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TREATMENT OF HYDROPHOBIA.
437
shading off the most intense inflammation cause the least degree of suffering to the come to the healthy parts; thus, in patient. I, therefore, tried a very large a simple incised wound, where the parts globe pessary. After using this for some have been brought together, and where ad- time without success, I had determined to hesion is going on, we see, at the edges, see what might be done by some deep scarimuch injection, dying away through a fications in the vagina, when, unfortunately, blush to the natural colour of the skin; a the patient slipped through my fingers, by suppurative inflammation is surrounded by breaking her leg, when she was taken to the an adhesive inflammation, dying away as hospital, which, I believe, in that neighthe last; and a gangrenous inflammation is I bourhood, generally means St. Bartholoterminated by a suppurative at the place mew’s. I think, upon the whole, that perso
until we
where Nature makes the effort to throw off the dead parts; this is circumscribed by the adhesive, in which there is hardness and effusion of lymph, and, further still, we see the injection, blush, &c. Having this knowledge, we find that in the case in question we have only to excite in the vagina such a degree of inflammation that the adhesive process shall reach through the vaginal parietes to the cellular tissue which
haps the best
means
which could
occur as
would be the contraction of a severe gonorrhoea on the part of the patient. And here I trust my professional brethren will not laugh at me, for I assure them that I speak not only in earnest, but in all modesty, for I hold that gonorrhoea is not contracted as a consequence of a contaminated sexual intercourse. I am the more inclined to think that gonorrhoea (provided it were connects the vagina to the surrounding sufficiently severe) might be a good means parts ; and this is what has been done, al- of cure from what occurs in the male when though, it would appear, unintentionally, under that disease, namely, the production ’in the various cases receded; thus, in the of chordee. In the meantime, I remain, Sir use of escharotics, and actual cautery, the your very obedient servant, JOHN CHIPPENDALE. gangrenous inflammation has been excited, while by Dr. Marshall Hall’s plan the sup10, Bedford-street, Bedford-square, June 10, 1839. purative has been produced. Now, we further ktiow that when inflammations terminate (in whatever way) they all, except the gangrenous, pass through the subordiTREATMENT OF HYDROPHOBIA. -nate stages, until that which was the most intense, after having come to the slight blush, returns to the natural state. And To the Editor qfTHE LANCET. this brings me to the case mentioned by Dr. Marshall Hall (LANCET, May 18, p. 316) SIR:—It is an old axiom that desperate where, some time after his operation, the diseases warrant the use of desperate reuterus was (as I understand) reprotruded. medies ; I am willing to subscribe to this I should look upon the want of success in doctrine, but I cannot, therefore, give my this case as dependent upon the inflamma- assent to the practice of combatting distion having begun to contract its sphere orders usually fatal with weapons equally when this accident happened, so that the so ; or, in other words, pitting one poison adhesive inflammation having left the parts against another, that the patient may have where it was required, and the solidifica- the pleasure of dying secundem artem, rather tion of the parts not being completed, the than by natural means ! I am induced to vagina was ineffectually returned to its make these remarks from having observed place. As the cicatrix in the vagina would, an interesting case of hydrophobia that was however, necessarily contract, I think this recorded in THE LANCET a short time since, by case, although solitary, is sufficient to show Mr. Cripps, of Liverpool, where the patient, that the cure does not depend upon the con- in my opinion, died of the remedy rather than the disease. It is referred to in the last traction of the vagina. I have alreadv remarked that I have en- week’s LANCET, and evidence adduced tertained these views for some years, but, tending to infer that the case terminated in as frequently happens when we wish to try typhus ; this inference I am disposed to an experiment, I had not been able to meet doubt, for reasons to be alleged, and as no with a case under my own care, when, at one has hitherto offered any comments last, I obtained one in my practice at the thereon, 1 beg permission, through the . Farringdon Dispensary. I then began to medium of your Journal, to do so, and at consider how I should set up a process of the same time to enter my professional inflammation in the vagina sufficiently in- protest against the abuse of powerful and tense for the adhesive inflammation to reach dangerous remedies on purely speculative through the walls far enough to carry my grounds. Hydrophobia has rarely, if ever, intentions into effect, in such a way, how- been cured ; it is allowed to proceed from ever, that I might not occasion inflammation a specific poison, operating on the nervous of the uterus by continuity, or of the peri- system alone, and, through its irritation toneum by contiguity, and which should thereon, producing violent spasms, more a cure
438
REFORM IN THE IRISH COLLEGE.
nearly resembling tetanus than any other other terms of the Dublin College of Surcomplaint. I should like to know with what geons ; that College has placed itself at the view the croton oil was given.in such a case, for I confess I do not see its indication; but, head of the movement party in Ireland; it granting the propriety of the remedy, how has at last perceived that the interests of its does Mr. Cripps justify its exhibition in members cannot be separated from those of such an enormous quantity? I have fre quently seen most violent symptoms pro the whole profession ; or, at least, that they duced by the administration of a single drop cannot be successfully sustained against the of this medicine, from its highly acrid and irritating effects upon the mucous membrane threatening army of apothecary-druggists, of the intestines. What, then, are we to ex- the Poor-Law Commissioners, the progress pect where twenty times this quantity is of public opinion, and 2400 intelligent and given, in a short space of time, to a patient whose nervous energy is already greatly ex- resolute Irish practitioners. Some persons, hausted ? Why, Sir,just what every intelli- we are well aware, look upon the course gent practitioner would anticipate,and what of conduct pursued by the Dublin College I have, no doubt, was the fact in this instance, iz., inflammation of the lining mem- with suspicion; they scrutinize its motives brane of the whole intestinal tube. I am and ask, " Can any good come from borne out in this opinion by the symptoms closely, detailed in the last week’s LANCET ; and " an evil source? Can a corrupt corporation hence Mr. Cripps may receive a solution to " be transformed into a healthy, free, benehis surprise at the patient’s so rapidly "ficial institution?" The metamorphosis is, sinking from typhoid symptoms, when he had apparently overcome the original com- no doubt, extraordinary; but the deformed plaint. I find no fault with the hydrocyanic may become transformed, and corruption acid being given, but I must be allowed to object to the dose, which, according to the may put on incorruption, if the original narrator’s account, had nearly proved fatal. body first die-if the soul of egotism and My only motive in making these observa- selfishness exhale, and allow the elements tions is to caution the junior branches of the profession against rashly administering to recombine under the vivifying influence of dangerous remedies, where others, compati- public virtue. The College of Surgeons has ble with life, may be used with an equal chance of success ; but where it is desirable expressly declared its desire to constitute, to administer such, why not do it through in conjunction with its brethren of other the same channel that has imbibed the poiColleges, an Irish Faculty of Medicine-one son, viz., the vascular system ? I confess that were a case of hydrophobia to fall great section of the tripartite National under my treatment, I should blister the Faculty of Medicine. Its leading officers whole spinal surface, and through that have expressed this decision with frankmedium introduce my antidote; at all events
I should consider it the safest and most ness, and it would ill become medical direct means of allaying nervous irritation. reformers to suspect a lurking insincerity I am, Sir, yours, &c. &c. so long as the acts of the College keep pace WILLIAM Moss. MOSS. with the liberal declarations of its memWindsor, June 1,1839. bers. Let us not, however, be led away by liberal sounds, but proceed to examtie the subTHE LANCET. stantial nature of some of the resolutions. How is the new College to be constituted? London, Saturday, June 15, 1839. It is proposed that physicians and surgeons WHEN we last referred to the Royal Col- should receive the same elementary educalege of Surgeons of Dublin, it was to de- tion, and should be members of one College. " that at the nounce its constitution, and to hold up to It was moved by Dr. TUOHILL, execration the narrow, monopolising acts"first formation of the College, all persons which excluded from its privileges, and holding degrees or diplomas in medicine or from all offices of trust in Ireland, 2400 out "surgery from any of the Colleges or Univerof 3000 educated physicians and surgeons. sities at present legally authorised to We are glad now to be able to speak in ° grant the same, who have been five years
shading off the most intense inflammation cause the least degree of suffering to the come to the healthy parts; thus, in patient. I, therefore, tried a very large a simple incised wound, where the parts globe pessary. After using this for some have been brought together, and where ad- time without success, I had determined to hesion is going on, we see, at the edges, see what might be done by some deep scarimuch injection, dying away through a fications in the vagina, when, unfortunately, blush to the natural colour of the skin; a the patient slipped through my fingers, by suppurative inflammation is surrounded by breaking her leg, when she was taken to the an adhesive inflammation, dying away as hospital, which, I believe, in that neighthe last; and a gangrenous inflammation is I bourhood, generally means St. Bartholoterminated by a suppurative at the place mew’s. I think, upon the whole, that perso
until we
where Nature makes the effort to throw off the dead parts; this is circumscribed by the adhesive, in which there is hardness and effusion of lymph, and, further still, we see the injection, blush, &c. Having this knowledge, we find that in the case in question we have only to excite in the vagina such a degree of inflammation that the adhesive process shall reach through the vaginal parietes to the cellular tissue which
haps the best
means
which could
occur as
would be the contraction of a severe gonorrhoea on the part of the patient. And here I trust my professional brethren will not laugh at me, for I assure them that I speak not only in earnest, but in all modesty, for I hold that gonorrhoea is not contracted as a consequence of a contaminated sexual intercourse. I am the more inclined to think that gonorrhoea (provided it were connects the vagina to the surrounding sufficiently severe) might be a good means parts ; and this is what has been done, al- of cure from what occurs in the male when though, it would appear, unintentionally, under that disease, namely, the production ’in the various cases receded; thus, in the of chordee. In the meantime, I remain, Sir use of escharotics, and actual cautery, the your very obedient servant, JOHN CHIPPENDALE. gangrenous inflammation has been excited, while by Dr. Marshall Hall’s plan the sup10, Bedford-street, Bedford-square, June 10, 1839. purative has been produced. Now, we further ktiow that when inflammations terminate (in whatever way) they all, except the gangrenous, pass through the subordiTREATMENT OF HYDROPHOBIA. -nate stages, until that which was the most intense, after having come to the slight blush, returns to the natural state. And To the Editor qfTHE LANCET. this brings me to the case mentioned by Dr. Marshall Hall (LANCET, May 18, p. 316) SIR:—It is an old axiom that desperate where, some time after his operation, the diseases warrant the use of desperate reuterus was (as I understand) reprotruded. medies ; I am willing to subscribe to this I should look upon the want of success in doctrine, but I cannot, therefore, give my this case as dependent upon the inflamma- assent to the practice of combatting distion having begun to contract its sphere orders usually fatal with weapons equally when this accident happened, so that the so ; or, in other words, pitting one poison adhesive inflammation having left the parts against another, that the patient may have where it was required, and the solidifica- the pleasure of dying secundem artem, rather tion of the parts not being completed, the than by natural means ! I am induced to vagina was ineffectually returned to its make these remarks from having observed place. As the cicatrix in the vagina would, an interesting case of hydrophobia that was however, necessarily contract, I think this recorded in THE LANCET a short time since, by case, although solitary, is sufficient to show Mr. Cripps, of Liverpool, where the patient, that the cure does not depend upon the con- in my opinion, died of the remedy rather than the disease. It is referred to in the last traction of the vagina. I have alreadv remarked that I have en- week’s LANCET, and evidence adduced tertained these views for some years, but, tending to infer that the case terminated in as frequently happens when we wish to try typhus ; this inference I am disposed to an experiment, I had not been able to meet doubt, for reasons to be alleged, and as no with a case under my own care, when, at one has hitherto offered any comments last, I obtained one in my practice at the thereon, 1 beg permission, through the . Farringdon Dispensary. I then began to medium of your Journal, to do so, and at consider how I should set up a process of the same time to enter my professional inflammation in the vagina sufficiently in- protest against the abuse of powerful and tense for the adhesive inflammation to reach dangerous remedies on purely speculative through the walls far enough to carry my grounds. Hydrophobia has rarely, if ever, intentions into effect, in such a way, how- been cured ; it is allowed to proceed from ever, that I might not occasion inflammation a specific poison, operating on the nervous of the uterus by continuity, or of the peri- system alone, and, through its irritation toneum by contiguity, and which should thereon, producing violent spasms, more a cure
438
REFORM IN THE IRISH COLLEGE.
nearly resembling tetanus than any other other terms of the Dublin College of Surcomplaint. I should like to know with what geons ; that College has placed itself at the view the croton oil was given.in such a case, for I confess I do not see its indication; but, head of the movement party in Ireland; it granting the propriety of the remedy, how has at last perceived that the interests of its does Mr. Cripps justify its exhibition in members cannot be separated from those of such an enormous quantity? I have fre quently seen most violent symptoms pro the whole profession ; or, at least, that they duced by the administration of a single drop cannot be successfully sustained against the of this medicine, from its highly acrid and irritating effects upon the mucous membrane threatening army of apothecary-druggists, of the intestines. What, then, are we to ex- the Poor-Law Commissioners, the progress pect where twenty times this quantity is of public opinion, and 2400 intelligent and given, in a short space of time, to a patient whose nervous energy is already greatly ex- resolute Irish practitioners. Some persons, hausted ? Why, Sir,just what every intelli- we are well aware, look upon the course gent practitioner would anticipate,and what of conduct pursued by the Dublin College I have, no doubt, was the fact in this instance, iz., inflammation of the lining mem- with suspicion; they scrutinize its motives brane of the whole intestinal tube. I am and ask, " Can any good come from borne out in this opinion by the symptoms closely, detailed in the last week’s LANCET ; and " an evil source? Can a corrupt corporation hence Mr. Cripps may receive a solution to " be transformed into a healthy, free, benehis surprise at the patient’s so rapidly "ficial institution?" The metamorphosis is, sinking from typhoid symptoms, when he had apparently overcome the original com- no doubt, extraordinary; but the deformed plaint. I find no fault with the hydrocyanic may become transformed, and corruption acid being given, but I must be allowed to object to the dose, which, according to the may put on incorruption, if the original narrator’s account, had nearly proved fatal. body first die-if the soul of egotism and My only motive in making these observa- selfishness exhale, and allow the elements tions is to caution the junior branches of the profession against rashly administering to recombine under the vivifying influence of dangerous remedies, where others, compati- public virtue. The College of Surgeons has ble with life, may be used with an equal chance of success ; but where it is desirable expressly declared its desire to constitute, to administer such, why not do it through in conjunction with its brethren of other the same channel that has imbibed the poiColleges, an Irish Faculty of Medicine-one son, viz., the vascular system ? I confess that were a case of hydrophobia to fall great section of the tripartite National under my treatment, I should blister the Faculty of Medicine. Its leading officers whole spinal surface, and through that have expressed this decision with frankmedium introduce my antidote; at all events
I should consider it the safest and most ness, and it would ill become medical direct means of allaying nervous irritation. reformers to suspect a lurking insincerity I am, Sir, yours, &c. &c. so long as the acts of the College keep pace WILLIAM Moss. MOSS. with the liberal declarations of its memWindsor, June 1,1839. bers. Let us not, however, be led away by liberal sounds, but proceed to examtie the subTHE LANCET. stantial nature of some of the resolutions. How is the new College to be constituted? London, Saturday, June 15, 1839. It is proposed that physicians and surgeons WHEN we last referred to the Royal Col- should receive the same elementary educalege of Surgeons of Dublin, it was to de- tion, and should be members of one College. " that at the nounce its constitution, and to hold up to It was moved by Dr. TUOHILL, execration the narrow, monopolising acts"first formation of the College, all persons which excluded from its privileges, and holding degrees or diplomas in medicine or from all offices of trust in Ireland, 2400 out "surgery from any of the Colleges or Univerof 3000 educated physicians and surgeons. sities at present legally authorised to We are glad now to be able to speak in ° grant the same, who have been five years