Mrs. P., æt. 45, weight one hundred and ninety pounds, height five feet four and a half inches, had for some years been feeble, unable to walk without panting, or to move rapidly even a few steps. Although always stout, her great increase of flesh had followed an attack of typhoid fever four years before. Her appearance was strikingly suggestive of anæmia.
She was subject to constant attacks of acid dyspepsia, was said to be unable to bear iron in any form, and had not menstruated for seven months. She had no uterine disease, and was not pregnant. Two years before I saw her she had been made very ill owing to an attempt to reduce her flesh by too rapid Banting, and since then, although not a gross or large eater, she had steadily gained in weight, and as steadily in discomfort.
She was kept in bed for five weeks. Massage was used at first once daily, and after a fortnight twice a day, while milk was given, and in a week made the exclusive diet. Her average of loss for thirty days was a pound a day, and the diet was varied by the addition of broths after the third week, so as to keep the reduction within safe limits. Her pulse at first was 90 to 100 in the morning, and at night 80 to 95, her temperature being always a half degree to a degree below the normal. At the third week the latter was as is usual in health, and the pulse had fallen to 80 in the morning, and 80 to 90 at night.
After two weeks I gave her the lactate of iron every three hours in full doses. In the fourth week additions were made to her diet-list, and Swedish movements were added to the massage, which was applied but once a day; and during the fifth week she began to sit up and move about. At the seventh week her pulse was 70 to 80, her temperature natural, and her blood-globules much increased in number. Her weight had now fallen to one hundred and forty-five pounds, and her appearance had decidedly improved. She left me after three and a half months, able to walk with comfort three miles. She has lived, of course, with care ever since, but writes me now, after two years, that she is a well and vigorous woman. Her periodical flow came back five months after her treatment began, and she has since had a child.
Early in the spring of 1876, Mrs. C., æt. 40, came under my care with partial hysterical paralysis of the right and hemi-anæsthesia of the left side. She had no power to feel pain or to distinguish heat from cold in the left leg and arm, though the sense of touch was perfect. The long strain of great mental suffering had left her in this state and rendered her somewhat emotional. Her appetite was fair, but she was strangely white, and weighed one hundred and sixty-three pounds, with a height of five feet five inches. As she had had endless treatment by iron, change of air, and the like, I did not care to repeat what had already failed. She was therefore put at rest, and treated with milk, slowly lessened in amount. Her stomach-troubles, which had been very annoying, disappeared, and when the milk fell to three pints she began to lose flesh. With a quart of milk a day she lost half a pound daily, and in two weeks her weight fell to one hundred and forty pounds. She was then placed on the full treatment which I shall hereafter describe. The weight returned slowly, and with it she became quite ruddy, while her flesh lost altogether its flabby character. I never saw a more striking result.
I have been careful to speak at length of these fat anæmic cases, because, while rare, they have been, to me at least, among the most difficult to manage of all the curable anæmias, and because with the plan described I have been almost as successful as I could desire.
Let us now suppose that we have to deal with a person of another and different type,—one of the larger class of feeble, thin-blooded, neurasthenic or hysterical women. Let us presume that every ordinary and easily attainable means of relief has been utterly exhausted, for not otherwise do I consider it reasonable to use so extreme a treatment as the one we are now to consider. Inevitably, if it be a woman long ill and long treated, we shall have to settle the question of uterine therapeutics. A careful examination is made, and we learn that there is decided displacement. In this case it is well to correct it at once and to let the uterine treatment go on with the general treatment. If there be bad lacerations of the womb or perineum, their surgical relief may await a change in the general status of health,—say at the fourth or fifth week. If there be only congestive or other morbid states of the womb or ovaries, they are best left to be aided by the general gain in health; but in this as in every other stage of this treatment it is unwise, and undesirable therefore, to lay down too absolute laws. Having satisfied ourselves as to these points, and that rest, etc., is needful, we begin treatment, if possible, at the close of a menstrual period, because usually the monthly flow is a time at which there is little or no gain, and by starting our treatment when it is just over we save a week of time in bed.
The next step is, usually, to get her by degrees on a milk diet, which has two advantages. It enables us to know precisely the amount of food taken, and to regulate it easily; and it nearly always dismisses, as by magic, all the dyspeptic conditions. If the case be an old one, I rarely omit the milk; but, although I begin with three or four ounces every two hours, I increase it in a few days up to two quarts, given in divided doses every three hours. If a cup of coffee given without sugar on awaking does not regulate the bowels, I add a small amount of watery extract of aloes at bedtime; or if the constipation be obstinate, I give thrice a day one-quarter of a grain of watery extract of aloes with two grains of dried ox-gall. I find the simple milk diet a great aid towards getting rid of chloral, bromides, and morphia, all of which I usually am able to lay aside during the first week of treatment.[27] Nor is it less easy with the same means to enable the patient to give up stimulus; and I may add that in the treatment of the congested stomach of the habitual hard drinker the milk treatment is of admirable efficacy. As I have spoken over and over of the use of stimulus by nervous women, I should be careful to explain that anything like great excess on the part of women of the upper classes, in this country at least, is, in my opinion, extremely rare, and that when I speak of the habit of stimulation I mean only that nervous women are apt to be taught to take wine or whiskey daily, to an extent that does not affect visibly their appearance or demeanor.
Meanwhile, the mechanical treatment is steadily pursued, and within four days to a week, when the stomach has become comfortable, I order the patient to take also a light breakfast. A day or two later she is given a mutton-chop as a mid-day dinner, and again in a day or two she has added bread-and-butter thrice a day; within ten days I am commonly able to allow three full meals daily, as well as three or four pints of milk, which are given at or after meals, in place of water.
After ten days I order also two to four ounces of fluid malt extract before each meal. The fluid malt extracts which now reach us from Germany have become less trustworthy than they formerly were. Some of them keep badly, and are uncertain in composition, one bottle being good, another bad. The more constant, and at the same time most agreeable, extracts are those now made in this country. Although their diastasic powers are usually less than is claimed for them, and vary greatly even in the best makes, they so far have seemed to me on the whole more satisfactory than the imported malts. It is very desirable that a thorough chemical study should be made of the various malt extracts, solid and liquid. I am sure that some of them are defective in composition, or vary notably as to the amount of alcohol they contain.