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.

847/858 page 711

$and the motions of the joints greatly impeded by the tubei\ les. The nails are often coarse and furrowed. The sores are for the most part of an indolent character, with a reddish or a foul surface, little discharge, and hard and irregular edges. When the ulcerations are seated on the fingers or toes, they are apt to sink deep and terminate in gangrene; and a very serious mutilation of the extremities hy the sloughing off of one or more of their ])halanges is the consequence. The tubercles very rarely make their ap- pearance on the tmnk of the body. The parts attacked become, in a great degree, benumbed, but rarely, if ever, lose their sensibility alto- gether. Frank describes the disease as being ac- companied with great torpor of mind and sluggishness of body, somnolence, and dis- turbed sleep. Mental depression amounting to extreme melancholy is the natural conse- quence of so hopeless a malady. Yet the general health, for a length of time, suffers infinitely less than could have been anti- cipated ; the actions of the respiratory and digestive organs continue long unafl'ected, and even the cutaneous functions are still tolerably performed, as is evidenced by the abundant perspiration which can be excited by active exercise. The pulse in Dr. Kinnis’s cases was generally accelerated and feeble; but others state that it remains throughout the greater part of the disease natural. The afl'ection has rarely been witnessed by a medical practitioner at its very commence- ment. In Mr. i.awrence’s patient, whose case is detailed in the Medico-Chirurgical Trans- actions, it seemed to have begun by a general swelling of the head and face, and stiffness of tiie limbs after a wetting:, on the subsidence of the swelling the tubercles began to appear on the ears, face, See. which were at first of the same colour as the surrounding skin, but be- came subsequently of a reddish and sometimes of a livid hue. The progress of the disease is very slow, and its termination, though it may be deferred for many years, almost always fatal, the un- fortunate jiatient being in the mean time dread- fully deformed and mutilated, and literally dying by inches. Recovery is, indeed, a very rare occurrence. In Mr. Lawrence’s case, the tubercles, it is true, disappeared in a great measure; but from the sudden impairment of the general health, which had been hitherto good, and from the simultaneous occurrence of thoracic symptoms, there was too much reason to apprehend that disease of the lungs had only supplanted that of the skin. Dr. Adams has described as one of the sym- ptoms of elephantiasis as it occurs in Madeira, a femoral tumor situated in the upper and front part of the thigh. Tliis was absent in the case which Mr. Lawrence has so ably described, but was found by Dr. Kinnis in most of those he had an opportunity of ex- amining—occasionally on one side only, but more frequently on both. It was placed a few inches below Poiqiart’s lipmerit, and was of an oblong form, as if arising from the enlai^ge- ment of two inguinal glands, and was about two or three inches in length, and moveable under the skin. At intervals of from one to four months, these swellings were liable to attacks of acute inflammation, preceded by rigor, and accompanied with febrile sym- ptoms, which subsided after three or four days, leaving the tumour nearly as before. These swellings have, however, in one or two in- stances been known to proceed to suppu- ration. As to the libido inexplebilis which has been mentioned as one of the features of the dis- ease, a great diversity of sentiment appears amongst the authors who have treated of it. The majority of these (V'idal and Johannis, Bancroft, Niehbuhr, &c.) certainly affirm its existence, but Dr. Adams, on the contrar)', asserts that the genitals become wasted; or if the disease come on before puberty, their development is interrupted, as seems to have happened in Mr. l>awrence’s case, in which the scrotum was shrivelled up and the testes were unnaturally small and soft; and in the four cases which fell under Dr. Bateman’s notice, both the appetite and the power were lost. Dr. Kinnis, on the other hand, who had still more extensive opportunities of observation, did not meet with this wasting of the sexual organs in a single individual, the testes in males and the breasts in females being always of their natural size; and the venereal appetite usually continued in its natural state. Men- struation is recorded to have been regular in two of the affected females, and a third had lately borne, and was still suckling, two chil- dren. f rom this want of accord amongst persons who have had abundant opportunity of ob- serving the complaint, we are at least justified in concluding that increased sexual propen- sities are not amongst the essential charac- teristics of the disease. It is possible that still more extensive inquiry may reconcile the ap- parent contradiction amongst authors, and shew that the tendency to disease in the organs of reproduction may be variously modified by climate, or by peculiar local circumstances, which have hitherto escaped investi^tion. Alterations in the intensity of these feelings is not a very rare occurrence in some cutaneous affections; and it is not improbable that the extension of irritation and of morbid action to the urino-genital mucous membrane may, in one stage of the affection, give rise to their unnatural exaltation, which may yet be fol- lowed, at a subsequent period and more ad- vanced stage, by the very opposite state. Pathology affords many analogous in.stances, in which a low degree and an early stage of chronic irritation in a secreting organ, leads to its increased action, whilst a higher degree of inflammation, or a more advanced period of the disease, often intemipts its functions altogether, and terminates in the atrophy of its structure.$