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irritant on a full stomach is, to protect the Alibert, singularly reticent regarding his perdelicate villous tissue of that viscus from its sonal experience with arsenic in affections of local action, and so escape mischief, which the skin, quotes some astonishing cures of might interfere for a time with a continuation elephantiasis, not only by it, but also by other of the treatment.

methods, one as unique as, perchance, in part The stomach, that common receptacle, indis- agreeable, being an exclusive diet of the indigposed from the nature of its functions to resent enous reptilia and turtles (conjoined with freirritation, and so unsusceptible to inflammatory quent sand baths), during a sojourn upon some processes that idiopathic gastritis has been utopian island where they abound; a gastrodenied, is peculiarly sensitive to arsenic, and, nomic healing, as regards the amphibian curious to relate, exactly the same lesions are tortoise, the most fastidious gourmet might not produced upon its internal surface when the scorn, but rather envy those for whose recovery poison is used at a distance on the exterior of it might have been adjudged the mode of cure; the body, as when placed directly in contact though, peradventure, the saurian and ophidian with it; this is explained by the fact that it is entrées, the flesh of lizards and vipers, included an eliminant, physiologically, of the mucous in his menu might be repugnant to the pampered lining of the alimentary canal, and so largely and exigeant taste. As for myself, should a and in such a concentrated form is it there leprous fate await me, commend me to the expelled, when a toxic quantity is even remotely turtle-soup and steaks; the baths, the lizards, applied, that its erosive action falls completely and the vipers I could forego, but, otherwise, and fully on that membrane, and destroys it. quite irresistible would be the toothsome regimen

As an alterative tonic arsenic has few supe- in vogue upon that desert isle. riors, and as an antineuralgic is considered Rayer confirms the favorable reports of infallible (to which hereafter reference will Fowler, Adair, Girdlestone, Willen, and be made) in gastralgia and supra-orbitar neu. Bateman, Bardely, Rush, Coxe, Otto, Fodéré, rodynia ; but it is in certain subacute and chronic and others, emphasizing the belief that arseniexanthems of the cuticle and corium that it is cal preparations are " d'une utilite incontestable deemed, when given internally, remedially, a dans plusieurs maladies graves de la peau ;' sine qua non; nor will it disappoint the prac-adding, that the initial dose should be small titioner who prescribes it intelligently in lepra, and the digestive apparatus in good condition, psoriasis, and scaly eczema. It is also of ser- when it may be essayed. vice as an adjuvant in prurigo, and the dis- But whatever merit may be imputed to it, in agreeable nocturnal itching of the skin of the what he terms “la résistance déplorable" of lower extremities of gouty subjects during cutaneous diseases, in frontal neuralgia, and attacks of indigestion.

chorea, arsenic is facile princeps, and surely is Hunt, who has probably used it more ex- entitled to the rank of a specific; the intertensively and tested it more thoroughly than mittent type of the former yielding to it any other person, declares that a chronic cuta- promptly and surely, while the latter, in all neous eruption which does not yield to arsenic its phases, is subdued by its judicious use, it is of syphilitic origin, and that all different alone being needed; while other forms of chrono phlogodes of the common integument neuralgia may require other analgesics, acwill assuredly vanish before it, if given suffi- cording to location and nature, the periodic ciently long, and in requisite doses, scouting the paroxysm of the supra-orbitar needs only the idea of injurious consequences from its continu- solution of Fowler, in 10. minim doses, i.i.d., ous and heroic use.

to give immediate and permanent relief, its This sweeping commendation should, how therapeutic action being similar to that disever, be received with caution, the experience played when it is employed against the paludal. of others not sustaining his sentiments, at least, of intermittents, compelling the inference that the innocuous nature of the drug; and we know one cause produces alike the ague and the that some individuals, from idiosyncrasy, can pain. take it only in the minutest quantity, which, It is well known that persons habituated to nevertheless, is usually quite sufficient, in these the atmosphere of malarial districts, although anomalous cases, to accomplish the purpose for no longer obnoxious to the quotidians and which it may be given.

tertians which strangers encounter, are yet

subject to attacks of “brow ague,” which, solidists and humorists appear before us, to though not so prostrating as the spasmodic and impress us with a not unfavorable contrast of pyretic outburst, is, notwithstanding, by reason the old time with the new. of its torture, dolor frontalis atrox, eloquent In the study of the cause, progress, and in craving means which may antagonize and termination of these aberrations, we discern prevent its recurrence, and, while cinchona is the malarial intoxication and the advancing the agent par excellence “ to break” the neurasthenia and neurotic erethism resulting miasmatic seizure, it is ordinarily impotent to therefrom, while the cure by the physiological cure neuralgia of the frontal branches of the influence (tonic and stimulating) of arsenic trigemini, for which the arsenical solution is points to a specific central adynamia as funcompetent and may always be relied upon damentally causative of all; and, as the with certainty to do.

highest function of the ganglion-cell is inThe peculiar increase and diminution of the hibitory, regulative of nervous energy, and painful crisis, the rise and fall, as it were, of preventive of explosions, algetic, convulsive, the wave of suffering, marks relationship to the or maniacal, its vis vita normal, being inirregular movements of the shaking ague, as dispensable to the proper exercise thereof, we well as to the clonic spasms of chorea (a mus- assume, from the salutary action of the remedy cular inco-ordination beyond the control of under consideration in such perturbations, by the will, sometimes powerful enough to throw the mental equilibrium preserved, muscular a child from the couch upon which it is vainly movements controlled, and pains subdued, that striving to repose), the choreic jerkings, the it possesses recondite properties, be they what algid shiverings of ague, and the neuralgic they may, be they tonic, stimulating, sedative, exacerbations and remissions being convulsive or alterative, which, in some inscrutable manexpressions, general or partial, doubiless etio ner, reaching that blastodermic molecule, imlogically the same, if natura morborum part to it the vigor, the primordial force, curationes ostendunt" be considered an aph- which, being impaired, is insufficient then to orism of practical purport (in this era of govern or restrain; but as here we are agnostic, scholastic subtleties and speculative research), likewise in other morbid conditions, its modus shown by the curative power of arsenious acid operandi, as stated, is equally unknown, in intermittent fever, intermittent neuralgia, whether by immediate contact, nervous transand St. Vitus's dance.

mission, or sympathy, whether as a corroborant The limit of this paper permits but a cursory by its primary impression, through the peptic review of the many disorders where benefit glands, on the process of chylopoietic digesaccrues from arsenic, in which, in concluding, tion (that veritable resuscitation from death to I would include the neuroses generally, espe- life), promoting general nutrition, molecular cially nervous asthma and angina pectoris, and somatic; or, with the products of that when given steadily as a prophylactic during regeneration entering the vasa lactea, and the intervals of the attacks; and the distress- thence the living stream of blood, where, ing dyspnoea of the last stages of phthisis, though per se a bane, it may prove antidotal where it is a precious boon, relaxing inspiratory to some plasma virus, or, finally (returning to spasm and favoring the thoracic automatism, the premiss), possibly by a vicarious substituwhich may continue until the final moment, tion of this ápony mineral, the nascent now so near; also, those rare cases of tempo- lustre of which, in different lights and shadows, rary mental alienation and eccentric conduct, mirrors alternately its dual qualities, lethal or at times simulative of hysteria, or epileptiform, vital, toxic or alexipharmic, malignant or alternating with cephalalgia, and recurring at benign. regular intervals after a definite period of moral and physical exemption, occasionally met with

DIAGNOSING THE Case. The doctor found the in mishy localities. Contemplating these phenomena, the mind patient raving in a paroxysm of incipient delirium.

“ Did your husband receive any bad news, any reverts to obsolete schools and tenets; with great shock just before he was attacked ?" Broussais we see the equipoise held by the “No ; the only thing he got was a gas-bill." functional balance broken, and the reciprocal “Ah, yes," said the physician, with a supersympathies and metastatic correlations of the natural intelligence, “a case of bill-ious fever.

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menorrhoea, and allied affections. The conGUAIACUM AS A PURGATIVE.

fection is nasty, but is appreciated by patients. By WILLIAM MURRELL, M D., F.R.C.P.,

At first I gave it in drachm doses once a day, Physician to the Westminster Hospital, London,

but they were not satisfied with this, and I had N our thi for new remedies there seems to to increase the dose to 2 drachms three times

be a danger that some of our good old a day. In this quantity it seems capable of fashioned drugs may be forgotten. Take guai- producing the maximum of inconvenience and acum, for example. In most of our text-books on discomfort, and gives unlimited satisfaction. materia medica we are told that guaiacum-resin The purgative effect is very pronounced, and acts as “a stimulant, diaphoretic, and diuretic.” in one case the patient had 56 evacuations in I cannot find that there is much evidence in the week. support of this view. Wood, of Philadelphia, In another case it produced a well-marked seems to be of the same opinion, for he says: rash, covering the arms and legs with

Guaiacum is believed by some to act as a an eruption which forcibly reminded one of diaphoretic, and to do good by increasing the copaiba. That this rash is rare may be ga elimination of the skin; but as I have not been ered from the fact that my colleague, Dr. C. T. able to obtain, either from medical literature or Fox, had seen only one similar instance. It from the exhibition of the medicine, any dis- was accompanied by intense itching, which tinctive proof of its having any such action to disappeared on discontinuing the drug. The any marked extent, I have preferred to consider guaiacum not infrequently gives rise to a burnthe drug as an alterative." Schmiedeberg, of ing sensation in the throat, and to obviate this Strasburg, curiously enough deals with it under I prescribed the 10 grains of the resin in 72 the head of “Drugs and preparations used for ounce of extract of malt, which answered all sorts of purposes, but now mostly antiquated admirably. This method of treatment is, and obsolete.” I am inclined to think that its perhaps, simply a return to the old-fashioned main action is as a laxative or purgative, and “Chelsea Pensioner," which consisted of this view is evidently shared by Dr. C. D. F. guaiacum, rhubarb, ginger, sulphur, and cerPhillips, who, in his well-known work on the tain other ingredients; but it is interesting, “ Vegetable Kingdom,” states that in large nevertheless. I am sure that a trial of the doses it produces “dryness in the mouth, guaiacum-resin as a laxative or purgative burning in the throat, a sensation of heat in according to the dose employed will be found the stomach, loss of appetite, heartburn, flatu- satisfactory. It is possible that if the drug lence, nausea, vomiting, and purging." My were triturated with cream of tartar, sugar of attention was drawn to the subject some two milk, or some other equally inert substance, its years ago by casually prescribing for a city man efficacy would be increased, and it would prosuffering from rheumatism some guaiacum duce the desired effect in smaller doses. lozenges made up with black-currant paste. He continued taking them long after the pains had ceased, and his explanation was that they THE CURABILITY OF CONSUMPdid him good by acting on the liver and

TION. bowels. He said that I or 2 of the lozenges

By FRANK WOODBURY, A.M., M.D. taken in the morning before breakfast acted F there is one fact upon which there is promptly and without inconvenience. I ordered the lozenges for other of my patients pathology of phthisis pulmonalis, it is that presuffering from constipation, and what is con- vention is better than cure. If there is one ventionally called “biliousness," and the therapeutic observation upon which there is result was equally satisfactory. The lozenges universal agreement, it is that the earlier in the not being available for hospital use, I had a disease the treatment is instituted, the greater confection prepared containing 10 grains of the chances of recovery. In fact, if patients guaiac-resin to a drachm of honey. This was submit to rational scientific treatment in the curiously popular with the patients, and for the very incipiency, before the anatomical changes last two years I have used it extensively, not have become serious and the interruption to only as a purgative, but in the treatment of physiological function correspondingly severe, chronic rheumatism, sciatica, tonsillitis, dys- the prospects of recovery are very good ; the

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great majority of such cases can be restored to rabbits inoculated with tubercular virus, which health by the means now at the command of recovered in the open field, while their comscientific medicine and sanatory science. It is panions confined in the hutches all succumbed also generally acknowledged as a clinical truth to the infection. The cause is different in the established by abundant experience, that, as various walks of life: in one it may be hardthe disease progresses, making greater inroads ship and exposure; in another, working as a into tissues and functions, the prognosis becomes weaver in a damp cellar, or as a spooler in a steadily less favorable, although not entirely dusty mill; in still another, the lowering of hopeless, until the lungs are riddled with cavi- vital force by losses of blood, from hæmorties and the system profoundly poisoned by the rhoids or excessive menstruation; in many it toxic principles proceeding from tubercular is due to venereal excesses. Dr. Thomas King suppuration.

Chambers and, later, Dr. Peter arraign dysTo the question, " Is consumption curable?" pepsia as a prolific cause of consumption, but the reply must be "yes, in probably the it is probable that the digestive disorder itself greater number of cases if taken in time." is only an evidence of failing vitality and a The tubercular process may be arrested, the portend of the coming disease. general nutrition may be improved and the What, then, is the rôle of the celebrated troublesome symptoms made to disappear.-on bacillus tuberculosis of Koch? To reply to certain conditions. What those conditions are this question correctly, and in accordance with must be determined separately in each indi. all the facts, experimental and clinical, it is vidual case. It has been said that the consump necessary to recognize two classes of patients tive is a physiological bankrupt. He does not, with pulmonary phthisis : 1. Those in whom however, become bankrupt all at once, but by the disease is primary, corresponding with this a comparatively slow process, and, to keep up morbid process produced experimentally in the illustration, it is easier to re establish him animals in the laboratory by inoculation or by before he has made large inroads upon his accidental infection, in which there is no preresources than when he is physiologically a disposition and no pretubercular stage. Such complete wreck. The causes of phthisis are cases rarely occur, but may be occasionally well known, and in many patients they stare encountered. the physician in the face. Unfortunately, it is 2. Those in whom the disease is grafted not in the power of either the sick man nor his upon another, and is the conclusion of some medical attendant in very many cases to change common morbid process. Here, as pointed out them and to remove the former from their by Niemeyer, the complication is serious and malign influence to a better environment. generally fatal, the tuberculosis in this case Among all the causes of consumption, there is being not so much a disease as a mode of none other so prominent as poverty, and all dying. To this class, unfortunately, most that it entails of insufficient and improper food, consumptives belong. unseasonable clothing, and unhealthy homes. In a communication which Professor Koch Ignorance and filth are prolific causes of made to the Tenth International Congress, he disease, and children born and bred under reported that as the result of experiments such auspices are deficient in vitality; if they extending over many years, he believed that survive the trials of infancy they are apt to he now was able to arrest the tubercular process perish later with tuberculosis or scrofula. It is by the use of certain chemical substances, quite possible, however, by removing them injected hypodermically, in the form of a from such unsanitary surroundings and supply- lymph. He has since made public more ing them with a wholesome food, with exercise details of his experiments, and the newspapers in the fresh air and other essentials of health, contain accounts of wonderful results in the to give them vitality and strength sufficient to case of human beings treated by his method, enable them to escape the threatened death but he has reserved the secret of the compofrom consumption. This has been demon- sition of his wonder-working lymph. It will strated in actual experience many times in the be seen in the telegraphic accounts in the daily observation of practicing physicians, but re- papers, of interviews with Koch, that the ceives striking corroboration from the experi. remedy is a chemical agent, that it is curative ments of Drs. Sternberg and Trudeau, upon only in incipient cases, that repeated injections

Can be used by any one, and when pure is harmless.

Is applied to an abrasion.

and produces toxic symptoms.

Must be injected hypodermically.

Its manner of preparation

etary and uncontrolled remedy.



are required, that it occasions toxic symptoms

Requires skilled operators, suggestive of atropine poisoning, and, finally, that it does not destroy the vitality of the bacil

For the present, at least, relus, but still further lowers the vitality of the and preservation are known; quires the use of a secret, propritubercular tissue, which must be removed by and are under supervision and surgical means or by necrotic process.

In conclusion, it may be stated that a radical If this is all, if this is the outcome of his

difference between the two diseases is found in widely-heralded and much vaunted discovery,

the fact that small- pox is self-protective, and, as we confess that we do not see much in it that will be of real service to our patients ; although, the rule, an individual loses his susceptibility the experimental fact that animals inoculated by surviving the first attack; on the contrary, successively with tubercular material and Koch's an infection by tubercular material predisposes lyinph can escape the effects of the former has to future attacks, provided the conditions favor

able for the outbreak of the disease are present. much scientific interest, and is important, if

Notwithstanding the ingenious argument of the true. Cases of incipient phthisis, as stated at the elder Flint that phthisis is a self-limited dis

ease, the clinical facts are against it, as recently beginning of this article, are curable by a method advocated by Sydenham, although

demonstrated in the able paper read by Dr. older than his time, the chief features of which William Porter, of St. Louis, before the Misare the proper regulation of life, and especially sissippi Valley Medical Association, in which out-door exercise. This is almost an axiom of

. medicine. The hygienic method is, in our

the consumptive, there is no such royal road to opinion, for the consumptive, the only road to health as the community anticipates from Koch's healih, and it is not clear that Dr. Koch pro- brief revival of the cruel and delusive hopes

investigations, which recently have led to a poses to abandon it. If this ancient method be followed, and the patient placed in a suitable that were warmed into life under the Bergeon

The effect upon the profession will environment, the use of powerful toxic agents is un necessary, the bacilli are overcome and probably be to lead them to look with more expelled by natural and comparatively safe favor on the method which Bartholow endeav

ored to popularize, of treating phthisical patients processes.

At all events, no matter under what guise it systematically by hypodermic injection, with may appear, or by what authority promulgated, remedies of established reputation for favorably the secret remedy must be tabooed by an honor- modifying the symptoms and delaying the able and self-respecting profession; it is equally progress of pulmonary phthisis. opposed to the spirit and letter of ethics, and to all scientific procedure and precept.

PRURITUS ÅNALIS. The public prints, it will be noticed, have assumed an analogy between the inoculation treat- T has occurred to me, in addition to the ment of Koch and vaccination for small-pox,


numerous causes mentioned in the various whereas there is no real resemblance between text-books, that the “anal glands” round the the two procedures, nor between the two affec- anal orifice are in many cases the pons et origo tions with which they are connected. It is only of this distressing complaint. necessary to point out a few of the more striking Professor Quekett many years ago pointed points of difference, in order to show how out these glands and explained their function.

They in health secrete an oily substance which Vaccine Lymph is a patho

Koch's Lymph is a chentical lubricates the orifice during the exit of fæcal logical product, taken from a substance, probably dissolved | matier. vesicle in a living animal. It contains bacteria, and is

In many of the lower animals these glands a laboratory are better studied where they are developed to

a greater degree. In many cases (in the beaver One inoculation sufficient.

are and dog) they are even found extending to the Destroys the susceptibility

Does not prevent re-infec- perineum. Is employed in health to

When these glands become altered so as to prevent the onset of disease.

Is employed in disease to

produce a diminished or excessive secretion,


unlike they are:

the infectious material from

which is a bovine

in the serum of a guinea-pig

Is claimed to be non-infec.
tious; and is

form of variola.


Several required

to disease.


restore health.

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