AT LE PERREUX 

London, 2 November 1890 

My dear Lafargue, 

Poor Nim is very ill. For some time past it would seem that there 
has been a recurrence of menstruation, and three weeks ago she suf- 
fered an appreciable loss of blood. Dr Read, whom we consulted, 
thought her complexion very sallow, although he found no trace of 
bile in her urine— which led him to suspect the possibility of an ute- 
rine tumour, but he didn’t examine her manually. She then began to 
feel pains in the left groin when her faeces passed through the colon 
towards the sigmoid flexure — these subsided again and I thought she 
was on the road to recovery until she began to suffer intense pain in 
her left foot. During all this time a total lack of appetite, severe thirst 
(she has been living on milk and beef-tea, no solid food). The pain in 
the left foot culminated in a thrombosis in a vein of the calf. It ap- 
peared to be taking its natural course, the pain diminished and this 
morning she woke up after a good night, somewhat refreshed in ap- 
pearance, if not actually cheerful. However between 11 and midday 

a change came over her and Read found she had a temperature of 
104°F. = 40°C., although the thermometer had been in her mouth 
for only a minute and a half. She has fallen, as it were, half asleep, her 
mental faculties are impaired and her pulse is rapid and feverish, con- 
sistent with her temperature. In fact Read suspects that, given the 
cachectic state of her blood (more or less indicated by the previous 
symptoms), the coagulated blood is decomposing and poisoning the 
live blood. He hopes to return here this afternoon with Heath of the 
Gower Street Hospital for a consultation. 

That’s all I can tell you just now. If Heath turns up, I shall let 
you know the result. 

Give Laura a kiss from me. 

Yours ever, 

F.E. 

Consultation with a Mr Packard, the only man who could be 
found. He thinks there has been a diffuse suppuration in the foot 
causing septicaemia. The method of fomentation has been changed 
and 4 grains = 4/15 gramme of quinine administered. The uterus was 
examined after a fashion, but at this stage nothing has been discov- 
ered save for a small slightly suspect spot by the orifice, to which, how- 
ever, no importance is attached ‘so rar’. Naturally there is always the 
possibility of an embolism and with it the possibility of further com- 
plications, pulmonary and otherwise. But the chap takes a more ‘Hope- 
FuL’ view of the case than Read does. 

If there is any change I shall write again tomorrow.