Part 8 (1/2)
Mrs. C. remained in bed in entire repose. She was fed, and rose only for the purpose of relieving the bladder or the r.e.c.t.u.m.
October 10.--Took one quart of milk in divided doses every two hours.
11th.--A cup of coffee on rising, and two quarts of milk given in divided portions every two hours. A pill of aloes every night, which answered for a few days.
12th to 15th.--Same diet. The dyspepsia by this time was relieved, and she slept without her habitual dose of chloral. The pint of raw soup was added in three portions on the 16th.
17th and 18th.--Same diet.
19th.--She took, on awaking at 7, coffee; at 7.30, a half-pint of milk; and the same at 10 A.M., 12 M., 2, 4, 6, 8, and 10 P.M. The soup at 11, 5, and 9.
23d.--She took for breakfast an egg and bread-and-b.u.t.ter; and two days later (25th) dinner was added, and also iron.
On the 28th this was the schedule:
On waking, coffee at 7. At 8, iron and malt. Breakfast, a chop, bread-and-b.u.t.ter; of milk, a tumbler and a half. At 11, soup. At 2, iron and malt. Dinner, closing with milk, one or two tumblers. The dinner consisted of anything she liked, and with it she took about six ounces of burgundy or dry champagne. At 4, soup. At 7, malt, iron, bread-and-b.u.t.ter, and usually some fruit, and commonly two gla.s.ses of milk. At 9, soup; and at 10 her aloe pill. At 12 M., ma.s.sage occupied an hour. At 4.30 P.M., electricity was used for an hour in the manner which I have described.
This heavy diet-list, reached in a few days by a woman who had been unable to digest with comfort the lightest meal, seemed certainly surprising. I have not given in full the amount of food eaten at meal-time. Small at first, it was increased rapidly owing to the patient's growing appet.i.te, and became in a few days three large meals.
It is necessary to see the result in one of these successful cases in order to credit it. Mrs. C. began to show gain in flesh about the face in the second week of treatment, and during her two months in bed rose in weight from ninety-six pounds to one hundred and thirty-six; nor was the gain in color less marked.
At the sixth week of treatment the soup was dropped, wine abandoned, the iron lessened one-half, the ma.s.sage and electricity used on alternate days, and the limbs exercised as I have described. The usual precautions as to rising and exercise were carefully attended to, and at the ninth week of treatment my patient took a drive. At this time all mechanical treatment ceased, the milk was reduced to a quart, the iron to five grains thrice a day, and the malt continued. At the sixth week I began to employ strychnia in doses of one-thirtieth of a grain thrice a day at meals, and this was kept up for several months, together with the iron and malt. The cure was complete and permanent; and its character may be tested by the fact that at the thirtieth day of rest in bed, and after five years of failure to menstruate, to her surprise she had a normal monthly flow. This continued with regularity until eighteen months later, when she became pregnant. The only drawback to her perfect use of all her functions lay in asthenopia, which lasted nearly a year after she left my care. Fatigue of vision for near work is a common condition of the cases I am now describing, and is apt to persist long after all other troubles have vanished. When there is no asthenopia I usually think well of the general chance of recovery; but in no case of feeble vision do I omit at some period of the treatment to have the optical apparatus of the eye looked at with care, because pure asthenopia, apart from all optical defects, is a somewhat rare symptom.
Neither am I always satisfied with the ophthalmologist's dictum that there is a defect so slight as to need no correction, being well aware, as I have elsewhere pointed out, that even minute ocular defects are competent mischief-makers when the brain becomes what I may permit myself, using the photographer's language, to call sensitized by disease.
The following ill.u.s.trations of success in this mode of treatment are taken from Dr. Playfair's book:[29]
”Early in October of last year I was asked to see a lady thirty-two years of age, with the following history. She had been married at the age of twenty-two, and since the birth of her last child had suffered much from various uterine troubles, described to me by her medical attendant as 'ulceration, perimetritis, and endometritis.' Shortly after the death of her husband, in 1876, these culminated in a pelvic abscess, which opened first through the bladder and afterwards through the v.a.g.i.n.a. Paralysis of the bladder immediately followed the appearance of pus in the urine, and from that time the urine was never spontaneously voided, and the catheter was always used. Soon after this she began to lose power in the right leg, and then in the left, until they both became completely paralyzed, so that she could not even move her toes, and lay on her back with her legs slightly drawn up, the muscles being much wasted. Towards the end of 1877, after some pain in the back of her neck and twitching of the muscles, she began to lose power in her left arm and in her neck, so that she lay absolutely immobile in bed, the only part of her body she was able to move at all being her right arm. Up to this time the pelvic abscess had continued to discharge through the v.a.g.i.n.a, and occasionally through the bladder, but it now ceased to do so, and there were no further symptoms referable to the uterine organs. Her general condition, however, remained unaltered, in spite of the most judicious medical treatment. She was seen, from time to time, by several of our most eminent consultants, all of whom recognized the probable hysterical character of her illness, but none of the remedies employed had any beneficial effect. There was almost total anorexia, the amount of food consumed was absurdly small, and the necessary consequence of this inability to take food, combined with four years in bed with paralysis of the greater part of the body, and the habitual use of chloral to induce sleep, had reduced a naturally fine woman to a mere shadow. In October, 1880, her medical attendant was good enough to bring her to London for the purpose of giving a fair trial to the Weir Mitch.e.l.l method of treatment, with the ready co-operation of herself and her friends, and she was conveyed on a couch slung from the roof of a saloon carriage, so as to avoid any jolt or jar, since the slightest movement caused much suffering. Two days after her arrival my friend Dr. Buzzard saw her with me, and, after a careful and prolonged electrical examination, came to the conclusion that contractility existed in all the affected muscles, and that the paralysis was purely functional. I could find no evidence in the pelvis of the abscess, the uterus being perfectly mobile, and apparently healthy. After a few days'
rest the treatment was commenced on October 16, the patient being isolated in lodgings with a nurse of my own choosing; and this was the only difficulty I had with her, since she naturally felt acutely the separation from the faithful attendant who had nursed her during her long illness. Her friends agreed not to have communication with her of any sort. It is needless to give the details of the treatment in this and the following cases. A mere abstract will suffice to indicate the rapid and satisfactory progress made.
”_October_ 16.--Twenty-two ounces of milk were taken, in divided doses, in twenty-four hours; on the 17th, fifty ounces of milk; on the 18th, the same quant.i.ty of milk repeated; ma.s.sage for half an hour; on the 19th, milk as before; bread-and-b.u.t.ter and egg; ma.s.sage for an hour and a half; twenty minims of dialyzed iron twice daily; on the 21st, a mutton-chop in addition to the above; ma.s.sage an hour and fifty minutes.
To-day she pa.s.sed water for the first time for four years, and the catheter was never again used. Chloral discontinued, and she slept naturally all night long. On the 23d, porridge and a gill of cream were added to her former diet; ma.s.sage three hours daily, and electricity for half an hour, and this was continued until the end of the treatment.
Maltine was now given twice daily.
”_October_ 30.--She is now consuming three full meals daily of fish, meat, vegetables, cream, and fruit, besides two quarts of milk and two gla.s.ses of burgundy. Considerable muscular power is returning in her limbs, which she can now move freely in bed.
”_November_ 6.--Sat in a chair for an hour. The ma.s.sage and electricity are being gradually discontinued, and the amount of food lessened.
”_November_ 17.--Walked down-stairs, and went out for a drive, and henceforth she went out daily in a Bath-chair. She has increased enormously in size, and looks an entirely different person from the wasted invalid of a few weeks ago.
”On November 26 she went to Brighton quite convalescent, and on December 11 came up of her own accord to see me, drove in a hansom to my house, and returned the same afternoon. She has since remained perfectly strong and well, and has resumed the duties of life and society.
”A somewhat curious phenomenon in this case, which I am unable to account for, was the formation on the anterior surface of the legs, extending from below the patellae half-way down the tibiae, of two large sacs of thin fluid, containing, I should say, each a pint or more, freely fluctuating, and quite painless. I left them alone, and they have spontaneously disappeared.”
”In May, 1880, I saw with Dr. Julius, of Hastings, an unmarried lady, aged thirty-one. Her history was that she had been in fairly good health until five years ago, when, during her mother's illness, she overtaxed her strength in nursing, since which time she has been a constant invalid, suffering from backache, bearing down, inability to walk, disordered menstruation, and the usual train of uterine symptoms. She used to get a little better on going to the sea-side, but soon became ill again, and in October, 1879, she was completely laid up. The least standing or walking brought on severe pain in her back and side, and she gave up the attempt, and had since remained entirely confined to her bed or sofa, suffering from constant nausea, complete loss of appet.i.te, and depending on chloral and morphia for relief. Many efforts had been made to break her of this habit, but in vain. Her medical attendant had recognized the existence of a retroflexion, but no pessary remained _in situ_ for more than a day or so, and he suspected that she herself pulled them out. I was unable to do more than confirm the diagnosis that had been made as to her local condition, but the pessary I introduced shared the fate of its predecessors, and she remained in the same condition,--in no way benefited by my visit. Things going on from bad to worse, Dr. Julius sent her to London for treatment in the early part of December. I now determined to try the effect of the method I am discussing, of which I knew nothing when I first saw her. It was commenced on December 11, and everything went on most favorably. A week after it was begun, when her attention was fully occupied with the diet, ma.s.sage, etc., I introduced a stem pessary, being tempted to try this instrument, which I rarely use, by the knowledge that she was at perfect rest, and that no form of Hodge had previously been retained. I do not think she ever knew she had it, and it remained _in situ_ for a month, when I removed it and inserted a Hodge, which was thenceforth kept in without any trouble. I may say that I do not think the retroflexion had much to do with her symptoms, except, doubtless, at the commencement of her illness, and she probably would have done quite as well without any local treatment. She rapidly gained flesh and strength, and very soon I entirely stopped both chloral and morphia, and she never seemed to miss them. On December 11, when the treatment was commenced, she weighed 5 st. 9 lbs. On January 20 she weighed 7 st. On January 25 she walked down-stairs, and went out for a drive, and from that time she went out twice daily. She complained of no pain of any kind, and, although she wore a Hodge, she did not seem to have any uterine symptoms. On February 1 she went to the sea-side, looking rosy, fat, and healthy, and has since returned to her home in the country, where she remains perfectly strong and well. A few days ago she came to town, a long railway journey, on purpose to announce to me her approaching marriage.”
”On September 10 a gentleman came to consult me on the case of his wife, in consequence of his attention having been directed to my former papers by a relative who is a well-known physician in London. He informed me that his wife was now fifty-five years of age, and that she had pa.s.sed ten years of her married life in India. At the age of thirty she was much weakened by several successive miscarriages, and then drifted into confirmed ill health. He wrote, on making an appointment, as follows: 'I will give you at once a short outline of her case. We have been married thirty-four years, of which the last twenty have been spent by her in bed or on the sofa. She is unable even to stand, and finds the pain in her back too great to admit of her sitting up. She is utterly without strength, of an intensely nervous temperament, and suffers incessantly from neuralgia. She has, moreover, an outward curvature of the spine.
There is not the slightest symptom of paralysis. Fortunately, she does not touch morphia, or any narcotic or stimulant, beyond a gla.s.s or two of wine in the day. That she has long been in a state of hysteria is the opinion of nearly all the many medical men who have seen her.'