Chapter II: Part 2

In this particular case most of the mass was resonant, but there was a lump the size of a goose-egg, close to the ring, that was hard and gave a perfectly flat precussion note—the omentum—congested by strangulation, the very irritation from which caused a tighter spasm of the muscle-fibres between which the mass protruded. I tried taxis faithfully; so had the old man, and we both failed. I used hot fomentations to no avail; I placed him at an incline of 45° and sprayed the mass with cold water to stimulate contraction of the muscles of the cord. They contracted sharply, but had no effect except to increase his pain. I lowered him to the horizontal position, covered him up with a hot blanket, and sat down to rest.

Here was an old man, hernia strangulated for some two or three hours, a serious case. It was growing worse every moment, and nothing seemed likely to avail but the knife. The spasm was intense. How could I relax it?

I hesitated to try an anesthetic for various reasons, one of which was that _I found a piece of candle burning in a beer mug at the feet of my patient_. Knowing the great value of hyosciamine in spasm of the viscera, I took from my ever-present alkaloidal granule-case hyosciamine amorphous, gr. 1–134, and gave it hypodermatically with morphine sulphate, gr. ¼, and atropine, gr. 1–250. In a few moments my patient said, “that’s better”; and in less than ten minutes a gurgling of gas was heard through the mass indicating relaxation of spasm. Thus encouraged I gave a second dose, adding to hyosciamine, gr. 1–250, strychnine arseniate, gr. 1–48, the latter to induce forced peristalsis. In less than ten minutes more, I heard a loud gurgling sound, and my patient cried, “him’s gone,” and, sure enough, it had. The entire mass had disappeared through a hole the size of a nickel.

A retentive bandage for the time, and a well fitted truss a few days after, completed the treatment of, to me, an interesting case, which leads me to suggest a “therapeutics for strangulated hernia” for your consideration.

2666 Commercial St., Chicago.

_PERISCOPE OF THERAPEUTICS._

By J. LINDSAY PORTEOUS, M.D., F.R.C.S., Ed.

METHYLENE BLUE.

Recently I have had an opportunity of proving the efficacy of this new solvent, and am much pleased with the result obtained.

During the months of August and September I had five children under my care, suffering from diphtheria. As all the children belonged to one Institution, had the same nurse, and in every way the same surroundings, I had a good opportunity of testing the solvent powers of this drug, as compared with others. In the first child, age 4 years, I used acetic acid spray as a solvent, giving iron and potassium chlorate internally. Although the membranes in fauces visibly shrank, the disease extended downwards rapidly, almost choking the patient. Intubation was resorted to, which for a time relieved the choking symptoms, but the child gradually, sank.

Two more children were seized with the disease and the fauces were painted with sulpho-calcine, a remedy I have used successfully for some years, and corrosive sublimate was given internally. The children improved, but the patches were a long time in shrinking. I applied an aqueous solution of methylene blue (1:9) to the patches by means of a camel’s-hair brush, three times a day. The effect was remarkable. Not only did the patches, after the third application, shrink, but the feverishness and restlessness abated. Three days after the commencement of the treatment all the patches in both children had disappeared.

Two more children, aged 5 years and 3½ years, were attacked. As the patches covered the uvula, tonsils and back of the pharynx, and no further down, I thought that I would try local treatment only. After a few days the patches disappeared, the fever left, and the children were convalescent.

PIPERAZIN AND PIPERAZIN HYDROCHLORATE.

I have of late had ample opportunity to test both piperazin and piperazin hydrochlorate as solvents of uric acid. Hitherto I have used the salts of lithium and potassium in the uric acid diathesis, but will now certainly always use the new solvent in preference to either of these. I have taken particular pains to watch the action of the drug—so feel confident in stating that it is the best of known uric acid solvents.

I have never noticed any toxic effects from the use of either preparation, but prefer the hydrochlorate on account of being less hygroscopic, although I believe piperazin can now be procured in lozenge-form in glass tubes, which greatly lessens the hygroscopicity.

I will now briefly give particulars of three cases of uric-acid diathesis treated with the medicine.

The first, a man aged 36, weight, nearly three hundred pounds, suffered much renal pain, with occasional symptoms of small calculi passing along ureter. The urine had very acid reaction. The microscope revealed numerous crystals. The murexide test likewise proved that uric acid was present in abundance. This patient, wishing to become thin, was put on a beef diet, no potatoes, few vegetables, etc., just the diet to increase the uric acid. He was put on the solvent treatment, giving twelve grains, divided into three doses daily. Each dose was given in a tumblerful of vichy water. In a few days the urine became neutral in reaction; the loin-pains left; also the constant desire to micturate caused by the irritation of the uric acid. The beef-treatment was kept up for several weeks and the weight was reduced by 11 pounds. This case shows that, although no precautions were taken to diminish the formation of uric acid, but the contrary, piperazin was sufficient to dissolve the crystals.

The second case was that of a man aged 50, weight, 215 pounds. He complained of pain, described as “burning” in loins; also a dull ache in bladder, frequent desire to micturate; sometimes urine was mixed with blood. Without altering the diet at all, which was always a liberal one, including beer every day, all the disagreeable symptoms disappeared while taking piperazin hydrochlorate. On several occasions there was a return, in a modified form, of the symptoms, but after a few doses of the drug they always disappeared.

The third case was that of a man 60 years of age, who had for years felt pain in kidneys, along ureter and in bladder, and never got much relief. I prescribed for him 5 grains of piperazin to be taken three times daily in large quantities of water. After a week’s treatment the pains had left, and he was better than he had been for years.

Gruber has used it with good results in diabetes. He considers that the action of the drug in this disease is inhibitory to the transformation of glycogen into sugar.

HYPODERMATIC ALIMENTATION.

Caird (_Edin. Med. Journal_, September, 1893) reports a case of extreme weakness and emaciation due to malignant stricture of the esophagus, which was improved by intra-muscular injections of sterilized olive oil. In the course of a week from three to four ounces of oil were injected into the gluteal region. There was no pain or inconvenience caused by the injection. Sugar was occasionally combined with the oil. None of the skin punctures inflamed. There seemed no limit to the amount of oil which a patient can tolerate.

Yonkers, N. Y.

* * * * *

COLD DUE TO BACTERIA.—Bacteria are likely to be blamed for all the
ills that flesh is heir to. Prof. Schenck now maintains that what we
call a “cold” is really due to these invisible pests. When one
enters a cold room after being heated the bacteria in it flock to
the warm body and enter by the open pores of the skin. Whatever may
be said of this hypothesis he seems to have proved by experiment
that bacteria in the neighborhood of a warm body move toward it. The
confirmed smoker may derive some comfort from the fact that tobacco
is inimical to them.—_London Globe._

Recent Medicaments.

A DECADE OF NEW REMEDIES.—“There are at least one hundred new remedies of synthetic origin now in general use that were not known ten years ago.” So an American contemporary says; but we doubt if anyone can compile a list of one hundred. Who will try?—_Chemist and Druggist_ (London), Sept. 30, 1893. We are not responsible for the original statement; but the invitation is general, and we are anxious that our English friend should have a prompt response from America, so here goes: Acetanilid, agathin, alpha-oxynaphthoic acid, alumnol, amyl-enhydrate, analgen, antipyrine, antiseptol, antispasmin, anti-thermin, aristol, asaprol, asepsin, benzanilide, benzonaphthol, benzosol, betol, bromal-hydrate, bromoform, bromol, chinoline, chloralamide, chloral-ammonium, chloralose, chlorphenol, creolin, cresalol, cresin, cresol, cresol-iodide, cresotic acid, diuretin, dulcin, ethyl bromide, ethyl chloride, eugenol, eugenol-acetamid, euphorin, europhen, exalgine, formalin, formanilid, gallacetophenone, gallobromol, gallanol, guaiacol-carbonate, homatropine, hydracetine, hydroquinone, hypnal, hypnone, ichthiol, iodol, iodopyrine, kairin, losophan, lysol, metaldehyde, methacetine, methylal, methyl chloride, methylene-blue, methylene chloride, methyl-violet, microcidine, naphthalene, naphthol, naphtopyrin, orexine, oxychinaseptol, paraldehyde, pental, phenacetine, phenetol, phenocoll, piperazine, pyridine, resorcin, resorcinol, saccharin, salacetol, salicylamide, saliphen, salipyrin, salocoll, salol, salophen, saprol, solutol, solveol, sozal, sozoiodol, styracol, sulphaldehyde, sulphaminol, sulphonal, tetronal, thalline, thermifugin, thilanin, thioform, thiol, thiophen, thioresorcin, thiosinamin, thymacetin, tolypyrin, tolysal, tribromphenol, trional, tumenol, uralium, urethane. This makes 114 new definite chemical products—and the list is not exhausted. It may also be urged that some of these products have been in use longer than ten years. This is the case only with naphthol, which was first recommended as an antiseptic in 1881; but we have omitted several legitimate new naphthol compounds, so that a balance is maintained. Other products, as acetanilid, guaiacol, anilin colors, pental, etc., were known as chemical products; but their medicinal application dates back less than ten years.

Referring to above list, a casual examination shows, that about thirty-three are patented products; between fifty-five and sixty bear proprietary “utility” names (including the thirty-three patented); and about thirty are absolutely free and non-proprietary. We may publish an accurate division with details on some future occasion.—_Notes on New Remedies._

* * * * *

LLARETA; A NEW ANTIGONORRHŒIC.—Dr. Infante (_Aerztl. Rundschau_). Llareta is the abbreviated name for _Haplopapus Llareta_, a plant growing abundantly in Chili, and with which the author claims to have obtained a radical cure within ten to fifteen days in every case of gonorrhœa in which it was tried. The following is his formula:

Fluid Extract Llareta 1 part.
Distilled water 30 parts.
Tablespoonful twice daily.

—_Amer. Med. Surg. Bulletin._

* * * * *

DISINFECTIN.—(_Pharm. Zeitschr. f. Russl._) Disinfectin is the name of a preparation intended for ordinary disinfection, said to be obtained as follows: 5 parts of the residue left in distilling crude naphtha are thoroughly mixed with one part (by volume) of concentrated sulphuric acid, and allowed to cool. The fluid portion is separated from the sediment, and gradually mixed with an equal volume of ten per cent. soda solution, and well shaken. Thus is obtained a yellowish-brown emulsion,—disinfectin,—which, when intended for use, is diluted with four parts of hot water, and thoroughly shaken.—_Amer. Med. Surg. Bulletin._

* * * * *

HIPPURIC ACID AS A DIURETIC.—This acid, obtained[1] from the urine of the cow, is a favorite diuretic with many French practitioners. Dujardin-Beaumetz prescribes it combined with lime:

℞ Hippuric acid 25 grammes
Milk of lime sufficient to neutralize it.
Simple syrup 500 grammes
Essence of lemon to flavor.

Four to six tablespoonfuls daily. As before mentioned it is excreted in the urine as benzoic acid.—_Provincial Medical Journal._

* * * * *

THYMOL IN TOOTHACHE.—Dr. Hartmann (_Deutsche Med. Wochenschrift_) has employed thymol in toothache from hollow teeth, in place of arsenious acid. He fills the cavity of the tooth with a tuft of cotton on which a few crumbs of thymol have been sprinkled. It does not irritate the mucous membrane of the mouth much, and it is easily removed by rinsing the mouth with water. If a rapid action is desired let the patient rinse the mouth often, with warm water, in order to facilitate the solution of the drug. It never increases the pain at first, as arsenic does, and is not poisonous.—_Lancet-Clinic._

* * * * *

CHLOROFORM NARCOSIS.—Resultation in chloroform narcosis has been accomplished by a new method devised by Maas, one of Koenig’s assistants of Goettingen. In the first case, the ordinary means of resuscitation had been tried for an hour without effect: respiration and pulse has entered ceasec. Maas then made rapid rhythmical compressions, about one hundred and twenty per minute, of the cardiac region, whereupon the heart’s action gradually increased and the patient recovered. In a second severe case responded with the same result to the treatment. Maas ascribes the effect of the cardiac compressions to the driving of the blood into the larger arteries.—_Chicago Medical Recorder._

THE AMERICAN THERAPIST.

_A Monthly Record of Modern Therapeutics_,

WITH PRACTICAL SUGGESTIONS RELATING TO THE
CLINICAL APPLICATIONS OF DRUGS.

JOHN AULDE, M. D., EDITOR.
1411 WALNUT ST., PHILADELPHIA, PA.

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Vol. II. JANUARY 15th, 1894. No. 7.

Editorial.

_INFLUENZA AND ITS TREATMENT._

The manifestations of Influenza in this section of the country during the past two months have been numerous and varied, although the malady has been far less directly fatal than on its first appearance in the winter of 1889–90. The different types of the disease, the pulmonary, the nervous and the abdominal, have been less distinctly marked, but it has been especially severe in the case of elderly people when appearing as an intercurrent affection. Another noticeable feature is, that the disease has shown a greater disposition to attack children than in former years, although when children have been enjoying usually good health, fatal results have been rare. This, however, has not been the case with sickly or puny children, as the disease has manifested itself in various ways, such as throat, ear and other complications. In many cases nothing more than the peculiar pains characteristic of the disease have been noticed; in others, it has passed off with nothing more serious than would result from a bad cold, so that large numbers have fought it out on this line. The prevalence of the malady in the vicinity of Philadelphia, and we presume this observation holds good elsewhere, has been wide spread, showing conclusively that it is largely dependent upon atmospheric influences. Indeed, up to the present writing, the condition of the weather has been extremely favorable to the development of influenza, and we all hope that better weather during the remainder of the winter will tend to check its spread.

Judging from published reports, the treatment of influenza during the present epidemic has been mainly symptomatic, simple remedies being employed in place of the powerful antipyretics and analgesics that were so extensively used three years ago, and this may account in part for the reduced mortality. In this connection the writer ventures to suggest the use of a limited number of remedies that have proven of signal service within the past two months. In the pulmonary type, to relieve the distressing and frequent cough, nothing has given better results than morphine hydrochlorate and pilocarpine hydrochlorate, given hourly in doses of one-fiftieth of a grain each, together. This combination seems to allay sufficiently extraneous irritation, while it favors the re-establishment of the normal secretions, and has shown remarkably favorable effects when broncho-pneumonia threatened to supervene. Given in these small doses, it produces neither narcotism nor depression, and the patient is ready to take his regular meals, to which is added liquid nourishment during the intervals. Hot milk—not boiled—and the free use of beef-tea made from a good extract of beef, are helpful in assisting to maintain the strength. In the abdominal type, with much pain along with mucous discharges from the bowels, showing involvement of the liver, a combination of mercury biniodide with codeine sulphate appears to control and modify the progress of the disease. One one-hundredth grain of the former with one-tenth to one-fifth grain of the latter may be administered every two hours, and along with this, where we have to contend with the pains peculiar to influenza—rheumatic and neuralgic—it is well to administer conjointly small doses of bryonia. From two to five drops of the tincture can be given at intervals of two to four hours. Cases which do not respond readily to bryonia, will often quickly show amenability to the administration of rhus toxicodendron, given in one-drop doses of the green root tincture at intervals of two hours. It is remarkable what power these two simple remedies exercise over the fugitive neuralgic pains peculiar to influenza, doubtless because they modify the nutrition of the cells composing the fibrous structures, enabling them to throw off waste products and thus maintain a condition approaching that of health. The after-treatment will embrace the administration of the arseniates of iron and strychnine, and in debilitated subjects this should be supplemented by the exhibition of cod-liver oil or petroleum in the form of emulsion.

It will be noted that nothing has been said in regard to the advisability of antiseptics, and for this reason, _viz._: That although the disease may apparently be associated with a micro-organism, this microbe plays no important part in the various manifestations of the disease. Whatever influence it may possess is, as we have seen from clinical experience, counteracted, discounted, by what the older physicians were pleased to term the _vis medicatrix naturæ_; and besides, we have absolutely nothing to warrant us in assuming that our present antiseptic measures and remedies exercise any perceptible influence when taken into the system, at least so far as regards this particular malady. Further investigations in this line may develop some new ideas in this respect, but for the present, we must rest content with the stern facts as we see them at the bedside. Special attention should be directed here to the theory of “_Digestive Leucocytosis_,” as elaborated by Professor Chittenden, published in another department of this number.

_AUTO-INFECTION IN ABDOMINAL DISORDERS._

In view of the complications arising in the course of abdominal diseases from auto-infection, and with our recent knowledge in regard to this important but insidious factor, it behooves the physician to be on the look-out for such manifestations. Toxic anemia, as portrayed by Dr. JOHN E. BACON, in our last number, brings to light some valuable truths which should ever be uppermost in the minds of those having to deal with occult affections.

Considering that we now have ample evidence that a sick person may be his own worst enemy, by reason of an unhealthy condition of the alimentary canal, it is not too much to assume that in many cases of prolonged illness, the complications arising may frequently be due to auto-infection, and thus, in addition to the disease which is seen, there is another disease engrafted upon the first which is insidious but persistent. The plan of using purgatives to unload the intestinal tract and relieve the portal circulation has its value, but the habit, once established, cannot be relieved permanently by this method. The addition of antiseptics is likewise a valuable feature in the treatment of this class of cases, and the two combined will often serve a useful purpose; but cases occur in which either method alone, or both combined fail, and it is then that we are compelled to study the philosophy of cell-function.

In this connection, the studies of POHL, as elaborated by CHITTENDEN, promise to shed a flood of light upon the vexed and complicated problem which involves the theory of nutrition. If digestive leucocytosis, as delineated by these authors, be true, and we have no reason to doubt their conclusions, then we have a satisfactory explanation of the value of proper food for the sick, to say nothing of the nutrition of those who ordinarily enjoy good health. The fact being admitted that white blood-corpuscles or leucocytes are more rapidly developed after the ingestion of food, it follows that this cellular activity was intended to accomplish or aid in accomplishing certain metabolic changes. And when to this fact we add the knowledge advanced by METSCHNIKOFF concerning the function of phagocytes, which are said to be modified white blood-corpuscles, together with the scientific demonstrations of VAUGHAN, that these cells produce through the activity of their nucleus an antiseptic substance, we have a complete scientific explanation of the need for suitable food stuffs, not only in illness of every description, but also as a precautionary measure against disease.

It is time that the study of the class of cases under consideration should be placed on a scientific basis, in order that we may have some definite idea of the objects to be attained—and the method of attaining them—expressed in terms which may be comprehended by the merest tyro in therapeutics, and to this end the contributions of METSCHNIKOFF, POHL, CHITTENDEN and VAUGHAN must be accepted as valuable preliminary data. The next thing in order will be to make these scientific facts clinical facts by making them practical, and it is therefore necessary that others should take up the task in order that the work may be carried to a successful termination.

_THE PRINCIPLE INVOLVED IN THE SUBCUTANEOUS USE OF BLOOD-SERUM._

An important revelation has been made to the medical profession in the form of a communication to the _Medical News_ (Jan. 13, 1894), by Dr. C. F. DARNALL, of Llano, Texas. According to the report, twins suffered from ptomain-poisoning, and one of them died. The surviving child was treated by the subcutaneous employment of a normal salt solution, but without apparent benefit. Later, this was followed by the use of two ounces of blood-serum drawn from the arm of the father, a healthy young man. To quote the words of the author, “The child was carefully watched, and reaction occurred in about six hours. Improvement gradually took place, and in six days, upon a diet of thin corn-meal gruel at first, later by fresh milk prepared, the child was well. It was placed at the mother’s breast at regular intervals, and at the time of writing, nearly nine weeks after the onset of the illness of the children, the lacteal secretion is fully established.”

Now, this is evidently a very interesting case, and all physicians who wish to understand the “whys” and “wherefores” would like to have some additional light thrown upon this occult subject. In this instance, there is no intimation that the father had been previously rendered “immune” to the peculiar ptomain which, in this case, is supposed to have been derived from a can of condensed milk. How, then, could this blood-serum have exerted a favorable change in the metabolism of the infant which was but ten weeks old? Our bacteriological friends will tell us that the benefits were due to the “_natural antiseptic properties_” of normal blood-serum; but the clinician and intelligent and conscientious physician will want to know from whence this peculiar property is derived. The blood is an alkaline fluid, and we are taught that antiseptic solutions, to be effective, must be acid. How does it happen, therefore, that blood-serum obtained from normal blood, which is alkaline, possesses antiseptic properties?

This question has already taken up so much space in the journal that, aside from our prospective subscribers, it would not be advisable to take further time for its elucidation. It will be sufficient, however, to say that it involves a principle first developed from a scientific standpoint by Professor VAUGHAN, who has shown conclusively that the antiseptic property of blood-serum is due to the fact that the nucleus of the white corpuscles secretes an actively antiseptic substance, a substance having all the characteristic of a proteid, which he has denominated “_nuclein_.” At the risk of becoming monotonous in furthering this measure, we repeat that nuclein solutions may be obtained from yeast-cells, from the yelk of the egg, from the thyroid gland, from the spleen and from other organs of the body, and when properly prepared, they are as powerful in modifying the multiplication of microorganisms as is corrosive sublimate or any other recognized bactericide. The principle underlying the subcutaneous use of blood-serum is, therefore, demonstrable, and is strictly within the confines of scientific medicine. How long it will require to educate the medical profession in this knowledge remains to be seen; but if it was merely an empirical claim or chimerical fancy, and backed by sufficient capital or government patronage, the period would be short indeed.

_EDITORIAL NOTES._

The contents of this issue of the AMERICAN THERAPIST are as usual
varied, practical, interesting, original—carefully arranged to make
the reading harmonious as well as profitable. We say this for the
benefit of those casual readers of this issue who are not yet—but
ought to be—subscribers and regular readers.

* * * * *

The American delegates to the International Sanitary Congress, to
meet in Paris this month, were named by the chief officer of the
Marine Hospital Service; the delegates are Dr. Stephen Smith, New
York City, Dr. Shakespeare, Philadelphia, and Dr. Bailhache,
Washington, D. C.

* * * * *

The advance copies of the “Minutes, Reports, Papers and Discussions
of the 41st annual meeting of the American Pharmaceutical
Association, held at Chicago, August 14th to 20th, 1893,” have just
been issued to members of the association. The regular bound volumes
of the “1893 Proceedings,” containing the notable annual report on
“Progress in Pharmacy,” will be issued later.

* * * * *

THE NEWBERRY LIBRARY.—Prof. Senn has made a munificent gift to this
institution by giving to it his collection of medical books,
including especially valuable works on anatomy and surgery, full
sets of periodicals, and the collection of books of the late
Professor Baum of Göttingen. With this nucleus, added to by other
donors, and its own already extensive collection and ample
resources, the Newberry Library is apparently in the front rank, and
will afford the profession in Chicago unexcelled bibliographical
facilities.

* * * * *

The four years’ course is gradually being adopted by all the leading
medical colleges. The Jefferson Medical College (Philadelphia) has
just concluded to make the four years’ course obligatory after this
year, and the Medico-Chirurgical College (Philadelphia) is
considering the advisability of making the same rule. The latter
college, by the way, has just established new professorships of
Otology, Genito-Urinary Diseases and Orthopedic Surgery; the new
offices will be filled shortly.

* * * * *

The PENNSYLVANIA STATE MEDICAL SOCIETY will hold its next meeting at
Gettysburg, May 15, 16, 17, and 18, 1894. Those desirous of
presenting papers are requested to notify, at an early date, the
Chairman, or any other member of the Committee of Arrangements. Dr.
E. E. Montgomery, of Philadelphia, is the chairman, and the other
members of the committee are: Dr. Isaac C. Gable, of York; Dr. Geo.
S. Hull, of Chambersburg; Dr. John C. Davis, of Carlisle; Dr. Henry
Stewart, of Gettysburg; Dr. George Rice, of McSherrystown; Dr. E. W.
Cashman, of York Springs.

* * * * *

The American Medical Association meeting is to be held this year at
San Francisco, on Tuesday June 5th. To Californians this date is a
little late for showing off their City and State to best advantage;
it will be a trifle too hot for comfort by that time. A better date
would have been May 5th, and by arranging early excursions the
visitors could have taken in Lower California in April, then the
Mid-Winter Fair—which will undoubtedly extend to May—and wound up
their hours with attendance at the Convention. Perhaps a general
request to re-consider the date should result favorably with the
Committee who make the date and all arrangements.

* * * * *

After a spirited and quite acrimonious campaign, the New York County
Medical Society held its annual election Monday evening, January
15th, 1894. All the candidates on the regular ticket, excepting Dr.
McLeod for president, were elected on the first ballot. For the
presidency three candidates were in the field, and none of them
obtained a clear majority on the first ballot; a second ballot
resulted in the re-election of Dr. McLeod. The candidacy of Dr.
Alexander, urged by the younger and progressive members, was the
disturbing cause in this election; the feelings of the contesting
factions were wrought to a high pitch, and the proceedings were so
turbulent that the daily press of New York took up the matter and
regaled the public with entertaining accounts of the contest. All is
now harmony again, we hope.

Correspondence.

_THE DOSE OF SANTONIN._

TO THE EDITOR:

_Sir_:—On page 678 of the Cincinnati _Lancet-Clinic_, of Dec. 9, 1893, appears a letter from J. M. Murkon, M.D., of New York, to the editor, calling attention to the dose of santonin, used as an emmenagogue, which I had reported in the AMERICAN THERAPIST, vol. I., no. 1, p. 8 (July, 1892). Dr. Murkon asks “whether the dose as given is not a misprint; if not, it is certainly more than dangerous, as five grains has caused a fatal result.”

I wish to say that in the year and a half since the article in question was written, I have often made use of _ten-grain_ doses of santonin for its emmenagogue effects, and in no instance have I learned of the slightest discomfort from such a dose. I rarely administer more than a single dose; but if more are required, I invariably wait twenty-four hours before giving them. The dose is always administered at night on retiring, and at the same time I order a mustard foot-bath, and frequently hot drinks _ad libitum_. I would say again that I have never seen this procedure lead to any untoward effects, or even any discomfort, and usually the menstruation is comfortably and apparently normally established by the next day.

I do not believe it is possible to produce miscarriage or abortion by this treatment. I have never seen it follow, and so certain am I of this fact that I have come to look upon it as being a safe and convenient means in making a differential diagnosis as to the presence or absence of conception in cases of suppressed menses. I am so confident of this diagnostic value that I am in the habit of saying to the patient when there is any doubt as to the cause of the suppression, “I shall give you a dose of medicine which will bring matters around all right if you have taken a cold, but if there is a natural cause for the arrest of the menstruation you need look for no results.” Who has not occasion, frequently, to decide for the anxious patient the _cause_ of delayed menstruation? They come to you insisting that the suppression is not due to conception, and are exceedingly importunate in their demands for relief. Here, then, is a medium through which I have frequently solved this perplexing question; and through which I have been enabled to conscientiously _prescribe_ for such cases, while otherwise I should have refused to use any means to afford relief, simply advising patience, and awaiting the tedious restoration of function by Nature’s own forces.

D. H. BERGEY, M. D.

1245 S. 28th St., Philadelphia, Pa.

_ICE IN BRONCHIAL ASTHMA._

TO THE EDITOR:

_Sir_:—In the November number of the AMERICAN THERAPIST, I contributed a short account of a long, violent and very refractory exacerbation of bronchial asthma, which yielded almost instantly to the application of ice-packs over the pneumogastrics. The vagi are held to contain both dilator and contractor filaments for the bronchial muscles. This attack seemed to me to be a convulsion, so to speak, of the afferent contractor filaments. By freezing the vagi, then, these violent motor impulses should be inhibited; and such turned out to be the case.

A day or two since I received a letter from Dr. Ezra Peters, of Missouri, saying: “I have just returned from a case of asthma very similar in every particular to the one reported by you in the November number of the AMERICAN THERAPIST, except that I did not use nitro glycerin. After a hard tussle for fifty-two hours for air, a fifteen minute’s application of the ice-pack to the neck caused the respiration to become quite full and free, and the pulse to fall from 138 to 80.”

I publish this additional experience in the hope that others will give this simple procedure a further trial.

ERNEST B. SANGREE, M. D.

2020 Arch St., Philadelphia.

Current Literature.

_NATURE’S CURE OF PHTHISIS._

Dr. Henry P. Loomis states (_Med. Rec._) that he has found quite a number of cases of recovery from phthisis. His summary is as follows:

1. Out of 763 persons dying of a non-tubercular disease seventy-one, or over nine per cent., at some time in their life had phthisis, from which they had recovered.

2. The new fibrous tissue by which the advance of the disease was apparently checked and the cure effected, developed principally by round-cell infiltration of the interlobular connective tissue, which in some instances had increased to an enormous extent. Some of the new fibrous tissue was formed later by round-cell infiltration in the alveolar walls and around the blood-vessels and bronchi. Pleuritic fibrosis appears to be secondary to tubercular processes in the lung substance. The interlobular connective tissue is the primary and principal source of the fibrosis.

3. Tubercle bacilli were present in the healed areas in three out of twelve of the lungs examined. These healed areas did not differ in their gross or microscopical appearances from those in which they were not found.

4. Thirty-six per cent. of all cases where the lungs were free from disease showed localized or general adhesions of the two surfaces of the pleura.

_VENTRO-FIXATION OF THE UTERUS._

Dr. Spaeth, of Hamburg, according to the _Lancet_, has now published reports of twenty-five cases in which he has performed the operation known as ‘ventro-fixation of the uterus.’ None of the cases proved fatal. In seventeen permanent anteflexion was obtained; in fourteen there was, besides the retroflexion, a diseased condition of the uterine appendages necessitating their removal. Of the cases that were not so complicated all except one were successful. Dr. Spaeth rarely fastens the stump of the broad ligament into the abdominal wound, usually stitching the fundus uteri directly to the parietal peritoneum. In the later cases he adopted Schede’s method—that is to say, silver sutures were drawn through the whole thickness of the abdominal walls at intervals of about an inch and a half, but they were not at first tied. In the intervals finer silver sutures were inserted through the sheaths of the recti, the peritoneum and the fundus uteri, and tightened, twisted, and cut short, the whole of course being beneath the skin; the thicker sutures were then tightened and twisted and the lips of the wound brought together with superficial catgut sutures. The subcutaneous silver sutures remained, but never gave any trouble. Dr. Schede and Dr. Spaeth are both of opinion that this method is the best for preventing any hernia, and that when it has been employed abdominal binders are unnecessary. Dr. Spaeth does not perform or recommend ventro-fixation in cases of retroflexion unless there is either disease of the appendages or chronic peritonitis.

_PNEUMONIA._

Croupous pneumonia has during recent times been defined as “an infectious disease characterized by inflammation of the lungs and constitutional disturbance of varying intensity.”

The recognition of an infection as a cause of this disease necessarily implies the existence of a specific germ, and as corollary we may state that this germ, like all germs, has a limited existence.

During the cause of the inflammation three stages have been recognized—congestion, red hepatization, and gray hepatization. Now, on a physician being called to a case of this kind, the query is, what is the best thing to do in the way of medical treatment?

If one consults some of his associates he will find remedies recommended _ad nauseam_. One declares the fever does no harm, while another is not satisfied unless one of the chemical antipyretics keeps the temperature near the normal standard.

Varying results, of course, follow these different treatments.

Having for a long time accepted and practised the doctrine that many diseases can be modified and conducted to a safe issue by giving a remedy that will attack the diseased cell-function, I have treated my cases of pneumonia in this way. The three remedies that I employ are aconite, bryonia and iodine. If I am called to see a patient during the first stage I give aconite and iodide of potassium, and on the development of the second stage I continue the iodide and also give bryonia. The aconite is given with a view of relieving the vaso-motor tension, and thereby equalizing the circulation; this, if doing nothing more, produces a measure of comfort. The last two remedies are given for their local effect. Now, as to a dose: in a half goblet of water I put ten drops of tincture of aconite, and in another goblet containing same quantity of water I put five grains of iodide of potassium, and give a teaspoonful alternately every hour. As soon as the second stage comes on I substitute five drops of tincture of bryonia for the aconite and continue to give in alternation with the iodide. If the heart becomes weak give one-fourth of a grain of extract of nux vomica every three or four hours. If the patient has much pain, hot applications are used. This with suitable food constitutes a treatment that bears excellent results. The physician who believes in giving large doses of quinine, ammonia, etc., will sneer at these small doses and hotly declare that nature cures independently of the drugs. In view of this declaration there is a compliment paid to _vis medicatrix naturæ_ that the writer recognizes, and to have such an ally is certainly a desirable help. Those who have faith in heroic dosage are not always mindful of this fact, nor yet of the condition which obtains under their hands, and that is a state of drug disturbance plus the disease. Nature here is hindered, not assisted.

S. B. CHILDS, M. D.,

The Brooklyn Medical Journal, Jan., 1894.

_DRUG ACTION._

Chemistry makes such rapid strides of late that it is impossible for the medical man in ordinary practice to keep pace with it. We have ptomaines and leucomaines, and in the literature of the journals these two terms are used indiscriminately, which is unfortunate, as tending to create confusion. While ptomaines are those alkaloidal products of metabolism belonging to the cadaver, or to any dead organism, whether animal or vegetable, the term is now applied to the same products in living tissues and which really are not ptomaines, but leucomaines. Chemically speaking, both ptomaines and leucomaines exist in the forms of monamines, diamines, and triamines, and have hitherto been regarded as resulting from the oxidation of ammonium salts by abstraction of water or from acids by substitution of amidogen. Yet the bacteriologists assure us that they are the secretions, or rather excretions, of bacteria, just in the same way that the strata of non-igneous rocks of the earth are formed primarily by the secretion, and secondarily by the excretion, of calcareous shells of diatoms, or of the cretaceous shells of those protozoans entitled rhizapods. Elsewhere in the SUMMARY I have expressed myself to this effect in nearly the same language, and while it may seem pedantic, it should be borne in mind that this is the age of terminology.

We, each of us, have our special ties—shall I say hobbies? One of us making the eye a specially will make use of ophthalmological terms. Another turns his attention to the technology of animal tissues, and still another, with an eye towards the bacteriological existences, leads us into a labyrinth of Greek and Latin technics.

We are talking of ptomaines and leucomaines, and that their existence is probably due to bacteria. These are regarded as toxines, and certain diseases are said to be caused by these toxines, and not from the bacteria themselves directly, but indirectly. I appreciate the idea that the curative results of these diseases are due to the antagonism of the remedies to these toxines, and not to the destruction of the bacteria. Before we inquire into the curative action of remedies we must first find out how these toxines produce disease. The tendency is to trace the origin of all disease to a change in the protoplasmic cells. This change is evidently due to a toxine. A healthy physiological change in the cells may be termed metabolism, while an unhealthy or pathological change may be termed katabolism. The question arises, in what way does katabolism arise from these toxines? It occurs to me that it must be due to chemical affinity, or as it is sometimes very properly called, _chemism_.

In a brief but very excellent article on therapeutic action by Dr. Thomas J. Mays, of Philadelphia, in the AMERICAN THERAPIST, he commences thus: “Every phenomenon in nature becomes intelligible only when considered in the light of force. Any scientific system of therapeutics must therefore be built on a broader basis than that of the mere drug action on the animal economy.” In this he is unquestionably correct; but when he, along with others, asserts that drug action is due to what is termed “interference,” to me, at least, he becomes unintelligible. I am utterly unable to take in the idea. When he refers it to molecular motion, which, after all, is chemical change, he is right. Heat, light, electricity, motion—each interchangeable, correlating with each other, constituting force—must be the source of all chemical action. These are, strictly speaking, proteodynamics. They act, as I have indicated, upon the cell. This action may be either metabolic or katabolic, and when the remedial agent is presented the change results. So true is this that the _vis vitæ_ itself results from chemism, so that every action, every change, has simply two factors—matter and dynamism.

In this connection permit me to make the following quotation from the _Medical News_: “Of course, it had been recognized that certain diseases are self-limited, and the phenomena of natural and acquired immunity were duly appreciated; but it required the knowledge gained by the advances in bacteriology to afford a rational explanation of these phenomena. There is yet much to learn. The beginning has but been made. Enough, however, has been seen to teach that disease has its chemistry, and that the treatment of the future will depend upon a knowledge of this fact and the application of chemic laws.”

The progressive physician does not believe that medicines _cure_. It is true he uses the word just as we say the sun rises and sets when we know that it does neither the one or the other, but that the phenomena are due to the revolution of the earth on its axis. The cell function is the building function, you may call it metabolism or anabolism. It is either a building or a repairing process. Now derange the process by means of toxines, and you have what may be called katabolism. The molecules are disorganized, the tissues become disorganized, and the result is impaired function. A remedy reaches the part; among the molecules of the remedy and the molecules of the protoplasmic cells chemism takes place; the toxine is antagonized, antidoted, neutralized, changed, and the metabolic process is established. This is the natural physiological process, and a healthy action results; and herein I have thought may be the secret of the action of minute doses. I will illustrate. In the chemical laboratory you have a combination of mercuric sulphate with about four-fifths its weight of chloride of sodium; and heating in a test-tube the result is mercuric chloride (HgCl{_2}), or corrosive sublimate. Repeat the experiment by using mercurous sulphate, with about a third of its weight of chloride of sodium, applying heat, and you have mercurous chloride (HgCl), calomel. Here by diminishing the amount of chlorine in one of the experiments you have quite a different result, due to quantivalence. Why, then, if the process of katabolism be chemical, may not a result be altogether different among the atoms of the molecules of the cells and of the medicine, in accordance with the law of definite proportions? If quantivalence exists among chemical radicals, why may it not exist among organic radicals?

J. F. GRIFFIN, M.D.,

The Medical Summary, Jan., 1894.

_DIGESTIVE LEUCOCYTOSIS._

Many investigators, seeking after an explanation of the methods by which nutritive material is carried from the alimentary tract to the different tissues and organs of the body, have called attention to the possible importance of the white corpuscles in the assimilation of food-stuffs, citing the fact that in a well nourished carnivorous animal there is a marked production of new cells in the lymph spaces of the intestinal mucous membrane after the ingestion of food, the extent of said production being apparently dependent upon the amount of assimilable elements contained in the food. It has been further supposed that this increased production of lymph cells is followed by a corresponding increase in the passage of leucocytes into the blood, mainly on the ground that only a comparatively few of the cells could have any local action in aiding the nutrition of the intestinal walls. There has been, however, a lack of positive proof of these assumptions until Pohl,[2] in his studies on the absorption and assimilation of food-stuffs, took up the matter experimentally, and sought to obtain some positive data bearing on the question. This investigator made a careful study of the physiological variations in the content of leucocytes in dog’s blood, using young animals and feeding them only one meal a day. The leucocytes were counted after Thoma’s method, preliminary experiments showing that there was very little difference in the number of white cells contained in a given volume of arterial or venous blood. Thus, in the case of a fasting animal, blood taken from the jugular vein contained 16,378 white corpuscles per cubic millimeter, while blood from the carotid artery of the same side contained 15,449 white cells per cubic millimeter. Further, from a well-fed animal, whose blood was examined during digestion, similar results were obtained, _i. e._, 27,036 from the jugular vein, and 26,866 from the carotid, thus showing that blood from the capillaries of either veins or arteries would give essentially the same results.

A single experiment, illustrative of the many reported by Pohl, may be given here, as showing the marked effect of food upon the number of white corpuscles in the circulating blood:

Time. Number white corpuscles per cubic millimeter blood.

9 A. M. 8,689
9 A. M. 100 grams meat fed.
10 A. M. 16,685
11 A. M. 17,296
5 P. M. 7,256
Maximal increase, 99 per cent.

About thirty distinct experiments were tried on ten different animals, with only two or three negative results to fifty positive ones. The results, taken collectively, plainly indicate that the increase in the number of leucocytes in the circulating blood, after the ingestion of food, is very marked, the maximal increase being 146 per cent., while the average increase amounted to 78 per cent. This, as Pohl states, would indicate for the total content of blood in an animal an increase in some cases of 1,000,000,000 of leucocytes. Control experiments showed that, normally, there were only comparatively small variations in the content of leucocytes in the blood, from hour to hour, in the absence of food. It is to be further observed that this marked increase in the number of white corpuscles in the circulating blood, after the ingestion of food, usually reaches its maximum in the third hour, _viz._: at a time when digestion would most probably have reached its height, no noticeable change being usually observed before the end of the first hour after the taking of food. Evidently, some transformation-products of the ingested food must be formed before leucocytosis becomes marked. The return to the normal number of leucocytes shows no regularity; in some cases being very gradual, in others quite rapid.

This marked action of food in increasing the number of leucocytes in the circulating blood, naturally raises the question whether all varieties of food possess this power, or whether it is limited to some one or more individual food-stuffs. In attempting to answer this question, Pohl tried a large number of experiments, the results of which afforded proof that neither water, salts, fats, carbohydrates, or even meat extracts, are able to materially affect the number of leucocytes in the blood. Proteid-containing foods, on the other hand, such as meat, Witte’s peptone, and gelatin peptone quickly raise the content of white blood corpuscles to a marked degree. Somewhat noticeable was the result obtained on feeding wheat bread. This food-stuff, in spite of its fairly large content of proteid matter, failed to exert any influence on the number of leucocytes in the blood, and in conformity with this result it was found that in herbivorous animals there was an utter lack of anything approaching a digestive leucocytosis, even after protracted fasting.

In attempting to explain the cause of this increase in the number of leucocytes in the circulating blood, after the ingestion of proteid food, we are at once confronted with the possibility of this apparent increase being relative rather than absolute; as possibly due to a loss of water from the blood, incidental to the marked outpouring of digestive juices accompanying digestive proteolosis. For this view, however, there is very little support. In the first place, the blood would need to become very much thickened by loss of water to account for the increased number of leucocytes observed in the experiments. Furthermore, we know that the outpouring of watery secretions into the intestine during digestion is accompanied by an absorptive current in the opposite direction, which would tend to counteract any tendency towards concentration of the blood, and, indeed, might lead in many cases to a direct dilution of this fluid. Again, if the increase in the number of white corpuscles is to be explained in this manner, there should be a corresponding increase in the number of red blood corpuscles. As a matter of fact, Pohl’s results show that those conditions of diet tending to increase the number of white blood corpuscles are without any noticeable effect on the red corpuscles. Abstraction of water can not, therefore, be the cause of the large number of leucocytes contained in the blood after a proteid diet. Much more plausible is the view that the increase is due to a more rapid transference of the corpuscles from their point of origin, _viz._: from the intestine and from the lymph glands of the mesentery, to the blood. In other words, it seems probable that digestive proteolysis in the stomach and intestine is followed or accompanied by a rapid production of new cells in the lymph spaces surrounding the intestine. If this view is correct, there should be a much larger number of leucocytes in the blood and lymph flowing from the intestine, in an animal in full digestion, than in the arterial blood coming to the intestinal tract. That such is the case is shown by the following experiment taken from the many reported by Pohl:

DOG WEIGHING 3,330 GRAMS, IN GOOD DIGESTION.

A.M.

8.50. Blood from skin contained 8,330 white corpuscles in cubic mm.

9.10. Blood from skin contained 9,618 white corpuscles in cubic mm.

120 grams meat and 20 c. c. water fed.

10.40. Blood from the skin contained 15,092 white corpuscles in cubic
mm.

10.55. Body opened, several loops made with the small intestine, and
blood withdrawn from vein and artery without any great loss of
blood.

WHITE CORPUSCLES IN CUBIC MM. BLOOD.

1. Intestinal loop. 11.35 A. M., venous blood contained 17,077.

11.39 A. M., arterial blood contained 7,649.

2. Intestinal loop. 11.40 A. M., venous blood contained 15,033.

11.40 A. M., arterial blood contained 7,061.

The facts would thus seem to warrant the assertion that, as a rule, the venous blood flowing from the intestinal tract of an animal, fed on a rich proteid diet, contains a much larger number of leucocytes than the arterial blood flowing to the intestine; although, if space permitted, we might instance certain occasional exceptions due to various causes, which, however, do not reflect against the view that there is a marked production of leucocytes in the lymph spaces surrounding the intestine, and in the lymph glands of the mesentery, as a normal accompaniment to digestive proteolysis.