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two families; one by W. Roper, bis wife, and seven Garrad 1 out of a family of 4 who recovered children ; the other by John Sparrow, his wife, and Pegg

ll of whom all recovered two children,

Threadgill 2 2

3 of whom one died Roper 6 ,

9 of whom all recovered From the commencement of the fever in Pegg's house,

Sparrow 1 1 they had kept quite close, declining all communication

4 who recovered

1 :

5 who recovered with the infected premises, and bad hitherto escaped. | Dary 1 ,

7 who recovered It struck me that if I could remove the two healthy | Gardener 1

in 5 who recovered families, and isolate them, I should, even if they did

ara There are several points in the history of the Dot escape, destroy the focus of contagion, and thus

8 epidemic which are extremely interesting :probably cut off the disease. I therefore waited upon

First. The effect of contagion,-i, e., of a morbific the Board of Guardians, and laid the case before them.

| poison, produced in, and exbaled from the buman body, There was some difficulty upon the subject, which

causing the same disease in others by direct communi. was, however, eventually removed. The Union Fever

cation, is distinctly clear. Hospital, which is a detached building, was given up

Secondly. The fact observed in all fevers, and well. to them, and after some persuasion, the Ropers and Sparrows' departed from the “city," which they left

established in regard to many other diseases,-viz.,

that a certain state of the system, at present unknown with all the regret of long attachment, and on the

and undefined, is essential to the reception of this 23rd of November, took up their residence in the Fever Hospital of the Union, which is about three

contagious principle, was well shown in the epidemic

I have described. In eight families, the members of miles from the “city.” The men were allowed to go to their work as usual. I confess that I felt interested

which were in daily, and some of them in hourly

communication with the party infected with this highly in this experiment, and made frequent enquiries after the emigrants. I had no fresh case, and “all well"

contagious ferer, twenty-seven out of forty-eight was the answer week after week which I received.

escaped. I began to congratulate myself that there was an end of

Thirdly. The interesting fact of the poison of fever the epidemic, but I was disappointed.

remaining dormant in the system for a fortnight Thirty-onc days after their removal to the Fever (Case 11,) one month (Roper and Sparrow,) or erea Hospital, one of the sons of Roper was attacked witb two months, (Gardener,) causing no alteration in the fever, and was followed by five other children in the health, until the state of the system was favourable to course of the week; and on the 31st of December, the development of fever, is clearly and unanswerably one of the children of Sparrow, making then seven out | demonstrated in the facts I bare related. of the thirteen. These cases fell under the care of Fourthly. The probability of contagion being effected another medical man, and all recovered. Their ages through the medium of a third party, who himself were 2, 4, 6, 7, 8, 10, 12, and they will number in my aever has sever, is strongly indicated in Case 13. list, Cases 14 to 20, inclusive. They remained three | I could extend these observations, but I have already months in the hospital.

occupied space enough, and I am anxious to avoid

detracting from any value which may attach itself to January 17th.

the facts I have related, by being tempted into the Case 21.-On the 17th of January, 1847, fifty-fire

fascination of theoretical speculation. days after the Ropers had been removed to the

Ooe word more, however, upon the all-important Hospital, Samuel Gardener, residing at the cottage marked 21 in the diagram, was attacked with fever,

| subject of treatment. Several (I think about nine,) had it very severely, having been reduced to the very

years ago, I bad nearly the whole management of an last extremity, but ultimately recovered. Samuel | epidemic similar to that which I have related, and Gardener had worked with the Ropers daily before occurring in the same parishı. In this case the symp• their removal to the Union, and this is all the connection toms commenced with a type which appeared sufficiently I could trace. None of the neigbours of Gardener inflammatory to warrant the abstraction of blood, bad the disease, and this is the last case wbich occurred.

which in three or four instances was done by myself, I have thus giren a brief description of every case and one or two by other practitioners ; but every the first and the last—in this, which I may fairly call case in which blood was taken, either generally or a distinct (though limited,) epidemic, commencing on locally, died. In fifty-four cases there were tea on the 25th of August, 1846, and ending on the 17th deachs, or about one in five. In the epidemic I have of January, 1847; lasting five months, arising without just related, in twenty-one cases there was only one any traceable cause, and communicated from individual death one in twenty-one a difference very great. to individual, in eighteen certain and clear, and of late years I have used the lancet very sparingly three other more doubtful, instances. It was con indeed in the treatment of all diseases, except those fined to eight families, of whom it attacked in the purely and acutely inflammatory ; but I have never case of

| taken a drop of blood from a patient labouring under

continued fever, and I have had no reason to regret the malaria of ague producing continued fever, it the omission.

vanishes altogether when brought to bear upon putrid In the instances above related, I kept two indications animal excreta, and this perhaps is the most natural before me:

theory we can devise to account for those cases in 1st. To obviate the effects of local congestion, of which no contagion can be traceda what I believe to be in fever altered blood; which l.. Stowmarket, November 24, 1847. effects, again, I believe we see in or about the capillary system, or ulceration of Peyer's glands, &c,; and,

2nd. To prevent my patients from dying by asthenia ;) SHORT NOTES OF THE- OPINIONS, AND to keep them, in fact, alive.

PRACTICE OF THE LATE JOHN PEARSON, The first indication I attempted to fulfil by the use ESQ., F.R.S., ON SYPHILITIC DISEASE. of the Pulvis Sodæ Comp, of Guy's Hospital, a most By W. S. OKE, M.D., Physician to the Royal South. useful medicine in these cases. It is composed of car

Hants Infirmary. bonate of soda, compound chalk powder, and calomel;

(Continued from page 654) sixteen grains contain one grain of calomel.'. Of this I When chancre is associated with pbymosis, it somegave from five to twelve grains every four hours, with or times ulcerates backwards as far as the arch of the without a solution of the carbonates of soda and pubes; at others it penetrates laterally into the canal ammonia.

of the urethra, causing the urine to communicate with The second indication I endearoured to fulfil by the the sore, and producing excruciating pain. adidinistration of port-wine, with or without brandy, so long as the orine is imperfectly discharged, the in large quantities.

ulceration of the integuments will continue to extend, In the cases I have detailed I had frequently abdomi- 1 and the pus and urine pass out together through one or nal and thoracic complications; in one case (11,) there more openings. was decided pneumonia, but I did not on this account Sometimes in complete pbymosis, ulceration takes omit the wine, though I pushed on the mercury. I place through the prepuce at the point where the corwas equally regardless of delirium, which is, probably, pora cavernosa join the glans, and the urine, haring always an effect of innervation in these cases, or of no other outlet, will be forced apwards at a right angle dry tongue. Whenever I found unequivocal indications with the urethra, producing the greatest possible annoy. of debility, as evidenced by a quick, thready, irritable ance to the patient. If the chancre, having perforated pulse'; trembling; sordes about the mouth and teeth, the urethra, has formed a sinus, making its way towards &c., I invariably gave wine. The result of the cases the scrotum, the urine will escape into the cellalar I have related fully bears out the propriety of the membrane, and produce great pain and inflammation, practice. Had I been able to get more wine down the

and in a few instances affect the testicle. When the throat of poor Ann Threadgill, (No. 10,) I believe that sings is narrow, and the aperture small, the infiammaI should have had no fatal case to record.

tion will extend, and form a small bard tumour near The doctrine of contagion in ferer is all-important the ossa pubis, the superincombent integaments not in these days of sanitary reform; every addition to our always being involved. In these cases the urine will knowledge, therefore, upon the subject, is valuable. I be expelled by squirts; and if the tumonr be neglected, Dr. Watson,. in his usual masterly manner, bas

the sinus will proceed downwards in the course of the brought much evidence and reasoning to bear upon the urethra, and produce fistula in perinæo. In another subject. He believes that malaria or miasmata pro- I instance, when the glans has been destroyed, the ulcera. duce a disease which is not contagious, and that con- ' tion will extend along the corpus spongiosum, and tinued fever, and the exanthemata are never caused by I cause the greater part of it to slough away, whilst the malaria, but are invariably produced by contagion,-l integaments may remain unaffected; but the sound i.e., by an animal poison arising in the individual, and

skin will so contract upon the space left by the propagated from one person to another, either by

og sloughing of the urethra, that the urine will be expelled actual contact, or by exhalations from the lungs or

in a stream not larger than a hair, and a balbous surface of the body. But this argument, it is clear,

enlargement will be found behind the point of con. must in itself extend to animal excretions, and what is

traction, by every effort to discharge it. There is undoubtedly true of the body, may thus, mutatis

generally at the same time thickening and induration of mutandis, be equally applicable to the dungbill or the

the prepace, with a contraction of its apertare. Should neglected privy. Dr. Watson says, having established

the ulceration include the common integuments, these, the proof of contagion, it is difficult to imagine any

as well as the corpus spongiosam, will be destroyed, other way of propagation. Granting that the diffi

and the arine will be discharged through a small culty is great as a mere mental effort, with respect to

aperture near the pubes, at the anterior part of the • Lectures, Vol. I., “Malaria;” and Vol. II., “Con

scrotum, wbilst the corpora cavernosa might probably tipoed ferer."

remain entire.

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· Chancres in the female are usually situated on the discharged from such sore shall not always produce "inner surface of the labia, on the nymphæ, or the voso other soressui generis,

tibulam, 'more rarely on the præputium clitoridis and when more chancres than one appear at the same margin of the meatus arinæ. Those on the outer time, tbey probably arise from the same source simul. surface of the labia have generally a crust formed apontaneously, and it is certain that more than one may them in consequence of their exposed situation. They appear. This, however, is an exception to the rule. are seldom, if ever, seen primarily in the vagipa. In Treatment of Gangrenous Syphilitic Sores.-When a sixty-three women, thirty had primary sores on the syphilitic sore is gangrepous, the first object is to check inder surface of the labia; twenty-seven on the res. | the gangrene, and promote a separation of the slough, tibulum; one on the anterior perinæum; and five on before any attempt is made to treat it as a specific the' nymphæ and præputiam.

case; it will therefore be best to poultice the part, In many cases the primary sore is solitary, but three and give bark, acids, &c. If the sore be out of sight, or four are oftener found in women than in men. This a decoction of poppies should be injected to wash out may arise from delay in procuring advice; for where the sordes.' Opiam must be given, but it will not be early application is made, there is seldom foand more advisable to give much wine. [n seven or eight days than one. Considerable pain, inflammation, and tame. ) probably the slough will separate ; and it will be faction of the labia frequently attend these ulcers, which judicious to wait till the gradulutions are rising, and enlarge and become very fætid.' Large sores on these the venereal action becomes evident, before mercury parts often become slougby and gangrenous, and it is is given. After the complete separation of the slough, not uncommon for the whole of the external parts, the syphilitic action is characterized by a foul appear. with part of the vagina, to slough away; indeed it ance of the sore, and by its elerated edges. It ought sometimes bappens that the body of the uterus is now to be treated as syphilitic, and the bark, &c. exposed, and the rectam lies loose in the ulcer. should be discontinued.

As a result of these deplorable cases, the cavity of Although this may be considered as a general rule, the vagina will be sometimes almost obliterated, and it has nevertheless its exceptions. Sometimes, notonly a space left just large enough to permit the exit withstanding the use of bark, opiam, and good living, of the urine. The lowest ciass of prostitutes are most the gangrene spreads, the pain becomes more severe, subjected to these severe ravages, from their inattention, and the patient's health declines. Iu such a case intemperance, poor diet, ayd frequent exposure to the ihe syphilitic virus is to be considered the immediate inclemencies of the weather.

cause of the mortification, and mercury is to be given Independently of the magoitude of syphilitic sores, freely with the other remedies, which will frequently a sore of a peculiar kind is sometimes formed at the be attended with success. lower and external parts of the labium, or on the (When extensive gangrene has taken place, and is anterior perinæum. This kind of sore frequently rapidly increasing, the case is attended with the deepest sloughs, and spreads towards the anus, having hard, I anxiety, both to the patient and surgeon; and it is not but not thick, edges, and the discharge from it approaches at all times easy to decide what treatment ought to be the nature of sanies. The patient is very weak and adopted, whether to give mercury freely, or done at all. irritable, and the sore is aggravated by the use of I ventare to make the following brief remarks on this mercury, and often becomes gangrenous. It is pro interesting point. bable this species of ulcer is caused by the syphilitic lst. If the gangrene has taken place goder the use matter coming in contact with an abraded sarface, or of mercury, its immediate discontinuance, and the use a pustule. It is a sign of a broken down constitution, of tonics, with a generous diet, are clearly indicated. and often proves fatal. Sometimes a troublesome! 20d. If previously to infection there existed a delidischarge from the vagina remains, after syphilitic cate, weak, or cachectic condition of the constitution, sores on the labia and nymphæ hare yielded 10 mercury,' even if no mercary had been used, the case should be which cannot easily be restrained by ordinary means; treated with tonics, especially the iodide of potassium, and sometimes it is almost impossible to remove the opiam, and a generous diet. But indurated swelling that is caused by them. If it be 3rd. If the primary sore quickly followed exposure, on the nymphæ or clitoris, excision may be employed, spread rapidly, with pain and inflammation, and soon but such a practice is justifiable only when it impedes became gangrenous, and if the general health had locomotion, or interferes with the functions of the been preriously unimpaired, then the destruction of the rectum or bladder.

parts may be fairly referred to the intensity of the : It is singular that the venereal virus seldom pro. virus, and the free use of mercury at once employed.) duces more than one or two primary sores, although Where there is a sloughing sore with phymosis, and 80 large a surface is exposed to infection; and if hæmorrhage takes place, if the prepace cannot be exposure to infection produces disease in so limited an retracted, it must be divided, although in sach a state extent, we are not to be surprised that the matter of the parts such a step is most undesirable. If the

of the

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bleeding be not very considerable, other means may be will be avoided; but when there is much enlargement previously tried, such as the injection of warm porter | it will be sometimes necessary to secure the bleeding or wine between the prepuce and glans.

vessels. The bæmorrhage generally springs from the glans The subsequent dressing may consist of dry lint, ponis, and although its texture, even in a healthy state, a pledget of lint, and a T bandage. The patient is to be is scarcely fit for the needle, and of course is much loss kept low and an opiate administered. After twenty. so in a state of disease ; it will be, nevertheless, right, four hours a poaltice may be applied. The sore will if prófase bleeding continne, to make the attempt to usually heal in about ten or foarteen days. stop it by such means, taking care to include a portion Excision may be also adopted, if the præputium of the surrounding parts in the ligature. If this clitoridis is very much enlarged and indurated; but method should not succeed, the bleeding vessel may be sach a mode of treatment is seldom necessary, compressed by the hand of an assistant as long as it! There is no specific mode of treating the sphacelating may be necessary, with a bit of sponge or puff.ball, or constitational scre above mentioned; there is generally a little bag, containing some powdered sulphate of quick and feeble pulse, but the patient does not suffer copper; and should these means fail, turpentine, boiled in any very great degree. Bark and mineral acids, over a candle in a spoon, may be poured apon the part with a nutritious diet, is the most suitable treatment; from which the blood issues; or the actual cautery, all and the best local applications will be those that give other remedies proving of no avail, may be applied. the least pain; a solution of the nitrate of silrer will

In order to make use of these more severe methods, / be attended with advantage. the prepuce of course will bare been divided. At first

(To be continued.) it is best to make the division by a single longitudinal incision, in order to liberate the parts, and to finish the operation after the sloughing process shall have ceased. | STRANGULATED HERNIA ON ITS PROPER If mercury be found to aggravate the local disease,

FOOTING. it must be discontinued, for it will be better that the


SURGICAL JOURNAL. * system should continue under the influence of the

syphilitic poison, than that the organs of generation I have written often on this subject, in expectation be destroyed, and the general health impaired, by that my views would prerail generally; in this I am means of mercury.

disappointed, therefore wish to explain still further, Treatment of Primary Syphilitic Sores in Women.

aware that buman suffering and life are involved in When chancres are accompanied by much pain and

the discussion. The theory and practice adopted

generally, as appears by the writing and teaching of inflammation, they may be washed with a lotion of

eminent men during the last century to the present calomel and lime-water, or with the Aqua Phagedænica

day, are that strangulation consists in displace. of the old Pharmacopæia. (Aqua Phagedenica is com.

ment of the hernia, and that replacement is the monly called the "yellow wash,” made by mixing two remedy. The protruded part is represented as if grains of the bichloride of mercury with a fluid ounce bound by a cord, and the practice is to push it back of lime.water.] By these means they will generally be until returned into the abdomen, to press it towards found to heal rapidly ; but if the sores be very large, the aperture, sometimes to grasp it with the hands; they may be dressed with the mercurial cerate.

also to try with the fingers of one hand at the top, to Where the inflammation anul tumefaction of the get in a small portion, whilst with the other to raise labia apd ngmpbæ are so great as !o confine the

from the bottom by various movements, and return the

remainder. It is a common practice to knead it as patient to ber bed, poultices, as well as the dressings

four is worked into dough ; in most casos many hands above mentioned, are to be applied; and if gangrene

are thus employed. One treatise, which is valued, bas taken place, the stale-beer poultice may be used, | advises perseverance for an hour in these attempts. together with the internal use of bark, mineral acids, &c. I have always considered the theory and practice as

As the result of syphilitic sores, there will some here laid down, erroneous. When we reflect that the part times be considerable enlargement and induration of is very often protruded, among the working classes, and the nymphæ; and if this state of the parts should not remains so many days, it is evident that situation out. bare been reduced by a full mercurial conrse, by

eide is oot the cause, and consequently, to return it is poultices, the vapour of bot vinegar-and-water, or

| not the remedy. With respect to the practice, it is spirit of wine, nymphotomy may be performed.

outraging every sound principle to grasp an infamed

and inflated intestine, and to push it back forcibly The operation may be done in the following

against a stiff tendinous border, which binds it as manner: Let the incision be commenced with the stated

with the stated. The aperture had been always filled up by the scalpel at the soperior part of the sympbæ, and carried

sed spermatic process, the hernia being added and anable downwards till within a quarter of an inch from the to expand, the intestinal tube is closed ap unavoidably bottom, at which point it should be terminated laterally in the ring. Surely the attendant irritation forbids By tbis method the principal artery of the symphe / such attempts as to press portion by portion; also as

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knea ling to get up a part. The neck formed by the | This is enough the gaseous nature of the Guid hernia as if solid, is immovably fixed, so as to present struggling for vent. This is the only handling I use, to a discerning eye, insuperable objections to all and it has always succeeded when resorted to in the manipulations at this stage; the too narrow space first instance. Water, ice, &c., hare often failed when wedging together what had presented two tubes, now accompanied by the taxis in the usual way, which is a inseparable, on account of the resisting ring. Cases certain counteractive of all means. It is quite clear of success have sometimes occurred during the more that after the sensibility has been lessened, gentle ments stated, and also when nope had been resorted to; pressure is safe, wbilst during the interim it is not so. these bave bappened when the symptoms were mild In failure of these means I operate, making a small and gentleness had been attended to. The removal of incision in the tendon to allow the gut to expand where strangulation where no effort had been made, strongly it is closed; having no view to returning the bernia encourages forbearance as to handling; the sponta. during the tumefaction, I gently endeavour to renovo Deous removal is in coincidence with our views of all the contents, assured that this is a sine qua non. inflammation of the viscera. The fact that any for. A case in extremis occurred at a London Hospital, midable ailment, for which much force had been the after failure of the usual means. The patient, rather usual remedy with eminent men, shall he remedied undressed, was carried across the yard to the room for without any other means in lieu of it, is most instruc. operating, on a cold day. The strangulation vanished tive. The surgeon who practices kneading must forget in transitu, which was discovered on exposure on the the firm state already observed upon, and that the operating table. This was witnessed by Mr. Lawrence, integuments alope can be moved, which latter yielding, junior, a student of high character. It calls to my imparts the feel that deceives: it is quite incompatible recollection two cases in which I could not attend at with the corded state allowed by all, that morements of the time, but had instructed the messengers to treat any kind could be effected. Surely the spermatic the cases as already detailed. On my arriral after cord and enclosed iptestine are by far too much for half an hour, I was informed that a shivering fit had the space, and too sensitive not to suffer severe injury seized them, and the strangulation vanished suddenly. through such practice ; fortunately the integuments in the course of thirty years I have treated two or interfere, and are protective in some measure.

three on an arerage annually, and wben in the early Presuming that the reasoning advanced, shews sufi. stage, successfully. ciently that return of the hernia into the carity is not In December, 1829, I met two well.qualified surgeons the suitable remedy, and also that the treatment at the prepared to operate promptly, because the touch gave beginning is injurious in every case, ultimate measures excessive pain ; on my applying cold water for about of improvement are to be considered.

a dozen minutes, the sensibility was so far abated, that The first feature strangulation presents is a swollen I applied my hand outside the folds of wet linen, gave intestine, ex situ, painful in the extreme at the aperture no pain, and removed the contents in the presence of where it is obstructed as to its passage inside and out the gentlemen who had decided that the knife was the side; it is also impervious here, impeding the circulation only remedy. of its contents, which being acrid in a high degree, I was present at the operation, by an experienced irritate and distend. It is clear that impervious surgeon, who, before and during the process, and twice Dess at this precise spot must be removed, so that the incising the tendons, failed to return the inflated contents may circulate as in health. This is the hernia; he raised himself on his toes, and drove the remedy in my view, which is supported powerfully part before him. In another case I interfered, and by the occurrence of a gurgling noise always accom- advised a trial to reduce the size, (pending the opera. panying the removal of strangulation; this poise arises tion, which was declined, and the usual practice from the air rushing through and opening the intestine persevered in. Both cases proved fatal. at the desired spot, leaving it free, and the bulk disap. Instances of the like description are recorded, in pearing. The celebrated Pott remarked this noise, which dissection shewed the part impervious, where but drew no inference from it; bad he dwelt on the the gut and tendon had been in contact. A case is occurrence as it invited, a rational practice would have reported in the London Medical Repository for Novembeen settled on ere this, instead of the farrago which- ber, 1825, in which the operation had been performed, bas so long darkened our course.

and gut returned, but was followed by intense pain, and In the opinion that the last points to which I have death. Dissection , shewed the part that had been adverted furnish a clue to success, I shall describe my fixed within the aperture during strangulations im. practice so as to carry out my views. I avoid the taxis or pervious and solid, for one inch and a half in length. touching the part, and place the patient in a cool situa. The operation was perfomed by Dr. Bishop, of Thornley, tion, often on the floor, the trunk being bent by raising Northamptonshire, who took the portion to London, the head and knees; wetred cloths are kept on the part, where Brodie, Cooper, and others saw it with great the cold being renewed every five minutes. The air is surprise, but observed that Mr. Geoghegan had anadmitted by open doors and windows, which often causes ticipated such an affection, in an essay on hernia, but a rigor and suddon disappearance of the hernia; if not, I produced po post-mortem facts in proof of his statement.* apply my hands to the sides near to the upper part, In conclusion, I beg to call the attention more closely and gently press them towards each other to lessen the area; thus a stream of the contents is impelled towards Surely success must ever present an opportunity of pro. the impervious tube, where it dissevers the closed coats.' ducing a posiomortem faci.

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