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IODINE AS A REMEDY FOR VOMITING.
265 draw candidates for its degrees. essentially a local university, and
A teaching university is it is this that is wanted for London, where, as has been said ad nauseam, there are the best museums and appliances for teaching in the world. I deprecate most strongly the watering down of the examinations of the existing University. I deprecate the admission, as equivalent, of the examinations of other bodies; the transformation-if it is seriously proposel-of Bachelors of Medicine into Doctors ; and the promotion of priggishness by tacking the word " honours " to certain existing degrees. These innovations will not give London what it wants. Neither will the introduction of faculties and boards of studies, although a step in the right direction, give London what it wants. The University of London must be careful to retain the standard of its examinations and its prestige, and then it will have nothing to lose and everything to gain by a real teaching university by its side. I am very jealous ot its lowering either by trying to be two things at once. I am, Sirs, yours faithfully, GEORGE COWELL. Jan. 29th, 1890.
IODINE AS A REMEDY FOR VOMITING. To the Editors
of THE LANCET.
SIRS, -I
constipated. I saw him the following day in bed, and he expressed himself as feeling better. The next day there was little or no improvement in his condition. He complained of no pain, but still felt very weak. He remained in this state until Jan. 16th, and on the 17th his father hastily summoned me to see the patient, who was in great pain owing to inability to void his urine. I foundthe lad’s bladder distended, and readily relieved him by passing a, No. 8 indiarubber catheter. Though able to move his legs in bed, he was unable to stand erect or assume the sitting posture when placed in the horizontal one. His appetite had returned, and nothing appeared to trouble him but the paresis or weakness of his legs. Mr. Weekes saw the patient at 5.30 P. M. and relieved his bladder. On the morning of the 18th I again drew off his urine; his legs were
was no loss of and the bowels had not acted since the 15th, and then only after a purgative. Mr. Weekes again emptied the patient’s bladder at 5.30 P.M. At 9 P.M. on the same day I was called to the patient, said to be "in a fit." I found him lying on his back, insensible, skin moist, pupils dilated, breathing laborious, with loud rattling sounds in the throat, pulse irregular and slow; he had been convulsed, and there was evidence of his having bitten his tongue. The patient never rallied, and died at 4 A.M. the next day. Whether paralysis has been hitherto observed as a sequela. of so-called influenza I know not, but from absence of other causes I am compelled to believe that the above case is an instance. Epidemic influenza is prevalent in this neighbourhood, and one can hardly doubt, from its nature, that the central nervous system is primarily involved. The neuralgic pains, intense headache, insomnia, pain at the back of the neck and down the spine, loss of taste (which is not uncommon) and of smell, deafness, the extreme prostration which follows in a few days, and in this case paralysis, clearly indicate that the nervous system is seriously and early implicated. The majority of patients suffer from great weakness of the lower extremities, and it is not unusual tofind them complaining of numbness of the hands and feet. Mr. Weekes tells me that his coachman, who has recently suffered from a typical attack of epidemic influenza, complained to him of the difficulty he experienced in emptying his bladder, and I have also seen another case. The pathology of this epidemic influenza must necessarily, in the present state of our knowledge, be speculative. It may be that the virus-possibly a microbe-which finds an entrance into the blood specially selects and exerts its influence on the nervous system, and there induces morbid processes. I may add, in conclusion, that coryza has not been a prominent symptom here-in fact, hardly noticeable. I am, Sirs, yours faithfully, J. J. BENNETTS, M.B. Chatham, Jan. 27th, 1890. were
then
sensation,
completely paralysed; there pain, no patellar reflex,
no
can confirm the evidence of M. Darthier, recorded in the annotation on page 144 of your issue of Jan. 18th, as to the value of iodine in vomiting. The use of this drug as a general gastric sedative is not entirely new, though its decided efficacy is perhaps not widely known. In the American Journal of Medical Sciences for April, 1883, page 413, is an article by Dr. Gaunt of New York on 11 The Use of Iodine as a Stomachic Sedative." He alludes to its employment of old in the vomiting of pregnancy, but shows that it is equally valuable in vomiting from a variety of causes. He instances acute indigestion, hysteria, septicaemia, nephritis, acute catarrhal gastritis, drunkards’ gastritis, and numerous cases of gastro-intestinal disturbance in children. The dose he employed was three to five minims of compound tincture of iodine, given at intervals of fifteen or thirty minutes, or sometimes less frequently. To infants he gave one minim or half a minim. Shortly after reading this article, and in the same year (1883), I tried it in several cases, and it has been a good deal used at Guy’s Hospital since then. I have generally given it in doses of three to five minims in two or four drachms of water every half-hour or every hour for six or eight hours, and then if it is necessary to continue it I have given it at longer intervals. But the result is often attained after the second or third dose. I have used it and known it used with success in the vomiting of Bright’s disease, in cerebral vomiting, in vomiting after chloroform, in the vomiting of migraine, in vomiting from gastric disease, and in other instances. Needless to say, it does not always succeed ; but it seems to me to have done good much more often than other drugs commonly used for this purpose, and to be a really valuable addition to our To the Editors of THE LANCET. means of treating cases of the kind. I I am, Sirs, yours faithfully, SIRS,-As observe, with some disappointment, that FREDERICK TAYLOR. St. Thomas’s-street, Jan. 22nd, 1890. your issue of this date contains neither comment on nor confirmation of the pathological suggestion made by Dr. Glover Lyon in THE LANCET of Jan. 18th, I trust you will allow me to supply the omission to the best of my THE EPIDEMIC OF INFLUENZA. ability. I refer to the theory which is embodied in these To the Editors of THE LANCET. words: "Epidemic influenza attacks primarily the cenSIRS,-Now that influenza is rife amongst us I venture to tral nervous system, producing cerebral and spinal pain." Permit me at once to state that Dr. Lyon’s view is supassume that the following necessarily rough notes of a case may interest your readers. ported by all that I have observed of the symptoms and On Jan. 7th E. T. W., aged seventeen, a tall, nervous- course of the malady which is now exciting so much looking youth, came to the consulting-room complaining interest. The extraordinary depression of the vital powers of headache, pains in his back and limbs-chiefly his which follows in its train, as shown by the condition of the legs,-and of general weakness. His mother, who accom- temperature and the vascular system, together with the panied him, gave me the following history: Her son remarkable neurotic recrudescence which is provoked by had never suffered from any illness, except measles when neglect of these important indications during the earlier very young, until Jan. 5th, when he awoke com- part of convalescence, would, it appears to me, of themplaining of intense frontal headache, pains down his selves point to the fact that we are in the presence of back and legs, and aching all over his body; he was hot a malady which in its essence is not a catarrh, as some and flushed, perspired freely, and felt sick. He re- seem to suppose, but a cerebro-spinal inflammation. I mained at home until the 7th, when he returned to his will now enumerate some of the more particular induties as assistant in a warehouse, but finding himself dications which tend to support Dr. Lyon’s suggesunequal to the task he sought medical advice. His tion. The signs of local inflammation, commencing in condition when he came to me was as follows:-He still the eyes, pass backwards, possibly through the medium complained of slight headache, aching down the back of the optic nerve, to the cranial nerve centres, and and legs, but more especially of extreme prostration, loss of within a few hours portions of the spinal cord, notably appetite, and insomnia. There was no sore-throat, and no the lower lumbar and sacral portions, are sensitive to deep cough. The tongue was furred, he felt sick, and the bowels percussion. The pains in the limbs which are felt early in
phthisis,
’
A teaching university is it is this that is wanted for London, where, as has been said ad nauseam, there are the best museums and appliances for teaching in the world. I deprecate most strongly the watering down of the examinations of the existing University. I deprecate the admission, as equivalent, of the examinations of other bodies; the transformation-if it is seriously proposel-of Bachelors of Medicine into Doctors ; and the promotion of priggishness by tacking the word " honours " to certain existing degrees. These innovations will not give London what it wants. Neither will the introduction of faculties and boards of studies, although a step in the right direction, give London what it wants. The University of London must be careful to retain the standard of its examinations and its prestige, and then it will have nothing to lose and everything to gain by a real teaching university by its side. I am very jealous ot its lowering either by trying to be two things at once. I am, Sirs, yours faithfully, GEORGE COWELL. Jan. 29th, 1890.
IODINE AS A REMEDY FOR VOMITING. To the Editors
of THE LANCET.
SIRS, -I
constipated. I saw him the following day in bed, and he expressed himself as feeling better. The next day there was little or no improvement in his condition. He complained of no pain, but still felt very weak. He remained in this state until Jan. 16th, and on the 17th his father hastily summoned me to see the patient, who was in great pain owing to inability to void his urine. I foundthe lad’s bladder distended, and readily relieved him by passing a, No. 8 indiarubber catheter. Though able to move his legs in bed, he was unable to stand erect or assume the sitting posture when placed in the horizontal one. His appetite had returned, and nothing appeared to trouble him but the paresis or weakness of his legs. Mr. Weekes saw the patient at 5.30 P. M. and relieved his bladder. On the morning of the 18th I again drew off his urine; his legs were
was no loss of and the bowels had not acted since the 15th, and then only after a purgative. Mr. Weekes again emptied the patient’s bladder at 5.30 P.M. At 9 P.M. on the same day I was called to the patient, said to be "in a fit." I found him lying on his back, insensible, skin moist, pupils dilated, breathing laborious, with loud rattling sounds in the throat, pulse irregular and slow; he had been convulsed, and there was evidence of his having bitten his tongue. The patient never rallied, and died at 4 A.M. the next day. Whether paralysis has been hitherto observed as a sequela. of so-called influenza I know not, but from absence of other causes I am compelled to believe that the above case is an instance. Epidemic influenza is prevalent in this neighbourhood, and one can hardly doubt, from its nature, that the central nervous system is primarily involved. The neuralgic pains, intense headache, insomnia, pain at the back of the neck and down the spine, loss of taste (which is not uncommon) and of smell, deafness, the extreme prostration which follows in a few days, and in this case paralysis, clearly indicate that the nervous system is seriously and early implicated. The majority of patients suffer from great weakness of the lower extremities, and it is not unusual tofind them complaining of numbness of the hands and feet. Mr. Weekes tells me that his coachman, who has recently suffered from a typical attack of epidemic influenza, complained to him of the difficulty he experienced in emptying his bladder, and I have also seen another case. The pathology of this epidemic influenza must necessarily, in the present state of our knowledge, be speculative. It may be that the virus-possibly a microbe-which finds an entrance into the blood specially selects and exerts its influence on the nervous system, and there induces morbid processes. I may add, in conclusion, that coryza has not been a prominent symptom here-in fact, hardly noticeable. I am, Sirs, yours faithfully, J. J. BENNETTS, M.B. Chatham, Jan. 27th, 1890. were
then
sensation,
completely paralysed; there pain, no patellar reflex,
no
can confirm the evidence of M. Darthier, recorded in the annotation on page 144 of your issue of Jan. 18th, as to the value of iodine in vomiting. The use of this drug as a general gastric sedative is not entirely new, though its decided efficacy is perhaps not widely known. In the American Journal of Medical Sciences for April, 1883, page 413, is an article by Dr. Gaunt of New York on 11 The Use of Iodine as a Stomachic Sedative." He alludes to its employment of old in the vomiting of pregnancy, but shows that it is equally valuable in vomiting from a variety of causes. He instances acute indigestion, hysteria, septicaemia, nephritis, acute catarrhal gastritis, drunkards’ gastritis, and numerous cases of gastro-intestinal disturbance in children. The dose he employed was three to five minims of compound tincture of iodine, given at intervals of fifteen or thirty minutes, or sometimes less frequently. To infants he gave one minim or half a minim. Shortly after reading this article, and in the same year (1883), I tried it in several cases, and it has been a good deal used at Guy’s Hospital since then. I have generally given it in doses of three to five minims in two or four drachms of water every half-hour or every hour for six or eight hours, and then if it is necessary to continue it I have given it at longer intervals. But the result is often attained after the second or third dose. I have used it and known it used with success in the vomiting of Bright’s disease, in cerebral vomiting, in vomiting after chloroform, in the vomiting of migraine, in vomiting from gastric disease, and in other instances. Needless to say, it does not always succeed ; but it seems to me to have done good much more often than other drugs commonly used for this purpose, and to be a really valuable addition to our To the Editors of THE LANCET. means of treating cases of the kind. I I am, Sirs, yours faithfully, SIRS,-As observe, with some disappointment, that FREDERICK TAYLOR. St. Thomas’s-street, Jan. 22nd, 1890. your issue of this date contains neither comment on nor confirmation of the pathological suggestion made by Dr. Glover Lyon in THE LANCET of Jan. 18th, I trust you will allow me to supply the omission to the best of my THE EPIDEMIC OF INFLUENZA. ability. I refer to the theory which is embodied in these To the Editors of THE LANCET. words: "Epidemic influenza attacks primarily the cenSIRS,-Now that influenza is rife amongst us I venture to tral nervous system, producing cerebral and spinal pain." Permit me at once to state that Dr. Lyon’s view is supassume that the following necessarily rough notes of a case may interest your readers. ported by all that I have observed of the symptoms and On Jan. 7th E. T. W., aged seventeen, a tall, nervous- course of the malady which is now exciting so much looking youth, came to the consulting-room complaining interest. The extraordinary depression of the vital powers of headache, pains in his back and limbs-chiefly his which follows in its train, as shown by the condition of the legs,-and of general weakness. His mother, who accom- temperature and the vascular system, together with the panied him, gave me the following history: Her son remarkable neurotic recrudescence which is provoked by had never suffered from any illness, except measles when neglect of these important indications during the earlier very young, until Jan. 5th, when he awoke com- part of convalescence, would, it appears to me, of themplaining of intense frontal headache, pains down his selves point to the fact that we are in the presence of back and legs, and aching all over his body; he was hot a malady which in its essence is not a catarrh, as some and flushed, perspired freely, and felt sick. He re- seem to suppose, but a cerebro-spinal inflammation. I mained at home until the 7th, when he returned to his will now enumerate some of the more particular induties as assistant in a warehouse, but finding himself dications which tend to support Dr. Lyon’s suggesunequal to the task he sought medical advice. His tion. The signs of local inflammation, commencing in condition when he came to me was as follows:-He still the eyes, pass backwards, possibly through the medium complained of slight headache, aching down the back of the optic nerve, to the cranial nerve centres, and and legs, but more especially of extreme prostration, loss of within a few hours portions of the spinal cord, notably appetite, and insomnia. There was no sore-throat, and no the lower lumbar and sacral portions, are sensitive to deep cough. The tongue was furred, he felt sick, and the bowels percussion. The pains in the limbs which are felt early in
phthisis,
’