Acidum Fluoricum in bilio-mucous diarrhoea.

By Dr. JOSEPH LAURIE.

Mrs. G. has been suffering for a month from diarrhoea. She attributed the attack either to exposure to cold, or to the effects of a small quantity of salmon which she had sparingly partaken of. Has from six to eight evacuations in the twenty-four hours. She describes the motions as consisting of "very loose bright yellow matter, and a quantity of mucus," each relief being preceded by considerable griping. The dejections take place chiefly during the night, or early in the morning; during the day they mainly occur soon after drinking, especially warm fluids, such as tea, cocoa, beef-tea. Her general health has always been indifferent. She resides in the country, and had taken the tinctures of Pulsatilla, Mercurius ž, China §, Arsenicum §, and Acidum phosphoricum, each for four successive days, in the order named, a dose thrice a day, without success. She had, moreover, put herself on simple and appropriate diet throughout the attack. After waiting eight days, during which she took no medicine whatever, she wrote to me for advice in consequence of the unabated continuance of the diarrhoea. I sent her Acid. fluor. 6., a few globules to be mixed in four tablespoonfuls of water, a dessertspoonful of the solution to be taken after each dejection. On the fourth day from the receipt of my letter she wrote;"The day I commenced taking the medicine I had six movements of the bowels; the next day I had only one, a copious loose stool; on the third day I had no action; and this morning I have had one natural movement, and feel better in every way than I have done for many weeks."

In this, and in the preceding case I selected Fluoric acid principally ex usu in morbis, having found it effectual in one or two other cases of obstinate diarrhoea, of a bilious type, which had resisted other remedies.

In ascites connected with diseased liver, some of our German colleagues have extolled the virtue of Fluoric acid after the previous employment of Arsenic. I tried it in two cases with benefit, but have mislaid my mems. thereof, and cannot recall the particulars with sufficient accuracy for publication.

Case illustrating the Pathogenetic Action of Buxus sempervirens on the Uterus. By GEORGE LADE, M.D., King's Lynn. On the 14th June, 1865, I was called upon to attend a young unmarried woman, the daughter of respectable parents, whose case presented the following symptoms: she had strong forcing pains, resembling those of labour, in the lower part of the abdomen, which varied greatly in intensity, and lasted for from twenty to thirty seconds to a minute or longer. She told me she first felt them three days before, and bore them without complaining, although they were sufficiently severe to prevent sleep, until a few hours prior to my visit, when their gradually increasing frequency and violence compelled her to make known her state to her friends, and to send for medical aid. There was no tenderness on pressure in the hypogastric region, no vaginal discharge, no abnormal action of bowels, pretty frequent desire to micturate, but no increase in the amount of urine emitted, and slight increase in the frequency of the pulse. She had not menstruated for three months, but indignantly denied to her friends that she was in the family way. The abdomen was not perceptibly enlarged, the breasts were not marked by any suspicious areolæ, and every sign indicative of pregnancy, except the suppressed catamænia, was absent. I was therefore forced to look upon the case as one of retained menses, and was about to prescribe for it in accordance with that view. But before deciding upon the most appropriate treatment to employ, the young woman voluntarily confessed to me that she had reason to believe she was enceinte, and that she had been taking something to provoke abortion. This something, she informed me, was the common box-tree (Buxus sempervirens), which she had procured from a nurseryman, and taken in the form of infusion at intervals of six hours for eight days up till the morning before I saw her. She attributed the pains to the action of the drug, and earnestly implored me not to arrest them altogether, but merely to lessen their violence, in order that the expulsion of the fœtus, which she felt certain would soon take place, might be accomplished. To quiet her fears, and at the same time secure implicit obedience to any directions that might be called for, I assured her I did not think she was in the family way at all, and if she would but

strictly attend to my injunctions, I should do all that was necessary for her welfare and comfort. I then made a digital examination per vaginam :-The body of the uterus appeared to be slightly enlarged, and its neck shorter than is usually found to be the case in the unimpregnated organ, while the whole of the mucous lining of the parts within reach was somewhat hot and sensitive to the touch. Retaining my finger in contact with the os during a pain, I distinctly felt an expulsive effort of the womb, unattended by any discharge. The impression conveyed to my mind by this examination was, that the cavity of the uterus was occupied by something, but whether by a fœtus and its membranes, or by pent-up menses, or anything else, I could not determine. I had the patient's own statement that she was with child, but with the exception of the suppressed monthly flux, there were none of the phenomena characteristic of pregnancy to corroborate her opinion. The most reliable writers on midwifery tell us that a woman may have conceived upwards of three and a half months without manifesting any positive sign of the fact. There was strong presumptive evidence that my case was confirmative of their experience. And taking this view of it, the duty imposed upon me was clearly this,—to arrest the pains, and prevent, if possible, the expulsion of the contents of the uterus. The question then arose, to what were the pains due ? Were they the result of the administration of Buxus sempervirens or not? If this plant gave rise to them, the proper treatment would be to apply an antidote to their exciting cause. I knew of no such antidote, and an examination of all the books in my library failed to give me any information on the subject. I therefore had recourse to the Materia Medica, a careful study of which pointed to Sabina as the appropriate medicine for the case. This medicine was given for some hours, but produced no apparent beneficial influence. Caulophyllin was then administered, and with a happy effect; the pains rapidly yielded, and remained quiescent for upwards of four hours. They then returned with inconsiderable violence, but the same medicine, in а higher dilution, was persevered with, and the pains gradually subsided, although they did not finally die away till the expiration of more than forty-eight hours after my first visit.

But

My object in presenting the details of the above case to the readers of the Journal is to draw the attention of my medical brethren to the Buxus sempervirens, and to elicit all the infor

mation respecting its therapeutic properties of which they may be in possession. Until the plant was recently forced upon my notice, I had not heard of its being used either by the profession or by the public as a medicinal agent. But it would seem to have long had a popular reputation as a promoter of abortion, as I have been lately given to understand, and the facts to which I have feebly given expression tend to show that that reputation does not stand upon a groundless foundation. My patient told me that one of her friends, who has since married and borne children, successfully employed it in her own person to rid herself of the consequence of an unlawful intercourse, but beyond the fact that it made the unfortunate young woman very ill, I could obtain no further information as to the manner in which it operated upon the system. Perhaps some practitioner who has the opportunity may work out the subject by making a careful proving of the drug. I think the labour would be well repaid by the results which would be obtained.

I may add that the only unpleasant effect, besides the abdominal pains, which my patient experienced from taking the infusion of box was a slight degree of nausea on one or two occasions.

Her urine was submitted to a microscopical examination a few days after the cessation of the pains, and gave satisfactory evidence of pregnancy.

Ranunculus in Pleurodynia. By Dr. DUDGEON.

A lady, æt. 27, had been confined three weeks when she went out for a drive. The day was cold, and during the drive an accident occurred to the carriage which frightened her considerably. In the evening she had a slight rigor, and complained of pain in the left side about the sixth and seventh ribs. The pain increased during the night and on the following day. I saw her in the evening of the second day. She was sitting rather bent forwards in bed, and leaning towards the left side. The slightest motion caused her intense pain like a knife thrust into her side and through to her back. The pulse 120, small, no heat of skin. She had been taking Bryonia. I carefully examined her chest but could detect no signs of pleurisy. The intense dread of any movement, which caused a renewal of the sharp stabbing pain,

the relief felt by a position that relaxed the intercostal muscles of the affected side, the dread of taking a full breath, and the absence of febrile and auscultatory signs convinced me I had to do with a case of severe pleurodynia or rheumatic affection of the intercostal muscles. I prescribed Arnica 1, every two hours. The following day the symptoms were as bad as before; in fact, they had not altered. She had been unable to lie down for a moment all night, and at my visit she was propped up with pillows, so that she leaned forwards and to the left side, her head resting on her breast. She could hardly bear me to touch the affected side, and screamed if she had to perform the slightest movement. The pulse was still 120 and weak; she was much exhausted by the want of sleep and the awkward position. She was afraid to breathe at all deeply as that gave her the same pain in the side. With all these symptoms there was no heat of skin, no auscultatory signs; she could eat pretty well, and nursed her baby as frequently as before her illness.

As the symptoms corresponded precisely to those of Ranunculus bulbosus on the thoracic region, I prescribed this remedy, four drops of the 1st dilution in half a tumblerful of water, a teaspoonful every half hour as long as the pain was violent; if the pain abated, the medicine to be given more rarely.

At my visit next morning I found my patient lying flat in her bed. She told me she had not taken the first dose of the remedy ten minutes, when she felt as she called it, a wrench in her side, and the pain was gone. She was enabled to lie down, and she slept profoundly, which she had not been able to do for a single instant for forty-eight hours previously. Nothing occurred to disturb the rapid recovery of this lady. The pain recurred in a slight degree several times, now on one side, now on the other, during the next three or four days, but each time it yielded immediately to a dose of Ranunculus.

Most of the chest symptoms of Ranunculus bulbosus point to a rheumatic affection of the intercostal muscles, and consequently depict the condition of my patient. Symp. 182 might have been drawn from my patient, it so accurately describes her state.

* * * "violent shooting pain superiorly behind the left nipple near the axilla; he dare not move or raise the arm, nor even straighten the upper part of his body without screaming out, but he must sit and stand with the head and breast bent forwards and towards the left side."

VOL. XXIV, NO. XCV.—JANUARY, 1866.

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