Chapter 22

"Denmark possesses three periodical journals of medicine, without counting those of the Royal Societies of Sciences and of Medicine of Copenhagen. The first and best of these journals, is the _Bibliothek for Læger_, published by a society instituted for the advancement of medical studies. CLASSEN, the founder of this association, bequeathed to it a sum of money, to purchase annually, some foreign medical works. This collection is composed of original memoirs, extracts, and announcements of other works, and a review of the _course_ of the faculty of medicine. It is specially consecrated to the practical department of the art--(three numbers per ann. of 70, to 100 pages each.) The 2nd collection, is the _Nye Hygæa_, the editor of which, (M. OTTO,) embraces in his plan, all the medical sciences. This journal, although specially devoted to physicians, is in reach of all those persons of education, who can be interested in a variety of important medical questions. It contains original memoirs, and extracts from foreign works, (five leaves per month.) The 3d collection, Archives for the History of Medicine in Denmark, (_Archiv. for lægevidens kabens historie in Danmark_,) does not appear periodically, but at indefinite times. Professor HERHOLDT, the editor, has only published one number, in 1823.

"As to inaugural dissertations for the doctorate, the number amounts only to three or four in the space of ten years; because the title of M. D. is not requisite to the practitioner in Denmark."

The above is taken from the Bulletin for February, the ensuing portion of the sketch is contained in the March number of the same journal.

"The medical literature of Sweden, must have been very insignificant in past ages, if we may form an opinion, from the total want of documents in relation to it. There existed no scientific lien between the physicians of that country, or even among those of the capital. A medical society might in vain have been sought for there, at a period, when they were common in all other countries. The Royal Academy of Sciences, published some essays relating to medicine, from time to time, but until 1807, a work on this topic was regarded as a sort of rarity. However, in the course of that year, seven physicians of Stockholm, united in order to found a society, which received the royal sanction, and took the title of _Svenska Loekare Soellskapet_, (_Society of Swedish Physicians_.) This institution, seemed to communicate to the practitioners of Sweden a new existence, and then really commenced the æra of medical literature in that country. The number of works published since that period, has scarcely amounted to more than one or two per annum. Dr. RABEN is the author of three works, which, though not large, give evidence of considerable knowledge and penetration: Their titles are: 1st. De præcipuis causis mali Scrophul. ejusque remediis Commentation. Lund. 1807. 2nd. A second volume on the same subject, written in the Swedish language, Lund. 1819. 3d. Observationes in Syphilidem, ejusque curationem, ubi novæ quoque proponuntur curandi rationes. Lund. Goth. 1821.

"We shall also mention among the works recently published in Sweden, 1st. A biographical and literary gallery of the physicians of that country, from the reign of Gustavus I. down to our own times, by Dr. J. F. SAKLEN. 2nd. FLORMANN'S Manual of Anatomy. Finally, a collection of the laws of the kingdom, which relate to medicine. The Medical Society of Stockholm, regularly publishes its transactions, _Svenska Loekare Soellskapets Handlingar_, the 10th vol. of which has just appeared. In it, are some remarkable cases, a table of the constitution of the atmosphere, and of the diseases which have prevailed at Stockholm, and in its environs; reports on the hospitals and baths of the whole kingdom; extracts from Medico-legal Examinations, recent discoveries, &c. M. ECKSTRÖM promises to publish a complete description of the variolous epidemic, which prevailed last year at Stockholm, and in the provinces. Besides these transactions, the secretary makes an annual report, on what passes at the sittings. To this he adds, short notices of the most interesting recent discoveries and observations, which he derives from foreign medical literature. He publishes this collection once a year, and adds some nosological articles. In closing this review, we ought not to forget to mention the collection of theses, defended at the university of Upsal, which is published yearly by Dr. ZETTERSTRÖM."

37. _Erysipelatous Mumps or Angina Parotidiana._--Dr. BEHR of Bernberg, has published in the _Journ. der Pract. Heilkund for July_, 1825, an account of this disease, which we find in the _Bulletin_ for Feb. 1826. Dr. BEHR'S "memoir is intended to pourtray the principal features of an epidemic prevalence of parotitis at Bernberg, in the months of December, 1822, and January and February, 1823. Dr. B. attributes it to the frequent and sudden variations of the atmosphere at that period." He says, "the disease is so rare in this country, that physicians of 30 years standing had never met with it before." Bernberg contains 6000 souls; it is divided into two parts by the Saale, and it is situated on the great road from Leipsic to Magdeburg, in a narrow valley, which runs from N. W. to S. E.

The precursory symptoms were rigors followed by heat, heaviness of the limbs, pains in the joints, especially in the evening, sense of tension in the region of the lower jaw, and sometimes a difficulty in mastication. The appetite was usually natural, with gastric symptoms only in the most severe cases. On the evening of the 3d day, there was an increase of uneasiness with chills and heat, after which the patient commonly enjoyed sweet sleep. The next day, on awaking, he felt tolerably well, and had no more sense of heaviness in his limbs, but his face was swelled on one or both sides. Speech and mastication were effected with difficulty; the lower jaw was _comme engourdie_, and a dull pain was felt in the ligaments of the joints; the tumefaction increased and soon extended from the ear to the cheek. On a careful examination, it was found to affect the parotid gland, and the surrounding cellular tissue. The tumour was hard, diffused, and not very painful, except on pressure. The colour and temperature of the swollen part were natural. In the evening, the pulse became hard and accelerated, the tongue white, the stools more consistent than common, and the urine pale. The following night he was agitated, frequently awakened by lancinating pains in the affected part, and sometimes by a sense of tension in the head. The following day, the tumour reached its maximum of elevation, and sometimes comprised the submaxillary glands of the same side. From this time, the pains did not increase, and the skin became slightly red only in a very few examples.

The disease having thus reached its acme, a gentle sweat commenced behind the ears, then extended over the whole tumour, and remained as long as the swelling lasted. This evening there was no fever, but a gentle perspiration continued throughout the night. The day following, being the 6th of the disease, the tumour was evidently diminished, and continued decreasing until its final disappearance, which occurred on the 9th, and sometimes on the 7th day. Until this period, abundant local perspirations in the day-time, less abundant, but more general ones in the night, were observable. When the disease was critical by urine with sediment, the diminution of the swelling was dated from this appearance; but the resolution was not perfected in some cases till the 14th day, and in such cases, the integuments of the part were covered with a mealy desquamation. Dr. BEHR did not observe any metastasis to the genitals, but he saw cases, in which the disappearance of the swelling, was followed by considerable fever with _augoisse_, and then an oedema, commonly situated on the head.

He often saw the termination by induration, but this soon yielded to a proper treatment. As to the contagion of mumps, the author thinks, it can only occur where there is desquamation of the integuments; and remarks on the analogy of this circumstance, with what occurs in scarlatina. Dr. BEHR thinks, that antiphlogistics are rarely indicated in the treatment of parotitis.

38. _Tænia._--In several cases in which gum. gutt., salts of tin, and other medicines, were unsuccessfully used for the expulsion of tape worm, Dr. BOUGARD succeeded in expelling them with pills compounded as follows: Merc. dulc. Extr. aloes, aa. gr. iij. divided into three pills. This dose was given every evening for eight days, and gradually increased or diminished, so as to procure three stools per diem. A rigorous diet was observed during this treatment.--_Rust's Magazin fur die gesamte Heilkunde apud Bulletin des Sci. Med. March_, 1826.

39. _Scrophula._--Dr. WETZ recommends the employment of caustic potassa in scrophula. He dissolves x grs. of caustic potassa in one ounce of orange-peel water, and gives from xij to xx gtt. four times a day, in a cup of broth. A solution of caustic potassa in six ounces of distilled water, is applied as a wash to the ulcers.--_Ibid._

40. _Digitalis._--We find in the Propagateur des Sciences Medicales for Feb. 1826, an account of the directions of Dr. NEUMANN of Berlin, for the employment of digitalis in pulmonic diseases: they are said to be the result of long experience. Digitalis is useless, says the writer, in all cases of suppuration of the lung, consequent to tubercles of that organ. It is of no avail in those suppurations, which succeed inflammatory hæmoptysis. It is employed without success in _local_ phlegmorrhagies of the lungs; but it almost invariably cures those chronic catarrhs, which depend on a state of erethism of the mucous lining of the bronchiæ. This disease is sometimes called chronic bronchitis, sometimes mucous consumption, pulmonic catarrh, and galloping consumption. If the diagnosis in this case be well made out, hopes may be entertained of a cure, one of the two following conditions being present:

A. The patient must be susceptible of the stimulant action of the remedy: this is often not the case. We may be sure the digitalis will not produce its effect, where the pulse of the patient remains _uniform and frequent after he has taken it for several days_. It does not suit such persons.

B. The medicine ought to be administered in a proper manner. To be good, the leaves, even in the dried state, should be perfectly green and free from any brown spots. Two ounces of the leaves, should be infused in six ounces of boiling water; and the patient may take a table spoonful every hour, until he feels nausea, or a sense of constriction in his throat, or flashing of the eyes, or irregular pulse. The use of the foxglove should then be interrupted for seven or eight days, in which interval, the full action of the medicine is developed, the pulse remaining irregular, and the mucous secretion diminishing gradually. If the first trial does not remove it entirely, a second course may be commenced after a few days.

FOOTNOTES:

[29] Series of Engravings to the morbid anatomy; fasc. 1. pl. 6. fig. 1, 2.

[30] Lond. Med. Review; vol. 4.

[31] Pathological Researches; Essay 1.

[32] Medical Researches on the Effects of Iodine in Bronchocele, Paralysis, Chorea Scrofula, Fistula Lachrymalis, Deafness, Dysphagia, White Swelling, and Distortions of the Spine. By Alexander Manson, M. D., &c. London, 1825.

[33] Carthamus Tinctorius.

V. SURGERY.

41. _Dr. Physick's operation for artificial anus, denied to have been performed!_--We have often had occasion to remark the claiming, and, we fully hope, the actual re-invention of American operations and practices among physicians on the other side of the Atlantic. As we are not a publishing people, it is, perhaps, not very strange that the French and English should be generally unacquainted with the discoveries and inventions which have been made among us; but here comes an actual denial of the invention having ever taken place!

Every American who has any pretensions to the character of a surgeon, is most probably familiar with the proposal and performance, by Dr. PHYSICK, of a peculiar operation for those cases of artificial anus, where the two ends of the divided or opened intestine adhere laterally to each other, in the manner of a double-barrelled gun. We are now told that M. RICHERAND, in his new work "On the recent progress of Surgery," "avoids giving this the least confidence." (Archives Generales, Janvier, 1826.) The reviewer in the Archives, in a paroxysm of angry jealousy for the honour of French surgery, deeply wounded, as he conceives, in the _admissions_ by M. RICHERAND of discoveries and inventions among the English and others, adds no small amount of ill-nature to this unworthy intimation, and makes the observations which we have translated below.

It is certainly an easy method of erecting reputations, to deny, directly, the priority of others in operations which a favourite has repeated. No matter though the knowledge of this priority be widely diffused; if readers can, by means of national predilections, be induced to place confidence in your denial, the effect, as far as relates to them, is completely obtained. Yet one would think it an ungenerous act, to call in question, and before partial judges, the veracity of such men as are here named. Where a physician reports cases which agree too well with his preconceived theories, we doubt the correctness of his observations; and with justice: for we know that an already formed belief will greatly tinge the most honest seeings and hearings of very sensible and honourable heads. But this is a far different thing from impeaching, in a manner entirely gratuitous, the moral honesty of the record of a historical fact, made by men at the head of their profession.

The reviewer, Mr. and probably Dr. L. C. ROCHE, comments as follows:

"1. Dr. PHYSICK never published any thing on this subject.

"2. Dr. DORSEY, who makes the claim for him, never published the work in which he does so, [the Elements of Surgery,] till 1813.

"3. In the English journal (?) and in that work, he contents himself with a simple assertion, without giving either the date of the operation, the name, age, or sex of the patient, the names of his assistants, or the details of the operation; _all points which men never forget to make known, when treating of the first attempt in a new operation of this importance_."

To the first of these comments we reply, that Dr. PHYSICK, to the great regret of his countrymen, has never been in the habit of publishing; but still possesses many useful improvements in medicine and surgery, which he has not committed to the press. On the other hand, however, he has taught this operation annually, to from three to four hundred pupils, in his lectures, during about twelve successive years; and this is no mean substitute for a publication in types. M. ROCHE'S memory will supply him with an instance of an eminent French surgeon, whom we shall not attempt to defraud of his laurels, who also made it his practice to leave the publication of his observations and improvements to his pupils.

To the second remark, the above is also a sufficient reply; but we will add that it was recorded in the case book of the Pennsylvania Hospital in 1809.

Our comment on the third observation of Mr. ROCHE may be brief. It is that we promise an account of the case for the next number of this Journal. In the mean time, the patient was well known to us and to many persons now living. The operation was performed in 1809.

In reply to that portion of the last observation, which we have marked with italics, we can assure the reviewer that he is mistaken; at least with regard to this side of the ocean. We Americans are a very peculiar people, and but little affected, as yet, with the cacoethes scribendi; a malady which the present work, in its humble sphere, is designed to disseminate. We are not in the habit of frequently publishing, and above all, of publishing volumes. Books are dear, private libraries small, public ones few, and encouragement for even the best original publications but limited. Of this we have known some melancholy instances. It is impossible for either a Frenchman or an Englishman to judge correctly of a country, which, in many important respects, is in such a different situation from his own.

It is a thing of by no means uncommon occurrence here, to make a valuable discovery or improvement in the healing art, and not to make it public. A striking instance of this fact, at least with the exception of the insertion of an imperfect account in the Eclectic Repertory, which very probably never reached England, is mentioned in our last number. We allude to the extirpations of diseased ovaria, by Dr. M'DOWALL, of Kentucky. Here a unique and brilliantly successful operation was performed, successful as yet beyond European imitations, and still the inventor and achiever of it did not possess vanity or industry sufficient to treat the public with a full account of it. M. ROCHE may find it hard to explain modesty of this species; but we can promise him, should these sheets ever reach his eye, and he still continue skeptical, abundance of proofs, and some more instances of the same kind.

42. _Gangrenous Sore Mouth of Children._--Dr. COATES begs permission to add the following quotation from FABRICIUS HILDANUS to the authorities quoted in his paper on gangrenous ulcer of the mouth, at the commencement of the present number.

"Gingivarum inflammatio maxime in infantibus in gangrænam interdum degenerat. Morbus enim magnus, vehemens et peracutus; magna quoque requirit remedia: sed quis illa in ore adhibere ausus?"--_De Gangræna et Sphacelo, Cap. IV. p. 773. col. 2. Edit. Beyeri. Francofurt ad Mæn._ 1646.

"Gangræna in partibus humidis, gingivis, palato, naribus, &c. raro sanabilis; in sphacelum autem degenerans, insanabilis."--_Cap. XI. p._ 781. _col._ 2.

This is all I find in that author, relative to the subject.

43. _Operation for Phymosis._--M. J. CLOQUET, has so improved this operation that no deformity results. He recommends the incision to be made at the _inferior_ surface, near, and parallel to, the frænum præputii. The longitudinal wound thus made, becomes transverse, as soon as the prepuce is drawn behind the glans penis, and cicatrizes in a line scarcely visible; so that the prepuce acquires in breadth what it loses in length. M. CLOQUET has, in this way, perfectly cured many patients; the prepuce appearing to possess its natural conformation.--_La Propagateur des Sci. Med. for March._

44. _Lunar Caustic on Wounds and Ulcers._--The practice of healing wounds and ulcers by natural or artificial scabs, to which the attention of the profession was first directed by Mr. J. HUNTER, has been too much neglected, and the circumstances under which it is useful, have not been accurately stated. In a small work published by Mr. HIGGINBOTTOM, in January last, at London, the practice of forming an _eschar_ by the lunar caustic over small ulcers and recent wounds, has been strongly recommended as saving the patient much pain, trouble, and danger. The whole surface is to be pencilled with the solid caustic so as to form an eschar, and where this remains _adherent_, the wound or ulcer invariably heals with comparatively little inconvenience. When effusion occurs under the eschar, whether of serum or of pus, there is more difficulty; but if this fluid be evacuated by a puncture, and the caustic applied to the orifice, the eschar will often remain adherent. Sometimes the fluid must be frequently evacuated. If the eschar does not separate favourably, a cold poultice may be applied, which not only removes the eschar, but lessens the irritation and inflammation. Should the sore not be healed, Mr. H. recommends the reapplication of the caustic. To prevent effusion under the eschar, and to preserve it adhering, he advises the whole to be covered with a piece of gold-beater's skin; but we may add, that as this effusion arises from too much inflammation, more powerful means may occasionally be employed, especially a solution of acetate of lead. LARREY recommends with the same view, after the application of moxa, the use of the aq. ammoniæ. Indeed any evaporating, cold, astringent lotion will be advantageous.

The application of the caustic, of course, produces some pain, but this soon subsides, and the patient experiences more ease than under any other mode of treatment.

_Particular cases in which the Caustic is useful._--In punctured wounds, it should be applied to the orifice and surrounding skin, and the eschar allowed to dry. The terrible effects of punctured wounds, are thus completely prevented, whether caused by needles, hooks, bayonets, &c. So also of wounds from saws; of bites from leeches and animals; of the stings of insects; and especially of those small scratches, and punctures, received in _anatomical dissections_. The danger of these last mentioned accidents may, according to Mr. H., be completely arrested by the prompt and free application of the lunar caustic. Even in neglected cases, when a small tumour has formed under the skin, attended with a smart stinging pain, he advises the tumour to be removed, and an adherent eschar to be formed by the caustic; and in still more neglected and advanced cases, where inflammation of the absorbents has supervened, "a free crucial incision is to be made, the caustic to be freely applied, and afterwards, the cold poultice and lotion; the usual constitutional remedies being actively enforced."

In _bruises_, especially of the shin, the adherent eschar from lunar caustic, has, with Mr. H., always effected a cure; and even when a slough has been produced, the application of the caustic will moderate the inflammation.

In _ulcers_, which are small, not exposed to friction or motion, and discharging little, the cure by eschar will be preferable; especially in those little irritable and painful ulcers often seen about the ancle and tendo Achillis. Apply first a cold poultice, and then form the eschar, which may be freely exposed to the air. Should the matter, nevertheless, collect, it should be evacuated by puncture as often as necessary, until the eschar remains adherent.

This practice is recommended by Mr. H., in various other affections; as in inflammation of the fingers; in the fungous ulcer of the navel in infants; in _tinea capitis_, &c. In this last case, we have ourselves used it with marked advantage. In all cases, the lunar caustic has a decided effect in _diminishing the irritability_ of the parts to which it is applied; and hence should usually be preferred for the purpose of forming a "_scab_," for such the eschar really is, in a practical view; and we think that our author has hardly done justice to nature's methodus medendi by "scabbing;" while he so ably and strenuously recommends his own imitation of her process. Scabs may be formed by the coagulation of blood; by the drying of mucus or pus; and by the formation of an eschar, by the actual or potential cautery. The surgeon may frequently reduce parts to the same situation, by the use of gold-beater's skin, court-plaster, or other unirritating applications, which prevent exposure and evaporation. In all cases, care must be taken to prevent the surrounding inflammation from transcending the adhesive stage.