John Thomson
1846 The Lancet  
434 indeed, has this kind of artificial leg been adapted to perform the motions of the natural one, that it is impossible to discover any difference between them; but, at the same time, the cost of this substitute for the leg is, unhappily, altogether out of the reach of the poor. When we reflect that every person who is obliged to wear the common wooden leg, not only loses the power of quick walking, but becomes deformed, it is a matter of great importance that surgeons should be familiar with
more » ... these consequences, more especially as it is too much the custom at our hospitals, as well as in private practice, for them to consider their duty at an end when they 'have amputated the limb, healed the stump, and directed the patient to an instrument maker : on the contrary, a very important duty still remains to be performed-namely, that of promoting the future welfare of the patient by prescribing a proper substitute for the natural limb ; and the immense funds subscribed for the support of most of our hospitals would surely afford some small allowance to be appropriated for the purpose of supplying poor patients with such improved wooden -legs, as would enable them to perform all the ordinary occupations of life without difficulty or distortion. This is a subject that army and navy surgeons, more particularly, would do well to take into consideration; since, with the assistance of such a wooden leg, soldiers and sailors might be enabled to discharge most of the common duties of the service, instead of being dependent, as they now are, from the moment they are deprived of a natural leg. When a person has occasion for the use of two wooden legs, the action being similar on both sides, no deformity of the trunk results, but the base of support at the lower end of the leg is so small, that progression is performed with great hazard of falling. Under these circumstances, the centre of gravity also moves in a series of arcs, instead of in nearly a horizontal line, and the velocity is mechanically restricted within much narrower limits than is the case with the natural legs. TREATMENT OF BRONCHITIS IN INFANTS.— EMPLOYMENT OF BLISTERS. By JOHN THOMSON, Esq., Surgeon, Aberfeldy, Perthshire. I CAN bear testimony to the good effects of calomel and ipecacuanha in the treatment of bronchitis in infants, (as recommended by Mr. Miller, No. 23, p. 703, of the last volume of THE LANCET,) in so far as the effects of these valuable remedies go ; but they cannot be exclusively depended upon, even when assisted by the warm bath and leeches ; and " the application of blistering plasters to very young children," so much dreaded by Mr. Miller, is not only " a safe plan of proceeding," but in many cases becomes absolutely necessary. Mr. Miller has taken eighteen months as the youngest age for an illustrative case, but has not favoured us with the result of his experience in the treatment of infants, as many days or weeks old, who are peculiarly liable to this disease, and not a few of whom die suddenly in consequence of its attack. According to my experience, " a warm bath" in this disease, at any age, is strongly to be objected to, when " the bronchitic affection is very severe," as its employment, however carefully conducted, is frequently followed by a general coldness of the surface, which increases the pulmonary congestion, instead of determining to the skin, while the process itself, stripping, &c., must be very distressing to the little sufferer, who frequently requires to gasp for breath. I will now state my plan of treating this disease in very young infants. If the child were but newly seized, and is a good deal "stuffed in the breast," pulse and breathing very frequent, and heat of surface much increased, I would adopt Mr. Miller's plan so far as by giving calomel and ipecacuanha, of each a quarter to half a grain every three or four hours, to infants from two or three weeks to two or three months old ; a grain of each to those from three to twelve months, less or more, according to the strength of the child and severity of the symptoms. Should the first dose produce vomiting, and several others be retained, so much the better; or occasional vomiting, when not severe, is rather in favour of than against the treatment, as much viscid mucus is discharged thereby. As the cough, difficulty of breathing, and other symptoms, are generally worse toward evening and during the night, followed by a remission toward morning and during the day, the calomel and ipecacuanha ought to be given as above while the severity of the exacerbation continues; and from a third of a tea-spoonful to a full tea-spoonful of the following mixture, every two or three hours during the remission :-ipecacuanha wine, two drachms ; antimonial wine, a drachm ; solution of muriate of morphia, and tincture of henbane, of each twenty minims; syrup of tolu, half an ounce; water, an ounce and a half: mix. The rectum should be cleared out with warm water-and-milk, and the child placed in bed, with its head and shoulders elevated, otherwise the efforts to cough and expectorate may never be effectually accomplished. The nurse should also lie in bed with it, especially during very cold weather, in order to maintain the proper degree of warmth, which is much better than heating the air of the room to the temperature frequently required. This plan will succeed in recent and not very severe cases, or in the first stage of the disease. But should the case become worse-face livid, eyes closed, breathing still more frequent, short, and gasping; nostrils widely dilated with each inspiration ; heaving of the chest and shoulders; the air scarcely penetrating the bronchi, which are now filling fast with secretion, every expiration being succeeded by a distressful panting moan ; inability to take the breast: these symptoms continuing without any intermission, -and which I call the second stage,-though it is still highly .proper to continue the use of the calomel and ipecacuanha, nothing will save the child without blistering the breast. This can be done with perfect safety, while the loss of a very small quantity of blood would speedily produce a fatal termination, by prostrating what remains of the vital powers. I have several times seen fatal effects from loss of blood by leeches applied to infants under twelve months, in this and other diseases; while I have never seen any danger arise from blistering very young infants with the common cantharides plaster, applied to the bare skin without any interposing substance. The "severe sloughing" and other mischief which sometimes take place, must be in consequence of culpable neglect in allowing blisters to remain on until they produce an " escharotic," and not simply and solely a rubcfacie7at effect. This can be effectually produced by leaving the common blistering plaster (spread thin on fine cotton or white calico, and its surface smeared with olive oil) on until the skin becomes red, which will happen in two, three, or four hours, according to the age of the child, strength and temperature of the skin. A soft warm poultice, in a muslin bag, oiled, ought then to be applied over the reddened surface for two or three hours, when the cuticle will be found elevated half an inch, and full of serous fluid, and great relief afforded to the little patient. The blistered surface must be dressed, until healed, with lard, fresh butter, or any simple unctuous substance, spread on very fine cotton. I have several times seen blistered parts " fester," in consequence of the coarseness of the texture of the dressings. The practitioner should not order a blister to remain on an infant for a definite period, but direct its removal as soon as redness is produced, which the nurse can easily ascertain by paring its edge occasionally. Many very young infants have I seen rescued from a speedy death, aud others much relieved, by blisters thus managed. Of course, the acetum cantharidis has its advantages, but it cannot be applied under every circuinstance. As soon as the more dangerous symptoms have been subdued, the use of the above mixture ought to be resumed or commenced, and if given at bedtime, and during the night if required, it will procure rest and promote expectoration. , During the progress of this disease, when children are unable to take nourishment, and especially when YOlmg infants cannot take the breast, the use of bland enemata of warm water, milk and sugar, beef tea, &c., once or twice daily, in small quantities, so as to be retained for some time, , will prove of much benefit, by assisting in removing offensive matter from the bowels, and supplying the system with nu-, tritious fluid by absorption. If this be not done, the various secretions will very soon become suspended, and, ere long, , cease altogether, when medicines will fail to exert any reme-. dial influence. , Aberfeldy, Perthshire, Jan. 1846. SYMPTOM IN HYSTERIA. AND ITS REMEDY. To the Editor of THE LANCET. SiR, -Perhaps a few remarks concerning a symptom of very frequent occurrence, may be of service to your younger readers. I allude to the pains in the left and right hypochondria, so often complained of by hysterical women. These pains are generally accompanied by other hysteiied symptoms, as globus hysterieus, and a copious flow of limpid urine. They are not of an inflammatory character, and are generally relieved by those remedies which have so extraordinary an effect in all forms of hysteria,-viz. the foetid drugs.
doi:10.1016/s0140-6736(02)35090-6 fatcat:ujeo7rdwp5d27l4we73f4b5ltu