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and carried into the circulation, and disease and death ensue."

If the virus lurks so long in the wound, how is it that " excision of the part has frequently failed," according to Mr. Youatt's own confession? The following explanation is, to us, very unsatisfactory.

"The knife may penetrate the deep and tortuous recess of the wound, in which the virus is lodged, and then its track will be empoisoned. Or if the incision be freely made round the wound, and does not penetrate into it, the blood will follow the knife; a portion of it will enter into the wound inflicted by the dog; it will come in contact with the virus; it will be contaminated; it will overflow that cavity; it will be received into the new incision, and it will carry with it the seeds of disease and death."

Mr. Youatt, therefore, abandons excision, and has recourse to the nitrate of silver as a caustic. The stick is to be sharpened to a point, and every sinuosity of the wound is to be searched and penetrated. The eschar having sloughed off, he advises the re-application of the caustic.

"It is painful to speak of one's-self; but I may, perhaps, here be permitted to say, that I have been bitten four times by dogs decidedly rabid. At each time I freely applied the caustic to the wound; and I am living to the present day. I have operated on more than four hundred persons, all bitten by dogs, respecting the nature of whose disease there could be no question.* I have not lost a patient. One poor fellow died of fright, but not one became hydrophobous. To what can I so natu

* "I am bound to add, that one of the surgeons of St. George's Hospital told me, that since his connexion with that establishment, he and his colleagues had operated on more than as many thousands, bitten by dogs (he could not say that all of them were rabid), and he was not aware that one of them had been lost. This, at least, is most consolatory, whatever may become of my theory of the caustic."

rally attribute this, as to some chemical affinity between the nitrate and the virus, by which an insoluble and inert compound is formed?"

II.

SLOUGHING ULCERATION OF THE PENIS BENEFITTED IN A REMARKABLE MANNER, BY VAPOUR-BATHING. THE following is an abstract from a paper which we believe was read before the Dublin Association, by Dr. H. C. Field.

A gentleman, aged 36 years, became Dr. Field's patient on the 1st September, 1829, for an extensive excoriation around the edge of the prepuce, the result of an imprudent connexion three months previously. The ulceration was daily extending the penis was swelled, red, shining, and evidently in a state of intense inflammation. The ulceration itself had a dark livid aspect-and a purulent discharge issued from under the prepuce. The patient refused to have the foreskin slit up, there being a natural phymosis, and therefore aperients, poultices, and tranquillity were enjoined. Sept. 2d. Great pain extending to the testes-ulceration livid and spreading in a deep circle round the prepuce-febrile excitement. Venesectio ad 3xx-saline purgatives—poultices-bolus of antimony and opium at bed-time. 5th. Relieved by the bleeding-but the tumefaction and livid inflammation had extended over the entire penis, which was exquisitely painful. A great portion of the prepuce was now destroyed by the ulceration, and rendered visible a deep foul ulcer of the glans penis. Leeches-fomentations-poultices. The anodyne antimonial at night. 8th Sept. The swell, ing is reduced, and the pain diminished; but the ulcer has extended, and has a dark gangrenous appearance, with ragged irregular edges. Almost the whole of the prepuce is gone. The whole of the penis is livid and extremely painful. Around the edge of the ulcer there is a vivid redness-next to this a purplish circle, which loses itself in the dark color of the penis. Leeches

tion soon disappeared. Quinine was now substituted for the bark. With the exception of a profuse hæmorrhage, which occured on the 3d of October, nothing obstructed the progress towards convalescence, till the 10th of October, when it was found that the granulations had nearly closed the orifice of the urethra, and required the use of the bougie. The irritation produced by this instrument caused some inflammation of the livid kind to return and threaten the patient. This, however, was speedily removed by the vapourbath, and on the 20th of October, the whole was cicatrized.

-a mercurial purge. 11th Sept. The vernosum-the countenance cleared up ulceration is still extending. The ni--and the inflammation and tumefactric acid was applied to the ulcer, and then lint saturated with a strong solution of opium; over all, a fermenting poultice. A grain of opium and 15 drops of nitrous acid to be taken thrice a day. 15th. Part of the eschar formed by the acid, and part of the dark gangrenous sloughs came away with each poultice; but the parts beneath were in a state of complete mortificationthe integument of the penis was sloughing more rapidly than the deep-seated parts. The patient was in an unhappy nervous state, with distressing palpita tion and nervous irritability. Camphor mixture with Hoffman's liquor, 6tis horis also a drachm of cinchona thrice a day, with the nitrous acid as before. The dressings to be repeated. 18th. Dr. Colles was called in consultation. The sloughing was steadily advancing

the pain in the last night had been great the body of the penis swelled and livid. The same remedies were recommended to be pursued, with the addition of balsam of Peru and carrot poultice. 22d Sept. The glans penis was now gone, leaving a surface and pendulous shreds, both gangrenous. A probe sunk deep into a disorganized structure. The patient was dejected had a small weak pulse, dark-colored tongue, &c. 25th. The mortification was now in possession of the corpora cavernosa penis, and rapidly extending towards the pubes. As a last resource the patient was advised to hang the penis, for half an hour at a time, over the steam of hot water, in a metal vessel, with flannel enveloping both the parts and the utensil, in order to retain as much as possible the vapour. The medicines continued, with the exception of the nitrous acid. 27th Sept. He was so much relieved by the vapourbathing, that he slept four hours in the night of the 25th. He therefore applied the vapour six hours daily from that period, as hot as he could possibly bear it. He has had no violent pain since the commencement of the steaming. The sores soon began to assume a more healthy aspect-a granulating point appeared on the left corpus ca

III.

SULPHATE OF QUININE IN ACUTE
RHEUMATISM.

Our readers know that Dr. Haygarth,
and many others since his time, ven-
tured to treat acute rheumatism-in
common parlance, rheumatic fever, by
bark instead of depletion. Numerous
cures, and speedy ones too, are report-
ed in the periodical journals, on this
plan; and these reports, even admit-
ting them "cum grano salis," as me-
dical reports should generally be re-
ceived, prove sufficiently that rheumatic
is not common inflammation. The in-
tensely buffed state of the blood, how-
ever, the frequent metastasis of the
phlogosis to the heart, the colour of the
urine, the temperature of the skin, the
thirst, and the rapidity of the circula-
tion, should induce us to be cautious
how we administer powerful tonics in
such conditions of the system.
have been led to these preliminary re-
marks by the hospital-report of a case
from the wards of the Royal Infirmary
of Edinburgh, recently published; and
as the case is very short, we shall first
introduce it to our readers.

We

"Catherine Morgan, ætat. 30, admitted on the fifth day of fever, accompanied with symptoms of acute rheumatism; she had likewise cough, diffused pain in the chest, increased by full inspiration; her respiration was hur

are not blind empirics and indiscrimi nate routinists on this side of the chan nel. We are disposed to think that the mercurial practice in acute rheu matic inflammation, adopted by Dr. Chambers and many other observant practitioners on this side of the Tweed, is far preferable to the tonic and stimulant treatment recorded in the foregoing case.

66

ried; expectoration mucous and adhesive; pulse frequent; bowels slow; she had a similar attack two months before. On admission, the symptoms of rheumatism were so prominent, as to hide or obscure many of the others. It was to this affection, consequently, that Dr. Duncan's attention was especially attracted; indeed the pectoral complaints were scarcely noticed at all till the day after he had ordered the remedy he The same accurate and veracious reconsidered it expedient to use against porter tells us something about a case of the rheumatism, this was the sulphate articular rheumatism" which yielded of quinine, concerning the efficacy of to the antiphlogistic treatment, "fol which, even in the most acute form of lowed up by the use of colchicum wine, in this disease, he had already given so the dose of three grains, repeated thrice decided an opinion; in this case, how- daily." Verily the reporter and his ediever, its administration did mischief to torial master are clever directors of the a certain extent, for on the following practice of medicine in this country!! morning the cough and dyspnoea could no longer be overlooked, and some annoying abdominal symptoms also made their appearance, the epigastrium being very tender to the touch, with considerable internal pain. The quinine was of course immediately omitted, and leeches were applied; their operation was followed with great relief, and during the right she slept better, and perspired abundantly. After this, the treatment of the case was exclusively antiphlogistic, and she was dismissed cured on the 29th of March."

How the cough, pain of chest, hurried respiration, quick pulse, and tepacious expectoration could be overlooked, after being noted on the day of admission-and especially by so able an observer as Dr. Duncan, we are unable to even imagine. It is distinctly stated that these symptoms accompanied the symptoms of acute rheumatism on admission-and yet the latter did hide or obscure the former !! We are very much inclined to suspect that these thoracic symptoms were occasioned by the administration of the tonic, as well as the pain and tenderness of the epigastrium. Such cases as these give fair scope for scandalization among our Broussaian brethren of the continent, and the ignorant or careless-perhaps mendacious manner of reporting them increase the evil tenfold. It is therefore necessary that a check should go forth with the evil, to show that we

In the same luminous report, we are informed that a young woman, who was evidently labouring under one of the anomalous forms of hysteria, (which in this case, assumed the character of Nephritis) was bled to 163-but whether ounces or pounds the reporter saith not. If any confidence indeed could be placed in the report, we should be rather surprized that the talented Dr. Duncan did not, at once, attribute the complaint to its proper class, and spare the effusion of human blood. repeated leechings and other depletive measures, "she was suddenly attacked with a similar pain (to that in the region of the kidneys) under the sternum." Although the hysterical Proteus shifted his ground, he did not elude the persevering enemy who depleted to 163 ounces or pounds!

IV.

MR. LAWRENCE ON CORNS.

After

FROM the talented lecturer's short disquisition on corns, we suspect that Mr. Lawrence never suffered from the "pinching of the shoe;" otherwise he would have recommended a more efficacious mode of treatment for this ignoble but very painful complaint. With the etiology, physiology, and pathology of corns, we shall not quarrel. The methodus medendi is not what quadrates with our experience.

1830]

"The palliative cure of corns, as we may call it, consists in cutting away the indurated cuticle, so as to remove from the inflamed skin, at all events, this mechanical source of irritation. The feet are first soaked in warm water, so as to moisten the indurated cu ticle; you then take a sharp knife and cut away the morbid cuticle which has accumulated over the inflamed parts of the skin. In doing this, after you have removed the inflamed part, you generally come to a sort of point, where the cuticle seems to extend deeper than at the other parts; indeed it appears as if at one point the disease extended farther into the skin than elsewhere, and this has been commonly called the root of the corn. It is said that you may lift up and take away in a mass that part of the hardened cuticle which is thus formed in the corn; but I apprehend it is not very easy to do this. However, if you cut away the thickened cuticle in this manner, and cover the part with soap plaister, or some other mild plaister, spread on leather, and direct the patient to wear shoes that produce no pressure, great relief is experienced. You find that usually the covering of the cuticle re-forms after this operation; but if the patient avoids the external source of irritation, the corn will not become seriously troublesome. If, however, considerable inconvenience be still experienced, you may proceed to further measures for the more effectual relief of the case-that is, after shaving away all the thickened part of the cuticle-you may rub the skin with Junar caustic. Thus you diminish the inflamed and irritable state of the skin, and then perhaps have no re-formation of the corn, if you avoid the external exciting cause; at all events the patient will derive very great alleviation from this simple process."

We are ready to grant that if the patient, after the erasure of the corn, wears shoes which " produce no pressure, great relief is experienced." But where are such shoes to be procured? Certainly not at Hoby's, nor at any fashionable shop in London. If we examine the feet of the Venus de Medicis, the Belvidere Apollo, or even the Far

nese Hercules, we can perceive no
But modern fashion aims at
corns.
making the anterior extremity of the
foot more narrow than the posterior-
the toes more acute than the heel. Mr.
Lawrence, therefore, should have re-
commended, at once, the sandals of
the Greeks and Romans, as the only
shoes that caused "no pressure." But
the gallopades and quadrilles of our
times will not harmonize with the san-
dal; and therefore some remedy must
pressure of the
be devised for the "
times." The simple cover of "soap
plaister" is insufficient; and we are
much surprized that Mr. Lawrence
should have overlooked the obvious
measure of throwing the pressure upon
less prominent parts, by means of a
series of plaisters with holes in their
centres, and then one general cover
over all. This is the only effectual de-
fence, so long as we wear shoes or
boots; and the mechanical explanation
of its efficacy does not at all deteriorate
from the chirurgical dignity of its eti-
ology.

The CHIROPODISTS of this luxurious age, (for we have now doctors for every part and disease of the body, from water on the brain to horn on the toes) make a great noise about the distinction between corns and bunyons. The following observations of Mr. Lawrence shew that these two affections are often conjoined or probably stand to each other in the relation of cause and effect.

"There is an affection somewhat allied to, and in fact often actually connected with corns, which, however, in some respects is different from them. It is that kind of swelling which is called bunyon. This forms on the prominent joint of the great toe, that is, the joint between the first metatarsal bone and the first bone of the toe, a part of the foot particularly prominent, and thus particularly liable to pressure from the boot or shoe. The swelling thus formed is larger, and generally attended with more redness of the skin and tumefaction, than we see in corn; but besides there is often a hardened and thickened state of the cuticle over the most prominent part of the swelling, which constitutes bunyon. I believe

the swelling of bunyon itself consists of inflammation of a bursa mucosa, which is seated between the skin and the prominent part of the joint in question; a bursa mucosa in a situation which is analogous to that of the patella or olecranon, and by the irritation of a bursa from the pressure of the boot or shoe, a state of inflammation arises with effusion into it. If you open this swelling, you find generally that a fluid escapes, When this is in a state of inflammation, you may adopt the same means that you would do in cases of inflammation of other bursæ leeches, poultices, lotions, or cold applications. Now the prominent part of the skin is liable to become the seat of corn, and I believe in many instances the irritation thus produced is the cause of the inflammation of the bursa. Sometimes the inflammation of the bursa becomes so considerable that a formation of matter takes place abscess occurs, and the matter makes its escape externally. If a corn form in this situation, you must adopt the means I have already described to you, and so far as the inflammation itself goes, you have only to adopt the usual antiphlogistic means, and afterwards take measures to protect the part which is the seat of disease from the pressure of the shoe or boot."

-

V.

TAX ON ENTERING THE PROFESSION. A sharp fire has lately been kept up between medici and mediculi respecting an apprehended additional tax on those who are entering the profession of medicine and surgery. The law is about to establish a tax, we understand, of about two hundred pounds on all those who are about to start in the pursuit of forensic wealth and fame. The reason alleged is the crowded state of the legal ranks, and the consequent deterioration, not only of the trade, but of the respectability of the members themselves. A redundancy of population has, in all countries where it exists, led to deterioration of morals and the commission of crimes. It cannot be otherwise. Poverty is the parent of

vice—and necessity is the mother of invention-not the invention of good for our neighbours, but of the means of filling our own bellies, no matter at whose expense. China furnishes a strik ing example of super-abundance of population. A bad harvest puts millions to death by hunger and leads to terrible scenes of cruelty. But at all times it authorises the crime of infanticideor what is equivalent to infanticide, exposure of infants on the rivers and in the streets. This crime against nature is permitted on account of the surplus of population. So, when a profession or trade becomes over-stocked, it leads to all kinds of vile tricks as well as to ingenious inventions. If it only produced generous and fair competition, all would be well; but he can have only a very small share of discernment, who does not see the host of disinge nuous arts which flow unavoidably flow, from redundancy of hands. Mɛ. DICULUS,* in censuring any measure that can check the influx of members into the medical profession, seems to overlook entirely this view of the subject—and to anticipate nothing but the improvement of medical science by the collision of rivalry, and the competition for bread. Alas! he knows little of the means and of the machinery which are called into operation in medical competition! The labour of improving medical science would stand a very poor chance, when opposed to the art of extending medical connexions, not by inventing more successful modes of treatment than our neighbours, but by devising more ingenious methods of traducing our competitors and aggran dizing ourselves at their cost! When MEDICULUS grows up in time, to the size of MEDICUS, he will see a little of this, both in town and country.

What is the remedy? Nothing, we conceive, can check the increase of the evil, but a diminution of the inordinate influx of members into the great professional family-whether legal or me dical. We certainly cannot admire a direct money-tax on aspirants, propos

• Medical Gazette, July 3, 1830.

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