ANTIPYRIN AS AN ANODYNE.

1024 bladder with a Thompson’s sound nothing could be felt, but drawing off the urine it was noticed that the last portion contained more blood than the first, indicating that the bleeding was vesical in its origin. On removing the sound a small portion of growth was found caught in the eye of the instrument, which, examined under the microscope, showed most typical villi. The presence of a papilloma was therefore very clearly established. As it appeared certain that any attempt to remove the growth in the patient’s extremely exhausted condition would prove unsuccessful, it was suggested that bladder drainage through a perineal opening should be carried out, simply with the object of arresting haemorrhage, to be followed after a time by an attempt to remove the tumour itself. To this the patient consented, and the following day he was admitted into the hospital for more careful nursing than he could obtain at home. On admission, ice was applied over the pubes and introduced into the rectum, and large doses of ergot and iron were given internally, but without any effect whatever on the bleeding, which was very free. On Feb. 5th perineal urethrotomy was performed in the usual way. On passing the finger into the bladder, a soft sessile growth, apparently about the size of a Tangerine orange, was felt springing from the right lateral wall. For the reasons already mentioned no attempt was made to remove it, especially as this would have been impracticable without proceeding to perform suprapubic cystotomy. The bladder was washed out with hot boracic lotion, and a rigid lithotomy tube left in the perineal opening. The operation was followed by complete arrest of the bleeding. The following day the urine was quite clear, and afterwards remained so. The bladder was washed out daily with boracic lotion through the perineal tube, which was removed at the end of a week. The perineal opening was quite closed on the twenty-third day. The cessation of the haemorrhage was followed by a rapid improvement in the patient’s condition. The pulse, which during the first fortnight varied from 134 to 140, gradually came down to 84. He quickly regained strength, putting on flesh, and losing his pallid, anmmic appearance. He was up and walking about the ward at the end of a month, being quite free from any bladder symptoms, and a fortnight later left the hospital, being anxious to gain more strength, and promising to return as soon as there was any recurrence of the haematuria, for the purpose of having the tumour removed by supraon

pubic cystotomy. The

case

drainage tumour.

illustrates the beneficial effect of bladder

arresting vesical haemorrhage when due to a Probably an important factor in the production of

in

bleeding under these circumstances is the contraction of the muscular wall of the bladder; every contraction, by interfering with the return of blood from a vascular growth like a papilloma, must produce in it a condition of extreme congestion, which is probably only relieved by a giving way of the thin-walled vessels of the villous processes, and consequently by haemorrhage into the interior of the bladder. With free bladder drainage the urine runs away as soon as it enters the viscus, and the latter, not being excited to contract by the presence of any urine, is kept in a state of physiological rest, which, as in this instance, was followed by a complete arrest of bleeding. This, of course, can only be temporary, but it has now continued for five weeks since the closure of the perineal opening, and as yet there is no indication of any recurrence of the haemorrhage. ANTIPYRIN AS AN ANODYNE. BY ARTHUR

JAMISON, M.D.

ANTIl’YRIN has been very greatly praised on the Continent almost perfect anodyne. I am fully aware that when a remedy does a very great deal of good it is often very new, and as time goes by it is found that the anticipations of the first trials are not realised. Hence I am very sceptical of the scores of remedies the business push of some energetic chemists keeps constantly before our notice ; yet I think I have seen such relief from the use of antipyrin that I venture to bring forward the following cases. CASE I.-Mrs. A-, aged forty-eight, consulted me on Jan. 12th for profuse menstruation and many sympathetic symptoms, all obviously connected with the commencing as an

very acute backache and left frontal The uterus, except being rather heavy, was normal, and there were no signs of ovarian mischief. I pnscribed bromide of potassium, ergot, and quinine. On the evening of the 14th the pain in the back seemed so acut thar I found her rolling about the bed in agony, and I gave her a hypodermic injection of morphia. This gave her & good night, but made her dreadfully sick. During the afternoon of the 15th the pain returned even more severely. It was described as darting and jumping up and down the backs of both thighs as well as the back. I now, in addition to the mixture, gave her one-thirtieth of a grain of phosphorus, This eased the pain very much, but on the 17th shecomplained so much of the disagreeable eructations of the phosphorus that I thought I would try another anodyne, and decided to give antipyrin, which was administered in five-grain doses every half-hour. The relief was most marked, and after the third dose the pain suddenly stopped. She was able to get up that afternoon, and the period stopped on the 19th. The next period began on Feb. 10th. It was very profuse, and about four hours after its commencing the old excruciating pain was felt in the back and down the course of each sciatic nerve. She immediately had recourse to the antipyrin in the same doses as before, and it was just as successful in giving complete freedom from pain. The pain returned two days afterwards, but two doses stopped it. There were no bad symptoms from the antipyrin, the only thing noticeable being that when the first three doses had been taken the pulse fell to 56. It had no effect on the menstrual menopause,

chiefly

neuralgia.

period.

CASE 2.-Mr. B--, aged sixty-one, a tall strongishlooking man, came to me on Feb. lst complaining of constant pain in the left lumbar region, and shooting forward into the groin of the same side. He had been a police superintendent, and had to leave the force for chronic rheumatism. The lumbar pain had been constantly troubling him more or less for twelve years, was increased by walking, and for the last three months had been getting more and more severe. It was not worse at night, and was relieved by sitting; for the last two weeks, the moment he began to

move, it increased so much that life was a torment to him. When awake he did not want to sit still perpetually, and, if he moved, his pain was so bad that he hardly knew what to do. He told me the pain came on one night in July, 1875, quite suddenly about 10 P.M, was very intense during that night, got easier towards the morning, and has been troubling him ever since. He has had in the interval many intercurrent attacks of rheumatism. He has passed four stones per urethram at different times, nearly the size of a pea, but longer and roughish, and he thinks his back was easier for a time after passing each concretion. Hs has now no pain in passing urine, nor any pain shooting into the testicle of that side, or over the pubes. Specific gravity of urine 1018, free from albumen, giving no deposit of phosphates, but a slight settling of urates. He can only get about with the aid of t wo strong sticks. He has had much treatment, has been to both Buxton and Bath, has had endless external applications, has tried galvanism, and lastly massage. Now, after hearing this long history, I felt that everything had been done that ingenuity could suggest, but, drawing a bow at a venture, I gave him antipyrin in ten-grain doses thrice daily, thinking I would add one more to the longish list of his advisers and not see anything more of him. On Feb. llth he visited me again. He told me that on the day of his coming to see me, as the medicine was not nasty he took three doses, and had had that night two hours’ refreshing sleep. This gave him a little confidence, so he continued taking the remedy, and found his pain diminish and his sleep increase. On Feb. 4th he could, to his surprise, get about with one stick. He continued to mend, and felt that day very much better, the pain not being half so bad as before; it was mostly in his groin. He was in such good spirits that he felt himself another man. His pulse, which had been 86 on his first visit, was now 70. On March 3rd I saw him again. This time he walked in without any sticks and had only a slight limp, and during the past week had hardly any pain. His pulse was now 64. I told him to discontinue the medicine, but to take it if the pain returned. On March 10th he came to say he was free still from pain in his back and groin, though he had had springes of rheumatism, but felt wonderfully well. CASE 3.-1 will only briefly mention this case. A barrister came to me who bad long been a sufferer from temporal neuralgia. He now treated himself with quinine and

1025 He had tried He had no doubt it had given him the greatest relief, though he still had slight attacks. Why he came to me was his alarm at finding his pulse go down to 52. For many years he had felt his pulse, which was generally 74, and naturally thought something was going to happen. I told him I thought it was the antipyrin, and advised him to stop it. The only connecting link in these cases was a rheumatic one. The patient in Case 1 came of a very rheumatic and gouty stock. In Cases 2 and 3 the patients had rheumatism. In the former I think the cause of the pain was to be found in the renal calculi setting up neuralgia, which continued from the subsequent ill health or from a neurotic bad habit; possibly there may still be a very minute fragment, and I would not like to say the cure has been permanent till a longer time has elapsed. At all events, I think these cases go to prove that in painful neuroses we have in antipyrin a remedy of great power and value, and well worth a more extended trial.

phosphorus pills, whichhe bought ready made. tonga, and a friend told him to take antipyrin.

ON A CASE OF VITILIGO. BY J.

vomicæ, and potass. brom., in respective doses of twenty minims, fifteen minims, and twenty grains thrice a day; the

Decidedly

other treatment to be discontinued.-22nd: better and stronger. To continue the medicine.-25th : Perseveres with this treatment and is now sufficiently recovered to resume work, after a cessation of nine months; the condition of the skin, however, remains unchanged. The principal interest in this case lies in the marked relation between the nervous centres and skin. We know how commonly this is indicated in many forms of mental disease: the harsh dry skin and bristling locks, which submit to no amount of combing or brushing in certain nervous disorders; the loss of hair and change of colour arising from undue overwork of the brain, and the cutis anserina induced by sudden shocks to the emotions. In the example before us the exhaustion of the nervous system induced by long exposure to the rays of the sun in an unusually hot summer, and attended by changes in the nutrition of the nerves supplying the skin, point to the cause of the phenomena, and suggest, if they do not explain, the origin of the disease. It is commonly regarded as being insusceptible to treatment, and the chief hope of recovery seems to be in the restoration of health and a return to the natural supply of nervous

force.

HAWKES, M.D.

AN example of this somewhat rare and remarkable disease having lately presented itself in my practice, I think a brief account of the case may prove interesting. The patient is an intelligent, well-developed man, aged thirty-three, an agricultural labourer, who has till recently enjoyed good health. He is married, and has one child two years old. He is sparely nourished, complexion rather dark,

irides brown, hair dark and thick, dark moustache and whiskers, habits temperate and regular, is a moderate smoker (about two ounces of tobacco per week), does not indulge in any excess, and is a thoroughly quiet, steady man. During the summer of last year he was regularly employed in hay-time and harvest working in the fields, and after being exposed to the heat of the sun began to experience feelings of lassitude and exhaustion, attended by pain in the head, chiefly posteriorly and towards the vertex. He also suffered from a constant aching sensation below the shoulder-blades and backs of the legs, and a feeling as though something was crawling beneath the skin. About the same time he noticed numerous patches on the body and limbs,where the natural colour of the skin was lost. He was not aware of any cause for this failing in health. On the forehead, about an inch from the margin of the hair, a band of lightcoloured skin, with distinct demarcation from the surrounding cuticle, is perceptible, running across the forehead and descending on either side to the superior malar bone, stopping near the zygoma, and extending behind to the mastoid process; it also invades the scalp, being distinctly visible among the roots of the hair. This loss of colour is very marked on the sides of the temples, where it resembles the white scar of a burn; it looks as if the epidermis had been peeled off, leaving the white cutis vera exposed. On the thorax and trunk are very numerous patches, irregularly circular, and measuring from two to three inches across, presenting the same appearance. On the arms and backs of the hands and fingers are countless similar blotches, each perfectly distinct, and looking as if a strong bleaching fluid had been sprinkled over them. The same patches exist on the lower limbs. There is no anmsthesia in any of these spots, nor is the hair growing upon them at all affected. He complains )f dull pain in the head and giddiness on stooping. Pulse soft and small. Tongue clear. Skin tolerably moist. Secretory functions normal. Suffers from sleeplessness. Has no symptom of paralysis or loss of power beyond what is above described. I prescribed a mixture containing bromide of potassium with liq. ferri perchloridi, and for a few days he experienced relief from its use; but finding the improvement not very marked, I substituted the following pill: two grains of pil, phosph. co. (B.P.), a quarter of a grain of ext. nucis vomicae, and a quarter of a grain of ext. cannabis ind., three times a day; also a mixture of tinc. cinchon. co., liq. hydrarg. perchl., and liq. arsenicalis.-March 26th : Has taken the pills and mixture for ten days, and feels decidedly better.-April 14th: Up to this date has continued these remedies with marked improvement to the general symptoms.-17th: Suffers still from restless nights. Ordered liq. ferri perchl., tine. nucis

A Mirror OF

HOSPITAL BRITISH

PRACTICE,

AND

FOREIGN.

Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborum et dissectionum historias, tum aliorum tum proprias collectas habere, et inter se comparare.—MORAGNI De Sed. et Caus. Morb., lib. iv. Proœmium.

ST. THOMAS’S HOSPITAL. CHELOID OF ABDOMEN ASSUMING MALIGNANT CHARACTERS ; ULCERATION AFTER NINE YEARS; ALMOST COMPLETE DISAPPEARANCE AFTER ERYSIPELAS; RECURRENCE; INFILTRATION WITH SMALL-CELLED GROWTH; SECONDARY GROWTHS; DEATH; NECROPSY; REMARKS.

(Under the care of Mr. WILLIAM ANDERSON.) THIS

case is a very unusual one in many respects, and the observations which were made during its progress at various intervals make it very valuable. We refer our readers to the remarks by Mr. Anderson, which are appended to the

case.

G. C-,aged into St. Thomas’s

thirty-two, whip maker, was admitted Hospital in August, 1886, with a large

of the thoraco-abdominal wall. The he first noticed a growth in the skin of the abdomen in 1873, when he was nineteen years of age. It was then a hard nodule, of the size of a walnut, situated upon the left side of the middle line, a little below the ensiform cartilage. He recollected having received a severe blow on the part five years before, but was uncertain whether the injury was followed by a scar or not. The

ulcerating tumour patient stated that

family history was good. The tumour enlarged progressively, but without pain, until April, 1882. At this time some smarting appeared, and the man presented himself at St. Thomas’s Hospital. He was well developed and of healthy aspect, and complained but little of the local ailment. The growth was nearly as large as a band, of irregular outline, but without any distinctly claw-like extensions, raised above the general surface, pale and scar-like in appearance, very hard, and

elevations of recent developdeep parts, and not tender diagnosed as cheloid, and this opinion was confirmed by the microscopical examination of a portion of the mass. Shortly afterwards he left the hospital. In September he returned. The growth was then greatly incrf ased in size, and some of the bossy irregularities, which had assumed large dimensions and a dusky red colour, had broken down, leaving a deeply excavated ulcer, with irregular, sharply defined border and indolent base. It was very tender to the touch, and from time to time was the seat of severe of a neuralgic character. The glands, however,

presenting two

or

three

bossy

ment. It was movable over the to the touch. The disease was

pain