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Page 31
I have been careful to speak at length of these fat an�mic cases,
because, while rare, they have been, to me at least, among the most
difficult to manage of all the curable an�mias, and because with the
plan described I have been almost as successful as I could desire.
Let us now suppose that we have to deal with a person of another and
different type,--one of the larger class of feeble, thin-blooded,
neurasthenic or hysterical women. Let us presume that every ordinary and
easily attainable means of relief has been utterly exhausted, for not
otherwise do I consider it reasonable to use so extreme a treatment as
the one we are now to consider. Inevitably, if it be a woman long ill
and long treated, we shall have to settle the question of uterine
therapeutics. A careful examination is made, and we learn that there is
decided displacement. In this case it is well to correct it at once and
to let the uterine treatment go on with the general treatment. If there
be bad lacerations of the womb or perineum, their surgical relief may
await a change in the general status of health,--say at the fourth or
fifth week. If there be only congestive or other morbid states of the
womb or ovaries, they are best left to be aided by the general gain in
health; but in this as in every other stage of this treatment it is
unwise, and undesirable therefore, to lay down too absolute laws. Having
satisfied ourselves as to these points, and that rest, etc., is needful,
we begin treatment, if possible, at the close of a menstrual period,
because usually the monthly flow is a time at which there is little or
no gain, and by starting our treatment when it is just over we save a
week of time in bed.
The next step is, usually, to get her by degrees on a milk diet, which
has two advantages. It enables us to know precisely the amount of food
taken, and to regulate it easily; and it nearly always dismisses, as by
magic, all the dyspeptic conditions. If the case be an old one, I rarely
omit the milk; but, although I begin with three or four ounces every two
hours, I increase it in a few days up to two quarts, given in divided
doses every three hours. If a cup of coffee given without sugar on
awaking does not regulate the bowels, I add a small amount of watery
extract of aloes at bedtime; or if the constipation be obstinate, I give
thrice a day one-quarter of a grain of watery extract of aloes with two
grains of dried ox-gall. I find the simple milk diet a great aid
towards getting rid of chloral, bromides, and morphia, all of which I
usually am able to lay aside during the first week of treatment.[27] Nor
is it less easy with the same means to enable the patient to give up
stimulus; and I may add that in the treatment of the congested stomach
of the habitual hard drinker the milk treatment is of admirable
efficacy. As I have spoken over and over of the use of stimulus by
nervous women, I should be careful to explain that anything like great
excess on the part of women of the upper classes, in this country at
least, is, in my opinion, extremely rare, and that when I speak of the
habit of stimulation I mean only that nervous women are apt to be taught
to take wine or whiskey daily, to an extent that does not affect visibly
their appearance or demeanor.
Meanwhile, the mechanical treatment is steadily pursued, and within
four days to a week, when the stomach has become comfortable, I order
the patient to take also a light breakfast. A day or two later she is
given a mutton-chop as a mid-day dinner, and again in a day or two she
has added bread-and-butter thrice a day; within ten days I am commonly
able to allow three full meals daily, as well as three or four pints of
milk, which are given at or after meals, in place of water.
After ten days I order also two to four ounces of fluid malt extract
before each meal. The fluid malt extracts which now reach us from
Germany have become less trustworthy than they formerly were. Some of
them keep badly, and are uncertain in composition, one bottle being
good, another bad. The more constant, and at the same time most
agreeable, extracts are those now made in this country. Although their
diastasic powers are usually less than is claimed for them, and vary
greatly even in the best makes, they so far have seemed to me on the
whole more satisfactory than the imported malts. It is very desirable
that a thorough chemical study should be made of the various malt
extracts, solid and liquid. I am sure that some of them are defective
in composition, or vary notably as to the amount of alcohol they
contain.
No troublesome symptoms usually result from this full feeding, and the
patient may be made to eat more largely by being fed by her attendant.
People who will eat very little if they feed themselves, often take a
large amount when fed by another; and, as I have said before, nothing is
more tiresome than for a patient flat on her back to cut up her food and
to use the fork or spoon. By the plan of feeding we thus gain doubly.
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