THE PRACTITIONER. MAY, 1877. IFFE Original Communications 7 MAX 77 ON THE USE OF WARBURG'S TINCTURE. BY JAMES TOMPSETT, M.R.C.S. AND Q.S.A., THE interesting and valuable article by Dr. Broadbent in the Practitioner of February last, "On the Use of Warburg's Tincture," must have aroused the attention of tropical surgeons. After reading Professor M'Lean's account of this agent in the treatment of malarious fevers, I felt overjoyed at the idea of having at last been made acquainted with a specific for them, and at once had a supply of the medicine imported to Jamaica. I have since that time applied it in the treatment of typical cases of remittent and intermittent fevers, and can testify to its great and certain efficacy. I will give one illustration of its sure and almost immediate action in such cases, and I may here remark that I believe its action to be always speedy, when the tincture is effectual. The wife of a brother practitioner had suffered, during the present month, from an acute attack of remittent fever, which lasted six days with only very slight remissions. On the night of the sixth day he became alarmed at her aspect, and sent for me. I found her intensely feverish, with an anxious, restless expression, answering questions in an NO. CVII. Y incoherent manner, and taking very little notice of those around her. Her tongue was red but moist, eyes much sunken, and features pinched. The pulse was 144, and very feeble. Respirations hurried. Temperature very high indeed. (Unfortunately my thermometer had been left at home.) She had taken little or no nourishment for twenty-four hours; vomiting had been present, but had ceased. Altogether the case was one that justly caused us great apprehension. I advised the immediate administration of Warburg's tincture, and two doses were given at an interval of three hours. The first produced a gentle sleep, very free action of the skin, and subsequently a free evacuation of the bowels. The second dose simply completed the cure of the fever, and when I revisited her in the morning I found her quite cheerful and free from the dangerous symptoms which were so marked twelve hours before. She informed me that the previous day was quite a blank to her, and that she had no recollection of occurrences that took place then. There was no return of fever, and she has made a good recovery. I could mention other cases of cure of malarious fevers by this wonderful medicine, bu tthe foregoing is sufficient. There is a type of fever, however, seen in Jamaica in which its curative qualities are not so speedily evident. I speak of typho-malarial fever, confounded by some with true enteric fever, but differing very essentially from that disease in many respects. In this there is marked benefit from its use, but not to the extent observed in the case I have related. It seems to exercise its powerful influence chiefly in uncomplicated cases of intermittent and remittent fever. One cardinal advantage that it has over all other preparations of quinine is that it can be given, if necessary, in the hot stage of malarious fever; whereas, quinine, pure and simple, cannot then as a rule be administered with safety. I have given the tincture once in yellow fever, but the result was unsatisfactory-increasing the vomiting and general distress of the patient. Still, I shall be inclined to repeat the experiment in future cases, and especially at the onset of the fever. ON THE TREATMENT OF CROUP. BY JOHN J. HIGGINS, A.M., M.D., New York, U.S.A. THAT croup assumes various forms, being often simply spasmodic, and at other times catarrhal, or again exudative, is fully set forth in our text-books. Yet no one on being called to a case of croup can say that it is simply spasmodic, and may not prove exudative. The most careful dissection of symptoms would neither enable one to determine nor justify such an assertion. On the contrary, the tendency to the progression of the one variety into that of the other, unless arrested by treatment, is a truth that cannot be gainsaid. Distinctions undoubtedly exist, and should be understood, but, practically, at the bedside, the forms are frequently insusceptible of differentiation. The croupy ring, once heard, should of itself awake in us activity, energy, and persistence in remedial measures which must not be relaxed during its continuance. The treatment consequently is that of croup, and not of one of its varieties. The indications in reference thereto may be divided into Special and General. The Special indications are: 1. Relief of spasm. 2. Relief to the congestion of the parts, by the promotion of their natural secretions. 3. Reduction of the inflammation by reason of which the membrane is being produced. 4. The dissolution and expulsion of such membrane. General Indications. Under this head are embraced, the restoration of the various functions of the system and the abate ment of fever-a sufficient but not sthenic support-the exhibition of diluents to encourage secretion, as also for the same purpose the respiration of a humid atmosphere,-and the rendering of the blood alkaline to counteract the tendency to the formation of fibrin. In noticing these indications more or less seriatim the use of emetics for the relief of spasm may be taken first. It is not only a time-honoured practice, but is in our repertory of medicines the sheet-anchor upon which reliance is placed for the relief of croup, and especially of that form of it termed spasmodic. As in the other forms spasm is likewise present, so emesis has been universally recommended in all varieties of the disease, and is a measure never to be neglected. The effects of emetics are not only mechanical, but also upon the system at large-systemic. These latter are upon the brain and nervous system essentially depressant, a temporary impulse only being communicated during the act itself; upon the mucous system an increase of secretion; on the vascular system (the mechanical impression attendant upon the act having subsided) the decreasing of its force, and the rendering of the pulse soft and of less frequency; on the respiratory system an increase of secretion from its mucous surfaces. The dislodgment and expulsion of accumulations which result at the same time, although usually classed among the mechanical effects, are also in fact systemic, for such dislodgment is assisted by, and frequently depends upon, the increased secretion which takes place, freeing such accumulation or exudation from its intimate connection with the subjacent tissues, and allowing an expulsive effort to avail for its removal. On the absorbent system the effects are stimulant, in so far as emetics lower the force of the circulation, it being a rule that the rate of absorption is in inverse ratio to this force. On the cutaneous system there is promotion of secretion. Emesis having taken place, the skin is found to be soft and moist, and in a general state of relaxation. On the muscular system the effect is impairment of energy. Harnack1 asserts "the destruction of the excitability of striated muscular fibre by all specific emetics." On the urinary system in general there is promotion of secretion. 1 Archiv. Exper. Path. ... The systemic effects then of emetics are upon the secretory systems an increase of functions, and upon the nervous, arterial, and muscular, the reverse. Such effects may well be termed antiphlogistic, and are those which in conjunction with their mechanical effects have led to the universal employment of emetics in croup. In opposition however to the antiphlogistic treatment of croup, Flint' says, "These measures (antiphlogistic) have been employed sufficiently to show that they are not successful, and if they do not do good they can hardly fail to do harm. The rational objects of treatment are to prolong life until the separation of the false membrane can be effected, and to promote the process by which this is effected." For the first object, viz., the prolongation of life, he recommends "concentrated nourishment and the judicious use of alcoholic stimulants." "Emetics," he says, "are to be employed with circumspection, in order not to conflict with the first object;" and asserts, "that it is useless to give emetics for the purpose of detaching the false membrane until the exudation has been loosened by the process of suppuration." Finally, he allows that "emetics, however, are not to be entirely withheld." Again, it is taught by Dr. Fabius, of Amsterdam,2 that "the effect desired from emetics is purely mechanical," thus ignoring the systemic effects-effects the production of which are so clearly indicated. In a disease so grave as the one under consideration surely no assistance should be lost sight of. Such exceptional views, however, weigh little in opposition to those of the mass of authors and practitioners by whom the antiphlogistic treatment, to meet the indications as previously given, is recommended, and it is undoubtedly the one in accord with the usual principles of therapeutics. Squire says, "Few diseases are so dependent for their relief in the prompt and careful adaptation of a thoroughly antiphlogistic treatment at their very commencement as is true idiopathic croup.... The induction of vomiting in the early stages is often the most effective means of arrest, and one that must be resorted to in all stages of the disease but the last." Evanson and Maunsell say, "We are prepared to recommend a strictly 1 Theory and Prac. Med. 2 Jour. für Kinderkrankheiten, 1870. 3 |