– Douglas M.Borland.
THERE are two types of conditions that indicate Lachesis in abdominal disturbances. The more common is that of the chronic alcoholic; the other is the definitely septic abdomen, and it does not matter whether it is a septic appendix or a septic gall- bladder. The chronic alcoholic with Lachesis indications has certain constant factors. You always get the tremulousness, the congested dusky appearance, the choking sensation round the neck and the desire for air. These chronic alcoholics often complain of exceedingly cold legs and feet-a Lachesis indication-and this is often associated with a certain amount of oedema. As regards the mentality of these alcoholics, in the more acute stage you may find the typical Lachesis mentality in which they wander about from one subject to another, and have the difficulty in speech, hurry, impatience and suspicion which you associate with this drug. But much more commonly these patients are in a very phlegmatic, indolent, melancholy state. Like all chronic alcoholics, they have typical morning aggravation. They wake with nausea, general malaise and weakness, and they steadily improve as the day goes on, often being quite lively in the evenings. When they are feeling horribly heavy and morning after, they are liable to complain of an acute headache on getting up, about the root of the nose, with violent neuralgic pains spreading over the head. They usually complain of a gnawing sensation in the stomach, which is relieved by food. The way in which the Lachesis patient takes his food is sometimes of help-he simply gulps it down. As a rule, after one of these rushed meals, the patient feels horribly bloated and is liable to have violent attacks of belching. Commonly, the tongue is dry and red, although in the worst cases the tongue develops a brownish streak down the centre. Occasionally I have seen a Lachesis alcoholic with a coated tongue and a red streak down the centre, identical with the red streak one associates with Veratrum viride. Lachesis alcoholic gastritis patients have a definite craving for alcohol, and many of them have a craving for oysters- champagne and oysters is the diet of choice. And, of course, any alcohol aggravates their gastric distress. These patients are liable to have a typical alcoholic liver, with a good deal of general tenderness over the liver and an aggravation from any pressure; they cannot bear any tight clothing. Later, they frequently develop ascites. In these chronic alcoholics, it is not unlikely that you will find some albuminuria; and a tendency to develop early retinal hemorrhages, particularly in the left eye, with violent pain and a sensation as if the left eyeball were being squeezed. Frequently there are recurring attacks of very offensive, putrid smelling diarrhoea. That is one type of case. The other is the septic abdomen. And here you find the dry, brown tongue more marked than the red. There is likely to be acute thirst; also the thick, difficult speech one tends to associate with Lachesis; the difficulty in putting out the tongue, and the marked tremor. No matter where the sepsis is, whether in the gall-bladder or the appendix, it is always associated with a feeling of intense distension, and it is always accompanied by the most extreme tenderness these patients can hardly bear to be touched at all, even the least touch on examination being extremely painful. They complain that they feel as if all the abdominal contents were twisted up into a tight ball and something would burst. They tend to have rises of temperature round about 10 o’clock in the evening, and they always feel worse after they have been asleep; they waken feeling poisoned, very often with a violent headache, as if thoroughly drugged from head to foot. There is one interesting point about their appendix abscesses or any abscesses down in the right iliac fossa : during the attacks of violent pain, the pain starts in the caecal region and extends down into the thigh and through into the sacrum on the right side. In gall-bladder infections, they get exactly the same kind of pain, and it tends to spread across into the stomach, not so much through to the back. In these conditions, they have the same bloated, dusky appearance, the same of general heat, the same desire for air, the feeling that they are being stifled, and very often the same complaint of cold extremities. If there is any discharge-for instance, in an appendix case after operation-it is always very offensive, the abdominal wound shows no sign of healing at all, and there are dark, unhealthy sloughs, usually associated with a tendency to bleed.