257

CASE OF "SYPHILITIC ASTHMA" CUBEDBY IODIDE OF POTASSIUM.

BY CHAS. R. FLEURY, M.D. Erlang., L.R.C.P. Lond.,SURGEON, PENINSULAR AND ORIENTAL COMPANY’S SERVICE.

C. J-, aged forty-two, in the service of the Peninsularand Oriental Company, had suffered for six years from asthma(dry), and had taken a great deal of medicine without derivingany benefit. Eighteen years ago he contracted syphilisłviz.,chancre and bubo ; was treated without mercury, and rapidlygot well. He had no organic disease. This man applied tome fifteen weeks ago, and, acting on the presumption that thedisease depended on syphilitic taint, I ordered five grains ofiodide of potassium with an ounce and a half of decoction ofsenega, to be taken three times daily. This was continued forthree weeks. The symptoms gradually subsided, and the manhas been up to the present time-that is, for a period of threemonths-quite free from the disease. He is at present undertreatment for an attack of rheumatism, contracted by sleepingin a wet bed. Formerly the least exposure to cold aggravated.all the symptoms; it is therefore worthy of note that therehas been no return of the asthma.The inference which I think deducible from this case is,

.that the disease was of syphilitic origin.Southampton, March 3rd, 1865.

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

ST. BARTHOLOMEW’S HOSPITAL.PHLEGMONOUS ERYSIPELAS FOLLOWING FRACTURE OF

THE FOREARM ; SIX DAYS’ DURATION ;AMPUTATION; RECOVERY.

(Under the care of Mr. HOLMES COOTE.)

Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborum,et dissectionum historias, tum aliorum, tum proprias collectas habere, et interuse comparare.-MORGAGNI De Sed. et Caus. Morb., lib. iv. Prooemium.

CASES like the two following are such as frequently present ithemselves to the notice of the practitioner, and when com-plicated with phlegmonous erysipelas, demand the seriousattention of the surgeon. In both amputation was resorted to,with the good results narrated in the details of each case. In

Mr. Coote’s patient the injury was found to be more extensivethan was at first supposed, and considering all the circumstancesthe patient’s recovery may be regarded as a fortunate one.Youth and a good constitution mainly helped to bring about-this result.

Thos. T-, aged twenty-three, was admitted into Harleyward on May 14th, 1864. He was an excavator employed on thefortifications at Sheerness, and was a powerful young man.Accustomed to drink about seven or eight pints of beer daily,besides spirits occasionally. On the 10th of May, while atwork, he fell from a height of about eight feet on to someplanks of wood, fracturing his left forearm, and bruising hishead and right hand. Next morning his arm had become muchswollen and red. He went to a surgeon, who put it up insplints. The arm, however, continued to swell, and becameso extremely painful that the splints were taken off, and hewas sent up to the hospital. On admission, four days afterthe accident, he appeared very ill. The whole limb up to theshoulder was immensely swollen, red, and brawny. Severalincisions were made in the forearm, but only a sanious serumexuded. The tissues over the seat of fracture were in a state

approaching to disorganization. A considerable amount ofhemorrhage from the wounds came on, which was stopped by

plugs of lint and a bandage, after which a poultice was appliedto the whole limb. Ordered two pints of porter, one pint ofbeef-tea, and eight ounces of brandy.May 15th.-Slightly delirious last night, but slept fairly

after being twice injected with a third of a grain of morphia(sub cute). Is better this morning; pulse about 100, soft andcompressible; bowels not open, but, according to his own state-ment, were much relaxed before he came in; tongue very muchfurred ; takes his nourishment well. Limb much the same asyesterday; no more haemorrhage; his right hand is swollen andpainful. Essence of beef, one pint daily.

17th.--Feels better; slept well after an injection of morphia;pulse 100; tongue cleaner than it was; bowels not open; slightdischarge of sanious pus from the wounds in the forearm; theupper arm is smaller, softer, and considerably less red than itwas. To have castor-oil at once.

I 18th. -Slept fairly ; bowels open freely; the upper arm con-tinues to improve; pulse about 100, fair volume ; respiration36; perspires profusely, but has not had any rigors. An abscesshas formed over the right wrist, which was injured in the fall;it was opened, and about an ounce of creamy pus let out. Tohave lemonade for a drink, and a mixture of cinchona threetimes a day.

20th. -The upper arm being now considered in a fit state foran operation, amputation was performed at the junction of theupper and middle third. On examination of the limb afterremoval, the soft parts over the seat of injury were in a stateof disorganization. There was a comminuted fracture of theradius close to the wrist-joint, which, however, was not in-volved, and the periosteum was completely stripped from bothbones almost as high up as the elbow-joint.21st.-Passed a fair night after a subcutaneous injection of a

third of a grain of morphia. This morning he is free frompain, and expresses himself better; tongue clean and moist ;pulse 104, soft and compressible; does not perspire so much ashe did ; takes his nourishment well.22nd.-Slept well and feels better. This morning the dress-

ings were removed, and the stump washed, suppuration com-mencing. Pulse about 100, regular; tongue slightly furred, butmoist; bowels open; skin cool.From this date no symptoms of importance supervened; the

wound granulated and healed, and the patient left the hospitalat his own desire in order to regain his strength in the country.

WEST LONDON HOSPITAL.PHLEGMONOUS ERYSIPELAS OF THE UPPER EXTREMITY,

AND SUPPURATION OF THE AXILLARY GLANDS, FOL-LOWING A PUNCTURE OF THE FOREFINGER ; AMPU-TATION; RECOVERY.

(Under the care of Mr. TEEVAN.)THE amputation of a limb is often unjustly looked upon as

an opprobrium to surgery. But when we consider that theend achieved is the preservation of life, and the removal ofa limb whose integrity is destroyed, we think the operationdeserves to be classed with the happiest results of conservativesurgery. In the case about to be related (from notes by Mr.Alderson, house-surgeon) the usefulness of the limb was gone,and the patient would infallibly have sunk had not amputationbeen resorted to. A point of interest was that the man was areformed drunkard. Now Virchow states that the drunkard’s

dyscrasia does not persist if the cause be removed, and thepresent instance would certainly seem to confirm that state-ment, for no one could have exhibited greater reparativepower after an operation than did this man.James G-, aged forty-five, a wiry, healthy-looking pot-

man, was admitted Aug. 3rd. A fortnight previously, hecame to the out-patients’ room with a whitlow of the rightforefinger, produced, he said, by a scratch from some rustymetal. He had formerly been a great drinker, but for thelast two years had led a very temperate life. A free incisionwas made into his finger, which was fully twice its naturalsize. At his next visit he expressed himself as free from pain,and the inflammation in the finger seemed nearly gone. OnAug. 3rd he presented himself at the hospital, and said that afew days ago, when the finger was nearly well, it was attackedwith inflammation, which rapidly spread. His countenancewas very anxious, his tongue furred, and his pulse quick andfeeble. It was evident that he was suffering from great con-

258

stitutional disturbance. The hand was greatly inflamed, andthere were red lines extending along the inside of the limb tothe axilla, where a mass of enlarged glands could be felt, andany pressure on them caused him much pain. He was at onceadmitted into the hospital. A poultice was then applied to the ’,finger, and the entire limb wrapped in hot fomentations. He Iwas ordered a mild purge, and to be well supported with beef-tea and stimulants.Aug. 5th.-The limb had yesterday become so brawny that i

the house-surgeon made several incisions into i, so that to-daythe redness and tenderness are much lessened.9th.-The size of the arm is much diminished, but the skin

looks of a dead leaden colour, and it is evidently extensivelyundermined. The axillary glands are suppurating. The manhas lost flesh, and looks anxious.16th.-The skin over the dorsum of the hand and all along

the outer side of the limb has sloughed away, so that theextensor tendons are exposed almost as clearly as if they hadbeen dissected out. The man’s pulse is weak, and he ema-ciates from day to day.

19th.-The muscles along the inside of the arm are nearlyall exposed, the skin hanging in tatters at places. As the manwas now in a very precarious condition, Mr. Teevan deter-mined, after consultation with his colleagues, to remove thelimb, as the only chance of saving life. Accordingly, the

patient was put under the influence of chloroform, and thearm was amputated just below the shoulder-joint, by a longinternal flap and a short external one, as the sloughing hadextended so much higher on the dorsum of the limb thanalong the inside. A few hours after the operation the mansmiled, and said he was very comfortable and quite free frompain.20th.-Slept very well last night; tongue clean; appetite

good.From this date he made a most rapid recovery, the wound

was healed in three weeks, and he left the hospital at the endof the following month, looking strong and well.

CHARING-CROSS HOSPITAL.

STRUMOUS DISEASE OF THE SHOULDER-JOINT;RESECTION; GOOD RECOVERY.

(Under the care of Mr. CANTON.)RESECTION of the shoulder-joint is a comparatively rare

operation, although we have placed several cases on record

where it has been performed in adults with a very fair share ofsuccess ; indeed more so than occurs with respect to almost anyother articulation. In the child it is still more uncommon, but

through the kindness of Mr. W. Travers, the resident medicalofficer, we are enabled to publish the following successful ex-ample in a little girl, aged four years :-

C. R-, aged four years, of the dark strumous type, wasadmitted into the children’s ward on Oct. 10th, 1864, withstrumous disease of the right shoulder-joint. The motherstated that about two years since the child had been ill withmeasles, from which she apparently perfectly recovered. Sometwo months after the attack had subsided it was noticed thatshe cried if the arm was roughly handled, and at length couldnot bear the joint to be moved at all. She also moaned a

great deal during her sleep. At this time the shoulder did notappear in any way swollen or inflamed. These symptoms con-tinued for twelve months, the pain evidently becoming gradu-ally worse. The child now, too, became pale, thin, and capri-cious. At the end of the twelvemonth the joint was noticedto be swollen, but not red ; the swelling slowly, yet certainly,increased ; the pain was more constant. At the expiration offour months from this time, an abscess formed in the axilla,burst, and discharged freely. The child was placed undermedical treatment, but without benefit, and, after remainingeight months longer, gaining no relief, she was brought to thehospital by her mother, and admitted as above.On admission, the shoulder was found swollen, and the

structures apparently thickened ; movement much impeded, andcausing great pain. A sinus still remained in the axilla, fromwhich exuded a thin sanious pus. The child looked wan andill; her countenance spoke of constant pain and anxiety. Thelimb was confined, and kept at perfect rest; and tonics, withgood nourishing diet, ordered to be given. Opiates, as far aspracticable in so young a subject, were given at night; yether nights were broken and fitful. This treatment was

pursued for upwards of a month ; and although the child’s

general health was very much improved, the disease seemedin no degree stayed, but rather increased. A probe passedalong the course of the sinus proved the head of the humerusto be extensively diseased. On Nov. 19th Mr. Canton re-moved the upper part of the bone, to the extent of about aninch and a half, together with a portion of the glenoid cavity,which was also found to be affected. The horseshoe-shapedflap was employed. The structures around the joint were foundthickened, and apparently in a state of strumous degeneration-But little blood was lost during the operation, and no vesselneeded a ligature. The edges of the wound were adjusted,and kept in position by the aid of sutures. A pad was placedin the axilla, and the arm gently, yet firmly, bandaged to thebody. No bad symptom followed the operation, and the childslept sounder the first night after than she had done for a verylong time. In the course of a few days her appetite improved,and the countenance lost its former constant look of pain. Ateach daily dressing the wound discharged a small quantity ofhealthy pus, which gradually became less, and has now en-tirely subsided. At this date (three months after the opera-tion) the wound has quite healed, and a fair amount of motionis obtainable. The child complains of no pain, and her health,is greatly improved.

Medical Societies.ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

TUESDAY, FEB. 28, 1865.MR. PARTRIDGE, F. R. S., PRESIDENT.

CASE OF ICHTHYOSIS OF THE TONGUE.

BY J. W. HULKE, F.R.C.S.,ASSISTANT-SURGEON TO THE MIDDLESEX AND ROYAL LONDON OPHTHALMIC

HOSPITALS.

I ICHTHYOSIS is a term provisionally applied by the author to<an affection of the mucous membrane of the tongue, whichconsists in hypertrophy of its epithelial and papillary tissues.It is characterized by yellowish-white, raised, tough, leatherypatches, which are clinically distinguished from syphiliticnodes, condylomata, and cancer. Mr. Hulke had seen butone case, which he relates.

i Mr. BiREETT, in 1853, saw a patient, an old sailor, who hada similar affection to that described by Mr. Hulke. It hadexisted many years, and was merely an annoyance.

Mr. HOLMES CooTE remarked that he had published a,

similar case in Holmes’s " System of Surgery," but had notgiven a name to the affection. It occurred in an old woman.There was no evidence of syphilis ; it was not cancerous, but

merely a thickening of the epidermis.Dr. STEWART said that the year before last a gentleman

from India came to ask him if an affection of his tongue wassyphilitic or not. After due inquiries, there was no groundfor the slightest suspicion of that as a cause. He had hadsyphilis four years ago, but had got well of it, and then mar-ried. Mr. Henry Lee saw him, and thought he was free fromsyphilis. All sorts of detergents were applied, and the solu-tion of the chloride of zinc had no effect. Dr. Neligan haddescribed a similar condition of the tongue in a case which, afterslight irritation, ended in cancer. His (Dr. Stewart’s) patientwas still in good general health.Mr. PAGET said the affection described by the author was

sufficiently rare to warrant each member giving his individualexperience. He referred to a specimen in the museum of St.Bartholomew’s Hospital taken from a patient who died ofcancer of the tongue, with disease of the lymphatic glands.Although ultimately the disease was cancerous, it had for tenyears resembled the condition described by the author of thepaper. This patient also used to pare down the growth as ifit were a corn. He (Mr. Paget) did not wish to imply that theform of disease was more likely to end in cancer when thispatient became old than many other diseases of the tonguewhich were accompanied by irritation. Mr. Hulke’s case wasthe first of the kind placed on record, and was interesting assuggesting that diseases of the tongue should be studied inconnexion with those of the skin. Mr. Paget then related acase which was, he believed, an instance of ringworm on thetongue.Mr. C. H. MOORE alluded to a case in which it was difficult

to distinguish cancer of the tongue from other affections ofthat organ. He referred to a case then under his care in Mid-