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extreme emaciation and debility appear. When we reflect upon the highly disordered state of the bile, if any be seemed, and upon the suspension of lhe digestive process, we cannot rationally expect that any chyle can be formed, or if that could happen, that it would be in a proper state for the lacteal absorbents to imbibe. As this is the principal source whence the body can derive its nourishment and strength, it must follow of course, when this fails, that.emaciation and weakness will present themselves. The only supply, during the long abstinence that obtains in the disease, proceeds from the absorption of fat that may have been accidentally deposited in the cellular substance. After this state has continued many weeks without a return of the healthy functions of the digestive organs, the bloofl becomes attenuated or in part depraved for want of a supply of chyle, and is effused on various parts of the body; whence in the skin we observe petechia;, and from the stomach and bowels bloody evacuations."
Whatever opinion may be entertained thus far respecting Mr. Coley's publication, we doubt not that he will receive the thanks of his brethren for communicating a faithful history of his judicious and successful treatment, as well as obtain the mote substantial reward of increasing practice and. reputation. Having determined the proximate cause of the disease to consist of a disordered action in some part of the digestive organs, the indications of cure, says Mr. Coley,
"Must be to expel from the intestinal canal any irritating materials that may have accumulated, and to excite the disordered parts into a vigorous and healthy action. These purposes may be answered in some measure by the exhibition of purgatives, but more completely and expeditiously by some preparation of mercury, which, when properly administered, is capable of promoting, in a peculiar degree, a healthy state of lhe viscera, concerned in the formation and absorption of the chyle, As the grand objects to be had in view are the encouraging a secretion of bile, when that is defective, and of the succus gastricus and intestinalis, so we must continue the employment of the mercury until these salutary changes occur. The manner in which I have given this medicine, and the extent to which I have carried it, may, to those who are unacquainted with its utility, appear very unusual. X was first led to the more general use of U by observing the rapid recovery consequent to the administration of a few doses of the oxyde or submuriate, in small quantities, in several cases of this disease, after a long continuance of purgatives had been productive of no benefit. These first cases were such as arose more particularly from a deficient action of the liver only, but 1 soon found that the same salutary consequence resulted from the employment of this medicine in those depending on disordered action in the bowels. I was the more pleased on observing the beneficial effects of the practice, on account of the frequent failures I met with by pursuing the usual mode of treating the disease only with aperient medicines. By that plan I loM many patients; but sjnee I have adopted the other
l i 2 mode mode of practice, although I have had hundreds of cases under my care, the complaint has not terminated fatally, excepting in one instance, where effusion took place in the brain, constituting hydrocephalus interims, in consequence of extreme debility from a previous disease.
"The intention with which most practitioners exhibit mercury in this disorder, is that of exciting a strong peristaltic action in the intestines;* but it will be found to exercise a still more speedy and beneficial influence when given with the view of its being absorbed into the system, when it rouses the liver to secrete its bile, the stomach to prepare the gastric juice for the purpose of digesting the food, and the intestines to convert that digested food into chyle, for the nourishment and repair of the enfeebled and emaciated frame. With this design I have in general continued it nearly through the whole of the illness, and have frequently, when it was requisite to produce a purgative operation, given four or five grains of the submuriate every other day, or oftener, for several weeks in succession, not only without any inconvenience, but with the most manifest advantage. Although my practice has been so bold and decisive, I have not met with a single instance of ptyalism nor of mercurial erythema; and the debility consequent on the evacuations has been incomparably less than would have resulted from the natural progress of the disease, or the common mode of treating it. That a return of the healthv action of the digestive organs, a circumstance most desirable in this complaint, may with justice be aitributed to the agency of this medicine, I think this fact will testify, namely, that in some very obstinate cases, in which, either from defective absorption, or from its passing off too rapidly from the bowels, it has not produced any salutary change after a long period of time, I have been induced to give half a grain or a grain of the submuriate, or a smaller dose of the oxyde, twice daily, which, at the end of three or four days, has generally effected a secretion of bile, removed the unnatural appearance of the faeces, and been speedily followed by a re-establishment of health.
"In simple cases of this disease, I know that the employment of purgatives alone will succeed; but in most of the cases requiring my assistance, there has been such an extreme torpidity of the chylopoietic viscera, as to render the use of mercurials necessary. In these instances, nothing with which our art can furnish us, could have saved the patients from destruction, had not, the most vigorous measures and firm conduct been pursued.
"As soon as I have visited a patient ill with this fever, I direct a dose of hydrargyri submurias to be given, containing from one to five grains, according to the age and constitution of the patient, the seventy of the attack, or the state of the bowels. Two or three hours having elapsed, a draught composed of sulphate of magnesia, tincture of jalap, and infusion of senna, is administered, and repeated every two hours, until a copious evacuation takes place from the bowels,
* "Hamilton, Pemberton. .Butter."
which I always carefully inspect. After this, the same dose of the tubmuriate is repeated every second night, and the draught the following morning, so as to produce several evacuations, until it be ascertained that the digestive organs have regained their natural energy. This effect will sometimes happen in a few days; at others several weeks will elapse before any favorable change will occur. If the constipation be very great, the aperient draught should be repeated every morning, or a dose or two of sulphate of magnesia, or of any other neutral aperient salt, so as to occasion one or two evacuations daily from the bowels. When the faeces have become healthy, they are found to be of moderate consistence, having some impressions of the larger intestines upon them; to be of a yellow color, resembling powder of rhubarb; and free from mucus and all other matter that is unnatural to them. As long as they seem to have undergone no change in their passage through the caecum, colon, and rectum, which is known by their fluidity and heterogeneous consistence, I direct the mercury to be given in a large dose in conjunction with, or followed by, a purgative, in the manner above described; but after the bowels have resumed their functions, and the only alteration in their contents is found to consist of a preternatural appearance as to color, I order the former medicine to be repeated once in twelve hours, or oftener, according to the urgency of the case, in small doses; by which means, at the end of a few days or a week a secretion of bile takes place, and the disease is entirely removed."
Having already far exceeded the space we had intended this small volume should occupy, we must close our notice of it without inserting either more particulars of the author's practice, or citing any of the cases which-he has selected tor publication. The book is worthy of perusal.
Edinburgh Medical and Surgical Journal, No. XXXIV.
I. Singular Case of Lithotomy, performed on a Man who had attempted to saw and break down the Stone in the Bladder. By John Rodman, M.D.
This very distressing case of calculus occurred to a man of singular idiosyncracy, who became and continued very corpulent on small quantities of meagre vegetable diet. Soon after the operation of lithotomy was with great difficulty performed on him, calculi again began to form; and in about a year from .the operation, it became necessary to cut into the urethra in the perinaeum to extract a calculus lodged there. In three months after this, it became evident that a stone was impacted about the neck of the bladder; and the novel part of the detail rests on the employment of a file and a boring instrument to diminish tr>e size of this stone. These instruments were applied to the calculus,
through through the opening in the perinseum. For a time the patient appeared to be relieved by this contrivance.; but died some weeks after, of mortification of the bladder and intestines.
II. Observations of the different Hypotheses published to ac
count for the Effects of the Wind of a Ball.
This anonymous writer considers the opinion of the mischievous effects arising from the " Wind of a Ball," to be the offspring of ignorance and superstition i and he acutely observes,
"Did the wind of a shot, the tremor of the atmosphere, the accumulation of electricity, or the developcment of any subtile matter by the flight of a ball, produce such fatal consequences, it is easy to perceive they must be equally numerous with ihe wounds which are received by actual contact. For, although it is not susceptible of arithmetical calculation, yet it may be justly inferred, that when two vessels fire right into each other, as many balls pass within a hair-breadth as those that strike men on-board. How, then, does it happen that, among the hundreds and thousands that strew the decks after a long and severe engagement, only one, two, or three, are found without marks of injury? If the principle operates in one instance, it must in all. All the effects arising from mechanical violence are seen and experienced, but those originating from this unknown, or these unknown causes, are heard of only once in ten thousand times."
It does, indeed, appear incomprehensible, if there be such a property or principle as the wind of a ball, possessing the efficient power of destroying life so suddenly, that it should so seldom act, seeing that, in every engagement, so many must come within its sphere of influence. The deaths occurring in battle where no external violence is detectable, are referred to extreme emotion and agitation of mind, by this writer; and the opinion is supported by analogical facts recurring in civil life from paroxysms of passion.
III. Observations on the Fever prevalent in the Mediterranean, as it occurred on-board one of his Majesty's line^of-battle Ships on that Station.
The writer of this paper had been stricken, he says, a priori., with the notiou that there was something in the climate of the Mediterranean station peculiarly predisposing to inflammation: and his practice and success in the " nearly one hundred cases" of which he gives the result, we cannot doubt confirmed his preconceived opinion.
In the fever here described, the cold stage was short; prostration of strength, violent head-ache, severe pain at the scrobiculus cordis, and very commonly in the thorax, sometimes -times with dypsnoea, but seldom cough, quickly succeeded the rigor. Full and hard pulse, increased heat, flushed face, rough and dry tongue, and constipated bowels, made up the catalogue of symptoms. Great thirst and irritability of the stomach seldom were present.
This fever occurred in the hot autumnal months, while the ship was at anchor in Port Malum.
"Blood-letting was the remedy principally relied on, and the extent to which it was carried was regulated by the patient's feelings, viz. either until a remission of pain or incipient deliquium took place. Before this was effected, 50 or 60 ounces were frequently abstracted by a large orifice, and, if the pain recurred, I did not hesitate to repeat the evacuation to the extent of 20 or 30 ounces more, within four-and-twenty hours from the first attack; at least this was the practice I latterly followed, and I found it successful. When thus freely employed on the first day, there was seldom occasion to hav« recourse to venesection beyond a third time."
In the " nearly one hundred cases" three only were fatal, in one of which the symptoms of gastritis were strongljfmarked; in the other two there was great determination to the brain.
"The three fatal cases alluded to above, were the three first that came under my care, and although, in compliance with the advice of the then physician to the fleet, I had recourse to blood-letting, yet, not being'thoroughly aware of the nature of the epidemic, I have reason to regret that 1 did not, early enough, carry that powerful remedy to the extent that 1 afterwards found I might do with advantage and safely. Indeed, if six-and-thirty hours are allowed to elapse without due evacuations, the most favorable time is gone, the inflammatory action much increased, and determination to some of the viscera already begun;—blood-letting becomes more than ever necessary, but the patient is less able to bear it.
"In addition to venesection, a moderate purging was kept up by calomel, conjoined with antimony, and assisted by small doses of the saline purgatives, largely diluted, having found that in this way they sat well on the stomach.
"In three cases, where there was no evident affection of the thorax or abdomen, and where the heat was unusually great, the cold affusion was employed. In all the three it procured great temporary relief; but in one, the disease terminated by an extensive abscess, situated over the gluteus maximus, and the other two were attacked, on the succeeding day, by severe pains in the thorax, which were relieved by the liberal use of the lancet.
"There occurred also six or seven cases, apparently slight, and in which, consequently, evacuations were more sparingly employed, but they eventually proved the most troublesome, as the fever terminated in, or was succeeded by, disease of the liver or spleen. Four of these were sent to the hospital, and I do not know their fate; the others recovered on-board, after a long course of mercurial preparations."