M. Sig. Tablespoonful from one to four a tumbler of tepid water. hours, to relieve pain.

THE

Medical Bulletin.

JOHN V. SHOEMAKER, A.M., M.D., Editor.
THE F. A. DAVIS CO., Publishers.
8. C. BERGER, Business Manager.

Philadelphia, April, 1895.

BELLADONNA IN THe diseasES
OF CHILDdren.

THE

HE management of disease in youthful patients usually devolves upon the general practitioner, and the graduate of yesterday is liable at any time to find himself confronted with the most serious problems. The rapid onset and the sudden fluctuations of disease in children compel the most alert attention on the part of the physician. Not only must we study the physiology of youth and the modified symptomatology of its diseases, but we must also acquaint ourselves with the special susceptibility of childhood in regard to powerful drugs. To a certain extent, therefore, the field of therapeutics presents important varia

tions in reference to children and adults.

could only be learned by experience that, comparatively speaking, it is better borne by children than by adults, and cases of fatal intoxication are exceptional in the former class of patients. The drug, fortunately, does not accumulate rapidly in the organism and is speedily eliminated in the urine.

A case was reported by Dr. Monteverdi in the Archivio Italiano di Pediatria of 1893, the patient being a child, 3 years of age, who had swallowed a collyrium containing about grain each of sulphate of atropine and hydrochlorate of cocaine. There were vertigo, excitement, delirium, dilated pupils, small and frequent pulse, cold extremities, and stertorous respiration. Notwithstanding this formidable array of symptoms and the fact that the child was not seen until four hours after the acci

dent, the patient recovered under the use of morphine hypodermatically, together with stimulating clysters and frictions. At the end of two hours the child began to recover from its intoxication.

In addition to the extract and tincture em

ployed in this country the French make use of a syrup of belladonna, which contains 75 centigrammes (about 12 minims) of the tincture to 10 grammes (21⁄2 drachms) of syrup, and is, therefore, by no means an inactive preparation. Some, as M. Cadet de Gassicourt, prefer in practice to dilute the syrup of belladonna by mixing it in proportion of 1 part to 3 parts of syrup of Tolu, making thereby a more manageable preparation which may be safely given in teaspoonful doses.

Belladonna is frequently of use in the diseases of children. It is particularly valuable in disorders of the respiratory apparatus, ac

Apart from heredity, the tissues of children are unaccustomed to morbid influences; neither have they by habit become habituated to the action of neurotic drugs. Thus in many instances reaction to medicaments is notably prompt and energetic, and posology requires a special study in connection with juvenile patients. We have taken pleasure, in previous issues, in referring to the pointed and practical studies of Dr. J. Comby in the therapeutics of childhood, and take occasion to follow him to-companied by excessive secretion or by spasday in his exposition of the applications of belladonna.* This is an exceedingly useful drug in various diseased conditions, but, like every active remedy, it is powerful for evil no less than for good. Its virtues and limitation, therefore, should alike receive careful study. It should be administered in accordance with the indications of the disease and the age of the patient. The physiological effects of belladonna are decided, and yet it is a fact which

* La Médecine Moderne, January 5, 1895.

modic action, from coryza with repeated sneezing to spasmodic bronchitis and whooping cough. In coryza with abundant discharge and difficulty of respiration on account of obstruction of the nasal fossæ it is advantageous to promote dryness of the pituitary membrane by the administration of belladonna. Simple laryngitis due to cold, laryngismus stridulus, essential or symptomatic spasm of the glottis are also favorably influenced by this remedy. In a great many cases it produces manifest

relief, acting both upon the laryngeal secre- and tetanus. These disorders, formerly treated tions and the nervous element which causes by massive doses of belladonna, have rarely the spasm. Tracheo-bronchitis and spasmodic been cured or ameliorated by this drug. It bronchitis, whether dependent or not upon la has been advocated as prophylactic against grippe, are equally ameliorated by the employ-scarlatina, but the experience of Barthez, Saintement of belladonna. As much may be said in its favor regarding its use in constitutional or symptomatic asthma, the asthma-like attacks of tracheo-bronchial adenopathy, of emphysema, and in paroxysms of dyspnoea. Although so beneficial in spasmodic affections of the upper respiratory passages, our author deprecates its use in pulmonary maladies accompanied by prostration and tendency to collapse, as pneumonia, broncho-pneumonia, etc.

Eugénie, and Balfour, not to mention numerous other observers, has failed to confirm this claim. Belladonna may often be advantageously employed externally and internally for the purpose of controlling itching in the diseases of the skin. In the night-sweats of tuberculosis it exerts a favorable influence. This remedy, to conclude, though powerful and efficacious in cases to which it is suited, should not be thoughtlessly prescribed. Its most successful action is found in flux from the pituitary or bronchial membrane, in salivary hypersecretion, in whooping cough, asthma, laryngitis, tracheo-bronchitis, etc. In other disorders, though it may render service, it is a less reliable remedy.

It is, above all, in whooping-cough that this remedy has been employed the most frequently and extensively in the form of tincture, syrup, or even sulphate of atropine. The sedative and antispasmodic properties of belladonna particularly distinguish it as suitable for use in a disease in which the spasmodic element overshadows all other manifestations. It is, there- A NEW METHOD OF DIAGNOSIS fore, universally employed in the spasmodic stage of pertussis. In order to obtain its beneficial effects it should be pushed until it begins

OF CANCERS OF INTERNAL
ORGANS.

HE therapeutics of advanced cancer is, it

to produce its constitutional manifestations. Tust be confessed, not an encouraging

Smaller doses do not succeed in allaying the spasmodic cough.

Apart from maladies of the respiratory ap paratus, belladonna has been employed as a sedative in painful conditions of the intestine, in stubborn constipation, and fissure of the anus. In constipation it is often associated with purgatives, as aloes, podophyllin, or scammony. In painful affections of the bowel belladonna is often superior to opium, and has the advantage over the latter of not causing constipation. It has also been employed in the dysmenorrhoea of young girls. Since the time of Trousseau belladonna has been much used in nocturnal incontinence of urine, probably acting in such cases by suppressing reflex action, anesthetizing the vesical mucous mem brane, and contracting the fibres of the sphincter. It must be admitted, however, that these explanations of its action are hypothetical and that the remedy often fails. The influence of belladonna is very uncertain also in epilepsy, the convulsive diseases of childhood, chorea,

THE

subject, especially when the disease is situated Nevertheless, the study of the natural history in internal organs and inaccessible to the knife.

of this terrible disease is of the utmost im

portance. Every manifestation, subjective or objective, which may facilitate the diagnosis,

is sure of a welcome from clinicians. The more complete our knowledge of the disorder, the greater is the hope that we may ultimately find the means of arresting its evolution. We have, therefore, read with much interest, a contribution by Professors V. Babés and G. Stoicesco, of the Medical Faculty of Bucharest, published in a recent number of a valued French exchange.* The authors begin their paper by remarking that Leube and Virchow had pointed out the generalization of gastric carcinoma by its extension to ganglia and especially to the subclavicular ganglia. Hen

*Sur le diagnostic du cancer des organes internes par l'examen

microscopique des petites tumeurs metastatiques sous-cutanees, Par V. Babés et G. Stoicesco, professeurs a la Faculte de Médecine de Bucarest. Le Progrès Médical, February 23, 1985.

that the vomiting commenced, he perceived
the development of small, scattered nodules
under the skin. When admitted to the hos-
pital he was notably pallid and extremely
emaciated. In the deeper layers of the skin
and beneath the integument were small, hard,
and mobile tumefactions varying in size from a
millet seed to a pea. They were discrete and
scattered over all the surface of the body. The
axillary and inguinal glands were somewhat
enlarged, but isolated and movable.
the cutaneous tumors was excised and ex-

noch and Friedreich, as well as Troisier, have since given similar descriptions. Jaccoud has also insisted, in his clinical lectures, upon the importance of cervical adenopathy in the diagnosis of cancer of the stomach. Analogous glandular metastases may accompany cancer of any of the abdominal organs, but, in more than half the cases, this involvement points to malignant disease of the stomach. Cancer of the uterus, moreover, causes enlargement of the inguinal glands and finally of those in other situations, particularly in the lower part of the body. The writers then come to the disamined at the Institute of Pathology and Bactinctive feature of their paper, and premise they have been able to find in medical litera ture but a few scattered allusions to generalized metastatic tumors of the skin. C. Wedl, indeed, describes a uterine carcinoma in which multiple cutaneous metastases were discovered at the autopsy. Professors Babés and Stoicesco base their communications upon three cases in which generalization of cancer in the skin and subcutaneous tissue was observed during life, and which they made use of as a valuable means of determining the presence of the malady in internal organs. The first case was a cancer of the stomach, the situation of which rendered the diagnosis very difficult. By a microscopical examination of a subcutaneous nodule their attention was directed to the existence of a gastric carcinoma. In a second case the same disease affected the womb. During life the diagnosis was not altogether clear as regards the nature of the uterine neoplasm, although the existence of a subcutaneous growth was looked upon as having a direct relation to the subject. From the third case it would seem that the title of their paper might be more comprehensive, for here the diagnosis of an internal sarcoma was established by the same process.

The first patient was a man 45 years of age. Six or seven months before coming under ob servation he had lost appetite, had begun to experience vague abdominal pains, and had ever since been losing flesh. About four months later he began to suffer, from time to time, from vomiting directly after the ingestion of either solid or liquid food. There had been no hæmorrhages. At nearly the same time

teriology. The lungs and heart were normal. Palpation of the epigastrium conveyed the impression of a diffuse and deep swelling, but not well marked nor constituting a tumor. The percussion sound seemed somewhat obscure and the stomach was slightly dilated. The epigastric and hypochondriac regions were sensitive to palpation and percussion. During the patient's sojourn in the hospital there was neither vomiting nor melæna. Death occurred five days after admission. From the microscopical examination the authors had been able to determine the carcinomatous nature of the subcutaneous tumors and even to establish their metastatic character, having as their point of departure a primary glandular and tubular carcinoma. On account of the gastro intestinal difficulties, the profound emaciation, and, above all, the result of examination of the sub. cutaneous growths, the authors did not hesitate, during life, to diagnosticate cancer of the stomach. At the autopsy the whole wall of the cardiac extremity of the stomach, espe cially at its posterior portion, was thickened, infiltrated by tissue of new formation, white and reticulated. The infiltration encroached upon the lower end of the oesophagus. It in. sinuated itself between the muscular fibres of the stomach and could be seen beneath the peritoneal surface as white, flat, and confluent patches. The mucous membrane was thickened, bosselated, and ulcerated. The stomach and intestines were contracted. Microscopical examination revealed the fact that the pathological alterations were due to glandular carcinoma of the stomach.

The second case was that of a woman, aged