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Page 42
At the end of two weeks the h�mic murmur had faded into a faint soft
bruit, though the mitral murmur was unchanged, the skin had improved in
color, the aches and weariness were gone, and the blood count had
reached nearly five million cells, with 50 per cent. of h�moglobin. The
extraordinary results of the blood examination were confirmed by
observations made by Professor Frederick P. Henry, Dr. Judson Daland,
and Dr. J.K. Mitchell, who all practically agreed. Professor Henry made
several studies and stained a number of slides, verifying in his report
the statements of the presence of megaloblasts and nucleated red cells
made above.
Owing to the necessity for an operation on the hemorrhoids, which caused
loss of blood, the patient was somewhat retarded in her progress to
recovery, but by the tenth week was so far better that the blood showed
no microscopic abnormalities, the count was full normal, and the
h�moglobin over 70 per cent. Her color and strength were good, the heart
was perfectly strong, the an�mic murmur was gone, and the oesophagus
was so much less irritable that it was possible to begin dilatation of
the stricture.
I have heard within a year that though occasionally annoyed by this last
trouble if she becomes much fatigued, she has remained in other ways
well.
Mrs. G., the daughter of nervous parents, was always a nervous,
over-sensitive, serious child, worked hard at Vassar, broke down,
recovered, returned to college, was attacked with measles, which proved
severe, and by the time she graduated had been made by her own
tendencies and the anxious attention of her family into a devoted member
of the class which I may permit myself to describe as health-maniacs.
Health-foods, health-corsets, health-boots, the deeply serious
consideration of how to eat, on which side to sleep, profound
examination of whether mutton or lamb were the more digestible
flesh,--these were her occupations,--and two or three years before her
panic about her health had been made worse by the discovery of an aortic
stenosis, of which an over-frank doctor had thought it best to inform
her. When I saw her she had been three years married, was childless,
and, between the real cardiac disease and her own anxieties about it,
had driven herself into a state of great physical debility and a mental
condition approaching delusional insanity.
A too restricted diet, lacking both in variety and appetizingness, had
had its usual result of upsetting digestion and destroying desire for
food. Even with the small amounts which she ate she considered it
necessary to chew so carefully and to feed herself so slowly that from
one hour to an hour and a half was used for each meal. The heart,
under-nourished, beat feebly, there was constant slight albuminuria with
evidences of congested kidneys, and she could only rest in a semi-erect
position.
The heart condition, with its renal results, proved the most rebellious
part of the trouble. A firm and intelligent nurse soon overcame the
difficulties and delays about food, and my final refusal to discuss them
disposed for the time of some of the fanciful theories about digestion
and so on. Her meals were ordered in every detail, and she was told that
they were prescribed and to be taken like medicine, and, fed by the
nurse, she began to take more nourishment. Massage relieved some of the
labor of the heart, and gradually the semi-erect posture was exchanged
inch by inch for a semi-recumbent one. Not to prolong the relation of
details, it was found needful to keep this lady in bed for five months
before the heart seemed to recover sufficiently to allow her to get up.
Even then, although improved in color, flesh, and blood condition, she
had to attain an erect station almost as slowly as she had had to reach
recumbency. Slow, active Swedish movements, to which gentle resistance
movements were very gradually added, helped the heart. Her cure was
completed by five or six months' camp-life in the woods, and she is now
the mother of a healthy child and herself perfectly well, the valvular
disease only to be detected by the most careful examination, and never,
even during pregnancy and parturition, causing any annoyance.
The surgeons, who once thought a floating kidney could be permanently
fixed in its place by stitching, have now concluded that this is very
doubtful, and the treatment of this displacement is never very
satisfactory by any method. Still, some success has followed long rest
in the supine position, which encourages the kidney to return to its
normal place, until careful full feeding has renewed or increased the
fatty cushions which hold it up. It is best during the first weeks of
treatment not to allow the patient to sit or stand, or if she should be
unable to avoid the occasional need for these positions, an abdominal
binder must be applied by the nurse and drawn tightly before she moves.
The masseuse is directed to avoid any movements which might further
displace the organ, and may cautiously push it upward and hold it there
with one hand while with the other the manipulation of the abdomen is
performed. However long it may require, the patient should not get up
until examinations, supine, lateral, prone, and erect, combine to assure
us that the kidney is replaced. Repeated investigation of this point
will be required,--for the kidney will sometimes be in place for a
little while and next day or even a few hours later have slipped down
again. Before any exertion is permitted, even ordinary walking, an
accurate close-fitting abdominal belt with a kidney-pad should be
applied. Those kept in stock are seldom properly adjusted, and usually
have the pad in the wrong place. If rightly made, they can be worn with
comfort and tight enough to be useful. If not rightly made, they are
useless instruments of torture.
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