The Advantages of Tracheotomy.—Mr. T. R. Jessop corroborates the views expressed in our last Number by Mr. A. E. Durham. He gives some very remarkable cases, showing the great usefulness of the operation. Indeed, one case was a veritable resuscitation of life. (Ibid.)
Arsenic a Cause of Shingles.—The very important problem as to whether arsenic, when continuously administered, is productive of shingles, is again discussed by Mr. Hutchinson. Mr. Hutchinson does not assert the fact to be more than a coincidence, but he relates several very interesting cases in which the prolonged use of arsenic was followed by shingles. (See Medical Times, April 17.)
The Treatment of Diabetes.—Dr. Basham records some cases of diabetes treated very successfully with alkalies and the phosphatic salts of ammonia, and he expresses an opinion very favourable to this method of treatment. The following is the prescription employed:—Phosphate of ammonia and carbonate of ammonia of each ten grains, aromatic spirit of ammonia half a drachm, water an ounce, added to the juice of a fresh lemon, and taken three times a day. This line of treatment was continued for four months, with the results tabulated below:—
| Mean | Sugar | |
|---|---|---|
| sp. gr. | per oz. | |
| September (began phosphatic salts) | 1037 | 18 grains. |
| October | 1040 | 18 grains. |
| November (great increase of urates) | 1036 | 6 grains. |
| December 4th (large proportion of urea and urates) | 1018 | ½ grain. |
| December 28th (urea and urates in excess, a large crop of crystals of oxalate of lime after cooling) | 1024 | Nil. |
| January 26, 1869 (same as above) | 1026 | Nil. |
(See British Medical Journal, April 10.)
Silver-wire Ligatures for the Pedicle in Ovariotomy.—Dr. Marion Sims calls attention to a recent case in which he performed ovariotomy, in order to explain his method of dealing with the pedicle. In the particular instance the walls of the abdomen were so thick, and the pedicle was so short, that it would have been impossible to secure it in the usual way by the clamp externally. In such cases he has always held that the pedicle is best secured with silver-wire ligatures and dropped back into the pelvic cavity. “If the pedicle be small, it is enough to transfix it with a double silver-wire and secure the two halves by firmly twisting the wires on opposite sides.” If it be broad, it requires a number of separate wires. This case required eight deep silver sutures for closing the external wound, care being taken to pass them through the divided edges of the peritoneal coat. A piece of lint, wet with carbolic lotion, was laid over the wound, and secured by a bandage, and a large compress of cotton wadding. The urine was drawn off for three days. There was no constitutional disturbance, and the patient was convalescent from the moment of the operation. (See British Medical Journal, April 10.)
Perchloride of Iron in Post-partum Hæmorrhage.—Mr. Hugh Norris corroborates the testimony of the various obstetricians who have spoken so favourably of this styptic. Injections of strong solution of the salt instantly arrest the hæmorrhage in this dangerous class of cases. He noticed also that the perchloride has a peculiar corrugating effect on the superficial muscular fibres, as well as on the mucous surfaces. He has noticed in less than five minutes after injection that the sphincter vaginæ, which had previously allowed the passage of the hand, became so contracted that it barely admitted a single finger. From this he concludes that one of its beneficial effects in these cases is the contraction of the muscular fibres of the uterus. He lays down the following conclusions in reference to this preparation:—(1) We possess no topical styptic in efficacy at all approaching the perchloride of iron; its effects being certain, perfect, and instantaneous. (2) In post-partum hæmorrhages, a solution of this salt, applied in the form of an intrauterine injection, is of the utmost value both in immediately arresting the flow of blood and also in causing a permanent contraction of the recently emptied uterus. Its presence in the cavity of the uterus post-partum is not only not injurious, but on the contrary, from its well-known antiseptic properties, may frequently be productive of positive benefit in more ways than one. Mr. Norris employs a saturated (?) solution of the perchloride. All clots must first be removed, and the long tube of the syringe should be introduced thoroughly into the uterus before injection. (Ibid.)
The Cure and Prevention of Scurvy.—In a paper in the Lancet, Mr. Archer Farr starts a doctrine which is yet, we think, to be proved, viz. that scurvy is not caused by the absence of certain alkalies and the presence of others. Indeed, he refers scurvy to the absence on ship-board of proper flesh-food, and he thinks that by supplying flesh in thoroughly good condition scurvy may be avoided. Lime-juice acts, he says, by taking the place of the gastric juice and digesting the food, and thus promoting the nutrition of the body (!). (See Lancet, March 27.)
Treatment of the Vomiting of Pregnancy.—Mr. John Harrisson recommends that in these cases hypodermic injection of morphia be tried. He gives the report of a very decided and serious case, in which nearly every conceivable remedy had been employed in vain. He then tried the subcutaneous injection of acetate of morphia, in doses of one-sixth of a grain, three times a day, and this instantly arrested the vomiting. (See British Medical Journal, April 3.)