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THE HEALTH OF THE CROWN PRINCE OF GERMANY.
1249
sanitary authority to undertake this duty themselves; and it facile princeps for the vast majority of such operations. should be remembered that it is precisely the poor (who can Other than for extraction there are various operations in neither pay nor arrange for the frequent visit of a scavenger, which cocaine can be beneficially employed." and who prefer to wait until there is a good load of stuff to remove) who most need the intervention of the authority in THE HEALTH OF THE CROWN PRINCE OF such a matter. Whatever the system or want of system is GERMANY. that prevails in Peterborough, it is evidently one that ON June 8th, Dr. 3,lorell Mackenzie, in the Wednesday, favours the retention in the vicinity of dwellings of the and Dr. W. Wegner, removed of the Crown Princess presence very materials which a sanitary authority should aim at a second piece from the growth in the left vocal cord of getting rid of at the shortest practicable periods. His Imperial Highness. At a consultation held the following Friday Professor Virchow read a most fully detailed report COCAINE AND ITS USE AS A LOCAL ANÆSof his examination of the growth, which he described as a THETIC IN DENTAL SURGERY. "pachydermia verrucosa." He stated that the portion subCOCAINE having now taken a place in the Dental Pharma- mitted to him showed a great increase in the number and copoeia for various uses, it was desirable that some résu1né of size of the epithelial cells, some of which were empty, the literature of the subject, especially with reference to the whilst others contained colloid matter, also that the papillae injection of the drug for producing anaesthesia, should be were larger and more numerous than in normal mucous made, and Messrs. Cunningham and Hern are to be congra tu- membrane. Numerous bloodvessels and nerves were found lated upon the exhaustive character of their respective in the growth, but we believe no morbid products were communications to the Odontological Society. Both papers present in the submucous areolar tissue. Professor Virchow cover much the same ground, and the conclusions arrived gave a most favourable prognosis. In view of Professor at are very similar. With regard to the physiological action of Virchow’s statement there is reason to hope that the Crown cocaine, much experimental research has been performed by Prince will in time be entirely cured, though it must not von Anrep, Mays, Biggs, Hughes Bennett, and others; and be forgotten that recurrence is a characteristic feature of although the results recorded are not quite uniform, yet these papillary growths. At the urgent request of Dr. these discrepancies are readily explained by the different Mackenzie the Crown Prince has ordered a detailed report methods of investigation, and the varying degree of suscep- of Professor Virchow’s examination to be published, and Dr. tibility to the drug of the individual animal or person. Virchow has informed us that this report will appear in full Generally, it may be concluded that cocaine produces the in this week’s issue of the Berliner Klinisclw Wochenselirift. following effects :-On respiration it first increases the number of respirations, then decreases them; in larger DEATH FROM OVERCROWDING. doses death ensues from paralysis of respiration. On ALTHOUGH overcrowding is pretty general in manuthe heart it has a depressant action, reducing the force and frequency of the pulsation, finally arresting the facturing towns, we seldom hear of a death from this cause. auricles and ventricles in diastole. In small and large A case has been recently investigated by Afr. Bowbottom, doses it produces at first constriction of the blood- the coroner for Wigan. It transpired at the inquest that vessels, with a rise of blood pressure, succeeded by a the deceased, a young man of twenty-two years of age, was considerable fall. Locally applied, cocaine also produces a labourer at some ironworks in the neighbourhood, and recontraction of the small arteries. On the nervous system, tired to rest on the night of the 6th inst. in his usual health. small doses increase the reiiex irritability of the cord; large He was called early next morning to go to his work, but doses reduce it considerably. On nerves, small doses stated he would not go that day. The other occupants of the heighten the irritability of the sensory fibres, but exert no room (lodgers) went to their work, and he was left alone. At effect on the motor fibres ; larger doses completely paralyse 9.30 A.M. he complained to the landlady that his throat was sensory filaments and greatly diminish the irritability of sore, and she applied a poultice. At 12.30 noon she sent for motor. Salivary secretion is markedly deficient in many, Dr. Brady, who at once went to the man, and found the A careful atmosphere of the room in which he was overpowering. The and the temperature raised in some cases. examination of the very large number of cases of cocaine window was opened, and, after examining the man, he came injection now collected has led both Mr. George Cunning- to the conclusion that he was suffering from the effects of ham and Mr. Hern to express very much the same views, mephitic gases ; his throat was of an intense purple colour, which we quote in the latter’s words. "In judging of the the neck slightly swollen, his general appearance indicated practicability of the employment of cocaine as an anoesthe- inefficient aeration of blood, and there were spasms at times tic for extractions, one has to weigh the advantages and of laryngismus stridulus. Dr. Brady gave directions as to afterdisadvantages of its employment, and compare it with treatment and left the house. The man died those agents for the production of general anaesthesia now wards. He made an attempt to vomit, fell back in bed, in use. After doing so, I am led to the following con- and died as if choking. Dr. Brady refused a certificate and clusion-viz., that as an agent for general use in extrac- communicat6d with the coroner, desiring a second medical tions1. The physical barrier to injection which the bony man at the post-mortem. The coroner ordered a post- alveolus interposes. 2. The pain, however slight, due mortem, and asked Mr. Berry to be present with The post-mortem appearances were those to the puncture of the syringe. 3. The mental suspense Dr. Brady. due to the necessity of waiting several minutes-between of poisoning by carbonic acid gas. The trachea was the injection and operation. 4. The full consciousness intensely congested, as were also the bronchial tubes. under which the operation is performed. 5. The varying The right side of the heart was filled with very idiosyncrasy of patients with reference to the drug. 6. The dark fluid blood ; the lungs and kidneys were congested, inconstancy of production of complete anesthesia. 7. The and dark in colour. The mucous coat of the stomach was necessity of limiting the dose, so that only one part of the in appearance as if stained with port wine lees. All the mouth can be safely anaesthetised for the same patient at a organs were healthy, with the exception of this venous congiven time, and that only such as to allow of one, or at gestion. There was nothing else to account for death. It most two, teeth being removed. These all combine to was shown at the inquest that in this house, with two relegate the drug to a subordinate and secondary position, rooms above and two below (and these small rooms), leaving nitrous oxide in the possession of the field eleven persons lived-a man, his wife, five children, and
shortly
as
sanitary authority to undertake this duty themselves; and it facile princeps for the vast majority of such operations. should be remembered that it is precisely the poor (who can Other than for extraction there are various operations in neither pay nor arrange for the frequent visit of a scavenger, which cocaine can be beneficially employed." and who prefer to wait until there is a good load of stuff to remove) who most need the intervention of the authority in THE HEALTH OF THE CROWN PRINCE OF such a matter. Whatever the system or want of system is GERMANY. that prevails in Peterborough, it is evidently one that ON June 8th, Dr. 3,lorell Mackenzie, in the Wednesday, favours the retention in the vicinity of dwellings of the and Dr. W. Wegner, removed of the Crown Princess presence very materials which a sanitary authority should aim at a second piece from the growth in the left vocal cord of getting rid of at the shortest practicable periods. His Imperial Highness. At a consultation held the following Friday Professor Virchow read a most fully detailed report COCAINE AND ITS USE AS A LOCAL ANÆSof his examination of the growth, which he described as a THETIC IN DENTAL SURGERY. "pachydermia verrucosa." He stated that the portion subCOCAINE having now taken a place in the Dental Pharma- mitted to him showed a great increase in the number and copoeia for various uses, it was desirable that some résu1né of size of the epithelial cells, some of which were empty, the literature of the subject, especially with reference to the whilst others contained colloid matter, also that the papillae injection of the drug for producing anaesthesia, should be were larger and more numerous than in normal mucous made, and Messrs. Cunningham and Hern are to be congra tu- membrane. Numerous bloodvessels and nerves were found lated upon the exhaustive character of their respective in the growth, but we believe no morbid products were communications to the Odontological Society. Both papers present in the submucous areolar tissue. Professor Virchow cover much the same ground, and the conclusions arrived gave a most favourable prognosis. In view of Professor at are very similar. With regard to the physiological action of Virchow’s statement there is reason to hope that the Crown cocaine, much experimental research has been performed by Prince will in time be entirely cured, though it must not von Anrep, Mays, Biggs, Hughes Bennett, and others; and be forgotten that recurrence is a characteristic feature of although the results recorded are not quite uniform, yet these papillary growths. At the urgent request of Dr. these discrepancies are readily explained by the different Mackenzie the Crown Prince has ordered a detailed report methods of investigation, and the varying degree of suscep- of Professor Virchow’s examination to be published, and Dr. tibility to the drug of the individual animal or person. Virchow has informed us that this report will appear in full Generally, it may be concluded that cocaine produces the in this week’s issue of the Berliner Klinisclw Wochenselirift. following effects :-On respiration it first increases the number of respirations, then decreases them; in larger DEATH FROM OVERCROWDING. doses death ensues from paralysis of respiration. On ALTHOUGH overcrowding is pretty general in manuthe heart it has a depressant action, reducing the force and frequency of the pulsation, finally arresting the facturing towns, we seldom hear of a death from this cause. auricles and ventricles in diastole. In small and large A case has been recently investigated by Afr. Bowbottom, doses it produces at first constriction of the blood- the coroner for Wigan. It transpired at the inquest that vessels, with a rise of blood pressure, succeeded by a the deceased, a young man of twenty-two years of age, was considerable fall. Locally applied, cocaine also produces a labourer at some ironworks in the neighbourhood, and recontraction of the small arteries. On the nervous system, tired to rest on the night of the 6th inst. in his usual health. small doses increase the reiiex irritability of the cord; large He was called early next morning to go to his work, but doses reduce it considerably. On nerves, small doses stated he would not go that day. The other occupants of the heighten the irritability of the sensory fibres, but exert no room (lodgers) went to their work, and he was left alone. At effect on the motor fibres ; larger doses completely paralyse 9.30 A.M. he complained to the landlady that his throat was sensory filaments and greatly diminish the irritability of sore, and she applied a poultice. At 12.30 noon she sent for motor. Salivary secretion is markedly deficient in many, Dr. Brady, who at once went to the man, and found the A careful atmosphere of the room in which he was overpowering. The and the temperature raised in some cases. examination of the very large number of cases of cocaine window was opened, and, after examining the man, he came injection now collected has led both Mr. George Cunning- to the conclusion that he was suffering from the effects of ham and Mr. Hern to express very much the same views, mephitic gases ; his throat was of an intense purple colour, which we quote in the latter’s words. "In judging of the the neck slightly swollen, his general appearance indicated practicability of the employment of cocaine as an anoesthe- inefficient aeration of blood, and there were spasms at times tic for extractions, one has to weigh the advantages and of laryngismus stridulus. Dr. Brady gave directions as to afterdisadvantages of its employment, and compare it with treatment and left the house. The man died those agents for the production of general anaesthesia now wards. He made an attempt to vomit, fell back in bed, in use. After doing so, I am led to the following con- and died as if choking. Dr. Brady refused a certificate and clusion-viz., that as an agent for general use in extrac- communicat6d with the coroner, desiring a second medical tions1. The physical barrier to injection which the bony man at the post-mortem. The coroner ordered a post- alveolus interposes. 2. The pain, however slight, due mortem, and asked Mr. Berry to be present with The post-mortem appearances were those to the puncture of the syringe. 3. The mental suspense Dr. Brady. due to the necessity of waiting several minutes-between of poisoning by carbonic acid gas. The trachea was the injection and operation. 4. The full consciousness intensely congested, as were also the bronchial tubes. under which the operation is performed. 5. The varying The right side of the heart was filled with very idiosyncrasy of patients with reference to the drug. 6. The dark fluid blood ; the lungs and kidneys were congested, inconstancy of production of complete anesthesia. 7. The and dark in colour. The mucous coat of the stomach was necessity of limiting the dose, so that only one part of the in appearance as if stained with port wine lees. All the mouth can be safely anaesthetised for the same patient at a organs were healthy, with the exception of this venous congiven time, and that only such as to allow of one, or at gestion. There was nothing else to account for death. It most two, teeth being removed. These all combine to was shown at the inquest that in this house, with two relegate the drug to a subordinate and secondary position, rooms above and two below (and these small rooms), leaving nitrous oxide in the possession of the field eleven persons lived-a man, his wife, five children, and
shortly
as