A. G. VANCE, M. D., SOMERSET, IND.
I would like to have a diagnosis and if possible some suggestions as to treatment in the following interesting case. I believe this case presents some unusual features, which may be useful in a similar case.
The patient is a boy eight years of age, of about the average size, with dark hair and gray eyes. On the day of his birth he had several spasms, and on the fourth day he had spasms every hour. From that time until he was four years old he had an occasional spasm, perhaps as often as one every three months. It was soon observed that if he had a movement from the bowels or if he passed his urine freely during a spasm, the spasm would almost immediately cease. The urine passed at this time had the color of milk.
After his fourth year, the convulsions became less, and during the past four years, he has had only a few, and in each case there was a large, free involuntary movement of the bowels.
When he was three months old an opacity appeared on both of his eyes, and he was entirely blind until he had passed his fourth year, when the film began to disappear very slowly and his sight gradually returned. Now there is only a small opaque spot on each pupil, and I think that will gradually clear up.
A peculiar feature of this condition is that the boy takes pleasure in lying on his back, and looking straight at the sun. He will do this by the hour, letting the sun shine directly in full strength into his eyes. The stronger and brighter it is, the better he likes it. At times he will take a glass that will reflect the strong rays of the sun and throw the light with that into his eyes. This gives him comfort and satisfaction, and though but a child, he claims that it helps his eyes. He is a very restless child, and is never still only when asleep. He sleeps flat upon his back and when awake he keeps his legs moving all the time.
Before a convulsion appears and during its continuance he suffers from severe pain in the stomach and bowels. It is a common thing for him to be very white around the mouth with a bright red spot on each cheek. His breath smells badly nearly all the time. He has been chronically constipated. He passes long strings of white mucus from the bowels, and sometimes there will be nearly a half pint of that which is apparently mucus and pus. He has had piles. He desires to eat constantly. He lies in the cradle most of the time, and when awake he makes a little crooning noise. His body is very poorly nourished, his feet are always cold and he takes cold easily. His voice has a distinct nasal twang.
This patient has been in the hands of many physicians with but little or no benefit. He has just come under my care. The general catarrhal condition is to me a conspicuous symptom.
COMMENT:—While there are structural changes in this case, that may yet need surgical interference, there are a number of clearly defined symptomic indications which can certainly be treated with medicine with great benefit to the patient. In the first place the entire gastrointestinal tract should be mildly but thoroughly irrigated. The colon should be irrigated at least every second day, the patient should have a rigid diet assigned to him, should eat with perfect regularity, and at first should take some simple form of digestive with everything he eats. It would be an excellent plan to give him a small quantity of glycozone before his meals, and to continue this for a period of three or four weeks if no untoward results appear. It must be seen to, also, that the patient takes but very little salt and especially that no inordinate desire for salt occurs.
After a period of three or four days of this treatment I should give the child one-fourth of a grain of santonin every three hours thoroughly triturated with sugar and milk.
At the same time he should have three grains of the bromide of strontium four or five times a day for a considerable period. He should receive a nerve sedative of some kind for two or three months, but this sedative might vary. The monobromate of camphor could be given for some time and gelsemium when the cheeks were red and the pupils contracted. In proper time a nerve tonic should be advised which contains phosphorus or the phosphates. The patient should not take too many medicines at once, it is better to give one at a time, always continuing, or changing in accordance with the exact indications. There is no doubt that medical treatment would be of great service to this patient. Small doses of jaborandi will help clear up the corneal opacity. It will also soothe the irritability of the mucous membranes, and improve the action of the skin, thus ridding the system of toxines.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.