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neither so protuberant nor so hard : that of the spleen, however, remained a little tumefied.
It was towards the decline of this bilious fever that a skilful physician, M. Lucas, was called in. He thought it proper to continue the treatment I had prescribed, and confirmed my prescription of the waters of Vichy, united with the acetate of potass. He thought the monient favourable for it. At first half a drachm only was prescribed for the two glasses the patient drank in the morning, and by degrees the dose was augmented to a drachm in each glass, The alvine evacuations continued bilious without being abundant.
Madaine de Stael appeared to get better every day. She was advised to get up, but, having felt some difficulty in standing, and more so in walking, she was soon obliged to remain in bed. She long complained of pain and spasms in the lower extremities; the urine became less; the skin resumed its yellow colour; she had borborigni, with a tumid abdomen, but not hard; the ædema of the lower extremities increased; that of the hands and even the arms was considerable.
Known diuretics were prescribed, as the tisane (beverage) of the five aperient roots, in which was infused chervil, and to which was added oxymel of squills. Slightly purgative clysters were also recommended, yet the ædema, or rather the anasarca, which increased, appeared to point out the proper use of blisters to the legs, which we were the more readily inclined to, as the patient had had, for several years, an eruption in the face, but which had long disappeared, yet we thought it necessary to take it into consideration.
The waters of Vichy were suspended, and replaced by the juices of plants, as water-cresses, borage (bourroche), dandelion, chervil, water trefoil, and live millepedes, bruised, in large quantities. These juices, well purified, with the addition of oxymel of squills, were given in the morning, in the dose of five or six ounces at twice. The patient also took, in the course of the day, a few glasses of an infusion of hops and chervil, with nitrous æther and tincture of digitalis, which was also employed in frictions, in powder, in a mucilaginous liquor.
This treatment was so efficacious that Mad. de S. was enabled to go out in a carriage, as the weather was fine; but this recovery did not continue. She complained one day, in returning from her drive, that, in getting into her barouche, she had bruised one of her feet; that the pains increased, and she could not go a single step or support herself on her legs, feeliug a stiffness and extreme weakness in the upper extremities, and more so in the lower ones, though at intervals they were very painful.
A skilful physician, called in, thinking the seat of the disorder in the liver, advised mercury in a gummy excipient, to which I could not subscribe, not thinking the seat of the disorder confined to that part, and mercury not appearing to me to be proper in the case, especially as there were ulcers on the tongue and in the mouth, This treatment was, however, tried, but soon abandoned, as the patient became much worse.
I wished to examine the state of the matrix. A celebrated ace coucheur, who was called in, thought it was enlarged. This was contradicted by an able surgeon, who decided that this organ was in no way altered; but he fancied the disorder lay in the spinal marrow, and that there was an extravasation in the vertebral canal. He thought blisters applied along the spine would be serviceable, and recommended a tonic liniment for the extremities, and even on the spine: this last article was exactly followed.
Numerous consultations followed, in which similar remedies were prescribed without success. A friction of tincture of phosphorus in like manner failed. The difficulty of motion in the lower extremities became greater; the upper opes, however, were a little more flexible. Mad. de S. complained of a pressure in the upper part of the breast, on which a physician, newly called in, applied a blister. Another well-known physician fancied he discovered symptoms of hydrothorax, and that he even heard a kind of undulation in the cavity, by means of a sheet of paper rolled up like a trumpet, and applied to the breast and his ear. I certainly did not agree in his opinion, or method of proof, as the swellings had decreased, the urine re-established, and slie was able to lie in her bed horizontally all day; but, as the spasms continued, the same physician thought adviseable to apply two plates of magnetised steel to the breast: the inefficacy of this was soon proved.
Mad. de S. became very thin: the stiffness continued, and she could not walk. Exciting and cooling remedies were applied with the same effect.
A physician of Geneva was joined to those of Paris: he proposed the internal use of mustard, to restore the nervous systems, and stimulating ointments on the spine, together with an infusion of bark that I had prescribed for some time. But there was already an impression of gangrene in the region of the os coccygis, and two or three spots of that nature on the left lower extremity, which determined us on proposing strong doses of the antiseptic remedy, so often successful; but the progress of the gangrene was so rapid that all the succours of art were unavailing. Madame de Stael died the 14th July, at four o'clock in the morning, after an illness of upwards of four months.
Her body was opened and embalmed. I was not called to at. tend this operation, but I learnt from M. Jurine, who was present, that there was neither dropsy in the chest nor any disorder in the spinal marrow or the vertebral canal, no extravasation, &c. The viscera were in a good state; the liver only appeared hardened in some parts longitudinally, but nothing to cause so severe an illness. I think my treatment had produced good effects.
May not some reproaches be made on the abuse of this treatment, and the employment of contrary remedies ? As the ordinary physician knew the patient well, and her disorder, and the success he had already obtained, ought it not to have inspired some confidence, nay entire coufidence, as well in the patient as her family? Madame de S. was evidently afficted with cachexy, which the bi
lious fever augmented; and was this even to a certainty removed? It is often followed by dropsy, and sometimes stupor and paralysis even of the lower extremities.
Would not the continuation of the juice of scorbutic and diuretic plants, which I had began to prescribe with success, to which was added the use of known depuratives, have been preferable to so many remedies which were administered, as the patient had been stationary for weeks, notwithstanding the use of stimulants prescribed on the one hand, and on the other cooling opiates. Extract of henbane was at one time proposed.
May not such treatment, continued for several months, have produced, or at least concurred, to the gangrene which was so rapidly followed by the death of Madame de Stael? PORTAL.
We have inserted the above, not with any view to canvas the practice of the Parisian physicians, but as a specimen of the phar. macy of that city, of which we shall 'hereafter make further mention,
Selections on the Elephantiasis of Aretæus. The Elephantiasis of Aretæus, or Lepra Arabum, has lately occurred in the Hospital at Edinburgh, a part of the world in which it was unknown in the days of the illustrious Professor Cullen. The suspicions of its infectious property, and of the salacity of the unhappy patients, was at one time so great, that Dr. Bateman, in a paper in Dr. Rees's Cyclopædia, did not scruple to consider the transmission of the disease from Africa to the West-India islands as a just punishment to the Creoles for the detestable practice of dealing in human flesh. Though, in his Synopsis, he has entirely retracted this opinion, yet he still seems to consider a salacious character as a part of the disease. As the subject will occur in our notice of Mr. Good's Nosology, in this Number, we have thought it might be desirable to bring the facts, and the authorities on which they rest, before our readers.
Ďr. Heberden, to whose ardeur and industry in promoting medical knowledge we owe the first suggestion of the “ Medical Transactions" of the London College, having a brother in Madeira, was not likely to lose such an opportunity of learning the history of a disease unknown in the northern regions. That gentleman's remark is, “ Notwithstanding the just abhorrence of this loathsome disease, it certainly is not so contagious as is generally imagined, for I have never heard of any one who has contracted the distemper by contact of a leper; and, on the contrary, am a constant witness of communication between lepers and other people without the least ill consequence.” He afterwards admits the hereditary property of the disease.
Dr. Adams, from the same island, comes next in order. As his account is official, and also as he is the first to mention that the hereditary extension of so loathsome and incurable a disease is NO. 224. 29
checked by a provision in the progress of the disease itself, we shall transcribe his account more at length.
Memorial presented to His Excellency Don Jose da Camera e Leme,
concerning the Inhabitants of the Lazaretto near Funchall. By JOSEPH ADAMS, M.D. Extra Licentiate of the Royal College of Physicians in London, and Physician in the Island of Madeira, With a further Account of that Institution.
The unfortunate objects of the lazaretto, near Funchall, cannot but attract the notice of every stranger: a disease entirely unknown in the colder regions, must, in a particular manner, excite the attention of an English physician, were it only from observing that of some of the men, whose scalp is well covered with hair, the chin is perfectly smooth. I had also remarked, that this want of beard is in some attended with a delicacy of voice, not indeed such as we perceive in eunuchs, but rather like that of boys. Still a doubt remained wbether this might arise from any change in the figure of the throat, which in most is considerably deformed by irregular proininencies. The voices of some are also very nasal, from similar
The first person we examined was a youth named Gonzalves, about twenty-three years of age. His face is strongly marked with the disease, with which he has been several years afdicted, though he has resided only two years in the house. His voice is nasal, his uvula either lost or concealed by the tubercles about his palate. Has no hair on his chin or pubes; his testicles can scarcely be felt; his scrotum, and all the organs, very much resemble those of a boy of six or seven years old, excepting that the prepuce is somewhat elongated. With all this he is cheerful, being free from pain; and, when asked whether the state of his throat made it difficult for him to swallow, answered, that bis only difficulty was in procuring enough to swallow. His father died of the disease.
The second, who passed under examination, was said to be one of fifteen children, born of both healthy parents, and grand parents. Of these children, four died young, and, by his account, of the disease, the rest are all healthy. The chin and genitals in this youth are as in the former subject, though he is considerably advanced beyond the age of puberty.
Manoel Fernandez is thirty-six years old; has been ill thirteen years; says he never had a beard; has but little hair on the pubes. His testicles are much wasted; has only one eye.
The above cases are sufficient to show, what was afterwards proved by an accurate general examination, that, when the disease attacks a male subject before the age of puberty, he never acquires that state; and that such as are affected later in life, gradually lose the power of procreation, as far as can be judged by the changes which take place in their organs.
The proofs of a defective organization in the women are scarcely less striking, as far as those organs can be examined.
Chronic diseases, which seem to arise spontaneously, and which never yield to the unassisted powers of the constitution, must have their cause in climate, predisposition in the patient's constitution, peculiarity of diet, or probably in all. If the first and third causes only exist, we may hope for relief in change of climate and mode of living; but if the disease never occurs, excepting where there is an original predisposition, the cure can only be permanent as long as the patient is removed from the exciting causes, As the predisposi, tion is born with the patient, the inference follows, that he must have derived it from bis parents; we are, therefore, apt hastily to conclude, that his offspring must be infected also ; and because this sometimes occur, we fix no limits to our extravagant terrors concerning what are called hereditary diseases. We do not consider, that, unless the disease can be traced back to our first parent, and thus involve us all, it must have originated in one whose ancestors, from the beginning of the world, were free from it. Still less do we take notice, that, when the disease has appeared in a family, it often ceases with the individual who is the first subject of it, and can rarely be traced beyond his immediate offspring.
It is not my intention to dispute that the predisposition to leprosy is hereditary. The number of subjects in the lazar house, from whose parents the disease may be traced, is sufficient to establish this fact. It is, however, a most important remark, that all those subjects, who appear to derive the disease from their parents, have been attacked at an early age; and, as far as we could learn, in those in whom the disease has shown itself at a later period, it has origi.
nated with themselves. It is not less notorious, that the disease • has gradually disappeared among the wealthier families, since they
have adopted a more generous diet, and since the increased mildness of the government has relieved them from anxielies, as destructive to health as poverty or want. The disease, though at present nearly confined to those whose diet is the poorest and most precarious, is yet, in a few instances, found to visit such whose situation is above want: and many, in the most abject state of poverty, escape it. Hence it follows, that no external cause will produce it, unless the constitution is predisposed to it. Now a predisposition must be derived from the parents, whether they are diseased or not.
Having thus, as far as it can be, settled the question concerning the hereditary nature of the disease, our next enquiry should be, how far it is infectious; but, as this more innmediately belongs to the mode of treatment, I shall first proceed to mark the particular signs by which the disease may be ascertained.
Among the unequivocal marks, we may consider tubercles about the face, particularly on the external ear, alæ nasi, eye-brows, or forehead.' These tubercles, till an advanced stage of the disease, are not only smooth, but have, for the most part, a higher cuinplexion than the natural skin, approaching nearer to the sanguineous hue, appearing as if semi-transparent, splendid as if the surface were smeared with oil, and, on a closer examination, sometimes exhibiting small blood-vessels ramifying on their surface. This ap