It is well to begin with small doses of the arsenic in form of Fowler’s solution. Two drops may be given thrice daily, in some bitter infusion, to a child between one and two years of age, and gradually increased to four drops. Seldom is it requisite to further increase the dose. Arsenic appears to exercise a marked control over the febrile symptoms of this disease. As the herpetic eruption diminishes, the child ceases to shun the light, and as the rash fades the pustule on the eye heals. The benefit of fresh air in the more obstinate forms of the disease is well known; but it is often difficult to convince parents that exercise in the fresh air will benefit the child. They imagine that it is rather hurtful than otherwise, because the intolerance of light is then a distressing symptom, proper means not having been taken to shade the eyes. A ready method is to place over each eye a pad of cotton wool, and over the pads a bandage, which should encircle the head, and tie on the occiput. The pads should be frequently renewed and the eyelids washed with warm water.
In a future paper I hope to bring forward additional facts on the subject, and conclude by giving the history of a number of cases.
Reviews.
Klinische Beiträge zur Erkentniss und Behandlung schwerer Krankheitsfälle. Von Dr. Adolf Hermann. Primararzt in Pest. Wien: W. Baumler, 1868. Gr. 8vo. pp. 282.
(Clinical Contributions to the Diagnosis and Treatment of severe Cases of Disease. By Dr. A. Hermann.)
The preface to this work explains that the author enjoys, at the “Israelitenspital” of Pesth, a considerable field of experience, but is less overburdened with cases than are many physicians of hospitals where people of all creeds are received, and thus has time to study them individually with the greater care. We gather that this volume, which is the fruit of official labours during two years, is the first of a series which it is intended to publish, and it fairly enough fulfils the promise which the preface holds out. One of the most interesting parts of the book is the observations on “tuberculous” affections of the larynx. We must say, however, that the general treatment of the subject of tuberculosis disappoints us, and certainly does not come up to the standard of accurate and careful work which the author has set up for himself. It shows few traces of that wide acquaintance with modern pathological researches on its subject which is more than ever essential to the clinical observer who would throw any light, even by means of the most diligent labours, upon those matters which are really the quæstiones vexatæ in regard to the nature and treatment of the various diseases commonly confounded under the name of tubercle. The last chapter in the book contains an interesting account of the author’s experience of the hypodermic injection of remedies. We observe with surprise that he comes to conclusions very unfavourable to the subcutaneous use of atropine, which he almost totally condemns. We entirely agree with him in the statement that doses as high as half a grain, or even less, will at times produce some cerebral and vaso-motor symptoms, but the persistent use of much smaller quantities does, we believe, meet with quite a different and a much higher measure of success. On the other hand, the author speaks with the warmest praise of the efficacy of hypodermic injection of morphia in all kinds of neuralgias; for these diseases he declares that there is no remedy comparable to it.
Annuaire de Thérapeutique, de Matière Médicale, de Pharmacie et de Toxicologie, pour 1869. Par A. Bouchardat.
M. Bouchardat’s well-known compact little yearly volumes are always welcome, and always useful; and this year the résumé includes a rather unusual number of interesting matters. The first thing which deserves notice is the recent researches on the therapeutic action of arsenic in phthisis; a subject which we have for some time past desired to discuss in this journal, but have been prevented by want of space and time. The very able paper of M. Moutard-Martin, read before the Academy in November last, called forth a report from M. Hérard, which speaks in such strong eulogy of the remedy as used in the manner and under the conditions laid down by M. Moutard-Martin, that we are considerably surprised to observe the small amount of notice which has been given to the subject in England. Arsenic has of course been long known as a tonic more or less applicable to phthisis, as to other states of debility. But the points so sharply brought out by the French author—the limitation of the therapeutic action of arsenic to the non-febrile periods and cases, and (on the other hand) its extraordinary efficacy within these limits, in restoring flesh and strength and general health, and wonderfully amending the state of the lungs themselves—are so important that they demand the serious and immediate attention of English physicians. M. Moutard-Martin employs the remedy in pills, as being more convenient than the liquid form; each of these pills (granules de dioscoride) contains a milligramme (·00156 of a grain) of arsenious acid, with manna and honey.
Another matter which deserves notice, and had escaped ours, is the experience of M. de Beaufort as to the efficacy of iodide of potassium in diseases of the lachrymal apparatus. This observer began by applying the treatment to comparatively recent and slight cases of obstruction of the sac and nasal duct, the result of coryza, chronic conjunctivitis, &c. Obtaining a speedy cure in several such cases, he proceeded to try it even in instances where a tough fibrous stricture had existed for a long time. Even in such apparently unlikely circumstances, he has twice obtained success by the treatment. Where there is lachrymal fistula, following an abscess of the sac, the iodide is also very useful, but its employment should be accompanied by applications of tincture of iodine.
A matter of some consequence is the opinion of M. Regnault respecting the comparative activity of various preparations of digitaline. In his preface to the seventh edition of Soubeiran’s Traité de Pharmacie, this author remarks on the serious difference which exists between various samples of so-called digitaline. He declares that he finds himself driven to employ exclusively the granules of Hornolle and Quevenne. Under the head of digitalis also we may notice the employment, by MM. Dumesnil and Lailler, of a combination of opium (in the form of extrait gommeux) with tincture of digitalis. This appears, according to the authors, to have a calming effect upon the excitement and sleeplessness of insane patients, with less tendency, at the same time, to congestive effects than is the case when opium is given alone. They say that not merely does it produce better immediate effects, but that it can be more harmlessly continued after the original excitement has calmed down than other narcotics. But they remark that as digitalis, in therapeutic doses at least, has a well-known tendency to wear out the susceptibility of the organism for it, it is best to suspend its use as soon as may be. Two formulas are employed by the author:—