_Joint Professor of Materia Medica and Therapeutics in Queen’s College,
Birmingham._
Our ordinary medicinal agents are substances from the animal, the
vegetable, and the mineral kingdoms: the one here to be treated of is of
that class of remedies which includes the great elements or forces of
nature: such are water, in all the varied forms of bath; electricity, in
its different developments; air, in all its modifications of pressure or
composition.
It is unfortunate that the application of these mighty remedies seems
liable to degenerate into charlatanism: partly perhaps because they have
the power—_wrongfully_ claimed for quack medicines—of doing good in many
apparently different forms of disease; partly because their use must at
present be limited to the few, and does not admit of ready introduction
into the practice of the many.
Nevertheless, the truthful study of these agents offers scope for the
highest science, and promises therapeutical results of the highest
value. The following cases are offered as data for judging of the value
of one of them. I do not propose to treat here of the chemistry of
oxygen,[9] nor of its physiological effects, nor even of the objections
which have been urged against its use—but simply to state facts which
have come under my own observation.
CASE I. _Emphysema pulmonum (hereditary)._—A lady of 55 had been for
many years the subject of constant dyspnœa, increased on all movement,
and often amounting to a sense of suffocation. A physical examination
revealed sibilant râles with prolonged expiration heard all over the
chest, which was of large capacity and more than normally resonant on
percussion; the heart’s action was weak and the circulation embarrassed,
as evidenced by œdema of the face and extremities.
She was subject to attacks of bronchitis occasionally, but, at the time
of treatment, the general health was in fair condition; the prominent
complaint was the difficulty of breathing.
On July 5, 1868, she inhaled a mixture of 3 pints of oxygen with 30 of
air: the results were favourable. Within a few days the dose was
doubled, 6 pints to 60: soon the proportion of 8 to 60 was used: and
later, 12 to 60, and with this dose we seemed to obtain such good
effects that I did not think it necessary to increase it. The
inhalations were taken at intervals of three or four days for a space of
six weeks; after each one, the lady experienced marked relief, which she
expressed as being able to take a deep breath and get sufficient air—a
feeling not known for years; as being able to move with comparative
ease, feeling buoyant, and more like healthy persons should feel, than
she ever remembered.
The only definite effect upon secretion was a more copious and facile
expectoration, always produced, and lasting for a day or two; the effect
upon the circulation was not marked at the time, but some palpitation
occurred, generally in the nights which followed the taking of the
larger doses; no other unpleasant symptoms whatever.
In attacks of exaggerated dyspnœa, as they occur sometimes in the
emphysematous, and in those peculiar, nervous, irritable states apt to
be induced by mental causes in the subjects of weak hearts, I have known
her come into my consulting-room, inhale for half an hour, and express
herself cheerful and composed. Nor was this the effect of fancy; for, at
first, the lady had a prejudice against the plan; now she esteems it
highly, nor has she ever found relief at all comparable to this, from
the many medicines prescribed at various times by various practitioners.
CASE II. is of the same nature, and occurred in a gentleman of 24, who
had had good health till twelve months before, when he noticed for the
first time wheezing, and afterwards cough, traceable partly to the dusty
nature of his business, partly to wearing damp clothes. The chest
symptoms continued so bad as to confine him to the house for three or
four months; afterwards, he seemed gradually to recover under the use of
tonics and cod oil, and the influence of a warmer climate, and when he
came to me in January 1869 for the first time, he looked well; however,
he complained of debility, of constant dyspnœa on exertion, and of
exaggerated attacks of it occurring suddenly at times, of some cough and
of glutinous expectoration; if he attempted to live well, as he had been
told to do—meaning especially the taking of wine—he usually got an
attack of epistaxis.
Physical examination revealed a sibilus at the end of inspiration, and a
rhonchus with expiration over all the right lung, except the apex; the
chest was very fully developed and abnormally resonant.
I prescribed for him inhalations of oxygen in the proportion of 12 pints
to 60 of air, and he took these twice in the week for five weeks; after
each one he expressed himself in much the same manner as the last
patient, was conscious of a general feeling of renewed health, of a
greater power of breathing, and of facility of expectoration; great
improvement took place in his condition, and I think it must be credited
principally to the gas; for, although I ordered him 10 to 20 drops of
tinct. lobeliæ at night-time, and later on tinct. fer. acetatis and
frictions with the linim. tereb. acet., yet it is to be borne in mind
that he had previously had a fair trial of expectorants, tonics, and
even change of air, without anything like equivalent relief.
CASE III. _Phthisis pulmonalis._—Mrs. W——, æt. 31, who had lost her
father and sisters of consumption, consulted me in Dec. 1867. For the
last six months had had cough, for the last three had emaciated, and at
this time had the prostration, night sweats, diarrhœa, and hectic of the
third stage of phthisis; hæmoptysis had occurred several times: the
expectoration was generally purulent. There were violent pains,
especially over left chest, and examination revealed a fine crepitus at
apex of left lung. The patient was treated with ordinary medicines, and
improved gradually. Opium in the form of an atomized spray was found to
be the best medicine for relieving cough, and procuring sleep; tincture
of steel and carbolic acid used in the same manner relieved, to a
certain extent, the profuse expectoration; and although the case became
complicated with a peri-uterine hæmatocele, in February 1868 she rallied
from this also.
It was July 1868 before she could walk as far as my house. Her principal
symptoms then were debility, pains in the chest, cough, and copious
muco-purulent sputum. At this time she began inhalations of oxygen in
the proportion of 6 pints to 60 of air, increasing by degrees to 12
pints. She took eight inhalations at intervals of two days, and then
found the above symptoms so much relieved as to be able to omit all
treatment for a time. She herself attributed great benefit to the gas,
and was taking no other special medicine at the time. Since then she has
borne fairly well the cares of a large family. She has gained flesh, and
though there is still a frequent cough, and sputum, and a mucous râle
about the left apex (I examined the chest two days ago), the progress of
the disease is arrested for a time at least.
CASE IV. points precisely in the same direction. In May 1868 I was
consulted by a gentleman of 19, whose father died of phthisis. He had
been steward on board a packet plying between Liverpool and New York;
got wet through on his last voyage, lung symptoms soon set in, and he
considers that his present ones date from three months ago. He has
constant cough, for which he can get no relief, profuse sweatings,
hectic, and extreme emaciation; in short, all the ordinary signs of
softening tubercle in the right apex, and had been sent home by medical
men in Liverpool to Handsworth,—just to die. However, he too rallied
under careful nursing, and with the help of ordinary medicinal agents,
and by July was able to walk to my house, and begin inhalations of
oxygen in proportion of 6 pints to 60. At this time the above-named
symptoms were all better, and his principal complaint was of difficulty
of breathing, and of pain in the side of the chest, and these did not
yield to medicines or to liniments. He continued to inhale twice a week
for two months, and at the end of that time was sufficiently recovered
to seek for a situation. He is now in the employ of the London and
North-Western Railway Company, has gained two stone, he says, and is 6
ft. 4 in. in height. I had an opportunity of examining his chest last
week, and detected only dry and interrupted respiration in one apex. I
should add that he continued the tinct. fer. perchlor. and cod oil
during and after his treatment by gas; but he distinguished relief to
the dyspnœa from the gas alone.
CASE V.—Rev. W. M——, aged 34, lost father, brothers, and sisters from
phthisis. In February 1868, when I first saw him, the prominent symptoms
had lasted six months—the dyspepsia, the tight cough, the loss of voice,
and the emaciation.
In March the physical signs of phthisis were evident in the left apex,
as was ascertained by Dr. Russell, who saw the patient with me at that
time. I need not detail symptoms or treatment, as they did not differ
from what is usual; suffice it to say that improvement took place, but
was temporary, and in April we recommended him to visit Jersey. He was
there for three months (being considerably longer than I had intended),
and at that time he thought that he found benefit from the sulphurous
acid spray. However, he returned as bad, if not worse, than when he
went, with night sweats, extreme prostration, cough, difficulty of
breathing, and purulent expectoration. It was in this condition, and
when he had had a trial of almost every other remedy, including a
prolonged course of cod oil, that I proposed oxygen to him, and he began
it July 24, 1868, in proportion of 6 pints to 60, increasing gradually
up to 10 to 60, and taking this two or three times a week up to October
8, a period of 2½ months; during the whole course of the time, he had
expressed himself as much relieved, both as to breathing power, cough,
character of expectoration, appetite, and strength. He had gained
weight, and the malady was quiescent. He had been accustomed to come
from the country by train, and to ride back in a cab. On one unfortunate
day (October 8), which was cold and very wet, he got into a cab the
window of which was broken, drove six miles in the night air, in the
course of that night got a sudden pain in the side, and dyspnœa, and
when I saw him next day pneumonia had attacked the right lung, and he
was desperately ill.
Now the point of the case is this. It has been said that the inhalation
of oxygen is liable to cause inflammation of the lung. Did it do so in
this patient? That must be a question to be decided on the evidence, but
I cannot think that it did. The dilution of the gas was great; the same
quantity had been inhaled for weeks before without any injury, and the
other exciting cause was such a probable one. At the end of a month’s
time he was convalescent, and urgently requested the resumption of his
inhalations. I consented, and he again expressed relief from them,
especially as to the dyspnœa; but effusion in the right pleura came on
gradually, but too surely; for some time we saw the end approaching, and
he died last month. Almost to the last he expressed benefit from the
gas, and he certainly suffered less than any consumptive patient whom I
have ever seen.[10]
CASE VI.—I adduce as an instance of another variety of dyspnœa a
warehouse woman of 27, who had also lost several brothers and sisters of
phthisis. Had been much depressed by nursing the last one through a long
and painful illness; she came to me in June 1868, with symptoms of
dyspepsia and history of attacks of urgent difficulty of breathing
coming on generally at a fixed hour of 9 or 10 in the morning;
occasionally after later meals; she kept constantly sighing deeply, and
had various symptoms of hysterical temperament; had also cough and
viscid expectoration; but a physical examination revealed nothing very
definite—perhaps puerile respiration in one lung and diminished
vesicular murmur in the other.
She was treated for some weeks with various stomachic and tonic
medicines, and went into the country for a fortnight; but the symptoms
remained more or less.
It was during an attack of this spasmodic or hysterical dyspnœa that I
first administered oxygen to her, in proportion of 5 pints to 30 of air,
and again in a double dose, only on three or four occasions.
It is possible that these doses were not large enough for a fair trial;
but, however, I wish to record that relief was given, but it was slight
and not permanent. Eventually the patient recovered under the use of
bromide of potassium and quinine. She has since married, and is well.
CASE VII. _Chlorosis._—Miss P——, æt. 21, had been employed for some
years with very long hours of work in a small close room; was stunted in
growth, with chlorotic complexion, drowsiness, headache, palpitation,
dyspnœa, and great fulness of the thyroid gland. Menstruation still
occurred, though scantily, and at intervals of six to ten weeks.
She came under my care in January 1868, and after regulating her hours
and her food as far as possible I prescribed various preparations of
iron, of magnesia, of aloes and myrrh, baths, and liniments, &c.
There was a gradual improvement in her condition with occasional
relapses, which obliged her to remain under treatment for many months.
In October 1868 the prominent symptom was headache, violent and
pulsating, and it was for this that I prescribed oxygen, after the
failure of many medicines.
_November 8th._—Inhaled 6 pints diluted with 30 of air; pulse 96 before
commencing, had same frequency at the end; the only special symptom felt
was a sense of oppression at the chest, but the headache was not so bad
as usual that night.
_9th._—When she entered my room the headache was violent; she inhaled 12
pints in 60 of air, and before finishing, the headache had disappeared,
and she felt better; this occurred on several _though not on all_
occasions, but she continued the use of the gas for ten days only. She
was then obliged to be away for a time, and the headaches returned
shortly afterwards: relief had been given, but not permanently.
Perseverance here _might_ have shown good results, but an opportunity
occurring soon afterwards of a residence in the country for some months,
I recommended her to take advantage of it; she has recently returned
much improved in health, and is following her occupation again.
The two following cases are somewhat allied to the last, in being
disorders of secretion or excretion, and are examples of that so common
complaint in town people, hepatic congestion; the results were
exceptionally favourable, and although under ordinary medicines patients
generally improve in a satisfactory manner, yet the malady sometimes
shows such a disposition to return, that one really scruples about
prescribing over and over again rhubarb, magnesia, nux vomica, acids, or
blue pill.
CASE VIII.—Mrs. B——, æt. 40, mother of a large family, had been subject
to bilious attacks for many years, and had several times been under my
care. In May 1868 she had pain over hepatic region, depression, nausea,
headache, and yellow conjunctivæ; the stools were frequent, loose, and
pale; menstruation was profuse, and occurred oftener than normal.
She took at first dilute acids with tinct. rhei co. and improved, but
relapsed at the end of June, and it was then that I recommended the gas
to her; the prominent symptoms being headache, depression, complete loss
of appetite, and a constriction about the chest “as if she could not get
air enough:” menorrhagia had been going on for two days.
_June 23d._—Inhalation of 4 pints in 60: there was not any marked
effect.
_25th._—6 pints in 60, and before the inhalation was over the headache
was relieved, and all that day she felt “lighter” and better, though
rather strange; to bed early, and slept and woke without headache, the
first time for nearly twelve months, and was nearly free from her
shoulder pain.
_27th._—Dose repeated with similar good results, and no medicine taken;
the diet was regulated as it had been before. To be brief, she took
eight inhalations on alternate days, and at the end of that time was
well enough to do without treatment: not that she was quite well, but
restored to her ordinary health, and the improvement has up to this time
continued.
CASE IX.—A lady of 21, after a period of great mental anxiety and of
close application to business, began to feel extreme depression,
drowsiness, anorexia, headache, nausea, and interscapular pain; the
pulse was slow, the face pale; there were palpitation and dyspnœa
without signs of organic disease. The symptoms had lasted about two
months, when I first saw her in July 1868. She took alkalies, aperients,
and appropriate medicines, and on the 12th took inhalation, 7 pints in
60. Here again the same remarkable effect was produced, in relieving
headache before the end of the quantity. She continued to inhale a
little larger dose every third day for a fortnight, without taking any
medicine for the latter part of the time. She has remained fairly well
ever since, and voluntarily expressed the great benefit which she
derived from the gas, especially as to relieving a sense of constriction
across the chest and dyspnœa.
Both these cases were tolerably acute, and occurred in persons of
naturally “sanguine” temperament, but it is necessary to record that
another case which I have treated more recently,—a young lady of
“bilious” temperament, who suffered from hepatic congestion in a more
chronic form,—found no special effect whatever from inhalations taken on
alternate days, for a fortnight.
CASE X. was one of albuminuria in a lady of 57. The disease had
commenced four years before, and her health had been markedly impaired
for the last twelve months (dating from an attack of vertigo, and loss
of consciousness). Last winter she had had bronchitis. She was a lady
highly connected, and had been under the care of several eminent London
physicians, who had concurred in advising her to go into the country for
a time, and I was sent for to see her in November last, when she had
already been at a country-house in this neighbourhood for some months.
She was feeble, with pallid face and injected cheeks; extremities
œdematous; dyspnœa to a great extent on the slightest exertion; tendency
to fainting and giddiness; urine deposited urates, and gave a cloud of
albumen with the usual tests. Almost the only remedy which had not been
given to her was this gas. I requested her to write and ask her
physician if he concurred in its use; he wrote back to say “by all
means,” and on November 18 she began with 14 pints in 60 of air. The
pulse was 78 at commencing, and did not vary. She took it six times at
intervals of three days. I had anticipated good from it, but there was
really no marked effect. She thought, in fact, that her headache was
rather worse afterwards, but I think that was better accounted for by
the carriage drive to my house and the extra excitement.
Treatment was omitted for a time, and in the interval she got an attack
of subacute bronchitis; on recovery she hired an apparatus of her own,
and began, on December 12, 16 pints to 60. I consider that she had a
week’s fair trial, but at the end of that time, what with leakage in the
machine and non-arrival of gas, the lady’s patience failed, and the
treatment was not persevered with. I mention these matters as an
instance of one of the difficulties that an unusual mode of treatment
must necessarily contend with. However, the result of this treatment,
such as it was, gave no encouragement to persevere.
CASE XI. resembled the last in the fact of there being organic disease.
She was a delicate and refined lady, of the age of 34, unmarried. With a
history of some years of spinal debility, and of congestive headache, at
this time (September 1868) there was general prostration, numbness, and
tingling in various parts, a sense of suffocation and of constriction,
and partial loss of power over limbs; but worse than all, the attacks of
headache of frightful intensity, attended with throbbing, flushing, and
confusion of thought, and generally located over the left eye, which
then protruded very much. Of these and other symptoms, some were
explicable on the hypothesis of congestion of the spinal cord, and parts
of the cerebrum, while some suggested a grave suspicion of
ramollissement; others, again, of a chronic thickening of the membranes.
My opinion was necessarily doubtful, but with regard to remedies oxygen
offered a prospect of relieving at least some of these symptoms; it is
said to have done so in recorded cases. Moreover, the patient had had
the best obtainable advice in her own town of Wolverhampton and in the
city of Cork, remedies prescribed by her physician had not benefited
her, and for some months she had been under homoeopathic treatment at
home and at Malvern. I recommended her to hire an apparatus for her own
use; and on October 4 she began with 12 pints to 50 of air, the
inhalation to be extended over the period of one hour. The necessary
exertion tired her, and she felt no appreciable relief. I did not like
to wait longer without attempting to relieve by some of our usual
remedies, and I prescribed gr. viij pot. brom. with ♏︎viij. liq. ergotæ,
as having a special influence in equalizing the spinal circulation.
_Oct. 12._—Head bad, but not so bad as usual. On 15th, menstruation came
on, and aggravated symptoms somewhat.
I directed inhalations to be increased in strength every day, until I
reached equal proportions of air and oxygen—as much as 30 pints of each.
On October 21 had an attack of prostration to a more extreme degree than
ever known before; she seemed, in fact, at the point of death from sheer
exhaustion. And here again we are met by the important question—Was this
due to oxygen? for experience recorded of its effects seems to warrant
this apparent paradox, that although in many cases a stimulant, in some
it is a depressant; that although it will increase the vital powers when
only moderately depressed, it will tend to lower them when they are
already very much lowered.[11] Or, again, was the prostration due to the
bromide of potassium?
Candidly, I do not think that it was due to these causes, partly because
she had had no inhalation for two days before, and no medicine for three
days, and partly because a depression similar, though less in degree,
has followed menstruation on other occasions, and this had been more
profuse than usual.
For the time I gave her quinine and brandy and a little morphia, and on
the 23d permitted her to resume inhalation, beginning at 12 to 60; she
again gradually increased the dose to 30 pints in the day. For the
bromide of potassium I substituted small doses of strychnia. The
administration of the gas in varying doses was persevered with till
November 4—a full month altogether—then I recommended her to discontinue
it. The effect was certainly not marked; if there was any, it might be
in relieving the sense of suffocation, which was not so bad during that
month as it had been before and since; but on the whole the gas must be
considered to have failed in this case. However, it will be remembered
that many other remedies had failed also, and the further progress of
the case has convinced me of the presence of serious organic disease; it
is in fact two months since I have ceased to entertain or give any hope
whatever of this lady’s recovery.
CASE XII. was one of general debility with irritable heart. A gentleman
of 35, who had lost several brothers by phthisis, and had been subject
to unusual harass and exertion, began to lose appetite, to grow thin,
and to suffer from lassitude, dyspnœa, and palpitation. When he came to
me in May 1868, the symptoms had lasted for two or three months, but I
could detect no physical signs of disease. For some weeks he took
quinine, aconite, and cod oil, and applied belladonna; still he did not
improve much.
On June 21, he inhaled 4 pints mixed with 30 of air, and felt a “greater
lightness”—no increase of palpitation. After four days of treatment, he
got an opportunity of spending a fortnight in the Highlands, and I
recommended him to try the breathing of oxygen there. He returned home,
however, in July, not so much improved as we had hoped, and still
complaining much of soreness about the chest, and oppressed breathing.
From this time to September he took an inhalation every third or fourth
day, and with perceptible benefit. It is true that he took, for some
weeks of the time, the hypophosphate of lime and cod oil, but still the
effect of the inhalation in improving breathing power, and appetite
especially, was immediate enough to convince us that it had a large
share in his recovery. He has remained fairly well since.
To resume: 12 cases are here related; 2 of the 12 are of organic, and in
all probability incurable disease, and these 2 derived little or no
benefit from the inhalation of oxygen; the other 10 found benefit as
recorded, some more, some less, but all of a kind which I have not seen
given by medicine alone. It remains to ask—Is there any common character
by which we may connect together this series of cases, and which may
enable us to say, oxygen is good for such and such a class of cases, as
we say iodide of potassium or quinine is good for such and such a class?
I think that we may find some such common character in the presence of
congestion, especially venous congestion, whether of the liver, the
lungs, or the uterus: more than this I will not say at present; the
classification of carefully-observed cases, and a rational theory of
this “modus medendi,” are points that require special study, and cannot
be dogmatised upon until we have a wider basis of facts.
ON THE HERPETIC FORM OF STRUMOUS OPHTHALMIA, AND ITS TREATMENT BY
ARSENIC.
BY ROBERT S. OGLESBY,
_Assistant Demonstrator of Anatomy in the Leeds School of Medicine._
Strumous Ophthalmia, associated with herpes of the face, or as it may be
termed the herpetic form of strumous ophthalmia, is a disease so often
met with in general practice, and one so little amenable to local
treatment, that I venture to say a few words regarding its treatment
constitutionally. I should hesitate to occupy valuable time and space
with what appears to be a trivial subject, on which much has already
been written, did I not believe that by so doing additional light might
be thrown upon the subject. For several years past I have been
collecting evidence, carefully sifting and placing all well-marked cases
aside for special treatment. The results obtained in the earlier batches
of cases thus treated, decided me to continue such treatment for a
lengthened period. The evidence thus obtained being highly satisfactory,
other treatment formerly employed was abandoned.
During the time that has since elapsed, I have continued to employ the
same remedy with the same good results.
This form of the disease generally presents itself in fat, red-faced
children who have the appearance of robust health. On questioning the
parents, they will perhaps inform you that the child was but small and
puny at birth, and for the first few months of its life it was sickly
and delicate, and not until lately had it become so stout and healthy.
They attribute the change to the purer air the child now breathes, for
they have removed from a populous and unhealthy district to one less
crowded and decidedly more healthy.
In such a child we find traces of constitutional defect in enlarged and
rickety joints, a head big and ill-shapen, and an anterior fontanelle
not completely closed. We find a thick and prominent lip, conspicuous
for the extent of mucous membrane it shows.
The intolerance of light is so intense that the child cannot bear even a
moderate degree, but persists in burying its face in its hands, or
hiding from the light in some dark corner. But what strikes us so
forcibly, and what really is so characteristic of the case, is the fact
that the patient’s face is disfigured with patches of herpes,—a fact
which makes us hopeful, as these cases are as a rule the most amenable
to treatment. To cure the disease of the skin is to cure the disease of
the eye in the most rapid and satisfactory manner.
In the majority of the cases which have come under my care, the eruption
was confined to one-half of the face below the brow. In a small
proportion the side of the nose was not affected, and in several the
skin of the upper lip and chin escaped altogether. The vesicles in most
of the cases appeared to follow the course taken by those branches of
the infra-orbital nerve which supply the skin of the face.
My notes do not supply me with any case where the eruption invaded the
brow, although I may have overlooked some such case in my earlier
investigations on the subject. The eruption was often accompanied by a
febrile condition more intense than I have ever met with in the other
forms of strumous ophthalmia.
Before proceeding to active treatment, instructions regarding diet,
regulation of the bowels, &c. should be given. The diet should be
plentiful, simple, and nutritious; and all articles of food likely to
unduly tax the digestive powers (which are as a rule weak in such
children) should be carefully avoided. Strict attention should be paid
to the bowels, which ought to be opened at least once during each day,
but oftener if the appetite be faulty, the tongue loaded, and the fæces
light coloured and of bad odour. These preliminary instructions having
been attended to, special treatment may be adopted.
It is well to begin with small doses of the arsenic in form of Fowler’s
solution. Two drops may be given thrice daily, in some bitter infusion,
to a child between one and two years of age, and gradually increased to
four drops. Seldom is it requisite to further increase the dose. Arsenic
appears to exercise a marked control over the febrile symptoms of this
disease. As the herpetic eruption diminishes, the child ceases to shun
the light, and as the rash fades the pustule on the eye heals. The
benefit of fresh air in the more obstinate forms of the disease is well
known; but it is often difficult to convince parents that exercise in
the fresh air will benefit the child. They imagine that it is rather
hurtful than otherwise, because the intolerance of light is then a
distressing symptom, proper means not having been taken to shade the
eyes. A ready method is to place over each eye a pad of cotton wool, and
over the pads a bandage, which should encircle the head, and tie on the
occiput. The pads should be frequently renewed and the eyelids washed
with warm water.
In a future paper I hope to bring forward additional facts on the
subject, and conclude by giving the history of a number of cases.
Reviews.
_Klinische Beiträge zur Erkentniss und Behandlung schwerer
Krankheitsfälle._ Von Dr. ADOLF HERMANN. Primararzt in Pest. Wien:
W. Baumler, 1868. Gr. 8vo. pp. 282.
(_Clinical Contributions to the Diagnosis and Treatment of severe
Cases of Disease._ By Dr. A. HERMANN.)
The preface to this work explains that the author enjoys, at the
“Israelitenspital” of Pesth, a considerable field of experience, but is
less overburdened with cases than are many physicians of hospitals where
people of all creeds are received, and thus has time to study them
individually with the greater care. We gather that this volume, which is
the fruit of official labours during two years, is the first of a series
which it is intended to publish, and it fairly enough fulfils the
promise which the preface holds out. One of the most interesting parts
of the book is the observations on “tuberculous” affections of the
larynx. We must say, however, that the general treatment of the subject
of tuberculosis disappoints us, and certainly does not come up to the
standard of accurate and careful work which the author has set up for
himself. It shows few traces of that wide acquaintance with modern
pathological researches on its subject which is more than ever essential
to the clinical observer who would throw any light, even by means of the
most diligent labours, upon those matters which are really the
_quæstiones vexatæ_ in regard to the nature and treatment of the various
diseases commonly confounded under the name of tubercle. The last
chapter in the book contains an interesting account of the author’s
experience of the hypodermic injection of remedies. We observe with
surprise that he comes to conclusions very unfavourable to the
subcutaneous use of atropine, which he almost totally condemns. We
entirely agree with him in the statement that doses as high as half a
grain, or even less, will at times produce some cerebral and vaso-motor
symptoms, but the persistent use of much smaller quantities does, we
believe, meet with quite a different and a much higher measure of
success. On the other hand, the author speaks with the warmest praise of
the efficacy of hypodermic injection of morphia in all kinds of
neuralgias; for these diseases he declares that there is no remedy
comparable to it.
_Annuaire de Thérapeutique, de Matière Médicale, de Pharmacie et de
Toxicologie, pour 1869._ Par A. BOUCHARDAT.
M. Bouchardat’s well-known compact little yearly volumes are always
welcome, and always useful; and this year the _résumé_ includes a rather
unusual number of interesting matters. The first thing which deserves
notice is the recent researches on the therapeutic action of arsenic in
phthisis; a subject which we have for some time past desired to discuss
in this journal, but have been prevented by want of space and time. The
very able paper of M. Moutard-Martin, read before the Academy in
November last, called forth a report from M. Hérard, which speaks in
such strong eulogy of the remedy as used in the manner and under the
conditions laid down by M. Moutard-Martin, that we are considerably
surprised to observe the small amount of notice which has been given to
the subject in England. Arsenic has of course been long known as a tonic
more or less applicable to phthisis, as to other states of debility. But
the points so sharply brought out by the French author—the limitation of
the therapeutic action of arsenic to the non-febrile periods and cases,
and (on the other hand) its extraordinary efficacy within these limits,
in restoring flesh and strength and general health, and wonderfully
amending the state of the lungs themselves—are so important that they
demand the serious and immediate attention of English physicians. M.
Moutard-Martin employs the remedy in pills, as being more convenient
than the liquid form; each of these pills (_granules de dioscoride_)
contains a milligramme (·00156 of a grain) of arsenious acid, with manna
and honey.
Another matter which deserves notice, and had escaped ours, is the
experience of M. de Beaufort as to the efficacy of iodide of potassium
in diseases of the lachrymal apparatus. This observer began by applying
the treatment to comparatively recent and slight cases of obstruction of
the sac and nasal duct, the result of coryza, chronic conjunctivitis,
&c. Obtaining a speedy cure in several such cases, he proceeded to try
it even in instances where a tough fibrous stricture had existed for a
long time. Even in such apparently unlikely circumstances, he has twice
obtained success by the treatment. Where there is lachrymal fistula,
following an abscess of the sac, the iodide is also very useful, but its
employment should be accompanied by applications of tincture of iodine.
A matter of some consequence is the opinion of M. Regnault respecting
the comparative activity of various preparations of digitaline. In his
preface to the seventh edition of Soubeiran’s _Traité de Pharmacie_,
this author remarks on the serious difference which exists between
various samples of so-called digitaline. He declares that he finds
himself driven to employ exclusively the _granules_ of Hornolle and
Quevenne. Under the head of digitalis also we may notice the employment,
by MM. Dumesnil and Lailler, of a combination of opium (in the form of
_extrait gommeux_) with tincture of digitalis. This appears, according
to the authors, to have a calming effect upon the excitement and
sleeplessness of insane patients, with less tendency, at the same time,
to congestive effects than is the case when opium is given alone. They
say that not merely does it produce better immediate effects, but that
it can be more harmlessly continued after the original excitement has
calmed down than other narcotics. But they remark that as digitalis, in
therapeutic doses at least, has a well-known tendency to wear out the
susceptibility of the organism for it, it is best to suspend its use as
soon as may be. Two formulas are employed by the author:—