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CARBOLIC ACID IN SMALL-POX.
494 tion of exaggeration, but the reverse ; and if a patient tells of previous rheumatic fever the majority may, I believe, be trusted. But for my own part I have never been satisfied It has been my with the mere statement of the patient. rule to inquire into the duration of the illness and the nature of the symptoms, and the description of the illness has usually tallied with the assertion; at any rate to this extent, that some illness had been experienced of the nature of To that extent acute rheumatism, gout, or osteo-arthritis. the opinion does admit of bias. Inquiries with reference to the hereditary transmission of rheumatism for some years past amongst the in-patients at Guy’s Ilospital whilst I was medical registrar, and later amongst my own out-patients there and at the Evelina have convinced me that children whose parents or close relatives have suffered from acute rheumatism are more liable than others to a series of symptoms or groups of symptoms. These are-acute rheumatism itself, of course, and also chorea, night terrors, a persistent form of anaemia, headache, and a condition difficult of description otherwise than as a slight chorea, which parents describe as nervousness. I should regard these affections as so many variations from some common ancestral type, perhaps acute rheumatism. I do not see that it is necessary in order to establish the reality of the relationship, that acute rheumatism should have pre-existed in each case. Evidence seems to me to show that acute rheumatism reappears upon transmission as acute rheumatism in many cases, but sometimes not so, but as chorea, or some of those conditions just named. But, after all, perhaps this is a question independent of the one raised by Dr. Sturges, which I now understand to be, "Is acute rheumatism the immediate cause of chorea ?" Upon that question, as I said before, I am inclined to assent to the answer given by Dr. Sturges, but without admitting that the doctrine of the hereditary transmission of the diathesis is in the slightest degree jeopardised. I would add that Dr. Sturges rather overstates me when he says that I deny that rheumatism is a direct and immediate cause of chorea. I only said that my figures supported his upon that point. But I expressly forebore to say more for two reasons : first, that, as he subsequently mentions, acute rheumatism is. often so slight and transient in children that it attracts no attention, and therefore may have existed when there is no history of its occurrence ; and, secondly, that previous writers-I may mention particularly M. Sée and Dr. PyeSmith-have dealt with far larger numbers than my own, and have come to an opposite conclusion. I am, Sir, your obedient servant, JAMES F. GOODHART. Weymouth-street, W., Sept. 21st, 1878
Correspondence. "Audi alteram
partem."
CARBOLIC ACID IN SMALL-POX. To the Editor
of THE LANCET.
SIR,—The prolonged discussion
in your columns which
suggestion of a new and local method of treating small-pox efficiently testifies to the interest felt in the subject, and to the professional consciousness of its great and pressing importance. The tenour of all the communications made to you has been decidedly in favour of the local Hospital, has followed my
use of carbolic acid. In all the cases in which it has been tried it has given some relief. It has relieved itching and irritation where it has been of no other benefit; whilst in many cases (some of them reported in the journals of former years) it has been thought to exercise a marked influence not only in preventing pitting, but also in diminishing the intensity of the secondary fever, and so lessening the violence of the disease. A communication which I have recently received from an eminent surgeon to the Bengal cavalry gives further valuable testimony to its beneficial influence in his hands against the development of the eruption and the fatality of the disease. On the other hand we have the evidence of Dr. Taylor as to its comparative failure in the most important respects when tried upon a large scale at the Small-pox Hospital, and especially in the worst, unvaccinated cases. He does not state, however, the strength of the local application employed, which is all-important. I cannot think that nitric acid, though doubtless a.powerful agent, would be (as has been suggested) a trustworthy substitute for carbolic acid for local application to the papules of small-pox. It is too destructive, and, moreover, would create a small eschar, and therefore a pitting of its The great merit of carbolic acid, on the other own kind. hand, is that, whilst it is quite powerful enough to destroy low germ life, it is inoperative (in small quantity) upon properly organised tissue. After all, therefore, that has been suggested and written, and in spite of the undoubted utility of the external application of carbolic acid, I fear it must be said that a real remedy for virulent and confluent small-pox is still required, and I therefore venture again to suggest to those who may have the opportunity of treating cases of variola to give the method I have suggested a fair trial-viz., the insertion into MOLLUSCUM CONTAGIOSUM. each vesicating papule of a small quantity of a strong solution of carbolic acid,-a method which from its aborting To the Editor of THE LANCET. efficacy in other local cutaneous affections, appears to me to German and some few English observers most SIR,—As give promise of good results in this more general and for- still doubt the contagious nature of the molluscum conmidable disease. of Yours obediently. tagiosum Bateman, any cases which strikingly illustrate PETER EADE, M.D.Lond., F.R.C.P. this strange and peculiar character of the disease are worthy Norwich, Sept. 23rd, 1878 of record. Nine cases of this disease, occurring coincidently in a THE RHEUMATIC ORIGIN OF CHOREA. school, have lately come under my observation. The disease first appeared during last November, and at that time in To the Editor of THE LANCET. one child only. Soon after Christmas, and before the first add to the the should be to of SIR,—I precision glad child was well, the molluscum appeared on several other details in my note on the rheumatic origin of chorea in THE children, and later on others were affected; in all, nine LANCET of September 7th by stating, if you will allow me, suffered more or less severely. This is, I believe, the largest the exact relationship, so far as it could be ascertained, of number occurring at one time yet recorded. In most cases, the rheumatic relatives to the thirty-two cases of chorea. the eruption was limited, as it often is, to the face and neck after lasting for some months, disappeared without Nineteen of the thirty-two were related to rheumatic in- and, any treatment. It is very difficult to understand how a dividuals. In three instances the mother had had acute disease of this kind is contagious, and yet the evidence its rheumatism; in two the father; in two both father and now so strong that it is impossible to doubt the fact. Your obedient servant. mother ; in four a brother or sister ; in three the grandThese had all or aunt. suffered from what they Manchester-square, Sept. 21st, 1878 ROBERT LIVEING, M.D. parent In the remaining five the history called rheumatic fever. was only one of rheumatism, and it must be confessed is too UNIVERSITY COLLEGE, LONDON.—The Examiners. indefinite to be taken without suspicion. But with regard to the history of acute rheumatism, I do not admit that this for the Medical Entrance Exhibitions have recommended Mr. W. C. C. Wilkinson, and Mr. E. Mr. C. M. is doubtful in the majority of cases. The family records of R. St. ClairMcShane, Corbin for the three Exhibitions of the respechospital patients are, no doubt, very imperfect and unequal tive values of f:30, JE20, and f:1O per annum, tenable for two —nay, even distorted; but this is so not usually in the direc- years.
I
Correspondence. "Audi alteram
partem."
CARBOLIC ACID IN SMALL-POX. To the Editor
of THE LANCET.
SIR,—The prolonged discussion
in your columns which
suggestion of a new and local method of treating small-pox efficiently testifies to the interest felt in the subject, and to the professional consciousness of its great and pressing importance. The tenour of all the communications made to you has been decidedly in favour of the local Hospital, has followed my
use of carbolic acid. In all the cases in which it has been tried it has given some relief. It has relieved itching and irritation where it has been of no other benefit; whilst in many cases (some of them reported in the journals of former years) it has been thought to exercise a marked influence not only in preventing pitting, but also in diminishing the intensity of the secondary fever, and so lessening the violence of the disease. A communication which I have recently received from an eminent surgeon to the Bengal cavalry gives further valuable testimony to its beneficial influence in his hands against the development of the eruption and the fatality of the disease. On the other hand we have the evidence of Dr. Taylor as to its comparative failure in the most important respects when tried upon a large scale at the Small-pox Hospital, and especially in the worst, unvaccinated cases. He does not state, however, the strength of the local application employed, which is all-important. I cannot think that nitric acid, though doubtless a.powerful agent, would be (as has been suggested) a trustworthy substitute for carbolic acid for local application to the papules of small-pox. It is too destructive, and, moreover, would create a small eschar, and therefore a pitting of its The great merit of carbolic acid, on the other own kind. hand, is that, whilst it is quite powerful enough to destroy low germ life, it is inoperative (in small quantity) upon properly organised tissue. After all, therefore, that has been suggested and written, and in spite of the undoubted utility of the external application of carbolic acid, I fear it must be said that a real remedy for virulent and confluent small-pox is still required, and I therefore venture again to suggest to those who may have the opportunity of treating cases of variola to give the method I have suggested a fair trial-viz., the insertion into MOLLUSCUM CONTAGIOSUM. each vesicating papule of a small quantity of a strong solution of carbolic acid,-a method which from its aborting To the Editor of THE LANCET. efficacy in other local cutaneous affections, appears to me to German and some few English observers most SIR,—As give promise of good results in this more general and for- still doubt the contagious nature of the molluscum conmidable disease. of Yours obediently. tagiosum Bateman, any cases which strikingly illustrate PETER EADE, M.D.Lond., F.R.C.P. this strange and peculiar character of the disease are worthy Norwich, Sept. 23rd, 1878 of record. Nine cases of this disease, occurring coincidently in a THE RHEUMATIC ORIGIN OF CHOREA. school, have lately come under my observation. The disease first appeared during last November, and at that time in To the Editor of THE LANCET. one child only. Soon after Christmas, and before the first add to the the should be to of SIR,—I precision glad child was well, the molluscum appeared on several other details in my note on the rheumatic origin of chorea in THE children, and later on others were affected; in all, nine LANCET of September 7th by stating, if you will allow me, suffered more or less severely. This is, I believe, the largest the exact relationship, so far as it could be ascertained, of number occurring at one time yet recorded. In most cases, the rheumatic relatives to the thirty-two cases of chorea. the eruption was limited, as it often is, to the face and neck after lasting for some months, disappeared without Nineteen of the thirty-two were related to rheumatic in- and, any treatment. It is very difficult to understand how a dividuals. In three instances the mother had had acute disease of this kind is contagious, and yet the evidence its rheumatism; in two the father; in two both father and now so strong that it is impossible to doubt the fact. Your obedient servant. mother ; in four a brother or sister ; in three the grandThese had all or aunt. suffered from what they Manchester-square, Sept. 21st, 1878 ROBERT LIVEING, M.D. parent In the remaining five the history called rheumatic fever. was only one of rheumatism, and it must be confessed is too UNIVERSITY COLLEGE, LONDON.—The Examiners. indefinite to be taken without suspicion. But with regard to the history of acute rheumatism, I do not admit that this for the Medical Entrance Exhibitions have recommended Mr. W. C. C. Wilkinson, and Mr. E. Mr. C. M. is doubtful in the majority of cases. The family records of R. St. ClairMcShane, Corbin for the three Exhibitions of the respechospital patients are, no doubt, very imperfect and unequal tive values of f:30, JE20, and f:1O per annum, tenable for two —nay, even distorted; but this is so not usually in the direc- years.
I