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becomes small, and hardly perceptible; thirst unquenchable, great prostration and fainting fits, without exception. Unfortunately, there are no post-mortem reports.
4. Genus Russula.
In regard to this genus, where there is great confusion of names, there is but one detailed account furnished by Alphons Barrelet, of a case of poisoning with R.fieteas. The symptoms which occurred in the course of six days after eating the broiled fungus were, nausea, pains in the bowels, vomiturition, actual vomiting, diarrhoea, coldness of the extremities, cyanosis of the face. Pupils sometimes normal, sometimes dilated, sometimes contracted, continued shivering of the limbs (sometimes interrupted by spasmodic contraction) proceeded to general clonic spasms, with entire loss of consciousness, involuntary urination, the pulse at first small and contracted and 84 per min., rose after emetics and sinapism to 100, and then sank to 80. On the third day, consciousness returned, the patient hears well, but is quite blind ; the muscular spasms abate gradually, the anguish of death and dyspnoea disappear; hallucinations set in for three days ; then a pseudo-erysipelas on the elbow, and numerous furunculi all over the body, but especially on the scapula and the small of the back. Got well in two or three weeks.
Tbeatment Of Fungus-poisoning.
Experience teaches us that the fungi yield with great difficulty and very slowly to the digestive powers, their remains have been observed in the faeces two days after eating them, and, according to very many observations, fragments but little altered have been vomited up on the second and third and once on the sixth day! The treatment of the poisoned has therefore to strive after a discharge of the ingesta by vomiting and purging, in order to satisfy the causal-indication; and this so much the more, as a favourable result may be hoped for even in late stages. The choice of the emetic can not be a matter of indifference, and requires so much the more consideration, because in many cases (chiefly as it appears with the A. muscarius) spontaneous vomiting entirely fails, and then the artificial inducement of it is very difficult, owing to spasms of the cardia and oesophagus. In some cases thirty-six grains of Tartar emetic were administered without effect. It deserves to be mentioned on this point that not unfrequently mechanical means, such as touching the fauces with a feather moistened in oil, and pressure on the abdomen, have been attended with success. The stomach-pump has been used by Paddie in several cases with effect. Amongst antidotes, the only sure one is Atropine, whose striking effects have been noticed in detail in the former article. Also vinegar and citron-juice are Bometimes useful, as well as common salt. Gallic acid (Grarbsaure), and lod. kali, which were recommended by one party proved utterly useless.
On Sulphide of Potassium, Sulphide of Sodium, and Sulphide of
By Sydney Kingee, M.D., Professor of Therapeutics in University College, and Physician to University College Hospital.
I wish to call attention to the value of sulphides, present in many natural waters, in abscesses, boils, and scrofulous sores. The influence of the group on the suppurative process is easily made manifest. Thus when Sulphide of Potassium or Calcium is administered, a thin, watery, unhealthy discharge becomes at first more abundant, afterwards diminishing, and throughout continues thicker and healthier, possessing indeed the characters of "laudable " pus. The condition of the sore improves correspondingly, and its healing is promoted.
The sulphides appear often to arrest suppuration. Thus in inflammation threatening to end in suppuration they reduce the inflammation, and avert the formation of pus. This effect is manifested when sulphur compounds are employed locally in acne indurata; but further on I shall speak more in detail concerning their employment in this eruption. The influence of this group is still more conspicuous after the formation of pus. They then considerably hasten maturation, whilst at the same time they diminish and circumscribe the inflammation. They promote the passage of the pus to the surface and the evacuation of the abscess. Their efficacy may be frequently demonstrated in cases of the following kind. An unhealthy child, from six to twelve
VOL. XXXII, NO. CXXVIII. APRIL, 1874. Z
months old, suffers from a slight sore throat, perhaps occurring in scarlet fever or measles. The sore throat produces considerable enlargement of the glands behind the angle of the jaw. The swelling, of stony-hardness, may be sufficiently large to interfere with swallowing and to push the head on one side. Suppuration takes place, but is very deep-seated, and for a long time there is neither redness of the skin nor fluctuation, and the pus very slowly makes its way to the surface, so that a fortnight, three weeks, or even a month may elapse before the abscess bursts, or is fit to be opened, when a deep hole is left, with considerable induration around it. The pain and constitutional disturbance are so great that the child sometimes dies; and even if this termination is averted, the deep discharging hole heals very slowly owing "to the indurated and unhealthy state of the adjacent tissues. If ajtenth of a grain of Sulphide of Calcium, mixed with a grain of Sugar of Milk, is given in such a case every hour or two hours, the results are most striking. The swelling becomes smaller, the pus reaches the Burface in four or five days, and when it is evacuated leaves a benign wound which quickly heals. The effects of these remedies are equally conspicuous in mammary abscesses, although in rare instances they appear temporarily to increase the pain—a remark which seems sometimes to hold good with respect to boils. But as a rule the pain is speedily mitigated. Singular to say, I have found these remedies of much less use in forwarding the maturation and expulsion of pua in indolent buboes, but my experience of their use in buboes has been but small.
It may be urged that it is difficult to imagine how these remedies can produce effects so different and apparently opposite as the dispersion of inflammation in one case and the expulsion of puB in another; but poultices and hot fomentations certainly possess the property both of subduing inflammation and of preventing suppuration, and in other cases of hastening considerably the evacuation of pus.
In boils and carbuncles these remedies yield excellent results. A tenth of a grain of Sulphide of Calcium, given every two or three hours, generally prevents the formation of fresh boils, while it lessens the inflammation and reduces the area of the existing boils, and quickly liquefies the core, so that its separation is much more speedy, thus considerably curtailing the course of the boil. Where the skin is not yet broken, and the slow-separating core therefore not yet exposed, the sulphides often convert the boil into an abscess, so that on bursting pus is freely discharged and the wound at once heals. These remedies meanwhile improve the general health, removing that debility and malaise ordinarily so markedly associated with these eruptions. In some cases, however, as in the deep-seated boils and abscesses of diabetes, they are powerless. In carbuncles the sulphides will generally be found equally serviceable, melting, as it were, the core into healthy pus, and so quickly expelling the dead and otherwise slow-separating tissue. In abscesses and carbuncles it is useful to apply Belladonna over the inflamed part to reduce inflammation and allay pain. The skin should be thickly smeared with equal parts of Belladonna and Glycerine, and over this a poultice applied, renewing the Belladonna each time the poultice is changed. Poultices, however, being liable to bring out a fresh crop of boils, one of the following plans should be adopted : Smear Belladonna ointment some distance round but not over the boil, and then apply a poultice, the greasy application thus protecting the neighbouring tissues. Or, still better, apply a Belladonna or Opium plaster on leather, with a hole the size of the boil, around the swelling, and through the opening smear Glycerine and Belladonna, covering all with a small poultice. The leather plaster efficiently protects tne surrounding skin and averts the production of fresh boils.
I have thought it worth while to mention these useful plans of protecting the boil; but it is scarcely necessary to observe that whilst investigating the effects of sulphides I have employed them alone, or at most sometimes using only a poultice. The good effects of sulphides are conspicuous in certain scrofulous sores not uncommonly seen in children. Scrofulous children during the first few months are sometimes subject to indolent abscesses in the cellular tissue which run a very slow indolent course. At first only a small hard substance is observable, no larger than a pea, under the skin, which is of natural colour, and movable over it. The small substances next suppurate and gradually enlarge, the skin becomes adherent to them, and changes in colour to red or even violet, while sometimes in their neighbourhood the smaller vessels become enlarged and even varicose. They may grow to the size of a florin, and when maturated feel soft and boggy. After a time a small circular opening appears, not larger perhaps than a pin's head, through which escapes a thin unhealthy pus. If deep seated, as on the buttocks, or in fat children, there may be very little or no discoloration of the skin. The chief noticeable character then is the small sharply-cut opening, as if a piece had been punched out. These formations follow one another, and may continue to distress the child for months or years. In mild cases a few only may form, whilst in severe cases there may be at one time ten or a dozen in different stages of development. When they heal they leave a white, sharply defined, but not deeply depressed scar. On the administration every hour or two of a tenth or twentieth of a grain of Sulphide of Calcium the following effects occur:—New formations seldom appear, although for months or years the child may have been infested with them. Many of the abscesses, especially in a very early stage of development, dry up and disperse, others generally speedily come forward and discharge their contents, the pus being laudable, instead of thin and unhealthy. The abscesses already in an open state improve, their pus becoming healthier, and the wound healing speedily.
In some cases, in addition to these subcutaneous formations, the bones also become affected. The phalangeal bones of the hand are most frequently attacked, but not uncommonly the metacarpal, and more rarely the metatarsal. Where the phalangeal bones are affected, one or several of the fingers become nodose. For a long time the skin remains pale and freely movable, but after a time suppuration ensues, when the swelling increases, the skin becomes red and painful, and after a time slowly softens at one point, remaining boggy for a considerable time before the abscess opens naturally. Then generally a little bone separates, or in bad cases the whole of the shaft comes away, leaving the epiphyses behind. When, an opportunity occurs to examine these bones before suppuration sets in, the shaft is considerably enlarged, very pale, and the cancellous structure infiltrated with a straw-coloured firm substance, whilst the epiphyses and their cartilages are healthy. Even an affection so severe as this may be considerably benefited by sulphides. Thus before suppuration has set in, or whilst it has made little way, they often remove the swelling, though large doses may be required. After much suppuration, their good effects depend in a great measure on the amount of