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ROYAL MEDICAL AND CHIRURGICAL SOCIETY.
313 the flooring, for containing mud or stagnant water, and holes hours after the inflammation of the glottis came on, and in the roof, for the admission of rain, and the windows only within twenty-four or thirty-six hours from the commenceeighteen inches from the floor, that they may be obliged to ment of the malady, the inflammation had not time to spread sleep in the draught of air; and let them have drill every far, and the air-tubes and lungs, and other organs, were sound. In the other cases, which were more protracted, the inflammorning, on wet ground, and when fasting, guard mounting, and all kinds of fatigue, not in the morning and evening, but mation had spread down the air-tubes, and there were marks during the hottest time of the day; when on sentry, no shed of inflammation in the chest, and an infiltration of a sercto keep off the direct rays of the sun; bad bread, putrid purulent fluid in the loose cellular tissue of the neck. The occasional connexion of laryngitis with erysipelas was meat, few vegetables, plenty of new rum, especially in the morning; discipline enforced by terror and punish- noticed by Dr. Cheyne in his article on laryngitis in the " ment, not by mind and prevention ; an hospital similar Cyclopaedia of Practical Medicine;" and again by Mr. Wood, to the barrack-room, without offices, always crowded, plenti- in a paper published in the seventeenth volume of the .Medicofully supplied with rum, scantily with water, and so ill regu- Chirurgical Transactions. The first person to treat expressly lated, that the men dread to enter it; a firm belief in the of it was Mr. Ryland, of Birmingham, in his work " On Disdoctrine of contagion, and a horror of approaching any person eases of the Larynx." affected with yellow fever. Let these directions be attended The author cites the facts related by Mr. Ryland, and to in Trinidad, or even in Barbados; and, especially when the observes that they prove conclusively that inflammation of air is stagnant, or charged with noxious vapours, subsequent the larynx, causing great swelling of the lips of the glottis, to long drought, the soldiers will soon die, some of them and infiltration of fluid in the submucous cellular tissue, and yellow, some of them with black vomit, and those first, in thus leading to speedy suffocation, occasionally results from the rooms where these directions have been most carefully the poison of erysipelas. observed."-pp. 24, 25. I He considers the following circumstances favour the opinion We trust that this receipt is never compounded at the he has expressed as to the nature of the disease : That the inflammation spreads in the same mode as in erysipelas of present day. It is melancholy to contemplate a loss of life so the skin, presenting the deep redness and swelling, and infildishonourable to us as a nation. tration of a serous or sero-purulent fluid, which occur in that As before observed, the Appendix, by our author’s father, disease; that it is more fatal than ordinary laryngitis; and contains many excellent suggestions, some of which we are that it occurs most frequently amongst the inmates of hospitals in which erysipelas prevails, and amongst such of them happy to learn have been adopted by government. as are peculiarly liable to erysipelas-viz., convalescents from In concluding, we regret to be obliged to express our discontinued fever or eruptive fevers, and those labouring under approbation at the rugged and almost uncouth style in which secondary syphilitic ulcers. this thesis is written. It much detracts from the pleasure we The author concludes with suggestions respecting the treatshould have otherwise experienced in examining the facts ment of the disease, and some general remarks on erysipelas. Mr. MORTON had listened with much pleasure to the paper here presented to our notice. just read, and agreed with the author that the disease to which it referred was closely related to erysipelas. In cases which had occurred under his own care, the ill-success of operations Medical Societies performed had resulted from the infiltration of the cellular tissues surrounding the organs leading to the lungs. He ROYAL MEDICAL AND CHIRURGICAL SOCIETY. could not agree with the author respecting the part at which an operation should be performed. He (Mr. Morton) preMARCH 9.—J. M. ARNOTT, ESQ., F.R.S., PRESIDENT. ferred the low operation, or tracheotomy, as an opening in the trachea gave the patient a better chance of escaping from inON taking the chair, the President returned thanks to the filtration surrounding the glottis. Dr. COPLAND had seen many cases similar to those recorded Society for the honour of his election-an honour which was much enhanced by a reference to the many illustrious men in the paper. They were usually the result of disease, conwho had preceded him. He made a brief statement regarding secutive on some of the exanthemata, either scarlet fever, the very prosperous condition of the Society, of the value of small-pox, or measles, the inflammation first attacking the its Transactions, its library, and meetings; and concluded by pharynx, and then extending to the larynx and trachea. expressing his determination of encouraging conversation at Most cases of erysipelas of the mouth and fauces were fatal the meetings, under all circumstances, and at all times. from this cause, the disease being associated with a depressed (Cheers.) Votes of thanks were then carried to the late Pre- condition of the system, and often apparently epidemic. With sident, Dr. Chambers, and the retiring secretary, Mr. Curling. respect to treatment, tracheotomy certainly afforded some of relief; but in a case which he had seen, in which ON CYNANCHE LARYNGJEA, OR ACUTE CEDEMATOUS INFLAMMATION hopes this operation had been resorted to, death took place, and the OF THE LARYNX. By GEORGE BUDD, M.D., F.R.S. were found in a state of such extreme congestion, as to i lungs The chief object of the author, in this paper, is to show that be sufficient to account for the fatal result. This congestion the disease known to practitioners under the above title isI was too great for the relief afforded by the operation to overreally erysipelas, commencing in the fauces, or in their neigh- come. He had expected to hear from the author some allubourhood ; and that it has been generally supposed to be con- sion to the treatment recommended by Trosseau and others, fined to the larynx, and has been termed laryngitis, in conse- of applying stimulants, as the nitrate of silver, to the glottis With respect to local external quence of its often proving fatal before the erysipelas has! itself, the use of calomel, &c. had time to spread far from this part. applications, he believed many of these were useful; but he In support of this view, he relates five fatal cases of this3would not enter on that portion of the subject. disease that have recently occurred in London : one in hiss Mr. HOLJBlES COOTE said that last summer, two cases of the disease under discussion occurred in St. Bartholomew’s Hosown practice in King’s College Hospital; three in the Dreadnought, the particulars of which were given him by Mr. pital. One patient was just recovering from a large ulcer in Hudson; and one in Charing-cross Hospital, under the care the leg, when he was seized with great difficulty of breathing; of Mr. Avery, the particulars of which have been publishedl leeches were applied to the throat, and antimony and other in the medical journals. powerful remedies freely employed, but the difficulty in-
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These cases, the author observes, were clearly examples off creased, and laryngotomy was resorted to. The patient, same disease; but they did not all begin exactly in the. however, sank, and, after death, the cellular tissue around In three, the inflammation commenced in the the glottis was found in a state of inflammation, pus was insame manner. fauces; in one, it commenced in the parotid gland; and inifiltrated beneath the tissues, some portions of which were one, the first appearance of it was an erysipelatous blush att mortified. In another case, a patient, having a slight wound the angle of the lower jaw. of the hand, and diseased wrist-joint, was suddenly seized, In all the cases, the inflammation soon spread to the glottis,!, when recovering, with the same symptoms as those observed and produced there the same effects-namely, redness andIin the former case. The larynx was opened early, but withgreat thickening of the epiglottis, and of the lips of thee out benefit. The disease seemed not only a consecutive one, glottis, with effusion of sero-purulent fluid in the submucouss but it appeared that it might come on at any time, as the cellular tissue-to such a degree as, in three of the cases, too result of some atmospheric influence. It did not seem to be produce almost sudden closure of the glottis, and consequentt the result of any particular disease, as there was none in the suffocation. hospital at that time. With respect to treatment, he believed In three of the cases in which death occurred within a fewv that in the more formidable cases we had no means of arrest-
the
314
ing its progress. He had no faith in local applications to the epiglottis, and thought that the treatment recommended by
I
Dr. Budd was the most likely to be successful. Mr. BUSK agreed in the main with the author of the paper as to the pathology of the disease. He related two cases which had occurred in the Seaman’s Hospital, for the purpose .of recommending a mode of treatment, which in these instances had been found quite successful. This treatment consisted in making a great number of minute punctures on the back of the tongue, the uvula, and pharynx, with a sharppointed bistoury. The operation was repeated every halfhour for two or threehours. The parts should be afterwards gargled with warm water: there was a great discharge of serum, and the relief was sudden and decided. He attributed the recovery in the two cases to which he had alluded, to this plan of treatment. It was only carrying out the principle recommended some years since by Sir R. Dobson, to be followed in cases of erysipelas affecting external parts. He, Mr. Busk, believed that this proceeding would often prevent the necessity of laryngotomy. Dr. CURSHAM thought that some of the cases referred to by !, the author of the paper, as recorded by Dr. Tweedie, were different from those which had occurred under Dr. Budd’s ’ own observation, Dr. Tweedie’s cases being diptherite. Dr. BUDD assured Dr. Cursham, that the cases recorded by Dr. Tweedie were precisely similar to those detailed in the paper before the Society. He had not gone at length into these cases, for fear of making his paper too long. They were cases following scarlet fever. Being lately by accident in the Museum of St. George’s Hospital, he saw three preparations of œdematous inflammation of the larynx. One of these cases was the result of erysipelas spreading from tho face to the organs of voice. In the second case, the disease came on after an attack of scarlet fever; pnd the third instance occurred to the porter of the hospital, who had not been affected with any other disease at the time. The patients were all inmates of the hospital. The disease only differed from erysipelas of the face, simply from the locality affected. Dr. THEOPHILUS THOMPSON believed that, though frequently allied to erysipelas, the disease under consideration sometimes occurred with all the characters of common sore throat, I, becoming dangerous, and even fatal, from the oedema which ensued, and blocked up the air-passage. He had not able to catch, during the reading of the paper, any allusion to constitutional remedies in the treatment of this disease. The operation was doubtless often necessary to save life, still the after-treatment was of the most vital importance. In this after-treatment he placed a high confidence in the effect of mercury. He related a case which he attended with Mr. Robarts, (and which, having been related at the Medical Society, was recorded in this journal at the time,) in which
WESTMINSTER MEDICAL SOCIETY. MARCH 6, 1847.—JOHN WEBSTER, M.D., F.R.S., PRESIDENT.
THE PRESIDENT, on taking the chair, expressed his thanks to the Society for having elected him, and assured them, that as former chairman and one of the oldest members of the Westminster Medical Society, he should endeavour, in every way, to advance its objects, which had ever been, and continued to be, the diffusion of medical knowledge. He congratulated the Society on its present flourishing condition. Dr. LANKESTER exhibited some calculi, consisting of the triple phosphate formation, and of about the size of a child’s tooth, which had been voided by a woman, thirty-three years of age. The history of the case was but imperfectly known; but it appeared, that after the receipt of an injury to the back, she was affected with pain in that region, unattended by paralysis or any other marked symptom, and that shortly after. wards she began to pass the calculi in question, each calculus having for its nucleus a hair, similar to the common short hairs of the body. These hairs, Dr. Lankester considered, were formations of the altered mucous membrane of the bladder. Mr. HANCOCK remarked that the formation of the triple phosphate calculus after injury was rare. He had seen many cases in which the phosphate-of-lime calculus had been the result of injury to the spine. He related a case of phosphateof-lime calculi which had formed round portions of hairpins, which had been introduced into the bladder by the patient, a woman, under the care of Mr. Gregory Smith. Dr. BOWMAN read a paper, which will be found in another column. The PRESIDENT corroborated the remarks of Dr. Bowman respecting the great prevalence of pneumonia in warm climates, as it was well known to be frequent and fatal in British Guiana, Italy, and other warm climates. Dr. SNOw, in allusion to the prevalence of pneumonia, as evidenced by the tables of the registrar-general, considered that these documents could not be relied on, as bronchitis was frequently confounded with pneumonia, particularly in children. The deaths were registered as inflammation of the chest, whatever the portion of the lungs affected. Mr. W. HARDING believed that bronchitis and pneumonia generally existed together in children, and that therefore the tables of the registrar-general would accurately define the cause of death. Dr. BOWMAN stated, in answer to a question, that the remark he had made in his paper, to the effect that the combination of tartar emetic with mercury usually retarded the development of the specific effect of the latter medicine, was the result of observation, and that it was more particularly the case laryngotomy was performed, apparently on a dying man. with respect to pneumonia, in which disease so much tartar The operation relieved him, immediate death, in fact, being emetic was used. averted. He was, however, not out of danger until the mouth Dr. AYRES questioned if the retardation depended on the had been made slightly tender by mercury, which was imnie- cause alluded to; he was of on the contrary, that it diately exhibited. He believed that the patient would have resulted mainly from the influence of the inflammation on the died, except for this constitutional treatment. system, and he was more convinced of the truth of this remark, The PRESIDENT, to show the erysipelatous nature of the dis- from its being found that mercury was long, comparatively, ease under discussion, related the following cases :-A gentlein showing its specific effect in cases of peritonitis in which tartar emetic was not used. He had analyzed the blood of a man was seized with a pain in the back of the throat, attended by difficulty of swallowing. Nothing could be seen. Leeches patient before and after salivation. In the latter case, it conwere applied, and blood afterwards taken from the arm. The tained much less fibrine than in the former. He could not, blood was buffed and cupped. He appeared better, but a few with the author, attribute more good to the opium than the hours after was suddenly seized with dyspnoea, and died. The calomel, in the case related. Dr. L.ANKESTER, in allusion to the remarks of the author in only disease found, was inflammation of the glottis, one of the margins of which had sloughed. Four days after, his wife, who respect to the value of bloodletting in cases of pneumonia, had attended him, was seized with an affection of the throat; stated, that in London there were many and numerous excepthe tonsils were enlarged. Erysipelas of the head and neck tions to the rule. Many cases of pneumonia which presented shortly afterwards developed itself. The daughter, who came themselves to us in this great metropolis would not admit of from the country to see her mother, suffered from inflamma- bloodletting at all, not even topically. He related an instance tion of the larynx and pharynx, and afterwards from erysipelas of a native of British Guiana, who, having become the subject of the head and face. When there was infiltration of puru- of pneumonia shortly after his arrival in England, was placed lent matter, he believed that in these cases the operation was simply under the use of calomel. The specific effect of the always fatal. We did not know what to do after the opera- medicine developed itself in thirty-six hours, and the patient He regarded the tartar emetic as our sheetsoon got well. tion in these cases. Mr. BRAsrBY CoorER spoke at great length on the subject; anchor in the treatment of the pneumonia of children. Dr. CHOWNE related the case of a patient, who, having first the chief point in his address referring to the general unsuccessful result of operations in chronic cases of affections of the suffered from intermittent fever, and then from typhus, belarynx and trachea. came, during the convalescence from the latter, and whilst Dr. BARBER related some cases in which erysipelas or inflam- under the use of supporting diet, the subject of pneumonia, mation of the glands of the neck proved fatal, without the and was bled for the attack. Under the use of antiphlogistic occurrence of dyspncea, or other symptoms mentioned by remedies he recovered. His experience led him to fear the Dr. Budd, but in which, after death, effusion was found under plan of depletion in the inflammatory attacks of children, the mucous membrane lining the larynx. He thought these and he thought the gentler the plan of treatment in such cases were very common. cases the better.
been
opinion,
-
-
.
These cases, the author observes, were clearly examples off creased, and laryngotomy was resorted to. The patient, same disease; but they did not all begin exactly in the. however, sank, and, after death, the cellular tissue around In three, the inflammation commenced in the the glottis was found in a state of inflammation, pus was insame manner. fauces; in one, it commenced in the parotid gland; and inifiltrated beneath the tissues, some portions of which were one, the first appearance of it was an erysipelatous blush att mortified. In another case, a patient, having a slight wound the angle of the lower jaw. of the hand, and diseased wrist-joint, was suddenly seized, In all the cases, the inflammation soon spread to the glottis,!, when recovering, with the same symptoms as those observed and produced there the same effects-namely, redness andIin the former case. The larynx was opened early, but withgreat thickening of the epiglottis, and of the lips of thee out benefit. The disease seemed not only a consecutive one, glottis, with effusion of sero-purulent fluid in the submucouss but it appeared that it might come on at any time, as the cellular tissue-to such a degree as, in three of the cases, too result of some atmospheric influence. It did not seem to be produce almost sudden closure of the glottis, and consequentt the result of any particular disease, as there was none in the suffocation. hospital at that time. With respect to treatment, he believed In three of the cases in which death occurred within a fewv that in the more formidable cases we had no means of arrest-
the
314
ing its progress. He had no faith in local applications to the epiglottis, and thought that the treatment recommended by
I
Dr. Budd was the most likely to be successful. Mr. BUSK agreed in the main with the author of the paper as to the pathology of the disease. He related two cases which had occurred in the Seaman’s Hospital, for the purpose .of recommending a mode of treatment, which in these instances had been found quite successful. This treatment consisted in making a great number of minute punctures on the back of the tongue, the uvula, and pharynx, with a sharppointed bistoury. The operation was repeated every halfhour for two or threehours. The parts should be afterwards gargled with warm water: there was a great discharge of serum, and the relief was sudden and decided. He attributed the recovery in the two cases to which he had alluded, to this plan of treatment. It was only carrying out the principle recommended some years since by Sir R. Dobson, to be followed in cases of erysipelas affecting external parts. He, Mr. Busk, believed that this proceeding would often prevent the necessity of laryngotomy. Dr. CURSHAM thought that some of the cases referred to by !, the author of the paper, as recorded by Dr. Tweedie, were different from those which had occurred under Dr. Budd’s ’ own observation, Dr. Tweedie’s cases being diptherite. Dr. BUDD assured Dr. Cursham, that the cases recorded by Dr. Tweedie were precisely similar to those detailed in the paper before the Society. He had not gone at length into these cases, for fear of making his paper too long. They were cases following scarlet fever. Being lately by accident in the Museum of St. George’s Hospital, he saw three preparations of œdematous inflammation of the larynx. One of these cases was the result of erysipelas spreading from tho face to the organs of voice. In the second case, the disease came on after an attack of scarlet fever; pnd the third instance occurred to the porter of the hospital, who had not been affected with any other disease at the time. The patients were all inmates of the hospital. The disease only differed from erysipelas of the face, simply from the locality affected. Dr. THEOPHILUS THOMPSON believed that, though frequently allied to erysipelas, the disease under consideration sometimes occurred with all the characters of common sore throat, I, becoming dangerous, and even fatal, from the oedema which ensued, and blocked up the air-passage. He had not able to catch, during the reading of the paper, any allusion to constitutional remedies in the treatment of this disease. The operation was doubtless often necessary to save life, still the after-treatment was of the most vital importance. In this after-treatment he placed a high confidence in the effect of mercury. He related a case which he attended with Mr. Robarts, (and which, having been related at the Medical Society, was recorded in this journal at the time,) in which
WESTMINSTER MEDICAL SOCIETY. MARCH 6, 1847.—JOHN WEBSTER, M.D., F.R.S., PRESIDENT.
THE PRESIDENT, on taking the chair, expressed his thanks to the Society for having elected him, and assured them, that as former chairman and one of the oldest members of the Westminster Medical Society, he should endeavour, in every way, to advance its objects, which had ever been, and continued to be, the diffusion of medical knowledge. He congratulated the Society on its present flourishing condition. Dr. LANKESTER exhibited some calculi, consisting of the triple phosphate formation, and of about the size of a child’s tooth, which had been voided by a woman, thirty-three years of age. The history of the case was but imperfectly known; but it appeared, that after the receipt of an injury to the back, she was affected with pain in that region, unattended by paralysis or any other marked symptom, and that shortly after. wards she began to pass the calculi in question, each calculus having for its nucleus a hair, similar to the common short hairs of the body. These hairs, Dr. Lankester considered, were formations of the altered mucous membrane of the bladder. Mr. HANCOCK remarked that the formation of the triple phosphate calculus after injury was rare. He had seen many cases in which the phosphate-of-lime calculus had been the result of injury to the spine. He related a case of phosphateof-lime calculi which had formed round portions of hairpins, which had been introduced into the bladder by the patient, a woman, under the care of Mr. Gregory Smith. Dr. BOWMAN read a paper, which will be found in another column. The PRESIDENT corroborated the remarks of Dr. Bowman respecting the great prevalence of pneumonia in warm climates, as it was well known to be frequent and fatal in British Guiana, Italy, and other warm climates. Dr. SNOw, in allusion to the prevalence of pneumonia, as evidenced by the tables of the registrar-general, considered that these documents could not be relied on, as bronchitis was frequently confounded with pneumonia, particularly in children. The deaths were registered as inflammation of the chest, whatever the portion of the lungs affected. Mr. W. HARDING believed that bronchitis and pneumonia generally existed together in children, and that therefore the tables of the registrar-general would accurately define the cause of death. Dr. BOWMAN stated, in answer to a question, that the remark he had made in his paper, to the effect that the combination of tartar emetic with mercury usually retarded the development of the specific effect of the latter medicine, was the result of observation, and that it was more particularly the case laryngotomy was performed, apparently on a dying man. with respect to pneumonia, in which disease so much tartar The operation relieved him, immediate death, in fact, being emetic was used. averted. He was, however, not out of danger until the mouth Dr. AYRES questioned if the retardation depended on the had been made slightly tender by mercury, which was imnie- cause alluded to; he was of on the contrary, that it diately exhibited. He believed that the patient would have resulted mainly from the influence of the inflammation on the died, except for this constitutional treatment. system, and he was more convinced of the truth of this remark, The PRESIDENT, to show the erysipelatous nature of the dis- from its being found that mercury was long, comparatively, ease under discussion, related the following cases :-A gentlein showing its specific effect in cases of peritonitis in which tartar emetic was not used. He had analyzed the blood of a man was seized with a pain in the back of the throat, attended by difficulty of swallowing. Nothing could be seen. Leeches patient before and after salivation. In the latter case, it conwere applied, and blood afterwards taken from the arm. The tained much less fibrine than in the former. He could not, blood was buffed and cupped. He appeared better, but a few with the author, attribute more good to the opium than the hours after was suddenly seized with dyspnoea, and died. The calomel, in the case related. Dr. L.ANKESTER, in allusion to the remarks of the author in only disease found, was inflammation of the glottis, one of the margins of which had sloughed. Four days after, his wife, who respect to the value of bloodletting in cases of pneumonia, had attended him, was seized with an affection of the throat; stated, that in London there were many and numerous excepthe tonsils were enlarged. Erysipelas of the head and neck tions to the rule. Many cases of pneumonia which presented shortly afterwards developed itself. The daughter, who came themselves to us in this great metropolis would not admit of from the country to see her mother, suffered from inflamma- bloodletting at all, not even topically. He related an instance tion of the larynx and pharynx, and afterwards from erysipelas of a native of British Guiana, who, having become the subject of the head and face. When there was infiltration of puru- of pneumonia shortly after his arrival in England, was placed lent matter, he believed that in these cases the operation was simply under the use of calomel. The specific effect of the always fatal. We did not know what to do after the opera- medicine developed itself in thirty-six hours, and the patient He regarded the tartar emetic as our sheetsoon got well. tion in these cases. Mr. BRAsrBY CoorER spoke at great length on the subject; anchor in the treatment of the pneumonia of children. Dr. CHOWNE related the case of a patient, who, having first the chief point in his address referring to the general unsuccessful result of operations in chronic cases of affections of the suffered from intermittent fever, and then from typhus, belarynx and trachea. came, during the convalescence from the latter, and whilst Dr. BARBER related some cases in which erysipelas or inflam- under the use of supporting diet, the subject of pneumonia, mation of the glands of the neck proved fatal, without the and was bled for the attack. Under the use of antiphlogistic occurrence of dyspncea, or other symptoms mentioned by remedies he recovered. His experience led him to fear the Dr. Budd, but in which, after death, effusion was found under plan of depletion in the inflammatory attacks of children, the mucous membrane lining the larynx. He thought these and he thought the gentler the plan of treatment in such cases were very common. cases the better.
been
opinion,