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.'

"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 vertebrae. I could detect no organic disease of any kind. The appet.i.te 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.

"It may be of interest, as showing what this system is capable of, if I copy her food diary on the tenth day after the treatment was begun; and all this, this bedridden patient, who had lived on starvation diet for twenty years, not only consumed with relish, but perfectly a.s.similated.

"Six A.M.: ten ounces of raw meat soup. 7 A.M.: cup of black coffee. 8 A.M.: a plate of oatmeal porridge, with a gill of cream, a boiled egg, three slices of bread-and-b.u.t.ter, and cocoa. 11 A.M.: ten ounces of milk. 2 P.M.: half a pound of rump-steak, potatoes, cauliflower, a savory omelette, and ten ounces of milk. 4 P.M.: ten ounces of milk and three slices of bread-and-b.u.t.ter. 6 P.M.: a cup of gravy soup. 8 P.M.: a fried sole, roast mutton (three large slices), French beans, potatoes, stewed fruit and cream, and ten ounces of milk. 11 P.M.: ten ounces of raw meat soup.

"The same scale of diet was continued during the whole treatment, and, from first to last, never produced the slightest dyspeptic symptoms, and was consumed with relish and appet.i.te. At the end of six weeks from the day I first saw her she weighed 7 st. 8 lb.,--that is, a gain of 3 st. 1 lb. It will suffice to indicate her improvement if I say that in eight weeks from the commencement of treatment she was dressed, sitting up to meals, able to walk up and down stairs with an arm and a stick, and had also walked in the same way in the park. Considering how completely atrophied her muscles were from twenty years' entire disuse, this was much more than I had ventured to hope. She has now left with her nurse for Natal, and I have no doubt that she will return from her travels with her cure perfected."

"Early in August I was asked to see a lady, aged thirty-seven, with the following history:--'As a girl of sixteen she had a severe neuralgic illness, extending over months: excepting that, she seems to have enjoyed good health until her marriage. Soon after this she had a miscarriage, and then two subsequent pregnancies, accompanied by alb.u.minuria and the birth of dead children.' 'During gestation I was not surprised at all sorts of nervous affections, attributing them to uraemia.' The next pregnancy terminated in the birth of a living daughter, now nearly three years old; during it she had 'curious nervous symptoms,--_e.g._, her bed flying away with her, temporary blindness, and vaso-motor disturbances.' Subsequently she had several severe shocks from the death of near relatives, and gradually fell into the condition in which she was when I was consulted. This is difficult to describe, but it was one of confirmed illness of a marked neurotic type. Among other phenomena she had frequently-recurring attacks of fainting. 'These were not attacks of syncope, but of such general derangement of the balance of the circulation that cerebration was interfered with. She was deaf and blind; her face often flushed, sometimes deadly cold; her hands clay-cold, often blue, and difficult to warm with the most vigorous friction. These attacks pa.s.sed off in from twenty minutes to a couple of hours.' Soon 'the attacks became more frequent, with the reappearance of another old symptom,--acute tenderness of the spine, especially over the sacrum. Then came frequent and persistent attacks of sciatica, and gradual loss of strength.' About this time there appears to have been some uterine lesion, for a well-known gynaecologist went down to the country to see her. Eventually 'she became unable to do anything almost for herself, for the nervous irritability had distressingly increased.

To touch her bed, the ringing of a bell, sometimes the sound of a voice, sunlight, &c., affected her so as to make her almost cry out.' 'If she stood up, or even raised her hands to dress her hair, they immediately became blue and deadly cold, and she was done for.' Then followed palpitations of a distressing character, with loud blowing murmur, and pulse of 120 to 140, for which she was seen by an eminent physician, who diagnosed them to be caused by 'slight ventricular asynchronism, with atonic condition of the cardiac as well as of all other muscles of the body.' 'She has no appet.i.te whatever.' 'Any attempt at walking brings on sciatica. She cannot sit, because the tip of the spine is so sensitive; any pressure on it makes her feel faint. She cannot go in a carriage, because it jars every nerve in her body. She cannot lie on her back, because her whole spine is so tender.'

"When consulted about this lady, I gave it as my opinion that any attempt at cure was hopeless as long as she remained in the country house in which she lived. I was informed that it was absolutely impossible to get her away, as she could not bear the motion of any carriage, still less of a railway, without the most acute suffering.

Eventually the difficulty was got over by anaesthetizing her, when she was carried on a stretcher to the nearest railway station, and then brought over two hundred miles to London, being all the time more or less completely under the influence of the anaesthetic, administered by her medical attendant, who accompanied her. I found this lady's state fully justified the account given of her. She was intensely sensitive to all sounds and to touch. Merely laying the hand on the bed caused her to shrink, and she could not bear the lightest touch of the fingers on her spine or any part near it. She lay in a darkened room at the back of the house, to be away from the noise of the streets, which distressed her much. She was a naturally fine and highly-cultivated woman, greatly emaciated, with a dusky, sallow complexion, and dark rims round her eyes. I could find no evidence of organic disease of any kind. Whatever lesion of the uterine organs had previously existed had disappeared, and I therefore paid no attention to them. Within a week I had the patient lying in a bright sunlit room in the front of the house, with the windows open, and she complained no longer of the noise. Within ten days the whole spine could be rubbed freely from top to bottom, and from the first I directed the ma.s.seuse to be relentless in her manipulation of this part of the body. In a few weeks she had gained flesh largely, the dusky hue of her complexion had vanished, and she looked a different being. The only trouble complained of was sleeplessness, but it did not interfere with the satisfactory progress of the case, and no hypnotic was given. After the first few days we had no return of the nerve-crises which in the country had formed so characteristic a part of her illness.

Her hands and feet also, at first of a remarkable deadly coldness, soon became warm, and remained so. In five weeks she was able to sit up, and before the fifth week of treatment was completed I took her out for a drive through the streets in an open carriage for two hours, which she bore without the slightest inconvenience, and the result of which she thus described in a letter the same evening: 'I never enjoyed anything more in my life. I cannot describe my delight and my astonishment at being once more able to drive with comfort. My back has given me no trouble, and I was not really tired.' This lady has since remained perfectly well, and I need give no better proof of this than stating that she has started with her husband on a tour round the world, _via_ India, j.a.pan, and San Francisco, and that I have heard from her that she is thoroughly enjoying her travels."

"The last example with which I shall trespa.s.s on your patience I am tempted to relate because it is one of the most remarkable instances of the strange and multiform phenomena which neurotic disease may present, which it has ever been my lot to witness. The case must be well known to many members of the profession, since there is scarcely a consultant of eminence in the metropolis who has not seen her during the sixteen years her illness has lasted, besides many of the leading pract.i.tioners in the numerous health-resorts she has visited in the vain hope of benefit. My first acquaintance with this case is somewhat curious. About two months before I was introduced to the patient, chancing to be walking along the esplanade at Brighton with a medical friend, my attention was directed to a remarkable party at which every one was looking. The chief personage in it was a lady reclining at full length on a long couch, and being dragged along, looking the picture of misery, emaciated to the last degree, her head drawn back almost in a state of opisthotonos, her hands and arms clenched and contracted, her eyes fixed and staring at the sky. There was something in the whole procession that struck me as being typical of hysteria, and I laughingly remarked, 'I am sure I could cure that case if I could get her into my hands.' All I could learn at the time was that the patient came down to Brighton every autumn, and that my friend had seen her dragged along in the same way for ten or twelve years. On January 14 of this year, I was asked to meet my friend Dr. Behrend in consultation, and at once recognized the patient as the lady whom I had seen at Brighton. It would be tedious to relate all the neurotic symptoms this patient had exhibited since 1864, when she was first attacked with paralysis of the left arm. Among them--and I quote these from the full notes furnished by Dr.

Behrend--were complete paraplegia, left hemiplegia, complete hysterical amaurosis, but from this she had recovered in 1868. For all these years she had been practically confined to her bed or couch, and had not pa.s.sed urine spontaneously for sixteen years. Among other symptoms, I find noted 'awful suffering in spine, head, and eyes,' requiring the use of chloral and morphia in large doses. 'For many years she has had convulsive attacks of two distinct types, which are obviously of the character of hystero-epilepsy.' The following are the brief notes of the condition in which I found her, which I made in my case-book on the day of my first visit. 'I found the patient lying on an invalid couch, her left arm paralyzed and rigidly contracted, strapped to her body to keep it in position. She was groaning loudly at intervals of a few seconds, from severe pain in her back. When I attempted to shake her right hand, she begged me not to touch her, as it would throw her into a convulsion. She is said to have had epilepsy as a child. She has now many times daily, frequently as often as twice in an hour, both during the day and night, attacks of sudden and absolute unconsciousness, from which she recovers with general convulsive movements of the face and body. She had one of these during my visit, and it had all the appearance of an epileptic paroxysm. The left arm and both legs are paralyzed, and devoid of sensation. She takes hardly any food, and is terribly emaciated. She is naturally a clever woman, highly educated, but, of late, her memory and intellectual powers are said to be failing.'

"It was determined that an attempt should be made to cure this case, and she was removed to the Home Hospital in Fitzroy Square. She was so ill, and shrieked and groaned so much, on the first night of her admission, that next day I was told that no one in the house had been able to sleep, and I was informed that it would be impossible for her to remain.

Between 3 P.M. and 11.30 P.M. she had had nine violent convulsive paroxysms of an epileptiform character, lasting, on an average, five minutes. At 11.30 she became absolutely unconscious, and remained so until 2.30 A.M., her attendant thinking she was dying. Next day she was quieter, and from that time her progress was steady and uniform. On the fourth day she pa.s.sed urine spontaneously, and the catheter was never again used. In six weeks she was out driving and walking; and within two months she went on a sea-voyage to the Cape, looking and feeling perfectly well. When there, her nurse, who accompanied her, had a severe illness, through which her ex-patient nursed her most a.s.siduously. She has since remained, and is at this moment, in robust health, joining with pleasure in society, walking many miles daily, and without a trace of the illnesses which rendered her existence a burden to herself and her friends.

"In conclusion, I may remark that it seems to me that the chief value of this systematic treatment, which is capable of producing such remarkable results, is that it appeals, not to one, but many influences of a curative character. Every one knew, in a vague sort of way, that if an hysterical patient be removed from her morbid surroundings a great step towards cure is made. Few, however, took the trouble to carry this knowledge into practical action; and when they did so they relied on this alone, combined with moral suasion. Now, I am thoroughly convinced that very few cases of hysteria can be preached into health. Judicious moral management can do much; but I believe that very few hysterical women are conscious impostors; and the great efficacy of the Weir Mitch.e.l.l method seems to me to depend on the combination of agencies which, by restoring to a healthy state a weakened and diseased nervous system, cures the patient in spite of herself."

CHAPTER IX.

DIETETICS AND THERAPEUTICS--(CONTINUED).

As additional ill.u.s.trations I shall now state a few cases of my own, without entering into minute details of treatment.

The following case is reported by Dr. John Keating, who watched it with care throughout:

P.D., male, aet. 53, after more than thirty years of close attention to business, which severely tried both mental and physical endurance, found himself, in January, 1877, at the close of some months of gradually increasing feebleness, absolutely unable to fulfil his usual duties, and the most alarming symptoms manifested themselves. There was a remarkable loss of nervous and muscular force; his limbs refused their support; his appet.i.te failed; the recollection of ordinary phrases involved distinct and painful effort; sleep became unattainable, except under the influence of powerful narcotics, and even that brief slumber was rendered valueless by the incessant convulsive twitching of the muscles.

His physician prescribed iron and strychnia; ordered an immediate abandonment of all business, and instant departure to a point where telegraph-wires were unknown and mails infrequent. He went at once to the Bahamas, pa.s.sing a month in that delicious climate in absolute inaction; more than another month was consumed in slowly returning; but, though some flesh had been gained, there was only a trifling improvement in the nervous condition.

May 1, 1877, Dr. Mitch.e.l.l examined Mr. P.D. The patient was sallow and emaciated, and coughed every few moments. He had night-sweats, nervous twitching, and slight dulness on percussion at the apex of the right lung, with prolonged expiration and roughened inspiration, and some increase of vocal resonance.

Mr. P.D. was allowed to be out of bed once a day four hours, and to spend one hour at his place of business. The treatment was as follows:

At 6 A.M., a tumbler of strong, hot beef-tea, made from the Australian extract.

At 8 A.M., half a tumbler of iron-water, and breakfast, consisting of fruit, steak, potatoes, coffee, and a goblet of milk. At 8.30 A.M., a goblet of milk mixed with a dessertspoonful of Loefland's extract of malt, with six grains of citrate of iron and quinine.

At 10 o'clock Dr. Keating administered the electricity.