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Page 43
Mrs. Y., �t. fifty-six, was sent to Dr. J.K. Mitchell by Professor Osler
for treatment. She had all the usual intestinal derangements and
discomforts attendant upon a floating kidney: constipation alternated
with diarrhoea, or rather with a sort of intestinal incontinence; vague
pains in the back, flanks, and stomach were frequent; attacks of acute
pain began in the right hypogastrium and ran down to the symphysis or
into the groin; she had constant flatulence, weight, and oppression
after food; was pale, flabby, and emaciated, but had no emotional or
nervous symptoms except an annoying amount of insomnia. The lower border
of the stomach was fully two inches below the navel in the middle-line,
even when only a glass of water had been taken. It was a little lower
after a small meal. The colon was distended and very variable in
position, probably changing its relations with the landmarks as it
happened to be more or less filled with food or gases. The abdominal
walls were flabby, relaxed, and pendulous, and the whole surface tender.
The patient gave a history of sudden loss of flesh with almost no
reason some three years before, and increasing indigestion in all forms
ever since. The tenderness made careful abdominal study difficult, but
lessened enough after a few days in bed to permit the perception of a
displacement of the right kidney, whose lower edge could be felt on a
level with the umbilicus and two inches to the right of it. No change of
position would bring it any lower. Examined with the patient prone,
two-thirds of the kidney could be outlined, extremely tender, and
causing nausea and sinking if pressed upon.
The chief trouble in treatment proved to be the irritability of the
intestines, which was brought on in most unexpected fashion by foods of
the simplest kind. For some time it was so persistent that the suspicion
of intestinal tuberculosis was entertained; but it finally disappeared,
and after that the case progressed more favorably and she was out of bed
with a tight belt and kidney-pad in a little more than twelve weeks. The
kidney was then, and has remained since, in its normal position. The
patient gained twelve pounds in weight, and should have gained more, but
she found the hot weather during the latter weeks of her treatment very
trying. The intestinal indigestion was only partially relieved, but the
gastric symptoms, the general pains, and weakness all disappeared, and
with precaution she will continue to improve. It is best to advise the
constant use of the belt in such a case. In a patient who has made a
large gain in flesh, as this one did not, and who has been found after
some months to maintain the increased weight, the belt might gradually
and experimentally be left off; but repeated examinations should be made
for a year or two to be sure that no displacement results.
I could relate cases of gain in flesh without manifest relief. As I have
said, these are rare; but it is less uncommon to see great relief
without improvement in weight at all, or until the patient is up and
afoot for some weeks; and I could also state several cases in which a
repetition of the treatment won a final and complete success after the
first effort at cure had failed or but partially succeeded; and of this,
I believe, Professor Goodell has seen several examples.
I have mentioned more than once the singular return of menstruation
under this treatment, and as examples I add a brief list of some
notable instances.
Mrs. N., �t. 29, no menstruation for five years; return of menstruation
at thirtieth day of treatment; continued regularly ever since during
three years.
Mrs. C., �t. 42, eight years without menstruation; return at fourteenth
day of treatment; now regular during five months.
Miss C., �t. 22, no menstruation for eight months; return at close of
sixtieth day of treatment; regular now for four months.
Miss A., �t. 26, irregular; missing for two or three months, and then
menstruating irregularly for two or three months. No flow for two
months. Menstruated at nineteenth day of treatment, and regular during
thirteen months ever since.
I had at one time intended to give, in the first edition of this work, a
summary of all my cases, with the results; but what is easy to do in
definite maladies like typhoid fever becomes hard in cases such as I
here relate. In fevers the statistics are simple,--patients die or get
well; but in cases of nervous exhaustion, so called, it is impossible to
state accurately the number of partial recoveries, or, at least, to
define usefully the degrees of gain. For these reasons I have not
attempted to furnish full statistics of the large number of cases I have
treated.
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