| Potion No. 1. | |
|---|---|
| Extrait gommeux d’opium | ⅓ grain. |
| Tincture of digitalis | 7½ minims. |
| Syrup | 1 ounce. |
| Distilled water | 5 ounces. |
| Potion No. 2. | |
| Extrait gommeux d’opium | ⅔ grain. |
| Tincture of digitalis | 15 minims. |
| Syrup | 1 ounce. |
| Distilled water | 5 ounces. |
According to circumstances, the stronger or the weaker of these two prescriptions is the allotted potion for twenty-four hours. We have recounted all this gravely, but must not be expected to preserve our gravity to the last. Not even the respected name of M. Dumesnil can keep down an irresistible tendency to laugh when we are seriously told that 7½ minims of tincture of digitalis, taken in two separate doses in the course of twenty-four hours, will avert the mischievous excitement which might otherwise be caused by ⅓ grain of extract of opium similarly distributed! That neither potion No. 1 nor potion No. 2 can be considered a dangerous narcotic we quite allow; but we fancy that must be because there is so little opium in either of them, not because there is so much digitalis. In fact, if we might be allowed to make a delicate suggestion to our therapeutical brethren of Outre-mer, it is, that just now they are going the least bit in the world crazy over digitalis and its wonderful properties. However, we have nothing but praise for such researches as those of MM. Oulmont and Hirtz, already noticed in these pages.
A small matter worth noting is the suggestion of M. Hager as to the bad effects of impure glycerine which are occasionally met with. It appears that certain glycerines, which are locally irritant when applied to the skin, prove to contain formic and oxalic acid; the latter is more especially the irritating agent.
Some interest attaches to a comparison instituted by M. Rabuteau between the action of sulphate of soda and that of sulphate of lithia. The former diminishes or removes thirst and produces constipation; the latter increases thirst considerably, and causes copious liquid stools and watery vomiting. The soda salt dries the alimentary canal, the other thickens the blood and pours out its watery element in abundant intestinal secretions.
The chlorides of sodium and lithium present analogous differences. The former does not purge when introduced into the veins, though it does purge when given internally in similarly large doses. Its ormolic effects are like those of sulphate of soda. Iodide of sodium has similar differences of effect, according as it is given by the veins or the alimentary canal. In short, the purgative effects of salines would appear to depend on the metallic and not on the metalloid element which they contain.
We must finish this hasty notice with a résumé of M. Rabuteau’s ingenious theory as to the cause of the constipation which so often succeeds saline purgation. According to him, if the dose of the saline be large almost the whole is directly eliminated by the alimentary canal; if it be medium, a part passes into the blood; if it be small, nearly the whole of it is absorbed into the blood. In the first case, purgation is violent; in the second it is slight; in the third it is nil, and there is even constipation. But as a certain quantity of the medicine may have been absorbed, even when there has been powerful purgation, there may be consecutive constipation from the presence in the organism of the purgative salt, which slowly eliminates itself from the intestinal surface. Rabuteau inclines to think, though it is impossible to affirm, that not merely saline, but other purgatives, show analogous differences of action.
In concluding our notice of this Annuaire, useful and interesting as it is, we cannot but repeat the complaint we made last year. It is astonishing to what an extent the accomplished editor has ignored some of the most valuable therapeutic work done both in Germany and in England. We venture to say that he would have done better to attend to these matters, than to fill so many pages as he has done with a reproduction of his own papers on the etiology of saccharine urine, which is clearly beyond the proper work of his Annuaire.
De la Médication Antipyrétique. Thèse de Concours. Par le Dr. A. Ferrand, Ancien Interne Lauréat des Concours des Hôpitaux, &c. &c. Paris: F. Savy, 1869. 8vo. pp. 90.
(On Antifebrile Medication. By Dr. A. Ferrand.)
The author of this treatise is a really distinguished man in the jeune médecine of France; and it is with a natural interest that we turn somewhat eagerly to the pages of his thesis to discover what are his ideas as to the part which treatment can play in pyrexia. One can hardly do better, in reviewing his work, than select the chapter on the “Indications in Fever,” as a kind of test object, to judge the quality of his work. Judged by this test, it must be pronounced very good. In a quiet and thoughtful manner, M. Ferrand inquires into some of the deepest problems of the physiology and chemistry of fever, and really hits, as it seems to us, most if not all of the principal difficulties which are troubling the minds of the most advanced pathologists and clinical observers in Europe. That he does not pretend to solve all these mysteries is no dispraise to him, but the reverse: at any rate it may be fairly said that he has carefully considered all the doubtful points by the light of the best observations in nearly every European country. If we were inclined to make any exception to his accuracy and completeness of information, it would be on the score of what he says, or rather omits to say, respecting the rôle played by hydro-carbonaceous foods in alimentation. He seems to us to greatly undervalue, if not to ignore, the incalculably important results of recent researches in deciding the rank of non-azotised aliments in feeding, and consequently in great part disarming, the destructive force of pyrexial combustion. He assigns, as it appears to us, an altogether exaggerated importance to the secondary effects of pyrexia upon the nervous system: while at the same time he appears inadequately impressed with the enormous destructive incidence of febrile action upon the tissues. Upon this point M. Ferrand would surely do well to consult the description of what passes in the organism in pyrexia which was given by Professor Haughton in his admirable address before the British Medical Association at Oxford. He seems to forget, what Professor Haughton therein so ably showed, that a typhus fever or pneumonia patient lying still on his back, and with scarcely anything moving except the organs of vegetative life, and the deep chemistry of the tissues, does in fact a heavier day’s work than any healthy labourer!—heavier, that is, as regards the inevitable destruction of tissue that must go to the maintenance of the most elementary and necessary acts of life, in the absence of the power to assimilate ordinary nutriment. It is this defect (as we think it) in his physiology which makes M. Ferrand’s practical remarks on alcohol so very inferior to those which he makes, in the practical therapeutic portion of his work, upon other agents which he thinks appropriate to the treatment of the febrile state. His account of Todd’s doctrine and school is indeed extremely inadequate, and proves, for the hundredth time, how much that remarkable teacher has been misunderstood by the majority of those who have criticised his opinions, or supposed opinions. Here is a sentence, for instance, of M. Ferrand’s, which is nearly as incorrect as it is possible for a sentence to be—“Alcohol, for instance, is ... stimulant and resolvent in small doses; but in larger and more continued doses it becomes antipyretic.” That is precisely what alcohol does not do. Given in large doses (relatively to the needs of the organism), it becomes eminently pyretic. It need not always raise the temperature of those parts to which we apply the thermometer; but, assuredly, given in such doses as produce phenomena of intoxication, it does most directly increase and give a mischievous impulse to the destructive processes going on in the organism.