ARGENTUM NITRICUM IN CHOREA By Dr. Gross, in Regensburg
The clinical cases which I here publish are not sufficiently explained by the proving of Nitrate of Silver, and this remedy may, therefore, fail to find justification in the eyes of the strict Homoeopaths for being applied in chorea. No special indications are given in the symptom register not even approximate as in Stramonium, Zincum, Hyosciamus, Cocculus, Nux vomica, Calcarea carb. And many others, but depressions and irritations of the motor nerves are plentifully recorded, and that lunar caustic has a direct action on the nerve centres, cannot be gainsayed, and may be read between the lines in our Materia Medica.
These clinical cases will show that I usually hesitated for a considerable time before giving Argentum nitricum, for the reason that being unable to physiologically explain the symptoms, I was forced to consult the Materia Medica, lest I should stray into promiscuous generalising and fail to cure, as do the more rational of our adversaries, and yet is so happened that an Allopathic cure brought about in the family of a friend by minute almost Homoeopathic doses, drew my attention to and incited me to the study of this drug.
That Allopaths cure chorea with Nitrate of Silver, is an old story. But I am sorry to say that I am as little able, as the cultivators of rationality, to give the reason why, or to describe the special form chorea which, according to our severe as well as indispensable rules, justify the exhibition of Argentum.nitr.
The following nosographs therefore make no pretence to scientific Homoeopath city; they simply relate facts and empirical cures, and I thought they would be of use in inciting to investigation:
CASE 1- Theresa G.aet. 6 ½ , a robust girl always had been healthy, when two months ago the first indications of chorea began to be manifested, which were treated without success Allopathically by anthelmintics. When I saw the child, on May 2d, I also was impressed with a suspicion of helminthiasis, and the whole symptom complex pointed to Mercurius. I accordingly gave Mercur. Sol. H. 6, a few globules mornings and evenings, and on the 9th day, three lumbrici and a considerable quantity of whitish-yellow tough mucus was discharged. After that, I waited some time without giving medicine. No more worms or mucus were discharged, and the chorea continued unabated. On the thirteenth day of my treatment, I gave China 3, twice a day a few pellets, and again mucus evacuation without worms occurred, I gave Calcarea carb., still hoping that with the total extinction of the deranged digestion, which made possible the creation of worms, the chorea would abate and cease; three weeks later, during which time Calcarea carb. 18th in globules, had been given at first once a day, then every third day, I had succeeded in doing away with the sour smell of the mouth, the attacks of colic and the bloated abdomen, but the chorea remained same as forty days before when I commenced treatment. On June 9th I find the following chorea symptoms recorded in my journal:
Persistent swaying of the body while walking or sitting, as if the spinal column were unable to support the body; there is passive falling of thee head from one side to the other; tearing in the arms, jerking the arms outward and upward; uncertainty of the hands; the child must make several attempts before being able to grasp anything with its hands or fingers; its food has to be put into its mouth. Similar jerking in the lower as in the upper thighs and of the feet; to tread securely is impossible. The walk is by starts a heavy laborious stamping, and she often falls to the floor; can only walk with support with manifold flinging of the lower extremities. Speech is indistinct; she rolls her tongue for several minutes in the mouth before succeeding in uttering a word. All other functions are in order, sleep is normal, and the ailment appears with awaking.
Ordination:- Argentum nitr.4, one grain daily, dry on the tongue. On the third day thee spasmodic motions of the throat and muscles of the tongue have ceased, the jerking of the extremities have moderated. The head obeys the will, speech is normal; four days later the child was able to eat by itself, though with exertion. From June 24th on, I gave Argentum nitr. 12, in pellets, one dose every third day, and by July 1st her feet felt so secure that she walked in the street alone.
On July 22nd the forty-third of the Argentum nitr. Treatment, and the eighty-third of the whole treatment, I was able to dismiss her, cured.
CASE 2- On December 28th a girl aet. 4 was brought by its mother. It’s was a strong child, looking quite blooming. The mother held it fast in her arms, for it could neither walk nor stand. It twisted and writhed and struggled violently, as if suffering most violent pains. The spasms in the muscles of the tongue, in the larynx and trachea, were especially violent. The little patient breathed with difficulty and irregularly, and having at the same time a catarrh of the bronchia, she seemed to suffocate for want of breath. The oblique muscles of the eyes were in full activity which, with a recurring spasm of the miserecti of the eye. Gave her an indescribably sinister expression. The very red face seemed to indicate an active congestion of the brain. But the heart, the pulse and carotids negative the supposition. For over two weeks this condition obtained, and there was not even a remission during sleep. If the nurse absented herself for a few minutes she would beat her hands and ankles against the sides of her little cot, injuring them.
Otherwise all organic functions were in order. Chorea continuing during sleep is, according to my experience, a bad symptom, and forebodes an unfavourable prognostication.
I prescribed, on December 28th, Argentum nitr. 4th trit. two grains vigorously shaken up in a vial with pellets. Of these pellets I gave a few every six hours. The first night the girl slept without the muscular spasm, and on awaking was able to eat, breathing tranquilly, for the spasmodic condition of the tongue, throat and windpipe had abated.
The rump and the extremities quieted down by January 9th to 20th, so that this attack of minor chorea was cured within twelve days from commencement of treatment.
CASE 3- Lisette G. aet. 2, of scrofulous constitution, flabby muscles, very well nourished, of gentle disposition, were troubled by chorea symptoms in consequence of a fright, since over eight months. During the whole time this girl suffered with jerks and sudden tearing in the arms and fingers, in consequence of which she had been frequently punished on account of poor penmanship and want of proficiency in fancy work. Her folks frequently remonstrated with her on account of uncanny movements while walking on the street, especially because of needless turnings of the body, for the muscles of the back and neck seem to have been implicated for a considerable time. The layman cannot differentiate in such cases between a bad habit and sickness. On January 12th the girl suffered a second fright. She was knocked down by a runaway horse, and remained prostrate and unconscious. Recovering after a few minutes, she was able to walk, but her face was distorted by frightful convulsions and she beat about her with her arms. When brought to bed she began to nod with her head and to throw it back. She made inarticulate noises and stamped with her feet. Her face was reddened, eyes injected, wild looks. Had violent palpitation of the heart; pulse is hard, beats over 100.
An examination of the whole body failed to disclose any injury, or even a trace of a contusion. Aconite 3d quieted the arterial system, but the chorea broke out on the second day in a fearful manner. The whole motor nervous system seemed to be implicated; the hundred and one diverse movements mock description. The child twisted herself in bed, cowered together into a ball, and in the next moment propelled herself to a horizontal position and bent backwards until her head touched her feet. She flung her extremities together and apart with incredible force; she tore the bedding and the clothing of her two nurses, who had to watch her day and night. After three to five hours of such turmoil, quite conscious all the while, she would have a deep swooning sleep for half an hour. At night she slept from four to six hours, and awoke refreshed to a renewal of her affliction. The trembling of her tongue and incessant motion of the muscles of deglutition, and the powerful and irregular expansions and contractions, afforded patient but little time to drink water of beef tea in small quantities, and she suffered with thirst and demanded to eat.
I tried to quiet patient by giving Opium, 3d trit., every three hours, a small powder dry on the tongue, but with no effect at all. After that the choice lay between Stramonium. Belladonna and Hyosciamus, and I concluded to give the last. Hyosciamus 12th for the first day, and the 3d on the second day, one to two drops every four hours, had no effect to speak of. The motion grew less violent, but insufficient nourishment and exhaustion may have been the cause of that.
To alleviate this misery, I commenced, on January 18th, to give Argentum nitr. 2d trit., two grains every six hours, and observed to my joy, that with the fourth dose the tongue became quiet, and the next day the region in and around the neck became more quiet; the head only made slow, simple nodding movements; patient drank without obstacle, and swallowed soup proffered in a spoon by watching a favourable moment of cessation of the spasms, but she could not take soup in long draughts without interruption a sign that the will was beginning to in flounce the motor nerve. The muscles of the rump and of the extremities retained their incessant action until the 5th day of the action of lunar caustic.
From the 22d of January, it was no longer necessary to have a nurse watch the child uninterruptedly. She would writhe and struggle and bend herself, then sit up in bed in a certain rhythmical slow tempo. She ate and drank in the midst of these movements, biding her time. Her speech was altogether indistinct and inarticulate. The other function proceeded normally. Patient now received mornings and evenings Argentum nitr. 4, one-grain doses, and for the next ten days made very satisfactory progress in convalescence. But about this time she experienced a violent shock, a fancied slight, an untimely threat, which seemed to have the effect of a fright, caused a bad relapse.
All symptoms and motions recurred with most intense and increased activity, and all this was accompanied by such intense cutting and burning colic, with diarrhoea and nausea; that I was forced to interpolate Colocynth. The stomach and intestinal symptoms subsided in a few hours, and on the day following we could go back to Argentum nitr. 4, which was given every six hours.
From February 3d, recovery made unexpectedly rapid strides First the motor nerves of the tongue subsided, then those of the throat external and inner, then those of the rump, and lastly those of the extremities; and on February 14th the child was entirely restored to health, on the twenty-eighth day of the medication with Argentum nitr., and on the thirty-eighth of the total treatment.
CASE 4- Margaret L. aet. 16, had chorea for over 2 ½ years. During the whole first year the jerks of the extremities and of the muscles of the rump occurred isolated; at home and at school the symptoms were looked upon as a bad habit, and she was accordingly admonished. After that time there occurred distortion of the face, and one-sided contraction of the muscles of the back, so that while sitting or walking, she was bent in a semi-circle. About this time her disposition became strikingly downcast and her character stubborn. She also had attacks of violent toothaches and tic douleureux.
Not until then was a physician (Allopathic) consulted, who treated her for a year and a half without success. The chorea assumed frightful proportions, and the prosopalgia held pace in the aggravation. The physician declared the case to be incurable, but held out a hope that the advent of catamenia might bring a turn for the better.
I saw the patient first on November 11th. She lay in bed; was very emaciated, face pallid, bearing the impress of a deep seated affliction. The eyes were dim; devoid of expression as if idiotic. The head turned and rocked on the rump in a circular motion; the mouth moved as if masticating, and with the tongue she made a loud, smacking noise. The spine bent in all directions, and the extremities executed hundreds of movements with great force. The uninterrupted agility of the muscles necessitated a close watch night and day; there was a constant danger of the patient being propelled out of bed. The wall was protected by a mattress, because she had beaten her hands and ankles sore already. At night she would sleep quiet for a few minutes to half an hour, very seldom for a few hours at a time, but with the moment of awakening the movements recommenced. Eating and drinking, as well as the least mental disturbance or the presence of strange persons in the sick room aggravated her condition.
The organs of respiration as well as those of digestion were undisturbed; the menses were absent. With all this, patient’s mind was very dejected; she wept a good deal, thought herself neglected, and at night she was much pestered by visions; she saw dead persons and ghosts, which made her tremble and perspire with apprehension, and she would only quiet down in a measure if her mother laid down with her in bed, embraced her as close as possible, and loudly spoke soothing words to her. The prosopalgia which had lasted for eighteen months, proceeded from the last two apparently healthy molars of the left lower Jaw, and extended to the left eye. The paroxysms exacerbated to delirium and downright desperation; they were aggravated by touch, by warm food and by noise. It appeared regularly at dusk every Evening, and in two or three attacks before midnight. At the same time the chorea rose to the highest pitch, so that even with the best of care she could not altogether be protected from contusions.
I was in hopes of being able, by curing the prosopalgia, to exert a beneficent influence on the chorea. The former ameliorated within about three weeks by the exhibition of Phosphorus and Hyosciamus, but it took Ignatia to heal it altogether by December 14th, or within thirty-four days of the treatment, a cure which lacks the city.
But my hopes were disappointed; the toothache and neuralgia had disappeared entirely, but the chorea steadily increased in intensity. It was a case of major chorea, with visions exaltations, hallucinations, with intermissions and paroxysms, the latter appearing on the minute. After midnight was the relatively quietest time.
A strong suspicion of worms, i.e., of ascribes, which had been seen at times some months back in the stool. Induced me to lose a week in giving Spigetia, Variana and Cina. No worms were passed, and the chorea steadily progressed. Finally I resorted to Argentum nitr., which twice had done me good service, but which I was loth to prescribe because it had so few of the symptoms of this disease.
On January 9th I gave one powder containing one grain of 3d trit., to be given every forenoon at 10 o’clock, dry on the tongue.
It was high time. Loss of appetite, sobbing, fever and a serious decrease in strength supervened, with dullness bordering on idiocy.
In the night, from the 9th to the 10th, patient slept from midnight until late in the morning without having had any of the evening and pre-midnight attacks. The visions and hallucinations ceased with that night. On the third day a decided improvement was perceptible also in the muscular spasms. On February 2d the patient for the first time left her bed and was able to sit on a chair, somewhat insecure, for the limbs still made erratic movements. But month, throat and rump were remarkably quiet, and she was able to walk with support.
With a tranquil mind, healthy appetite and especially quiet sleep, she soon regained her strength. With the beginning of March the menses appeared copiously and without trouble.
Patient sat and took walks without attendants and help, with only isolated jerks such as she had thirty months before. Argentum nitr. Was given in the 4th to 6th trit., and in the 12th dilution at greater intervals, and by the 4th of May the girl had entirely recovered her health after having been treated by me for twenty-six weeks, and after having been under the influence of lunar caustic for sixteen weeks. Chorea is a disease that frequently ceases of its own accord. Reputed cures of chorea are of times of little value, and only such can be claimed as being scientific cures in which, after the specificum has been found, a favourable impression is made within a few hours or, at most, a few days after administering the medicine even though the prognosis was an unfavourable one.