bleeding is invariably successful, as I have never known one instance in which it failed. Immediately on recovery from fainting, the cough, &c. terminate, and respiration becomes free and easy." This mode of treating croup was strongly recommended by us about two years ago; the professor however states that he received information of it from a Dr. Dick of Alexandria, whom he represents to be one of the most bold and successful practitioners in his country. Small and repeated bleeding, recommended by some eminent practitioners, the professor declares to be an abuse of a very important remedy. On the first attack of inflammation of a vital part, the abstraction of blood should unquestionably be sufficiently copious to produce a decisive effect; indeed the object of bleeding is to unload the vessels of the part so completely, as to convert the inflammatory affection into a mere irritative one, that may be cured by an anodyne and a derivating treatment, as blistering, purging, warm bath, &c. A practitioner has lately published a case of irritative inflammation of the lungs, which was after some weeks subdued by repeated bleeding. This patient lost in the course of a few weeks a quantity of blood equal to the third of the weight of her body. Had she been copiously bled on the first attack, the disease might have terminated in as many days as it continued weeks. This case shews the of sanguification, even when a person is kept on a spare vegetable diet, and under the influence of debilitating medicines. power BLISTERS.-Dr. Gregory of London, having, in the course of the last winter, had occasion to observe several instances in which the application of blisters to infants and very young children, was attended with much inconvenience, and even danger, has published the following observations, which he hopes will prove of some service, particularly to the junior members of the profession. "The frequency of acute inflammatory affections in infants has been long acknowledged, while at the same time it has been a matter of general observation and regret, that the smallness of the veins of the arm at an early period of life, precludes us, in a large proportion of cases, from our most powerful means of subduing that formidable state of disease. Practitioners have therefore had recourse to different substitutes for general blood-letting. Leeches, cupping, foxglove, and tartarized antimony, are those most frequently resorted to; but the employment of blisters is, at least, equally general. That blisters are possessed of very decided power in subduing inflammatory diseases of children; and that they are frequently, nay, most commonly applied without producing any local or general inconvenience, must, I think, be admitted. It is equally important, however, to be aware, that in many instances they have occasioned unpleasant symptoms; and my object in the present communication is to point out what these are, in what description of cases they are most likely to occur, and by what means they may be best prevented, or, if occurring, removed. These remarks bear no relation to the questions which have so often been agitated, to what extent, and in what manner, blisters prove useful in inflammatory disease? It is generally admitted, that they are chiefly serviceable in the latter stages of the complaint, and after the violence of the symptoms has been subdued by other and more appropriate means. It has therefore been argued by some, that they are applied only when the disease itself is yielding; and that they might, consequently, be dispensed with without injury to the patient. I have little doubt that this view of the question is, in many instances, perfectly correct; and though I believe it to be inapplicable as a general rule of practice, yet it surely illustrates the position which I would wish to enforce, that the indiscriminate employment of blisters in the diseases of children, upon the mere ground of the presence of inflammatory action, is improper; and that their application is not on a par with the injunction of low diet, or a laxative, or a pediluvium; but that it must, in each case, be as maturely weighed as the propriety of venesection, leeches, or cupping." "In the first place, then," proceeds the Doctor, "I would remark, that the application of a blister to the skin of infants and young children, is often followed by a high degree of inflammation, spreading considerably beyond the surface occupied by the plaster. So high, indeed, will the inflammation run in some instances, that sloughing and gangrene of the parts follow; and this is the first way in which I have seen blisters prove fatal. The skin at this age is very tender and irritable, and loaded with blood vessels; and this would of itself be sufficient to account for the fact; but it is probably dependent also on some peculiarity of constitution." "Even if the blister on its first application, does not produce that high degree of local irritation, which is here supposed, it will occasionally be found that much inconvenience attends it in its subsequent stages. The blister refuses to heal under any system of management: a copious discharge of purulent matter at length takes place from it. In some places ulceration eats deeply into the substance of the true skin. At other times fungous granulations shoot out from the surface of the sore, When this state of things has continued for any length of time (a fortnight for instance, or three weeks) the constitution begins to suffer; the pulse becomes quick; the tongue dry; there is marasmus and restlessness; and in bad cases, convulsions, which terminate fatally. Here it appears as if the long continued discharge was the direct cause of the mischief. I am fully aware that a discharge to at least an equal extent and for a much longer time, is generally kept up by surgeons, with a view of combating local disease in a joint, and that similar symptoms are not found to occur, so as to deter them from practice in these cases. "I am unable to reconcile this apparent contradiction, unless by supposing that it is chiefly in feverish and inflammatory states of the system, where the skin is hot and dry, that these unpleasant effects are likely to be experienced. Several circumstances, however, induce me to think that such a supposition is not altogether gratuitous. In all the worst cases of the kind, which have fallen under my notice, such a state of symptom did really exist; but at the same time, I am by no means confident that in a purely chronic disease, or even in a healthy state of body, similar symptoms might not be expected. "That in a large proportion of cases, they are the result of neglect or mismanagement, I am perfectly ready," says the Dootor, " to admit, and consequently that they may be prevented or obviated; but I am inclined also to believe that occasionally they will occur, notwithstanding all the care of the practitioner. The necessity of attention on his part is in either case equally apparent; and I would strongly urge the propriety of his occasionally examining the state of blistered surface in every case, and not trusting the dressing of it to the nurse, as is too frequently practised. "The manner of obviating the bad effects of blisters in young children, may be thus briefly stated. They should, in the first place, never be applied when the symptoms are sufficiently urgent to demand the evacuation of blood. Bleeding from the arm, or if that is impossible, the application of cupping glasses or leeches should never be omitted, under the hope that the application of a blister will supersede their necessity. "I cannot lose this opportunity of expressing my persuasion of the great utility of a small bleeding in those feverish attacks of children, which, if neglected or checked only by slighter measures, frequently terminate in effusions on the brain. A timely bleeding then, will often preclude the necessity of having recourse to a blister; and I think I have said enough to show that much more inconvenience, and fully as much danger, results from the application of a blister, as from the puncture of a lancet or the bites of leeches. If a blister is, after all, considered to be indispensable, as I well know it will be found to be in many cases, the bad effects I have described may often be prevented by applying it of moderate size, and allowing it to remain on for only a moderate space of time. This will vary in different children. Frequently the blister may be taken off at the end of five hours, but it should seldom or never be continued on for more than ten. Attention should also be paid to the healing of the blister. If mild applications are found ineffectual, they should be changed for cooling lotions, or what answers better in most cases, adhesive plaster. Dry powders appear to me to be improper. Where the granulations are superabundant, the surface should be touched with lunar caustic, which is certainly preferable to blue stone. The pimples that frequently form around the blistered surface during the process of healing, require also a share of attention; for want of which, I have frequently seen them degenerate into ulcers, and occasion a degree of irritation not inferior to that of the blister itself." The skin of an infant or young child is so very irritable, that we never allow a blistering plaster to remain on it longer than two hours, (on an adult four hours are sufficient.) In that time a degree of inflammation is excited sufficient to produce a blister in a few hours, with a dressing of spermaceti ointment. The ulceration and disturbance of the nervous system, which follow a blister, are occasioned by continuing the blister on the part some time after the cuticle has broken; the consequence of which is, so much irritation is excited in the true skin (cutis), and in the cellular membrane under it, as to destroy their vitality, and a troublesome sloughing will ensue, particularly, as the Doctor observes, when the fever runs high, and the skin is hot and dry. The occurrence of fatal convulsions is not the consequence of excessive discharge from the ulcerated surface, but of the irritative effects of the ulcer and surrounding inflammation on the nervous system. The discharge is never so copious as to occasion a dangerous degree of debility even in an infant, and in our opinion it is more likely to prevent convulsions than to produce them. As to the granulations, they generally give way to dry lint with an over-dressing of spermaceti ointment, spread on lint. If they should be very exuberant, an astringent powder, as rhubarb, or Peruvian,· or oak bark, is preferable to lunar caustic or the blue stone, on account of not producing pain, which, in a very nervous infant or child, might bring on convulsions. Blisters and other irritants applied to the skin, in cases of internal inflammation, never prove beneficial until the system of blood vessels have been sufficiently unloaded. When the disease is thus rendered more an irritative than inflammatory, the inflammation excited on the skin by a blister, or a powerful irritant, as the strong water of ammonia, never fails to prove very beneficial, on the principle of derivation. When the blood vessels are not previously unloaded by bleeding, blisters and irritants often aggravate the mischief by increasing the fever or temperature of the body. This effect in children, and during the first stage of pulmonary consumption, we have often witnessed. FLATULENCE.-(Continued from page 923.)-The air which collects in the lower portion of the intestines, particularly the colon, is carburetted hydrogen. It does not appear to be, like the flatus of the stomach, the consequence of indigestion, for it is very frequently unattended with any symptom of debility or morbid excitement of the stomach. Nervous subjects, particularly gouty ones, are very subject to an accumulation of this gas, and so far from its being a disease, they are never better than when it takes place and passes off freely, and when it is not produced they are generally much indisposed, with pain in the head and general nervous irritation. With them, the occurrence of this flatus is a certain indication of approaching convalescence, under a variety of nervous diseases, particularly gout, rheumatism, nervous fever, head-ache, &c. We are not aware that any writer has noticed the evolution or secretion of this gas, in the human intestines, and thre source of it is at present involved in some obscurity. It is never found in the stomach, duodenum, or small intestines, but always more or less in the colon, where the fæces undergo a change. The office of this portion of the intestinal canal, is, probably, as we have observed in an early number, to separate feculent matter from the blood, for we find that there is a very considerable secretion from its internal coat, which gives the contents the fæcal characters. The colour of the fæces as much depends on this part performing its office, as on the secretion of the liver, the dark or blackish colour of the fæces being derived from it, and not from morbid bile, as many writers suppose. The carburetted hydrogen gas may be the consequence of the formation of fæces; but from the quieting effects of its free expulsion on the nervous system, we are inclined to suspect, that it is either discharged from the nervous system, or from the blood into the colon. Those who indulge in the free use of vinous and spirituous liquors, and particularly in strong malt liquors, are very subject to this species of flatulence; but as the gas is never found in the stomach, duodenum, or small intestines, it is evidently not immediately extricated from them. The air from the lungs of inebriates is strongly impregnated with this gas. Venous blood also contains it, as well as carbon, and as both pass off by the lungs, we may ask, is this gas, like the carbon, the product of that process of calorification in the body, or what we have termed animal ignition, to maintain its natural temperature? It is worthy of notice, that when the temperature of the body is kept up by immersion in water heated to the degree of 98 or 100, (blood-heat), neither hydrogen nor carbonic acid escapes from the lungs, and the blood taken from a vein has the appearance of that of an artery. The production of carburetted hydrogen is therefore not a disease, but a secretion necessary in some nervous or gouty subjects, to keep the system healthy, or to quiet the brain and nerves. In such habits, the object of practice, under certain circumstances, is rather to increase than check it, and assuredly, when the system becomes irritable or feverish, to promote it. The remedy we have found most beneficial in this respect, is the composition we have noticed in an early Number, under the head of the Bengal Antibilious Pills, and it was on this account chiefly that we recommended the remedy to gouty, or what are termed bilious subjects, for they not only, act on the liver, but promote the secretion of the colon. A stimulating lavement, as solution of aloes, or Epsom salts, in thin gruel, is also very efficacious. People, however, subject to this gas should, by abstemious regimen, and particularly by avoiding an excess of vinous and spirituous liquors, render the secretion of the gas unnecessary. IODINE.-Dr. Proudet, of Germany, informs us that he has administered this article in cases of wen, with the most decided advantage. We have now under our care four cases of wen, in which the tincture of iodine has proved very beneficial. The tumours, after a trial of three weeks, have diminished more than one half, and from their soft state, we have no doubt of its succeeding in dispersing them. The results of numerous trials in cases of scrofula, have satisfied our minds that it does possess antiscrofulous properties. In one case of scrofulous inflammation of the left eye, attended with opacity of the cornea, and thickening of the conjunctive tunic, it completely succeeded in subduing the inflammation, and removing the opacity in three weeks. Scrofulous ulcers, after the internal use of the tincture, for a week or two, lose their character, exhibit a healthy appearance, and heal kindly. In scrofulous enlargement of glands, it has also succeeded. In the latter cases, as well as in wens, we have also employed bleeding, as directed in our last number, for organic diseases of the lungs, &c. The dose of tincture of iodine is from fifteen to thirty drops. The vehicle we have employed for its exhibition, is the decoction of marshmallow root. SCALD HEAD.-A respectable physician informs us, that he has found the application of the following ointment to the parts affected, every night and morning, after shaving the scalp, to succeed in the most obstinate cases of this disease: Take of acetate of copper, very finely powdered, two scruples; He also directed the bowels to be well evacuated twice a day with the basilic powder. ITCH. We have met with several cases of this disease, that had resisted the long application of sulphur ointment, and other remedies, which yielded in a few days to the solution of the sulphuret of potass in water (a drachm to a pint), as recommended by Sir Arthur Clarke, of Dublin. The parts affected were well washed with it, by means of flannel, every night and morning. |