946

demand for neuralgic information is alcinto inflicting the task of studying a deadlanguage on the fourth class of a villageschool. In conclusion, Mr. Editor, letme observe, that notwithstanding thesatisfaction which your correspondentevinces at the various extra chargeswhich he must have been subjected to, Iapprehend the majority of his companionsare of opinion that twenty guineas is an

ample fee for all they are taught at theCollege, and that Mr. Coleman ought, outof this sum, to provide and pay theteachers of the different departments, aswas clearly intended at its foundation. I

am, Sir, your obedient servant,CHARLMS CLARK.

Veterinary Infirmary, Stamford Street,March, 18:34.

CHARLES CLARK.Veterinary Infirmary, Stamford Street,

MIDDLESEX HOSPITAL.

TREATMENT OF VARIfOSH VEINS.

A DIFFERENCE in the mode of treatingvaricose veins having existed for sometime at this hospital between Sir CHARLESBELL and Mr. MAYO, the subject hasgiven origin to much conversation amongthe students, who are often at:a loss whichmode they should adopt in future prac-tice. They have often seen a patientrapidly recover under a plan of treatmentwhich, in a succeeding case, required weeks, perhaps months, to effect a cure,although the constitutional differences andthe nature of the complaint have not beenvery dissimilar. Under one surgeon per-haps three cases on his list will be cured

evidently to his satisfaction, while it willsometimes happen immediately afterwardsthat he is unsuccessful in a fourth case,treated under circumstances not unlikethe preceding three.We shall give some cases treated ac.

cording to each mode :-

Cases treated by Mr. Mayo.CASE 1.—Caroline Hawkins, aetat. 44.

Had been a servant, but was latterly occu-pied in washing and making up linen, whichobliged her to remain in a standing posi-tion for many hours during the day. Shementioned, that in August last she was

severely attacked with cold, under whichshe labonred for some time, and at lengthderived relief from, as she supposes, a

copious perspiration. While recoveringfrom the attack, she observed her rightleg to be swollen, and four days after, she perceived an enlargement of the veins inthe fore and upper part of the limb. Ac-

cording to her statement, it consisteci of a

simple enlargement, with a sense of dif:I ficulty in using the leg. This continued

3 for a fortnight, the veins gradually in-t creasing in size, when she found that at* about the middle of the limb, just at thetermination of the varicose vein, the skin! had assumed a brownish hue, and was: tender. Shortly afterwards, a minute

! abscess formed, which in four days sup*purated, and finally became a large ulcer.Simple dressing was applied to it, but atlength it became so painful, that on the28th September she came to the Hospital,and was seen by Mr. Mayo. The ulcerthen presented a very angry appearance.It was of nearly the size of a halfcrownpiece, having an inflammatory blush to-wards its centre; near the edge the skinwas white, and the cuticle was destroyedfor a short distance, leaving the rete muco-

I sum visible. The vein ran nearly through

its centre, its larger half being internal.Jt appeared more swollen in the eveningthan at other periods. Mr. Mayo re-

marked, that the case presented a favour-:able opportunity for trying his mode oftreatment, namely, the formation of anulcer by an eschar, with the design ofexciting adhesive inflammation aboutthe veins, and thus cutting off the circu-

Ilation from the sore, without which it

would be difficult to effect a cure. The

previous good state of her general health,and her spare hahits, would, he said, pre-vent the inflammation from becoming dif-fused along the course of the vessels,=the only evil to be guarded against insuch cases. For the cough he orderedthe following expectorating mixture:-R Mist. Camph. 8 ounces; Tinct. Opii,half a dram ; a teaspoonful to be takenevery six hours. Compound colocynth pill10 grains at bed-time. He then orderedhis "paste," which consists of two parts ofsoap, and one of potassa fusa, to be appliedat about an inch above the sore.

30. The application of the caustic pro-duced but a slierht eschar, and it was there-fore used again, the woman, however,complaining of the pain caused by it the

first time. The cough being still urgent,the expectorating mixture was continued,and the pill at bed-time.

Oct. 3. A large ulcer was the result, theappearance indicating that the design ofexciting adhesive inflammation could beaccomplished. There was copious hemor-

rhage, which was stopped by a compress.The old ulcer looked more healthy; it hadlost its inflammatory blush, and was less

painful. Continue the expectorating mix-ture, and the compound colocynth pill,five grains, at bed-time.

5. The new sore presented an angryappearance, but the hemorrhage had-

947

ceased. Its soreness prevented her sleep- would retain them. For the cough sheirtg, and whenever during the night the was ordered the following :—R Camphor-cough became urgent, she imagined that ated Mixture 10 (,zs.; Syrup of Poppiesa needle was passed through the centre 2 ozs; Tincture of Opium 30 drops; Tar-of the new ulcer. She appeared very tarized Antimony 1 gr. Take a teaspoon-nervous. The former sore looked ex- ful every four hours, and for the stomachtremely well, and there was every appear- the following:—R Inficsiozz of Gentiaraance of its cure being shortly effected. ounces; Tincture of Columba 3 drams;Continue the expectorating mixture. Tincture of ITaleriara 2 drams. A table-

Simple ointment to both sores. — R Opium, spoonful every evening. To remove con-

1½ gr. ; Colocynth, 2 grs.; Soap, 1 gr. ; stipation, let her have two Compound Co-to be made into a pill to he taken at bed- I locyyatle pills at bed-time. Let the sore betime. poulticed.

7. She slept well during the last two Sept. 24th. This mode of treating thenights, and her appearance was consider- general system was preferred for the pre-ably better. The iuflammatory blush of sent, as until that was amended, Mr.the new ulcer is fast subsiding, and there Mayo could not think of applying localappears every prospect of adhesion in a irritantsparticularly as the nervous systemfew days. The old sore is healing quickly seemed greatly deranged, as was evidentunder the use of simple ointment. On from her starting at the slightest noise andthe whole she is getting on very well. The her phantasmatic dreams. Continue thecough is less urgent. Let the cough mix- medicines except the pills.ttire be used every night at bed-time only. Oct. tith. Better in all respects, thoughThe other medicines to be discontinued. the nervous irritability was only slightly

9. Appears remarkably well. Adhesion diminished. The sore I!resented an iiiflani-has taken place in the vein, and the cir- matory appearance. Very low and ir-culation has adopted another course. The ritable while it was dressing. On remov-

simple dressings were now used, under ing the poultice, a quantity of dark bloodwhich she recovered so well as to be also came away. It was now of the sizeenabled to walk about in a week, and in a of half-a-crown ; its edges were yellow,fortnight she left the hospital quite well. and the painful itching about its surface

was very troublesome.Case 2.-Hannah Walker, ætat. 56, was It was now evident that some other

admitted into Peppy’s Ward, Sept. 20th. treatment should be adopted. It was,She has laboured under an affection of the therefore, thought advisable to commencelungs for the last three years, which re- changing the course of the circulation, forduced her considerably. Her person was which purpose a, portion of Mr. Mayo’sextremely emaciated and miserable. Her paste of about the size of a large pea wascough, which is always very severe, is placed an inch and a half above the sore,more violent in the autumn than at other and retained there with adhesive plaster.periods. She says that she has laboured She was then ordered the followingunder chronic rheumatism for the last draught:—R Camphorated Mixture 3five years. About two months since, be- ounces ; Tincture of Opium 20 drops. Atea-ing exposed to the rain for four hours, spoonful to be taken every four hours.the pulmonic affection was so much in- 3. The heat of the skin caused the po-creased, that she was confined to her bed tassa fusa to liquify and run towards thefor six weeks. The use of sudorifics and back part of the leg, the irritation fromgentle aperients relieved her a little, when which caused excessive pain ; and on ex-in the seventh week she perceived an en- amining the parts next day an eschar waslargement of the veins in her right leg. visible, which surrounded the leg, andThis in a few days increased so consider- caused a larger slough at the sides than itably as to cause her ultimately to apply did on the vein where it was intended toat this hospital. When seen, the swollen act. The nervous sensibility was hy thisvein had a black tinge, which in a few accident considerably increased—so muchdays changed to yellow ; its size increased, as to forbid the further application of theparticularly towards the lower part. caustic for a few days. Her proximity toShortly afterwards, suppuration having the fire, it seemed, increased the liquifyingtaken place, a small orifice was made with qualities of the paste, and she was there-a lancet, which gave exit to a quantity of fore placed in a corner of the ward formatter. This was the commencement of three days, when a second application wasa sore, the cure of which became very tried, liquefaction restrained, and the ac-difficult. During the latter stage of her tion on the pait made more serviceable,distemper, the stomach rejected food, and though not to the extent expected, as itshe fancied that it was only when she felt only destroyed the cutis, leaving all be-;the absolute necessity of viands, that it neath unaffected. A third application

948

was, consequently, made next day,— marked, that they had not for the last tenagainst the inclination of the patient, I years known so large a number of patientswho strongly remonstrated against what labouring under varicose veins to be at ashe designated cruel treatment. On re- given period in the institution as there

moving the plaster twenty-fonr hours had lately been. In one week twenty-afterwards, the vein was found completely three cases were counted.divided, the upper part much inflamed, and , , ,, ,,

filled with clotted blood. While the parts Cases treated by Sir C. Bell.were thus exposed, she was seized with a Sir CHARLES BELL, observes, that thefit of coughing, which induced the coagu- conncxion between the pulmonary andlum to give way, and hemorrhage sue- general venous systems is too apparent,ceecled, which compelled resort to he had even in health, to escape observation into the compress and bandage, during the practice.

" When," he says (addressingemployment of which the original sore the students), " we find respiration in thewas dressed with simple ointment; it had slightest degree impeded, the veius ofabated nothing of its inflammatory ap- the aleck alway become distended. Thispearancc. In live days time the compress effect is not only perceptible in thatand bandage being removed, hemorrhage particular part, hut may be seen in the

again succeeded, when their immediate same class of vessels all over the body.reapplication was necessary, and they My first object, therefore, is to try to pre-were continued for a week longer. On vent plethora of the pulmonary system,their removal again it was discovered that if it have not already taken place, or toalthough the blood had partially coagu- mitigate its injurious tendency if it have.lated, there seemed no disposition toad- In order to avoid the former, I directhesive inflammation, the object which had some illild cooling aperient previous toall along been so much desired. It was and during the application to the affectedalso discovered on more minutely ex- limb, enforcing also a moderate system ofamining the parts that the ceagulum was , diet, and prohibiting animal food alto-not perfect, as a small quantity of blood gether. In those persons who have notoozed from the upper sore. This, as the laboured under severe affections of the

compress became relaxed, found its way thoracic region, this precaution was foundto the vein beneath, which being olaen to quite sumcient to secure them againstreceive, it, the circulation in the original constitutional disturbance as a conse-

sore was thus kept up, causing it to pre- quence of throwing into the system a.

sent a very angry appearance. It was quantity of blood equal to the previousnow determined to keep the bandage contents of the varicose swellings, or ofmore tight than before, and not to remove the reduction of œdema, should such beit for a week. At the termination of that the case. In six weeks after the com-period, however, there appeared just as mencement of treatment (provided thelittle symptom of inflammation. in this! constitution be otherwise sound), a ba-

particular part as at any previous time, lance appears to be established, and thewhich being attributed by Mr. MAYO to diminished velunle of the lower extremi-the emaciated state of her frame, and the ties occasions no embarrassment to the

watery state of the sanguineous system, ordinary occupations of life. In con-

another method was resolved on, namely, siclering the treament of this distemper,that of placing the compress and bandage when accompanied by ulcers, there are

above the lately-formed sore, to cut 06’, by’ ! many important facts to be regarded,pressure, the circulation from the affected such as the age of the patient, the state oflaart, and by again applying the caustic, the general organs important to life, andto excite inflammation, ill the vein. ’ This particular circumstances -of the constitu-was accordingly done, and on the follow- tion at the time, before we decide on theing day symptoms of inflammation had propriety of even attempting a cure. Itevidently set in, and these were excited , is well known that the constitutional re-by touching it occasionally with caustic.’ sources in advanced age are very limited;At length such a degree of inflammation they are confined to the accomplishmentwas produced as caused the sides of the of a few ordinary efforts, and the powersv.ein to adhere, of the individual to accommodate the sys-Dec. 1. The above object was attained tem to circumstances aJ nearly gone.

this day, and though the original sore We must, therefore, be careful how wecontinues at this date still under treat- clisturu the system in the performance ofment, it was so modified for the better, its functions, as the diseases to which agedthat a reasonable degree of hope existed persons are subject are often prescribedthat it would be perfectly well in a few for at the risk of life. The local treat-days. ment of this distemper has for its prin-

- The medical officers of the hospital re cipal object the lessening of pain in the

949

part, whether it be ulcerated or not, and 30. The blood showed a buffy coat. Sheenabling the patient to use the erect po- feels considerably relieved in her chest ;sition and employ the limb, or else, by inhales without pain ; the cough easier ;dividing the distended vessels, to direct bowels free; the pain in her leg increased.the blood into other channels. I gene- Nov. 7. Continues to use the expecto-rally adopt the palliative mode, which rating mixture; the cough slight; pain inconsists in the use of the calico bandage the chest departed; the bandage was re-applied, as equally as possible, from the moved, and the œdema found to less.

mstep to about six inches above the knee. The distended veins were not near so pro-One of the objections urged against this minent as before. (Let the bandageis, the liability of displacemeat, which made tighter than before. Discontinue therenders it necessary to re-arrange the expectorating mixture, and let her be

bandage every day. But this may be ob- placed on the low-diet list.) A few daysviated, by stiching the folds to each other afterwards it w’a.3 found necessary to ab-along its entire course, if a sufficient cie- stract eight ounces of blood, in conse-

gree of pressure be used, or at least by quence of a return of pain in the chest.

coiling it three times about tne limb. It Under this palliative treatment she con-frequently succeecls in altering the Irritat- tinned, replacing the bandage every week,ble condition of the parts, and removing until Dec. 22, when she departed quitewell.the pain altogether. When ulcers are -

present, the only change made is, that of C:7.;e 2.-Jane Armstrong, sot. 45, amar-leaving a space open at those parts, for ried woman, and mother of several chil"the application of dressings, which should clren, entered Northumberland ward onbe renowed daily. The bandage may be the 2nd of Nov. with varicose veins andleft on for week. The dressings in an ulcer, of which she gives the followingwhich I have most confidence, are com- history :-- About two months ago, while

posed of straps of soap-plaster, applied taking a pail of water up-stairs, she fellwith pretty moderate pressure. This is backwards, and felt so much hurt by thethe mode of treatment which has been accident that she kept her bed for a fewmost successful with me." days, at the end of which period she in-tended resuming her occupations, but was

Ca8e 1.—Hannah Allen, ætat. 32, a ser- prevenced by a severe pain in her rightvant, enterecl the hospital on October the hip. For two days after the fall she had28th, and was placed in Percy’s Ward. partial retention of urine, which then dis-Her principal employment at home was appeared. If owever, she continued to re-washing, which obliged her to continue trieve for a fortnight, when she felt a

standing sometimes during ten hours a slight degree of soreness and numbness ofday for the last twelve months. About her right leg, with a sense of coldness.six weeks since she perceived, for the This continued for a week, when onefirst time, a swelling in the veins of her morning, while pulling on her stockings,left leg, ’which in a foitnight increased so she perceived that the veins of her legconsiderably, and was attended with such were swollen, and in a week from thatsevere pain, as prevented her walking. period the vessels became so distendedA few days afterwards she perceived that and painful as to cause her some alarm.her leg had swollen, which so alarmed She then became an out-patient at a dis-her, that she determined on entering the pensary, and so continued until the forma-hospital. She there complained of cough, tion of a tumour, which soon became anbut could not refer it to any particular ulcer on the vein itself, caused her tocause, not having been exposed to cold. apply at this hospital. The pain in herShe felt pain in the right side, under the hip still continued, though in a rnitigatedbieast, which was increased when making degree, and sometimes there was a sore-a full inspiration. Her appearance in(ii- ness in the neck of the bladder when itseating plethora, and her health in other contents were discharged. It is more thanrespects being pretty good, sixteen ounces five years since she gave birth to a child,of blood were taken from the arm, and when her general health was very good.the following expectorating mixture was On examining the ulcer, it presented anordered:-& Ti’ater of Acetate of Am- angry appearance towards the centre; itsmonia, 10 ounces; Tincture of Opium, edges were rough, and covered with yel-30 drops; Tartarised Aniimony in solu- lowish matter; the vein passed throughtion, 17 grains; Syrup of Poppies, 6 drams. its centre, and the external coat seemedMix. Let a tablespoonftil be taken every destroyed. She complained ’of the painsix hours. As she complains of constipa- occasioned by dressing, and seemed verytion, let her have two aperient pills at nervous whenever the ulcer was ex-

bed-time. The bandage is to be applied posed to the atmosphere. Shewas orderedfrom the ankle to a space above the knee. to be placed on low diet. To take two

950

gentle aperient pills at bed-time. ThEbandage was placed on, from the ankle t(

four inches above the knee, with a spaCtleft for the dressings of soap-plaster aniadhesive straps at each side, which bouncthem pretty firmly in their places. AIthe end of a week the bandage was re-moved, when the veins appeared slightlyreduced, but the sore was as angry as be-fore. This may in some degree be ac-counted for by her unwillingness to re-main in bed. Being healthy in other

respects, she objected to remaining in a

quiet position, and, notwithstanding thepain of which she complained, walkedabout the ward.

Nov. 16. The bandage was again re-moved, and the veins found improved inappearance, being much less in size thanbefore ; indeed the change was so percep-tible as to indicate a speedy cure of thevenous affection. The sore, however, con-tinued as at the last report, though its in-flammatory appearance was less. Not-

withstanding the improved state of theveins, the sore occasioned the greatest painwhenever it was dressed, the operationproducing tears. Feels pain in the regionof the bladder after the renal discharge.-A Pill of Compound ext. Colocynth, 12grains; Opium, 4 grains; Soap, 3 grains ’,make into four pills, one to be taken atbed-time.- 13:, Balsam Copaiba, 10 dropsthree times a day.

2:3. The veins have a healthier appear-ance, their distention has considerably re-duced since she commenced using the

pills. The pain has decreased on dressingthe sore, but its appearance is not indica-tive of improvement. The discharge isstill very great, and its edges have a yel-low unhealthy appearance. The pain onmaking water is less. Continue the medi-cine, and increase the dose of Balsam Co-.paiba to 15 drops.Under this treatment she continued

until the 26th of Dec., when she insistedon going home. At that time the veinswere quite well, and reduced to their usualdimensions, but the sore, although it hada healthier appearance, was of pretty muchthe same size as when she entered, theonly change being their assumption of ahealthy appearance. The medical at-.

tendant remarked that the difficulty inhealing the sore arose from the currentof blood passing so quickly, and also theloss of the outer coat of the vessel itself,which brought it more into contiguity with Ithe muscles surrounding the inflammatoryparts. The only objection he had to herdeparture was the too early use she mightmake of the limb. Some practitioners, he :said, would, in a similar case, have changed ;

(the current into another channel alto-

j gether, by partially dividing or obliteratingthe vein ; but independent of the uncer.·

tainty of success, by the production of adhesion from inflammation brought on bythis process, he had a strong objection toit from the ccnstitutional irritation (towhich females of delicate frame, or per-sons who readily became the subjects ofnervous excitement, were liable) which hadgenerally been its attendant when he hadseen it practised. He had no doubt but

this local inflammation would soon yieldto a healthy state of the system generallyin which case nature would step in andeffect a better result than could possiblybe brought about by the agency of surgery.’’ There is a certain stage (he added) towhich those ulcers may be brought, whenit would be advisable to allow anothor’ agency to operate for a certain time, andbring to a completion what the surgeonhad commenced. I am of opinion that it’ is better to allow the current of blood topass through the sore for some time, thanto retard its course, particularly when theinflammatory stage suhsides, and the

healthy process commences, for at thatperiod an effort is made by the system toretrieve the injury done to the parts bydisease, which can never be permanentlyeffected if the channel which is the sourceof life and energy to the system generallyhe dried up. The permanent reparationrequired in thf present instance is a

thickening of the coats of the vein, and astrengthening of the muscular structureitself, which never can be effected sex as toensure its permanency unless the bloodbe permitted to flow there. Whenever Ifincl it necessary to turn the channel for ashort time during the existence of activeinflammation in the parts, I generallyapply a pad and compress within an inchand a half of the point at which the veinenters the affected part."

Jan. 6th, 1834. The patient was seenout of the hospital to-day by one of thepupils, who reported that the case wasmore favourable than when the patientleft the house. The sore was diminishingin size.

Case 3.—Jane Walford, a?t. 23, was ad-mitted into the hospital on the 2nd of No-vember, labouring under varicose veins ofthe left leg. The account she gives ofher affection is, that about three weekssince she was exposed to cold for sometime, which shortly afterwards affectedher with a cough, and soreness in the chestand under her left breast; that althoughadvised to have some blood taken away,she disregarded the admonition, to whichshe attributes the continuance of the

951

cough and pains in her limbs. A fortnightafter the commencement of the attack shefound the veins of her left leg swollen, andthis in six days time increased to such adegree as to cause her great alarm, andultimately to determine her toenterthehos-pital. The vessels at this period were verymuch distended,—the medical attendantremarked, to a greater extent than he hadpreviously observed in any case in so shorta period. This may be said to be in partattributable to the plethoric state of hersystem, the patient being a full, robnst,young woman. The usual means were

employed. The leg was bandaged from theankle to the knee, and she was ordered to re-main in bed constantly, and to take the fol-lowing expectorating mixture :—R 14’ater

of Acetate of Ammonia, 3 ounces ; Cinna-mon Water, 4 ounces ; Balsamic Syrup, 1ounce; Camphorated Tinct. of Opium, 3 ,

drams; Tart. Antimony, 1 grain; a table-spoonful to be taken three times a-day,with two compound colocynth pills at bed-time. To be kept on low diet, withoutale or porter.

,

Nov. 9. The cough is better ; the bowelsare free, and are not quite regular; novisible amendment in the veins; com-

plains of numbness in the leg and thigh,and there is a want of sensibility at cer-tain periods. Let the medicines alreadyprescribed be persevered in, except thepills, which for the presert are to beomitted.

16. The cough quite gone; she com-plains, however, of pain in her chest, par-ticularly under the left hreast. On re-

moving the bandage from her leg, therewas no visible contraction of the vessels.The only effect it had had, was that offlattening them ; but when the handageremained off for two hours, as it did onthe present occasion, they dilated as muchas before it was applied. It was here re-

marked, that in such a plethoric sub-ject a longer period was necessary thanin ordinary cases, and that the strengthand fulness of the system should be re-duced before a cure could be expected.The bandage was accordingly perseveredin, changing it every week until the 20thof December, when there seemed someslight indication of contraction in the ves-sels. This was evidently the result of a

change in her general system. She was

considerably thinner than she had beenbefore the alteration, and to this circum-stance Sir CHARGES attributed the amend-ment which had commenced.

Jan. 4, 1834. The bandage was re-

moved this day, and although the im-provement was not great, yet there wassome amendment. The veius were re-

duced in size, and flatter, and althoughthe bandage was kept off for two hours,the distention which constantly occurredon former occasions did not return. The

sensibility of the limb was restored, andhopes were entertained, and subsequentlyconfirmed, that a few weeks more wouldcomplete a cure, without recourse beinghad to more urgent measures.

THE CORONER’S BILL.

HAVING examined the new Bill for the

regulation of the election of Coroners forCounties with every attention which it is

in our power to bestow on it, we feel it an

I imperative duty to state that it does not

contain a single clause which is worthyof the approbation of the Legislature. Al-

though in eight inquests out of ten the

medical duties connected with inquestsare of the utmost importance to the wel-fareof society; and although the Coro-ner’s Court is, strictly speaking, a medicalinstitution; and although the treatmentwhich medical practitioners have expe-rienced throughout England has givenrise to loud, bitter, and general com-

plaint on the subject; yet, not a singleprovision exists in the Bill to prevent a

repetition of such grievances,-to obviateso many sources of dissatisfaction. As the

Bill is now constructed, it cannot be passedinto a law without reflecting disgrace onthe discernment and wisdom of the Legis-lature. We must again urge, as a matterof propriety, the postponement of the

measure until the House is put in posses-sion of the Report of the Medical Com-mittee. Mr. CRIPPS himself cannot rea-

sonably object to such a proposal, and we,entreat that Hon. Gentleman to examine

with that degree of care which the im-

portance of the proposed measure de-

mands, a Bill which has been put into his’hands by some individual whose intentions.may be meritorious, but whose capacity is,not equal to the task which he undertook-to discharge, when he patched up the do-

cument in question.