Chapter 20

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.

"G.K..., a soldier aged 21 years, thin, tall, and who during his infancy had been subject to ascarides, has occasionally voided during more than 10 years past, portions of tænia. He had used several purgative medicines, by which several yards of this worm had been expelled; but annoyed with so many attempts at obtaining its total expulsion, he had ceased, three years before, the use of all sorts of anthelmintics. But the phenomena resulting from the presence of the animal being aggravated, the patient applied for advice to Dr. DE POMMER, who found him labouring under the following symptoms:--Frequent pain in the abdomen, and especially in the umbilical region, accompanied with a sense of burning heat, and alternate distension and depression of the abdomen. Appetite sometimes keener than in health; at others nearly lost. In the morning before breakfast, the patient was seized with extraordinary weakness, and general uneasiness, accompanied with trembling of the limbs, ineffectual attempts to vomit, a sense of constriction in the throat, and a profuse salivation. All these symptoms disappeared after K... had taken food; but reappeared two hours after. Milk and farinaceous aliments were the only articles of which he could make use without an aggravation of his disease. The pulse was febrile; sleep good, but attended with dreams. The pupils were in the natural state. From the symptoms, and from the history of the case, Dr. P. was induced to make use of the oil of turpentine in the following manner. The patient was ordered in the morning, before breakfast, three table spoonsfuls of the remedy, at half an hour's interval. The first doses produced only a few borborygma. Two more table spoonfuls occasioned a vomiting of mucous matter. Three more table spoonfuls were exhibited, and followed by a stool of solid fæces, mixed with which were five small pieces of tænia. The patient not finding himself incommoded, took in the space of an hour, three more table spoonfuls of the remedy, after which he experienced some pain in the head, and vomited about one pint of bilious liquid. An hour after, the same quantity of the medicine was taken, and followed again by vomiting, but after a repose of half an hour K... discharged, per anum, firm and greenish fæces, and with them five ells of tænia. The urine discharged had the smell of violets. He again took a few spoonfuls of the vermifuge, which were not followed, however, with any fæcal discharge, and only with some vomiting of mucus, and slight vertigo. In the afternoon the patient felt well, and experienced a great appetite, in which he indulged. From this moment he recovered, and has ever since enjoyed good health. The quantity of the remedy used was six ounces."

It appears, from the observations of Dr. P., that the gastric irritation occasioned by the spirits of turpentine, has never amounted to phlogosis, and has generally subsided after the remedy had been discontinued. Nevertheless, as the spirit of turpentine is a very powerful stimulant, we would not venture to recommend its use, when there exists an inflammation in the gastro-enteritic system. We are aware that it is resorted to in burns, and highly eulogized in puerperal and yellow fever. In the first, it is certainly very useful, but on what principle we know not, except perhaps that its stimulus is different from that existing in the diseased part. But in the second case, it acts, not on the diseased surface, but by revulsion, on the mucous membrane; and as regards its virtues in yellow fever, we are rather sceptical in respect to what has been said on the subject. In this opinion we are supported by the testimony of our friend Professor RHEES, whose situation of house surgeon to the fever hospital, during the epidemic of 1820, afforded him ample opportunities of testing the propriety of the practice.

In the number for March 1826, of the Revue Medicale, M. MAUDRU relates two cases in which large portions of tænia were expelled, and the patients cured, by means of a strong decoction of the bark of pomegranate. The first patient took, in one day, two pounds of the decoction made with four ounces of the remedy. The second patient took six ounces of the bark in decoction, in the course of forty-eight hours. In neither case did the medicine occasion unpleasant effects, with the exception, in the second patient, of slight colicky pains.

28. _Action of the Oil of the Euphorbia Lathyris._--At a meeting of the Academy of Medicine, (section of pharmacy) M. BALLY read the results of some clinical experiments made by him at the hospital of La Pitié, on the action of the oil of the euphorbia lathyris. The preparation used by him, had been made by means of alcohol and expression. It appears to be a little more active than the other preparations. Administered to fifteen individuals of different ages, it did not produce very various results, nor prove very active in its purgative effects. As a purgative, indeed, it is far less active than the croton oil, and requires to be given in much larger doses; as much as six or ten drops. It has also the bad property of exciting emesis, by which it is rejected from the stomach. On the other hand, however, it does not, like the croton oil, produce salivation, and is, on the whole, regarded by M. BALLY, especially when fresh, as a useful purgative in diseases of children.--_Archives Generales, Decembre, 1825._

29. _Medicinal properties of the Apocynum Cannabinum, or Indian Hemp._--In an essay on this plant, submitted to the medical faculty of Jefferson College, by Dr. M. L. KNAPP, we are informed, that in doses of 15 or 30 grains it possesses emetic properties. It was besides, on trial, found to be cathartic, expectorant, diuretic and diaphoretic. It appears to have been generally administered in powder, and Dr. K. remarks, that "in decoction, it seems to lose some of its emetic properties, and to act more upon the bowels as a hydragogue cathartic." "The root possesses all the medicinal properties of the plant, and is active throughout, both in its cortical and ligneous portions. Water or proof spirit is its proper menstruum."

This article was prescribed with success in dropsy, by Dr. KNAPP, and by Dr. PARRISH of this city. It was likewise used in intermittent fever, in bilious affections, amaurosis, hernia humoralis, dysentery, chronic rheumatism, &c. Dr. KNAPP appears to have derived benefit from its use as an alterative in a case of fever in a child, attended with disordered bowels. "The powders (gr. ii. each at intervals of three hours,) were regularly persisted in for a week, and the child's health went on gradually improving. Neither vomiting nor purging was produced, but the morbid heat and thirst were allayed, the stools became natural, the skin soft and moist, and the functions of digestion and assimilation were gradually restored, and the child is at this time fat and healthy."--_American Medical Review, &c. April_ 1826.

30. _Remarkable effects from the external application of the Acetate of Morphia._--M. DUBOURG has recently published the result of an experiment made at the hospital de la Pitié, with the acetate of morphia, which we regard as sufficiently interesting to be noticed in this place. The patient had been affected twelve months before with puerperal peritoneal inflammation, complicated with cerebral symptoms, from which, notwithstanding a most energetic antiphlogistic treatment, she never entirely recovered. When she was admitted into the hospital, she presented the following symptoms:--"considerable emaciation; skin hot and pungent to the feel; pulse small and frequent; tongue of a pale rose colour, dry at the tip and edges, brown and smooth in the centre as far as the basis; severe pain on the least pressure on the epigastrium and over the whole abdomen; cardialgia, nausea, vomiting of all solid and liquid aliments, and during the empty state of the stomach, violent efforts to vomit occurring at irregular intervals; abdomen tense and tympanitic; violent intermittent pain along the course of the intestines; constipation; sensation of fatigue and lassitude in the lumbar region and in the extremities; dragging pains in the inter-scapular region; extinction of the voice; urine red and scanty; the face animated and bearing no marks of profound suffering; agitation, and total want of sleep."

The disease was regarded as a chronic gastro-entero-peritonitis, and treated accordingly, by the antiphlogistic regimen; but no benefit was derived from this plan. The patient continued to vomit almost every thing she took, with the exception of sugar and a paste made with the Iceland moss. A blister was applied to the epigastrium on the 15th of February, seven days after her admission. Called to her assistance on the 22nd of February, on account of an aggravation of the vomiting, M. LAMBERT, one of the house pupils of the hospital, endeavoured to calm the symptoms by means of the acetate of morphia in powder, applied to the raw surface of the blister. Half a grain was used in this way, and in a few minutes the vomiting disappeared, and the patient passed a better night than she had yet done. M. SERRES having authorized the continuance of this method, M. DUBOURG the next day applied half a grain in the same way; and the patient slept the whole night. The remedy was applied every day with the same effect, and was gradually increased to two grains and a half. From the first application of the remedy, the symptoms gradually subsided; aliments were retained and properly digested; the pain and swelling of the abdomen disappeared, and on the 14th of March the patient was regarded as in a fair way of recovery.--_Archives Generales, March_ 1826.

In some remarks which accompany this interesting case, M. DUBOURG, seems to doubt the correctness of the first diagnosis, and to view the disease as a nervous, rather than as an inflammatory affection of the abdominal viscera.

31. _Cure of Urinary Calculi by means of the internal use of the Bicarbonate of Soda._--At a late meeting of the Academy of Medicine, Mr. ROBIQUET read a memoir on the use of this salt in cases of urinary calculi. Having learnt from Mr. DARCET, that the use of the waters of Vichy changes the quality of the urine from acid to alkaline, Mr. R. conjectured, that this effect should be attributed to the bicarbonate of soda contained in them; and from this circumstance, he was led to administer this salt internally, in cases of calculi composed of uric acid. In July last, he made the experiment on a man 74 years of age, who had laboured under symptoms of the disease since the month of February, and in whom, by means of the sound, a small and soft calculus had been detected. Mr. R. ordered him 10 grains of the bicarbonate in the course of the day, dissolved in two pounds of water--prescribing at the same time, hip baths, injections, &c. At the end of fifteen days, much benefit had already resulted from this treatment; and in a month, the patient appeared to be cured. Nevertheless, the remedy was continued until November, when the patient passed through the urethra, a small calculus composed of uric acid, which appeared to have been the nucleus of a much larger one, the exterior strata of which had been worn off. From that period, the patient has not experienced any unpleasant symptom; but the sound was not resorted to, to ascertain whether the first calculus before felt, could be detected.--_Archives Generales, February, 1826._

32. _Attempt to cure Abdominal Dropsy, by exciting Peritoneal Inflammation._--In the number of the London Medical and Physical Journal for April, 1826, a case of ascites is related by H. R. OSWALD, Esq. in which the cure was attempted to be effected, by exciting peritoneal inflammation. The following symptoms were noticed at the time of application for advice: the abdomen measured nearly six feet in circumference, was exceedingly hard and tense; but not tender. The patient "could hardly walk across her cabin from dyspnoea and debility, and the weight and tension of the tumour; which caused her to bend the body much forward, leaning her hands on her knees. The emaciation was very considerable; the appetite good; thirst considerable; tongue clean; pulse 120, and small; skin dry, harsh, and rough; bowels habitually costive; urine scanty." "This affection commenced about twelve months ago, after an obstruction of the catamenia for nearly a year, arising, as was supposed, from exposure to cold. The swelling was preceded by lancinating pains in the abdominal and lower part of the thoracic cavities, but which, after a few months, ceased entirely; and the disease had, in a chronic manner, gradually arrived at its present oppressive form."

Paracentesis was performed several times; cathartics, diuretics, the lancet, blisters, and tonics were resorted to, with relief from some of the symptoms. The tumour, however, returned several times, so that M. OSWALD despairing of effecting a cure by following the same plan, and recollecting a case of ascites, which was cured apparently by an inflammation having supervened in the peritoneum, from the orifice made by tapping remaining open, attempted to produce the same effect in the present patient, by keeping the orifice of the wound open by means of a small tent. In this he partly succeeded, for in the course of a few months, all symptoms of the effusion had disappeared; health and strength had much improved, and the patient had experienced a return of the menstrual discharge, which had been suppressed for nearly three years.

About a year afterwards, however, the disease returned. Paracentesis was again performed several times, and a tumour was perceived to have formed in the lower part of the abdomen. The patient died in about five or six months from the re-appearance of the effusion. On dissection, much water was found in the abdominal cavity, which was lined by a dense, white, and rough looking membrane, of a fragile and diseased structure. The intestines behind this membrane, were unusually small, and of a dark leaden colour. The tumour above alluded to, was discovered to be situated in the region of the right ovarium; it was a tubercular, carcinomatous, and pale coloured fungus, possessing a structure not unlike that of the placenta, and was formed in the interior of the sac, which being traced further back, was found to be the cyst of a dropsy, originating in the right ovarium at the fundus of the sac, or "more properly speaking of its neck."