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To revert: The patient when first seen was Micturation being frequent, painful and diffisuffering with intense lancinating pains radia cult, I made use of the catheter, removing a ting over the entire abdomen; cold extremi- large quantity of highly colored urine. The ties; entire surface covered with colliquative bladder remained paretic for several days, callsweat; upon palpation tenderness became so ing for frequent relief by means of the cathegreat that the slightest touch provoked a pleater. On the fifth day I concluded to move the from the patient to desist; abdomen greatly bowels, which was effected by a dose of castordistended, yielding a tympanitic percussion oil, one action ensuing, accompanied by pronote; nausea and vomiting present, but not lapsus ani, which was easily reduced, but very marked; bowels moved directly after my arri- painful and annoying. After the fifth day val, in consequence of a large dose of castor convalescence became evident, she gradually oil that had been previously given to overcome gaining strength and a desire for food, which the torpidity which for some time had been was restricted to milk and animal broths. present; pulse quick, intermittent and almost
J. SAMUEL PRICE, M. D. imperceptible. I at once administered mor- West Point, Texas. phia sulph. gr. 74, and ordered warm poultices applied to the abdomen with a view to moder
Guarana in the Treatment of Headaches. ating the inflammatory action that I considered
Editor MEDICAL WORLD: had become aroused in the peritoneum from an extension of that process from the uterus by
Origin.- Paullinia sorbilis is a climbing contiguity of surfaces, through the intervention shrub with pinnate leaves, small flowers and of the Fallopian tubes.
pyriform, beaked capsules, containing one to
three slimy, blackish brown, subglobular seeds. After having quieted the patient, I ordered a
It is indigenous' to Northwestern Brazil. Part stimulant in the form of cognac brandy, which
used. The seeds. Constituents.
Guarana was freely given at regular intervals throughout contains an alkaloid, guaranine-identical with the course. In two hours reaction came on with slight febrile symptoms. Visited the pa- of coffee, tea and cocoa)-starch, gum, and a
caffeina, theina and theobromina (the alkaloids tient in six hours, and could discern no favor. peculiar form of tannic acid, called paullinioable change. She persisted in lying on her
tannic. right side, with thighs flexed, insisting that it was impossible to turn in ; that it induced recognized as a cerebral excitant, similar to
Physiological Action. The alkaloid has been alarming syncope with every effort to change those of coffee, tea and cocoa, in which it position.
probably occupies the first place. The acid Advised an ounce of sweet milk given in paullinio-tannic appears to have the usual asconjunction with the brandy. The poultices tringent properties of tannic acid, combined no longer being grateful I suspended their use,
with a peculiar anesthetic action on the termisupplementing with turpentine stupes. Incor- nal filaments of the sympathetic in the stomach porated three grains quinia sulph. with the and small intestines. morphia sulph., in capsules, giving one every Medicinal Uses.-Guarana has been exten. three hours. Anticipating the shedding of the sively used in France, in the treatment of diarepithelium in the inflammatory area, thus rhea and dysentery, and they have certainly leaving a pyogenic membrane, I directed the proved its efficacy in these maladies, given in former drug not only as an antipyretic and from 15 to 30 grains per diem, in divided tonic, but also with a view to prohibit, or at doses. least partially suspend the migration of the Paullinia sorbilis has of late come into great white corpuscles. The latter drug rendered repute as a remedy for headache. In this counservice in relieving pain, quieting peristaltic try it has been used almost exclusively in headmovement of bowels and conducing a general aches of a purely nervous origin; but in France quiescent state, so much to be desired in bring- and North Italy it has been used and gained ing about resolution.
great popularity in the treatment of that by far The patient seemed to be doing nicely up the larger class of headaches: those due to a to the third day, being able to turn in bed and sympathetic origin with the digestive tract. having manifested a desire for the nourishment Last year I had occasion to treat a case due given, when fever rose to 104°, which was to this sympathetic origin, giving a A. oz. ss combatted and subdued by the use of large dose of the fluid extract, which procured aldoses of quinine, alternating with ten grains most immediate relief. of antipyrine, of which three doses were given. Then I became convinced that the effect To remove the accumulated fecal matter I used gained was not all attributable to the alkaloid, an enema of equal parts of glycerine and water. guaranine; but in part undoubtedly due to the
peculiar anesthetic (local) action of the paul- American practitioners, in the use of paullinia linio-tannic acid on terminal filaments of the sorbillis have been owing (a) to the poor qualsympathetic in the alimentary canal, for these ity of the drug, ard (6) in the too small dose. reasons:
II. That paullinia sorbilis contains that happy (1) That the effects were gained only by a combination of a cerebral excitant with the pesufficient dose to coat the lining of the stomach culiar stomachal anesthetic agent, making it at over, and were gained before the alkaloid could once a remedy for the large class of headaches : have had that effect on the brain.
those not due to organic changes. (2) That, when this was the case, the mem III. That, having removed the exciting brane being coated over by the drug, there was causes, the combination of paullinia sorbilis, no susceptibility to attacks by the ingestion of rhamnus purshiana and nux vomica is cerundigestible articles, which had always been a tainly the best to remove that neurasthenic consure forerunner of an attack.
dition of the alimentary canal which is the Now, acting on these principles, I abstracted predisposing or remote cause of headaches. all the alkaloid from a given specimen of the
CHAS. H. SPRINGER, M.D. fluid extract, and carefully preserved the resi Dundee, Ohio. due, consisting of paullinio-tannic acid, starch
[The preparations reported above were those
of Parke, Davis & Co-Ed.] Case 1.-On Aug. 13
I called to see Mrs. R., aged 42, suffering from a severe headache;
Ergot in Obstetrics. been subject to like attacks, at longer or shorter intervals, for a number of years. Also has
Editor MEDICAL WORLD: pyrosis at the time of or preceding the attacks.
My own experience in the use of ergot in Administered A. dr. iij of the residue as above
labor is suggested to my mind as proper for every half hour.
publication. I have been in constant practice Aug. 14. 'Headache passed away with second
of medicine and surgery for forty years; have dose. Gave pills :
taken a special course in obstetrics and obstetB Ext. casc. sag.,
rical operations under Prof. Joseph Kucher, of Guarana..
..Kā gr. ij
Vienna, Austria, and in Bellevue, N. Y., Ext. nucis vom.
gynecology, so have had some theory as well as Fiat pillulamj. Sig.-One pill night and morning for
experience. I wish to say that for forty years five weeks.
I have used ergot constantly under the followApril 1, 1883. Has had no recurrence of the ing circumstances and in the following manner. attacks yet.
1. Whenever the parts are ready for labor, Case II.-Oct. 3. I was called to see Mrs. the os dilated, head presented, and there is lack B., aged 37, suffering from a severe headache; of energy. has had attacks of same for years; has gastral 2. Sometimes when the parts are not ready, gia and obstinate constipation, and is of seden but there is headache and “false pains," as tary habits.
Gave fl. dr. iij of the residue women are wont to term them, I give a little every half-hour.
ergot to “settle things," and see what is to be Oct 4. Headache passed away with fifth dose. done. Sometimes this course results in making Gave pills:
more pains, sometimes in making less. In the R Ext. rham. pursh..
former case, if labor sets in really, I increase Ext. paul. sorb..
the ergot, and get through with the case. Ext. nuc. vom ...
3. When by previous history I suspect postFiat pill j. Sig.-One night and morning for six
partum hemorrhage, I give a drachm of the weeks.
fluid extract of ergot just before the delivery of April 20. Has had no recurrence of attacks the placenta. yet.
My rule for giving it is to put two or three These and some others might be adduced, drachms into a half teacup of water, and give a showing the efficacy of the drug in headaches teaspoonful every 15 minutes, and increase if of both nervous and sympathetic origin. But, necessary to increase the force of labor. admitting its efficacy, owing to its alkaloid, in During this period of forty years I have not nervous headaches, I think it may safely claim had but three cases of hour-glass contractions, a place, and perhaps the highest, in the treat and two of those cases were attended by a midment of the major class : the sympathetic head. wise, and not seen by me for a number of aches.
hours after confinement, when ether or chloroAnd the conclusions I have been impartially form was given, the hand inserted, and plaled to are these :
centa removed without trouble. The other 1. That the want of success, on the part of case had taken ergot, but got along well by
gr. iij .gr. ij ..gr. ss
using ether and removing by the hand. The Two Cases Practical Gonorrhea and Erysipelas. number of cases lost in this time is so smali
Editor MediCAL WORLD : that I will not report them for fear of seeming
My experience has been that it is not the to boast. At least suffice to say that I shall continue to practice hereafter as heretofore in large surgical or gynecological cases that are the use of ergot. E. H. KEABLES, M.D.
the dreams of under-graduates, so much as the
little cases that one meets in practice that give Alma, Col.
one trouble. I remember how a chum of mine Burning Feet.
in the dissecting room worked for several days Editor Medical WORLE:
over a subject to determine just where to cut, In the November number of The WORLD,
in case he should have a patient with abscess of
the liver. I hope he has had many opportunipage 429, C. C. C., Barksdale, Va., asks for
ties of making his longed-for cut, but I rather treatment for burning feet. As he gives no
think he has had many more occasions to open history or symptoms we can only guess at what ails his patient. We therefore guess that his
up an abscess and then not have it get well in
time to suit the patient. I do not think there patient has hypertrophy of the heart, and in
is any disease a young doctor feels better qualiconsequence has too much circulation in the
fied to treat when he first unfurls his profesextremities, or it may be a neurosis. I would
sional banner to the air than gonorrhea. Of suggest that he try belladonna or aconite (tincfure), in one-drop doses to quiet the heart (if course after he has been beaten out of his fee
a few times, and fails to cure a few cases hypertrophy exists) also one-half dr. flext ergot wherein whiskey and sexual excesses have joined three times daily to contract the vessels.
hands against him, his zeal relaxes some; but hypertrophy do not exist give nerve sedatives.
it takes a good many experiences to satisfy him Had C. C. C. written his name in full I should
that gonorrhea is not so very easily cured at all have answered him by letter, but as he did not
times. In time he learns that there are few I am obliged to answer through the best medical
diseases more disagreeable to treat. Those journal in the world.
who have the disease, as a rule, deserve to Franklin Grove, III. W. C. SMITH, M. D.
have it, and the same recklessness that led them
to where it was for distribution prompts them Uterine Inertia.
to hold all professional counsel at arm's Editor MEDICAL WORLD:
length. Noticing Dr. W. V. M. Taylor's report of A case came under my notice lately that was 1000 cases of confinement, I do not find one to me unique. The young man, not knowing similar to a recent case I had of entire atony the nature of the disease, gave nature a chance of the uterus.
to effect a cure, and by the time he placed There were no pains or contractions, neither himself under my care he had all the gonorcould they be excited. The child actually rhea one man could well attend to. The forestruggled itself to the vulva, and was extruded skin was long and contracted, so much so that by pressure of the abdominal muscles. The when I saw him he could not retract it at all. placenta, on account of absence of uterine con- The entire organ was swollen to almost the full tractions, was firmly held, and the fear of a size in state of erection, while the scrotum was hemorrhage, induced me to leave it till the also swollen. Injections were out of the questhird day, when finding it at the vulva, it was tion, and, on account of the swollen condition also delivered by the abdominal muscles. There of the penis, he suffered constantly from chordee. was no hemorrhage.
At night he suffered intensely. To add to the The patient has made a good recovery. patient's distress, he had a constant fear that Complete inertia of the uterus is not common,
his folks would find out what was the matter as I have noticed but one case in the journals with him, and so he could not use hot water during many years.
baths as he should. By a free use of cathartics, New York. SAMUEL SWAN, M.D. rest in the recumbent position, and liberal im
bibition of alkaline diuretics, the patient reThe specific gravity of healthy blood is covered; but, while it lasted, it was quite interabout 1055, but in very robust individuals it esting to me and very much so to the patient. may reach 1059. In pregnant women,
it I have lately had an opportunity to test Dr. naturally falls, sometimes as low as 1045. Waugh's cure for erysipelas in a very young
patient. Jimmy B., aged eleven months, while Injury or irritation of the cervical spinal cord playing on the floor with several other children, causes contraction of the pupils, through the was stepped on by one of the children and the sympathetic nerve.
calf of the leg was badly bruised. The leg began to swell, and at the end of twenty-four many of my fever patients, more especially hours the entire leg, from ankle to knee, was those threatened with congestion of some organ swollen and tender, and erysipelas starting at or part of their body, and I do not now rememthe seat of injury. I was called thirty hours ber that I ever had reasons to regret it. I bled after erysipelas was first noticed. The little older and younger people, and even children sufferer was put on fluid extract of jaborandi in less than one year old, when suffering from two-drop doses every two hours. This dose pneumonia, rheumatism or inflammation of the was increased to six drops every hour before brain, and always with benefit to my patients, the effects of the drug were shown by flow of although I now seldom resort to bleeding as a saliva and slight diarrhea. The dose was then therapeutical measure in those affections. diminished, and so given that the full effects of
As progressive professional men it becomes the drug were shown every day. In seven days
our duty to think, study, observe, hear, yield all signs of erysipelas had disappeared, and the to convictions, even should they not be agreechild's appetite and playfulness had returned.
able to our prejudices, and report results honBefore the disease was cured it had extended to estly. When we take up a new medicine we the body. I regard the drug as a specific, or
are apt to lay aside our former "old reliable," as nearly so as any drug can merit that title in
and although previously always a good, faithful this disease. I can imagine no other treatment and trustworthy friend, he is forgotten, and we that would have promised any hope in a child associate with the young and less reliable, simso young and following a wound.
ply because we are fond of a change. J. A. De ARMOND, M. D. Le Claire, Iowa.
The late Professor Charles D. Meigs, of Philadelphia, recommended early and free
venesection as the only safe and proper remedy Venesection as a Therapeutical Agent.
in puerpural fever and puerpural convulsions. Editor Medical WORLD:
My experience has been equally satisfactory, Venesection as a therapeutical agent is not although not so extensive. No less than one of modern introduction. It was considered eighteen and as many as twenty-four ounces the sheet anchor to subdue inflammatory or should be taken from a full-blooded or highly fever action before aconite, veratrium viride, sanguinous woman. It was an old custom to gelsemimum, quinine, bromide of potassium, bleed women during or about their eighth chloral hydrate, ether or the hypodermic month of pregnancy. syringe were introduced as reliable febrifuges This procedure is often times very necessary and antispasmodics. These remedies have now and would avoid many unpleasant after conseattained a foothold in the profession so firm quences to the lying.in women. Plethoric that they cannot be displaced, yet I am not females suffering from varicose veins, flashes of prepared to discard venesection altogether, for fever, giddiness, or pain in legs, if they consult reasons which I am going to state.
me, I generally bleed them once, twice or thrice The objections to venesection by the non- during one terın of gestation and always with bleeding portion of the medical fraternity are: the best results following. The good blood flows away and the bad re- You may ask—what do you mean by the best mains in the system; it robs the patient of a results following? I mean that it relieves the certain amount of vital fluid, of which Solomon pain, removes the tension from the over-charged the Wise says, “the blood thereof is the life veins which have become varicosed by neglected thereof." It is painful and frightful. It pro over-distension, procures sleep, facilitates labor, duces a wound which may be followed by in- and the patient has an early and good “getting flammation, erysipelas, phlebitis, blood-poison-up.” Some one may say—stupid and cruel ing, nerve-injury, artero-venus aneurism, either doctor. " That mother should not be robbed of which may be followed by serious conse- of her blood which she so much needs for the quences or death. Each opponent to venesec- support of the fruit of her womb." This reasontion will advance his own arguments and en- ing would seem logical, but logic is at times at deavor to maintain his point, however weak or variance with facts. well that point may be taken.
Some years ago a pale-looking elderly gentleBefore upholding venesection more fully, I man asked me to bleed him. I said-Peter, you may remind the reader that aconite, veratrium, have no blood to spare. You should have gelseminum, ether, morphia, chloral and anti- medicine to make more blood for you, and I febrin are all potent and dangerous drugs, and gave him some with “no good." He asked require even greater knowledge and care in me again and again, and I always repeated my their administration than does the lancet. logic-Peter, you have no blood to spare: The
In the earlier years of my practice I bled I fourth time he replied"I don't care whethet
I have blood to spare or not, I want to be bled, His left upper eyelid paralyzed, no fever, and and if you will not bleed me I will get some no pain. Sensation of the left arm and leg enother doctor who will." I knew that his words tirely gone, pulse normal. I did not bleed him meant, get another family physician, and to on my first visit because I thought it was not save myself I saidall right, I'll bleed you, and I indicated. I am now sorry that I did not. did. One month after the bleeding I saw him, Next morning he had considerable fever, full, and was surprised at his improvement. He re
He re- bounding pulse, slight delirium, and pain in his ported, much increased in weight and strength, head. The left eye much congested. I dow and his health, sleep and appetite much im bled him freely, and the appearance of the proved. At his request, and without using my blood revealed the fact that the man was serilogic I bled him again, and he enjoyed good ously ill. On my first visit he said he had not health for four years more, after which he be- selt badly previous to his present trouble. came consumptive and died at sixty-nine years. After venesection, I told him that he had not Two of his grown up children had died pre. been enjoying good health for some time. His viously of the same disease.
wife replied that he had been complaining at I treated an old lady, aged sixty-five years, for least one week previous to the hemiplegia. pain and heat in the the top of her head, roar- My first conclusion was that the man had his ing noise in her ears, sleeplessness, giddiness, head down too long, and the pressure of blood loss of appetite, at times double vision, full pulse, caused a meningeal artery or vein to rupture, mental depression, absent mindedness and often producing a small meningeal hemorrhage. not able to do her little house work. A six Bromide and iodide of potassium and morphia months' course of medicine did her no good, controlled the pain, veratrum viride the pulse, and I proposed to quit medicine and resort to and calomel and comp. ext. colocynth the venesection every four to six weeks until better bowels. Sensation has returned, he is able to or worse. To this she consented and the im. walk with the aid of a cane, but his arm is provement was well-marked from the beginning. useless. A full bleeding on my first visit She has neither been bled nor taken medicine might have avoided some of the after consefor several years and is enjoying good health. quences.
An octogenarian lady during her eighty-first, The direct beneficial effects of venesection second, third, and fourth years, was bled when may be summed up as follows. As a febrifuge ever she suffered from giddiness, tremors, and it diminishes the volume of the blood current, a tight phthisicy cough, and was always re- thereby relieving the heart and lung action as lieved by one or two operations.
well as the tension on the involved blood vesMany of my apoplectic patients I bleed on sels, cuts short fever and inflammation and my first visit, and have not regretted it. In the greatly assists each threatened organ to resume abstraction of blood the physician has the the even tenor of its way. advantage of an ocular inspection of the life In some people, from some cause or another, fuid. This is a matter of paramount import- a slow and imperfect action of the heart and ance. In some cases the blood is thin and lungs causes the blood to become super-charged almost a bright red; in others it is dark and with carbon and other effete material, the thick, almost as black as tar; in some we no- greater portion of which is found in the ven. tice the buffy coat, and in other instances the ous circulation. The question-how much blood surface of the blood in a very short time is has the patient in his system? is not so imporcovered with a thick, coagulated, yellowish, or tant as—how much poor blood has he? If he pale-green jelly-like serum, and very little red has too much poor blood, open a vein and let fibrinated fluid remaining. The inspection of some out, then direct your attention to the sethese different conditions of the blood, the creting and excreting organs, and aid them with same as an ocular inspection of the urine and proper remedies.
proper remedies. If all diseases are produced feces of patients reveal to the anxious and ob- by an impure condition of the blood and the serving physician what, under other circum- main channels carrying this impurity are found stances, he could not know.
to be the veins, then we must tap one of these About ten weeks ago I was called to see a channels to relieve the system of its impurity. young man aged 29 years, married, and a Gaping, yawning and sighing are forced infarmer by occupation. He had been in his spirations and expirations of air. We must barn, and had stooped with his head down in have fresh air, and if we are too sleepy, or too a grain bin to gather feed for his chickens. lazy to breathe properly nature forces us to Upon rising up he felt giddy and fell over on open our mouths wide, and take a long and the floor completely paralyzed on the left side, deep inspiration and expiration so that we may although perfectly conscious. His speech and not die from asphyxia. the muscles of his face and tongue not affected. Venesection, like every other potent remedy,