Carbolate of Soda as a Remedy for Itch.—Dr. Zimmermann, of Braunfels, remarks that no one who sees much of itch will deny that we are without any remedy which acts with the certainty of a specific. In private practice, where we cannot readily obtain the proper baths, frictional manipulations, &c., cases are apt to be very inveterate. The popularity of petroleum and Peru balsam is due chiefly to their being neither very disagreeable nor very troublesome in the use; but petroleum has not justified its reputation,[[12]] while Peru balsam, which really is very valuable, especially in recent and in children’s cases, is unfortunately very costly. Zimmermann is inclined to hope that in carbolate of soda he has found a remedy that will cure scabies, tuto, cito et jucunde, though his experience is not yet sufficient for absolute proof. He employs a solution of 160 to 320 grains of the salt in about 7 ounces of water; this is to be well rubbed into the affected parts thrice daily. In two or three days every case of Zimmermann’s, even the inveterate ones, has been completely cured, and this without any annoyance or interruption of the patient’s ordinary business. There is no irritative erythema of any consequence from the frictions. Carbolate of soda may be used as a disinfectant and deodoriser; for this purpose 16 to 32 grains to 7 ounces of water is sufficient. (Der Praktische Arzt. März.)
On the Contra-indications of Anæsthesia.—M. Gosselin considers that alcoholism renders patients very unfit for taking chloroform, and thinks that to all persons above 50 years of age, and given to intemperance, chloroformisation should be forbidden; or at any rate only applied with the greatest caution, and never for a long time together. Professor Nagel, of Vienna, has recently opposed this wholesale condemnation. In delirium tremens, chloroform narcosis is often very useful, especially where it is necessary to set fractures. The severest delirium, on which large doses of opium produce no effect, has been repeatedly calmed by chloroformisation in Nagel’s own practice. Alcoholism only so far contra-indicates anæsthetics, that in refractory subjects it is necessary to push the agent in such large doses that, even with the greatest care, there is a risk of asphyxia.
An even more positive contra-indication to chloroform is found by Gosselin in the case of stupor following severe wounds. No one will dispute that narcotisation is at first entirely out of the question; it only remains doubtful for how long a time after the injury it is unsafe to give chloroform for operative purposes. Gosselin is for total exclusion, since even after the apparent departure of stupor, a kind of concealed shock to the system may still exist, and would render anæsthesia dangerous. He also thinks that in recent dislocations, especially of the shoulder, chloroform is not only usually needless, but contra-indicated by the fact that the patient’s want of sensibility may permit such force to be used as may inflict severe injuries upon the nerve trunks; and even in old dislocations chloroform should not be used till other means have been tried. This contra-indication, also, is opposed by Nagel, who brings a large amount of experience to controvert it; it even happens, sometimes, that the muscular tone can be sufficiently relaxed for the reduction without any loss of consciousness. The chief contra-indication to chloroformisation which Nagel admits is the pre-occurrence of long-standing or considerable (arterial) hæmorrhage, and advanced age, especially if there be also heart or lung disease, vascular degeneration, emphysema, &c., also the fact that the operation might cause blood to enter the larynx; and in hernia, because of the tendency to vomit. He recommends the greatest care in giving it to refractory patients, who struggle, scream, and hold their breath. The danger of asphyxia increases every moment, and it is necessary to have ready the means of throwing in a stream of pure air or of oxygen, through the nose, sprinkling the patient with cold water at the same time. Nagel has also observed that the restlessness and oppression produced by half-felt pain in incomplete narcosis, and the consequently insufficient respirations, may produce an even fatal exhaustion. Narcosis should therefore be properly kept up as long as it is wanted. (Der Praktische Arzt.)
[It is very necessary that we should study the opinions of foreign physicians and surgeons as to the dangers of anæsthesia. At the same time, I think it right to protest here that the cautions given even by Nagel, and still more those which Gosselin inculcates (with two exceptions), are to me inexplicable. At least they can only be understood upon the supposition that the means of inducing anæsthesia which are employed by these authorities are extremely inefficient and improper. A former very large experience of chloroform administration, some years ago, impressed me with the confident belief that if chloroform be given with proper care and with a Snow’s, or still better a Clover’s apparatus, there is really no danger whatever in its use, except in two cases—that of shock after severe injury, and that of delirium tremens. I cannot admit that a patient who is in a fit condition to undergo a surgical operation at all is placed in any worse position for supporting the shock of it by the fact that he has been chloroformised, if this has been skilfully done—the case of severe shock from injury always excepted.—F. E. Anstie.]
Subcutaneous Injection of Mercury in Syphilis.—Dr. A. Stöhr records a series of clinical observations on this method of treatment, which are very interesting. He considers that the subcutaneous injection of the bichloride is the most effective and direct means of producing the curative effects of mercury which has ever been applied. Stöhr employed the treatment for 96 patients; in almost all the cases it was carefully ascertained that no specific treatment had been previously adopted. His cases included a larger relative proportion of inveterate syphilis than those treated by Lewin in his researches, described by M. Bricheteau in the Practitioner for March. Stöhr considers that the hypodermic method is not needed for the milder forms of syphilis. Old and obstinate cases, on the other hand, in which inunction or other forms of mercurialisation have been vainly tried, are particularly appropriate for a trial of the subcutaneous method. It is especially indicated in such cases as those of iritis and of dangerous laryngeal affections, in which it is important to produce a very rapid effect; also in severe and extensive syphilitic skin affections, in which inunction cannot be applied. Syphilis of the bones and periosteum, and syphilitic gummata, are but little influenced by hypodermic mercurialisation. In cases accompanied by severe marasmus, the hypodermic use of mercury is contra-indicated. It is also inappropriate to the treatment of those persons who have to be treated as outpatients of a hospital. Stöhr employs a solution of corrosive sublimate in distilled water: he had at first tried a solution in glycerine, but this did not prove practically convenient. The dose ordinarily used was ⅛ of a grain; the daily employment of this only slowly produces ptyalism. When ¼ grain doses were used daily, the slighter symptoms of ptyalism never failed to occur by the third or fourth day, and the severer phenomena by the eighth or ninth; so that, with few exceptions, the administration of 2 or 2½ grains in this way produced such a strong development of salivation that the treatment had to be interrupted. (Deutsches Archiv f. klin. Med. V. 3 and 4.)
The Treatment of Diabetes.—Dr. Leube gives an elaborate report of two cases of diabetes in which he made the most careful daily observations of the quantity of water, of sugar, &c. He arrives at the following therapeutic conclusions:—Pure meat diet (with only almond bread) was the most powerful means of reducing the sugar excretion. Of drugs which were tried, arsenic had by far the most remarkable effect in reducing the sugar. Saikowsky discovered, some three years ago, that the continuous administration of arsenic for several days to animals entirely removed all glycogen from the liver; and that then neither puncture of the fourth ventricle nor curara poisoning would produce diabetes at all. Leube made the therapeutical application of the drug which these experiments suggest. He administered Fowler’s solution in doses equivalent to about ⅓ grain of arsenic daily. The effects were most striking during the period when the patients were taking a mixed diet. With mixed diet, and without arsenic, the daily average of sugar was 570 grammes in one case; arsenic reduced it to 352 grammes, on the average of 79 day and night observations; and substantially the same result was obtained in the other case. The use of this drug would appear to promise results of real importance. (Deutsches Archiv f. klin. Med. V. 3 and 4.)
A German Criticism of Lister’s Treatment of Abscesses.—Dr. W. Rosco publishes a very sharp critique on this plan of treatment, which has lately become so fashionable. He analyses minutely the sixteen cases which were published in the Archiv f. Heilkunde (and reported in the Practitioner for July 1868), and maintains that the results obtained were not more favourable, if so favourable, as those which are often obtained without any use of carbolic acid. Rosco maintains that there are two weighty objections to the too free and indiscriminating use of this treatment for abscesses. In the first place, there is a danger that surgeons, trusting blindly to the antiseptic action of the carbolic acid dressing, will open cold abscesses either unnecessarily early, or even in cases where incision is altogether improper. Secondly, the caustic or irritant action of the acid will occasionally produce mischievous effects. But the main point of his argument is directed to the demonstration, that even the most brilliant results which have been obtained in England, and published by Lister and others in the columns of the Lancet, are by no means conclusive in showing that the carbolic acid was really the curative agent. He observes, moreover, that although in England the treatment has been most extensively tried everywhere, the majority of hospital surgeons appear very sceptical about it. Undoubtedly Lister’s method deserves every attention, and should be tried in appropriate cases, but the inquiry should not be made with too much credulity, but with prudent doubt. (Archiv f. Heilkunde, 2, 1869.)
Electricity in the Diseases of Children.—Dr. Ullersperger gives a good summary of existing knowledge as to the uses of electricity in the paralyses of common and special sensation, and of motion, in children. The paper is a useful one, but does not contain any original matter on which it is necessary to comment here. (Journ. of Kinderkrankheiten, and Jan. Feb. 1869.)
Liebig’s Food for Infants.—Dr. Kjelberg related to the Gesellschaft schwedischer Aerzte his experience of the use of Liebig’s food for infants as a remedy. Six cases of diarrhœa occurred in the Children’s Hospital among infants of from 1½ to 2 years; five of them had already been treated with medicine without effect. A thin broth made from the “food” was given them as their only nourishment, and all medicine was discontinued. The motions at once assumed a better appearance. In one case, which had no previous treatment, the effect of the exclusive use of Liebig’s food was very striking. Kjelberg says that he had used the treatment in two cases of children, private patients, in whom not diarrhœa, but obstinate constipation was the malady. The children were still suckled, while the food was administered. The peristaltic function of the bowels rapidly became normal and regular. Kjelberg thinks that Liebig’s food possesses the capacity of regulating the activity of the intestinal canal. (Ibid.)
Hypodermic Injection of Ergotin in the Treatment of Aneurism.—Professor Langenbeck writes an important paper on this subject. From the well-known influence of ergot in provoking contractions of the organic muscular film of the uterus, he was led to think that a similar stimulation might be produced by it, with beneficial effect, in the muscular coats of arteries in cases of aneurism. The first case in which he employed it was one of subclavian aneurism in a man aged 45. The tumour was treated in the first place on Jacobson’s plan, with the repeated application of moxas, and a great diminution of all the symptoms took place, and lasted for three years; but the pulsation continued. In consequence (as the patient thought) of an excessive summer heat, a relapse took place, the tumour enlarged greatly, and all the old symptoms returned. Three centigrammes of aqueous extract of secale were injected over the tumour, with great relief to the pain and consequent insomnia. Between January 6 and February 17 about 30 grains of ergotin were injected, with the effect of so greatly relieving the symptoms of pressure in veins, that the pain and paralysis of the arm and hand were diminished to a remarkable extent. The pulsations of the aneurism were also sensibly weakened, and the tumour somewhat sunken. In a second case—one of aneurism of the radial, about an inch and a quarter above the wrist, and which had existed for many years—about 1/4th of a grain of aqueous extract of secale (dissolved in seven times its bulk of half and half glycerine and sp. rectif.) was injected into the skin above the tumour, and on the following day the tumour appeared to have vanished. The cure became permanent, and the only trouble was a local erythematous inflammation which lasted some days. Langenbeck discovers that it was natural that a more powerful effect should be produced by the remedy in radial than in subclavian aneurism, since the radial artery is more copiously furnished with muscular fibres than the subclavian. (Berlin Klin. Wachensch. 12, 1869.)