TOXIC EFFECTS OF CONIUM MACULATUM.

BY F. W. LANGDON, M.D.,

Professor of Anatomy, Miami Medical College.

As the probable basis of the death-potion of Socrates, this plant well deserves to be ranked with the classic poisons. The production of dangerous symptoms by the use of its pharmaceutical preparations is, however, comparatively rare in modern times, and for that reason, if for no other, a recorded cases is of interest in connection with the study of its action on the human organism.

*

About 10 o'clock p. m., on October, 188-, I was hurridly summoned to see Mrs. who, I was informed, had been found unconscious in her room. On arriving, I found the patient to be a lady about thirty-five years of age, of medium height, well developed and nourished; fair complexion, black hair, dark brown eyes.

Decubitus dorsal; entire surface pale, cold and moist; temperature not taken. No marks of violence apparent. She was profoundly comatose, with limp extremities, eyelids closed; completely dilated, irresponsive pupils, and total abolition of reflex irritability.

Pulse 90, very soft.

Respiration 10 to 12 per minute, shallow, spasmodic, with occasional stertor. Lips cyanosed; mouth open; odor of alcohol on breath. Urine not tested-appearance normal.

She had been alone for four or five hours, and the only history obtainable that threw any light upon the case was, that she had been indulging freely in port wine for two or three days, averaging a pint to a quart per day. As this amount was not likely to be the cause of such profound symptoms, I at once suspected the presence of some other poison" in addition.

After placing a copious supply of hot-water bottles to the spine and extremities, the patient was well covered with blankets, and a faradic battery sent for. Pending its arrival an exploration, of the room revealed a four-ounce prescription vial, containing

* About twenty-five recorded cases are referred to in Index Catalogue Libr. Surg. Gen. Office 1882, iii, 340.

H. C. Wood (Mat. Med. Therap. and Tox. 1878, 346) quotes three fatal cases from use of its preparation.

a drachm, perhaps, of a reddish fluid, and inquiry at the dispensing drugstore produced the prescription as following:

The bottle had been refilled about thirty hours before my visit, and emptied with the exception of about a drachm or less. The history obtained indicated that the patient had taken nearly the whole of it (equal to about seven drachms of tincture of conium), a few hours before my arrival, and while in the mental state incident to "soberingup," after free indulgence in port wine during the day.

Under the influence of the external warmth, the color and temperature of the skin improved, some reflex irritability was manifested, (e. g., the eyelids responded to irritation of the conjunctiva), and the arterial tension increased, although the pulse was not altered materially in frequency. Cautious applications of aqua ammonia to the nostrils produced a decided increase in depth and frequency of respiration, and a low moaning sound was uttered at irregular intervals. Steady improvement being manifest,

the use of electricity was deemed unnecessary.

In half an hour after application of the hot water bottles the muscles of deglution were able to fulfill their functions sufficiently well to allow of the administration of alternate doses of strong coffee and carbonate of ammonia; and consciousness was partially restored within two hours from the time of beginning treatment. Twelve hours later the only effect of the conium noticeable was the widely dilated pupils.

The coldness of surface, absence of reflex irritability, and slowed respiration rate, answer to the third (and last) stage of conium poisoning as described by Tiryaker;* the pulse-rate, however, being inɔreased, perhaps owing to modification of the action of the poison by the previously ingested alcohol. Just how much of the effects noted were due to the alcohol and how much to the conium is perhaps a mooted question, but the history indicated the ingestion of the sedative to overcome the later effects of the alcohol, rather than its acute toxic action.-65 West Seventh Street.

*Le Progres Medical, June 14, 1879, quoted in monthly abstract, Med. Sci. Philadelphia, October, 1879, p. 436.

TREATMENT OF GASTROINTESTINAL

DISEASES OF INFANTS, BY SOME OF THE GERMAN AUTHORITIES, (Monti, Wiederhoefer, Soltmann.) [CONTINUED.]

BY OTTO W. FENNEL, M.D., Cincinnati.

ACUTE DYSPEPSIA.

As regards dyspepsia, which has its site principally in the stomach, and, in the acute form, is to be considered a pure functional disturcance, characterized by loss of appetite, belching, vomiting, colic pains, and yellow-greenish stools of acid reaction, we must say, the infant possesses a physiological disposition for it from a want of development and number of the gastric follicles, and therefore it is of especial importance that a timely, energetic dietetic and medicinal treatment is instituted. When allowed to run its course, dyspepsia leads but too frequently to intestinal catarrhs and inflammations, or to the chronic form characterized by various anatomical changes in the intestinal mucous membrane, and which constitutes about the most difficult and unthankful disease of this period of life for successful treatment.

In the treatment of acute dyspepsia, the principal factor to be considered is the etiology, whether the result of causes within the child itself, viz: due to anatomical changes of the digestive organs, anamolies of secretion (pepsine absence), etc., or as is much more frequently the case, is due to causes from without, viz: qualitative and quantitative anomalies of nutrition from improper feeding, and as regards these latter cases, we not only have to deal with children fed on farinaceous foods or cow's milk, but likewise with those who receive the breast at irregular intervals and too often, given whenever the child cries, as a sort of "quieting" remedy (as the mother terms it), or where the mother's milk is changed by the various physical and psychical causes. The examination of the milk in these cases, microscopically, for size and quantity of fat globules, and chemically, for reaction and specific gravity, can always readily be made, and well repays the busy practitioner by frequently saving him all other unnecessary work.

When the infant becomes dyspeptic, in spite of good, pure milk, it should be stopped a few days, and veal broth, sugared albumen with water, or a gelatine solution (10.0 to 1⁄2 Liter of water), given

instead, with a gradual increase of additional milk until stools are once more normal. In older infants the Biedert cream (mentioned in our last) or Liebig's malt-milk soup, seem to be the best substitutes; but as soon as possible a return to the milk diet is advisable. When the dyspepsia is the result of the numerous farinaceous foods, a good milk together with a meat broth or gruel may be tried, and if these yield no good results, and a wet nurse cannot be obtained, the Biedert cream may again often be used with great benefit.

As regards medicinal treatment, first when there is present heart-burn, sour odor from the mouth after vomiting, and the stools are acid, lumpy, and contain white, flocky detritus masses of the milk (undigested caseine), remedies are indicated to overcome this acidity when a few doses of calomel (0.01 to 0.03) does not arrest the process satisfactorily. The latter acts as an antifermentative; indigested or fermenting bodies are expelled from the intestine, and at the same time the paroxysms of colic dependent upon their presence, and irritation of the sensory intestinal nerves cease entirely. Lukewarm klysmata of chamomile, massage of abdomen, and internally an aromatic tincture with opium, are additional aids (tinct. aromatic, spirit. æther, aã gtt xx, tinct. opii gtt i-iij, aquæ 45.0: teaspoonful every 2 hours). When the colic is of a serious character, meteorismus is severe, and the sphincter contraction is marked, a careful introduction of an empty syringe into the rectum and withdrawal of the gases is a manipulation highly to be recommended, and is often followed by a surprising and immediate relief. Of the remedies to overcome the acidity, sodium bicarbonate and phosphate, magnesia oxide, and precipitated carbonate of calcium usually combined with rheum, are the principal ones in use.

When we infer, from the vomit containing non-coagulated milk, and the stools are of a foul odor, that there is a want of secretion of the acids, either muriatic (o. 3:45) or phosphoric (1.0:45) acid in barley water or some fruit syrup are old time remedies. Especially has muriatic acid maintained its reputation, aiding as it does sɔ markedly the digestion of the proteins. When the dyspepsia continues, the loss of pepsine must be made good from without; the latter is usually given in conjunction with the acid (pepsini 1.0, acidi muriat, gtt x, aquæ 90.0, glycerine 10.0; teaspoonful every three hours), or in powder form (0.05 per dose). The younger the child, the earlier the pepsine should be administered; in premature births, weak, atrophied, or anæmic infants, it

is always indicated. In these cases, as a rule, a rhachitic or scrophulous or diathesis existing, the result of farinaceous preparations or milk too rich in sugars and caseine, but poor in fats, (condensed form), we have to deal not only with the dyspepsia, but likewise with a very obstinate form of constipation. Through the soft expanded abdominal walls the faecal impactions may be readily felt in lhe transverse colon, and which, in from two to three day intervals, are pressed out as hard, brittle, clay-like masses, and are attended by severe colics and exertions. In these cases rectal injections of water, or even better, internal administration of substances that act mechanically by coating fæces with a layer of fat, thus aiding in their more rapid descent, increasing peristalsis without irritating, and at the same time possessing tonic and nutritive properties, are highly to be recommended. This is most readily accomplished either by castor or codliver oil. We give them in a mucilage emulsion with or without additional syr. of senna (Olei ricini, 30.0; olei morrhuæ, 20.0; g. arab. q. s. ut ft. emulsio c. aqua, 150.0; syr. senna, 20.0. Teaspoonful every three hours). This medication is likewise more or less of a prophylactic one for the prolapsus ani and anal fissures so often complicating the chronic constipation; when they occur salicylvaseline is of service. The intertrigo is best treated by means of frequent washings of soap and water; if necessary, solutions of tannin and alum may be employed, likewise powders, especially lycopodium, but salves should never be used.

CHRONIC DYSPEPSIA.

Just as simple as is the treatment of the acute and sub-acute dyspepsias, equally as difficult is that of the frequently relapsing and gradually verging chronic form. Here usually the dissolving and coagulating properties of the gastric juice have been destroyed, the function of the pancreatic juice on the fats suspended, and as a result the of the decomposition of the intestinal contents, catarrh, inflammation and ulceration have followed. The stools are of foul odor, and mixed with large masses of mucus, greatly resembling those of enteritis. The frequent vomiting of large quantities of mucus, entire want of appetite from the marked atony of the gastric mucous membrane, gastrectasie with its complications, meteorismus, etc., are the symptoms in these cases that try the knowledge and patience of the physician to their utmost. When the infant, having arrived at this stage, and the nutrition sadly inter