1848: Rev. Joseph Garland to Dr. Cleveland Buck

How Rev. Garland  might have looked

How Rev. Garland might have looked

This letter was written by Rev. Joseph Garland (1811-1901), the son of Samuel Garland (1771-1855) and Mary (“Molly”) Batchelder (1775-1833). Rev. Garland was married to Clarissa Loring (1811-1883) in December 1844. They had four children: Joseph Batchelder Garland (b. 1845), Clara Elizabeth Garland (b. 28 January 1847; d. 17 April 1848), and twins: Edmund Newell Garland (1848-1852) and Clara Elizabeth Garland (1848-1943).

Rev. Garland wrote the letter to Dr. Cleveland Buck (1788-1865), the son of Ephraim Buck (1761-1828) and Dorcas Beard (1760-1834). Dr. Buck was married to Charlotte Preble (1788-1869). It is conjectured that Dr. Buck was a former acquaintance of Garland’s from his earlier residence in Maine.

The lengthy letter describes the death of the Garland’s second child — an infant daughter named Clara Elizabeth Garland. Included with the letter is a description of treatment written by one of the attending physicians, Dr. John Bachelder, who may have been a relative of his through his mother’s side. Dr. Bachelder also includes a detailed autopsy of the young girl’s digestive tract.

Dr. John Bachelder (1818-1876) graduated from Dartmouth in 1841 and received his medical diploma from the Massachusetts Medical Society in 1845. He commenced his practice in Monument village (a part of Sandwich Massachusetts; now called Bourne) in 1844. He married Martha Swift Keene. He afterwards practiced in Plymouth, Massachusetts. He served for a short time as an assistant surgeon during the Civil War.

After reading this letter, one can’t help but feel that had the young girl been left alone by the treating physicians, she might have survived her ailment. Her progression of treatments, which included doses of lead acetate and turpentine, suggest desperation on their part, and not only failed to bring the girl relief but may have contributed to her death.

Stampless Letter

Stampless Letter

TRANSCRIPTION
Addressed to Dr. Cleveland Buck, Woolwich, Maine

Monument [Massachusetts]
May 1st 1848

Dr. Buck
Dear Sir,

We are in deep affliction. Two weeks ago this morning death entered our circle & snatched away forever from our embraces our dear little Clara Elizabeth after (as the physicians decide) a very uncommon, mysterious & severe sickness of just four weeks. From the Thursday after she was taken sick on Monday till her death we were almost hourly expecting her death. Apparently she was very well until she was suddenly taken with violent vomiting attended by excessive purging on Monday. Her case was so remarkable & uncommon to us all that (knowing that you would feel interested in it), I have prevailed with our physician to detail before & on the rest of this sheet to you minutely the symptoms & developments of her case from the beginning. And it would be a great gratification to her parents if (judging from the description of her case) you would inform us whether you ever had such a case or not & whether you could suggest the first cause of her sickness. Our physicians, both skillful & well read & successful, say that they never heard or knew of such a case. And Dr. Leonard for some time was physician in Boston & has for some years had a very extensive practice & is reported to be one of the most eminent & scientific physicians in this region.

From the first of her sickness till within eight days of her [death], she seemed to lose no flesh, but appeared a little bloated until those tumors under her jaw appeared & were _uttered by the sugar of lead. When they disappeared, the bloating & flesh seemed to go with them & at the same time there was considerable watery & shiny emission in her evacuations. The Post Mortem examination as Dr. Bachelder has described, disclosed the fact that one kidney was ____ putrid. He actually ________. What could cause that? is to her parents a painful & anxious inquiry. Could a blow or a kick from Joseph in play with her, or his getting onto her back, rolling over with her on the floor, cause it? We have had very painful fears that she picked up something from the floor & eat that was poisonous. We know of nothing, however, of this kind unless it be a little bit of white yellowish shaving soap which her mother nibbled off of a cake with which she washed her the day before she was taken sick. Could that poison her?

One physician says that the symptoms from the first were as if she had been poisoned. They were very obstinate & unyielding to medicine. Indeed, for ten or twelve days it was almost impossible to get medicines or any thing else for many minutes on her stomach so excessive was her vomiting. I feel very desirous that a knowledge of her case should if possible to your profession & living all the good ___ as possible. For this objective, a Post Mortem examination. Dr. Bachelder has written minutely the results and if it will not be too much trouble & an improper request, will you gratify me enough after reading the description to give me your opinion & I should be willing generously to compensate you for it, for to tell the plain truth, I have more confidence in your opinion in such a case.

Your kind letter was gladly received some weeks ago & would have before been answered but for ___. Remembrance to your family & the rest of all our dear friends. Woolwich, I have room no more. Very respectfully, — Joseph Garland

Case of Clara Elizabeth Garland

March 20. She was attacked very suddenly without any apparent preliminary symptoms, with ____  _____ and diarrhea. It did not seem probable that she had for taken of any indigestible or unusual food. The contents of her stomach and bowels were at first similar in appearance, being of a greenish color and serous. Within a day or two _____ and before she became fully under the action of medicine, the excretions of the bowels assumed a pulpy, semifluid consistence — clay colored and extremely fetid. This condition continued but a short time, and then changed for the better. There was very little constitutional distress and no fever, appetite good, and little or no apparent suffering. Prescription. Hydr___ in 4 gram doses every ____. Diet restricted to breast milk — drink cold water. ____ stimulant to the stomach and ____ ____ represented a more healthy appearance. I never deemed it safe, ____ suggestion of the child’s parents, to allow _______ medicine which she had in their possession, ______ing so a recipe which they showed me later. The chalk mixture was also given at the same time. This treatment seemed to exert no influence upon the excretions, and the Tr. of cat__ [?] was substituted for the Tr. but with no better success. A solution of acetate of lead was then employed. This however could not be retained upon the stomach. A simple infusion of cat___ with a little cinnamon bark was next tried but with no avail. Powders of acetate of lead, ___ and clover’s powder met with no better success. The discharges, however, under the last combination became much less frequent, but rather worse in quality; and the vomiting was but little appeased. For the latter symptom, in addition to the other means, a poultice covered with spice (puluclaws & cinnamon) was applied to the epigast____. There was still some appetite and no apparent fever, no tenderness of the abdomen upon pressure.

March 27. All astringents were laid aside and powders substituted, composed each of colonel & ____ each 1/6 grain, extra. hyascium ½ grain every 4th hour. Small ___ of starch, and the daily use of the warm bath were employed. Under this treatment the diarrhea decidedly abated and the vomiting occurred seldom. Chiefly when there was an attempt to force down medicines. For a week she seemed slowly convalescing. All medicine was omitted except very small doses of port wine. A careful attention to the diet, the daily use of the warm bath, and a short ride in the open air every pleasant day were the principal means relied upon for complete restoration. The citrate of iron was tried in half grain doses, but discontinued after two days in consequence of a sudden and alarming change in her symptoms. This took place April 5th. A severe chill was immediately succeeded by a violent fever. The evacuations were not much altered. She was treated with the warm bath, small glasses ___ & chalk, and clover’s powder. From this period, she had suppression of urine, which was relieved intervals of from 24 to 36 hours by the spirits of nitre — ______ and _____ _____ to the hypogastrium. The bladder, however, seldom appeared full and never tender on pressure. The difficulty seemed to originate in the kidneys rather than in the bladder. But there’re was no means by which we cold arrive at an accurate diagnosis.

April 7. Met Dr. Leonard of this town in consultation. At this time there was a slight improvement but the symptoms were alarming still. He considered the case to be irritation or inflammation of the alimentary canal. At this time the suppression of urine did not attract my serious attention or apprehension, and I do not recollect whether this symptom was even mentioned to Dr. Leonard. He certainly did not prescribe for it. The excretions of the bowels were not at this period frequent, but rather dark & greenish, and appeared to consist chiefly of mucus intermingled with specks of blood. The abdomen at no time was distinctly tympanitic or tender upon pressure. Dr. Leonard advised the hydr. e. fret & clover’s powder; for diet & drink, nothing but gum arabic mucilage & also freely scarified  the gums, although there were no decided ___ of irritation there. This treatment was unremittingly followed for several days. At first it seemed to be affected with partial success. But the evacuations never assumed a healthy aspect. The guns were again scarified in 3 or 4 days after the first operation. About April 12, there appeared a small hard swelling in the right parotid gland. A few hours after, a similar swelling appeared in the left gland. Not many hours afterwards, there was a general ____ faction of the cellular substance surrounding each gland, and extending from one to the other. There had been considerable edema of the face and neck, and perhaps of other parts of the body during the greater part of her sickness. The swelling about the neck was kept constantly wet with a solution of acetate of lead, and in little more than 24 hours it entirely disappeared together with the general edema. This event was quickly followed by a total change in the excretions of the stomach & bowels. They now had the appearance of fluid ink, intermixed with grains of solid mater resembling coffee grounds.

About the time of these changes in the excretions, the oil of turpentine was commenced. At first — one drop for a dose. Afterwards, two drops every 4th hour. This was discontinued with the 3d or 4th dose in consequence of symptoms of stranqury [?] and stuesmus [?] with bloody and mucus excretions from the bloody and rectum — very frequent and generally simultaneous. These were almost identical in appearance and emitted an exceedingly offensive odor. For several hours it was a disputed point whether these discharges were from the bladder or rectum, nobody conjecturing that they came from both, being generally simultaneous; but the frequency of them enabled us by actual observation to satisfy ourselves beyond a doubt of their two-fold origin.

At intervals of some hours, the black evacuations, as heretofore mentioned, occurred. These were entirely different if character from the others, and seemed to originate in a different part of the alimentary canal. These were not attended with much tenesmus [?]. The prescription at this period was the hyde.c.cret & clover’s powder — each ½ grain every 3 hours. Also infusion of elm bark, starch injections with laudanum were attempted, but could not be retained for a moment. While under this treatment, she rapidly sunk and expired on the morning of the 17th of April.

Autopsy. 24 hours after death. The brain and organs of the chest were not examined because no symptoms of disease of these parts was apparent or suspected during life. The abdominal viscera were carefully examined in presence of Dr. Leonard. There were some marks of peritoneal inflammation in several places though not very distinct. The cavity of the peritoneum contained 2 or 3 ounces of brownish fluid, not however resembling any that was found in the intestines. The stomach contained a small quantity of the ink matter like that which was vomited just before death; also a little of what was supposed to be the mucilage of the elm bark which had been taken a day or two previous. Both these substances were found in considerable quantity throughout the whole alimentary tract. Undoubtedly there was mucus mixed with the mucilage — especially in the large intestines. This substance did not seem to mingle at all with the black fluid wherever they were found in contact. Near the pyloric orifice of the stomach, there was considerable vascularity of the mucus surface, of a pinkish hue but without softening or ulceration. This was the appearance of the greater portion of the mucus membrane of the small intestines. About the middle of the ilium, the cold of this tissue approached that of red slate and the substance was in a disorganizing process. All the ____ of this part of the intestine rent while resting on the blade of the scissors. It was not possible to determine the existence of inflammation of the peritoneal ___, as it was highly colored by lying in contact with the liver and gall bladder. This colored portion was very thin and translucent. Whether the contact of the liver or gall bladder had anything to do with the changes met with here, I am unable to decide. There was nothing further remarkable until the rectum was reached. No distinct shafts of ulceration were found above this part. Plyer’s glands were uncommonly distinct and prominent but otherwise unchanged.

The intestines generally were extremely attenuated and translucent. There was but a mere trace of mesentery [ink blot]…was characteristic of nearly all the tissues and ___ the body generally. The _____ in the rectum was distinctly diminished about 5 inches from its outlet. All below was extensively diseased. There was scarcely a trace of mucus or sub-mucus cellular tissue to be found. The muscular coat presented a very uneven and jagged surface as though it had been gnawed. Some of the depressions were very deep. This tissue was generally very much thickened, being in some places nearly two fines in depth; and in this respect contrasting strongly with the attenuated condition of the same tissue in the visceral parts of the intestine. It had a dark and mottled complexion and in spots considerably softened. The subjacent cellular tissue was infiltrated with a considerable quantity of yellowish transparent serum. The peritoneum covering this part was considerably thickened. In depth, color, and elasticity, it resembled tendon.

— J. Bachelder, Attending Physician

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