Ammonium Carbonicum
to account for this sudden shutting off of so large a portion of the pulmonary air-current. Against a developing pneumonia, there was not at any time a rise of temperature, yet this is often absent in the aged. There was, on the contrary, a prolonged chilliness. As to any purely circulatory cause, this patient was arteriosclerotic and there was a very weak heart action, with more or less dyspnea on exertion, and the general circulation was very feeble. Whatever the cause, we must rule out edema of the lungs, owing to the fact that the occlusion was not located at the base of the lung and was not bilateral and, furthermore, there was no kidney involvement, and not sufficient myocardial degeneration to account for it – and auscultation did not disclose a sufficient liquid rale.
To corroborate the pneumonic theory, there was dullness in this area for a period of about five days, with extreme weakness, a badly coated tongue and abdominal distension. Of course, not very diagnostic symptoms of pneumonia, but even with the absence of the characteristic sputum and fever and the presence of extended dullness would exclude the latter.
What was I to do? Neither remedy had, in the least, relieved, and the patient resigned herself to the inevitable. In Gatchell’s Pocket Book I had read the indications for Ammonium carbonicum [in rather crude doses] in edema of the lungs and, having witnessed the death of a patient with double pneumonia from this complication, although never having used the remedy, the symptoms before me brought it to my mind. The indications there given are these: "Feeble heart’s action; cyanosis, drowsiness; great accumulation of serous fluid in the lungs, which the patient is too feeble to expectorate." I had read, too, its indication in Guernsey’s Key Notes as follows: "Often there is much rattling, as of large bubbles in the chest; chest feels faint, it is tiresome to breathe, …"
It was with gratification, therefore, after prescribing it, and especially in the 200th potency, that I found, on returning to my office, the following corroboration in The Guiding Symptoms: "Sputa thin, foamy; adynamic state, with rattling of large bubbles in the chest. Bronchitis in the aged." I had also a vague recollection of reading something on this remedy in THE MEDICAL CENTURY, and it is only now, as I write, that I have been prompted to look it up; when I find, to my gratification, in the very article I had in mind, this verification of its symptomatology. From "Ammonium Salts," an article on Materia Medica Studies, by A. Leight Monroe, M.D., Fla. – "In these small spheres don’t forget the ammonium salts. They belong distinctly with the venous hyperemias. There is not so much a venous stasis present as a lack of declaration of the blood." An old friend, a wonderful practitioner, now dead, Dr. Lucy of Kentucky, used to say, "Don’t forget Ammonium carbonicum in all ’carbonate’ conditions. This blue surface may also be associated with the expectoration of ’blue’ mucus. Ammonium carbonicum should be associated with Antimonium tartaricum, especially in the treatment of capillary and senile bronchitis. Also with Ipecacuanha, Stannum, Lycopodium and Carbo vegetabilis. Often succeeding like magic, where these others all fail." Here then, was an exact reproduction of the symptoms before me: Carbo vegetabilis and antimony had both failed.
As to the patient: In despair, almost, I sought in my case of infinitesimals for the remedy, but a few darkened pellets remained – themselves almost carbonized, as it were, from long contact with the thin cork. The precious supply was dissolved in a