Louisville, Ky.
POSSIBILITIES IN THE THERAPY OF NUX VOMICA.
(Second Paper.)
By E. Macfarlan, M. D.
Further clinical observations in the therapy of nux vomica have afforded me an accumulation of evidence of its efficacy in certain and hitherto untried affections of neurotic origin.
Case I.—Was called, about one year ago, to Mrs. McG., age, 36. Found she had just miscarried at about four months pregnancy. The fetus and placenta had been expelled, but owing to inefficiency of uterine contraction, there was profuse hemorrhage; consequently soon after my arrival I found I had to contend with not only hemorrhage, but a grave case of syncope. Her extremities became cold, and the heart-beat was scarcely perceptible; and surely the case was rapidly becoming one of heart-failure. Quick action was necessary, and I at once concluded to test nux vomica, and proceeded immediately to administer one drop doses of the tincture every five minutes. When the sixth dose had been given the radial pulse-wave could be felt, and the heart-beat distinctly heard. After five more doses the pulse was nearly normal; warmth of body was restored and she was able to converse. Hayden’s viburnum compound brought on good uterine contraction, and I succeeded in controlling the hemorrhage. In a few hours after the first dose of nux vomica I found my patient in such a comfortable condition of reaction that I left for home.
About six months afterward I was called in the early part of the evening to Mrs. McG., who believed she was again pregnant and threatened with miscarriage. She had pain in the back and profuse hemorrhage. I was getting good control of the hemorrhage when syncope set in, and on finding it was becoming protracted and her condition very similar to that for which I had used the nux vomica so successfully, I at once resorted to the same treatment and with the same satisfactory result.—But I must state, she was mistaken as to pregnancy. In the course of that night she passed a very large blood-clot which was the cause of her trouble; it evidently had been accumulating in the uterus through several menstrual periods.
Case II.—In the fall of 1892, I was called to Rose L., (colored), age, 20. Her symptoms at first were of indigestion and sluggish liver, and congested portal circulation; but on further investigation of the case I discovered considerable tenderness over the left ovary. On the third day of my attendance, contrary to my advice to remain in bed and keep quiet, feeling quite comfortable in the afternoon, and getting permission of her mother, she left her bed to sit in an adjoining room. In the early evening of that day I was sent for in haste to see Rose. I found her in a prolonged state of syncope, and her mother was greatly alarmed, fearful she would die. The patient’s pulse was small, weak and frequent, and counted 112; extremities cold; she was in a semi-conscious state, and when aroused would reply in a whispering voice, but immediately relapse into indifference to her surroundings. It seemed to approach so nearly to a case of heart-failure that I administered nux vomica in my usual way as to dosage and intervals, resulting within an hour in complete restoration of pulse, warmth of body and consciousness, and my patient became quite cheerful and talkative.
Case III.—C. M., age, 28, had an attack, of acute inflammatory metastatic rheumatism. In the third week of the attack and while the disease was yielding to treatment, he was attacked with an exceedingly troublesome cough, but as he had been confined to his room, and in fact to the bed, by the rheumatism during this time, I was puzzled to account for the cough. Then I began to observe more closely the character of the cough and expectoration. A careful auscultation did not reveal any bronchial inflammation. By closely questioning the patient I found the cough was paroxysmal, and commenced with an annoying tickling in the throat; the cough steadily increased in violence with the return of every paroxysm until it became exhausting, and the patient would feel quite prostrated after each attack. I found also, his most severe paroxysms came on within ten minutes after his evening meal. I accordingly timed my evening visit for observation. I was now satisfied—having watched a paroxysm from beginning to end, which lasted over 30 minutes—that the cough was laryngeal and neurotic.
On examining the sputa it was found glairy and tenacious, and not such as we find in inflammatory conditions of mucous membrane of the air passages. I had given him a mixture which included compound tinct. benzoin and codeine without effect, but now being convinced the affection was of neurotic origin, it occurred to me to make a trial of tincture nux vomica in my one-drop-five-minutes-dosage. I timed my call the next evening so as to be present when the paroxysm of cough commenced. My patient had just finished his evening meal, and we had been conversing hardly ten minutes when the cough set in and rapidly increased in violence, and then came my opportunity for the crucial trial of nux vomica in this case. When I had given the seventh one drop dose the paroxysm began to yield, and by the time we had given the tenth dose it was almost over, the patient having an occasional cough. My patient was very happy over the sudden and unexpected relief afforded by the medicine I had just given him in such small doses, and of course was curious to know what it was. He then told me, these hard paroxysms sometimes lasted up to midnight, and on one occasion it had lasted almost until morning. I left him drops to take in the night in case he should have another paroxysm.