A dictionary of practical surgery : comprehending all the most interesting improvements, from the earliest times down to the present period : an account of the instruments and remedies employed in surgery : the etymology and signification of the principal terms : and numerous references to ancient and modern works, forming a "catalogue raisonné" of surgical literature / by Samuel Cooper.

  • Samuel Cooper
Date:
1825
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical surgery : comprehending all the most interesting improvements, from the earliest times down to the present period : an account of the instruments and remedies employed in surgery : the etymology and signification of the principal terms : and numerous references to ancient and modern works, forming a "catalogue raisonné" of surgical literature / by Samuel Cooper. 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.

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    self suffered from this distemper: indeed, the nature of an ulcer of either kind must, after a short time, effectually prevent any intercourse; and we often find, that their peculiar characters only appear after the ulcer has existed for several days. I firmly believe also, that, in the greater number of cases of sloughing ul- cer, where mercury is not given, no secondary symptoms would appear: and, in those cases in which they did appear, I apprehend, they would be equally dependent on the state of the constitution, as to the mode of cure, and their destructive characters. In other words, my observations lead me to conclude that these ulcers do not depend upon a specific poison, but on the state of die constitution, under particular excitement; and that, when secondary symptoms occur, they are not dependent on the state of the ulcer; although I am ready to admit, that, in a constitution where an ulcer will readily become phagedenic, the secondary symptoms, when they occur, may be different to a certain extent from those that follow more simple ulcers, in a healthier habit of body. (Guthrie in Med. Chir. Trayis. Vol. 8, p. 564.) My observations lead me to believe, with Mr. Gu- thrie, that, primary sloughing ulcers do not depend upon any peculiar poison, and I am also disposed to join him in the opinion, that, when hurtful local treatment is out of the question, they are chiefly owing to the state of the constitution. According to my expe- rience, all kinds of ulcers on the genitals, may, from particularity of constitution, im- pairment of health, and sometimes from the pernicious effects of the immoderate and in- discriminate employment; of mercury, assume in their progress a sloughing disposition, and even have it from their very commencement. Mr. Rose mentions a case, in which a healthy young man was affected with a sloughing sore on the penis, in consequence of a suspicious connexion. It was not attended with any C.institutional disturbance, and yielded readily to mercury. The same patient, twice after- wards, at a very considerable interval, had a fresh infection, and the sores each time had precisely the same character as the first. This, sjys Mr. Rose, is no uncommon occurrence, and it is not probable that the sloughing and appearance of the sores arose from the pecu- liarity cf the poison. (Med. Chir. Trans. Vol. 3, p. 420.) And another intelligent and ex- parienced surgeon, who has particularly at- tended to this investigation, declares his con- viction, that many varieties of sore, indepen- dently of the sloughy chancre, mentioned by Mr. Carmichael, lead to constitutional symp- t mis, differing in no respect from those he has described, and admitting of the tame mode of care. Nor does he believe, with Mr. Car- michael, that only one particular species of sore is capable of producing the true secon- dary svmptoms of lues. (J. Bacot, on Syphi- lis, p. 51.) r-rom tnese observations, I think, we may sifely infer, that, with respect to the sloughing ulcer, it neither arises from the application of any one specific poison to the part, nor is it connected with any regular train of secondary symptoms. Dr. Hennen assures us, that he has fre- quently had occasion to observe, that eruptions of the same nature and character have suc- ceeded to the foul indurated, excavated ulcer, and to the simple excoriation. In fifteen cases of eruptions, unaccompanied by any other symptoms, which succeeded the Hunte- rian sore, six wete tubercular, five exanthema- tous, two pustular, one tubercular and scaly, and one tubercular and vesicular. In four cases, following the same sore, but in which the eruptions were complicated, with sore throat, two were tubercular, one was tu- bercular and scaly, and one was tubercular and exanthematous. In twelve cases, following the non Hunte- rian sore, and in which eruptions were the only symptoms, six were pustular, three were ex- anthematous, and one was tubercular and scaly. In seven cases, where the eruption was accompanied with sore throat, three were ex- anthematous,' two were tubercular, one was papular, scaly, and tubercular, and one was pustular and tubercular. Dr. Hennen also recites an instance, in which a Hunterian chancre was, at the distance of ten weeks, succeeded by a papular eruption, which, in the course of a month, was removed by low diet, purgatives, and the decoction of sarsaparilla. In two months afterwards, an eruption of a similar nature appeared without any fresh in- fection. This was treated with mercury, which was administered five weeks, so as to excite a moderate salivation. Under this treatment, the eruption faded, having, during its progress, assumed the appearance of vesicles and pustules, and at length falling off in arnber- coloured scales with livid bases. Notwith- standing this mercurial course, the patient was a third time admitted, ten weeks afterwards, (without any intervening prrnary affection,) with a pustular eruption, \v lich was finally cured without mercu'y, and ■ he pustules fall- ing off in squamuhj. In another month, vithout any fresh in ection, re was a fourth time taken into hos; ital with a very thickly dispersed pustular e-uption, somewhat dif- ferent front the forner, the pustules being more numerous, sn aller, rid acuminated. They yielded to m n - mere trial treatment. During all these att; cks the e was aphthous sore throat, and occa ional fl} ing pains in the joints. The inference draw i from this case is, that even a full and judic ously conducted mercurial course does not ] revent the re- appearance of veneieal eruptions, and that they assume at different times, different cha- racters, notwithstanding the interruption they receive in their natural progress by the use of that remedy. (On Military Surgery, Ed. 2, p. 528—530 ) After these accounts, I can have no hesitation in coming to another con- clusion, which is, that, with the exception of the partial confirmation of Mr. Carmichael's doctrine by Mr. Rose, as far as relates to the fr.-quency of papular eruptions after superficial primary ulcers, the regular connexion of parti- cular forms, of secondary symptoms with any given descriptions of primary sores, is so far from being supported by the testimony of other