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AN ACCOUNT OF CASES OF CONSUMPTION TREATED BY IODINE INHALATION, WITH THE IODINE FORMULA.
189 as I am not in the habit of making nnystery or concealment towards my prostatements without having facts to support ffessional brethren. I appeal with confidence them, I need, in the present instance, only tto my former writings in proof of my habitual give the titles of Mr. Carmichael’s works ccandour, and unreserved freedom of compublished in Germany and the United States. imunication. Any foraigr. bookseller will be happy to Notwithstanding that upon a late occasion procure copies of them for Ar. J.’s perusal. I explained myself rather in general, than Mr. Carmichael’s Essay on Scrofula was the particular terms, for the reasons stated in I first of his works published in Germany. A my publication, * I have been most diligent notice of it was printed in the Leipsic Lite- in answering fully the numerous inquiries rary Gazette for May, 1817, and a free addressed to me as well by letter as translation of it by Dr. John Ludwig Chou- 1verbally ;and I rest, therefore, perfectly lant, along with the Essays of Henning and satisfied with the ’° mens conscia recti." Goodlad on the same subject, was published I shall ever hold myself regardless of at Leipsic in 1818. At the same place, in unfounded aspersions, illiberal opinions, 1819, was published a translation, by C. and remarks, which appear to emanate from Gottlob Kiihn, Professor of Surgery, of Mr. malevolence, and certainly partake not in Carmichael’s Essay on the Uses and Abuses any degree of the pure spirit of criticism. of Mercury in the Treatment of Venertal The following is the formula which I find Diseases. The second edition of his work most reason to approve :on Venereal Diseases has likewise been Iodinœ, gr. viii ; t translated into German. Not having seen Potassœ hydriodat., gr. v. ; t Alcoholis, ss; this, I can give no particulars respecting it. And a second American edition of his Aquœ distillat., vss. M. fiat mistura. The above is the smaUest proportion of second edition on the Venereal, has been published by Dr. Emerson at Philadelphia hydriodate necessary towards the solution in 1825. Now, Sir, I believe it is usually of the prescribed portion of iodine ; and, on allowed that an author is known in the lite- the other hand, if more were employed it rary capitals of those countries where his would engage too much of the iodine, and thus the efficient agent would not exist free works have been translated or edited. Having, Sir, completed the disgusting in sufficient quantity to be remedial. As task of unfolding and exposing the compli- this delicate agent iodine is very volatile, I cated tissue of meanness, scurrility, prevari- find it advantageous to divide the dose for cation, and misstatement, which compose each inhalation, whatever it may be, into the two first letters signed Ar. J. inserted two portions, and recommend two-thirds to in your S82d and 386th Numbers, and pur- be used for the first half of the time (the porting to come from the pen of one of the whole time being fifteen or twenty minutes); professors of the ltoyal College of Surgeons the other third for the remaining period. in Ireland, I shall for the present conclude In commencing with the remedy, I never and reserve myself for another occasion t< think it necessary to prescribe less than a reply to the third precious sample of tht drachm as the total quantity for each inhalalearned and accurate professor’s cool, philo. tion, and rarely find it expedient to go beyond six drachms. Almost invariably, I use sophical candour, and love of truth. A.B. with each inhalation ftom twenty to thirtyfive minims of the saturated tincture of conium, which has the effect of softening the action of the iodine, without impairing AN ACCOUNT OF its useful properties, in addition to its distinct power of allaying irritation. CASES OF CONSUMPTION I have the satisfaction of being confirmed TREATED BY IODINE INHALATION, hy my further experience, on the high advantages of the use of inhalation, as an auxiWITH THE IODINE FORMULA. liary treatment, in pulmonary consumption, morbid states of the air pasBy Sir CHARLES SCUDAMORE, Knt., M.D. and in several sages. I say auxiliary, because I do not wish it to be that I confine my To the Editor of THELANCET. treatment to the use of inhalation, although SI n;take up my pen with much plea- I deem this part of my plan as primary, aud sure in order to obey the call of the profes- most important, and even indispensable. sion for the exact formula of the iodine * I tnay heie observe that I should have been inmixture which 1 have been led to prefer ass correct 111 prescribing a formula in my book, because not at that time so fully satisfied mya principal remedy in my method of treat- self, asI had I have now done, in regard to the most ment by inhalation. favourable proportion of the ingredients. Let me at the same time repel the in+ It is important that these medicines shonid of use sinuation having had any design to oposbess the greatest punty.
Now,
J
supposed
.
190
Much professional scepticism appears to be entertained concerning the possibility of affording any material relief in cases of conThis I
always a sense of restraint ; night perspirations ; considerable emaciation ; great debility; the pulse usually beyond 100; the
It is, I animal heat 100°. The examination by the the interests stethoscope indicated pectoriloquism and to consider any g-argouillement on the right side. On the disease as absolutely incurable. Oar art isleft-side the voice did not give any marked doubtless, bounded by certain timits, but let; indications, but the respiration was impernot these limits be still further circumscribed fect, and the sound on percussion not sufficientlyclear. His medical attendants had by our own supineness and prejudices. I hope I shall not prove too intrusive on pronounced him to have tubercles and ulceyour pages, or tedious to the reader, if I ration, and advised a change of climate as offer a cpncise statement of three cases, the only chance of prolonging his life. I submitted this patient to the combined which I consider as illustrating the value of the combined method of treatment which I treatment of inhalation of iodine and coLave endeavoured to advocate. nium ; of counter-irritation by means of the acetic solution of cantharides used leeches CASE. ’’ A lady, aged 56, of slight and delicate twice for the relief of pleuritic pain; directed form, had been out of health for two years. the chest to be washed night and morning When she consulted me, she had suffered with a mixture of a solution of tannin, eau from severe cough during six months, and de Cologne, and acetic acid ; prescribed mecomplained of a strongsense of soreness in dicines internaily, partly sedative, and partly the trachea, just below the thyroid cartilage, tonic, every attention being paid to the increased by pressure ; she was then dsbili- state of the digestive organs, and the diet tated. Every afternoon a paroxysm came also being strictly regulated. Four months have now elapsed, and the on of incessant cough, attended with the most remarkable difficulty of breathing; patient is almost restored to health. Every suspending the power of all bodily exertion, urgent symptom is removed. He is quite and this state continuing till evening, ren- free from cough ; the expectoration is redered her quite prostrate with languor. Her duced from three or four ounces in the 24 nights were restless, and perspiration was hours, to two or three drachms. He proconsiderable. There was much expectora- g-ressively gains both flesli and strengtha tion of positively purulent appearance and and it may be truly stated, that marked often mixed with blood. There appeared amendment took place from the first moto me sufficient indication of the existence ment the inhalation was used. of ulceration of the mucous membrane of CASE. the trachea. In the treatment which had A lady, aged 32, slight in figure, of fair been adopted, eight or ten blisters had been complexion, always of delicate health, the applied over the affected part, and various mother of several children, took cold in the medicines had been administered without middle of June 1830, and soon became af. any benefit. The patient despaired of re- fected with a troublesome cough, and this covery. speedily followed by hectio fever, emaciation, I employed the inhalation of iodine and and debility. Digitalis was administered
sumption.
must
condemn.
conceive, Sir, less adverse of science than of humanity
to
conium ; applied repeatedly at intervals solution of cantharides
in
the in free doses, with much disadvantage to strong acetic acid the powers of the constitution, and no relief
(of which I have made mention in my book), as to keep a constant state of counter-
the symptoms. When I first visited this patient in Januirritation, and prescribed internal medicines ary 183 J, I found her situation very alarmadapted to the varying circumstances of the ing. The pulse ranged from 120 to 130 ; case. In the course of one week a remark- the animal heat was 103° ; the cough was able improvement was effected in this pa- violent ; the expectoration to the extent of three or four ounces in 24 hours, partly tient, and in six weeks a cure. coloured with blood, and the rest of very CASE. A gentleman, aged 30, of slight figure, puriform appearance, having a peculiar faint and rather narrow chest, had been the sub- odour, and furnishing a colvured ring, on ject of consumptive symptoms for two years; being inspected between pieces of plate improvinga little in health in the summer glass before a taper ; the emaciation excesmonths, but duringthe rest of the year sive, and the debility such, that she was confining himself to a regulated tempera- carried from room to room. The night perture in contiguous apartments. Even with spirations were so profuse, as completely to this care he suffered from an incessant saturate the bed-clothes with moisture; cough, attended with copious expectora- there was a loathing of food ; the cheeks tion, puriform and often sanious; the re- were drawn in, and the whole aspect of the spiration was hurried by slight causes. He patient was that of one fafft hurrying to the to
so
had pains
occasionally
in the
chest, and grave.
191 .
which had been brought there examine. The parents of the marked pectoriloquism, and strong gargou- child stated, that six months ago it was in illement. On the left side, the siglls were perfect health, but that since that time it comparatively favourable, both as to voice, had become unwell, and the disease had the respiration, and the sound elicited by been supposed by its medical attendant to be hydrocepholus. With this impression percussion. has most steadily pursued the calomel had been exhibited in doses of inhalation of iodine and conium, with the FOUR GRAINS THREE T’MES A DAY;the however, instead of getting better, exception of using chlorine and conium for ten davs, when 1 again directed the iodine, became daily worse, and they were now from a conviction of its superior efficacy. 1 anxious for Mr. Lawrence’s opinion. On have constalltlv maintained counter-irrita- the removal of the bandages, which had en. tion in one or other part of the chest, by tirely concealed the face, a must horrid means of the liquid blister before mentioned, sight presented itself. A large, deep, and the chest has been washed every night sloughing ulcer, exhaling a strong mercuand morning with the astringent lotion of rial foetor, extended from the lower eyelid The medicines have been va- to the mouth, and from about the centre of tannin, &c. ried. At first I prescribed sulphate of qui- I the malar bone to the side of the nose. nine with sulphuric acid, &c. in the day, ’. There was also a smaller ulcer on the posand acetate of morphia at night. Latterly, terior part of the neck, and several on the no opiate has been required, aud much be- back ! Not the slightest evidence existed nefit has been derived from full doses of the of the child’s bemg hydrocephalic. Mr. mistura ferri composita. The diet through- Lawrence prescribed appropriate remedies, out has been allowed to the full point of aud recommended that the infant be taken nutrition, animal food having been taken into the hospital, to which the parents ob. twice a day since the change of appetite, jected, saying they were convinced the which quickly took place after the com- child could not recover. Mr. Lawrence mencement of my treatment. Porter of the entertained a similar opinion, and stated best quality has- been taken daily to the that the ulcers were produced by the use of mercury. The child was then removed amount of a pint and a half. I have the pleasure now to state the fol- from the hospital, lowing account of the patient as contrasted with my first description :—The pulse is ABUSES AT GUY’SHOSPITAL. soft, regular, firrn, and in frequency only from 86 to 96; the animal heat 970; the A student of Guy’s Hospital complains cough very slight ; the expectoration not of great injustice on the part of Mr. Morgan exceeding half an ounce in the 24 hours ; towards his pupils. He says, " In the the perspiration at night very moderate, and prospectus of lectures it was stated, that not always occurring ; the sleep continued those on surgery would be delivered by through the night almost without interrùp- Messrs. Key and Morgan, but as soon as tionthe strength much lestored, and flesh the former gentleman bad iinisbed his share is returning. J venture now to entertain of the course, it was, for several nights 101very great hope of au ultimate recovery ; lowing, posted up that Mr. Morgan was in the advantages, however, have not been ac- I the country, and prevented from lecturing, quired in one uniform progress of amend- and he was, consequently, on his return ment ; on the contrary, there have been obliged to lecture every night instead of several relapses, evidently arising, as I have three times a week, to the great inconveconsidered, from repeated softening of tu- nience of the students. Besides this, for bercles. The convalescence of the patient, two seasons he has made promises of lechowever, appears to me now much more turing on poisons, which certainly should assured than at any former period. I have constitute a part of the course ; the excuse to apologise for the length of this article, Mr. Morgan gave for some time was, that and am, Sir, he could not get a rattle-snake, but now he Your obedient servant, unceremoniously declines giving us the lecCHARLES SCUDAMORE. tures at all. It was likewise stated in the Wimpoie Street, April 27. prospectus, that lectures would be given on On examination discovered on the
Thislady
by the stethoscope, I month old, right side pretty well- for him to
child,
comparative anatomy by Mr. Bell and Mr. Morgan, but not one has been given. When also Mr. Morgan visits the hospital, he SHAMEFUL CASE. hurries through the wards as if he consiAs Mr. LAWRENCE was goiug through dered it a waste of time to be there ; and if the wards of St. Bartholomew’s Hospital, he be requested to see a patient, instead of on Friday last, his attention was directed doing so at once, he promises to come the to au infant, apparently about a twelve- next day-a promise which is seldom kept.
Now,
J
supposed
.
190
Much professional scepticism appears to be entertained concerning the possibility of affording any material relief in cases of conThis I
always a sense of restraint ; night perspirations ; considerable emaciation ; great debility; the pulse usually beyond 100; the
It is, I animal heat 100°. The examination by the the interests stethoscope indicated pectoriloquism and to consider any g-argouillement on the right side. On the disease as absolutely incurable. Oar art isleft-side the voice did not give any marked doubtless, bounded by certain timits, but let; indications, but the respiration was impernot these limits be still further circumscribed fect, and the sound on percussion not sufficientlyclear. His medical attendants had by our own supineness and prejudices. I hope I shall not prove too intrusive on pronounced him to have tubercles and ulceyour pages, or tedious to the reader, if I ration, and advised a change of climate as offer a cpncise statement of three cases, the only chance of prolonging his life. I submitted this patient to the combined which I consider as illustrating the value of the combined method of treatment which I treatment of inhalation of iodine and coLave endeavoured to advocate. nium ; of counter-irritation by means of the acetic solution of cantharides used leeches CASE. ’’ A lady, aged 56, of slight and delicate twice for the relief of pleuritic pain; directed form, had been out of health for two years. the chest to be washed night and morning When she consulted me, she had suffered with a mixture of a solution of tannin, eau from severe cough during six months, and de Cologne, and acetic acid ; prescribed mecomplained of a strongsense of soreness in dicines internaily, partly sedative, and partly the trachea, just below the thyroid cartilage, tonic, every attention being paid to the increased by pressure ; she was then dsbili- state of the digestive organs, and the diet tated. Every afternoon a paroxysm came also being strictly regulated. Four months have now elapsed, and the on of incessant cough, attended with the most remarkable difficulty of breathing; patient is almost restored to health. Every suspending the power of all bodily exertion, urgent symptom is removed. He is quite and this state continuing till evening, ren- free from cough ; the expectoration is redered her quite prostrate with languor. Her duced from three or four ounces in the 24 nights were restless, and perspiration was hours, to two or three drachms. He proconsiderable. There was much expectora- g-ressively gains both flesli and strengtha tion of positively purulent appearance and and it may be truly stated, that marked often mixed with blood. There appeared amendment took place from the first moto me sufficient indication of the existence ment the inhalation was used. of ulceration of the mucous membrane of CASE. the trachea. In the treatment which had A lady, aged 32, slight in figure, of fair been adopted, eight or ten blisters had been complexion, always of delicate health, the applied over the affected part, and various mother of several children, took cold in the medicines had been administered without middle of June 1830, and soon became af. any benefit. The patient despaired of re- fected with a troublesome cough, and this covery. speedily followed by hectio fever, emaciation, I employed the inhalation of iodine and and debility. Digitalis was administered
sumption.
must
condemn.
conceive, Sir, less adverse of science than of humanity
to
conium ; applied repeatedly at intervals solution of cantharides
in
the in free doses, with much disadvantage to strong acetic acid the powers of the constitution, and no relief
(of which I have made mention in my book), as to keep a constant state of counter-
the symptoms. When I first visited this patient in Januirritation, and prescribed internal medicines ary 183 J, I found her situation very alarmadapted to the varying circumstances of the ing. The pulse ranged from 120 to 130 ; case. In the course of one week a remark- the animal heat was 103° ; the cough was able improvement was effected in this pa- violent ; the expectoration to the extent of three or four ounces in 24 hours, partly tient, and in six weeks a cure. coloured with blood, and the rest of very CASE. A gentleman, aged 30, of slight figure, puriform appearance, having a peculiar faint and rather narrow chest, had been the sub- odour, and furnishing a colvured ring, on ject of consumptive symptoms for two years; being inspected between pieces of plate improvinga little in health in the summer glass before a taper ; the emaciation excesmonths, but duringthe rest of the year sive, and the debility such, that she was confining himself to a regulated tempera- carried from room to room. The night perture in contiguous apartments. Even with spirations were so profuse, as completely to this care he suffered from an incessant saturate the bed-clothes with moisture; cough, attended with copious expectora- there was a loathing of food ; the cheeks tion, puriform and often sanious; the re- were drawn in, and the whole aspect of the spiration was hurried by slight causes. He patient was that of one fafft hurrying to the to
so
had pains
occasionally
in the
chest, and grave.
191 .
which had been brought there examine. The parents of the marked pectoriloquism, and strong gargou- child stated, that six months ago it was in illement. On the left side, the siglls were perfect health, but that since that time it comparatively favourable, both as to voice, had become unwell, and the disease had the respiration, and the sound elicited by been supposed by its medical attendant to be hydrocepholus. With this impression percussion. has most steadily pursued the calomel had been exhibited in doses of inhalation of iodine and conium, with the FOUR GRAINS THREE T’MES A DAY;the however, instead of getting better, exception of using chlorine and conium for ten davs, when 1 again directed the iodine, became daily worse, and they were now from a conviction of its superior efficacy. 1 anxious for Mr. Lawrence’s opinion. On have constalltlv maintained counter-irrita- the removal of the bandages, which had en. tion in one or other part of the chest, by tirely concealed the face, a must horrid means of the liquid blister before mentioned, sight presented itself. A large, deep, and the chest has been washed every night sloughing ulcer, exhaling a strong mercuand morning with the astringent lotion of rial foetor, extended from the lower eyelid The medicines have been va- to the mouth, and from about the centre of tannin, &c. ried. At first I prescribed sulphate of qui- I the malar bone to the side of the nose. nine with sulphuric acid, &c. in the day, ’. There was also a smaller ulcer on the posand acetate of morphia at night. Latterly, terior part of the neck, and several on the no opiate has been required, aud much be- back ! Not the slightest evidence existed nefit has been derived from full doses of the of the child’s bemg hydrocephalic. Mr. mistura ferri composita. The diet through- Lawrence prescribed appropriate remedies, out has been allowed to the full point of aud recommended that the infant be taken nutrition, animal food having been taken into the hospital, to which the parents ob. twice a day since the change of appetite, jected, saying they were convinced the which quickly took place after the com- child could not recover. Mr. Lawrence mencement of my treatment. Porter of the entertained a similar opinion, and stated best quality has- been taken daily to the that the ulcers were produced by the use of mercury. The child was then removed amount of a pint and a half. I have the pleasure now to state the fol- from the hospital, lowing account of the patient as contrasted with my first description :—The pulse is ABUSES AT GUY’SHOSPITAL. soft, regular, firrn, and in frequency only from 86 to 96; the animal heat 970; the A student of Guy’s Hospital complains cough very slight ; the expectoration not of great injustice on the part of Mr. Morgan exceeding half an ounce in the 24 hours ; towards his pupils. He says, " In the the perspiration at night very moderate, and prospectus of lectures it was stated, that not always occurring ; the sleep continued those on surgery would be delivered by through the night almost without interrùp- Messrs. Key and Morgan, but as soon as tionthe strength much lestored, and flesh the former gentleman bad iinisbed his share is returning. J venture now to entertain of the course, it was, for several nights 101very great hope of au ultimate recovery ; lowing, posted up that Mr. Morgan was in the advantages, however, have not been ac- I the country, and prevented from lecturing, quired in one uniform progress of amend- and he was, consequently, on his return ment ; on the contrary, there have been obliged to lecture every night instead of several relapses, evidently arising, as I have three times a week, to the great inconveconsidered, from repeated softening of tu- nience of the students. Besides this, for bercles. The convalescence of the patient, two seasons he has made promises of lechowever, appears to me now much more turing on poisons, which certainly should assured than at any former period. I have constitute a part of the course ; the excuse to apologise for the length of this article, Mr. Morgan gave for some time was, that and am, Sir, he could not get a rattle-snake, but now he Your obedient servant, unceremoniously declines giving us the lecCHARLES SCUDAMORE. tures at all. It was likewise stated in the Wimpoie Street, April 27. prospectus, that lectures would be given on On examination discovered on the
Thislady
by the stethoscope, I month old, right side pretty well- for him to
child,
comparative anatomy by Mr. Bell and Mr. Morgan, but not one has been given. When also Mr. Morgan visits the hospital, he SHAMEFUL CASE. hurries through the wards as if he consiAs Mr. LAWRENCE was goiug through dered it a waste of time to be there ; and if the wards of St. Bartholomew’s Hospital, he be requested to see a patient, instead of on Friday last, his attention was directed doing so at once, he promises to come the to au infant, apparently about a twelve- next day-a promise which is seldom kept.