Volume 1

Tracts on delirium tremens, on peritonitis, and on some other internal inflammatory affections, and on the gout / by Thomas Sutton.

  • Sutton, Thomas, 1767-1835.
Date:
1813
    on the second day of the attack. This was a painful affection, extending down the outer and fore part of the thigh, which was not at all increased by pressure on the thigh itself, but consi- derably. so when the affected flank was pressed; by which pressure, however, — very little uneasiness was excited in the original station of the disease. On this day it was agreed, (as much blood could not be expected to be taken away by leeches,) that the patient should be cup- ped on the outer part of the thigh affected, when twelve ounces of blood were taken away, and another blister applied to the original part, as the first immediately healed. On the following © day, the patient did not find himself much relieved, and was worse in the evening, when a warm fomentation was directed to the thigh and flank; but no relief was experienced from it during the night: on the other hand, the patient thought it aggravated the pain; and so
    convinced was he of this, that he was happy to lay it aside. This day being the sixth of the disease, the patient passed tolerably ; but in the evening I was sent for in haste, and found him in the most torturing pain in the thigh, augmented considerably by the least motion, or by pressure on the original seat of the disease. I must here men- tion, that the pulse had been, from the first day, from one hundred and ten to one hundred and twenty, and more fre- quently the latter; that the bowels had been kept active by the’sulphate of mag- nesia, and that a dose of tincture of opium had, for the three preceding nights, been given, beginning with twenty- five drops, and increasing the quantity by five drops each night. In the former attacks, ic had been thought to hdve given relief, and was therefore had re- course to in this. The tongue had been considerably coated, and continued so; the urine was discharged in sufficient
    quantity, and the skin had been fre- quently moist and soft, for some time together, and. perspiration to some extent had occurred. Neither these, however, nor any thing that had been hitherto done, had produced any sensible diminu- tion of the disease, in so far as it affected the constitution; and though the local pain of the part first affected was not so great, yet the pain evidently arising from this, and extending down the thigh, was now greater than had ever been expe- rienced by the patient in this or any of the former attacks. Previous to this time, I had communicated to the physi- cian who attended with me, the case and treatment of peritonitis above described, © in order, if necessary, that we might have recourse to the same means, if we found the usual mode of proceeding marked with inefficacy, or the disease likely to prove obstinate or lasting. At the present moment, the common course of proceeding would have sug-
    gested the use of the warm bath; but the ineflicacy of the warm fomentation in this case, on the preceding night, the certainty that the act of removal into the hot bath would increase the sufferings of the patient, whose limb would not bear the least motion without a grievous augmenta- tion of pain, dissuaded me from that mea- sure. An augmented. dose of opium would most probably have given tempo- rary relief, which it would have been proper to have relied upon, if nothing else could be done with a prospect of more permanent advantage; and _ loral blood-letting, which it was agreed should be in future employed, if any, would have been’ too slowly come at, and, from the effects experienced from it before, too uncertain for our present occasion. Hav- ing, on the contrary, witnessed the be- neficial effects of a cold application in the case just related, I was induced to give this remedy a trial in this instance ; and under these circumstances, as, should it
    fail, I saw no reason in the world to expect any harm to result from its use, ie therefore determined, in an indirect rnanner, to recommend some application - of this kind. For this purpose, having _ first endeavoured to fix the attention of the patient, and those about him, to the advantages that might ensue from the use cf opium as an external application, under the present circumstances, I took thie opportunity of mixing about two drams of the tincture, which was in the rom, with ten ounces of water, and rescommended this to be constantly ap- p lied in linen cloths, which weré fre- q uently taken off, and kept wet with the ccyid lotion. In the course of less than ai\ hour, I saw enough of alleviation of pain, to be perfectly easy about the result of the effects of the remedy. The do.se of opium, in the evening, was in- cre ased to forty drops. In the morning, I found the patient’s pulse to be 97, he had, passed a tolerable night, and felt