E-text prepared by Juliet Sutherland, Josephine Paolucci, and the Project
Gutenberg Online Distributed Proofreading Team (http://www.pgdp.net)
Note: Project Gutenberg also has an HTML version of this
file which includes the original illustration.
See 29307-h.htm or 29307-h.zip:
(https://www.gutenberg.org/cache/epub/29307/pg29307-images.html)
or
(https://www.gutenberg.org/files/29307/29307-h.zip)
THE
NORTH AMERICAN
MEDICAL AND SURGICAL
JOURNAL.
CONDUCTED BY
HUGH L. HODGE, M.D. | CHAS. D. MEIGS, M.D.
FRANKLIN BACHE, M.D. | B. H. COATES, M.D.
AND
R. LA ROCHE, M.D.
NON DOCTIOR, SED MELIORE IMBUTUS DOCTRINA.
VOL. II.
PHILADELPHIA:
PUBLISHED BY J. DOBSON, AGENT.
JESPER HARDING, PRINTER.
1826.
_Eastern District of Pennsylvania, to wit_
BE IT REMEMBERED, that on the 31st day of March, in the 50th year of the
Independence of the United States of America, A. D. 1826, Hugh L. Hodge,
Franklin Bache, Charles D. Meigs, Benjamin H. Coates, and Rene La Roche,
of the said District, have deposited in this office the Title of a Book,
the right whereof they claim as Proprietors, in the words following, to
wit:
"_The North American Medical and Surgical Journal. Conducted by Hugh L.
Hodge, M. D., Franklin Bache, M. D., Chas. D. Meigs, M. D., B. H.
Coates, M. D., and R. La Roche, M. D. Non doctior, sed meliore imbutus
doctrina. Vol. II._"
In conformity to the act of Congress of the United States, intituled,
"An act for the encouragement of learning, by securing the copies of
maps, charts, and books, to the authors and proprietors of such copies,
during the times therein mentioned;"--and also to the act, entitled, "An
act supplementary to an act, entitled, "An act for the encouragement of
learning, by securing the copies of maps, charts, and books, to the
authors and proprietors of such copies, during the times therein
mentioned," and extending the benefits thereof to the arts of designing,
engraving, and etching historical and other prints."
D. CALDWELL, Clerk of the Eastern District of Pennsylvania.
CONTENTS
OF VOL. II.
No. III.
ORIGINAL COMMUNICATIONS.
ART. PAGE.
I. Description of the Gangrenous Ulcer of the mouths of children.
By B. H. Coates, M. D., one of the Physicians to the Philadelphia
Children's Asylum, &c. 1
II. Case of Purpura in an Infant, attended with extraordinary
symptoms. By R. M. Huston, M. D. 24
III. History of the Natural and Modified Small Pox, or of the
Variolous and Varioloid Diseases, as they prevailed in
Philadelphia, in the years 1823 and 1824. By John K. Mitchell,
M. D., and John Bell, M. D., attending physicians at the
then Small Pox Hospital. With a plate. 27
IV. Remarks on the Pathology and Treatment of Yellow Fever.
Arranged from the notes of Dr. J. A. Monges, of Philadelphia. 53
V. Remarks on the Prophylactic Treatment of Cholera Infantum.
By Joseph Parrish, M. D., one of the Surgeons to the Pennsylvania
Hospital. 68
VI. Case of Neuralgia cured by Acupuncturation. Communicated
by J. Hunter Ewing, M. D. 77
ANALYTICAL REVIEWS.
VII. Researches into the Nature and Treatment of Dropsy in the
Brain, Chest, Abdomen, Ovarium, and Skin. By Joseph Ayre,
M. D., &c. 79
VIII. An Essay on Venereal Diseases, and the Uses and Abuses of
Mercury in their Treatment. By Richard Carmichael, M. R. I. A.
With Practical Notes, &c. By G. Emerson, M. D. 109
IX. Remarks on some Means employed to destroy Taenia, and expel
them from the Human Body. By Louis Frank, M. D.
Privy Counsellor of her Majesty, Maria Louisa, Duchess of
Parma. 114
X. Researches, Physiological and Pathological, instituted principally
with a View to the Improvement of Medical and Surgical
Practice. By James Blundell, M. D., Lecturer on
Physiology and Midwifery at the United Hospitals of St.
Thomas and Guy. 119
XI. An Inquiry into the Nature and Treatment of Diabetes, Calculus
and other Affections of the Urinary Organs. By William
Prout, M. D., F. R. S. With Notes and Additions, by S.
Colhoun, M. D. 125
MEDICAL LITERATURE.--RETROSPECTIVE REVIEW.
XII. Tractatus de Ventriculo et Intestinis, cui praemittitur alius, de
Partibus continentibus in Genere, et in Specie de iis Abdominis.
Authore Francisco Glissonio. Lond. 1677, 4to. 138
QUARTERLY SUMMARY OF MEDICAL AND SURGICAL INTELLIGENCE.
ANATOMY, 155
1, Papillae of the Tongue. 2, Villi of the Stomach and Intestines. 3,
Minute distribution of the Vessels of the Liver. 4, Trachea perforating
the Aorta. 5, Monsters. 6, Malformation of the Heart. 7, Acephalous
Mummy. 8, New Anatomical Plates. 9, A Manual of Osteology. 10,
Soemmering's Work on the Anatomy of the Ear. 11, Does the conjunctiva
run over the Cornea?
PHYSIOLOGY, 158
12, Electro-Galvanic phenomena of Acupuncturation. 13, Variations in
Milk. 14, Hyoscyamus dilates the Pupils of the Eyes. 15, Worms in the
Eye. 16, Digestion.
PATHOLOGY, 161
17, Dothinenteria--Pustules of the small Intestines. 18, Dr. Broussais.
19, Whooping Cough. 20, Antiperistaltic Globus--Globus Hystericus.
21, Non-contagion of Yellow Fever.
THERAPEUTICS, MATERIA MEDICA, AND THE PRACTICE OF MEDICINE, 166
22, Iodine. 23, Non-mercurial Treatment of Syphilis. 24, Cancer treated
by Antiphlogistics. 25, Essential Oil of Male Fern as a remedy in Cases
of Taenia. 26, Tincture of Bastard Saffron for the expulsion of Taenia.
27, Oil of Turpentine in Taenia. 28, Action of the Oil of the Euphorbia
Lathyris. 29, Medicinal Properties of the Apocynum Cannabinum or Indian
Hemp. 30, Remarkable Effects from the external application of the
Acetate of Morphia. 31, Cure of Urinary Calculi, by means of the
internal use of the Bicarbonate of Soda. 32, Attempt to cure Abdominal
Dropsy by exciting Peritoneal Inflammation. 33, Artificial Respiration.
34, Secale Cornutum. 35, Animal Magnetism. 36, Sketch of the Medical
Literature of Denmark, Sweden, and Norway. 37, Erysipelatous Mumps or
Angina Parotidiana. 38, Taenia. 39, Scrophula. 40, Digitalis.
SURGERY, 192
41, Dr. Physick's Operation for Artificial Anus denied to have been
performed. 42, Gangrenous Sore Mouth of Children. 43, Operation for
Phymosis. 44, Lunar Caustic on Wounds and Ulcers. 45, Haemorrhage from
Lithotomy. 46, Extirpation of the Parotid Gland. 47, Aneurism from a
Wound, cured by Valsaiva's method. 48, Protrusion and Wound of the
Stomach. 49, Oesophagotomy. 50, Retention of Urine, caused by a
Stricture of the Urethra, relieved by a forcible but gradual Injection.
51, Tracheotomy. 52, Fistula Lachrymalis. 53, Aneurisma Herniosum. 54,
Extirpation of the Two Dental Arches affected with Osteo-sarcoma. 55,
Traumatic Erysipelas. 56, Obliteration of a portion of the Urethra,
remedied by an Operation. 57, Artificial Joint cured by Caustic. 58,
Epilepsy cured by Trephining.
MIDWIFERY, 205
59, Gastrotomy. 60, Caesarian Operation, performed with safety to the
Mother and Foetus. 61, Extirpation of the Uterus. 62, Uterine Haemorrhage.
CHEMISTRY AND PHARMACY, 208
63, State in which Morphia exists in Opium. 64, Peculiar Principles of
Narcotic Plants. 65, Relative quantities of Cinchonia and Quinia with
indention in the most esteemed Varieties of Peruvian Bark. 66, Sulphate
of Quinia, extracted from the Cinchona Bark, exhausted by Decoction.
67, Analysis of Rhubarb. 68, Alkaline Lozenges of Bicarbonate of Soda.
69, Presence of Mercury in Samples of Medicinal Prussic Acid. 70, Proposed
Method of preparing Protoxide of Mercury by precipitation, for
Medical Employment. 71, Goulard's Extract of Lead.
QUARTERLY LIST OF AMERICAN MEDICAL PUBLICATIONS, 214-16
No. IV.
ORIGINAL COMMUNICATIONS.
ART.
I. On the Epidemic of 1825 in Natchez, Miss. By Ayres P.
Merrill, M. D. 217
II. History of the Natural and Modified Small Pox, or of the Variolous
and Varioloid Diseases, as they prevailed in Philadelphia,
in the years 1823 and 1824. By John K. Mitchell,
M. D., and John Bell, M. D., Physicians at the then Small
Pox Hospital. (Concluded from page 53.) 238
III. Cases of Nervous Irritation, exhibiting the Efficacy of Cold as
a Remedy. By S. Jackson, M. D. 250
IV. Remarks on the Pathology of Jaundice. By G. B. Wood, M. D. 260
V. Account of a Case in which a New and Peculiar Operation for
Artificial Anus was performed in 1809. By Philip Syng Physick, M. D.,
Professor of Surgery in the University of Pennsylvania, &c. Drawn up for
publication by B. H. Coates, M. D. 269
VI. Observations on Asphyxia from Drowning, to which is added
a Case of Resuscitation. By Edward Jenner Coxe, M. D. 276
ANALYTICAL REVIEWS.
VII. Traite Zoologique et Physiologique, Sur les Vers Intestinaux de
l'Homme. Par M. Bremser, D. M. Traduit de l'Allemande
par M. Grundler, D. M. P. Revue et Augmentee de Notes.
Par M. de Blainville, D. M., &c. Avec un Atlas. Paris, 1824.
Anatomie des Vers Intestinaux, Ascaride, Lombricoide, et
Echynorhynque Geant. Memoire Couronne par l'Academie
Royale des Sciences, qui en avoit mit le sujet au Concours,
pour l'annee 1818. Avec 8 Planches. Par Jules Cloquet,
&c. &c. A Paris, 1824 297
VIII. Precis Theorique et Pratique, sur les Maladies de la Peau.
Par M. S. L. Alibert. 2 Tomes. 8vo. Paris, 1810-1820. 322
IX. Thoughts on Medical Education, and a Plan for its Improvement;
addressed to the Council of the University of London.
Dictu Necessaria. Plin. London, 1826.
Projet de Loi, presente aux Chambres dans la Seance du 14
Fevrier 1825, par S. E. le Ministre de l'Interieur, Sur les
Ecoles Secondaries de Medecine, les Chambres de Discipline,
et les Eaux Minerales Artificielles. 344
MEDICAL LITERATURE--RETROSPECTIVE REVIEWS.
X. Recherches sur le Tissu Muqueux, ou l'Organe Cellulaire, et
Sur Quelques Maladies de la Poitrine. Par Theophile Bordeu,
Docteur en Medecine des Facultes de Paris, et de
Montpelier. Paris, 1767, 12mo. 376
QUARTERLY SUMMARY OF IMPROVEMENTS IN MEDICINE AND
SURGERY
ANATOMY, 395
1, Notice of a Double Male Foetus, by W. E. Horner, M. D., &c. 2,
Imperfect Development of the Cerebral Organs in Monsters. 3, Imperforate
Vagina. 4, Fallopian Tubes. 5, Monsters. 6, Foetus grafted into
the Chest of another. 7, Foetus without a Stomach, Head or Anus. 8,
Congenital Hydrocephalus, with Transposition of the Viscera. 9, Unusual
Arrangement of the Aortic Branches.
PHYSIOLOGY, 403
10, Influence of the Great Sympathetic Nerve on the Functions of Sense.
11, Cutaneous Absorption. 12, Abstinence. 13, Hippomane Mancinella.
14, Cutaneous Absorption. 15, Regeneration of Divided Arteries.
16, Mineral Poisons.
PATHOLOGY, 406
17, Are we followers of Dr. Broussais? 18, Influenza. 19, Diarrhoea
Infantum. 20, Tetanus. 21, Small Pox.
THERAPEUTICS, MATERIA MEDICA, AND THE PRACTICE OF MEDICINE. 411
22, Tincture of Iodine in Gonorrhoea, Bubo, Scrofula, &c. 23, Acetate
of Lead and Tincture of Opium in Dysentery. 24, Powers of Digitalis in
Palpitatio Cordis. 25, Tartar-Emetic Ointment in Epilepsy. 26,
Antiphlogistics
in Recent Cases of Epilepsy. 27, On the Efficacy of Nitrate
of Silver in the Treatment of Zona or Shingles. 28, On the Remedial
Effects of Camphor in Acute and Chronic Rheumatism. 29, Examination
of the Question, whether the Medical Use of Phosphorus internally, is
useful, injurious, or equivocal. 30, Nitrous Acid and Opium in Dysentery,
Cholera and Diarrhoea. 31, Tartar Emetic in Pneumonia Biliosa. 32,
Bark of the Ampelopsis in Catarrhal Consumption. 33, Obstinate Vomiting
cured with Extract of Marigold. 34, Vomiting of Fat and Blood. 35,
Rupture of the Spleen. 36, Chilblains cured with Chloride of Lime. 37,
Local Spontaneous Combustion. 38, Dr. Painchaud on Tic Douloureux.
39, Duration of Life among the Romans. 40, Difference of Mortality
from 1775, to 1825. 41, New Method of Percussion of the Thorax. 42,
Acid Nitrate of Mercury. 43, Effects of Ardent Spirits. 44, Colombo
Root. 45, Poison of Mushrooms. 46, Antisyphilitic Decoction of Zittmann.
47, Acetate of Ammonia, a Remedy for Drunkenness. 48, Mortality
of Leeches. 49, Black Drop. 50, Doses of Calomel in days of
yore. 51, Buying a good Practice. 52, Sore Nipples. 53, Anderson's
Quarterly. 54, Antiquity of Cow Pox and Origin of Small Pox from it.
SURGERY, 431
55, Lithotritie, on Breaking the Stone in the Bladder. 56, The High
Operation. 57, Sutures in Wounds of the Bladder. 58, Paracentesis
Thoracis. 59, Stricture of the Oesophagus. 60, Wound of the Brain. 61,
Luxation of the Metatarsus; the history drawn up by M. Dusol, D. M.
MIDWIFERY, 438
62, Uterine Haemorrhage. 63, Polypi of the Uterus. 64, Caesarian
Section. 65, Case of Difficult Parturition. 66, Case of the Pelvis becoming
enlarged.
CHEMISTRY AND PHARMACY, 440
67, L'Artigue's Process of preparing the Watery Extract of Opium. 68,
Berzelius' Method of Detecting Arsenic in the bodies of Persons poisoned
by it. 69, Action of Certain Metallic Substances on the Animal Economy.
QUARTERLY LIST OF AMERICAN MEDICAL PUBLICATIONS, 444-48
CONTENTS
ORIGINAL COMMUNICATIONS.
PAGE
ART. I. Description of the Gangrenous Ulcer of the Mouths
of Children. By B. H. Coates, M. D. one of the
Physicians to the Philadelphia Children's Asylum,
&c. 1
II. Case of Purpura in an Infant, attended with extraordinary
Symptoms. By R. M. Huston, M. D. 24
III. History of the Natural and Modified Small-pox, or
of the Variolous and Varioloid Diseases, as they
prevailed in Philadelphia in the years 1823 and
1824. By John K. Mitchell, M. D., and John
Bell, M. D., attending Physicians at the then
Small-pox Hospital.--With a plate. 27
IV. Remarks on the Pathology and Treatment of Yellow
Fever. Arranged from the Notes of Dr. J.
A. Monges, of Philadelphia. 53
V. Remarks on the Prophylactic Treatment of Cholera
Infantum. By Joseph Parrish, M. D., one of the
Surgeons to the Pennsylvania Hospital. 68
VI. Case of Neuralgia, cured by Acupuncturation.
Communicated by J. Hunter Ewing, M. D. 77
ANALYTICAL REVIEWS.
VII. Researches into the Nature and Treatment of
Dropsy in the Brain, Chest, Abdomen, Ovarium,
and Skin. By Joseph Ayre, M. D., &c. 79
VIII. An Essay on Venereal Diseases, and the Uses and
Abuses of Mercury in their Treatment. By
Richard Carmichael, M. R. I. A., with Practical
Notes, &c. by G. Emerson, M. D. 109
IX. Remarks on some means employed to destroy
Taenia, and expel them from the Human Body.
By Louis Frank, M. D., Privy Counsellor of her
Majesty, Maria Louisa, Duchess of Parma. 114
X. Researches Physiological and Pathological, instituted
principally with a View to the Improvement
of Medical and Surgical Practice. By James
Blundell, M. D., Lecturer on Physiology and
Midwifery, at the United Hospitals of St. Thomas
and Guy. 119
XI. An Inquiry into the Nature and Treatment of Diabetes,
Calculus, and other Affections of the Urinary
Organs. By William Prout, M.D. F.R.S.
With Notes and Additions, by S. Colhoun, M. D. 125
MEDICAL LITERATURE.
XII. Retrospective Review.--Tractatus de Ventriculo
et Intestinis, cui praemittitur alius, de Partibus
continentibus in Genere, et in Specie de iis Abdominis.
Authore Francisco Glissonio. Lond.
1677, 4to. 138
QUARTERLY SUMMARY OF MEDICAL AND SURGICAL
INTELLIGENCE.
I. Anatomy. 155
II. Physiology. 158
III. Pathology. 161
IV. Therapeutics, Materia Medica, and the Practice of Medicine. 166
V. Surgery. 192
VI. Midwifery. 205
VII. Chemistry and Pharmacy. 208
QUARTERLY LIST OF AMERICAN MEDICAL PUBLICATIONS. 214
FOOTNOTES:
THE
NORTH AMERICAN
Medical and Surgical Journal.
JULY, 1826.
ORIGINAL COMMUNICATIONS.
FOOTNOTES:
ARTICLE I.--_Description of the Gangrenous Ulcer of the Mouths of
Children._ By B. H. Coates, M. D. one of the Physicians to the
Philadelphia Children's Asylum, &c.
Having had opportunities of witnessing the ravages and unmanageable
character of this destructive disease, I have long and deeply felt the
want of some written account, both of the malady, and of a proper mode
of treatment. Some research and observation, made in consequence of this
feeling, have terminated in the acquisition of more fixed ideas, and of
a practice hitherto successful. This convinced me, that it became my
duty to lay the result of these inquiries before the public, for the
benefit of others. There is, perhaps, no stronger and more peculiar
reason for wishing American physicians to write, than the opportunities
they possess, of describing and recording many important varieties of
morbid affection, which were either unknown to our predecessors, or the
descriptions of which, uncombined and uncompared, are only to be found
by searching among the more neglected tomes of a public library. Of
this, the present case will afford a fair example; as well as an
instance of an American physician, who had described the disease from
nature, having, from want of encouragement, false modesty, or some other
cause, kept it back from publication.
Ever since the establishment of the Children's Asylum, under the care
of a committee of the guardians of the poor, of the city and liberties
of Philadelphia, in the spring of 1819, this useful institution has been
annually visited by the new and distressing scourge of which we are
treating. It has here prevailed in a considerable number of cases,
forming the principal source of anxiety and trouble during the winter
season, and annually sweeping off its little victims, in a manner
rendered peculiarly awful by its insidious approach, its loathsome
effects, and its apparently uncontrollable progress. Various scattered
cases of a similar affection have come within my knowledge, during the
last few years; occurring in the practice of several physicians, as well
as in my own. In no place, however, near Philadelphia, other than the
above, has there existed, so far as I know, a sufficient number of cases
at the same time, to enable a physician to examine it in much detail, or
to make comparative trials of different modes of treatment, so as
clearly to determine the most successful.
_References to Authors._--The notices of this complaint given by
authors, to which I have been enabled to refer, are few, and generally
too scanty to supply much means of forming a satisfactory judgment, or a
practice in which confidence can be reposed. They consist, principally,
of the mere mention of an affection resembling that of which we treat;
and, in some instances, it is even doubtful whether they are describing
the same disease. No notice is taken of this affection in any of our
common books; with the exception of the last edition of COOPER'S
Surgical Dictionary,[1] and of UNDERWOOD'S work on diseases of children.
It is there described under the erroneous title of _cancrum oris_. A
reference is given to PEARSON'S Surgery; and the article in the
Dictionary is taken exclusively from that work. As this is the only
authority with which I am acquainted, that gives a tolerably full
account of a disease somewhat similar to that of which we are treating,
I have concluded to extract the whole passage, in the words of the
author.
"The canker of the mouth is a deep, foul, irregular, foetid ulcer,
with jagged edges, which appears upon the inside of the lips and cheeks;
and is attended with a copious flow of diseased saliva.
"This disease is seldom seen in adults; but it most commonly attacks
children, from the age of 18 months, to that of 6 or 7 years. When the
ulceration begins at the inner part of the lip, it exhibits a deep,
narrow, sulcated appearance, and quickly spreads along the inside of the
cheek; which becomes hard, and tumefied externally. The gums are very
frequently interested in this complaint, and, in such cases, the teeth
are generally found in a loose and diseased state; matter is often found
in their sockets, and abscesses sometimes burst externally through the
cheek, the lip, or a little below the maxilla inferior: and it is not
uncommon to see an exfoliation of the alveolar processes, or even of the
greater part of the lower jaw. Among the children of poor people, where
this disease is neglected or mismanaged at the beginning, a dreadful
gangrene will sometimes supervene.
"The remote causes that give origin to this disease are not very
obvious. I think it occurs most frequently among children that live in a
marshy situation; that are sustained by unwholesome food; and where a
due attention to cleanliness has been wanting. The cancrum oris has been
described by some writers, as a complaint very common in England and
Ireland, where it is sometimes epidemical among infants. It, however, is
commonly seen in other kingdoms, and prevails more especially in those
houses where a great number of children are crowded together. I am not
able to determine whether it is or is not contagious.
"But adults are not wholly exempted from this morbid affection, and it
is not easy in all cases, to distinguish the cancrum oris from a
cancerous or venereal ulcer in the mouth; since the uvula, tonsils or
fauces may be the seat of each disease. I have seen ulcerations on the
uvula and tonsils, with all the marks of a venereal sore, in patients
where the presence of such a virus could not be suspected; and by
treating them as canker of the mouth, they have been speedily cured.
"The canker of the mouth ought to be distinguished from aphthae, the
epulis and parulis, scurvy, cancerous ulcers, venereal ulcers and
exulceration from the use of mercury.
"_The mode of treatment._--It will be proper,
"1. To remove the diseased teeth, bone, &c. if possible.
"2. To prescribe a milk and vegetable diet, and to allow a prudent use
of fermented liquors.
"3. It will be adviseable to exhibit such remedies as, Peruvian bark;
sarsaparilla; elm bark; mineral acids.
"The external applications that I have generally found successful have
consisted of such as the following:
"_Preparations of copper_; a diluted mineral acid; burnt alum; decoction
of bark with white vitriol; tincture of myrrh, &c."[2]
Of the above articles, those which we have indicated by italics are
omitted in the last edition of COOPER'S Dictionary; and, in a former
one, they are directly prohibited with strong reprobation. Nevertheless,
it is among these that we have found, beyond comparison, the most
successful one.
Mr. PEARSON prefixes to the preceding article a list of synonymes, with
references to authors, in the manner of writers on natural history. They
are as follow: _Aphthae Serpentes._--SENNERTUS; Medicina Practica.
_Labrosulcium, seu Cheilocace._--ARNOLDUS BOOTIUS. _Oris
Cancrum._--MUYS. STALPAART VANDER WIEL. _Gangraena Oris._--VAN SWEITEN.
_Gangrene scorbutique des Gencives._--Auctores Gallici.
Of these, SENNERTUS[3] merely mentions, under the article aphthae, that
the latter sometimes spread around the fraenum and tongue, occasionally
corroding the subjacent parts. He is so far from giving a clear
description, under the head of Aphthae Serpentes, of any affection
analogous to that we are about to record, that he quotes GALEN as
remarking, very properly, that these are not aphthae at all, but putrid
ulcers.
ARNOLD BOOTIUS, in his little treatise "de morbis omissis," of diseases
omitted in the books, published in London, in 1649,[4] gives, from his
own observation, an account of a disease, to which he applies the names
above attributed to him. It differs from the cases which have attracted
our attention, chiefly in its situation. He describes it as an ulcer,
soon becoming black and foetid, corroding the inside of both lips,
separating them widely from the gums and allowing them to fall outwards
upon the face; thus producing a horrible deformity. Besides this, the
author states, that a deep fissure usually extended down each half of
the inside of each lip; thus adding four deep and ghastly ramifications
to the ulcer. This shocking affection is stated to have prevailed
extensively, both in England and Ireland; in which latter country the
author practised and held several important offices. It occasionally
became epidemic, and then destroyed great numbers of children. It
principally prevailed between 2 and 4 years of age; though it was
occasionally met with both earlier and later in life. It was frequently,
but not always, accompanied with aphthae.
This disease was, in general, successfully treated by our author, with a
decoction of "Chaerephyllum, Quinquefolium, Myrrhis, Rosae et Salvia;" in
which was dissolved a "sat magna copia" of white vitriol.--A combination
about as precise as some of the prescriptions which have been
recommended to me, for the present disease, in this country. With this
mixture, he touched the ulcers several times a day; and then washed them
with a liniment of acetate of lead, aqua plantaginis, and oleum
rosaceum. He also used _issues_ in both arms; and confined the patient,
in more obstinate cases, for drink, to a decoction of sarsaparilla,
china, and several other articles, which we will spare our readers. To
this disease, BOOTIUS devotes about five small 18mo. pages, forming his
tenth chapter.
VANDER WIEL cites BOOTIUS, and expresses his belief, that the disease
described by the latter was identical with one which he saw himself.
This last, however, though described in a cursory manner, appears to
resemble much more nearly the disease of the Children's Asylum;
beginning in the gums, and extending to the adjacent parts. He treats it
by the following lotion:
R. Mel. Rosar. [Symbol: ounce]i
---- Aegyptiaci, [Symbol: dram]ij
Olei Vitrioli, gtt. _aliquot._
misce.
Under this treatment, and by removing the teeth, when loose, the small
number of cases he saw recovered in a few days.
VANDER WIEL was a practitioner in Holland; and, though he does not
specify the fact, his cases were probably in a marshy country.[5]
MUYS, in a little treatise entitled "Chirurgia Rationalis,"[6] published
in 1684, has an account of a disease, which is evidently supposed by
PEARSON to be that which he describes. This also, however, appears to
have been a "labrosulcium;" an ulcer between the lips and the incisor
teeth. There is but little to be gathered from his paper; as it is
principally occupied with an attempt to prove, that this ulcer is owing
to an accumulation of _acidity_ in the blood, increased, at this point,
by the putrescence of particles of food which collect there. He
illustrates this doctrine by an examination of a _burnt rag_ under a
microscope; and this he considers as in a state analogous to the
gangrene. "Opinionum commenta delet dies," &c. We give his treatment;
which is aimed at acidity.
R. Theriaci, [Symbol: dram]ijss
Ung. Egypt. [Symbol: dram]iss
Gum. Laccae, et
Spirit. Sal. _Armon._ aa [Symbol: scruple]ij
---- Cochleariae, [Symbol: dram]ij
_m._ ft. ung.
To be softened with a little alcohol, the part washed with the mixture
six times a day, and a rag moistened with the same compound left in the
ulcer. Here we take leave of the Chirurgia _Rationalis_.
In the 14th volume of the Memoirs of the French Royal Academy of
Surgery, are papers containing accounts of two cases, which have some
points in common with the disease of which we treat; but the identity of
at least one of which it is hard to establish. The first piece is
entitled, "_Sur la gangrene scorbutique des gencives dans les enfans.
Par feu M. Berthe._"[7] The author is described, in a note, as a young
surgeon of great promise, who was carried off by an early death. M.
BERTHE commences by quoting FABRICIUS HILDANUS; who describes a gangrene
of the gums, occuring principally at about 4 years of age, and of which
all the patients died. FABRICIUS takes the occasion to give a caution to
young surgeons, to avoid being too sanguine in predicting recovery from
gangrenes. Next a case is given us, drawn from M. SAVIARD, in which
death was the result. This author seems, subsequently, to have had
somewhat better success, but at the expense of horrible disfigurements;
such as great holes through the cheek, and the loss of a large piece of
the jaw; which, indeed, are described as having been worse than death.
In another case, recorded by M. POUPART, in the "Histoire de l'Academie
des Sciences," this affection terminated in death; preceded, however,
and in the opinion of the author, caused, by the production of two
tumours, one by the side of the tongue, the other inside of the cheek.
This is not at all unlike the progress, which will be hereafter
mentioned to have taken place in many of the Asylum cases.
M. BERTHE then remarks, that the greater number of instances of gangrene
of the gums had terminated unfavourably.
His own patient was ill from April to September, 1753; and exhibited
swelled and bleeding gums, frequently projecting beyond the
teeth,--black and foetid stools, foetid urine, and ecchymoses over
the surface of the body. He treated it with antiscorbutics, internally
and externally, and apparently with success. The patient, however,
relapsed in January, 1754; when M. BERTHE proceeded to a very different,
and far more severe treatment. The gums were pared away, in many
successive operations; and the wounds were washed with aluminous water.
A roll of linen was, during the intervals, kept fastened in the
patient's mouth, for the purpose of allowing the escape of the fluids of
the part; which he apprehended to possess a putrid character, and to
aggravate the original disease, whenever they passed into the stomach.
At length, his patient recovered, and continued well.
It appears to the writer of these notes to be hardly necessary to state,
that M. BERTHE evidently mistook the disease; the latter being in
reality scorbutic, and not a single symptom of gangrene being described
during its whole history.
The same, however, cannot be said of M. CAPDEVILLE; whose "_Observations
sur les effets rapides de la pourriture des gencives_" appear in the
same volume with the foregoing, and immediately subsequent to it.[8]
This writer's case took place after a fever, and no tumefaction of the
gums nor ecchymoses of the skin are mentioned as occurring in it. M.
CAPDEVILLE attended this case in consultation, in 1764; and complains of
too feeble means being employed, as the case was trusted to
antiscorbutics. This treatment ended in death. M. C. refers to VAN
SWEITEN, whose correct account we shall mention; and it is evident that
it was the disease of the Children's Asylum: though he manifests a
strong propensity to connect it with scorbutus, and the "blanchet," or a
species of aphthae, which destroyed a great number of children in the
Foundling Hospital, in 1746. Reference is also made to cases which
occurred in "La Pitie," under the care of CHOPART. Of these, a very
scanty account is given. They terminated in death; after a treatment by
lotions of honey of roses and spirit of vitriol, with emollient and
resolvent cataplasms.
VAN SWEITEN, in the article devoted to the consideration of gangrene,[9]
has left us a far more exact description of the disease, into which we
are inquiring. Practising in a marshy country, he had frequent
opportunities of meeting with it; and his account of it, and his mode of
treatment, though brief, are every way worthy of the close, practical
inquirer into nature, and the sound medical philosopher. His description
is not unmixed with strong expressions of horror and commiseration at
its ravages. He describes it in a manner so similar to that in which it
now prevails, that no doubt can exist of the identity of the diseases.
He acknowledges, however, "rubedo, calor, dolor," among its symptoms.
Cochlearia, theriaca and similar articles, according to him, are almost
always injurious. If no foetor exist, (and, of coarse, no actual
mortification,) he applies a solution of sal ammoniac or nitre, with
some vinegar or lemon juice; sometimes as a lotion, sometimes by keeping
a rag imbued with it always in the ulcer. Hard rubbing he reprobates. If
the disease have made progress, and foetor exist, muriatic acid is
used: in the less aggravated stages, diluted with honey of roses and
water; in the worst cases, pure. This practice he states never to have
failed him, unless where the bone was affected.
In an early edition of Dr. UNDERWOOD'S Treatise on Diseases of Children,
in the library of the Pennsylvania Hospital, no mention is made of this
disease; although an article is devoted to "_gangrenous erosion of the
cheek_." The account is wholly borrowed from a work by Mr. DEASE, of
Dublin, "on the diseases of lying-in women," &c. also in the library.
Mr. DEASE describes this affection as occurring from 2 to 6 or 8 years
of age; especially in unhealthy children, including such as have been
subject to worms. The whole body often appeared cold upon the approach
of the disease. A black spot then occurred, but _without marks of
inflammation_, on one of the cheeks or lips. The whole cheek was
sometimes destroyed, and the lower jaw fell down upon the breast.
Muriatic acid, infusion of roses, the effervescing draught, and, in the
decline of the disease, bark, broths, jellies, and wine, besides
magnesia or rhubarb, to remove the putrid matters swallowed, were the
internal remedies employed. The parts were washed and injected with
muriatic acid, diluted with chamomile or sage tea; and afterwards
dressed with the acid, mixed with honey of roses, and, over this, a
carrot poultice. By this practice, Mr. DEASE lays claim to almost total
success.
In the Philadelphia republication of Dr. UNDERWOOD'S book, taken from
the sixth London edition, there is an article entitled Cancrum Oris. The
author appears to have read PEARSON'S account; but as his description
does not at all agree with the disease of which we are treating, nor
with that of Mr. PEARSON, we shall not stop longer to analyse it.
I have no doubt, from views that will be hereafter developed, that many
of the above writers have had cases similar to those which we are about
to describe; but have mistaken them, from the want of a sufficiently
early and close inspection of the ulcers. In the second stage, this
disease much resembles an inflamed sore between the lips and gums,
extending to the latter; although I hope to prove that this state of
things is secondary.
_Locality of the Disease._--The Philadelphia Children's Asylum is
situated in South Fifth street, between Prime and Federal streets, in
the district of Southwark. The soil is what is called alluvial, or
rather diluvial; as is well known to be the case with all that district,
lying south of Philadelphia, as well as the southern part of the city
itself. The house was built, and for many years occupied, as a mansion,
by the head of a most respectable and wealthy family. Its situation
possesses some of the qualities usually selected in choosing the site of
a country seat. The buildings stand on a swell of ground, leaving an
open lawn, now interrupted by several unoccupied streets, and extending,
on the right hand, to the banks of the Delaware, and, on the left, to
the Navy Yard and part of the suburb of Southwark. Towards the north,
it is not far from the edge of a thickly built appendage of the city.
The district immediately south of the Asylum is marshy, and has long
been noted for the prevalence of intermittent fevers; but the slightly
elevated site of the building had been generally healthy, and continued
so, till the universal and distressing epidemic, which infested all the
outskirts of Philadelphia, in 1822 and 1823. Even at this period, the
persons resident at the Asylum, were far from suffering so severely as
the adjacent neighbourhood; and, since those years, it has again become,
in general, tolerably healthy. In 1819, 1820, 1821, and 1822, a lot,
situated at a short distance, on which were deposited the contents of a
number of privies, proved a source of great inconvenience, and some
disease, at the Asylum. This focus of effluvia, together with the
general and copious use of similar materials in manuring the adjacent
fields, occasioned an intolerable stench, and generated diarrhoeas, in
the early part of the spring. When the grass and weeds, however, were
grown sufficiently to protect the surface of the soil from the sun and
wind, this effect entirely ceased; and I know not that any other
inconvenience was experienced from the same source, unless we attribute
to this, as may fairly be done, the destruction of the purity of the
well. This formerly afforded very good water; and, since that period, it
has much improved. When the corporations of Southwark and Moyamensing
shall introduce, as it is to be hoped they will, the Fairmount water
into their streets, one remaining cause of inconvenience and ill health,
will be removed from the Children's Asylum.
_Prevalent Diseases._--Ophthalmias and furuncular eruptions, the latter
principally on the face, are epidemic every year; generally in the
spring and early summer months. When prevalent in the city, the measles,
small pox, and varioloid disease have reached the Asylum; the scarlatina
has, at no period, I believe, been peculiarly troublesome there.
Intermittents, which were anticipated by many, from the nature of the
situation, have seldom, if ever, prevailed in the house, to any very
considerable extent. One of the worst visitations which it has
experienced, in this respect, was in the autumn of 1823. In many cases,
it was in patients who had been labouring under disease of this
description, that the ulcer we are about to describe exhibited itself;
but it was by no means confined to those who were known to have so
suffered. Many, perhaps, most of the children affected, were free from
any apparent ailment; although it is by no means impossible that the
little, uncomplaining subjects were, at the time, labouring under what
has been called "febricula" or "inward fever."
_Regimen._--To the impurity of the water we have already adverted. The
diet of the children furnishes them with meat every day, with the
exception, during a part of the existence of the institution, of two
days in every week. Molasses was freely used; indian mush was greatly in
demand; and the breakfast and supper were of bread and milk. During the
summer months, this diet was abundantly nourishing; but in winter, it
was thought that an additional quantity of animal food was desirable;
and, accordingly, it was, during the two last winters, given every day.
_Description of the Disease._--The ulcer of which we speak, may begin in
many parts of the mouth. In by far the greater number of cases, however,
it commences immediately at the edges of the gums, in contact with the
necks of the teeth, and, most generally, of the two lower incisors. A
separation is found here; which exhibits a slight loss of substance at
the extreme edge of the gums, and, as far as I have observed, a
whitishness of the diseased surface. In some instances, though not very
frequently, this is preceded by a slight swelling and redness. In this
state, the disease may continue for a long time; and I have reason to
believe, that patients have remained thus affected, during the whole
period of three months, for which I attended the Asylum. At one time,
when the disease was at its height, threatening several patients with
destruction, I found upwards of 70 children, out of a population
amounting to about 240, more or less affected with these ulcerations. No
remarkable change is at this stage observable in the functions of the
little sufferer; except a general air of languor and weakness. The
appetite and the muscular activity continue, but are somewhat reduced;
not sufficiently, however, to disable the child from attending school,
taking the air, or continuing his ordinary practices. In this state, no
symptoms of irritation have been at all discovered. The skin is cool
during the day, no pain is complained of; and no account has ever been
given me of any nocturnal paroxysm of fever. It would appear to be
purely a state of asthenia. We are, however, by no means certain, that
there was no concealed irritation in the system. We were, of necessity,
obliged to depend, in a great measure, upon the reports of nurses, and
other females; and these were liable to overlook, or mistake for mere
weakness, the signs of an obscure disease. In this manner, commencing
cases were frequently not discovered, and nothing was done, till the
affection had made further progress; and this continued until the
ascertained existence of the epidemic in the house, combined with the
recollection of its former ravages, had excited an alarm, which led to
the inspection of the mouths of all the children in the institution.
The disease, in this form, must be within the curative powers of nature;
as, if this were not the case, we should hear of more numerous
unfavourable terminations. It has seldom, however, if at all, been
within my power to witness this tendency; and, when not controlled by a
particular treatment, the cases have almost always either remained
stationary, or increased in severity. Its first progress is, most
generally, by extending to the edges of the gums round other teeth;
frequently affecting a large portion of the dental arches. A very early
progress is, however, mostly effected, down the length of the tooth, in
the direction of the socket; and, in this way, the disease commits great
and unsuspected ravages. When it reaches the edges of the bony socket,
the tooth begins to be loose, and when drawn, exhibits portions of the
fang, including parts which had been contained within the alveolus,
entirely denuded of their periosteum. Indeed, from observation, I should
say, that the latter membrane was the part, which was the most
peculiarly liable to injury and death from this disease; and it is by no
means clear, to my apprehension, that this is not frequently the
commencement of the complaint. The injury generally proceeds with
augmenting rapidity; especially when it has affected the deeper parts:
and it is while in the act of rapidly spreading, that it occasions
gangrene.
In the production of gangrenous sloughs, it much resembles the
descriptions usually given of sloughing ulcers. A portion of the parts
immediately subjacent to the ulcer loses its life; this rapidly
separates; and, before or after a complete removal, a fresh slough is
formed in the same manner. The sloughs are generally black, with
ash-coloured edges. I have not been able to discern a change of colour,
the production of vesicles, or any material tumefaction, as antecedent
to the gangrene. There is generally, by this time, an increased heat in
the parts; with the sensation termed "calor mordens." The discharge now,
for the first time, becomes acrimonious; giving pain when it comes in
contact with cuts in the finger; and excoriations are produced on all
parts in contact with the sloughing ulcerations; as the lips, the
cheeks, the tongue, and the adjoining surface of the part where the
ulcer is situated.
As soon as the external gangrene has reached the level of the edge of
the bony socket, and frequently much sooner, the adjacent portion of the
latter is found deprived of its life; forming a necrosis. The death of
the periosteum in the socket, at least that of the fang of the tooth,
precedes, by some interval of time, that of any portion of the bone
itself.
When gangrene is formed, a fever of irritation is generally developed.
In regard to the time at which this takes place, there is a great
diversity in different constitutions. It has appeared to me to depend,
principally, upon the inflammation of the mouth, which is secondary to
the original disease, and, in most cases, to arise from the acrimony of
the discharge. It is aggravated by loss of rest, want of nourishment,
and, probably, by putrid matter finding its way into the stomach. To the
latter cause I also refer a diarrhoea, which almost uniformly comes
on, towards the close.
There are accounts of a similar disease having begun on the inside of
the cheeks. I have, however, never seen a well-marked instance of this;
the cases which were supposed to be such having, in every instance, been
also found to exhibit ulcerations at the edges of the gums. That the
disease spreads from the gums to the cheek, is a fact which have often
seen exemplified. It is, indeed, the most usual termination of bad
cases. After producing gangrene and necrosis in the gums and alveoli,
and after the discharge becomes, as above stated, acrimonious, a
gangrenous spot is not unfrequently found about the opening of the
Stenonian duct, on the inside of the upper or lower lip, opposite the
incisors, in some other part of the inside of the lip or cheek, or in
more than one of these situations at the same time. Whether this be
owing to excoriation from the discharge, or to some other cause, I
cannot say; it has, however, in every instance which I have seen
sufficiently early to witness its rise, been subsequent to the symptoms
previously described.
When the gangrene reaches the cheek or lip, however, very active
inflammatory symptoms are uniformly developed. In the cellular substance
of these parts, they assume the well known characters which have been
attributed to the _phlegmonous_ species. We have a great thickening,
forming, in the cheek, a large, rounded, prominent tumour, with great
heat and pain. Sometimes redness is perceived externally; but, more
frequently, the great distension of the skin of the cheek seems to empty
the cutaneous vessels; giving to the part, a smooth, polished, dense,
white appearance, very much resembling the effect of a violent
salivation. I have no doubt that this is the tumour described by
POUPART, and alluded to in an earlier part of this paper. Great
thickness and hardness have always occurred, in the other situations
where this gangrene has approached the external cellular masses of the
face; in the lip, however, they are less remarkable, perhaps from the
smaller amount of cellular matter. After reaching this stage, a black
spot is frequently seen on the outer surface of the swelling. This
spreads rapidly; and has always been, in my own experience, the
immediate harbinger of death. It is proper to state, however, that I
have heard it said, that cases had recovered in this city, in which the
gangrene had produced a hole through the cheek. Under what physician's
care this occurred, I have never learned.
In two cases it commenced in the fauces; and was marked by the same
unsuspected progress. In one of these, the little patient was remarked
to be languid, but had no positive external marks of disease. The mouth
was examined, and found healthy; but no suspicion of the real situation
of the disease was entertained, till after 3 or 4 days more, when he
complained of a slight sore throat. A large gangrene of the tonsils,
half-arches and pharynx, was now found; and the event need hardly be
told.
The closing stage of this affection is marked by large gangrenous
patches in the gums; deep fissures between these and the teeth; the
latter loose, or falling out; large pieces of the alveolar processes,
often containing the roots of several teeth, in a state of entire
necrosis; the whole lining membrane of the mouth suffering a violent
excoriation; the whole adjacent external cellular substance, hard and
swelled; large gangrenous spots in the inside of the cheek or lips,
occasionally extending quite through to the outer surface; a total
incapability to sleep, or to take the least food; fever; a swelled
abdomen, and diarrhoea.
_Dissection._--The inspection of the body after death had never thrown
much light upon this obscure affection. Since I began to prepare
materials for this paper, I have been able to dissect but one subject.
The appearances were as follow:
_Exterior_, emaciated.
_Alimentary canal_, externally and internally, altogether in a natural
state, except what appeared to me to be owing to the subsidence of blood
to depending portions of the intestines. The mucous membrane was
carefully examined throughout its whole length; but not being at that
time aware of the importance, attached, by some pathologists, to small
rednesses in this organ, it is highly probable that some such may have
been overlooked.
_Liver and Spleen_, enlarged, but of a natural appearance.
_Heart, thoracic oesophagus, and one kidney_, (the other not
examined,) natural.