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applied several times on the inflamed part and for two solution of the nitrate of silver over the remaining · or three inches beyond the inflamed margin on the part of tbe scalp. Neither of the ears were in the least
healthy skin. It requires to be applied very freely all affected. The solution of the nitrate of silver had over the scalp, where it scarcely or never produces' apparently formed a barrier, over which the erysipelas
did not spread. vesication.
| On the 10th the patient was in every respect In about twelve bours it will be seen if the solution
improving. has been well applied. If any inflamed spot be from this time Miss A. recovered without interunaffected by it, it must be immediately re-applied to ruption. it. Sometimes even after the most decided application
Case II. of the nitrate of silver the inflammation may spread, I visited Miss B., aged 30 years, on the evening of but it is then generally much less severe, and it is the 18th of December, 1843. She had been indispused erentually checked by the repeated application of this several weeks. There were considerable fever, a quick remedy. I have in some cases of traumatic erysipelas,
pulse, and pain of the head, and she had a patch of found the inflammation to spread more severely and
erysipelas on the upper part of the nose, and a little
across the lower part of the forehead. I prescribed more rapidly than in the idiopathic, but by the free
an emetic of ipecacuanha, followed by a dose of repeated application of the nitrate of silver, it has at
chloride of mercury and compound extract of colocynth, length been subdued.
and the sulpbate of magnesia in infusion of senna. The following cases are selecied to illustrate this On the morning of the 19th, the erysipelas had
spread all over the face, and as bigh as the forehead,
close to the scalp, and there was no atatement of the Oase I.
constitutional symptoms. I bled her whilst sitting up On the 6th of August, 1844, I visited Miss A., l in bed until she fainted, and directed the head to be 20 years of age, of very delicate constitution, and of shared, and I tben applied the solution of the nitrate a stromous dialbesis. She had been exposed to the of silver all over the face, and one half of the scalp. rain, and had neglected to change her damp clothing. In tbe evening I applied the solution of the nitrate She experienced the common symptoins a!tending a of silver over the remaining part of the scalp; having cold, accompanied by a slight erysipelalous jofam- round that one ear had become ioflanned, I applied mation of the right side of the cheek and nose. The the solution bozb upon it and around the other ear constitutional symptoms were so slight, and the pulse affected. so little accelerated, that I wished to avoid the applica- ! 20th. 'The fever was considerably abated; the pulse tion of the nitrate of silver, thinking the inflamination was 100. From this day the patient was conval might be subdued by other remedies. I directed thirly grains of ipecacuanha as an emetic, and in three
CASE III. hours after its operation iwo pills, containing three
I visited Miss C., aged 20 years, on the 14th of grains of chloride of mercury, and eight grains of the Septe
September, 1844. She had a sense of coldness and compound extract of colocynth, followed by a purga
pain of the limbs the day before; she had then a slight · Live of salts and senna, repeated every three hours
degree of erysipelas on the left side of the nose, cbeek, until it bad operated freely.
and upper lip. I directed an emetic and pill, with 7th. Early the following morning, although the
the compound colocynth powder and chloride of meremetic and purgative had operated satisfactorily, she
cury, followed by an active dose of infusion of senda was labouring under a serere attack of fever; the pulse
and sulphate of magnesia. was 140, and the erysipelas bad spread considerably
In the evening I found the erysipelas increased and on her face and forehead, and slightly on her scalp.
spreading towards the ear; the lower eyelid was conI opened a rein in tbe arm, and bled her in the
siderably swollen, but the erysipelas had not reached semi-recumbent position to the amount of twelve
tbe forehead; pulse 100; no pain of the head. I * Ovuces, when she became faint.
applied the strong solution of the nitrate of silver all
Her head being shaved, the concentrated solution of the nitrate of
over the infamed surface and the surrounding healthy silver was applied upon and beyond tbe whole of the
skin for several inches, particularly around the ear. inflamed surface, and also around the ears, to prerent
A grain and a half of chloride of mercury, with two them becoming inflamed. I applied it very freely over
grains of the antimonial powder, was given every six one half of the scalp, thinking this might be sufficient,
hours, and a saline effervescing medicine every three as only a sniall portion of the forehend was affected.
hours. -1 prescribed two grains of the chloride of mercury,
16th. The application had been effectual, and there with two of antimonial puwder, every six hours.
wus no increase of the erysipelas; the pulse was 80. There appeared no increase of the inflammation or
Case IV. the 8th, and the pulse, 120 ; the bowels had been well Mr. J. S., aged 30 years, had slight febrile symptoms moved.
on the 11th of December, 1813, which arose from 91b. She bad a restless fererish night, attended witb exposure to cold. He had taken aperients and saline slight delirium, the pulse being 120. There was no medicines. Two days afterwards there was a patch incrense of erysipelas on the face, but it was spreading of erysipelatous inflammation on the right side of the on the remaining part of the scalp. I applied the face, without any considerable increase of fever. The
nitrate of silver was well applied on the indained part, kept unknown to us by the designation of lunar caustic, and on the surrounding skin. There was no further affording the most striking instance of the influence of extension of erysipelas.
a term, or of a classification, upon the human mind. It will be observed in the two last cases, when the
The nitrate of silver and the hydrate of potassa, (as nitrate of silver was promptly applied, before the erysi
indeed all caustics,) are as the poles to each other, the pelas had produced severe constitutional symptoms,
first preserves the secord destroys; the first induces that the progress of the disease was instantly arrested,
cicatrization, the second ulceration. and that the patients speedily recovered. In the case Nottingham, July 27th, 1847. of Miss B , although the erysipelas at first was suffered to proceed, the application of the nitrateof silver to the whole scalp prevented any cerebral ON THE TREATMENT OF BURNS AND affection, and the patient was convalescent in a short
SCALDS. time. In the first case related there were restlessness
By CLEMENT CARLYON, M.D., Truro. and delirium fifteen hours after tlie application of the
The paper of Dr. Payne, of Nottinghamn, in a late bitrate of silver, but it was observed that the scalp
number of the Provincial Medical and Surgical Journal, where the nitrate of silver had not been applied was relative to the use of treacle as an application to burns, inflamed, and on the decided application of the nitrate is borne out in all its recommenda:ions, by my experiof silver on the whole of the scalp, the delirium ence of an analogous mode of treatment. ceased. From these cases, as well as from iny experi- ! The main object appears to be the coinplete exclusion ence of many rears, I conclude that the speedy appli- of the air from the 'scolded or bornt surface. The cation of the nitrate of silver will arrest the progress circumstance of a negro child, which bad fallen into of erysipelas, and prevent cerebral cuischief. It is also
a vessel of boiling molasses, having been snatched
from death, and almost from suffering, by 'being of great practical importance to subdue erysipelacous
immediately plunged into a heap of cotton, which inflammation ia the commencement, for I have observed
adhered to every portion of the skin and thereby when the attacks have been severe, that the patients
excluded all excess of air, is well known. The result afterwards become more subject to a recurrence of the I was perfect recovery without the application of any disense.
further means whatever. So extraordinary a case The great obstacie to the general and free use of the drew the attention of the faculty to the modus operandi nitrate of silver, even at the present day, appears to of the cotton. It was agreed that the total exclosion arise from the impression on the minds of many sur. of air from the injured parts was the chief thing; and · geons that it is a caustic-a destructive agert. If they
from that time (half a century ago) to the present, could be divested of that idea, and use it as freely as
this lias been, more or less, the governing principle in
the treatinent of fearful accidents. Where nothing they would a common blister of cantharides, their fears
better is at hand, powdering the parts thorougbly would soon subside, froin repeatedly observing the
willa four has been found to answer well. Time out of safety of the application, and also its beneficial effects.
ouind it had been the practice to use neutral cerates In my own practice I bare always considered it a safer and liniments, (such as oil and lime-water) in these reinedy than cantharides, as it may be applied freely cases; and they still continued to be extensively used, over a surface, even where very active inflammation but their efficacy is far inferior to that of the agent exists, or where there is an extensive surface denuded recommended by Dr. Payne, or to that of clarifed of its cuticle. This remedy has also the advantage of bones. not affecting the bladder, or producing strangurs.'}
cine stran i . Whenerer the latter could be procured, I have The nitrate of silver is not a caustic in any sense of
invariably recommended it, smearing the scalded
surface with it in a luke-warın state, and then corering the word. It subdues inflammation, and induces
the parts with cotton, cotton-wadding, or lint. I have resolution and the healing process. It preserves, aod had no ex
had no experience of the use of treacle, but I have does not destroy, the part to which it is applied. If I often said if honey be not at hand, use treacle. The we compare a caustic, as the lydrate of potassa, with fact is, that boney, even when clarified, which iaiprores the nitrale of silver, we find that the bydrate of potassa and facilitates its application, is of the two, the more destroys and induces a slough and the ulcerative pro- perfect shield; and where the injury has been supercess; but if we touch a part with the nitrate of silver, ficial, whether the cuticle has been removed or not, che eschar remains for a time, and then falls off, leaving it may not even be necessary to repeat the applicathe subsequent parts irealed.
Jition. After the application of the honey and cottonIf an ulcerated surface secreting pus be touched by
wadding, altention should invariably be directed to the The nitrate of silver, the succeeding discharge is imme
temperature of the part, so as to reduce it or raise
it by the application of damp cloths and pledgels diately converted into lymph; it is the property of the of linen. bydrate of potassa, on the contrary, to induce not In cases of no great sererity this is all that will be only ulceration but suppuration. In short, the pecu- required to be done; it being merely necessary to come diar properties of the nitrate of silver have long been "tinue the covering till the total absence of pain and
tenderness indicates a return to the healthy state. In any further suggestions from me, that the same
those dreadful cases, which are too frequently occurring, practice is applicable to a variety of local affections, * where the very powers of life are shaken and succumb, such (e.g.) as ulcerated chilblains, &c., where the
it must be obvious that so siipple a mode of procedure affected parts are weak and irritable.
ST. PANCRAS DISPENSARY. which I was passing, to see a child, four or five years of age, the lower half of whose person was literally | CASES ILLUSTRATIVE OF TAE CONDITION burns to death; the skin was 88 bard as the hardest
OF THE SYSTEM WHICH IS ACCOMPANIED leatber, from about the navel downwards, whilst all |
BY OXALIC URINE. above had a patural appearance. There was no
By EDWARD BALLARD, M.D., Lond., Physician to expression of uneasiness in the child's countenance,
***the St. Pancras Royal General Dispensary, and and to my astonislament, a bit of gingerbread was
Medical Tutor in University College, London. eaten readily and with apparent gratification. There was no perceptible pulse, no manner of chance of!
(Continued from page 409.) life being prolonged beyond a very brief period,
Case VI.-CHRONIC RHEUMATISM. she in fact lived for about an hour from the time A. L., aged 28 years, presenting no hereditary len. I first saw her. It is evident that in this instance dency whatever to disease, has been married nine years, no application could bave done the least good; and in that time has had four children and one miscar. and between such cases and the mildest that occur, riage. She nursed her two first children from eighteen there will be an incalculable gradation. When par months lo two years, and has had one at her breast now ticular methods of treatment therefore are recom- for more than a twelvemodih; applied at the Dispensary mended, regard must be bad to the limits within on the 18th of June, 1816. It appears that for more which they can reasonably be expected to be of service. than two years she has been the subject of painful
In all cases of breach of surface, from the most swelling of the small joints of ibe hands and feet. Her trifling abrasion of the cuticle, (to which the applica- illoess commenced shortly after the birth of her third tion of a bit of white-brown paper is better tban any child, in consequence of exposure in the draughts of air otber,) to the most extensive ulceration, there is no and dampness of a wastbouse, with pains in all the indication of cure so important as that of the exclusion joints, large and small, of a severe kind, but without of air. In the course of a long continued practice, uby redness or swelling, and without any febrile dis. I have witnessed many cases of traumatic tetar.us, turbance. As these pains left her, the small joints of but I do not recollect an instance wbere the precau the hands began one by one to be affected with pain, tion of keeping the wounded or ulcerated parts well. redness and swelling; and from time to time the together, and well covered and protected from ibe metatarso.phalangal joints of the feet became similarly access of the external air, had been sufficiently affected. At present all the smaller joints of the hands attended to.
and the metatarso-phalangaljoints of the feet are painful, Some years since, a good deal was written about tender, and swollen; in those of the hands which have the efficacy of tbe balsam of Peru, as an application to been more recently affected there is mobility, with redpainful ulcers, and to parts approaching to a state of ness and more or less fluctuation, while those which mortification ; such, for instance, as Port's well known have been longest affected are incapable of being fully cases of mortifying extremities. It is to that eminent extended are not red, and do not appear to contain surgeon we were first indebted for the substitution of fuid, but are heard to crack on being freely moved. a lenient mode of treatment for severe measures in The heels are also tender and painful, the wrists and these cases, wbich are often dependent on irremediable ankles swollen and painful, but not red; and there causes, and admit only of palliative treatment. But are pain and tenderness in the legs, knees, thighs, hips, I bare seen, again and again, most surprising benefit arms, elbows, and shoulders. All these pains are to arise from anointing the parts, even when extensively relieved by warmth. She feels languid and weak, and discoloured, and almost black, with clarified honey; l is frequently chilly in the mornings. Has occasional carefully covering thens, when 80 anointed, with folds pain across the loins; ber appetite is Jeseclive, but there of cotton-wadding, and placing thein in the easiest is very little thirst; bowels open; tongue presents a possible position. The inunction will require to be slight whitish fur; pulse 95; small and weak; urine repeated at intervals of one or more days; and tbe full-coloured, acid, specific gravity 1031, rather clondy, greatest care must be taken to enrelope the parts well with a moderate cloud-like sediment, consisting almost with the cotton. By this simple inode of treatment entirely of octobedra, some of them being very minute. the living colour has returned, and the parts bave No albumen. Ordered to wean ber infant. R. Potassii been preserved under circumstances which were deemed Bromidi, gr. iij.; Inf. Calumbæ, oz. ins. Fiat haust. hopeless. In such cases the balsam of Peru might quartis horis suipend. be too stimulant; but, if honey were not at band, I 251b. Pain considerably improved, bas put on her would recommeod treacle as its substitute.
boots this moming which she has not been able It will occur to the experienced practitioner, without 'to do for the last fortnigbi. Uripe four pints in the
last twenty-four hours, pale, acid, specific guavity 1015, Remarks.--Rheumatism, especially chronic rbeunr cintaining bo octobedra. The Bromide of Potassium tista, and still more particularly that form of it which has been increased to five grains.
manifests its alliance to gout, by attacking the small Jurie 30th. Was exposed to a draught on the 27th, joints in preference to the large ones, is not commonly and since then has suffered from headache, tenderness met with in persons previously in robust health, but of the scalp, and increase of all her pains, but does apparently requires for its development a constitutional not feel so langaid in the mornings. Auge Potassii predisposition, derived from hereditary or chronic debiliBromidum, ad gr. viij.
tating causes. Perbaps it is for this reason that Julg ist. Urine passed this morning, specific gravity chronic rheumatisma is su difficult to deal with, and 1025, contains an abundance of Octobedra.
frequently so little under the influence of remedial 8th. No improvement; urine of specific gravity 1025, agencies. Perhaps it is on this account also that contains very few octobedra. Omit. Med. R. Potassii oxalate of lime, though by no means constantly Lodidi, gr. v.; Inf. Calumbæ, oz. isso, ter die sumend. excreled with the urine, is so, not uncommonly, during 14th. Much tbe same; urine in all respects as on
its progress. Chronic rheumatism is familiar to erors the 8th. Auge Potas. Iod., ad gr. viij.
one as a sequel of the acute, but it may also be chronic 24th. Pains have not been any better; urine has op from the first; in other words, there may be no fobrile to this time been of lower specific gravity, that of the disturbance to mark its origin, and the only perceptiblo last twenty-four hours 1019; occohedra remain small
ailment may be debility, conjoined with the local dis. and few, Omit. Med. R. Vini Colchici, m. xx.; Az. ease. Apesample of this most obstinate apd iatractable Menth. Pip. oz. iss. Fiat haust ter die samend. I form is displayed in the case befure us. The patient
29th. Has not improved so far as the extremities are attributed ber illness to the operation of cold and wet, concerned, but there has been less pain in the head.' which no doubt co-operated with the tendency derived Urine of last twenty-four hours, four pints, cloudy, from the debilitating influence of over-lactation, &c., with a cloud-like deposit occupying one-third of its in the production of the disease. She appeared to be bulk, specific gravity 1029, re-action very acid. The
benefitted at first by the administration of the bromido deposit contained an abundance of moderately large of potassium ; but this, as well as the iodido, failed to octobedra. Auge Vip. Colchici, ad dr. ss.
give relief when her complaint was exaggerated by August 10th. Finds her general health improved, renewed exposure. Colchicum produced more permaand with the exception of the arms the pains are all Dept relief, and its full effect was followed not by a betler. Head and eyes were very painful yesterday. dinipation, but by a remarkable increase of the oxalic Urine contains rery few octohedra. Auge Vin. Colchici, deposits. Whether the less violent operation of that ad m. xlv.
medicine had any thing to do with the ultimate disap. "20th. Medicine purged her from the 14th to the 18th,
pearance of the oxalate from the uriue, I may be per. and from this time the pain became less violent and
mitted to doubt, in consequence of having observed the headache ceased. Urine of last twenty-four hours
another remarkable coincidence as respects the atmos. cloudy, with a cloudy deposił, containing an abundance
pheric temperature and the barometric pressuro. When of octohedra some very large, some aggregated ;
| these were high, and especially when they suddenly re-action acid, specific gravity 1030. Omil medicine.
rose, the oxalates discharged became abundant, wbile 25th. The arms have have been more painful siace
the opposite states were followed by a corresponding the omission of the medicine ; has taken a fresh cold
diminution. Much mischief has been done to scientific and has suffered a febrile attack with headache and medicine by the stress which has been laid upon indivi. vomiting. Urine contained abundance of octobedra as dual coincidence; but, for all that, every step which it before, with a slight excess of lithate of ammunia. To takes in advance is founded upon an accumulation of resume medicine, with Vin. Colcb., dr. ss.
them. I cannot say that I can bring a parallel from my September 7th. Pains have been less for the last recorded experience to assist in placing a value on week. The urine of the Ith was of specific gravity this observation, although in two instances [ bave '1016, and containod only a few octohedra.
seen something approaching it. But nevertheless I Ilth. Has had no medicine since last repori, and I feel justified in directing to it the attention of those pains bave been worse. No octoliedra in this morning's who may feel interested in ibe existence of oralato uripe.
of lime in the urine, since if sufficient instances are Oct. 13th. Has beon very little better up to this collected, we may be assisted in explaining some of date, but is improved in general strength. The urine those variations in its quantity which are well known eramined from time to time was fouod to contain vo to occur independently of variations in a disease. octobedra. Contin. haust; R. Tinci, Aconite, oz, ss;
CASE VII.-- LUMBAGO. Linin. Saponis, oz. iss. Fiat Liuim. partibus dol. ! infric.
C. B., aged 63 years, by occupation à charwoman, 29th. Finds relief from the use of the liniment; badly off in her circumstances, and upable to procuro sutfered for the last week from rheumatic pains affectiog a sufficiently nutritious diot, applied at the Dispensary the side of face aud jaw; general health improved; on August 18th, 1846. She states that three weeks urine of this morning of natural colour, with a moderate ago she did an unusually hard day's work, connected very light cloud at the bottom, - consisting of an with much stooping, the windows of the rooms being abundancy of octohedra; re-action strongly acid; constantly open. The following night she had no specific gravity, 1023. Discharged.
sleep, and in the morning was attacked with pain of
* a shooting character through the loins, extending down Remarks. I would direct attention here to the seat
the back part of the thighs to the calves of the legs. which ihe rheumatism occupied in reference to the She never suffered from rheumatisra before. At the ordinary employments in which she was engaged. The present time the pain is limited to the loins and calves stooping posture, predisposed to lumbago, rather than
of the legs; is worse by day than by night, appearing articular rheumatism, on exposure to an exciting cause i to be relieved by the warmth of the bed. It gives her on the principle which hospital practice frequently
great paid to stoop or raise herself from the stooping illustrates that, parts which are most exerted are composture. There is some tenderness in the loins, aod monly those first or even solely attacked with the that part is copiously perspiring. She is pale, weak,'| disease, or at any rate they are those which suffers from and desponding; the only feverish symptom which it most severely. I have seen this illustrated in the she has is a sense of heat in the palm of the bands, University College Hospital, in the case of the upper and over the abdomen. She has lost her appetite, extremities being preferred by the disease to the lower, and her bowels are habitually costive. Three days or oge arm selected by it rather than the other. Dr. ago'she had some watery soor eructations for the first Williams notices the same phenomenon in his valuable time in her life. Sto states that her urine is scanty, work on the “ Principles of Medicine," referring it but not opake. Ordered R. Calomel, gr. iij; Pulv.) with great probability to the retention of some of the Zingib., gr. ij.; Palr. Jalapa, gr. sv.; Fiat pulv. station products of the transformation of the muscular textures. sotend. R. Beeberidæ Sulph., gr. r.; Ext. Gent., the elimination of which the system frequently attempts, 9. 9., pro pil ter die sumend.
as in the present case, by the establishment of local 251h. The lumbar pains she considers more sorere, sweats. but those in the calves have disappeared. She got Bier feet wet two days after I saw her, and has suffered
PROVINCIAL from corýza and cough since., Appetite is improving M edical & Surgical flournal. and there has been no return of the eructations ; bowels have been freely, purged. Continue pil.; Omni nocle ; WEDNESDAY, AUGUST 25, 1847. sumat Pil. Rhei. Co., gr. x.; Applic. Eppl. Picis lumbis.
** The proceedings at the Anniversary Meeting Sept. Ist. The lumbar pain has been very serere, of the Provincial Medical and Surgical Associabut is much less so now; catarrh is lessening; states tion at Derby, were highly satisfactory, and that her urine has been very high coloured; bowels in reference to several subjects of importance insufficiently acted on. Repet, Pals. Catharlic, alternis to the welfare of the Association, presented diebus. Coplin. Pil. Bebeerinæ.
features of considerable interest. , Upon some 4in. Considers herself stronger; catarrh has not
of these we shall hereafter find opportunity to quite disappeared ; lumbar pains distinctly less and less constant; urine passed this morning cloudy, but rather
enlarge, but on the present occasion we are high coloored, depositing a very abundant dense
more particularly desirous of directing atlention fawn.coloured sediment; specific gravity, 1026; re.
to that part of the proceedings which has referaction acid; no alhunen. The deposit consists of
ence to the treatment of the Medical Officers of lithate of ammonia, entangling and concealing an
Poor-Law Unions. The subject was, on this abundance of octohedra, of large size, both separate occasion, formally introduced to the notice of and aggregated, which became obvious on warming it. the Association by a deputation from a meeting Continue Pals. Cathartic and Pil.
of gentlemen holding these appointments, which 8th. Still some lumbar pain remaining. Two days had recently been held at Matlock Bath, and ago vomited some watery matter after eating some fat the resolutions passed at that meeting, on the food; bowels not sufficiently acted upon. Continue question of the remuneration of the Union Pil. Bebeerinæ. R. Olei. Crotonis gti., ij.; Micæ Medical Officers for their services, and the treata panis 4. 9. pro. pil., viij. ; Capt. j., omni nocte.
ment experienced by them from the Poor-Law Ilth, Bowels act regularly twice a day; lumbar pains
authorities, were read and ably supported by Mr. disappearing ; some cough remaining still; urine has
Cantrell and Mr. Tasker, two of the deputation. not been opake since the specimen examined on the
The statements of these gentlemen were 41b; that passed this morning is rather pale, slightly
listened to with deep interest, and evidently cloudy, and presents a slight cloud-like deposit, which contains some circular thin plates, with concentric
made a considerable impression, calling forth markings, but no octohedra ; specific gravity 101. the sympathies, not only of those who had suf
15th. Has no pain worth mentioning, but is still fered or were suffering under like indignities and Jow-spirited; bowels act once daily; urine contains no' injustice, but also, we believe, of almost every oxalates or other saline deposit. . . . . gentleman present. The response which was
18th. Is much stronger, and can walk with much made to this statement by Mr. Douglas Fox, Jess fatigue ; is less low-spirited, and complains only or Dr. Conolly, Dr. Hodgkin, Dr. Hutchinson, and alight weakness of the ankles ; appetite improving; other gentlemen, though not themselves perbowels regalar; urine presents no oxalates or other sonally interested in the subject, yet of the salige deposito Discharged.
highest reputation for genuine benevolence, and