LONDON MEDICAL SOCIETY. March 11th, 1833.

815

rently, by the confined artery, and which

action of the carotid’ and who first directed my attention

to

its

greatly impeded her use when in Pars. The French language breathing, that she was frequently obliged being so generally known, it is here given to sit up in the night to prevent suffocation. as I received it. She complained aiso of occasional dysmePour faire la Pommade de Gondret.— norrhaea and general debility. Je fais fondre dans unpaelonde l’axonge The patient said, that she had not otherj’ajoute plusieurs ou seulement deux wise been subject to glandular swellings: auquel cuillerees d’huile d’olive, suivant que je that about six years ago, after taking severe veux avoir !a ou moins con. cold, this tumour first made its appearance ; sistante.-2° . pommadelaplus est fondue, Lorsque grasse, that it was then much smaller, and could la verse dans un flacon ordinairement a je easily be moved about in every direction, 4onces, bouché à l’emeri jusqu’amoitie except towards the back of the neck. Me. de ee flacon, puis je le rempli d’ammoniaque dical advice was then procured in the counliquide tres cnnceutre jusqu’a ce qu’il n’extry, and lotions, &c. were employed, but iste plus que quatre a cmq lignes entre le without beneficial result. Coming after- bouchon et le niveau du Je wards to town, she obtained admission to the remue fortementle flacon liquide.—3°. apres avoir serre South-London Dispensary, where she con- le bouchon à l’aide d’une ficelle, et l’avoir tinued under treatment for some months, entortillé dans une serviette je le plonge but the tumour still remainingundiminished, ensuite dans de 1’eau froide, on glacee." extraction was spoken of as the only available remedy; and not possessing courage * This is what we call, common ammoIt certo submit to an operation, all other means niac liniment, " tres concentré." were then given up. Admitted, at a sub. tainly puts us strongly in mind of the fact, sequent period, as an out-door patient at thatthe French make a great deal of a very Guy’s Hospital, very active aperients were little thing. given her, and ointments to rub in upon the so

1°.

part affected. These remedies were continued for several months, but not proving successful, extraction was again proposed, and this, for a year or two, put an end to all

LONDON MEDICAL SOCIETY.

March 11th, 1833. treatment, until the time I saw her in the Mr. KINGDON, President. state above described. The names of the gentlemen who had attended to the case, were a sufficient proof SINCE the last meeting the anniversary that no essential remedy usually employed dinner and annual elections of this society had been neglected; and in order not to have been held, and Mr. KINGDON, amongst hazard a similar treatment, I recommended other changes, was chosen President. Toan issue to be made on the diseased part, night he was installed, and returned thanks ; with the " Pommade Ammoniacale:" A after which, votes of thanks were passed pale serous discharge soon commenced, and to the late President, Dr. Burne—the the patient was directed to renew the dress- Vice Presidents, Mr. Callaway, Mr. Kingings night and morning, adding more or less don, and Drs. Whiting and Uwinsof the ointment, accordingto the irritation to the Treasurer, Dr. Shearman,-to the it produced, so as not to allow the surface ofOrator at the late meeting, Mr. Salmonthe wound to exceed the size of a small pea. to the Librarian, Mr. Dendy-and to the Messrs. Headland and Jones, By this means the enlargement gradually diminished, as also the throbbing and dif- who, severally (where present), acknowthe honour in appropriate terms. ficulty of respiration, and thus, in the course of nine months, the tumour was completely reduced. Tonics, consisting principally 01 ’ METASTASIS OF RHEUMATISM. TREATMENT the carbonate of iron and occasional gentle OF RHEUMATISM BY MODERATE BLEEDaperients, constituted the rest of the treat. INGS AND Qt.’IKINE. COLCHICUM. ment. A few weeks ago the same indiviMr. C LIFTO-, then related a case of sudden dual returned to the dispensary to be reo lieved from a cold, but has not experienced metastasis of rheumatism to (as he thought) the least return of the tumour. I am, Sir;,!the diaphragm, which drew forth a discussion that occupied the remainder of the your obedient servant, He had never before seen a meII. S. CALDWELL, M.D. H. of that kind. The occurrence was tastaeis Camberwell, Feb. 26th, 1833. one of great interest at the moment, and 1’.S. The ointment not being procurable’ excited the highest alarm in the sick-room. in London, the annexed" Formule" wa:’He had been attending a delicate female, sent me by a gentleman who had been irI who formerly laboured under a pulmonary the habit of preparingit for Dr. Gondret but was now recovered from that,

Secretaries,

ledged

evening. !

affection,

816 and suffered an attack of acute rheumatism in the legs, feet, and knees. He gave her during several hours after it had set in, moderate doses of the vinum colchici, which subdued the pain; but two hours after he left ’her he was summoned again in great haste, in consequence of a violent acces sion of the disease in another part. On returning to the house, he found her breathing with the utmost difficulty, the countenance excessively anxious, and the symptoms altogether so startling, that both himself and all around her believed her to be in the agonies of death. The state of’ the pulse was, in fact, the only consolatory indication. Though the dyspnoea was great beyond measure, the pulse was but 88, and not small nor fluttering. This induced Mr. Clifton to believe, that the disease was not The attack did not inone of the heart. volve the intercostal muscles, but appeared to be purely one in which the diaphragm was affected, preventing its descent into the abdomen. The labour of respiration resembled the extremest degree of that sort of difficult breathing which marks the ad- i vanced stage of centonitis. when the tu- i mefaction Is augmented. This continued for some hours, during which hot water to the feet, and doses of ether and opium, were resorted to, with the effect, in

greatly

Dr.WHiTiNG thought this theory very plau.

sible, and that acute rheumatism was certain.

ly far too freely treated by bleeding. He used it moderately in most cases, just to subdue the inflammatory action, and then employed quinine to prevent the return of the attack. He begged particularly to call attention to this practice, and wished that practitioners would give it a trial. The success of the plan in his hands was such, that he would advise every practitioner in the kingdom to give it a trial. He positively found the quinine to be as remedial in acute rbeumatism as he did in ague. As soon as he saw a case, he had the patient bled, and directly after the lancet was used, he gave two grains of sulphate of quinine every three or four hours, continuing it until the pain was gone. So effectual was this, that if a cure was not immediately performed, a subse. quent attack, which was very rare, was sure to be a very mild one. (Much surprise was expressed by some members at these statements. The Doctor, therefore, subsequently enlarged on the subject, expressing the following views, partly made public some years since, he said, in one of the medical periodicals, and since fully confirmed by additional experience.) He regarded quinine a

not as

a

stimulant,

but

as

medicine which had the marked influence

the nervous system, of preventing the of morbid action in cases where disease had once been subdued. Thus, in mities were wholly removed. The case was regarded as a singular one, acute rheumatism (arthritis;not common and led to a debate on bleeding in rheu- muscular rheumatism, which was quite anmatism. Mr. Clifton having first been other disease), he first produced a reduction asked why he did not bleed for the acute of the pain by a bleeding,-and then the rheumatism, in addition to givingcolchicum, morbid action of the parts being subdued— Mr. Clifton’s reply was, because the patient he threw in the quinine to prevent its rewas too delicate to bear it. But first of all, appearance ; and most effectual, surpris. Mr. PROCTOR rose to express an opinion, ingly effectual, was this mode of treatment. that metastasis of rheumatism to the heart, He besought practitioners, generally, to try &c. was much more common now than it the quinine on their own persons, in this light, used to be, from whatever source the fre- and in acute rheumatism he was persuaded that they would never adopt any other plan. quency might arise. Dr. BURNE thought so too, and the cause He used to give colchicum, either bleeding he ascribed to the large bleedings employed or not in addition, as circumstances seemed by the moderns to subdue rheumatism, to indicate, and occasionally it would cure a which appearing to them to be a disease patient in a few days, but the quinine, after that would allow bleeding with advantage, bleeding, was invariably successful in his was consequently thus treated to an ex- hands. He had seen patients who had been cessive extent, and ended in the frequent lying very ill with rheumatism for a long metastasis complained of. Rheumatism, period, defying all other treatment, whom however, was a constitutional disease, the quinine had restored to full walking which bleeding would not cure. Continued condition in two or three days. Many other depletions reduced the extremities to a medical men were also now employing it, state which rendered them unable to sup- and his former pupils often wrote to him to port rheumatic attacks, and the disease, say how successful the plan was in their consequently, not being really expelled the practice. Dr. SHEARMAN thought that metastasis svstem, flew to the heart, as a central part which was better able to suffer and keep of rheumatism was now much more frequent up the rheumatic diathesis. Entertaining than formerly, and he often was at a loss to these views, he bled sparingly in the I account for it ; but he now thought that the disease. was to be traced to the increased

eight hours, of producing relief, subsequent which the rheumatic pains in the extre-

to

over

returra

Ilil.difference

817

mania for evacuations, and to some change in the constitutions of men. To profuse bleeding he objected, on the ground that inflammation was an accidental concomitant, not an actual feature, of genuine iheumatism.

Monday,

March 18th, 1833.

Mr. KINGDON, President. RHEUMATISM.—ELATERIUM. TURE.

ACUPUNC-

Mr. CLIFTON relied almost entirely on THE spirit of discussion was slow of dethe wine of colchicum in his cases. Dr. scent this evening. The CHAIRMAN tried to was certhat used bleeding say, Fordyce to invoke it by asking whether the mischievtainly very fashionable in rheumatism, but ous effects of colchicum were produced on that he never in his life derived advantage the sensorium or the mucous membranes, from it. but the inquiry fell still-born. So Mr. Mr. PROCTOR, referring to the varying DENDY started the novel proposition that efficacy of the two forms of colchicum, ob- the metastasis of disease was not the transserved tllat at Gravesend,where rheumatism ference of disease from one spot to another, is so common, they state that they cannot but a new attack, produced so violently in a depend at all on the wine. but onlv on the fresh part, as to hide from the patient’s powder of the root, half a draclim of which feelings the effects of its continued existthey usually give every ,four hours. They ence in the original seat. The position consider the powder there as a specific. In thus stated was rather untenable, as Mr. London, however, it was almost a useless Dendy afterwards saw, but it served as a stimulant, however, to conversation, inducmedicine compared with the wine. Mr: SALMON.

Mr. Wigan, of Brighton, an experienced practitioner, finds the powdered

colchicum in doses of ten grains three times day, the most effectual of all remedies, and recommends it strongly. a

Mr. HOOPER. Then it cannot be good, I for half a drachm, if pure, will, I have found, poison a patient.

fancy;

ing, by and by,

Dr. UWINS to rise, and speak of the of rheumatism, and to recommend elaterium, in considerable doses, in the first stages of rheumatic affection, declaring, on the strength of his own experience, that " it would not only tend to shorten the duration of the disorder, but would, in fact, destroy the disease in the bud, and prevent a long course of inconvenience and suffering." It should be given in grain or half-

treatment

Mr. DENDY. Yet I have given in one drachm and a half of the vinum col- grain doses, every morning, according to chici in the course of the day, after taking the degree of pain experienced, and the twenty ounces of blood. The neighboursmalignancy of the disorder. Its precise of the patient sent to me to stop the cries action he could not explain, but he was led which his rheumatic pains produced. Three to give it at first, from, he believed, its or four doses produced but little relief, and tendency to produce nausea, and set the in my absence the patient was so deter- secretions at work. His patients said that mined on a cure, that he took four tea- it was a verv unpleasant medicine, but the spoonsful at a dose of the wine, procuredrelief produced fullv counterbalanced its straight from Apothecaries Hall, four times disagreeable mode of operation. a day, and the effect was to restore him at Mr. SALMON asked,-What of acupuncIn my limited exture in rheumatism1 once to health. perience it has failed. Mr. COLE said he had known a scruple of Mr. DENDY. And in mine too. When the powder, given in three doses, produce, it was proposed, it certainly effected in a gentleman aged 70, ulceration of the some singular cures, but, of late, success intestines, which took three years in cur- does not seem to have attended it. Amongst

case. a

first

ing.

the cures it formerly produced, was one that Mr. BLENCATRNE said he had tried Dr. came within my knowledge, where it benepractitioner in a very Whiting’s plan, and been disappointed fited both manner. andThe Earl of Egremont in it. agreeable was a martyr to rheumatism, and some A glance at the clock stopped a further years since, after having been treated by prolongation of the discussion. every medical man of note in London, without obtaining relief, he retired to his seat The with Dr. three which cases * Blundpll’s name was connected at the end at Petworth, in despair. A friend of mine, of Dr. Waller’s observations last week, who resided in Sussex at that time, hapto get an early copy of M*-. Cliurch. page 754, should have been stated to be pened ill’s little work on acupuncture, and tried cases of’spontaneous evolution. the remedy therein advocated with perfect

patient

,

success on an

old

woman

who

was a

protege