VIII. Obfervations on Gangrenes and Mortifica- tions, accompanied with, or occajioned by, con-

vulfive Spafms, 0r arifing from local Injury, producing Irritation. By Charles White, Efq+ F. R S. Surgeon to the Infirmary and Lunatic

Hcfpital, and Fice - Prefident of the Literary and Philofophical Society at Manchefter, &c. 8vo. Warrington, 1790.

FOR fome time after the Peruvian bark

was firft recommended in the cure of gan-

grene, it was confidered as a certain remedy in

every affe&ion of that fort; but although in

many of thefe it has been found very powerful and efficacious, there have been others in which it has been exhibited with lefs fuccefs, or has

altogether failed. Thefe failures have led fome

men of great eminence in practice to place lefs reliance on its virtues than it feems really to deferve, and to be even doubtful if it has any well-founded claim to a preference to ? cordials

in general. This has probably been owing to its

[ *68 ]

its having been given indifcriminately in all

cafes, notwithftanding they arofe from a va-

riety of caufes totally different, and which na- turally required very different treatment.

That the bark will not flop all mortifications that may be, and have been, flopped by other remedies is evident from the many trials that

have been made, both of that medicine and

opium, in that particular fpecies which attacks the feet and toes, and which, though flow in its progrefs, is accompanied with local pain or

general uneafinefs. The Public is under great

obligations to the late Mr. Pott for the crite-

rions by which this fpecies of mortification

may be'diftinguifhed with precifion, and the re- commendation of large and repeated dofes of

opium as its mode of cure. The ingenious and refpedlable author of the

work before us flatters hirnfelf he has found

out alfo a remedy for another fpecies of gan- grene, which is the fubjedt of the prefent effay ; but notwithftanding this remedy, as well as that of opium, juft now alluded to, may ftand the teft of experience and time, the baik, he can-

didly obferves, will ftill be ufeful in mortifica-

tions occafioned by a relaxed habit, by a bro-

ken and difiolved crafis of the blood, and in thofe

[ 169 ]

thofe arifing from a kind of acrimony attended with putrefcency. And in cafes highly inflam-

matory, bleeding, he adds, and the ant;iphlo- giftic plan will be neceffary, together with ni- tre and the mineral acids.

In general, this conclufion, he remarks, may be fafely drawn, that gangrene, arifing from different eaufes, in different habits, and under

particular circumftances, requires different me- thods of treatment; as, in general, all the dif-

ferent fpecies of a diforder, ranged under one

head, will not, at all 'times, and in all cafes, be cured by one and the fame medicine, though, curable by others. The particular fpecies of mortification which

is the fubjeft of the pamphlet before us is

that accompanied with, or occafioned by, con- vulfive fpafms, or arifing from local injury, pro- ducing irritation, which is alfo of the fpafmodic kind. The remedy Mr.White recommends for this is- a large and frequently repeated dofe of mufk and fait of hartlhorn, the ufe of which, ?he tells us, he difcovered rather unexpectedly and by accident.' Mufk and the volatile alkali, he allows, have been given before his time; but he does not find that they have, generally, been prefcribed in fufficient quantities, or ever

V'OL. XI. Part II. Y admi-

?' C >7? ]

adminiflered in this fpecies of mortification; fo that hitherto the full extent of their virtues,

efpecially in this complaint, has not been ob- ferved or afcertained.

Our author is well aware of the uncertainty of afcertaining medical fadls, efpecially when thofe fads are not very numerous; and he alfo

knows that mortifications will frequently pro- ceed to a certain point and then flop, without much affiftance; as if the diforder had come to

a crifis, and nature, after having thrown all the morbid matter on one part, had, by her own exertions, relieved herfelf. In mortification, he obferves, arifing from cold, it is not very uncommon to fee the complaint flop as foon as the caufe is removed.

When he firft employed this medicine in the

complaints to which his prefent publication re-

lates, it was not from any expectation, he owns, of flopping their immediate progrefs, but mere-

ly to combat difagreeable fymptoms, fuch as the fingultus, fubfultus tendinum, and other convulfive fpafms. He foon found, however, that it not only removed thefe unpromifing ap-

pearances, but alfo procured eafe, lleep, and a

gentle diaphorefis, whilft, at the fame time,

the mortification regularly flopped. The cir-

. cumflance

[ ]

cumftance ftruck him, but he fcareely ven-

. tured to flatter himfelf that it was owing, in

the firfl inftance, to the medicine, till, from re-

peated trials of it, he obferved the fame uni- form effects. He affaires us, that in moft of

the cafes, in this fpecies of mortification, that

have occurred in his pra<ftice, it has fucceeded

to the utmoft of his wifhes, viz. when the com-

plaint has been accompanied with, or occafioned

by, convulfive fpafms, or has arifen from local

injury, producing irritation. He has tried it

in gangrene and mortification arifing from other

caufes, and not attended with thofe fymptoms, but has frequently been difappointed in its

effects.

As proofs of its efficacy, Mr. White gives the following account of four of the cafes

that occurred during the firft four years of

his giving this medicine.

Many other fimilar cafes, we are told, have occurred to him fince, and been attended with the fame fuccefs, but thefe he has thought it would be fuperfluous to defcribe. On dubious

'

points, as the author very properly obferves, too many cafes can hardly be produced; but convinced, as he is, of the fa&s he relates, he has thought it unneceffary to multiply them,

Y 2 efpecially

[ *72 ]

efpecially as they will receive additional ftrength from a thefis which his friend, Mr. Darbcy, late houfe furgeon of the Manchefter Infirmary, intends to fupport for a degree in phyfic.

"CASE I.

<e On the 13th of September, 1778, I per- ie formed the operation of lithotomy upon Mr. ct Patrick, a gentleman aged fixty-two, and ce extracted a ftone weighing; between three

I O O

tc and four ounces. The inflammatory fymp- C? toms ran very high for two or three of the " firft days, attended with great pain and ten- ei fion of the abdomen. The antiphlogiftic <c

plan was purfued, together with anodyne fo- <l mentations and embrocations to the parts af- ci fedted; but the tenfiori and pain of the ab- i? domen not giving way, the belly, on the (c fourth day after the operation, was rubbed 6i with mercurial ointment, and it was repeated " t.vvice a day. His pulfe was quick, and his "

tongue dry. On the fixth a lingultus came tc

on; there was no digeftion in the wound; (( and the other bad fymptoms continued. I <c directed four fpoonfuls of the julepum e mcf- iC cho to be taken every three hours. On the 6i feventh he remained much the fame as the

"

preceding

t *73 ] "

preceding day. After this, a little digeftion ec

appeared upon the wound; the hiccup was (: leis frequent; the pain and tenfion of the " abdomen abated ; and all the fymptoms ,be- <c

came more favourable. I now entertained cc

hopes of his recovery till the twenty-feventh, " when he had a violent, cold, fhivering fit, and <? all the bad fymptoms returned with greater u: force. His pulfe was one hundred and forty 14 in a minute, his fkin dry, and tongue brown

and hard, without the leaft moifture upon.it. te The hiccup was conftant; the fubfultus ten- " dinum very violent: he was delirious; his C? belly was greatly enlarged, and emphyfema- "

tous; the wound black, and perfectly mor- " tified. I had not now the leaft idea of his fi

recovery; but, in order to abate the fingul- tc tus and fubfultus tendinum, I ordered him

? 1

a bolus, containing ten grains of mulk, with the fame quantity of fait of hartfliorn, every

lf three hours. He was not able to take more <s than four bolufes in the day, and confe- "

quently only forty grains of mufk with an ef equal quantity of fait of hartfnorn. On the " next morning, the twenty-eighth, a little " moifture appeared upon the Ikin, bur, in te other refpects, he continued as the day be-

" fore.

C >74 ] " fore. On the twenty-ninth the mufk and ef fait of hartfhorn were continued in the fame ce quantities, and my expectations.were more t? favourable. His delirium abated on the te thirty-firft; and I prevailed on him to take e: daily eighty grains of mufk with eighty

grains of fait of hartfhorn. On the thirty- ct fecond he was fenfibly better; his pulfe did

not exceed one hundred in a minute; the fkin and tongue were moift; the belly began

Cf to fubfide; and the mortification feerned to " be flopped. On the thirty-third he conti- ** nued to mend, but the eighty grains of mulk

and eighty grains of fait of hartfhorn were " perfevered in. On the thirty-fourth he took ?C one hundred and twenty grains of muik, and ct as much fait of hartfhorn. " All his bad fymptoms left him on the

es thirty-fifth *, the mortified paits Houghed w

away, and he gradually recovered. In the ?c whole of this cafe one ounce and thirty-fix ** giains of mnfk were taken, and the fame " quantity of fait of hartfhorn.

"CASE II.

et James Ogden, of Manchefter, aged forty- fix, was, on the 6th of March, 1780, re-

t( ceived

C 17 5 ] " ceived into the Manchester Infirmary for a "

compound fradture of the leg. It foon be- C?

came inflamed; fvvelled confiderably, with <c much tenfion; lhewed little figns of digef- se

tion; and on the fifth day began to grow " livid. The 'bark was given in confiderable tc quantities; but notwithftanding. the life of " it, the,livid parts were completely mortified- <? His pulfe beat one hundred and forty 111 a " minute; his ikin was hot and dry, and his tc

tongue, without moifture, brown and hard, " A fingultus and fubfultus tendinum came "

on; he had a wildnefs in his looks, fucceed- " ed by a delirium. On the eighth day from f( the accident I directed him to take a bolus, ?( containing ten grains of mulk, with tea " grains of fait of harrihorn, made up with " conferve of rofes, every three hours. He <c

llept better the following night than he had "

ever done fince his misfortune, though he " had no opiate, and the next morning he was " in a breathing fweat. His fymptoms gra- (C dually abated, but he continued the ufe of tC the bolus till he had taken two ounces and a " half of mufk, and as much fait of hartfliorn. " The mortification flopped, and the dead "

parts, feparating from the living, camc

" away

t '?? 3 ec

away in large floughs; but there was fuch a

fc confiderable lofs of fubftance, that he was <c not able to leave the Infirmary till the nth " of December, upwards of nine months from tc the accident, when he was difcharged, cured, " with a very ufeful leg.

"CASE III.

ec On the ill of May, 1782, a maiden lady, " about forty years of age, and of a very cor- <e pulent habit of body, was feized with cold <e fhiverings, fucceeded by much fever, and an <c eryfipelas in her face. A very fenfible apo-

thecary, who firft faw her, fent her a purg- Ki ing potion, an aperient clyfter, and fome al-

kaline draughts, with a grain of camphor, to *e be taken with lemon juice in the a& of ef- <c fervefcence, which were to be repeated every <c four hours. The next day the purging po- <e tion was again ordered. I faw her on the " third, and found her in a flate of delirium, " with great drowfinefs, fubfultus tendinum, <c attended with naufea, a very quick pulle, " and the face much fwelled and livid. I di- ee redted her an aperient apozem, with nitre, to " be taken occafionally ; and a bolus, compofed " of. ten grains of mufk and ten grains of the

cordial

[ '77 ] cordial confedtion, to be repeated every five or fix hours, On the fourth, the naufeaand delirium remaining, I ordered her to take

two or three fpoonfuls of the camphor julep, made with vinegar inftead of water, frequent- ly in the day. On the fifth her ftomach was

more fettled, but as lhe difliked the mufk

bolus, it was changed into pills. On the

fixth lhe feemed much better in every re-

fped:; the mufk was omitted, and the bark was ordered, in draughts, to be taken three times a day. On the feventh her face grew more painful, and an anodyne fomentation was frequently applied to it, which appeared to procure fome eafe. On the eighth all the bad fymptoms returned with greater violence. Her face was more livid, the delirium ran

very high, and the fubfultus tendinum was very troublefome, with a pulfe of one hun- dred and thirty-five in the minute. I then

directed ?her ten grains of mufk, with five

grains of fait of hartfliorn, in pills, to be

taken immediately, and to be repeated 3s often as flie could be prevailed upon to take them. On the ninth fhe was very fenfibly relieved, her lleep had been more natural,

ce and fhe was in a gentle perfpiration. On the

Vol. XI. Part II. Z " tenth

C *7.8 ) ,

I

'? tenth the delirium and fubfultus tendinum %

i ,

tc left her, but the mufk and fait of hartfliorn ee were continued. On the eleventh the hvid- te nels of the face disappeared, and every fymp- <c torn became much more favourable; pylfe "

one hundred in a minute; but the mulk and " fait of hartfhorn were repeated. On the cc twelfth, pulfe ninety in a minute, Ihe ad- il vanced very faft towards recovery, and took " the laft dofe of mulk that I thought necef- " fary. On the thirteenth every bad fymptom 6( h id entirely left her, and lhe recovered

without any farther interruption.

" CAS E IV.

tf Sufan Cheetham, .of Afhton under-Line, ee fourteen years of age, had the misfortune of " a compound fradure of the fore-arm, by a tc fall on the 27th of June, 1782, which was te bandaged by a country furgeon. She was

^ brought to the JVLmchefter Infirmary on the "

29th, and^ though only two days after the " accident, her arm was completely mortified ?? almoft as high as the flioulder, and the fwei- c< ling and inflammation had extended even

<f {till farther, and feemed to be progreffive. c< THe mortification and other bad fymptoms

" had

[ *79 ]

had made fuch a progrefs, that there was

little expectation fhe could live many hours. Of all mortifications, indeed, none are per- haps fo often fatal, or advance with luch

rapidity, as thofe oecafioned by compound fractures of the fore-arm. Under fuch pref- fing circumftances, no time was to be loft. She took immediately twenty drops of the tindh theb., and foon afterwards a bolus,

containing fix grains of mufk and three

grains of fait of hartfhorn. The bolus was

repeated every three hours. Orders were

alfo given for the opiate to be repeated as often as it was neceffary to procure eafe and

fleep, but Hie had no occafion for it, the

'mufk and fait of hartfhorn anfwering every purpofe of that fort. The next morning the mortification feemed to have made no

farther progrefs; fhe was perfectly com-

pofed ; her pulfe only one hundred ; and the bolus appeared to have agreed with her fo well, that ten grains of mufk and fix grains of fait of hartfhorn were ventured on every three hours. She took, by this means, eigh- ty grains of mufk and forty-eight grains of fait of hartfhorn every day, and, though a tender and delicate girl, they were fo far

7. ^ " from

[ rto ] C( from heating her, that every bad fymptorn C( of fever gradually ceafed. The decodtion <e of the bark was then directed; but Ihe dif- <e liked the tafte fo much, that lhe took very " little of it. In about ten days the mortifi- ce cation was not only Hopped, but far ad- " vanced in its feparation, and every other dif- cc agreeable apprehenfion vanilhed. The bo- ee lus was in confequence only.given twice each ee day, and fhe was prevailed upon to take the " bark, as being lefs expenfive. On this " change of medicine every bad fymptom " fpeedily returned ; her pulfe became as quick <c as ever, and her delirium and lofs of lleep iC were equally as troublefome. The bark was, " therefore, thrown afide, and recourfe again

had to the bolus every three hours, which ec foon produced the very favourable appea- te ranees that had before attended it. She

" continued the ufe of it till Ihe had taken (( two ounces of mu|k and nine drachms of " fait of hartftiorn. She then feemed to have " no farther occafion for the medicine, and fhe tf has been well ever fince. The fore-arm

*c dropped off at the elbow, and the os humeri ce was fawn off above the middle of the bone.

<c From

[ i8i 3 " From this cafe I apprehend the efficacy of this medicine may be clearly inferred. The

relief of the child's complaints when the mufk and fait of hartihorn were adminifter-

ed, the return of them when they were

omitted, and their vaniihing again as foon as fhe began to take them a fecond time, are the cleareit proofs in its favour. It is im-

poffible to wilh for a cafe in which its powers and operations can be more furely traced.

From the moment when it was firft taken its

effects became diflindtly vilible, and the dif-.

order was at once checked in its progrefs: on its temporary omiffion the patient imme- diately relapfed, and the complaint returned with all its former vigour. The medicine

was again applied to with the fame happy confequences, the diforder was a fecond time

overpowered by its virtues, and a complete cure was obtained."

IX. Path*