It results from a report of the cases of syphilis admitted into the public institutions of Sweden, that 3,574 were treated in 1822; 3,465 in 1823, and 3,355 in 1824. During the course of this last year, 55-3/10 per centum of all the patients were treated by the mercurial method, and 35-1/10 per centum by the non-mercurial method, and by low diet; 2-1/2 per centum by means of fumigations. MM. Kessler, Wurster, Ronberg, and Sandmark, prefer the dietetic method, and consider it as the surest of all those hitherto employed. Relapses are rare. In 1822 they amounted in relation to the whole number of cases, to 11-2/3 per centum; in 1823 to 10-1/4, and in 1824 to 10-2/3. After the treatment by starvation, they amounted in 1822 to 7-3/4 per centum; to 7-1/3 in 1823; and to 8-1/3 in 1824. After the mercurial treatment, in 1822 to 17-1/2 per centum; in 1823 to 14-1/16; and in 1824 to 14-1/2. Bulletin des Sci. Med.
We hope to lay before our readers at some future period, an analysis of Mr. Richond's work above alluded to, as well as of one on the same subject by Mr. Jourdan of Paris, author of some essays on the origin of syphilis, translated and published here a few years ago.
24. Cancer treated by Antiphlogistics.—Of all diseases classed among the opprobria medicorum, cancer has hitherto been justly viewed as holding the most conspicuous rank, and it is only within a short time, that it appears to have been treated on correct principles, and that cures have been detailed by individuals of undoubted veracity. The idea of the inflammatory nature of cancer, and of the propriety of treating it by means of antiphlogistics, has been held many years ago, and supported by Vasalva in Italy, Fearon in England, Hufeland in Germany, Pouteau and Vacher in France, not to mention other high authorities. But, notwithstanding the success attending this practice, it was too simple for the supporters of cancerous humours and specific inflammations, and seemed, in consequence, to have been abandoned by them, in their search after anti-cancerous or specific remedies; and little was heard of it, until revived by the disciples of the physiological school of France, and particularly by its founder professor Broussais, and by professor Lallemand of Montpellier, the result of whose experience is published in a thesis, lately defended at Montpellier by Dr. Mareschel.
We have been led to these reflections from reading the above essay, and another on the same subject, published by Dr. J. A. Puel, in a late number of the Archives Générales de Medecine. Dr. P. details many cases, which were treated by his father, by means of leeches, emollients, purgatives, &c. so early as 1807. In most of these cases, the practice appears to have been very successful. As it is our wish to impress our readers with the propriety of making a fair trial of this method, in cases of scirrhus and cancer, we shall select and translate a few cases from the latter essay. It is proper to premise, however, that the practice must not be viewed as completely successful in every case, and that the older the complaint, the less confident we ought to be, in respect to the happy results of the case. Nor is it to be expected, that boldness in the employment of the lancet and leeches, will answer as well as a perseverant, constant, but moderate use of these means. Chronic inflammations are not to be removed by storm, but by a chronic use of remedies, and particularly by attention to diet.
We cannot at present determine precisely the proportion of cures effected, by this method, of scirrhus or cancer, in a given number of cases, and how far it will surpass, in point of success, the common method of treatment by specific narcotics and escharotics; but, even supposing that it is not more successful, (which we are disposed to deny,) it has at least the vast advantage of being more comfortable, and much less painful to the patient.
Mrs. D. enjoying good health, and mother of three children, was brought to bed in 1823, of a healthy child, which, however, she did not suckle. With a view of suppressing the secretion of milk, irritating applications to the breast were resorted to, which brought on an inflammation of that organ. Emollient poultices were now applied; these, however, did not prevent the formation of an abscess, which was opened by means of caustic potash. The suppuration, for a few days, was abundant and the matter discharged healthy. Purgatives were prescribed, with the view of suppressing the discharge, and mercurial ointment was rubbed on the tumour, to produce its absorption. These remedies were not successful, because no means were employed to arrest the inflammation, which gave rise to the suppuration.
When the patient applied for advice, she had been sick already four months, and presented the following symptoms. She was very much emaciated, and laboured under fever, resulting from a gastro-enteritic inflammation, kept up by purgatives and deostruents, (fondans,) which, from the commencement of the attack, were prescribed for her. The ulceration of the mamma was of the size of a five frank piece, unequal and gray, and gave issue to an ichorous and fœtid purulent matter. The edges were thick and everted, and surrounded with an erysipelatous inflammation. The whole mamma was large and hard, and the seat of lancinating pain. Thirty-five leeches were applied around the tumour, and gave rise to a profuse hæmorrhage, which continued many hours. From this, the patient experienced so much relief from pain, as to be able to take some repose, of which she had been deprived for some weeks. Emollient poultices and drinks were prescribed, and a low diet enjoined. By all these means, the pain was lessened, and the swelling much diminished. Leeches were again applied, and the other remedies continued. The wound gradually improved, and in forty five days, was completely healed.
Mr. P. was called on the 25th of September, 1817, to attend a lady, who had been affected for two days with uterine hæmorrhage, which he succeeded in arresting. The following history of her complaint was given to him: she had aborted about 18 months before, and since that time, had experienced every fortnight an uterine hæmorrhage, which generally lasted five or six days. During the intervals, she complained of deep seated pain, numbness and cramps, in the lower part of the abdomen, in the thighs and groins. The pain was much aggravated when she had a stool—walking, especially when long continued, was painful, and attended with a sense of dragging, which was only relieved by repose. From the same period, her disposition had changed from gay and lively, to melancholy and morose—her digestive functions were slow and painful—she was affected with leucorrhea, and during coition, felt much pain, and often lost some blood. On examination per vaginam, it was found, that the neck of the uterus was elongated—the anterior lip of the same organ was soft to the feel—the orifice somewhat enlarged, and painful when the finger was introduced into it. On the inferior lip there was a small unequal and painful spot, which was regarded as a superficial ulceration; the uterus was a little prolapsed, and somewhat enlarged; the pulse small and frequent; febrile exacerbations every evening; sleep not refreshing, and interrupted by short lancinating pain in the uterus.
The disease was judged by Mr. P. to be a chronic metrites, with ulceration, and all the symptoms usually attending incipient cancer. Guided by this belief, and notwithstanding the already long duration of the disease, and the debility of the patient, the following treatment was adopted—complete repose in the horizontal posture—leeches to the vulva, repeated several times—vaginal injections, with emollient decoctions—hip baths—very low diet. After persevering in this plan twenty days, the patient appeared much better, and was allowed to sit up. General baths were substituted for the partial ones. The same treatment was continued, with the exception of the leeches, and at the end of thirty days more, all the symptoms of the disease had completely disappeared. Mrs. P. was allowed to spend the following spring in the country, from whence she returned in very excellent health. She has since continued to enjoy it, and has borne several children.
Cases nearly similar, are detailed by Mr. Mareschal, as having occurred in the practice of professor Lallemand. The same gentleman, also gives the history of two cases of external cancerous sores, in which the same treatment was adopted. The patients having died during the progress of the cure, of other diseases, an opportunity was offered, of examining by dissection, the changes that had occurred in the parts. We cannot enlarge on the subject in this place, and can only remark, that these changes were such, as to lead us to hope, that less difficulty will be experienced in the treatment of sores reputed cancerous, by the local antiphlogistic plan, than is commonly supposed. At any rate, recommended by such high authorities, the practice deserves a trial.