of urine had taken place, I gave her laxatives of manna and syrup of roses twice or three times, and thus, after having suffered for many years in the most miserable manner from these symptoms, and after having tried without benefit the prescriptions of the most noted persons amongst us, she was happily restored to health by me in this simple manner. "The witnesses of this case were Dr. Francis Bernard, Dr. William Gibbons, Dr. Praise Watson, Dr. Christopher Crell, Dr. Thomas Botterell, Dr. George Fleming, Viri doctrinâ et omnium virtutem genere eminentes.”” CASE IX.-" A-P-, the wife of a London merchant, aged 32, sent for me on the 17th September 1697. She made water with great difficulty, only by drops, and with extreme pain. On introducing the sound (for her relatives thought she was suffering from calculus,) I found the neck of the bladder swollen and inflamed, and on pressing the tumour with the finger pus appeared and escaped. I enquired the cause of the complaint, and was told by the attendants that they referred it to a very difficult labour which she had had about nine weeks previously; the child having been a large one, with a still larger head. This happened, not in the hands of a common accoucheur, but in those of Dr. Chamberlain, who had been obliged to have recourse to instruments. "After premising as I am accustomed to do, I ordered the following: Ꭱ Cantharid. integr. prope ignem sicc. gr. xxxvj. Camphor. ol. amygd. dulc. solut. ij cum Conserv. q. s. M. f. Bol. No. vj; the first to be taken at seven in the morning, the second at eleven, the third at five in the afternoon, and at bed-time my usual dose of camphor and opium. The day following to take the three remaining boluses. "She took three boluses without any pain, drinking freely both before and after them of an emulsion and also of milk sweetened with sugar. By the aid of these she passed fœtid urine copiously. About seven in the evening she had still more frequent and copious discharges. "On the second night I repeated the anodyne, with plentiful potions of barley water, honey water, &c. She took on that day the fourth and fifth boluses, the sixth was omitted, my intention having been entirely accomplished. "I requested Sir Richard Blackmore, physician to the King, to visit this lady, which he did, and examined the case and my prescriptions with great care." CASE X.-" On the 14th November, 1697, I extracted four calculi from the bladder of Mrs. Browne, (then living in Hat and Tun Yard, in Hatton Garden, but now in King Street, Westminster;) she was suffering at the same time from a most fœtid ulceration of the bladder. She was cured by Cantharides and Camphor, after my usual method, and is now living as mentioned, and in the enjoyment of good health and spirits." Various minor cases are added, from which I select the following, because they are cures of dropsy, (probably arising from renal disease,) by the same method. "Maria Calloway in Warwickshire, niece to Mr. Wilcox in Tower Hill, was cured of a dropsy by Cantharides; now more than twelve years ago, and she has had no relapso, and is still living and well. "Mrs. Wilcox had been cured by me in the same manner eighteen years ago. The swelling of the abdomen had become so great that she could not see her own feet. I not only succeeded in expelling the water, but in restoring the natural tone of the viscera. She is still living and in the enjoyment of health." If practitioners are afraid of giving Cantharides in substance, Dr. Greenfield recommends the following tincture: Cantharid. 3j, his superfunde, Spir. Nitr. fortiss. 3 ij digerantur simul per horas xxiv, Spir. Vin. 3 vj digerantur simul quo diutius eo melius. Postea filtretur. The dose is from xii to xl drops twice a day." I may observe here that the reason why Dr. G. was able to give Cantharides in such enormous doses was, that they were greatly injured by his mode of preparation. It is well known that even moderate heat, impairs very much the activity of the fly, and when it is observed that he orders them "Tost. non cremat."- "roasted, but not burnt,"-we may well imagine how much their power has been destroyed before being administered. Such is the outline of this interesting little volume. I had intended to have added some cases and observations from other sources, as well as two or three from my own practice, but a fear lest my communication should become tedious suggests the prudence of postponing these to a future opportunity. THE SKIN AND ITS DISEASES. BY DR. RUTHERFURD RUSSELL. (Continued from p. 243.) ALTHOUGH We propose to adhere to the pathological order adopted in the former part of this paper in speaking of the treatment proper for the individual maladies there detailed, yet before doing so it may be well to direct our attention to the different points of view from which this important class of diseases may be regarded, in order to arrive at the principles applicable to their successful management. They present four aspects. First, the purely local lesions of the integument; as, for example, those which arise from the chafing of the surface, or the action of some chemical irritant on a particular part, or from the bites or stings of insects, or from the presence of insects keeping up a continual irritation. In all these cases the removal of the cause of offence may be sufficient to restore the injured part to its natural healthfulness. The second class consists of those diseases which affect the skin secondarily, their primary effect being upon the system at large; as, for example, small-pox. The amount and degree of cutaneous affection in this disease is a most important element, both as regards its prognosis and treatment. In fact, we may look upon the extensive pustular eruption as in some respects, independent of the original constitutional cause, depending on the special state of the skin for the conditions of its development, and itself causing a new disturbance of the system. One of the best illustrations which could be given of the power topical influences exert, in modifying the development of the eruption of a constitutional disease, is afforded by the following case related by Dr. W. Budd, in an interesting paper on the Symetry of Disease, published in the 25th volume of the London Medico-Chirurgical transactions." A sailor was admitted into the Dreadnought on account of a bruise inflicted on one side of his breech by a fall into the hold of a ship. In the course of some days he left the hospital, having recovered from the injury, but still shewing a bruise-mark on the breech. A short time afterwards he was again admitted with severe febrile symptoms, which terminated in the eruption of small-pox. The pustules were discrete and very few in number all over the body, except in the exact seat of the former bruise, and there they were extremely numerous, and for the most part confluent." We have quoted the case at length because we look upon it as full of instruction. It puts beyond a doubt the importance of studying the progress of the pustules per se; shewing that their number and size are not always at least an index of the general severity of the disease, but depend upon some peculiarity of the skin; and it may be of great importance in mitigating the affection of the system to adopt local measures for moderating the cutaneous eruption. What the special means are which best subserve this purpose we shall discuss in full when speaking of small-pox; at present we adduce it as an example of the importance of paying the strictest attention to the state of the skin in all diseases, which although involving the whole constitution tend to excite a specific morbid alteration in that organ. The third class of these diseases are those in which the skin assumes a sympathetic or vicarious action, holding direct relation with some morbid condition of an internal organ. In some cases the external affection is vicarious, that is, on its appearance the other malady suddenly subsides, to reappear as suddenly on the disappearance of this. Speaking of the trifling complaint strophulus intertinctus, Willan says "the papular eruption is in many cases connected with a weak, irritable state of the alimentary canal and consequent indigestion; for if it be by any means suddenly repelled from the surface, diarrhoea, vomiting, spasmodic affection of the bowels, and of the general disturbance of the constitution succeed." * Willan supports this statement made on his own observation by the authority of other accurate observers. In this instance the cutaneous affection is not merely sympathetic but vicarious, or in other words, there has been a transference of the morbid action from the bowels to the skin. The subject of vicarious diseases is one of immense importance in a therapeutic point of view, as well as extremely interesting in itself, but it would be out of place to do more here than direct attention to it as one of the sources of erroneous treatment; for as in small-pox there may be danger of our using too few local measures, there is as much danger of our using too many in this and similar eruptions. At the same time we must draw a distinction between vicarious and sympathetic affections, for while the former ought not to. be hastily attacked, it may be proper to direct vigorous treatment against the latter. The distinction between the two classes is this: in the one-the vicarious-the morbid action leaves a dangerous seat of operation, such as the intestines, and takes up its abode on a part it cannot materially injure: in the other—the merely sympathetic-the disease does not quit its original place of settlement, but establishes besides a dependency in some other part, and the two may act not alternately to the relief, but simultaneously to the distress of the system. In such cases, of which prurigo may be taken as an example, curing the secondary disease is like crushing the colony of a hostile power. One source of mischief is quelled, and the other is abated. The remaining class consists of those diseases which depend upon the presence of some constant constitutional taint, and as * Willan, On Diseases of the Skin, p. 22. |