– BENERJEE.P,

Diabetes and fistula 

 Case no. 7
 21. 3. 1916.
 Mr. -; age 36 or 37. Medium build; complexion fair; intelligent; was used to brain work. Had been suffering from fistula since 1907, and from diabetes since last year. The fistula was not giving much trouble, though he could feel that it was on account of the fistula that his health was gradually declining. He was, however, anxious for diabetes, and wanted some treatment for it.
 History:-
 When 25 or 26 years of age, the patient had a large number of boils mostly on his back towards the close of one summer. Now, these boils almost all of them passed off, but there was one close to the rectum, and it was not going away. Later on, it healed up, but it soon broke out again. This however continued for some time, and it healed up again, and so on several times. There was some pain in it and some pus when it used to break out. Gradually it resulted in a perpetually running abscess with continuous oozing. It was operated upon after a year or so, and the surgeon declared that it was not likely to be cured by operation, as it looked like running into a fistula. And it turned out to be so. No further operation was gone through, and it was continuing as before. Then, from 1915 (beginning of winter), the patient began to have an increase of urine. This was attended with constipation. The constipation continued or rather increased, so much so, that there was hardly a motion even after 7 or 8 days-not even on purgatives. And the urine increased still more.

 Present symptoms:-
 The fistula had a very small opening and the edges were hard. There was some pain, but the original sensitiveness was gone. There was a yellowish, bloody, awfully fetid smelling discharge from it, and the discharge was continuous. Though the opening was small, the whole area over an inch was very hard and raised. The spot seemed warm to the touch. The pain in the fistula used to increase after stool, and this aggravation lasted for a pretty long time. Worse in summer and winter, and comparatively better in rainy season. The pain was the same, whether the stool was hard or soft. Temper awfully irritable, and it used to be aggravated by noise. Fetid sweat in the hands and feet.
 There were not many symptoms about the diabetes. There was some thirst. The quantity and the number of urine were excessive, and it was awfully strong smelling. Could not tolerate milk. Could not tolerate cold but was not better from warmth.
 24. 3. 16. Nitric Acid-200, one dose every morning for 4 days continually and then placebo. No change even after fifteen days.

 8. 4. 16. Nitric Acid-500, one dose only, and after 7 or 8 days the urine seemed to have been reduced to some extent.
 26. 4. 16. Nitric Acid-1000, one dose only, and report was received after 10 days that the urine was still less and the patient mentally better. Placebo for 20 days.
 24. 5. 16. No further reduction in the number and quantity of urine. The smell was as strong as before. Nitric Acid-1,000 again.
 18. 6. 16. No change; one dose of Hepar Sulph.-200, and placebo for 20 days.
 3. 7. 16. No change; one dose of Nitric Acid-10m. and plenty of placebo.
 13. 7. 16. The urine had increased awfully; awful thirst. No medicine, but placebo for 15 days.
 26. 7. 16. Urine was almost normal. Placebo.
 18. 8. 16. No trouble about the urine. But the fistula was increasing. No medicine. Placebo for 2 months.
 15. 9. 16. No change about the fistula, and no trouble about urine. Placebo for 20 days.
 24. 9. 16. The urine had increased again and the fistula was painful. Nitric Acid-50m., one dose only, and placebo for 3 months.
 21. 12. 16. During the last three months, the fistula was painful twice only, and there was no trouble about the urine. The patient was unable to say when the smell in the urine and sweat had disappeared. The urine was perfectly normal, and the sweating of the hands and feet much less. Placebo.

 3. 2. 17. Better in all respects, but the fistula was not completely gone. Some burning in the hands and feet. Could not use any covering in those parts, even in the cold of February.
 16. 3. 17. The burning in the hands and feet was totally gone. But the fistula was painful and was oozing continually. The patient had grown impatient by now, and was despairing of cure. Nitric Acid-c. m. one dose only and placebo for 3 months.
 13. 4. 17. The fistula seemed to have healed up. On an examination with a magnifying glass, it however appeared that there was a slight opening yet, but there was no oozing of anything, while the hardened and raised surrounding was almost soft and smooth as normal.
 No more medicine had to be used.
 Remarks:-(1) Two quite different diseases were cured with the same medicine, but why?-If the selection is miasmatic, it is the patient that is cured, and if the patient is cured, all diseases or rather all disease-manifestations in him are bound to go.
 (2) The first symptom always goes away last, and the last symptom first. This must happen in a true course of cure, and it happened exactly in this case. The diabetes which came last went away first, and the fistula which came first went away last. This case nicely explains the law of-“Disappearance of symptoms in the reverse order of their coming”.

 (3) The patient in this case was Syco-Psoric, and the Sycotic element was predominant, and the use of Nitric Acid was as an Anti-Sycotic.
 (4) The fetid smell of the urine should not be mistaken for a local symptom. The smell was certainly due to the abnormal functions in the patient.

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