THE REMARKABLE EFFECTS OF FIXED AIR In Mortifications of the Extremities. TO WHICH IS ADDED, THE HISTORY OF SOME WORM-CASES.
BY JOHN HARRISON, Surgeon, Of EPSON, SURRY.
LONDON: Printed by BAKER and GALABIN, INGRAM-COURT, FENCHURCH STREET.
M.DCC.LXXXV.
[Price ONE SHILLING.]
THE REMARKABLE EFFECTS OF FIXED AIR In Mortifications of the Extremities.
MRS. BUDWORTH, a midwife, of Epsom, aged 90, was seized, on the 19th of January, 1780, with a violent inflammation on the calf of the leg, attended with excruciating pain. It came out, upon enquiry, that she had been subject, for five or six months before, to occasional chills, or shiverings, which were attributed to her years; but, upon the whole, she had been as well as people commonly are at so advanced an age. She had frequently experienced erratic pains in the lower extremities for many years preceding, and latterly her legs and feet would occasionally become oedematous; but she had never been attacked by any complaint of consequence, which probably was owing to a very regular, or rather abstemious, mode of living. Notwithstanding there was a very considerable inflammation of the part, the pulse was neither hard nor very quick. Indeed the degree of fever was by no means so strongly marked in the pulse as it was in the tongue, which was dry, rough, and discoloured. I applied the Saturnine poultice to the leg, and directed four spoonfuls of the following mixture to be taken every six hours:
Take of decoction of the bark, 6 oz. and a half; Huxham's tincture of bark, one ounce; Thebaic tincture, one drachm and a half; cordial confection, one drachm; solutive syrup, two drachms; Mix them together.
The next day the pain and inflammation were much the same, and the poultice and mixture were continued as before.
21st. The medicines had not been regularly given. The inflammation was extended as low down as the heel, with a livid appearance; and vesications here and there, with a blackness underneath, denoted the mortification to be begun. I applied a poultice, of linseedflour with elder-ointment, over the whole leg and heel, renewing it twice a day, and continued the mixture. Her diet was sago, salop, and water-gruel, with the addition of a little brandy, cinnamon, and nutmeg.
From this time to February the 20th, the mortification spread slowly, and at length reached the heel. The medicines were taken very irregularly; but, when she did take them, it was observed they relieved the pain. The body was occasionally kept open by an infusion of sena, and sometimes an emollient clyster was thrown up. She took brandy and wine freely with her gruel and sago, and sometimes would get down a bit of veal or chicken.
She now (February 20) refused medicine altogether: I therefore resolved to try the effects of a fermenting poultice. I applied a composition of flour, yest, and honey, in the act of fermentation, laying it on thick over the whole affected part. Upon taking it off, at the end of thirty-six hours, I must acknowledge I was surprised to see the alteration. There was a free discharge of thin matter; the lividness was abated; and the painful twitchings, which for some days past had been very troublesome, were considerably lessened.
February 23, 24, 25. The cataplasm was renewed daily, and the sloughs (which were about-half an inch deep) separated fast: the twitchings less painful, and less frequent.
March the 1st. The sloughs were quite separated, and the ulcer began to cicatrise. The pain was gone, and her health visibly improved.
March the 2d. A spot upon the os sacrum was shewn me this day, of the size of a halfcrown, black and mortified. I directed some of the same poultice to be made, stiffer than the former, and applied upon leather. By the 7th a digestion was effected, and the part put on the appearance of healing. In the mean time the sore in the leg continued to heal.
March the 8th. She was taken with a fainting-fit, from which she was recovered with some difficulty. I directed a cordial mixture, but she could take but little of it; and, refusing all nourishment, sunk gradually, and expired the next day.
The day before she died, I examined the leg. The sore looked very pale, and rather dry; but there was not the least appearance that threatened a return of the mortification. The sore had contracted about a fifth part.
The fermenting cataplasm I made use of in this case, was made thus: Take of honey two parts, yest one part, wheat-flour a sufficient quantity to form a consistence neither stiff nor soft; set it before the fire, and apply it when it begins to rise.
It was Mr. Buckle's particular request that his case should be published.
CHRISTOPHER BUCKLE, Esq. of Banstead, near this place, aged 70, was attacked with a mortification of the great toe, January the 11th, 1780, without any preceding illness. It appeared in the form of a black speck at the top of the toe close to the nail, and the ball of the toe was livid and emphysematous. I directed him to make use of the following fomentation twice or three times a day, an hour at a time:
Take of crude salt of ammoniac, an ounce; camphorated spirits of wine, two pints; Mix them together.
After somenting, the toe was dressed with balsam of copaiba, warm, and a large poultice was applied of linseed flour with a little lard. A drachm of the bark, in powder, was given every four hours; and he was to keep his body open with the Scotch pills.
January the 14th. The toe was very flaccid, which induced me to make an incision into it; when I discharged, without pain, a pale watery fluid. I now wished him to try opium in conjunction with the bark; but, as I could not persuade him to take opium internally, I contented myself with dissolving two ounces of it in the fomentation.
By January the 22d, the mortification was spread, and vesications appeared on the second, third, and fourth, toes. I now prevailed upon Mr. Buckle to allow the addition of Thebaic tincture, of which he took 120 drops every twenty-four hours, and an ounce of bark, in substance, in the same space of time.
January the 25th. The mortification was stopped; but, the event being still very dubious, I requested farther assistance. A gentleman of the first eminence (Mr. Pott) in surgery was sent for from London; who approved of what had been done, and directed the continuation of the same applications and medicines.
January the 28th. Some faint signs of digestion appeared; but, to cut the history short, it was not until the 28th of February that the sloughs were all separated. In the mean time my patient was repeatedly brought to the brink of the grave, by a violent
Heart-burn.
cardialgia and
Looseness.
diarrhoea at first, and afterwards by an accumulation of excrement in the
Straight gut.
rectum, which I, with great difficulty, unloaded by means of a large marrow-spoon.
April the 16th. The sore was healed, and I took my leave; but, July the 1st, Mr. Buckle relapsed. On the side of the
The bone of the foot which sustains the little toe.
metatarsal bone of the little toe a blister had arisen; which being snipped, it formed an eschar as black as ink. At his request I applied the fermenting poultice mentioned in the first case, for he was determined to die rather than submit to the former course of medicine.
August the 2d. He was completely cured, without any internal medicine whatsoever. Mr. Sanxay, of this neighbourhood, paid three visits during the cure, and faw the progress of it with admiration.
November the 10th. He relapsed again. A large vesication arose on the inside of the heel, which, being snipped, formed an eschar as before. The fermenting poultice was applied. This eschar was rather larger than a crown-piece, and almost as deep as the heelbone. It was healed, with great difficulty, on the 24th day of October, 1781, when it was firmly cicatrised without any other application save that of daily washing the ulcer with tincture of myrrh before the poultice was applied.
Mr. Buckle, from October the 24th, 1781, to the 3d of December, 1782, had no return of his mortification, but received a stroke of the palsy on that day, for which, on the 5th, two blisters were applied to the calves of the legs; they were prevented from mortifying by the timely application of the fermenting poultice.
December the 26th. The blisters were healed; and, on the 10th of January, 1783, this worthy gentleman, after having supported himself with great fortitude and patience, sunk under the disease, and, I cannot forbear adding, to the great regret of all those who were acquainted with his excellent character.
THE HISTORY OF SOME WORM-CASES, With an INTRODUCTION.
THE frequent instances I saw of the most deplorable effects from worms, both in infants and adults, during my residence at Charles-Town, in South Carolina, induced me to make many trials of various remedies recommended to me in that country for their
Worm-destroying.
anthelmintic virtues. I had very early opportunities in life of becoming acquainted with the medicines commonly employed in such cases, and had often reason to lament the inefficacy of some of them and the dangerous roughness of others. The tender age and reduced state of those who are the greatest martyrs to this disease seem evidently to point out the mildest remedies as most desirable, whilst, at the same time, the common obstinacy of the complaints as loudly calls for the most powerful assistance. Those, therefore, who have trusted to rhubarb, Aethiop's mineral, worm-seed, powder of tin, and the expressed oils, have frequently had the mortification to be spectators of the daily progress of the disease; and the bolder practitioner, who has scoured the stomach and bowels with antimonials, mercurials, and the violent drastic purges, has had but little reason to boast of the superior efficacy of
his
medicines, when the original complaints have been succeeded by a lingering and fatal hectic.
The remedies, which I hereby recommend to the patronage of the public, are the result of ten years experience, during which time I have never known an instance of their failing; but, efficacious as they are, they operate with the greatest mildness, and are subject to no ill consequences whatever afterwards. They may be taken at any time, requiring not the least confinement; on the contrary, gentle exercise assists the medicine as well as the patient. It is not only in the more
evident
and
marked
worm-cases that they are of use; they are equally serviceable in that
slow
fever which is so frequent in the metropolis, and which is commonly called the worm-fever, though oftentimes the patient is cured without the discharge of actual worms. In short, in all foul bowels, attended with costiveness, shortness of breath, and sallow countenance, I can most conscientiously recommend these medicines, as they never fail to remove the symptoms gradually, clearing the skin and restoring health.
Notwithstanding these medicines may be given without any risk from cold, they nevertheless require to be altered, and proportioned to the strength, age, habit, and other circumstances, of the patient; which renders it absolutely necessary that he should be attended both before and during the time of taking them, otherwise it will not be possible to administer them with any degree of certainty.
I cannot conclude without attempting an apology for the intrusion of an
unknown
medicine upon the courtesy of the public: but, as I cannot at present reveal the secret, and am perfectly satisfied that, upon trial, its own merits will sufficiently recommend it, I shall only beg leave to add, that no one, who is acquainted with the virtues of James's powder, will think himself authorised to dispense with its use because he is ignorant of the precise form of the composition.
I subjoin a cursory history of a few cases, by way of adding weight to what I have advanced above.
CASE the FIRST.
1781. October 30. A boy, aged about eleven years, son of Charles Greenfield, a labouring man, who supplies the village of Epsom with water, was attacked with St. Vitus's dance. I gave him a mixture of liquid laudanum two drachms, assafoetida-tincture four drachms, made into a six-ounce mixture; of which he took a large spoonful at a time, often, without relief.
November 2. Being of opinion, that worms are the most common cause of convulsions in young people, I gave him three worm-purges, which brought away several worms, and he gradually recovered.
1782. May 29. He relapsed, and was cured by taking six doses.
1783. January 20. He relapsed again; for which I made him continue the medicines, once every three days, for twenty-five days.
October 20. He is stronger and heartier than ever; and is at this time perfectly well.
His friends would not permit him to take a few doses while he was well, by way of prevention, or, in my opinion, he would not have relapsed.
CASE the SECOND.
1782. June 21. The child of Esau Archer, a labouring man, aged between two and three years, was brought to me in strong convulsions. I gave her eight doses of the medicines. She voided several worms, and was perfectly cured.
CASE the THIRD.
1782. March 19. The Reverend Mr. Price's cook-maid, a young woman, aged twenty-three, was seized with violent convulsion-fits, for which, being very
Full of blood.
plethoric, she was bled; and an emetic was prescribed, with a nervous anodyne draught at bed-time, and a purging mixture to take the next morning.
March the 20th. Continuing almost in the same state, a mixture of liquid laudanum and assafoetida-tincture was prescribed, without relief.
21st. A purge of jalap and a few grains of prepared mercury were prescribed; after the operation, the mixture with laudanum and assafoetida was continued.
22d. A physician of eminence was called. He recommended half an ounce of the herb called ladies-mantle, to be divided into eight doses, of which one was to be taken three times a day.
24th. At times she put on the appearance of being relieved. The flowers of ladies mantle were continued until April the 5th, when she relapsed, and was convulsed as severely as at the beginning. An electary, of valerian, Russia castor, and conserve of rosemary, with an infusion of rue and soot-tincture, in a mixture, after it, was prescribed.
April the 7th. Extremely ill. A perpetual blister was made between the shoulders.
17th. From the 7th to this day never entirely free from the convulsions. An ounce of valerian-powder was divided into four doses, one of which was taken every six hours in four spoonfuls of the rue-mixture. In the evening of this day, she was so ill as to be scarcely able to swallow. A musk-draught was directed to be taken every eight hours, as it could be got down.
April the 22d. No success having attended the medicines prescribed, it made the doctor determine to try a nostrum; which was two scruples of the lungs of a calf, dried in an oven and powdered, twice a day, in three spoonfuls of strong rue tea. After taking these powders a few days, her complaint put on the appearance of mending, and we hoped for success; when, to our great mortification, on the 7th of May, she was attacked as violently as ever. The blister was renewed.
May the 8th. A box of pills, composed of wood-soot and balsam of amber, was directed; three or four to be taken three times a day.
May the 12th. The pills were continued; but the doctor despaired of her getting the better of the fits, as they generally lasted four or five hours without intermission.
May the 20th. A quack-medicine was recommended, which had the appearance of sweet spirit of vitriol; one phial was said to be a cure for all convulsions. She took two phials with no apparent success.
June the 6th. The doctor gave her over, declaring it was not possible for her to live. This being the case, I informed her friends of a worm-medicine which I gave with great success, and recommended it to her; to which they consented. I sent eight doses, one to be taken morning and evening. Before she had taken all, several worms were voided; and once more her complaint put on the appearance of mending.
May the 11th. The powders were continued; and she discharged an amazing large quantity of worms, knotted. She was much altered for the better.
17th. Her countenance began to assume the appearance of returning health. The convulsions had entirely left her. Appetite good; strength increasing; daily voiding worms.
25th. Almost able to do her business. Nevertheless, as she had voided so large a quantity of worms, I continued the medicines once a day by way of security, and left them off in three days.
June the 30th. Perfectly recovered.
July the 2d. I thought it necessary to give her three doses more of the medicines, to secure her health.
18th. Gave her three doses for the same reason.
1783. June 18. Gave her three doses by way of prevention.
October the 30th. She is in good health, and better than she had been for years before.
CASE the FOURTH.
1783. July 20. — Graham, Esq. M. P. requested me to see his son, an infant, aged two years, ill, as I was informed, of a wormfever. I found his belly very large and swelled, his countenance sallow, a slow fever, pulse quick and small, his mouth full of little ulcers, and costive. The first dose of the worm-medicine gave him a large, foetid, slimy, stool, very loose, which afforded him great relief.
21st. The medicine was repeated, which gave him another stool. He was much better.
22d. The medicine was repeated again.
26th. The gentleman, who attended, wrote, that the child was recovering fast, and needed no more of the medicine.
CASE the FIFTH.
August the 4th. Stephen Caleb, of Banstead, a village near Epsom, brought his son to me, a boy about eight or nine years old. He had, for several months past, languished under a slow fever, pain of the stomach, and now and then was thrown into a convulsionfit. He was much emaciated; could hardly walk alone. I gave three doses of the medicines, which brought away several long worms. He had less fever, and was much better.
17th. Repeated the medicines. He voided more worms. His pain in the stomach, and fits, entirely left him.
September the 30th. Recovered.
CASE the SIXTH.
1783. August 20. James Edes, a shoemaker, at Banstead, brought his son to me, a boy aged nine years, who had been very ill several months with a worm-fever, pain in the stomach, a cough, and enflamed eyes. I cured him with eleven doses of the medicines. He voided many worms.
CASE the SEVENTH.
1783. April 11. Mrs. Foreman's footman, at Epsom, aged twenty-two or twenty-three, applied to me. He complained of a fixed pain in the pupils of his eyes, which seemed remarkably dejected; a florid countenance, flushing often, pain of the right side and stomach, a tickling cough; a small, thready, unequal, pulse; hectic heats and night-sweats. An emetic was administered, and the next morning a cooling purge. He was advised to eat little flesh; to take butter-milk for breakfast and supper, or whey, or milk-porridge; and to eat freely of sallad and other vegetables.
April the 27th. A blister was applied between the shoulders, and made perpetual for several weeks; and, as he grew worse, he was directed to abstain from animal food. To shorten the history, he continued in this state until the seventh of August following, when he was advised to go and try his native air in Sussex.
September the 9th. He returned much in the same state, excepting that the pain was fixed in the stomach; constant and severe, always, after eating ever so little; to use his own words, it had the feel of something striking gently against his stomach.
26th. Daily growing weaker, I recommended him to take the
Worm-destroyer.
anthelmintic, apprehending that worms might be the cause of his complaint.
October the 1st. He had taken eight doses, and voided several knotted worms of various sizes.
16th. From the 26th of September to this day, he took, morning and evening, a dose of the medicine, and every day voided some worms. His pain in the stomach, cough, hectic heats, &c. have all disappeared, and he is now well.
20th. He voided more worms. On that account, I sent him three more doses of the medicines. He is perfectly well, without any complaint, October the 23d, 1783.
February the 28th, 1785. Remains well.
THE END.