Part 6

=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.)

Notes and Queries.[13]

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.”