- On hospital gangrene, and the sloughing phagedenic ulcer, which occurs on board ships of war, and in naval and military hospitals. Our author describes the disease as it appeared at Deal Hospital between the years 1807 and 1816. "In situations where hospital gangrene prevailed, and an ulcer or amputated stump were the parts attacked, the previously healthy secretion of pus became first greatly lessened; and such secretion as did appear on the dressings, or on the surface of the parts, was thin, darkcolored, and acrid; the surface of the ulcer lost its florid appearance, and assumed a comparatively pale and glossy aspect. The disease will sometimes commence from a point or vesicle on the margin of an ulcer, or on a slightly abraded surface, as stated by Mr. Blackadder, and at other times from various parts of the surface of the ulcer; but when the disease has so appeared, there has been no vesicle on the ulcerated surface, but only a small, gangrenous point; and I have observed, that when the disease has shown itself in this manner, it spreads sometimes more in one direction than in another, and not as when the vesicle has been the precursor of the disease; for in such cases the gangrened spots spread from the vesicle, as from a centre, equally in all directions: but I cannot say that I have uniformly noticed the vesicle on the margin, and certainly never on the surface of an ulcer; and I have once or twice seen the disease attack the whole surface of an ulcer, as it were, spontaneously, in the course of one night. "I have never known hospital gangrene to attack the sound skin, but uniformly either in an old ul cer, an inflamed pimple, or a wounded or abraded surface of some kind; and it is inconceivable how very minute the wounded part has sometimes been on which the disease established itself, and with what rapidity it advances when once established. Swelling and inflammation, immediately around the wounded part, will sometimes commence in a few hours; at other times these symp toms proceed more slowly. The inflammation nearest to the wound, or injured part, is exceedingly dark or high colored, which, as it extends from the central point, becomes gradually less and less red, till it becomes blended with the healthy skin; and indeed, in this respect, the areolar inflammation in hospital gangrene very much resembles that which attends the vaccine vesicle when at its height, with this difference, that it is much more violent in degree, more extensive, and attended with a great deal more pain, tension, and tumefaction of the neighboring parts. "The disease is now attended with a pricking or stinging pain, as described by Mr. Blackadder.. After a day or two, a circular sloughing ulcer, somewhat depressed in the centre, will be found to occupy the place of the original injury: the edges of the ulcer are frequently pectinated or jagged, of a bluishpurple color, having underneath ' numerous small elevated and angry looking points,' like irritable granulations, of a brick color; and they are possessed of acute sensibility.* The areolar inflammation now ex These two last characters of the disto say, been always met with in my pracease have not, certainly, it is but correct tice. tended in all directions: these parts are exceedingly painful to the touch, and if the disease be seated over the tibia, the pain is greatly increased by the tightening of the inflamed skin, from the weight and dragging of the muscles on the posterior part of the leg, if due attention be not paid to the position of the limb. "The slough, which occupies the whole of the circular ulcer, is of a dark brown color, and of a glairy, gelatinous or slimy consistence; though I have sometimes found it to possess a certain degree of firmness, and, in this latter case, the disease has appeared to me to be always of a more inveterate character. "In hospital gangrene the smell is very peculiar,-it is sui gene ris,' and approaches more to that sour, disagreeable. smell which we meet with from ulcerated toes, attended with a carious state of the bone, than to any other smell I can describe. There is verv little discharge at first, but which increases, and is of a thin darkcolored sanies; and to the silver probe it gives the appearance of an unpolished copper wire. In cases where the bone has been affected by the disease, and when the sloughs have been thrown off, and the ulcer restored to a healthy state, I have remarked, also, how very rapidly the discolored portion of the bone has been cast off by the process of exfoliation. "I have never known the attendant fever to precede hospital gangrene; but when this disease has once invaded a part, the fever is commonly smart, with a hot, dry skin, generally full pulse and furred tongue, and sometimes delirium. The disease proceeds rapidly, if not arrested, and occasionally terminates fatally, or in the loss of a limb, or of an eye, if the disease has been seated near either of these parts. The following conclusions come to by Mr. Blackadder, according to my observations, are most strictly correct. 1st. That the morbid action could, almost always, be detected in the wound, or sore, previous to the occurrence of any constitutional affection. 6 "2dly. That in several instances the constitution did not become affected till some considerable time after the disease had manifested itself in the sore. "3dly. That when the disease was situated in the inferior extremities, or hand, the lymphatic vessels and glands in the groin and axilla were observed to be in a state of irritation, giving pain on pressure, and were sometimes enlarged before the constitution showed evident marks of derangement. 66 4thly. That the constitutional affection, though sometimes irregular, was in many cases contemporary with the second or inflammatory stage. "5thly. That all parts of the body were equally liable to become affected with this disease.' To which I would add, that the disease has, in my practice, been more frequently met with on parts of the body where the bones are but slightly covered with soft parts, such as over the tibia, the cranium, carpal, metacarpal, tarsal, and metatarsal bones: but I have very seldom seen a case of it situated over the costæ; probably from the circumstance of the chest being less liable to ulcer or injury than these just noticed, excepting from gunshot wounds. "6thly. That when a patient had more than one wound, or sore, it frequently happened that the disease was confined to one of the sores, while the other remained perfectly healthy, and that even when they were at no great distance from each other.'" From observations made by Mr. H., he is induced to consider the disease as highly infectious, rather than contagious. At the same time he relates several cases where it was propagated by contagion. The correctness of his inference from his own statements therefore does not appear to us very evident or conclusive. In whatever situation," says Mr. H., "hospital gangrene may originate, whether it be in a hospital, a ship, or in a private house, the first step to be taken by the surgeon is the immediate removal of the attacked into any other situation more elevated, if possible, more airy, and more roomy than that which he has previously occupied; and in the meanwhile proper measures must be taken to cleanse and thoroughly ventilate, by a perflation of air, the place whence they came, both to prevent others from being attacked who may be left, and to secure an immunity from a relapse, to such as have gone through the disease by removal, and have been returned to their old quarters." In the official documents derived from all the naval hospitals and hospital ships in the kingdom, we observe a striking coincidence of opinion in relation to the causes, mode of prevention, and general treatment of hospital gangrene. The rapid decline of the disease of late years is mainly attributed to the more rigid observance of cleanliness and ventilation; to the more regular and abundant supplies of vegetables, and more especially to the free employment of limejuice, as well as to the dryness of the atmosphere between decks. That the principal change in the treatment is the introduction of depletion in the place of bark and wine, which has been attended with increased success, and is adduced as a strong argument in favor of the opinion that there is increased action in the first stages of the disease. Appended to Mr. H.'s reply to the Commissioners for Transports, &c. we find the following observations on his mode of treatment. "Immediately on the admission of a case of contagious ulcer, I make it an invariable rule either to apply leeches to the circumscribed inflammation surrounding the ulcer, or to make deep scarifications on the inflamed skin, of about an inch in length, similar to those I have recommended in the treatment of erysipelas phlegmonodes. After this I pour undiluted limejuice over the ulcer and incisions, sprinkle the surface of the ulcer with Peruvian bark, and doubling a piece of lint, well moistened in the same acid, I lay it over the parts, and pass a bandage loosely round the whole, repeating this dressing twice or three times a day. "At bedtime three grains of submuriate of mercury is administered, and the following day a saline cathartic; the former is continued for some days every evening, and the latter repeated every third or fourth day. An opiate is also prescribed when the constitutional irritation is great lemonade is given as a common drink; and, when the attending fever runs high, antimonials are found useful. Under this treatment, in eight and forty hours, the areolar inflammation begins to disappear, and the slough from the diseased parts is thrown off, leaving a clean healthy ulcer, but most commonly with the bone exposed, if the ulcers have been situated near it." Mr. H.'s summary of the treatment of hospital gangrene, we consider valuable, and hope it will be found acceptable to our readers. "Dr. Gillespie recommends undilute citric acid, or limejuice, as a local application to the ulcered or diseased part; and his medical treatment consists chiefly of a perspirable skin, free alvine evacuations, and pure air. "Dr. Hennen had first recourse to emetics and occasional purgatives, taking care, at the same time, that the skin was kept perspirable, if possible. He states afterwards, that he found venesection, and an antiphlogistic regimen, introduced by staff surgeon Bogie, the best treatment. "In the local treatment, he used large fermenting poultices over the sores; and if great tension and inflammation of the limb existed, cloths dipped in saturnine solutions were applied, and the more irritable ulcers were dressed with lint moistened in tinct. opii, or camphor dissolved in oil, or a paste of camphor and opium. Where the fetor was very great, levigated charcoal or powdered bark was employed, or, as he says, at last diluted nitric, or citric acid were applications from which he derived some assistance. "The sores were kept clean, and exposed during dressing to the fumes of nitrous acid gas. The walls, roofs, and floors of the wards were daily whitewashed, and he preferred tow for washing the sores to sponges, because it was not used twice. "Mr. Blackadder recommends the local use of solutions of arsenic, such as Fowler's, or the liquor arsenicalis of the London Pharmacopoeia, and the arsenical paste of the French surgeons. He strictly enjoins cleanliness of the person, and also that of the ulcer: over the latter he pours a tepid solution of the subcarbonate of potass; and the solution of arsenic, he says, is to be diluted with an equal quantity of water, or in recent cases more dilution will be necessary, and a piece of lint moistened with this solution is laid over the ulcer. "This practice of dressing should. be continued till a darkcolored and dry slough occupies the whole surface of the sore, and till the patient is removed from the burning and lancinating pain which is characteristic of the disease: afterwards, as the slough is thrown off, the sore is to be dressed with an ointment composed of ol. terebinth. and unguent. resin. flav. in equal proportions, and poured over the parts as hot as can be borne. "This dressing is to be repeated two or three times a day, carefully washing the sore with the solution of potass, and covering it afterwards with a piece of dry lint, and passing a bandage. Common dressings and a well applied bandage are to be used when the ulcer is clean and free from sloughs. "Mr. B. does not appear to found described in the London Pharmacopoeia, and in the Pharmacologia of Dr. Paris, 2d vol., p. 230, 6th ed., London. place much confidence in deple- been employed in England for ma→ tion, excepting when circum- ny years, and its properties are stances point out its necessity. After longprotracted disease, a nourishing diet and cordials, with opium, are recommended. The bowels at all times to be particularly attended to. "Mr. Welbank recommends the local application of undilute nitric acid to the ulcer, after having washed the parts and removed as much of the loose slough as can be done with convenience; and, according to his statement, this practice had been uniformly successful. He protects the neighboring skin with a thick coating of lard or cerate; he then proceeds to press steadily, for some minutes, a thick pledget of lint, previously immersed in undilute acid, on every point of the diseased surface, till it appears converted into a firm and dry mass, and the parts are afterwards covered with simple dressings, and evaporation kept up externally by cooling lotions." The chapter ends with a translation of MM. Portal and Deschamp's report to the Royal Institute on M. Delpech's Mémoire on Hospital Gangrene, to which we beg to refer our readers; and a few desultory remarks on Mr. Baynton's mode of treating ulcers on the legs by adhesive straps. Physical and chemical properties. -The white, viscous juice, obtained from lettuce by incision, is bitter; it concretes and turns. brown quickly; it becomes hard and brittle, after the manner of gums, but it easily takes a clammy consistence if it be exposed to the open air. If it be kept in a bottle well stopped, it disengages an odor slightly ammoniacal, and very volatile. The juice, evaporated by a heat, preserves the peculiar odor of the plant, and is endowed with a very great sapidity. After drying, it attracts the humidity of the air, which distinguishes it from the extract of lettuce prepared by the ordinary process by means of fire, which continues dry, when exposed to the open air; dissolved in distilled water, the filtered solution is clear and of a yellow brown: this liquor reddens strongly litmus paper; ammonia determines in it a white flocculent precipitate, which appears to be formed, for the most part, of phosphate of lime; the aqueous solution of galls occasions, likewise, an abundant From Baxter's Translation of Majendie's For- precipitate; it is the same with mulary. THRIDACE OR LACTUCARIUM. The lactucarium of Dr. Duncan, of Edinburgh, such as is prepared in London by Mr. Probart, and the thridace, thridax, Gr. lettuce of Dr. Francis, is nothing else than the white, viscous juice of the garden lettuce, lactuea sativa hortensis, extracted without fire, when in flower. This juice has oxalate of ammonia, of nitrate of barytes and silver, and alcohol in a large quantity; the chloride of platina produces none. Messrs. Caventou and Boulay, who wished to ascertain if there existed in thridace a peculiar principle analogous to morphine, have not met with any. Mode of preparation.--Mr. Duncan, of Edinburgh, has pointed |