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We look on with sorrow and pass resolutions in our medical societies to condemn the use of intoxicating liquors, many physicians pledging themselves to withhold it and not to prescribe nor allow its use in their practice. Nevertheless, the same men will prescribe morphia, opium, hydrate of chloral and its kindred preparations, and by so doing they excite and encourage a malady that is as dangerous and destructive as that induced by the use of spirituous drinks can possibly be. The difference is only the one makes a raving maniac, carrying snakes in his boots, causing the committing of murder and crime, sending men to the gallows and penitentiaries. The others the morphia and opium make their victims become downright fools in many instances, perfect blanks in this world; filling our insane asylums, bringing misery and despair, not only upon themselves, but on those with whom they associate, or are connected. In the face of all this let me conclude with a word of caution, which may be well worthy our honest consideration, and may be well formulated in a few words: "Use morphia but seldom; and use as little as possible."
DIGITALIS WITH SUICIDAL INTENT.
By ROBERT A. Reid, M. D., Boston, Mass.
Every now and then emergent cases arise when the practitioner needs his wits about him, but we can imagine no circumstances which could be more painful than to be called to a case of poisoning, either intentional or accidental, and not know what to do; for in such cases not only must the right thing be done, but it must be done quickly. Cases of cutthroat or suicidal attempts with morphia, strychnia, arsenic, or other well-known poisons, are not so very uncommon; but the following case which came to our notice some months since is the only one, in our experience, where Digitalis had been employed as the instrument of death.
The would-be suicide was a woman, unmarried and about fifty years of age. She was exceedingly intelligent and till
the past few years had been greatly esteemed for admirable traits of character, as well as for rare personal charms. About five years prior to her rash attempt she had attended and cared most assiduously and tenderly for a sister who had died from phthisis; since which time she had been regard as decidedly "queer." The first manifestation of mental disturbance noticed, was her obstinate refusal to talk concerning the deceased sister, to whom she had been devotedly attached, or even to allude to her. She most adroitly evaded all attempts to lead her to in any way show that she remembered that such a person had existed. When her mother inquired, with a purpose, who had made a certain article of fancy-work, instead of replying: "Lucy"-the deceased sister-she would say; "It was made here in the house." Having never manifested anything more than similar eccentricities, refusing to see former friends, adopting a few set questions which she propounded each day to everyone whom she saw, she was not deemed "dangerous." Nevertheless, as a wise precaution, all articles which could be used for self-injury were kept from her, and she was never left alone.
Her mother, aged eighty-six years, was supposed to have fatty degeneration of the heart and suffered from occasional attacks of dyspnoea, and had been advised by her physician to procure a vial of tincture of Digitalis and take a few drops each day. This she had done at intervals for years, and apparently with more or less benefit. Watching the opportunity, the daughter obtained the bottle, a two-ounce vial, from the sideboard, and drained its contents. It is uncertain just what quantity was taken, but the vial was said to be full-probably about two ounces. When seen she was partially collapsed. The radical pulse was slow-about 30 per minute, irregular and almost imperceptible. There were large alvine evacuations, nausea, vomiting, loss of vision, and faintness almost to syncope. The prospect altogether seemed a gloomy one, though complete restoration finally took place.
Such cases are not very common, and yet as Digitalis is used so commonly and carelessly, and has, as is admitted on all
hands, a cumulative action, the most alarming symptoms may arise without any warning and without increase of what was deemed a safe dose.
In such a case we should endeavor to wash out the stomach, hoping to remove any of the drug unabsorbed, or not yet ejected, if vomiting had occurred. Not every physician has a stomach-pump at hand, but an effectual substitute may be improvised by taking a piece of rubber-tubing a few feet long -five or six-and introducing one end into the stomach, the other end being held above the head, and water poured into it through a tin funnel, the spout of a coffee-pot, or other device. If, after the stomach is nearly full, the tube be pinched while distended with water, and the external end placed below the level of the stomach, it will act as a syphon and empty it. Nothing else being at hand an ordinary rubber enema-apparatus with a bulb in the centre, will fill the bill if the valves be removed, or, as is apt to be the case, they are out of order. A point worth remembering, when the pump itself is used, is that a little water should be introduced before an attempt is made to empty the stomach. Failing of any of these appliances, resort must be had to an emetic; and the question is seldom which is the best, but which can be first obtained. Some people vomit readily enough and with them a drink of tepid water and the introduction of the finger or a feather into the throat will answer; but most persons require something more, and in their cases mustard-a tablespoonful in a half-pint of water-will prove most useful, besides having the advantage of being always at hand.
Digitalis kills by paralysis, or spasm of the heart, which is found rigidly contracted. Stimulants, alcoholic and ethereal, are our best means of opposing this, and if not retained by the stomach they should be introduced into the rectum or injected subcutaneously. There is also a tendency to fatal syncope, which is especially apt to occur when the patient attempts to make any exertion, even to sit or stand up. In fact, patients under the full influence of Digitalis, which is sometimes purposely and unwisely (we think) induced, are only safe when in a horizontal posture, and this should be maintained for a time after all symptoms have subsided.
It is no easy matter to say positively what is the fatal dose of Digitalis, as much doubtless depends on the patient's age and condition, the condition of the stomach as regards food, the occurrence of copious and early emesis, and the strength of the preparation. The probabilities are that considerably less than two ounces will destroy life with much certainty, though this is not the only case where recovery has taken place after such a dose. No doubt Digitalis has its uses, but it also has its dangers, and in our opinion the latter far outweigh the former. We find it possible to practice without it.
ANCIENT NOTES ON CONVALLARIA MAJALIS.* By RICHARD E. KUNZE, M. D., New York City.
The Lily of the Valley, for the past two years, at most, has attracted the general attention of the medical profession as a new (?) remedial agent. And while manufacturing druggists are straining their optics in the direction of the cardinal points of the compass, with a view of bringing to light some new remedies, when we come to study up some of their "finds," it is quite interesting to discover how very ancient indeed not a few of them seem to be.
This most delicate of early spring-flowering plants, is indigenous to both Europe and Northern Asia, and is much cultivated in every temperate clime as a garden plant. When on the twentieth day of May, the first bloom of some lilies of the valley growing in a modest corner of the garden back of my office greeted my sight for the first time this year, some of the earliest recollections of my boyish strolls in the Thuringian vales and on forest-clad knolls were vividly flashed before my mind again. And while contemplating, the thought struck me, that it would be an opportune time to write up an article in honor of this sweet emblem of innocence and modesty, a title which Convallaria majalis has earned for itself in the language of flowers.
To the little I personally know about this Lily of the Valley, I shall add much that was known to others centuries ago,
Read at the West-Side Medical Society, June 7, 1883.
if only to verify Solomon's saying, that there is nothing new under the sun. After briefly referring to the æsthetic and economic value of this plant, I will give the popular side of the question so far as it relates to its medicinal value, and lastly, refer to a number of ancient herbalists, whose bones for centuries have rested under the sod.
For more than a year, medical journals have eagerly snatched up every article relating to this supposed new remedy, the same as a hungry dog would a bone without masticating, and still the hunger of our therapeutists seems not to be satisfied until everything shall be known about this agent. I shall soon expect to see them fight for the honor of having introduced so old a remedy into the New Continent, and I hope that no one will dispute the precedence of the most "Ancient of Schools" in that direction.
Convallaria Majalis L. inhabits the copses of vales and shady mountain slopes. In Germany, where it is known as the May-flower, May-bell, etc., on account of its flowering in May, little peasant-girls may be seen coming into towns and cities every morning, offering baskets full of this sweetest of all the lilies, tied up in large bunches, at less than one cent a bouquet, which here in New York would cost from half to one dollar each in a glut market of flowers. Hundreds of thousands of the roots of Lilies of the Valley (called "pips" by cultivators) are annually imported into this country from the Saxon duchies, to be forced into bloom for the holiday trade. At such a time of winter a single spray of this flower sells at florists' establishments at from fifteen to twenty-five cents apiece. But the plants are cultivated here, too, so that in some localities Convallaria Majalis, has escaped from the gardens and become naturalised like any other foreign intruder.
Poets have long sung the praises of this frail little plant, whose tiny, white, bell-shaped flowers adorn the forms of living as well as of departed friends.
"Ye loftier Lilies, bathed in morning's dew,
Of purity and innocence renew
Each lovely thought;—and ye, whose lowlier pride
In sweet seclusion seems to shrink from view
You of The Valley named, no longer hide
Your blossoms meet to twine the brow of purest Bride.”—Barton.