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70, spare habit, but good general health, had a tumour at the angle of jaw, of four years' standing. (She resided in Tully, Onondaga Co., New York.) The tumour was about the size of an orange, very hard, with lancinating pains through it. Diagnosis, schirrus of the parotid gland. It was determined to extirpate it. Previous to extirpation it was decided to tie the carotid, which was done by myself, and Dr. Narmon Van Dusen, of Tully. At the commencement of the operation, considerable hemorrhage attended, but, the operation was finished, and the patient recovered, the wound healed, and the ligature came away on the 28th day of the operation. The patient was well one year from the operation, but I understood the tumour returned again in the course of two years, and she finally sunk under it. But she recovered perfectly from the operation of tying the carotid. This was in May, 1844, and has never been reported before.—Ibid.
Gase of Ercision of the whole of the Genital Organs.-By E. W. H. Beck, Asst. Surg. U. S. A. (Communicated in a letter to the Editor, dated, U. S. Hospital, Matamoras, Merico. May 8, 1947.) Sir.—Permit me to report to you a case that lately came under my care, which, from its oddity and interest, is certainly entitled to a page in your excellent journal. J. B., ætat. 31, stout build, bilious temperament, had been a member of the army, but now in the position of bar-beeper in a grocery; on the evening of March 9ih, during a fit of delirium tremens, and unmanageable behaviour, was confined in the guard-house. A few minutes after his confinement he borrowed of a fellow-prisoner a short, thick, one-bladed, pocket knife, with which he completely excised the whole of the genital apparatus, close to the body. Flinging them violently into one corner of the room, he very heroically remarked--- Any d—d fool can cut his throat, but it takes a soldier to cut his privates off.” This was at seven and a half o'clock. His companion gave the alarm, and the surgeon of the Mississippi regiment, happening to be in the same building, got to him about ten minutes after the accident. Every effort was made to secure the spermatic arteries, but their immediate retraction was so great that he failed in getting ihem. I was sent for in consultation, but being absent from my room at the time, the courier returned to the doctor stating the fact. The man was bleeding to death, and, in the desperation of the moment, he determined to apply the actual cautery to the bleeding surface.
Ai eight o'clock, a few minutes after its application, I saw him, and as the bleeding had almost entirely ceased, a large bunch of rags was applied as a compress, and secured by the appropriate bandages; his hips a little elevated; cold applications to the abdomen, and perfect rest and quiet for three hours ; at which time he was removed to the General Hospital, and placed in the surgical ward under my care. The amount of blood lost was estimated by all present at near or quite one gallon. One fact worthy of notice here is, that eight or ten minutes after the bleeding commenced, complete consciousness was restored, nor did he exhibit a symptom of delirium tremens, afterwards. On my visit next morning, he lamented his condition as a sensible man, asked my opinion of his danger; complained of no pain ; skin cool; pulse slightly jerking, and tremulous ; 88 in frequency. I ordered him barley water, and, fearful of hemorrhage, did not disturb the bandages until a disposition to pass water, which was early the following morning. To remove the dressing the more easily, a soft poultice was applied; and after some difficulty in find. ing the urethra and passing the catheter, evacuated the bladder, with but a little oozing of blood from the surface and one minute artery, which I secured by torsion. Ever after this, his water passed with. out artificial assistance ; his pulse became equal and soft after a gentle aperient, and absolute diet. Dry dressings-until a yellowish sloughy secretion was coming off, when I washed with a solution of chlorinated soda, and applied simple cerate. The 100 luxuriant granulations, which soon arose, were suppressed with caustic, and the whole had kindly cicatrized in five weeks from the occurrence of the accident.
The last few days of the healing process, a large silver catheter, and afterwards, an oiled lent, was retained in the urethra, to prevent any contraction, to which there was a great tendency, and around which the orisice closed with a firm callous edge. The superior surface, or that above the urethra, presents a flat, or rather concave appearance, the posterior slightly elevated or ridge-like.--Ibid. Poisons and Counter-Poisons Therapeutically considered. By M.
. BOUCHARDAT.- Hôtel Dieu, in consequence of its central location, is the hospital most frequently selected by the administration and people of Paris whenever any accident or case of sudden disease occurs requiring immediate assistance. Among these there are of course a great many cases of poisoning, to which my attention has consequently been frequently directed. I have made also a great many experiments on aniinals in reference to counter-poisons, so that I think myself capable of giving some very useful information on this subject. I intend in this article to embody the results of such researches which have been as yet unpublished or scattered throughout my “ Formulaire,” iny " Annuaires," the second edition of my “Manuel de Matière Médicale,” or any other publications of the last year. I publish this notice in my “ Annuaire” of 1847, because it is a work destined for the hands of both physicians and pharmaceutists, for I think that a thorough knowledge of certain parts of therapeutics is as necessary for the latter as the former; in fact, in urgent cases which call for immediate attention requiring a very exact knowledge of their nature, we are obliged to call upon the pharmaceutist, who is always at home, while the physician is very liable to be absent. In this respect there is a great deficit in the education of the pharmaceutist, which can only be remedied at present by publications like the one I here give.
The assistance required by any individual who has been poisoned may be considered under three heads. The poison having been discovered, the first indication is to evacuate it. For this purpose we einploy emetics, emetics and cathariics together, purgatives, or the slomach-pump. The second indication is to administer the antidote. The third is to bestow upon the patient those attentions his condition requires, and which may be divided into those suitable in all cases of poisoning, and those adapted to each particular case.
1. To evacuate the stomach of its poison, tartar-emetic is most generally had recourse 10; the dose is five centigrammes (3 of a grain) dissolved in half a tumbler full of water, and repeated two or three times after an interval of a few minutes. The patient should drink freely of tepid water, and it is often advantageous to assist the inclination to vomit by tickling the fauces. If tartar-emetic is not at hand, it may be substituted by the sulphate of copper, twenty centigrammes, (three grains,) dissolved in two table-spoonsful of water, and repeated if necessary ; sometimes this emetic is preferable to the former because it acts more promptly.
When the poison is insoluble, and there is reason to believe that it has passed out of the stomach into the small intestines, it is better to administer an emetic and cathartic combined. Twenty centigrammes (three grains) of tartar-ernetic may be dissolved with sixty grammes (two ounces) of sulphate of soda or magnesia in two pints of water, and then administered to the patient as rapidly as he can take it. It has been recommended in cases of poisoning from vegetable substances to use a strong solution of table salt, which acts both as an emetic and a cathartic, 50 grammes (an ounce and a half) 10 to the litre (two pints) of water. This is at times a very valuable therapeutic agent because it is always at hand, and we cannot administer an evacuant too soon.
When the poison has been taken per anum, and has entered the large intestines, we must have recourse to enemata.
A very excellent enema may be prepared in these cases composed of twenty grammes (five drams) of senna, fifty grammes (an ounce and a hall) of sulphate of soda and five hundred grammes (one pint) of water; this injection is much better than those more drastic in their action; these are slower in their operation, and I have often seen them prescribed without success. When we cannot succeed in procuring emesis, and the poison is still in the stomach, it is best to introduce the stomach tube and pump out the contents.
2. A counter-poison is, according to my view, any substance which will form an insoluble or inoffensive compound with the poison which has been taken. There are some general rules which it is necessary to mention in reference to the employment of these counter-poi
We ought to give the preference to those which are perfectly innoxious, and which are most likely to be at hand. We should administer a quantity which will more than suffice to neutralize the poison, for the antidote may be rejected almost as soon as it is swallowed, and in the most fortunate cases even the compound is not wholly insoluble; then again we wish to destroy the poison as quickly as possible, and we can do this most readily by having the antidote in excess.
There are several counter-poisons which form compounds with the poisons which are possessed of a slight degree of solubility; these may after some time become redissolved in the intestinal canal, and cause a return of the bad symptoms. In these cases it is necessary to induce full evacuation of the stomach and bowels after administering the antidote.
When the poison has passed into the small intestines an insoluble counter-poison should be selected, otherwise its action might be liinited to the s!omach.
3. Poisoning is a disease produced by a known cause, and it is necessary to treat it with those remedies whose powers we have learned by experience. In almost if not quite all cases of poisoning, death results as a consequence of the great disturbance which takes place in the organs of respiration and circulation. It is necessary, Therefore, to watch these organs, the constant exercise of whose func. tions is indispensable to life, and to take every means to prevent their suspension, for with their suspension comes death.
The circulation is to be kept up by sustaining the animal heat by means of warm clothing, frictions, hot water and sinapisms applied to various parts; sometimes it is well to practice moderate venesection. Respiration is assisted by the free admission of fresh air, by alternate pressure on the walls of the thorax, by blowing into the nostrils, or by galvanism. When the secreting organs eliminate readily any poison that may have been absorbed, it is important to increase the activity of such, as Orfila has recommended in advising the use of diuretics in poisoning from antimony and arsenic which are separated from the blood by the kidneys, and as we have recommended in prescribing those articles which increase the secretion of bile when the poison is separated by the liver;—this is the case with almost all the mineral poisons.
When the poison has been absorbed and cannot be easily and quickly removed from the economy, and if we cannot act upon it in The blood with the antidote, we must have recourse to remedies which are not injurious in themselves, and yet counteract the effects of the poison. This is the way that coffee acts in poisoning from opium.
We shall now commence the particular consideration of the individual poisons.
Poisoning from Acids. I think I have explained in the most satisfactory manner the therapeutic effects of poisoning by acids.
In cases of poisoning from acids, the antidote alone is sufficient to restore the patient, without having recourse to evacuants.
All authors on therapeutics and toxicology recommend for neutralizing the acids the administration of magnesia, alkaline carbonates, soap, this is all very well, but it does not suffice. I think I have done a great service in founding a precise treatment to be pursued in these cases of poisoning. In the first place (as recommended by every one) we must ad
minister magnesia in excess; I prefer the hydrated magnesia, the preparation of which will be given in another place, in speaking of M. Bussy's work on an antidote for arsenious acid. This alkaline earth possesses some very great advantages; it is innoxious, purgative and insoluble, so that it can pass into the small intestines and neutralize any acid that may have passed into them; but its insolubility unfits it for fulfilling one very important indication. I have proved that in cases of poisoning by sulphuric acid, the acid is absorbed, and that when it gets into the blood it may cause clots to form which will interfere with the circulation and thereby cause death. It is necessary, therefore, to follow up the sulphuric acid which has been absorbed, by giving after the magnesia some soluble alkaline substance which will be readily absorbed, and dissolve the clots which may be forming. The best alkali for this purpose is the bicarbonate of soda. It should not be given before ihe magnesia, because the large amount of carbonic acid which would be disengaged might facilitate those perforations of the stomach which are so much to be feared in poisoning by acids. Magnesia is not liable to this objection ; and we must first neutralize with it ihe acids contained in the digestive organs. The following is the formula which I have often adopted in these cases of poisoning.
1. Twenty to fifty grammes (five to twelve drams) diffused in a litre (two pints) of water.
2. After the use of the magnesia, the patient must drink freely of a solution of bicarbonate of soda, ten grammes (two dramıs) to the litre being a good proportion for the solution.
Since I have been connected with the Hôtel Dieu, this trealment has been adopted at my request several times in very grave cases, and it has always been successful. It has been prescribed in cases of poisoning from sol. of indigo in sulphuric acid, from sulphuric acid diluted with its own weight of water, and from nitric acid.
N. B. It must be remembered that this treatment will not answer where the soda salts formed by the acid are poisonous, as is the case with arsenic acid, &c.
Poisoning from Alkalies. The only treatment in these cases is that recommended by all authors. It is necessary to administer lemonade, or vinegar and water, in a sufficient quantity to neutralize the alkali which has been taken. If potassa or its carbonates have been taken, I prefer tartaric acid, for the potassa salts are not so innoxious as is generally supposed, and the bitartrate of potassa is the least objectionable of them.
Poisoning from Arsenious Acid. Within a few years there have been a great many experiments made to discover which is the best antidote for arsenious acid, and
* In two cases, I, as well as C. Couriard, have found these clots lodged at the commencement of the femoral artery, in consequence of which the circulation in that leg had been stopped and mortification brought on, which caused the death of the individual.