THE DOSE OF ATROPIA FOR SUBCUTANEOUS INJECTION.—I wish to answer the
query of Dr. Sisson in the _Practitioner_ of last month with every
caution, but I have formed a strong opinion on the subject in question.
A “Country Practitioner,” who wrote to this journal in February, states
that he used to give hypodermic injections of more than ⅕ grain of
atropia daily, to the same patient, for years. Now I stated in my paper
in this journal (July 1868), that such doses as these are utterly
unsafe, and I retain that opinion. Supposing that the sulphate of
atropia was good, which it is very possible it was not in the “Country
Practitioner’s” case, I can affirm, from my own knowledge, that there
are many patients to whom such a dose would be dangerous and probably
fatal, if it were really fairly introduced into the subcutaneous tissue.
_I have seen uncomfortable atropism from the injection of less than
1/100 grain_: a case occurred to me only a week or two since. It is
therefore unadvisable to begin, at any rate, with large doses. With a
large experience of subcutaneous injection, I am enabled to say with
confidence that 1/60 or 1/50 grain doses are what are best borne by the
majority of persons; that sometimes, but not often, it is necessary to
go as far as 1/30 grain; and that not unfrequently patients will not
bear as much as the 1/60 without uncomfortable atropism. Hence my
recommendation to practitioners to commence, experimentally, with such a
small quantity as the 1/120 grain.—F. E. ANSTIE.
STRYCHNIA AS A REMEDY IN A SEVERE CASE OF NERVOUS HYPERÆSTHESIA.—Mr. H.
A. Allbutt, of Leeds, writes to us:—“The following case may be of some
interest to the readers of the _Practitioner_, as in some of its
symptoms it presented some curious phenomena. Mrs. A——, a married lady,
about thirty-six years of age, consulted me in last November for
lameness, and great pain and difficulty in walking, with obscure pains
in her back and sides, severe palpitation, restless nights, loss of
appetite, and great nervousness. She often, too, complained of dimness
of vision, and the thumb was at times flexed across the palm of the hand
in a spasmodic manner. In addition to these symptoms, she suffered from
prolapsus uteri and menorrhagia. The difficulty and pain in walking
were, however, the most prominent features of the case. She could not
raise her feet the height of a step, and her locomotion was most
curious, consisting of a sort of corkscrew motion, or twisting of the
foot and thigh each step that was taken. This had been going on for
three years, sometimes better and sometimes worse, but on the whole she
was gradually getting worse. I learned from her that when younger she
had been of a strong, healthy nature, and suffered from little illness
till her marriage. She seems to have suffered severely during her
various confinements from floodings, &c., and from the time of her last
confinement she has been affected more or less in the manner described.
In regard to the cause of this condition, I am of opinion that her
nervous system had been much weakened, and thrown into an excitable
condition by the shocks of labour and by the floodings at those times.
In this opinion I was borne out by Dr. Allbutt, of Leeds, who saw the
case with me. The treatment at first consisted of the various
preparations of steel, of which I found the ferri ammon. cit., combined
with bromide of potassium, to be the best. Tannic acid pessaries were
also ordered to be introduced into the vagina for the relief of the
prolapsus uteri, and a hypodermic injection of morphia was given every
night for three weeks. Under the influence of these remedies she
improved in her general health, and the lameness was improved in a
slight degree; in fact, she seemed to arrive at a certain standard of
health and to advance no further. I was now induced to try strychnia, in
the form of pills, combined with carbonate of iron. The dose was 1/20
gr. twice a day. The effects were marvellous. The lameness is fast
disappearing, and she is able to walk out of doors, which she has not
done for fifteen months. I firmly believe she will be quite cured if the
treatment is persevered in.”
MURIATE OF AMMONIA AS A REMEDY.—Dr. Cholmeley has kindly sent us a note,
the manuscript of which, by an unfortunate accident, has been mislaid.
The substance of his remarks is as follows:—He confirms the observations
of Dr. Anstie, in a paper in the December number of the _Practitioner_,
as to the great efficacy of the muriate of ammonia as a remedy for
neuralgic and myalgic pain. But Dr. Cholmeley goes on to say, that with
regard to a matter on which Dr. Anstie spoke more doubtfully,—the
efficacy, namely, which certain authors have ascribed to this drug as an
emmenagogue,—he has formed from a large experience a decided opinion in
favour of the utility of this medicine. He is convinced that in a very
large number of cases of absent or suppressed menstruation, muriate of
ammonia acts in a very direct and powerful manner in establishing or
restoring the flux. Dr. Cholmeley has now experimented with the muriate,
in doses of 10 to 20 grains, in so large a number of hospital and
dispensary patients, that he cannot suppose there is any room for
fallacy in this conclusion.
[Since the date at which the paper referred to by Dr. Cholmeley was
written, we have had occasion to employ the muriate of ammonia in two
cases of amenorrhœa, with apparently very striking and direct results of
a curative kind. As yet, however, we must confess ourselves unable to
lay down any definite rule as to the class of cases to which it is
applicable with the best chance of success, beyond a general idea that
it acts best in persons not anæmic, but possessing a weak and mobile
nervous system.—EDS. PRACT.]
ETHER SPRAY IN OPERATIONS ABOUT THE ANUS.—Dr. John Barclay, of Banff,
writes to us as follows:—“I write to corroborate what was written by Mr.
Alexander Bruce, in the _Practitioner_ for last month, concerning the
employment of ether spray in operations about the verge of the anus. I
have experience of it in two cases. The first was the slitting up of a
hæmorrhoid containing a clot, and when the ether spray was directed on
the part the patient screamed in intense agony, comparing it to nothing
else than the introduction of a red-hot iron. The pile was opened
without it, and the patient said the cutting was as nothing compared
with the spray. The second case was very similar to this, and the result
here was the same. So that I never dream now of recommending the
freezing by ether in operations in that region. I may remark that it is
a curious thing ice never seems to give pain when so employed.”
TREATMENT OF HÆMORRHOIDS.—Mr. J. Christophers, of Wadebridge, Cornwall,
sends us the following note:—“The pain and risk attending operations for
the removal of hæmorrhoids, whether by knife, ligature, cautery, or
caustic, render valuable any less heroic mode of treatment, whereby the
necessity for using the means alluded to may be dispensed with, or even
rendered less frequent. The term hæmorrhoid or pile being used to
signify a tumour caused by enlarged or varicose veins at the lower part
of the rectum, the definition of the disease would seem to indicate its
treatment—pressure and support. The benefit resulting from pressure on
tumours, and from pressure and support applied to varicose veins
situated on the surface of the body, is manifold and manifest. The same
good results often attended pressure internally applied in cases of
hæmorrhoids, and frequently in cases of prolapsus also. Occasionally
after having introduced the finger into the rectum, in cases of
hæmorrhoids, for the purpose of exploration, I have heard with surprise
the patient affirm that the examination had temporarily relieved the
severity of his pain. Continuous pressure exercised by means of the
rectum plug, of a size, form, and material suited to these cases, in
many instances, affords immediate relief, and often effects ultimate
cure; the rectum plug being nothing more than a simple cone or peg,
terminating in a short stem or disk, having a hole bored through its
long diameter formed of metal, ivory, wood, membrane, or of other
material capable of inflation. Any of these substances answer the
purpose, some being suited to one kind of case, some to another. Those
formed of wood have in my hands answered well, and have often achieved a
success that has exceeded my expectations. The shape and size best
suited to individual cases experience soon teaches. A not unfrequent
obstacle in treating cases by the rectum plug will be found to consist
in the intolerance by the rectum in some patients at first of its
presence; perseverance in its use gradually and surely overcomes this
difficulty. After a short probation all discomfort ceases, and the plug
can be worn by day and by night, sitting, riding, walking, or standing,
with the best results, and that not only in cases of hæmorrhoids, but in
bad cases of prolapsus also. So much is this the case that many who have
worn a rectum plug, though with difficulty at the beginning, give up its
use, even when the malady that demanded its application is cured, with
reluctance and regret, saying that they derive comfort and support from
its presence. These circumstances induce me to think that this safe and
simple means of treating hæmorrhoids has been too much neglected, and
for this reason I venture to bring it under the notice of the
_Practitioner_.”