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The other case which I mentioned as having been in the hospital under Dr. Thompson’s care, and which has remained under my own observation ever since, has followed so very similar a course, that I shall read you a brief history of it, before proceeding to point out the mode of management which I have hitherto found to be the most successful in delaying the progress of this malady.
E. B., aged 26, needlewoman, was admitted into Northumberland ward in March, 1865. Dr Thompson asked me to examine her on the day of admission. Ten years before, she had hurt her hip, and cupping, which was resorted to for her relief, had been followed by ulceration; but she had been in generally good health and had worked hard until November, 1854. She began to fall asleep over her work, to have frequent attacks of vomiting, and to suffer from gastralgia and from breathlessness and palpitation on exertion. About Christmas, her friends noticed that her complexion was becoming darker. On admission, her pulse was exceedingly small, and she complained much of lassitude and vertigo when she moved about, or even raised herself suddenly in bed. She had no appetite, but constant thirst and craving for cold water. Her respiration was quick and shallow, with a tendency to yawning. There was slight dulness on percussion immediately below the right clavicle, and considerable tenderness on pressure in the right hypochondrium. Her face was generally dusky, with ill-defined patches of a darker brown on the forehead and cheeks; the conjunctivæ, as usual in this disease, remaining white. The chest was dusky, the nipples and areolæ intensely brown, and the mammæ atrophied; a circumstance I have observed in other females suffering from this disease. The cicatrices on the ulceration on the hip and of a burn on the right elbow were stained brown, and there was a dark line nearly round the abdomen, corresponding to the line of pressure of a string belonging to her dress. Here you will recognise the same train of symptoms and the same characteristic features of discoloration of skin which I have described in the other cases. This patient improved very much in the hospital, and left it, at the end of some weeks, for the Convalescent Institution at Walton-on-Thames. On her return home, she discontinued the treatment and resumed her work, but fell off again in a month or two; and, on being sent to in haste, I found her one night lying exhausted, cold, almost pulseless, sighing and yawning, retching at every movement, and complaining of intense pain in the hypochondrium. In fact, she seemed almost dying, and I brought her at once to the hospital; where, however, she again rallied, and was
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