2
607 turing druggists, is far from being a pure protoiodide, containing much peroxide, free iodine, mixed with a variable amount of the proto salt. Mr. Donovan, of Dublin, has recommended a process, published in the " Dublin Medical Press," which insures an almost genuine protoiodide. The acetate tincture of iron, much used on the other side of the channel, when properly prepared (which is a matter of much difficulty), will be found a most useful therapeutic agent, well agreeing with most persons requiring the use of this metal. From some researches of Dr. Aldridge, of Dublin, pub- lished in the 11 Dublin Journal," some years past, it would appear that this preparation contains a proto- acetate of iron in combination with acetate of potass, ! which, from galvanic action, prevents the iron from passing into a higher state of oxidation, by its electro- positive condition. : ’The green carbonate of iron, as found in the mistura ferri comp., contains a notable quantity of a proto salt; its very general efficacy need scarcely be adverted to. I may here notice the carbonate of iron with sugar, which seems to have the remarkable property of preventing further oxidation, it is, I believe, an efficacious tonic. And lastly, iron, as found in chalybeate waters, not- withstanding the inconvenient bulk of the menstruum, in the state of pure protoxide in combination with carbonic acid, is very generally allowed to be the most effectual ferruginous agent. On reviewing these several preparations, it will be ap- parent that their efficacy would seem to be in the ratio of the proto salt present in each. What exact part iron plays in the process of sanguifi- cation remains to be discovered (it is to be hoped that this abstruse physiological question will, ere long, admit of elucidation, through the strides making in organic chemistry by the renowned Liebig, and other continental chemists), but the fact is certain, that the red particles of the blood are increased in a very apparent manner, and most probably this action, if not absolutely necessary, is facilitated by the metal being in a state of minimum oxidation. I have not noticed, in the above short review, the citrates, their chemical and therapeutic properties not having been yet sufficiently tested by the profession. Tunbridge Wells. ON THE USE OF ALKALIES IN CONSUMPTION. By J. S. CAMPBELL, M.D. IN the year 1841, I published a work on the subject of Tuberculous Consumption, which THE LANCET reviewed with some degree of favour in the nineteenth number of that Journal for 1841 -2. I therein took occasion to enter on a good many points connected with the pathology, as well as treatment of that formidable disease, but one of my leading objects was to express a strong belief in the value of an alkaline treatment, when perseveringly employed. Since that period I have not published a line on the subject, though both my own additional experience and the reports I have received from others have gone far to confirm my former convictions. In conformity with the usual practice, I then thought it proper to illustrate my views by recording some cases, taken from many others I might have printed; but I feel 80 perfectly convinced that no plan of treatment in this disease ought to be received with any confidence, unless a certain amount of permanence can be connected with presumed benefit, that up to this period, as already named, I have entirely abstained. On these grounds you will oblige me by inserting this letter, chiefly intended to show how the cases, originally reported nearly three ye-trs ago, now remain. They were then arranged under three heads. The first head contained eleven, presumed to be fair examples of phthisis in its early stages. The sympathetic as well as physical evidence on which I rested was there given. The second contained three only, my object being to hint at the possibility of tubercular absorption, while the, adventitious deposit was as yet unsoftened. And the third contained three cases of consumption ia its very advanced stages, and were reported only to show how, at times, very unexpected results arise, even late ia this intractable malady Against any imputation ofabsm’d assumption, I thought I had pretty well guarded myself, by the few lines which succeeded the report of those three cases ; but as it apparently suits certain parties in our profession to be inspired with a holy horror of the man, who thinks that medicine, beyond the mere treatment of symptoms, can be of the least use in consumption. You will much oblige me by here appending, as a note, the paragraph I refer to.* , ! Of the eleven cases reported under the first head, out died in October, 1842. Three of them I have been un- able for a long time to trace. The remaining seven are, alive, and comparatively well, subject only to the occa- sional inconveniencies which result, and ever must result, from a condition of lung, partially impaired, and always prone to disease. In the majority of these seven, the physical state of the lung appears to remain stationary. The advantage gained has seemingly arisen from the non-extension of disease. One exception to this alone occurs in the case of Mary Lucas. The physical signs before reported are in charac- ter the same, but so far as the ear can contrast sounds at such a distance of time, they are less marked, and the inference from them less decided. At all events, she is robust and well. The last time I saw her was three weeks ago ; she then applied, in consequence of a slight but acute 11 cold," from which very simple treatment speedily freed her. Of three cases, contained in the second class, I can give an account of two only. The first, named Bull, was ia gentleman’s servant, and consequently of migratory habits ; I have not heard of him for two years. The se- cond and third (Stanley and Vivers), are alive, and im the enjoyment, the one of good, the other of tolerable, health. Stanley was a young girl, who has since gone to service, and though still slender in form, and sallow in complexion, fulfils somewhat laborious duties without discomfort, and is free from pectoral symptoms. The second of the two (Vivers) is a highly nervous person, and liable to occasional attacks of hysteria, but presents no symptoms of pulmonic disease. In neither instance do the physical signs essentially vary now from those originally given. It would appear, therefore, that of fourteen cases which I reported nearly three years ago, and described as fair average examples of phthisis in its early stages, one only is known to be dead, nine known to be living, and four whose fate is entirely unknown. Since then I have treated about four hundred more of the same kind, on the same principles, but must, at present, be content to say, simply that results have, in my own belief, been highly satisfactory. I need scarce add, that one and all of the cases named have been essentially treated by the caustic alkali, super- adding, as far as circumstances permitted, a close atten- tion to the various points of accessory practice, which I before attempted to lay in detail before the profession. In the majority of examples there might be recommended -without much hope of execution-pure air, light but nutritious diet, proper clothing, and, equal to all, per- haps, a due regulation of stimulants, both in quality and * « In reporting this and the two preceding cases, I could desire most emphatically to disclaim any wish to have them considered as examples of what usually occurs when an alkaline treatment is persevered in ; or of what indeed occurs under any treatment whatsoever; so far from this, these three cases are by far the most marked examples of benefit I have seen from treatment, when this was commenced after the second, or reactive stage of phthisis had been fully established ; but even these few may, if properly viewed, hold out to us a useful lesson, and direct our attention to a remedy, of whose efficacy when employed early, I cannot entertain any doubt whatever."-(Campbell on Tuberculous Consumption, p. 400.)

ON THE USE OF ALKALIES IN CONSUMPTION

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Page 1: ON THE USE OF ALKALIES IN CONSUMPTION

607

turing druggists, is far from being a pure protoiodide,containing much peroxide, free iodine, mixed with avariable amount of the proto salt.

Mr. Donovan, of Dublin, has recommended a process,published in the " Dublin Medical Press," which insuresan almost genuine protoiodide.The acetate tincture of iron, much used on the other

side of the channel, when properly prepared (which is amatter of much difficulty), will be found a most usefultherapeutic agent, well agreeing with most personsrequiring the use of this metal.From some researches of Dr. Aldridge, of Dublin, pub-

lished in the 11 Dublin Journal," some years past, itwould appear that this preparation contains a proto-acetate of iron in combination with acetate of potass, !which, from galvanic action, prevents the iron from

passing into a higher state of oxidation, by its electro-

positive condition. :

’The green carbonate of iron, as found in the misturaferri comp., contains a notable quantity of a proto salt;its very general efficacy need scarcely be adverted to.I may here notice the carbonate of iron with sugar, whichseems to have the remarkable property of preventingfurther oxidation, it is, I believe, an efficacious tonic.And lastly, iron, as found in chalybeate waters, not-

withstanding the inconvenient bulk of the menstruum, inthe state of pure protoxide in combination with carbonicacid, is very generally allowed to be the most effectualferruginous agent.

On reviewing these several preparations, it will be ap-parent that their efficacy would seem to be in the ratio ofthe proto salt present in each.What exact part iron plays in the process of sanguifi-

cation remains to be discovered (it is to be hoped thatthis abstruse physiological question will, ere long, admitof elucidation, through the strides making in organicchemistry by the renowned Liebig, and other continentalchemists), but the fact is certain, that the red particles ofthe blood are increased in a very apparent manner, andmost probably this action, if not absolutely necessary, isfacilitated by the metal being in a state of minimumoxidation.

I have not noticed, in the above short review, thecitrates, their chemical and therapeutic properties nothaving been yet sufficiently tested by the profession.Tunbridge Wells.

ON THE USE OF ALKALIES IN CONSUMPTION.

By J. S. CAMPBELL, M.D.

IN the year 1841, I published a work on the subject ofTuberculous Consumption, which THE LANCET reviewedwith some degree of favour in the nineteenth number ofthat Journal for 1841 -2.

I therein took occasion to enter on a good many pointsconnected with the pathology, as well as treatment ofthat formidable disease, but one of my leading objectswas to express a strong belief in the value of an alkalinetreatment, when perseveringly employed. Since that

period I have not published a line on the subject, thoughboth my own additional experience and the reports Ihave received from others have gone far to confirm myformer convictions. ,

In conformity with the usual practice, I then thoughtit proper to illustrate my views by recording some cases,taken from many others I might have printed; but I feel80 perfectly convinced that no plan of treatment in thisdisease ought to be received with any confidence, unlessa certain amount of permanence can be connected with

presumed benefit, that up to this period, as alreadynamed, I have entirely abstained. On these grounds youwill oblige me by inserting this letter, chiefly intended toshow how the cases, originally reported nearly threeye-trs ago, now remain.They were then arranged under three heads.The first head contained eleven, presumed to be fair

examples of phthisis in its early stages. The sympatheticas well as physical evidence on which I rested was theregiven.The second contained three only, my object being to

hint at the possibility of tubercular absorption, while the,adventitious deposit was as yet unsoftened.And the third contained three cases of consumption ia

its very advanced stages, and were reported only to showhow, at times, very unexpected results arise, even late iathis intractable malady Against any imputation ofabsm’dassumption, I thought I had pretty well guarded myself,by the few lines which succeeded the report of those threecases ; but as it apparently suits certain parties in ourprofession to be inspired with a holy horror of the man,who thinks that medicine, beyond the mere treatment ofsymptoms, can be of the least use in consumption. Youwill much oblige me by here appending, as a note, theparagraph I refer to.* ,

! Of the eleven cases reported under the first head, outdied in October, 1842. Three of them I have been un-able for a long time to trace. The remaining seven are,alive, and comparatively well, subject only to the occa-sional inconveniencies which result, and ever must result,from a condition of lung, partially impaired, and alwaysprone to disease.

In the majority of these seven, the physical state of thelung appears to remain stationary. The advantage gainedhas seemingly arisen from the non-extension of disease.One exception to this alone occurs in the case of MaryLucas. The physical signs before reported are in charac-ter the same, but so far as the ear can contrast sounds atsuch a distance of time, they are less marked, and theinference from them less decided. At all events, she isrobust and well. The last time I saw her was three weeks

ago ; she then applied, in consequence of a slight butacute 11 cold," from which very simple treatment speedilyfreed her.Of three cases, contained in the second class, I can give

an account of two only. The first, named Bull, was iagentleman’s servant, and consequently of migratoryhabits ; I have not heard of him for two years. The se-cond and third (Stanley and Vivers), are alive, and imthe enjoyment, the one of good, the other of tolerable,health. Stanley was a young girl, who has since gone toservice, and though still slender in form, and sallow incomplexion, fulfils somewhat laborious duties without

discomfort, and is free from pectoral symptoms. Thesecond of the two (Vivers) is a highly nervous person,and liable to occasional attacks of hysteria, but presentsno symptoms of pulmonic disease. In neither instancedo the physical signs essentially vary now from thoseoriginally given.

It would appear, therefore, that of fourteen cases whichI reported nearly three years ago, and described as fairaverage examples of phthisis in its early stages, one onlyis known to be dead, nine known to be living, and fourwhose fate is entirely unknown. Since then I havetreated about four hundred more of the same kind, on thesame principles, but must, at present, be content to say,simply that results have, in my own belief, been highlysatisfactory.

I need scarce add, that one and all of the cases namedhave been essentially treated by the caustic alkali, super-adding, as far as circumstances permitted, a close atten-tion to the various points of accessory practice, which Ibefore attempted to lay in detail before the profession. Inthe majority of examples there might be recommended-without much hope of execution-pure air, light butnutritious diet, proper clothing, and, equal to all, per-haps, a due regulation of stimulants, both in quality and

* « In reporting this and the two preceding cases, Icould desire most emphatically to disclaim any wish tohave them considered as examples of what usually occurswhen an alkaline treatment is persevered in ; or of whatindeed occurs under any treatment whatsoever; so farfrom this, these three cases are by far the most markedexamples of benefit I have seen from treatment, whenthis was commenced after the second, or reactive stage ofphthisis had been fully established ; but even these fewmay, if properly viewed, hold out to us a useful lesson,and direct our attention to a remedy, of whose efficacywhen employed early, I cannot entertain any doubtwhatever."-(Campbell on Tuberculous Consumption,p. 400.)

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quantity, but these are one and all, often by necessity,frequently by prejudice or habit, denied to the poor. Inthe small minority of examples, I have more or less beenenabled, from the patient’s position in life, and a dueconfldence in myself, to carry all my views into execution,and may fairly say, that just as the means and will of sodoing existed in the patient, so has been the comparativesuccess or failure of the attempt.

I write, Sir, with a sincere hope of impressing the mem-bers of our profession generally, with such an amount ofconfidence as may induce them to test the validity of theprinciples recommended. That they will, like myself, beoften disappointed, is undoubtedly true, but they willoften succeed I feel equally convinced of, and that toan extent greater than by the use of any other means atpresent known. But let me beg of them to draw the linebetween a merely fanciful success, founded on the alter-nation of symptoms, and those more permanent benefitswhich spring from a lim-itation of the local malady, in wl-iieh, ’to a large extent, such symptoms originate.

I for the time conclude, not wishing to burden your Icolumns, although the subject be one of deep interest,and one on which I have yet much more to say.

Weymouth-street, Portland-place,June 3, 1844.

CARIES OF THE ARYTENOID CARTILAGESOCCASIONING DEATH.

By MICHAEL K. O’SHEA, Esq., M.R.C.S.

ON the 20th of this month I was called to J. M.,aged forty-nine, a sawyer by trade. On my arrival Ifound him labouring under hoarseness, with lengthenedinspirations, and hissing respirations. There was much

dyspnoea, frequently increased by paroxysms of greaterforce, also occasional orthopnoea. The face was pale,ghastly, and anxious, indicative of extreme distress, andhe spoke with a whispering tone. In addition to these

symptoms there was difficult deglutition, and some sore-ness about the region of the larynx when pressed.Sounds were good on percussion ; pulse 120, quick andwiry. He referred his whole malady to the neighbour-hood of the larynx, and mentioned that he felt some-thing in his throat, which, if got out, he was sure wouldrelieve him, though not conscious of having swallowedanything. Having looked steadily down the pharynxduring an inspiration, I could perceive the epiglottisraised, and of a vermilion colour. Under all these cir-cumstances I looked upon his case as one of laryngitis,there being then no apparent reason to imagine a foreignbody in the glottis. Having bled him to the extent oftwenty ounces I ordered a mustard poultice (wet withvinegar and turpentine) to be applied over the laryngeal-region for two hours, together with the following pills :-Calomel, ten grains ; opium, one grain and a half; forthree pills, one every third or fourth hour. I shouldhave remarked that the blood was buffed and cupped.Regimen, barley-water, with toast and water.

21. There was no abatement of the former symptoms.Ordered to continue the pills. During the course of theday there were frequent dejections of bloody mucous andIlocculent matter; then a diarrhoea becoming troublesomeI ordered a creta mixture, with tincture of opium andcatechu. ’

On the 22nd, every symptom still increasing, and thepulse still wiry, I considered tracheotomy a desirableproceeding, and to this end consulted Mr. N. Miskin,the district poor-law medical officer, who immediately ivisited the case, but was inclined to postpone the opera-tion till the effect of further remedies should be tested. iHe accordingly bled him a second time, and recom- 1mended a blister to the throat, with six powders, contain- i

ing a quarter of a grain of the potassio-tartrate of i

antimony each, with a view of keeping up nausea, andsuppressing the supposed increased action of the larynx. 1

Thursday, the 23rd, arrived, but with it no alteration 1of symptoms, and no nausea being produced, I ordered i

potassio-tartrate of antimony, four grains ; tincture of 1

opium, half a grain; distilled water, six ounces. Mix; 1two tablespoonfuls every third hour. Passed a very bad 1

night; symptoms by no means alleviated ; orthopncea in-creased, and head and face bedewed with cold clammysweats. As now tracheotomy was indubitably indicated,I called up Mr. Miskin, who promptly obeyed thesummons, and having accompanied me to the patient’shouse, we performed the operation in the usual way.During the time of operating the respiration was so muchdisturbed that the upper portion of the trachea wasdrawn beneath the first bone of the sternum; and Iwould remark, that endeavouring to steady the tracheawith a tenaculum, as recommended by Dr. James Mur-ray, of Dublin, and practised by Mr. Carmichael, pro-duced such violent fits of coughing as to considerablyembarrass the furtherance of the operation. I found,having cut down on the trachea, the best mode of steady-ing it was by introducing into the wound the forefinger ofthe left hand, which, when gently pressed on the carti-

lages, served as an excellent director for the knife, andwhere the sense of feeling was an invaluable adjunct.There was no important vessel wounded, and the loss ofblood did not amount to more than one ounce and ahalf, principally venous. Our patient survived the ope-ration but four hours; the respiration was establishedthrough the tracheal tube introduced into the opening.

Post-mortem Five Hours after Death.A small superficial incipient ulcer at the posterior part

of the right thyro-arytenoid ligament. The correspond-ing portion of ligament at the left side removed by ulcer-ation, which affected the arytenodeus and adjacentmuscles, a perfect abscess being formed in that situation.The arytenoid cartilage of the left side was detached, andconverted into an osseous carious substance, cuniform,and wedged into the rima glottidis, the base cor-

responding to that portion which originally articulatedwith the cricoid cartilage posteriorly, and in its presentaspect looking towards the velum palati. The caries was

being communicated to the cricoid cartilage of the sameside, which formed the posterior boundary of the abscess.Epiglottis enlarged. No appearance of acute inflamma-tion about the larynx. Lungs generally healthy, butslight tuberculous deposit in the left lower lobe, and, asmight be expected, some congestion of these organs, withpartial emphysema. The heart was extremely muscularand large. The layer closing the foramen ovale was

prolonged into two sacculated bodies, floating in the rightauricle, having their concavities towards the left auricle.The aortic valves much diseased, and converted into akind of cauliflower excrescence, of a semi-cartilaginous,fatty, granulated substance, which could be rubbed downbetween the fingers. There was one ounce of fluid in thebody of the pericardium.The previous history of this man is rather unsatisfac-

tory, as I can only learn that he was subject to an irritat-ing cough, without expectoration. He was a personunfortunately addicted to inebriety, but was never sus-pected of any venereal taint. He was particularly fondof fish, and it is assumed that he once swallowed a fish-bone ; should such be the case, we might imagine howthe foundation was laid for the abscess of the glottis,though it is not unlikely it originated in a different cause,as we have an incipient ulcer on the opposite side, whichno doubt, in his cachectic habit, had he lived, would pro-duce similar disease to that of the left, constitutingphthisis laryngea. The question arises, Was the necrosedarytenoid cartilage lodged in the rima glottidis from the20th? I conceive not, but that it was making its escapefrom the abscess, and this tended to produce the violentsymptoms which were so prominent, nor is it unreason-able to suppose that during its egress it produced by itsirritation, as a foreign body, a certain degree of inflam-mation, which, though not apparent on the post-mortem, may have been subdued by the venesection andmedical treatment to which he was subjected.But what seems to me a striking feature in the case is,

that when the detached cartilage got into the rima glot-tidis it did not pel:fectly suppress respiration, and causeinstant suffocation, by inducing a closure of that aper-ture whilst it continued there. However, if we considerthe very extensive lesion which existed on the left side ofthe larynx, including in its destruction the muscular