Part 19

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 Médecine 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 Gräafe'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.

We have been led to these reflections from reading the above essay, and another on the same subject, published by Dr. J. A. PUEL, in a late number of the Archives Générales de Medecine. Dr. P. details many cases, which were treated by his father, by means of leeches, emollients, purgatives, &c. so early as 1807. In most of these cases, the practice appears to have been very successful. As it is our wish to impress our readers with the propriety of making a fair trial of this method, in cases of scirrhus and cancer, we shall select and translate a few cases from the latter essay. It is proper to premise, however, that the practice must not be viewed as completely successful in _every_ case, and that the older the complaint, the less confident we ought to be, in respect to the happy results of the case. Nor is it to be expected, that _boldness_ in the employment of the lancet and leeches, will answer as well as a perseverant, constant, but moderate use of these means. Chronic inflammations are not to be removed by storm, but by a _chronic_ use of remedies, and particularly by attention to diet.

We cannot at present determine precisely the proportion of cures effected, by this method, of scirrhus or cancer, in a given number of cases, and how far it will surpass, in point of success, the common method of treatment by _specific_ narcotics and escharotics; but, even supposing that it is not more successful, (which we are disposed to deny,) it has at least the vast advantage of being more _comfortable_, and much less painful to the patient.

Mrs. D. enjoying good health, and mother of three children, was brought to bed in 1823, of a healthy child, which, however, she did not suckle. With a view of suppressing the secretion of milk, irritating applications to the breast were resorted to, which brought on an inflammation of that organ. Emollient poultices were now applied; these, however, did not prevent the formation of an abscess, which was opened by means of caustic potash. The suppuration, for a few days, was abundant and the matter discharged healthy. Purgatives were prescribed, with the view of suppressing the discharge, and mercurial ointment was rubbed on the tumour, to produce its absorption. These remedies were not successful, because no means were employed to arrest the inflammation, which gave rise to the suppuration.

When the patient applied for advice, she had been sick already four months, and presented the following symptoms. She was very much emaciated, and laboured under fever, resulting from a gastro-enteritic inflammation, kept up by purgatives and deostruents, (_fondans_,) which, from the commencement of the attack, were prescribed for her. The ulceration of the mamma was of the size of a five frank piece, unequal and gray, and gave issue to an ichorous and foetid purulent matter. The edges were thick and everted, and surrounded with an erysipelatous inflammation. The whole mamma was large and hard, and the seat of lancinating pain. Thirty-five leeches were applied around the tumour, and gave rise to a profuse hæmorrhage, which continued many hours. From this, the patient experienced so much relief from pain, as to be able to take some repose, of which she had been deprived for some weeks. Emollient poultices and drinks were prescribed, and a low diet enjoined. By all these means, the pain was lessened, and the swelling much diminished. Leeches were again applied, and the other remedies continued. The wound gradually improved, and in forty five days, was completely healed.

Mr. P. was called on the 25th of September, 1817, to attend a lady, who had been affected for two days with uterine hæmorrhage, which he succeeded in arresting. The following history of her complaint was given to him: she had aborted about 18 months before, and since that time, had experienced every fortnight an uterine hæmorrhage, which generally lasted five or six days. During the intervals, she complained of deep seated pain, numbness and cramps, in the lower part of the abdomen, in the thighs and groins. The pain was much aggravated when she had a stool--walking, especially when long continued, was painful, and attended with a sense of dragging, which was only relieved by repose. From the same period, her disposition had changed from gay and lively, to melancholy and morose--her digestive functions were slow and painful--she was affected with leucorrhea, and during coition, felt much pain, and often lost some blood. On examination per vaginam, it was found, that the neck of the uterus was elongated--the anterior lip of the same organ was soft to the feel--the orifice somewhat enlarged, and painful when the finger was introduced into it. On the inferior lip there was a small unequal and painful spot, which was regarded as a superficial ulceration; the uterus was a little prolapsed, and somewhat enlarged; the pulse small and frequent; febrile exacerbations every evening; sleep not refreshing, and interrupted by short lancinating pain in the uterus.

The disease was judged by Mr. P. to be a chronic metrites, with ulceration, and all the symptoms usually attending incipient cancer. Guided by this belief, and notwithstanding the already long duration of the disease, and the debility of the patient, the following treatment was adopted--complete repose in the horizontal posture--leeches to the vulva, repeated several times--vaginal injections, with emollient decoctions--hip baths--very low diet. After persevering in this plan twenty days, the patient appeared much better, and was allowed to sit up. General baths were substituted for the partial ones. The same treatment was continued, with the exception of the leeches, and at the end of thirty days more, all the symptoms of the disease had completely disappeared. Mrs. P. was allowed to spend the following spring in the country, from whence she returned in very excellent health. She has since continued to enjoy it, and has borne several children.

Cases nearly similar, are detailed by Mr. MARESCHAL, as having occurred in the practice of professor LALLEMAND. The same gentleman, also gives the history of two cases of external cancerous sores, in which the same treatment was adopted. The patients having died during the progress of the cure, of other diseases, an opportunity was offered, of examining by dissection, the changes that had occurred in the parts. We cannot enlarge on the subject in this place, and can only remark, that these changes were such, as to lead us to hope, that less difficulty will be experienced in the treatment of sores reputed cancerous, by the local antiphlogistic plan, than is commonly supposed. At any rate, recommended by such high authorities, the practice deserves a trial.

The Revue Medicale for February 1826, contains the details of a case lately cured at La Pitié, by Mr. LISFRANC. The patient, a woman, aged 36 years, of a strong and good constitution, had suffered the removal of a cancerous breast, 18 months previous to her admission into the Hospital, on the 10th October, 1825. The following symptoms were observed. On the whole surface of the cicatrix were felt a number of engorged ganglia, and an induration situated on the large and small pectoral muscles, and spreading from the clavicle to all the external and superior part of the thorax, and as far as the axilla, where other swollen ganglia were felt. The enlarged surface was elevated about half an inch above the level of the chest. Severe lancinating pains were at short intervals felt by the patient--which came on without any evident cause, and were particularly severe on the least pressure of the swollen part.

This patient was treated by means of frequent and copious bleeding from the arm--the very frequent application of leeches to the inflamed part, and to the upper and interior part of the thighs, to bring on the menstrual discharge--digitalis to remedy the frequent palpitations--emollient applications, and low diet. On the 10th of January, she was considered well;--the swellings and pain having disappeared--the menstrual discharge being well established, and the movement of the arm (which during the progress of the disease had been impeded from the swelling in the axilla) perfectly free.

We are happy to learn that this practice is pursued with success by the Spanish physicians, as may be readily found by a reference to a late number of the Periodico de la Sociedad Medico Quirurgica de Cadiz, which contains cases of scirrhous mamma cured by the repeated application of leeches.

25. _Essential oil of Male Fern, as, a remedy in Cases of Tænia._--The male fern has long been regarded as a valuable anthelmintic medicine; but, as every powder administered in large doses, its exhibition is difficult and disagreeable; so much so, indeed, that many patients refuse to make a sufficiently constant use of it to ensure its beneficial effects. Struck with this inconvenience, M. PERCHIER, a pharmaceutist of Geneva, has lately made some experiments with a view of discovering its active principle, and to see whether this latter may be administered with equal success with the powder or infusion of the plant. We are happy to learn that the result of his experiments are very satisfactory. We translate the following observations from a memoir on the subject, read on the 7th of October last, by Mr. GENDRIN, before the medical society of the department of the Seine. "This medicine, which is a fatty oil extracted by distillation from the æther, in which the powder of the root of the male fern has been macerated, has caused in many cases, the expulsion of the tænia, without occasioning nausea, colics, or any other morbid phenomena." "It is exhibited at bed time, either in an oily potion, in pills, or incorporated in an electuary, in doses of 18 or 20 drops. On the following morning, a similar dose is given, and two hours after, two ounces of castor oil are administered. In most cases, the tænia is expelled in the course of the day, but if this does not occur, the same doses of the oil are given in the same way, and followed by a similar quantity of the castor oil. The fatty oil of fern, has an æthereal and empyreumatic smell; its colour is brown, and its consistence rather greater than that of castor oil; it is, however, easier to separate in drops. Its taste is acrid, pungent, empyreumatic, and very disagreeable."--_Propagateur des Sciences Medicales, Janvier 1826._

26. _Tincture of Bastard Saffron[33] for the expulsion of Tænia._--Dr. CHISHOLM, of Canterbury, has lately used with success, in a case of tænia of many years standing, the vinous tincture of bastard saffron. The patient had already undergone various plans of treatment, and had especially used the oil of turpentine in very large doses. Dr. C. was induced to try the above remedy, from having noticed, that in a case in which it had been prescribed for the cure of rheumatism, a large portion of tænia had been expelled. He consequently administered two ounces of the tincture; advising the patient to take a table spoonful more of it mixed in a little water, two or three times a day. On the third or fourth day after commencing the use of this remedy, the patient voided a large portion of the worm, and has since been free from the usual symptoms of the disease.

27. _Oil of Turpentine in Tænia._--Although the oil of turpentine is used in many parts of this country, in cases of tænia, we have good reasons for believing, that some physicians continue, notwithstanding the testimony in its favour, to hesitate exhibiting it in doses sufficiently large to destroy and promote the expulsion of the worm. Such being our opinion, we are induced to offer here a few remarks on the subject, and to notice a memoir published by Dr. DE POMMER, in a late number of Hufeland's Journal. The employment of this remedy in such cases, is not of recent origin, having been resorted to many years ago by the Swedish practitioners, and subsequently revived by the English. In Germany it has recently been used by Professor OSAN, and we believe particularly by Dr. DE POMMER, who appears to have prescribed it boldly in very many instances, and in some, after the ineffectual employment of all other anthelmintics. Dr. P. adds, that he never saw any bad effects resulting from its use, and that patients are very little liable to relapses when treated by it.

Among the cases detailed by Dr. DE POMMER, we select the following, as calculated to show the manner in which the Dr. uses the remedy.