Volume 5 — A SIGNIFICANT CASE.

Account of a Fast, undertaken for the Cure of a Profound Blood Disease.

The following account of a fast is worthy of attention. It is rigidly accurate in principle, as far as I could make it so, and I am responsible for its truthfulness. But the subject of it, feeling that he is engaged in a duty and “labour of love,” as he expresses it, is yet naturally anxious to prevent his identity from being discovered; and so, while the facts of the narrative are true in principle they have been varied in a few details for the purpose of preventing the recognition of the subject of them.

They occurred in the history of a man of about 40 years of age, who fell ill of an infectious disease some 20 years ago, while living abroad. The exact time of the infection is not known. The patient was treated by qualified doctors living in the same country as himself, and there is no reason to believe that he was not properly and skilfully treated. He had, however, for years buoyed himself up with the hope that he should be able to come to England for the best treatment, and recently he found himself in this country for that purpose. It goes without saying that the eminent men consulted treated him after the most modern and approved methods, which were also, so far as knowledge goes, the most likely to benefit him. Not only as to treatment must it be assumed that the best was done, but the diagnosis also is supported by the authority of the doctors seen, and was confirmed by physiological and pathological investigation. This would be recognised if it were possible to publish names, places and dates which are withheld from the courteous reader for the reason already given. I can only say that I entirely concur in the diagnosis and in the suitability of the treatment.

The man came under my care on a Sunday, the fast, which is the subject matter of this communication, having been commenced on the Friday six weeks before that day, the last food having been taken on the Thursday at 5 p.m. I saw him, therefore, on the forty-fifth day of the fast. His pulse was 59, soft, steady, regular. Temp. 96.8 degrees, about 11 a.m. He was able to be up, and walked actively, all his bodily movements being active and his mind quite clear and rational. His weight on the day after I first saw him was, in the same clothes as when weighed at the beginning of the fast, 129½ lbs. He said he weighed 171 lbs. on the machine at the commencement, and therefore the loss of bodily weight up to that time was 41.5 lbs. The average loss of weight during the 46 days of the fast was about nine-tenths of a pound daily if the 41.5 lbs. loss is divided by the 46 days of the continuance of the fast up to that time—41.5/46 = .9 lbs. almost exactly.

When he came to my consulting room on the forty-sixth day, about 2.15 p.m., the pulse was 64, temp. 95.6 degrees (thermometer 3 minutes under tongue). He was much troubled with a nasty expectoration of mucus. His breath was very offensive. No enlarged glands could be felt in either groin—perhaps a trifling enlargement in the right. In middle of front border of right tibia a little irregularity is felt, and a small hollow, which he thinks is filling up; but it might be that the exudation on the bone immediately above and below the hollow is somewhat reduced, as this would equally give the suggestion that the hollow is filling up. There is a similar but rather smaller irregularity on the left tibia also. He felt rather weak that day, which he attributed to not having had his usual walk the day before. The nasal cavity consists of a large grey septumless cavern showing dry crusts. The issuing breath is most offensive. Patient had drunk freely of water, he said, to the extent of 4 or 5 quarts a day during the fast but when I said—do you mean that you have been taking over a gallon of water daily?—he rather hesitated, and did not think it was so much as that. He had not measured it and had taken it cold usually, though occasionally hot, and had taken it without stint as he wanted it. On the forty-eighth day of the fast he complained of being weak but worst of all, he said, his breath was very offensive to himself. It was so to me also—faint, fetid, putrid. His sense of smell was greatly impaired, so much so that he could not smell the offensiveness of the bowel-excreta which came away every day on using the gravitation-enema, and which were horrible to by-standers. It would seem from this as if his distress at the bad smell of his breath was probably due to a perversion of the sense of smell, which can be easily understood if we reflect that the disease-process was going on in the region where the smell-apparatus is specially located. The temperature was 96.2 degrees that morning the patient said. At 2 p.m. when I saw him the pulse was 68, regular, even, steady. He says he was feverish last night. I suppose he felt hot. He sleeps well, but says he hears the clogs of the mill-hands as they go to their work in the mornings. Has lost 2 lbs. weight in last 2 days. Temp. 93.6 degrees to my observation 2.30 p.m. Says he feels “done at the stomach.” His voice is poor. Expectorates somewhat freely. A small blob of green thickish mucus in ordinary white mucus came away in my presence. Urine acid 1010. No glucose. Faint trace of albumin to heat and picric acid: also to nitric acid. The right lachrymal punctum is blocked; the tears run down the cheek; and I failed to get even a hair-thick wire into it. Evening, pulse 65, temp. 97.2 degrees in bed with hot-water bottle. Fæces most offensive, no bowel-excreta coming away except to enema. Forty-ninth day. In bed, temp. 97.2 degrees, pulse 65, soft, steady, regular. No great emaciation of limbs. Showed me some green expectoration. He says it is from Salvarsan as it is exactly like what he was injected with! The motion to the enema as offensive as before, but the breath is less offensive to me: not so fetid.

On this day patient completed 7 weeks of fasting. Feels sick and as if he would vomit. About midday he did vomit about a teaspoonful of dark green stuff, very bitter and acid (bile, I should call it, though he calls it “pure citric acid”) and immediately after that he got rid of a motion without the use of the enema, brown, dark and very offensive still. I think the breath, however, is rather less offensive; and so I thought also two days ago. Temp. 97, pulse 67, soft, steady, regular; about 1.30 p.m. In bed since fiftieth day of fast. Not feeling very ill and not specially emaciated, though the buttocks are thinning; but legs and thighs and arms and forearms not specially thin. He came to me to be weighed on the forty-ninth day and weighed 127½ lbs. Fifty-second day of fast. Still in bed. Condition much the same as to pulse, temperature, etc., and as to emaciation so far as observation goes. Remained in bed, not because unable to be up, but because he thought it would be better for him to be resting. On the fifty-fourth day, as he still felt sick, I gave him, at his request, an emetic in the form of 10 grains of copper-sulphate. This was followed by sickness after about an hour, when he got rid of a very little of the same green stuff as before. Bile? But the difficulty is to understand how, after all this time of fasting, he should still feel sick and with inclination to vomit. On the fifty-fifth and fifty-sixth days of the fast he remained in bed, the condition being much the same. On Thursday, the fifty-sixth day, he broke the fast at 5 p.m., just 8 weeks after beginning it. He had meant to go on for 60 days, and I did not think that there would have been any danger in his doing so; but I did not press him to continue any longer. He took 3 oranges on that day; and on the Friday he took 5 more. I advised him not to increase the quantity of food too quickly. The breath has been quite sweet during the last two days. He has been too weak to take enemata, so we cannot say if motions would still have been offensive. And as there is no weighing machine in his room, we don't know the exact loss of weight sustained during the fast, though there is no reason to think that it has averaged more than .9 lb. a day. Up to the time of stopping the enemata, pieces of mucous membrane and mucus itself came away from the bowel, and the motions were very offensive. He seems to have a mucous enteritis without fever.

On the fourth day after breaking the fast, patient took 6 oranges, 4 apples and a banana; and he ordered much more food, which, however, I advised him not to take. On this day his bowels were opened naturally, with a very offensive motion. But the breath was much sweeter, in fact not offensive at all.

On the sixth day he came to my consulting-room and weighed 128 lbs. Pulse 80, soft, steady, regular. He had not slept all night and had had to be up no fewer than 6 times to have his bowels opened. No diarrhœa, he said, but full motions, the first 3 very offensive. Breath not offensive. Has dry pharyngitis and is complaining of sore throat.

Next day. Weight 133 lbs. Bowels acted again, 1 a.m., 3 a.m., 6 a.m., 9 a.m. and 1 p.m. Large motions. I told him I thought he was taking too much food. Pulse 104. Not sleeping well. Complained of sore throat.

Eighth day. Weight 138 lbs., a gain of 5 lbs. a day for 2 days. Pulse 80 at 7 a.m. (his own statement), at 2.30 p.m. pulse 100, temp. 99.4 degrees. Bowels acted at 12 midnight, 3.30 a.m. and about 11 a.m. Went that day to have his photograph taken. The throat was better. Tongue dry and leathery. It was plain to me that he was taking too much food. He was having a mixed diet and taking much and often. He said his “mouth was coming to pieces,” and in fact the mucous membrane was glazed and peeling; also the lips. On the ninth day he returned home.

The loss of weight can be seen from the following statement. On commencing the fast the weight was 171 lbs.

First day weight was 171 lbs.

Sixth day " " 165½ "

Seventh day " " 163½ "

Twelfth day " " 158 "

Fifteenth day " " 155½ "

Eighteenth day " " 150½ "

Twenty-fifth day " " 142½ "

Forty-seventh day " " 129½ "

Forty-ninth day " " 127½ "

Fast ended on fifty-sixth day. On the sixth day after breaking the fast the weight was 128 lbs. On the next day it had risen to 133 lbs. and on the following day to 138 lbs. In the first 47 days of the fast the loss of weight was 43.5 lbs., or an average loss of .888 lbs. daily (43.5/49 = .888 lbs.) The loss of weight for the last 8 days before the fast was broken is not known as patient was in bed, though it probably was at much the same rate as during the other times of the fast when the weight was taken on the scales.

The following comparative measurements are interesting. Of course he had been eating for a week after the termination of his fast, so that the measurements taken on that day would be higher probably than if they had been taken seven days before, when he broke the fast.

Bodily Measurements.

At Commencement of Fast.At Termination of Fast.

Forearm 11 inches 9⅝inches

Arm 11½ " 8¾ "

Hips 38 " 32½ "

Thigh 21¼ " 16 "

Pelvis 37½ " 30½ "

Calf[1] 15¼ " 13½ "

Neck 14½ " 12½ "

Chest 38 " 31¼ to 34½ "

Patient kept a diary during his fast, but it does not seem necessary to reproduce its statements here. It shows that he walked about during the time, notes the state of the weather as foggy or very foggy or freezing, mentions that water was taken, sometimes hot apparently, as on 15th March, “after glass of hot water, pulse 70, temperature 98½ degrees.” No doubt drinking the hot water had elevated temporarily the mouth-temperature, as it does. The diary also notes that he felt weak, had a bath, or did not have a bath, notes the pulse-rate, etc., as also the effects of the daily enemata. On the twenty-ninth day of the fast he took a bottle of Apenta Water. Such are samples of statements from the diary.

A. Rabagliati, M.A., M.D.

The remainder of this article deals with conclusions of great interest and value, and will appear in our next issue.—[Eds.]