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A CASE OF TRIPLETS.
316 means of measuring its amount, aud adapting it to the case. It is indeed but in a small proportion of cases of skin diseases that active depletion is required. Very frequently tonics and a liberal scale of diet are the things most clearly indicated ; yet there are numerous cases, especially in the order vesiculae, in which the torments of the patient cannot be relieved but by a free abstraction of blood, a severe administxation of purgatives and antimony, and a very restricted diet: .and this system must be pursued without regard to any limits but those indicated by the pulse and the skin, and the general tone of the system. In these cases relief follows depletion, as .a spring rises when a load is removed. The features, which are generally dull and heavy, and of a dingy hue, become bright and clear as the treatment proceeds, and the patient frequently remarks that he finds himself stronger on bread .and water than he was on meat and beer. During the earlier stages of the treatment the disease often becomes worse, every dose of medicine appearing, as patients express it, " to ’throw it out;" but it at length subsides rapidly, and gets well either spontaneously or under the influence of alteratives. - CASE I.-Mrs. Paged forty, applied at the dispensary on the 18th of March, 1853, having suffered severely for six months with a vesicular eruption on nearly all the fingers of both hands, which rendered her almost helpless. She had been the I subject of this disease occasionally for twenty years, and always suffered most during the period of lactation. She is nursing an infant a few months old. Her pulse is rapid and her skin hot, "but she calls herself tolerably well. Some pills were given her, consisting of aloes, colocynth, cambogia, and blue pill, to be taken every alternate night, and a saline aperient, with half a grain of the potassio-tartrate of antimony, three times a day. -No beer or meat allowed. March 29th.-She has taken her medicine regularly; but the eruption has increased in extent and severity; the discharge has Tormed hard crusts ; the fingers are swollen, and the itching is tormenting. Skin still hot, and pulse frequent and firm. ’Leeches to be applied to the fingers, and the medicine and diet to be continued. April 29th.-She has lost her infant from some inflammatory attack; was relieved by the leeches, but is costive; has neglected her medicine while nursing her sick child. Resume the
satisfactory
medicines. May 20th.-No
improvement; appetite failing; catamenia Continue the medicines. 27th.-Fingers much worse. Repeat the leeches and continue .’the medicines. June 3rd.-much relieved; health improved. Continue the medicines. 10th.-The hands are better, but the eruption has attacked "the face and tarsi; complains of giddiness. Six leeches to be applied to the temples; continue the medicines. l7th.-Less giddy; catamenial flow profuse; feels very - weak. Take a grain of beberine three times a day dissolved in
present.
water.
much less of weakness than when the treatment was first commenced. It is quite possible that in this case the blood might havebeen rendered impure by the absorption of foecal matter; but the cases of acute eczema complicated with constipation, and yielding to purgatives, are extremely common both in children and adults. Sometimes a chronic form succeeds, which requires the chloride of arsenic, but a large majority are found to yield to depletion long-continued, and somewhat unsparingly administered. In many of these cases the patient appears feeble, looks pale, complains of weakness and lassitude, and has been improving his diet in order to gain strength. The pulse, however, is generally full and strong, and after a full bleeding, with doses of calomel, purgatives, and antimonials, the patient will often express himself There is, as feeling stronger than he has done for months. in these cases, a condition of pyrexia with diminished secretions, which is unnoticed by the patient, and unless the pulse is carefully examined, likely to be overlooked by the practitioner. In fact, it is quite clear that in many instances it is overlooked, for the patients have generally been treated with Plummer’s pill, iodine, and sarsaparilla, the state of the bowels (often loaded with hardened faeces) having been entirely neglected. I may be allowed here to say that the simple principle of successful treatment consists in regarding the skin disease as not the thing to be treated, but simply as a sign of something wrong elsewhere; and when this is rectified by ordinary treatment, the skin recovers immediately. The only difficulty in the diagnosis is, that the patient of the skin only, and requires to be questioned and crossquestioned before the real condition of the constitution can be ascertained. It remains to be observed, that nearly all the forms of cutaneous eruption attended by the secretion and discharge of serous or purulent matter, will yield to this kind of simple treatment without arsenic, mercury, or any other powerful On this point I have seen no reason to alter the alterative. opinion I published six years ago, that, "by rectifying what is obviously wrong in the general system, we put the patient into a condition in which the local disease has a chance of getting well; and sometimes this is all we haveto do ; the vis naedicatrix naturce will accomplish the rest:’* These few words present the outline of all I shall have to advance in these papers; but as, by reason of their fewness, they have been overlooked by hasty readers, by whom I have been ignorantly charged with administering arsenic indiscriminately, and by holding it out as "apanacea in skin diseases," I deem it a duty I owe to myself, as well as to the profession, to illustrate by cases what it was I wished to be understood by the phrase, ’’rectifying what is obviously wrong in the general system," particularly as in that phrase is comprehended all that is requisite in the treatment of the ordinary forms of cutaneous disease.
plaining
complains
A CASE OF TRIPLETS. 24th.-Face and hands worse; health better, but weak. BY R. C. SHETTLE, ESQ., M.R.C.S.E. & L.S.A. ’.Continue the beberine, with purgatives. July lst.-Better and stronger ; skin improving. Continue THE points in the following case most worthy of notice are, the medicines. in my opinion, first, the extreme exhaustion which my patient August 2nd.-She has had one or two boils, and is now manifested at so early a period without any apparent cause, suffering from an attack of epidemic diarrhoea ; eruption Mrs. C- not being a person of very delicate habit, and nearly well. Take a dose of calomel and rhubarb, and continue having passed through the period of gestation with but little the mixture. inconvenience; and, secondly, the fact of there being no haemor16th.-Quite well; feels better and lighter than for many rhage to contend a,gainst-a circumstance of no less importis much reduced in flesh, but not in strength. No ance than the :.months; preceding, as from the very atonic state of the external application was used except cold wet rags. uterus there was much cause to dread such would be the case CASE 2.—M. B-, a female servant, aged twenty-eight, of to a considerable extent. a spare habit, presented herself at the Dispensary, July 6th, At four o’clock in the morning of the 30th July last I was 1852, with an eczematous eruption on the hams, legs, arms, and summoned to attend Mrs. C-, aged twenty-four, who was neck, which had existed about twelve months, but had much in labour with her first child. On the house the - increased for the last four or five weeks. Her occupation as nurse informed me that Mrs. C-- reaching had been in slight pain a cook renders the disease almost intolerable, as every approach the whole of the preceding day, but that labour pains during to the fire aggravates the itching. She complains of being very had not come on until three o’clock, when they sent for me. weak, but the bowels are always constipated ; she is otherwise an examination, I found the os uteri about Upon making A of dose in good health. compound rhubarb pills every other one-third dilated, the vertex presenting, and the membranes night, and two drachms of sulphate of magnesia, with half a (during pain) protruding slightly through the os. The pains, grain of quinine, three times a day. which had not been severe or long-continued, now gradually July l3th.-Skin improving, but the bowels constipated. increased in severity, and came on. about every ten minutes; Compound colocynth and blue pill every night. indeed all seemed progressing favourably, and I fancied Under the action of purgatives she rapidly improved, but labour would terminate in three or four hours. About six ’the disease returned with increased severity several times. o’clock the membranes (which were quite thin) ruptured; the Leeches, purgatives, and antimonials, with a rigid diet, were os uteri becomingfully dilated by eight o’clock, the head at length found to be the only remedies available; and after down upon the perinseum, in which there was an .ten months of this treatment, in which an active purgative pressed absence of all rigidity. Labour pains after this time began to was taken every other night for the whole period, she was * Hunt on the discharged with a sound skin, in improved health, and comSkin, (1847,) page 8.
317
flag, and my patient exhibited other signs of exhaustion ; the pulse becoming quick and irritable ; the tongue dry; brown, and coated. Although it was a first labour, there being an absence of all rigidity in the external parts, I administered a dose of the volatile tincture of secale in a little brandy-andwater, in the hope that labour pains might be again brought on, but without effect. By one o’clock the pains had entirely ceased, I therefore and she became very irritable, with pulse 120. considered it proper to have recourse to the forceps, with which I delivered her of a girl at twenty minutes past one P.M. Finding the uterus contained a second child, I once more administered stimulants, in the hope of inducing natural labour pains, especially as the womb had been partially
bad. He was in good health until a short time ago, but has been gradually getting worse. He smokes some little daily, but finding himself unusually affected by even half a pint of ale, he has of late abstained from it; he used to drink more, but never largely. There is no aching in the bones, or pain of his temples, nor any eruption, and all primary syphilitic symptoms were repeatedly denied to have ever occurred. Bowels open; stools reported natural; no flatulence; urine scanty, but natural. Recommended to discontinue smoking, to eat beef and mutton rather underdone, and to drink a little ale. Dilute nitric acid, one drachm and a half; tincture of capsicum, half a drachm; tincture of cinchona, one drachm; decoction of cinchona, eight ounces; one ounce to be taken emptied of its contents; but I was again doomed to be dis- three times a day. Camphor and extract of taraxacum, of appointed. After waiting an hour, I introduced my hand, each five grains ; in two pills, to be taken every night. Feb. 28th.-Has ceased to work at his former employment, ruptured the second bag of membranes, and brought down the feet of the child, which I delivered immediately. Finding yet and feels better, having been as much as possible in the open another, I again introduced my hand; but as the head was the air; tremors are apparently diminished; appetite poor. Corimost dependent, I had to turn, which was soon effected, and the tinue medicine. child delivered with but little suffering to the mother. A March 3rd.—Feels better; less tremor; tongue steady ; bandage had been applied round the abdomen before the birth speaks more easily ; teeth more firm ; step more decided. of the first child, and had been tightened when necessary ; but Ordered to rinse the mouth out four or five times a day, with during the delivery of the three infants (girls) there had been a saturated solution of alum. Continue mixture and pills. no pain, and consequently no contraction of the womb. The 6th.-Again better, and has much less tremor; tongue after-births (three united) were not thrown off by the natural steadier ; a coppery eruption has appeared upon the neck ; process from the surface of the uterus, and I considered it eyes tender, but reported to have been so before the mercurial would be better to remove them at once than to delay doing so, influence. Continue mixture and pills. as she would then have to be disturbed again for the purpose of lOth.-Feels much better; has little or no trembling, and introducing my hand for the third time. I separated the his tongue is steadily protruded; the gums continue in the placenta with the nails, and by grasping the womb externally same condition. Continue mixture, with tincture of canthawith the other hand, induced contraction of that organ, and rides, two drachms. He is anxious to resume his work, but brought them away, without any hsemorrbage, by three o’clock. being warned of his increased liability to the disease he has I immediately gave a stimulant, and made the bandage round resolved to take advice, and entirely to give it up. the abdomen as tight as possible. The uterus contracted firmly, 13th.-He now walks steadily, and speaks, almost distinctly. and showed no disposition to re-dilate. I then ordered that she His hand, when advanced, is slightly tremulous. There is a should be kept as quiet as possible, hoping she would get some blueness of the eyelids marking exhaustion, and the upper refreshing sleep, while I retired to an adjoining room, desiring eyelid trembles. His teeth are loose from absorption of the to be summoned should any untoward symptom present itself. alveolar processes; gums spongy; pulse weak; bowels open After the lapse of an hour I was informed that she was not once daily. Continue mixture and pill, and use the alum wash quite so well, and had not obtained any sleep. I found her very for the mouth. 24th.-He rapidly improves, and can now even write a restless, complaining of dimness of sight, and she had lost the use of one side. I administered brandy, ether, and ammonia at little. Continue the remedies. At this period he discon= intervals, and at six o’clock she appeared more rational and tinued his attendance, probably considering himself cured. Extreme debility of the system, from the injurious effectsquiet, dozing occasionally until after eight o’clock, when she awoke with jactitation and all the signs of approaching death, of mercurial vapours inhaled, or otherwise applied to the and expired six hours after the termination of labour, entirely, body, was the original cause of all the symptoms appearing in to all appearance, from nervous exhaustion. The children are this case, which is of a class affording a peculiarly interesting field for observation in the town of Birmingham, where there living, and at this time doing well. are so many manufactures which expose the workmen to the Donhead, St. Andrew, near Salisbury, Sept. 1853. influence of mercury. The tendency to suffer from it is found to be much increased by drinking, which acts in a twofold manner-first, by producing cirrhosis or myristicate liver (the latter the much more frequent of the two), it disorders the blood by obstructing the circulation ; and also, secondly, by producing a sedative action succeeding its primary stimulant effects. The morbid symptoms depend upon mercury in QUEEN’S COLLEGE, BIRMINGHAM. a state of vapour-whether in the finely divided state, or only The mercurial vapour after oxidation, is yet undecided. CASE OF MERCURIAL TREMOR. seldom produces salivation, but depresses the nervous system, Reported by HENRY JAMES FRANKS, M.R.C.S.E., House-Surgeon to the and hence the action of the heart; convulsive movements Warneford Hospital, Leamington.) arise from the unrestrained action of antagonist muscles, and. not from any irritation. The prognosis, as in this case, is THE report of the case of mercurial tremor at St. Thomas’s favourable as regards life; but the attack is often repeated, Hospital, with the comments thereupon, in THE LANCET of and the liability is considerably increased by having been September 10th, reminded me of a similar case, which occurred once affected. The liability is guarded against by working in at the Queen’s Hospital, Birmingham, under the care of the a room with the draught from the operator, by careful late Dr. Wright, whose clinical clerk I then was, and of which ablutions, and by rinsing the mouth out with warm water, the following account is extracted from my note-book : all which prophylactic measures the manufacturers, in a Charles N-, aged thirty-two years, was admitted as an highly creditable manner, promote to the utmost of their out-patient February 25th, 1842. He had been a glass-cutter, power among the men; yet, as in this case they seem to have but had never used lead. Two years ago he went into another been strictly attended to, they are not always found to be part of the same establishment as a looking-glass silverer, where sufficient. It is necessary that tone be given to the system he works in:the,following manner :-He takes puremercury, and by exercise, which is far too much neglected, by a careful spreads it on a stone with tinfoil, then sweeps the dross off the diet, and, above all, by avoiding intemperance, to which the foil, spreads upon it a layer of mercury one-eighth of an inch temptation is very great, from the liberal wages these men thick, and floats the glass on the mercury. He has at his work obtain. This also causes them to have considerable reluctance been as clean as possible, has used careful ablutions, and always to change their employment, which ought, if possible, always .applied the nail-brush when he gave up work. His teeth, which to be done after a workman has once suffered from an attack are carious, are becoming loose; there is a white line, from undue of this kind. The treatment consists essentially in increasing epithelial secretion, at the margin of the gums, but he has had no the tone of the system, and relieving any immediate symptoms .bleeding from the gums ornose; there are great tremors, approach- which may arise. Cinchona, in this case, was chosen as the ing to paralysis, and an indecision in speaking resembling stam- tonic, with an excess of nitric acid to afford oxygen, and to mering. He has lost two stone weight during the last two years. render the mercury soluble; and tincture of capsicum was The tongue is wavy, from nervous debility, and he suffers added, lest the muscles of the stomach should resemble in from nocturnal perspirations; memory is rather failing, and those of the other parts.
appetite
Hospital Reports.
-
condition
satisfactory
medicines. May 20th.-No
improvement; appetite failing; catamenia Continue the medicines. 27th.-Fingers much worse. Repeat the leeches and continue .’the medicines. June 3rd.-much relieved; health improved. Continue the medicines. 10th.-The hands are better, but the eruption has attacked "the face and tarsi; complains of giddiness. Six leeches to be applied to the temples; continue the medicines. l7th.-Less giddy; catamenial flow profuse; feels very - weak. Take a grain of beberine three times a day dissolved in
present.
water.
much less of weakness than when the treatment was first commenced. It is quite possible that in this case the blood might havebeen rendered impure by the absorption of foecal matter; but the cases of acute eczema complicated with constipation, and yielding to purgatives, are extremely common both in children and adults. Sometimes a chronic form succeeds, which requires the chloride of arsenic, but a large majority are found to yield to depletion long-continued, and somewhat unsparingly administered. In many of these cases the patient appears feeble, looks pale, complains of weakness and lassitude, and has been improving his diet in order to gain strength. The pulse, however, is generally full and strong, and after a full bleeding, with doses of calomel, purgatives, and antimonials, the patient will often express himself There is, as feeling stronger than he has done for months. in these cases, a condition of pyrexia with diminished secretions, which is unnoticed by the patient, and unless the pulse is carefully examined, likely to be overlooked by the practitioner. In fact, it is quite clear that in many instances it is overlooked, for the patients have generally been treated with Plummer’s pill, iodine, and sarsaparilla, the state of the bowels (often loaded with hardened faeces) having been entirely neglected. I may be allowed here to say that the simple principle of successful treatment consists in regarding the skin disease as not the thing to be treated, but simply as a sign of something wrong elsewhere; and when this is rectified by ordinary treatment, the skin recovers immediately. The only difficulty in the diagnosis is, that the patient of the skin only, and requires to be questioned and crossquestioned before the real condition of the constitution can be ascertained. It remains to be observed, that nearly all the forms of cutaneous eruption attended by the secretion and discharge of serous or purulent matter, will yield to this kind of simple treatment without arsenic, mercury, or any other powerful On this point I have seen no reason to alter the alterative. opinion I published six years ago, that, "by rectifying what is obviously wrong in the general system, we put the patient into a condition in which the local disease has a chance of getting well; and sometimes this is all we haveto do ; the vis naedicatrix naturce will accomplish the rest:’* These few words present the outline of all I shall have to advance in these papers; but as, by reason of their fewness, they have been overlooked by hasty readers, by whom I have been ignorantly charged with administering arsenic indiscriminately, and by holding it out as "apanacea in skin diseases," I deem it a duty I owe to myself, as well as to the profession, to illustrate by cases what it was I wished to be understood by the phrase, ’’rectifying what is obviously wrong in the general system," particularly as in that phrase is comprehended all that is requisite in the treatment of the ordinary forms of cutaneous disease.
plaining
complains
A CASE OF TRIPLETS. 24th.-Face and hands worse; health better, but weak. BY R. C. SHETTLE, ESQ., M.R.C.S.E. & L.S.A. ’.Continue the beberine, with purgatives. July lst.-Better and stronger ; skin improving. Continue THE points in the following case most worthy of notice are, the medicines. in my opinion, first, the extreme exhaustion which my patient August 2nd.-She has had one or two boils, and is now manifested at so early a period without any apparent cause, suffering from an attack of epidemic diarrhoea ; eruption Mrs. C- not being a person of very delicate habit, and nearly well. Take a dose of calomel and rhubarb, and continue having passed through the period of gestation with but little the mixture. inconvenience; and, secondly, the fact of there being no haemor16th.-Quite well; feels better and lighter than for many rhage to contend a,gainst-a circumstance of no less importis much reduced in flesh, but not in strength. No ance than the :.months; preceding, as from the very atonic state of the external application was used except cold wet rags. uterus there was much cause to dread such would be the case CASE 2.—M. B-, a female servant, aged twenty-eight, of to a considerable extent. a spare habit, presented herself at the Dispensary, July 6th, At four o’clock in the morning of the 30th July last I was 1852, with an eczematous eruption on the hams, legs, arms, and summoned to attend Mrs. C-, aged twenty-four, who was neck, which had existed about twelve months, but had much in labour with her first child. On the house the - increased for the last four or five weeks. Her occupation as nurse informed me that Mrs. C-- reaching had been in slight pain a cook renders the disease almost intolerable, as every approach the whole of the preceding day, but that labour pains during to the fire aggravates the itching. She complains of being very had not come on until three o’clock, when they sent for me. weak, but the bowels are always constipated ; she is otherwise an examination, I found the os uteri about Upon making A of dose in good health. compound rhubarb pills every other one-third dilated, the vertex presenting, and the membranes night, and two drachms of sulphate of magnesia, with half a (during pain) protruding slightly through the os. The pains, grain of quinine, three times a day. which had not been severe or long-continued, now gradually July l3th.-Skin improving, but the bowels constipated. increased in severity, and came on. about every ten minutes; Compound colocynth and blue pill every night. indeed all seemed progressing favourably, and I fancied Under the action of purgatives she rapidly improved, but labour would terminate in three or four hours. About six ’the disease returned with increased severity several times. o’clock the membranes (which were quite thin) ruptured; the Leeches, purgatives, and antimonials, with a rigid diet, were os uteri becomingfully dilated by eight o’clock, the head at length found to be the only remedies available; and after down upon the perinseum, in which there was an .ten months of this treatment, in which an active purgative pressed absence of all rigidity. Labour pains after this time began to was taken every other night for the whole period, she was * Hunt on the discharged with a sound skin, in improved health, and comSkin, (1847,) page 8.
317
flag, and my patient exhibited other signs of exhaustion ; the pulse becoming quick and irritable ; the tongue dry; brown, and coated. Although it was a first labour, there being an absence of all rigidity in the external parts, I administered a dose of the volatile tincture of secale in a little brandy-andwater, in the hope that labour pains might be again brought on, but without effect. By one o’clock the pains had entirely ceased, I therefore and she became very irritable, with pulse 120. considered it proper to have recourse to the forceps, with which I delivered her of a girl at twenty minutes past one P.M. Finding the uterus contained a second child, I once more administered stimulants, in the hope of inducing natural labour pains, especially as the womb had been partially
bad. He was in good health until a short time ago, but has been gradually getting worse. He smokes some little daily, but finding himself unusually affected by even half a pint of ale, he has of late abstained from it; he used to drink more, but never largely. There is no aching in the bones, or pain of his temples, nor any eruption, and all primary syphilitic symptoms were repeatedly denied to have ever occurred. Bowels open; stools reported natural; no flatulence; urine scanty, but natural. Recommended to discontinue smoking, to eat beef and mutton rather underdone, and to drink a little ale. Dilute nitric acid, one drachm and a half; tincture of capsicum, half a drachm; tincture of cinchona, one drachm; decoction of cinchona, eight ounces; one ounce to be taken emptied of its contents; but I was again doomed to be dis- three times a day. Camphor and extract of taraxacum, of appointed. After waiting an hour, I introduced my hand, each five grains ; in two pills, to be taken every night. Feb. 28th.-Has ceased to work at his former employment, ruptured the second bag of membranes, and brought down the feet of the child, which I delivered immediately. Finding yet and feels better, having been as much as possible in the open another, I again introduced my hand; but as the head was the air; tremors are apparently diminished; appetite poor. Corimost dependent, I had to turn, which was soon effected, and the tinue medicine. child delivered with but little suffering to the mother. A March 3rd.—Feels better; less tremor; tongue steady ; bandage had been applied round the abdomen before the birth speaks more easily ; teeth more firm ; step more decided. of the first child, and had been tightened when necessary ; but Ordered to rinse the mouth out four or five times a day, with during the delivery of the three infants (girls) there had been a saturated solution of alum. Continue mixture and pills. no pain, and consequently no contraction of the womb. The 6th.-Again better, and has much less tremor; tongue after-births (three united) were not thrown off by the natural steadier ; a coppery eruption has appeared upon the neck ; process from the surface of the uterus, and I considered it eyes tender, but reported to have been so before the mercurial would be better to remove them at once than to delay doing so, influence. Continue mixture and pills. as she would then have to be disturbed again for the purpose of lOth.-Feels much better; has little or no trembling, and introducing my hand for the third time. I separated the his tongue is steadily protruded; the gums continue in the placenta with the nails, and by grasping the womb externally same condition. Continue mixture, with tincture of canthawith the other hand, induced contraction of that organ, and rides, two drachms. He is anxious to resume his work, but brought them away, without any hsemorrbage, by three o’clock. being warned of his increased liability to the disease he has I immediately gave a stimulant, and made the bandage round resolved to take advice, and entirely to give it up. the abdomen as tight as possible. The uterus contracted firmly, 13th.-He now walks steadily, and speaks, almost distinctly. and showed no disposition to re-dilate. I then ordered that she His hand, when advanced, is slightly tremulous. There is a should be kept as quiet as possible, hoping she would get some blueness of the eyelids marking exhaustion, and the upper refreshing sleep, while I retired to an adjoining room, desiring eyelid trembles. His teeth are loose from absorption of the to be summoned should any untoward symptom present itself. alveolar processes; gums spongy; pulse weak; bowels open After the lapse of an hour I was informed that she was not once daily. Continue mixture and pill, and use the alum wash quite so well, and had not obtained any sleep. I found her very for the mouth. 24th.-He rapidly improves, and can now even write a restless, complaining of dimness of sight, and she had lost the use of one side. I administered brandy, ether, and ammonia at little. Continue the remedies. At this period he discon= intervals, and at six o’clock she appeared more rational and tinued his attendance, probably considering himself cured. Extreme debility of the system, from the injurious effectsquiet, dozing occasionally until after eight o’clock, when she awoke with jactitation and all the signs of approaching death, of mercurial vapours inhaled, or otherwise applied to the and expired six hours after the termination of labour, entirely, body, was the original cause of all the symptoms appearing in to all appearance, from nervous exhaustion. The children are this case, which is of a class affording a peculiarly interesting field for observation in the town of Birmingham, where there living, and at this time doing well. are so many manufactures which expose the workmen to the Donhead, St. Andrew, near Salisbury, Sept. 1853. influence of mercury. The tendency to suffer from it is found to be much increased by drinking, which acts in a twofold manner-first, by producing cirrhosis or myristicate liver (the latter the much more frequent of the two), it disorders the blood by obstructing the circulation ; and also, secondly, by producing a sedative action succeeding its primary stimulant effects. The morbid symptoms depend upon mercury in QUEEN’S COLLEGE, BIRMINGHAM. a state of vapour-whether in the finely divided state, or only The mercurial vapour after oxidation, is yet undecided. CASE OF MERCURIAL TREMOR. seldom produces salivation, but depresses the nervous system, Reported by HENRY JAMES FRANKS, M.R.C.S.E., House-Surgeon to the and hence the action of the heart; convulsive movements Warneford Hospital, Leamington.) arise from the unrestrained action of antagonist muscles, and. not from any irritation. The prognosis, as in this case, is THE report of the case of mercurial tremor at St. Thomas’s favourable as regards life; but the attack is often repeated, Hospital, with the comments thereupon, in THE LANCET of and the liability is considerably increased by having been September 10th, reminded me of a similar case, which occurred once affected. The liability is guarded against by working in at the Queen’s Hospital, Birmingham, under the care of the a room with the draught from the operator, by careful late Dr. Wright, whose clinical clerk I then was, and of which ablutions, and by rinsing the mouth out with warm water, the following account is extracted from my note-book : all which prophylactic measures the manufacturers, in a Charles N-, aged thirty-two years, was admitted as an highly creditable manner, promote to the utmost of their out-patient February 25th, 1842. He had been a glass-cutter, power among the men; yet, as in this case they seem to have but had never used lead. Two years ago he went into another been strictly attended to, they are not always found to be part of the same establishment as a looking-glass silverer, where sufficient. It is necessary that tone be given to the system he works in:the,following manner :-He takes puremercury, and by exercise, which is far too much neglected, by a careful spreads it on a stone with tinfoil, then sweeps the dross off the diet, and, above all, by avoiding intemperance, to which the foil, spreads upon it a layer of mercury one-eighth of an inch temptation is very great, from the liberal wages these men thick, and floats the glass on the mercury. He has at his work obtain. This also causes them to have considerable reluctance been as clean as possible, has used careful ablutions, and always to change their employment, which ought, if possible, always .applied the nail-brush when he gave up work. His teeth, which to be done after a workman has once suffered from an attack are carious, are becoming loose; there is a white line, from undue of this kind. The treatment consists essentially in increasing epithelial secretion, at the margin of the gums, but he has had no the tone of the system, and relieving any immediate symptoms .bleeding from the gums ornose; there are great tremors, approach- which may arise. Cinchona, in this case, was chosen as the ing to paralysis, and an indecision in speaking resembling stam- tonic, with an excess of nitric acid to afford oxygen, and to mering. He has lost two stone weight during the last two years. render the mercury soluble; and tincture of capsicum was The tongue is wavy, from nervous debility, and he suffers added, lest the muscles of the stomach should resemble in from nocturnal perspirations; memory is rather failing, and those of the other parts.
appetite
Hospital Reports.
-
condition