Dietetics and Therapeutics (Continued) : Part 1

Fat and Blood
by S. Weir Mitchell, M.D.

(Page 9 of 14)

As additional illustrations 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, æt. 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 appetite 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, passing 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. Mitchell 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.

At 12 o'clock Mr. P.D. might be dressed, making as little personal effort as possible. The second goblet of milk and malt was administered, and a carriage took him to his office, where he might remain till two o'clock, when the carriage brought him for dinner, preceded by half a tumbler of iron-water. All walking was forbidden.

After dinner (which included a goblet of milk) the third goblet of milk and malt was swallowed; then a short drive might be taken, but by four o'clock the patient must be undressed and in bed.

At 6 P.M. the third dose of iron-water presented itself, and a light supper of fruit, bread-and-butter, and cream, followed by the fourth goblet of milk and malt. Two quarts of milk were thus swallowed every day in addition to all other food.

At 9 P.M., massage one hour, with cocoa-oil, followed by beef-soup, four ounces.

At the fourth week the soup was given up; dialyzed iron was substituted for all other forms. June 4, electricity was given up. The malt was continued until June 20.

May 6, Mr. D. weighed in heavy winter dress one hundred and twenty-five pounds; June 20, in the lightest summer garb, he weighed one hundred and thirty-three pounds; in August his weight rose to one hundred and forty pounds, and he has continued to gain. When last I saw him, a year later, he was strong and well, had no cough, and had ceased to be what he had been for years - a delicate man.

I am indebted to the late Professor Goodell for the following case, which I never saw, but which was carried on with every detail of my treatment. As the testimony of an admirable observer, it is valuable evidence. Professor Goodell writes as follows:

"Some four years ago, Mrs. Y., a very highly intelligent lady, from a neighboring city, came to consult me. She suffered dreadfully at each monthly period, and had constant ovarian pains and a wearying backache, which kept her on a lounge most of the day. She was also barren, and altogether in a pitiable condition. After a two months' treatment she returned home very much better, and soon after conceived. As pregnancy advanced, many of her old symptoms came back, but it was hoped that maternity would rid her of them. The shock of the labor, however, proved too great for her already shattered nervous system. She became far more wretched than before, and again sought my advice.

"At this time I found all her old pains and aches running riot. She got no relief from them night or day without large doses of chloral. The slightest exertion, such as sewing, writing, and reading for a few minutes, greatly wearied her. Even the simple mental effort of casting up the weekly housekeeping expenses of a very small household upset her, and she had to give it up. The act of walking one of our blocks, or of going down a short flight of stairs, or of riding for an hour in a well-padded carriage, gave her such 'unspeakable agony' - to use her own words - that she would have an hysterical attack of screams and tears. So emotional had this constant nerve-strain made her that she could not sustain an ordinary conversation without giving way to tears. Much of her time was spent in bed; in fact, she was practically bedridden.

About the Author

Silas Weir Mitchell was an American physician and writer. He studied at the University of Pennsylvania in that city, and received the degree of M.D. at Jefferson Medical College in 1850. During the Civil War he had charge of nervous injuries and maladies at Turners Lane Hospital, Philadelphia, and at the close of the war became a specialist in neurology.