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somewliat, from general debility. I therefore contented myself with prescribing tonics and anti-rheumatics, with apparently some benefit, as, at the expiration of two weeks, during which period I called to see hier several times, I found her symptoms so much improved that I ceased visiting her. It was not many days, however, until slie again required my services, and informed me that she was not so well, and complained more of weakness, but not so much of pain. She was at all times disposed to despondency, and particularly so during sickness, but appeared more so now than at any former time. I now made some slight changes in the treatment, still, lowever, continuing the tonics. I found the prominent rheumatic symptoms considerably improved since I had last seen her; but the symptoms of debility had increased. Upon calling again, I found no improvement, but, on the contrary, the case appeared to be assuming a more serious form, and I therefore instituted a searching investigation. When I last saw her, two days previously, her pulse beat about eighty-five per minute, but it was now increased to about a hundred, and indicated increased debility to a marked degree. The symptoms, generally, were now much aggravated. She complained incessantly of extreme weakness, weariness, faintness, vertigo, palpitation of the heart, etc., and completely exhausted the list of adjectives expressive of general debility and despondency. At this time she complained very little of pain in the extremities, but I found, upon examination, that her right thigh was considerably swollen, and, also, that there was a dark spot upon it, about the size of a hand, and resembling very much in appearance, a contusion; but she could recollect of having received po injury that could have caused it. Besides this large spot, which was situated at the inferior and posterior portion of the right thigh, almost within the flexure of the knee joint, I found, upon closer inspection, a number of smaller ecchymoses, several of which were quite distinct, but most of them first beginning to form, and but slightly discolored, somewhat elevated, firm, and of a nodular appear. ance. There were also a few of these petechia on the left extremity, but no large ones, and little, if any, swelling. These indications, in connection with the condition of the gums, left no doubt as to the true nature of the disease. The gums were purplish and spongy, with numerous small fungosities appearing, which increased to a very large size in a few days, and assumed a perfectly livid appearance, some of them arising above the crown of the teeth. From this time the symptoms increased in severity, and developed themselves very rapidly. The dyspnea became intense, at times amounting almost to suffocation, the petechial spots increased in
number and size, and did not now confine themselves to the lower extremities, but were to be found on different parts of the body, as well as on the upper extremities. The lower limbs became much swollen and cedematous, and the debility, at this stage, was excessive. The pulse arose in a few days to 140 per minute; the bowels became much constipated; the urine quite scanty, and, in fact, all the symptoms continued increasing in severity, for about a week after I became aware of the true nature of the case, when they began to decline, and in about two weeks from this time she was entirely well, with the exception of the usual debility resulting from a severe attack of this disease. As soon as I had fully made up my mind as regards the nature of the malady, I insisted, in the strongest terms, on the patient making a radical change in her diet, which, as before stated, was almost entirely devoid of vegetables. My efforts, however, in this direction, were not as successful as I could have desired, as I was at first unable to induce her to make use of more than part of a very small potato or onion at each meal, owing to the extreme, almost insane, prejudice which had possession of her mind upon this subject, whilst there was no reason on earth, except this prejudice, why she should not have made a full meal on this sort of food ; her appetite being good, and her digestive organs, considering the circumstances, in a rather remarkably healthy condition. By increasing the amount a little from day to day, and, after persevering in this manner for about a week, and perceiving no evil effects result therefrom, she allowed herself to be persuadel that she could endure the remedy, at least better than the disease. At the same time that I prescribed this diet, I also ordered lemonjuice, in the forın of lemonade, to be taken freely, and at regular intervals; but here, too, I was met by the most persistent opposi
Her prejudice here was, if possible, stronger than in the case of vegetables. She exclaimed, with tears in her eyes: “ That will surely kill me, as I never could use the least bit of lemon.” Finding, however, that I was inexorable in my demand, she ended the controversy by declaring: “I will take it, and, if it kills me, you will be responsible.” I assured her she need not give herself any uneasiness about that, as I would most willingly assume all such responsibility. She did not, however, enter into this determination with the resignation of a martyr, as she seemed to consider herself, for she partook of it, as of the vegetables, very sparingly indeed. I know she would have improved much more rapidly had she used the vegetables and lemons more freely, and, contrary to her expectations, no unfavorable indications arose from their use, but, on the contrary, she almost immediately began to improve.
A few days after commencing this treatment, I ordered 20 grs. of citrate of potassa, to be taken in solution, every six hours; with, I think, some benefit, but I believe the case would have progressed as favorably, and almost, if not quite, as rapidly, without it, if the diet and lemon-juice treatment, as prescribed, would have been strictly adhered to, as I am sure the whole trouble was caused by a want of proper diet, and I believe it would have been removed by supplying this want alone, but, as before stated, perhaps not quite so rapidly.
Except an occasional dose of mild cathartic medicine, and an astringent wash for the mouth, this was all the treatment the case required, until after the scorbutic symptoms disappeared, when I put her on tincture of chloride of iron, and sulphate of quinia, upon which she improved rapidly.
There was, besides the rarity of this disease, another cause, which tended to inspire me with the peculiar interest I felt in the case I have just related. It was the fact that during our late civil war, a severe epidemic of this disease prevailed in the “Army of the Potomac,” in the spring of 1862, during the memorable Peninsular campaign, which was marked by exposure and deprivation, those fruitful sources of this terrible malady, and I, being a medical officer, on duty in that portion of the army, was an interested witness of the scourge, and participated in the efforts which were made to combat it, but which were deplorably unavailing until there was a radical change made in our commissary supplies. We were powerless in the struggle. Our drugs were entirely inert so far as this disease was concerned. It marched right on to death. We fully appreciated our helplessness; the reality was terrible, and our apprehensions were truly fearful. The commissary department was entirely destitute of fresh vegetables, the season of their greatest scarcity was upon us, and the last year was particularly noted as one of extreme scarcity of this variety of productions, so that it was only with the greatest difficulty, and after weeks of delay, that we succeeded in procuring a small quantity of potatoes and cabbage, the beneficial effects of which were marvellous. Previous to this, the disease advanced with giant strides, to destruction and death, without the slightest apparent impediment to its advance: but now we became master of the situation, and, whilst our patients had been dropping off like fies before the chilly autumn frosts, that fatality now entirely ceased, and cases which were almost at death's door, and rapidly progressing in that direction, accompanied by symptoms of the most aggravated form, where the gangrened flesh was already dropping
from the bones, now suddenly and almost miraculously halted in their course, quickly began to improve, and eventually entirely recovered.
There is no disease to which humanity is subject that is more easily managed, and the treatment of which is more simple, when the proper prophylactic and antidotal remedies are at land; but without them, it is as furious as a hurricane, and as formidable as was the plague in Egypt.
A. J. HERR, M.D.
Mrs. Good, aged 19, well formed, of healthy parentage, in August, 1874, in company with another lady, took a drive; she was obliged to bear a part of the weight of the driver on her left leg, which made her very tired, and for the next seven days had considerable pain in her left leg. After the pain had entirely ceased, a small tumor manifested itself on the left labium, the size of a marble, but entirely free from pain, and thus it continued with but little inconvenience, for nine months, almost disappearing on menstruation, but after the flow, returning, and increasing a little in size, changing from the size of a marble to a shelled walnut, in these nine months. About April, 1875, she became pregnant, when the tumor began to grow more rapidly, but entirely free from pain until September 12, while away from home, she seated herself uncommonly hard upon a stone step, in a manner bruising the tumor, which gave her considerable pain, and after that, was never entirely free from pain. The tumor almost of a sudden gained an enormous size ; September 13, found her in bed, tongue coated, marked chills, fever, pulse 100, pain in her limbs and spine, with great thirst, tumor was hard, fixed, and of a dark appearance, measuring 5 inches by 3; fourteen days afterwards the tumor bad reached the enormous size of 92 inches long, 5ż wide, extending from the symphysis to the coccyx and almost entirely filling up the outlet of the pelvis; perceiving fluctuation at several points, I applied locally, collodion; constitutionally, iron ; quinia, ammon. mur.; continued this treatment for two weeks, the tumor gradually diminishing in size, until it decreased fully one-half; the patient was in good spirits, and nothing was dreamed of but a speedy recovery, when the tenesmic efforts of the bowels in a passage, in a manner acted upon the tumor, and in forty-eight hours it had almost regained its former size, and after that, nothing seemed to check its deatlrly progress. Soon an ulcer appeared at its anterior portion under the symphysis, out of which we took clotted blood ; later, one at the anus, presenting enlarged subcutaneous veins, thin,
undermined, and livid edges, with great elasticity, and a constant discharge from these foul ulcers of a sanguinolent nature, left no doubt of it being encephaloid cancer. But the most difficult question to solve was, how to deliver this woman who had already gone seven months in her pregnancy, as the outlet of her pelvis and up into her pelvis as far as the finger would reach, was filled with a cancerous mass; nothing seemed to answer but Cæsarean section, when labor set in, December 8. The os dilated, head rotated and came down, in a manner pushing the tumor before it, to almost the point of emerging; there it stuck; severe hemorrhage set in, from the marked compression of the tumor; immediate delivery had to be effected, or fatal hemorrhage would ensue; a most desperate attempt was made to apply the forceps, which was accomplished, and the child delivered, although lacerating the tumor in a frightful manner, almost with fatal hemorrhage. But fortunately it yielded ; from the time of delivery the case slowly but steadily kept progressing on its deathly road for about two months, when the suffering of the poor patient was ended by death; in the mean while numerous ulcers appeared all over the surface of the tumor, with large pieces sloughing out.
W. H. HARTZELL, M.D. ADAMSTOWN, LANCASTER Co., Pa.