CACHEXIÆ.
After what has been said in a preceding chapter of the tonic effects of electric baths, it would scarcely appear necessary to introduce the subject of cachexiæ. If I do so nevertheless, it is only to be afforded the opportunity of relating the following case, which possesses sufficient interest to render its introduction here desirable. The first portion of it has already been published (Med. Record, No 216), but to this I have to add what occurred subsequently.
Case XXXII.* Mercurio-syphilitic Cachexia.—Mr. L., aet. 27, had primary syphilis about four years ago. Subsequently had inveterate constitutional symptoms, for which he was under medical treatment both here and in Europe. When he had sojourned in the latter country some time, he was pronounced cured by his physicians. He married, and returned to this country in the fall of 1872. A few weeks after his return he fell into a gradual decline, which confined him to the house—and part of the time to bed—for eight months, during the latter portion of which he had discontinued all medical treatment. It was with difficulty that, assisted by his wife, he managed to reach my office. I found him terribly enfeebled; greatly emaciated; sallow complexion. He was much annoyed by rheumatic pains, which I considered specific. His condition was so exceedingly low, that I decided to postpone all medication until he should be stronger. I ordered galvano-faradic baths, i.e. the galvanic current in the bath as an eliminative, the faradic as a tonic. The first bath was taken on November 20th, 1873. For one month he took the baths, and nothing else. He was then so much stronger, that I felt justified in instituting a mild specific course of treatment, the baths being continued as theretofore. At the end of two months the patient was nearly as strong as ever, was able to resume his occupation, and had gained twenty-seven pounds in weight.
Thus far this case was published as above stated. For the sake of the interest attaching to it, I will now proceed to give its further history. Mr. L. remained to all appearances well until July, 1874, when he commenced to suffer from headache and constipation. On the 23d of August following, while I was absent from the city, he presented himself to the gentleman who attended to my practice during my absence, with paralysis of the external rectus muscle of the left eye. He also consulted a specialist, who pronounced the paralysis rheumatic. When I returned from the country he presented himself for treatment. I commenced a series of daily electric applications to the affected muscle, which failed to respond to the faradic current, but contracted very readily when the slowly interrupted galvanic current was employed. As I had strong suspicions that syphilis was at the bottom of the trouble, I also administered iodide of potassium in gradually increasing doses—not however until electrization and strychnia employed for some weeks had failed to do any good. The administration of the iodide met with no better success. The patient’s general health gradually declined. On October 22d, he complained of numbness in the left leg, which gradually increased, the leg at the same time becoming paretic, so that the patient required the aid of a cane for ordinary locomotion. His condition now became rapidly worse. His movements became ataxic. Anæsthesia of the bladder, paresis of this and the intestine, with obstinate constipation, loss of appetite, emaciation, etc., rapidly supervened. I suspected the development of gummata on the meninges of the brain and cord, and advised him to use the inunction cure, and to remain at home until he should be well. This, on account of the business losses which it involved, he was very much averse to doing. He consequently proposed a consultation with an eminent physician, which was had. This gentleman pronounced the case one of spinal (either multiple or posterior) sclerosis, and discarded the syphilitic theory. A consultation two days subsequently with another physician had a like result. In deference to the opinion of these gentlemen, I treated the patient in accordance with their diagnosis. This was in the second week of November. The patient became rapidly worse. He soon ceased to walk—he tumbled about. After six days’ treatment, considering his life in imminent danger, I reiterated my advice to institute the inunction cure, and the patient then acquiesced. Nov. 24th I ordered a drachm of Unguent Hydrarg. to be used every evening; I could not however prevail on the patient to remain at home during the treatment. He continued to grow worse. Nov. 26th he had complete retention from vesical paralysis, and sent for me at night to relieve him. Thenceforth until he got nearly well he was obliged to use the catheter regularly. A few days after this, fortunately for himself, he fell down as he was leaving a horse car, and sprained his ankle. I say fortunately, for this accident compelled him to remain at home. From this time he began to improve. December 2d I substituted for the ointment a twenty per cent solution of the oleate of mercury, of which he used a drachm morning and evening. The improvement from this day was exceedingly rapid. On the 4th of December he had regained control of the bladder. The constipation, which had been very obstinate, also began to yield. From this date he used the oleate only once daily, and discontinued it entirely on the 14th. On the 10th he had already resumed his avocation, and the same month absolutely danced at a ball. He took iodide of potassium for a time after his mercurial course. He has since been and is now in perfect health.