450

We have already noticed the inflammatory nature oflepra, and as long as the inflammatory action is present a.powerful stimulating tonic like arsenic appears the last.remedy a prudent practitioner would think of employing,and one, I am satisfied, which would never be used, ifmen took time to think for themselves, rather than takefor granted what has been written by others ; it is notuntil the disease has obtained a passive or atonic con-dition that arsenic is of use ; if used earlier, from itsknown excitant properties, it is certain to increase ratherthan cure the disease for which it is exhibited. A medicalman, says Mr. Erichsen,* 11 find, amongst a number ofremedies, arsenic strongly recommended in a particulardisease, as lepra or eczema, for example ; but as there isno mention made as to the period of the affection inwhich it should be employed, he very probably adminis-ters it whilst the complaint is still in an active inflamma-tory condition ; the consequence of this is, that the dis-ease being stimulated unduly, becomes aggravated in itssymptoms, and the confidence of the practitionerin a veryvaluable remedy is shaken; whereas, had it been em-ployed a few weeks later, the happiest results might haveattended its administration." This opinion, I know fromexperience, to be correct, I hence, therefore, quoted theseforcible words at length, rather than make them appearmy own by putting the same sentiments in another form ;but this leads the practitioner to another inquiry equallyimportant, viz., the period at which arsenic ought to beemployed. This is a question that may be very easilyanswered, and it may be laid down, I think, as a generalrule, that arsenic cannot be taken with advantage in anycase in which mild topical stimulants increase, perma-nently, the severity of the affection. I think with Dr.A. T. Thompson, there are very few cases of any of thevarieties of lepra t in which more than one moderatebleeding is not requisite, even where the tonic plan isindicated. When the skin is highly inflamed, much thick-ened, and stiff, of a vivid red colour, intermixed with ayellowish hue (where the cuticle is separating in large IBakes), the heat, pain, and itching, are often extremelytroublesome, and the motions of the limbs are almost im--practicable,-in this state of habit the irritability must bediminished by emetics, mercurial purgatives, and bleed-ing. The local affection will be rendered less agonisingby tepid baths, smearing the parts with cream or oil, andthe prussic acid lotion.

It would be useless to take up additional space with a

long list of the useless medicines which have from veryancient times been lauded for their curative properties inlepra. I will here repeat the caution already given, thatmuch injury has been done by prescribing for the nameof the disease, by looking upon arsenic as the invariableremedy for lepra at every stage of it; we must only em-ploy it after the inflammatory condition has been sub-dued by proper remedies. Certain cases are benefited bythe external and internal use of the waters of Leamington and Harrowgate, in this country, and of Bareges,.Cauterets, Bagneres, Bagnoles, St. Gervaise, and

d’Enghien, on the continent. The sulphureous vapourbaths are still more useful. Some of the more usefullocal applications have already been mentioned, particu-larly the ointment composed of equal parts of the un-guentum hydrargyri nitratis and the unguentum picis.M. Biett recommends an ointment, composed of fromtwelve to fifteen grains of the ioduret of sulphur(readily prepared by melting in a flask equal parts ofsulphur and iodine), and one ounce of lard. The oint-ments should be applied at night and washed off in themorning.We have yet to mention one of the most valuable re-

medies for all the varieties of lepra (after the inflamma-tory symptoms have disappeared), the decoction of thetwigs of the solanum dulcamara ; this medicine, if

memory serves me, was first introduced by Sir Alexander

* " Medical Gazette," May, 1843.t Lepra vulgaris, lepra alphoides, and lepra nigricans

must all be looked upon as varieties, and cannot be re-garded as distinct species. This part of the subject ismost ably treated by Mason Good, and is worthy atten-tive examination.

’

Crichton, and may be given, in doses of two or threeounces, thrice every day, and gradually augmented untila pint is taken daily. Any of the preparations of arsenicmay be given with advantage in this decoction.

In Mr. R.’s case I found also advantage from the one-twelfth of a grain of the bichloride of mercury in tinctureof bark at bed-time, which was substituted for Plummer’spill, and also from employing water, sweetened, andmoderately acidulated with nitric acid, as a commonbeverage.

I have now noticed briefly a few of the leading pointswhich may be regarded of practical utility in the treat-ment of lepra vulgaris, and have also pointed out someerrors into which the young practitioner may, withoutcare, fall,—errors that can only be discovered by expe-rience, and which may easily be avoided. Towards theconclusion of the disease, moderate friction will be par-ticularly useful ; the progress of the cure is marked bythe scales becoming very dry at their edges, and detach-ing themselves at the centre. But the treatment mustnot end here ; our efforts must be continued until every’trace of leprosy is removed, nor must we leave our patientwithout reminding him of the inclination of lepra to paya second visit, and the necessity of guarding against areturn by the most strict attention to diet and the occa-sional use of appropriate medicines. When, however,the disease again and again returns, I would prescribebleeding, the sulphur-fume baths, and the arsenical solu-tion ; a light and moderate diet; the avoidance of maltliquors and ardent spirits ; for every indulgence in thesewill be apt to induce a return of the disease, and willmost undoubtedly aggravate the symptoms during anattack of it.

East Retford, April 9, 1844.

ON THE USE OF ALKALIES IN RHEUMATISM.

To the Editor of THE LANCET.

SIR,—Will you favour me by inserting an answer,which shall be as short as I can make it, to an anony-mous correspondent, in your number of this day’s date,who has written under the pseudonym of ENDOCAR-DITIS," and let me hope he will not be offended (for I donot wish to offend) if I ask him why he has not writtenin his own name? Let his opinions be what they may,no one has any right to be offended with fair and justcriticisms on published opinions ; and out of discussions,conducted without acrimony, good is surely likely tocome. I can readily imagine the disappointment of onewho seems so anxious for improvement in the practice ofour profession as « ENDOCARDITIS" does, at not findingthe treatment of rheumatism more fully discussed than itis in my paper; yet I am in no degree answerable forthat disappointment, for have I not there written, "I

do not mean in the present paper to go into the detailsof the different modes of treatment, nor to describe theindications pointing to one mode of treatment ratherthan to another; but I would ask those medical gentle-men who," &c. &c. (See p. 305, of THE LANCET, June 1.) ,

Surely " ENDOCARDITIS" has no right to find fault withwith me for not doing that which I said I did not meanto do.

If my views on the pathology of rheumatism prove tobe correct, they will clear up the obscurity in which it isnow involved, and they will lead to a most importantchange in treatment as well as to most beneficial results.They have arisen in my mind during a watchful practiceof several years, which was carried on under circum-stances favourable for accuracy of observation.

If there is any tone of false pretension in my article onrheumatism I am sorry for it; I wished to avoid every-thing of the kind; nor do I think I deserve the littlesarcasm conveyed in the word "enlightened," used by" ENDOCARDITIS." All I want is, that setting asidehypothesis or theory, alkalies should be fairly used in theway I have pointed out, and the result reported.To the question, Why not analyse the blood ? I answer,

that had I been myself sufficiently experienced in themanipulations of analytical organic chemistry, or hadI known any good practical chemists where I then

451

resided, an analysis would have long ago been made, andas soon as I can I mean to procure the assistance of someable chemist. But let the analysis show what it may thefacts will remain unaltered, and if such analysis werenot confirmatory of my views, I must then content

myself with prescribing alkalies, the same as heretofore,and refer for justification to that rational empiricism -ifI may so express myself--upon which is founded thepractice of many of the most eminent medicos of ourday. What is known of the modus operandi of most medi-clines iWhen I said alkalies were prophylactic of heart dis-

ease in rheumatism, I could have added that they areuseful also in the cure. We have lately read some goodpapers by Dr. H. Bennet, and in some of the continentalperiodicals, wherein the nitras potassae is advocated inrheumatism. It is not unlikely that this medicine is de-composed and the alkali absorbed." ENDOCARDITIS" carps at the word may,"—what

other word could I use, or ought I to have used ? He

says heart disease might have been set up without myhaving discovered it. This is not likely, for with an at-tention especially directed to the disease in question, I,firstly, never failed to auscult; I, secondly, have been usedto the stethoscope ever since 1820 ; and lastly, heart dis-eases are, according to my experience, very easy of detec-tion. I never meant to insinuate that heart disease doesnot, or might not, occur at the onset of rheumatism.Any one of experience could not be so ignorant,-and,indeed, the pathological origin I have endeavoured tosketch out would prepare us to account for the simul-taneous onset of both diseases.

Finally, I hope yet to meet " ENDOCARDITIS" infriendly discussion under his own name,-as we look forin an Englishman and a gentleman-and I should be stillmore glad to study with him any intractable cases of dis-eases in which I feel so much interest. If he wouldfavour me with a call I think I could give him such evi-dence as could not fail to please him, who seems to be ananxious seeker after improvement in the practice of ourprofession. I am, Sir, your most obedient servant,

J. J. FURNIVALL.Weymouth-street, Portland-place,

June 22, 4844.P. S.-« From the constitution of the blood we have

no right to expect that under any circumstances it wouldexhibit the characters of an electro-negative body,though, as you will see from my formula for the chyle,that the fatty acids, lactic acid, &c., may easily be derivedfrom it. By means of litmus-paper these acids, if ever

existing in a free state, would be easily detected in theserum."—Dr. G. Kemp.

DR. WIGAN ON DUALITY OF THE MIND.

To the Editor of THE LANCET.

SIR,-A severe domestic calamity has so entirely occu-pied my time and thoughts during the last two monthsthat my work on the Duality of the Mind has been laidaside and almost forgotten.In resuming it, I have looked over the numbers of THE

LANCET, which had lain by me unread, for any notice ordiscussion to which it might have given rise on my pro-fessedly crude " Propositions," and am surprised to findseveral objections stated to my arguments (!) notwith-

standing my early disclaimer of them as anything butunsupported assertions, placed in that shape for the con-venience of reference, and waiting confirmation by evi-dence hereafter to be adduced. The propositions formbut a small part even of what I read to the society, and itwould have been better perhaps to defer the publicationtill the proofs were ready, but I could not anticipate thedelay.

’

I am by no means unacquainted with the early writingsof Gall on this subject, and have noticed them in mybook. There are, however, as Dr. Davey remarks,earlier writers who have made similar guesses. St. Paul,indeed, seems to have entertained the same opinions;but it is one thing to suggest or assert that there is a statue

in the block of marble, and quite a different thing to takethe chisel and give it form and expression.

Dr. Davey cannot entertain too exalted an idea of themerits of Dr. Gall as an original thinker, and the authorof a grand and important discovery. It will be foundthat my arguments are founded on the plurality of organs.The arbitrary division of the convolutions, where no ana-tomical difference can be detected, the location of theorgans of the respective faculties, and, above all, the dis-tinctions he would establish between the different modesof mind, form, however, a totally different question, onwhich men of equal talent, equal acquirements, and equalexperience, ridicule and despise each other’s convictions.My own opinion can weigh nothing in the matter, andtherefore I withhold the expression of it."Anch’ son Pittor."-I have read perhaps as much

as Mr. Sheppard or Dr Davey, although I may not haveseen so much of insanity. I venture, however, to assert,that there is not one of the objections to my theoryhitherto stated which is not anticipated and refuted inmy book. Whenever my opinions are fairly before thepublic I shall listen to criticism with deference, and witha desire to be convinced if in error. Till then it is im-

possible to judge of the nature and validity of my arguments ; I cannot think it likely that any one should im-provise an objection which has not been considered anddecided in my own mind during the last five and twentyyears. I have never supposed or asserted that « thehemispheres of the brain have each one faculty, and thatthat one is either good or bad." On the contrary, it hasalways seemed to me a contradiction that the same organshould give the propensity and control the propensity at thesame time for that would imply that antagonist functionscould be synchronously performed. I have entered fullyinto this discussion in my tenth chapter.On sleep, intoxication, pervigilium, catalepsy, concits-r

sion, and coma, it will, indeed, surprise me if I have saidnothing new and true; should it prove so, however, theexample of complacent self-delusion will not be unique.Without presuming to compare myself with Dr. Jenner,

I cannot but smile at the uniformity in the reception ofall new doctrines. His facts were first denied, and whenthese were firmly established it was contended that theywere known long before he was born-which was cer-tainly true-some merit, however, is still conceded to theman who introduced vaccination. The consequenceswhich will follow the adoption of my theory, if proved,are, in my opinion at least, equally important, but everyman thinks his own hobby the finest horse in the field,though it be only a donkey. I am, Sir, your obedientservant,

A. L. WIGAN.London, June 22, 1814.

P. S.-When I had nearly finished my task there waspointed out to me a paper by Mr. Hewett Watson, in the9th volume of the " Phrenological Journal," entitled," What is the Use of the Double Brain ?" The idea putforth, suggestively, by that writer is absolutely the sameas that which forms the groundwork of my own specula-tions, though, as will be seen, it forms but a very smallpart of what I hope and expect to prove to the satisfac-tion of every reader, phrenologist or not. I do notthink it would be possible to offer a more conclusive proofhow entirely the theory was unknown and unsuspectedthan the fact that such a suggestion should have passedunnoticed when promulgated by a man like Mr. HewettWatson, in a work so extensively known as the " Phre-nological Journal." Should that able and accomplishedwriter again take up the subject, I feel quite satisfied thathe will feel himself justified in stating his opinions- dog-matically.

The course of genuine tuberculous phthisis is generallyvery slow in old age ; there is seldom any colliquativesweats or purging. In most cases, the deposition of thetuberculous matter is limited to one or two circumscribedparts of the upper lobes, and is not disseminated throughthe substance of the lungs.