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exertion, or going up stairs. Toward night the legs swelled. The pulse was one hundred.
On the 7th of April, this 'woman appeared before the consultation of the medical officers of the dispensary. I believe that none of these gentlemen had any doubts with regard to the nature of the case. She has, during the course of the treatment, repeatedly been examined by them. The reports, which were drawn up at each examination, I shall subjoin to my own account of the case.
With regard to the medicines that she has used, I may say here, once for all, that it has been necessary to employ opiates pretty freely, from the beginning of her treatment to the present time, both to relieve the pain and procure sleep ; this last has been effected very imperfectly. Saturnine lotions have been useful to prevent the inflammation, and excoriation of the discharge. Aperients (principally sulphate of magnesia) were also at first necessary, but in a few months ceased to be requisite. She has taken also a few other medicines, occasionally, but as they had no marked influence on her complaints, I need not trouble the reader with an account of them.
She consented to give the regimen a fair trial, and entered upon it on the 10th of February, 1813.
I also advised her particularly to use as much fruit as possible. As the strength was radically impaired, I recommended her to be sparing of exercise, but rather to use considerably a horizontal posture.
For more than half a year very little ground was gained. The muscular strength diminished, and the pains continued to be very severe. But the pulse was reduced in frequency: it became habitually about eighty in the minute; the discharge became less offensive, and, apparently, less acrimonious.
In August, 1813, she had a considerable respite from pain, which continued for three weeks. But it then recurred with great severity; but still, though the paroxysms were as frequent as during the former part of the year, she found that the severity of them was upon the whole sensibly diminished. The respiration became rather stronger. With the pains, the discharge (which had been checked) returned; it was green and foetid.
In the middle of December, the discharge nearly ceased, and the pain likewise. What she now principally complained of was an almost total want of sleep, and of appetite, with great lowness of spirits.
During the ensuing half year, the symptoms of cancer were more completely got under. In the middle of April, 1814, the relief was very great. In June, the pain was quite gone, and the discharge was very trifling. In August she was discharged, principally at her own request, with all the symptoms of carcinoma subdued. The general state of the health, too, was considerably improved.
But in the October following, she again became a patient. The pain had returned with severity, having been brought on, apparently, by the approach of the cold weather. It was again attended with some trifling discharge. This aggravation of the disease was, however, of short continuance. In four or five weeks it was removed, and she again was restored to her habitual state of a cessation from pain, almost complete, and the discharge stopped, except, perhaps, in a quantity so small as to be hardly perceptible, and as to be no inconvenience.
The present state of this, considered as a local disease, is very nearly as has been just described. Habitually she is without pain or discharge. But she has occasional attacks, which last a few days, or a week. They are severe enough to break her rest, and give her uneasiness; but not enough to cause confinement, or to prevent her doing the work of her house. The last of these attacks was in the middle of February of the present year.
The proper symptoms of carcinoma, then, the pain and the discharge have been subdued and kept under by this treatment. The account to be given of the general state of the constitution, though not so satisfactory as the effect upon the local disease, has been still sufficiently encouraging.
In fact, the chief complaints, now for about fourteen months, have been much less regarding the original symptom of the disease than the general state of the health. Want of appetite, the sleep disturbed by tumultuous dreams, and sometimes wholly interrupted; want of breath, lowness of spirits, general debility, aching, and lassitude, have been the principal subjects of complaint. Upon the whole, however, the health has sensibly improved; so that she is, at present, considerably better than she was a twelvemonth ago.
The pulse continues calm, heing commonly about eighty in the minute. The respiration is still not strong, but it has mended. The appetite remains bad. The sleep is disturbed, but upon the whole it is more calm than formerly. The muscular strength is a little improved ; the spirits are better; there is more cheerfulness and animation in the countenance.
I think it right to add that, except from the use of opium, what she has found the greatest benefit and comfort from has been the unrestricted use of fruit and recent vegetables, as radishes, etc. When she has been able to use any other sustenance, the stomach would receive willingly something of this nature; and at night, when the tongue and fauces were dry and clammy, chewing some fruit was found to be the most certain and pleasant resource.
When we consider the deplorable, and hitherto desperate nature of this disease, that when affecting the internal organs, it must be deemed a more advanced stage of the complaint than a state of scirrhus in an external gland, this account will, I hope, be deemed as satisfactory as can be reasonably expected. The conclusions to be drawn from the facts stated are the very same as those which flowed from those related under Case XIIL of this work. If I therefore repeat them, I trust that the importance of the subject will be deemed a sufficient apologv. It follows then from this statement—
1st. That this disease was evidently carcinoma. Its history, at the first examination, made this sufficiently evident.
2d. That the disease continues to be carcinoma at this time. The same symptoms" which at the beginning authorized us to give it this designation, still recur, but with a much inferior degree of severity. The effect of the treatment then has not been, strictly speaking, to cure the disease, but to control and mitigate the symptoms.
3d. But by the regimen, life itself has been preserved* It will not be disputed, I suppose, that even a twelvemonth is as much as, under the common habits of life, a case of uterine cancer might be expected to last. Two years must be, indisputably, beyond all probability. But five-and-twenty months hare now elapsed, and the patient is not only alive, but in a state of improved health.
4th. The disease has made no local progress. On the contrary, the symptoms have been all soothed and tranquilized.
5th. The ulcerative process has been wholly superseded.
6th. I may add that the facts of this case may be applied to the treatment of dropsy as well as to that of the cancer. There was, when she first became a patient of the dispensary, some anasarcous swelling of the iegs, as I have noted. This continued nearly in the same state for the first year, or year and a half. It is now nearly, if not entirely gone. The flow of urine has throughout continued very copious.
I need hardly say how much encouragement the result of this case gives to those afflicted with external cancerous tumors to adopt this mode of dieting. For here was every sign of a radically impaired and enfeebled constitution; the appetite greatly injured, the breath bad, the legs swelling, the strength declining; in fine, all the great and important functions imperfectly performed, though there was no breach of substance, nor any apparent great local disorganization. How absurd then (by the way) is it to say that this disease is in its origin local. But we know that many persons with true cancerous tumors enjoy, even for years, a relatively good state of health; most undoubtedly, infinitely better than the subject of this report. I should hope, therefore, that gradually they may be made sensible of what is most proper to enable them to pass the remaining term of life with as much ease and comfort as their situation renders admissible.
It remains only to add to this account the reports of the case taken at the Consultation Committee at the dispensary.
Present at the Consultation Committee, 7th April, 1813, Dr. Clutterbuck, Dr. Birkbeck, Dr. Lambe, Mr. Vaux, and Mr. Norris.
Mrs. A. R., aged forty-two, has complained since June last of severe shooting pains at the lower part of the abdomen, with a great discharge of foetid acrid matter; there likewise exists considerable tenderness of the hypogastric region, with difficulty of making water. For upward of five years, the catamenia have not occurred, but pain and hardness of the breasts have been frequently noticed. The bowels are regular, but the evacuations are attended with pain, and the discharge of clots of blood. Within the vagina no swelling can be perceived, but the uterus has descended. She has employed opium with temporary alleviation of the symptoms, and other medicines without any benefit.
August 4th, 1812.—Present, Dr. Clutterbuck, Dr. Lambe, and Mr. Vaux.
Mrs. A. R. asserts that the pains are aggravated, but the discharge is less in quantity and less foetid at present; such variations, however, she states are not unusual. The lower extremities are become anasarcous. Her rest is now much interrupted. The pulse is generally about eighty in the minute, with frequent intermissions; a circumstance also noticed about two months since. Sumat Hydrosulph. Ammonia gtt. vj. ter in die sensim dosim augendo. _
February 2d, 1814.—Present, Dr. Clutterbuck, Dr. Birkbeck, Dr. Lambe Mr. Vaux, and Mr. Young.
Mrs. A. R. states tbat the pains are much easier, though she still obtains but little rest. The discharge, which is less than formerly, is yellow and without blood. The hydrosulphuret was soon discontinued, and cort. cinchonas taken, which is directed to be discontinued."
August 3d, 1814.—Present, Dr. Clutterbuck, Dr. Birkbeck, Dr. Lambe, and Mr. Vaux.
Mrs. A. R. now reports herself to be much improved. There is not any discharge, and but little pain. She has chiefly used opium, with a vegetable diet and distilled water.
February 1st, 1815.—Present, Dr. Clutterbuck, Dr. Birkbeck, Dr. Lambe, Mr. Vaux, and Mr. Young.
Mrs. A. R. declares that she has persevered in the use of vegetable diet and distilled water since the last report, with no inconvenience, excepting the sense of weakness, and considerable craving for food. She is in all respects improved.
On some Cases of Disease which have appeared under the Regimen.
It is not possible, in my opinion, to devise any other proof with regard to the agents which have the greatest influence on health than that which has been given in the preceding pages. I have taken, as it has been seen, examples of diseases acknowledged to be incurable, when they were presented in such a stage as to afford any rational prospect of relief, and have given the results of experience. To these are added observations, accumulated now to a considerable number, in other cases, as they have occurred in practice. These may not all of them have been of equal weight or importance. It is enough,