78 REPORT — 1841. 



and a chronic spreading inflammation of the surface ensues. Dr. Thomson considers 

 the exterior or reticular layer of the cutis to be the seat of the disease. The diagnosis, 

 requisite to distinguish it from other species of Porrigo, and other pustular diseases, 

 was minutely given, and a case detailed exhibiting the author's mode of treatment. 

 The principal remedies were bleeding and alteratives, particularly the iodides of arse- 

 nic and of mercury, in minute doses, with the liquor potasses and the iodide of po- 

 tassium in sarsaparilla decoction. The frequent use of the tepid bath, with milk and 

 farinaceous diet, were found useful until the termination of the disease, when more 

 generous food and tonics, particularly the syrup of the iodide of iron, and the solution 

 of the chloride of calcium in the decoction of sarsaparilla, were required. As topical 

 remedies, none were found useful but the tepid bath, and a strong solution of nitrate 

 of silver pencilled over the aifected parts. The description was illustrated by drawings 

 representing the disease in its aggravated form, and also in progress of decay from ap- 

 propriate treatment. 



Abstract of a paper on the value of Opium as a remedy in Rheumatism, and 

 on the circumstances which shoidd regxdate its employment. By Theo- 

 PHiLus Thompson, M.D. 



One of the most remarkable instances of the successive over-valuation and unrea- 

 sonable disuse of a remedy is exhibited by the history of opium used for the cure of 

 rheumatism. Nearly forty years since. Dr. De la Roche, a London physician, was 

 accustomed to treat the disease with opium in doses of a grain and a half three times 

 a day ; at the same time promoting perspiration by warm clothing, and the use of beef 

 tea as diet. The practice, as recommended by De la Roche in the ' Edinburgh Medical 

 and Surgical Journal,' was to some extent imitated, but not generally adopted, and it 

 soon fell into disuse. Recently, however, the practice has been revived by some 

 of the American physicians, and Dr. Corrigan of Dublin has published accounts of 

 cases in which his principal dependence was on this remedy, and in some of which 

 the results were unusually happy. The object of the present communication is to 

 define the conditions in which this powerful remedy is likely to prove efficacious, so as 

 to prevent as far as possible future fluctuations of opinion respecting it, and to guard 

 against its unfortunate misuse or unjust discontinuance. The author of this paper has 

 adopted the opium plan in many cases with very gratifying results. In one instance 

 of severe rheumatic affection of the shoulders and knees, associated with valvular dis- 

 ease and enlargement of the heart and with gastric inflammation, after the relief of the 

 gastric symptoms, a grain of opium was administered every two hours. The pain was 

 speedily relieved, and after twenty pills had been taken entirely removed ; in seven 

 days from the commencement of the treatment the patient walked about the room 

 seeming well, and the peculiar barking which had attended the first sound of the 

 heart had become indistinct. 



An artist who had long been subject to severe rheumatism, and whose constitution 

 had been repeatedly shaken by prolonged treatment conducted on the usual plan, 

 was attacked with a violent rheumatic affection of the knees and arms. A single 

 small dose of colchicum wine produced great sickness and depression. He was 

 immediately put on the opium treatment, and his own report five days afterwards 

 was as follows : — " I have followed up the pills, and with this result, that I am free 

 from pain and much stronger, and I am sure this is an excellent way of subduing 

 the disease." 



A young medical practitioner, who had suffered for months from rheumatism of 

 the back and limbs, against which the whole artillery of anti-rheumatic remedies had 

 been directed, with no other effect than that of leaving him pallid, weak, desponding, 

 anxious, and with a threatened affection of the heart, willingly adopted the opium 

 treatment, in doses of a grain and a half every two hours. He took seventy pills in 

 four days, and in seven days was able to visit his patients. 



In most of the rheumatic cases in which full doses of opium have been given, the 

 skin has perspired profusely, the quantity of lithates in the urine has been consider- 

 able, and the bowels have not been constipated : the relief has been more prompt 

 and complete than that- experienced from the common modes of management, and 

 the strength has been rather improved than deteriorated under the treatment. On 



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