Chapter 19

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. Iodinæ, [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 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.