Part 21

As a stimulant, the unguentum resinorum, either alone, or mixed with red precipitate, is often used; but it seldom is of service, and often makes the sore irritable. If, however, the ulcer become very indolent, this, or the citrine ointment, properly diluted, may be of service. The same may be said of the other common stimulating applications.

This application forms a very useful remedy for the scrophulous ulceration of the eye-lids, which we so frequently meet with.

Poultices made of bread and sea water have been recommended, but seem to possess little power of accelerating the cure.

Solutions of alum, of blue vitriol, corrosive sublimate, of the nitrites of copper, bismuth, and silver, are sometimes useful to wash the sore with.

This substance is the basis of a celebrated lotion for the face, which is sometimes useful in chronic pustules, which are frequently of a scrophulous nature. It promotes suppuration, the pustule then scabs, and, when this falls off, the part is sometimes found sound below. It is made by dissolving corrosive sublimate in an emulsion of bitter almonds.

The recent leaves of the wood sorrel bruised, and applied raw to the sore, is sometimes useful. The same may be said of cloths dipped in lemon juice, or vinegar and water.

Saturnine ointment is much employed by some, for abating heat and pain; but is inferior to compresses dipped in cold water.

Sometimes only the anterior part of a scrophulous tumor suppurates and ulcerates, and the deeper part of it remains swelled and hard. In this case, the bottom is generally covered with a slough, which comes slowly away piecemeal, and is renewed for some time, until the tumor subsides, partly by sloughing, partly by absorption, and partly by the subsidence of the remaining inflammatory action. In this case, sprinkling the surface lightly with precipitate, or blue vitriol, is of service; and this may be alternated with the common warm poultice. When the surface becomes cleaner, dry lint forms a very good dressing; and this may be covered with a pledget of linen spread with cerate. Afterwards pressure is useful.

The irritable overacting sore, or what has been called the struma maligna, is very difficult to manage, especially as it is frequently connected with a diseased state of the bones or tendons below.

The hepatized ammonia, diluted in the manner formerly mentioned, or simple ointment, mixed with opium, are sometimes of use.

Poultices of bitter almonds, beat up with a little olive oil into a fine pulp, and then warmed, occasionally relieve the pain, and make the ulcer more healthy.

Carrot poultices, or warm poultices made of bread and strong decoction of camomile flowers, are also sometimes of use.

Carbonic acid gas, or carbonated hydrogene, are sometimes of temporary, rarely of permanent advantage.

Anodynes, internally, are useful here, as in other painful sores.

In all cases of scrophulous inflammation or ulceration, it is useful to exhibit, alongst with the proper local treatment, such internal medicines, and to attend to the constitution, in such respects as may be deemed proper. Upon these points I have already made some observations.

When the local disease cannot be cured, and has induced the scrophulous hectic; when this cannot be removed by the means commonly employed, and which have been mentioned in the dissertation on simple inflammation, then the diseased part must be removed, if its situation permit. This must not, however, be rashly done, but must be delayed until we ascertain, that our remedies, general and local, (which must be used with assiduity and care), are of no avail. It is not sufficient that the hectic continues, and that other appearances are almost stationary; they ought to be augmenting, in order to justify amputation of a useful and important part; because every practitioner must have observed the recoveries which take place, even after the hectic fever has made considerable progress. On the other hand, we must not allow the constitution to suffer too much, but must interfere, whenever we perceive that our labours are fruitless, and that the hectic is regularly and progressively increasing, and the strength sinking. When this is observed, the only chance for life is an operation; and every day this is delayed adds to the risk attending it; for there is a degree of injury, more than which the constitution cannot sustain, and which will prove fatal, even although the exciting cause be removed. To fix the proper period requires judgment in the surgeon; but he may be enabled to do so, by attending carefully to the state of all the symptoms; for whenever these continue progressively to become worse, and have reduced the patient already to a state of weakness, which cannot be much increased without danger, he may consider it as impossible to delay amputation longer with any hopes of success.

Having made these observations on this species of scrophula, I shall now conclude, by shortly mentioning the mode of treatment adopted by the older practitioners.

Bleeding, which at first was made use of according to the custom of the day, was soon laid aside, on observing, that, in many cases, it was manifestly hurtful, and in every instance useless. But although the plan of general depletion was given up, yet local evacuations were much insisted on; for they held it as absolutely requisite, that the brain should be purged of its pituita, (the redundancy of which produced the disease), by errhines, fomentations to the ears, and the application of issues and sinapisms to the head. The stomach was cleared of viscosities, by emetics of mustard or broom-seed; the bowels, by aloes; and the skin and kidneys, by sudorifics and diaphoretics.

Having thus procured a sufficient evacuation, the patient was desired to smell a pomum odoratum, composed of styrax, amber, myrrh, aloes, and many other ingredients; the vapours of which were supposed to get up to the anterior ventricles of the brain, and dry them. Hunger and thirst, by drying the juices, were decreed to be salutary. Every thing was rendered nauseous with medicine. The bread was seasoned with anise and fœnugrek seeds, and the drink consisted of decoctions of guaiac and mastic wood, which last was “a friend to the brain and viscera.” As a condiment to these medicated meals, Arnoldus de Villa Nova treated his patients to the burnt sponge, mixed with salt and pepper.

Laurent. de Strum. Nat. p. 67.

But these, and indeed all the medicines yielded by the materia medica, were considered as trifling, and of no avail, when compared to the miraculous power possessed by the king, who, with one touch of his hand, could banish this dreadful disorder, and dry up all the sores. So valuable did this royal prerogative appear in the eyes of many, that it became a national controversy, whether it belonged to the French or English; whilst the Romish and Protestant churches reciprocally urged this prerogative of the king of the country where they were established, as a manifestation from heaven of the justice of their cause.

In France, the king touched publicly, at four dated feasts in the year, preparing himself the day before by prayer and fasting; then entering the apartment where the sick were arranged, the patients were individually presented by the chief physician to his majesty, who placed his hand upon their head, pronouncing these words, “Le Roy te touch, et Dieu te guarit.” The sick then retire, and soon find a manifest amendment. “In some the ulcers dry up; in others the swellings diminish; and, wonderful to relate, in a few days, more than 500 out of 1000 are perfectly cured!”--“Hic hœrant philosophi, cœcutiunt medici, stupet prophanum vulgus.”

Upon reading these accounts, we smile at the credulity of mankind; but we pity them, when we learn, that near a thousand every year made weary and expensive pilgrimages, from very distant countries, to purchase this imaginary benefit.

DISSERTATION VI.

On the Cancerous Inflammation.

The cancerous inflammation generally comes in slowly, in some glandular part, which becomes rather harder, and somewhat larger, than it ought to be; but the pain, for the most part, at first is trifling. By degrees, both the hardness and swelling increase, and a pain, like the pricking of needles, is felt in the part. This pain, after some time, becomes more violent, darting through the whole of the gland, and leaving a sensation, as if the part had been rudely wrung or twisted. The tumor still remains moveable under the skin, which is of the natural colour; but when the disease has continued a little longer, a greater degree of inflammation takes place, and adhesions are formed betwixt the skin and the gland, or the gland and the parts below, at the same time that the pain becomes more continued. The skin now becomes puckered, or drawn inward, and of a dirty or leaden hue, which in time acquires more of the red, but is never of a bright colour. The veins are varicose, and the tumor is, with difficulty, moveable. When the skin becomes red, we may be able to discern a superficial fluctuation, which proceeds from part of the gland forming an abscess. This at last bursts, and discharges a thin yellowish matter, which frequently oozes out in very considerable quantity; the orifice enlarges, and the sore penetrates, for a little way downward, pretty rapidly, and the edges become hard, and overlap a small part of the disk of the sore; but, soon after this, a fungus rises up; and although, in some places, the ulcer may become deeper, yet its chief progress is laterally.

Although the affected gland becomes rather larger, yet the surrounding cellular substance sometimes diminishes, and the neighbouring glands are rather contracted, in which case the part seems to be shrunk.

This abscess sometimes, though very rarely, occupies the whole of the gland, but oftener only a part of it; and if the gland be large, there are sometimes several abscesses, of considerable size, which form unconnectedly with each other, and burst separately.