been in use as a remedy for taenia. The Carey Street Report for Feb.
1810, informs us, that a mechanic in Durham, having been very successful
in the treatment of taenia by means of this article, the circumstance was
communicated by Dr. SOUTHEY, of that place, to Dr. LAIRD of London; and
it was accordingly prescribed in doses of [Symbol: ounce]ss. to [Symbol:
ounce]ij. at several of the London charities. It had been found, says
the report, that ol. tereb. might be thus given, as safely as so much
gin, and frequently caused the expulsion in two hours: Dr. KNOX says it
has been in use in Germany for fifty years for the expulsion of taenia.
The experience of Dr. KNOX, concerning taenia, at the Cape of Good Hope,
is the most extraordinary that we are acquainted with. Dr. SPARMAN, the
traveller, had observed, that worms were exceedingly common in the
northern parts of the colony; but Dr. KNOX, who was there in 1819, did
not notice any special prevalence of verminous disorders, "previous to
Oct. 1819, when the _tape worm became so general among the troops, as to
resemble an epidemic_."[19]
Most of these troops had been employed on a short campaign to the east
of the great fish river. They had been compelled to live on very bad
beef and mutton, driven and starved half to death; and Dr. KNOX thinks
he has proved, that the taenia in these cases did "arise from the use of
unwholesome animal food; from the flesh of animals, which had been
diseased." Two out of five of the troops, who had been thus employed and
fed, were affected with worms. Of a detachment of 86 vigorous, healthy
young men, 36 were found, on inquiry, to have _tape_ worm. Those who
remained in the colony did not suffer so much, as those who had been out
on the campaign, the ratio being as one to four; whereas of the others,
it was two to five. Dr. KNOX had ample experience of the utility of
turpentine during this singular prevalence of taenia. Concerning the 36
men above mentioned, he says, "the cure of all, who chose to adopt the
means, was easily effected by small doses of the spts. of turpentine,
after the failure of purgatives and various other remedies."
He considers ol. tereb. as the _most efficacious remedy_. He does not
approve of large doses, because of headach, vertigo, and delirium, which
have been produced by them in "many patients."
"I have generally found," says he, "that from one to two drachms of ol.
tereb., given in a little water, morning and evening, for three
successive days, were sufficient to destroy the taenia solium, (even in
the most obstinate cases,) and cause it to leave the intestines, without
the aid of any purgative medicine." He advises, however, to give a
little castor oil each day about noon.
It has been a very common observation in regard to the dose of
turpentine, that the patient suffers more cephalic distress when it is
given in small quantity, than in a large dose. The writer of this has
been obliged to desist from the exhibition of oil turpentine, in doses
of [Symbol: dram]ij twice a day, in consequence of a vertigo so
considerable, as to alarm and distress his patient very much. Perhaps
there might have been in this case some peculiar liability to nervous
excitation, which in another patient would not have been worthy of much
notice. Dr. KNOX'S opinion is of great weight.
The celebrated remedy of CHABERT, Dr. KNOX thinks, owes its efficacy to
the ol. terebinth. combined with it.
Dr. FRANK, whose name stands at the head of this article, was informed
by the celebrated helminthologist, Dr. BREMSER, at Vienna, in 1814, that
he had for ten years preferred the use of CHABERT'S remedy, and with
invariable success.
CHABERT was a veterinary surgeon of Alfort, who used the animal oil of
Dippel in many diseases of animals, as well as those of men. This oil he
often gave for the purpose of removing taenia in his animals. He often
combined it with spt. terebinth. and gave equal parts of these
substances, in doses of [Symbol: dram]i.[20] The London Medical
Repository states, that CHABERT'S remedy is prepared from
Ol. Corn. Cerv. Foetid. 1 part.
Ol. Terebinth, 3 parts.
These are well mixed, and left at rest four days; they are then
distilled in a sand bath, till three-fourths of the liquor has passed
over. It must be kept tightly stopped, out of the light.[21]
The great objection to CHABERT'S remedy is its disgusting flavour; which
is the more obnoxious, because the remedy must be continued for a length
of time. Dr. FRANK cured two persons affected with taenia solium, after
considerable perseverance with it: he cured two other persons with a
preparation as follows:
Ol. Terebinth. [Symbol: ounce]ss
Aether Sulphuric. [Symbol: dram]ij
Pulv. G. Arab. [Symbol: ounce]ss
Aq. Flor. Chamam. distil. [Symbol: ounce]xvj _m._
Two spoonfuls morning and evening.
Four of these mixtures were sufficient to cure the patients, who
remained well two years afterwards.
A fifth patient, unable to take the last named medicines, was cured by
the boluses subjoined:
Sem. Santonic. pulv. [Symbol: ounce]ss
Pulv. Jalap.
Ferri Sulphat. aa [Symbol: dram]i
Ol. Corn. Cervi, gtt. viij.
Syrup. q.s.
Make 20 boluses.
One to be taken morning and evening. These 20 boluses being repeated
three times, the patient found himself perfectly well. In the above 5
cases, the taenia was discharged in fragments.
Dr. FRANK does not say much concerning the bark of pomegranate root,
which has come into vogue lately as a remedy for taenia. He refers to the
Med. Chirurg. Transact. Vol. XII. for accounts by some English
physicians, and remarks, that Dr. GOMEZ, the Portuguese physician, had
cured 14 cases with this bark.
Dr. POLLOCK (vide Ed. Med. and Surg. Journal, Oct. 1819) treated a
child, aged 14 months, with the decoction of bark of pomegranate root,
so far back as the year 1811. This infant, under the use of the
medicine, discharged at several times upwards of 30 feet of taenia
solium, and was cured. We learn also from the Med. Repository,[22] that
MM. DESLANDES, SOURYA, and BOURGEOISE, have employed pomegranate with
great success; that the decoction generally expelled the worm in two
hours; that it sometimes occasioned vomiting and griping pains; and that
it has been a common remedy for tape worm, in the East Indies, and among
the blacks of St. Domingo.
From the same source we are informed, that the French pharmaceutists
recommend, before boiling the bark, that it should be allowed to swell
(macerate) in cold water. [Symbol: ounce]ij of bark should be boiled in
lbij of water to [Symbol: ounce]xii. Of this decoction, [Symbol:
ounce]ij may be taken every half hour. The worm is here said to be
passed often in twelve hours instead of two. It may be necessary to
continue this plan four or five days, taking care to suspend the
medicine, in case any vertigo, or intestinal disease supervenes. A dose
of castor oil is recommended after the 4th bottle; even though the worm
be happily for the patient expelled.
In the Revue Medicale is a case, in which pomegranate succeeded in
discharging three ells of taenia; but the patient broke off the worm in
attempting to extract it with too much violence. This circumstance
recalls us to the consideration of Dr. FRANK'S communication. He
recommends much caution in the extraction of those portions of taenia,
which have remained partly in the intestine; and says that Dr. CAGNOLA
proposed touching the extruded portion with prussic acid, in hopes of
killing the whole animal by means of this violent poison. Dr. GARLEKE
adopted this plan on an extruded portion of four inches in length, and
in one hour afterwards the _whole animal came away dead_. Dr. F.
suggests, that the electric shock might weaken the taenia, so as to cause
it to let go its hold, and thus be unresistingly extracted. BRERA
recommended that the worm should be tied with a piece of silk. In this
manner, it is retracted into the bowel, but begins to descend again not
long afterwards. He dissuades from any attempt at forcible extraction,
which excites the most distressing sensations in the bowels, and causes
the risk of bringing on convulsions.
We are informed by Dr. FRANK, that a surgeon of St. Petersburg succeeded
by passing the worm through a canula, and the canula through the
sphincter ani muscle, so as to obviate the resistance caused by its
contraction. In this manner, he easily succeeded in withdrawing the
taenia _whole_, which is always desirable.
The writer of this article succeeded in removing many pieces of taenia
from a female, by means of the tincture of black hellebore, given in
doses of a teaspoonful for another object. The patient has since been
affected with the same symptoms, and took to-day, Oct. 19th, in doses of
[Symbol: ounce]iss, repeated every hour, sixteen ounces of a decoction
of the rind of pomegranate fruit, (none of the cort. rad. being
procurable); after which she took a dose of castor oil. It is said, we
know not on what authority, in a French journal, that this preparation
possesses the same powers as the root. It may be so; but this patient
had no discharge of the tape worm, after swallowing the whole of this
very astringent decoction, and following up the plan by taking [Symbol:
ounce]iij of ol. ricini.
Perhaps the taenia had been effectually destroyed before. She has seen
none of the joints for 18 months. The accounts, however, of the
expulsion of taenia by the bark of the root, are so encouraging, that we
have much pleasure in recommending it to the notice of the medical
public in this country.
FOOTNOTES:
[18] Ed. Med. and Surg. Jour.
[19] Ed. Med. and Surg. Jour. July, 1821.
[20] Dict. des Sciences Medicales.
[21] There can be no particular benefit derived from the distillation.
The simple mixture of the materials, above indicated, is all that is
necessary. CHABERT'S remedy is therefore easily prepared.
[22] Lond. Med. Repos. April, 1825.
ARTICLE 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. London, 1824,
pp. 146, 8vo.
Dr. BLUNDELL is the author of some celebrated experiments on the
physiology of generation, and the transfusion of blood. The work at
present under consideration consists of physiological observations
and experiments, the substance of a paper read before the
Medico-Chirurgical Society of London, in the year 1823, and not
heretofore published; of experiments on a few controverted points,
respecting the physiology of generation; and lastly, of some remarks on
the operation of transfusion.
The first part seems intended to ascertain what degree of lesion, or
losses by extirpation, the body may sustain without inducing death; and
thus, to open a way for improvements in surgery, by rendering the
surgeon not only more bold and fearless, but more frequently successful
in his attempts to preserve life, or counteract the inconvenient effects
of disease and accidents. We shall make a short analysis of the first
paper.
In four experiments, Dr. B. removed the left kidney of the rabbit, by
incision on the outer edge. Ligatures were applied to prevent bleeding.
Two died; one in 60 hours, the other in 4-1/2 days: both of
inflammation. One recovered, and lived 5 or 6 weeks, and then died. The
4th also recovered, but died in 5 or 6 weeks. On examination, a sac was
found (in place of the kidney) filled with a semi-fluid substance,
resembling custard, p. 4.
In seven rabbits, removed the spleen. One recovered permanently, and one
lived six months. p. 5.
In five rabbits, opened the abdomen, and punctured the fundus of the
bladder with a lancet. Three of them recovered entirely. p. 6.
In two rabbits, cut off one-fourth of the bladder with scissors, having
applied a ligature first. One died in seven months; the other still
lives in good health.
Into the peritoneum of four rabbits, threw [Symbol: ounce]i of human
urine; then washed it out by injecting tepid water. One died of collapse
in less than 24 hours, and two of inflammation, in 60 and 19 hours
respectively. The fourth is now (12 months) in good health. p. 7.
In seven, injected [Symbol: ounce]xi decoct. quercus into the
peritoneum. Only one recovered.
Dr. B.'s inferences from the foregoing experiments are:
1st. "Large apertures into the peritoneum of the rabbit, do not
immediately induce a dangerous prostration, of strength." p. 9.
2ndly. "Large apertures into the peritoneal sac of the rabbit,
are not necessary, nor perhaps generally, productive of fatal
inflammation."
3dly. "In the rabbit, the kidney, the spleen, and a large piece
of the bladder may be extirpated, without necessarily causing
death; though death under the first operation is probable." p.
10.
4thly. "When the abdomen is laid open, and parts are removed
from it in the rabbit, the first danger arises apparently from
collapse; the second from general inflammation; and the last
from chronic disease." (Vide experiments.)
5thly. "The rabbit's abdomen is very tender, probably no less
so than that of man." See exper.
6thly. "Success in abdominal operations on the rabbit,
furnishes a presumption in favour of success in similar
operations on the human abdomen; and, therefore, from these
experiments, we may infer, _presumptively_, that moderate
openings into the human peritoneum will not necessarily, nor
even generally prove fatal from inflammation or otherwise; and
further, that certain viscera or parts of viscera, not
essential to the welfare of our structure, may be removed from
the belly, without necessarily, or even generally, producing
death. The extirpation of the kidney must be highly dangerous;
but there is a presumption in favour of the successful removal
of the spleen, the ovaries, or even of large pieces of the
bladder." p. 11, 12.
Dr. B. having stated the foregoing results and inferences, proceeds by
relating instances of severe injury sustained by the _human_ body,
without being followed by death. These are confirmatory of his
inferences from the experiments on rabbits. The instances given are--an
os uteri torn off; extensive laceration of the uterus and rectum in
labour; four uteri extirpated on account of chronic inversion, (p. 13.)
One of these last under his own care. It was removed by a wire, and came
off in 11 days, without one bad symptom, (p. 14.) Rupture and laceration
of the abdominal coverings, four fingers' breadth, the bowels hanging
out, (p. 14.) Two spleens removed; one in a soldier after the battle of
Dettingen, who recovered without inconvenience afterwards; the other in
a Mexican, whose case is related by Dr. O'BRIEN, in his Inaugural Essay,
Edinb. 1818, (p. 15.) Three cases of rupture of the dropsical ovary. Two
cases of opening into the abdomen, for the extirpation of dropsical
ovaries, (p. 18.) Five cases of laceration of the uterus by natural
efforts. Four of the women died, but in the fifth, Dr. BLUNDELL turned
and delivered, after the child had escaped into the peritoneal sac, and
the woman recovered, (p. 20.) Cesarian operation, three times by friend
of Dr. HAIGHTON; once successfully, (p. 22.)
Dr. B. says, "From these (facts) few as they are, I feel conscious that
no certain inference can yet be drawn; though _presumptive_ inferences
certainly may, and they seem to me to be the following:
"1st. Small wounds, as tapping, hernia, &c. do not induce fatal
peritonitis; and therefore the vulgar opinion that inflammation
in a spot of the peritoneum will almost invariably diffuse
itself over the greater part of it, is probably unfounded.
"2nd. Extensive divisions of the peritoneum are not necessarily
fatal by inflammation or otherwise, and _probably_ not
generally so.
"3d. That the womb, spleen, and ovaries, may be removed in the
mode mentioned, without necessarily, and, _presumptively_,
without generally destroying life.
"4th. That the gravid uterus may be torn open; the child may
escape into the peritoneal sac; the os uteri may be torn off:
not indeed, so far as these cases may be relied on, without
great danger, but twice, in seven instances, without death. p.
28.
"5th. The peritoneum and abdominal viscera will bear more
injury than the British surgeons seem disposed to admit.
"6th. That the above observations on the human abdomen, are in
unison with those drawn from observations on the rabbit; and
that observations made on the brute have more correspondence
with those on the human being, than is generally believed."
Dr. BLUNDELL next remarks, that the facts related create a suspicion
that a bolder abdominal surgery would not be unattended with success,
and recommends the following operations to "_consideration_ merely, and
not to practice, except in otherwise desperate cases."
1st. "When the Cesarian section is performed, divide or remove
a small piece of Fallopian tube, so as to prevent the danger of
reimpregnation, without destroying the sexual propensity. The
need for a second operation might thus be certainly prevented,
without scarcely increasing the danger."
2ndly. "Extirpation of healthy ovaries."
3dly. "The extirpation of the ovarian cyst in scirrhus,
combined with dropsy, or in simple dropsy." He remarks, "This
operation will, I am persuaded, ultimately come into general
use; and if the British surgeons will not patronize and perform
it, the French and American surgeons will." p. 26.
4thly. "The removal of a large circular piece of the cyst in
ovarian dropsy, when the sac itself cannot be extirpated."
5thly. "The removal of the cancerous womb, when the ulceration
first makes its appearance. Might not the womb be taken out
above the symphysis pubis, or through the outlet of the
pelvis?" &c. 27.
6thly. "Extirpation of the puerperal uterus." He suggests the
removal of the whole womb after the Cesarian section, in order
that the smaller might take place of the larger and more
formidable wound through the uterus--but says expressly, "No
operation perhaps can be more unpromising, shall I say more
unjustifiable, in the _present state of our knowledge_; but I
thought it proper to mention it." &c. p. 28.
7thly. "Should the bladder give way into the peritoneum," he
asks, "Why should we not lay open the abdomen, tie up the
bladder, discharge the urine, and wash out the peritoneum
thoroughly, by the injection of warm water?" p. 28.
8thly. - - - - -
9thly. Injection of astringents into the ovarian cyst or
peritoneal sac, unjustifiable.
10thly. "In cases of strongly characterized introsusception,"
why not make an opening into the peritoneum; and "pass the
small intestines, fold by fold, through the fingers." Dr. B.
has repeatedly done this in the dog and rabbit, without
producing death, or extensive and dangerous inflammation.
11thly. In the rabbit, he has tied an abdominal artery, and
carried the end of the ligature with a broad needle out through
the back, opposite to the place of the vessel. This ligature
can come away, and is a better mode than to leave it hanging
out at the abdomen, or entirely among the bowels, where it
forms a sac of puriform matter, and to appearance lays the
foundation of chronic disease. p. 30.
Dr. BLUNDELL closes this paper by saying, that since the substance of it
was read before the Medico-Chirurgical Society in 1823, Dr. RITZIUS, a
Swedish physician, had informed him in London, "that the complete
removal of the cancerous womb had been, to his personal knowledge,
performed on the Continent five times. All the patients recovered from
the operation," &c. "The womb was removed through the outlet of the
pelvis." p. 36.
Since we read Dr. BLUNDELL'S recommendations to the new operations, we
have been astonished to notice in the Ed. Med. and Surg. Journal, July,
1825, that a German surgeon had actually treated a case of ileus in the
manner recommended by Dr. B. It is from Hufeland's Journal of Feb. 1825.
After it was ascertained that an immoveable introsusception existed--
"The patient was placed on a convenient table. We examined
accurately the situation of the hardening, (_which marked the
diseased part_), and determined on opening the abdomen at the
outer edge of the right rectus muscle, about two inches above
the navel. After dividing the integuments with a common
scalpel, and making a small opening in the peritoneum, I
introduced my finger, and with a blunt pointed scalpel divided
the peritoneum, so as to make it correspond with the external
opening, which was between two and three inches. I then
besmeared my hand with oil, and carried it into the abdomen, in
order to feel for the indurated part. Scarcely had I introduced
my hand, than an attack of the pain came on, and a portion of
the intestines was protruded through the wound, which was
immediately replaced by my assistant. On continuing the
examination, I discovered in a transverse portion of the ileum,
a foreign substance, just where the hardened intestine was to
be felt. I drew the intestine out, in order to examine it more
minutely. The intestine was neither inflamed nor expanded, but
it contained in its cavity a soft coherent and compact mass,
which at its upper part was somewhat compressed, and thus felt
harder than the rest. So far as I could follow this part of the
intestine, this contained matter was to be felt: I also here
immediately detected an intus-susception, but in spite of all
my efforts I could not reach the commencement of it, so as to
bring it out. Two modes of proceeding were open to me, in order
to remove the intus-susception; either to make a transverse
incision in the integuments, from the right to the left side,
or to open the intestine itself. The last mode seemed to me the
most adviseable, both because the patient was already very much
exhausted, and because the operation would be sooner completed.
The intestine was opened at the end of the discovered
intus-susceptio, and immediately a part of the strictured
intestine came into view. I introduced my finger into the
opening in the intestine, which was made about two inches in
length, and gradually pushed the intus-suscepted part back from
the right to the left side, whilst I gently drew that part of
the intestine which contained the intus-susceptio towards me.
By this means I fortunately succeeded in unfolding the tangled
intestine, which amounted to two feet in length. There was not
the slightest trace of inflammation, nor any thing unnatural to
be discovered in the part; there was merely a round worm, which
was situated in the upper part of the intus-susceptio. The
intestine was brought together by means of six spiral stitches,
after the manner of the glover's suture, and the end of the
silk was allowed to hang out of the external wound in the
abdomen."
The sutures were removed on the 8th day. On the 14th day, the man was
cured, and continues well up to the date of the account.
ARTICLE 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. _From the second London Edition, published in 1825; with
Notes and Additions_, by S. COLHOUN, M.D. Philadelphia, Towar & Hogan,
1826; pp. 308.
A very acceptable service has been done to the medical profession in
this country, by the present republication of Dr. PROUT'S work on
affections of the urinary organs. The American physician will now have
it in his power, at a reasonable cost, to possess one of the best
treatises on this interesting subject. From the known accuracy of Dr.
PROUT as a chemist, and his reputation as an accurate observer of
nature, much new light was naturally expected as the result of his
observations. Nor indeed have these high expectations been disappointed.
After a careful perusal of his work, we have formed the highest opinion
of his powers, both as an original thinker, and experimental inquirer.
Dr. PROUT begins his treatise with some introductory remarks on the
composition of the urine, and on urinary derangements generally. After
giving a comparative tabular view of the composition of the blood, and
healthy and diseased urine, he proceeds to notice in succession, their
principal constituents. As albuminous urine is of frequent occurrence in
dropsical complaints, and its presence regulates in some degree the
practice proper to be pursued, the following characters, given to it by
Dr. PROUT, should be well understood.