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MR. SYME'S CLINICAL LECTURES.
596 had not been
being
now
properly conducted.
attained, I have only
The
object
I had in view regret that
vomica or strychnia. How important I have only to remark that a surgeon who had been called to the case previous to myself (though unknown to me at the time) had simply ordered the application of a mustard cataplasm to the region of the neck, considering it a case of ordinary spasm. The patient at the period of my visit had been from an hour to an hour and a half under the poisonous influence, the symptoms of which yielded satisfactorily to the exhibition of sulphate of zinc emetics and cold effusion, both of these having a decided immediate effect, while the stomach-pump and other agents were in the course of preparation. The patient progressed favourably forthwith. I am, Sir, your obedient servant, WILLIAM HENDRY, M.R.C.S. Hull, June, 1855.
active
principle
of
nux
may prove the distinction!
to express my
there should be any misapprehension on the subject. I am, Sir, your obedient servant, JAMES SYME. Edinburgh, June 4th, 1855. P.S.-The following extract from a letter of the patient’s father to the gentleman who had been relieved from the medical charge of his family, will show that the impression upon his mind was not precisely what, according to Mr. Erichsen, he and his colleagues wished to convey:The friend who took W- to London carried him to Mr. Erichsen and Sir B. Brodie, who, having reference to such history as I could give of the case, wished to have it for a time under supervision. When I came up, I found with them Messrs. Stanley and Fergusson. They all treated it as a case they feared more than they hoped in, but concurred in having it under further observation and treatment, and absolute resty’ MR. SYME’S CLINICAL LECTURES. holding that, though it might soon become necessary, amputaTo the Editor of THE LANCET. tion was not then requisite, nor would they then feel justified in resorting to it. For the first ten days of rest and treatcommon, no doubt, with all your readers, I feel SIR.-In ment, such a great diminution in the size of the arm, and other very grateful to Mr. Syme for his most valuable Lectures on favourable changes, followed, that they were very hopeful (! !) Clinical Surgery, now concluded. I trust when Mr. Syme rebut W-’s stomach got disordered for some forty-eight hours, sumes his course, he will still make THE LANCET the meand whether that acted on the arm, or was only a symp- dium of the practical results of his original mind. diffusing tom of increased activity, I know not, but it was imme- The of such lectures, Mr. Editor, shows your publication diately followed by a sudden and alarming increase of size in consideration for the interests of your readers, and determithe diseased arm. Though this did not go on, and the arm nation to keep THE LANCET the organ of our profession. became again more quiet, still the decided tendency was to I am, Sir, your obedient servant, increase; and some other symptoms, deemed unfavourable, R. B. June, 1855. especially a pulsation, occurring, fresh consultations were held, and after an examination by probes, they all concurred in SURGERY OF THE WAR. advising the removal of the limb, unless a preliminary internal examination should show, which they did not expect, the tumour to be different from what they feared." WANT of space alone prevented us last week presenting our readers with the official return of the state of the sick and wounded, in the army in the Crimea, obligingly forwarded to SMALL-POX IN UTERO. us for publication by the Director-General. Still, however, To the Editor of THE LANCET. though now advanced in June, a short analysis of the report SiR,—In October, 1853, I attended Mrs. C- in her con- may prove instructive. Since then, it appears, Dr. Alexander finement with a male child. In the August previously Mrs. and Dr. Painter, with an hospital-ship fitted out for the exC- had a very severe attack of small-pox. I vaccinated pedition, have been detached on medical duty to Kerteh and the child in January, 1854, from points and from the arms of Perekop. The very general prevalence of fever in the Crimea early in two healthy children; but every attempt failed of producing the vaccine vesicle, or any constitutional disturbance whatever. May was most marked. Of 23,251 men, of which the army was then composed, 3386 were sick and under medical care, I am, Sir, your obedient servant, with 64 officers, Of 3386 men sick, 1921, or about two-thirds, J. T. M. June, 1855. were labouring under fevers and various febrile affections allied to typhoid; while of 64 officers ill, about half were suffering POISONING BY NUX VOMICA. from fevers or protracted diarrhœa; only 16 from gun-shot To the Eclitor of THE LANCET. wounds. In the LightDivision and Second Division, according to the SiR,—Often as medical practitioners may be summoned to the assistance of those unfortunate individuals, whose mental report, fevers were excessively prevalent; in the latter Division disturbance and depraved determinations induce to the at- fevers constituted one-half of the sick list, while in the Third tempted commission of suicide, it will now and then happen Division some prospect of decrease of fever previously enterthat substances out of the ordinary course of poisonous agents tained had not been realised. Some cases, " indistinctly are seized upon to effect the direful purpose, occasioning sympmaculated," and complicated with diarrhœa, which seem to toms during the earlier moments of development which tend be typhoid, did not realise the expectations formed of the to embarrass the attendant. utility of quinine, and appeared more amenable to emetics. On the 15th of May, at ten P.M., having been urgently reo In the Second Division, relapse fever, probably from the influquested to visit a person, supposed to be in a fit, I did so with- ence of malaria, was frequent; while, again, in the Fourth out delay, but was surprised to find my patient quite conscious, Division, of 4727 men, the total number of sick in camp was without stupor, or cerebral congestion, or pains, or other appa- 455, of which 215, or one-half, were suffering from fever. rent ailment than that of a mental depression which had given The Cavalry Division was stated to be rather free from fever, occasion to the act, and a pulse accelerated beyond ordinary while the sanitary condition of the First Division was even symptoms to account for. In the course of ten or fifteen still more satisfactory. In these Divisions quinine wine, minutes, however, convulsive twitches began to show them- as a prophylactic against the aguish fevers of the Crimea, selves in the hands and feet, subsequently extending to the was given with manifest advantage. The Ambulance Corps facial and respiratory muscles, and exhibiting complete tetanic was in better working order, and during the week 90 sick from spasm, even to the development of most violent opisthotonos; the Light Division were removed from the malaria of the then on a sudden all was calm; the patient expressed his camp tents to Balaklava. It was gratifying to find also that sentiments, and changed his position with facility, and with almost all the regiments, as well as the Artillery corps, were apparent freedom from all abnormal affection, although posi- furnished with "hospital huts." Diarrhœa and scurvy had tively under the influence of a poison which in a few moments, diminished in proportion to the supply of better food, of freshby the next convulsive paroxysm, might snap asunder the vegetables, and better covering for the soldiers. The medical thread of his existence; and thus symptoms followed in in- officers, however, were suffering from sickness and overwork. creasing violence every five or ten minutes, until the exhibition In the First Division six surgeons were on the sick report, as of remedial measures happily took decided effect. It was well as two others sent invalided on board ship with sick leave. elicited that the man, being upwards of thirty years of age, Of 3386 sick men we find only 331 wounded, while of 64having been discharged from his situation, goaded by remorse, officers 16 were wounded, showing the greater tendency of the had taken about two drachms of a gray powder, sold at shops men to fall into fevers and other diseases, the result of ex-under the titleof "Butler’s vermin and insect killer," labelled posure. Under the head of phlegmonous ulcers we find 173 of which, as thus related, denoted symptoms men ill; of gun-shot wounds, 28 cases, of which the following. poison, thetoeffects the class of narcotic irritants, probably to the are the most interesting :belonging ,
,
_______________
being
now
properly conducted.
attained, I have only
The
object
I had in view regret that
vomica or strychnia. How important I have only to remark that a surgeon who had been called to the case previous to myself (though unknown to me at the time) had simply ordered the application of a mustard cataplasm to the region of the neck, considering it a case of ordinary spasm. The patient at the period of my visit had been from an hour to an hour and a half under the poisonous influence, the symptoms of which yielded satisfactorily to the exhibition of sulphate of zinc emetics and cold effusion, both of these having a decided immediate effect, while the stomach-pump and other agents were in the course of preparation. The patient progressed favourably forthwith. I am, Sir, your obedient servant, WILLIAM HENDRY, M.R.C.S. Hull, June, 1855.
active
principle
of
nux
may prove the distinction!
to express my
there should be any misapprehension on the subject. I am, Sir, your obedient servant, JAMES SYME. Edinburgh, June 4th, 1855. P.S.-The following extract from a letter of the patient’s father to the gentleman who had been relieved from the medical charge of his family, will show that the impression upon his mind was not precisely what, according to Mr. Erichsen, he and his colleagues wished to convey:The friend who took W- to London carried him to Mr. Erichsen and Sir B. Brodie, who, having reference to such history as I could give of the case, wished to have it for a time under supervision. When I came up, I found with them Messrs. Stanley and Fergusson. They all treated it as a case they feared more than they hoped in, but concurred in having it under further observation and treatment, and absolute resty’ MR. SYME’S CLINICAL LECTURES. holding that, though it might soon become necessary, amputaTo the Editor of THE LANCET. tion was not then requisite, nor would they then feel justified in resorting to it. For the first ten days of rest and treatcommon, no doubt, with all your readers, I feel SIR.-In ment, such a great diminution in the size of the arm, and other very grateful to Mr. Syme for his most valuable Lectures on favourable changes, followed, that they were very hopeful (! !) Clinical Surgery, now concluded. I trust when Mr. Syme rebut W-’s stomach got disordered for some forty-eight hours, sumes his course, he will still make THE LANCET the meand whether that acted on the arm, or was only a symp- dium of the practical results of his original mind. diffusing tom of increased activity, I know not, but it was imme- The of such lectures, Mr. Editor, shows your publication diately followed by a sudden and alarming increase of size in consideration for the interests of your readers, and determithe diseased arm. Though this did not go on, and the arm nation to keep THE LANCET the organ of our profession. became again more quiet, still the decided tendency was to I am, Sir, your obedient servant, increase; and some other symptoms, deemed unfavourable, R. B. June, 1855. especially a pulsation, occurring, fresh consultations were held, and after an examination by probes, they all concurred in SURGERY OF THE WAR. advising the removal of the limb, unless a preliminary internal examination should show, which they did not expect, the tumour to be different from what they feared." WANT of space alone prevented us last week presenting our readers with the official return of the state of the sick and wounded, in the army in the Crimea, obligingly forwarded to SMALL-POX IN UTERO. us for publication by the Director-General. Still, however, To the Editor of THE LANCET. though now advanced in June, a short analysis of the report SiR,—In October, 1853, I attended Mrs. C- in her con- may prove instructive. Since then, it appears, Dr. Alexander finement with a male child. In the August previously Mrs. and Dr. Painter, with an hospital-ship fitted out for the exC- had a very severe attack of small-pox. I vaccinated pedition, have been detached on medical duty to Kerteh and the child in January, 1854, from points and from the arms of Perekop. The very general prevalence of fever in the Crimea early in two healthy children; but every attempt failed of producing the vaccine vesicle, or any constitutional disturbance whatever. May was most marked. Of 23,251 men, of which the army was then composed, 3386 were sick and under medical care, I am, Sir, your obedient servant, with 64 officers, Of 3386 men sick, 1921, or about two-thirds, J. T. M. June, 1855. were labouring under fevers and various febrile affections allied to typhoid; while of 64 officers ill, about half were suffering POISONING BY NUX VOMICA. from fevers or protracted diarrhœa; only 16 from gun-shot To the Eclitor of THE LANCET. wounds. In the LightDivision and Second Division, according to the SiR,—Often as medical practitioners may be summoned to the assistance of those unfortunate individuals, whose mental report, fevers were excessively prevalent; in the latter Division disturbance and depraved determinations induce to the at- fevers constituted one-half of the sick list, while in the Third tempted commission of suicide, it will now and then happen Division some prospect of decrease of fever previously enterthat substances out of the ordinary course of poisonous agents tained had not been realised. Some cases, " indistinctly are seized upon to effect the direful purpose, occasioning sympmaculated," and complicated with diarrhœa, which seem to toms during the earlier moments of development which tend be typhoid, did not realise the expectations formed of the to embarrass the attendant. utility of quinine, and appeared more amenable to emetics. On the 15th of May, at ten P.M., having been urgently reo In the Second Division, relapse fever, probably from the influquested to visit a person, supposed to be in a fit, I did so with- ence of malaria, was frequent; while, again, in the Fourth out delay, but was surprised to find my patient quite conscious, Division, of 4727 men, the total number of sick in camp was without stupor, or cerebral congestion, or pains, or other appa- 455, of which 215, or one-half, were suffering from fever. rent ailment than that of a mental depression which had given The Cavalry Division was stated to be rather free from fever, occasion to the act, and a pulse accelerated beyond ordinary while the sanitary condition of the First Division was even symptoms to account for. In the course of ten or fifteen still more satisfactory. In these Divisions quinine wine, minutes, however, convulsive twitches began to show them- as a prophylactic against the aguish fevers of the Crimea, selves in the hands and feet, subsequently extending to the was given with manifest advantage. The Ambulance Corps facial and respiratory muscles, and exhibiting complete tetanic was in better working order, and during the week 90 sick from spasm, even to the development of most violent opisthotonos; the Light Division were removed from the malaria of the then on a sudden all was calm; the patient expressed his camp tents to Balaklava. It was gratifying to find also that sentiments, and changed his position with facility, and with almost all the regiments, as well as the Artillery corps, were apparent freedom from all abnormal affection, although posi- furnished with "hospital huts." Diarrhœa and scurvy had tively under the influence of a poison which in a few moments, diminished in proportion to the supply of better food, of freshby the next convulsive paroxysm, might snap asunder the vegetables, and better covering for the soldiers. The medical thread of his existence; and thus symptoms followed in in- officers, however, were suffering from sickness and overwork. creasing violence every five or ten minutes, until the exhibition In the First Division six surgeons were on the sick report, as of remedial measures happily took decided effect. It was well as two others sent invalided on board ship with sick leave. elicited that the man, being upwards of thirty years of age, Of 3386 sick men we find only 331 wounded, while of 64having been discharged from his situation, goaded by remorse, officers 16 were wounded, showing the greater tendency of the had taken about two drachms of a gray powder, sold at shops men to fall into fevers and other diseases, the result of ex-under the titleof "Butler’s vermin and insect killer," labelled posure. Under the head of phlegmonous ulcers we find 173 of which, as thus related, denoted symptoms men ill; of gun-shot wounds, 28 cases, of which the following. poison, thetoeffects the class of narcotic irritants, probably to the are the most interesting :belonging ,
,
_______________