The warning was justified by events, for though he did not begin taking the tablets till 8 p.m., at 7 a.m. of the next day copious diarrhoea set in and great prostration due, as I considered, to the too free elimination of morbid material. Naturally the Ferrum pic. tablets were stopped and medicine again discontinued.
Improvement at once set in, and on March 7 patient wrote: ” I am feeling much better, and everyone tells me they see a great improvement within the last week.” The letter went on to say that appetite and sleep were good flatulent pains had left, food was digesting, and except that this legs were weak and his feet and last symptoms I pointed out to him was evidence that the emunctories of the system were at work and the absorbents thrown into increased activity. This proved to be the case, and these swellings soon went down and without the development of any kidney complication.
On March 24 reports: Getting on very well. Swelling of the feet going down, but toes are swollen. Has some scalding pains spreading up from the knees in the muscles with sensitiveness to the touch, and yet a feeling of deadness in them. Bowels were disturbed ( from a chill?) yesterday, stools light-coloured and liquid, and sometimes only flatulent expulsions. Crocus sativus O A. was now given, and on March 28 his daughter wrote:
” My father is too unwell to write to you. On Sunday he got your letter and dose and took the latter at 1 o’clock p.m. Bowels were disturbed 9.30 p.m. same day, and next day at 1.30 and 8.30 a.m., and several times during the day and again this morning.
” All day yesterday he was feeling most miserable; achy, oppressive and drowsy, so much so that he was unable to take anything after his tea at 5 p.m., All through the night he has been in much pain, passing wind, and woke up during the night feeling very sick, with sudden rush of salt water in his mouth; the sickness he managed to stave off, but early this morning it again came on, and he threw up about three pints of very sour and acid stuff. Has had heartburn yesterday and all night, and now severe acid eructations.”
The writer goes on:
” He cannot help thinking the medicines you give him are somewhat too strong for a weak stomach and frame such as his, but of course you know best; he merely wanted to let you know his stomach has always been very weak, and he was never been robust. You will probably get this letter early this afternoon, and if necessary telegraph instructions.”
In reply to this I sent a dose of Camphor bromide, 3rd dec., and on April 10 had up a report that for the last day or two he had been much troubled with flatulence and a feeling of soreness and of tightness across the abdomen and the waist, with a full feeling in the chest, and a hot burning sensation in the passages; the swelling of the feet and legs had disappeared for twenty days. Also, the report went on to say that after the Camphor bromide he had had a good night, but much pain and indigestion up to the 3rd and 4th of April (about which time I ordered him a teaspoonful of castor oil every morning), and that since then he had been considerably relieved.
On April 26 patient was able to come up to town by himself to see me, a different man in every respect from what he had been in February; then he was lying prostrate, all medicinal treatment having been discontinued, his state being considered hopeless, and being fed entirely by the bowel; now, though thin, he was sturdy and strong, and able with ease to take this long journey unattended.
As he suffered from a faint, weak feeling before food, and heat and soreness in the pit of the chest, with tendency to looseness of the bowels, I gave a dose of Ornithog. umbel., and he has remained perfectly well ever since. Not a single dose of medicine has he required from that day (April 26, 1899) to this (May, 1900)
It will be evident to the intelligent reader that in dealing with the cancerous affections of the pylorus and adjoining regions we have to do with disease that are very easily acted on, so easily that the difficulty is to dislodge them in a way commensurate with the patient’s safety. Thus in the first of these two cases, that of the artist, I have since been told by him that shortly after I took him in hand after the dose of Iris versic he brought up quite a fair sized pail full of dark glutinous matter, while in that of W.H.M. it is evident that an unmistakable intolerance existed to all but unit doses.
Now when men in an advanced stage of disease go bringing up pails full of thick grumous material it is evident that the process must be very exhausting, and not only so, but that if the channels through which this material has to find an outlet get blocked, a condition obtains that is incompatible with life.
And this is a danger that is present in all advanced types of these diseases; the patients may die though beneficially acted upon. My contention, therefore, is that these diseases can be easily acted upon, and that in our anxiety to bring about recovery, stimulated of course by the same desire on the part of the patient, we must not endeavour to hasten recovery by undue repetition of the remedy.
A very good instance of this is afforded by cancers of the gullet. Here we get an obstruction produced by the narrowing influence of the cancer upon the lumen of the oesophagus. The very moment the remedy acts, as remedies very easily act, upon the affection, a quantity of phlegm, often very offensive, comes away, and the chance for the patient depends upon his allowing this action to expend itself upon the disease. If therefore the physician, blind to Nature’s warning, repeats his doses under the old and spacious plea “of its being necessary to push the remedy,” he will inevitably hasten the death of his patient. And the more related the dose has been to the disease, the more necessary is it observe this warning.
What, then, is the upshot of the whole matter? It is this, that in the diseases of which I have just given examples, the struggle at elimination of the diseased products has almost as much to do with the obstinacy of human nature as with the intractability of the disease to be treated.
Facts are facts, and progress in medicine depends upon putting a right estimate upon these facts, and deducting from them legitimate inferences.
I claim for these facts and the attendant inferences an important and a power that is provable by the existence in this life of these three men, in the enjoyment of perfect health, who had been declared by leading authorities to be, each one of them, in a dying condition: I refer now to Mr. Murrell, the Southampton artist, and to W.H.M.
