Volume 1

The Cyclopaedia of practical medicine : comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc. / edited by John Forbes ... Alexander Tweedie ... John Conolly.

Date:: 1833-1835

Credit: The Cyclopaedia of practical medicine : comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc. / edited by John Forbes ... Alexander Tweedie ... John Conolly. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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$have knowii the disease affect nearly every member of a large wealthy family in Galle, the females of which, as they did not expose themselves to the sun, were not liable to a transition of temperature of above ten or twelve degrees during a whole year. Dr. Hillary was of opinion that the local affection is a con- sequence of the precursory fever, while Dr. llendy adopts a very different view of its pathology, and considers the fever to be a result of the topical inflanamation; asserting that unless the local affection is severe, there is no fever. In cases where the internal or- gans are affected, and the functions impaired, constitutional excitement may thereby be ex- cited ; but it is difficult to conceive that a febrile affection should be the result of the chronic enlargement of an extremity. In some respects there is a considerable analogy between erysipelas and the disease in question. During the early stage of elephant leg the external characters of both diseases are similar. The topical affection in either disease rarely terminates in abscess. In erysipelas the inflammation is, however, commonly much more confined to the skin than in this disease; and so far as we are acquainted with the latter affection, it differs from erysipelas in regard to its periodicity, or liability to recur at short in- tervals, without any appreciable cause.* Treatment. — The treatment recommended by Rhazes seems to be as consonant to reason, and as consistent with the pathology of the disease, as any that has been suggested. It consisted of general bleeding in violent cases ; emetics, laxatives, a light diet, and confine- ment to bed. \N hen an inferior extremity was affect'd, he recommended that the limb should be rubl>ed with an epitheme composed chiefly of alum and vinegar, and that it should be bandaged from the toes to the knees. The natives of C'exion seldom resort to any other remedial means in this disease, but keep their couch or rather their mat, and drink freely of ginger tea. Dr. IMusgrave asserts that, “ in ad- dition to warmth locally applied, and the or- dinary’ ])urgative and febrifuge medicines, mercurial saturation of the system was the best means of securing the patient against tlie erratic disposition, and accordingly ptyalism was the usual companion of convalescence from an attack of this very common com- plaint : ’ for, he adds, “ I am indeed strongly disposed to believe that, since the mercurial treatment has become general, the number of cases, ending in a local or permanent depo- sition of lymph, has been materially lessened.” —“ Many individuals subject to this disease, whom I have attended for a number of years, continued to shake off each successive return * Soldiers and sailors in the West Indies are frequently affected with smart attacks of an ephe- meral fever, accompanied with an inflammatory Slate of the lymphatics of the extremities. The writer of this note has seen, in such cases, a red line from the foot to the groin, indicating the course of the lymphatic trunk.—J. F. Editor. without retaining the slightest trace of its having existed, or at most with a trifling in- duration of the inguinal glands.” In the case of a young lady, at Point de Galle, belonging to a family several of the members of which were affected with this disease, the first attack was treated by the free application of leeches and wann fomentations. Calomel was administered so as slightly to affect the mouth. A second attack which oc- curred shortly afterwards was treated in the same manner. Effusion did not take place, and no return of the disease was experienced for the two years she was under observation. When either of the great cavities was im- plicated, Dr. iMusgrave had recourse to the lancet. Some of his medical brethren were afraid to bleed, from an “ idea that the inflam- mation was erysipelatous.” He is of opinion, however, that “ the redness differs little from that of jihlegmon, and suppuration under the fonn of genuine abscess is an extremely com- mon occurrence; while, on the other hand, external gangrene is rarely, and vesications are almost never observed.” Dr. Mu.sgrave seems to have had extensive experience in this disease, and his plan of treatment certainly deserves a trial. It may, however, be observed that,according to his doctrines, ptyalism should be the “ companion of almost every disease that occurs in the West Indies. Authors who have described this disease, generally, if not universally discountenance the amputotion of a morbidly enlarged limb. They assert that the constitutional symptoms are apt to recur, accompanied with inflam- mation of some of the viscera, or of an ex- tremity of the other side of the body. To amputate a limb while the paroxysm of fever continued to return, although at distant in- tervals, would, in the present state of our knowledge of this affection, be injudicious; but if the recurrence of acute symptoms had ceased for a very long period, we should be much disposed to recommend the removal of a huge, deformed, and perhaps ulcerating mass of leg or arm. The writer amputated the arm of a native of Ceylon on account of an enormously enlarged fore-arm and hand, simi- lar to the case recorded in the Edinburgh Medical Journal, vol. xiii. page 54, by the late Dr. Kennedy. In this instance the man continued healthy, and no other limb became affected. Cases have occurred, in which, in conse- quence of ulceration, a great quantity of a glairy fluid has been discharged, and the mor- bid enlargement has undergone a reduction to a very considerable extent. An artificial outlet of this kind has been tried in the scrotum, and, according to report, with advantage. Iodine, from the advantage which has been derived from it in goitre, might be tried with some prospect of benefit: the patient should always, if possible, be removed from the dis- trict where the disease is endemic. (J. Scott.)$