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CASE OF ARRESTED PULMONARY TUBERCULOSIS, BY DR STOKES. Some years ago I saw a gentleman, who came to town labouring under all the symptoms of well-marked phthisis. The disease had been of some months' standing, and the patient was a perfect picture of consumption. He had a rapid pulse, hectic, sweating, purulent expectoration, and all the usual physical signs of tubercular deposit, and of a cavity under the right clavicle. I may also state, that the history of the disease was in accordance, in all particulars, with this opinion. I saw this patient in consultation with a gentleman of the highest station in the profession, and we both agreed that there was nothing to be done. This opinion was communicated to the patient's friends, and he was advised to return to the country. In about eighteen months afterwards a tall and healthy-looking man, weighing at least twelve stone, entered my study, with a very comical expression of countenance :-"You don't know me, doctor," he said ; I apologized, pleading an inaptitude that belongs to me for recollecting faces. “I am,” he said, “ the person whom you and Dr — sent home to die last year. I am quite well, and I thought I would come and show myself to you." I examined him with great interest, and found every sign of disease had disappeared, except that there was a slight flattening under the clavicle. “Tell me," said I, “what you have been doing ?” “Oh!'' he replied, "I found out from the mistress what your opinion was, and I thought as I was to die I might as well enjoy myself while I lasted, and so I just went back to my old ways.” “What was your system of living ?" said I. “Nothing particular," he said, "I just took whatever was going.” “Did you take wine?" “Not a drop," he replied ; “ but I had my glass of punch, as usual.” “ Did you ever take more than one tumbler?” “Indeed I often did.” “How many ? Three or four?” “ Aye, and more than that, I seldom went to bed under seven !” “What was your exercise ?” “Shooting," he said, “ every day that I could go out." "And what kind of shooting ?” “Oh, I would not give a farthing for any shooting but the one !” “What is that?" Duck shooting.” “But you must have often wetted your feet?" "I was not very particular about the feet,” says he, "for I had to stand up to my hips in the Shannon for four and five hours of a winter's day, following the birds.”
So, gentlemen, this patient spent his day standing in the river, and went to bed after drinking seven tumblers of punch every night; and if ever a man recovered from phthisis he had done so when I saw him on that occasion. Suppose, now, that he had been confined to an equable temperature, and a regulated diet, and had been treated in all respects secundum artem, what would have been the result ? Any of you can answer the question. In point of fact, this very treatment had been adopted during the first thee months of bis illness, and his recovery may be fairly attributed not so much to the duckshooting and whiskey-punch, but to the tonic and undepressing treatment which he adopted for himself, and which his system so much required to enable him to throw of the disease. --Medical Times.
PROFESSOR FORGET ON TIE NON-IDENTITY OF TYPHOUS AND TYPHOID FEVER.
Although typhous and typhoid fevers resemble each other very much in their external appearances, Professor Forget of Strasburg believes that they are clinically and essentially different in their nature. They are anatomically different ; they are not equally frequent in their occurrence ; and typhoid fever may arise from many causes, quite irrespective of infection. In follicular enteritis the typhoid condition is not constantly present, and it is usually secondary; while in typhus, the prostration and stupor, attending its invasion, indicate a powerful intoxicating principle, acting primarily as a poison, which is not usual at the commencement of the typhoid state. Gastro-intestinal symptoms are more constant, and primitive in typhoid than in typhus fever ; for in it they are occasionally found existing alone; and we very rarely see cases of follicular enteritis which do not present the rough
NEW SERIES.--NO. II. FEBRUARY 1855.
(saburral), punctulated, and rosy tongue; also gargouillement and pain in the right iliac region, and either diarrhea or constipation. Though other symptoms may coexist with them, they are never wholly obscured. In typhus again, especially at its outset, the tongue is frequently moist, smooth, and white; meteorism and abdominal pain are absent, and there is no derangement of the process of defcecation. If we except the rosy, lenticular spots, peculiar to typhoid fever, and which constitute, according to M. Forget, its most constant differential sign, there are no symptoms in general connected with either malady which are not purely accessary and inconstant. Typhoid fever is usually slow, and gradual in its course, and in simple uncomplicated cases its evolution is in exact ratio to the development of the intestinal lesion. In typhus, on the other hand, the disease is very violent at first, and afterwards becomes suddenly or alternately better or worse, and often in those cases which appear the most unfavourable, it advances rapidly and spontaneously to a favourable termination. Ataxia characterises it more than it does typhoid fever.
As regards the treatment of the two diseases, Professor Forget says that while, in typhoid fever, this must always be adapted to the peculiarities of each particular case, special attention must be paid to the intestinal ulcerations which are present during its course, and that all those medicines should be avoided which are calculated to aggravate these lesions of the alimentary canal. There is no need for this caution in cases of pure typhus.-Gaz. Med. de Paris, Nos. 42-48. 1854.
DR PARKES ON THE DIAGNOSIS OF TYPHOUS AND TYPHOID FEVERS. You are brought to see this young woman, we will say, for the first time; the specific rose-spots are gone ; she is labouring to all intents and purposes under severe bronchitic and chest symptoms (a chemist, or practitioner with a druggist's shop, has prescribed, and given cough mixtures, perhaps, without seeing her); you find her respiration 30 in a minute, cough incessant, with some expectoration, nervous symptoms also well-marked; vertigo complained of, torpor, the eyes closed; she is delirious at night; she has also diarrhea, pain over the abdomen, pulse quick, tongue furrowed and somewhat coated. Suppose, I say, you were called to such a patient, and moreover she is unable to give any account of the previous illness, how are you to make the diagnosis? There are only two waysone the positive method, the other the method as it is called by "exclusion." The first is obvious enough, and will of course be more valuable to the practised eye of the experienced physician, who seizes the nature of the case at the first glance by a sort of intuitive knowledge of what typhoid really is. Now the method of diagnosis by exclusion—the plan of logic-writers, per viam exclusionis, in this and other diseases, is one, though not without disadvantages, one yet of no mean importance. The first question you resolve in your mind will be-Is she or he, as the case may be, labouring under any of the idiopathic fevers? any of the exanthemata ? No. Is it typhus? You make the same answer, as the eruption in ty-phus is as different from ty-phoid as scarlatina from measles. The eruption is absent in patients under 22 or 21 (this patient's age is about this). Is it relapsing fever, so common some years, as 1828-29? No. You ask yourself, then, is it typhoid ? Yes. Nervous symptoms are marked, chest symptoms and diarrhea also ; the latter loose, granular, yellow, so peculiar to typhoid. You have soreness of the right iliac fossa; but then you say we have no rosespots, and then you remember in at least 20 per cent. these rose-spots are not found. You must weigh and balance all these circumstances in your mind.Medical Times and Gazette.
[in Edinburgh it has been found impossible to make out the distinctions between typhus and typhoid eruptions, here so positively laid down in accordance with the opinions of Dr Jenner.]
DR SYME'S CASE OF TETANUS SUCCESSFULLY TREATED BY CHLOROFORM. On the 18th of August 1853, I was called to visit a young gentleman, aged twelve years, who was suffering much from paronychia of his left thumb
which I treated by incision. I did not see him again until the 25th of August, on which day I found him labouring under well-marked symptoms of tetanus; the muscles of the face, neck, and abdomen were permanently rigid, and the other well-known symptoms of tetanus were present. The treatment usually adopted in tetanus was immediately put in force : thus calomel and opium, etc, were perseveringly administered up to the 30th of August, but without any marked benefit, the disease still increasing, the spasmodic seizures becoming more frequent and violent ; the muscles of the jaws were so rigid, the teeth were so completely closed, and the difficulty of swallowing so great, that not even fluid nourishment could be given to the patient. In consultation with Mr Cusack, it was determined to try the effects of chloroform inhalation, which I administered with much difficulty, owing to the violent resistance which the patient made; he inhaled a considerable quantity, and remained under its full influence for upwards of twenty minutes ; after the anæsthetic effects of the drug had passed away, the boy was able to swallow a glass of wine without much difficulty, and from that moment he gradually but steadily improved, and on the 19th of October he was perfectly well. The paronychia was slow in healing, the nail was not detached until the patient had nearly recovered from the tetanic symptoms.
I am fully aware that, in other hands, tetanus has been successfully treated by chloroform ; thus two such cases have been lately detailed in the Dublin Medical Press. Every additional case is, however, in my mind, well worthy of being recorded, as it is only in this way that the power of chloroform, in certain cases of tetanus, can be made known to the profession at large.--Dublin Hospital Gazette.
THERAPEUTICAL NOTES. I. NEW REMEDY FOR PRURITUS VULVAE.-Dr Scholz recommends an Indian plant, the Caladium seguinum, which is used by the natives of India as an anaphrodisiac, for the treatment of those cases of this most distressing malady, which are due rather to a hyperaesthetic condition of the parts, than to any lesions of the mucous membrane of the vulva. The plant belongs to the Aroideae. Scholz has used it with great success in two cases which had previously resisted all remedies ; and he administered it in the form of an alcoholic tincture, in doses of six drops.--Arch.-Gen. de Méd., Sept. 1854.
II. THE ACTION OF COPAIVA BALSAM.-Dr Roquette of Nantes, believes that copaiva only acts as a curative agent, in affections of the urino-genital organs, by means of the peculiar qualities which it imparts to the urine, and that it is useless in inflammations of those portions of the genital mucous membrane which do not come in contact with the urine during its passage. He considers it, therefore, to be of no utility in balanitis, vaginitis, uterine catarrh, epididymitis, blenhorrhagic ophthalmia, etc. ; unless, in these affections, the patients do not object to take copaiva, in order to have copaiviferous urine to use as an injection, which would be no advantage, seeing they can be cured by other means more prompt and simple, and less disagreeable. As it has been satisfactorily proved, that when copaiva is tolerated, it is eliminated from the system almost exclusively by the kidneys, and that consequently it is present in large quantity in the urine,-Dr Roquette considers, that when we administer this remedy, we should endeavour to prevent diarrhea, vomiting, nausea, etc., as much as possible, in order that the remedy may solely leave the economy through the kidneys.-L'Union Méd., 14th and 18th Dec. 1854.
III. ANAPHRODISIAC PROPERTIES OF BROMIDE OF POTASSIUM.—Thielmann recommends this remedy as an excellent anaphrodisiac in satyriasis, in the frequent and painful erections during gonorrhea, in spermatorrhea, and in nymphomania. He administers it in doses of from 2 to 3 grs, every two or three hours ; and, at the sametime, enjoins a mixed vegetable and milk diet, and forbids all acid substances.-Med. Zeit. Russl., 1, 1854.
IV. HYDROCHLORATE OF AMMONIA IN CHRONIC BRONCHITIS.--Dr Delvaux alleges that, in cases of chronic bronchitis, he has found the greatest benefit from the use of muriate of ammonia, in doses of from 15 grs. to 2 scruples, in the 24 hours. Before commencing its administration he orders a purgative, and during its use he enjoins a strict regimen. He has found that its use soon renders the cough less troublesome, the dyspnoa less urgent, and the appetite better. It causes an increased flow of urine, and also an augmentation of the cutaneous transpiration.-Presse Méd. Belge; and Revue Med. Chirurg. de Paris, July 1854.
V. SULPHATE OF STRYCHNIA IN CHOREA.- Professor Trousseau has proposed for the treatment of chorea, a mixture containing 5 centigrammes of sulphate of strychnia to 100 grammes of syrup, so that a dessert spoonful (or 10 grammes) of the syrup, contains half a centigramme of strychnia. A spoonful of the syrup is given every hour and a half till rigidity (roideur) occurs. When sufficient has been taken to produce this effect, the rigidity occurs 10 minutes or so after the last spoonful. After this effect has been produced, the medicine is discontinued for the day, and no more is administered till the next day, when the treatment is recommenced till rigidity is again produced, and so on till a cure is accomplished.
M. Moynier has published a paper giving the results of treatment by this remedy in 43 cases, of which 32 were girls, and 11 boys. The average date at which a cure was accomplished was the 330 day in the case of girls, and 74 days in that of boys.–Archiv. Gén. de Méd., July 1854.
VI. CHLOROFORM AND ETHER COMBINED AS AN ANAESTHETIC.-M. Robert, in his report on chloroform to the Societé de Chirurgie, recommended a mixture of equal parts of chloroform and ether as the best anaesthetic agent. M. Cel. laries has subsequently published (Gaz. Méd. de Montpellier, 1853), the results of experiments made by him with the compound upon rabbits, etc.; and he reports very favourably as to its efficiency as an anaesthetic. The two fluids combine together, without the occurrence of any precipitate, and the odour of the compound is said to be far from disagreeable.-Gaz. Méd. de Paris, No. 96, 1854.
VII. ARSENIATE OF IRON IN HERPETIC AND SQUAMOUS ERUPTIONS.-On the 17th July 1854, Mr Duchesne Duparc read a memoir on this subject to the Academy of Sciences in Paris. The following is a brief resumé of his researches :- 1st, Arseniate of iron, in common with other preparations of arsenic, possesses great efficacy in the treatment and cure of herpetic and squamous skin diseases. 2d, Its great advantage is, that it may be administered in sufficient doses without occasioning any of the prejudicial physiological effects which are often induced by other preparations of arsenic. 3d, Whether we give this remedy singly, or combined with other substances, we should always administer it in gradually increased doses, beginning with goth, both, or ich of a grain, according to the age, constitution, and, above all, the condition of the digestive functions of the patient. 4th, M. Duparc asserts confidently, from long and extensive experience, that a daily dose of th of a grain of the remedy, continued uninterruptedly for the requisite time, will cure any herpetic or furfuraceous affection in the adult, however old or obstinate it may be. 5th, No absolute rule can be given as to the duration of the antiherpetic treatment by this preparation, inasmuch as this must necessarily vary according to the patient's age and constitution ; the severity of the malady; and, above all, the extent to which the drug is tolerated by the stomach. 6th, Tropical remedies of acknowledged utility, are not counter-indicated during the use of the arseniate of iron; but, on the contrary, the internal or external use of certain thermal sulphureous mineral waters, has been found to be a powerful adjuvant to the treatment.-Gaz. de Hopitaux, 25th July 1854.
VIII. Benzin or BENZOLE AS A REMEDY FOR ANIMAL PARASITES:-Qur readers are probably aware that benzin or benzole is a clear, colourless fluid , possessed of a pungent etherial odour, which is produced by the decomposition of benzoic acid, or other organic substances, at a light temperature. It was long ago ascertained by Milne Edwards, that its vapour was very fatal to insects. This property has led M. Reynal, of the veterinary school at Alfort, to employ it for the treatment of pedicular maladies among animals. He has found that it destroys the parasites in these diseases, more surely, and with more safety to the animal, than tobacco-juice, mercurial ointment, or any other of the many remedies used. It destroys the epizoa without at all injuring the skin.
It is proposed to use this fluid in the parasitical diseases of the human skin, especially in pityriasis, or morbus pedicularis, and in scabies, etc.—Bulletin Gén. de Therapeutique, 30th July 1854.
IX. LAXATIVE DRAUGHT.-The following is a formula for a laxative preparation, very much used in Germany, especially in the Grand-Duchy of Luxemburg, which is said to have the advantage, over the simple infusions of senna, of purging moderately without occasioning griping pains.--R. Fol. sennæ. spiritu vini extractorum. 3iv; Fol. sambuci ziiss ; Seminis Faeniculi et sem, anisi. vulgaris. ãä 3x :-concisa et contusa misceantur : in dispensatione adde :-potassae tartratis zvij.
The draught is administered in the form of a tea-like infusion.-Gaz. des Hopitaux, 17th August 1854.
X. VINEGAR IN SCABIES.-Professor Le Cour of Caen, recommends, for the cure of itch, forcible frictions of the parts affected with a hard sponge, soaked in good vinegar, performed thrice daily, so as to penetrate the skin, and rupture the vesicles. He has tried this treatment, with the most complete success, in ten cases, the average length of the treatment being less than five days. He thinks this treatment preferable to all others on account of its speedy action-its inexpensive nature-its freedom from unpleasant odours, and its easy application. He suggests that similar results might probably be obtained by frictions with the mineral acids dissolved in water.-Gaz. des Hop., 26th Sept. 1854.
XI. SULPHATE OF QUININE IN PATHISIS.-Dr Muntendam, a Dutch physician, has just published a paper to show that, from his experience in twentytwo cases, sulphate of quinine, given along with acetate of morphia, or even alone, is capable of prolonging the life of the patient in many cases of phthisis, and that it may even effect a cure in those cases in which a tubercular deposition has just commenced, especially in married women and children." He alleges that, when given continuously in small doses, it does not cause dyspnoea, diarrhea, headache, or any disagreeable effects; and he believes that in very many, but not in all cases of phthisis, it should be ranked as one of the best remedies for the disease. ---Nederlandsch Lancet, and Gaz, des Hopit., 21st Dec. 1854.
XII. Borax INJECTIONS IN INFANTILE DIARRHEA.-M. Bouchut considers infantile diarrhea to be of two kinds; the one, symptomatic of lesions of the intestinal mucous membrane ; the other, idiopathic, a nervous or catarrhal flux from the great intestine, which may occasion death, without leaving any material morbid appearances. In the latter variety, M. Bouchut recommends clysters containing the bi-borate of soda, as peculiarly efficacious. This remedy proves as beneficial as it does in aphthae of the mouth, it acts as a weak astringent on the intestinal mucous membrane, and as an alkali in neutralising the acid secretions poured out by it, which lead secondarily to ulceration of the bowels, and especially of the anus.
He uses clysters containing from 10 to 20 grammes of the salt, in 125 grammes of water.
In cases of infantile diarrhea symptomatic of intestinal ulcerations, M. Bouchut has found benefit from the use of borax, administered internally in the dose of 2 grammes, in 80 grammes of a mucilaginous emulsion.-Gaz. des Hopitaux, 16th Sept. 1854.