free border to the eyelid. The raw surface was then covered with a piece of skin as large as a half-dollar taken from the patient's thigh. Large skin-grafts have succeeded in a few cases reported; but in this case nothing was claimed more than an experiment. If the large graft failed, the surface could afterwards be treated with the smaller ones, as was done with the rest of the scalp. The eyes were not injured further than the laceration of the lids in consequence of which the left eye is partially closed. The vision is so good that she does sewing and takes lessons in music. After the scalp began to heal, the downy hair on the neck took on an extraordinary growth, and this hair is now fourteen inches long and curly. I propose to follow up this case and learn, if possible, the result of Dr. Warren's operation to-day, and may give your readers the benefit of it. The case is one of great interest, in showing the value of skin-grafting when followed up with the commendable perseverance exhibited by the gentlemen who had charge of this case. R. M. LACKEY.

"COLOCYNTH AND COLOCYNTHIAN REFLEC

TIONS."

SHOPIERE, Wis., October, 1877.

In a very learned article, with the above heading, Dr. Tucker, in your last issue, gives us the result of his reflections, which is in his mind, doubtless, an original discovery, to wit: "That colocynth will allay the pain caused by excessive peristaltic action, better than any drug in use, not excepting opium, providing it be used in the proper dose."

Now if Dr. Tucker will take up "Behr's Therapeutics," (homeopathic) and turn to page 473, he will find these words: "The treatment of such a colic is very satisfactory. We possess a remedy against it which is almost always effective, whereas every other method of treatment seems without any avail. We mean Colocynth." And by turning to the Materia Medica of Hemple, Hering, Burt, and other Homeopathic writers, he will find that colocynth has held a place high in their estimation in this class of disorders, including diarrhoea and dysentery.

Thus we often find that what at first seems to us to be an original discovery, ultimately proves to be but a "bequest from antiquity." And the Doctor will, upon investigation, find that the hydragogue action of colocynth has not been the limit of its usefulness. C. L. GISH, M. D.

WAS A QUARTER OF A GRAIN TOO LARGE

A DOSE?

In the August (1877) number of the CHICAGO MEDICAL JOURNAL AND EXAMINER, Dr. Ingals published a paper, entitled: "Danger from Hypodermic Injection," in which the doctor says: "I was called in the night to see a woman, who, from continuous watching with sick children, had become debilitated, and, as a result, suffered at times from severe pains of a neuralgic character. I dissolved one

*

fourth of a grain of morphia in pure water, and administered it under the integuments on the outer side of the arm.

The doctor then states, "in a few seconds the breathing becomes stertorous; the pulse failed; the lips and countenance become livid, etc., etc." The woman, he tells us, was, however, resuscitated.

The paper also contained reports of cases Nos. 1, 2 and 3, by E. Wenger, M. D. Cases 1 and 3 died; but the doctor did not state the dose administered in either case. Now this article may have one of two effects upon the profession; first, it may deter physicians from using the hypodermic syringe in cases where it would be the means of saving life; and, secondly, it may induce others to use morphia hypodermically in doses large enough to destroy life. I have used morphia hypodermically for the last ten years, and have not had a single bad result, other than an occasional inflammation at the point of introduction. My rule has been to always commence with a dose one-third the amount I would have given internally, and never without atropia.

Prof. R. Bartholow, in his excellent work on Hypodermic Medication, says, on page 41: "The dose of morphia for hypodermic injections varies from to of a grain. In

1

commencing it should not exceed one-third of that ordinarily administered internally. It is prudent in all cases to test the physiological capabilities by a moderate dose before resorting to the maximum amount. Women are, as a rule, more easily affected than men; of a grain is a sufficient dose for many of the conditions requiring an injection. Maximum doses may be administered with safety if combined with atropia." And on page 102, "atropia in small doses- of a grainincreases the hypnotic power of morphia. The pain-relieving power of morphia is increased by atropia. When toxic doses are used, the narcotism of morphia is overcome by atropia, and vice versa." Prof. H. C. Wood, of Philadelphia, in his work on Materia Medica, page 218, says: "I have seen very alarming results from the injection of one-sixth of a grain, and one-half a grain has produced death. In females, unless very robust, the maximum dose should be of a grain; in men one-sixth to one-quarter."

With the evidence given, and the effects of one-fourth of a grain upon the doctor's patient, the reader will be able to answer the question that heads this paper.

Du Quoin, Ill.

JOHN MCLEAN.

For the information of the reader who desires to answer the foregoing questions, I may state that, in the case which I reported, the dose was not large enough to relieve the pain for any considerable time, and it was not sufficient to cause sleep.

The writer fears that the report will have the effect, either to encourage the use of the medicine in excessive doses, or to deter physicians from administering it by the hypodermic method when it may be needed.

Certainly the unfortunate result from one-fourth of a grain cannot induce physicians to give larger quantities; and as to the second criticism-if the report induces greater caution in the administration of remedies, it will have accomplished the end for which it was intended.

Regarding the usual dose of morphia, and the dangers from hypodermic injections, I will have something to say in a future number. E. FLETCHER INGALS.

Summary.

I. GYNAECOLOGY.

Sept.,

INFLUENCE OF ALCOHOL UPON THE QUALITY OF THE NURSE'S MILK.-Verney. (Jour. de Méd. et de Chir. prat. 1877, p. 417.)-The author, in discussing the influence of alimentation upon the quantity and quality of milk, gives the details of two cases which indicate very clearly that the excessive use of wine by the nurse is dangerous for the child at her breast.

In the first case, observed by Charpentier, a three-weeks-old infant, whose nurse seemed to be in excellent condition, after thriving up to a certain date, began to be agitated and enervated upon each occasion when it was put to the breast; it ceased to sleep, had a reddened aspect and lost that contented expression of the child which is properly fed. And yet the nurse had an abundance of milk, very rich in globules. After several days, the child being then five weeks old, it exhibited a copious rash upon the face, the neck and portions of the trunk; the agitation which followed each application to the breast persisted and a real convulsive attack followed, which could not be explained by any of the causes usually operative in such cases. After an exceedingly careful investigation, it was finally discovered that the nurse, finding the large and vigorous infant capable of exhausting her supply of milk, which had already been furnished for nine months, had, in order to increase the quantity, drunk four bottles of wine daily. This amount she had tolerated so well, as not to excite the suspicions of her mistress. Charpentier concluding, hence, that the child was suffering from alcoholic intoxication, had the nurse placed under surveillance and limited daily to a halfbottle of wine, a bottle of beer and a litre or two of barleywater, with a nutritious diet. In a few days, the infant

1

completely recovered its health, the agitation and convulsions ceased and the rash disappeared.

Verney cites a similar case where convulsions of the infant resulted from the alcoholic habits of the nurse, who drank from six to eight glasses of wine daily, and one during the night. The convulsions resisted bromide of potassium, musk, baths, calomel and belladonna, and yielded only when the nurse was restricted in the quantity of wine imbibed.

EXCESSIVE CAUTERIZATION OF THE CERVIX UTERI.-J. Wallace. (British Medical Journal, 1877, Oct. 6.)-In our days the application of caustics to "an ulcer of the womb" has become such a routine practice that the following observations of Dr. W. may well merit our attention: "What are the immediate pathological results of weekly or bi-weekly applications of the nitrate of silver, which is the agent in most favor with practitioners, to the os tincæ? Inflammation and ulceration, lit up again and again by each application, followed in some instances by atrophy, and in others by hypertrophy of the cervix, with hard, painful cicatrices, and more or less contraction of the tissues and closure of the os, or even complete obliteration; endocervicitis and endometritis, the mucous lining of the cervical canal being more or less destroyed, and an ulcerated irregular surface remaining instead. Secondary functional derangements of the uterus follow, manifested first by dysmenorrhoea of a metrorrhagic character; and as the obstruction increases, regurgitation of the menstrual fluid takes place through the fallopian tubes, setting up ovarian, perimetritic, and general pelvic inflammations, with all their subsequent miseries.

The portio vaginalis uteri in some cases is so destroyed by caustics, that a hard, depressed cicatrix alone remains of it, and this is generally painful to the touch; the os is small, but not sufficiently so to account for the severe dysmenorrhoea. In such cases, the mucous membrane of the cervical canal is disorganized, and covered with uneven granulations, which bleed on the most gentle touch of the sound, and are so