404 or upper opening through which the intestine protrudes; (you will find that the point of the finger pressed firmly on this spot will effectually prevent any protrusion;) on this point lay the wooden pad, taking care that it does not press on the pubic bone. Place the leather pad on the lower part of the hollow of the back, pass the strap round the opposite hip, and loop it on the button screw in front. No under strap is re- quired. " Care must be taken to select an instrument that is of the proper size and shape, that fits everywhere closely and accu- rately, and that is not stronger in the spring than is absolutely required." Reviews. Pharmacopccia ad Usum Nosocomii Phthisicm-U1n &-c. accommo- data. Landini: Bradbury & Evans. 1848. pp. 36. THis neat little work is the pharmacopoeia in use at the Hospital for Consumption and Diseases of the Chest at Brompton ; it contains one hundred and three such formulas as are usually prescribed by the medical officers of that insti- tution. These comprise many combinations, an acquaintance with which will be found suggestive and useful to the prac- titioners engaged in the treatment of pulmonary diseases in general. We observe amongst the mixtures, two in which the nau- seous character of cod-liver oil is overcome, in one case, by its union with mucilage, and in the other, by being combined with liquor potassse. We take this opportunity of remarking that the Hospital for Consumption is deservedly attracting much public notice. Medical Societies. MEDICAL SOCIETY OF LONDON. MONDAY, OCTOBER 2, 1848.—MR. HANCOCK, PRESIDENT. MERCURY AND ITS EFFECTS. MR. HANCOCK inquired if any members had tried the plan I recommended by some French surgeons, of giving calomel in very small doses, in inflammatory cases 1 The dose recom- I mended was a twentieth part of a grain every hour, day and night, until the specific effect of the medicine was produced. He had tried this plan with two patients in Charing-cross z, Hospital, both of whom had been admitted with inflammation of the testicle, consequent upon gonorrhoea. In one case, he gave a twentieth of a grain of calomel every hour; in the I other, a twentieth of a grain every three hours. In the first case, the patient was salivated in thirty-six hours; in the second case, in forty-eight hours. The advantages of this mode of producing ptyalism was, that the effect was milder and more II controllable than where larger doses were administered; the bowels were also unaffected. The mode of its administration i was as follows:-Calomel, one grain; confection of opium, a ’, scruple; divide in twenty pills-one every hour. In the cases related, the effects of this medicine were most decided. , Mr. MIDDLETON had been occasionally surprised to see small doses of the mercury and chalk produce ptyalism in children of all ages, when given merely as an alterative. Large doses of calomel failed to produce any such effect. He had seen salivation produced in a child by a single dose of the mercury with chalk. Dr. WILLSr3IRE had never seen ptyalism in a very young child, though he had observed its effects on the mouth from the administration of this medicine. Mr. HOOPER had never seen a child salivated by calomel. With respect to small doses of calomel to produce the specific effects of mercury on the constitution, he had long been in the habit of employing them. One grain every three or four hours he found more effective than larger doses. Mr. HiRD said, that if all the beneficial effects of mercury could be obtained from the small doses mentioned by Mr. Hancock, then, indeed, would the new plan be very useful. His opinion, however, founded, it was true, on his experience of the small doses, was, that in acute inflammatory diseases of serous membranes they would be found less effective in lowering the heart’s action, and producing the other specific effects of mercury than the more commonly employed doses. He had seen the worst effects of mercury in children, when employed as alteratives. Dr. WILLS HIRE admitted that the specifics of mercury were exerted most beneficially. In cases of syphilis in young chil- dren, one grain of the mercury with chalk, and two grains of soda, night and morning, generally, in ten or fourteen days, succeeded in effecting a cure, but without producing saliva- tion. He threw out a hint that mercury in inflammation might not be so effective as some had imagined, and appealed to the opinions expressed by Dr. Alison, and by a reviewer in Forbes’s Journal, on this point. Mr. RoBARTs believed that the effects of mercury were in- fluenced and modified much by the period of year, state of weather, &c., at which it was administered. He had tried the plan of treating chronic catarrh with small doses of blue-pill, as recommended by Dr. F. Thompson, and published in THE LANCET, with much success. Mr. HANCOCK had found, in cases where it was thought almost impossible to produce salivation, that a few grains of iodide of potassium, administered in the intervals, was most effective. Mr. Bisnop had observed the same circumstance. foreign Department. Quinine prophylactic of Puerperal Fever. THE idea that quinine is preservative against puerperal fever was started by M. Alphonse Leroy, of Rouen, in 1793. M. LEUDET put it to the test in an epidemic which occurred in 1843, and lasted for three months, administering it before the accustomed period of the first appearance of the malady. For this purpose he employed the quinine in 15 grain (one gramme) doses, and in the few cases it was then tried in, no fever fol- lowed. He repeated his experiments in two other epidemics, occurring in the years 1815 and 1846, when he found that those submitted to this medicine did not contract the fever. To give the statistics:-Of 83 women who entered the Hotel Dieu de Rouen, between September, 1843, and January, 1844, 74 took no medicine, and 21 of them were seized with puer- peral fever, whilst the remaining nine were dosed with the quinine, and escaped contagion. Again; between July 8th and August 9th, 1845, 26 deliveries occurred: 11 women were sub- mitted to no medication, and eight of them were attacked with the epidemic fever; of the 15 others, treated with sulphate of quinine, one only caught the disease. Lastly, between the 9th of March and the 21st of April, 1846, 36 women were delivered: of the 19 who took no quinine, 11 were attacked; of the 16 submitted to its action, only one was seized with fever. The following is the manner in which M. Leudet employs the quinine:--As soon as the newlv delivered woman has a little recovered the shock of child-birth-viz., in about four hours after delivery, 15 grains of the medicine are given in the course of the 24 hours, in three portions. The same quantity is prescribed the next day, but on the third day it is diminished to ten grains, and the same dose is persevered in until the usual period of the accession of the fever has passed by, up to about the sixth day. The occurrence of milk fever is not always an indication to stay the quinine, for in very many cases that febrile disturbance is very slight. The plan of using quinine as a prophylactic has been subse- quently adopted in Paris by M. Cazeaux, who could, from his experience, however, make no report of its efficacy. Never- theless, any remedy holding out such a promise, in so fearful a disease, should not be thrown aside until after a ca,’eful and repeated trial. On the other hand, hygienic measures must be looked upon as by far the best safeguards, both against the development and the propagation of puerperal fever. Nitrate of Silver in Mercurial Ptyalism. Numerous have been the remedies proposed in severe sali- vation, but none of them is so effectual as we could wish. The nitrate of silver is now advocated as a powerful curative agent in the mercurial ptyalism, by M. BOUCHACOURT, in the Journal de Médecine de Lyon. He narrates a case in which almost all the known agents had been vainly resorted to, but upon the use of a solution of the nitrate of silver, rapid recovery took place. The solution was made of the strength of one part of the salt to sixty of water, and was applied to the mouth and tongue by means of a staff covered with lint. Its application caused at first some pain, particularly where there were aphthous patches, but in a few minutes great relief was expe-
Transcript
404
or upper opening through which the intestine protrudes; (youwill find that the point of the finger pressed firmly on thisspot will effectually prevent any protrusion;) on this point laythe wooden pad, taking care that it does not press on thepubic bone. Place the leather pad on the lower part of thehollow of the back, pass the strap round the opposite hip, andloop it on the button screw in front. No under strap is re-quired.
" Care must be taken to select an instrument that is of theproper size and shape, that fits everywhere closely and accu-rately, and that is not stronger in the spring than is absolutelyrequired."
Reviews.
Pharmacopccia ad Usum Nosocomii Phthisicm-U1n &-c. accommo-
data. Landini: Bradbury & Evans. 1848. pp. 36.THis neat little work is the pharmacopoeia in use at theHospital for Consumption and Diseases of the Chest at
Brompton ; it contains one hundred and three such formulasas are usually prescribed by the medical officers of that insti-tution. These comprise many combinations, an acquaintancewith which will be found suggestive and useful to the prac-titioners engaged in the treatment of pulmonary diseases ingeneral.We observe amongst the mixtures, two in which the nau-
seous character of cod-liver oil is overcome, in one case, by itsunion with mucilage, and in the other, by being combined withliquor potassse.We take this opportunity of remarking that the Hospital
for Consumption is deservedly attracting much public notice.
Medical Societies.
MEDICAL SOCIETY OF LONDON.
MONDAY, OCTOBER 2, 1848.—MR. HANCOCK, PRESIDENT.
MERCURY AND ITS EFFECTS.
MR. HANCOCK inquired if any members had tried the plan Irecommended by some French surgeons, of giving calomel invery small doses, in inflammatory cases 1 The dose recom- Imended was a twentieth part of a grain every hour, day and night, until the specific effect of the medicine was produced.He had tried this plan with two patients in Charing-cross z,
Hospital, both of whom had been admitted with inflammation of the testicle, consequent upon gonorrhoea. In one case, hegave a twentieth of a grain of calomel every hour; in the Iother, a twentieth of a grain every three hours. In the firstcase, the patient was salivated in thirty-six hours; in thesecond case, in forty-eight hours. The advantages of this modeof producing ptyalism was, that the effect was milder and more IIcontrollable than where larger doses were administered; thebowels were also unaffected. The mode of its administration iwas as follows:-Calomel, one grain; confection of opium, a ’,scruple; divide in twenty pills-one every hour. In the casesrelated, the effects of this medicine were most decided. ,
Mr. MIDDLETON had been occasionally surprised to seesmall doses of the mercury and chalk produce ptyalism inchildren of all ages, when given merely as an alterative.Large doses of calomel failed to produce any such effect. Hehad seen salivation produced in a child by a single dose of themercury with chalk.
Dr. WILLSr3IRE had never seen ptyalism in a very youngchild, though he had observed its effects on the mouth fromthe administration of this medicine.Mr. HOOPER had never seen a child salivated by calomel.
With respect to small doses of calomel to produce the specificeffects of mercury on the constitution, he had long been inthe habit of employing them. One grain every three or fourhours he found more effective than larger doses.Mr. HiRD said, that if all the beneficial effects of mercury
could be obtained from the small doses mentioned by Mr.Hancock, then, indeed, would the new plan be very useful.His opinion, however, founded, it was true, on his experienceof the small doses, was, that in acute inflammatory diseases ofserous membranes they would be found less effective in
lowering the heart’s action, and producing the other specificeffects of mercury than the more commonly employed doses.
He had seen the worst effects of mercury in children, whenemployed as alteratives.Dr. WILLS HIRE admitted that the specifics of mercury were
exerted most beneficially. In cases of syphilis in young chil-dren, one grain of the mercury with chalk, and two grains ofsoda, night and morning, generally, in ten or fourteen days,succeeded in effecting a cure, but without producing saliva-tion. He threw out a hint that mercury in inflammation mightnot be so effective as some had imagined, and appealed to theopinions expressed by Dr. Alison, and by a reviewer inForbes’s Journal, on this point.Mr. RoBARTs believed that the effects of mercury were in-
fluenced and modified much by the period of year, state ofweather, &c., at which it was administered. He had tried theplan of treating chronic catarrh with small doses of blue-pill,as recommended by Dr. F. Thompson, and published in THELANCET, with much success.Mr. HANCOCK had found, in cases where it was thought
almost impossible to produce salivation, that a few grains ofiodide of potassium, administered in the intervals, was mosteffective.Mr. Bisnop had observed the same circumstance.
foreign Department.Quinine prophylactic of Puerperal Fever.
THE idea that quinine is preservative against puerperal feverwas started by M. Alphonse Leroy, of Rouen, in 1793. M.LEUDET put it to the test in an epidemic which occurred in1843, and lasted for three months, administering it before theaccustomed period of the first appearance of the malady. Forthis purpose he employed the quinine in 15 grain (one gramme)doses, and in the few cases it was then tried in, no fever fol-lowed. He repeated his experiments in two other epidemics,occurring in the years 1815 and 1846, when he found thatthose submitted to this medicine did not contract the fever.To give the statistics:-Of 83 women who entered the HotelDieu de Rouen, between September, 1843, and January, 1844,74 took no medicine, and 21 of them were seized with puer-peral fever, whilst the remaining nine were dosed with thequinine, and escaped contagion. Again; between July 8th andAugust 9th, 1845, 26 deliveries occurred: 11 women were sub-mitted to no medication, and eight of them were attacked withthe epidemic fever; of the 15 others, treated with sulphate ofquinine, one only caught the disease. Lastly, between the9th of March and the 21st of April, 1846, 36 women weredelivered: of the 19 who took no quinine, 11 were attacked;of the 16 submitted to its action, only one was seized withfever.The following is the manner in which M. Leudet employs
the quinine:--As soon as the newlv delivered woman has alittle recovered the shock of child-birth-viz., in about fourhours after delivery, 15 grains of the medicine are given inthe course of the 24 hours, in three portions. The same
quantity is prescribed the next day, but on the third day it isdiminished to ten grains, and the same dose is persevered inuntil the usual period of the accession of the fever has passedby, up to about the sixth day. The occurrence of milk feveris not always an indication to stay the quinine, for in verymany cases that febrile disturbance is very slight.The plan of using quinine as a prophylactic has been subse-
quently adopted in Paris by M. Cazeaux, who could, from hisexperience, however, make no report of its efficacy. Never-theless, any remedy holding out such a promise, in so fearfula disease, should not be thrown aside until after a ca,’eful andrepeated trial. On the other hand, hygienic measures mustbe looked upon as by far the best safeguards, both againstthe development and the propagation of puerperal fever.
Nitrate of Silver in Mercurial Ptyalism.Numerous have been the remedies proposed in severe sali-
vation, but none of them is so effectual as we could wish. Thenitrate of silver is now advocated as a powerful curative agentin the mercurial ptyalism, by M. BOUCHACOURT, in the Journalde Médecine de Lyon. He narrates a case in which almost allthe known agents had been vainly resorted to, but upon theuse of a solution of the nitrate of silver, rapid recovery tookplace. The solution was made of the strength of one part ofthe salt to sixty of water, and was applied to the mouth andtongue by means of a staff covered with lint. Its applicationcaused at first some pain, particularly where there wereaphthous patches, but in a few minutes great relief was expe-
405
rienced, and the patient was able to sleep-a refreshment ofwhich he had been robbed for four nights. For the two or threefollowing days the lotion was applied twice daily, and aboutthe fourth day all inflammation had subsided.
lllode of Detecting Small Quantities of Opium.The process proposed by M. HENSLER consists in treating
the powder of opium by boiling sulphuric ether, and evapor-ating ; a fat, viscous residue is left, containing crystals ofmeconine and narcotine. If this compound be treated withboiling water, the meconine is dissolved, and the narcotinemay then be dissolved in alcohol; but in the solution thusprocured another substance exists, named by Merk porphyr-oxine, which possesses the property of assuming a reddishpurple colour if heated with dilute hydrochloric acid.Porphyroxine is neutral, and crystallizes in brilliant needles.Sulphuric and nitric acids render it of an olive colour; it isdissolved in dilute sulphuric and muriatic acids, and the heatproduces a rosy or reddish purple colour, according to thedegree of dilution. Alkalies decolorize the liquid, and throwdown a white precipitate.
If it is wished to discover opium in a compound medicinalpreparation, a little liquor potassae should be first added, andthen some ether stirred in; after that, a strip of blotting-papershould be soaked in the ethereal extract, and then dried, re-peating this several times. If the strip be now moistenedwith dilute hydrochloric acid, and brought into contact withwatery vapour, it becomes more or less red, in proportion tothe quantity of opium present.
Porphyroxine (which gives this characteristic reaction)being insoluble in water, the above test will furnish no resultwith preparations of opium, having only the gummy (orwatery extract) for their base ; crude opium itself, or analcoholic or ethereal solution of it, must be present, in orderto the efficacy of the test.
Elimination of Antimony.M. GA.ISNEY and others have of late occupied themselves in
searching for antimony in the urine and fseces of patients whohave been taking kermes mineral as a medicine; this sub-stance having recently been strongly advocated in the treat-ment of typhoid fever, as pointed out in the foreign article ofthis journal a few months back. By Marsh’s apparatus, spotsand rings of antimony have been procured from the urine and
’’
iseces ot such patients, but chiefly from the latter, the renalsecretion having given but negative results on two or threeoccasions. The source of the antimony in the urine is pro-bably derived not from the insoluble rulphuret, (kermes,) butfrom some soluble salts of antimony mixed up with the latterin its comparatively impure state, as found in commerce.MM. Milloir and Laveran, in studying the elimination of
emetic tartar, observed the persistence of the metal in theorgans of the body, and its expulsion after a long interval.
Enlargement of the Spleen not a Caacse of Ague.The discussion, in the Academy of Medicine, on M. PIORRY’S
theory has been very animated; (we have given his conclu-sions in THE LAKCET, of Aug. 19th, page 213.) Among thespeakers, MM. CARTEL and RocHoux have taken prominentparts. From the observations of the former gentleman, weextract the following passage, remarkable for clear reasoningand fair deductions from facts-" The influence of marshmiasmata is not exercised exclusively on the spleen; it firstacts on the blood, the stimulating faculties of which it dimi-nishes. The action of the nervous system is consecutive, anddependent on the concentration of the circulation in the largecavities. The influence of this system, which in the coldstage is very secondary and almost passive, becomes verypredominant in the hot stage. (M. Piorry maintains thatague is a neuropathy.) The spleen is neither the seat nor thecause of fever; it is not its seat, because fever has no especialseat. How could the engorgement of that viscus bring on thecold stage ! When the blood recedes from the surface of thebody, it does not accumulate in the spleen in a larger propor-tion than in the other viscera; and as for reaction, which isthe principal element of fever, and particularly of intermittentfever, it is evident that the spleen, by its texture or func-tions, is not more-nay, less-calculated than other parts ofthe organism to produce it. It need but be remembered,that the spleen does not elaborate any secretion, whilst theliver is a highly important secreting organ. It is hardlynecessary to mention, that the tumidity of the spleen is as un-likely to produce the third or sweating stage as the second.
The very intermittence of the fever proves that the disturb-ance of the nervous system is quite secondary to, and the re-sult of, the influence of the blood. We can easily conceivehow the blood undergoes epuration in the second or thirdperiod, and we cannot help seeing that the irritation ceasesas a consequence of this epuration. The irritation can there-fore be looked upon neither as the disease itself nor the causeof the same. The cause of a fit of ague, considered quite un-connectedly, is complex; the cause of the cold stage is not thesame as that of the hot stage. If the epuration of the bloodwhich takes place in the latter were complete, the fits would notreturn at all. The epuration is, however, merely partial, butit suffices for re-establishing a due equilibrium for some hours,until the produce of the epuration has been expended. Theinfluence of the vascular and nervous systems is not equal ineach of the three stages; the nervous system, in the algideperiod, loses part of its power, and this period might, in fact,
: be considered as the disease. I have stated that this cold, stage is a sort of incipient death, and the truth of this state-! ment is found in the fact, that those who die of ague gene-, rally expire in the algide period. At the advent ot the
second stage. we become aware that Nature has succeeded inovercoming the disease for a time. The influence of the nervoussystem is then apparent, and by it the reaction is affected. Itis well known that reaction is the essence of the fever. Thesecond stage may indeed be considered as an admirable testi-mony of the power of the organism. How is it that all feversare not periodic 1 Because a reaction of a few hours does inall fevers, not suffice for the control of the morbid agent-viz.,the miasm which has been absorbed. The influence of thismiasm has some analogy with that of deleterious gases, for itinjures the principle of excitation existing in the blood. Itsaction is less rapid than the effect of carbonic acid gas, becauseit is mixed up with respirable air, whilst this gas does not un-dergo such alteration. The stimulus of the blood is gone inasphyxia, or it is reduced to so small an amount that life isspeedily extinguished. In a patient affected with ague theblood retains enough stimulus to excite the viscera, when it isaccumulated in them by the agency of the cold stage, andhence arises the reaction which my adversaries are in the habitof confounding with a mere transmission or communication,entirely losing sight of the proportions of the excitation. Theprinciple of reaction lies in the excitement of the nervoussystem.
DEGLUTITION PROMOTED BY DASHING COLDWATER IN THE FACE.
To the Editor oj THE LANCET.SiR,-Your readers will remember the interesting commu-
nication of Mr. Simpson in THE LANCET for Dec. 1842, p. 437,and will doubtless be struck with the following paragraph:-
" I waited patiently about ten minutes till the rice wasboiled, and then put some into my mouth with my fingers;but after chewing a little, I found I could not swallow it.One of the natives observing my distress, dashed some coldwater with his hands into my face, which, washing the ricedown my throat, at first almost choked me, but it causedsuch an exertion of the muscles, that I soon recovered thepower of swallowing."-Narrative of the Disasters which befelthe Ship Juno, in June, 1795.
This account was given by the second mate.I am, Sir, your obedient servant,
larpoc.
INCONVENIENCES OF INDIA-RUBBER STOCKINGSAND KNEE-CAPS.
To the Editor of THE LANCET.Sm,-The vulcanized india-rubber stockings, knec-caps, &c.,
possessing as they do the valuable qualities of elasticity andstrength, carry with them at the same time the serious dis-advantages of not only creating very unpleasant warmth onthe skill, but also of evolving copious streams of sulphurettedgases. The clothes become saturated with these; articles ofgold and silver blackened by them; and for days after theremoval of the bandage or stocking the skin itself retainsmuch of the feetid odour.
I have tried these articles on my own person, and, ea’jpen-entiâ docenti, I beg leave, through the columns of your widely-circulating periodical, to call the attention of the professionto these results, in order that disappointments, and perhaps re-proaches, may be avoided.
I have the honour to be, Sir, your obedient servant,STEPHEN O’RYAN, A.M., M.D.STEPHEN O’RYAN, A.M., M.D.
