1058

esa.cUc acid internally and excraco ot oeiiiidonna externallywas very effective in relief of pain and promoting the generalwell-being of the patient.

Wimpole-street, W. __ _______

XRRITANT POISONING FROM ("HEWING THE SHOOTSAND LEAVES OF DIEb’1’ENB.CIIIA SEGU.1NA.

Bv ALEX. NAPIER, M.D. GLASG., F.R.F.P.S. GLASG.,PHYSICIAN, VICTORIA INFIRMARY, GLASGOW; EXAMINER IN

MEDICINE, GLASGOW UNIVERSITY.

Two cases of rather severe local irritant poisoning from asomewhat unusual cause have come under my observation

lately. At about 4 o’clock on the afternoon of Feb. 15th a

gardener employed in hothouse work gave to three labourerswho were assisting him a few leaves and shoots of a plantto chew, saying they would taste just like tobacco ; this was idone as a trick, but the results exceeded expectations. Oneof the labourers simply had the plant in his mouth for a fewseconds, and on tasting it at once spat it out; even so hisilips and tongue became sore and swollen, but not so severelyas to cause him to enter hospital. He went home and waslost sight of. The other two attended at the infirmary.CASE I.-The patient, a man, aged 34 years, was admitted

to the Victoria Infirmary, Glasgow, about an hour after hismisadventure. He had chewed the plant vigorously, mainlyin the left side of his mouth, this being instantly followed bysevere burning pain in the mouth, tongue, and lips, and thenby marked swelling of the tongue, lips, and cheeks.On admission speech was impossible, owing to the enormous

degree of swelling of the tongue, most marked on its leftside ; the tongue filled the mouth, protruded slightly, andwas almost quite immobile. There was a constant dribblingof saliva from the mouth. The upper and lower lips werevery much swollen, especially towards the left ; while thesoft tissues of both cheeks were greatly swollen, indurated,and tender. Both submaxillary glands were much enlargedand tender, especially on the left side, and the left parotidgland was swollen. The tongue was coated with a thick,creamy, soft fur, its mucous covering was cedematous, withhere and there some small blisters on its upper and undersurfaces. Swallowing was almost impossible and breathinga matter of extreme difficulty. There was no rise of tem-

perature throughout; all the other organs were normal, butexamination of the urine showed slight reduction of Fehling’ssolution.

Treatment.-In view of the respiratory difficulty and of thepossibility of extension of the swelling to the larynx pre-parations for’tracheotomy were made should it be required.The operation was rendered unnecessary, however, by thevigorous use of ice externally and as far as possible by themouth, and also by the use of a spray containing adrenalinand cocaine. Under this line of treatment the swelling andpain gradually subsided, but a week elapsed before the

patient could leave hospital, and even then the left parotidgland was still slightly enlarged and tender.CASE 2.-This patient, a man aged 52, suffered even more

severely than the former one, having chewed the shoots ofthe plant more energetically and for a longer time. Hepresented exactly the same appearances locally, but on amore extensive scale, the tongue in particular beinguniformly and not unilaterally enlarged. In the course ofthe first night after admission he was repeatedly nearlysuffocated owing to recurring attacks of dyspnoea. In thiscase also the urine gave a slight reduction of Fehling’s solu-tion. When the patient was dismissed a week later therewas still considerable enlargement of the left submaxillarygland.

There can be no doubt at all as to the extreme energy withwhich the juice of this plant acts as a local irritant, espe-cially to mucous surfaces. There is not much detailedinformation to be got regarding it in any of the sources towhich I have had access. Dorvault’s L’Officine" " (Paris,1880) has at p. 530 a short note to the following effect : "TheAruna of the Antilles; Aq-?zm or Caladium Seguinum, IJieffen-bachitc Segnin2, the Dumb Cane in English ; derivedfrom the West Indies, having the general appearanceof a banana plant, a repulsive odour, and a corrosive andpoisonous jnice ; used as a fomentation, as a diuretic, and aremedy for gout." Foster’s 11 Illustrated EncyclopaedicMedical Dictionary " adds little to this. After stating the

pianh’a position botamcally, among the arums, and giving alist of species, it goes on to say : ’’ Dumb Cane, a WestIndian species, highly poisonous, the juice being so acrid asto cause the tongue to swell and prevent articulation. Anointment is prepared from it by the negroes of the WestIndies by boiling it in lard, which they use for dropsicalswellings. The plant has also been recommended to beused internally for dropsy. A wholesome starch has beenobtained from the stem. The juice is used for marking onlinen. "

From the foregoing it may be inferred that in olden timesin the West Indies refractory slaves were made to chew theplant as a punishment, and judging from its action in theabove-neted cases the power of the plant to producedumbness (of a kind) is entirely beyond question.Glasgow.

___________________

Medical Societies.HUNTERIAN SOCIETY.

The Therapmdic Valzbe oj Alcohol.A MEETING of this society was held on March 27th, Dr.

7. HINGSTON Fox, the President, being in the chair.’ Sir VICTOR HoRSLEY opened a discussion on the Thera-peutic Value of Alcohol, by remarking upon the enormousdecrease in the amount of alcohol used at hospitals and otherinstitutions in the last 25 years. This decrease was duepartly to our increased knowledge of its action and partlyto the number of newly discovered drugs at our disposal.More material evidence was, however, needed as to its valuein clinical work, but in spite of this need, most members ofthe profession held a pretty decided opinion on the drug, oneway or the other. Alcohol was now prescribed sometimes as astimulant, whatever that might mean, sometimes in an exactlycontrary sense as a narcotic, and, very rarely now, as

a "tonic." Its narcotic action was undoubted, but hebelieved that the so-called stimulation effects were reallythe phenomena caused by the removal of the control of thehighest nerve centres. The error of the belief in a tonicaction was shown by comparing the appearance of dogs whohad been total abstainers with that of the same breed whohad been moderate drinkers over a period of three years.But old traditions clung closely to the medicinal use ofalcohol. The extraordinary idea that whisky was good forrheumatism had never had any real foundation, and he hadbeen surprised to see many medical gentlemen sampling’’ diabetic whisky " at the last annual meeting of the BritishMedical Association. Sir Victor Horsley then proceeded todeal with the effect of alcohol in certain clinical conditions.He could not speak of the treatment of pneumonia from personalexperience, but he believed that whereas 25 years ago alcoholhad been regarded as a sheet-anchor, it was now discardedby most physicians in treating that disease. We had certainlylearnt during that period that the patient’s resistance to thepneumococcus was diminished by alcohol, and the Registrar-General had even gone so far as to ascribe the excessivedeath-rate from pneumonia in males to the fact that theyconsumed more alcohol on the average than females. Heasked physicians present whether blood pressure and cardio-graphic records showed that alcohol could be called a cardiacstimulant in pneumonia, and what was its relation to the

grave symptom of arrhythmia. The effect of alcohol in

pyrexia was the sum of its effect on the infective processunderlying the pyrexia and its effect upon the increasedkatalytic metabolism that was going on. There was now a

large mass of evidence to show that alcohol lowered theresistance to infecting agents. Even in very small quantitiesit diminished the amount of complement in the blood, itinhibited phagocytosis. it lessened the resistance .of thered corpuscles to hasmolytic agents, and, as had beenshown by Laitinen in regard to B. typhosus, it injuredthe bactericidal power of the body fluids. Proceedingto discuss the vexed question whether alcohol lessenednitrogenous destruction or no, Sir Victor Horsley was ofopinion that Professor Max Gruber had got nearest the truthwhen he had shown that alcohol first increased the destruc-tion of proteid, but after being administered for a fortnightor more an immunisation occurred and it acted as a true

1059

proteid sparer. This action was, however, of no therapeuticadvantage, for as metabolism would be lowered by the toxicagent the resistance to disease would inevitably be diminishedas well. The net result therefore would be the reverse of

profitable, and the practical experience of the fever hospitalsshowed that this was amply recognised now. He supposedthat most surgeons had given up the use of alcohol

altogether in the treatment of shock. By its action onthe autonomic nerve-centres it caused a fall in blood

pressure and a diminution in the respiratory excursion. Itsaction on the isolated heart had been the subject of

many experiments, not always with uniform results. Dixonbad found a definite initial increase in the work done afterthe addition of a 0-4 per cent. solution of alcohol, butwith stronger solutions there was a paralysing effect from thefirst. Backmann, on the other hand, had shown that therewas a gradual fall in the work done from the very first, andthat arrhythmia had been produced even with very minutequantities of alcohol. The heart could easily be restored toits normal condition by substituting a weak solution ofdextrose for alcohol, and tracings of these experimentsshowed very clearly the futility of alcohol as compared withdextrose as a foodstuff for the heart. The use of sugar in allarmies and in the Boer war illustrated this point. Finally,Sir Victor Horsley was of opinion that alcohol should beavoided as a therapeutic agent, if only on account of itshabit-producing properties. He feared that the medicalprofession had been responsible for a good deal of harm inthis way. He considered that the disadvantages of the drugfar outweighed its advantages, and he, at any rate, wouldnot employ it.

Professor A. R. CusHrTY said he spoke under the disadvan- I,tage of being without strong convictions. He could not con-demn the use of alcohol as a deadly sin ; he regarded it ratheras a drug which possessed certainly no specific action, butwhich brought substantial relief to many patients. Until a fewyears ago all pharmacologists had agreed that the stimulantaction on the heart was fabulous. Then Dixon had demon-strated that the heart beat more strongly under the influenceof alcohol in small quantities. He (Professor Cushny) believedthat the methods of experimentation were very oftenfallacious. The "isolated" heart was unprotected by theplasma and was much more susceptible to drugs. In intactanimals he had always found a weakening of the heart-beatfrom the outset when alcohol had been administered. Theymust dismiss the idea that alcohol was a stimulant drug of anyimportance to man. He did not, however, share the viewthat alcohol could be called a deadly poison in infective pro-cesses. It had certainly been shown that in intoxicant doses itrendered rabbits much more liable to infection, and they wouldall agree that the same held good for man. But as the dosesused had become smaller the results had become increasinglyindefinite, and he concluded that very moderate drinkingcould in no way be considered to lessen the resistance toinfection. Alcohol, like chloral or opium, was of real use inmedicine by making life more tolerable to the patient. Hebelieved that cases of alcoholism that genuinely arose out ofits medicinal use were very rare.

- - --

Dr. F. J. SMITH spoke as a practising physician. Herecalled the time when as a house physician he had seenalcohol prescribed literally in quarts. He now used it verysparingly in hospital work, but he could not honestly say thatthe results of treatment were one whit better or worse sincethe old days. He prescribed alcohol in practice first becauseit often made life tolerable for his patients. It induced hope,and hope and the results of hope could not be measured byexperiment. Secondly, he prescribed it to patients who hadfound that it had helped them to eat. In such cases hebelieved it acted indirectly as a tonic. He ventured to

suggest that the heart in the experiments which had beenbrought forward was certainly not working under theconditions under which it worked in man. Moreover,animals, prior to any experimentation, were by natureteetotalers.

Mr. M. CURSHAM CORNER spoke after 30 years’ experiencein general practice. He had found whisky of great servicein old people with rheumatic pains and in cases of lungtrouble where there was tight breathing and the skin wasnot acting well. He had used brandy with success in heartdisease, and had given it per rectum in cases of collapse inmidwifery.

Dr. SMITH asked whether peripheral stimulation in the

mouth and gullet might not play a part of some import-ance in the therapeutic action of alcohol. Perhaps this

might explain some of the conflicting results obtained byexperiments on animals on the one hand, and clinical experi-ence on the other.

Sir VICTOR HORSLEY was of opinion that the reflex effectof this peripheral stimulation would be of very short dura-tion. In his view most of the euphoria produced by alcoholwas a delusive effect.

Mr. F. S. KIDD deprecated the value of the experimentalevidence that had been brought forward. He stronglyobjected to experiments on animals being put before thegeneral public as if the results obtained from them held goodfor human beings. Sir Victor Horsley had told them the effect.,of alcohol in diminishing the resistance to infecting organisms,but he would like to ask what effect alcohol had on, say, the

pneumococcus itself ? 2 Did it not diminish its vitality ? Hbhad himself been injecting alcohol into urethroa infected,with gonococci, and he had found that the gonococci were-considerably the worse for the injection. He regarded,alcohol as a lubricant which greased the wheels of life.

Dr. T. B. HYSLOP (President of the Society for the Study ofInebriety) congratulated Sir Victor Horsley and the otherswho had taken part in the discussion on the temperate wayin which they had handled the subject. The question whetherhe was justified in using alcohol had often come before himin the treatment of mental disease. He had often encountered

grave conditions of insomnia which seemed to be untouched>by all hypnotics. He recognised that alcohol, like chloralybromide, and other drugs, exerted a deleterious effecton brain cells. The ordinary nightcap he regarded as

exceedingly deleterious. Alcohol was first taken for its

exhilarating effects, and later it was found impossible tosleep without it. He believed that the hypnosis produced byalcohol was in the nature of an auto-intoxication, for theoxygen used to eliminate the alcohol was drawn from thesupply available for oxidising the ordinary waste products ofmetabolism. For this reason a subject in whom sleep hadbeen induced by alcohol woke up feeling very tired. Inasylum practice alcohol had gradually been eliminated fromdiet as well as from therapeutics.The discussion was adjourned until Wednesday, April 24th,

at 9 P.M., at the London Institution, Finsbury-circus, E.C. Allmembers of the medical profession are invited to attend.The President, Dr. R. Hingston Fox, will open the adjourneddiscussion, summing up the arguments of the speakers on theopening night. It is expected that the following will speak : oSir T. Lauder Brunton. Mr. C. W. Mansell Moullin, Dr W. H. B. Stoddart, Dr. E. W. Goodall, Dr. Langdon Brown,and Dr. A. S. Currie. Sir Victor Horsley will reply.

WEST LONDON MEDICO-CHIRURGICALSOCIETY.

Rheumatoid Arthritis.A SPECIAL meeting of this society was held on April 12th

at the West London Hospital, Mr. W. McADAM ECCLES, thePresident, being in the chair.

After an instructive exhibition of cases, skiagrams, museumspecimens, and bacteriological preparations had been exa-mined, the PRESIDENT introduced a series of short papers,and demonstrations with a working definition of RheumatoidArthritis as follows : An arthritis affecting many joints, but.chiefly the smaller ones, and occurring usually in the female-sex. and always due to the absorption of a toxin.

Dr. F. J. POYNTON gave a short account of experimentalwork on the causation of the disease, illustrated with lanternpictures. Dr. Poynton said that he would take only one com-paratively small point in the great problem before them, andwhich, perhaps, some might think hardly deserving of theoccasion. This was the demonstration that one micrococcus-

namely, that which he believed to be the cause of acute rheu-matism-might experimentally produce in animals various.

types of arthritis. He would demonstrate by lantern slides andspecimens the occurrence of acute transient arthritis, osteo-arthritis, and peri-articular arthritis. In all these exampleshe would emphasise that no suppuration had occurred.The different lesions depended upon the severity andduration of the arthritis, which resulted from intravenous.inoculation. He himself believed that among the many