"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 vagina. 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 vagina, 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 Mitchell 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 quantity of milk repeated; massage for half an hour; on the 19th, milk as before; bread-and-butter and egg; massage for an hour and a half; twenty minims of dialyzed iron twice daily; on the 21st, a mutton-chop in addition to the above; massage an hour and fifty minutes. To-day she passed 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; massage 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 glasses 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 massage 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 patellæ half-way down the tibiæ, 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 appetite, 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, massage, 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 passed 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 glass 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.'
"Although the attempt to cure so aggravated a case as this was certainly a sufficiently severe test of the treatment, I determined to make the trial, and had the patient removed from her own home and isolated in lodgings. I found her in bed, supported everywhere by many small pillows, and wasted more than, I think, I had ever seen any human being. She really hardly had any covering to her bones, and looked somewhat like the picture of the living skeleton we are familiar with. It may give some idea of her emaciation if I state that, though naturally not a small woman, her height being five feet five and a half inches, she weighed only 4 st. 7 lbs., and I could easily make my thumb and forefinger meet round the thickest part of the calf of her leg. The curvature of the spine said to exist was a deceptive appearance, produced by her excessive leanness, and the consequent unnatural prominence of the spinous processes of the vertebræ. I could detect no organic disease of any kind. The appetite was entirely wanting, and she consumed hardly any food beyond a little milk, a few mouthfuls of bread, and the like. From the first the patient's improvement was steady and uniform. The way she put on flesh was marvellous, and one could almost see her fatten from day to day. Within ten days all her pains, neuralgia, and backache had gone, and have never been heard of since, and by that time we had also got rid of all her little pillows and other invalid appliances.