« ForrigeFortsæt »
Aug. 17.-Reports entirely cured.
Aug. 3.—Ellen V , age 40, married. Irish. Cancer of breast, involving the whole gland, with considerable enlargement of the axillary glands. Says she has not slept for several nights; no appetite, and cannot work. Earns her living by washing. This patient applied to Prof. Newton for an operation, who sent hier to the Dispensary with a note desiring us to “keep her along" until cooler weather, and suggesting the use of carbolic acid. Two openings had formed, one two inches below the nipple to its inner aspect, and large enough to contain a small hen's egg, the other about one and a half inches to the upper and outer aspect of nipple ; both bied freely every day. We gave her a quart of solution of carbolic acid, ten grains to the ounce; injecting the cavities thoroughly at the time, and directing her to lightly plug them with lint saturated with the solution.
Returned in two weeks. Cavities decreased in size one half; says she slept well the first night after using the wash, has had no pain since; continue treatment.
Sept. 8.—Patient returns; one cavity entirely filled with healthy granulations, the second rapidly filling; the gland has decreased in size one-half; the induration of the axillary glands has entirely disappeared. Says she has no more trollble with it, can work hard as ever, and positively refuses an operation.
The peculiarity of the case is, not so much the alleviation of local, as the entire removal of constitutional symptoms, which were fast prostrating the patient. Will some noted cancer doctor enlighten us? There was no constitutional remedy used.
Aug. 6.--Henry M-age 39, married. Scrofulous ulcer of the leg, extending from the knee to below the anklejoint, the leg being enlarged to nearly double its size. There was a cavity in the posterior aspect of sufficient magnitude to admit of a goose egg.
This condition has existed five years, and been treated at all the Dispensaries in this city without relief. Acknowledges to have been a drunkard.
R Acidi Carbolici, 3 iss.; Glycerini, 3i.; Aquæ, 3 vij.
M. Apply freely to leg, also make a wad of lint, saturate and place in excavation.
R Tinct. Ferri Mur., 1xv. Ter. die sumcnd.
Aug. 17.-Ulceration confined to ankle and cavity, whichi is about one-fourth its former size, and filled with healthy granulations; continue treatinent.
Aug. 24.—Still improving.
Sept. 10.—Leg almost natural size; nothing left of cavi ty but a small ulcer, the rest of the leg assuming a healthy appearance.
Aug. 25.-Eliza R—, age 36. Injury to perineum from instrumental labor at Bellevue Hospital. Frightful swelling, inflammation, and ulceration ; irritation with ulceration of meatus urinarius, also diarrhæa with tenesmus.
R Alc. Fld. Ext. Geranii, 3i.; Alc. Fld. Ext. Agrimoniæ, 3iv.; Alc. Fid. Ext. Dioscoriæ, 3ii.; Alc. Fld. Ext. Hyoscyami, 3i. M. Take a teaspoonful three times daily.
Sat. Sol. Chlor. Porassa for a wash to parts; rest and good food.
Sept. 11.—Reports cured.
Aug. 31.—Mary B, age 7. Tinea capitis, following scarlet fever; tongue coated, appetite fair. R Pulv, Jalapæ Co., grs. XX.
Nocte sumend. Acidi Carbolici, 3i.; Acidi Acetici, 3 ij. ; Glycerini, 3 ss.; Aquæ, ad 3 viij. Fiat lotio.
Sept. 2.--Improving ; continue wash.
Sept. 5.---Mrs. C, age 45. Salt-rheum, two weeks' standing; hands much swollen and fissured.
B Acidi Carbolici, mxi.; Aquæ, 3 iv.; Ft. lotio. Apply freely.
R Potassæ Acetatis, 3 ijss.; Ext. Fld. Stillingiæ Co., 3 ss.; Aquæ, 3 iss. M. 3i. Ter, die sumend.
years duration ; intermittent in character; obtains in erening; more violent in suunmer.
R Ammon: Hydrochloratis, grs. x. Statim sumend. .
The dose to be repeated every fifteen minutes until relieved, up to four doses; if they should not prove effectual, desist from its use.
Sept. 5.- Patient says she took three powders, and was entirely free from pain; slightly returned the second day, took one dose with entire relief.
Existing State of Medical Practice.
Mr. W. WILMOTT, in an address before the Chemist's Assistants' Association upon the Value of Medicine, gives the following interesting information:
From a large number of prescriptions actually dispensed in the city of London, I selected one thousand. These were written by different medical men for different diseases, and different symptoms of disease. They were also written at different seasons of the year (Spring, Summer, Autumn and Winter), during a period extending over the past ten years. I did not select thein on account of any specialty they possessed, but took them as they were copied, in writing, in the book kept, as usual, for that purpose. As, in this work, my eye passed over many thousands of prescriptions, I was enabled to satisfy myself that those I had selected represented with sufficient accuracy any similar number which might be collected in any part of London, and, by fair inference, any multiple of that number to the extent of hundreds of thousands. Here, then, I possessed a true key to the existing state of medical practice” in this country.
Having these prescriptions at my command, I submitted them to an analysis (if I may use the term) which, I am bound to say, proved to be a work of considerable time and labor. The result arrived at, after much careful noting, I will now place before you.
While the pharmacopæia contains 768 medicaments simple and compound, medical men do not adopt'in actual practice inore than 485; and what is rather remarkable, three-fourths, or 75 per cent., of these occur less than once in every 100
prescriptions written ; so that if we take the remaining fourth, or the leading remedies, as they may be called, we shall find that these are prescribed three times where the rest are only prescribed once. The inference to be drawn from this is, that if a medical practitioner were to treat disease with these 120 leading medicines, according as he may select them, and no others--presuming the whole 485, now in use, to be of equal value--the “odds," if I may be allowed the expression, would be 1 to 3 against his success, as compared with the practitioner who held the advantage of the entire range of remedies; but as these medicines are not all of equivalent value, as shown by the fact that 75 per cent. occur less than once in every 100 prescriptions, the advantage of the additional number above one-fourth would be so reduced, as to render the chances of the two practitioners very nearly equal. We shall see whąt further inference can be drawn in this direction.
It is impossible to pass over the fact that a few medicines take the lead in medical practice, to the comparative exclusion and neglect of all the rest. Quinine heads the list by a long way, then Chloric Ether, Bicarbonate of Potash, Aro. matic Spirit of Ammonia, Iodide of Potassium, Mercurial Pill, Compound Extract of Colocynth, and so on. Twentyfive of these medicines show an average occurrence of once in seventeen prescriptions, while those which remain, taken collectively, show an average occurrence of once in one hundred and sixty-six prescriptions. This is scarcely, perhaps, a fair calculation, but the difference is a very wide one, and serves to show where the greatest reliance in the power of drugs may be found to exist.
With regard to the prescriptions examined, it is well worthy of rote, that of the 485 medicines ordered or prescribed, 429 are to be met with in the pharmacopeia; a reshowing the desirability of a thorough knowledge and appreciation on our parts of this important work.
It is perhaps, however, in the form of simple remedies that we shall best estimate the value of the medicines prescribed by the physician. Here the number is reduced to 171, and the order of things is somewhat changed. Mercury takes the lead, and stands prominently at the head of the list. Mercury, the very name of which strikes terror into the minds of nervous and timid patients, is still the foremost remedial agent employed by the medical profession.* After
** And yet,” says Sir Thomas Watson, “we are distracted by doubts whether the powerful influence it exercises on the body be for good or
mercury we have potash, then bark, then opium, and then iron. If we take twenty-five of these leading simple substances, as in the case of the compounds, we shall find that 95 per cent. of all the prescriptions written contain one or more of them in some recognized form. This, I think, brings the whole matter into the smallest compass, and places us in a position to offer such further brief comments as the subject may seem to require. (Chemist and Druggist.)
The Effects of Tight Lacing.
The Lancet thus sums up the evil effects of the fashionable custom of compressing the female thorax :
1. Tight-lacing seriously limits, indeed almost annihilates, the respiratory movements of the diaphragm; for the
1 pinch comes just on that portion of the ribs to which the great muscle of inspiration is attached, and squeezes them together so as to throw it almost or altogether out of work. 2. The constant pressure of the corset on the muscles which should support the spine gradually impairs their nutrition, so that they are no longer able to do their work, and the victim of tight-lacing feels wretched the moment her artificial supports are removed. 3. The hinderance to breathing with the diaphragm tlırows the work of respiration chiefly, if not altogether, upon the upper intercostal muscles and the muscles of the neck, and a permanent condition of imperfect aëration of the blood results, causing general languor and debility. 4. The abdominal viscera, especially the stomach and liver, are violently squeezed, and driven downward from their nat. ural position; and the never failing result of this is impairinent of digestion and assimilation. This dyspepsia may or may not be attended by pain and other obvious symptoms; these generally exist, but their absence does not imply the absence of mischief. 5. The uterine functions are always
for evil in the diseases for which it is given.” Could anything be more eminently unsatisfactory, or more abundantly disheartening than this ? Of all the medicaments in the Materia Medica, the one which is most relied on, and most frequently prescribed for the cure of sickness and disease, is still so far a puzzle and a mystery to the medical profession, that it is not known "whether the powerful influence it exercises on the body be for good or for evil in the diseases for which it is given." Well, indeed, may the natural history of disease be asked for, and an investiga: tion into the physiological action of drugs be demanded, with a view of placing the whole therapeutical art on a surer and more scientific foundation.