Medical reports of cases and experiments : with observations, chiefly derived from hospital practice : to which are added, an enquiry into the origin of canine madness : and thoughts on a plan for its extirpation from the British isles

Dedication

To WILLIAM FALCONER,

Dear Sir;

THE Reputation which you have so deservedly acquired^ by your learned and valuable Writings, might have excused the Dedication of a Medical Work, from even a Stranger. But, as I am indebted to you for many kind and friendly Offices, and as the Publication of the following Pages has had the good Fortune to meet with your Approbation and Encouragement, I feel both authorized, and highly gratified, in prefixing your Name, as a Public Testimony of my Esteem, Respect, and Gratitude.

Preface

THE Author, in the following pages, submits to the public, some part of the fruits of his observations and practice, during a period of sixteen years, at the Manchester Infirmary :— An Institution which yields to none in the Kingdom, in its extended, and Hberal provision for the relief of every description of disease, to which the laboring classes of society are exposed. It has been generally admitted, that Hospitals upon a large scale, in populous districts, afford excellent opportunities for clearing up many doubtful points in the History of diseases, and likewise duly ascertaining the value of novel, as well as^ established modes of cure. Experiments and observations, in these Institutions, may be carried on upon an extensive, varied, and contrasted plan^ and, when thought worthy of publication, the facts are deserving of that credit, which a recorded practice, open to the observation and comments of all connected with a public Hospital, so justly entitle them to receive. Whatever therefore may be tbought of the value, in other respects, of the following Medical Reports, they may, at least, lay;

A 2 claini

VI PREFACE.

claim to authenticity and correctness. How far indeed the Author's general inferences from the premises, and his particular observations on many of the facts, may be deemed fair and allowable, must be left for others to determine.

He has not, however, attempted to imitate the conduct of some medical writers, who, professing* to treat on subjects purely practical, strenuously endeavour to establish a favorite hypothesis, to which their facts and reasonings are rendered entirely subservient. Indeed, to this idol of their fancy, they are bften not only implicitly attached, but are so bigoted, as to expect an equal degree of devotion on the part of their readers.

The Author is wedded to no particular theory, nor the follower of any medical sect. Formerly a pupil in the schools of several celebrated teachers, he may have been, like many others, in the season of youthful ardour and inexperience, too much dazzled with the novelty and splendor of system, to apply to himself, with justice, the sage maxim of " Nullius addictus jurare in verba magistri." But the period of such blind attachment has been long over. He is now arrived at that sober age, and - has

PREFACE. YU

has been so far disciplined in the school of practice, as to be enabled to distinguish between the ingenious, but delusive speculations of the framers of systems, and the rational inductions of cautious experience.

No doubt there are but few systems of medicine which do not embrace useful and important truths. But it i^tbe Author's opinion (which he has endeavoured to follow in practice) that the practitioner acts most wisely, who, in imitation of the conduct of Cicero, in adopting the eclectic sect of philosophy, chuses out of each of the various medical systems, such portions of their doctrine, and experience, as, in his own mind, approaches nearest the character of truth.

It may perhaps be objected to the Author, that he has reported some of the cases too much in detail. But if it be considered, that in such instances he has chiefly had in view, either the illustration of diseases imperfectly understood, or the due approtiation of novel and important remedies, there wiii not, he trusts, be much room for censure on this head. In the reports of Diabetes Mellitus^ he particularly felt himself justified in transcribing such a

detail

Till PREFACE.

detail, from his Journal^ of the cases as seemed best calculated to illustrate the symptoms and peculiar treatment of this singular and distressing malady. But, he has adopted a different method in his practical survey of Chronic Rheumatism :^A complaint, whose history and mode of cure, axe, for the most part, well known and understood. He has therefore, on this subject, confined himself chiefly to a statement of the general result of his practice; except when the importance or novelty of the remedies employed, on some singular modification of the disorder, seemed to render a fuller description and explanation, not only proper, but absolutely necessary.

If the present attempt to contribute to the stock of practical information, be favorably received by his medical brethren, it is the Author's intention, as soon as compatible with his engagements, to select, for publication, a series of clinical reports, on some other diseases, chronic as well as acute, which have more particularly fallen under his observation.

TABLE

TABLE OF CONTENTS,

I. Dedication --». = „ iii

IJ. Preface «----, t

III. Of Chronic Rheumatism - » « I

IV. Two Cases of a singular Affection of the Calves of the Legs ^ » - - 43

V. Of Diabetes Mellitus » . - - 68 yi. Experiments on Diabetic Urine - - 159

VII. Effects of Galvanism in Paralysis - 183

VIII. Medical Effects of Oxyd of Bismuth - 218

IX. Miscellaneous Observations on Canine and Spontaneous Hydrophobia, to which is prefixed, the History of a singular Case of Hydrophobia - - - - - . 230

X. An Inquiry into the Origin of Canine Madness^ and Means of its Extirpation - - 305

LIST OF ERRATA.

Page Line,

19 28 Note, for Dr. Dabey, read Dr. Darbey,

110 13 /or the diminishing, rcac? diminishing.

114 14 /or has, reac? have.

150 24 for dimunition, read diminution.

133 1 f/e/eTbat.

161 2 for Chemical, read Chemical.

182 ' 6 Table, for Enterites, read Enteritis,

2,12. 9 for nine, read eleven.

£66 Note 2d, for humo, read homo.

%n Note ditto, for 'vicebatur, read videbatur,

298 for accessary, read accessory.

The Author trusts^ that his Distance from the Press^ Kill be admitted as an Apology for the above List of of Errata,

OF CHRONIC RHEUMATISM,

T^HIS is;, perhaps, one of the most com» -■- mon of the many lingering and painful maladies that afflict mankind. It is a disease to which the poor and labouring classes arc peculiarly subject, but the extent of its ravages is best ascertained by the medical attendants on large Hospitals.

Chronic rheumatism^ and its varieties, form a large proportion of the medical cases which are admitted into the Manchester Infirmary; and it may be readily conceived that such cases are both numerous and severe, when it is known, that the occupation of weaving is carried on, not unfrequently by preference, and sometimes from necessity, in damp and confined cellars within the town ; and that the surrounding country abounds with colliers, bleachers, dyers, and other artisans, who are necessarily exposed to sudden and great changes of temperature.

But if the poor and industrious classes of

society in this neighbourhood are more than

B commonly commonly exposed to chronic rheumatism^ thej and their medical advisers have the consolation to find;, that in the general Infirmary of the districts particular attention has beeii paid to furnish every means for the comfort and relief of this description of patients.

The institution of vapor and warm baths^ both for general and local purposes^ an electrical and galvanic apparatus^, and the convenience of small;, comfortable and distinct wards^ are demonstrative proofs of the attention paid to the rheumatic class of patients. Under such favorable circumstances^, I entered upon the task of treating the most inveterate cases of chronic rheumatism w^ith every reasonable prospect of success.

At all events^ an excellent opportunity w^as afforded of ascertaining the real nature of many remedies^, v^hich have been considered as efficacious in the cure^ or relief^, of this disorder.

It would be trifling and useless to enter into any detail of the generality of the cases which have been submitted to my care. Indeed^, the history of chronic rheumatism and its treatment are both too well known to afford an expectation of the discovery of much novelty either of principles or facts; but still I am of opinion, that the communication of the

general general result of the treatment (under circumstances favorable both for practice and accurate observation) of a large number of cases^ will be likely to prove useful^ by establishing on a firmer basis^ some of the various modes vrhich have been generally recommended for the cure of this disease. It will be proper to premise^ that I mean to include under the term chronic rheumatism^ such painful affections of the muscular fibres^ membraneS;, and joints^ as are unattended with fever, specific virus, or peculiar derangement of the stomach and bowels; and which are seldom accompanied with external tumor or inflammation, but are very liable to shift suddenly from one part to auother, and are readily propagated along the course of the membranes and muscular fibres. This definition will include chronic lumbago^ sciatica, and what has been considered a distinct disease,— nodosity of the joints.

No doubt the violence and inveteracy of chronic rheumatism are modified by the peculiar structure of the part which it affects. When the large joints with their ligaments, such as the hip joint, and lumbar vertehns become affected, the contiguous nerves often sufiler from the same cause, and a long train

B 2 of

<± CHRONIC RHEUMATISM.

of aggravated symptoms arise, which are with great difficulty subdued.

The practice therefore must be regulated according to these varying circumstances; but I think myself intitled to assert^ from a large induction of facts^ that the rationale of the practice in the cure of every species of chronic rheumatism^ is in general simple and uniform. It consists in removing passive inflammation^ and restoring the debilitated vessels and muscular fibres to their due tone and action.. These ends are chiefly to be accom-^ plished by topical applications^ although internal remedies are by no means to be neglected.

I find from an inspection of my medical* case book^ that two hundred and sixty-nine persons ( exclusively of a considerable number which were of a mixed and doubtful nature ) labouring under severe chronic rheumatism, have been admitted under my care as in-patients of the Infirmary.

The majority of these cases were of long standing, and had been brought from distant parts of the country to the Infirmary, as the last resource, after the usual means had failed.

I shall now proceed to offer some general

practical practical remarks on the effects of those remedies which appear to be most efficacious in the cure or relief of chronic rheumatism under its different forms ; and at the same time^ report a few cases to illustrate the effects of those anti-rheumatic medicines^ which have not been generally introduced into practice; and^ in order to bring the general result into one viewj I shall furnish tables from which «ome useful practical conclusions may be drawn.

Warm, and Vapor Baths.

The general recommendation of the warm bath^ to excite sweating, in most instances of chronic rheumatism, led me to expect great advantage from its use. Experience, however, has corrected my too sanguine expectation. When the disease had raged for a length of time, and induced both local and general debility, or when protracted deepseated pains liad infested the larger joints, as in sciatica and lumbago^ I have found much harm to result from the warm bath. Sweating indeed, in such cases, relieved for the moment^ but it subsequently aggravated the local as well as general symptons.

When the pains were of more recent date,

and and chiefly attacked the muscles and their membranous coverings, occasionally shifting from one part to another, and the strength Was at the same time but little reduced, then a moderate use of the warm bath proved highly serviceable. If this remedy however failed to produce good effects, after one or two trials it was laid aside, as its continuance under such circumstances, uniformly tended to protract the patient's recovery. By the term warmhath, I allude to water heated to an hundred degrees and upwards. But a tepid bath, from eighty-four to ninety, I have found an useful auxiliary in soothing pain, relaxing the stiffened joints and rigid fibres ; especially in elderly patients, whose strength had been greatly reduced by the length and violence of the disorder. Still I consider both the warm and tepid bath as remedies of inferior value, when compared with the topical and sometimes general use of hot water in the form of vapor.

Whenever the joints w^ere found so rigid as to be nearly immoveable, and the pain upon motion exquisitely severe, or when the muscles had become contracted and almost paralytic; and indeed, in every protracted case of the disease of the hip-joint, lumbago, or sciatica, the vapor of

hot

CHRONIC RHRUMATISM. 7

hot watei% locally and properly applied^, afforded (especially in conjunction with other topical applications ) a safe^ and often successful remedy. The mode of applying it must be regulated according to circumstances. Our apparatus consists of a boiler^ from which steam is conveyed through pipes^ that arc so constructed^ as to admit of being conveniently applied to different parts of the body. In all obstinate affections of the joints^ a pipe of nearly half-inch diameter is to be preferred^ and a quarter of an hour is the shortest period for its application. It is better^ as a general rulCj \o commence with a pipe of smaller size^ and only to permit the vapor to strike upon the affected part^ at some distance from its aperture. By these means an inconvenience will be avoided^ which has sometimes prevented the steady application of the remedy; viz. too great irritation of the skin from an excess of heat. By degrees^ the parts will be enabled to bear a considerable column of vapor^ at a very small distance from the extremity of the pipe; and thus the remedy will be most likely to produce its full effect. I have entered into these particulars^ concerning the local application of this remedy^, from a conviction^ that its advantages are not generally rally nor sufficiently appreciated. At the same time I must observe^ that it was found to act only as a powerful auxiliary. For I have in vain attempted to disperse some obstinate rheumatic affections^ by relying solely on its use. My experience of the effects of the general vapor-bath is but limited. There have been but few cases in which I have deemed it prudent to excite the violent degree of sweatings that is the consequence of this application. But whenever it was thought necessary to produce such an effects I found it the most certain and efficacious means that could be employed for the purpose.

Electricity, and Galvanism.

The former of these powerful agents I have long been in the habit of enjploying, as a remedy in obstinate rheumatic complaints. When the disease more particularly affected the muscular fibres^ and was attended with torpor^ rigidity^, and diminution of vital heat, the application of electricity^ by sparks or shocks^ was often attended with manifest advantage; but it was in conjunction with the topical application of vapour^ that its effects were more powerfully and beneficially exerted. The plan which I have generally pursued^ isj

first first to order the diseased parts to be exposed to the action of vapor; and^ during this operation^ a stimulant liniment to be diligently rubbed upon their surface; and finally^ the application of electricity. The operation of drawing sparks^ more or less powerful, according to the state of the disease^ is^ in general^ to be preferred to the administering of shocks. I have seen some cases of purely chronic rheumatism of several years standing, where the patients were so helpless as to be brought in a litter to the Infirmary^ completely recovered by the steady, diligent, and conjoined use of these remedies, along with tonics and anodynes.

It may not be improper to state, as a caution, that the parts which have undergone the above-mentioned operations, ought to be carefully enveloped in flannel; and indeed, such a covering should be constantly worn, where the natural heat is any way deficient: I mention this latter circumstance, because I have seen instances, ( especially in young subjects) where flannel or other warm covering aggravated the patient's sufferings, by increasing the degree of heat, when it was already too abundant. But such an excess of local temperament does not often occur in

chronic chronic rheumatism^ and is generally of short duration.

My experience of galvanism in this disease^, is at present rather confined. I have applied this remedy in some cases vv^ith advantage. But I have not been able to succeed in any instance Avhere electricity^ and other powerful remedies have intirely failed. It seems to be chiefly indicated^ where the nervous energy, as well as muscular activity and vigor^ is much enfeebled by long continued pain and in-action. In two cases of this kind^ I found galvanism of great service ; but not more so than what might have been expected from the applica-> tion of electricity,

Topical Bleeding, and Issues.

These remedies are of essential benefit in the relief and cure of some of the most painful and harrassing species of rheumatic affections. Indeed^ where the ligaments and membranes of the joints are the peculiar seat of the disease, or an enlargement of the extremities of the bones has taken place^ the first attempt at relief, especially in young and vigorous subjects, should be directed to local bleeding; either by leeches, or what is to be preferred^ the operation of cupping and

scarifying.

CHRONIC rheumatism: H

scarifying. Wkeii the pain and irritation are abated bj repeated Ueeding, no time should be lost in securing a drain from the part bj the aid of issues. I am enabled from numerous comparative trials, to recommend the application of a caustic in preference to the knife, for the purpose of establishing an effectual drain. The kali purum answers the purpose better than any other caustic which I have tried. I have seen several hip-cases, of long standing, yield to the persevering use of these means ; but it was often necessary, in order to remove the rigidity and want of tone in the parts which remained, after the subsidence of the more violent symptoms, to have recourse to the combined aid of vapor and electricity. In very obstinate cases of sciatica, which resisted all other means of relief, I have witnessed the happiest effects from issues; but then it must be observed, that it was often necessary to surround the joint with several of these drains, and the degree of irritation and discharge, was moderated or increased, according to the obstinacy of the disease, and the strength of the patient. I have seen in a hip-joint case, three of these artificial openings succeed, when two have failed. I am completely satisfied, that want of success in

the the cure of many of these long protracted caseS;, is owing to the neglect of a vigorous and persevering use of the means above recommended. For the J have succeeded under the steady discipline of Hospital practice^ after their former failure under a feeble and desultory mode of application in private.

Blisters, and Rubefacients.

When the pains affected only ihe fascia and superficial fibres of the muscles^ great relief vras obtained by covering the affected parts with a blister; but it was frequently found more beneficial to use this remedy at a distance from the seat of the disease. Thus in some recent and slight cases of sciatica, a blister proved speedily and certainly useful^ when applied to the inferior extremity of the thigh bone. Indeed,, whenever the complaint seized upon any of the larger and deep seated muscles^ at their origin near the joints the mode of applying blisters to the inferior extremities of such muscles^ and near to the points of their insertion;, was found to be highly beneficial.

In every obstinate case of chronic rheumatism^, where from the nature and situation of the diseased partj issues could not with safety or convenience be applied^ recourse was always

had had to blisters as a substitute. But experience has taught me never to rely upon blister s^, in severe cases of a local nature^ when the aid of issues can be obtained. With respect to their mode of application^ I have found a repetition of fresh blisters to be preferable, as producing less distress to the patient, and greater effects upon the disease, to the practice of keeping up a constant sore bj stimulating the vesicated parts with blistering ointment.

The utility of rubefacients in relieving pain, and entirely removing slight instances of chronic rheumatism, was often experienced. They may be employed, according to circumstances, either in the form of liniment or plaster. When the pains were local and permanent, but not very severe, great advantage resulted from stimulating the skin and supporting the heat of the part by the aid of warm plasters. The following composition proved of excellent use in that most tedious kind of chronic rheumatism, which often attacks young females soon after the age of puberty; and is attended for the most part with stiffness and swelling of the ancle and knee joints. Indeed, wherever the disease had left a thickening and almost indurated state of the integuments, as well as rigidity of the tendons and ligaments

of li CHRONIC RHEUMATISM/

of the joints^ the local stimulus of this application was attended with good effect.

Epithema StimulanSj

K • P« Gummi amraoniaci, Jfs. Aceti scillae Jiij. coque siinul leni igne. ad spissitatem idoneam & materiam frigefactam cola; deinde super aluta illam extende; & Pulv : sal ; ammonice muriat : ad libitum, superficiei inspergito — ft. Epithema. — The addition of more or less of the muriated ammonia, must be regulated according to the degree of irritation which it may be thought proper to excite. In most cases it is better to use it sparingly at first.

After the trial of numerous kinds of liquid rubefacients^ with a view to relieve pain^ and remove the atony of the muscular fibres^ which more or less prevail in every case of chronic rheumatism^, I give to the following liniment a decided preference.

J^ : Linimenti saponis, ^ij Aq. ammoniae, "J Tinct Cantharid : > i^ 3 ij

opii )

G : Camphor, 31 M. ft. Linimentum.

The liniment should be diligently rubbed

upon the parts affected^ after the skin has been

warmed and irritated by the friction of hot

dry^, and coarse cloths ; or the application of

the flesh -brush.

In

In almost every instance where it was adviseable to employ vapor locally^ but especially in sciatica and lumbago, I have directed this liniment to be diligently and plentifully rubbed in upon the parts^ while they were exposed to the vapor pipe. By this method its stimulating effects were heightened^ pain was abated, and the cure much accelerated.

Internal Remedies.

I must confess I have met with much disappointment in the trial of many remedies^ highly recommended by practical writers for the cure of chronic rheumatism. There have been few examples, but those are certainly of an important kind, where internal medicines have singly completed the cure of very severe and obstinate cases. The internal remedies which have been most generally recommended, are of two kinds: viz. 1. sudorifics, 2. medicines of a stimulating nature, which abound in essential oils and resins. To these, mercurial preparations must be added. With respect to the use of sudorifics, I soon found that much caution was required in their exhibition. In more recent attacks, where the disease was diffused over the whole frame, and attended with violent pain and occasional

febrile

CHRONIC RHEUMATISM.

febrile accessions^ much advantage was derived bj exciting moderate sweating; but if this were carried to a profuse degree^, not only great debility^ but an aggravation of the pains ensued. In shorty I can speak decidedly of the injurious effects of sudorifics^ when pushed to any great extent^ in every instance of severe local affection of the joints; and also in mo&t other cases where the disease has been long continued^ and the patient's constitution much debilitated. In chronic Imnbago and sciatica^ I have never experienced any lasting benefit to result from this mode of practice. Small doses of antimonial powder combined with calomel and opium^ were certainly useful in allaying pain and irritation ; but their efficacy consisted rather in palliating symptoms^ than curing the disease^ when of a serious and obstinate kind. The same observation will nearly apply to the use of stimulant remedies^ such as resin of guaiacum, the class of terebrinthinates^ and of essential oils. In the most aggravated instances of general chronic rheumatism, where great torpor and debility prevailed^ guaiacuin in such large doses as the stomach and bowels would bear, was found to be a powerful auxiliary ; and certainly the most geFierally efficacious of all the internal

remedies remedies that were employed. But I have seen no instance of its complete success^ when unaided by topical applications^ in any species of the disease where much local injury of the joints had taken place. It acted most beneficially when exhibited in substance^ well triturated with mucilage; to which was occasionally addedj Gum kino, or Tinct> opii, to prevent its effects on the bowels. In many obstinate cases the ammoniated tincture of guaiacum^ incorporated with mucilage^ and joined to a strong decoction of bark^ proved of great service^ where the constitution was broken down by the violence and length of the disease. There were but few protracted cases in which the Peruvian bark was not prescribed with advantage as a tonic^ especially at the close of the disease. It was^ however^ never administered with any other design than as an auxiliary. In future I shall certainly be induced to make a trial of this remedy as a principal mean of relief*. The propriety of employing it in the cure of acute rheumatism lias been long sanctioned by the recommenda-

* Since writing the above, I find this practice in chronic rheumatism has been attended with success ; and is strongly recommended by a writer iaa periodical JournaL iSee Medical and Phj/sical Journal for November ^ 1806,

0 tion tion of Dr. G. Fordyce, Dr. Fotliergill, and Sir Edward Hulse^ and lately so strongly confirmed by the extended and valuable experiments of Dr. Haygarth, (and I would add the testimony^ if it were necessary^ of my own recent experience of its superior efficacy) that there can be no reasonable distrust of the utility and safety of the practice. Now as there is no doubt of the affinity between the acute^, and chronic species of this disease (the former frequently terminating in the latter) the bark would seem to be a remedy^, under many cir* cumstancesj equally suited to both.

TurpentinCj in every form^ was an ungrateful medicine to the stomach ; often impaired the appetite; and did not produce^ when even duly persisted in^ such salutary effects as the remedy before mentioned. I shall notice hereafter the use of mercury in one kind of chronic rheumatism^ or at least in a disease nearly allied to it. There is another internal remedy which has enjoyed a very high local reputation in Lancashire; and was introduced about thirty years ago into practice^ hj one of the physicians of the Manchester Infirmary. It is the Oleum Jecoris aselli *;, or Cod-liver oil^

and

* I understand, hovvever, that the oil most commonly used is obtained iTom another species of fish, belonging

to and was recommended to me b j my late highly respected colleague and friend Dr. Percival^ as deserving a fair and extensive trial in chronic rheumatism. It is a medicine so very nauseous both in smell and taste, that however disguised^ many delicate stomachs cannot bear it; yet I have known this repugnance not only overcome; but, such is the power of habit, a relish for its high flavour succeeds to the original disgust. From long and repeated experience^ I am enabled to speak of it as a medicine of efficacious, but limited powers. In some instances, where every other means have proved unsuccessfnl, it has operated in a manner so decidedly beneficial, as to excite astonishment. But, on the other hand, it has frequently failed in some of the mild, and more common rheumatic affections. The circumstances under which I have found it most advantageous^ when used both externally and internally, are the following, 1st. In the chronic rheumatism of elderly persons, where the muscles and tendons have become rigid, and the joints nearly inflexible, in consequence of the disease

to the same genus, the Gaelics Molva, or Ling; a very concise and accurate account of its introduction into practice at our Infirmary, is to be met with in a letter from Dr. Dabey, which is inserted in the 2nd yoI. (last edition) of Dr. PerciTal's Essays,

C 2 having haying been brought on by excessive labor> hard fare, dampness, and cold, 2nd. In women whose constitutions have been worn out by repeated rheumatic attacks after parturition^ and more especially in the decline of life. I havci seen a few patients recover intirely by the exhibition of the oil ; who> on their admission into the house, were unable either to preserve the body in an erect posture, or support its weight on the lower extremities. I do not intend to enter into any explanation of the Tnoclus operandi of this medicine in curing rheumatism. Whether it subdues the disease by exciting a specific action upon the small obstructed vessels, or whether it serves to lubricate the rigid fibres, by favoring the secretion of fat, I shall not pretend to determine ; but the fact certainly is, that patients who have for some time taken this remedy, are disposed to increase in bulk and fatness, and it scarcely ever was attended with decisive advantages without producing these effects, in a greater or less degree. Warm table-beer is the vehicle for the oil, which the lower order of patients most commonly prefer. The dose was from half an ounce, to an ounce and a half, twice or thrice a-day, according to the delicacy of the patient's stomach, and the