LIQUOR POTASSÆ A TEST FOR SUGAR IN THE URINE.

751

produced by the angle formed at the neck of the dual had of its properties (having used it extensively in Upon an attempt to introduce the catheter, its his business) as well as the morbid appearances, I am point met with an obstruction, which was overcome by inclined to believe that a large quantity had been swalpushing up the tumour, and thus rendering the angle at lowed. The question naturally arose at the inquestthe point of flexion less acute. She now evacuates Whether, after taking a fatal dose of this poison, he could the bladder without the use uf the instrument.into- have put the tumbler into the pot de chmnbre, and then duced a stem-pessary, taking care that the os uteri was, pushed this utensil under the bed, turning himself afterprevious to its introduction into the vagina, situated in the wards upon his left side. I have, however, no doubt but concavity of its round plate ; an astringent injection was such was the fact, as there are a few cases on record prescribed, and the use of the hip bath, and she was re- showing that this poison does not always immediately commended to regulate the bowels by taking castor oil destroy volition. if necessary ; this plan produced great comfort at first, The appearance of the veins was remarkable. This but she was obliged to discontinue it for a short time, as may be accounted for in some measure by the state of the she was affected with diarrhoea, after which she again weather (May) as well as the time of examination (seventy resumed it with benefit. hours, p.m.). I have examined several bodies at a later CASE 5.-M. Levret observers,-" Ten years since period after death, but I never observed the veins in the I was requested to see a lady, residing in Paris, same condition. The muscular fibre presented. a redder who was said to have a large uterine polypus, in appearance than natural ; this I haveoften observed in consequence of which I took with me a leaden sound, dogs killed by this poison. We have yet much to learn respecting the action of which I had been in the habit of using where, my finger was not large enough to reach the bottom prussic acid upon the system, and I hope that some of of the vagina, to enable me to form an opinion of your correspondents will be able to furnish cases which the size and attachment of the upper part of the tumour. will throw some light on this interesting point. I found the patient in bed, and, instead of a polypus, there was protruding from the vagina a tumour, of a LIQUOR POTASSÆ A TEST FOR SUGAR IN THE URINE. pyriform shape, somewhat flattened at the sides, and in several places excoriated with a discharge of an offensive JOHN MOORE, Esq., one of the Resident Medical odour exuding from the excoriated places. The base of By Officers of the Queen’s Hospital, Birmingham. the tumour measured six inches in circumference, and was situated within the vulva; in length the tumour OF the tests employed for the discovery of sugar in the measured six inches at its anterior part, and at its posurine Dr. Golding Bird has given the preference to terior not quite so much ; where it was not excoriated it "it can be applied to urine in a few was of a pale flesh colour. When the patient was stand- Trommer’sjuice; minutes, and its indications are most satisfactory ;" it is, os uteri I the was situated at the lowest introing, part. open to this objection, that the least variation duced the sound, previously oiled, and it passed seven however, in the quantity of the chemical reagents used causes coninches before any obstruction was offered to its passage." siderable modification of the colour produced ; this I (Journal de M6decine, vol. xl., page 360.) have seen vary in experiments upon the same urine from a light reddish-yellow to a dark claret; the deposit which DEATH FROM PRUSSIC ACID. follows the application of this test is greater than can be fully accounted for by the formation of the red oxide of By EDWARDS CRISP, Esq., Walworth. copper, and is, doubtless, partly due to the action of liq. the urine, for when these two are boiled MAY 4, 1839, ten, a.m., I was requested to see imme- potassae upon a reddish-brown precipitation occurs. together diately Mr. -, aetat. 42, Walworth, whom, on reachIt is singular that the well-known combined action of ing the house, I found dead. He was lying on the right heat and alkalies upon grape-sugar should not have sugside of the bed, the body inclining to the left; the face the probability of their being advantageously used gested a with white the suffused, frothy mucus upon the lips ; as a test for the presence of this substance in the urine. skin of the extremities cold ; that of the trunk a little That liquor potassae when boiled with diabetic urine prowarm. I supposed he had been dead about an hour. I duces a characteristic colour was first noticed by my ascertained from his wife that he had been as well as Mr. Palmer, dispenser to the Queen’s Hospital. usual the night before, with the exception of a slight friend, This led him, with myself, to consider that it might be had I also learned that his much debeen spirits cough. made practically useful, and induced us conjointly to In pressed in consequence of reverses in business, &c. institute the following experiments which clearly prove the pot de chambre, which had been pushed some distance its utility :under the right side of the bed, was found a tumbler with Experiment 1. An excess of liquor potassae: was boiled a two-ounce empty stoppered bottle, the printed label specimens of diabetic urine, the one (prussic acid) floating in urine. The stopper out of the with two different a, being of sp. gr. 1.044, slightly acid, passed by a bottle. female patient of the hospital; the other 6. I received an order from the coroner to examine the b. being of sp. gr. 1.037, strongly acid, voided by a body, which I did with the assistance of my friend, Mr. male patient. Webber, about seventy hours after death. External Appearances.-The body stout and muscular. The result, in each instance, was the same, viz., the mixflocculent, then again more clear. As Bloody serum flowed from the mouth. The skin gene- ture first became commenced the fluid acquired a slight yellow rally was tinged with a violet colour, especially on the ebullition gradually became darker, eventually predepending parts of the body. The left arm (the under- tinge, which a rich claret colour ; when set aside to cool, a senting most) presented a very singular appearance,-the cutatook place, the supernatant neous veins being distended with blood of a purple colour; reddish-brown precipitation still having a rich claret colour. crimson spots and streaks were also visible on various Experiment 2 Liquor potassse in excess was now sepaparts of the body. The abdominal and thoracic viscera were in a healthy state, excepting their colour, which was rately boiled with c. Healthy urine, sp. gr. 1 .020, slightly acid. heightened by the purple and bluish state of the blood ; d. Healthy urine, sp. gr. 1.020, strongly acid. the heart empty, and very flabby. I could not detect the e. Albuminous urine, sp. gr. 1.00S, acid. odour of prussic acid in any part of the body. Mr. Webber, however, thought he could, but he was not cer- In neither case was any change of colour effected. To tain. The coronary vein of the stomach was distended the urines* c, d, and e, a small quantity of pure crystalwith air to the size of a goose-quill. This appearance I line grape-sugart was separately added, and each succesThe vein when pressed produced a sively subjected to the action of heat and liquor potassse ;; never saw before. crackling sound. * In the albuminous urine e, no coagulation occurred, Remarks.-The above case, in many respects, will be considered important. The quantity of acid taken could this being prevented by the presence of liq. potassae. not be ascertained but from the knowledge the indivit Obtained by Mr. Palmer from the urine a. was

bladder.

liquor

752 each trial

produced the same result as that recorded in paired by the general causes of that complaint, and that it had no great physical hold upon the frame. experiment 1. I should be sorry, indeed, if the relation of this case Experiment 3. Grape-sugar was successively boiled with liquor potassae and alcohol, and with distilled water should in any way deter medical men from having reand liquor potassae ; in each instance a dark sherry course to the tartar emetic in inflammatory diseases of colour was produced. (Cane-sugar, boiled under the the chest. It is decidedly the best medicine, and the same circumstances, presented but a very faint yellow only caution necessary in its use is with drinking patients whose health has become impoverished, and who are tinge.) On the application of the test here proposed to diabetic peculiarly the subjects of delirium tremens, and in whom urine, it is seen that no change of colour at first takes alone this would become a dangerous disease. I have treated thousands of patients with tartar emetic, place, glucic acid then formed being colourless ; by the continued application of heat, however, this acid is and never yet saw any serious results from it. In severe changed into the melassic, which contribntes a highly inflammations it hardly ever produces sickness until the characteristic hue to the liquid; this is not the natural inflammation subsides ; I therefore like to find this effect reddish-brown colour of melassa acid, a modification generally. I have given doses to adults under the above thereof being produced by some of the urinary consti- condition who could not at other times bear the smallest tuents. particle in a mixture without distressingly nauseating Boiled with distilled water containing l-lOùOth of its effects. I shall at a future time trouble you with some remarks weight of grape-sugar, liquor potassae yields a bright amber colour, and as the quantity of sugar is increased at length on the uses of this remedy in other cases. Manor House, Shacklewell-green, so is the depth of colour augmented in equal ratio; when the proportion of sugar in the tested solution amounts to i August 26, 1844. *** We cannot admit, with Mr. Whitaker, that tartar 1-60th, the colour produced is that of a dark-brown emetic scarcely ever produces sickness in severe inflamsherry. There appears to be no fallacy in the proposed test, and mations. We have, on the contrary, seen its administraits great simplicity (a most essential property) renders it tion nearly invariably followed by severe vomiting in capable of immediate application. None of the alkalies pneumonia, whenever it has been given in half-grain or manifest so decided an action as potash; ammonia pro- grain doses every half-hour or hour.-ED. L. duces none, probably owing to its extreme volatility. CASE OF August, 1844. ’

DELIRIUM THE RESULT

TIC DOULOUREUX AND PERSISTENT PTOSIS PRODUCED BY LIGHTNING. By R. H. ALLNATT, M.D., A.M., F.S.A.

OF THE

ADMINISTRATION OF TARTAR EMETIC IN PNEUMONIA.

By I

JAMES

S. WHITAKER, Esq., F.L.S.,

PERCEIVED a

and M.R.C.S.

notice in last week’s LANCET of the

prostrating effects of tartar emetic on young persons. It brings to my mind a case which I think highly interesting and rare. I was sent for, about a year and a half Itgo, to a Mr. Walton, of Bishopsgate-street. I found him with acute

pneumonia, and in a state of instantly bled him, and gave him a

imminent sixth part of a grain of tartar emetic every two hours. In the evening I bled him again, and increased the medicine to The next day he a fourth of a grain every three hours. was still in great pain, no sickness, and symptoms very urgent. I gain bled him, and continued the medicine. The following day I was sent for in a great hurry ; he was then in a half frantic state, with a countenance of health, yet expressive of much pleasurable excitement; tremors of the hands, picking of the bedclothes, and everything that came within his reach ; unusual activity; great volubility of speech; extraordinary craftiness; and altogether involved in the plainest symptoms of delirium tremens. At this time every appearance of the pneumonia had left him. I now altered my plan, and administered solid opium in grain doses every two hours till the next day, when he remained much the same, having had no rest. I then increased the dose to three grains, and he got several hours sleep in the night, and on the following morning awoke quite rational, with not a particle of disease of any description. After this he took little or no medicine, recovered his strength, and has been well ever since. I may remark that I never saw a case of this marked kind before. I had often seen symptoms arise resembling these, but could not explain them tillthen. The gentleman treated of was a spare man, very abstemious, and one who certainly never would have had delirium tremens as The disappearance of the pneua result of debauchery. monic symptoms was sudden and unexpected, but a new action could not go on with the old one, and I confess that seeing my patient in much jeopardy, I was glad to find a disease of a generally tractable character substituted for one which threatened soon to destroy life. The ease with which the delirium tremens was subdued, moreover indicated that the constitution was not im-

danger.

I

THE following case affords, perhaps, rather a singular instance of the awakening of a natural predisposition from a violent and sudden shock sustained by the nervous system. From the history of the patient’s previous life I had no hesitation in ascribing the whole of the symptoms there enumerated to hysteria; the hysterical condition, strongly marked, having been fully developed and called into energetic action by the stroke of lightning In what consists the peculiar to which I have referred. state of the brain, in these manifestations of hysteria, it is easy, in the present state of our knowledge, to determine ; but it is evident, I think, that an abnormal condition had, in this instance, been aroused sufficiently powerful to produce the train of effects which immediately followed the application of the exciting cause. The stomach having been acted upon by the brain involved the liver also in functional disturbance, and its vitiated secretion having been regurgitated into that viscus gave rise to preternatural excitement of the ganglionic nerves, with which it came into immediate contact, and produced the neuralgia, which was a mere secondary effect, depending upon a complex reaction. There was no evidence of disturbed function of the uterus. The close connection of all the portions of the cerebro-spinal axis, or, perhaps, in the instance before us, the isolated condition of the cerebrum itself, and the ready transference of morbid action from one part to another within its influence, will suggest a probable explanation of the simultaneous accession of the hysterical symptoms. Mrs. Nash, Little College-street, Westminster, July 12, ] 843. This patient called upon me, suffering from a severe attack of neuralgia of the superior branches of the trifacial nerve, and hemicrania. The paroxysms were periodical, during which vomiting occurred, and food taken at the previous meal returned undigested. The pain of the head extended over the right half, and on the corresponding side the eye was nearly closed by the drooping lid, which could not be raised without considerable effort. The pupil was permanently dilated, and did not regain its natural contraction on the admission of light. The other eye was unaffected. She stated that about a month previously to the present application she was visiting a friend in the country, and, being seated near an open window, during a violent thunder-storm, she was struck by a vivid flash of lightning which produced giddiness, vomiting, and a violent paroxysm of hysteria, in which state she was taken to bed,