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veloped them with blood clots. At the greater curvature of the stomach was a large hematoma, conical, with broad base, simply extravasated blood. The aneurism itself was completely surrounded by fresh blood clots, and the cellular and fibrous tissues, connecting the tumor with the left kidney and surrounding that organ were so completely filled with fresh blood that the two had the appearance of one tumor eleven inches in its long diameter, and not until we had cut into the mass did we ascertain that it contained a kidney. The aneurism proper freed from all extraneous tissues had diameters of five inches one way by seven the other.
The aneurismal sac was thickly lined with irregular plates of fibrin. Some of these, one very large one, had become displaced in the process of washing the tumor and freeing it from the mass of fresh blood which surrounded it. Some fresh blood clots of considerable size were found between plates of fibrin, showing that they were not firmly adherent. It seems indeed strange that some pieces had not become dislodged and carried into the blood current during life.
KALI PHOS. IN NERVOUS DYSPEPSIA.*
By W. T. LAIRD, M.D.,
Watertown, N. Y.
LINICAL experience has shown that kali phos. frequently
proves curative in those cases of nervous dyspepsia in which anacardium is apparently indicated, but fails to relieve.
In many symptoms these two remedies are almost identical. Both have accumulation of gas in the abdomen, frequent eructations, and the same weak, gone, sinking feeling in the epigastrium, extending through to the spine. In both these symptoms occur as soon as the stomach is empty or partially empty, and in both the distress is relieved by eating. How then shall we distinguish between them?
In anacardium the symptoms recur with almost clock-like regularity, two hours after a meal; in kali phos., the interval may vary from one to three hours, but patients are not always close observers, and we can, therefore, place but little reliance upon this distinction. Neither can we depend upon the fact that anacardium has a more
* Read before the Homeopathic Medical Society of the State of New York, at Syracuse, 1898.
marked gastralgia than kali phos., for many of our worst dyspeptics never have any severe pain in the stomach.
Clinical experience has taught me to rely upon the following symptoms in making a differential diagnosis: Both the anacardium and the kali phos. patients have frequent aggravations or relapses; but in anacardium these are always due to dietetic errors, while the kali phos. patient is invariably worse after excitement or worry, no matter how rigid the diet may have been. In other words, the causes in the former are physical, in the latter, mental.
Again, the kali phos. patient is always decidedly nervous, and the more strongly the neurasthenic element is marked, the more surely is the remedy indicated.
A third important distinctive sign is the condition of the urine. Two years ago one of my patients drew attention to the fact that every outbreak of the gastric trouble was accompanied by a marked diminution in the quantity of urine, which had a milky appearance and deposited a thick, white sediment on standing. Chemical analysis showed that this deposit consisted of phosphates. Repeated observations have shown that this condition is invariably present in nervous dyspepsia when kali phos. is indicated.
The excess of phosphates varies greatly in different patients; in some instances it is so great that the urine is turbid, while in others it is so slight that it can be detected only by a careful chemical analysis.
Several other remedies beside anacardium may be regarded as analogous to kali phos.; kali. carb., natrum carb., natrum phos., phosphorus, sepia and sulphur resemble it in the weak, gone feeling in the stomach, while chelidonium, graphite, mezereum, natrum phos. and petroleum are similar in the temporary relief of the gastric trouble by eating, but in other respects these remedies differ so widely from kali phos. that no comparison is necessary.
The indications for this drug in nervous dyspepsia may be summed up in four lines:
A neurasthenic patient :
By WILLIAM LATHROP Love, M.D.,
Brooklyn, N. Y.
YSTERIA is a diseased state of the nervous system, evidenced
by an almost innumerable variety of symptoms, and characterized by increase, diminution or perversion of various nervous functions.
The Greek derivation of the word shows that the ancients considered that a disordered uterus was the cause of this trouble.
Later investigations, however, show that although symptoms may be brought on or increased by disease of the uterus or its appendages, that such disease is not essential, because men, as well as women, suffer from hysteria. Loomis says that anything which affects the emotions powerfully, such as fright, anger, jealousy, grief and disappointment, predisposes to its development, and secret nursing of imagined wrong or anxiety is especially liable to induce it. Sexual abuse, masturbation and premature cessation of ovulation are, at times, exciting causes of hysteria. Among savage nations and hardworking women it is unknown or rare. Occupation and position in life have much to do with its production.
It is intensified at the menstrual period—is more often found in single than in married women, and usually occurs between the ages of puberty and thirty years.
An impressionable nervous system predisposes hysteria. There are no pathological changes, consequently no morbid anatomy.
Professor Osler in defining it has adopted the definition of Möbius, namely: "A state in which ideas control the body and produce morbid changes in its functions."
It is impossible in most cases to date the commencement of the disease, because the onset is so insidious and the growth so gradual. An inherited neurotic temperament may be fostered in childhood by some predisposing cause or environment, and although the first decided symptoms, as paralysis or convulsions, may appear later in life, apparently on account of some trifling mental shock or bodily injury, the existence of the disease must date much farther back. The persistence of certain symptoms is a marked feature in some
*Read before the Homeopathic Medical Society of Kings.
cases; in others, the symptoms appear and disappear with great rapidity without reference to locality. Jolly divides the leading symptoms into disturbances of sensation, motion, circulation, secretion, excretion and of the mind. Hyperæthesia is one of the most constant symptoms incident to hysteria. When well marked, the lightest touch causes convulsive niovements. Circumscribed areas of anæsthesia, or of normal sensibility, may appear in the midst of a hyperæsthetic region.
Sensitive spots are often found over the vertebræ, on the neck, breast, abdomen, joints and elsewhere. Sensitiveness and pain in the ovarian region are often found, generally on the left side. Pressure over this region sometimes produces a convulsive attack, and again, continued and heavy pressure, cuts short such an attack when
The "hysterical joint,” which often occurs about the knee, wrist or ankle, is accompanied by pain, often swelling of the part and great sensitiveness, which disappears sometimes suddenly and spontaneously.
The senses of smell and taste may be abnormally acute, and violent emotions, likes and dislikes are greatly exaggerated. Pain in the skull, as though a nail were being driven into the head, known as clavus hystericus, is regarded by some as pathognomonic, al though it should be remembered that it is often found in neurasthenia and in allied nervous states.
Spasmodic contractions appear in almost every part of the muscular system. They may be limited to one muscle or set of muscles, or be widely spread, as in general hysterical convulsions. The contractions are sometimes tonic or continued, as in tetanus, or clonic, in which there are alternate involuntary contractions and re
Paralysis may attack any or all of the extremities, ap
hemiplegia or a paraplegia, and attacking single muscles or groups of muscles.
Variations in the peripheral circulation are frequent. Flushes are common, and congestion of the head is liable to co-exist with
I will invite your attention to the following case, which lately came under my notice. On November 12, 1897, I was called to see Miss mer, at which time the family had gone to their summer home in
laxations. pearing as a
Her family history was unobtainable, for, unknown to herself, she was an adopted daughter, her parents having died when she was
less than a year old. While never particularly robust, she had attended school and had played about as other children. For the last few months, however, she had appeared less lively, was at times irritable, and instead of being fond of outdoor sports, she preferred to sit around the house with members of her family, and to read and sew. Even at this, she easily tired, the appetite became less, and the color of her cheeks faded. The mother had ascribed these symptoms to the fact that she was growing so rapidly. The menstruation had always been regular, but it became less in amount. She had never had any pain, but always just before the period the neck became swollen and the throat sore. These symptoms, however, would disappear with the establishment of the flow.
On the day mentioned she had cramps in the legs, together with the above premonitory symptoms, and a severe frontal headache. The menstruation had not appeared, however, despite the use of the home remedies, gin, mustard foot bath, etc.
Upon inquiry I found that there was almost suppression of urine, the total amount passed per day being not over fzvi to fzx.
There was no bloating anywhere, and after examining the urine I could find nothing the matter with it, except that, of course, it was very much concentrated.
Tablespoonful doses of apocynum t. i. d. stimulated the kidneys, and in a few days the amount passed averaged a pint to a pint and a quart.
This was the only improvement for, within two days, she developed a nervous hacking cough, and shortly thereafter went into a condition of coma. The sleep was very heavy; she could not be aroused by calling or by pressure on any spot, or by sticking pins along the course of the ulnar nerve.
The breathing had a peculiar rasping sound, and the face and muscles of the body began to twitch convulsively.
This continued for a while; she tossed herself all around the bed, and I had to put gloves on her hands so that she could not scratch her face.
An unhappy delirium set in; she would cry and sob and call out; she seemed to have especial concern for her father, whom she saw in all sorts of perilous positions.
Suddenly, without any warning, the coma, delirium and convulsive twitchings ceased and the patient awoke, smiled and conversed intelligently, and had no knowledge whatever of the conditions that had so alarmed her family. These comatose states continued day after day, lasting all the way from a few minutes to twenty-four