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ERYSIPELAS.
624 term of E.rophthidmia, under which right eye, which had been all whether of the globe itself or the before is now affected affections, operation, tically as strong as ever. During the progress of of surrounding parts that cause displacethe disease in the left, the right had felt ment and protrusion of the eye, are jumbltd weak, and occasionally painful on exercise, together. No diseases ought to be named from such a circumstance as this, which is so that he could not use it freely. The mass removed from the orbit consisted merely an effect or symptom. If the name of the collapsed and shrunk eyeball in front, be, however, retained, we should obsem with a hard and incompressible substance the distinctions made by the German ophbehind, extending to the point at which thalmologists. When the eye is merely the nerves and vessels had been divided. protruded, and not altered in any other The recti muscles, unaltered in appearance respect, they call it erophthabnos ; if the dis. or texture, covered this substance, the ex- placed eye be inflamed, they term it exoplt-
The
sympathe-Iindefinite
terior of which had the usual appearance of thalmia ;when the eye falls out of the orbit, the orbital fat, except that it was more in consequence of its posterior connexions dense. An incision was cairied from be- having been divided, or from paralysis of fore backwards, directly through the centre all its muscles, they call the case ophthalmoof the entire mass. An apparently recent ptosis. Mr. Lawrence has never seen the coagulum of blood separated the sclerotica latter occurrence. from the choroid coat, the latter, with the retina, being compressed by the coagulum into a thick cord, extending from the optic nerve to the iris ; there was no trace of "ERYSIPELAS. humours ; the sclerotica was natural ; the morbid growth adhered to it closely behind, and the optic nerve proceeded through the To tise Editor of 1 crE LANCET. centre of the mass. The latter was a dense Sin,-On all disputed doctrines in medi. compact structure, of schirrous firmness, resisting the edge of the knife ; its exterior cal science, it seems desirable to obtain consisted of alight grey texture, very much information from competent practical per. like that of a scirrhous breast, while in the sons, whethel’ their ’l1wde Y’ti,eit2)zeiit has been interior this was intermixed with a light sitceessfitl or not, because their failures as yellow, yet firm substance, resembling what well as their success must convey valuable is seen in scrofulous diseases. information. Under the influence of this Mr. Lawrence observed, that he used impression, I offer you my unvarnished conthe expressions " scirrhous firmness" and tribution towards an elucidation of the na. " scirrhous structure" merely to describe ture, and the best mode of treating, erysithe character of the morbid production, and pelas. I have found this disorder exceednot to convey an opinion that it was of a ingly prevalent in this district, and I accarcinomatous nature. He did not enter- count for this frequency from three contain the slightest apprehension that disease current causes : the occupation of the inwould return ; yet, on reviewing the history habitants, which is almost wholly in spinof the case, and comparing with its course ning or weaving cotton in mills at a temthe bulk and texture of the morbid growth, perature of about75° Farenheit ; the climate, he was satisfied that the latter would have which is generally very damp, with frequent continued to enlarge, and the sufferings of cold winds, the natural results of a deep dale the patient would have continued to in- in the mountainous region of the Peak, and crease, had the disease been left to itself, the many thousand acres of moorland surso that the operation must be considered to rounding us on all sides ; and lastly, the have been absolutely necessary. food, which for the most part consists of ]’1’11". Lawrence considered this, in the viands that disorder stomachs that are iidt first instance, as common inflammation and very vigorous. The practice I find most suppuration, and he" originally entered it in I efricient leads me to consider erysipelas as his case book as deep-seated suppura- i wholly symptomatic, and that it always detion in the orbit." The symptoms corre- I pends on some derangement in the chylosponded in all respects to those of the few poetic system ; and, whether the disorder instances which he had seen of abscess in assume the red, sinning, burning characthe orbit. Ile would not have expected, ter, or the yellowish hue, and œdea ]J1’iol’i, that a common cause, namely, long matous aspect, and whether accompanied exposure to severe cold, would prcduce in by vesicles or not, or preceded by, and therea healthy young man a diseased growth fore seeming to be caused by wounds, the similar in external character to the malig- principle of my practice is the same, and nant changes of structure. this is to clear out the passages with all According to the usual arrangement of convenient dispatch ; and for this pnrpose diseases, this case would come under the the followingmedicines are generally used
I,i
peculiar
THE DUBLIN COLLEGE OF SURGEONS.
625
Po, Pulv. ipecac. j. ft. emetic. imprimis sum.
Pil. hydr.gr. x. hord somni sumantur. vel, R Subm. hydr. gr. vi. Pulv.jalapx, gr. viij.
Syrupi,
q. s.ft. bol. h.
R Magn. sulph. zi. ad. Sodce carbon. zi.
THE LANCET.
London, Saturday, January 26,
s. sum.
zii.
1828.
IF the violation of justice always implied breach of the law, we should have little R Plumb. sitperacet. 5ss. difficulty in proving the illegality of the Aqua distill. bj.ft. lotio. to be applied constantly to the part in the exclusion practised by the Dublin College more acute erysipelas, but if instead of the of Surgeons, after what has been advanced shining, burning, and red aspect of the parts on the iniquity of that usage. Though this they assume the yellow hue and œdematous swelling, with probably small vesicles, the supposition is not invariably true, yet we following lotion is substituted, but in other conceive weshall be able to show that the respects the treatment is the same : College cannot plead in its defence the Px Liq. ammon. acet. zij. usual apology of " summum jus summa inSpt. vini R. zi. Aq. distillat. q. s.ft.bj. M.ft lotio. juria ;" but that, to a contempt of equity, it the parts to be frequently bathed with it. has added a wilful infraction of its own It is often necessary to repeat the pil. hydr. statutes. To reduce this charge to a more two or three successive nights, the bowels being kept open by the alkaline aperient;-, demonstrative form, it will be necessary to in severe cases I have given the pil. hydr. examine the spirit of that clause of the twice a day; rarely has it been necessary which it has assumed as a j ustificato bleed, and I have never had recourse to charter, of nor has scarifications matter tion of its conduct ; its literal meaning, as any kind, ever formed under the integuments. In one the common sense of the extreme case, where the head, and succes- interpreted by medical profession ; and the precedent es· sively every part of the body was involved in the disease, I varied the practice, and tablished by the very founders of the Coloften in the use of evacuants and bleeding I employed cinchona and liq. am. acet. in lege. For the accomplishment of the first full doses every four hours. Only one fatal of these intentions, a statement of the circase of erysipelas has occurred in my praccumstances under which the College charter tice during my residence in this district; in which time, I think, at the lowest calcu- was conferred, presents, perhaps, the best lation, I have had more than fifty cases, means ; but of these circumstances we and in the solitary unfortunate case, I have cannot speak from personal observation, nor no doubt the result was wholly the effect does any written record remain, from which of neglect. In conclusion, I beg, Sir, to be under- information on the subject could be destood as only submitting my practice, and rived. Tradition, however, which is quite the results, to the consideration of your forour purpose, in a matter of such readers. I presume not to think myself competent to say, how in all cases the dis- recent date, represents the condition of the order should be treated, because I doubt surgical profession in Ireland of a most not that peculiar occupations, locopositions, anomalous character, antecedent to its inatmosplierical peculiarities, and vicissitudes, will all modify the affection, and may there- corporation. It was composed, in short, of fore require other means than those 1 have the most heterogeneous materials ; of many ’ found so efficient. who served apprenticeships, and of more who I am, Sir, never had a master ; of persons who had Your obliged and most obedient servant, licenses, and of others who practised by a PAUL SLADE KNIGHT. sort of hereditary right, deduced from their fathers ; of the members and graduates of Glossop, Derby, Dec. 31, 1827. every College, British, Scotch, and contiuental;of individuals, in fact, who acquired bss. M.fiat mistura, ij. 44 q.q. herd.
Aq. menth. p. q. s.ft. sum.
cochlearia
’
a
sufficient
No. 230.
The
sympathe-Iindefinite
terior of which had the usual appearance of thalmia ;when the eye falls out of the orbit, the orbital fat, except that it was more in consequence of its posterior connexions dense. An incision was cairied from be- having been divided, or from paralysis of fore backwards, directly through the centre all its muscles, they call the case ophthalmoof the entire mass. An apparently recent ptosis. Mr. Lawrence has never seen the coagulum of blood separated the sclerotica latter occurrence. from the choroid coat, the latter, with the retina, being compressed by the coagulum into a thick cord, extending from the optic nerve to the iris ; there was no trace of "ERYSIPELAS. humours ; the sclerotica was natural ; the morbid growth adhered to it closely behind, and the optic nerve proceeded through the To tise Editor of 1 crE LANCET. centre of the mass. The latter was a dense Sin,-On all disputed doctrines in medi. compact structure, of schirrous firmness, resisting the edge of the knife ; its exterior cal science, it seems desirable to obtain consisted of alight grey texture, very much information from competent practical per. like that of a scirrhous breast, while in the sons, whethel’ their ’l1wde Y’ti,eit2)zeiit has been interior this was intermixed with a light sitceessfitl or not, because their failures as yellow, yet firm substance, resembling what well as their success must convey valuable is seen in scrofulous diseases. information. Under the influence of this Mr. Lawrence observed, that he used impression, I offer you my unvarnished conthe expressions " scirrhous firmness" and tribution towards an elucidation of the na. " scirrhous structure" merely to describe ture, and the best mode of treating, erysithe character of the morbid production, and pelas. I have found this disorder exceednot to convey an opinion that it was of a ingly prevalent in this district, and I accarcinomatous nature. He did not enter- count for this frequency from three contain the slightest apprehension that disease current causes : the occupation of the inwould return ; yet, on reviewing the history habitants, which is almost wholly in spinof the case, and comparing with its course ning or weaving cotton in mills at a temthe bulk and texture of the morbid growth, perature of about75° Farenheit ; the climate, he was satisfied that the latter would have which is generally very damp, with frequent continued to enlarge, and the sufferings of cold winds, the natural results of a deep dale the patient would have continued to in- in the mountainous region of the Peak, and crease, had the disease been left to itself, the many thousand acres of moorland surso that the operation must be considered to rounding us on all sides ; and lastly, the have been absolutely necessary. food, which for the most part consists of ]’1’11". Lawrence considered this, in the viands that disorder stomachs that are iidt first instance, as common inflammation and very vigorous. The practice I find most suppuration, and he" originally entered it in I efricient leads me to consider erysipelas as his case book as deep-seated suppura- i wholly symptomatic, and that it always detion in the orbit." The symptoms corre- I pends on some derangement in the chylosponded in all respects to those of the few poetic system ; and, whether the disorder instances which he had seen of abscess in assume the red, sinning, burning characthe orbit. Ile would not have expected, ter, or the yellowish hue, and œdea ]J1’iol’i, that a common cause, namely, long matous aspect, and whether accompanied exposure to severe cold, would prcduce in by vesicles or not, or preceded by, and therea healthy young man a diseased growth fore seeming to be caused by wounds, the similar in external character to the malig- principle of my practice is the same, and nant changes of structure. this is to clear out the passages with all According to the usual arrangement of convenient dispatch ; and for this pnrpose diseases, this case would come under the the followingmedicines are generally used
I,i
peculiar
THE DUBLIN COLLEGE OF SURGEONS.
625
Po, Pulv. ipecac. j. ft. emetic. imprimis sum.
Pil. hydr.gr. x. hord somni sumantur. vel, R Subm. hydr. gr. vi. Pulv.jalapx, gr. viij.
Syrupi,
q. s.ft. bol. h.
R Magn. sulph. zi. ad. Sodce carbon. zi.
THE LANCET.
London, Saturday, January 26,
s. sum.
zii.
1828.
IF the violation of justice always implied breach of the law, we should have little R Plumb. sitperacet. 5ss. difficulty in proving the illegality of the Aqua distill. bj.ft. lotio. to be applied constantly to the part in the exclusion practised by the Dublin College more acute erysipelas, but if instead of the of Surgeons, after what has been advanced shining, burning, and red aspect of the parts on the iniquity of that usage. Though this they assume the yellow hue and œdematous swelling, with probably small vesicles, the supposition is not invariably true, yet we following lotion is substituted, but in other conceive weshall be able to show that the respects the treatment is the same : College cannot plead in its defence the Px Liq. ammon. acet. zij. usual apology of " summum jus summa inSpt. vini R. zi. Aq. distillat. q. s.ft.bj. M.ft lotio. juria ;" but that, to a contempt of equity, it the parts to be frequently bathed with it. has added a wilful infraction of its own It is often necessary to repeat the pil. hydr. statutes. To reduce this charge to a more two or three successive nights, the bowels being kept open by the alkaline aperient;-, demonstrative form, it will be necessary to in severe cases I have given the pil. hydr. examine the spirit of that clause of the twice a day; rarely has it been necessary which it has assumed as a j ustificato bleed, and I have never had recourse to charter, of nor has scarifications matter tion of its conduct ; its literal meaning, as any kind, ever formed under the integuments. In one the common sense of the extreme case, where the head, and succes- interpreted by medical profession ; and the precedent es· sively every part of the body was involved in the disease, I varied the practice, and tablished by the very founders of the Coloften in the use of evacuants and bleeding I employed cinchona and liq. am. acet. in lege. For the accomplishment of the first full doses every four hours. Only one fatal of these intentions, a statement of the circase of erysipelas has occurred in my praccumstances under which the College charter tice during my residence in this district; in which time, I think, at the lowest calcu- was conferred, presents, perhaps, the best lation, I have had more than fifty cases, means ; but of these circumstances we and in the solitary unfortunate case, I have cannot speak from personal observation, nor no doubt the result was wholly the effect does any written record remain, from which of neglect. In conclusion, I beg, Sir, to be under- information on the subject could be destood as only submitting my practice, and rived. Tradition, however, which is quite the results, to the consideration of your forour purpose, in a matter of such readers. I presume not to think myself competent to say, how in all cases the dis- recent date, represents the condition of the order should be treated, because I doubt surgical profession in Ireland of a most not that peculiar occupations, locopositions, anomalous character, antecedent to its inatmosplierical peculiarities, and vicissitudes, will all modify the affection, and may there- corporation. It was composed, in short, of fore require other means than those 1 have the most heterogeneous materials ; of many ’ found so efficient. who served apprenticeships, and of more who I am, Sir, never had a master ; of persons who had Your obliged and most obedient servant, licenses, and of others who practised by a PAUL SLADE KNIGHT. sort of hereditary right, deduced from their fathers ; of the members and graduates of Glossop, Derby, Dec. 31, 1827. every College, British, Scotch, and contiuental;of individuals, in fact, who acquired bss. M.fiat mistura, ij. 44 q.q. herd.
Aq. menth. p. q. s.ft. sum.
cochlearia
’
a
sufficient
No. 230.