Chlorine employed concurrently with the counter-poison of Dr. Smith may be of great service. 3. When the animal is apparently lifeless, free effusions of cold water on the spine should be made. I, as well as M. Louyet, have tested this plan, recommended by Dr. Robinson. Poisoning from Vegetable Alkalies and Substances which contain them. The largest proportion of the vegetable alkalies may be regarded as very dangerous poisons to man. They act in small doses and are very quickly absorbed. It is of the greatest importance, therefore, to evacuate the stomach of them as quickly as possible, according to the directions previously given. The only counter-poison which has been as yet discovered, is the compound solution of iodine. I have given in my "Annuaire" of 1842 all the details of the insoluble compounds which result from the reaction between this preparation and the vegetable alkalies; they are ioduretted hydriodates, and are insoluble in acidulated water. Of all the insoluble compounds formed with a vegetable alkaline base, there is none which is so insoluble in acidulated water as this. The following is the formula which I make use of for an antidote to vegetable alkalies: Iodine, Iodide of potassium, 20 centigrammes. 66 40 not 5 centigrammes, as has been printed (p. 33) in the second edition of my "Manuel de Matière Medicale." This solution should be given in doses of half a tumbler full at a time, and vomiting should be kept up so that none of the precipitate shall remain behind. This counter-poison has been used with success in cases of poisoning by opium, the salts of morphia, aconite, and I have tried it on animals poisoned by opium, the salts of morphia, belladonna, stramonium, tobacco and strychnia. It may be also used with success in poisoning by cicuta, ananthe and other umbellifera, by stavesacre, white hellebore, sabadilla, colchicum and the salts of quinine, but it is of no use as an antidote to digitalis. I cannot say whether it would be useful in cases of poisoning by the agaricus. The compound solution of iodine is always more useful as a counter-poison for vegetable alkalies than the nut-galls or tannic acid; for although the latter forms an insoluble compound in almost all cases, it is very liable to be redissolved by an excess of acid, which is often found in the stomach. Poisoning by Opium and the Salts of Morphia. 1. The stomach must be emptied by emetics, by cathartics, and, if possible, by the stomach-pump. 2. The compound solution of iodine should then be administered. 3. The narcotic effects should be counteracted by the use of coffee in large doses. This is not an antidote, but nevertheless it is an excellent remedy to counteract the narcotic effects. The best way is to administer it without sugar, but with the addition of a small quantity of alcohol. I give it thus because I wish it to be absorbed very quickly, and it is known that sugar retards absorption in the stomach. All our experiments on the digestion of sugar go to prove this fact; alcohol in small quantity favours absorption. The following is the recipe I make use of. Coffee, roasted and ground, 50 grammes; from which we obtain by lixiviation, 500 grammes of the fluid extract; to this add 20 grammes of brandy, one-fourth of which is to be taken at intervals of five minutes. Coffee may also be administered by injection. Poisoning by Belladonna, Stramonium, Tobacco, and otber AcroNarcotics. 1. Evacuate thoroughly the digestive organs. 2. Administer the compound solution of iodine, keeping up at the same time the vomiting. 3. Bleeding, and if reaction is pretty great, cooling drinks, baths, &c. Poisoning by Nux Vomica, St. Ignatius' Bean, Strychnia, Brucia and other products or compounds of Strychnia. Strychnia and its compounds does not give the least offence to the stomach, and it is for this reason that carnivorous animals, such as lions, wolves and dogs, whose stomachs are so sensitive that they reject all other poisons, may be readily destroyed by this substance. 1. It is best, therefore, to bring on full emesis as soon as possible; strong salt water or tartar emetic, are the agents to be employed in preference. 2. The compound solution of iodine should be given at the same time. It is necessary to give an excess of the antidote, for I have proved that the resulting compound, although wholly insoluble in acidulated water, could still poison. It is true it requires a larger dose and a longer time for the poisoning to take place, but still it is best to give plentifully of the antidote and keep up free emesis. 3. We have as yet no good clinical reports on the means necessary to counteract the tetanic convulsions caused by the absorption of strychnia; there are, however, some general principles that may be followed without danger. Death in these cases always results from asphyxia, because the respiratory muscles, whose constant action is so indispensable to life, become so rigid that they lose their functions. In this respect strych nia differs essentially from other poisons, the preparations of mercury for instance; the latter destroy vitality, while the former increases to a high degree the action of the involuntary muscles, which is the cause of the asphyxia. If the respiration could be continually kept up until the paroxysms had passed off, all danger, all disease would disappear, unless it be a lassitude following the intense excitement. This is not the case with other poisons; convalesence in those cases is slow, difficult and often doubtful, for they attack the vital organs. In poisoning by strychnia, then, respiration must be kept up by every means, by inspirations of air or of oxygen, by alternate pressure on the thorax, &c. Opium, the most prompt and sure agent to counteract the tetanic effects of the strychnia, should be given either by the mouth or the rectum as circumstances may indicate. I would administer without hesitation from thirty to forty drops of Sydenham's laudanum in fifty grammes of water and watch the effects. I stop here, and will complete this subject I hope at some future period, when I will review the more important points. Means of Recognising the Presence of Morphia in Cases of Poisoning by that Substance.-This method is detailed in the Gazette Médicale, as proposed by M. Mermu. The solid matters ejected from the stomach are first to be washed with water, slightly acidulated with acetic acid. The product of the several washings is to be mixed with any liquids which can be collected. If one has liquids only at his disposal, those are to be mixed with the water, acidulated as above. In either case, the resulting mixture is then to be evaporated to dryness, and treated with boiling alcohol, to separate the animal matters. To the alcoholic liquid, previously filtered, some tincture of gall-nuts is to be added-the tincture being made of 125 parts of alcohol with 250 parts of coarsely powdered gall-nuts; and the whole to be let digest fifteen days, which will precipitate the little animal matter dissolved by the alcohol, and the combination of tannin and morphia thence resulting will remain in solution. The liquid is next to be filtered, mixed with a small quantity of distilled water, and then a solution of gelatine to be added in excess, in order to decompose the tannate of morphia. The morphia having gone over to the gelatine, the tannin with which it was previously in combination becomes dissolved by the spirit. To separate the precipitate of tannin and of gelatine, it is necessary again to filter; and when the alcohol is evaporated, the morphia will be left, which may be recognized by its particular tests.-London Lancet. Hydatids of the Lower Lip.-Dr. Heller, of Stuttgard, has seen five cases in which acephalo-cysts were developed in the lower lip, and always on its inside. The causes of this affection are unknown; in two cases it was attributed by their patients to their having bitten the lip. It appears first as a small and hard lump, which rapidly increases, so that in one month it may attain the size of a cherry; it gives rise to pain, deformity, and difficulty in moving the lip. The hydatids are seated immediately beneath the mucous membrane, and are transparent. The largest Dr. Heller has seen was of the size of a nut. If one succeeds in removing them without opening their cavity, they are found to be made up of a round vesicle, full of fluid, transparent as water, and with a diaphanous and tender wall. The only means of curing this affection consists in the extirpation of the cyst, and this must be total, otherwise it will reappear; hence, as a precautionary measure, nitrate of silver may be applied after the removal of the tumour.-Ibid. Simple Treatment of Prolapsus Ani. By DR. HAKE.-Take a piece of sponge four or five inches long, an inch and a half wide, and half an inch thick-the more elastic a bit you can find the better; roll this, in a damp but not wet state, pretty tightly, so that the roll, if relaxed, would be ready to spring back into its full length, and it will then make a roll of some little substance, round, but still soft; and its length, when thus rolled, will of course be an inch and a half. Apply it then lengthwise to the anus, so that it may be pressed, about the centre of it, quite home and firmly to that part. Taking care that it may remain so, stretch a length of adhesive plaster, about fourteen inches long, and three and a half wide, more or less, straight across the nates, rather low down, and contrive so that while the plaster adheres on one side, you press the other side closer to its opposite before you fix the length finally where it is to remain. Then sit down, at first gently upon it, and it will become very firm and fast as long as the plaster is good. I need not say that these two pressures constantly going on do the work capitally, and without any inconvenience worth speaking of-I mean, the two pressures of the roll of sponge always striving to unwrap itself, and the cross-band of adhesive plaster always keeping it from doing so by holding the nates sufficiently close together to hinder it. The working is really perfect when a little use and management has got a person into the way of it. But to facilitate matters, I will set down a few observations, at the risk of being tedious and more particular than I need be. I never put this on until that time of day when I am going to ibe standing about, or to take exercise, whether walking, riding, or dr ving; but it should be put on then for all of these. In the evening, I take off the plaster, but leave the sponge in its place, where it has got by that time so firmly fixed by gradual spreading and swelling, that there is no danger that anything short of a great exertion will loosen it, and it is of course more comfortable to do without the plaster when it is not wanted. The sponge should be washed in cold water every time it is taken off, and in cold weather the plaster should just cross the fire before it is put on; in moderately warm weather it will adhere of itself, especially if it is sat upon for half a minute. The same plaster is better the second day than even the first, and will do very well the third day--this where economy is an object. Wash the parts where the plaster goes every morning, or oftener, with cold water, or water and vinegar, wash them well, and the skin will never suffer. If the plaster leaves something sticky behind it when it is taken off, rub it with a very little spirit of wine, and the towel will remove it. If there be an irritation about the anus, or gut that comes down, wash it with vinegar and water, and the relief will be wonderful, and that part of the evil soon cured. This wash cannot be too much praised for this purpose, for piles, and for the like. I leave it for you to say whether something might not be dropped upon the sponge, or the sponge dipped in something which would promote a complete cure. What I have said is perfectly cleanly, secures exercise and comfort, and very gradually, I believe, tends to set things right again. The relief is, indeed, so perfect, and it is relief from such suffering, that, without a bit of braggadocio, I do think no sufferer from such malady would feel that he could be grateful enough for being brought acquainted with the treatment I have described, though its perfect management will require a little experience at least, and perhaps some advice at first.-id. Case of Malformation of the Heart, in which death resulted from Obstruction of the Trunk of the Pulmonary Artery. By THOMAS B. PEACOCK, M. D. The subject of this case was a boy, fifteen years of age, who had from early life exhibited slight appearances of cya nosis. Twelve months before his death he was thrown from a cart, andafter that period the lividity of the countenance became much more marked, and he was subject to frequent attacks of chest affection, and to palpitation. His last illness was of eight days' duration, and commenced with rheumatic symptoms, followed by difficulty of breathing and pain in the chest. When admitted into the Royal Free Hospital, he exhibited very marked cyanosis, and a loud murmur, accompanying the impulse of the heart, was audible in the præcordia, and along the sternum. At the situation of the base of the heart the murmur masked all other sounds; but toward the apex, and the lower and right side of the sternum, it was followed by a loud second sound. He died a few hours after his admission. On examination, the aorta was found to arise in part from the right ventricle, and the orifice and trunk of the pulmonary artery were of very small size. The right ventricle was also separated by a supernumerary septum into two cavities, one being the infundibular portion, giving origin, as usual, to the pulmonary artery; the other consisting of the sinus of the ventricle, communicating with the aorta. The abnormal septum was incomplete over a space about equal in size to that by which the aorta communicated with the right ventricle. The orifice of the pulmonary artery was provided with only two valves, and these were so thick and rigid as to occasion a further contraction of the aperture. The trunk of the vessel was entirely obstructed by partially decolorized coagula, which were laminated and adherent to the thickened and diseased valves and coats of the vessels. The author remarked |