The American cyclopedia of practical medicine and surgery: a digest of medical literature (Volume 2).

  • Hays, Isaac, 1796-1879.
Date:
1834-1836
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Licence: Public Domain Mark

Credit: The American cyclopedia of practical medicine and surgery: a digest of medical literature (Volume 2). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    this character, in the N. E. Journal of Medicine and Surgery. IX. 337.) The tumour was seated over the first cervical vertebrae, so as to extend some inches on the scalp. Very dangerous cerebral symp- toms supervened, but they yielded readily to the blister. Drs. T. D. Mitchell and J. B. Beck have also furnished us with some important observations illustrative of the use of epispastics in the treatment of anthrax. (See Bib. to this Art.) As a means of affording temporary re- lief, Dr. Physick informs us that he is in the habit of resorting to blisters, when an- thrax is attended with that excessive pain which is compared by the patient to the application of burning coals. The relief they afford is great, but it rarely continues beyond twenty-four hours ; their applica- tion may, however, be repeated as occa- sion requires. Dr. Physick employs the blisters, under these circumstances, even in the first stage, or, to use his own words, as soon as the disease is certainly known to be anthrax. f. Cautery. The employment of caus- tics, in the cure of anthrax, is of very an- cient date, and a variety of them have been recommended for this purpose. Ar- senic was used as early as the days of Agricola : Le Dran employed corrosive sublimate, and Riverius, some others. Celsus depended mainly upon the actual cautery, which he applied after dividing the eschar, so as to permit the heat to act upon the living parts beneath. It would be more curious than useful to relate the opinions and arguments of the sup- porters and opponents of this plan of treat- ment. Suffice it to say, that the greatest objection advanced against it—the severi- ty of the application—is more specious than real. It must be remembered that in this disease, the extreme branches of the nerves of feeling are inflamed and pressed on in such a manner as to experience the highest possible degree of irritation, for this irritation goes on increasing until it deprives them of life : how then can a remedy which accomplishes the destruc- tion of these parts almost instantaneously, produce more pain than the slower torture of the disease ? We have had occasion to witness the application of the actual cau- tery, in several cases of severely painful disease, notwithstanding the very infre- quent employment of this measure in America, and we can bear testimony to the fact that the application of an iron at a white heat, produces very little pain: at a less temperature, its effects are indeed severe, because it does not then destroy the cutis instantaneously. Surely there can be no more effectual mode of remov- ing the mechanical causes of the violence of this disease, than the destruction of the parts by cautery, after all hope of resolu- tion is at an end. Many authors object to cautery when the disease affects the face, for the same reason that Marjolin pro- scribes incisions under the same circum- stances, to wit, because of the deformity likely to result from the application! This is strange; for neither remedy is advo- cated except in cases which are, or will inevitably become, complicated with gan- grene, which accident must induce still greater deformity, if the case is left to na- ture. The happy effects of the actual cau- tery, employed after the manner of Cel- sus, are illustrated in a case of anthrax of the face, by M. Poxjteau. ((Euvres Pos- thumes. II. 515.) The potential cautery is considered by many as more painful than the actual; and from the few instances in which we have employed or witnessed the applica- tion of the latter, we have been inclined to the same opinion ; but the highest sur- gical authority in America stands in some degree opposed to us. Dr. Physick thinks that the rapidity of action displayed by the caustic potash, which certainly ren- ders it much less severe than any other agent of the same class, is productive of less suffering to the patient than even the heated iron. Casteris paribus, the alkali will always receive a general preference to the iron, in this country, because of the terror inspired in the patient by the latter measure, and the natural aversion of the surgeon to a plan of treatment so alarm- ing to the friends and attendants. But there is still another and a stronger argu- ment advanced by Dr. Physick. He thinks that the ulcers resulting from burns are always unhealthy, and peculiar; whereas those that follow the application of caustic potash are simple, healthy, granulating sores. The former have a strong tendency to form irregular callous ruga? in the cica- trices, and almost always heal with diffi- culty. The latter, on the contrary, cica- trize readily, and leave a smooth sur- face, productive of little deformity. (See Burns.) He has therefore recommended, and continues to employ, the caustic al- kali, in preference to the actual cautery, in the treatment of anthrax. The proper time for the application of this remedy is the commencement of the second stage, when the orifices begin to form in the