Monneret gives subnitrate of bismuth in excessive doses, five drachms to one ounce a day. Dujardin-Beaumetz says opium is the an-exosmotic substance par excellence, and that the two best preparations are diascordium and laudanum. He prescribes in his hospital practice: Bouchard highly recommends iodoform and charcoal powder. Simon, Guyot and Potain have shown that in malarial diarrhoeas, the "sulphate of quinine cures as by enchantment." Dr. Thompson's modification of the old Hope's Diarrhoea Mixture is very efficient in many cases: R. Dilute nitric acid........ M. S. Two teaspoonfuls in a little water. ziv. 3jss. 3j. Ziv. Drs. Bond and Edwards recommend in the Practitioner the tincture of cannabis indica in the treatment of summer diarrhoea. It is stated to possess advantages of not interfering with the digestive functions, but on the contrary to accelerate their return. The dose given is ten minimes in conjunction with other remedies. Naphthalin is acquiring a good reputation as an efficient remedy in the treatment of diarrhoea, when it is due to disturbance in the small intestine. Adults can take five to fifteen grain doses with glycerine and charcoal. Pichini successfully treated eight cases, with signs of fermentation, with the following: Vegetable charcoal, finely powdered....... 33%. 3xii. Dissolve the iodoform in the ether; thoroughly mix in the powdered charcoal; add the glycerine after ether has evaporated. Teaspoonful or tablespoonful every twenty-four hours in a glass of water. BY HARRIET L. HARRINGTON, M. D., BOSTON, MASSACHUSETTS. Flora W., thirteen years. At six years of age she had rheumatic fever, which left her with organic heart disease. I first met patient professionally two years ago; found her very nervous, and irritable, not at all strong, with a decided mitral murmur. About a year ago she suffered for several weeks from a severe attack of pericarditis. During this illness she could not lie down, was propped up in a chair day and night, and kept under the influence of morphine, which was the only thing that relieved her. It was thought impossible at that time for her to recover. After this she improved in health, and was doing nicely until she commenced to menstruate in October, 1886. Her flow was profuse and irregular, lasting from eight to twenty-one days, with one to three weeks intermission. There was dysmenorrhoea, with a great deal of abdominal tenderness. In December I prescribed a mixture of iron and quinia, asking the mother to let me know when the flow commenced again, which she did on January 4, 1887. I found patient flowing a little, free from pain, pulse full and strong, had vomited once, she had been having frequent epistaxis during the past two months. I gave ergot, ten drops, three times daily, to be increased if needed. On the 5th her nose bled freely for an hour, but was arrested finally by ice to nape of neck and bridge of nose. The child was deathly white and pinched-looking, eyes dark and staring. Ergot, twenty drops, with tincture digitalis, five drops, was given every three hours. January 6: Flow has increased, she has had epistaxis during the night. The ergot nauseates her, but she keeps it down. I gave suppositories of morphia sulphate, one-eighth of a grain every six hours, as she did not sleep during the night. On the morning of the 9th she had a decided chill lasting twenty minutes. Temperature, 104.3°; pulse, 120 to 140; respiration, 36 (no fever previous to this); skin hot and dry, lips and mouth parched, breath very offensive, no pain, vomited once. Dr. T. saw the child with me, in consultation. He said she had as much as she could possibly stagger under, and that recovery was doubtful. Examination of heart at this time revealed, besides the organic mitral murmur, aortic and pulmonary anæmic murmurs, due to the extreme weakness from loss of blood. R. Norwood's tincture veratrum viride. S. One drop three times daily. Symptoms to be watched carefully; also: B. Pil. quin. sulph...... S. Four daily if she can bear them. grs. ii. January 10: Temperature, 102°; pulse, 100. Had vomited eight times since my last visit (about twenty-four hours), vomit very green looking; generally does this from sympathy whenever her heart is troubling her; she has used three suppositories, during the night she slept a little; has complete anorexia. On the 11th: temperature, 98.4°; pulse, 80; nasal hæmorrhage lasting on and off for four hours during night; is still flowing but not as freely; sitting up in a chair with pillows, as she cannot lie down. Veratrum reduced to one drop daily, quinine pills to three daily. January 12: Cathartic pills given, as her bowels had not moved for four days; more simple remedies had failed. After her bowels moved freely she took more nourishment. On the following day, as the flow continued, I stopped the ergot and gave R. Acid. sulph, aromat. S. Ten drops every four hours. January 14: By advice I went back to the ergot again, giving it with tincture belladonna, as follows: R. Ext. ergot, fluid..... Tinct. bell.... S. Every four hours. 20 gtts. January 18: Had ten towels during the past thirty-six hours, is also suffering from the constitutional effects of the belladonna, throat and nose dry, pupils dilated, eyes bright, has also complained of queer feelings. The ergot and belladonna were both discontinued, and the aromatic sulphuric acid tried again, thoroughly but without benefit. On the 20th she had twelve towels in fifteen hours, and by the advice of another physician I tried the ergot for the fourth time, giving it with extract hamamelis, each one-half teaspoonful every three hours. During the next twelve hours she used ten towels. I then insisted on an examination which had been refused before. This revealed bands of adhesions to right, uterus small and slightly anteverted. As the mother objected to hot douches, thinking the child too weak, I used vaginal injections of tannate of glycerine, also introduced a pad. The following day the flow was not as profuse, but she vomited constantly, not being able to keep anything on her stomach. I then discontinued the ergot mist, as ergot in any form has seemed to increase the flow, but gave the quinine pills, three daily, also aromatic spirits of ammonia for the nausea. January 24: For two days the tannin seemed to be checking the flow, but during the past twelve or fifteen hours she has had to be changed every hour, and the nausea continues. Three to four quarts of water as hot as could be borne was then given in a vaginal douche. Tannin being added to the last quart. Egg and milk given by enema. Quinine pills stopped. January 25: Only two towels during the past twelve hours, but vomiting continues. I then ordered all nourishment to be given by enemata. Iced ginger ale by mouth to relieve the thirst, also bismuth subnitrate, fifteen grains every four hours. I repeated the hot vaginal douche. On the 26th as she seemed very weak, and the flow was less, I omitted the hot douche, but on the 27th as the flow was increasing I gave it, using a great deal of tannin with it. On the 29th she craved food again, kept down a little cold milk. January 31: Commences to take nourishment again, and retains it. Wine was ordered, flow has almost ceased, douches discontinued, as they weaken and disturb her a great deal. February 1: 6 P. M.—I was sent for in haste and found patient suffering much from mind; this was soon relieved by massage, and aromatic spirits of ammonia in hot water. She had not urinated for ten hours. February 3: Is suffering greatly from prostration, but retains food, complains of pain in back and head. February 5: Seems better, but vomits a great deal of yellowish-looking substance. R. Hydrarg. chlor. mite........... Soda bicarb........... grs. ii. grs. x. M. et div. powder number six. S. Take one every hour. February 7: Has not vomited since taking the powders, which caused a free evacuation from bowels. Flow has entirely ceased, having lasted thirty-four days. February 9: R. Ferri et quin cit....... Tr. nucis vom... Glycerine...... Aqua...... ziiss. ziss. Zi. Ziii. M. S. Teaspoonful three times daily before meals. Pulse stronger, 140; is sitting up; a little excited by my visit. February 13: Was dressed for the first time in five and a half weeks, eats ravenously, everything tastes good to her. I do not allow her to take any steps, but she seems more quiet, and satisfied if her clothes are on, is very pale, but bright. She passes a large amount of urine, but it is normal, drinks a great deal, both probably due to the impoverished condition of her blood. From this time on she improved rapidly, but did not menstruate again for four months; has gained what flesh she lost during her illness, also ten pounds besides. Examination of heart shows only mitral murmur, as before illness. In this case nothing did as much good towards checking the hæmorrhage as the hot vaginal douches. August 20: When heard from a few days since, patient had flowed regularly for three months past, although profusely. CLINICAL LECTURES. TREATMENT OF SYPHILIS. BY G. FRANK LYDSTON, M. D., CHICAGO, ILLINOIS. Lecturer on the Surgical Diseases of the Genito-Urinary Organs, and on Venereal Diseases, in the College of Physicians and Surgeons, Chicago. REPORTED FOR THE PHYSICIAN AND SURGEON BY SPECIAL STENOGRAPHER. GENTLEMEN: There is a strong tendency on the part of most teachers upon the subject of therapeutics, to speak only of the good effects which are claimed to result from the administration of various drugs, and to avoid the discussion of those evil effects which are likely to occur at the hands of the inexperienced or careless practitioner. This I believe to be wrong, |