Page images
PDF
EPUB

of iodide of potash; 2, two and a-half scruples of iodine, and five scruples of iodide of potash; 3, three scruples of iodine, and six scruples of iodide of potash; 4, four scruples of iodine, and eight scruples of iodide of potash. For adults, to a similar quantity of water, 1, two drams of iodine, and four drams of iodide of potash; 2, two and a-half drams of iodine, and five drams of iodide of potash; 3, three drams of iodine, and six drams of iodide of potash; 4, four drams of iodine, and eight drams of iodide of potash. The fourth degree LUGOL does not employ, the third being the strongest he uses.

This, according to LUGOL (a), is the most efficient and certain mode of curing scrofula, and the conditions depending on it. My own observations, as well as those of other medical men, completely correspond with the advantage of this treatment (b).

(2) The cod-liver oil is to be given twice a-day, beginning with one table spoonful, and gradually increasing it up to six; to children it must be given in proportionate smaller doses. To get rid of the filthy taste, the mouth should be rinsed immediately before taking it, with cold water or with brandy, and directly after it is swallowed, a cup of herb tea, of lentain, cinnamon, or Seville orange flower should be drank. The external application of the oil in way of friction, is also very efficient for the dispersion of swellings. To be effectual, the oil must be given for a long time. Children always take it willingly, and invariably better than adults, who generally cannot overcome their antipathy to it. After the use of the oil, as well as after the use of iodine, more powerful digestion, better appetite, and even actual voracity, have been noticed. Although chemical observations have given different results as to whether iodine be contained in the oil or not, there appears to be no doubt that the various kinds of oil as met with in commerce, have given rise to the various results, as the true cod-liver oil does contain iodine, but the white oil usually does not, the latter not being cod-liver oil, but seal oil; the former only therefore should be ordered. Hence may be explained the various opinions of numerous physicians on the operation of the oil (c).

Fresh walnut leaves and their decoction have of late been particularly recommended against scrofula; two or three cups of the infusion of the fresh leaves daily, with syrup or honey. Also night and morning pills of three and a-half grains of the extract of the leaves, or a table spoonful of the syrup prepared from the same extract. NEGRIER (d). The frequently remarkable effect of POLLINI's decoction is to be principally ascribed to the walnut shells it contains.

[RUSSELL observes, that " in the treatment of scrofulous ulcers under the ordinary circumstances of the complaint, the simplest and mildest dressings answer best. When the patients are using a course of sea-bathing. it is usual to wash the sore with sea-water over and above the momentary application of the sea-water during the immersion of the whole body. Cold spring-water is likewise a favourite application with many practitioners; and from much observation, it appears that the operation of cold is well-suited to counteract the state of inflammation which accompanies scrofulous sores." (p. 105.) BURNS is also of the same opinion as to the use of cold water, but couples it with pressure by adhesive straps. If the sore require stimulating, black wash with or without mucilage of acacia, and with or without tincture of opium, is a very excellent application. But oftentimes these scrofulous sores are quite unmanage able, and will not be soothed or healed with any application. Under these circumstances our entire reliance rests on the improvement of the constitution, simultaneously with which the sores mend.

I scarcely ever use iodine, except as iodide of potash, which is a most excellent medicine, either employed internally or externally. I commonly give from three to five grains of the iodide twice a day, either in an ounce and a half of compound infusion of gentian with a drachm of any warm aromatic tincture, or in four ounces of compound decoction of sarsaparilla, and to either vehicle add a drachm of syrup of poppies, which it is well to commence with, as it will generally prevent the nausea which frequently occurs without it. Occasionally, after taking the iodide of potash for some days, salivation is produced, which I have observed again and again." And

(a) Mémoires sur l'emploi de l'Iode et des bains iodurés.

(b) MÜLLER, Ueber die arzneiliche Wirkung und Anwendung der Jodine. Würzburg, 1832.

KUNZ, Ueber die Anwendung der Jodine in Scrophulösen Krankheiten nach eigenen Erfahrungen und mit vorzüglicher Berüchsichtigung der Versuche und Beobactungen Dr. LUGOL's; in Rust's Magazin, vol. xxxvii. p. 61.

HANKE, Ueber die med. Wirkung des Jods; in Journal VON GRAEFE und VON WALTHER, vol. xxvi. pt. iv. p. 445.

BRERA, Saggio clinico sul Iodio, &c. Padua, 1822. 8vo.

(c) BREFELD, Der Stockfisch-Leberthran in natur historischer, chemischer, und pharmaceutischer Hinsicht, besonders aber seine Heilwirkungen in rheumatischen und scrophulösen Krankheitsformen. Hamm, 1835. 8vo.

(d) Mémoires sur le Traitement des Affections Scrofuleuses par les préparations de Feuilles de Noyer; in Archives Générales de Medecine, Third Series, vol. x p. 399. vol. xi. p. 41. (Fourth Series) vol. iv. p. 133.

sometimes it disagrees with the stomach and the patient loses appetite and becomes worse instead of better. Under either of these circumstances it must be left off. When used as an ointment, a drachm of the salt to an ounce of lard is a very useful application; more commonly employed, however, to glandular swellings than to sores. It is best applied either simply spread upon lint, or by dressing the surface after the removal of the cuticle by a blister. Either of these modes is preferable to rubbing the ointment in, for frequently when the skin is thin and the patient irritable, after three or four rubbings the skin inflames, the cuticle cracks and it is necessary to withhold the application to prevent the establishment of a sore.

Some Surgeons are fond of painting enlarged scrofulous glands with tincture of iodine, which very commonly blisters the skin; or if it do not, it destroys the cuticle, which flakes off in large pieces. I do not think it a very efficient remedy, though by some so esteemed.

I have given cod-liver oil several times with much advantage; but it is abominably nauseous, and as it owes its efficacy to the iodine it contains, it is certainly preferable to give the iodine in some more agreeable form.-J. F. S.]

777. The scrofulous inflammation of the upper lip, nose, and cheeks, which often leads, by ulceration, to considerable destruction, in which the cartilages of the nose shrivel, is, with simultaneous general treatment, not so easily checked and diminished with anything, as by bathing with decoction of solanum nigrum, alone, or with the addition of sublimate or repeated touchings with nitrate of silver. When the scrofula is very inveterate and connected with considerable degeneration, a satisfactory change in the whole body, and a cure, can alone be effected by either of the lastmentioned modes of treatment, by the hunger-cure, by the smear-cure, ZITTMANN's decoction, and the like.

IV. OF GOUTY ULCERS.

SYDENHAM, THOS., M. D., Tractatus de Podagrâ et Hydrope. London, 1683. 8vo. GRANT, Beobachtungen über chronische Krankheiten, vol. i. Von der Gicht. Leipzig, 1792.

ROWLY, WILLIAM, The Gout and Rheumatism cured or alleviated. London, 1780. 8vo. WENZEL, Dissert. de Ossium arthriticorum indole. Mogunt., 1791.

BARTHEZ, Traité des Maladies Goutteuses. 2 vols. Second Edit. Montpellier, 1819.

8vo.

SCUDAMORE, CHAS., M. D., A Treatise of the Nature and Cure of Gout, &c. Fourth Edit. London, 1823. 8vo.

VON VERING, J., Heilart der Gicht. Wien, 1832.

778. Gouty Ulcers (Ulcera arthritica, Lat.; arthretischen Geschwüre, Germ.; Ulceres arthritiques, Fr.) are consequent on the existence of gout in the body, with which they are more manifestly or secretly connected. They are usually superficial, their bottom is wide, reddish brown, smooth, contracted, and seemingly very deep, from the wasting of the cellular tissue, and from the union of the skin with the underlying fibrous tissues; they secrete a quantity of serous fluid, which corrodes the parts surrounding the ulcer, and not rarely blackens the linen. Their edges are mostly irregular, pale, and hard, but under inflammation rosy and painful. They become worse periodically, from bad air, or the gouty affections become worse on the incipient improvement of the ulcer.

779. These ulcers occur either from accidental injury during general gouty affections, or after gouty inflammation and swelling, which run into ulceration; they are therefore situated mostly in the lower extremities, and in the neighbourhood of joints. Their diagnosis is generally easy,

VOL I.

2 8

though it may be difficult, if the patient, excepting the ulcers, have not suffered any decided gout. In these cases the symptoms must be especially attended to, which usually accompany anomalous gout, as disturbed functions of the bowels and liver, unnatural urinary secretion, irritating, often periodically wandering pains in the limbs; also blennorrhoea, eruptions of the skin and the like, which are often closely connected with the ulcer.

780. These ulcers are generally very stubborn; are often kept up by the deposition of chalky masses; their cure must therefore be undertaken with great care, because the patient is liable to the danger of a metastasis. 781. In treating arthritic ulcers the general affection must always be attended to. Above all, the patient's mode of living must be specially regulated, frequently the very contrary to the previous course directed, and therefore a change to a diet sometimes with more meat, but more frequently to a more simple vegetable food, with suitable exercise. According to the different character of the gout, means must be employed which either promote or diminish the perspiration and the flow of urine. MINDERER's spirit, antimonial wine, aconite, guiaicum, camphor, the various preparations of antimony, the alkalies, the vinum seminis colchici, and so on; or bitter strengthening remedies, the calmus, bark, bitter extracts, steel, or the more opening and purging remedies. Baths, especially those containing sulphur, are of very great use.

The vinum sem. colchic. autumn. I have proved to be generally the most efficient remedy against gout and rheumatic affections. The result of my observations and experience on this remedy, that its efficiency depends on the increased production of uric acid in the urine during its use (a), has been fully confirmed by the experiments of LEWIN (6).

782. The local treatment of the ulcer is guided in part by the general treatment. If the ulcer have an inflammatory character, it must, in addition to the removal of all irritants and proper general treatment, be covered merely with a dry warm vegetable poultice; all moist and wet remedies must be avoided. If the ulcer, as is commonly the case, have a torpid character, it must be covered with mercurial or cicuta plaster, with empl. de minio with camphor and opium, a powder of bark, camphor, and white sugar is to be daily strewed upon the sore, rubbing in mercurial ointment with camphor around the wound, and swathing the part with waxed taffeta, or the application of camphorated bags of vegetables. SCHMUCHER'S plaster of assafatida, soap, ammoniacum, and vinegar of squills often does good service, even when there is accompanying exposure of bone. In this treatment derivation must also be kept up at the same time with issues, setons, and the like.

If the ulcers do not heal, their cure must not be forced by contracting and drying remedies. The ground of their stubbornness often depends on local complication; they may be even incurable, if seated in parts which are already completely disorganized.

The earthy masses (urate of soda) often, in gout, deposited in the joints, in the cellular tissue, or in the mucous bags, is consequent on repeated inflammation and effusion thereon dependent. If they be in any quantity, the motion is more or less disturbed, and by their irritation, or by a fresh attack of gout, inflammation and suppuration are produced, the skin breaks, and the chalk-like mass is gradually discharged. A dry piece of this substance often penetrates the skin, and remains as an excrescence, without exciting inflammation and suppuration. If the collection of these masses produce

(a) Heidel, klin. Annal., 1827, vol. iii. p. 345. (b) ROBERT LEWIN, jun., On the physiological

and therapeutical effects of Colchicum autumnale; in Edinburgh Medical and Surgical Journ., No. 148.

inflammation, it must be got rid of by mild treatment. If they be observed beneath the skin, the swelling must be opened; we do not then endeavour to press out the earthy masses; they gradually discharge themselves with the pus, by the continued use of softening poultices. If the inflammation be abated, the removal of the earthy mass may be often facilitated by taking away part of the overlying skin. If a large ulcer be formed with a deposit of this kind at its bottom, it is best removed by the application of caustic remedies, by which the cells containing the earthy matter are destroyed (a).

OF IMPETIGINOUS ULCERS.

783. Among Impetiginous Ulcers (Ulcera impetiginosa, Lat.; impetiginösen Geschwüre, Germ.: Ulcères impétigineux, Fr.) are to be considered those which form, in their course, chronic eruptions of the skin. Hereto belong the herpetic ulcer, the scalled head, milk-crust, and itch. These ulcers are to be considered throughout as symptoms of chronic eruption of the skin, and are determined by the great degree and long continuation of the eruption, by its easy recession from one part, and fixing upon another, or by mechanical influences, itch, and the like.

784. The actual causes of chronic eruptions are, principally, a bad condition of the digestive organs, stagnation in the portal system and liver, disturbance of the secretions, dyscrasy, the use of bad, putrid and acrid victuals and drink, residence in foul air, want of cleanliness, dirty employments, working among wool, acrid remedies and contagion operating on the skin. Hence impetiginous ulcers may be divided into, 1, the simply local; 2, into those which are connected with general causes; and, 3, those originating from contagion.

785. The treatment of impetiginous ulcers must vary according to the condition of the ulcer, and the causes upon which the eruption depends. If the ulcers be inflamed and painful, the general treatment must be to diminish irritation and to soothe. A more strict antiphlogistic plan of treatment is indeed rarely necessary; a suitable dietetic regimen, and the use of cooling purgatives, are ordinarily proper. According to the variety of the cause, the remedies to be employed must be sometimes solvent, sometimes for the improvement of the digestion and assimilation, sometimes for the restoration of the suppressed secretions. As in the constitutional, though not contagious eruptions, a morbid matter is produced and in a manner thrown off, we must assist its separation by the natural drains, the skin, the urinary organs, and the alimentary canal. The remedies which effect this object are especially sulphur, and its various preparations, antimonials, decoctions of woods, dulcamara, sassafras, juniper, sarsaparilla, carex arenaria, mezereon, pansy, and the like. In very old eruptions, and in considerable degeneration of the skin, mercurials, sublimate, and arsenic are especially useful; and the cure may often be effected merely by remedies entering into and altering the whole constitution, as the friction-cure, the hunger-cure, ZITTMANN's decoction, and the like, hereafter to be mentioned.

786. The local treatment must have special reference to the state of the inflammation, and so long as that continues, mild applications and salves, luke-warm baths and the like can alone be used. If the irritation have subsided, so long as the internal cause is unremoved, the local remedies must be used with caution, because relapse and destruction are easily pro(a) MOORE, J., On Gouty Concretions or Chalkstones; in Medico-Chirurg. Transactions, vol. i. P. 112.

URE, A., Ib., vol. xxiv. p. 30, recommends especially the benzoic acid, up to a scruple, after mealtime.

duced. Sulphur, sublimate, red and white precipitate, alkalies, and the like especially may be used as ointments, solutions, and baths. If the skin be completely degenerated, the application of caustic, and the entire destruction of the diseased part of the skin is often necessary. In this treatment attention must be paid to cleanliness and suitable diet, each of the above-described ailments must be diminished, and a derivation kept up by issues, setons, and so on.

A.-OF HERPETIC ULCERS.

ROUSSEL, H. F. A., Dissert. de variis herpetum speciebus, causis, symptomatibus. Cadom., 1779. 8vo.; in SCHLEGEL's Thesaurus path. therapeut., vol. ii. p. 1.

POUPART, Traité des Dartres, 1782. 12mo.

CONRAD, J., Zusätze zu POUPART's Abhandlung von den Flechten. Strasburg, 1785. MÜHLENPFORT, Dissert. de Ulceribus esthiomenis eorumque methodo medendi rationali. Kilon, 1795.

HENSLER, P. G., De herpete seu formicâ veterum labis venereæ non prorsus experte. Kilon, 1801. 8vo.

TILESIUS, W. G., Theorie der flechtenartigen Ausschläge. Ein Versuch zur näheren Bestimmung der chronischen Hautkrankheiten. Leipzig, 1802. 8vo.

ALIBERT, Description des Maladies de la Peau observées à l'Hôpital Saint Louis, et expositions des meilleures méthodes suivies pour leur Traitement. Paris. fol. third

book.

RAYER, P., Traité théorique et pratique des Maladies de la Peau, &c., 2 vols. Paris, 1826-27. 8vo. Ib., Translated into English by R. WILLIS, M.D. London, 1835. SCHIES, L., Dissert. de Lupo. Hala, 1831.

The Works of Bateman, ScheDEL and CAZENAVE, on Diseases of the Skin.

787. Herpetic Ulcers (Ulcera herpetica, Lat. ; flechtenartigen Geschwüren, Germ.) are characterized by the following appearances :-at first there is perceived on some part of the skin, inflammation or little bladders, whence are produced crusts or scabs which subsequently either scale off like bran, or fall off in larger pieces, and expose an inflamed patch of the skin, from whence exudes a fluid of peculiar smell and colour, which drying, fresh crusts are produced, and these again fall off. These ulcerations generally do not penetrate deeply, but readily spread on the surface, and are usually accompanied with much burning and itching.

If the herpes spread over a large surface of the body, the perspiration is diminished, the nourishment is disturbed, the action of the bowels stopped, and at last hardening of the bowels, hectic fever, swelling of the feet and so on are produced.

788. Herpes (Lichen, Serpigo, Lat.; Flechte, Germ.) is divided, according to its form, into Herpes furfuraceus, crustaceus, squamosus, pustulosus, phlyctanoides, erythemoides, according as at the onset it is connected with bran-like scales, crusts, pustules, blisters, or inflammation. It is called eating herpes (Herpes exedens, rodens, phagadanicus, Lupus, Lat.; fressende Flechte, Germ.) when the ulceration (generally situated on the tip of the nose, on the cheeks and lips) spreads quickly; in this case the parts are eaten away and often considerably destroyed by an acrid fluid beneath a thick scab, or where thick brown or blackish scabs are formed upon roundish sores with bluish edges, dirty colour, and surrounding swelling, which enlarge and eat away the parts without secretion of ichor, as it were by dissolving them. When a pustulous eruption dries to a hard scab upon the hairy part of the chin and cheeks it is called

« PreviousContinue »