Brief Contributed Articles
ARTHUR V. LYON, M. D., BROCKTON, MASS.
In these days, when from experiments on the lower animals, cactus is pronounced absolutely inert, it may be interesting to ask if in the following case it had any value or not.
L. J. F. 54 years old. Ice cream manufacturer; married; well nourished; habits excellent; family history negative; past history uneventful. Consulted me at the office for difficulty in breathing, which had been increasing for some six weeks. Pulse was 140, of fair character. Appetite fair; no evidence of digestive disturbance. Examination of chest: lungs negative; heart, apex in mammary line—no murmurs. Abdomen, negative. Urine, large quantity, s. g. 1010. Solids, normal, no albumen or sugar; phosphates increased; urea practically normal; no casts.
Diagnosis: Dilated heart and tachycardia.
Treatment: He was advised to rest, to have a simple diet, and keep the bowels well open. He was given aconitine gr. 1/134 every 2 hours. Strychnia 1/60 gr. four times a day. He was asked to report in a week. At the end of the week he reported, and no improvement was manifest, but he confessed that he had kept at work, doing all he could, reasonably. The aconitine was replaced by sparteine, and the strychnia was increased to gr. 1/50 at a dose. At the end of another week he reported again without improvement, and I insisted that he must give up and rest, or I should not treat the case farther. This was January 25, 1907. He concluded to change physicians, and placed himself under the care of a colleague, who treated him largely with tinct. digitalis and infusion of digitalis with an iron preparation. On March 8th I was called to his home. He was now taking rest as a matter of necessity. He was unable to lie down, and his feet and legs were swollen up to his body. The heart was in much worse condition than when last seen—apex beat in sixth interspace two inches outside the mammary line, and as a result presumably of the dilatation there was incompetence of both mitral and aortic valves. Pulse was very rapid and could not be counted at the wrist. By auscultation it varied from 150 to 160, and was very weak. There was marked pulmonary oedema. The prognosis was very grave. An ice bag was ordered over the heart. He was placed on strychnia sulph. gr. 1/30, every 3 hours, strophanthin gr. 1/134 and digitalin gr. 1/67, every 2 hours. Later caffeine gr. 1/6 and convallamarin gr. 1/3 were used to replace the former combination. He grew worse rapidly, marked ascites developed, and he could rest only in a perfectly upright position. The end seemed near. Sleep and relief for his great distress were secured only by hypodermic of morphine and atropine.
At this time, while desperately looking for something which might promise better than the treatment used so far, I recalled, cactus, a remedy I had used in a few cases of functional heart trouble with satisfactory results. On March 22nd, deciding that at least cactus could do no harm, and that he was going to die anyway, I stopped all other medicine, and ordered three drops Merrell's tincture cactus, every two hours. Inside of twenty-four hours his condition began to improve. He had had but 1/4 gr; morphine, his dyspnea was less severe, the pulse was countable at the wrist. Within another twenty-four hours improvement was marked.
To make a long story short, from that time his improvement was rapid and steady. He went back to work, avoiding heavy lifting, and severe exertion of all kinds, and is as well subjectively as he ever was, although he has grown very fleshy, which discommodes him some. His heart shows evidence of compensatory hypertrophy, but beats regularly. The murmurs are very slight.
The question is thus raised, what did it? Was it a miracle, for such would a change like that, occurring spontaneously, appear to me, when I consider the outcome in comparison with many cases in a similar condition; or, was it cactus? Satisfactory results from its continued use, although in less desperate cases, since then, have left me still choosing as the one best in this case— cactus.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.