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the old school.
I will not enter into minutiæ. Suffice it to say, that Broussais's leech practice has bled thousands into the grave.
How great the authority of Broussais once was, is well known. It is now on the wane:*
What other means has he to conquer acute
Local bleeding, I am well aware, is much recommended in inflammatory diseases of children. It is generally understood that the great irritability of children inclinesthem to those maladies which make the application of lecches essential.
I am not favorably disposed to the theory of irritation, and therefore am neither friendly to the lancet nor to the leeches.
It has fallen to my lot, says Professor Dunglison, to witness some alarming cases of exhaustion, especially in children, where leeches have been applied. In two
*The following statistic table will confirm the assertion of the diminished success of the Broussaisian doctrines. In 1823, France still exported leeches to the number of more than a million. After this, she exhausted not only her own supply, but also that of England, Germany, and Hungary, and has even drawn them from Moldavia and Wallachia
..1,188,855 .196,950 .868,650 ...868,650
I should like to see a calculation of the pills used in the United States for one year only.
cases, indeed, the result was fatal. In both cases, due ount of blood was lost before the cause of the sinking was discovered; and in one of them every attempt to arrest the flow of blood failed. These cases are rare, but they constitute objections to the use of leeches, which do not apply to cupping (?) (we doubt that cupping can fill up the place of leeching) the flow from the wounds made by the scarificator being readily arrested.
When leeches are applied to soft parts,-for example, to the abdomen, it is truly astonishing (!) how much blood sometimes is detracted; praticularly when a poultice is applied over the bites, and the patient is kept warm in bed. This is more likely to occur in children than in adults. On this account, leeches should never be applied late at night on children. (The advice is a good one; but in cases of urgency, neglect will kill the little patient, and the allopathic physician has no better means at hand than leeches.)
Blisters, Setons, Cauteries, Ointments.
The great extent of the tegumentary membrane, the manifold functions which it performs, render it an important consideration in relation to health, and in disease.
Studied under the two-fold point of view of conformation and structure, the tegumentary membranes of the outer surface, and of the inner passages of the body, have characters which are common almost in their whole extent. T2
The greater number of the exanthemous inflammation,
mottles etc.. (savs Raver *) attend 10 divisions of the tegumentary membranes simultaneously. The runnings of the eyes, the nasal, laryngeal and tracheal catharrhal affection of measles corresponds to the exanthema of the skin, which characterizes the diseases on the general surface, and the matter secreted by the bronchi presents a peculiar character in relation with the species of inflammation which is going on. In scarlatina, the mucous of the mouth and pharynx, almost always,—and that of the stomach and intestines, occasionally, presents a dotted redness altogether analogous to that which is observed upon the surface of the skin. The eruption in this disease is followed by desquammation of the cuticle, and the mucous membranes, furnished with an epithelium, cast this pellicle off in a precisely similar manner.
The observation of Heberard† have shown that the skin may become changed into a mucous membrane, and this, in its turn, into external integument, under certain circumstances. In fact, when any portion of the outer surface of the body is, for a long time, subtracted from the influence of the atmosphere, as during the treatment of certain fractures, when the leg is kept for many weeks bent upon the thigh, and, the intugements of the femoral and crural portion in the region of the twist of the knee are
*1 reatise on the Diseases of the Skin, by P. Rayer, M. D.
tHeberard, memoire sur l'analogie qui existe entre les systemes muque¤x et dermoide.
maintained in contact; and in the folds of the skin of very lusty infants, we see that the cutieule softens and disappears, and that the surface of the skin ends by secreting mucous exactly like a mucous membrane. On the other hand, we know that in old cases of prolapsus of the uterus, and of the anus, the mucous membranes of the intestines become thickened and dry, and by degrees acquire every appearance of the skin. From this hasty sketch of the internal and external integuments of the body, it is easy to perceive that they bear a great analogy to one another. Observation has taught us, (says Beclard*), that a healthy state of the skin coincides with that of the mucous membrane. Persons of a delicate whitish skin are very apt to suffer under morbid secretions of the skin and mucous membranes, and on many other diseases which affect both membranes at the same time.
Even Hippocrates knew that an increased secretion of the mucous membranes proceeds from a diminished cutaneous secretion.
Every one knows that a checked perspiration, or other morbid impression on the surface of the body, will lead to diseases of the lungs, stomach, intestines, kidneys, bladder,
Females ought to be particularly careful, being more liable to inveterate maladies through improper treatment of the skin.
*Elemens d'anatomie generale, par A. P. Beclard.
THEORY AND PRACTICE
The intimate connection, sympathetic relation, or contact between external and internal parts. The great sensibility and susceptibility of the skin to inimical impressions, it seems to me has never been duly appreciated by the practitioners of the old school. Were it otherwise, it could not have escaped their notice, that this hodge podge business of plastering, blistering, cauterisation, removing or repelling itch, or other cutaneous maladies, by irritating ointment, can have no other but an injurious tendency to the system.
In the fullest conviction of the truth of this assertion, I will quote the following examples.
The inflammation of the skin, (says Prof. Dunglison,) caused by vesicants, is occasionally attended with fatal consequences. It is of the erysipelatous kind, and under particular circumstances as regards age, condition of the system, etc., the inflammation eventuates in gangrene and death.
In very young children, great irritation is apt to be induced by blisters; and if the child be labouring under any eruption of the skin,-such, for instance, as is present in measles or scarlet, the inflammation may terminate unhappily. We can hardly imagine an occurrence more disagreeable to the philanthropist, than that of a patient dying in consequence of the application of an agent from which he expects a cure, or at least a mitigation of the symptoms. Great caution is therefore necessary in the use of these agents in very early life, especially in the