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Tuesday, June 18, 2013

Gangrene of the lung

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Gangrene of the lung
 Gangrene of the lung (S. Mary Ives)
 Gangrene of the lung 
 Lachesis mutus 
 Case 

I was recently sent for in haste to come out in the country and see a woman with "lung fever." Obeying this hurried summons at 10:00 PM, I found my patient a little old woman, old and withered even for her seventy years; a face full of restless distrust and anxiety, and every movement characterized by sharp, short jerks. The history of the case was as follows: Has not been well for the last two years, a general failing in health. In November last she contracted a severe cold, and has coughed more or less ever since, expectorating "yellowish matter." Some two or three days previous to my visit she had taken a fresh cold due to sudden chilling after being overheated. Pain in the left chest developed which finally drove her to bed. A physician was summoned, and then another; the latter prescribed, but said it was useless to go on with the case as the woman could not get well at her age.
 It was then I was called and found my patient presenting the following picture: Lying in bed flat on the back, unable to lie on the left side; must lie on the back or right side, but any movement caused agonizing pain in left chest, causing her to scream aloud. Breathing quick and shallow; flapping of wings of nose. Cough causing distressing pain in left chest, between the third and fourth ribs -during cough she grasped that portion of the chest. Expectoration of mouthfuls of thick, yellow pus: in quantity, some three of four ounces in twenty-four hours. Sleepless, she had opiates. "Fever" every afternoon from 3-4pm, lasting until late in evening: throws all covers off and wants windows open. Intense restlessness during fever, throwing arms and legs about. Thirst "awful" -unquenchable.
 Upon making a physical examination, which was very difficult to make, as the patient strongly objected, an area of dullness was found over the site of acute pain. viz., between the third and fourth ribs on the left side and a few inches from the sternum. Percussion seemed very painful, and so a detailed examination was impossible. Prescribing upon this picture, I gave Lycopodium cm, one dose. The next morning she said she was better; had slept better; pain was decidedly less, cough and expectoration about the same. That afternoon the fever came at usual time, accompanied by restlessness, etc. and the following morning she complained of more pain again. Lycopodium cm was repeated. Day after day the case went on; sometime a little better and yet with a gradual decline in strength and increase of symptoms. The fever came faithfully each day, always sometime the late afternoon, 3-5pm.
 The restlessness grew worse, until it was something dreadful to behold; she would fling an arm here, then the other somewhere else, and off would go a leg in one direction and the other away off some other place: quick, sharp, darting movements, quick as a flash. The fever was of a continued type, its time of aggravation in afternoon and the pulse corresponded. She grew distressingly irritable, occasionally very angry: discarded me many times over; hated her nurse, distrusted her: distrusted me; refused absolutely to tell her symptoms when I questioned her; insisted on being kept informed as to her husband's doings; though really too weak to move her head from the pillow, if she heard a door open downstairs she would make an effort to raise herself up and strain every nerve to listen to what was going on. Kept close watch over things in the room: if a pillow was missing: "Where's my feather pillow: what have you done with it?" "How many table napkins have you got down stairs? Go fetch them and let me see," and so on, so suspicious and distrustful. All this time the cough kept on, expectoration profuse, of yellowish pus, which began to grow greenish in hue and to have a horribly offensive odor; was stringy and difficult to get rid of; the mouth became literally covered with aphthous patches: the tongue was glazed and parched; dry and shiny in the highest degree. She complained of a dreadful taste and awful soreness in the mouth. Sleeplessness worse before midnight. Breathing rapid. Refused absolutely to allow me to look at her chest, as she claimed that I "punched" her and made her much worse.
 During these three weeks I prescribed remedies as the case seemed to me to indicate them; Arsenicum, Phosphorus, and Pyrogen, but evidently my perception was at fault. Nothing touched her, until after a thorough re-study of the case, at a time when death seemed almost inevitable, Lachesis opened up before me, and I gave it in the cm. potency, one dose. It covered the suspicious disposition, the character of the restlessness, the darting, rapid movements, intense heat with intolerance of clothing, and demand for fresh air, the glazed tongue and aphthous mouth, and last, but not least, the suppurative process in the left chest with gangrenous character and peculiar characteristic expectoration; green and horribly offensive, actually putrid.
 I gave her the Lachesis and then came the tug of war. Away she went down into the very gate of death, but not to pass through, thanks be to our homoeopathy. Twelve hours after the administration of the remedy I was called early in the morning with the word that my patient was dying. I hastened to the house and found her supported in bed by her weeping husband and two somewhat terrified nurses. A violent coughing spell had aroused her, and with the gagging cough she was bringing up mouthfuls of the vilest stuff, green, putrid smelling pus; the stench was truly horrible, permeating the whole room. After this attack subsided she lay back in an exhausted faint. As consciousness returned she was given some nourishment, after which she went quietly off to sleep, and rested more peacefully than for days. Twelve hours later came just such another time when more of this stuff was ejected, and from that time on the patient made a rapid and uninterrupted recovery. In two weeks time she was sitting up in her room, sewing, could eat and sleep well and enjoy life generally. No cough, occasional expectoration of a whitish mucus.
 During the time of the recovery, some two weeks, the parotid glands became very much swollen, presenting an appearance of mumps; first the right side and then the left; as the left side commenced to swell the right-sided swelling commenced to decrease. As quickly as these glands showed signs of swelling the aphthous patches in the mouth began to clear up, the tongue grew moist and soft and the dreadful, unquenchable thirst became a horror of the past.
 At thirteen weeks since first seeing her, this patient was attending to all her household duties: caring for her garden, visiting her neighbors, etc., and proving herself as meddlesome an old lady as ever.
 Since the above case was reported, I have seen many evidences of the sound cure of this patient. It is a daily occurrence for her to walk two or three miles, and this oftentimes in inclement weather.
 -Dr. S. Mary Ives, Middletown CT,
 October 28, 1901
 Mary Ives was a pupil of Kent in Philadelphia in 1895. In 1946 she was still living and practicing in Middletown. 
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