1898 American Journal of the Medical Sciences  
thirtysix years, first consulted me in regard to his health. He was extremely despondent and melancholy, and stated that for weeks he had eaten very little, barely enough to keep alive, sometimes eating only once a day; that he was losing strength rapidly, and that, owing to increasing dis¬ comfort in the lower part of the right side of the abdomen he feared that there might be some disease of the appendix. For sixteen years he has been an invalid. He is over six feet tall, and weighs about 140
more » ... nd weighs about 140 pounds. He is much emaciated, of dark, sallow complexion, and melancholy expression. He has never had any seri¬ ous acute disease. No tuberculosis in his family. His father died about a year ago of sarcoma of the superior maxillary bone. His mother died of apoplexy in her sixty-sixth year. A brother and sister died of typhoid fever. One brother and two sisters are living and healthy. At various times he has been treated for supposed disease of the liver, for chronic indigestion, for weak heart, for neurasthenia, nervous pros¬ tration, etc. He does not remember ever having had an attack of abdom¬ inal inflammation. He was always delicate as a child, but until his sixteenth year he enjoyed fairly good health. About that time he broke down with what was called nervous prostration, and he has never been well since. For sixteen years past he has been conscious of discomfort, weight, uneasiness, and occasional sharp, sudden pain all through the region below and to the right of the umbilicus. He always eases himself in this region as much as possible. These feelings are becoming more and more intense, with at times a dull, heavy, aching pain and a feeling as if a mass as large as au orange was there. Often there is distention, and he passes much flatus. His general symptoms are those of malnu¬ trition and auto-intoxication from faulty assimilation of food. Often his digestion is so poor that for days he eats almost nothing. He then be¬ comes so prostrated and weak that he can scarcely walk. Such is his present condition. At these times his pulse is weak and slow (58 or 60), and there is a dull and heavy feeling in the head as though a weight were on it. He recovers slowly from these attacks, and is able to take moderate exercise and even ride a bicycle. The discomfort and pain in the right iliac region has increased considerably during the past six months. The bowels, though seldom constipated, are usually costive, and he uses glycerin suppositories for relief. He is very despondent, and says that life is not worth living ; that he would be willing to lose his right arm if thereby his general health could be improved. Physical Examination. He is extremely emaciated, sallow, and anaemic, with an expression of deep despondency. The tongue is trem¬ ulous, large, flabby, and slightly coated. Lungs normal. Action of heart weak and slow (58). Valvular sounds normal; no organic lesion.
doi:10.1097/00000441-189810000-00003 fatcat:fgiagnh7pzfx7ioo7cajyzbaam