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EXTRAORDINARY CASE OF IMPOSTURE.
610
It may have been this sort of abuse of titles that makes Mr. by proving that they have practised for ten years without Syme say, soon afterwards, that "any attempt to determine the trafficking in drugs, and during that time performed surgical estimation in which medical men are to be held by ushering operations, implying surgical accomplishment. 3. Let all graduates of British universities be eligible for them upon the stage of practice in different ranks, is no less impracticable than irrational :’ Now, de facto, it is, and has the membership of the College of Physicians, either imme. ever been, practised, not only in the medical, but in all other diately after graduation, by coming under certain precautionary and pursuits, with great advantage, as in law, engagements as to future deportment, or otherwise by proving divinity, soldiership, &c.; and of its rationality the world ’ ten years of private practice as physicians. must be, and is, the judge. We know, as matters of fact, that 4. Let all gentlemen, whether physicians or surgeons, be the men who take honours at universities do gain a certain entitled to the above honours on receiving any hospital or advantage thereby, and that the studious and enterprising other public appointment that clearly implies the highest young surgeon who aspires and attains to the fellowship of qualifications. his College, does demonstrate something to the world, which I would leave the fellowship of the College of Physicians gives him a certain prestige; all which has nothing to do a free election, as it is at present, of those members who have with the trite occasional fact, that other students who may attained professional, or literary, or scientific eminence; and I not have distinguished themselves at an earlier period, may, quite coincide with Mr. Syme as to the error of repeated at a later, obtain high reputation. If Mr. Syme really thinks elementary examinations. Not a little of the confusion of otherwise, he must then resolve all tests whatever into a mere titles above referred to is due to the pushing forward of cerfarce, which is manifestly absurd-too absurd to require an tain inferior men, with qualifications otherwise dubious, to answer. unnecessary tests. Thus a private country physician of barely Further on, Mr. Syme has two very notable sentences-espe- respectable attainments may feel his importance ratified or cially notable, after his decided advocacy of a mixed practice. increased by the membership or fellowship of the college, He is speaking of the proposed College of General Practitioners, while the hospital physicians of the great towns are already and says, firstly, " The new college would have sunk, beyond full of honour, without such addition to their university recovery, all who were unwise enough to enrol themselves degree. Hence the frequent contrast between titles and under its charter of degradation;" and secondly, " If the actual position. Yet this does not invalidate the efficacy of new college were ever established, its leading members could a real and required test; for the hospital physician, as may be scarcely maintain a dignified place in the profession," &c. supposed, could pass the ordeal if he deemed it necessary, With this view I quite agree; but that Mr. Syme should pen which it is not. He might cheerfully pay the inauguration such sentences,-in juxtaposition with those that go to support fee, and join the college as a scientific association; but he the mixed system of practice in Scotland, and the uniformity could not unnecessarily present himself before it, to be tested of titles and degrees, certainly seems very inconsistent and for qualification already proved before his university, and, it illogical. He is thus condemning the mere enrolment of in- may be, the whole world.
professions
dividuals by a new law, or charter, while he is abetting the actual existence, in fact and. in practice, of those- same persons who at present are under the wings of the Edinburgh College of Surgeons, or the two ordinary examining boards of Englandor else are mere renegade graduates, poaching on the field of
apothecary practice.
The facts of the question are simply these: that in Scotland the College of Surgeons examines into all the qualifications necessary for a general practice-embracing medicine, surgery, midwifery, and pharmacy; while, in England, for examination as to these branches, two authorities must be resorted toviz., Surgeons’ College, and the Apothecaries’ Company; but, from the confused use of the names surgeon, apothecary, surgeon-apothecary,’general practitioner, with the occasional dash of doctor, or accoucheur, much misunderstanding has arisen, and the public have got puzzled as to the real status of professional men. This confusion is further increased by certain very ordinary practitioners making insane boasts as to their double and sometimes triple qualifications, as they express themselves. Now I think that men should study the esse quam videri; and I do not disapprove of that proposition lately made by the College of Physicians, that no one should be allowed to use the title of doctor, unless he acted up to it according to the ordinary expectation of the people of England ; and if Mr. Syme saw clearly, or wished our great University well, he would not seek to employ his argumentative powers in endeavouring to place her graduates in the same position as that of the licentiates of the Apothecaries’ Company. The worthier sons of our illustrious Alma Mater will not thank him for this unadvised precipitancy. They are, or ought to be, physicians, and not a species of tradesmen, "remnnerated," to use Mr. Syme’s word regarding the general practitioners of England, " for professional services by the price attached to their drugs." I, for one, must repudiate Mr. Syme’s ill-judged intercession, and I know that I shall find an echo from the breasts of more than half of the physicians of England, as well as from those brother graduates who, being compelled by circumstances to engage in general practice, have yet the good taste and policy to lay aside their titles for a more convenient season, by which they help to maintain the dignity of the degree, and themselves ultimately reap the fruits of it. I shall now, as briefly as possible, state my own propositions-viz. 1. Let all members of the Edinburgh College of Surgeons who desire to practise in England be admitted to that privilege on paying the difference of fees to the College and Hall respectively which, in total, would be-say .621. 2. Let all ordinary members be admitted to the fellowship at any time they--choose, by undergoing an adequate examination, practical as well as theoretical; or, on the other hand;
I
March,
1850.
am.
&c..
EDINENSIS
IN
ANGLIA.
EXTRAORDINARY CASE OF IMPOSTURE. To the Editor of THE LANCET. SIR,—I forward the enclosed extract from a local paper, thinking you may consider it worthy of a corner in your journal. We have been forcibly struck with the very close resemblance which the case bears to what Mr. Mayo ("Outlines of Human has described as " white gangrene" of the skin; and Pathology") at page 341 of Johnson’s Medico-Chirurgical Review for April, 1836, (where this portion of Mr. Mayo’s work is copied,) the reviewer adds the history of a case which also seems identical in character with it. So appositely, indeed, does our case answer to the descriptions above alluded to, both as regards the first appearance of a patch, (i.e. on our attention being first called to it,) and in its subsequent stages, as well as in the youth and the otherwise perfect health of the patient, that although such high authorities seem not to have entertained the slightest notion but that all was the effect of legitimate disease, we cannot persuade ourselves otherwise than that they were as thoroughly deceived as have been the early attendants of our patient.-I am, &e. GEO. FRED. HODGSON, House Surgeon. Sussex County Hospital, Brighton, May 7, 1850
a
(From the Brighton Gazette, May 2nd, 1850.) At the weekly board of the Sussex County Hospital yesterday, remarkable and almost incredible case of imposture was ex-
posed.
A woman, named Betsy Ginn, aged 23, (received three weeks since as an in-patient, on the recommendation of a subscriber and a surgeon’s certificate,) was charged by her surgeon with wilfully producing the disease for the cure of which she had applied to the hospital. The statement made against her was, that very numerous diseased patches of the skin, over nearly the whole of her body, limbs, and face, were the result of her own application to the parts of hydrochloric acid, (spirit of salt.) Several patches were nearly as large as the palm of the hand; and they were in different stages, the recent ones being yet in a gangrenous condition, others (from which the sloughs had separated) were deep and troublesome ulcers, and many (the majority) had healed, but with disfiguring scars, and in some places to the injury and contraction of the adjacent sinews. The following arguments were advanced by her attendant:That the parts of her body (as her back, &c.) not readily accessible to her own hands, remain perfectly sound and free from scars; that the affection was totally different from any disease which he had ever witnessed ; that the three fresh patches which
I
611 had shown themselves during her stay in the County Hospital had been scrutinized, and that some distilled water, with which they had been carefully washed, gave with chemical tests abundant evidence of the presence of hydrochloric acid; that a little hydrochloric acid which he had up from the surgery, and applied to her skin, had produced a whitish and gangrenous spot, a miniature fac-simile of the others; and lastly, that on searching her clothes, a vial had been found containing the remains of some hydrochloric acid. The woman, after many denials and prevarications, at length admitted her guilt; and further, that she had been practising the deception for a period of nearly three years, four months of which she had spent in the Colchester Hospital, and nine weeks in Uni-
versity College Hospital, London, without the imposture being While begging for mercy, she stated that she had discovered. been induced so to act, in the hope of obtaining a better home than
a
workhouse.
THE MEDICAL PROFESSION AND THE LICENSED VICTUALLERS’ INSURANCE COMPANY. To the Editor of THE LANCET. SIR,—Permit me to occupy a short space in your journal, for the sake of putting my brother practitioners on their when applied to by the Licensed Victuallers’ Insurance
guard, ompany. A short time
those persons who have these accumulations in a large degree) in the same manner as the kidneys in some idiosyncrasies—and that the dyspeptic symptoms of these individuals, in some measure, are to be traced to the presence of these substances in the stomach, brought into it by the insalivation of the food. As we are that from fifteen to twenty ounces of saliva are daily secreted —a large portion of which is necessary to incorporate with our aliment, it appears no great stretch of imagination to believe the possibility of the circumstance. I was induced to employ the acetic and citric acids internally, on finding them the best means of detaching the laminse of tartar, which usually fix themselves on the molar teeth and posterior part of the incisors of persons who are peculiarly subjected to gout and its modifications; the great relief afforded to urgent symptoms by these remedies, has fully warranted the opinion I entertained of their efficacy—and I believe that the same ch,mical action is brought about on the secretions by the administration of the lemon-juice as by the acetic acid. It is a rare circumstance to find much or any tartar’ on the teeth of persons who are of the leucoplalegmatic temperament; and I wish to draw the attention of the scientific dentist to this important subject-and if my position be confirmed, it will be one more proof of the unity of medicine and surgery-a point so strongly urged by you for years. I am. Sir. vour obedient servant. J. C. ATKINSON, M.D. Westminster, May, 1850.
told
since, I received a letter, with the usual re- ON THE PROPRIETY OF STIMULATING THE SALIVARY GLANDS ALTERNATELY WITH THE reply to the queries respecting the health of Mr. J. R-. I replied, that I was not in the habit of filling up such KIDNEYS. forms without a fee, and that if the company did not forward To the Editor of THE LANCET. me a fee, I must call upon Mr. J. R- to see if he was SIR,—In reply to the question proposed by Mr. Levison, willing to be subject to such an imposition. I called upon my " whether in the effusion of the cellular membrane it would be and to him the cause of delay, at the same patient, explained stimulate the action of the salivary glands alternately judicious to time telling him not to insure with any company which did with the kidneys ?" I should say, that it is very doubtful if any not pay a fee for the opinion of the medical referee. vicarious evacuation, such as sometimes spontaneously occurs, Mr. J. R- very properly refused to be saddled with payPustularization rarely can ever be successfully imitated by art. ment of a fee, and so, as I thought, the matter ended. In a affords the relief that is experienced from a pustular eruption, few days, however, Mr. J. R- requested me to fill up the nor does leeching the verge of the anus remove hepatic or cereform, and volunteered to be answerable for my fee. bral congestion like an effusion of blood from the hsemorrhoidal Now, Sir, pray mark the result. I did as my patient re- vessels. The case mentioned Mr. Levison is certainly a very quested, when, to my surprise,-for I had not written anything curious instance of vicarious bydischarge of calcareous material.unfavourable to my patient, although strictly in truth, the In this case it is probable, if the lady had been restricted to the liberal company surcharged him 1:5per annum on his pre- use of distilled or rain water filtered i. e., to water conmium, to which, when he objected, they replied, that the extra taining no earthy or neutral salts, in all probability, the supply of X5was on account of my report. So much for confidential such salts would soon have ceased to abound being stopped, they of communications. I have to apologize for the length this in the secretions. Instead of taxing the kidneys by diuretics, or letter, but believing it may prevent my fellow practitioners the salivary glands by sialogogues, both of which class of eva from being betrayed in a similar manner by the worthy cuants will add to the existing debility, I would suggest the exLicensed Victuallers’ Insurance Company, I have given the pediency of following the natural indication by evacuating statement at length, and faithfully. the fluid in the direction of the t:ffusion, through the skin, by I beg to subscribe myself, your humble servant, acupuncturation, by the application of blisters above the calf of R. M.D. Hatfield-place, Bermondsey, May 9, 1850. SHARPE, the leg, dressing them with the water-dressing, or by promoting P.S.-If I can make a company, however unjustly, pocket a free transpiration by means of the oil-silk vapour-bath to the feet and legs. £5 peranuum, is it not worth a guinea ? The decoction of senega-root is a remedy which combines the threefold action of a sialogogue, a diuretic, and a diaphoretic, quest
to
-
and therefore admirably suited for a case of this kind. A strong decoction of the fibrous roots of the leek in chicken-broth, or a strong decoction of parsley-roots, or of the pyrola umbellata, in SIR,—A letter from your talented correspondent, Mr. Levison, milk, have each been successfully used in removing the dropsical leads me to forward you the following particulars regarding the effusion from the lower extremities consequent upon heart affection. But I would further suggest, that it should be borne in diagnostic property of Saliva in Gout. It is the usual practice to examine the urine in search of the mind, that the effusion in these cases is the natural mode of relief, calculous diathesis, but we do not look to the teeth as exhibiting and not a part of the disease, and therefore not so much the of cure as of prevention. any token of the presence of those concretions which, generally, object The necessity for this mode of relief is caused by an overin some constitutions, lead to stone in the bladder, and in others, to earthy deposits in joints. These concrements are of variable loaded state of the capillary vessels, true plethora ad vires. nature, but they have more or less lithic acid in their composi- All that is necessary to prevent this state is to restrict the patient to a very moderate allowance of food, both solid and fluid. In tion as a predominating ingredient. For many years I have looked at these deposits on the teeth of order to avoid the inconvenience of thirst, the patient should persons, with great interest, inasmuch as they appear and dis- abstain from those heating articles of diet which excite thirst, appear with more or less rapidity, according to particular changes substituting ripe fruits, particularly strawberries, -and wellof diet. One gentleman, in particular, of this kind of diathesis, dressed vegetables, for a more solid and liquid diet. I am, Sir, your obedient servant, used to afford me a good deal of amusement by his remarking, J. PIDDUCK, M.D. whenever I proceeded to look into his mouth, that he hoped that I should not " catch the Tartar," that he had strictly observed P.S.-The fact that the iodide of potassium exerts but little, the regimen I had recommended-but too frequently the too if any, control over cutaneous eruptions, unless its administration rapid reproduction of the tartar told the tale of his neglect of the is preceded by that of mercury, suggests the inquiry, is not the orthodox rules. I am led to believe that the parotid sub-lingual iodide remedial of the mercury, and not of the original disease? and sub-maxillary glands, all eliminate the calculous materials- and are not these eruptions rather mercurial than syphilitic, or viz., ammonio-magnesian phosphates, calcareous phosphates, perhaps the result of a combination of the metallic with the animal lithic acid, and some urea-(to this latter substance I attribute poison? If this question be answered in the affirmative, does it much of that offensive odour which is present in the breath of not suggest another question, not how much mercury the consti.
CONDITION OF THE SALIVA IN GOUT. To the Editor of THE LANCET.
It may have been this sort of abuse of titles that makes Mr. by proving that they have practised for ten years without Syme say, soon afterwards, that "any attempt to determine the trafficking in drugs, and during that time performed surgical estimation in which medical men are to be held by ushering operations, implying surgical accomplishment. 3. Let all graduates of British universities be eligible for them upon the stage of practice in different ranks, is no less impracticable than irrational :’ Now, de facto, it is, and has the membership of the College of Physicians, either imme. ever been, practised, not only in the medical, but in all other diately after graduation, by coming under certain precautionary and pursuits, with great advantage, as in law, engagements as to future deportment, or otherwise by proving divinity, soldiership, &c.; and of its rationality the world ’ ten years of private practice as physicians. must be, and is, the judge. We know, as matters of fact, that 4. Let all gentlemen, whether physicians or surgeons, be the men who take honours at universities do gain a certain entitled to the above honours on receiving any hospital or advantage thereby, and that the studious and enterprising other public appointment that clearly implies the highest young surgeon who aspires and attains to the fellowship of qualifications. his College, does demonstrate something to the world, which I would leave the fellowship of the College of Physicians gives him a certain prestige; all which has nothing to do a free election, as it is at present, of those members who have with the trite occasional fact, that other students who may attained professional, or literary, or scientific eminence; and I not have distinguished themselves at an earlier period, may, quite coincide with Mr. Syme as to the error of repeated at a later, obtain high reputation. If Mr. Syme really thinks elementary examinations. Not a little of the confusion of otherwise, he must then resolve all tests whatever into a mere titles above referred to is due to the pushing forward of cerfarce, which is manifestly absurd-too absurd to require an tain inferior men, with qualifications otherwise dubious, to answer. unnecessary tests. Thus a private country physician of barely Further on, Mr. Syme has two very notable sentences-espe- respectable attainments may feel his importance ratified or cially notable, after his decided advocacy of a mixed practice. increased by the membership or fellowship of the college, He is speaking of the proposed College of General Practitioners, while the hospital physicians of the great towns are already and says, firstly, " The new college would have sunk, beyond full of honour, without such addition to their university recovery, all who were unwise enough to enrol themselves degree. Hence the frequent contrast between titles and under its charter of degradation;" and secondly, " If the actual position. Yet this does not invalidate the efficacy of new college were ever established, its leading members could a real and required test; for the hospital physician, as may be scarcely maintain a dignified place in the profession," &c. supposed, could pass the ordeal if he deemed it necessary, With this view I quite agree; but that Mr. Syme should pen which it is not. He might cheerfully pay the inauguration such sentences,-in juxtaposition with those that go to support fee, and join the college as a scientific association; but he the mixed system of practice in Scotland, and the uniformity could not unnecessarily present himself before it, to be tested of titles and degrees, certainly seems very inconsistent and for qualification already proved before his university, and, it illogical. He is thus condemning the mere enrolment of in- may be, the whole world.
professions
dividuals by a new law, or charter, while he is abetting the actual existence, in fact and. in practice, of those- same persons who at present are under the wings of the Edinburgh College of Surgeons, or the two ordinary examining boards of Englandor else are mere renegade graduates, poaching on the field of
apothecary practice.
The facts of the question are simply these: that in Scotland the College of Surgeons examines into all the qualifications necessary for a general practice-embracing medicine, surgery, midwifery, and pharmacy; while, in England, for examination as to these branches, two authorities must be resorted toviz., Surgeons’ College, and the Apothecaries’ Company; but, from the confused use of the names surgeon, apothecary, surgeon-apothecary,’general practitioner, with the occasional dash of doctor, or accoucheur, much misunderstanding has arisen, and the public have got puzzled as to the real status of professional men. This confusion is further increased by certain very ordinary practitioners making insane boasts as to their double and sometimes triple qualifications, as they express themselves. Now I think that men should study the esse quam videri; and I do not disapprove of that proposition lately made by the College of Physicians, that no one should be allowed to use the title of doctor, unless he acted up to it according to the ordinary expectation of the people of England ; and if Mr. Syme saw clearly, or wished our great University well, he would not seek to employ his argumentative powers in endeavouring to place her graduates in the same position as that of the licentiates of the Apothecaries’ Company. The worthier sons of our illustrious Alma Mater will not thank him for this unadvised precipitancy. They are, or ought to be, physicians, and not a species of tradesmen, "remnnerated," to use Mr. Syme’s word regarding the general practitioners of England, " for professional services by the price attached to their drugs." I, for one, must repudiate Mr. Syme’s ill-judged intercession, and I know that I shall find an echo from the breasts of more than half of the physicians of England, as well as from those brother graduates who, being compelled by circumstances to engage in general practice, have yet the good taste and policy to lay aside their titles for a more convenient season, by which they help to maintain the dignity of the degree, and themselves ultimately reap the fruits of it. I shall now, as briefly as possible, state my own propositions-viz. 1. Let all members of the Edinburgh College of Surgeons who desire to practise in England be admitted to that privilege on paying the difference of fees to the College and Hall respectively which, in total, would be-say .621. 2. Let all ordinary members be admitted to the fellowship at any time they--choose, by undergoing an adequate examination, practical as well as theoretical; or, on the other hand;
I
March,
1850.
am.
&c..
EDINENSIS
IN
ANGLIA.
EXTRAORDINARY CASE OF IMPOSTURE. To the Editor of THE LANCET. SIR,—I forward the enclosed extract from a local paper, thinking you may consider it worthy of a corner in your journal. We have been forcibly struck with the very close resemblance which the case bears to what Mr. Mayo ("Outlines of Human has described as " white gangrene" of the skin; and Pathology") at page 341 of Johnson’s Medico-Chirurgical Review for April, 1836, (where this portion of Mr. Mayo’s work is copied,) the reviewer adds the history of a case which also seems identical in character with it. So appositely, indeed, does our case answer to the descriptions above alluded to, both as regards the first appearance of a patch, (i.e. on our attention being first called to it,) and in its subsequent stages, as well as in the youth and the otherwise perfect health of the patient, that although such high authorities seem not to have entertained the slightest notion but that all was the effect of legitimate disease, we cannot persuade ourselves otherwise than that they were as thoroughly deceived as have been the early attendants of our patient.-I am, &e. GEO. FRED. HODGSON, House Surgeon. Sussex County Hospital, Brighton, May 7, 1850
a
(From the Brighton Gazette, May 2nd, 1850.) At the weekly board of the Sussex County Hospital yesterday, remarkable and almost incredible case of imposture was ex-
posed.
A woman, named Betsy Ginn, aged 23, (received three weeks since as an in-patient, on the recommendation of a subscriber and a surgeon’s certificate,) was charged by her surgeon with wilfully producing the disease for the cure of which she had applied to the hospital. The statement made against her was, that very numerous diseased patches of the skin, over nearly the whole of her body, limbs, and face, were the result of her own application to the parts of hydrochloric acid, (spirit of salt.) Several patches were nearly as large as the palm of the hand; and they were in different stages, the recent ones being yet in a gangrenous condition, others (from which the sloughs had separated) were deep and troublesome ulcers, and many (the majority) had healed, but with disfiguring scars, and in some places to the injury and contraction of the adjacent sinews. The following arguments were advanced by her attendant:That the parts of her body (as her back, &c.) not readily accessible to her own hands, remain perfectly sound and free from scars; that the affection was totally different from any disease which he had ever witnessed ; that the three fresh patches which
I
611 had shown themselves during her stay in the County Hospital had been scrutinized, and that some distilled water, with which they had been carefully washed, gave with chemical tests abundant evidence of the presence of hydrochloric acid; that a little hydrochloric acid which he had up from the surgery, and applied to her skin, had produced a whitish and gangrenous spot, a miniature fac-simile of the others; and lastly, that on searching her clothes, a vial had been found containing the remains of some hydrochloric acid. The woman, after many denials and prevarications, at length admitted her guilt; and further, that she had been practising the deception for a period of nearly three years, four months of which she had spent in the Colchester Hospital, and nine weeks in Uni-
versity College Hospital, London, without the imposture being While begging for mercy, she stated that she had discovered. been induced so to act, in the hope of obtaining a better home than
a
workhouse.
THE MEDICAL PROFESSION AND THE LICENSED VICTUALLERS’ INSURANCE COMPANY. To the Editor of THE LANCET. SIR,—Permit me to occupy a short space in your journal, for the sake of putting my brother practitioners on their when applied to by the Licensed Victuallers’ Insurance
guard, ompany. A short time
those persons who have these accumulations in a large degree) in the same manner as the kidneys in some idiosyncrasies—and that the dyspeptic symptoms of these individuals, in some measure, are to be traced to the presence of these substances in the stomach, brought into it by the insalivation of the food. As we are that from fifteen to twenty ounces of saliva are daily secreted —a large portion of which is necessary to incorporate with our aliment, it appears no great stretch of imagination to believe the possibility of the circumstance. I was induced to employ the acetic and citric acids internally, on finding them the best means of detaching the laminse of tartar, which usually fix themselves on the molar teeth and posterior part of the incisors of persons who are peculiarly subjected to gout and its modifications; the great relief afforded to urgent symptoms by these remedies, has fully warranted the opinion I entertained of their efficacy—and I believe that the same ch,mical action is brought about on the secretions by the administration of the lemon-juice as by the acetic acid. It is a rare circumstance to find much or any tartar’ on the teeth of persons who are of the leucoplalegmatic temperament; and I wish to draw the attention of the scientific dentist to this important subject-and if my position be confirmed, it will be one more proof of the unity of medicine and surgery-a point so strongly urged by you for years. I am. Sir. vour obedient servant. J. C. ATKINSON, M.D. Westminster, May, 1850.
told
since, I received a letter, with the usual re- ON THE PROPRIETY OF STIMULATING THE SALIVARY GLANDS ALTERNATELY WITH THE reply to the queries respecting the health of Mr. J. R-. I replied, that I was not in the habit of filling up such KIDNEYS. forms without a fee, and that if the company did not forward To the Editor of THE LANCET. me a fee, I must call upon Mr. J. R- to see if he was SIR,—In reply to the question proposed by Mr. Levison, willing to be subject to such an imposition. I called upon my " whether in the effusion of the cellular membrane it would be and to him the cause of delay, at the same patient, explained stimulate the action of the salivary glands alternately judicious to time telling him not to insure with any company which did with the kidneys ?" I should say, that it is very doubtful if any not pay a fee for the opinion of the medical referee. vicarious evacuation, such as sometimes spontaneously occurs, Mr. J. R- very properly refused to be saddled with payPustularization rarely can ever be successfully imitated by art. ment of a fee, and so, as I thought, the matter ended. In a affords the relief that is experienced from a pustular eruption, few days, however, Mr. J. R- requested me to fill up the nor does leeching the verge of the anus remove hepatic or cereform, and volunteered to be answerable for my fee. bral congestion like an effusion of blood from the hsemorrhoidal Now, Sir, pray mark the result. I did as my patient re- vessels. The case mentioned Mr. Levison is certainly a very quested, when, to my surprise,-for I had not written anything curious instance of vicarious bydischarge of calcareous material.unfavourable to my patient, although strictly in truth, the In this case it is probable, if the lady had been restricted to the liberal company surcharged him 1:5per annum on his pre- use of distilled or rain water filtered i. e., to water conmium, to which, when he objected, they replied, that the extra taining no earthy or neutral salts, in all probability, the supply of X5was on account of my report. So much for confidential such salts would soon have ceased to abound being stopped, they of communications. I have to apologize for the length this in the secretions. Instead of taxing the kidneys by diuretics, or letter, but believing it may prevent my fellow practitioners the salivary glands by sialogogues, both of which class of eva from being betrayed in a similar manner by the worthy cuants will add to the existing debility, I would suggest the exLicensed Victuallers’ Insurance Company, I have given the pediency of following the natural indication by evacuating statement at length, and faithfully. the fluid in the direction of the t:ffusion, through the skin, by I beg to subscribe myself, your humble servant, acupuncturation, by the application of blisters above the calf of R. M.D. Hatfield-place, Bermondsey, May 9, 1850. SHARPE, the leg, dressing them with the water-dressing, or by promoting P.S.-If I can make a company, however unjustly, pocket a free transpiration by means of the oil-silk vapour-bath to the feet and legs. £5 peranuum, is it not worth a guinea ? The decoction of senega-root is a remedy which combines the threefold action of a sialogogue, a diuretic, and a diaphoretic, quest
to
-
and therefore admirably suited for a case of this kind. A strong decoction of the fibrous roots of the leek in chicken-broth, or a strong decoction of parsley-roots, or of the pyrola umbellata, in SIR,—A letter from your talented correspondent, Mr. Levison, milk, have each been successfully used in removing the dropsical leads me to forward you the following particulars regarding the effusion from the lower extremities consequent upon heart affection. But I would further suggest, that it should be borne in diagnostic property of Saliva in Gout. It is the usual practice to examine the urine in search of the mind, that the effusion in these cases is the natural mode of relief, calculous diathesis, but we do not look to the teeth as exhibiting and not a part of the disease, and therefore not so much the of cure as of prevention. any token of the presence of those concretions which, generally, object The necessity for this mode of relief is caused by an overin some constitutions, lead to stone in the bladder, and in others, to earthy deposits in joints. These concrements are of variable loaded state of the capillary vessels, true plethora ad vires. nature, but they have more or less lithic acid in their composi- All that is necessary to prevent this state is to restrict the patient to a very moderate allowance of food, both solid and fluid. In tion as a predominating ingredient. For many years I have looked at these deposits on the teeth of order to avoid the inconvenience of thirst, the patient should persons, with great interest, inasmuch as they appear and dis- abstain from those heating articles of diet which excite thirst, appear with more or less rapidity, according to particular changes substituting ripe fruits, particularly strawberries, -and wellof diet. One gentleman, in particular, of this kind of diathesis, dressed vegetables, for a more solid and liquid diet. I am, Sir, your obedient servant, used to afford me a good deal of amusement by his remarking, J. PIDDUCK, M.D. whenever I proceeded to look into his mouth, that he hoped that I should not " catch the Tartar," that he had strictly observed P.S.-The fact that the iodide of potassium exerts but little, the regimen I had recommended-but too frequently the too if any, control over cutaneous eruptions, unless its administration rapid reproduction of the tartar told the tale of his neglect of the is preceded by that of mercury, suggests the inquiry, is not the orthodox rules. I am led to believe that the parotid sub-lingual iodide remedial of the mercury, and not of the original disease? and sub-maxillary glands, all eliminate the calculous materials- and are not these eruptions rather mercurial than syphilitic, or viz., ammonio-magnesian phosphates, calcareous phosphates, perhaps the result of a combination of the metallic with the animal lithic acid, and some urea-(to this latter substance I attribute poison? If this question be answered in the affirmative, does it much of that offensive odour which is present in the breath of not suggest another question, not how much mercury the consti.
CONDITION OF THE SALIVA IN GOUT. To the Editor of THE LANCET.