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do not intend to enter into any lengthy was that twice in the same individual disquisition, but merely to state briefly during its use in five grain doses every a few clinical facts, occuring in my own two hours, a slight feeling of fulness in praetice, regarding the use of one of the frontal region was complained of, our newer remedies in a class of diseases with a very moderate tinuitus aurium. very prevalent during the summer Acting upon the hypothesis of its anmonths.

tiseptic action in the intestinal canal, Salol, or Salicylate of Phenol, was the range of application of Salol in bowel first introduced to the profession in 1886 complaints is very extensive, and it has as a substitute for Salicylic Acid and become almost routine practice with me the Salicylates in the treatment of acute to prescribe it in every case of diarrhea articular rheumatism. Analised, it is or dysentery to which I am called, feelfound to be composed of about forty ing certain that if not always alone per cent. of carbolic acid, and sixty per directly curative, yet it does always cent. salicylic acid; it is a white powder exert a beneficial modifying influence. crystalline, almost tasteless of a faint | The best form of administration I have but very persistent odor and nearly found to be either the pills or in emulinsoluble in water, but is soluble in sion. ether, alcohol and the fatty oils. Its The following cases taken at random tastelessness is very probably due to its from my case-book will serve to illusinsolubility in the saliva. It passes trate the good effect to be derived from nearly, or quite, unchanged through the Salol: stomach, but is broken up into its two Case 1. Was called June 4th to see component parts soon after passing into Willie S., aged 11 months—bottle fed the small intestine, acting there and child-sick two days with Cholera inthroughout the whole intestinal tract as fantum; severe pain over abdomen; a disinfectant or antiseptic. Salol in movements from bowels every hour; this respect possesses an immense ad- passages greenish and watery and with vantage over both of its constituents, an intensely acid odor; some vomiting; Solicylic acid in doses sufficient to pro- ordered lime water in the milk, one part duce its disinfectant action being to six, and only small quantity to be extremely vanseous and repugnant given every hour. Prescribed: to the taste, and often so irritat

R. Tr. pii Deod, ing to the stomach as to produce emesis;

Bismuth Subnit,

3vi and of carbolic acid we cannot intro

Mist. Cretae, duce enough to disinfect the canal on M. Sig. Aq. menth. Pip. q. s. ad. Ziv account of its intense local caustic action. Teaspoonful every two hours, also I have never seen Salol even in gener- teaspoonful liquid beef peptonoids every ous and often repeated doses, produce three hours. any unpleasant gastric symptoms, but No improvement noted for fortyon the contrary have frequently observ. eight hours, except less frequent vomited the tongue clear off, and have seen ing; then ordered ! grain Salol every nausea allayed during its adminstration. two hours, and Bismuth mixture every The only unpleasant effect noted during four to eight hours. After the second a rather extended experience with Salol | dose of Salol vomiting ceased entirely,

m. xii

stools became much less frequent and him with frequent pulse, elevated temof a decidedly more natural appearance perature, anxious facies, great pain in and odor; in eighteen hours movements abdomen, not constant- movements were controlled. Bismuith mixture dis- from bowels every half hour, with great continued, and Salol given in grain tenesmus and containing from the first doses for another day—then discharged blood and mucus-quite typical dysencured. A second attack equally severe tery. Careful inquiry failed to show in its beginning three weeks later was that anything irritating had been taken controlled in twelve hours by simply giv- into stomach; applied a mustard sinaping 1 grain doses Salol every two hours. ism to abdomen; gave by mouth Bis

Case 2. Patrick T., 10 months old; muth subnit, grs. 5, and Dover's powder bottle fed child, taken August 3d with grs. i, every two hours, and ordered thin non-inflammatory infantile diarrhæa, starch enemata, each containing gtts. 5 attended with severe pain and marked of laudanum, following each evacuation. vomiting, ordered lime water and Bis- Next morning finding that the enemata muth mixture as in case 1, to be given were immediately rejected and served every four hours; also Salol, gr. i, every to increase the tenesmus, discontinued two hours. In twelve hours vomiting them, and added grs, ii, of Lactopeptine and pain had stopped and discharges to the powders. No improvement in were controlled perfectly.

thirty-six hours, except slight diminuCase 3. Ethel P., 8 months old, tion in frequency of discharges. Then delicate bottle fed child, attacked Aug began Salol grs. ij, every two hours, ust 3d, with moderately severe cholera continuing powders as before. In two infantum, attended with the character- days the mucus and blood had entirely istic greenish stools preceeded by severe disappeared from the passages and the pain, moderate vomiting, decided de- little patient made a slow but sure pression. Directed lime water in the recovery. A peculiarity of this case was milk, and the Bismuth mixture, as in that neither plain milk, milk with lime cases 1 and 2, also gentle counter-irrita- water, or even peptogenic milk powder, tion to whole abdomen. In twenty- or cream alone or diluted with water four hours no improvement except de- could be digested, but would be either crease of vomiting, and the Bismuth vomited or passed per anum in coagumixture had been rejected every time, lated masses; the diet was confined to it was then discontinued, giving instead liquid beef peptonoids, rice thoroughly Lactopeptine, gr. iii, and Bismuth sub-boiled and eaten only moistened with a nil. grs. ii, in powder, every four hours, little water, and the expressed juice of and Salol 3-4 gr. every two hours. Im- raw beef. from which all fat particles provement began at once and next day had been carefully removed. I have the pain, vomiting and excessive bowel given this in extenso because discharges were all controlled; continu- it proves very conclusively to me the ed the Salol however three times a day very marked good effect of Salol. for two days more.

Case 5. Jacob W., 18 years of age, Case 4. Called suddenly in the night, called July 29th, profuse diarrhæa atAugust 25th, to Herbert B., aged four tended with marked pain; had continuyears, a rugged, healthy child. Founded twenty-four hours, and for which

case

21 years

home remedies had been used with no small quantity of blood and mucus and effect at all, except that pain was in attended by considerable pain and creasing and passages becoming more

tenesmus. Had taken a great number frequent. Could obtain no history of

of home prescriptions but objected any indiscretion in diet. Prescribed Pil. Salol, each grs. 5, one to be taken strenuously to “Doctor's stuff.” Saw every two hours, also Bismuth Subnit, her Sept. 20th, and prescribed Pil. grs. 10, and Dover's powder, grs. 4, Salol, each grs. iiss, two to be taken every four hours,

After fourth dose of every two to four hours, also liquid Salol the movements markedly decreas- beef peptonoids, a dessert-spoonful every ed in frequency and were entirely con

four hours to counteract weakness and trolled in twenty-four hours.

depression. The improvement was Case 6. Martin H.,

of
age,

almost immediate and in two days the bartender, temperate, taken July 31st

mucus and blood had entirely disapwith acute summer diarrhæa, not fol

peared and the evacuations had become lowing excessive eating or drinking. natural. Took a variety of remedies with no Case 9. Harry M., 10 years old--a benefit for thirty-six hours, when I saw delicate boy, subject to attacks of diarhim and ordered Pil. Salol, each grs. 5, rhæa, called "bilious” by his usual medione to be taken every two hours, also a cal attendant. Saw him August 31st, mixture containing of Bismuth Subnit, after having been sick four days; was grs. 10, Tully powder, grs. 5 and pare having from 6 to 10 thin watery movegoric, gutt, 20. Improvement in twelve ments from bowels, during the twentyhours when all medicine was omitted, four hours, attended with no pain, but with return of previous symptoms. brought on by the slightest exertion, Then

and
the Salol, grs. 5, every two
gave

a good deal prostrated. hurs, and discharged him well next Ordered Pil. Salol, each grs. iiss, one day.

pill every two hours, also Bismuth SubCase 7. Mrs. A. B. B., aged 29 years; nit, grs. 6, Dover's powder, grs. ii, Lacpregnant three months with first child; topeptine, grs. iii, every four hours. In following unusual exertion in hot sun

the following twenty-four hours only was taken with profuse watery diarrhea had three passages, and they were of a accompanied by severe pain and pos

more natural character; discontinued tration. Domestic remedies failed to powders, but continued Salol, and folrelieve and I was called in twenty-four lowing day discharged him convaleshours from commencement of attack. cent, but continued Salol three times a Directed Pil. Salol, each grs, iiss, one day, one hour after eating, to counterpill every two hours. After the third act the fermentative action going on in pill the movements and pain ceased the small intestine. entirely, and on second day was obliged Case 10. Wm. T., colored, aged 44; to order a mild laxative to open the taken suddenly with acute, profuse diarbowels.

rhea Sept. 20th, which continued until Case 8. Mrs. S. P., 81 years old; mild 3 p. m. the 21st, when I was called. Predysentery, having 8 and 12 discharges scribed 4 grs. Salol in emulsion ever from bowels per diem, each containing | two hours. Next morning discharges

was

2

of age,

had stopped entirely and he made an but had no special medical attention. uninterrupted recovery.

Early in 1887 she became pregnant, and Case 11. Allie C., years

in October was delivered at full term taken sick Sept. 2nd; profuse watery by myself. Her confinement was undischarges from bowels of a greenish complicated, and her recovery unintercolor, and very frequent, but with no rupted. She resumed her household pain. Directed Salol, gr. i, in emul- duties sooner than I thought advisable, sion every two hours, and gave no other

on account of not being able to secure medicine. Result-Complete relief in proper help. She never became quite six hours.

as robust as she had been, and comCase 12. Mrs. S., colored, aged 40 plained of constant dragging pain in the years; September 24; in second week of back and pelvis, but especially on the typhoid fever, having from 4 to 8 move

left side; the tendency to constipation ments from bowels during the day. continually increased, her general health Ordered grs. 4, of Salol in emulsion failed in spite of tonic treatment, and three times a day. After four doses her face assumed a cachetic appearance. the movements ceased entirely and a

In January I was called to see her on mild laxative was needed to open the account of a more than ordinarily obstilowels.

nate attack of constipation, the bowels Many more cases might be cited to

not having moved for seven days, substantiate these and still further prove although enemata had been employed the good effect to be derived from the every day. During the next three administration of Salol in these bowel days she took successively calomel, 20 complaints, but with the result simelar grains in divided doses, castor oil, sulthe recital would be tiresome. In Salol, phate of magnesia and sulphate of soda,

but without any effect. Then I prethen, we have a valuable addition to our list of remedies with which to com

scribed an aloin, strychnia, belladonna bat these prevalent summer diseases. and ipecac tablet every three hours; by

mistake she took one of these every In no case, however, should the dietwhich under any method of treaument

hour until twenty had been taken, at is of the utmost importance--be over

the same time using hot water enemata looked or neglected.

twice daily. No effect was produced

beyond excessive tympanites. Digital CHIRONIC INTESTINAL OBSTRUC

examination of the rectum showed it to TION-REPORT OF CASE be empty; per vaginam a sensitive inAND OPERATION.

duration was discovered posterior to, BY WILLIAM PHIPPS MUNN, M. D., ALLE

and slightly to the left of the uterus. GHENY, PA.

Dr. W. S. Foster now saw her in conPaper read before the Allegheny County Medical sultation. Placing her in Sims' posiSociety, September 18, 1888.

tion, with the hips well elevated, we inASE:-Mrs. E. A., aged thirty-one, troduced the long tube of a stomach is the mother of five children, the

pump into the rectum, until it encounteryoungest aged eleven months, the oldested some obstacle at or near the sigmoid is twelve years of age. Two years ago flexure, which was partially passed after she began to be of a constipated habit, I a little careful manipulation, and then

CASE

injected about a quart of hot water into she gained strength for several weeks, the bowel. She could feel this passing and at the end of the month she was through the descending and transverse able to be out of bed for a few days, colon, but on rising and using the cham- but the improvement was only temporber, only the water retained in the rec- ary, and the end of April found her tum was evacuated; the remainder once more bed-ridden. Two attacks of drained away slowly after several hours, localized peritonitis occurred between but only one or two small lumps of fæcal this time and the 10th of June, and each matter passed. Five times in the next time the patient rallied more slowly. three days I repeated this manuever, Her appetite began to fail, and even the adding each time an ounce of castor oil semi-daily administration of salines failto the warm water in the syringe, and ed to keep the contents of the bowels she finally had a free fluid movement,

soluble. The contants catharsis was very large in quantity. This was on also a severe drain on a naturally strong the fourteenth day, and all this time, constitution. although the abdomen was somewhat The exact nature of the obstruction distended and the pelvic pain continued could not be determined, but it was ceras before, there was no elevation of tainly at or near the sigmoid flexure. temperature or any other sign of peri- The possible conditions were from; 1st, tonitis.

simple stricture or narrowing of the Following this attack she improved | bowel; 2nd, a neoplasm, perhaps maligmuch, but it was found necessary to nant, involving the bowel at this point; keep the contents of the bowels in a fluid 3d, constriction by fibrinous bands, recondition by the daily administration of sulting from peritonitis; 4th, a tube or salines; neglect of this for twenty-four ovary, probably the left, attached to the hours was invariably followed by a re- bowel as a result of inflammatory action currence of the old

symptoms, and and forming the obstruction. necessitated a return to the long tube Palliative and expectant treatment of the stomach pump, as before. All and persistent use of electricity having this time she kept up the daily use of utterly failed, and the patient's conthe hot vaginal douche; but, notwith- dition becoming progressively worse, standing this, the induration in the pos- operative interference seemed the only terior cul de sac appeared to increase; resort, with the view of removing the the left ovary could be isolated by care-obstruction if possible; and if not reful bi-manual examination, and though movable, to then stitch the bowel to the somewhat enlarged and very tender, it abdominal wall, and establish a fæcal was very slightly movable. The right fistula. ovary seemed to be normal in size, loca- Accordingly, on July 13th, assisted tion and mobility, but was abnormally by Dr. W. S. Foster, I opened the absensitive. Her pelvic pain radiated domen by a linear central incision five from the ovaries, and was constantly in- inches in length. The whole length of creasing in severity. Early in March the bowel, except the transverse colon, an attack of peritonitis threatened, but which was inaccessible, was carefully was averted by the free and persistent examined for constricting bands, but use of saline cathartics. Following this none were found; no stricture could be

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