gallstones. His father has suffered from catarrh and gastric troubles.

Diagnosis of the remedy. The most characteristic symptoms were the pain as of a pin in the right side of the throat on swallowing, and the testicular affection passing from left to right; but unfortunately, they had not been recorded.

The choice of the remedy, therefore, had to be made from the more general symptoms. The Repertory gave the following :

Testes tender. Adel., Arn., Asaf., Cimicif., Clem., Coloc. (right and left), Eriod. (left), Kali-bichr. (left), Kali-nitr., Merc.-iod.-rub. (right), Merc.-sol., Nitr.-ac., Ocim.

Testes swollen. Acon., Agn., Alum (left), Ant.-t., Apis, right, Loris, B, Are Bar mis, B), A, BeAr, Am. (also left), Canth., Carlsb., Cinchon., Clem., (also right), Con., Cop. (also left), Cub., Dig., Elaps., Graph. (also right), Indium. Iod. (also right), Jacar., Kali-brom., Kalr-c., Magnes-austr., Merc., Merc.-c., Merc.-sol., Merc.-sulph., Mezer (also left), Mill., Natr.-c., Nitr.-ac., Nux, Ocim. (also left), Ol.-an., Phos.-ac. (also left), Plumb., Podoph. (left), Psor., Puls. (also right), Rhod. (also left), Ruta (Selen.), Spong., Strychn. (left), Sulph., Tarent. (right), Tepl., Thuja, Zinc.

Testes hang down. Amm.-c., Arn. (in bed), Bell., Camph., Cinchon., Chinin.-s. (right), Clem. (also right), Croton (right), Gels., Hep., Iod., Lycop., Magn.-m., Nitr.-ac., Phos.ac., Puls., Sanic., Silic., Staph., Sulph. (also in bed), Sulph.ac., Tarent.

Shooting in the throat on swallowing. Alumen., Bar.-c., Boris, Bry., Calc., Cinchon., Cinch.-s., Chlorum., Clem., Con., Eleis., Gamb., Graph., Hep., Kali-c., Lach, Led. Lobel.-inft., Lycop., Nitr.-ac., Petr., Phos-ac., Plectr., Khus Silic., Stram., Sulph.

Swelling of the parotid gland. Ailanth., Amm.-c., Arsen., Aur., Bar.-c., Bell., Brom., Bry., Calc., Carb-an, Carb-v., Cham:, Cinchon., Cist., Cocc., Con., Dig., Dulc., Fagop., Graph., Hyos., Ign., Kali-c., Lach., Merc., Merc.-sol. (right), Nitr.-ac., Nux, Phosph., Plumb. (right), Puls., Rhus, Sant. (left), Sep. (also right), Silic., Sulph., Sulph.-ac., Sumb. (left), Viper.

This reduces the list to Nitr.-ac., which has five symptoms; and Cinchon., Clem., and Sulph., each of which has four. Of these four remedies, only Sulph. Has inflamed tonsils, thus limiting the choice to Nitr.-ac. And Sulph. The existing symptoms of the patient failed to differentiate further. Still, I selected the latter remedy, not only as being the principal antipsoric, but also because clinical experience has shown it to be one of the chief remedies for the effects of the suppression of symptoms. I gave one dose of Sulphur mm (F. C.); diet of milk and barley-water; and an enema of warm water.

Dec. 22nd.-The enema last evening removed some masses of feces like walnuts. Slept from midnight to 2 a.m.; otherwise, was restless and jerky. Testes are huge and tender. This morning seems brighter and less drowsy. Had an evacuation this morning, after which he felt faint and very weak. Tongue cleaning towards the tip. Temperature at 10 a.m. 103°. Pulse 120. 'l'eeth feel elongated, and as if they pressed into gums on biting on them. To take beef-tea.

Dec. 23rd.—Temperature yesterday at 8 p.m. was 101°4; at 8 a.m. today 98. Testes are much better. Brain quite clear, but still giddy. Has taken more food. Pulse 72. Slept well last night from 11.30 p.m. to 2.35 a.m.; afterwards, I'm a little, only pop in for a few minutes at a time.

Dec. 24th.—Temperature yesterday at 8 p.m. was 98•4; today at 8 a.m. 97•2. Testes are nearly well. No vertigo or teeth symptoms. Tongue cleaning. Mumps has subsided a lot. Temperature in the evening 97•4.

Dec. 26th.-On 25th, morning, temperature 97•2; evening, 98. This morning, 97. Testes a little swollen, but not tender. Tongue nearly clean. Stronger, and has partaken of the Christmas turkey. Still constipated, and has had to use an enema again.

Dec. 28th.-(Letter.) Patient is going on all right: temperature normal morning and evening; pulse perfect; appetite good, but bowels will not act.

Dec. 31st.-Was again telegraphed to visit him. Patient seemed quite well yesterday; bowels were regular for the last three days, and appetite was good. Two days ago, I was able to go downstairs. Today, about 11.30 a.m., he felt a sudden pain in his right testis, which made him feel faint and look white. The pain was as if it had been squeezed, and it had lasted ever into the inguinal canal. The testis looks rather red, but is not swollen. Mumps has quite subsided. Tongue natural. Temperature 98•2. Has gone back to bed on account of the severity of the pain. No exciting cause for this second attack could be discovered.

Diagnosis of the remedy.- The symptom "pain as if the testis had been squeezed "was not recorded in the Materia Medica, so I took the most analogous symptom.

Contractive pain in testis.—Alum., Berb., Bufo., Camph., Cinchon., Merc.-ac., Nux, Plumb., Scill., Silic. (left), Spong., Sulph., Thug.

Contractive pain in the spermatic cord.— Alum. (also right), Berb., Calc. (Chinin.s.), Kali-c., Nux, Teur.

This reduces the list to Alum., Berb., and Nux; and as Nux, alone of these three, has swelling of the parotid gland, I selected it as the simillimum, and gave one dose of Nux 50 m (F.C.) at 5.10 p.m.

Jan. 1, 1892.—Pain improved much after two or three hours. He had a good night, and this morning the pain is very slight.

Jan. 12th.- Reports that he has remained relatively well and went skating today.

April 12th.—Remains in good health.

Comments.—(1) This was undoubtedly a case of metastasis to the testes and brain, arising from exposure to cold. It illustrates in a marked degree the necessity for the use of the clinical thermometer, which, though it affords no special indication for the remedy, often records the existence of danger, which otherwise would be undetected till too late. The evidence of temperature afforded by the touch is never a reliable guide; I have seen cases where the thermometer did not show any very abnormal rise of temperature, though the skin was painfully hot to the touch; and, conversely, as in the present case, the touch sometimes shows but a faint indication of the existing fever.

(4) Though the fever was high, I did not give Aconite, for the all-sufficient reason that the totality of the symptoms did not indicate it. Probably, there is no remedy in our Materia Medica which has been more abused than this drug. It is often stated to be par excellence the remedy for fever, and even "the backbone of the Materia Medica"; hence, it has usually been improperly given for this symptom alone, irrespective of the remainder of the symptoms, for which, perhaps, some other remedy has been alternated with it. This practice is both unscientific and unsatisfactory. Almost every remedy in the Materia Medica produces some form of fever, and therefore, any one of these may be indicated where there is a rise of temperature. Aconite should only be given where the fever is characterized by Aconite symptoms (e.g., extreme restlessness, fear of death, & etc.); and these did not exist in the present case.

(3) Here again is shown the value of clinical symptoms to supply the deficiency of our provings. The transference of the disease from the left to the right testis has not yet been recorded, and if verified, will prove a characteristic symptom. Also, the pain from a pin in the right side of the throat on swallowing ought not to be overlooked, as it was a symptom of the attack. However, it had improved before the Sulphur was given.

(4) The necessity of always relying upon our Materia Medica and not being restricted to the list of medicines nosologically arranged in works on Therapeutics is also evident. Haue (Special Pathology and Therapeuties, 186%, p. 106) mentions sixteen remedies, including sulphur, under Parotitis; but he only mentions Carb.-veg. And Arsen. for metastasis to testes, and none for metastasis to brain, which latter phenomenon he ignores altogether. Guernsey, also (Obstetrics, 1879, p. 891), though he alludes to the metastasis to the brain, only mentions Bellad. as suitable to these cerebral conditions, and does not refer to Sulphur at all. As Hering used to say, " any disease may require any remedy," if the symptoms of the individual patient indicate it. As homeopathic physicians, we treat patients, not diseases.

(5) The mechanical, and therefore unscientific, manner in which some of our Repertories are arranged, is again exposed by a critical study of them about this case. Allen's Symptom Register (p. 870), under " Parotid Glands," gives" sensation as if mumps were coming on, Trif.-p."; but at p. 795, under " Mumps," he records, " sensation as if she would have mumps, Hydrophob." Thus, two identical symptoms are given under different rubrics, merely on account of a slight verbal difference of expression. The very best Repertory, both for arrangement and completeness, is Dr. E. J. Lee's Repertory of Characteristics.

(6) It may be noticed that after the unscientific treatment of the diphtheria by two strong medicines in alternation and a gargle, troublesome sequelo resulted. After homeopathic treatment, there should be no such sequela. 48, Sussex Gardens, Hyde Park, W.