Part 3
When I reached home that evening I do not think my patient was any happier than I was over my success with the nux vomica in a purely experimental case. The next morning Mr. M. informed me that he had slept through nearly the entire night, which, owing to the cough, he had not been able to do in a week. The patient from that night had no return of severe paroxysm of coughing. I furnished him with fresh drops every day, and he became so well posted in their dosage and use that in a few days the cure of the cough was complete. And I may here add that I have had several similar cases of cough since that, and the nux vomica has succeeded in all. If physicians would more closely diagnose their cases of cough, I will venture to say, there might be discovered more than one case of neurotic origin and laryngeal.
CASE IV.—Mrs. L. S., age 40, is of nervous temperament and has occasionally attacks of a mild form of hysteria. About one month ago I was called to Mrs. S., who, I found, had the usual symptoms of “grippe.” I treated her accordingly, and she was convalescing nicely. I had made my morning call, and found her doing fairly well—excepting that she complained of a slight shortness of breath. I carefully examined her lungs, but there were no indications of pneumonia. In the afternoon, about 3 o’clock, I received a hurried message to come without delay to see Mrs. S. I found her in a very nervous, somewhat hysterical and desponding condition; her face was flushed, she had distressing dyspnea, cardiac palpitation, pulse 112, small, weak and frequent, which of course was due to the functional cardiac derangement—there being no indication of organic disease. She called my attention particularly to her difficult breathing so soon as I reached her bedside, and begged for relief. I took in the situation at a glance, and wasted no time in thinking of a remedy to meet the case. My previous experience, and knowledge of the efficacious therapeutic action of nux vomica in neurotic affections, prompted its immediate use in this case.
The fifth one drop-five-minute dose reduced the pulse to 100, and in a measure relieved the distressing dyspnea. When four more doses had been given the pulse dropped to 90, and the dyspnea was so nearly conquered that the patient expressed her thankfulness for such speedy relief after a steadily increasing suffering of over four hours. By the time four more doses had been taken respiration was normal and the pulse 84. My medical mission was accomplished, and I left my patient—who was now feeling very comfortable—with instructions to continue the one-drop doses every half hour for four more doses, and then every hour up to bedtime. Next morning she was sitting up in her bed feeling quite comfortable, with respiration normal and pulse 78, the palpitation having entirely subsided. She has had no further trouble up to date.
CASE V.—About two weeks after the occurrence of this last, I was called to Mrs. E. C., age 31. I found her suffering from great dyspnea and palpitation. She was also greatly troubled with flatulent dyspepsia and frequent eructations. The difficulty of breathing and the palpitation of the heart had been increasing for several hours, and as it was a new experience in her life, she and her husband became greatly alarmed lest the attack should prove fatal. But I knew my patient, as she had been one of my clientele for many years. I knew she was of nervous temperament and slightly hysterical. I wasted no time, but administered tinct. nux vomica according to my usual plan; the particulars in this case would only be a repetition of others, and it is unnecessary to recite them. The result was an equally happy recovery.
314 W. 126th St., New York.
_THE THERAPEUTICS OF STRANGULATED HERNIA._
By W. C. ABBOTT, M. D.
No doubt some will smile at the above caption, and say: “The idea! Who ever heard of such a thing?” Others will read what follows and, perhaps, profit thereby.
Strangulated hernia is looked upon as, strictly, a surgical affair, only two ways of treatment being thought of, _i. e._, reduction by taxis or, in case of failure—and if the patient and family will consent, the knife. The former usually fails, and consent to the latter is frequently so long deferred that the result is anything but satisfactory; hence, any measure which is at the same time simple and helpful should be looked upon as a valuable acquisition.
The plan of treatment which I wish to present will best be understood if illustrated by the record of a case in hand. One morning, recently, I was summoned hurriedly to see an elderly German laborer, whose “breach was down,” so the messenger said, and it surely was. Such a scrotal display I never saw before; a mass larger than a child’s head, and as hard and tense as a foot-ball. I thought, at first, that part of it must be an old hydrocele, but was assured by the sufferer that “him all goes back.” This rupture was of some ten years standing. Formerly the hernia was retained with a truss, but of late years it had been allowed to go up and down according to circumstances, never having become strangulated before. Now, my experience has been that when an old man who has had years of practice reducing his hernia fails to put it back, the surgeon has a job on his hands.
In this particular case most of the mass was resonant, but there was a lump the size of a goose-egg, close to the ring, that was hard and gave a perfectly flat precussion note—the omentum—congested by strangulation, the very irritation from which caused a tighter spasm of the muscle-fibres between which the mass protruded. I tried taxis faithfully; so had the old man, and we both failed. I used hot fomentations to no avail; I placed him at an incline of 45° and sprayed the mass with cold water to stimulate contraction of the muscles of the cord. They contracted sharply, but had no effect except to increase his pain. I lowered him to the horizontal position, covered him up with a hot blanket, and sat down to rest.
Here was an old man, hernia strangulated for some two or three hours, a serious case. It was growing worse every moment, and nothing seemed likely to avail but the knife. The spasm was intense. How could I relax it?
I hesitated to try an anesthetic for various reasons, one of which was that _I found a piece of candle burning in a beer mug at the feet of my patient_. Knowing the great value of hyosciamine in spasm of the viscera, I took from my ever-present alkaloidal granule-case hyosciamine amorphous, gr. 1–134, and gave it hypodermatically with morphine sulphate, gr. ¼, and atropine, gr. 1–250. In a few moments my patient said, “that’s better”; and in less than ten minutes a gurgling of gas was heard through the mass indicating relaxation of spasm. Thus encouraged I gave a second dose, adding to hyosciamine, gr. 1–250, strychnine arseniate, gr. 1–48, the latter to induce forced peristalsis. In less than ten minutes more, I heard a loud gurgling sound, and my patient cried, “him’s gone,” and, sure enough, it had. The entire mass had disappeared through a hole the size of a nickel.
A retentive bandage for the time, and a well fitted truss a few days after, completed the treatment of, to me, an interesting case, which leads me to suggest a “therapeutics for strangulated hernia” for your consideration.
2666 Commercial St., Chicago.
_PERISCOPE OF THERAPEUTICS._
By J. LINDSAY PORTEOUS, M.D., F.R.C.S., Ed.
METHYLENE BLUE.
Recently I have had an opportunity of proving the efficacy of this new solvent, and am much pleased with the result obtained.
During the months of August and September I had five children under my care, suffering from diphtheria. As all the children belonged to one Institution, had the same nurse, and in every way the same surroundings, I had a good opportunity of testing the solvent powers of this drug, as compared with others. In the first child, age 4 years, I used acetic acid spray as a solvent, giving iron and potassium chlorate internally. Although the membranes in fauces visibly shrank, the disease extended downwards rapidly, almost choking the patient. Intubation was resorted to, which for a time relieved the choking symptoms, but the child gradually, sank.
Two more children were seized with the disease and the fauces were painted with sulpho-calcine, a remedy I have used successfully for some years, and corrosive sublimate was given internally. The children improved, but the patches were a long time in shrinking. I applied an aqueous solution of methylene blue (1:9) to the patches by means of a camel’s-hair brush, three times a day. The effect was remarkable. Not only did the patches, after the third application, shrink, but the feverishness and restlessness abated. Three days after the commencement of the treatment all the patches in both children had disappeared.
Two more children, aged 5 years and 3½ years, were attacked. As the patches covered the uvula, tonsils and back of the pharynx, and no further down, I thought that I would try local treatment only. After a few days the patches disappeared, the fever left, and the children were convalescent.
PIPERAZIN AND PIPERAZIN HYDROCHLORATE.
I have of late had ample opportunity to test both piperazin and piperazin hydrochlorate as solvents of uric acid. Hitherto I have used the salts of lithium and potassium in the uric acid diathesis, but will now certainly always use the new solvent in preference to either of these. I have taken particular pains to watch the action of the drug—so feel confident in stating that it is the best of known uric acid solvents.
I have never noticed any toxic effects from the use of either preparation, but prefer the hydrochlorate on account of being less hygroscopic, although I believe piperazin can now be procured in lozenge-form in glass tubes, which greatly lessens the hygroscopicity.
I will now briefly give particulars of three cases of uric-acid diathesis treated with the medicine.
The first, a man aged 36, weight, nearly three hundred pounds, suffered much renal pain, with occasional symptoms of small calculi passing along ureter. The urine had very acid reaction. The microscope revealed numerous crystals. The murexide test likewise proved that uric acid was present in abundance. This patient, wishing to become thin, was put on a beef diet, no potatoes, few vegetables, etc., just the diet to increase the uric acid. He was put on the solvent treatment, giving twelve grains, divided into three doses daily. Each dose was given in a tumblerful of vichy water. In a few days the urine became neutral in reaction; the loin-pains left; also the constant desire to micturate caused by the irritation of the uric acid. The beef-treatment was kept up for several weeks and the weight was reduced by 11 pounds. This case shows that, although no precautions were taken to diminish the formation of uric acid, but the contrary, piperazin was sufficient to dissolve the crystals.
The second case was that of a man aged 50, weight, 215 pounds. He complained of pain, described as “burning” in loins; also a dull ache in bladder, frequent desire to micturate; sometimes urine was mixed with blood. Without altering the diet at all, which was always a liberal one, including beer every day, all the disagreeable symptoms disappeared while taking piperazin hydrochlorate. On several occasions there was a return, in a modified form, of the symptoms, but after a few doses of the drug they always disappeared.
The third case was that of a man 60 years of age, who had for years felt pain in kidneys, along ureter and in bladder, and never got much relief. I prescribed for him 5 grains of piperazin to be taken three times daily in large quantities of water. After a week’s treatment the pains had left, and he was better than he had been for years.
Gruber has used it with good results in diabetes. He considers that the action of the drug in this disease is inhibitory to the transformation of glycogen into sugar.
HYPODERMATIC ALIMENTATION.
Caird (_Edin. Med. Journal_, September, 1893) reports a case of extreme weakness and emaciation due to malignant stricture of the esophagus, which was improved by intra-muscular injections of sterilized olive oil. In the course of a week from three to four ounces of oil were injected into the gluteal region. There was no pain or inconvenience caused by the injection. Sugar was occasionally combined with the oil. None of the skin punctures inflamed. There seemed no limit to the amount of oil which a patient can tolerate.
Yonkers, N. Y.
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COLD DUE TO BACTERIA.—Bacteria are likely to be blamed for all the ills that flesh is heir to. Prof. Schenck now maintains that what we call a “cold” is really due to these invisible pests. When one enters a cold room after being heated the bacteria in it flock to the warm body and enter by the open pores of the skin. Whatever may be said of this hypothesis he seems to have proved by experiment that bacteria in the neighborhood of a warm body move toward it. The confirmed smoker may derive some comfort from the fact that tobacco is inimical to them.—_London Globe._
Recent Medicaments.
A DECADE OF NEW REMEDIES.—“There are at least one hundred new remedies of synthetic origin now in general use that were not known ten years ago.” So an American contemporary says; but we doubt if anyone can compile a list of one hundred. Who will try?—_Chemist and Druggist_ (London), Sept. 30, 1893. We are not responsible for the original statement; but the invitation is general, and we are anxious that our English friend should have a prompt response from America, so here goes: Acetanilid, agathin, alpha-oxynaphthoic acid, alumnol, amyl-enhydrate, analgen, antipyrine, antiseptol, antispasmin, anti-thermin, aristol, asaprol, asepsin, benzanilide, benzonaphthol, benzosol, betol, bromal-hydrate, bromoform, bromol, chinoline, chloralamide, chloral-ammonium, chloralose, chlorphenol, creolin, cresalol, cresin, cresol, cresol-iodide, cresotic acid, diuretin, dulcin, ethyl bromide, ethyl chloride, eugenol, eugenol-acetamid, euphorin, europhen, exalgine, formalin, formanilid, gallacetophenone, gallobromol, gallanol, guaiacol-carbonate, homatropine, hydracetine, hydroquinone, hypnal, hypnone, ichthiol, iodol, iodopyrine, kairin, losophan, lysol, metaldehyde, methacetine, methylal, methyl chloride, methylene-blue, methylene chloride, methyl-violet, microcidine, naphthalene, naphthol, naphtopyrin, orexine, oxychinaseptol, paraldehyde, pental, phenacetine, phenetol, phenocoll, piperazine, pyridine, resorcin, resorcinol, saccharin, salacetol, salicylamide, saliphen, salipyrin, salocoll, salol, salophen, saprol, solutol, solveol, sozal, sozoiodol, styracol, sulphaldehyde, sulphaminol, sulphonal, tetronal, thalline, thermifugin, thilanin, thioform, thiol, thiophen, thioresorcin, thiosinamin, thymacetin, tolypyrin, tolysal, tribromphenol, trional, tumenol, uralium, urethane. This makes 114 new definite chemical products—and the list is not exhausted. It may also be urged that some of these products have been in use longer than ten years. This is the case only with naphthol, which was first recommended as an antiseptic in 1881; but we have omitted several legitimate new naphthol compounds, so that a balance is maintained. Other products, as acetanilid, guaiacol, anilin colors, pental, etc., were known as chemical products; but their medicinal application dates back less than ten years.
Referring to above list, a casual examination shows, that about thirty-three are patented products; between fifty-five and sixty bear proprietary “utility” names (including the thirty-three patented); and about thirty are absolutely free and non-proprietary. We may publish an accurate division with details on some future occasion.—_Notes on New Remedies._
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LLARETA; A NEW ANTIGONORRHŒIC.—Dr. Infante (_Aerztl. Rundschau_). Llareta is the abbreviated name for _Haplopapus Llareta_, a plant growing abundantly in Chili, and with which the author claims to have obtained a radical cure within ten to fifteen days in every case of gonorrhœa in which it was tried. The following is his formula:
Fluid Extract Llareta 1 part. Distilled water 30 parts. Tablespoonful twice daily.
—_Amer. Med. Surg. Bulletin._
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DISINFECTIN.—(_Pharm. Zeitschr. f. Russl._) Disinfectin is the name of a preparation intended for ordinary disinfection, said to be obtained as follows: 5 parts of the residue left in distilling crude naphtha are thoroughly mixed with one part (by volume) of concentrated sulphuric acid, and allowed to cool. The fluid portion is separated from the sediment, and gradually mixed with an equal volume of ten per cent. soda solution, and well shaken. Thus is obtained a yellowish-brown emulsion,—disinfectin,—which, when intended for use, is diluted with four parts of hot water, and thoroughly shaken.—_Amer. Med. Surg. Bulletin._
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HIPPURIC ACID AS A DIURETIC.—This acid, obtained[1] from the urine of the cow, is a favorite diuretic with many French practitioners. Dujardin-Beaumetz prescribes it combined with lime:
℞ Hippuric acid 25 grammes Milk of lime sufficient to neutralize it. Simple syrup 500 grammes Essence of lemon to flavor.
Four to six tablespoonfuls daily. As before mentioned it is excreted in the urine as benzoic acid.—_Provincial Medical Journal._
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THYMOL IN TOOTHACHE.—Dr. Hartmann (_Deutsche Med. Wochenschrift_) has employed thymol in toothache from hollow teeth, in place of arsenious acid. He fills the cavity of the tooth with a tuft of cotton on which a few crumbs of thymol have been sprinkled. It does not irritate the mucous membrane of the mouth much, and it is easily removed by rinsing the mouth with water. If a rapid action is desired let the patient rinse the mouth often, with warm water, in order to facilitate the solution of the drug. It never increases the pain at first, as arsenic does, and is not poisonous.—_Lancet-Clinic._
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CHLOROFORM NARCOSIS.—Resultation in chloroform narcosis has been accomplished by a new method devised by Maas, one of Koenig’s assistants of Goettingen. In the first case, the ordinary means of resuscitation had been tried for an hour without effect: respiration and pulse has entered ceasec. Maas then made rapid rhythmical compressions, about one hundred and twenty per minute, of the cardiac region, whereupon the heart’s action gradually increased and the patient recovered. In a second severe case responded with the same result to the treatment. Maas ascribes the effect of the cardiac compressions to the driving of the blood into the larger arteries.—_Chicago Medical Recorder._
THE AMERICAN THERAPIST.
_A Monthly Record of Modern Therapeutics_,
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Vol. II. JANUARY 15th, 1894. No. 7.
Editorial.
_INFLUENZA AND ITS TREATMENT._
The manifestations of Influenza in this section of the country during the past two months have been numerous and varied, although the malady has been far less directly fatal than on its first appearance in the winter of 1889–90. The different types of the disease, the pulmonary, the nervous and the abdominal, have been less distinctly marked, but it has been especially severe in the case of elderly people when appearing as an intercurrent affection. Another noticeable feature is, that the disease has shown a greater disposition to attack children than in former years, although when children have been enjoying usually good health, fatal results have been rare. This, however, has not been the case with sickly or puny children, as the disease has manifested itself in various ways, such as throat, ear and other complications. In many cases nothing more than the peculiar pains characteristic of the disease have been noticed; in others, it has passed off with nothing more serious than would result from a bad cold, so that large numbers have fought it out on this line. The prevalence of the malady in the vicinity of Philadelphia, and we presume this observation holds good elsewhere, has been wide spread, showing conclusively that it is largely dependent upon atmospheric influences. Indeed, up to the present writing, the condition of the weather has been extremely favorable to the development of influenza, and we all hope that better weather during the remainder of the winter will tend to check its spread.