Abbildungen der Seite
PDF
EPUB

led me to think I should find it; indeed, the very intelligent gentlemen who were in attendance, said that this condition, of general appearance was sometimes present a long time before death. Upon his body were numerous petechiae, now very much faded, but which were at first quite dark.

The father of this child had died a few days before, in the same manner, after an illness of forty-eight hours.

This epidemic commenced in February, during the prevalence of the south wind, and after the disappearance of the snow. Scarlatina, in a mild form, had preceded it as an epidemic. It was, thus far, confined to the valley in which the village of Elmira is situated, and had occurred mostly among the poor, yet not entirely. The family whose house I visited, was in a comfortable dwelling, andin easy circumstances. The soil of this valley is composed chiefly, I think, of sand and gravel, and allows the surface to become easily drained. It is probable, however, that a substratum of frost has not permitted this drainage to be complete during the period of the present epidemic.

In all, twenty cases have occurred, of which only four had recov ered. It was not confined to any period of life.

The usual signs which characterize the disease, are a general malaise, coldness of the extremities, and of the face, nose, chin, ears, while the head is rather warmer than natural; stupor, occasionally delirium, and sometimes no cerebral disturbance whatever. The head is gradually drawn back, and the muscles of the neck become rigid. Often, no pulsation can be felt at the wrist, when the physician is first called. The stomach and bowels are not much, if at all, disturbed. Petechiæ occur at an early period.

The plan of treatment adopted has generally been stimulating: such as alone seemed to be indicated. Hot baths, medicated with cayenne pepper, mustard, brandy, &c., also hot mustard cataplasms, and frictions. Internally, the patients have taken brandy, camphor, quinine, &c.

Since I have returned home, Dr. Flood has informed me that fifteen more cases have occurred, of which four terminated fatally within from one to two hours after the accession of the disease; but that under the plan of treatment described, four others, who were seen within from twenty to thirty minutes after the attack, recov ered.-[Buffalo Medical Journal.

Etherization in Convulsions.

Dr. N. J. Knight communicates to the Boston Medical Journal his experience with ether in controlling convulsions, and especially the convulsions of children, as follows:

"I think etherization in cases of convulsions in children and adults, is not fully known and appreciated. To every case of teething convulsions, in my practice for the last three years, I have adminis

tered the pure sulphuric ether, and immediate restoration has followed with the most pleasing effect.

"A severe case of puerperal convulsions occurred in my practice last month. A lady who had, at three previous pregnancies, miscarried at periods varying from four to seven months, was taken with the usual symptoms of abortion, and sent for me in haste. Perfect quiet and an anodyne were prescribed; the alarming indications soon passed off, and I left. About three o'clock the next morning I was sent for, and found the patient recovering from a convulsive fit. Bleeding, a cathartic, cold to the head, sinapisms, to the neck, legs, etc., did not prevent the recurrence of three more convulsions in less than ten hours, when I commenced the administration of sulphuric ether, and although no more convulsions occurred, it was not until near the end of forty-eight hours that the nerves became so calm as to allow the ether to be omitted altogether. Ten days from the first attack the lady was delivered of a seven months' child, which had evidently been dead from the time of the first convulsion. "I have had a severe case of convulsions of a married lady, this week, and etherization shortly restored the patient to a healthy condition.

"I consider ether really the only safe and efficient remedy for convulsions of teething children, or adults, now known to the Profession Probably the half is not yet learned that etherization can accomplish for suffering humanity."-[ Cincinnati Med. Observer.

On Fissure of the Anus, and its Radical Cure, without a Bloody Operation. By Dr. CHAPELLE. (Read before the Academy of Medicine, Paris. (Translated from the Gazette Hebdom.)

There is in this disease a neuralgic element which is its principal constituent. This accounts for the inefficiency of the therapeutical agents employed for the cure of the wound alone. All topical agents which do not act vigorously upon the neuralgic element, have been and cannot fail to be powerless. Among the curative means prescribed for this affection, the incision of the sphincter, used by Boyer, and since his time, adopted by most modern surgeons, has been the most successful. This operation acts in the same manner as the division of nerves in other neuralgias. Observation shows that the therapeutical result is the same whether the section is made at some distance from the muscle, or near to the fissure itself, another proof that the erosion of the mucous membrane is of but slight importance in this disease.

It was the decision as to the neuralgic character of this affection which led me to the discovery of a means for curing fissure of the anus, as simple as it is efficacious. Chloroform dissolved in alcohol is the means with which I have invariably succeeded.

I diminish or increase the proportion of chloroform according to

the degree of sensitiveness of the patients. Ordinarily, I use the following: B. Chlorolorm Alcohol

1 part. 5 parts.

I proceed as follows: With the fingers of the left hand I separate the borders of the anus, then I introduce deeply into this opening a badgers hair brush, previously saturated in the chloroform solution, and then withdraw the fingers. The sphincter naturally presses upon the brush, expresses the liquid which it contains, which acts rapidly upon the contracted tissues, produces a severe and penetrating heat upon the contaminated surfaces, and particularly upon the points where the fissure exists. Soon after the abnormal contraction ceases, and the patient only feels the effect of the liquid applied.

This mode of treatment is quite inoffensive. It has no other inconvenience than the local and immediate pain which follows the application of the chloroform liquid, but this disagreeable sensation soon passes off. Fourteen cases of anal fissure are reported, in which this means was used with constant success. Of these fourteen cases, four were cured by a single application: six by two; in three others it was necessary to have recourse to it three times; and in one, only, four applications were necessary before a cure was obtained. [American Medical Monthly.

On Urticaria. By Professor BUDD.

Nettle-rash may be produced in various ways; but its most frequent cause, and that which especially concerns us at present, is the imperfect digestion of particular articles of food. Among the substances that have been observed to bring it on, are shell-fish, especially crabs and muscles, pork-pie, fish, when tainted or out of season; honey, mushroons, cucumbers, almonds and oatmeal. The symptoms are too well known to require notice. The main object of treatment is to expel as soon as possible the offending matter. The stomach should first be emptied by an emetic of ipecacuanha or sulphate of zinc, and the bowels then cleared by a warm but quickly acting purge. To allay the cutaneous irritation, Dr. Budd is in the habit of prescribing a lotion, made by mixing half a drachm of acetate of lead and half an ounce of tincture of opium with eight ounces of water.

In those cases in which the nettle-rash seems to be referable to several substances in common use, rather than to one special substance, it may sometimes be kept off by the administration (before dinner) of the rhubarb and ipecacuanha pills, or of a few grains of rhubarb. Dr. Budd gives a case which shows, very satisfactorily, the occasional efficacy of rhubarb in this disorder.

66

'It sometimes happens (says he,) especially in women, that the nettle-rash though depending immediately on the stomach, occurs only when digestion is weakened by over-fatigue, or by profuse monthly discharges, and that remedies of a different class are avail

ing. In some such cases, when all the means I have before spoken of had failed, I have known the eruption to disappear under the use of carbonate of ammonia, alone or in conjunction with the tincture of gentian."-[British and Foreign Med. Review.

Upon a Method of Treatment Preventive of Puerperal Fever. By M. PIEDAGNEL. (From the Gaz. Médicale.)

M. Piedagnel communicated to the Academy of Sciences, Paris, in its sitting of Nov. 24, 1856, the following note upon a method of treatment preventive of puerperal fever:

During an epidemic of puerperal fever, at Paris, lying-in women were distributed through the various hospitals, and a certain number were received into the wards at Hotel Dieu, under the charge of M. Piedagnel. Conscious of the uncertainty of medication against this disease, M. Piedagnel thought it might not be impossible to prevent its occurrence, and forthwith endeavored to discover the

means.

Knowing that quinine had often been employed with advantage in this disease, and that it prevented the access of pernicious intermittent fever, a disease usually more severe than puerperal fever, and recalling that during the cholera of 1853-54 he had obtained undoubted preventive results from its use; knowing also that iron, which has a positive action upon all the economy, has also been employed with advantage against puerperal fever, it seemed that by associating them, good results might accrue from their administration. But as puerperal fever ordinarily commences suddenly, and is not always preceded by any partial alteration, he thought the administration of these medicaments, which could not produce any injurious result, might be made before the appearance of the disease, when its irruption was feared.

The patients he received were well watched, and kept carefully clean. The windows of the wards were kept open almost all the time, even at night, when the weather would permit; fire was kept day and night in the stoves, so as to produce currents of air, and the treatment used was as follows:

As soon as a woman entered the wards to lie-in, or if she had been delivered, she took two pills, each containing about one and a half grains of quinine and fifteen grains of sub-carbonate of iron, and in the evening the same quantity; and as long as she remained in the hospital she took morning and evening the same dose, drinking linden-flower water and a bottle of Spa water. All the functions were watched and preserved as much as possible in their physiological integrity. This was the treatment in simple cases, but in those in whom the signs of the fever had become developed, the dose of the medicament was increased progressively each day as high as 5, 10, and 15 grains of the sulphate of quinine, and of a 3j. to a 3 iss. of the iron. As soon as the symptoms became milder, the amount of the medicaments were reduced.

Of 94 women delivered under his care, only one died of puerperal fever contracted in his wards.-[American Med. Monthly.

Medicinal Substances introduced into the Large Intestine by Enemata. By M. BRIQUET. (From the Gazette Hebdomadaire.)

M. Briquet read before the Academy of Medicine, Paris, Session of Dec. 30, 1856, a paper entitled "Upon the Absorption of Medicinal Substances introduced into the Large Intestine under the form of Enemata," from which he drew the following general conclusions:

1. The liquid comprising the enema can easily reach the cœcum, and consequently come in contact with a very extensive absorbing surface.

2. The mucous membrane of the large intestine and the fluids which cover its surface, have no chemical action upon the substances introduced into the large intestine, and that there is no absorption of anything which was not primitively in solution.

3. When any of the soluble salts of quinine are administered in enema in doses below fifteen grains, a little more than a third of the quantity administered is eliminated, and consequently has been absorbed.

4. When more than fifteen grains are administered it is not tolerated well, and only a fifth or a sixth of it absorbed.

5. At whatever dose the sulphate of quinine may be given, it produces ordinarily the cerebral symptoms, very slowly and very imperfectly.

6. Traces of elimination and consequently of absorption, are not observed till an hour after the administration of an enema, and then it is very slight.

7. The duration of the elimination is generally quite short, and ordinarily from two to three days at the longest.

8. The greater or less quantity of the liquid, yet limited to a certain degree, the more or less viscid nature of the liquid, and finally the addition of the salts of morphine to the alkaloids of cinchona, do not sensibly modify the absorption.

9. Young people absorb better than adults; old people of both sexes badly.

10. The alkaloids of cinchona administered in enemata in doses below fifteen grains, can produce, in this way, all the effects to be expected from the exhibition of these alkaloids in small doses, by the mouth, and can very well take their place.

11. The same is not true of those cases where a large dose is required; there is not sufficient absorption to produce the severe stupefying effects.

12. More than thirty grains of sulphate of quinine at a time cannot generally be tolerated by the large intestine.

These conclusions are applicable, more or less, exactly to the different substances employed in enemata.—[Ibid.

« ZurückWeiter »