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SALIVATION FROM NITRATE OF BISMUTH.
675 without something like unanimity, it would the bismuth powders, which she had by her; be impossible for us to pursue ?1 I am, Sir, on the next day her gums were tender, and she was afraid of again having a sore mouth; your obedient servant, B.
but by some laxative medicine, and,great care in her diet, the attack was warded off, and she has continued well ever since. I am, Sir, your obedient servant, T. P. W. W.T. 1840. Jan. 16, London, SALIVATION FROM NITRATE OF BISMUTH.
Uckfield, Sussex, Dec.
To the Editor
1839.
of THE LANCET.
SIR:-In THE LANCET for January 11, a is related of salivation produced by bismuth. It is not yet fully ascertained whether salivation, following the exhibition of bismuth, is merely an incidental occur-
TRIAL BLEEDINGS.—NOTE FROM MR. ANCELL.
case
To the Editor of THE LANCET.
SIR:—In reference to a note, published whether the two facts are to be in THE LANCET, of Jan. llth, I find in Dr. considered in the relation of cause and Marshall Hall’s " Researches on the Morbid effect. This question can only be decided and Curative Effects of Loss of Blood," by a careful observation of facts, and by after mentioning the fact, that the system legitimate conclusions, drawn from them. tolerates the loss of very various quantities In the mean time I beg to lay before you of blood in various diseases,Dr. Hall states, the following case, which came under my at page 179, " that the practical application own observation :-A housemaid, about 26 of this fact consists chiefly in its affording a years of age, complained, on her first apply- rule for blood-letting, in all cases in which ing for relief, of uneasiness about the region this measure is required to be fully instiof the stomach, much increased by food, tuted ; a guard against undue blood-letting, which was generally returned about an hour both in this and some other cases ; and a after eating. Throughout the day there source of diagnosis." The rule in question had been a constant rising of clear acid is, that the patient should be placed perwater into the mouth ; continual headach fectly erect in a chair or bed, and bled to the for several months, more urgent within a very first appearance of deliquium. week or two, and always greatly exaggerated At page 181, of the same work, Dr. Hall by taking beer or fruit; bowels confined; states more explicitly as follows:—" A tongue white; catamenia regular; no appe- further application of this fact flows from tite for meat, but great craving for fruit, the adoption of the rule. In doubtful cases pastry, and vegetables. She was ordered it furnishes us with a fresh means of diagblue pill with colocynth at night, with a nosis. If much blood has nowed before combination of the sulphate and carbonate syncope has occurred, we must suspect of magnesia, and tincture of rhubarb during if little, we must suspect the day ; and directed to live on the most that, however similar the symptoms, the simple diet, avoiding fruit, pastry, and case is, in fact, of a different nature,-pervegetables. Under this treatment, in a few haps irritation, perhaps exhaustion." In a conversation with which I have been days, all the symptoms disappeared, excepting the ejection of the watery fluid from the favoured by Dr. Hall, I find, that he nowhere mouth. I now ordered her seven grains of intended to recommend what I have desigthe trisnitrate of bismuth, and ten of carbo- nated as trial bleedings ; but that the above nate of magnesia, twice a day ; this she con- method of diagnosis should apply only in tinued to take for ten days, with great bene- those cases where it had been previously fit, the pyrosis almost disappearing. The determined, from the history and symptoms, next day, on calling, she told me, that the that the full detraction of blood was re"spitting" had returned, and she complained quired, and for the purpose of regulating of the gums and mouth being very sore; she the quantity of blood to be lost. was clearly salivated, and that not slightly. On my own part, I still venture to sugThe powders were immediately discontinued, gest, if a doubt remains on the mind of the the bowels freely acted upon, and a chloride practitioner, whether the qualities of a small of lime gargle ordered to be used. The quantity of blood might not be examined mouth, notwithstanding, became very sore, advantage, before proceeding to bleed and ulcerated in several parts. Whilst the in full. I am, Sir, your obedient servant, mouth was still sore, she left her place, and H. ANCELL. I lost sight of the case; but when I saw her again, the salivation had quite gone off, and 30, Albion.street, Jan. 20th. the pyrosis entirely disappeared. A few weeks after, being unwell, she took one of
rence,
or
inflam ation;
with
but by some laxative medicine, and,great care in her diet, the attack was warded off, and she has continued well ever since. I am, Sir, your obedient servant, T. P. W. W.T. 1840. Jan. 16, London, SALIVATION FROM NITRATE OF BISMUTH.
Uckfield, Sussex, Dec.
To the Editor
1839.
of THE LANCET.
SIR:-In THE LANCET for January 11, a is related of salivation produced by bismuth. It is not yet fully ascertained whether salivation, following the exhibition of bismuth, is merely an incidental occur-
TRIAL BLEEDINGS.—NOTE FROM MR. ANCELL.
case
To the Editor of THE LANCET.
SIR:—In reference to a note, published whether the two facts are to be in THE LANCET, of Jan. llth, I find in Dr. considered in the relation of cause and Marshall Hall’s " Researches on the Morbid effect. This question can only be decided and Curative Effects of Loss of Blood," by a careful observation of facts, and by after mentioning the fact, that the system legitimate conclusions, drawn from them. tolerates the loss of very various quantities In the mean time I beg to lay before you of blood in various diseases,Dr. Hall states, the following case, which came under my at page 179, " that the practical application own observation :-A housemaid, about 26 of this fact consists chiefly in its affording a years of age, complained, on her first apply- rule for blood-letting, in all cases in which ing for relief, of uneasiness about the region this measure is required to be fully instiof the stomach, much increased by food, tuted ; a guard against undue blood-letting, which was generally returned about an hour both in this and some other cases ; and a after eating. Throughout the day there source of diagnosis." The rule in question had been a constant rising of clear acid is, that the patient should be placed perwater into the mouth ; continual headach fectly erect in a chair or bed, and bled to the for several months, more urgent within a very first appearance of deliquium. week or two, and always greatly exaggerated At page 181, of the same work, Dr. Hall by taking beer or fruit; bowels confined; states more explicitly as follows:—" A tongue white; catamenia regular; no appe- further application of this fact flows from tite for meat, but great craving for fruit, the adoption of the rule. In doubtful cases pastry, and vegetables. She was ordered it furnishes us with a fresh means of diagblue pill with colocynth at night, with a nosis. If much blood has nowed before combination of the sulphate and carbonate syncope has occurred, we must suspect of magnesia, and tincture of rhubarb during if little, we must suspect the day ; and directed to live on the most that, however similar the symptoms, the simple diet, avoiding fruit, pastry, and case is, in fact, of a different nature,-pervegetables. Under this treatment, in a few haps irritation, perhaps exhaustion." In a conversation with which I have been days, all the symptoms disappeared, excepting the ejection of the watery fluid from the favoured by Dr. Hall, I find, that he nowhere mouth. I now ordered her seven grains of intended to recommend what I have desigthe trisnitrate of bismuth, and ten of carbo- nated as trial bleedings ; but that the above nate of magnesia, twice a day ; this she con- method of diagnosis should apply only in tinued to take for ten days, with great bene- those cases where it had been previously fit, the pyrosis almost disappearing. The determined, from the history and symptoms, next day, on calling, she told me, that the that the full detraction of blood was re"spitting" had returned, and she complained quired, and for the purpose of regulating of the gums and mouth being very sore; she the quantity of blood to be lost. was clearly salivated, and that not slightly. On my own part, I still venture to sugThe powders were immediately discontinued, gest, if a doubt remains on the mind of the the bowels freely acted upon, and a chloride practitioner, whether the qualities of a small of lime gargle ordered to be used. The quantity of blood might not be examined mouth, notwithstanding, became very sore, advantage, before proceeding to bleed and ulcerated in several parts. Whilst the in full. I am, Sir, your obedient servant, mouth was still sore, she left her place, and H. ANCELL. I lost sight of the case; but when I saw her again, the salivation had quite gone off, and 30, Albion.street, Jan. 20th. the pyrosis entirely disappeared. A few weeks after, being unwell, she took one of
rence,
or
inflam ation;
with