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ON THE TREATMENT OF DISEASE BY BLOODLETTING.
371 persons a very small speck on a bone will give rise to greatt constitutional irritation and death, while in others, nearlyT the whole of the body of one or more vertebrae may be3 sloughed away without endangering the life of the individual. It would be superfluous in these lectures to enter minutelyr
prejudice in
favour of any
one
Ihie of treatment, and in my
employed the sulphuric acid, both of which I then vigorously adopted the calomel terminated fatally. treatment, the result of which the statistical table on the two next pages will prove, the details being faithfully copied from into the details of the constitutional treatment of caries, whenimy czse-booh, and the greater number of the cases having been the nature of the taint in the constitution has been thoroughtyr visited with me by my friend, Dr. John James M’Gregor, a genunderstood, as that would lead to all that belongs to the patho- tleman who has had great opportunities of seeing the disease logy and treatment of syphilis, scrofula, and other predisposingboth at home and in India. affections; and it is necessary only to mention the great value Having now given the profession a faithful report of my íirst two
cases
.
-
of the mercurial and iodine salts in the constitutional taints totreatment of cholera, with the result, I shall add a few pracwhich I have just referred. Since the promulgation of the viewsi tical observations which occur to my mind, one or two of which of Lugol. on the influence of iodine in scrofula, I can bear testi- I have not seen in authors on the subject. Out of thirty cases mony, from many years’ experience, of the special value of com- of cholera, I had twelve deaths, two of which were treated by binations of iodine and iron in diseases of the bones when asso- the sulphuric acid, which leave but ten treated by mercury. One aborted, and sunk immediately after delivery. One was ciated with a scrofulous constitution. With regard to the surgical treatment of caries, it must be convalescent, but was destroyed by repeated doses of brandy, borne in mind, that the disease in the bones always begins in an administered by a drunken father. Another sunk from having inflammatory condition of its texture, and it may be either no attendant but a drunken nurse. One was exposed, during acute or chronic, but it is very frequently of a chronic character, collapse, to the draught caused by an open window and door, of such a low type that the disease often runs into a state of and another was drenched with chilled water by a hydroulceration before much attention is given to it by the patient; pathist. I found in one of the fatal cases, that the medicine and in this case there is frequently so much delicacy of consti- was improperly mixed with water, the calomel adhering to the tution as to forbid any depletory measures, and the issues, sides of the vessel; so that, fairly speaking, I could trace six of setons, moxas, cauteries, and blisters applied as counter-irri- the ten deaths to incidental circumstances. I remarked those tants over the parts affected, in many of these cases fail to pro- cases made the best recoveries where no stimulants were given; duce the great relief expected from them. Still, in some cases and during convalescence, when the cholera had disappeared, they are said to be instrumental to the cure. In caries, (espe- there was in almost every case sub-acute gastritis, whether cially of the vertebral column,) rest is absolutely requisite, and arising from the mercury, stimulants given, or the disease itself, pressure on the bones affected should, as much as possible, be I cannot pretend to say, but this complication readily yielded removed; for this purpose, triple, inclined and prone planes, to blisters and iced water. In conclusion, I can say with truth, water and spring beds, and other mechanical apparatus, have that from the result of my experience I consider collapsed been provided. Having already published my views of the cholera, if seen by the medical man in time, and if his instruc.comparative merits of these contrivances, it will be unnecessary tions are rigorously carried out, a very manageable, and by no means fatal, disease. In few instances did the calomel fail, at present to call your attention to that subject. to the treatment of abscesses which are formed when administered in two grain doses at short intervals, to in cases of caries of the bones, much difference of opinion has produce reaction, by diminishing the evacuations, promoting prevailed. The question is, after the disease has been cured, perspiration, causing the kidneys to resume their functions, whether an abscess, such as a psoas abscess, should be left to and, in fact, restore the general harmony of the system. The the efforts of nature, or be made the subject of surgical treat- greatest caution should be observed in permitting the patient ment. Sometimes the pus disappears spontaneously by absorp- to return to solid food, one of my patients having nearly fallen tion; at other times it will remain for several years without avictim to his imprudence in this respect. Soho, October, 1854. giving rise to any mischief. Occasionally the walls of the abscess give way, and the contents are discharged, and do not again accumulate; in other cases, the pus becomes, after a ON THE time, converted into fat. Dupuytren and many other surgeons maintain that it is highly dangerous to open abscesses resulting TREATMENT OF DISEASE BY BLOODLETTING. from caries, and that " it is preferable to leave them to nature, BY JOHN LANGLEY, ESQ. whether the caries yield to treatment or not." Mr. Abernethy (Concluded from page 208.) and others, again, have recommended opening the abscess by a lancet, and healing the wound by the first intention immediately THE following case, in reference to diagnostic symptoms, after having discharged the matter. It is always important to ascertain whether the disease in the vertebras is still makingbears a strong analogy to Case No. 1, and in order to abridge progress or not, (which may be done in the manner already the narrative, I shall give a brief but faithful summary of the for six weeks prior to his having been explained,) as it is obvious that the abscess would require being treatment I adopted and without the usual gentlemanly etiquette, repeatedly opened as long as the ulceration of the bone con- unceremoniously, tinues ; but as long as the presence of the matter is productive taken out of my hands, and placed under the care of Dr. of no constitutional irritation, it may perhaps be much better Watson; and, forsooth, because his friends thought that my to let it alone, from the consideration that it has frequently having taken from my patient 160 ounces of blood in three I must, with malice prepense, haveadesign upon his happened that the health of patients has rapidly changed for weeks, life, which they were determined to frustrate by removing him the worse immediately after the operation. from me who, by the by, had implicit confidence in me himself, I having been his family medical attendant for nearly
With regard
OBSERVATIONS ON THE TREATMENT OF CHOLERA. BY
GEORGE
ALLEN, ESQ., L.S.A.
DISTRICT SURGEON OF ST.
ANN’S,
SOHO.
Ix bringing before the profession the result of my experience in the treatment of the present epidemic, as district surgeon of
twenty
years
:-
CASE 2.-Mr. W. Buzz,of Holles-street, Cavendish-square, suffering from a distressing sensation in the head, which he very emphatically called a " boaty feel," applied to me for advice. Upon examining the case, and from his general plethoric appearance, I bled him largely from day to day, generally with some relief, but not such as to give him any comfortable freedom from his " old-boaty feel," as he invariably called it. These bleedings I repeated more or less until the aggregate amount reached the extent of 160 ounces, which so alarmed his friends that they insisted upon his consulting Dr. Watson, to whom. he and his friends, in a truly lachrymose manner, described how I had starved and bled him; in fact, that I had quite " outSangradoed Sangrado,"describing, at the same time, the " oldboaty feel," and other symptoms of so-called nervous irritation, which condition, although having existed pre2·ioual to his ha1’ing lost one ounce of blood, Dr. Watson attributed to my treatment, and resulting from the debility caused by the great loss of blood, and advised the patient to live generously, and take some wine, at the same time prescribing quinine in combination with steel. This confirmed the opinion his friends
St. Ann’s parish, where the plague seemed for a season to have concentrated its most deadly virus, I feel I am merely performing a public duty, the omission of which would be highly In the present paper I make no pretence to censurable. originality whatever. The treatment of cholera by mercury was, I believe, that which in-1832 obtained the greatest confidence of the profession, and has since been ably and successfully practised by Dr. Ayre and others. If I am not mistaken, it is that which every day’s experience will prove to be alone worthy of that confidence, and to be the sole remedy upon which, when properly and regularly administered, we can depend for the salvation of our patient. Upon my appointment as one of the district surgeons of St. Ann’s, I had no had formed of my violent
proceedings,
and condemned
me
in
372 TABLE
OF
CHOLERA CASES.
373
TABLE—(CoHKM.)
374 their estimation and that of my patient, who went on " his way rejoicing" in the change. But, alas ! his serenity was
In three or four days he became not of long duration. much worse, his "boaty feeling" so far increased as to prostrate him on the ground. He again visited Dr. Watson, who not quite persisting in his former opinion, thought some advantage might be obtained by taking away some blood locally, and ordered him to lose fourteen ounces by cupping, which Mr. Betts soon abstracted from the nucha, Dr. Watson at the same time substituting saline febrifuge medicines for the ferrosulphate of quinine, with active aperients. But neither the cupping nor medicine warded off the crisis thegenerousdietandsteel had promoted, for a few nights afterwards he had an apoplectic fit in his bed, to which I was summoned; and to which, after the treatment I had experienced, I reluctantly went, and 8a1’ed lais life, by bleeding to the extent of fifty ounces, when the stertor ceased, the convulsive restlessness was subdued, and perfect consciousness succeeded the usual semi-sensitive state attending such attacks. With very little medical treatment and careful diet he soon recovered, and resumed his usual active pursuits in business; and, I am happy to have lately heard, has continued in good health ever since. I feel much gratification in giving this case thus fully to the professional world, as it so strongly and irrefutably shows how unjustly a valua0le mEa81l1’e is condemned from lack of experience in its importance; when I think every candid and impartial reader, not pinning his faith upon a Dickson, or any such doctrinarian, but thinks for himself, reads over and over again this case, and asks himself the two following questions:—What harm did the abstraction of 224* ounces inflict upon the future state of this gentleman ? also, What treatment saved his life ?-will have no doubt upon this
S-,alivery stable-keeper in Albany-street, to me about four months since, under the following condition of suffering:-He had been afflicted for some months previously, with varying intensity, in the following mannera most painful sciatic affection, the pain extending all around the hip into the upper part of the thigh, with deep-seated CASE 4.-Mr.
applied
pain in the iliac fossa, greatly impeding the separation of his thighs, the act being also accompanied with excruciating pain.
for the last month unable to lie down or arise without and when having sat down, compelled to. remain statu qaso until assisted, when he suffered equal agony. I considered it a case of sciatica, with some painful condition of the obturator nerve, and extensive rheumatic inflammation. Previous to my seeing him, colchicum, carbonate of iron, morphia, cajeput oil, and all the usual remedies, were adopted, but without success. I advised bleeding, and took fifty ounces. Not the least tendency to syncupe. In less than halfan-hour he could move his limbs with much less pain. As he was not in the least prostrated, I renewed the fillet, and abstracted twenty-five ounces more. Both quantities being weighed netted seventy-five ounces. Still no syncope. Could get in and out of bed this night without pain. Could sit down and raise himself without pain, which he did in the presence of a friend of mine the same night. Walked to Piccadilly and back the following day, and is now in better health than he has been for years. What is tic douloureux but the sameaffection alteri loco? He
was
suffering torture,
The following cases show the unequivocal value of bloodletting in gouty diathesis-a condition in which it is pertinaciously repudiated :CASE 5.-George E-, Buckingham-street, Fitzroy-square, had been occasionally subject to gout for a long period, and, question. The two following cases of inflammatory neuralgia, if I after some recent annoying attacks, was seized with intense may be allowed the expression, I think clearly provethe pain of the great toe, with considerable swelling and fiery redtruth of my theory in reference to the cause of pain ness, extending over the instep, with the usual podagral, surface. He had considerable fever. I bled him to fifty generally, viz., that it depends upon an irritable and painful shiny condition of the nerves, never existing per se, but caused by ounces. He fainted. On recovery from the syncope, the pains the pressure of contiguous over-distended bloodvessels from had subsided; he could bear considerable pressure without the redness disappeared, and the swelling gradually repletion or hypertrophied tissues or membranes adjacent to pain; such nerves or nervous niaments, and which (iuversing the order subsided in the course of twelve hours, since which period, now of one of Cullen’s signs of inflammation) accounts for the dolor upwards of six years, he has not experienced the slightest. tendency to relapse. cum tMMKM’e in inflammatory congested conditions of anyexCASE 6.-Mr. H-, Southampton-street, F’itzroy-sqnare, ternal or i2tei,)ial organ or parts of organs, or of any of the constituents of the body into which bloodvessels enter. We all had a severe attack of gout in September, 1850. Every symp-know from experience the acute torture from the slightest tom yielded to one bleeding of forty ounces in twenty-four pressure of any substance, even aeriform, as when we gently hours. These are not isolated cases, and I think it worthy of reinhale a breath of air, over a denuded dental nerve. I believe I
mark and consideration that in these cases the treatment is soand uncomplicated with drug remedy, that it is impossible to ascribe the benefit to any other cause than the giving the sceptic no room to quibble as to which place, having been long, unavailingly, under several medical depletion, cause to attribute the favourable result. I have some most me in in to of severe early 1853, consequence gentlemen, applied cases, showing how the fatal progress in advancedpain in the lumbar region, extending into the gll1taei muscles important and the hips, involving a most painful condition of the sciatic stages of phthisis pulmonalis, recognised by the first medical nerves; in the inguinal fossa;, also, down the thighs into the talent in London, have been arrested, and are still kept in knees, a rigid, painful state of the gastronemic muscles and abeyance, by frequent bleedings, resorted to whenever a certaim of healthy vascular action or repletion is exceeded,ligaments of the ankles, giving him in walking excessive pain, boundary and depriving him of the power of raising himself from his seat when a recurrence of haemoptysis and purulent expectoration without much difficulty and excessive pain: his nights were supervenes, but is immediately arrested by timely depletiony also generally painful and sleepless, unless under the influence and one case in particular, where an accidental pleurisy, of morphia. Having relieved minor affections of this kind, occurring from cold taken from a tedious stethoscopic examinawhen the pain became so dreadful upon inspiration, that L commonly called rheumatic, by modified bloodlettings, I pro- tion, on three successive days, and had the happiness to witness’ posed to bleed him, and abstracted from him fifty ounces of bled not a remission of the pleuritic inflammation, but also of £ the whole not the he erect only time, blood, slightest tendency sitting to syncope supervened, and he declareci, "He should not have the physical signs of consumption, and this after the prognosis. known he had been bled if he had not witnessed the operation;" of Dr. Theophilus Thompson, Dr. Walshe, and Dr. Thomas he gradually recovered in a short time, is perfectly free from Davies, that her pulmonary disease was so far advanced she This lady is now alive, enjoying any kind of lameness, has thrown off his hobbling, crippled would not liveweek. perhaps as delicate in appearance as any in. gait, and moves now in his active avocations, freely and pain- tolerable health, lessly. I only gavehim, in addition, a little purgativemedicine, London; yet such is the congested condition of her lungs, and and enjoined abstemious diet. He is at the present time in "Not in the least," was the reply. "Well, bleeding is now quite out of excellent health, and would be happy to confirm this statement fashion." " I am sorry it should be, and hope it will be soon revived; it ig-to any sceptic, t the only thing that did me the least good, and no doubt would have the same effect upon all similar cases." " But, did he do nothing else but bleed you?" * This amount includes the fourteen ounces ordered by Dr. Watson. Only gave me a few doses of aperient medicines." " Did he not diet you?" t The sarcasm and professional persecution I experience on account of my " He desired me to eat animal food only three or four days a week." " What "I here digressed a little from Mr. Langley’s of did he let you drink?" honest and unflinching avowal my practice, little inferior to the persecution of the great man who discovered the circulating course of the important fluid, injunction to refrain from fermented or spirituous liquors, and took a weak the fjundation and preservation of life in normal action and quantity, cannot glass of grog sometimes at bedtime." " You did, did you? Aye, that did itI be better elucidated than by the following-:—The gentleman the subject of it was that cured you, not the bleeding. I thought there was something." "But this paper was met some time back by a surgeon whose patient lie had how eameit I did not find benefit fi om this, my usual habit, before I was bled ?"’ formerly been, who expressed himself astonished at the miraculous change " Good morning, I ant glad to see you well, good bye," ended this colloquy. Another professional gentleman in my own immediate neighbourhood,. wrought in his condition, and inquired,=How came it about?"-when Mr. S- told him a friend recommended him to a gentleman of the name of meeting a friend of mine, who told him he was on his way to consult me, said, Langley. "II know Mr. Langley well, what did he do for you? did he bleed, "Take care! He will be sure to bleed you," making use of what appeared to for that’s his panacea?" "Yes, he did; he took fifty ounces of blood from me his little mind a splendid bon most,-" He’ll ble2d a candlestick." I only say to at one time." "Good God! were you not faint? very ill and weak after it?" him, and to other equally liberal minded men, eot-ete, nemo me impune lacesscit.
the vague terms of muscular, nervous, rheumatic, &c. &c., are all involved in this one condition of nervous oppression. CASE 3.-Mr. S-,of Upper Charlotte-street, Portland-
simple
375 I am compelled, at least minous-like effusion accompanied the course of the larger veins four times a year, to take from her at each bleeding an average on the convexiui-es; here and there a small quantity of semiquantity of twenty ounces: It would afford me the greatest concrete yellowish exudation was observed. There was conpleasure to present this lady to any gentleman in the profes- siderable effusion into the ventricles, (four to five ounces,) and sion who may marvel at this extraordinary treatment. I am great softening of the central parts of the brain. Much concertain, as are also the lady herself and her husband, that her gestion of the vessels at the base existed, and abundance of life has frequently been saved in pulmonary inflammation by semi-concrete yellow matter was also present there. In only these means. This lady kindly saw Dr. Routh, the secretary of one or two spots could we find a granular development of the the London Medical Society, not one hour after I had taken exudation. On opening the abdomen, ample evidence was eighteen ounces of blood from her. Dr. Routh’s seeing her found of the severity of the general tuberculosis, and also of the was the result of accident, having met him en passant; and I entero-colitis. The intestines, as well as the mesenteric wished him particularly to see the case, having been present glands, were in a state of tuberculosis. The spleen was loaded upon my reading a paper at the London Medical Society upon with yellow matter, which was also deposited in its peritoneal investment. In both the lungs grey granulations existed this important subject. in the left were some large softening yellow whilst generally, CASE 7.-Captain M-Great Portland-street, aged sixtyThe nodules. bronchial glands were tuberculous. The One years. Frequently subject to very severe attacks of gout. For several years previously had a very painful affection of absence everywhere of adipose tissue was very striking. E. J--, a girl, two years and three months old, was the intercostal muscles, with crampy sensations of the stomach, to the Infirmary in June of the present year. " She brought which Dr. Chambers considered to be a gouty metastasis,* -nd is of Jewish extraction on the father’s side, who lives in a low, warm aromatic with and carminamedicine, opiates prescribed Waterloo-road. Her sister was a patient tive aperients, during which course of treatment he (Captain damp place near the at the Infirmary for two years, and died about a month M-) became so much worse, that during an exacerbation he ago of general tuberculosis, enlargement of the liver, called me to his assistance. Upon examination of the case, and ascites."" The mother states that the patient was "well ’which presented but one leading feature-high inflammatory and hearty" until about five weeks back, when " she began to fever, with severe local pain-I could suggest no other rationally fever," to get thin and week, and unable to stand. The child ’curative measure than bleeding, the effect of which as a sedanow exhibits the symptoms of typhoid remittent, which, contive (and the only valuable and permanent one in such cases) sidering the external appearance of the patient, (marasmus, seems quite to be overlooked by the profession, or, from want hair on arms, &c.,) and the history of her of experience, misunderstood. He was most boisterous in his long eyelashes, is regarded as dependent on the process of tuberculosis. sister, told him to that Dr. Chambers - opposition bleeding, adding Under the treatment put in force the child seemed to rally - never to be bled. His pain, however, became so intense, that and was occasionally carried out and about by her he said, "You may cut my head off, if you like."Itook away somewhat, but was usually, as the mother said. " All for laving between forty and fifty ounces of blood, and applied a mustard mother, and sleeping." A fortnight after she brought her to the cataplasm, and gave twenty minims of Battley’s sedative Infirmary, she took her out with her (Thursday) for the benefit solution. His pain was greatly diminished in a short time, of the air, and, according to the mother’s account, was going before the opiate could possibly have taken effect. He slept on four consecutive hours. I remained with him, his friends down the Marsh, when she felt the child hang heavy her arm. She told her to "hold up," and, turning round to - fearing some serious event from the bleeding. which they had look at her, saw froth and blood coming from her mouth, and been so strongly forewarned against. On the following day her child in convulsions. The latter continued off and on he some relapse of pain and stomach spasm. I the child then lying quiet and not to be roused; bled him again from the same orifice to twenty ounces, and until night, " indeed, there was no moving in her until the Monday after," gave him one ounce of castor oil. No return of pain; no other when she appeared a little better, but it was found she had medicine than magnesia as an aperient; quite convalescent in lost power over her right side; in fact, there was hemiten days, and able to attend his club daily, as his wonted Under the influence of a blister to the nape of the - custom. He had not had one single attack of gout more than plegia. neck, a purgative, and ammonia, the patient became four or five years after this period, when he called upon me. conscious, putting out her tongue when told. She continued Albany-street, January, 1844. much in the same way, but every now and then shaking or trembling, until Thursday, when another attack of convulsions supervened, and continued for more than an hour. MEMORANDA RELATIVE TO SOME CEREBRAL The child again lay quiet and motionless until the next day, when, "after a twist in the mouth,she died quite quietly early in AFFECTIONS OF CHILDREN. the morning. Mr. Besley and myself examined the body the next day. The child had been tall for its age, the body was BY W. HUGHES WILLSHIRE, M.D. Edin., much emaciated, and the capillary development of that PHYSICIAN TO THE ROYAL INFIRMARY FOR CHILDREN, ETC. character so frequent in tuberculous children. The skull was (Continued from p. 170.) thin, and not adherent to the dura mater, the meningeal vessels gorged, and much white semi-opaline effusion existed beneath the arachnoid, over the whole of the hemispheric No. VII. convexities. At the margin of the posterior part of the right and in the course Abdominal Phoof Meningitis occurring surface was a of exudation. hemispheric racic Tuberculosis.-F. C-,alittle boy, one year and eleven The brain matter was soft slight patchbut granular the central generally, especially months old, had suffered from diarrhoea, (with occasional interportion; there was rather free effusion into the ventricles, the missions) for several weeks. He was reduced to a state of latter were dilated, and the choroid plexus was highly much exhaustion, the marasmus was great, and he appeared coloured. At the base of the brain but very slight effusion or to be labouring under the symptoms of general tuberculosis, or exudation was The cerebellum was rather softer present. entero-colitis, or of both. Suddenly an attack of convulsions I than usual. On opening the chest, the lungs were found loaded appeared, from which he rallied, passing into a condition of with much grey, and a slight amount of yellow, tubercular semi-stupor, and continuing in this state for nearly a week, when matter, and the bronchial glands were enlarged by the preanother attack of convulsions ensued, and death immediately sence of the latter. Nofurther examination was prosecuted. followed. Dr. Westley and myself examined the body, which Three important stages in the history of " acute hydrocewas extremely emaciated, the integuments, of a dirty-brown phalus"-as the tuberculous or granular meningitis of modern colour, hanging in folds and wrinkles about the thighs. The pathology is still frequently called in this country-may be vessels much and albuwere whitish, meningeal congested, thus pointed out. First, that stage which extends from, and includes the time of, the actual recognition of the ventri* I never could reconcile myself to this term, as applied to the migratory cular effusion, and the belief of its constituting the essence of character of disease from one locality to another. I think the attack of the the disorder, or of its being the sole malady; secondly, the same character, in any distant part of the system, far more rationally and consistently referrible to the same cause which produced it in its original period when this doctrine was denied, when the effusion was situation, than to suppose the consequence of the same disease leaving one regarded as of seconclary occurrence, or only a consequence of part must be its attack of another, or the diminishing its intensity in one the real disorder, which was believed to be congestion or inpoint should increase it in another. I have relieved violent podagral inflam- flammation of the meninges; thirdly, that stage when the mations and pain by cold evaporating lotions, always deprecated from fear of producing metastasis-a false induction I think it might as well be inferred connexion of the cerebral disease with the tuberculous diathesis that a poker heated to redness at one pole might have its increased tempera- was pointed out, and in which the opinion was generally enterture tnnsmitt-ed to the other by plunging the heated extremity into cold tained that " acute hydrocephalus" was in most instances water. It is really time these absurd notions should be abrogated. Why meningitis of a tubercular character. But another step in tha should Medical science be so far in the background?
predisposition to inflammatory action,
experienced
,
prejudice in
favour of any
one
Ihie of treatment, and in my
employed the sulphuric acid, both of which I then vigorously adopted the calomel terminated fatally. treatment, the result of which the statistical table on the two next pages will prove, the details being faithfully copied from into the details of the constitutional treatment of caries, whenimy czse-booh, and the greater number of the cases having been the nature of the taint in the constitution has been thoroughtyr visited with me by my friend, Dr. John James M’Gregor, a genunderstood, as that would lead to all that belongs to the patho- tleman who has had great opportunities of seeing the disease logy and treatment of syphilis, scrofula, and other predisposingboth at home and in India. affections; and it is necessary only to mention the great value Having now given the profession a faithful report of my íirst two
cases
.
-
of the mercurial and iodine salts in the constitutional taints totreatment of cholera, with the result, I shall add a few pracwhich I have just referred. Since the promulgation of the viewsi tical observations which occur to my mind, one or two of which of Lugol. on the influence of iodine in scrofula, I can bear testi- I have not seen in authors on the subject. Out of thirty cases mony, from many years’ experience, of the special value of com- of cholera, I had twelve deaths, two of which were treated by binations of iodine and iron in diseases of the bones when asso- the sulphuric acid, which leave but ten treated by mercury. One aborted, and sunk immediately after delivery. One was ciated with a scrofulous constitution. With regard to the surgical treatment of caries, it must be convalescent, but was destroyed by repeated doses of brandy, borne in mind, that the disease in the bones always begins in an administered by a drunken father. Another sunk from having inflammatory condition of its texture, and it may be either no attendant but a drunken nurse. One was exposed, during acute or chronic, but it is very frequently of a chronic character, collapse, to the draught caused by an open window and door, of such a low type that the disease often runs into a state of and another was drenched with chilled water by a hydroulceration before much attention is given to it by the patient; pathist. I found in one of the fatal cases, that the medicine and in this case there is frequently so much delicacy of consti- was improperly mixed with water, the calomel adhering to the tution as to forbid any depletory measures, and the issues, sides of the vessel; so that, fairly speaking, I could trace six of setons, moxas, cauteries, and blisters applied as counter-irri- the ten deaths to incidental circumstances. I remarked those tants over the parts affected, in many of these cases fail to pro- cases made the best recoveries where no stimulants were given; duce the great relief expected from them. Still, in some cases and during convalescence, when the cholera had disappeared, they are said to be instrumental to the cure. In caries, (espe- there was in almost every case sub-acute gastritis, whether cially of the vertebral column,) rest is absolutely requisite, and arising from the mercury, stimulants given, or the disease itself, pressure on the bones affected should, as much as possible, be I cannot pretend to say, but this complication readily yielded removed; for this purpose, triple, inclined and prone planes, to blisters and iced water. In conclusion, I can say with truth, water and spring beds, and other mechanical apparatus, have that from the result of my experience I consider collapsed been provided. Having already published my views of the cholera, if seen by the medical man in time, and if his instruc.comparative merits of these contrivances, it will be unnecessary tions are rigorously carried out, a very manageable, and by no means fatal, disease. In few instances did the calomel fail, at present to call your attention to that subject. to the treatment of abscesses which are formed when administered in two grain doses at short intervals, to in cases of caries of the bones, much difference of opinion has produce reaction, by diminishing the evacuations, promoting prevailed. The question is, after the disease has been cured, perspiration, causing the kidneys to resume their functions, whether an abscess, such as a psoas abscess, should be left to and, in fact, restore the general harmony of the system. The the efforts of nature, or be made the subject of surgical treat- greatest caution should be observed in permitting the patient ment. Sometimes the pus disappears spontaneously by absorp- to return to solid food, one of my patients having nearly fallen tion; at other times it will remain for several years without avictim to his imprudence in this respect. Soho, October, 1854. giving rise to any mischief. Occasionally the walls of the abscess give way, and the contents are discharged, and do not again accumulate; in other cases, the pus becomes, after a ON THE time, converted into fat. Dupuytren and many other surgeons maintain that it is highly dangerous to open abscesses resulting TREATMENT OF DISEASE BY BLOODLETTING. from caries, and that " it is preferable to leave them to nature, BY JOHN LANGLEY, ESQ. whether the caries yield to treatment or not." Mr. Abernethy (Concluded from page 208.) and others, again, have recommended opening the abscess by a lancet, and healing the wound by the first intention immediately THE following case, in reference to diagnostic symptoms, after having discharged the matter. It is always important to ascertain whether the disease in the vertebras is still makingbears a strong analogy to Case No. 1, and in order to abridge progress or not, (which may be done in the manner already the narrative, I shall give a brief but faithful summary of the for six weeks prior to his having been explained,) as it is obvious that the abscess would require being treatment I adopted and without the usual gentlemanly etiquette, repeatedly opened as long as the ulceration of the bone con- unceremoniously, tinues ; but as long as the presence of the matter is productive taken out of my hands, and placed under the care of Dr. of no constitutional irritation, it may perhaps be much better Watson; and, forsooth, because his friends thought that my to let it alone, from the consideration that it has frequently having taken from my patient 160 ounces of blood in three I must, with malice prepense, haveadesign upon his happened that the health of patients has rapidly changed for weeks, life, which they were determined to frustrate by removing him the worse immediately after the operation. from me who, by the by, had implicit confidence in me himself, I having been his family medical attendant for nearly
With regard
OBSERVATIONS ON THE TREATMENT OF CHOLERA. BY
GEORGE
ALLEN, ESQ., L.S.A.
DISTRICT SURGEON OF ST.
ANN’S,
SOHO.
Ix bringing before the profession the result of my experience in the treatment of the present epidemic, as district surgeon of
twenty
years
:-
CASE 2.-Mr. W. Buzz,of Holles-street, Cavendish-square, suffering from a distressing sensation in the head, which he very emphatically called a " boaty feel," applied to me for advice. Upon examining the case, and from his general plethoric appearance, I bled him largely from day to day, generally with some relief, but not such as to give him any comfortable freedom from his " old-boaty feel," as he invariably called it. These bleedings I repeated more or less until the aggregate amount reached the extent of 160 ounces, which so alarmed his friends that they insisted upon his consulting Dr. Watson, to whom. he and his friends, in a truly lachrymose manner, described how I had starved and bled him; in fact, that I had quite " outSangradoed Sangrado,"describing, at the same time, the " oldboaty feel," and other symptoms of so-called nervous irritation, which condition, although having existed pre2·ioual to his ha1’ing lost one ounce of blood, Dr. Watson attributed to my treatment, and resulting from the debility caused by the great loss of blood, and advised the patient to live generously, and take some wine, at the same time prescribing quinine in combination with steel. This confirmed the opinion his friends
St. Ann’s parish, where the plague seemed for a season to have concentrated its most deadly virus, I feel I am merely performing a public duty, the omission of which would be highly In the present paper I make no pretence to censurable. originality whatever. The treatment of cholera by mercury was, I believe, that which in-1832 obtained the greatest confidence of the profession, and has since been ably and successfully practised by Dr. Ayre and others. If I am not mistaken, it is that which every day’s experience will prove to be alone worthy of that confidence, and to be the sole remedy upon which, when properly and regularly administered, we can depend for the salvation of our patient. Upon my appointment as one of the district surgeons of St. Ann’s, I had no had formed of my violent
proceedings,
and condemned
me
in
372 TABLE
OF
CHOLERA CASES.
373
TABLE—(CoHKM.)
374 their estimation and that of my patient, who went on " his way rejoicing" in the change. But, alas ! his serenity was
In three or four days he became not of long duration. much worse, his "boaty feeling" so far increased as to prostrate him on the ground. He again visited Dr. Watson, who not quite persisting in his former opinion, thought some advantage might be obtained by taking away some blood locally, and ordered him to lose fourteen ounces by cupping, which Mr. Betts soon abstracted from the nucha, Dr. Watson at the same time substituting saline febrifuge medicines for the ferrosulphate of quinine, with active aperients. But neither the cupping nor medicine warded off the crisis thegenerousdietandsteel had promoted, for a few nights afterwards he had an apoplectic fit in his bed, to which I was summoned; and to which, after the treatment I had experienced, I reluctantly went, and 8a1’ed lais life, by bleeding to the extent of fifty ounces, when the stertor ceased, the convulsive restlessness was subdued, and perfect consciousness succeeded the usual semi-sensitive state attending such attacks. With very little medical treatment and careful diet he soon recovered, and resumed his usual active pursuits in business; and, I am happy to have lately heard, has continued in good health ever since. I feel much gratification in giving this case thus fully to the professional world, as it so strongly and irrefutably shows how unjustly a valua0le mEa81l1’e is condemned from lack of experience in its importance; when I think every candid and impartial reader, not pinning his faith upon a Dickson, or any such doctrinarian, but thinks for himself, reads over and over again this case, and asks himself the two following questions:—What harm did the abstraction of 224* ounces inflict upon the future state of this gentleman ? also, What treatment saved his life ?-will have no doubt upon this
S-,alivery stable-keeper in Albany-street, to me about four months since, under the following condition of suffering:-He had been afflicted for some months previously, with varying intensity, in the following mannera most painful sciatic affection, the pain extending all around the hip into the upper part of the thigh, with deep-seated CASE 4.-Mr.
applied
pain in the iliac fossa, greatly impeding the separation of his thighs, the act being also accompanied with excruciating pain.
for the last month unable to lie down or arise without and when having sat down, compelled to. remain statu qaso until assisted, when he suffered equal agony. I considered it a case of sciatica, with some painful condition of the obturator nerve, and extensive rheumatic inflammation. Previous to my seeing him, colchicum, carbonate of iron, morphia, cajeput oil, and all the usual remedies, were adopted, but without success. I advised bleeding, and took fifty ounces. Not the least tendency to syncupe. In less than halfan-hour he could move his limbs with much less pain. As he was not in the least prostrated, I renewed the fillet, and abstracted twenty-five ounces more. Both quantities being weighed netted seventy-five ounces. Still no syncope. Could get in and out of bed this night without pain. Could sit down and raise himself without pain, which he did in the presence of a friend of mine the same night. Walked to Piccadilly and back the following day, and is now in better health than he has been for years. What is tic douloureux but the sameaffection alteri loco? He
was
suffering torture,
The following cases show the unequivocal value of bloodletting in gouty diathesis-a condition in which it is pertinaciously repudiated :CASE 5.-George E-, Buckingham-street, Fitzroy-square, had been occasionally subject to gout for a long period, and, question. The two following cases of inflammatory neuralgia, if I after some recent annoying attacks, was seized with intense may be allowed the expression, I think clearly provethe pain of the great toe, with considerable swelling and fiery redtruth of my theory in reference to the cause of pain ness, extending over the instep, with the usual podagral, surface. He had considerable fever. I bled him to fifty generally, viz., that it depends upon an irritable and painful shiny condition of the nerves, never existing per se, but caused by ounces. He fainted. On recovery from the syncope, the pains the pressure of contiguous over-distended bloodvessels from had subsided; he could bear considerable pressure without the redness disappeared, and the swelling gradually repletion or hypertrophied tissues or membranes adjacent to pain; such nerves or nervous niaments, and which (iuversing the order subsided in the course of twelve hours, since which period, now of one of Cullen’s signs of inflammation) accounts for the dolor upwards of six years, he has not experienced the slightest. tendency to relapse. cum tMMKM’e in inflammatory congested conditions of anyexCASE 6.-Mr. H-, Southampton-street, F’itzroy-sqnare, ternal or i2tei,)ial organ or parts of organs, or of any of the constituents of the body into which bloodvessels enter. We all had a severe attack of gout in September, 1850. Every symp-know from experience the acute torture from the slightest tom yielded to one bleeding of forty ounces in twenty-four pressure of any substance, even aeriform, as when we gently hours. These are not isolated cases, and I think it worthy of reinhale a breath of air, over a denuded dental nerve. I believe I
mark and consideration that in these cases the treatment is soand uncomplicated with drug remedy, that it is impossible to ascribe the benefit to any other cause than the giving the sceptic no room to quibble as to which place, having been long, unavailingly, under several medical depletion, cause to attribute the favourable result. I have some most me in in to of severe early 1853, consequence gentlemen, applied cases, showing how the fatal progress in advancedpain in the lumbar region, extending into the gll1taei muscles important and the hips, involving a most painful condition of the sciatic stages of phthisis pulmonalis, recognised by the first medical nerves; in the inguinal fossa;, also, down the thighs into the talent in London, have been arrested, and are still kept in knees, a rigid, painful state of the gastronemic muscles and abeyance, by frequent bleedings, resorted to whenever a certaim of healthy vascular action or repletion is exceeded,ligaments of the ankles, giving him in walking excessive pain, boundary and depriving him of the power of raising himself from his seat when a recurrence of haemoptysis and purulent expectoration without much difficulty and excessive pain: his nights were supervenes, but is immediately arrested by timely depletiony also generally painful and sleepless, unless under the influence and one case in particular, where an accidental pleurisy, of morphia. Having relieved minor affections of this kind, occurring from cold taken from a tedious stethoscopic examinawhen the pain became so dreadful upon inspiration, that L commonly called rheumatic, by modified bloodlettings, I pro- tion, on three successive days, and had the happiness to witness’ posed to bleed him, and abstracted from him fifty ounces of bled not a remission of the pleuritic inflammation, but also of £ the whole not the he erect only time, blood, slightest tendency sitting to syncope supervened, and he declareci, "He should not have the physical signs of consumption, and this after the prognosis. known he had been bled if he had not witnessed the operation;" of Dr. Theophilus Thompson, Dr. Walshe, and Dr. Thomas he gradually recovered in a short time, is perfectly free from Davies, that her pulmonary disease was so far advanced she This lady is now alive, enjoying any kind of lameness, has thrown off his hobbling, crippled would not liveweek. perhaps as delicate in appearance as any in. gait, and moves now in his active avocations, freely and pain- tolerable health, lessly. I only gavehim, in addition, a little purgativemedicine, London; yet such is the congested condition of her lungs, and and enjoined abstemious diet. He is at the present time in "Not in the least," was the reply. "Well, bleeding is now quite out of excellent health, and would be happy to confirm this statement fashion." " I am sorry it should be, and hope it will be soon revived; it ig-to any sceptic, t the only thing that did me the least good, and no doubt would have the same effect upon all similar cases." " But, did he do nothing else but bleed you?" * This amount includes the fourteen ounces ordered by Dr. Watson. Only gave me a few doses of aperient medicines." " Did he not diet you?" t The sarcasm and professional persecution I experience on account of my " He desired me to eat animal food only three or four days a week." " What "I here digressed a little from Mr. Langley’s of did he let you drink?" honest and unflinching avowal my practice, little inferior to the persecution of the great man who discovered the circulating course of the important fluid, injunction to refrain from fermented or spirituous liquors, and took a weak the fjundation and preservation of life in normal action and quantity, cannot glass of grog sometimes at bedtime." " You did, did you? Aye, that did itI be better elucidated than by the following-:—The gentleman the subject of it was that cured you, not the bleeding. I thought there was something." "But this paper was met some time back by a surgeon whose patient lie had how eameit I did not find benefit fi om this, my usual habit, before I was bled ?"’ formerly been, who expressed himself astonished at the miraculous change " Good morning, I ant glad to see you well, good bye," ended this colloquy. Another professional gentleman in my own immediate neighbourhood,. wrought in his condition, and inquired,=How came it about?"-when Mr. S- told him a friend recommended him to a gentleman of the name of meeting a friend of mine, who told him he was on his way to consult me, said, Langley. "II know Mr. Langley well, what did he do for you? did he bleed, "Take care! He will be sure to bleed you," making use of what appeared to for that’s his panacea?" "Yes, he did; he took fifty ounces of blood from me his little mind a splendid bon most,-" He’ll ble2d a candlestick." I only say to at one time." "Good God! were you not faint? very ill and weak after it?" him, and to other equally liberal minded men, eot-ete, nemo me impune lacesscit.
the vague terms of muscular, nervous, rheumatic, &c. &c., are all involved in this one condition of nervous oppression. CASE 3.-Mr. S-,of Upper Charlotte-street, Portland-
simple
375 I am compelled, at least minous-like effusion accompanied the course of the larger veins four times a year, to take from her at each bleeding an average on the convexiui-es; here and there a small quantity of semiquantity of twenty ounces: It would afford me the greatest concrete yellowish exudation was observed. There was conpleasure to present this lady to any gentleman in the profes- siderable effusion into the ventricles, (four to five ounces,) and sion who may marvel at this extraordinary treatment. I am great softening of the central parts of the brain. Much concertain, as are also the lady herself and her husband, that her gestion of the vessels at the base existed, and abundance of life has frequently been saved in pulmonary inflammation by semi-concrete yellow matter was also present there. In only these means. This lady kindly saw Dr. Routh, the secretary of one or two spots could we find a granular development of the the London Medical Society, not one hour after I had taken exudation. On opening the abdomen, ample evidence was eighteen ounces of blood from her. Dr. Routh’s seeing her found of the severity of the general tuberculosis, and also of the was the result of accident, having met him en passant; and I entero-colitis. The intestines, as well as the mesenteric wished him particularly to see the case, having been present glands, were in a state of tuberculosis. The spleen was loaded upon my reading a paper at the London Medical Society upon with yellow matter, which was also deposited in its peritoneal investment. In both the lungs grey granulations existed this important subject. in the left were some large softening yellow whilst generally, CASE 7.-Captain M-Great Portland-street, aged sixtyThe nodules. bronchial glands were tuberculous. The One years. Frequently subject to very severe attacks of gout. For several years previously had a very painful affection of absence everywhere of adipose tissue was very striking. E. J--, a girl, two years and three months old, was the intercostal muscles, with crampy sensations of the stomach, to the Infirmary in June of the present year. " She brought which Dr. Chambers considered to be a gouty metastasis,* -nd is of Jewish extraction on the father’s side, who lives in a low, warm aromatic with and carminamedicine, opiates prescribed Waterloo-road. Her sister was a patient tive aperients, during which course of treatment he (Captain damp place near the at the Infirmary for two years, and died about a month M-) became so much worse, that during an exacerbation he ago of general tuberculosis, enlargement of the liver, called me to his assistance. Upon examination of the case, and ascites."" The mother states that the patient was "well ’which presented but one leading feature-high inflammatory and hearty" until about five weeks back, when " she began to fever, with severe local pain-I could suggest no other rationally fever," to get thin and week, and unable to stand. The child ’curative measure than bleeding, the effect of which as a sedanow exhibits the symptoms of typhoid remittent, which, contive (and the only valuable and permanent one in such cases) sidering the external appearance of the patient, (marasmus, seems quite to be overlooked by the profession, or, from want hair on arms, &c.,) and the history of her of experience, misunderstood. He was most boisterous in his long eyelashes, is regarded as dependent on the process of tuberculosis. sister, told him to that Dr. Chambers - opposition bleeding, adding Under the treatment put in force the child seemed to rally - never to be bled. His pain, however, became so intense, that and was occasionally carried out and about by her he said, "You may cut my head off, if you like."Itook away somewhat, but was usually, as the mother said. " All for laving between forty and fifty ounces of blood, and applied a mustard mother, and sleeping." A fortnight after she brought her to the cataplasm, and gave twenty minims of Battley’s sedative Infirmary, she took her out with her (Thursday) for the benefit solution. His pain was greatly diminished in a short time, of the air, and, according to the mother’s account, was going before the opiate could possibly have taken effect. He slept on four consecutive hours. I remained with him, his friends down the Marsh, when she felt the child hang heavy her arm. She told her to "hold up," and, turning round to - fearing some serious event from the bleeding. which they had look at her, saw froth and blood coming from her mouth, and been so strongly forewarned against. On the following day her child in convulsions. The latter continued off and on he some relapse of pain and stomach spasm. I the child then lying quiet and not to be roused; bled him again from the same orifice to twenty ounces, and until night, " indeed, there was no moving in her until the Monday after," gave him one ounce of castor oil. No return of pain; no other when she appeared a little better, but it was found she had medicine than magnesia as an aperient; quite convalescent in lost power over her right side; in fact, there was hemiten days, and able to attend his club daily, as his wonted Under the influence of a blister to the nape of the - custom. He had not had one single attack of gout more than plegia. neck, a purgative, and ammonia, the patient became four or five years after this period, when he called upon me. conscious, putting out her tongue when told. She continued Albany-street, January, 1844. much in the same way, but every now and then shaking or trembling, until Thursday, when another attack of convulsions supervened, and continued for more than an hour. MEMORANDA RELATIVE TO SOME CEREBRAL The child again lay quiet and motionless until the next day, when, "after a twist in the mouth,she died quite quietly early in AFFECTIONS OF CHILDREN. the morning. Mr. Besley and myself examined the body the next day. The child had been tall for its age, the body was BY W. HUGHES WILLSHIRE, M.D. Edin., much emaciated, and the capillary development of that PHYSICIAN TO THE ROYAL INFIRMARY FOR CHILDREN, ETC. character so frequent in tuberculous children. The skull was (Continued from p. 170.) thin, and not adherent to the dura mater, the meningeal vessels gorged, and much white semi-opaline effusion existed beneath the arachnoid, over the whole of the hemispheric No. VII. convexities. At the margin of the posterior part of the right and in the course Abdominal Phoof Meningitis occurring surface was a of exudation. hemispheric racic Tuberculosis.-F. C-,alittle boy, one year and eleven The brain matter was soft slight patchbut granular the central generally, especially months old, had suffered from diarrhoea, (with occasional interportion; there was rather free effusion into the ventricles, the missions) for several weeks. He was reduced to a state of latter were dilated, and the choroid plexus was highly much exhaustion, the marasmus was great, and he appeared coloured. At the base of the brain but very slight effusion or to be labouring under the symptoms of general tuberculosis, or exudation was The cerebellum was rather softer present. entero-colitis, or of both. Suddenly an attack of convulsions I than usual. On opening the chest, the lungs were found loaded appeared, from which he rallied, passing into a condition of with much grey, and a slight amount of yellow, tubercular semi-stupor, and continuing in this state for nearly a week, when matter, and the bronchial glands were enlarged by the preanother attack of convulsions ensued, and death immediately sence of the latter. Nofurther examination was prosecuted. followed. Dr. Westley and myself examined the body, which Three important stages in the history of " acute hydrocewas extremely emaciated, the integuments, of a dirty-brown phalus"-as the tuberculous or granular meningitis of modern colour, hanging in folds and wrinkles about the thighs. The pathology is still frequently called in this country-may be vessels much and albuwere whitish, meningeal congested, thus pointed out. First, that stage which extends from, and includes the time of, the actual recognition of the ventri* I never could reconcile myself to this term, as applied to the migratory cular effusion, and the belief of its constituting the essence of character of disease from one locality to another. I think the attack of the the disorder, or of its being the sole malady; secondly, the same character, in any distant part of the system, far more rationally and consistently referrible to the same cause which produced it in its original period when this doctrine was denied, when the effusion was situation, than to suppose the consequence of the same disease leaving one regarded as of seconclary occurrence, or only a consequence of part must be its attack of another, or the diminishing its intensity in one the real disorder, which was believed to be congestion or inpoint should increase it in another. I have relieved violent podagral inflam- flammation of the meninges; thirdly, that stage when the mations and pain by cold evaporating lotions, always deprecated from fear of producing metastasis-a false induction I think it might as well be inferred connexion of the cerebral disease with the tuberculous diathesis that a poker heated to redness at one pole might have its increased tempera- was pointed out, and in which the opinion was generally enterture tnnsmitt-ed to the other by plunging the heated extremity into cold tained that " acute hydrocephalus" was in most instances water. It is really time these absurd notions should be abrogated. Why meningitis of a tubercular character. But another step in tha should Medical science be so far in the background?
predisposition to inflammatory action,
experienced
,