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patients to one's consulting rooms will hardly enable one to write understandable English without previous study.
De VAtrophie axiale du Nerf Optique. Par le Dr. De Keersmaecker.
This is a reprint of an article by our Belgian colleague in the Receuil d' Ophthalmologic The disease was of the hereditary character, and was observed by the author in five different members of one family. It is characterised by central amblyopia which generally occurs suddenly at about fifteen years of age, gets worse for several weeks, and then either retrogrades or remains stationary for an unlimited time unless altered by treatment. The ophthalmoscopic sign most generally noted is an atrophic appearance chiefly on the external section of the optic disc and the neighbouring retina. The author offers a theoretical explanation of the hereditary nature of the disease. He asks, "May not a person who has a central amblyopia caused by poisoning" (he does not suggest by what) "transmit the defect to his posterity in the same way as guinea-pigs who have had their sympathetic nerve divided transmit the defect to their young ones?" That question seems to us less important than the other one—how the disease is to be cured—and the author gives us his treatment of one of - his cases:—Continuous current, Weiss's piles, 8 elements, negative pole on the eye, positive on the temple near the orbit, for five minutes every day. Iodide of Potassium (dose not stated). The result was great amelioration after two months.
Students' Guide to the Examination of the Pulse. By Byrom Bramwell, M.D., 2nd edition. Edinburgh: 1883.
In this second edition the author gives a full account of Dudgeon's sphygmograph, with illustrative woodcuts, but his illustrations of pulse-tracings are all, as in the first edition, done by the less correct instrument of Marcy.
GLEANINGS, THERAPEUTIC AND PATHOGENETIC.
Cases cured by Aconitine.
In a work recently published by Drs. Laborde and Duquesnel, entitled Des Aconits et de 1'Aconitine, we find a number of cases of cures by the alkaloid which do not teach us anything new concerning the therapeutic power of Aconite, but are interesting as corroborating the curative action of the drug which was first discovered by Hahnemann's experiments.
Obs. 1. Prosopalgia.—In May, 1875, we were consulted by a lady aged twenty-five, who complained of horrible pain in the whole left side of the face, which nothing she had used had succeeded in mitigating. This lady generally enjoyed good health. About the end of February, the cold being exceptionally severe, she went out of her house at night with nothing on her head, while snow was falling. Her sufferings dute from that time. They commenced by a painful point beneatli the orbit and towards the temple, which gradually extended through the whole cheek and to the mastoid and sub-occipital regions. The teeth are sound but the gums are congested, red, and painful through their whole extent. The menstruation is regular. The expression of her face is that of suffering, her features are pinched and retain a timorous immobility, as if she dreaded the slightest movement or touch. Merely stroking lightly the cheek with the finger suffices to bring on an attack of pain with lachrymation, salivation, and fibrillary spasms. The sub-orbital, temporal, superior, and inferior maxillary regions, are especially sensitive to pressure. The neuralgia is continued, but the evening and nocturnal aggravations are so severe that for some time back the patient has had to be watched lest she should do herself an injury in her fits of despair. She only sleeps for a few hours in the morning when completely worn out by pain and insomnia. She can hardly take any food, especially of a solid nature. She has wasted away considerably and is excessively weak. Opiates only gave temporary relief at the commencement, but this was not maintained even when their dose was increased. These having failed it was resolved to give Aeonitine. One granule (containing I milligramme) of Nitrate of Aeonitine was prescribed, to be taken at 6 p.m., a second granule five or six hours afterwards, a third next day, about noon. The first two granules gave such relief that the patient, in spite of orders to the contrary, took the third granule in the night. She soon presented the symptoms of an overdose of Aconitine: general sense of coldness, tendency to faint, precordial anxiety, nausea, and finally vomiting. These accidents soon subsided spontaneously, and had completely disappeared when the patient came to me next day and confessed that she had gone beyond my prescription, but that she felt she was cured. She was delighted to say that for the first time for two mortal months she had been able to Bleep, and had escaped her frightful tortures. In spite of this unmistakeable result she was ordered to continue the treatment, but not to take more than two granules during the night and one during the day. This she did, and the third day all pain had completely disappeared, the sleep was perfect, her countenance serene, appetite returned, and she could perform all her household duties. She continued to take one granule at night and one during the day for another week, then only one granule at night for another week. She has now been quite well for fifteen months.
Obs. 2. Prosopalgia.—A young lady, residing near the preceding case, wrote to us in November, 1875:—" I have pains all over the left side of the face, just like those from which Mrs. X— suffered, who was cured by you. I shall feel obliged if you will tell me quickly what to do, as I cannot hold out long against them." I concluded from this brief statement that Mrs. B— had facial neuralgia, but I knew not under what circumstances the disease had arisen, what was its cause, what its duration, or whether it was symptomatic or idiopathic.
I asked her for information on these points, and was told that the neuralgia on the left side of the face had suddenly appeared two days ago in consequence of getting a chill at night; that Bhe had no decayed teeth that might have set up the pain; that the neuralgia was continual, with aggravations in the evening and night, but that there were no intermissions. These data were sufficient indications for Aconitine. I sent her therefore ten granules of crystallised Nitrate of Aconitine (of \ milligr. each), with directions to take one granule every five hours, but not more than three in the twenty-four hours.
A few days afterwards the patient informed me that the pains had completely ceased after three granules, but by way of precaution she continued taking one granule per diem for eight days. She has remained till now (eight months) free from any attacks of pain.
Obs. 3. Prosopalgia.—One of our friends on his return from his country quarters told us that the lady of the house at which he had been staying was suffering for the last twelve days from horrible pains in one side of the face, which did not give her a moment's rest, caused her to weep and moan constantly, and did not allow her to take the slightest nutriment. She had not derived the slightest benefit from the remedies used, chiefly Opium. My friend, who is not a medical man, could not tell me the form nor the dose of the Opium given. The patient was in despair and felt she could not continue to live in such torture. My friend, who had heard of the effects of Aconitine in certain neuralgias, asked if it might not be of use in this case, and begged me to give him some with directions for its use. remarked that there were various kinds of neuralgia, and that it was important to know the condition under which this neuralgia had appeared in order to be able to judge whether the remedy were suitable. That one of the essential conditions was the etiological one. On this point my friend was not able to present me with any information beyond his belief that there had been a preliminary chill. He was certain that the lady was not subject to neuralgia, toothache, or earache. Yielding to his solicitations I gave him twelve granules of crystallised Nitrate of Aconitine, which he sent to the lady with instructions similar to those given in the previous cases.
After the lapse of two days my friend showed me a letter from the patient, which said:—" The small pilules you sent me immediately removed my horrible pain. Only since it has gone I have very violent itching all over the body. Perhaps this is caused by the medicine "—which it most likely was, as that is one of the effects of Aconitine, though it has mostly been observed after hypodermic injections.
The authors insist that Aconitine is very useful in facial neuralgia proceeding from a chill, and they think the above cases prove this. They give a case of neuralgia depending on caries of the teeth where Aconitine was of no use, as a negative proof of their proposition. With respect to this we would observe that the last case differs from the previous ones, not only in etiological, but probably also in essential character, and will hardly establish the conclusion of the authors.
Obs. 4. Prosopalgia. A washerwoman, set. 36, of robust constitution and usually healthy, has been suffering torture for a month from right facial neuralgia, caused, it would seem, by a chill. Blisters, Morphia, Quinine, given so as to cause Quinine intoxication, extraction of a tooth, all failed to relieve her.
July 21st.—Present state : excessive hypersesthesia of all the right side of the face, especially along the course of the supraand infraorbital and auriculo-temporal branches. In the intervals painful spots, general dermalgia over all the parts supplied by the fifth pair of nerves as far as the middle of the chin and the suprahyoid region, also in the interior of the mouth. Excessive secretion of tears and saliva. One half milligramme crystallised Nitrate of Aconitine was injected at once under the skin of the neck on the affected side. Soon afterwards feeling of peppermint on the tongue, which seems to enlarge and become paralysed; great heat throughout the body; exaggerated size of lips and chin; difficult respiration ; numbness of the limbs; inclination to vomit; general weakness. These symptoms lasted from 6 p.m. (the time when the injection was made) until midnight. During this time the neuralgic pains had materially diminished.
22nd.—9.30 p.m., pulse 84, temp. 376° C. At 10 a.m., injection of half a milligramme of Nitrate of Aconitine. 11 a.m., pulse 90, temp. 37-7°. The tingling in the lips and hands is pretty severe; there is even a sensation of slight enlargement of the chin and nose; some heat throughout the body and slight anxiety. At 11.30 a.m., pulse 78, temp. 37-4°. All the limbs are numb ; the affected side of the face is almost insensible to cold and to touch.