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AN ACCOUNT OF SOME DISEASES OF THE TONGUE,
154 therefore, is the necessary condition of inflammatory Its presence may be ascertained by a more simple means than the microscope, successfully resorted to by Gluge and Bennett. Whenever inflammatory softening exists, a small stream of water breaks down and carries off the cerebral substance, which, as we have seen, is not the case in hsemorrhagic softening. This kind of softening is not, as has been stated, the result of senile gangrene, for there is no gangrenous odour, nor of disease of the cerebral arteries, which is nearly always limited to the larger arteries. When the pus is yellow, red, and sanguinolent, the coloration is due to the presence of more or less extravasated blood, and not to vascular inflammation of the substance of the brain-a state which, as has been seen, does not exist. What occurs in contusion of the brain illustrates this fact. A more or less quantity of blood is extravasated, infiltrated, I giving rise to the peculiar dotted red appearance already described. The blood may by its presence irritate the partly disorganized cerebral tissue, and give rise to inflammation and suppuration. When this is the case the pus is tinged with the blood which it dissolves. Sometimes the blood is not absorbed, nor does inflammation at once follow; but the infiltrated tissue remains so, and becomes indurated; around this red induration pus may form. Cases of this kind are considered by M. Durand to be cases of softening terminating by induration, whereas they are cases of induration terminating or complicated by softening. Inflammatory softening may thus occur from external and from internal causes. From the above facts we may draw the following inference :That of a hundred cicatrices found in the brain, ninety-eight may, at first sight, be attributed to apoplexy with laceration, or to infiltration of blood; that of the two remainingdoubtful cicatrices, an attentive examination will shew that one of them has also the same origin, and that the remaining one belongs, in all probability, to some other disease, and not to softening.
ence
of pus,
softening.
ON THE CURABILITY OF SOFTENING.
The
curability of inflammatory softening of the brain
is
by no
proved, although advocated of late by many physicians, MM. Lemasson, Dechambre, Sims, Legroux, and Durand. M. Rostan, who formerly believed that inflammatory softening was curable, has recently declared that he no longer considers it as
means
such.
The
probabilities are against its curability. Old age is so predisposing cause to softening, that some physicians have considered the disease as belonging exclusively to the aged; and yet even with them softening is, perhaps, not oftener primitive than in one case in a hundred. The principal immediate cause of softening is the pre-existence of an apoplectic clot or cicatrice in the brain. Out of a hundred individuals previously powerful
a
attacked with
from Whenever there is destruction of cerebral tissue, a cure can scarcely be said to take place, at least such a cure as occurs in other organs; for the most perfect cerebral cicatrices are enormous deformities, as compared with those of other parts of the body. Moreover, suppurative inflammation of the brain tends to extend itself, and not to become circumscribed, as is evident by the invariable extension and general fatality of traumatic inflammation of the brain, and by the extreme rarity of encysted abscesses of that organ. The study of the symptoms of inflammatory softening, with reference to its curability, is not much more satisfactory than that of its pathological anatomy, as they are identical with those of cerebral apoplexy and infiltration. at least as far as our present knowledge of these symptoms enables us tojudge. In order to appreciate correctly the symptoms of softening, it would be necessary to study them exempt from complication in adults in full possession of their mental faculties; whereas, as we have seen, the disease nearly alwaysoccurs in aged persons, mostly reduced by age to a state of mental obtusion, in itself nearly a disease, and who have either previously suffered from apoplectie attacks, or are actually labouring under pectoral disease. M. Rochoux concludes his memoir by stating, that although he has now been studying this disease during thirteen years, as physician to Bicêtre, (the Paris asylnm for aged and insane men, and the male counterpart of the Salpetriere,) he has not arrived at any data whatever with reference to the diagnosis of inflammatory softening of the brain, which is as obscure to him as on the first day of his arrival at Bicetre; and that science does not possess a single well-authenticated undeniable case of its cure.
apoplexy, sixty
at least
die,
at
a
later
period,
softening of the cerebral substance around the cicatrice.
AN ACCOUNT OF SOME DISEASES OF THE TONGUE, By WILLIAM MACLURE, Esq. Surgeon. (Read before the Harveian Society.) CASE 1.-The Rev. C. M--, on the 28th of March last, consulted me about a long, rather deep, ash-coloured, and painful ulcer, which he had on the right edge and lower surface of his tongue. The dorsum of the tongue was much loaded, and I therefore attributed the affection to derangement of the digestive organs. I prescribed for him some pills composed of blue pill, and the diluted extract of aloes, with a gargle, made up of borax, honey of roses, rose-water, and common water. With these he returned to his cure in N-, and I heard no more of him till the 1st of May, when he returned to town. Things were then much worse. His whole tongue and the inside of his mouth were covered with similar sores, so as to render him incapable of reading aloud, speaking, or eating, except with very great pain. He was forced to live on slops, and give up his clerical functions. Appearances were rather alarming; I entertained hopes, however, that there was nothing malignant about the affection,but that it was merely an attack of rather a bad kind of thrush. I told him so, and prescribed the use of sarsaparilla, combined with the iodide of potassium. I gave him also a gargle, composed of the sulphate of alumina, dissolved in the infusion of roses. The former alterative pill was exchanged for one compounded of extract of colocynth, extract of rhubarb, and blue pill. With these he went to D-, where he intended to reside till his recovery. This course of treatment was continued till the 24th, rather more than three weeks. At the end of that period he returned to town, when it was seen that the greatest possible improvement had taken place. The cure indeed seemed to be complete. As the tongue, however, was still to a considerable degree loaded, though now there were no ulcerations, I thought it advisable to continue acting on the stomach and liver, so as to restore these organs to a more healthy state. For this purpose I continued the use of the pill before mentioned, but discontinued the draught, substituting in its place one composed of the infusions of cascarilla and rhubarb, combined with tincture of columba, the liquor of potash, and camphor julep. In the use of this he persisted till the middle of June, when he departed for the Continent with his family, quite well. This disease is different from the cases of what is called cancrum oris which I have seen. The latter consists of sphacelation more than of ulceration, and must be treated differently. I perceive that Mr. Liston, in one of his lectures published in THE LANCET, (lect. viii.,) notices the disease which I have described, but he does not seem to have met with any instances of it, of so aggravated a form as the above. " Slight ulcers of the tongue," says he,"which are not ofmalignant kind, may be removed by some local application, and a healthy process brought about. Endeavour to make the patient keep the organ as quiet as possible ; touch the surface of the sore perhaps pretty freely, once for all, with nitric acid, and then let him have some lotion to clean the part-a solution of alum or of the biborate of soda. At the same time you must endeavour to correct the state of the constitution by some alterative, some of the preparations of arsenic or of iodine." It will be recollected that my case became much worse under the use of the biborate of soda, but got well rapidly after the sulphate of alum had been substituted for it in the gargle, along with the constitutional treatment which I have detailed.’ CASE 2.-In the same lecture, Mr. Liston mentions a case which he had once met with, of an enormous swelling of the tongue from the exhibition of a small quantity of mercury, a couple of Plummer’s pills, one of which the patient took two, nights in succession. "Iwas sent for," says Mr. Liston, " in a great hurry, and I found him in a miserable state, his tongue protruding to a great extent, and very much inflamed. The disease may be combated by active antiphlogistic means-by bleeding at the arm, and applying leeches at the side of the neck. If the tongue is much swollen and fills up the whole mouth, and if the respiration is at all interfered with, you must take even more active means than these-an incision must be made in the organ, and you must treat it as you would inflammatory swelling in other exposed parts of the body. If this is not done, deep suppuration may take place in the tongue, and the patient be placed in great jeopardy. You make a free incision in the direction of *
Oil of
ordinary tar, obtained by distillation alone, or with water, consists in great measure of unaltered oil of turpentine, mixed, however, with empyreumatic oily products, which give it
powerful odour and a dark colour. The residual pitch contains much pine-resin, and thus differs from the solid portion of the hard-wood tar. a
21st
September,
1844.
t Since this paper was read my patient has returned from his tour, with, so far as ulceration is concerned, his tongue quite well. His attention, however, has been sometimes recalled to that organ by a kind of pricking which he feels from its pain, very tip. Upon exaapparently proceeding mination I thought I could direct er a reddish point in that quarter. This point I touched with nitric acid once, and it would seem with a good effect; for he wrote me the other day that the pricking pain was now much less ptreeptible.
155 the tongue, one, perhaps, along each side of the median line, and this will be attended with profuse haemorrhage." Mr. Liston’s remarks on this subject reminded me of rather a remarkable case of the sort which I met with a long time ago, when I was a very young practitioner. A paper-maker at Dalmuir, not far from where I was then located, applied to me with a venereal sore throat. The ulceration had proceeded to rather an alarming extent, and it was of importance to bring the system as speedily For this purpose, as possible under the influence of mercury. blue ointment was rubbed in twice a day, in the usual quantity, and blue pills were given internally. Whilst the patient was thus going on cautiously under my directions, his brother, a sailor, Jack having ascertained how the land lay, came home from sea. and thinking the land-lubber of a doctor who had his brother in tow, was not giving him enough of the blue butter," advised him,
one Sunday, when they were both at home together all day, to rub in the whole box of ointment at once, before a blazing fire, observing how their doctor on board ship "hove his shipmates down with mercury in fine style," when anything was wrong with them, and that they got well in less than no time! In pursuance of this sage advice, nearly two ounces of strong mercurial ointment were rubbed in at one or two sittings, Jack assisting strenuously at the operation. The consequence may easily be anticipated. In a day or two afterwards ptyalism came on to an immense extent; the gums and glands swelled, and the tongue, every day getting larger and larger, lolled out of his swollen mouth, the saliva at the same time flowing in torrents, and his breath emitting an intolerable foetor. The patient continued for some time a most hideous and pitiable object. Eat he could not, and to sleep he scarcely dared, for fear of suffocation! It was impossible also to get any kind of purgative medicine down his throat. He was bled, I believe from the arm, and leeched; but I was not then bold enough to make free incisions in the tongue. Enemata were given, both purgative and nutritive, and latle else .could be done. Things having come to the worst, in the course of a few weeks they began to improve ; salivation, pain, and fcetor, became less, and the swelling of the tongue diminished; but lo! even then he could not retract that organ within the limits of his mouth! The reason of this inability was not at first very obvious, but on examination it soon became more so. Upon introducing my finger into the patient’s mouth I discovered, to my great trepidation and alarm, that the tongue on both sides of the mouth was adhering to the insides of his cheeks, and could not, of course, be pulled backwards. Both speech and deglutition were, owing to this, very imperfectly performed, and there was little chance of their improving so long as the motions of the tongue were thus effectually restrained. Ulceration had taken place, probably both on the insides of the cheeks, and on the lateral parts of the tongue, and these raw surfaces coming together, and remaining, from the tumefaction of the parts, long and intimately in contact, adhesion had taken place, and presented the difficulty with which I had now to deal. The difficulty, however, was not so great as I at first apprehended. The adhesions easily gave way to the pressure of the finger applied to the edge of the tongue on either side, and thus the parts were restored to their natural liberty. Upon inspection, the venereal ulceration of the throat was found to be quite well; and the man gradually acquired his former health, and strength. In the absence of better matter, I thought the detail of these - cases might be interesting, especially the latter, as it was attended with an accident which is not likely to occur often, and to which I have seen nothing similar recorded.
of pure iodine, iodide of potassium, and hog’s lard, but found, upon trial, to give her so much pain, and produced so much irritation, that I was forced to abandon its use
composed
this
was
For it I substituted the following ointment: and extract of conium a drachm, rubbed up with seven drachms of prepared hog’s lard. This ointment was ordered to be rubbed into the palm of her hand every day, both morning and evening. Besides these remedies, local and general, she took occasionally an alterative and aperient pill, made up of blue pill and the compound extract of colocynth. The consequence has been, after about a month’s steady use of the remedies, that the hand has become quite well, the skin being now, for the first time these two years, soft, white, flexible, active, and completely free from itching, heat, and every unpleasant appearance and feeling. Nor has the tongue as yet shewn any tendency to alternative disease, as before, so that we have reason to hope-the constitution having been set to rights by the means employed-the former chain of morbid sympathy between the distant organs of which we have been speaking, and a metastasis of the psoriasis, from the one to the other alternately, took place so often, for so long a time, has been at last broken and destroyed, permitting both to remain in their healthy
after
a
few
days’trial.
viz., white oxide of mercury four grains,
condition.
HaIley..strcet,
Jan. 4, 1845.
ON THE INJECTION OF TANNIN FOR THE CURE OF ANEURISMS. R. A. VARICAS, Esq. Surgeon, London. By A NEW and practicable means of cure for this disease has been for a long time desired; indeed, few in the profession but have had occasion to deplore the want of one, where the ligature is considered impracticable. Often has it been their painful lot to stand by, powerless, watching the unerring progress of the disease to its fatal termination; and even when the ligature has been determined upon, how frequently are its results considered hazardous or doubtful! Aneurism by anastomosis cannot always be cured, although the carotids themselves be tied. Others cannot be reached by the needle with certainty and safety, from the nature of their situation and connexions. Even disease of the coats of the vessel, and excessive debility, will be sufficient reasons to cause one to pause and wait the efforts oi nature either to work the cure or produce the awful catastrophe. How seldom the former, and how frequently the latter, every one of experience cannot but have been a too frequent witness! Under these circumstances, I am emboldened to lay before the profession a new method of producing an artificial coagulum of blood, to any extent, in the interior of vessels; and hope, at the same time, it will receive a dispassionate consideration. From the known chemical action of tannin upon albumen, and from its facility of application, I am induced to recommend its injection into vessels thus diseased. The effect is to produce the coagulation of blood, and thereby obstruct the circulation in that direction. This desirable object has been attempted before by other means, but such have been proved inefficacious, inasmuch as the coagulum obtained has been too inconsiderable to carry out the end in view. There are a few precautionary measures to be noticed in the performance of the operation of injection; I will therefore proceed to explain the manner in which it should be conducted, and the kind of instrument adapted to its application. A small syringe, either of silver or glass, should be fitted CASE 3.-Since the foregoing cases were read to the Society, accurately, with a long, very fine tapering canula and stilet, I have been consulted by a young married lady for rather a much curved, and furnished with stop cock. The vessel having curious affection. She informs me that her tongue becomes been cut down upon sufficiently to enable the operator to arrive occasionally bestudded with small ulcerations, and afterwards, at it easily with his finger, the canula is to be directed along it when these get well, the palm of her left hand becomes affected into the artery, with its concavity turned towards the heart; and with a sort of psoriasis palmaris. The tongue is at present quite the syringe, previously filled with a saturated solution of tannin, well, but the palm of her hand is covered with the eruption. (all air being, of course, excluded,) should then be attached to it, When this gets better, however, she expects her tongue to whilst an assistant, compressing the artery at its distal side. so as become again the seat of disease, for thus they have alternated to retard the circulation through it, the process of injection for a considerable time past-she says about two years. The should commence, with a force proportionate to the remoteness chief reason for which she consulted me at present, however, is, from, or propinquity to, the heart; also to whether it be perthat she has gout in one of her feet. I believe that the whole formed on the distal or cordal side of the aneurism. In aneurism series of her complaints depends on some derangement of the by anastomosis, or noevus, sufficient power should be applied to digestive organs, though that is not made very apparent by ex- carry the injection some way into the vessels, and the canula ternal symptoms. I gave her an alterative pill, and a tonic should be introduced with its convexity towards the heart. As soon as the aneurismal pulsations cease, the pressure should mixture, combined with colchicum, and an alkali. The gout has already disappeared, and even the hand is much im- be gradually withdrawn from the artery, and time be allowed for proved. As soon as the gout was got rid of, I substituted the heart to exert its force against the coagulum: if the pulsations for the tonic mixture, in which, as I have just said, were of the sac recommence from this having taken place, the injection wine of colchicum and carbonate of soda, a mixture composed of should be performed anew, before withdrawing the instrument. the extract of sarsaparilla, combined with the iodide of potassium. It is possible that, after the lapse of time, the coagulum (if formed) As a local application to her hand, I prescribed an ointment, will contract disproportionately with the sac, and pulsations
’
ence
of pus,
softening.
ON THE CURABILITY OF SOFTENING.
The
curability of inflammatory softening of the brain
is
by no
proved, although advocated of late by many physicians, MM. Lemasson, Dechambre, Sims, Legroux, and Durand. M. Rostan, who formerly believed that inflammatory softening was curable, has recently declared that he no longer considers it as
means
such.
The
probabilities are against its curability. Old age is so predisposing cause to softening, that some physicians have considered the disease as belonging exclusively to the aged; and yet even with them softening is, perhaps, not oftener primitive than in one case in a hundred. The principal immediate cause of softening is the pre-existence of an apoplectic clot or cicatrice in the brain. Out of a hundred individuals previously powerful
a
attacked with
from Whenever there is destruction of cerebral tissue, a cure can scarcely be said to take place, at least such a cure as occurs in other organs; for the most perfect cerebral cicatrices are enormous deformities, as compared with those of other parts of the body. Moreover, suppurative inflammation of the brain tends to extend itself, and not to become circumscribed, as is evident by the invariable extension and general fatality of traumatic inflammation of the brain, and by the extreme rarity of encysted abscesses of that organ. The study of the symptoms of inflammatory softening, with reference to its curability, is not much more satisfactory than that of its pathological anatomy, as they are identical with those of cerebral apoplexy and infiltration. at least as far as our present knowledge of these symptoms enables us tojudge. In order to appreciate correctly the symptoms of softening, it would be necessary to study them exempt from complication in adults in full possession of their mental faculties; whereas, as we have seen, the disease nearly alwaysoccurs in aged persons, mostly reduced by age to a state of mental obtusion, in itself nearly a disease, and who have either previously suffered from apoplectie attacks, or are actually labouring under pectoral disease. M. Rochoux concludes his memoir by stating, that although he has now been studying this disease during thirteen years, as physician to Bicêtre, (the Paris asylnm for aged and insane men, and the male counterpart of the Salpetriere,) he has not arrived at any data whatever with reference to the diagnosis of inflammatory softening of the brain, which is as obscure to him as on the first day of his arrival at Bicetre; and that science does not possess a single well-authenticated undeniable case of its cure.
apoplexy, sixty
at least
die,
at
a
later
period,
softening of the cerebral substance around the cicatrice.
AN ACCOUNT OF SOME DISEASES OF THE TONGUE, By WILLIAM MACLURE, Esq. Surgeon. (Read before the Harveian Society.) CASE 1.-The Rev. C. M--, on the 28th of March last, consulted me about a long, rather deep, ash-coloured, and painful ulcer, which he had on the right edge and lower surface of his tongue. The dorsum of the tongue was much loaded, and I therefore attributed the affection to derangement of the digestive organs. I prescribed for him some pills composed of blue pill, and the diluted extract of aloes, with a gargle, made up of borax, honey of roses, rose-water, and common water. With these he returned to his cure in N-, and I heard no more of him till the 1st of May, when he returned to town. Things were then much worse. His whole tongue and the inside of his mouth were covered with similar sores, so as to render him incapable of reading aloud, speaking, or eating, except with very great pain. He was forced to live on slops, and give up his clerical functions. Appearances were rather alarming; I entertained hopes, however, that there was nothing malignant about the affection,but that it was merely an attack of rather a bad kind of thrush. I told him so, and prescribed the use of sarsaparilla, combined with the iodide of potassium. I gave him also a gargle, composed of the sulphate of alumina, dissolved in the infusion of roses. The former alterative pill was exchanged for one compounded of extract of colocynth, extract of rhubarb, and blue pill. With these he went to D-, where he intended to reside till his recovery. This course of treatment was continued till the 24th, rather more than three weeks. At the end of that period he returned to town, when it was seen that the greatest possible improvement had taken place. The cure indeed seemed to be complete. As the tongue, however, was still to a considerable degree loaded, though now there were no ulcerations, I thought it advisable to continue acting on the stomach and liver, so as to restore these organs to a more healthy state. For this purpose I continued the use of the pill before mentioned, but discontinued the draught, substituting in its place one composed of the infusions of cascarilla and rhubarb, combined with tincture of columba, the liquor of potash, and camphor julep. In the use of this he persisted till the middle of June, when he departed for the Continent with his family, quite well. This disease is different from the cases of what is called cancrum oris which I have seen. The latter consists of sphacelation more than of ulceration, and must be treated differently. I perceive that Mr. Liston, in one of his lectures published in THE LANCET, (lect. viii.,) notices the disease which I have described, but he does not seem to have met with any instances of it, of so aggravated a form as the above. " Slight ulcers of the tongue," says he,"which are not ofmalignant kind, may be removed by some local application, and a healthy process brought about. Endeavour to make the patient keep the organ as quiet as possible ; touch the surface of the sore perhaps pretty freely, once for all, with nitric acid, and then let him have some lotion to clean the part-a solution of alum or of the biborate of soda. At the same time you must endeavour to correct the state of the constitution by some alterative, some of the preparations of arsenic or of iodine." It will be recollected that my case became much worse under the use of the biborate of soda, but got well rapidly after the sulphate of alum had been substituted for it in the gargle, along with the constitutional treatment which I have detailed.’ CASE 2.-In the same lecture, Mr. Liston mentions a case which he had once met with, of an enormous swelling of the tongue from the exhibition of a small quantity of mercury, a couple of Plummer’s pills, one of which the patient took two, nights in succession. "Iwas sent for," says Mr. Liston, " in a great hurry, and I found him in a miserable state, his tongue protruding to a great extent, and very much inflamed. The disease may be combated by active antiphlogistic means-by bleeding at the arm, and applying leeches at the side of the neck. If the tongue is much swollen and fills up the whole mouth, and if the respiration is at all interfered with, you must take even more active means than these-an incision must be made in the organ, and you must treat it as you would inflammatory swelling in other exposed parts of the body. If this is not done, deep suppuration may take place in the tongue, and the patient be placed in great jeopardy. You make a free incision in the direction of *
Oil of
ordinary tar, obtained by distillation alone, or with water, consists in great measure of unaltered oil of turpentine, mixed, however, with empyreumatic oily products, which give it
powerful odour and a dark colour. The residual pitch contains much pine-resin, and thus differs from the solid portion of the hard-wood tar. a
21st
September,
1844.
t Since this paper was read my patient has returned from his tour, with, so far as ulceration is concerned, his tongue quite well. His attention, however, has been sometimes recalled to that organ by a kind of pricking which he feels from its pain, very tip. Upon exaapparently proceeding mination I thought I could direct er a reddish point in that quarter. This point I touched with nitric acid once, and it would seem with a good effect; for he wrote me the other day that the pricking pain was now much less ptreeptible.
155 the tongue, one, perhaps, along each side of the median line, and this will be attended with profuse haemorrhage." Mr. Liston’s remarks on this subject reminded me of rather a remarkable case of the sort which I met with a long time ago, when I was a very young practitioner. A paper-maker at Dalmuir, not far from where I was then located, applied to me with a venereal sore throat. The ulceration had proceeded to rather an alarming extent, and it was of importance to bring the system as speedily For this purpose, as possible under the influence of mercury. blue ointment was rubbed in twice a day, in the usual quantity, and blue pills were given internally. Whilst the patient was thus going on cautiously under my directions, his brother, a sailor, Jack having ascertained how the land lay, came home from sea. and thinking the land-lubber of a doctor who had his brother in tow, was not giving him enough of the blue butter," advised him,
one Sunday, when they were both at home together all day, to rub in the whole box of ointment at once, before a blazing fire, observing how their doctor on board ship "hove his shipmates down with mercury in fine style," when anything was wrong with them, and that they got well in less than no time! In pursuance of this sage advice, nearly two ounces of strong mercurial ointment were rubbed in at one or two sittings, Jack assisting strenuously at the operation. The consequence may easily be anticipated. In a day or two afterwards ptyalism came on to an immense extent; the gums and glands swelled, and the tongue, every day getting larger and larger, lolled out of his swollen mouth, the saliva at the same time flowing in torrents, and his breath emitting an intolerable foetor. The patient continued for some time a most hideous and pitiable object. Eat he could not, and to sleep he scarcely dared, for fear of suffocation! It was impossible also to get any kind of purgative medicine down his throat. He was bled, I believe from the arm, and leeched; but I was not then bold enough to make free incisions in the tongue. Enemata were given, both purgative and nutritive, and latle else .could be done. Things having come to the worst, in the course of a few weeks they began to improve ; salivation, pain, and fcetor, became less, and the swelling of the tongue diminished; but lo! even then he could not retract that organ within the limits of his mouth! The reason of this inability was not at first very obvious, but on examination it soon became more so. Upon introducing my finger into the patient’s mouth I discovered, to my great trepidation and alarm, that the tongue on both sides of the mouth was adhering to the insides of his cheeks, and could not, of course, be pulled backwards. Both speech and deglutition were, owing to this, very imperfectly performed, and there was little chance of their improving so long as the motions of the tongue were thus effectually restrained. Ulceration had taken place, probably both on the insides of the cheeks, and on the lateral parts of the tongue, and these raw surfaces coming together, and remaining, from the tumefaction of the parts, long and intimately in contact, adhesion had taken place, and presented the difficulty with which I had now to deal. The difficulty, however, was not so great as I at first apprehended. The adhesions easily gave way to the pressure of the finger applied to the edge of the tongue on either side, and thus the parts were restored to their natural liberty. Upon inspection, the venereal ulceration of the throat was found to be quite well; and the man gradually acquired his former health, and strength. In the absence of better matter, I thought the detail of these - cases might be interesting, especially the latter, as it was attended with an accident which is not likely to occur often, and to which I have seen nothing similar recorded.
of pure iodine, iodide of potassium, and hog’s lard, but found, upon trial, to give her so much pain, and produced so much irritation, that I was forced to abandon its use
composed
this
was
For it I substituted the following ointment: and extract of conium a drachm, rubbed up with seven drachms of prepared hog’s lard. This ointment was ordered to be rubbed into the palm of her hand every day, both morning and evening. Besides these remedies, local and general, she took occasionally an alterative and aperient pill, made up of blue pill and the compound extract of colocynth. The consequence has been, after about a month’s steady use of the remedies, that the hand has become quite well, the skin being now, for the first time these two years, soft, white, flexible, active, and completely free from itching, heat, and every unpleasant appearance and feeling. Nor has the tongue as yet shewn any tendency to alternative disease, as before, so that we have reason to hope-the constitution having been set to rights by the means employed-the former chain of morbid sympathy between the distant organs of which we have been speaking, and a metastasis of the psoriasis, from the one to the other alternately, took place so often, for so long a time, has been at last broken and destroyed, permitting both to remain in their healthy
after
a
few
days’trial.
viz., white oxide of mercury four grains,
condition.
HaIley..strcet,
Jan. 4, 1845.
ON THE INJECTION OF TANNIN FOR THE CURE OF ANEURISMS. R. A. VARICAS, Esq. Surgeon, London. By A NEW and practicable means of cure for this disease has been for a long time desired; indeed, few in the profession but have had occasion to deplore the want of one, where the ligature is considered impracticable. Often has it been their painful lot to stand by, powerless, watching the unerring progress of the disease to its fatal termination; and even when the ligature has been determined upon, how frequently are its results considered hazardous or doubtful! Aneurism by anastomosis cannot always be cured, although the carotids themselves be tied. Others cannot be reached by the needle with certainty and safety, from the nature of their situation and connexions. Even disease of the coats of the vessel, and excessive debility, will be sufficient reasons to cause one to pause and wait the efforts oi nature either to work the cure or produce the awful catastrophe. How seldom the former, and how frequently the latter, every one of experience cannot but have been a too frequent witness! Under these circumstances, I am emboldened to lay before the profession a new method of producing an artificial coagulum of blood, to any extent, in the interior of vessels; and hope, at the same time, it will receive a dispassionate consideration. From the known chemical action of tannin upon albumen, and from its facility of application, I am induced to recommend its injection into vessels thus diseased. The effect is to produce the coagulation of blood, and thereby obstruct the circulation in that direction. This desirable object has been attempted before by other means, but such have been proved inefficacious, inasmuch as the coagulum obtained has been too inconsiderable to carry out the end in view. There are a few precautionary measures to be noticed in the performance of the operation of injection; I will therefore proceed to explain the manner in which it should be conducted, and the kind of instrument adapted to its application. A small syringe, either of silver or glass, should be fitted CASE 3.-Since the foregoing cases were read to the Society, accurately, with a long, very fine tapering canula and stilet, I have been consulted by a young married lady for rather a much curved, and furnished with stop cock. The vessel having curious affection. She informs me that her tongue becomes been cut down upon sufficiently to enable the operator to arrive occasionally bestudded with small ulcerations, and afterwards, at it easily with his finger, the canula is to be directed along it when these get well, the palm of her left hand becomes affected into the artery, with its concavity turned towards the heart; and with a sort of psoriasis palmaris. The tongue is at present quite the syringe, previously filled with a saturated solution of tannin, well, but the palm of her hand is covered with the eruption. (all air being, of course, excluded,) should then be attached to it, When this gets better, however, she expects her tongue to whilst an assistant, compressing the artery at its distal side. so as become again the seat of disease, for thus they have alternated to retard the circulation through it, the process of injection for a considerable time past-she says about two years. The should commence, with a force proportionate to the remoteness chief reason for which she consulted me at present, however, is, from, or propinquity to, the heart; also to whether it be perthat she has gout in one of her feet. I believe that the whole formed on the distal or cordal side of the aneurism. In aneurism series of her complaints depends on some derangement of the by anastomosis, or noevus, sufficient power should be applied to digestive organs, though that is not made very apparent by ex- carry the injection some way into the vessels, and the canula ternal symptoms. I gave her an alterative pill, and a tonic should be introduced with its convexity towards the heart. As soon as the aneurismal pulsations cease, the pressure should mixture, combined with colchicum, and an alkali. The gout has already disappeared, and even the hand is much im- be gradually withdrawn from the artery, and time be allowed for proved. As soon as the gout was got rid of, I substituted the heart to exert its force against the coagulum: if the pulsations for the tonic mixture, in which, as I have just said, were of the sac recommence from this having taken place, the injection wine of colchicum and carbonate of soda, a mixture composed of should be performed anew, before withdrawing the instrument. the extract of sarsaparilla, combined with the iodide of potassium. It is possible that, after the lapse of time, the coagulum (if formed) As a local application to her hand, I prescribed an ointment, will contract disproportionately with the sac, and pulsations
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