that almost every one believes in it, to a greater or less extent,
appears undeniable; but there, as well as here, most of the more
rational, and moderate minded men are evidently of the only school a
physician ought to belong to, the _eclectic_. Borrowing largely from
BROUSSAIS, and having had their minds powerfully stimulated by the
succession of striking and novel ideas which he has introduced, they
think it unmanly to "bind themselves to his chariot-wheel," but form
conclusions for themselves from every resource within their power. If
the great French reformer really wishes to establish as absolute a power
over the minds of his followers, as MAHOMET or PYTHAGORAS did, and as
the above-quoted extract seems pretty fairly to indicate, he must
certainly undergo many mortifications. Notwithstanding the
"inebranlable" nature of his dogmas, M. MIQUEL has furnished us with
several variations from them, in the writings of Messrs. BOISSEAU,
ROCHE, SANSON, REMUSAT, RICHOND, and BEGIN; and the last-named
individual has had a public dispute with his preceptor.
M. BEGIN has produced his promised work on surgery, according to the
principles of the new school. We have not seen the volume, but have read
a review of it in the Revue Medicale, by M. BELLANGER. The latter
describes it as a cursory work, having for its object the adaptation of
surgery to a set of general principles, rather than a detailed system
of instructions how to proceed in each individual case. It contains only
what is easy to be remembered, and omits those matters for which it is
usual to refer to books. Thus two pages only are appropriated to
fractures of the body and neck of the femur! and twenty-six for the
whole subject of fractures, wounds, and six or eight of the most
important diseases, of bones! Yet all this criticism is not without a
compliment, well-merited at least by the former productions of the same
author, to his talents and ingenuity.
19. _Whooping-cough._--"There is no disease of children, in which the
resources of medicine are more manifestly serviceable than in an
obstinate whooping-cough." Such, in amount, was the opinion of Dr.
UNDERWOOD, and Dr. WATT uses language almost equally strong. Certainly,
we are not at all times equally successful or equally sanguine in
America.
Dr. A. CAVENNE considers whooping-cough a true bronchitis, a pulmonary
catarrh; accompanied with greatly heightened nervous symptoms, owing to
the irritable period of life at which it occurs, and particularly to its
frequent existence in nervous constitutions. Professor TOURTELLE calls
it a pneumo-gastric, pituitous catarrh; and certainly, the pupils of a
modern school will find no difficulty in recognizing symptoms of
gastritis in its severer forms. The further inferences drawn by Dr.
CAVENNE, are as follows:
1. That the whooping-cough, in an individual of a sanguine temperament,
requires, in general, the use of bleeding, and a debilitating regimen.
2. That bleeding and a debilitating treatment are equally necessary,
whatever be the temperament, in whooping-cough of the chronic form.
3. The antispasmodics are necessary in nervous constitutions.
4. That blood-letting and the debilitating treatment should be rejected,
when the subject is endowed with a lymphatic temperament. This
observation, says our author, is equally applicable to early infancy, in
which lymph predominates over the red blood, and the fluids are more
diluted.
Finally, if the disease be obstinate and there be disturbance in several
functions, there is certainly reason to believe that a lung, a viscus of
the abdomen, or the brain, is in an unfavourable condition; (the author
means of the inflammatory kind;) and this is ground for the moderate
abstraction of blood.--_Journ. Univ. Feb._
20. _Antiperistaltic globus. Globus hystericus._--Dr. TROLLIET, of
Lyons, observes that hysteria cannot, with propriety, be said to exist
in the male sex; that it arises, as its name imports, from derangement
of the uterus, and that CULLEN and SYDENHAM have done wrong, and stand
alone, in teaching the contrary. When there exists a real hysteria, the
contractions are not confined to the intestinal regions, but invade the
neighbouring parts; (quere, which of them contract?) they are always
accompanied, when existing in a high degree, with convulsions and loss
of the mental powers. In the intervals, the patients affected can
satisfy their appetite.
Antiperistaltic globus may occur from various causes; and either in the
intestines or the oesophagus.
That of the intestines is met with chiefly in advancing age; and is
generally produced by daily and often-repeated pressure on the abdomen,
as practised in various professions. Hard labour and bad diet also
greatly aggravate it. At first pain in the intestines occurs, aggravated
by labour; together with derangement of digestion.
The sensation of a globe then appears on the lower and left side of the
abdomen; and, after performing various circuits, finally reaches the
stomach; from which is soon after discharged, with great relief, a
quantity of gas, issuing from the mouth. Vomiting of an acid and burning
fluid, as also of the food, is not uncommon as an accompaniment. This
ball is about the size of a man's fist, and is sensible to the external
touch, and even to the sight. The patients possess the power, to a
certain extent, of controlling its motions, and relieving the pain,
which is often extremely violent, by pressure.
Indigestible food always aggravated the disease. Some could only
tolerate milk, broth, and other fluids. A weaver was obliged to quit his
profession, from the pressure on the abdomen which it required,
occasioning the paroxysms.
The treatment consisted in
1. Avoiding the original causes.
2. The use of a species of corslet, (plastron,) to prevent future
pressure on the abdomen.
3. A rigid diet. We do not understand why, firstly, articles containing
a great deal of fecula, and, as it is said, "requiring a great action of
the intestines," are forbidden, while, in the second place, rice is
recommended. "Bouillon aux herbes," (a laxative decoction,) rice-cream,
and milk, were found the best. Wine was injurious. Assafoetida and
camphor were useful, and were administered in boluses. Purgatives were
injurious. Emolient enemas were useful.
Of antiperistaltic globus in the oesophagus our author saw only two
cases, which were not complicated with hysteria. The patients had both
been subject to rheumatism; and, in one of them, this had been
supplanted by an eruption Of tetter: on the disappearance of which last
the globus appeared. These cases were cured, the latter by a severe,
light diet, and some antispasmodics, the names of which are not
mentioned; the other by curing the rheumatism.
Dissections are somewhat difficult to obtain; unless where some other
more mortal disease exists. In one, scirrhus of the pylorus was found;
the stomach greatly enlarged; the small intestines contracted, _red
outside and gray within_. (Where was the redness situated; in the
peritoneal or the muscular coat? We must _guess_ the latter.) The
stomach was pale gray, and thickened. The large intestines were dilated,
and gray.--_Journ. Univ._
21. _Non-contagion of Yellow Fever._--Dr. VALENTINE, of Nancy, has
printed a pamphlet of a single sheet, in which he finds himself involved
in all the turmoil, through which American physicians passed during the
period which intervened between 1793 and 1805. Dr. V. gives his
authority decidedly in favour of the non-existence of a contagion in
this disease; and grounds his opinion upon the innumerable cases of
patients affected with the disease and otherwise, who have escaped from
infected districts, without communicating the malady in any instance, to
the persons with whom they lived; upon the healthiness of ports, from
which it has been said to have been introduced, &c. Dr. V. is not, as
some of his countrymen have been, unwilling, from some unimaginable
cause, to make use of the immense mass of American evidence; though he
observes, and with justice, that experiments should be repeated in
France, in order to set the public mind at rest in that kingdom. He
proposes the employment of criminals for this purpose; and recommends
every mode of the most close contact which his imagination could
suggest. He mentions experiments of this kind having been made in the
United States; and by M. GUYON, of Martinique, on his own person.
He quotes Dr. CHERVIN's labours, with great and just applause. This
indefatigable and daring physician has now spent upwards of ten years in
accumulating proofs upon this single question.
At the commencement of the pamphlet, the arrangement of which does not
seem to us to be quite clear and easy, Dr. V. gives a sketch of the
situation and localities of Leghorn. He traces the fevers of that place
to putrid matters, perceptible by the sense of smell; and principally to
obstructed drains. He does not give the exact degree of heat, but merely
states that it was excessive, and followed by heavy rains.
IV. THERAPEUTICS, MATERIA MEDICA, AND THE PRACTICE OF MEDICINE.
22. _Iodine._--In the former numbers of this journal, we offered some
observations respecting the medicinal properties of iodine, intending
then to present in one of our future numbers an elaborate analysis of a
valuable work on this subject, by Dr. Manson, which appeared in England
sometime last year.[32] Fearing, however, that the want of room and time
will prevent us from fulfilling this task, as soon as soon as might be
desired, we have thought that a condensed notice of its contents would
be acceptable in this place.
It appears that previously to the discovery of iodine as a medicinal
agent, our author used the burnt sponge in bronchocele, a disease very
common in the neighbourhood of Nottingham, where he practices. But when
the effects of the former remedy was announced, Dr. M. prepared a
tincture composed of one drachm of iodine to two ounces and a half of
rectified spirit, (spec. grav. 916.) and prescribed it very extensively
in doses of from 10 to 30 drops three times a day, according to the age
and strength of the patient. Dr. MANSON has presented a tabular view of
116 cases of bronchocele treated by iodine, and also a detailed account
of 15 more cases, with appropriate remarks. Of the former, there were,
viz:--
Males--Cured, 10
Much relieved, 1
Discharged for non-attendance, 1
Improving under treatment, 3--Total 15
Females--Cured, 66
Much relieved, 9
Not relieved, 2
Discharged for non-attendance, 10
Improving under treatment, 14--101--116
Whilst using the tincture internally, Dr. MANSON occasionally had
recourse externally to a liniment composed of
Liniment. Sap. Comp. [Symbol: ounce]i
Tinct. Iodinae, [symbol: dram]i _m._
Some patients can bear this quantity rubbed into the tumour once, and
sometimes twice a day; though in some, the skin is so tender, that the
liniment cannot be so frequently used. Dr. M. prefers this liniment to
the common iodine ointment, as less liable to evaporation. In France, we
believe Dr. RICHOND prefers rubbing in the tincture itself. The
following remarks are useful:
"In some _individuals_, after the preparations of iodine have been given
internally for some time, they are apt to occasion headach, giddiness,
sickness of stomach, with some degree of nausea, langour, and inaptitude
for exertion; when these unpleasant sensations and effects occur, the
best plan to remove or obviate them is to suspend, for a time, the use
of the medicine, or to reduce the dose, as may seem most expedient." A
reduction of dose, from fifteen to twelve drops, was the plan adopted by
our author on this occasion.
2d. _Paralysis._--Want of success with the ordinary modes of treating
this disease, induced Dr. MANSON to try the effects of iodine.
"The wonderful powers of iodine, which I had recently witnessed; and a
long previous acquaintance with the same remedy as it exists in burnt
sponge, in reducing morbid enlargements of the thyroid gland, led me
from analogy, to think, that in cases of palsy, from tumours or fluids
pressing on the brain or spinal cord, or from morbid thickening of the
investing membrane of the cord itself, iodine might prove a useful
remedy not only by stimulating the nervous system, and removing morbid
tumefaction and effusion, but also by correcting the strumous state of
the constitution that often gives rise to the disease."
The following interesting case as abridged in the Medico-Chirurgical
Review, for January 1826, we take the liberty to transcribe.
"J. Watterton, aged 19, was admitted into the General Hospital of
Nottingham, on the 27th of March, 1821, having been ailing since
October, 1819. Stated that he had at first been attacked with pain in
the bowels, which having ceased, the lower extremities became swelled
and painful.
"After this, his neck became stiff and painful, with shooting pains from
the neck into the left side of the head. These also disappeared, and did
not afterwards return. This was about nine months ago, and, at that
time, he suddenly lost the power of the left arm, and in a short time
afterwards, that of the left lower extremity. Some time after this, he
recovered, partially, the use of the left arm; the leg remaining
paralytic. About this time, the _right_ half of the body was
instantaneously and completely palsied. He has continued ever since in
this wretched state, getting worse rather than better, passing his
stools and urine, involuntarily. He lies on his back, and, with the
exception of the left arm, he is completely paralytic on both sides,
from the neck downwards. The sense of feeling is very much
impaired--there is no distortion of the face, nor impediment of
speech. Is troubled with twitchings in the lower extremities.
_Purgatives--blisters to the nape of the neck, and to be kept open._
"It appears that, about two years ago, he had a bloody purulent
discharge from both ears. The left still continues to discharge a
purulent looking matter. Purgatives were continued till the 6th of
April, when the tincture of iodine, in doses of 15 drops, was given
thrice a day. April 9, can raise the right arm nearly to the head; but
the power of the lower limbs has not improved. The twitchings have
decreased. Purgatives--the tincture of iodine to be increased to 20
drops ter in die. 10th. Evinces some muscular power in the lower
extremities to day--feels stronger--can retain his urine for some time.
14th. Continues to improve. The left foot is become exquisitely
sensible, and that extremity is often drawn up spasmodically towards the
body. The iodine to be increased to 25 drops. 16th. The paralytic
symptoms continue to yield to the powerful influence of the iodine. When
his meat is cut, he can now feed himself with the left hand;--can raise
the right hand to the chin, and draw the right upper extremity up
towards the body. He continues to hold his water. The iodine is
increased to 30 drops, thrice a day--from this date to the 7th of May,
the medicine was occasionally obliged to be intermitted and again
commenced in smaller doses. At this period, however, the patient could
walk from his bed room to the day ward with very little assistance.
19th. He can walk without any assistance, except that of a stick to
steady him. June 9th, can walk without a stick. He is gradually
recovering the power of motion and sense of feeling. Drops agree.
Appetite good, and is allowed full diet. July 3d, the patient was
discharged cured."
Besides this highly interesting case, 24 more of paraplegia, hemiplegia,
and partial paralysis, are given in detail, in which the iodine was
exhibited with various success. In his prefatory remarks to this
chapter, Dr. MANSON observes, that although he has been able to cure
only a proportion of the cases of palsy that have come under his care
since April 1821, yet he has been much more successful in his practice
since that time, than he was previously with the use of all the ordinary
means.
Having succeeded so well in paralysis, Dr. MANSON was induced to try the
effects of iodine in chorea, which he thinks is more closely allied to
palsy than is supposed, and is linked to it by that species of the
disease called shaking palsy. Of chorea treated with iodine, and showing
the efficacy of the remedy, Dr. MANSON details eleven cases, and
concludes this section with a tabular view of 72 cases treated at the
General Hospital near Nottingham, between the 6th of October, 1812, and
the 5th of October, 1824. In all the cases detailed by our author, the
iodine was administered after purgatives, and throughout the treatment,
the bowels were carefully regulated by aperient medicines.
Dr. MANSON next records the results of his experience with iodine in
scrofula--detailing three cases of scrofulous enlargement of the
conglobate glands--two of scrofulous ulcers, and four of scrofulous
ophthalmia; in all of which, the most beneficial effects were obtained.
Our author details eleven cases of fistula lachrymalis, in which iodine
produced the happiest results. He was led to prescribe iodine in this
disease from the circumstance, that one of the individuals to whom he
gave it for paralysis, laboured under the fistula, and was promptly
relieved of it, whilst under the use of the remedy.
Dr. MANSON has likewise detailed nine cases of deafness cured, or
greatly relieved, by iodine. In most of these cases, the disease
originated from obstruction of the Eustachian tube, the consequence of
swelling of the tonsils, or of the membrane of the tube itself, from
previous inflammation.
Seven cases of dysphagia, eleven of white swelling, four of morbus
coxarius, and eleven of distortion, form the subjects of the four
succeeding sections. The medicine in all these cases, manifested so very
decided a power in arresting the progress, and even in curing the
disease, that we think ourselves safe in recommending a trial of it in
similar cases. As the iodine, however, is a powerful stimulant, we would
advise it not to be prescribed when there exists any fever, and
especially when there are any decided signs of gastric irritation, as it
would be likely to aggravate it.
23. _Non-mercurial treatment of Syphilis._--In the first number of this
Journal, we inserted an essay on this subject, by Dr. THOMAS HARRIS, of
this city, in which the author confirms, by the results of his public
and private practice, the statements of the British army surgeons
respecting the efficacy and safety of the non-mercurial treatment.
Since that period, having noticed that, by the worthy editor of a
respected cotemporary, it is asserted that though mercury fails, "yet
from the most ample experience in Europe, the present practice of Paris,
England, Ireland, and the Continent generally, we must lean to the idea,
that its use, under proper regulations, must be always adopted, as the
only safe mode of cure in these diseases," we deem it but justice
towards Dr. H. to call the attention of our readers to the result of the
extensive experience of some physicians on the continent of Europe. Not
to mention BROUSSAIS himself, who appears to have rejected mercury
almost entirely in the treatment of primary or secondary symptoms, we
may cite Mr. RICHOND, who reports that he treated, at the military
hospital of Strasburgh, nearly 3000 cases of syphilis in all its grades,
the vast majority of which were completely cured without mercury, and
simply by means of antiphlogistics, emollients, and revulsives. Mr.
RICHOND, besides some essays in the Archives Medicales, and a summary of
his experience in the preface to his work on apoplexy, has lately
published an elaborate work on the subject. In the October number of the
Annales de la Medecine Physiologique, Mr. BECQUART of the military
hospital of Bayonne, details twenty-six cases of gonorrhoea,
inflammation of the testicles, chancres on the glans and lips, buboes,
excrescences around the anus, &c., all of which were cured without
mercury, and with the same remedies as were employed by Mr. RICHOND. We
might adduce the testimony of other French physicians, and particularly
of M. BEGIN, but we deem it unnecessary, as the above will be sufficient
to show that in France the practice meets with the support of many very
intelligent physicians. We annex the conclusions of Dr. OTTO of
Copenhagen, drawn from an extended personal experience, and from his
researches on the subject. Dr. OTTO'S essay is contained in a late
number of Graafe's and Walther's Journal, and the conclusions are
published in the Edinburgh Medical and Surgical Journal. Dr. O. remarks:
1. That the cure of syphilis, without mercury, has been asserted by so
many authorities, that the fact can no longer be doubted. If, then, the
disease could formerly be cured without mercury, it may certainly now be
much easier, as it has lost much of its violence and obstinacy.
2. Syphilis can undoubtedly be radically cured in this manner; but then
the cure is of longer duration, and the diet requires considerable
restriction.
3. The secondary symptoms, and a return of the complaint, are certainly
more frequent; but the symptoms are not so difficult of removal; and the
treatment has a much more speedy effect.
4. As the treatment without mercury requires a longer time, it appears
more practicable in hospital than in private practice; and on the other
hand, the patient can be better watched in a hospital, which, on account
of the diet, is of great importance.
5. As ulcers on the genitals are often not syphilitic, and the use of
mercury is contraindicated from a predisposition to scrofula or phthisis
existing in the individual, it is consolatory to learn from the results
of experience, that this medicine is not always necessary, and that a
radical cure, by more simple and innocent means, can sometimes be
effected. Where, however, the physician is anxious to avoid the possible
evils which mercury is capable of producing, and also to prevent loss of
time, there remains a middle way, namely, to employ mercury, whose
specific action can scarcely be denied, in moderate doses.
It results from a report of the cases of syphilis admitted into the
public institutions of Sweden, that 3,574 were treated in 1822; 3,465 in
1823, and 3,355 in 1824. During the course of this last year, 55-3/10
per centum of all the patients were treated by the mercurial method, and
35-1/10 per centum by the non-mercurial method, and by low diet; 2-1/2
per centum by means of fumigations. MM. KESSLER, WURSTER, RONBERG, and
SANDMARK, prefer the dietetic method, and consider it as the surest of
all those hitherto employed. Relapses are rare. In 1822 they amounted in
relation to the whole number of cases, to 11-2/3 per centum; in 1823 to
10-1/4, and in 1824 to 10-2/3. After the treatment by starvation, they
amounted in 1822 to 7-3/4 per centum; to 7-1/3 in 1823; and to 8-1/3 in
1824. After the mercurial treatment, in 1822 to 17-1/2 per centum; in
1823 to 14-1/16; and in 1824 to 14-1/2. _Bulletin des Sci. Med._
We hope to lay before our readers at some future period, an analysis of
Mr. RICHOND's work above alluded to, as well as of one on the same
subject by Mr. JOURDAN of Paris, author of some essays on the origin of
syphilis, translated and published here a few years ago.
24. _Cancer treated by Antiphlogistics._--Of all diseases classed among
the opprobria medicorum, cancer has hitherto been justly viewed as
holding the most conspicuous rank, and it is only within a short time,
that it appears to have been treated on correct principles, and that
cures have been detailed by individuals of undoubted veracity. The idea
of the inflammatory nature of cancer, and of the propriety of treating
it by means of antiphlogistics, has been held many years ago, and
supported by VASALVA in Italy, FEARON in England, HUFELAND in Germany,
POUTEAU and VACHER in France, not to mention other high authorities.
But, notwithstanding the success attending this practice, it was too
simple for the supporters of cancerous humours and specific
inflammations, and seemed, in consequence, to have been abandoned by
them, in their search after anti-cancerous or specific remedies; and
little was heard of it, until revived by the disciples of the
physiological school of France, and particularly by its founder
professor BROUSSAIS, and by professor LALLEMAND of Montpellier, the
result of whose experience is published in a thesis, lately defended at
Montpellier by Dr. MARESCHEL.