cases. As regards the first proposition, since this medicine is universally acknowledged as producing certain styptic and other salutary effects, melæna and ordinary passive hemorrhage, is it not reasonable to infer that it will be equally effectual in fevers, not recognising inflammation as their proximate cause and attended with a somewhat similar pathological condition? In regard to the second proposition, its well known physiological influence on the renal and cutaneous vessels proves it to be, as a diuretic and sudorific, the very remedy which nature points out, in the means she herself adopts in the spontaneous cure of malignant fever. Besides these long and well known properties, and also its acknowledged action on the nervous system, I believe that turpentine possesses antiseptic or antiscorbutic qualities, as I have in several instances observed in scurvy, and particularly in scorbutic ulcers of the leg, indicated by their florid, healthy appearance, after a few doses of this medicine. That it is not in the doses above mentioned a stimulant, but, on the contrary, an indirect sedative, and, therefore, not counter-indicated in the first stage of yellow fever, our experience here most satisfactorily proved in hundreds of cases, as it has also since done in the treatment of dysentery. Unprejudiced as I hope I am, and being anxious to bring this really valuable remedy more into notice by an honest appeal to plain ascertained facts, I beg respectfully to state, in the most earnest and unqualified manner, that instead of exciting the circulation, it quieted it, and allayed the urgency of the primary pyrexia by quickly (and, in some cases, almost immediately) restoring the pent-up secretions. The moderate bleeding, which was generally practised at the commencement, and frequently found essentially necessary to divert local determinations, no doubt materially assisted it in its action on the skin and kidneys, and on this account must be considered as a very important step in this mode of treatment. Turpentine is, therefore, a mere simple, innocuous remedy, which, besides its sedative, styptic, and antiseptic properties, possesses also the peculiar power, in its action on the secretions and excretions, generally, of re-establishing and keeping open the two great natural drains of the system-viz., those by the skin and kidneys, the functions of which, we all know, are amongst the first to be impaired or impeded on an attack of fever. That it claims attention from its having the advantage over specific medicines in this disease, such as quinine, calomel and quinine, and biberine (mercury being now considered not a specific, of which we have numerous proofs), is sufficiently obvious, from the nature of its action being readily explained, and from its use being equally beneficial in the last as in the first stage of the disease; I mean, when black vomit, bloody dejections, and low delirium have set in; and as a testimony to its good effects, we had several recoveries from black vomit, attributable entirely to its influence. Viewing, therefore, the pathology of yellow fever, as being primarily connected with a morbid alteration of the blood, and admitting the analogy between its phenomena and the action of a septic poison on the system, borne out, as their identity is, by the rapidity of the morbid action, the salutary efforts of nature, and the speedy convalescence-what better remedy, I beg respectfully to ask, do you require than this, which, like ammunition in a besieged citadel, supplies the means of defence, till the poison, like the enemy, is worn out and overcome? In conclusion, I have to observe that during the last winter I had an opportunity of trying this remedy in a very severe case of typhus fever, as did also a friend here in eight other cases, with excellent effect, given in the following formula :-Spirit of turpentine, spirit of nitric ether, of each three drachms; compound tincture of lavender, two drachms; camphor mixture, four drachms. Of this mixture (well shaken up), a tea-spoonful was given in a wine-glassful of water every four hours. I was led to prescribe the turpentine in this form to save the patient I attended, who was very poor, the expense of a larger mixture, and combined it with the nitrie ether, to guard against strangury, which I was afraid would be easily excited in this timate. The other ingredients appear to answer tolerably well in disguising the rpentine taste and smell; but the inodorated is much preferable to the common sentine nt these cases its beneficial effects were equally well marked as in mitting fevers of Bermuda; and I have no doubt, should any isposed to try this mode of treatment in the typhoid fevers of nprejudiced mind and observant eye, the result will prove the -Lancel, Aug. 27, 1853, p. 183. be unre mecific diseases, it is by no me Tosses in in the subcutaneous cellu base mi antoine rent-looking fluid is the sub febrile disturbance may prec #simmon, perhaps, in the situat are imited to it. Sometimes, inste anticre of paralent-looking fluid is con events ut this rarely happens if th of two or three mme i hove deratie. mal. fer contente far size excente that if a vannt. The apta v nammation bat presta te wenation of the pus are usually of most trim and, be patient's aeratos é de xence of the local ailment bei fret derived from the pen to an T.I the physician at the same ti observes fucsiation. Remetinn, vrae. he age of inflammation are m manifest, aut vine pe men there or can tay at some spots, at others t inflammatory agua than a wither wefore the after their disappearance any evidence of he presence of una a je tetested. The local lesion is limited the first stage These Suseminated shapes he whestamenne fsane after or during the p gress of the ante men'le fiuenues we so cred pretty generally to have their ori in a disant sandition of the word anme they are held to be critical, i evacuants of perrant matter there they are regarded merely as lo inflamations, eacted in a fizessen mndition of the stood a diseased conditi which great he mea rammation ↑ restes a tendency to terminate in the ex dation of a stems mesoríne ref exention into an albuminous fluid and ce of low organisering Temation a astema possessing the same properti in so many pass a he me ime sold to indicate the existence of a definite diseased sont en 1o be Nue from that hat wastema is formed, just as the dep sit of many names Vane stana in the same body at the same time, is held indicate the existentex of a tate to fivesse & he wong in the person who is the se of them. The des hat hoop houtaranya inllestions of purulent-looking fluid small size, and the ormation of vakuutu • iftonded with ittle constitutional distur ance, are due to air baton ridt matian ting in the wind 199 10 nable to se enterained he m stitutional daarmee n + me globales or any other, circu aum minnead: it would be too unt noted 18 being attended by little co then find taas great winstitucional permament occur are the same var yet rafarred, we now a propter and accompanies the est teng ituated in the cellul ✔ormulent-looking fluid a nother cases, we find th ne visstema is exuded in dopominated in masses throug Tagomagition for the first to the la desimatanees under which mes from a definitely di a phot round it can nere vide diffusion of the loc duannad tate of the blood. This di * he land in which purulent di The ruenne membranes after som tate 'n plich we seratch or abr La cvistones of “his condition of the blood or sy whetyst'es deeper chase to have typom In modern times fir 999 To bem var neacrinted with the an ju tha vien slation of Coreign mat ofered to 18 3 tinny pathological gent eased state of the wood argued, that the When affections, may int alan terped ease seems payes vineply aliviad ne fint vardition charges is it he ma imp imm sion "festers tem genera m recognised whic 200 of the "purulent diathesis:" and he defined it to be a new modification of the organism characterised by a tendency to suppuration in the solids and coagulable fluids. Amid much pathologically erroneous, the doctrine of Tessier appears to contain an important truth, viz., that in a certain number of cases of disseminated abscesses the febrile disturbance is established before any local disease is set up, and, consequently, before any pus is formed, and by inference, that the abscesses are, in such cases, merely the effects of a special alteration of the element from which that blastema is exuded out of which they are developed. Although the morbid condition of the blood, which is thus manifested by its effects, is common as a consequence of the acute specific diseases, it sometimes arises without having been preceded by any other disease, i. e., as a primary substantive affection. Of this, the following case appears to me to offer some evidence: A man, aged 31 years, of temperate habits, and usually enjoying health, after feeling generally poorly for two or three days, became decidedly ill July 23rd. The symptoms were-heat of skin, headache, a furred tongue, and disinclination for all exertion. On the evening of the 24th, a red patch appeared on the outer aspect of either leg. On the 25th, there was induration of the same patches. On the 26th, there was redness of the left shoulder, and a red, indurated, elevated patch on the outer aspect of the left upper arm. The mind was now confused. He came under my care in University College Hospital on the 28th. At that time his mind was confused, and occasionally wandered. His movements were rather tremulous, and there were now and then some twitchings of the muscles of the face. He was rather restless, and slept but little. There was no headache. The complexion was thick, and rather sallow. The tongue moist and red at the tip and edges, and on its dorsum was a little dirty fur. The abdomen was rather full and resonant, but not tender. He passed, during twenty-four hours, one stool. The pulse was 96, moderately full, but rather weak. The heart's sounds were natural. Red patches the redness gradually shading into the hue of the surrounding skin, some indurated, others not-were seated on the outer aspect of the right thigh, the calf of the left leg, the anterior aspect of the left tibia, the inner and anterior aspect of the right upper arm, and the centre of the right deltoid. The whole surface was carefully inspected. There was not the slightest trace of suppuration at any spot; no redness or tenderness in the course of any of the veins in the vicinity of the red spots, nor, so far as could be ascertained, elsewhere. There was no cough. The respirations were 24 in the minute. Time will not permit me to detail the daily notes of the case. Suffice it to say, that many other red patches appeared at varions parts of upper and lower extremities, that pus was evacuated from two seated on the anterior aspect of one tibia,that fluid was effused into the knee-joints, and probably into one ankle-joint,—and that at no time was there reason to believe that any internal organ was the seat of purulent deposits. The patient recovered completely at the expiration of about a month from the first symptoms of illness. The following is the abstract of a case of this disease, which occurred subsequently to measles: A boy, aged four and a half years, was admitted, under my care, into the fever ward of the hospital for sick children, in August last. About a week after the disappearance of the rash of measles, the child never having been free from symptoms of illness, the wrists were observed to be swollen; then an abscess formed in the subcutaneous tissue of the back. Subsequently, collections of pus formed on the dorsum of the right hand, over the right wrist, in and over the left elbow-joint, under the right gluteus maximus, in the cellular tissue about the right psoas, and in the left hip-joint; and there were purulent discharges from the ears. He died about five weeks after the swelling of the wrists commenced. No purulent fluid was found in any internal organ. The examination of the body was made by my friend, Dr. Ballard. In these cases, as in the majority of those belonging to the same order, the subcutatissue and joints were exclusively the seats of the collections of purulent fluid however, abscesses are found in the lungs; but then they are w in number, and in a much less advanced state than those *** such V sm the over-excited nervous system "handsomely," as sailors say, and besides restor the appetite. I shall conclude this paper by saying that I have lately used quinine as a proph lactic with much success. Indeed I now make a point of giving it to all who ha recently arrived from Europe, especially midshipmen who have never been in tropics before. I use it in the doses recommended by my friend, Dr. Cambell, Kingston, Jamaica-three grains twice a day, taken as bitters.-Lancel, July 1853, p. 75. 5.-PRACTICAL OBSERVATIONS ON YELLOW FEVER AND ITS TREATMENT WITH SPIRITS OF TURPENTINE. By JAMES LAIRD, Esq., Edinburgh. [To Dr. Gilbert King is due the credit of having first used this remedy in bili remittent fever. Mr. Laird is of opinion that this disease is not of an inflammat diathesis, but a blood poison from external influences-the organic lesions be secondary. Hemorrhages from the nose, mouth, and bowels, of a passive charac proved that the blood was in a dissolved and deteriorated condition.] It appears natural to conclude that the blood, after its primary impregnation. rather at the commencement of the attack, becomes afterwards further contamina by the non-elimination of the different excretions, as is known to take place in tain forms of jaundice, in milk fever, and disease of the kidneys. With this view, therefore, in regard to the pathology of yellow fever, and th is good reason to believe also of cholera, supported as it is by the analogy of action of certain poisons on the system, I will now endeavour to prove the c sistency and reasonableness of the turpentine mode of cure. During the epider it was first prescribed by Dr. King, in five very bad cases of this disease, with view solely, I believe, of restraining passive hemorrhage, when its peculiar salut influence was so strikingly observed. This happened on the 27th of August, ab a month after the fever had broken out; a revulsive plan of treatment, includ general and local bleeding, to a large extent, having, up to this period, been p tised with very unsatisfactory results. After these experiments on the five c alluded to, all of whom remarkably recovered (and two were reported as ha had black vomit), the turpentine was afterwards given in every case and in e stage of the disease, with what success documents then sent into office will sh When I joined the hospital on the 19th of September, the epidemic may be sai have been at its height, and there were then 103 cases of fever under treatm The general mode pursued was a moderate bleeding at the commencement (from to 20 ounces), followed by cupping or leeching, if it seemed necessary. If the patient had received no medicine prior to admission, the primæ viæ v cleared out by a purgative dose of calomel or blue pill, along with solution of som salts, and the turpentine then given in doses of twenty minims in a little phorated water three times a day. In consequence of strangury, it was occasion administered in combination with sweet spirits of nitre; but this troublesome sy tom was happily of but rare occurrence, and then generally consequent on application of blisters. Small doses of tincture of opium, and also castor oil, occasionally combined with it, in cases attended with frequent bloody and other vitiated dejections, or in an opposite state of the bowels. The auxiliary treat comprised sinapisms and blisters to the epigastrium, emollient enemata, and du the stage of debility, wine negus, beef tea, &c., and cinchona injections. principal remedy being, therefore, the turpentine, since in the generality of the o nothing else was given, I consider it, without any prejudice whatever, as a ren in bilious remittent fever, not only perfectly consistent with, but particularly cated by, the symptoms during life, and also the appearances after death, for following reasons:-First, the hemorrhagic character of the disease, depen doubtless, on some change either in the chemical or vital properties of the circ ing fluid; secondly, from the speedy embarrassment of the different excretory tions, particularly that of the kidneys, a diminished or suppressed excretion of having been particularly observed here as the most unfavourable symptom proved by the frequently contracted and empty condition of the bladder in cases. As regards the first proposition, since this medicine is universally acknowledged as producing certain styptic and other salutary effects, melæna and ordinary passive hemorrhage, is it not reasonable to infer that it will be equally effectual in fevers, not recognising inflammation as their proximate cause and attended with a somewhat similar pathological condition? In regard to the second proposition, its well known physiological influence on the renal and cutaneous vessels proves it to be, as a diuretic and sudorific, the very remedy which nature points out, in the means she herself adopts in the spontaneous cure of malignant fever. Besides these long and well known properties, and also its acknowledged action on the nervous system, I believe that turpentine possesses antiseptic or antiscorbutic qualities, as I have in several instances observed in scurvy, and particularly in scorbutic ulcers of the leg, indicated by their florid, healthy appearance, after a few doses of this medicine. That it is not in the doses above mentioned a stimulant, but, on the contrary, an indirect sedative, and, therefore, not counter-indicated in the first stage of yellow fever, our experience here most satisfactorily proved in hundreds of cases, as it has also since done in the treatment of dysentery. Unprejudiced as I hope I am, and being anxious to bring this really valuable remedy more into notice by an honest appeal to plain ascertained facts, I beg respectfully to state, in the most earnest and unqualified manner, that instead of exciting the circulation, it quieted it, and allayed the urgency of the primary pyrexia by quickly (and, in some cases, almost immediately) restoring the pent-up secretions. The moderate bleeding, which was generally practised at the commencement, and frequently found essentially necessary to divert local determinations, no doubt materially assisted it in its action on the skin and kidneys, and on this account must be considered as a very important step in this mode of treatment. Turpentine is, therefore, a mere simple, innocuous remedy, which, besides its sedative, styptic, and antiseptic properties, possesses also the peculiar power, in its action on the secretions and excretions, generally, of re-establishing and keeping open the two great natural drains of the system-viz., those by the skin and kidneys, the functions of which, we all know, are amongst the first to be impaired or impeded on an attack of fever. That it claims attention from its having the advantage over specific medicines in this disease, such as quinine, calomel and quinine, and biberine (mercury being now considered not a specific, of which we have numerous proofs), is sufficiently obvious, from the nature of its action being readily explained, and from its use being equally beneficial in the last as in the first stage of the disease; I mean, when black vomit, bloody dejections, and low delirium have set in; and as a testimony to its good effects, we had several recoveries from black vomit, attributable entirely to its influence. Viewing, therefore, the pathology of yellow fever, as being primarily connected with a morbid alteration of the blood, and admitting the analogy between its phenomena and the action of a septic poison on the system, borne out, as their identity is, by the rapidity of the morbid action, the salutary efforts of nature, and the speedy convalescence-what better remedy, I beg respectfully to ask, do you require than this, which, like ammunition in a besieged citadel, supplies the means of defence, till the poison, like the enemy, is worn out and overcome? In conclusion, I have to observe that during the last winter I had an opportunity of trying this remedy in a very severe case of typhus fever, as did also a friend here in eight other cases, with excellent effect, given in the following formula :-Spirit of turpentine, spirit of nitric ether, of each three drachms; compound tincture of lavender, two drachms; camphor mixture, four drachms. Of this mixture (wel shaken up), a tea spoonful was given in a wine-glassful of water every four hours. I was led to prescribe the turpentine in this form to save the patient I attended, who was very poor, the expense of a larger mixture, and combined it with the nitrie ether, to guard against strangury, which I was afraid would be easily excited in this climate. The other ingredients appear to answer tolerably well in disguising the turpentine taste and smell; but the inodorated is much preferable to the common turpentine. In all these cases its beneficial effects were equally well marked as in the continued and remitting fevers of Bermuda; and I have no doubt, should any of your readers feel disposed to try this mode of treatment in the typhoid fevers of this country, with an unprejudiced mind and observant eye, the result will prove the truth of these remarks.-Lancel, Aug. 27, 1853, p. 183. |