Clinical lectures on the principles and practice of medicine / by John Hughes Bennett.

  • Bennett, John Hughes, 1812-1875.
Date:
1870
Catalogue details

Licence: Public Domain Mark

Credit: Clinical lectures on the principles and practice of medicine / by John Hughes Bennett. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    1023/1060 (page 993)
    SCORBUTUS. Case CCLXXXIII.*—James Dcrmot, set. 21, railway laborer—admitted May 2Vth 1847. Has been working on the Caledonian line of ruilway for nine months, and enjoyed good health till three months ago, when he received a blow on the right tibia. This produced a sore, and an ulcer formed. His diet consisted of bread, coffee, ham, butter, and sugar; but no milk or fresh vegetables. On admission, an elliptical-shaped ulcer, about two inches in length, is seated over the middle of the tibia, covered with irregular Hvid granulations, and surrounded by a raised purple edge. Another ulcer, the size of a shilling, is seated below this, and a third similar one on the outside of the leg. Eighteen mouths ago his left leg was burnt, and over the seat of the old cicatrix a number of ulcers, similar to those on the opposite leg, exist. One of these, towards the lower part of the leg, is the size of half-a-crown, and more livid than the others, which are smaller. The gums are swollen and fleshy, but not livid. Pulse 74, soft. Bowels constipated. To have full diet. 5 Aluminis 3i; Aqum 3 viij. Solve. Ft. Gargarisma. ]J Sued limonis 3 iij ; Sacchari § iss; Aquoe 3 iss. M. Sumat pro potu ex aqua indies. June 2d.—Ulcers looking more healthy. Their surface to be touched with nitrate of silver. July 11th.—Has slowly got well since last report, and is now discharged. Case CCLXXXIV.*—John M'Kenzie, set. 26, railway laborer—admitted July Vth, 1847. During the last two months his diet has consisted chiefly of coll'ee or tea, with, bread, butter, and sugar, but no milk. Two weeks ago pain and swelling came on in his left leg. Soon afterwards the right leg was also affected, and both became dis- colored. Epistaxis now occurred, and has continued at intervals ever since, and has been so severe during the last two days that his nostrils have been plugged. On admission, the left leg is much swollen, and of a purple color chiefly on its anterior and inner aspect. The right leg is similarly affected, but to a less degree. Ha com- plains of pain and stiffness in both limbs, especially about the ankles. The gums are slightly swollen, and livid at the edges, but do not bleed on masticating food. Pulse 80, soft. Tongue clean. Bowels regular. To have full diet. July 20th.—Since ad- mission the symptoms hare gradually disappeared, and to-day he was dismissed cured. Commentary.—During the year from October 1846 to October 1847 no less than 231 cases of Scorbutus entered the Royal Infirmary, of whom 30 also labored under continued fever. Of the entire number, nine were females, and seven died. In the previous year only one case entered the Infirmary, and in the following one only six. I myself treated between seventy and eighty of these patients, having succeeded Dr. Christison in the charge of a long shed which contained a large number of them, besides seeing others who came into my other wards. At the same period, there existed a most extensive epidemic of typhoid or typhus fever. Yet it is singular that the causes which produced scurvy, mostly in the able-bodied population, and especially among the class of laborers or navvies then working on our railways, were of a kind distinctly dift'erent from those usually giving rise to continued fever ; the potato crop had failed for two successive seasons, and caused among the poorer population the consumption of a diet, not only deficient in vegetables, but of milk and fresh meat also. Among the railway laborers, the truck system, and establishment of local stores where provi- sions of inferior quality were given on a ruinous system of credit or ex- change, greatly assisted the absence of vegetables in causing the disease. The previous winter had been severe and protracted; so that whilst food of all kinds was high priced, the work and exposure of the laboring popu- lation were unusually severe. But scanty and improper diet, and * Reported by Mr. J. Robertson, Clinical Clerk. 63