OBSERVATIONS UPON THE NATURE AND TREATMENT OF BOIL AND CARBUNCLE.

and aponeuroses die very easily. The rapid decay of this material, and its numerous deeply-seated connexions, render the NATURE AND TREATMENT OF BOIL AND local management of a carbuncle truly formidable. The sepation of the sloughs discovers enormous chasms, and the powers CARBUNCLE. of endurance and reproduction are indeed heavily taxed to restore the sufferer in circumstances of such urgency. I have BY BENJAMIN TRAVERS, JUN., F.R.C.S.L., &c., remarked on two occasions where I knew the strumous taint to FORMERLY RESIDENT ASSISTANT-SURGEON AT ST. THOMAS’S HOSPITAL, AND LECTURER ON SURGERY. be very decided, that boils recurred frequently, leaving indo. lent sores behind them, which healed slowly or imperfectly. In these cases, change of air and steel medicines, also the salts PART L containing iodine, as the syrup of the iodide of iron and the INTRODUCTION. hydriodate of potass, will be found useful. I have now seen a THE progress of scientific surgery since the death of John good many carbuncles, but I do not remember ever to have seen Hunter has been but a continued illustration of the great a scrofulous person so attacked. Boils, on the contrary, are in individuals whose aspect bespeaks that truths he first propounded. Mr. Abernethy made considerable common enoughThe sexes are not by any means equally dig... temperament. advances in the direction pointed out by his illustrious preto these actions : women, it is well known, do not suffer posed decessor, but the most profound and comprehensive exposition like men from carbuncles. The case of acute anthrax occurring of those facts which collectively belong to the department of in the female is altogether rare and exceptional. The reason constitutional pathology has proceeded from the pen of one of this difference is obvious. It does not depend upon organiwho still survives. The treatise on " Constitutional Irritation" zation, but upon the very opposite mode of being observed by the sexes in a state of civilization. Amongst men, the enfeebled has secured for its author that kind of reputation which ex- frame of age and the habitual valetudinarian are quite as liable tends far beyond the limits of a kingdom, and it is accorded to to an attack of acute carbuncle as the over-fed voluptuary or him wherever surgery is professed as a science, or its import- the nervous invalid. In all these instances, vitiated secretions. ance as the least exclusive department of medicine is honestly materially influence the period and nature of the illness. Carbuncle is certainly of rare occurrence in early adult life-under and upheld. recognised I have treated in succession two gentlemen between The local treatment of disease is at all times a work of great thirty. and forty-five for bad carbuncle. One of these cases thirty nicety, but, the labour is lightened and expedited by a just underwent the further complication of acute gout. I recognise two forms or modes of action in carbuncular disappreciation of its remote causes; and he whose mind is ease. The first is vigorous and acute, marked by pain, often a method which of that occupied by frequent contemplation character. Here there is an early tendency.to implies an early concentration of the powers of life, so as to agonizing in its a term which I adopt as it is contrasted with the acumination, arrest local disorder at the smallest cost to the health of his pointing of an abscess. The surrounding induration is of rapid patient, certainly selects the safest ground whereon to combat production, extending, ordinarily, beyond the tegumentary disdiseased actions, whether chronic or acute. coloration ; but having reached a certain limit, it shows no The following remarks, upon the substitution of a brief and further disposition to spread or take on a renewed action. effectual remedy for the employment of the knife in the local These are cases which are further marked by febrile reaction, management of a most painful, and at times a very dangerous, a loaded tongue, great restlessness, and the like. They are complaint, are offered in the sense here suggested. My purpose the result of intemperance and bad secretions, in a full habit. is to exhibit a new illustration of the great utility and im- They are the direct consequence of exposure to cold or some portance of watching the course of the natural surgeon, and such powerfully exciting cause, and stand in marked contrast aiding him more effectually than heretofore, in circumstances with a second form of the disorder, which may be termed the of great urgency, by a closer imitation of the original design of chronic kind. This belongs to the wasted habit of age, or the that artist than is implied by the coarse and abrupt inter- exhaustion incident to organic changes elsewhere ; also the deference with a highly critical process, such as the deep crucial pressed condition of body which belongs to anxiety and nervous incision of a ripecarbuncle. I find, on referring to the very depression. On these occasions, the deposit is larger and more little which has been said by systematic authors upon this slowly progressive ; the skin suffers to a great extent. There is subject, that the common opinion concerning the origin of a more hardness and discoloration, but less tension, in the early boil or furuncle is, that it commences in the skin follicles, stage of the complaint. The pain is dull and continued, but being an inflammation which extends into the cellular sub- not so intense, and more easily controlled by opium. In the stance, and terminates in a defined slough of that tissue. The first case it is commonly safe and right to purge the patient dead material being eliminated, cicatrization easily ensues. freely. In the second, less is required in this particular, and This action having been noticed to be of easy recurrence in the laxatives must be used with caution. In either case, the causyoung and robust has given rise to the vulgar notion that it is tic, if its application is properly timed, is attended with the a sign of redundant health and strength. It is simply a result best possible effect. Its use gives more pain, and afterwards of sympathy with some occult disorder or irritation of the seems to exert a more sudden and complete control over the mucous membrane of the stomach or intestine, such as is prospread of the disease in acute carbuncle. Its effect is slower voked under other forms of disturbance in that organ. The in the chronic form of the action ; it is less complained of, and origin and course of a boil is that of a carbuncle upon a smaller the sloughs separate more gradually ; but when once that stage scale; it is a specific inflammation, marked by a deposit of of the action has been established, the progressive induration is. fibrine or adhesive matter, the common antecedent of a slough, arrested, the tumour becomes flatter and softer, the skin recobe it no larger than a bean or split-pea. Some are very prone vers in a marked manner, and any further structural change in to boils from their infancy. These are commonly florid and this tissue is suspended, beyond those parts which from the fleshy as children, with large appetites; they have a large first were clearly defined and marked out as being the points visceral development, but the heart at times gives proof of a of issue for the subjacent sloughs. The dangerous form of the feeble action, not in keeping with the other external signs of disorder is of the latter or chronic kind, which is subject to vigour. The pulmonic circulation is easily affected by weather ulterior complications, such as gout and remote visceral lesions, or over-exertion, as evidenced by a tendency to cough on very typical of an organic and permanent degeneration. The occurrence of what is called a core in boil or carbuncle slight pretexts; and the disposition to complain of chilliness or cold feet is indicative of a want of tone in the skin capillaries. a deep-seated plug of dead lymph, interspersed with shreds of Whenever, under such circumstances, the appetite flags, and cellular and membranous texture-seems to have induced a the secretions are unhealthy, the surface is very liable to exhibit belief that this product represents all the event or effect of the symptoms of furuncular irritation. Probably a very slight local inflammation, and that there is little or no compromise of accident determines the place of the boil, or it may be that the tissue beside or beyond it. This is a doctrine to which I candense granular structure of the scalp and posterior cervical not subscribe. The violence of the inflammation certainly kills region in some, and the looser parts in others, have a quicker the tissue which it attacks. This core or bed of waste lymph disposition to undergo that primary stasis wherein the com- belonged originally to the deposit which bounded and defined plaint comwences. In all the true or final cause of the local the limits of their sloughing process; but in carbuncle it forms action is the distempered quality of the circulating blood. but a small part of the decayed and spoiled substance, which Childhood is never invaded by carbuncles. The white tissues escapes so abundantly after the use of the caustic in the second are not fully developed at that age, and are, comparatively stage of the disorder. When we consider that in the case of a boil there is always speaking, very vascular. In old age, we know that tendons OBSERVATIONS UPON THE

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slough,be it no bigger than a nail-head, we must conclude that the malady is not confined to the part. The surface of a limb may be beaten to discoloration, a bone is broken to comminution, nay, the body will suffer the worst forms of contusion, and yet mortification is no certain consequence of the mischief. The nervous depression, the indigestion, the affusion nf cold air, damp weather, or whatever may be said to have provoked the illness associated with an anthrax or an eruption of boils, does not cause the local change. That depends upon which a mere pus an impure or chemically altered formation cannot operate in the sense of crisis or relief. In these circumstances of an enforced necessity for a sudden decay of tissue, that is most likely to be first affected which dies ’soonest, and whose place in the economy is most easily supplied, ordinarily by a direct reproduction. (To be continued.) a

blood, upon

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STRYCHNIA BY ERNEST P.

POISONING, AND ANALYSIS. WILKINS, ESQ., M.R.C.S., F.G.S., &c.,

Newport. G-, aged twenty-three, took three grains of strychnia on a biscuit, with suicidal intent, Feb. 8th, 1857, at ten P.M., and retired to bed. He was first discovered by his screams, or MR.

rather "bellowings," at half-past ten P.M., and he died at four A.M. Feb. 9th. My assistance in the case was requested ’, by Mr. Tuttiett. We found him suffering from frightful ’, periodical tetanic convulsions of the voluntary muscles and jcongestion of the face. At first opisthotonos was so severe as to force him off the bed on to the floor. During the attack, the feet were inverted, the soles of the feet arched, the fingers clenched, (not forcibly,) the elbows flexed, the arms bent over the chest, the eyeballs fixed and protruding, pupils dilated, the neck stretched backwards and twisted. The attacks occurred at intervals of half an hour, more or less, and were so violent as to shake not only the bed but even the house. After the attacks subsided very copious sweating ensued. His consciousness was perfect. He acknowledged to have taken the strychnia, and feared he had not taken sufficient. He conversed in gasps, asked to be held when the tetanic z, attacks were coming on, and to be turned over during their ! presence; he also asked for drink, but took it with difficulty, i, as the attempt brought on convulsions, and was effected only after several attempts; when swallowed, it was ejected by jerks. During the intervals of his periodic convulsions, sudden I and powerful shocks and twitchings occurred; these were produced or increased by the slightest touch. The twitching of the muscles of the face resembled those of epilepsy. He had a feeling of dread, and begged he might not be left alone. He died asphyxiated during a violent convulsive attack, which fixed all the respiratory muscles. The heart was observed to beat after respiration had ceased; the pulse, which had been i 150, became feebler gradually, and ceased to beat. Our treatment consisted of emetics of sulphate of zinc, which produced no effect; the throat was tickled with a feather,

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and other viscera (and some blood) to my friend, Dr. Marshall Hall. This he forwarded to Professor Taylor, who has taken the trouble to make an analysis. In a letter to me, he says: " I have waited, however, in order that you might know the results obtained in Edinburgh :tnd Dublin, as well as in London; and 1 only received the report of Dr. Christison and Dr. Douglas Maclagan yesterday morning. We have all three, acting independently, used a process known as that of Stas of Belgium, which has been found quite inadequate to detect strychnia in the bodies of animals poisoned by a quarter of a grain. " Dr. Geoghegan, professor of medical jurisprudence in the Royal College of Surgeons, Ireland, made a minute analysis of the kidney. He reports that, with the greatest care, he could not detect the slightest trace of strychnia by any one test or property. On subsequently adding a minute portion of to the residue, it was immediately revealed. strychnia " Drs. Christison and Douglas Maclagan had the portion of lung and liver which you sent. They have examined both, and report as follows:-’ The result is, in one word, wholly negative. We worked by Stas’ method; everything went smoothly with the manipulations; and eventually riot only did the bichromate of potash fail to give any reaction of strychnia, but in no stage of the process-alcoholic, watery, or etherealwas there the faintest trace of bitterness,’ &c. " Ihad the assistance of Mr. Scanlan, a good pharmaceutical chemist, who has manufactured the alkaloids. We occupied three weeks in our analysis, operating on, I st, the blood; 2nd, the heart; 3rd, the coats of the stomach; 4th, the contents of the stomach. " In the three first there was not the slightest trace of strychnia, either by taste or by any of the tests. In the dry residue from contents of the stomach we obtained, by one colour test, a slight purple passing to a red colour. The liquid, however, had rather the bitter taste of caramel than strychnia. No crystals of strychnia could be procured. Hence, but for the fact that we knew deceased had died from strychnia, we should have placed no reliance on this result. In short, when a man’s life depended on the answer, I should decline to say that such a result was conclusive of the presence of strychnia. " Imay remark that your case was particularly favourable to the discovery of the poison in an absorbed state, if it admits of unequivocal discovery, as the man lived five or six hours, during which time there would have been a much larger deposit (if any) in the tissues, than would occur where death took place in an hour or two. " You have here, then, the results of men who have been many years engaged in these researches for poison, who can have no interest whatever in altering or suppressing facts, or stating anything but the truth; and, further, the case was one which, above all others, should have shown theabsorbed’ poison, if it could be shown, and the result is this :-A man may die from strychnia; some of the poison may or may not be found remaining in the stomach according to dose and other circumstances, but not a particle of the poison, in an absolute state, will be found in other parts of the body!" P.S.-This communication has been delayed for the result of experiments by Dr. Marshall Hall with the frog’s strychnoscope. This I have not received, but will send on to you as soon as it arrives. Isle of Wight, May, 1857. .

&mid ot;

which produced slight vomiting.

An attempt was made to z, the stomach-pump, but it produced such terrible convul- ’, sions, and he bit upon the gag so fearfully, that we decided to desist, and gave camphor, ammonia, and chloroform. We re- ’’, mained with the patient till he died. Autopsy, seven hours after death.-The body was remarkably rigid, so as even to allow it to be lifted up by the heels like a piece of timber. The surface of the body was much congested. especially the legs; the toes were not incurved. In thirtyfive hours after death, when we opened the body, the fingers were rigidly contracted, although the general rigidity had in some measure subsided. The dura mater was congested, as was also the upper and posterior part of the right hemisphere of the cerebrum. The plexus choroides was tinged with dark blood; the puncta vasculosa were numerous and large; the ventricles contained more serum than natural; the pericardium contained no serum. The heart was flabby, the right side filled with frothv, dark blood, mostly in a fluid state ; the left side empty. The lungs were congested with blood of a darker colour than natural. The intestines were healthy, but distended with flatus; the liver healthy; the bladder contained half-a-pint of urine. I forwarded the stomach with its contents (undisturbed) use

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MIDWIFERY STATISTICS. TORTUOSITIES OF THE UMBILICAL CORD. BY JOHN S. BEALE, ESQ., M.R.C.S.E., &c., Paddington.

LENGTH

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over a record of midwifery cases attended by I was astonished at the number of times in which the umbilical cord was found encircling the neck. In 1220 cases, it was once wound round the neck in 175, twice round in 32, and thrice round in 7 cases. In 1 case, the cord was crossed over the chest and back, and looped under both axillse; it measured 58 inches in length. In 3 cases, there was a single knot on the cord, and on one funis were two knots. Dropsy of the cord occurred once, increasing its breadth to two inches, and rendering it very tortuous. The shortest cord was five inches in length. (In Dr. Rigby’s " Midwifery" there is mention of a case in which it was but two inches long, and another in

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looking

myself,

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