parietes of the thorax a few ecchymoses were visible on the anterior surface of lungs, but on turning forward lungs and exposing the posterior surfaces of the visceral pleura, it was seen to be almost covered with fine ecchymoses (not pleural), and in the pericardium and endocardium similar changes were found. Right lung weighed 16 ounces, left 13 ounces. Liver smooth, swollen, of bright yellow colour, had undergone extensive fatty degeneration, weighed 68 ounces. Muscular tissue of heart pale and granular; no fatty striæ; valves normal and competent; heart weighed 10 ounces. Spleen weighed 6 ounces, was congested and hard. Kidneys swollen, their surfaces smooth and pale, cortex marked with fatty striæ, pyramids of pinkish tint. Right kidney weighed 5 ounces, left 6 ounces. Stomach dilated, containing 1 pint of clotted, grumous-looking, brown fluid; mucous membrane pale and swollen, a few small ecchymoses. Intestines oontained a quantity of mucus, not otherwise altered. Brain pale and wet, not otherwise changed. Poisoning by Laburnum (Biggs, Brit. Med. Journ., June 9th, 1883).—A boy, æt. 4, had eaten some flowers and was very ill. Quantity eaten not known. Came into house and said he could not walk, had become cold and seemed drowsy, and had been slightly sick. When seen at 2 p.m. was lying quietly in bed with dilated pupils, which, however, contracted under stimulus of bright light. Was very pale (usually bright colour); surface cold, some matter vomited showed particles of laburnum flowers. Very drowsy; pulse 104, small; temp. 95°. Thirty minutes later in much the same state. There had been more copious vomiting, and much vegetable matter ejected. Still very drowsy; pulse 130; temp. as before. An hour later temp. 93.6°. This condition lasted till 5.30 p.m.; a slight vomiting; slept well. Then he seemed to recover. The pupils became almost normal, temperature rising to normal. Seemed quite recovered. Convallaria majalis.—Juk (Proceedings of Kieff Med. Soc., 1862, Fasc. 1) says:-1. It is useful in nervous disturbances of the heart's action. 2. It does not give any constant and positive results in cases of heart disease with disturbed compensation. 3. It does not increase the amount of urine [almost all the observers say it does; in the only case in which we have seen it used in full doses it exercised a very decided diuretic action]. 4. The heart's action becomes slower and more regular soon after the administration of a dose. 5. It does not possess any cumulative action nor does it interfere with digestion. Chromic Acid in Ulcers of the Tongue.-Mr. Henry T. Butlin (Practitioner, March, 1883) has a paper on the use of Chromic acid in solution as a topical application to ulcerated tongues. To homoeopathists this will not be surprising. The solution used was ten grains to the ounce of water, the patient being told to paint the ulcerated parts three or four times a day. This was sometimes followed by a little smarting, but the relief afforded made the patient bear this cheerfully. Mr. Butlin discovered this "almost by chance." He took the idea from Sir James Paget's recommendation of the use of a saturate solution of the acid in gouty psoriasis of the tongue. The first cases he tried it on were two men suffering from chronic superficial glossitis, due to excessive drinking and smoking, combined with syphilis. These were rapidly improved and practically cured, after long previous treatment with tannic acid and glycerine. Another patient (J. B—), “suffering from secondary syphilitic ulcers of the borders of the tongue, small but deep and jagged, and from ulceration of the cheek," after much vain dosing with Hyd. c. Cret., Pot. Iod., and Liq. Hyd. Bichlor., was almost completely cured in a week by the Chromic acid solution. Another man (T. L—), who had a number of flat mucous tubercles from secondary syphilis, for which he had taken Hyd. c. Cret. gr. iij, from June till October, dusting his tongue with calomel the while, without the slightest benefit, was rapidly cured by the application of Chromic acid. In a week his tongue was almost well, and in from two to three weeks "scarcely any trace of the tubercles remained.” Mr. Butlin thinks it unsuited for tertiary syphilitic conditions, but gives one case which it cured in less than a month after the usual mercurial treatment had been tried in vain. The primary attack of syphilis had occurred ten years previously. The condition presented by the tongue was "small, ragged, and deep syphilitic ulcerations of the tip and borders," which it was feared might turn into epithelioma. Nitrite of Sodium in Angina Pectoris.-Dr. Matthew Hay (Practitioner, March, 1883) contributes a paper on Nitrite of Sodium, and especially its use in angina pectoris, as compared with Nitrite of Amyl and Nitro-glycerine. The following proving of the salt is of interest :-" On three separate occasions I took five, ten, and twenty grains of the salt. I then observed that the rate of my pulse became accelerated shortly after taking each dose, and more distinctly after the largest dose. But what was more remarkable, I experienced, within a few minutes after taking the two larger doses, a feeling of fulness in my head and eyes, accompanied by a throbbing sensation. There was also a slight, almost doubtful, flushing of the countenance. The sense of fulness and throbbing continued for an hour or more after the administration of the salt, without at any time being so intense as to be unbearable, or even severe enough to prevent me from proceeding with my usual duties. Indeed, it was comparatively trifling and caused me no inconvenience. The smallest dose of the salt produced a similar effect, but of very short duration and very slight degree, so slight as almost to have escaped observation. These experiments were repeated on myself and a few of my friends, and always with the same result.” Drs. Reichert and Weir Mitchell, and Mr. Hinsdale, a student in the University of Pennsylvania, experimented with Nitrite of Potassium. They took the salt in doses varying from three to ten grains, and on one occasion Mr. Hinsdale took thirty-five grains in the course of six hours. "In no instance were alarming effects experienced. The pulse was always considerably increased in rapidity, the effect beginning to be observable in from one to two minutes after taking the Nitrite, and continuing from one to three or four hours. After a few minutes a slight flushing of the face was sometimes perceived, accompanied by a gentle feeling of warmth in this and other parts of the body, and by a slight fulness of the head, along with some throbbing of the cranial arteries, especially if the dose exceeded five grains." The authors concluded that Nitrite of Potassium is nearly identical in action with Nitrite of Amyl. The following note by Dr. Hay will give a good idea of the crude notions of drug action entertained by the dominant school:-"It is unfortunate that they employed in their experiment the potassium and not the sodium combination, for the sodium is per se practically inactive, whilst the potassium acts powerfully on all muscular structures, &c;" and the same is shown by this-to us-amazing statement:" Moreover, it appeared highly remarkable that two salts, as Nitrite of Amyl and Nitro-glycerine, whose bases differ so widely in their pharmacological activity, should so exactly agree in their physiological action and therapeutic application, &c." This comes of studying the action of drugs in poisonous doses on animals, and taking the coarse results thus obtained as the complete and final explanation, instead of studying the finer and only characteristic features of their action as to be observed on man. Dr. Hay rejects Reichert and Mitchell's statement that Nitrite of Potassium and Nitrite of Amyl are identical in action, he sums up as follows:-"Yet the effect upon which the therapeutical value of Nitrite of Amyl is 'supposed' to depend-the dilatation of the smaller arteries and lowering of the blood-tension-follows the administration of either salt, and in this important respect, therefore, the two salts agree in action." This "supposition " Dr. George Balfour has proved to be an error in his work on Diseases of the Heart. He has there shown that of two specimens of Nitrite of Amyl, both of which will dilate the arterioles, only one-freshly prepared or specially preservedwill relieve the paroxysm of angina; and, on the other hand, that in certain cases of heart disease angina only came on when the blood-pressure fell. The relief afforded by the Nitrite of Amyl was not by its dilating power. The patient Dr. Hay treated was a man of forty-two. The pain complained of began in the middle of the front of the chest and extended over a space the size of the hand. It gradually extends till felt between the shoulderblades, passing down both arms to finger-tips, and especially severe in right wrist. He had an uneasy sensation in the chest for two or three minutes before it appeared. The pain lasted generally fifteen minutes, sometimes five or ten only, and was quite excruciating. Just before the pain began to abate he felt a throbbing between the shoulders at the back of the chest, no sense of suffocation, no sickness, no giddiness. Nitrite of Amyl in capsules, about five a day, lessens the severity of the attacks and largely wards them off. His diet was regulated and stimulants forbidden. The inhalation dulled, but did not entirely dispel the pain, and it caused giddiness and headache. He was afterwards put on the following, the analogy in physiological action having suggested it to Dr. Hay : B Sodii nitritis, 3; Aquam ad fl. 3 xij. Solve. Sig. Dose one to two teaspoonfuls. This proved much more effective than the Nitrite of Amyl, one dose in the morning often sufficing to keep off an attack all day, and when an attack supervened to remove it entirely, and not deaden the pain merely. The good effect was produced without any physiological action being obtained—this to Dr. Hay's astonishment. It required, however, a teaspoonful of the solution (about two grains of the salt) to produce the effect and ward off an attack, neither ten, twenty, nor thirty drops of the solution being sufficient. Less of the pure salt might have sufficed, Dr. Hay thinks, as the specimen supplied him by one of the first chemists contained 66 per cent of Nitrate of Sodium, 33 only being Nitrite. Nitrite of Amyl acted more quickly in an attack, but did not shorten it, only dulled the pain. Nitrite of Sodium, when once its action asserts itself, in from two to three minutes relieved the pain completely. The duration of the preventive action was also much longer-by several hours-than that of the former. Nitro-glycerine was given on one occasion in the following prescription: B Sol. nitro-glycerini (1 %), fl. 3j; Aquam ad fl. 3vj. M. Sig. Dose one to two teaspoonfuls. This acted quite well in preventing or relieving the spasms of pain, but was always followed by distinct throbbing in the head accompanied by some degree of pain and giddiness. The preventive action was longer than that of Nitrite of Amyl, but hardly so long as that of Nitrite of Sodium. We content ourselves with placing these observations before our readers, and offer no comments as to what the nature of the action was. -- Poisoning by Enanthe crocata. -A Greek, æt. 30, admitted to South Devon Hospital January 13th, 1881, unconscious. Previous day had taken a quantity of what he thought was wild celery, but which was the above plant. He ate part of root and some of stem. Two hours afterwards ate a full meal and felt quite well. In fifteen minutes suddenly vomited violently. In five minutes was unconscious, with twitchings about limbs and face. Copious flow of thick tenacious mucus from mouth. Coma for twelve |