SelbyW. Plummer
1897 The Lancet  
DEGENERATION is not uncommonly in persons past middle life the source of various uncomfortable symptoms, and in a tropical country such as that of Trinidad, where old age is to some extent premature, we may expect to find senile troubles manifested sooner than in colder climates. Not unfrequently we meet with cases of diarrhoea in persons approaching or beyond sixty years of age, which can only be ascribed to degeneration of the intestinal walls, due either to albuminoid disease or to some
more » ... rted action presumably associated with degeneration. The patient whose illness I am about to describe was a female fifty-six years of age and was a member of a family one of whom I had been attending only a few days previously for poisoning by alkaline ptomaines, an accident which not unfrequently occurs in these parts. She had always enjoyed good health until about twelve months ago, when a small tumour, the nature of which was not properly ascertained, was removed from her nose. About nine months ago she observed an undue looseness of the bowels, since which time she had had three attacks of diarrhoea, each of them more severe than the preceding one. The present attack was therefore the fourth. When I first saw her, her temperature was 101'2° F. and her pulse 84; the heart's area was normal ; the sounds were very feeble, bat no abnormality in the rhythm could be detected ; there was dimness of sight and well-marked arcus senilis of both eyes ; the tongue was slightly furred. The patient retched very often and occasionally vomited ; she also complained of great pain in her abdomen ; it was tender on pressure, and she passed fluid evacuation at intervals of twenty minutes or half an hour. As there had been cases of ptomaine poisoning in the house I considered this illness to be of the same kind, and ordered ;brandy milk with soda water, and a mixture containing bismuth sub-carbonate and nepenthe. During the next twenty-four hours the diarrhoea was less frequent, but symptoms of cardiac failure were deveJop.:.d, so urgent that death appeared to be imminent. The patient had repeated attacks of fainting, sometimes at intervals of fifteen minutes ; her skin was almost icy cold, her lips were livid, and the pulse at the wrist was scarcely perceptible. I was at this time informed that she had suffered from fainting fits during her previous attacks of diarrhoea, although hever so seriously as at present. Taking into consideration the marked degeneration of her corneal tissue shown by the arcus senilis, her dimness of vision, the failure of the circulation, and the chronic diarrhoea, I came to the conclusion that degeneration resulting from senile changes might have originated her troubles. Artificial warmth was supplied by hot-water bottles and nannela wrung out of hot water ; a mixture containing five drops of tincture of digitalis and twenty drops of spirit of nitrous ether was given every four hcurs and improvement commenced immediately. When she was able to walk about the room five drops of tincture of strophanthus were given three times a day in place of the digitalis ; and except for a slight giddiness on getting up in the mornirg she has satisfactorily recovered. There can be little doubt about either the degeneration of her heart muscle or the prompt efficacy of the digitalis in strengthening the heart's action, and thereby improving the circulation.
doi:10.1016/s0140-6736(01)95862-3 fatcat:kftex4brz5aablfqwcb2kxmglq