—No. 4.] LONDON, SUNDAY, OCTOBER 26, 1823.

SURGICAL LECTURESDELIVERED BY

SIR ASTLEY COOPER, BART.

Theatre, St. Thomas’s Hospital,MONDAY EVENING,Oct. 20th, 1823.

LECTURE FiFTH.

WE shall, said Sir Astley, first

speak ofThe TREATMENT ùf CHRONIC

INFLAMMATION.The remedies employed here

must have a slow, gradual actionon the secretions. You cannottake this disease by storm. And,if your medicines are attended byviolent actions, you will do harminstead of good. The principle ofthis complaint is the same as thatof acute inflammation, being thearrest of secretion. Chronic in-flammation is frequently producedthrough the influence oflhe mind:thus, long- continued grief will

completely stop the secretion ofbile; again, loss of appetite, froma deficiency of gastric juice, is

occasioned by anxiety of mind;and even an ulcerated state of the

stomach, has been produced by along continuance of the same

cause. But let what will cause

the stoppage of secretion, some

enlargement will be the result; asswelling of the liver, testicles,joints, the formation of commontumours, as the fatty,—or those ofa specific kind, as the fungous.

In diseases of a chronic kind,give calomel and opium; and Icannot point out to you a betterexample of their good effects thanis observable in inflammation of

the iris (circle round the pupil ofthe eye). A person comes into the

Hospital with the iris, havingaround it a zone of red or yellowspots, according to the violence

of the complaint; the part beingin a state of extreme vascularity,you give this patient five grains ofcalomel, and one grain of opium,

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twice a day for a fortnight, and toa certainty he gets well ; yet thisdisease was formerly consideredincurable. If the patient be afemale, or naturally of a delicateconstitution, then two or three

grains of the calomel should begiven, instead of five, as abovenamed: when the mouth becomes

affected, you must discontinue the

mercury, or its consequences will

prove aggravating to the disorder.The most common medicine, and

probably as a general one the bestthat is administered in chronic

inflammation, ’is the pil. hydr.submur. comp. (Flummer’s Pills);they act at one and the same timeon the secretions of the liver, intes-tines, and skin, and if you can

succeed in restoring these, the

disease, if recent, will soon disap-pear, for then there will be no

congestion, and consequently noenlargement.

Another excellent medicine for

the cure of chronic complaints, iscomposed of an eighth of a grainof oxymuriate of mercury, (corro-sive sublimate) dissolved in halfa pint, of the compound decoctionof sarsaparilla. In the Hospitalswe merely give it dissolved in irectified spirits of wine: the abovequantity may be taken in the ’,course of a day; one half in the ’’,,morning, and the other in the

evening; continue it as long as

you think necessary, taking careto watch its effects on the gums,and always keeping in mind, thatmercury given to excess, will tendto increase, rather than destroyconstitutional irritation. As sarsa-

parilla seems to possess the powerof lessening irritability, we fre-

quently give it with mercury, as

above combined; and which me-dicine has often a most extraor-

dinary effect on opacities of the

cornea, and may be prescribedin even very bad cases, with the

greatest prospect of success. A

girl from Sheerness, was in Guy’sHospital some time since, and inwhom the opacity was so great,that she was nearly blind ; quiteso in one eye: the usual remedies

employed in similar cases, weretried, without obtaining the leastbenefit; she then was recom-

mended the compound decoctionof sarsaparilla, with the oxymu-riate of mercury, and in a short

time she recovered her sight.The best alterative for the re-

moval of chronic disordera in chil-

dren, is one grain of the hydr. cu.cret. (quicksilver, with chalk) andtwo or three grains of powderedrhubarb, mixed together/and givenmight and morning: this compoundis exceedingly mild, and will havea particularly benign influence on

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the liver and intestines. One

grain of oxymuriate of mercury,dissolved in an ounce of’ tincture

of bark, and from ten to fifteen

drops, according to the age of

the child being given twice a

day,, will likewise be found a veryvaluable medicine. It is said that

the mercury is decomposed by thebark ; but whether or not, said Sir

Astley, it has been attended with

so many good effects, that I shallcontinue to prescribe it ; and es-

pecially in those cases where thereis enlargement of the mesentericglands. (The principal character-istic of this disease is an increase

of the belly, but a decrease of the

limbs.) Calomel and rhubarb,the hydr. cu. cret. (quicksilver,with chalk), and soda, will also befound medicines of much power in

the chronic diseases of children.

Lastly, as it is not advisable to

give -these little creatures mer-!cury, if it can be avoided, a medi-cine, composed of two grains of

rhubarb, and five grains of the

carbonate of iron, given two or

three times a day, will often renderits employment unnecessary : thismedicine acts as an aperient andpowerful tonic.On the LOCAL TREATMENT of

INFLAMMATION.

The nature of inflammation, saidSir Astley, I hope you all now

thoroughly understand ; that the

vessels of the part are in a dilatedstate, and that they have an in-creased action. Much has been

said about the application of coldin these affections. People havebeen arguing about words ratherthan ideas; but it really is not

worth while to attend to such fas-

tidious, nonsensical objections ashave been started against this

remedy. Though cold is not a

positive quality, yet it is capableof affording great relief in inflam-mation - tirst, by lessening the

size of the vessel-secondly, bylessening action, and which- it

effects by diminishing nervous

irritability. If cold be applied tothe system generally, it has the

power of lessening the frequencyof the pulse in an extraordinarydegree. Sir Astley tried this

upon himself. He went out of

his house one evening into the

garden when warm, his pulse be-ing 86 ; at the expiration of anhour it was 76 ; and at the end

of one hour more, was reduced

to 65 ; and had not only lessenedin quickness, but also in fulness.Cold will produce torpor, and

even death.

A curious instance of this kind

occurred near Halifax, in NovaScotia: Dr. Scott had been dininga little way in the country with

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some friends ; and they were ontheir return at night, when one ofthe party separated from the rest,saying to a companion, that hewould frighten some of them by-and-bye. However, they reachedHalifax without seeing any thingmore of him. At this the partybecame alarmed for his safety,and returned for the purpose of

finding him. He was discovered

behind a hillock of snow, in the

erect position, but quite dead.Another curious instance of

this kind is related in Cook’s

Voyages, when some of the officersand crew of one of the ships werelanding at Tierra del Fuego. Dr.

Solander, who was of the party,particularly cautioned them not togo to sleep; that it was exceed-ingly dangerous to do so in coldsituations. It happened, bow-

ever, that the Doctor was him-

self the first who became drowsy;it was with the greatest difficultythat his companions could keephim in motion; and it was onlyby great perseverance that theysucceeded in getting him back tothe ship alive.When cold is locally applied to

an inflamed part, it lessens its

nervous energy and robs it of its

heat ; but cold must be severe in-

deed, if it brings the internal partsof the body below a temperature

of 98 degrees. Even here, in thewinter, many parts of our bodies

vary in temperature from twentyto thirty degrees; thus a thermo-metor applied to the toes when

they are cold, will be found to pos-sess twenty degrees less heat thanexists on the calf of the leg.--=Cold therefore applied to excess,destroys life ; while heat, on thecontrary, is one of the actions bywhich it is supported.Even on the living body you

may apply cold to a part until itactually becomes frozen. Mr.

Cline and Mr. Sharp were onceattending a patient who hadstrangulated hernia; to reduce

which, they applied ice enclosedin linen cloths, and these they con-tinued for thirty-six hours: nowas the ice dissolved, the water

formed by it ran down upon the

man’s groin; and the inner side ofhis thigh, and the parts where-on this stream passed became

completely frozen ; proper ap-plications restored them to life ;inflammation and slight mortifica.;tion succeeded: the hernia how-ever was reduced, and the maneventually did well. In these

cases apply ice in a bladder.It frequently happens in this

country, during severe winters,that -the lobes of the ears and

tips of the noses of those who are

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much exposed to the weather, willbecome frozen : they may be re-stored to life again by rubbingthem with snow.

One of the best lotions that can

be applied to an inflamed part,is composed of one ounce of rec-tified spirits of wine, and five

ounces of water. Goulard water

is also much extolled for reducinginflammation, and lessening pain;but when too long applied, or toostrong, ithas been known to destroynervous irritability in too great adegree; Mr. Foster, of Guy’s sawa person in whom the upper eye-lid became completely paralyzedfrom its improper application.

In applying the spirit of winelotion, let your cloths be thin, sothat the spirit may combine withthe heat of the part, and carry it

off in the form of vapour; this isthe way in which its good effectsare produced.

Sir Astley remarked, that hedid not recommend the applicationof ice to inflamed places ; it irri-tates, and is apt to produce gan.grene.Some years since, when Sir

Astley was making a series of

physiological experiments, he

wished to ascertain what effects

would be produced upon the pulseby the sudden application of severecold, for which purpose he plunged J

his arm to the shoulder into snow ;at the time of the immersion the

pulse was 80, but immediately roseto 120 ; this result was contraryto all that he had ever been

taught on the subject-the pulsesometimes did not rise so high as120, not being more than 110, butwas hard and wiry. The immer-

sion in so great a degree of coldcaused great pain, and conse-

quently was a source of irritation.This experiment led Sir Astleyinto an examination of the prin-ciples of the cold bath ; and hefound, that when a person in healthtakes a cold bath, who is unac-

customed to do so, that it will pro-duce irritation ; ; but, on the con-trary, when a person in a state ofirritation or fever goes into a cold

bath, it tranquillizes the nervous

action, and thereby acts as a

remedy.Sir Astley, at one time, had in-

jured his health by being too

much in the dissecting-room, andwas in the habit of dischargingfrom his stomach a good deal ofblood; a considerable degree ofsympathetic fever was the conse-quence ; in this condition he went

into the country for the benefit of apure atmosphere, and he therehad frequent opportunities of no-ticing the influence of cold uponan irritable pulse, in his own per-

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son.—of an evening, when in thehouse, his pulse would be at 120,but upon going out into the coldair it sunk in a very short time to

100, and by a longer continuanceof the cold it became still less fre-

quent. Thus where there is greatirritability of the nervous systemand where the heart is sending itsblood through the different chan-nels with accelerated motion, coldwill prove invigorating, by destroy-ing the first of these affections, andreducing the latter to the naturalstandard.

In a word, therefore, cold re-lieves inflammation when locallyapplied—by abstracting heat-

by lessening the diameters of theblood vessels-and by diminish-ing the action of the part arisingfrom the destruction of its nervous

irritability.The next mode of relieving in-

flammation, is by the applicationof heat and moisture : this looks

like contradiction, but it is not so.It would be a contradiction to

apply ’heat alone, and its applica-tion would certainly do harm ; but’the reverse is the result, when’united to moisture, for the two

produce relaxation, open the

pores, give rise to perspiration,thereby removing congestion, andoccasioning all the beneficial

effects that would arise from the

application of leeches. The se-

dative effects of heat and mois-

ture are well exemplified by whathappens when a person takes awarm bath ; a man, for instance,with a pulse at 75 goes into waterheated to 100 degrees, his pulsesoon rises to 100, presently he

perspires freely, his pulse be-comes less frequent, yet soft;

great relaxation follows, and if

he were not removed would ab-

solutely die, so extensive is the

exhaustion that it occasions. Here

then is direct proof what heat andmoisture do, when they are ap-plied generally ; and when used

locally, their action on the partis precisely the same.

Fomentations are ordered pre-cisely with the same view, viz. tarestore the secretrons, by whichthe tension of the vessels is re-

moved, and the pain much abated.Fomentations occasionally are

medicated, being composed of ca-momile flowers and poppy heads,&e. ; but Sir Astley does not con-sider that these possess any ad-

vantages over mere water, at leastwhere the surface of the skin isunbroken.

Poultices are likewise used uponthe same principle ; the kind ofpoultice is of little consequence,

provided, as in the preceding case,the skin be entire. ’

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The next method of relievinginflammation is by the applicationof leeches ; these relieve upon thesame principle as poultices andfomentations, viz. by abstractingfrom the part a portion of its

fluids, and consequently lesseningthe pain and tension ; after the

leeches drop off, the bleedingmust be encouraged, and this maybe done by bathing the part withwarm water.

To some persons, and in some

situations, however, the applicationof leeches is attended with very

great inconvenience; as occasion--

ally, for example, in inflammationof the testicles. We do not find

this an inconvenience in the hos-

pitals ; but frequently, to privatepractice, we see persons in whomit is of, the greatest consequencethat a bleeding from these partsshould be concealed. Now, asthere is much mess, trouble, and

consequent exposure from an ap-plication of leeches, what we doin such cases is this : we requestthe person to stand before us, and,with a lancet, puncture some ofthe small veins on the front of the

scrotum; in this manner, and witha little warm water, you get anyquantity of blood you please; andwhat is of very great consequence,you stop it when you please; for,by placing the patient in a recum-

bent posture, and by applyingsome cold water to the puncture$,the blood will immediately ceaseto flow. In this way, then, youmay take away blood from the

scrotum, for inflamed testicles,with but very little trouble, andwithout any exposure.The learned Professor here said,

(and at the same time putting hishand on one of the recently ampu.-tated stumps which were lyingupon the table) that he had a fewmore remarks to make, but thesewould be on another subject; viz.The occasional retraction of the

skin of a stump, after amputation.A surgeon at Worthing, took of

a boy’s arm, pretty near the

shoulder-joint; the stump healedkindly, and all was thought to bedoing well: some months after,however, he complained of pain,and the skin retracted to such a

degree, that the bone projectedthrough it at least an inch ; in thisstate, he came to town, and SirAstley, upon examining the partnear the arm-pit, put his fingerupon a small tumour: this occa.-

sioned the boy to jump, as thoughhe had been electrified ; Sir Astleythen performed the operation ofamputation at the shoulder-joint,and upon examination, it was foundthe tumour that had been touch-

ed, before the operation, and which

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produced the electric shock, wasa large ganglion of nerves, fromwhence had arisen the irritable

contraction of the skin.

Previously to the above case, aboy was sent to Sir Astley, with astump similar to the one we have

just described, but of the leg; theends of the bones were cut off,and the boy left the hospital ap-parently well : but soon after thearm case from Worthing had beenoperated upon, and the nature ofthe disease ascertained, this boyagain returned, having his stumpin a painful irritable state, and theskin evidently retracted. Know-ing now (said Sir Astley,) the

cause of the mischief, I cut down

upon, and took out the end of,the posterior tibial nerve : the badsymptoms disappeared, and the

lad recovered.Going round the Hospital the

other day, Sir A. met with anothercase resembling the above, but,in point of irritability, much worse.At the particular request of thiswoman, Sir A. amputated, and henow exhibited the part to the stu-dents : the nerves appeared to beenlarged, and had formed a gang-lion partially resting over the ex-tremity of the bone; this had pro-duced such a degree of irritation,that no part of the stump couldbe touched without exciting a kind

of electric shock ; in fact, -thewoman appeared like a,sensitiveplant.. : -

- _

How the nerves become longerthan the bones in these cases, doesnot admit of easy explanation.

! -The amputated stumps of whichwe have just spoken were left upon’the table at the conclusion- of thelecture, when each student hadan opportunity of examining thosebeautiful and peeuliar- specimensof disease.

St. Thomas’s Hospital.

WEDNESDAY EVENING,Oct. 22, 1823;

LECTURE SIXTH.

WE concluded -the last Lecture,said Sir Astley, by describing theadvantages that are derived in

Inflammationby the local abstr4e’-tion of blood, and explained themanner in which those advantagesare produced.

’, We shall now proceed to de-scribe

The TREATMENT of CHRONICINFLAMMATION.

in the Acute, as has alreadybeen explained to you, our objectis to decrease vascular’ action ; -but in the chronic we endeavour