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Lectures INTRODUCTORY TO THE STUDY OF DISEASES OF THE SKIN.
JUNE 25, 1870. remaining quite prostrate for twenty-four hours. On the ; following day, however, they both seemed a little better, and took some food. A second injection of pus was now
Lectures INTRODUCTORY TO
THE
STUDY
OF
practised on both animals to the same amount, but the first dog had, the meanwhile, been getting two grammes of sulphite daily, while the latter was only getting plain food.
The effect of the second injection was most interesting: both dogs were affected instantly alike; both were seized with stupor; in both the pulse was rapid but feeble, while the respiration was greatly accelerated; both dogs refused BY DR. McCALL ANDERSON, to eat;, both lay down in a state of stupor; and, when made THE IN PRACTICE OF MEDICINE ANDERSON’S UNIVERSITY, PROFESSOR OF to rise and walk, they tottered and reeled across the room. PHYSICIAN TO THE ROYAL INFIRMARY AND TO THE The first dog, however, continued to receive, daily, a, dose DISPENSARY FOR SKIN DISEASES, GLASGOW. of two grammes of sulphite of soda, and in four days was so far recovered as to be able to eat his food with relish, while the wound in the femoral vein was rapidly healing. LECTURE VIII. The other dog fared differently : he got no sulphites. either GENTLEMEN,-In the previous lecture a case of hereditarily before or after the operation, and the result was that he worse; the wound in the thigh became gansyphilitic eczema was described in which iodide of potassium daily became limb the swelled up, and ten days after the second grenous, failed, but mercury succeeded; and also one of supposed the dog died, with all the symptoms of typhus ; injection hereditarily syphilitic pemphigus in which the iodide was the first dog being already about and well."* successful. We pass naturally from these cases to the conOne other experiment may be mentioned. Polli took sideration of the value of iodide of potassium in the treat- two large dogs, as similar as possible both in size and ment of syphilitic skin diseases; but, as time presses, I health, and, having administered to one of them eight must content myself by laying down the following rules for grammes daily of sulphite of soda, he injected into the femoral veins of both dogs three grammes each of the its use :muco-purulent discharge obtained from the nares of the 1. The longer the interval which has elapsed between the same glandered horse which had served for a previous excontraction of the syphilitic taint and the development of periment. The first dog, which had received the sulphites, seemed at first to suffer the most from the injection. It at the eruption, the more likely is it to be of service. 2. If the patient is cachectic, it is, as a rule, to be pre- once fell to the ground as stunned, and its breathing was ferred to mercury, except in recent cases of syphilis, when rapid and panting; but in a few hours it began to recover, and the it was able to eat. The second dog the mercurial vapour bath, or some such treatment, is more bore the following day better, and did not appear to sustain so operation likely to prove successful. severe a shock; but on the following day it began to mope, 3. The more extensive the tertiary eruption, the more towards evening it was very drowsy, and with difficnlty it certain is it to yield to iodide of potassium; although to could be got to stand; by the third day the animal’s extremities had become oedematous and painful; by the this rule there are numerous exceptions. a purulent discharge was running from its nose and fourth, 4. If there is any tendency to syphilitic disease of the eyes, and the wound in the thigh was now almost gannostrils or neighbouring parts, iodide of potassium should grenous. On the fourth day the animal died, worn out by be withheld, or given with great caution, for, if it produces pain, fetid suppuration, and diarrhoea. The first dog was this time completely recovered."t coryza, it is very apt to aggravate the morbid condition of by ’ For further details I must refer those who are specially the parts. in this subject to Dr. De Ricci’s. paper, and Pro5. It should be given in full doses. fessor Polli’s work "On the use of Alkaline Sulphites in The last rule is one of great importance, and all the more the Treatment of Diseases depending on Morbific Ferso seeing that one of the most distinguished surgeons of ments." the present day recently recommended, in one of the mediupon these data, and believing that impurity of cal journals, the administration of doses of three grains; theActing blood lies at the root of those cases of recurrent furunwhile my own experience has led me to conclude that ten culi in which no local or special constitutional cause can be grains is the proper dose in the majority of cases, and that detected, I made a trial of the hyposulphite of soda in this occasionally as much as thirty or forty, thrice daily, may and in some instances I was surprised at the be requisite. It is generally advisable to prescribe it in complaint; as in the following case:result, combination with a bitter, and in cachectic subjects a little "A man, of good constitution, but who for some iron is a valuable addition, as in the following prescrip- monthsyoung had suffered from a series of boils, appearing printion :—Ammonio-citrate of iron, three drachms; iodide of cipally upon his legs, came for advice to the Dispensary for potassium, one ounce; syrup of ginger, six ounces; com- Skin Diseases. The complaint had not moderated iu the pound infusion of gentian, eight ounces; water to twenty- least when I saw him; for the furunculi were coming out in four ounces: a tablespoonful in a large wineglassful of rapid succession. I prescribed for him half a drachm of the water thrice daily. hyposulphite of soda, thrice daily, in water; and from that The alkaline sulphites and hyposulphites.-Some years ago day he never had another boil." Polli of Milan made experiments with the sulphites and Before giving the medicine we must make inquiry as to hyposulphites of potash, soda, and magnesia. Having the condition of the general health, especially as to the state proved, by experiments-"first, that sulphites, when ad- of the bowels, which are frequently constipated, and correct ministered to a living animal, are carried, as such, into the any derangement which may be present. It should be circulation, and diffused all over the organism without the ’, given largely diluted, as in the following prescription :-slightest inconvenience to the animal; and, secondly, that i Hyposulphite of soda, an ounce and a half; simple syrupy the presence of these salts in the liquids and solids of the ’i one ounce; cinnamon water to twelve ounces: a tablebody retards the putrefactive fermentation for a very con- i spoonful, in a large wineglassful of water, thrice daily, on he took two dogs of about the same i an empty stomach. siderable period: Dr. De Ricci prefers the sulphite of magnesia for insize, and equally in good health; he fed them exactly alike for five days, with the exception of administering to one of ternal administration; "because it is not so unpalatable, them two grammes of sulphite of soda daily-the other dog and is less likely to produce diarrhœa; and because, in getting exactly the same food, minus the sulphite. At the consequence of the atomic weight of magnesia, it contains, end of five days he injected into the femoral veins of both bulk for bulk, more acid than the soda salt." He cites a, animals one gramme of pus taken from a fetid abscess oc- case of chronic pemphigus in an old gentleman over eighty, curring in a broken-down constitution. The operation in in which the external use of a saturated solution of sulphite both cases was carefully performed, and the animals suf* Dublin Quarterly Journal of Medicab Science, vol. xxxvi., p. 470: fered but little. Immediately after the injection both dogs article by Dr. De Ricci. and down refused all. food, appeared stupefied; they lay t lb., p. 407.
DISEASES
OF
THE
SKIN.
"
interested
......
No. 2443.
C c
898 of soda., and the internal administration of the sulphite of magnesia, had a remarkably beneficial effect.* It appears, then, that the alkaline sulphites and hyposulphites are of value in the treatment of some diseases of the skin; and that they are deserving of a more extended trial than has hitherto been accorded to them.
NOTES OF A
CASE
OF ACUTE TRAUMATIC TETANUS TREATED BY CHLORAL.
the patient lay for the first time on his side, the abdominal and thoracic muscles much less tense, and the legs flexed. Breath exhales chloral, ; no stertorous breathing; pulse and temperature the same as last visit. 15th.-Noon : Pulse 94; temperature 99°. Chloral given Patient is easily roused. Complains of£ as on the 14th. pain in the muscles of the back and legs. He can open his mouth widely; tongue dry and brown; conjunctiva very red; speaks thickly. Ordered chloral to be given every five hours in half-drachm doses. 16th.-Noon : Pulse 90 in sleep ; temperature 99°; general condition of patient the same as yesterday. Aperient medicine given.
1’7th.-Noon : Pulse 90; temperature 98°. Fifteen grains and half a drachm of chloral to be given alternately every WHILE chloral is upon its trial the following details four hours, as the muscles are less rigid and the spasms Of this case may not be altogether uninteresting to the almost gone. 18th.-After a second dose of aperient medicine, the profession :bowels were moved freely, without any severe spasms ocOn May 12th I was called to see J. S-, a healthy, mus- curring. Pulse in sleep 86; temperature 982°. Chloral as cular man of sober habits, aged thirty-four. I found him before. On the morning of the 20th, patient progressing favourlying on his back, his head bent backward, and sunk deeply -in the pillow. He had a well-marked tetanic expression of ably. Fifteen-grain and half-drachm doses of chloral continued. In the evening, found patient much worse; pulse face, and could open the mouth to the extent of only half intermitting, 130; temperature 98°; breathing in long deep .an inch. He was sweating very profusely, and his pulse was sighs; surface moist; extremities cold; no spasms. Upon 112. On moving the bedclothes for further examination, he inquiry, found he had been most injudiciously lifted out of had a severe opisthotonic spasm, during which there was bed while the soiled linen was removed. Ordered hot bottles to the feet and sides, stimulants to be freely given (two great depression of the ensiform cartilage, accompanied by ounces of brandy every hour), and chloral to be intermitted severe pain in the praecordia, and catching of the breath. for a few hours. These spasms recurred at short intervals. After the spasm 21st.-Patient much better; pulse 100, regular; tempethe abdominal and thoracic muscles remained persistently rature 935°. Complains much of pain in the back and legs, hard, the back slightly arched, the legs straight, and their and suffers from spasm. Chloral as before. The After this date, the patient steadily improved. muscles rigid. The breathing was shallow and irregular. and gradually decreasing Therewas no difficulty in swallowing fluids, and no evidence chloral was given in varying quantities till the 3rd of June, when it was discontinued. of laryngeal spasm. June 6th.-Patient quite convalescent; entirely free from After a prolonged search a small suppurating wound was hardness of the muscles ; takes solid food with ease, and found at the base of the nail of the left thumb. He stated has no discomfort wbatever. that a fortnight ago (April 27th) a thorn had run into his Remarks.-This (though the ninth) is the only case of thumb, but that he had altogether disregarded the wound, traumatic tetanus I have seen recover. To what extent the as it had given him no trouble, though he thought the chloral had to do with the recovery it is not easy to deterthorn had not been all removed. Further, that on the 9th mine exactly. That it played a most important part as a of May he began to suffer from pain in the neck and stiff- palliative in the treatment no one will deny. I have chosen ness of the jaw. On the 10th he was worse, and took salts to call the case one of acute tetanus, because, although .and senna, which acted very severely. On the llth the nearly a fortnight had elapsed between the reception of the medicine still continued to act, spasms affecting the whole wound and the occurrence of trismus, although the tempebody occasionally occurred, and he was entirely confined to rature on the fourth day was only 103°, and although the bed. He said that since the 9th he had slept but little, on muscles of the larynx and of deglutition were unaffected account of the pain in the back. A slight incision through before the first dose of chloral was given, the extent, frethe skin was sufficient to expose the portion of thorn left, quency, and severity of the spasms, the intensity and length which was easily withdrawn, and a poultice applied. As he of the diaphragmatic spasm, and the persistent rigidity of was some distance from town, I left him two fifteen-grain the thoracic and abdominal muscles, were as great as in the doses of Dover’s powder, to be given with an interval of fatal cases I had seen. The high temperature noted in three hours between them. tetanus-110° Fahr.,and over 44°C. (NVunder’lich)-is geneOn the following day (13th) it was found he had passed a rally observed towards the end of the disease when fatal; sleepless night, and had suffered severely from spasms, re- and this remark applies frequently also to the spasm of the curring at short intervals. Condition generally much the muscles of the pharynx and larynx, which sometimes resame as yesterday. Pulse 112; temperature 103°; profuse main unaffected for days even in fatal cases, and only subsweating. Determined to give chloral alone in subsequent sequently become the seat of spasm. Whether in this medical treatment. At 2.30 P.M., one drachm of chloral was instance the use of chloral prevented the spasm spreading given, and in five minutes he was asleep, rigidity of the to these muscles of course we cannot say, but it is not immuscles of the abdomen, thorax, and legs still remaining. probable. In giving the chloral, it was observed that the Slept without stertor till 7 P.M., when he awoke, took beef- patient was less rapidly affected by it as the doses were retea with relish, and slept till 9.30 P.M. At 10 P.M., pulse 100 ; peated, and that the first dose of one drachm had the most temperature 99.5° (note the fall). He has no perspiration, and marked effect, reminding one very much of the rapid effect does not complain of pain; muscles still very tense. Gave of chloroform in cases of severe and protracted labour, half a drachm of chloral, which was repeated at A.M. on where the patient is much exhausted. The congestion of the 14th, and also at 6 A.M., 10 A.M., and at 12 A.M., making the conjunctiva was very great during the exhibition of the in all three grains and a half in the twenty-four hours, fluid remedy, and continued for some days after the doses were food being taken freely, sometimes before and sometimes much lessened. after the medicine. In all, the patient had six ounces and a quarter of chloral (To prevent repetition I may say here that fluid food and during the three weeks, on an average of two to two and a half stimulants were well taken throughout the illness, and had drachms per diem. After the 20th the chloral was someundoubtedly much to do with the favourable issue of the times intermitted for several hours ; but when more than six hours elapsed, the symptoms invariably became more case.) 14th.-Noon: Pulse 100; temperature 990; no sweating; intense, and the patient required a larger dose more fremuscles very rigid; diaphragmatic spasms recur at longer quently repeated during the next eight or twelve hours. intervals. Since 12 o’clock yesterday has had three drachms Not uufrequently an extra half-drachm of chloral was given ’of chloral, given in half-drachm doses. At the evening- visit in addition to those noted in the report for some specially " severe time of suffering. Dublin Quarterly Journal of Medical Science, vol. xlii., p. 363. , BY ALEX.
.
BALLANTYNE, M.D.EDIN.
Lectures INTRODUCTORY TO
THE
STUDY
OF
practised on both animals to the same amount, but the first dog had, the meanwhile, been getting two grammes of sulphite daily, while the latter was only getting plain food.
The effect of the second injection was most interesting: both dogs were affected instantly alike; both were seized with stupor; in both the pulse was rapid but feeble, while the respiration was greatly accelerated; both dogs refused BY DR. McCALL ANDERSON, to eat;, both lay down in a state of stupor; and, when made THE IN PRACTICE OF MEDICINE ANDERSON’S UNIVERSITY, PROFESSOR OF to rise and walk, they tottered and reeled across the room. PHYSICIAN TO THE ROYAL INFIRMARY AND TO THE The first dog, however, continued to receive, daily, a, dose DISPENSARY FOR SKIN DISEASES, GLASGOW. of two grammes of sulphite of soda, and in four days was so far recovered as to be able to eat his food with relish, while the wound in the femoral vein was rapidly healing. LECTURE VIII. The other dog fared differently : he got no sulphites. either GENTLEMEN,-In the previous lecture a case of hereditarily before or after the operation, and the result was that he worse; the wound in the thigh became gansyphilitic eczema was described in which iodide of potassium daily became limb the swelled up, and ten days after the second grenous, failed, but mercury succeeded; and also one of supposed the dog died, with all the symptoms of typhus ; injection hereditarily syphilitic pemphigus in which the iodide was the first dog being already about and well."* successful. We pass naturally from these cases to the conOne other experiment may be mentioned. Polli took sideration of the value of iodide of potassium in the treat- two large dogs, as similar as possible both in size and ment of syphilitic skin diseases; but, as time presses, I health, and, having administered to one of them eight must content myself by laying down the following rules for grammes daily of sulphite of soda, he injected into the femoral veins of both dogs three grammes each of the its use :muco-purulent discharge obtained from the nares of the 1. The longer the interval which has elapsed between the same glandered horse which had served for a previous excontraction of the syphilitic taint and the development of periment. The first dog, which had received the sulphites, seemed at first to suffer the most from the injection. It at the eruption, the more likely is it to be of service. 2. If the patient is cachectic, it is, as a rule, to be pre- once fell to the ground as stunned, and its breathing was ferred to mercury, except in recent cases of syphilis, when rapid and panting; but in a few hours it began to recover, and the it was able to eat. The second dog the mercurial vapour bath, or some such treatment, is more bore the following day better, and did not appear to sustain so operation likely to prove successful. severe a shock; but on the following day it began to mope, 3. The more extensive the tertiary eruption, the more towards evening it was very drowsy, and with difficnlty it certain is it to yield to iodide of potassium; although to could be got to stand; by the third day the animal’s extremities had become oedematous and painful; by the this rule there are numerous exceptions. a purulent discharge was running from its nose and fourth, 4. If there is any tendency to syphilitic disease of the eyes, and the wound in the thigh was now almost gannostrils or neighbouring parts, iodide of potassium should grenous. On the fourth day the animal died, worn out by be withheld, or given with great caution, for, if it produces pain, fetid suppuration, and diarrhoea. The first dog was this time completely recovered."t coryza, it is very apt to aggravate the morbid condition of by ’ For further details I must refer those who are specially the parts. in this subject to Dr. De Ricci’s. paper, and Pro5. It should be given in full doses. fessor Polli’s work "On the use of Alkaline Sulphites in The last rule is one of great importance, and all the more the Treatment of Diseases depending on Morbific Ferso seeing that one of the most distinguished surgeons of ments." the present day recently recommended, in one of the mediupon these data, and believing that impurity of cal journals, the administration of doses of three grains; theActing blood lies at the root of those cases of recurrent furunwhile my own experience has led me to conclude that ten culi in which no local or special constitutional cause can be grains is the proper dose in the majority of cases, and that detected, I made a trial of the hyposulphite of soda in this occasionally as much as thirty or forty, thrice daily, may and in some instances I was surprised at the be requisite. It is generally advisable to prescribe it in complaint; as in the following case:result, combination with a bitter, and in cachectic subjects a little "A man, of good constitution, but who for some iron is a valuable addition, as in the following prescrip- monthsyoung had suffered from a series of boils, appearing printion :—Ammonio-citrate of iron, three drachms; iodide of cipally upon his legs, came for advice to the Dispensary for potassium, one ounce; syrup of ginger, six ounces; com- Skin Diseases. The complaint had not moderated iu the pound infusion of gentian, eight ounces; water to twenty- least when I saw him; for the furunculi were coming out in four ounces: a tablespoonful in a large wineglassful of rapid succession. I prescribed for him half a drachm of the water thrice daily. hyposulphite of soda, thrice daily, in water; and from that The alkaline sulphites and hyposulphites.-Some years ago day he never had another boil." Polli of Milan made experiments with the sulphites and Before giving the medicine we must make inquiry as to hyposulphites of potash, soda, and magnesia. Having the condition of the general health, especially as to the state proved, by experiments-"first, that sulphites, when ad- of the bowels, which are frequently constipated, and correct ministered to a living animal, are carried, as such, into the any derangement which may be present. It should be circulation, and diffused all over the organism without the ’, given largely diluted, as in the following prescription :-slightest inconvenience to the animal; and, secondly, that i Hyposulphite of soda, an ounce and a half; simple syrupy the presence of these salts in the liquids and solids of the ’i one ounce; cinnamon water to twelve ounces: a tablebody retards the putrefactive fermentation for a very con- i spoonful, in a large wineglassful of water, thrice daily, on he took two dogs of about the same i an empty stomach. siderable period: Dr. De Ricci prefers the sulphite of magnesia for insize, and equally in good health; he fed them exactly alike for five days, with the exception of administering to one of ternal administration; "because it is not so unpalatable, them two grammes of sulphite of soda daily-the other dog and is less likely to produce diarrhœa; and because, in getting exactly the same food, minus the sulphite. At the consequence of the atomic weight of magnesia, it contains, end of five days he injected into the femoral veins of both bulk for bulk, more acid than the soda salt." He cites a, animals one gramme of pus taken from a fetid abscess oc- case of chronic pemphigus in an old gentleman over eighty, curring in a broken-down constitution. The operation in in which the external use of a saturated solution of sulphite both cases was carefully performed, and the animals suf* Dublin Quarterly Journal of Medicab Science, vol. xxxvi., p. 470: fered but little. Immediately after the injection both dogs article by Dr. De Ricci. and down refused all. food, appeared stupefied; they lay t lb., p. 407.
DISEASES
OF
THE
SKIN.
"
interested
......
No. 2443.
C c
898 of soda., and the internal administration of the sulphite of magnesia, had a remarkably beneficial effect.* It appears, then, that the alkaline sulphites and hyposulphites are of value in the treatment of some diseases of the skin; and that they are deserving of a more extended trial than has hitherto been accorded to them.
NOTES OF A
CASE
OF ACUTE TRAUMATIC TETANUS TREATED BY CHLORAL.
the patient lay for the first time on his side, the abdominal and thoracic muscles much less tense, and the legs flexed. Breath exhales chloral, ; no stertorous breathing; pulse and temperature the same as last visit. 15th.-Noon : Pulse 94; temperature 99°. Chloral given Patient is easily roused. Complains of£ as on the 14th. pain in the muscles of the back and legs. He can open his mouth widely; tongue dry and brown; conjunctiva very red; speaks thickly. Ordered chloral to be given every five hours in half-drachm doses. 16th.-Noon : Pulse 90 in sleep ; temperature 99°; general condition of patient the same as yesterday. Aperient medicine given.
1’7th.-Noon : Pulse 90; temperature 98°. Fifteen grains and half a drachm of chloral to be given alternately every WHILE chloral is upon its trial the following details four hours, as the muscles are less rigid and the spasms Of this case may not be altogether uninteresting to the almost gone. 18th.-After a second dose of aperient medicine, the profession :bowels were moved freely, without any severe spasms ocOn May 12th I was called to see J. S-, a healthy, mus- curring. Pulse in sleep 86; temperature 982°. Chloral as cular man of sober habits, aged thirty-four. I found him before. On the morning of the 20th, patient progressing favourlying on his back, his head bent backward, and sunk deeply -in the pillow. He had a well-marked tetanic expression of ably. Fifteen-grain and half-drachm doses of chloral continued. In the evening, found patient much worse; pulse face, and could open the mouth to the extent of only half intermitting, 130; temperature 98°; breathing in long deep .an inch. He was sweating very profusely, and his pulse was sighs; surface moist; extremities cold; no spasms. Upon 112. On moving the bedclothes for further examination, he inquiry, found he had been most injudiciously lifted out of had a severe opisthotonic spasm, during which there was bed while the soiled linen was removed. Ordered hot bottles to the feet and sides, stimulants to be freely given (two great depression of the ensiform cartilage, accompanied by ounces of brandy every hour), and chloral to be intermitted severe pain in the praecordia, and catching of the breath. for a few hours. These spasms recurred at short intervals. After the spasm 21st.-Patient much better; pulse 100, regular; tempethe abdominal and thoracic muscles remained persistently rature 935°. Complains much of pain in the back and legs, hard, the back slightly arched, the legs straight, and their and suffers from spasm. Chloral as before. The After this date, the patient steadily improved. muscles rigid. The breathing was shallow and irregular. and gradually decreasing Therewas no difficulty in swallowing fluids, and no evidence chloral was given in varying quantities till the 3rd of June, when it was discontinued. of laryngeal spasm. June 6th.-Patient quite convalescent; entirely free from After a prolonged search a small suppurating wound was hardness of the muscles ; takes solid food with ease, and found at the base of the nail of the left thumb. He stated has no discomfort wbatever. that a fortnight ago (April 27th) a thorn had run into his Remarks.-This (though the ninth) is the only case of thumb, but that he had altogether disregarded the wound, traumatic tetanus I have seen recover. To what extent the as it had given him no trouble, though he thought the chloral had to do with the recovery it is not easy to deterthorn had not been all removed. Further, that on the 9th mine exactly. That it played a most important part as a of May he began to suffer from pain in the neck and stiff- palliative in the treatment no one will deny. I have chosen ness of the jaw. On the 10th he was worse, and took salts to call the case one of acute tetanus, because, although .and senna, which acted very severely. On the llth the nearly a fortnight had elapsed between the reception of the medicine still continued to act, spasms affecting the whole wound and the occurrence of trismus, although the tempebody occasionally occurred, and he was entirely confined to rature on the fourth day was only 103°, and although the bed. He said that since the 9th he had slept but little, on muscles of the larynx and of deglutition were unaffected account of the pain in the back. A slight incision through before the first dose of chloral was given, the extent, frethe skin was sufficient to expose the portion of thorn left, quency, and severity of the spasms, the intensity and length which was easily withdrawn, and a poultice applied. As he of the diaphragmatic spasm, and the persistent rigidity of was some distance from town, I left him two fifteen-grain the thoracic and abdominal muscles, were as great as in the doses of Dover’s powder, to be given with an interval of fatal cases I had seen. The high temperature noted in three hours between them. tetanus-110° Fahr.,and over 44°C. (NVunder’lich)-is geneOn the following day (13th) it was found he had passed a rally observed towards the end of the disease when fatal; sleepless night, and had suffered severely from spasms, re- and this remark applies frequently also to the spasm of the curring at short intervals. Condition generally much the muscles of the pharynx and larynx, which sometimes resame as yesterday. Pulse 112; temperature 103°; profuse main unaffected for days even in fatal cases, and only subsweating. Determined to give chloral alone in subsequent sequently become the seat of spasm. Whether in this medical treatment. At 2.30 P.M., one drachm of chloral was instance the use of chloral prevented the spasm spreading given, and in five minutes he was asleep, rigidity of the to these muscles of course we cannot say, but it is not immuscles of the abdomen, thorax, and legs still remaining. probable. In giving the chloral, it was observed that the Slept without stertor till 7 P.M., when he awoke, took beef- patient was less rapidly affected by it as the doses were retea with relish, and slept till 9.30 P.M. At 10 P.M., pulse 100 ; peated, and that the first dose of one drachm had the most temperature 99.5° (note the fall). He has no perspiration, and marked effect, reminding one very much of the rapid effect does not complain of pain; muscles still very tense. Gave of chloroform in cases of severe and protracted labour, half a drachm of chloral, which was repeated at A.M. on where the patient is much exhausted. The congestion of the 14th, and also at 6 A.M., 10 A.M., and at 12 A.M., making the conjunctiva was very great during the exhibition of the in all three grains and a half in the twenty-four hours, fluid remedy, and continued for some days after the doses were food being taken freely, sometimes before and sometimes much lessened. after the medicine. In all, the patient had six ounces and a quarter of chloral (To prevent repetition I may say here that fluid food and during the three weeks, on an average of two to two and a half stimulants were well taken throughout the illness, and had drachms per diem. After the 20th the chloral was someundoubtedly much to do with the favourable issue of the times intermitted for several hours ; but when more than six hours elapsed, the symptoms invariably became more case.) 14th.-Noon: Pulse 100; temperature 990; no sweating; intense, and the patient required a larger dose more fremuscles very rigid; diaphragmatic spasms recur at longer quently repeated during the next eight or twelve hours. intervals. Since 12 o’clock yesterday has had three drachms Not uufrequently an extra half-drachm of chloral was given ’of chloral, given in half-drachm doses. At the evening- visit in addition to those noted in the report for some specially " severe time of suffering. Dublin Quarterly Journal of Medical Science, vol. xlii., p. 363. , BY ALEX.
.
BALLANTYNE, M.D.EDIN.