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The Therapeutic Gazette effect the arsenical solution in chorea must

EDITED BY

HORATIO C. WOOD, M.D.,

AND

ROBERT MEADE SMITH, M.D.,

PHILADELPHIA.

DETROIT, MICH., Feb. 15, 1887.

GEO. S. DAVIS, Medical Publisher, Box 470.

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(Journal increased to 72 pages.)

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I

Leading Articles.

DOSAGE.

N the reading of a suggestive address upon the present state of therapeutics given by Dr. William Whitla, before the Ulster Medical Society, our attention was forcibly attracted by an account of his experience in one of the London hospitals. A brilliant clinical lecturer, speaking of the treatment of chorea, said, "From what I know and have seen of the pathology of chorea, I did not believe that arsenic could be of the slightest use to it; nevertheless, I determined to prove it, and I have demonstrated the fallacy which some men still cling to. I treated so many cases of chorea with teaspoonful doses of aqua camphora, and a similar series with arsenic, and the results were precisely similar. My large class of students have taken a deep interest in the experiments, and you can ask any of them do they believe in arsenic now." Possibly the distinguished physician knew positively very little about the pathology of chorea, certainly he failed to comprehend at all the therapeutics of the disease; for Dr. Whitla found that he was giving Fowler's solution in exceedingly small doses, whereas it is perfectly established that to have an

be administered in ascending doses until it produces puffiness about the eyes, albuminuria, or a marked gastro-intestinal disturbance, or, in other words, until it produces slight toxic effects. For the successful treatment of a disease the right remedy must not only be employed, but it must be given in the proper dose and in the right manner. Very frequently it is essential to produce distinct physiological effects of the drug; but in some cases a long-continued mild influence is necessary. Sometimes a single hard physiological blow will produce an effect not to be obtained by even a very continuous repetition of slighter blows, precisely as a rotten log may yield to a single powerful blow from the axe, but receive innumerable taps without splitting.

Although the subject has been so often written upon, and is so familiar as to be trite, yet possibly a few practical illustrations of the remarks just made may be of some service to some of our readers. At least in this part of the world strychnine is frequently prescribed in doses of a 40th to a 60th of a grain as a tonic during the convalescence of acute diseases, or during the nervous exhaustion which so frequently results from overstrain, or from the long-continued effect of hard work and cold weather during a long winter. In the amounts named the alkaloid is probably serviceable as a simple bitter in increasing the tone of the digestive organs, but that it has any general effect upon the vaso-motor system or upon the general nutrition is highly problematical. As an ordinary dose, of a grain of strychnine is not too large. We have given it three times a day in cases innumerable, and have never in more than one or two cases seen any evidences of its peculiar physiological action. When, as in protracted convalescence, or in extreme nervous exhaustion, or in the rapid loss of power of the spinal cord sometimes produced by metal-poisoning, a pronounced strychnic effect is desired, the doses should be rapidly increased until slight muscular stiffness, general unrest, or other evidences of toxic effect be manifested.

Some years ago it was our fortune to see a case in which after an acute illness the patient failed utterly to recover. Weeks went by, and there was no gain of strength or nutrition, although there was no disease present. Strychnine had been given in doses of of a grain three times a day. The nurse was ordered to give four granules a day, but thought that the physician meant to give four granules at a dose. The result after the third dose was a

decided but not serious attack of strychninepoisoning, the secondary effect being that in two or three days the patient gained a great deal more in strength and general tone than he had previously in as many weeks, and in a very short time was practically well.

Not long ago we were called to a child five years old, suffering from violent sore throat and acute enlargement of the cervical glands, but without faucial exudation. We ordered

two drops of tincture of belladonna to be given every two hours until our next visit unless some evidences of its action appeared. It so happened that the directions were plainly written upon paper, but the nurse gave 20 drops of the tincture until the child had taken So drops. A distinct poisoning resulted, though the symptoms were not very alarming and did not require treatment. The enlargement of the cervical glands and the sore throat disappeared in the night.

We sincerely trust that the lesson we are attempting to inculcate in this editorial will not be misunderstood. It is not that medicine should be given in indiscriminately large doses; it is that the physician should study the dose as carefully as the disease or selection of its remedy, and should adapt the dose, to the needs of the patient. We have seen a very minute dose exactly meet the requirements when a large dose of the same remedy would do harm. Thus, whilst in chorea arsenic must be given in overwhelming dose, in certain conditions of the mucous membranes, especially of the throat, good is achieved by giving very small amounts of the alterative for a length of time. There are certain persons whose throats become inflamed upon the least exposure to cold, the attacks yielding readily to treatment, but continually recurring. One or two drops of Fowler's solution given three times a day for four or five months will often so modify the constitution of the patient that the throat will remain well. The matter is one of considerable importance, since it is probably possible sometimes to stave off or prevent serious disease of the pulmonic mucous membrane which may end in a chronic consumption.

The excessive administration of medicines is a great evil. The physician should know just as well when to withhold as when to give. Boldness should be tempered by caution, and caution should be upheld by boldness.

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VENESECTION.

E have recently received the first volume of the "Travaux du Laboratoire," Université de Liège, under the editorship of Professor Fredericq. The volume contains researches of interest, most of them too purely physiological to be discussed in detail in our columns. There is, however, an elaborate. study of the effect of the abstraction of blood which has a direct bearing upon practical therapeutics. Professor Fredericq finds that the effect of bleeding upon the cardiac pulsations is produced through the pneumogastric nerve, and varies in different animals according to the power of this nerve. In the dog and the pig the cardiac pulsations are accelerated and become uniform. the ox and probably also in man the pulsations are simply accelerated. In the rabbit, in which the pneumogastric nerves have little power, the cardiac rhythm is not influenced. Contrary to opinions generally received, and based upon experiments made in the dog, in the rabbit the arterial pressure is greatly and enduringly lessened by a bleeding which does not exceed one per cent. of the body weight.

In

The effect of the bleeding upon the respiratory changes and upon calorification varies according to the state of the animal. In the rabbit during digestion bleeding produces marked lessening in the amount of oxygen consumed and the carbonic acid liberated, also in the amount of heat which is radiated from the animal when placed in a calorimeter. In the fasting rabbit the decrease in the consumption of oxygen is only momentary. In a little time the interstitial combustion rises again and frequently passes much beyond what it had been before bleeding. The animal put in the calorimeter gives off more heat than before the bleeding, although the rectal temperature is usually distinctly abated. It would seem, therefore, that bleeding gives rise to the dilatation of the cutaneous vessels.

Professor Fredericq conceives that his researches warrant the following conclusions:

First. That it is only proper to employ bleeding to lessen the mass of blood when there is intense pulmonary, cerebral, or other congestion which demands immediate relief. That under these circumstances the bleeding simply is a means of putting aside an immediate danger.

Second-That when, as in pulmonary œdema or in acute pneumonia, or in pleurisy, there is a sudden outpouring from the blood, bleeding

may do good by leading to the absorption of interstitial lymph.

Third. Although in the dog the effects of bleeding upon the blood-vessels are so transitory, yet their permanency in the rabbit indicates that they may also in man be enduring, and therefore it is not irrational to withdraw blood when there is high vascular tension and imminent cerebral congestion or apoplexy.

Fourth. That though the effect of bleeding upon the calorification might at first thought seem to indicate a field for usefulness in the treatment of febrile and inflammatory disorders, yet as bleeding seems to produce excessive destruction of the albuminous substances of the system, and therefore acts like fever, its employment for the lessening of fever is a very doubtful procedure.

IN

STROPHANTHUS.

N a previous issue we have already alluded. to the cardiac stimulating powers claimed to be possessed by this drug. Unfortunately, the plant has been only obtained with great difficulty. There seems also to be considerable doubt as to what form of preparation is therapeutically most active, and we find various drug firms are using different parts of the plant for preparing the tincture, although Prof. Fraser has claimed that the seeds alone contain the active principle of this drug.

Dr. Fraser's formula for making this tincture is that one ounce of seeds, first deprived of their oil or fat by means of ether, in which the active principle is insoluble, is percolated by rectified spirits to produce eight fluidounces of tincture. Dr. Fraser has used tinctures of varied strength, but, finding the above too concentrated for convenient use, recommends one in which one part of the seeds alone without the hairs should be percolated with ten parts of rectified spirit, the dose of this tincture being 4 to 8 minims. He is especially emphatic in stating that the seeds and pods should not be used together, for, although the pods contain active principles, the relation of the tincture obtained from them and the tincture made from the seeds has not been determined.

Mr. W. Martindale, writing in the Pharmaceutical Journal and Transactions for November 20, 1886, states that he has examined tinctures prepared from the seeds, from the pericarp, and from the hairs, and, though he has found that all these parts contain the active principle, the tincture prepared from

the hairs is weakest, and that from the seeds is the strongest, in acting on the heart-muscle. They are also all of them powerful musclepoisons, and, according to the statement of Mr. T. F. Bradford, this particularly applies to the pod tincture, but more experiments are needed to decide accurately their relative value. As the drug is an extremely expensive one, it is evident therefore that if other parts of this plant, in addition to the seeds, contain the active principle, they might for the sake of economy be used for preparing the active principle.

In this country Dr. C. L. Dana has extended our knowledge of the action of this plant through the report of a series of cases read before the Practitioners' Society of New York, on December 3, 1886 (Medical Record, December 18, 1886), in which he has used the drug. In one or two cases of Bright's disease in which Dr. Dana used this drug little or no striking benefit was observed as regards the cardiac irregularity and weakness, while in three cardiac cases progressive improvement occurred while the drug was being administered. In two cases marked improvement occurred after strophanthus was administered, while previously no special improvement was observed, three cardiac tonics having been already tried without avail in one case and two in the other.

Dr. A. A. Smith also stated that strophanthus had been used in the wards of Bellevue Hospital. In two cases of pulmonary œdema it was administered with good results. The first was a case of mitral systolic and double aortic lesion in which pulmonary œdema developed after unusual exertion. Five minims of the tincture were given every four hours, and the patient recovered. He also reported a case of pulmonary edema occurring in pneumonia, and a case of emphysema, in which this drug appeared to produce excellent results.

Dr. Beverley Robinson at the same meeting read notes of twelve cases in which strophanthus was used with success, even in some instances after other cardiac tonics had failed to produce any result, though perhaps it is worthy of note that often the mere change from one cardiac tonic to another will increase the quantity of urine for a day or two, or more.

In this connection it is worthy of note that two enterprising English drug firms expect to become millionnaires at the expense of the public through the sale of this drug. We learn that these firms claim to have "cornered" the market in strophanthus, and have so advanced

its price as to make at present, in view of the uncertainty of its action, any ordering of the new heart-tonic in physicians' prescriptions entirely unwarranted. The present market price of the tincture of strophanthus-and it is to be noted that no definite strength is announced-is one dollar per ounce. Now, even if we admit that this tincture is made from the clear seeds and in the proportion first recommended by Prof. Fraser,-i.e., one pound of seeds to eight pints of spirit,-that would bring the price of the seeds to one hundred and twenty-eight dollars per pound. We further learn that the English firms which are thus attempting to fleece the general public are offering the clear seed at one hundred and sixty shillings (forty dollars) per pound; and recollecting that the manufacturers of the tincture do not state that this tincture is made from the seeds alone, and that Dr. Fraser has more recently recommended a much more dilute tincture, it is evident that the profit made in this transaction must be simply enormous, provided the medical profession can be gulled into playing into the hands of such extortioners.

It is highly probable that this drug may prove to be a valuable adjuvant to our other means of treating a weak heart; but neither we nor our patients are compelled to rely on it alone, and until the manufacturing druggists learn that the medical profession cannot be played as puppets to fill their pockets, Strophanthus Hispidus should be let severely alone.

PILOCARPINE AS A GALACTAGOGUE.

T

a philosophical lover of his race few things are more disheartening or more saddening than a puling, whining, emaciated shadow of a baby dragging a fraudulent food from a no less fraudulent teat encasing the yawning mouth of the flinty bottle. Cheated in the very beginning of his life, the unfortunate being draws in, but not with his mother's milk, his first lessons of fraud. This disheartening spectacle is almost universal among the upper classes of Americans. In the race for civilization and culture the lacteal glands seem to have been left entirely behind. Any one, therefore, who would discover a medicinal or other method of bringing about an Eve-like development to our American women would confer a great boon upon the rising humanity, though he might incur the anathemas of the numerous manufacturers who batten upon the sufferings of

the young and the deficiencies of the old. Castor oil leaves, faradization, ale, milk, and the various remedial measures employed by the laity and the profession to remedy the great and growing evil have in the past amounted to nothing. We therefore, with not altogether untempered hopefulness, call the attention of our readers to the investigations of M. Chéron, who has studied the action of pilocarpine upon the mammary glands, and believes that he has found in it a specific. The treatment has been practised by him in nine cases with satisfactory results in all but one. Five centigrammes of the nitrate of pilocarpine were hypodermically injected as soon as the milk became scanty, whether this took place suddenly or by degrees. The injection was repeated every day. Under its influence the skin of the face and, afterwards, that of the body became hot for a few moments, but there was seldom any moisture. It is essential to success not to produce diaphoresis. If the scantiness of secretion has existed for some time, ten or twelve injections are required; on the other hand, if it has come on suddenly, two or three will suffice. The treatment had no ill effect either on the nurse or the nursling.

A NEW LOCAL ANESTHETIC.

T is well known in Southern Australia that a great many sheep and cattle are annually killed by eating Euphorbia Drummondii, which is very poisonous, according to the quantity of milky juice which it contains. It appears from the statement of Dr. Schomborgh that sheep, bullocks, and horses die in from twenty-four hours to seven days after eating it. They present paralysis of the extremities, hanging of the head as if tipsy, while the body does not seem to be impaired. At first the weed is avoided, and taken only on account of extreme hunger, but afterwards it is sought after and eaten with great avidity.

Dr. John Reid, of Germein, announces in the Australasian Medical Gazette, No. 61, 1886, the discovery of an anesthetic alkaloid in this plant, which he terms drumine. The method which he employs for the isolation of this alkaloid is to make a tincture, which, after standing for a few days, is evaporated to get rid of the spirit, ammonia added in excess, and the solution filtered. The residue, after the ammoniacal odor has disappeared, is dissolved in diluted hydrochloric acid, and the filtrate is filtered through animal charcoal to

destroy the abundant coloring-matter. The filtrate is evaporated slowly, and leaves the alkaloid. This alkaloid deposits from solutions in acicular and stellate crystals with little taste, freely soluble in chloroform and The crystals deposited from the hydrochloric acid solution and filtered through animal charcoal are circular or boat-shaped at the circumference, and stellate, or perhaps more correctly, disks, as if formed of concentric circles, with radiating fissures. They are colorless, and under a high power of the microscope the acicular crystals are in some cases rhomboid in shape. Dr. Reid thinks that perhaps this difference in shape, and the different degrees of solubility of these different-shaped crystals in chloroform, would perhaps indicate that two alkaloids are present, but his researches have not yet enabled him to speak positively on this point.

Experimenting on cats, Dr. Reid found that on placing a few drops of a four per cent. watery solution of this alkaloid in one of the eyes, in a few moments it was tolerant of contact with the finger, while the pupil was not appreciably dilated. In another instance

conception as to what is the action of this alkaloid. It is to be hoped that the plant will be subjected to a renewed analysis that Dr. Reid's statements may be confirmed or disproved, and that the alkaloid, if such be present, be subjected to thorough physiological and clinical examination.

WE

E welcome to our exchange table the new journal of Laryngology and Rhinology, which is to be edited by Drs. Morell Mackenzie and B. Norris Wolfenden, and published monthly by the Churchills, of London, and P. Blakiston, Son & Co., of Philadelphia. We should suppose that the journal would be an absolute necessity to all those who treat diseases of the throat and nose. It is chiefly composed of abstracts from the world's recent literature, and reports of the transactions of French, German, English, and American societies. To us it appears to thoroughly represent the current thought on the subject.

THE ANTISEPTIC TREATMENT of
SUMMER DIARRHEA.

At the annual meeting of the New York Academy of Medicine, held January 6, 1887, DR. L. EMMETT HOLT read a paper on the 'Antiseptic Treatment of Summer Diarrhoea" (Medical Record, January 15, 1887). speaker stated that he did not undervalue other methods of treatment than the use of drugs, such as careful feeding, change of air, etc., but the object of the paper was to discuss what additional measures were useful.

he injected 3 grains subcutaneously in the Reports on Therapeutic Progress. back, and, apart from anesthesia, with the production of no apparent action. The following day he states that he gave a large dose to the same animal, but does not name the quantity, and in a few moments the legs were completely paralyzed, while breathing was slow and performed with difficulty. As the animal was apparently dying, strychnine was injected, and produced only a few fibrillary twitchings of the face-muscles, but no general convulsion, and death soon followed. Dr. Reid also experimented with this drug upon himself, trying it upon his tongue, nostrils, and hand, and found very marked anesthesia in all cases, even the sense of taste and the bitterness of quinine being abolished on the side of the tongue to which it was applied. Taken internally, he found that small doses, although he does not say in what quantities it was administered, produced no constitutional effects. In a case of sciatica in an old man, a subcutaneous injection of 4 minims of a four per cent. solution relieved the pain. He also employed it in a case of catarrhal jaundice, relieving the pain and tenderness in the stomach, and in neuralgic tic it has produced successful results by dropping it in the eye.

It is to be regretted that Dr. Reid's experiments are so crude, and show such entire ignorance of the commonest methods of pharmacological investigation, as to give no reliable

cases.

All the causes of summer diarrhoea-excessive heat, improper or artificial feeding, and bad hygienic surroundings-united to produce a dyspeptic condition, which was really at the bottom of nearly all of these The age showed it could not be heat alone, for the disease was not frequent at the Of 431 most tender age,-under six months. cases, only twelve per cent. were under six months, while fifty-nine per cent. were between six months and two years. The explanation was that under six months most of the children were fed at the breast. Improper and artificial feeding was quite as important as heat, as Hope had found in 591 fatal cases that only 28 had no food but the breast.

Heat depressed vital energy, increased de

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