Extrait gommeux d’opium ⅔ grain.
Tincture of digitalis 15 minims.
Syrup 1 ounce.
Distilled water 5 ounces.
According to circumstances, the stronger or the weaker of these two
prescriptions is the allotted potion for twenty-four hours. We have
recounted all this gravely, but must not be expected to preserve our
gravity to the last. Not even the respected name of M. Dumesnil can keep
down an irresistible tendency to laugh when we are seriously told that
7½ minims of tincture of digitalis, taken in two separate doses in the
course of twenty-four hours, will avert the mischievous excitement which
might otherwise be caused by ⅓ grain of extract of opium similarly
distributed! That neither potion No. 1 nor potion No. 2 can be
considered a dangerous narcotic we quite allow; but we fancy that must
be because there is so little opium in either of them, not because there
is so much digitalis. In fact, if we might be allowed to make a delicate
suggestion to our therapeutical brethren of _Outre-mer_, it is, that
just now they are going the least bit in the world crazy over digitalis
and its wonderful properties. However, we have nothing but praise for
such researches as those of MM. Oulmont and Hirtz, already noticed in
these pages.
A small matter worth noting is the suggestion of M. Hager as to the bad
effects of _impure glycerine_ which are occasionally met with. It
appears that certain glycerines, which are locally irritant when applied
to the skin, prove to contain formic and oxalic acid; the latter is more
especially the irritating agent.
Some interest attaches to a comparison instituted by M. Rabuteau between
the action of sulphate of _soda_ and that of sulphate of _lithia_. The
former diminishes or removes thirst and produces constipation; the
latter increases thirst considerably, and causes copious liquid stools
and watery vomiting. The soda salt _dries_ the alimentary canal, the
other thickens the blood and pours out its watery element in abundant
intestinal secretions.
The chlorides of sodium and lithium present analogous differences. The
former does not purge when introduced into the veins, though it does
purge when given internally in similarly large doses. Its ormolic
effects are like those of sulphate of soda. Iodide of sodium has similar
differences of effect, according as it is given by the veins or the
alimentary canal. In short, the purgative effects of salines would
appear to depend on the metallic and not on the metall_oid_ element
which they contain.
We must finish this hasty notice with a _résumé_ of M. Rabuteau’s
ingenious theory as to the cause of the constipation which so often
succeeds saline purgation. According to him, if the dose of the saline
be large almost the whole is directly eliminated by the alimentary
canal; if it be medium, a part passes into the blood; if it be small,
nearly the whole of it is absorbed into the blood. In the first case,
purgation is violent; in the second it is slight; in the third it is
_nil_, and there is even constipation. But as a certain quantity of the
medicine may have been absorbed, even when there has been powerful
purgation, there may be consecutive constipation from the presence in
the organism of the purgative salt, which slowly eliminates itself from
the intestinal surface. Rabuteau inclines to think, though it is
impossible to affirm, that not merely saline, but other purgatives, show
analogous differences of action.
In concluding our notice of this _Annuaire_, useful and interesting as
it is, we cannot but repeat the complaint we made last year. It is
astonishing to what an extent the accomplished editor has ignored some
of the most valuable therapeutic work done both in Germany and in
England. We venture to say that he would have done better to attend to
these matters, than to fill so many pages as he has done with a
reproduction of his own papers on the etiology of saccharine urine,
which is clearly beyond the proper work of his _Annuaire_.
_De la Médication Antipyrétique. Thèse de Concours._ Par le Dr. A.
FERRAND, Ancien Interne Lauréat des Concours des Hôpitaux, &c. &c.
Paris: F. Savy, 1869. 8vo. pp. 90.
(_On Antifebrile Medication._ By Dr. A. FERRAND.)
The author of this treatise is a really distinguished man in the _jeune
médecine_ of France; and it is with a natural interest that we turn
somewhat eagerly to the pages of his thesis to discover what are his
ideas as to the part which treatment can play in pyrexia. One can hardly
do better, in reviewing his work, than select the chapter on the
“Indications in Fever,” as a kind of test object, to judge the quality
of his work. Judged by this test, it must be pronounced very good. In a
quiet and thoughtful manner, M. Ferrand inquires into some of the
deepest problems of the physiology and chemistry of fever, and really
hits, as it seems to us, most if not all of the principal difficulties
which are troubling the minds of the most advanced pathologists and
clinical observers in Europe. That he does not pretend to solve all
these mysteries is no dispraise to him, but the reverse: at any rate it
may be fairly said that he has carefully considered all the doubtful
points by the light of the best observations in nearly every European
country. If we were inclined to make any exception to his accuracy and
completeness of information, it would be on the score of what he says,
or rather omits to say, respecting the _rôle_ played by
hydro-carbonaceous foods in alimentation. He seems to us to greatly
undervalue, if not to ignore, the incalculably important results of
recent researches in deciding the rank of non-azotised aliments in
_feeding_, and consequently in great part _disarming_, the destructive
force of pyrexial combustion. He assigns, as it appears to us, an
altogether exaggerated importance to the secondary effects of pyrexia
upon the nervous system: while at the same time he appears inadequately
impressed with the enormous destructive incidence of febrile action upon
the tissues. Upon this point M. Ferrand would surely do well to consult
the description of what passes in the organism in pyrexia which was
given by Professor Haughton in his admirable address before the British
Medical Association at Oxford. He seems to forget, what Professor
Haughton therein so ably showed, that a typhus fever or pneumonia
patient lying still on his back, and with scarcely anything moving
except the organs of vegetative life, and the deep chemistry of the
tissues, does in fact a heavier day’s work than any healthy
labourer!—heavier, that is, as regards the inevitable destruction of
tissue that must go to the maintenance of the most elementary and
necessary acts of life, in the absence of the power to assimilate
ordinary nutriment. It is this defect (as we think it) in his physiology
which makes M. Ferrand’s practical remarks on alcohol so very inferior
to those which he makes, in the practical therapeutic portion of his
work, upon other agents which he thinks appropriate to the treatment of
the febrile state. His account of Todd’s doctrine and school is indeed
extremely inadequate, and proves, for the hundredth time, how much that
remarkable teacher has been misunderstood by the majority of those who
have criticised his opinions, or supposed opinions. Here is a sentence,
for instance, of M. Ferrand’s, which is nearly as incorrect as it is
possible for a sentence to be—“Alcohol, for instance, is ... stimulant
and resolvent in small doses; but in larger and more continued doses it
becomes antipyretic.” That is precisely what alcohol does not do. Given
in large doses (relatively to the needs of the organism), it becomes
eminently pyretic. It need not always raise the temperature of those
parts to which we apply the thermometer; but, assuredly, given in such
doses as produce phenomena of intoxication, it does most directly
increase and give a mischievous impulse to the destructive processes
going on in the organism.
We have no wish, however, to leave an unfavourable impression of M.
Ferrand’s very able pamphlet on our readers’ minds. On the contrary, we
refer them with confidence to the work as a repository of a large amount
of accurate and careful thought and observation on the nature and the
remedies of the pyrexial state.
_A Practical Treatise on Perimetritis and Parametritis._ By J.
MATTHEWS DUNCAN. Edinburgh: Adam and Charles Black. 1869.
Though we have nothing to do with the pathology of this work, it may be
as well to explain the meaning of the terms employed in the title, so
that the value of the author’s therapeutics may be the better
understood. Objecting to such expressions as pelvic cellulitis and
inflammation of the uterine appendages, Dr. Duncan adopts in part the
phraseology of Virchow, and employs the words perimetritis and
parametritis, the former to signify inflammation of the uterine
peritoneum, and the latter to imply inflammation of the cellular tissue
in connexion with the uterus. With the justification of such a
terminology we need not concern ourselves, but we may express a regret
that so much of the author’s observations are confined to the natural
history of these affections, and so little to the all-important problem
of treatment. In a work extending over nearly 250 pages, one expects to
find therapeutics represented by a greater space than that included in
about a sheet of printed matter. Our disappointment, too, is enhanced
when we find the author, in many instances, limiting himself to the
vaguest of generalities, and, while sceptical as to opinions which do
not coincide with his own ideas, credulous to a high degree on some
points of traditional medicine. The only methods of treatment on which
Dr. Duncan at all dwells are those of leeching and poulticing—save that,
in a few words on internal remedies, he urges the use of mercury to
produce slight salivation, and rejects, what many think so valuable, the
employment of opium. He is strong on the subject of poulticing, and his
statements are in accordance both with practical experience and _à
priori_ reasoning. He impresses seriously on his readers the importance,
during the acute stage, of keeping up the poultices constantly night and
day. As to blood-letting, his practice is definite, though his arguments
from physiology in support of it are, we must confess, insufficient for
us. Local leeching is, in his opinion, vastly superior in its effects to
more distant venesection; and doubtless there is much good in the
practice of applying a few leeches over the groin or to the perineum.
But the following argument in favour of the former plan of distant
blood-letting strikes us as being of that painfully unprecise character
which unhappily is so much associated with medical research:—
“The profession in this country at least has lost all faith in this
treatment, as well as in the corresponding doctrine regarding
venesection of special veins of the upper extremity in disorders of the
head. But enough remains in the well-known and, it appears to me,
well-founded belief in the value and efficacy of the pediluvium in
menstrual affections to prevent us from regarding these therapeutics as
absurd; and, although not dreamt of in our modern and too
self-sufficient medical philosophy, yet laws of sympathy between distant
parts may be discovered which will explain and inculcate some such
remedial measure, which now appears to be unreasonable.”
How, in the name of all that is “positive” in medical science, is
therapeutics to advance an inch while philosophers reason to truth in
this fashion? It would not be more absurd for a chemist to support a
gratuitous speculation on the faith of a future recognition of
phlogiston, than for an intelligent practitioner to establish a
therapeutical fact by argument such as that which Dr. Duncan employs.
When the author confines himself to telling us under what circumstances
blood-letting should be adopted, he gives us the result of a valuable
and wide clinical experience; but his hypotheses are, we confess, too
much for us. We cannot understand why Dr. Duncan completely overlooks
the subject of restoratives and tonics in perimetritis and parametritis;
and we should be glad to hear his reason for ignoring such very
important agents in the treatment of these affections.
_The Atlas of Venereal Diseases._ By M. A. CULLERIER. Translated from
the French, by F. J. BUMSTEAD, M.D. Philadelphia: Henry C. Lea,
1868.
We wish for once that our province was not restricted to methods of
treatment, in order that we might say something of the exquisite
coloured plates in this fine volume; for the work is essentially one to
aid in diagnosis rather than to detail means of cure. The Atlas, which
Dr. Bumstead has not only translated, but very materially added to from
his own stores of knowledge, is in every respect a most useful work for
the practitioner, who is often called on to diagnose an affection which
in the absence of a truthful history may appear either syphilitic or not
in nature. With the aid of these handsome plates, there need be little
difficulty in the identification of a syphilide. It must not be
supposed, however, that therapeutics are neglected, or sacrificed to
etiology. Both author and editor give us a very full account of the
remedies now in vogue, and of their own clinical observations. We have
not seen anything on the subject of the hypodermic employment of
mercury, but the internal administration of the salts of mercury and
iodide of potassium is of course enjoined. Indeed, the chapters on the
treatment of syphilis are not the best. The section devoted to the
remedial measures to be attempted in gonorrhœa strikes us as being
copious and well arranged, and contains some sound, practical
commentaries by the editor, who disapproves of the porte-caustique and
other heroic modes, and recommends the use of an extremely weak
injection of nitrate of silver (gr. ⅙ to the ℥j.) every three or four
hours. His suggestions as to general treatment are equally judicious. In
every respect this Atlas will be found most useful for reference by the
busy practitioner.
_The Medical Formulary, &c._ By B. ELLIS. Twelfth Edition, revised by
ALBERT H. SMITH, M.D. Philadelphia: Lea, 1868.
The aim of this work is to supply the young physician with the means of
writing “elegant and judicious” prescriptions; and if we may judge by
its success, the book must be one which meets a want. But we cannot help
saying that the habit of writing “elegant and judicious” prescriptions
is one of the barbarisms of the practice of ancient times which we
should gladly see consigned to oblivion. It fosters charlatanism, and
utterly retards all efforts to found a rational system of therapeutics.
How can any logical induction, or any generalization of the slightest
value be drawn as to the remedial effect of drugs administered after the
mode laid down in such books as the “Formulary?” Without pausing to
consider a recipe for pills which are “elegantly” and alliteratively
styled “Chapman’s peristaltic persuader,” let us ask what can be the
judiciousness of the following marvellous concoction of substances?—
_Elixir of Cinchona._
℞ Quiniæ sulphatis, gr. xxv.
Quinidiæ sulphatis,
Cinchoniæ sulphatis, āā gr. x.
Sacchari, ℥xx.
Olei anisi,
Olei fœniculi, āā gtt. ij.
Olei cinnamonii Zeylandici, gtt. vj.
Olei cari, gtt. j.
Olei aurantii, ♏︎xl.
Spiritus Curaçoæ, f. ℥vj.
Alcoholis deodorati,
Aquæ rosæ,
Aquæ, āā Oj.
Caramel, ℨiij.
Misce secundem artem!
_Conservative Surgery, with Reports of Cases._ By ALBERT G. WALTER,
M.D. Pittsburg: Johnston.
This is a very verbose treatise on the mode of dealing with lacerated
wounds, &c. The author recommends free incisions along the whole length
of the limb, and the subsequent application of poultices and
fomentations, assisted by general and local supporting measures. As is
usual in such cases, he cites a vast series of cases, which, as is
equally usual, might be cited in evidence of a very large number of
different and conflicting propositions. There is some sense in the
author’s practice, but a terrible deal of nonsense in certain of his
physiological speculations.
Clinic of the Month.
=The Pressure and Ligature Methods of treating Aneurism.=—In the course
of a lecture on aneurism of the femoral artery Mr. Paget, adverting to
these two methods, speaks of them thus: “Taking large numbers of cases
of aneurism together, they are very nearly balanced, on the one side for
pressure, and on the other for ligature. In favour of pressure there is
the experience of the surgeons in Dublin. They seem to have a much
larger number of aneurisms, especially of aneurisms of the popliteal
artery, to treat than we have in England, and they have certainly a
large amount of success. I have no doubt this is in part due to a
well-arranged system, and to the house-surgeons and dressers acquiring a
more special skill than we have yet achieved. On the other hand, there
is the remarkable success attained by surgeons who have constantly
practised, with great skill, the ligature. The success of Mr. Syme in
the ligature of the femoral artery for popliteal aneurism has been so
great that any one who might fairly expect to attain nearly the same
measure of skill would undoubtedly follow the ligature rather than the
pressure. I would prefer, however, to leave the subject open for your
own observation, and say, endeavour to ascertain, as far as you may be
able, which are the cases for the ligature and which are those in which
pressure is more likely to lead to a good result. And in many cases in
respect of which you are doubtful, pressure may be tried first and the
ligature afterwards.” (See _Lancet_, April 24.)
=Treatment of Atonic Dyspepsia.=—Dr. Thorowgood, in a paper just
published, refers to the existence of torpor of the colon as a
complication in cases of this kind. In treating cases of dyspepsia
occurring in those who work hard with their brains and have but little
“tone” about the stomach and bowels, he is convinced that the more we
refrain from the administration of purgatives the better. At one time he
used to think that when the tongue was crusted a purgative could not be
amiss; but to whatever degree this holds good with strong country people
and over-fed townspeople, it does not apply to those who have feeble
appetite and who work hard. In these cases he has seen an acid mixture
or a chalybeate do more service in cleaning the tongue and promoting
digestion than alkalies or aperients. If the colon be filled with
scybalæ, the best evacuant is a table-spoonful of castor-oil in
peppermint water. When the constipation takes on a less or more
obstinate character, he uses a saline chalybeate in imitation of the
saline chalybeate waters of Kissingen, Harrogate, &c. In addition he
gives a zinc pill, with extract of henbane, at night. But he avoids the
use of opium. (See _Lancet_, April 24.)
=Anaemia and Chlorosis treated by Nickel and Manganese.=—Dr. Broadbent
lately read a paper before the Clinical Society (April 9th), in which,
on the principle that chemical substances closely allied have similar
action, he recommended manganese and nickel as substitutes for iron in
the treatment of chorea. He recorded various cases, in some of which
good results appeared to follow this method.
=Operation for Chronic Inversion of Uterus.=—At the meeting of the Royal
Medical and Chirurgical Society, on the 13th of April, Dr. Barnes read a
paper, in which he described a new operation for the relief of chronic
inversion of the uterus. He gave the statistics of the different methods
now in use. He stated that the ligature and excision were open to the
double objection that, besides being very hazardous to life, success was
only achieved at the expense of mutilating the patient. Forcible taxis
was a violent and often fatal proceeding. Sustained elastic pressure had
given remarkable results, but cases would occur where the constricted
cervix uteri would resist simple pressure. He then described a case of
inversion of six months’ standing, which had resisted elastic pressure
kept up for five days, and in which he resorted to a plan then
practised, he believed, for the first time, of making three longitudinal
incisions into the os uteri, so as to relax the circular fibres; taxis
then applied quickly succeeded, and the woman made an excellent
recovery. He proposed, therefore, as the best proceeding where simple
sustained elastic pressure fails, to make an incision on either side of
the os uteri, and then to re-apply the elastic pressure, as being safer
from the risk of laceration than the taxis. (See _British Medical
Journal_, April 24.)
=A Presse-artère for Compression of the Arteries=, which may be found
useful in some cases, has been described by Mr. B. Wills Richardson, of
Dublin. The tubular _presse-artère_ which he has invented is intended
only for immediate compression, but it was used with good result in the
amputation of the fore-arm. The new instrument is composed of two parts.
(1) A fine silver or a fine German silver tube. To the upper end of this
tube a small milled button is soldered. The button facilitates the
turning or screwing of the tube by the fingers of the surgeon. A female
screw is formed upon the upper half of the inside of the tube. (2) A
steel stem having two jaws at its lower end. These jaws are perfectly
smooth on their opposed as well as on their outer surfaces, and free
from any cutting edge. They are so arranged as to open and close
parallel to each other. At the upper end of the stem there is a handle
nut. It is hexagonal only in the present instrument; but, for
recognition in wounds, the handle nut of the _presse-artère_ intended
for large arteries should have some other form when more than one
instrument is in use. The nut is fitted to the stem by means of a square
mortise to prevent it from turning on the stem during the screwing or
unscrewing of the tube. The handle nut is secured in its position by a
smaller but screw nut. The upper half of the stem has a male screw cut
upon it, and is adapted to the female screw on the inside of the tube.
The inventor claims the following advantages for this piece of
apparatus:—(1) The smallness of the space it occupies. (2) Facility of
application and removal. (3) Accurate graduation of the compression by
means of the fine screw arrangement. (See _Medical Times_, April 24.)
=Catgut in the Ligature of Arteries.=—In a communication to the
_Lancet_, Professor Lister, after giving numerous pathological details,
refers to the practical importance of catgut as a ligature. He states
that by applying a ligature of animal tissue antiseptically upon an
artery, whether tightly or gently, we virtually surround it with a ring
of living tissue and strengthen the vessel where we obstruct it. This
antiseptic animal ligature consists of catgut steeped in carbolic acid
and oil. And with such a ligature Professor Lister says he should now
“without hesitation undertake ligature of the innominate, believing it
to be a very safe proceeding.” He thus expresses himself as to the
necessary qualities of the ligature:—“The method which I have found to
answer best is to keep the gut steeped in a solution of carbolic acid in
five parts of olive oil, with a very small quantity of water diffused
through it.” A larger proportion of the acid would impair the tenacity
of the thread. If a mere oily solution is employed, the gut remains
rigid, the oil not entering at all into its substance. But a very small
quantity of water, such as the acid enables the oil to dissolve, renders
the gut supple without making it materially weaker or thicker. And,
curiously enough, the presence of this small amount of water in the oily
solution gradually brings about a change in the gut, indicated by a deep
brown colour; after which it may be placed in a watery solution for a
long time without swelling, as a portion prepared in a simple oily
solution does. This is a great convenience; for an oily solution is
unpleasant to work with during an operation, and exposure to the air
soon renders gut suppled with water rigid from drying. But when it has
been treated in the way above recommended, it may be transferred to a
watery solution at the commencement of an operation, and so kept supple
without having its strength or thickness altered. “For tying an arterial
trunk in its continuity, catgut as thick when dry as ordinary purse-silk
will be found best. But for ordinary wounds, where, if one ligature
happens to break, another can be easily applied, much finer kinds may be
employed, and are convenient from their smaller bulk.” (See _Lancet_,
April 3.)
=The Advantages of Tracheotomy.=—Mr. T. R. Jessop corroborates the views
expressed in our last Number by Mr. A. E. Durham. He gives some very
remarkable cases, showing the great usefulness of the operation. Indeed,
one case was a veritable resuscitation of life. (Ibid.)
=Arsenic a Cause of Shingles.=—The very important problem as to whether
arsenic, when continuously administered, is productive of shingles, is
again discussed by Mr. Hutchinson. Mr. Hutchinson does not assert the
fact to be more than a coincidence, but he relates several very
interesting cases in which the prolonged use of arsenic was followed by
shingles. (See _Medical Times_, April 17.)
=The Treatment of Diabetes.=—Dr. Basham records some cases of diabetes
treated very successfully with alkalies and the phosphatic salts of
ammonia, and he expresses an opinion very favourable to this method of
treatment. The following is the prescription employed:—Phosphate of
ammonia and carbonate of ammonia of each ten grains, aromatic spirit of
ammonia half a drachm, water an ounce, added to the juice of a fresh
lemon, and taken three times a day. This line of treatment was continued
for four months, with the results tabulated below:—
Mean Sugar
sp. gr. per oz.
September (began phosphatic salts) 1037 18 grains.
October 1040 18 grains.
November (great increase of urates) 1036 6 grains.
December 4th (large proportion of urea and
urates) 1018 ½ grain.
December 28th (urea and urates in excess, a large
crop of crystals of oxalate of lime after
cooling) 1024 Nil.
January 26, 1869 (same as above) 1026 Nil.
(See _British Medical Journal_, April 10.)
=Silver-wire Ligatures for the Pedicle in Ovariotomy.=—Dr. Marion Sims
calls attention to a recent case in which he performed ovariotomy, in
order to explain his method of dealing with the pedicle. In the
particular instance the walls of the abdomen were so thick, and the
pedicle was so short, that it would have been impossible to secure it in
the usual way by the clamp externally. In such cases he has always held
that the pedicle is best secured with silver-wire ligatures and dropped
back into the pelvic cavity. “If the pedicle be small, it is enough to
transfix it with a double silver-wire and secure the two halves by
firmly twisting the wires on opposite sides.” If it be broad, it
requires a number of separate wires. This case required eight deep
silver sutures for closing the external wound, care being taken to pass
them through the divided edges of the peritoneal coat. A piece of lint,
wet with carbolic lotion, was laid over the wound, and secured by a
bandage, and a large compress of cotton wadding. The urine was drawn off
for three days. There was no constitutional disturbance, and the patient
was convalescent from the moment of the operation. (See _British Medical
Journal_, April 10.)
=Perchloride of Iron in Post-partum Hæmorrhage.=—Mr. Hugh Norris
corroborates the testimony of the various obstetricians who have spoken
so favourably of this styptic. Injections of strong solution of the salt
instantly arrest the hæmorrhage in this dangerous class of cases. He
noticed also that the perchloride has a peculiar corrugating effect on
the superficial muscular fibres, as well as on the mucous surfaces. He
has noticed in less than five minutes after injection that the sphincter
vaginæ, which had previously allowed the passage of the hand, became so
contracted that it barely admitted a single finger. From this he
concludes that one of its beneficial effects in these cases is the
contraction of the muscular fibres of the uterus. He lays down the
following conclusions in reference to this preparation:—(1) We possess
no topical styptic in efficacy at all approaching the perchloride of
iron; its effects being certain, perfect, and instantaneous. (2) In
_post-partum_ hæmorrhages, a solution of this salt, applied in the form
of an intrauterine injection, is of the utmost value both in immediately
arresting the flow of blood and also in causing a permanent contraction
of the recently emptied uterus. Its presence in the cavity of the uterus
_post-partum_ is not only not injurious, but on the contrary, from its
well-known antiseptic properties, may frequently be productive of
positive benefit in more ways than one. Mr. Norris employs a saturated
(?) solution of the perchloride. All clots must first be removed, and
the long tube of the syringe should be introduced thoroughly into the
uterus before injection. (Ibid.)
=The Cure and Prevention of Scurvy.=—In a paper in the _Lancet_, Mr.
Archer Farr starts a doctrine which is yet, we think, to be proved, viz.
that scurvy is not caused by the absence of certain alkalies and the
presence of others. Indeed, he refers scurvy to the absence on
ship-board of proper flesh-food, and he thinks that by supplying flesh
in thoroughly good condition scurvy may be avoided. Lime-juice acts, he
says, by taking the place of the gastric juice and digesting the food,
and thus promoting the nutrition of the body (!). (See _Lancet_, March
27.)
=Treatment of the Vomiting of Pregnancy.=—Mr. John Harrisson recommends
that in these cases hypodermic injection of morphia be tried. He gives
the report of a very decided and serious case, in which nearly every
conceivable remedy had been employed in vain. He then tried the
subcutaneous injection of acetate of morphia, in doses of one-sixth of a
grain, three times a day, and this instantly arrested the vomiting. (See
_British Medical Journal_, April 3.)
Extracts from British and Foreign Journals.
=Carbolate of Soda as a Remedy for Itch.=—Dr. Zimmermann, of Braunfels,
remarks that no one who sees much of itch will deny that we are without
any remedy which acts with the certainty of a specific. In private
practice, where we cannot readily obtain the proper baths, frictional
manipulations, &c., cases are apt to be very inveterate. The popularity
of petroleum and Peru balsam is due chiefly to their being neither very
disagreeable nor very troublesome in the use; but petroleum has not
justified its reputation,[12] while Peru balsam, which really is very
valuable, especially in recent and in children’s cases, is unfortunately
very costly. Zimmermann is inclined to hope that in carbolate of soda he
has found a remedy that will cure scabies, _tuto_, _cito et jucunde_,
though his experience is not yet sufficient for absolute proof. He
employs a solution of 160 to 320 grains of the salt in about 7 ounces of
water; this is to be well rubbed into the affected parts thrice daily.
In two or three days every case of Zimmermann’s, even the inveterate
ones, has been completely cured, and this without any annoyance or
interruption of the patient’s ordinary business. There is no irritative
erythema of any consequence from the frictions. Carbolate of soda may be
used as a disinfectant and deodoriser; for this purpose 16 to 32 grains
to 7 ounces of water is sufficient. (_Der Praktische Arzt. März._)
=On the Contra-indications of Anæsthesia.=—M. Gosselin considers that
alcoholism renders patients very unfit for taking chloroform, and thinks
that to all persons above 50 years of age, and given to intemperance,
chloroformisation should be forbidden; or at any rate only applied with
the greatest caution, and never for a long time together. Professor
Nagel, of Vienna, has recently opposed this wholesale condemnation. In
delirium tremens, chloroform narcosis is often very useful, especially
where it is necessary to set fractures. The severest delirium, on which
large doses of opium produce no effect, has been repeatedly calmed by
chloroformisation in Nagel’s own practice. Alcoholism only so far
contra-indicates anæsthetics, that in refractory subjects it is
necessary to push the agent in such large doses that, even with the
greatest care, there is a risk of asphyxia.
An even more positive contra-indication to chloroform is found by
Gosselin in the case of stupor following severe wounds. No one will
dispute that narcotisation is at first entirely out of the question; it
only remains doubtful for how long a time after the injury it is unsafe
to give chloroform for operative purposes. Gosselin is for total
exclusion, since even after the apparent departure of stupor, a kind of
concealed shock to the system may still exist, and would render
anæsthesia dangerous. He also thinks that in recent dislocations,
especially of the shoulder, chloroform is not only usually needless, but
contra-indicated by the fact that the patient’s want of sensibility may
permit such force to be used as may inflict severe injuries upon the
nerve trunks; and even in old dislocations chloroform should not be used
till other means have been tried. This contra-indication, also, is
opposed by Nagel, who brings a large amount of experience to controvert
it; it even happens, sometimes, that the muscular tone can be
sufficiently relaxed for the reduction without any loss of
consciousness. The chief contra-indication to chloroformisation which
Nagel admits is the pre-occurrence of long-standing or considerable
(arterial) hæmorrhage, and advanced age, especially if there be also
heart or lung disease, vascular degeneration, emphysema, &c., also the
fact that the operation might cause blood to enter the larynx; and in
hernia, because of the tendency to vomit. He recommends the greatest
care in giving it to refractory patients, who struggle, scream, and hold
their breath. The danger of asphyxia increases every moment, and it is
necessary to have ready the means of throwing in a stream of pure air or
of oxygen, through the _nose_, sprinkling the patient with cold water at
the same time. Nagel has also observed that the restlessness and
oppression produced by half-felt pain in incomplete narcosis, and the
consequently insufficient respirations, may produce an even fatal
exhaustion. Narcosis should therefore be properly kept up as long as it
is wanted. (_Der Praktische Arzt._)
[It is very necessary that we should study the opinions of foreign
physicians and surgeons as to the dangers of anæsthesia. At the same
time, I think it right to protest here that the cautions given even by
Nagel, and still more those which Gosselin inculcates (with two
exceptions), are to me inexplicable. At least they can only be
understood upon the supposition that the means of inducing anæsthesia
which are employed by these authorities are extremely inefficient and
improper. A former very large experience of chloroform administration,
some years ago, impressed me with the confident belief that if
chloroform be given with proper care and with a Snow’s, or still better
a Clover’s apparatus, there is really no danger whatever in its use,
except in two cases—that of shock after severe injury, and that of
delirium tremens. I cannot admit that a patient who is in a fit
condition to undergo a surgical operation at all is placed in any worse
position for supporting the shock of it by the fact that he has been
chloroformised, if this has been skilfully done—the case of severe shock
from injury always excepted.—F. E. ANSTIE.]
=Subcutaneous Injection of Mercury in Syphilis.=—Dr. A. Stöhr records a
series of clinical observations on this method of treatment, which are
very interesting. He considers that the subcutaneous injection of the
bichloride is the most effective and direct means of producing the
curative effects of mercury which has ever been applied. Stöhr employed
the treatment for 96 patients; in almost all the cases it was carefully
ascertained that no specific treatment had been previously adopted. His
cases included a larger relative proportion of inveterate syphilis than
those treated by Lewin in his researches, described by M. Bricheteau in
the _Practitioner_ for March. Stöhr considers that the hypodermic method
is not needed for the milder forms of syphilis. Old and obstinate cases,
on the other hand, in which inunction or other forms of mercurialisation
have been vainly tried, are particularly appropriate for a trial of the
subcutaneous method. It is especially indicated in such cases as those
of iritis and of dangerous laryngeal affections, in which it is
important to produce a very rapid effect; also in severe and extensive
syphilitic skin affections, in which inunction cannot be applied.
Syphilis of the bones and periosteum, and syphilitic gummata, are but
little influenced by hypodermic mercurialisation. In cases accompanied
by severe marasmus, the hypodermic use of mercury is contra-indicated.
It is also inappropriate to the treatment of those persons who have to
be treated as _out_patients of a hospital. Stöhr employs a solution of
corrosive sublimate in distilled water: he had at first tried a solution
in glycerine, but this did not prove practically convenient. The dose
ordinarily used was ⅛ of a grain; the daily employment of this only
slowly produces ptyalism. When ¼ grain doses were used daily, the
slighter symptoms of ptyalism never failed to occur by the third or
fourth day, and the severer phenomena by the eighth or ninth; so that,
with few exceptions, the administration of 2 or 2½ grains in this way
produced such a strong development of salivation that the treatment had
to be interrupted. (_Deutsches Archiv f. klin. Med._ V. 3 and 4.)
=The Treatment of Diabetes.=—Dr. Leube gives an elaborate report of two
cases of diabetes in which he made the most careful daily observations
of the quantity of water, of sugar, &c. He arrives at the following
therapeutic conclusions:—Pure meat diet (with only _almond_ bread) was
the most powerful means of reducing the sugar excretion. Of drugs which
were tried, _arsenic_ had by far the most remarkable effect in reducing
the sugar. Saikowsky discovered, some three years ago, that the
continuous administration of arsenic for several days to animals
entirely removed all glycogen from the liver; and that then neither
puncture of the fourth ventricle nor curara poisoning would produce
diabetes at all. Leube made the therapeutical application of the drug
which these experiments suggest. He administered Fowler’s solution in
doses equivalent to about ⅓ grain of arsenic daily. The effects were
most striking during the period when the patients were taking a _mixed_
diet. With mixed diet, and without arsenic, the daily average of sugar
was 570 grammes in one case; arsenic reduced it to 352 grammes, on the
average of 79 day and night observations; and substantially the same
result was obtained in the other case. The use of this drug would appear
to promise results of real importance. (_Deutsches Archiv f. klin. Med._
V. 3 and 4.)
=A German Criticism of Lister’s Treatment of Abscesses.=—Dr. W. Rosco
publishes a very sharp critique on this plan of treatment, which has
lately become so fashionable. He analyses minutely the sixteen cases
which were published in the _Archiv f. Heilkunde_ (and reported in the
_Practitioner_ for July 1868), and maintains that the results obtained
were not more favourable, if so favourable, as those which are often
obtained without any use of carbolic acid. Rosco maintains that there
are two weighty objections to the too free and indiscriminating use of
this treatment for abscesses. In the first place, there is a danger that
surgeons, trusting blindly to the antiseptic action of the carbolic acid
dressing, will open cold abscesses either unnecessarily early, or even
in cases where incision is altogether improper. Secondly, the caustic or
irritant action of the acid will occasionally produce mischievous
effects. But the main point of his argument is directed to the
demonstration, that even the most brilliant results which have been
obtained in England, and published by Lister and others in the columns
of the _Lancet_, are by no means conclusive in showing that the carbolic
acid was really the curative agent. He observes, moreover, that although
in England the treatment has been most extensively tried everywhere, the
majority of hospital surgeons appear very sceptical about it.
Undoubtedly Lister’s method deserves every attention, and should be
tried in appropriate cases, but the inquiry should not be made with too
much credulity, but with prudent doubt. (_Archiv f. Heilkunde_, 2,
1869.)
=Electricity in the Diseases of Children.=—Dr. Ullersperger gives a good
summary of existing knowledge as to the uses of electricity in the
paralyses of common and special sensation, and of motion, in children.
The paper is a useful one, but does not contain any original matter on
which it is necessary to comment here. (_Journ. of Kinderkrankheiten_,
and Jan. Feb. 1869.)
=Liebig’s Food for Infants.=—Dr. Kjelberg related to the _Gesellschaft
schwedischer Aerzte_ his experience of the use of Liebig’s food for
infants as a remedy. Six cases of diarrhœa occurred in the Children’s
Hospital among infants of from 1½ to 2 years; five of them had already
been treated with medicine without effect. A thin broth made from the
“food” was given them as their only nourishment, and all medicine was
discontinued. The motions at once assumed a better appearance. In one
case, which had no previous treatment, the effect of the exclusive use
of Liebig’s food was very striking. Kjelberg says that he had used the
treatment in two cases of children, private patients, in whom not
diarrhœa, but obstinate constipation was the malady. The children were
still suckled, while the food was administered. The peristaltic function
of the bowels rapidly became normal and regular. Kjelberg thinks that
Liebig’s food possesses the capacity of _regulating_ the activity of the
intestinal canal. (_Ibid._)
=Hypodermic Injection of Ergotin in the Treatment of
Aneurism.=—Professor Langenbeck writes an important paper on this
subject. From the well-known influence of ergot in provoking
contractions of the organic muscular film of the uterus, he was led to
think that a similar stimulation might be produced by it, with
beneficial effect, in the muscular coats of arteries in cases of
aneurism. The first case in which he employed it was one of subclavian
aneurism in a man aged 45. The tumour was treated in the first place on
Jacobson’s plan, with the repeated application of moxas, and a great
diminution of all the symptoms took place, and lasted for three years;
but the pulsation continued. In consequence (as the patient thought) of
an excessive summer heat, a relapse took place, the tumour enlarged
greatly, and all the old symptoms returned. Three centigrammes of
aqueous extract of secale were injected over the tumour, with great
relief to the pain and consequent insomnia. Between January 6 and
February 17 about 30 grains of ergotin were injected, with the effect of
so greatly relieving the symptoms of pressure in veins, that the pain
and paralysis of the arm and hand were diminished to a remarkable
extent. The pulsations of the aneurism were also sensibly weakened, and
the tumour somewhat sunken. In a second case—one of aneurism of the
radial, about an inch and a quarter above the wrist, and which had
existed for many years—about 1/4th of a grain of aqueous extract of
secale (dissolved in seven times its bulk of half and half glycerine and
sp. rectif.) was injected into the skin above the tumour, and on the
following day the tumour appeared to have vanished. The cure became
permanent, and the only trouble was a local erythematous inflammation
which lasted some days. Langenbeck discovers that it was natural that a
more powerful effect should be produced by the remedy in radial than in
subclavian aneurism, since the radial artery is more copiously furnished
with muscular fibres than the subclavian. (_Berlin Klin. Wachensch._ 12,
1869.)
=Pruritus of the Skin of the External Auditory Meatus.=—Dr. J. Gueber
describes under this name, not the itching and eczema of the ear so
often left after scabies, but a special affection, first named as above
by Hebra, in which the itching is the _only_ symptom. It occurs most
frequently in middle age, and in persons who, from one reason or
another, have a defective circulation. There are frequently periodical
exacerbations of the irritation. Gueber recommends, as a palliative,
applications of water and oily matters for radical cure, repeated
painting with a strong solution of nitrate of silver, till inflammatory
reaction is set up. Along with this, however, there must of course be a
suitable rational treatment, according to the special indications which
present themselves. (_Allgem. Wien. Med. Zeitg._ 52, 1869.)
=New Remedies.=—Dr. G. W. Lawrence, writing to the _Philadelphia Medical
and Surgical Reporter_, states that the following substances, whose
qualities he briefly describes, have been recently tried by him in
practice:—_Quiniæ Iodo-Sulphas_. It has proved to be a desirable
alterative and tonic, serviceable in consecutive syphilis, scrofula,
cachexia, neuralgia, some forms of paralysis, and in debilitated
conditions of the general system. Given in pill form, or mixed with
syrup of sassafras bark or blended with elixir of Calisaya bark.—_Iodide
of Antimony._ An alterative, used chiefly in skin diseases, those forms
arising from constitutional ills and secretory disturbances. Prescribed
with aromatic syrup of dulcamara. He has recently used iodide of
antimony as an anaphrodisiac with satisfactory results. He combined it
with lupulin, and gave it in pills every six hours.—_Iodide of
Manganese._ Alterative, administered generally with the iodide, or some
other desirable preparation of iron, or with quiniæ iodo-sulphas, in
anæmia and chloro-anæmia, with resin podophyllin, in chronic splenic and
hepatic derangements. In the alterative agency of manganese, he fancied
that a determined action is exercised on the ganglionic system of
nerves.—_Glycerole Pyrophosphate of Iron._ In the formula pure glycerine
is substituted for sugar, or simple syrup; each fluid ounce (with
glycerine) contains sixteen grains of pyro-phosphate of iron. This new
preparation is unchangeable, and is one of the most palatable of that
family of tonics. He employs it usually as an eutrophic in that spanæmic
condition of the system so frequently provoked by the protracted use and
abuse of iodides and bromides of potassium. He also uses it when
indicated, in progressive paralysis, motor ataxia, in threatening a
supposed incipient _ramollissement_ of the brain and spinal marrow.
=Carbolate of Lime in Pertussis.=—Dr. Snow, of Providence, has suggested
the use of carbolate of lime in hooping-cough, and in all cases it has
apparently produced a marked effect in diminishing the frequency and
severity of the paroxysms. Small quantities of the carbolate of lime are
placed in saucers in the room where the child sleeps; merely sufficient
to make the odour perceptible. (_New York Medical Record._)
=Bromide of Potassium and Antimony in Puerperal Convulsions.=—Dr. T. N.
Simmons reports the history of a case of puerperal convulsions, in which
the efficacy of these remedies was evident. A primipara, while in
labour, with the head of the child in the inferior strait, was seized
with a violent convulsion, which was followed by four others, with an
interval of about 15 minutes between each. Chloroform proving of no
benefit, bromide of potassium was administered, beginning with a dose of
40 grains in combination with half a grain of antimony. In combination
with the bromide one-half grain of the antimony was given every hour and
a half or two hours, until three grains of the antimony were taken.
After the first dose there was a return of four paroxysms. The first
occurred within an hour, the second in two hours, the third between
three and four hours, and the fourth in eight hours. Their intensity and
duration were also diminished in the order of their recurrence.
Convalescence was rapid. (_N. O. Journal of Medicine._)
=An Acidulated Solution of Pepsine as a Solvent for False Membrane in
Diphtheria.=—Dr. W. H. Doughty has communicated to the _Richmond and
Louisville Medical Journal_ an article upon this subject, with a history
of a case in which he was entirely satisfied with the efficacy of
pepsine in diphtheria. The patient was about 25 years of age, of feeble
general health from intermittent fever. He presented himself with sore
throat. For the affection cauterization was resorted to, and a gargle of
chlorate of potash ordered. The throat became very much inflamed and
swollen, and the glands about the neck enlarged. About the fourth day
exudation of membrane was observed under the tongue, a portion of which
was removed with forceps. The swelling increased, and the membrane
continued to re-form. Quinine and stimulants were freely used, with
inhalations of lime-water. On the fifth day commenced the application of
pepsine to the membrane, keeping up the same general treatment. Pepsine
was used in the following proportion: ℞ pepsine ℨj; acid muriatic,
dilute, gtt. x; water q. s. ad ℥iij.: M. and filter. This was applied by
means of a hair pencil continuously. A few hours from the commencement
of the application, “the mouth, as far as visible, is cleaner and
better.” On the next day the patient feels better; no appearance of
exudation; mouth is clean, but continues to discharge broken-down opaque
masses from the throat, and thinks he must have suffocated but for the
solution employed. The breathing is comparatively easy and cough less.
Patient died on the seventh day, of asthma.
=Impermeable Dressings in Eczema.=—In an article on this subject in Mr.
Erasmus Wilson’s “Journal,” Mr. Alfred Pullar makes the following
remarks on the value of this mode of dressing:—“The method of local
treatment first brought into notice by Professor Hardy at the Saint
Louis Hospital in Paris, consists in covering the diseased parts
completely with vulcanized india-rubber cloth (_toile caoutchouquée_).
The material used for this purpose is ordinary cotton cloth covered with
a solution of caoutchouc and subsequently vulcanised: by this means it
is rendered impermeable to watery fluids, and acquires on one side a
smooth surface. The therapeutical effects resulting from a covering such
as that described would seem to depend essentially upon two
conditions:—_First_, the exclusion of the air. As it has been proved by
experience that the influence of the atmosphere increases the
inflammation of the diseased surface, its complete exclusion fulfils an
important indication in the treatment: this is accomplished by the
india-rubber covering, which also protects the abnormally sensitive skin
from variations of temperature. _Second_, the retention of the
secretions of the skin. These—exuded in considerable quantity, and
_unchanged_ by the atmosphere—are retained in contact with the skin, and
seem to act by relaxing the inflamed structures. Whilst visiting Hardy’s
wards at the Saint Louis Hospital, I had the privilege of seeing several
cases of eczema treated by this means (these cases being chiefly eczema
of the limbs in old people). The impermeable dressing was so applied as
to cover completely the affected parts, and was removed, from time to
time, in order to be cleaned and re-applied. Under this treatment, the
painful symptoms of the disease were greatly relieved; and the morbid
surface gradually assumed a more healthy appearance.” (_Journal of
Cutaneous Medicine_, April.)
=Tetanus treated with Calabar Bean.=—Drs. Boslin and Curron (_Chicago
Medical Journal_) have treated a case of acute traumatic tetanus of
violent character with large doses of morphia and calabar bean. For a
portion of the time, a grain and a half of morphia and three grains of
the powdered bean in glycerine were given every hour, with the manifest
effect of quieting the patient and relieving the spasm. The patient
recovered.
=The Therapeutics of Bismuth.=—In the _California Medical Gazette_, Dr.
W. F. Mac Nutt has a paper on “Some of the Uses of Bismuth,” in which he
states that he finds this drug more valuable than it is often supposed
to be. Some of his ideas on its therapeutics are novel. “I believe,” he
says, “that bismuth not only destroys the sulphuretted hydrogen present
in the bowels, but is an antiseptic to albuminous matters, preventing
their putrid decomposition. That bismuth destroys the sulphuretted
hydrogen present in the bowels, is proved by the fact that if
administered for a few hours in considerable quantity the flatulence
disappears; and if a dose of oil is given, the evacuations are as black
as tar, where the evacuations were natural or clay-coloured before the
bismuth was given. It is the chemical action of the gas upon the bismuth
which gives the evacuations their black colour. But a small portion of
bismuth, when given in powder and in doses from gr. v to gr. xx, is
dissolved in the stomach and absorbed. The remainder passes undissolved
into the bowels, and while it may have some local anæsthetic action on
the bowels as on the stomach, it will be comparatively inert unless
there be sulphuretted hydrogen present. Its action on the sulphuretted
hydrogen is more particularly demonstrated when given for chronic
diarrhœa. Some have attributed to bismuth astringent, tonic, and
sedative properties, on account of their success with it in chronic
diarrhœa. Others have given it for the same disease without the
slightest benefit, and consequently have denied that it has astringent,
or sedative, or tonic properties. While the fact is, that in cases of
diarrhœa that are caused or kept up by the poisonous effect of
sulphuretted hydrogen, I have given bismuth, combined with a few grains
of Dover’s powder, with more real benefit to the disease than any drug I
could administer. Opium alone is useless, or worse. Charcoal, by
absorbing the gas, has been, next to bismuth, the most beneficial.
Chambers on ‘Indigestions’ says that it is ‘rare to find sulphuretted
hydrogen or hydro-sulphate of ammonia excreted without watery or soft
pultaceous stools. They appear to be purgative poisons.’ They are not
always purgative poisons.”
=Physiological Action of Absinthe.=—The following are the conclusions
which M. Magnan laid before the French Academy of Sciences, and which
have given rise to some discussion in the weekly journals:—1. The
epileptic or epileptiform accidents in alcoholism—or, in other words,
alcoholic epilepsy—are of a radically different nature, according as the
alcoholism is acute or chronic. 2. In acute alcoholism the epilepsy is
under the complete influence of an external agent, of a poison
(absinthe) which of itself alone causes the epileptic attack; it is
epilepsy by “intoxication.” 3. The alcoholic epileptics exhibit the
ordinary features of simple alcoholic cases, and also superadded
phenomena, among which the epileptic attack is dominant. 4. These two
groups of symptoms (the alcoholic symptoms and alcoholic convulsions),
united in the same subject, have a relation to the twofold nature of the
poison (absinthe), whose elements are absinthe and alcohol. 5. In
chronic alcoholism the epileptic or epileptiform accidents are under the
direct control of organic modifications which take place in the patient.
The excess of liquids, in gradually altering the tissues, renders them
capable, under the influence of various causes, of producing by
themselves convulsive epileptiform phenomena, accidents analogous to
those that we see take place in other patients in certain cases of
lesions of the nervous centres (general paralysis, tumours of the brain,
&c.) (_Comptes Rendus_, April 5.)