would ultimately recover her lost senses, that was, CASES FROM PRIVATE PRACTICE. when the effects of the drink had subsided. By JOHN RICHARD WARDELL, M.D., Edin.; Opposing this opinion, and being borne out in it by Late President of the Royal Physical and Hunterian Medi- Mr. Cole, the described remedial measures were ener cal Societies, Assistant Pathologist in the Royal Infir-getically continued,—that is, she was treated for narmary, Edinburgh, &c. &c. (Continued from page 629.) CASE IV. POISONING BY LAUDANUM. cotism, though no further light had yet been thrown upon the case. After some time a low and indistinct muttering was at intervals elicited, and in half an hour from this her cries began to be stronger and louder, when she began to struggle, and gave evidence of experiencing pain from the mustard plasters. In the course of another hour she partially opened her eyes, and in no long time at intervals called out for her This morning, November 6th, 1845, I was quickly summoned, it being reported that she had fallen downscious of her situation, and although she remained mother. Soon afterwards she manifestly became conin a fit. On arrival I found her laid in a helpless and Ann H. , aged 19, maid-servant at an inn, of sanguino-phlegmatic temperament, muscular system well developed, healthy-looking before the attack. prostrate condition; countenance looked sunken and congested; pupils dilated, and one (the right,) of greater diameter than the other; had vomited about the room, and the ejected matter seemed to be more than half a pint, and emitted a strong spirituous odour; no bowel complaint, but sickness was persistent during the first half hour, after which she sank into an alarming collapse; pulse 60, of tolerable volume, felt labouring and oppressed to the touch. The inmates of the house being interrogated, it was reported that she had during the previous part of her servitude (several months,) always manifested cheerful or rather buoyant spirits. No particular quarrel or disagreement had taken place between herself and mistress, nor with any other individual, as far as could be ascertained. Her fellow-servant stated that she had that morning prosecuted her wonted avocations in the ordinary manner, nor did she perceive anything unusual either in her appearance or vivacity. At half-past eight o'clock ber mistress ordered her to clean out one of the rooms, to which employment she repaired with her accustomed alacrity. Not more than from ten to fifteen minutes after this she was found helplessly reclining in an armchair, being quite unconscious of her situation, and was carried into another apartment, in which I first saw her. At first it might have been considered a fit, from the sudden manner in which her illness supervened, but it was pretty evident, on a general and deliberate view of the case, there were far greater reasons for concluding that poison had been taken. Mr. Cole regarded the case as such, and in his opinion I fully acquiesced. The stomach-pump, without loss of time, was introduced, and the organ washed out two or three times with warm water. She was now carried (being quite power lethargic and dull when not interrogated and left alone, yet upon questions being put she answered rationally. The rubbing and agitation was yet persevered in. As she gradually regained her intelligence, it was repeatedly asked what she had taken, yet such enquiries could elicit no other reply than the monosyllable-RUM, and she persistingly denied having taken any description of poison. From the general appearance of the case, and a deep conviction of the want of truth in this statement, I determined not to cease in my questions until she made a true confession. At length she said she had swallowed laudanum, with an intent to destroy herself. More vigorous enquiries gave the information as to where the bottle had been deposited. From the accounts of herself, as well as the statements of others, it was ascertained that two or three days previously her mistress had procured half an ounce of the tincture of opium for the tooth-ache, of which not more than a few drops had been used to moisten a piece of lint. The vial-a four-drachm one-was, as the girl told us, placed in a tumbler glass, on a shelf in the bar over the spirit kegs, which on being produced shewed that only a portion of its contents (not half, certainly,—say a hundred drops,) had disappeared since the previous evening, at which time the mistress saw the bottle full, The patient stated that on seeing the vial she took it, and mixed a portion of the poison into a wine-glassful of dry rum, which she quickly swallowed, and then` The only under-servant to the other maid with whom she had in a few minutes became unconscious. reason which she assigned for having committed this rash act, was her mistress having said that after Martinmas, (the period at which servants are hired in this part of the country,) she should act as hitherto been placed on equality. There were no less,) to a warmed bed, hot bottles were applied to the circumstances inferring that she was pregnant, and her feet, fomentations to the epigastrium, sinapisms to the character was that of being a strictly virtuous girl. It legs and along the region of the spine; other parts of the was subsequently ascertained, that on one or two occabody were vigorously rubbed with hot flannels, ammonia was applied to the nostrils; flagellation, shaking sions not long before, she told one of her acquaintances incessantly, &c., were also had recourse to, indeed she that she had an impression “she should die soon," was never allowed for a moment to rest quietly. For although, as above remarked, she was not, nor had some time her case seemed very doubtful, the prostrato herself, some bland liquids and the following mixture been, of melancholy mood. After having fully come tion was so great. At this time another opinion was obtained from a physician of considerable information, but this gentleman pronounced her to be in a state of deep intoxication, and conceived that if left alone she were ordered: - R. Sp. Ammon. Co., dr. ij; Mist. Camph., oz, viij. Sit mist. Capt., oz j., quarta quaque hora. Vespere.-Is much better, and is capable of being removed to her own home, two miles distant in the from the depositions of others, as there were no circumcountry. 7th. This morning is dull and somewhat desponding, as she maintains a sullen taciturnity; bowels open; tongue clean; pulse natural. 8th. To-day has regained her wonted spirits; never alludes to her indisposition, and is in every respect as usual. After this she entered upon another situation, and since that period has enjoyed good health, and been in every respect well. REMARKS. It is not without being fully aware that of all descriptions of poisoning, that by opium and its preparations is in these kingdoms by far the most common, and when it is remembered that innumerable cases occur which do not go on to a fatal termination, and therefore are unknown to all save the few individuals amongst whom they happen, the total number of instances of poisoning by this drug annually must be very considerable. In the years 1837 and 1838, no less than 198 persons were killed by it in England and Wales alone, being nearly two-thirds of the fatal cases resulting from all kinds of poisoning, it therefore must needs be far too common to present anything of novelty to the reader, if merely regarded as an ordinary instance of the kind; but as I humbly opine there are certain considerations of more than usual interest associated with the example now given, it has on such account been forwarded to these columns. In those instances which are connected with medicolegal enquiries, all such cases as appear exceptional examples to general rules are particularly eligible for being recorded ; an accumulation of such data as might from time to time be collected, would thus necessarily be of very eminent service in tending to the correct determination of judicial questions, and might occasionally lead to the detection and punishment of crime, or remove an imputation from the innocent. stances leading to the supposition that the patient had herself committed the rash act. No fault had been found with regard to her previous conduct; no vessel was discoverable that contained any deleterious matters; indeed no conclusion whatever could then be come to as explicable of the matter. Mr. Cole, in whose practice the case occurred, first saw the patient, and he very correctly deemed it a case of poisoning, and not a fit, as many of the surrounding people, (not without somewhat plausible reasons, owing to the suddeness of the attack, which certainly gave some colouring to such supposition,) considered it to be. By the comatose symptoms supervening with so much celerity, apoplexy was not a little resembled; and as regards the sickness, we know that vomiting very often occurs during the apoplectic seizure. But apoplexy is more liable to come on in those advanced in life, and, notwithstanding there have been girls at this age who have died of apoplexy, yet such cases are of very rare occurrence-the mere exceptions to a general rule. There is not much risk of mistake with epilepsy; in the epileptic paroxysm there arises much more tonic convulsive agitation of the limbs; there is foaming at the mouth, a rigidity instead of flaccidity of the muscles, the convulsions cease, and during the intermissions the lividity of the countenance, etc., disappear, until the return of another paroxysm. Now, under the influence of narcotic poisoning the facial congestion does not alternately go and return; poisoning by opiun, however, has been regarded and treated as epilepsy, but the mistake is much more liable to be made where prussic acid has been the noxious agent employed. The states then which may be mistaken for this kind of poisoning are apoplexy, deep drunkenness, and sometimes (though this has seldom been the case,) epilepsy. It is reported that a strong spirituous odour was emitted from the ejected matters; was it then deep intoxication? An extreme degree of drunkenness has been treated as poisoning, and conversely, cases of poisoning regarded merely as drunkenness. In this example it was very conclusive that rum had been drunk, but in what quantity was then unknown, and from being thus satisfied that spirit had been taken, such fact was not a little likely to mislead and allure the practitioner from the real cause of the affection. The physician who was called in, as mentioned in the case, arrived at the conclusion that it was powerful inebriety, chiefly from the consideration of the indubitable evidence that liquor had been taken. Now, if it had been drunkenness, this state of helpless pros When summoned to a case manifesting the symptoms of narcotic poisoning, there are not unfrequently perplexing appearances and even the best informed of our profession have at times erred, in arriving at a wrong diagnosis, because such an instance might simulate other diseases, and other diseases liken this affection. An error of this kind is most likely to occur where there is no clue to conduct the practitioner into a right way of viewing the case beneath his notice. A correct detail of such particulars as might be elucidated from those who were acquainted with the previous history of the patient, together with all the collateral information which could be gained at the moment, ought to receive the most scrupulous attention; and will be found of paramount importance in assist-tration could not possibly have come on so soon as ing us in arriving at the proper conclusion. On a perusal of the above case, however, it will be observed, that there was very little or no aid to be derived Parliamentary Reports. in from ten to fifteen minutes, and that it did supervene thus rapidly there was unquestionable proof, because in no longer time previously she had been seen prosecuting her usual duties. Again having MEDICINAL ACTION OF ARSENIC. vomited so freely, as manifested by the ejections scattered over the floor, one might have supposed that the whole or most of the spirit would have been expelled from the stomach; besides the lividity of the countenance, the declension of température, and other symptoms, presented more the features of poisoning than drunkenness. "Intoxication," says Mr. Taylor in his excellent work, "has been considered to retard the operation of opium. Observations of this kind 661 has been swallowed along with a narcotic poison, to know, if possible, the quantity of liquor drunk, because with the possession of such information our fears might be in some degree allayed, or we might then become more accurately aware of the real extent of the danger. (To be continued.) PROVINCIAL must of course be accidental, and there is scarcely a Medical & Surgical Journal. sufficient number of cases reported of narcotic poisoning under these circumstances to justify a decided opinion on the point. It was observed of a person who had swallowed a strong dose of opium while partially intoxicated, that the symptoms were some hours before they were manifested. Perhaps, strictly speaking, the symptoms in these cases are masked.”* The retardation of the operation of the drug by being taken with intoxicating liquors will evidently depend upon the QUANTITY of the latter which may be drunk; if only a small portion, why it is fair to infer that such would act as a stimulant, and consequently counteract the effects of the poison; but when much liquor has been simultaneously swallowed, instead of acting as a stimulant, it would rather prove a sedative, and thus favour more than oppose the effects produced by the poison, because we know that all descriptions of stimulants only stimulate to a certain degree, and beyond this point they become sedatives. Moderate cold stimulates; when excessive it is a sedative, producing sleep, coma, or death. Stimulants are those agents which operate by accelerating the actions of a living part, which are chiefly manifest by heightening the circulatory function. Now, when such agents are particularly applied to the vital organs, properly so called, the vascular functions of those organs are first considerably increased, and precisely commensurate with this anormal increase of action, follows a declension of power; and thus we see that this sequel must depend Increase of action, upon the power of the first cause. therefore can only be rendered excessive to a certain point, after which it declines, and the effects, as already said, are proportional to the extent of the agent or agents which thus operate upon our frames. In the instance of this girl, only from one to two wineglassfuls of neat rum had been taken, and in the sickness a great portion must have been vomited; it is therefore fair to conclude that the spirit could not have had considerable effect in the induction of any particular results, and certainly there is reason to believe that the liquor would, according to the views now given, tend to avert more than accelerate the hypnotic qualities of the poison, because the portion retained must have rather stimulated than otherwise. It is of paramount importance, then, in all cases where spirit *Taylor's "Manual of Medical Jurisprudence," page 23, WEDNESDAY, DECEMBER 1, 1847. THE ATTENTION OF EVERY MEMBER OF THE PROVINCIAL ASSOCIATION IS EARNESTLY RE< QUESTED TO THE FOLLOWING PROPOSITION :-In our leading article for the number of the Journal issued on the 24th of March in the present year, on the results of medical treatment, reference was made to a plan suggested by Mr. Hunt, of Herne Bay, for the improvement of medical science; and notice was given that “a series of questions would shortly be addressed to each member, touching his professional experi< ence on various practical subjects." The first subject selected for these enquiries, is the Medicinal Action of Arsenic, a powerful and active mineral, concerning the effects of which the profession appears to be much divided in opinion. There is reason to believe that certain formidable diseases which will yield to no other remedy, may be destroyed by arsenic carefully administered. It is known, however, that many practitioners, conceiving it to be a dangerous remedy, from motives of caution abstain altogether from its use, and that others administer it sparingly and timidly, partly from an imperfect acquaintance with its action on the human system, and partly from doubts of the propriety of having recourse freely to the use of a rank poison, the effects of which have become a question of controversy. With a view to collect all the information which the experience of practical men can furnish, in order that by comparing and arranging the facts so collected, the controverted points may be examined, and if possible, satisfactorily explained and adjusted, each member of the Association is particularly requested to furnish replies to the following series of questions. It will be noticed that they relate only to the facts which have attracted the observation of the members,-not to the inferences which they may respectively have drawn from these facts, and it is earnestly hoped that no member will refuse prompt compliance with a request which it will be perceived is addressed to each one by the special sanction of the Council. The object of the questions is to obtain the results of the experience of practical men who are not accustomed to publish their cases: but it is not intended to stop here. So soon as all the members have responded, the facts will be arranged statistically, and then compared with all the authentic records of the same description which can be gathered from treatises or articles already printed,—the whole to form the subject of an essay which will ultimately appear in one of the Society's publications, and which it is hoped cannot fail to be in some degree instructive to the profession. It is respectfully submitted that greater certainty will be obtained if members carefully abstain from all statements which are not either to be found in their note books,the subject, not referred to in these questions? or distinctly imprinted on their memories. a full stomach or fasting; whether in increasing, decreasing, or uniform doses; whether alone, or in combination; whether in hospital or private practice. 11. What proof can you offer that the preparation you have used was pure? 12. Have you used arsenic externally? In how many cases, and in what diseases; and with what effect, local and constitutional? QUESTIONS. 1. In how many cases have you had an opportunity of watching the internal administration of arsenic in medicinal doses ? 2. Did you ever see a case in which arsenic so administered, proved fatal; and if so, what are the proofs that the death of the patient was caused by arsenic; and what dose was administered and how often? 3. Have you any proofs, that under your own observation, arsenic has ever, in medicinal doses proved seriously or permanently detrimental to the health? If so, state the symptoms, and mention the facts which prove that arsenic was the injurious agent. 4. Did you ever see it administered without producing any apparent effect on the system, and if so, in what dose, and how long was it persisted in? 5. In what disease or diseases have you seen arsenic useful, and to what extent? What proofs can you give of its efficiency? 6. Irrespective of its therapeutic efficacy, what effects have you observed to result from the medicinal use of arsenic? And what proofs can you adduce that these effects were real-not imaginary ? 7. Is there any one symptom (or more) which you have found invariably resulting from its exhibition; and what symptom or symptoms? 8. Have you noticed much variableness in its -action in different cases, or the contrary? Have you observed its effects modified by age, sex, or idiosyncrasy; and to what extent? : 9. State generally the conditions which have guided you in the administration of arsenic,; what you have regarded as the sign or signs of an overdose; and what the circumstances are, which in your experience have seemed to contraindicate its use. 1 10. State particularly what preparation you have used; what doses; whether administered on 13. Can you refer to any valuable papers or treatises on the medicinal use of arsenic, which may assist in the prosecution of this enquiry? 14. Can you mention any facts of interest occurring under your own eye, connected with To prevent the trouble of unnecessary repetition, it is proposed that the answers be returned according to the order of the questions,—thus; for example Question 1.-Answer, "In 50 cases," (more or less.) —Answer, "No proofs, or, in one instance, permanent Question 4.- -Answer, "Never;" (as the case may be.) Question 5.-Answer, “In 10 cases of intermittent fever, in 20 cases of cutaneous disease, in 10 of neuralgia, &c., &c., concisely enumerating the cases, and citing the proofs of its efficacy. factory, of course, in which the medicine has Those proofs will be deemed most satis been exhibited alone uncombined; and those especially in which, by intermitting the medicine for a time, the disease having been checked, has been observed to return, and has again and again been checked by resuming the medicine. It is likewise requested that the answers may be returned, as far as possible, numerically, (not in general terms,) so that they may be arranged, collated, and compared in a tabular form. It is hoped that every member will return his answers to the questions here proposed, on or before the 1st of January, 1848, addressed to Thomas Hunt, Esq., Surgeon, Herne Bay, Kent, who is appointed by the Council to receive them. (Signed) JAMES HEYGATE, President of the Association. CHARLES HASTINGS, President of the Council. མན་སོ Review. Cold and Consumption; or Consumption, its Prevention and Cure, by Cold, as a Constitutional, and Inhalation, as a Local Agent, &c. &c.. By HENRY C. DESHON, Member of the Royal Colleges of Physicians and Surgeons of London, &c. London: 1847. 8vo. pp. 153. When we meet with a book written by a member of our profession upon the nature, prevention, and cure of a specific disease, and dedicated, as a mark of peculiar respect, to a gentleman who occupies an eminent position in our ranks, we are undoubtedly entitled to assume that it is a volume expressly intented for the benefit and instruction of ourselves. Whether, under any circumstances, it be desirable that works upon special maladies should be compiled merely for the amusement and information of the nonprofessional public, is a point upon which there may be a difference of opinion, although we have almost invariably found the question answered in the negative, and, as we think, with the utmost propriety and justice, because we conscientiously object to every method of popular advertising. If, however, any one of our brethren be willing to risk the undertaking, and does, notwithstanding the established rule, collect from various sources certain medical statements, and presents those statements in familiar language to the world at large, we think that he is bound to specify distinctly at the commencement of his work, the nature of his design, and that he ought not to prefix a dedication calculated to convey a totally erroneous impression. We also think that it becomes him to be especially careful as to the strict accuracy of all that he expresses, and particularly with regard to the superiority of his own knowledge and treatment of disease, as compared with the knowledge and treatment possessed and adopted by members of the profession generally. “The serious disease which commonly goes by the Again, at page 148, Dr. Deshon relates a case which There The work of Dr. Deshon, entitled "Cold and Consumption, or Consumption, its Prevention and Cure," must, we will charitauly hope, have been exclusively intended for the public. It does not contain a single medical truth with which every one who has diligently attended one course of lectures upon Phy-accuracy of his practical observations and deductions. siology, and one course of lectures upon the Practice of Medicine, is not perfectly familiar. We do find, however, some statements with which we were not previously conversant, and which we cannot without due investigation add to our catalogue of truths. For example, at page 63 we are told that "an affection of the larynx, absurdly named phthisis laryngea, is • sometimes present during the course of this disease; it is generally sympathetic, and of short duration, though sometimes idiopathic, caused by inflammation of the mucous and submucous structure of that organ.""not on account of its augmented temperature, but by We would refer Dr. Deshon to the following quotations. The first is from Dr. C. J. B.Williams: We expected to find numerous and forcible arguments proving that cold is an important agent in the cure of pulmonary phthisis. It is stated that in Russia the disease is almost unknown. Also in "Guelph, in Upper Canada, an upland district famed for its bracing air!" It is stated that " damp and marshy districts do not conduce to tubercular deposition." At page 68, it is stated that a "damp atmosphere must be a warm one,—i. e., it must cóntain much latent heat”! page 86 it is stated that a warm atmosphere is beneficial, At reason of its increased moisture." Supposing all these statements to be correct, what would be the deduction ? |