BOLDINE IN HERPETIC ERUPTIONS The role of the liver in this skin disease, with a suggestion of remedies for internal use, including not only boldine but other substances which have been found of value THE HE liver occupies, at the present time, much of medical attention, and we may now discover the relation of certain diseases to this organ as never thought of before. Let us take for our subject arthritism, or rather herpetism. Who would formerly Who would formerly have thought of the liver in the evolution of this last-mentioned diathesis? Arthritism was said to be due to a defect of nutrition. The question was whether this defect was primary or secondary, whether it was due to poor functioning of the intercellular exchanges, or whether these functionizing defects came from a certain nervous weakness. Good reasons were found for both of these hypotheses. Thus, according to Lancereaux, arthritism was a neurosis, and according to him the nerve-cells were those which were first affected, and their functional weakness determined the diathesis. The default of nutrition began with nervousness and ended with dyspepsia. According to to others, notably Albert Robert, it is dyspepsia which engenders nervousness. According to Charles Bouchard the primitive trouble exists in the intercellular exchanges. Lastly Hayem harmonizes the different theories by saying that arthritism is a trophoneurosis. Much is spoken of today of intoxication, and there is very little doubt that a prolonged intoxication, whether it be of internal origin (autointoxication), external origin or alimentary origin, whether it be the consequence of an infection or of a vice of nutrition, may engender an arthritism when the soil is prepared for it. Under the same conditions a young and predisposed individual may have convulsions or may even present a clear case of epilepsy. There is a very intimate family relationship between certain nervous diseases and arthritism. The following is what I once said on this subject: "All defects may engender epilepsies, and among the faults degeneracy and hysteria should be placed in the first rank. They produce epilepsy by exhausting the soil, or rather by presenting a feeble and irritable soil. So, too, do defects of nutrition produce epilepsy by a kind of tendency to intoxication." Arthritism is probably like epilepsy, but the result of an intoxication. This has already been proved beyond doubt in all cutaneous manifestations, such as eczema, psoriasis, lichen, zoster and herpes which are signs of arthritism. Urticaria as an instance is frequently found in a particularly tenacious manner in neuroarthritics. In the same way as then must be a special predisposition for an epilepsy to ensue, so there must be another not less special predisposition for an arthritism to ensue while the intoxication is really the same. And this special predisposition has very probably its seat in the liver, as I will here try to show. And that which I am to say about arthritism applies equally to herpetism. Gout, diabetes hepatic colic, nephritic colic, lithiasis, even varices are manifestations of herpetism. All these diseases depend upon some chronic intoxication, but how do they become arthritism? Intoxication is produced when the intercellular equilibrium is disturbed and when the emunctories become insufficient for the elimination of the toxins, and that equilibrium is disturbed when the liver becomes insufficient. Its functions are indeed multiple. Is it not this organ by the throwing of whose bile into the digestive tube assimilation is facilitated and fermentation prevented? It is well recognized at the present day how great a part the liver plays in autointoxication. And again, is it not this organ which destroys the toxins which are brought to it by the blood current? The bile is indispensable for the intestines. Not to speak of the results which chemical analysis might reveal are there not other things which clinical observation aided by physiology may disclose to us? Heart and stomach have nerves in common. Who has not noticed cardiac palpitation after a repast? Who knows whether these palpitations, coming as they do from bad digestion, have not their point of departure from a biliary insufficiency due to a hepatic insufficiency? Our distinguished confrère, Dr. George Petit, saw an obstinate diarrhea yield to the absorption of one dosimetric granule of biliary salts composed of equal parts of glycocholate and taurocholate of sodium. This is easily explained and is conformable to logic. His merit consists in his having had recourse to the remedy and to have expected the results. The antisepsis which the biliary granules were able to produce was less noxious to the organism than any other antiseptic. An important point in therapeutics is to give the organism that which it is lacking. This the Dosimetric Institute (Paris) will understand when to its well-stocked therapeutic arsenal it has added the granules of the hepatic salts which are able to combat hepatic insufficiency. According to Emile Sergent there is no doubt that certain forms of rheumatism may be due to thyroid insufficiency. Dr. Dr. L. Levy and H. de Rothschild have lately defended this opinion before the Medical Society of the Hospitals. This well-defended theory serves not only in certain cases of chronic rheumatism due to thyroid insufficiency, but with greater reason in cases of arthritism due to hepatic insufficiency. The administration of the bile salts is as rational in cases of hepatic insufficiency resulting from an insufficiency of secretion or from a retention of secretion. by a calculus as is the administration of thyroid extract in cases of thyroid insufficiency. It must be added here that while the administration of thyroid extract may sometimes become dangerous in certain cases, as in exophthalmic goiter (which arises more from an exaggeration of vascular tissue than from a hypertrophy of glandular tissue properly so called), the use of bile salts on the other hand is legitimate in all cases of hepatic insufficiency. I have at present a number of patients under treatment to whom I give the bile salts. The observation of these cases will be completed, and they appear to me already convincing. But before I used the bile salts I combated a number of cases of hepatic insufficiency with such granules as I had then at my disposition, that is, granules of boldine, calomel, and podophyllin, and with them I obtained excellent results in nearly every trouble appertaining to herpetism. This does not constitute a specific treatment of herpes but it is a valuable adjuvant to the treatment. In stimulating the liver directly, seeking to increase its secretions, I endeavor to make the digestive tube antiseptic and facilitate the elimination of toxins. Dosimetric physicians have special antiherpetic granules at their disposition of the following composition: Strychnine arsenate, 1-2 milligram; veratrine, 1-2 milligram; milligram; arsenous acid, 1-2 milligram. These granules stimulate the nerves and act tonically; they calm the itching through the veratrine they contain. Calcium sulphide is also a great help. It is an internal antiseptic par excellence, it sometimes can succeed alone in a most tenacious skin affection, such for instance as recurrent herpes. The same treatment is of value in other affections in which, though the skin ailment is not severe, the complexion is frequently subicteric and the conjunctivæ are yellowish. I thought best to employ also frequent laxatives, either podophyllin or calomel granules, or granulated seidlitz salt, to which I add boldine. While boldine decongests the liver it sedates it also at the same time. I often employ boldine alone in order better to observe its effects, and the results are very encouraging. Last January I attended a man suffering from hepatic colic. Of the treatment which he pursued I shall not speak at present, but his two daughters of 18 and 16 years of age had occasionally slight pains in the region of the liver and stomach. Their conjunctivæ were tinged with yellow, at times, and they frequently suffered from urticaria. I gave them six bodine granules daily. On the third day a slight greenish diarrhea occurred. I continued the granules (but only three a day) for eight days; although all pathologic symptoms disappeared I continued the boldine granules, two a day, till the month of March. It was noticeable that the pains which had frequently occurred before the boldine treatment never occurred again, nor were the conjunctivæ discolored, and the skin became spotless. I regard boldine as a blood depurative, and I used this expression before my patients to make them accept the treatment. I advised them to take the granules from time to time in order to prevent the recurrence of the trouble for which they called me to treat them. DR. PEGEAND, in La Dosimetrie, September, 1908. POSOLOGY OF DIGITALIN IN ASYSTOLE Four granules of 1-4 of a milligram each of digitalin Nativelle [this is a French crystallized digitalin], or fifty drops of a solution of 1:1000, which represents one milligram of digitalin, given once or twice a day. If. the myocardium is much altered it is best. to give still feebler doses. Or twenty drops may be given the first day, and ten drops. the next three days. Then let the patient. rest fifteen days or even less if the heart is strongly affected. After this delay the digitalin is given in doses of two granules of 1-10 of a milligram of digitalin Nativelle, or ten drops of a solution of 1:1000, four days in succession, so as to maintain a cardiotonic action.-Gazette des Hopitaux, 1908, p. 1413. BEER YEAST IN BURNS Doctor Plantier of Annonay, France, communicated recently to the Societé médicale de la Drome et de l'Ardeche the happy effects he obtained from the employment of beer yeast in the treatment of burns of whatever degree. After a careful preliminary disinfection the yeast is prepared for the dressing as follows: Beer yeast, dry or fresh or granulated, is mixed up with sufficient tepid boiled water to get the consistency of the plaster-of-Paris used in bandaging for fractures, etc. This is spread on strips of sterilized gauze for several thicknesses and the gauze is thoroughly impregnated with it. The burns are covered with these strips parallel to the axis of the limb and not across it, so as to avoid compression of the circulation, which is disagreeable and may even do harm by consecutive contraction from drying. The strips should be very carefully applied and then secured with a few turns of a roller bandage. In a few minutes, or even seconds, after this dressing is applied there is a remarkably prompt sedation of the pain and a feeling of ease comparable to that after a large hypodermic injection of morphine. The same dressing is carefully repeated in the same manner until the sore is healed, in one, two or three days, or whenever the dressing becomes dry, cracked, or when it was imperfectly applied, or when the pain starts up again. When blisters occur they must be opened carefully with a sharp disinfected bistoury and emptied and the epidermis carefully and minutely replaced and pressed down. As the result of this careful treatment there will be no suppuration and therefore no bad odor nor any deforming cicatrix, nor any sloughing except of such portions as have been completely carbonized (burned to a crisp). The burn is by this treatment converted into an aseptic sore and healed in a few days. Gazette des Hopitaux, 1908, p. 1412. [THE GLEANER wishes to remind the reader in this connection of the great benefit from the simple horse-serum treatment by injection in case of large burns. That the red blood-cells suffer in such cases there is no doubt, and that healthy blood serum added to the affected blood ought to be a healing means to it and the patient, there is every reason to expect. These two treatments combined ought to be tried promptly and reported.] SAPOTOXIN FROM AGROSTEMMA GITHAGO The hemolytic effect of this sapotoxin is chargable to the direct damage done to the red blood-corpuscles, starting from their surface which encloses the corpuscle with a kind of membrane or mantle-layer. The fact that sapotoxin attacks such bodies. as cholesterin and compounds of cholesterin and lecithin seems to be a further confirmation of the view that a part of the mantlelayer of the red blood-corpuscles consists of the one or the other or of a compound of both of these bodies. Sapotoxin is a cell poison. For instance it is able to bring about the death of monocellular living beings, such as leukocytes, in a short time. A decided alteration of the medulla of medullated nerves by sapotoxin could not be detected. In fresh striated muscular fiber the appearance of the striæ seemed to be affected in some places by the action of sapotoxin. Sapotoxin or a transformation product produced a specific effect upon collagenous connective tissue which made it assume a jelly-like form. In the digestive tract sapotoxin produces changes which show under the microscope all the characteristics of acute ulcerative formations.-VON J. BRANDL, in Arch. fuer Experiment. Pathologie u. Pharmakologie, 1908, p. 299. [THE GLEANER would direct the reader to see the article, "Sapotoxin Group," in Sollmann's "Pharmacology," second edition, p. 512.] SOAP BUBBLES As a New Year's gift for our alkalometric little ones THE GLEANER copied from a German source the following recipe for the best soap-bubble "suds:" Take 300 grains of finely scraped white castile soap and dissolve it in one quart of soft, pure, warm water, and let it stand for twentyfour hours. Pour off the fluid from any settlings and dissolve in it 300 grains of granulated sugar. The name of the author of this mixture is known as Terguem. So much for the children. CHIMAPHILA UMBELLATA Dr. Soules recommends the fluid extract of this plant against diabetes mellitus. It should be administered for a month while a strict diabetic diet should be observed. In conjunction with this an arsenical treatment also should be given, and after this month the patient should resume his usual die and mode of life. If sugar occurs again in the urine the patient should again take up the chimaphila cure -L'Union Pharm., 1908, p. 34. ADRENALIN AS A LOCAL ANESTHETIC M. Gilbert analyzes an article by M. Sardou about the good effects of adrenalin as a local anesthetic. The article refers to a certain number of observations in which the remedy calmed neuralgia or rheumatic pains.-Gazette des Hopitaux, 1908, p. 1444. L AST month we announced that we should publish an article written some years ago by Dr. George H. Simmons, then a practising homeopathic physician, on "Medical Ethics", discussed from the homeopathic viewpoint. Since making this announcement we have learned that this article has been offered to and will be published in another journal. We have therefore decided not to reproduce it this month. Those interested, as we are sure many will be, can read it elsewhere. We prefer, any way, to stick to the pure "ethics" of real manhood-and to talk (and we hope live and we'd like to get) the "square deal." DRUNKENNESS IS A CRIME I am sure neither CLINICAL MEDICINE nor its eaders would like to have a fellow student of its pages misunderstood on the temperance question, which he is liable to be without the following explanation: Were it not that some men make a bad use of intoxicants no one would object to their manufacture or sale. Some men make a bad use of knowledge, but it does not follow that to prevent this all should be kept in ignorance. Some make a bad use of money, but to prevent this we do not propose to keep all in poverty. Some make a bad use of their vocal organs, the organs are not to blame but the one who misuses them; so it is the man who misuses alcoholic liquor who should be held responsible for so doing. Civil government is a divine institution. The moral law, which prohibits everything that is wrong, and only what is wrong, is the supreme law of the universe, with which every human law should harmonize. "God's law is perfect," and yet it prohibits neither the manufacture nor the sale of alcoholic liquor as a beverage. One who teaches that these things should be prohibited practically says: "God's law is not perfect." Which shall we believe, man or God? The apostle Paul teaches that the civil ruler is the minister of God, a revenger to execute wrath upon him that doeth evil. -Rom. 13:4. The drunkard is an evil-doer and should be punished. The penalty for drunkenness should be a forfeiture of citizenship for one year. Treat drunkenness as a crime, and it logica'ly follows that the man who knowingly furnishes liquor to make another drunken is a party to the crime of drunkenness. Annually men, seeking office, spend millions upon millions of dollars for liquor to secure the votes of drinking men in the caucus and at the polls. Were the loss of citizenship the penalty for drunkenness the practice of furnishing liquor for political purposes would cease at once. Then every man in office would be a sober |