amination disclosed two enormous hypertrophied follicular masses, occupying the lateroposterior angles of the pharynx, each about three-fourths of an inch in length, of the thickness of a lead-pencil, and jutting inward and forward from_behind the corresponding posterior pillar. In the normal state a whole chain of muco-lymphoid follicles ranges along in this location, and it is the hypertrophy of this entire row of glands on each side which is the chief feature in the case. TREATMENT. For the purpose of destroy ing these growths by the galvano-cautery an electrode was extemporized by uncoiling the wire end of a Fleming moxa-electrode, thus converting the coil into an elongated loop. This was so curved as to accurately approximate the mass. The loop heated instantly to a white heat by the action of the battery; produced its slough with but little pain and no hemorrhage. After several operations, performed at proper intervals, the growths were entirely removed. CASE II. Follicular naso-pharyngitis or adenoid vegetations at the vault of the pharynx. Operations by the galvano-cautery écraseur. The symptoms were those of post nasal catarrh. Examination, in addition to morbid conditions of other parts, revealed numerous hypertrophied follicular masses-socalled adenoid vegetations covering and filling up the vault of the pharynx; some of these appeared in the rhinoscopic mirror as pendant pear-shaped bodies, others were sessile, and still others had the appearance of several cockscombs crowded together. TREATMENT.-Removal of the hypertrophied masses is the only satisfactory means of relief. This he first sought to accomplish with a Lowenberg cutting forceps, but the effort resulted unsatisfactorily. The cold snare and other methods were tried and abandoned, until finally he found that the object could be attained most easily and with the least pain and inconvenience to the patient by means of a galvano-cautery écraseur. He constructed an écraseur for the case by bending a fine pair of straight tubes, threaded with a platiuum loop, to the proper curve to pass behind the velum palati and touch the hypertrophied mass. The naso-pharynx was sprayed with cocaine solution. Guided by the rhinoscopic image he introduced the écraseur and caused it to encircle one of the growths, then connecting the battery, the loop, heated instantly to redness, was as rapidly wound in on the windlass, and the vegetation thus severed at its base. There was no pain, no hemorrhage, and but little subsequent irritation. The op erations were repeated weekly until the growths were entirely removed. CASE III. Malformation of the anterior pillars of the fauces. The symptoms were a sense of constriction in the pharynx and snoring. The malformation discovered was of the anterior pillars, i. e., of the palato glossal folds. These originated properly in the ve lum, but increasing in breadth they covered the tonsils, and then a part only of the fold a considerable portion of the inner surface of the side of the tongue, the larger portion continuing in the normal pathway forward to swept backwards and incorporated itself with the posterior pillar, forming a thick band which continued downward in the latero posterior angle of the inferior-most portion of the pharynx. sil, together with the portion of the anterior TREATMENT. The overgrowth of each tonpillar which covered it, was excised by means of the galvano cautery ecraseur, and at the same time the abnormal attachments of the anterior pillars to the pharyngeal wall were severed. CASE IV.-Membranous occlusion of the posterior nares. plete obstruction of the left nasal chamber, most violent headaches, vertigo, left sided deafness and fetor of the breath. A tense membrane was found to cover the left choana almost completely, and another to partially occlude the right choana. These membranes were incised by the galvano-cautery knife electrode, properly curved, and introduced from behind. Complete relief to all symptoms. Certainly the galvano-cautery can be abused, and a word of caution is not unnecessary in this respect. Accurate diagnosis, precise indications for its use and a certain amount of skill on the part of the operator are essentials to its judicious employment. The Fleming battery has advantages over any other that he has seen, not the least of which is the arrangement by which the plates may be immersed and withdrawn from the fluid by means of a pedal easily manipulated by one foot. DR. F. O. STOCKTON, in opening the discussion, said: I have listened with a great deal of pleasure this evening to the paper; the cases are all very interesting. It does not seem necessary to spoil an electrode in order to make one for a special case; it seems to ine that the ordinary flat electrode, by simply bending it down, would answer the same purpose. The trouble is we must have new instruments for every case that comes up. Unfortunately all practicing physicians, many of them who understand the throat and nose, are not so situated that they can run into an instru ment maker's establishment at any time and have an electrode made, and I think it is wise to keep down to the standard instruments which can be bought at any time, and which are always at hand. Another point I would like to speak of is the idea that follicular pharyngitis and adenoid vegetations are one and the same thing. Some authors consider them the same and others do not. Bosworth, of New York, claims that follicular pharyngitis and adenoid vegetations are one and the same. The battery which Dr. Casselbery shows is the one I have used in my practice for three years. I have tried a number of others, and found this one the most satisfactory. A short time ago I saw a modification of it which I think is a little better; it was devised by Dr. Sajous, of Philadelphia, but it is not on the market at present. Many of our prominent writers have rather discouraged people from using the galvano cautery, as they say it requires a great deal of skill and knowledge, not only of the anatomy of the part we are working upon, but also of electricity and the management of instruments. Dr. Morell Mackenzie, of London, makes that objection to the galvano-cautery; in fact, he says that all, or nearly all the operations can be performed by simpler means. Dr. Cohen, in his last work, also refers to the difficulty of managing it, but, I think if they had used the instruments of to-day they would not have found that difficulty. [TO BE CONTINUED.] CORRESPONDENCE. LYONS, IND.. Oct. 15, 1886. Editors Review: I received your sample copy of journal of Sept. 18, and am much pleased with it. I was specially attracted by an article on the Influence of Malaria and Quinine upon Pregnancy and Parturition in your editorial. I will say I live in a section where the malaria is strong. I have been in practice here about ten years, and have had fair opportunities of observing the effects of malaria and quinine upon pregnancy and parturition. The results of my observations are as follows: 1. That malaria has a strong tendency to produce premature labor. 2. That quinine, when malaria is present, does not produce uterine contractions, the effect of the drug being expended in some other way, or the nervous system is not so susceptible to its effects, or probably both. 4. That the effect of labor is to aggravate and prolong an attack of malaria, and also that parturition occurring during an attack of malarial fever is more liable to be followed by dangerous complications. So often does this occur, I am always in dread until they pass the fifth or sixth day. The most common complication in the warm months is peritonitis, Yours respectfully, Jos. MULLANE, M. D. NOTES AND ITEMS. "A chiel's amang you takin' notes, And, faith, he'll prent 'em." -"A Homely Cough Mixture."-I have not for the past five years found a cough among my patients, no matter what the age or what the cause, whether bronchial, laryngeal, pneumonic, tubercular or nervous, that did not receive more or less benefit from the free administration of a mixture prepared as follows: One pint bottle of Nicholson's or Hoff's malt extract; Whiskey (best), six ounces; Juice of six lemons; Crush sugar, two ounces, Mix and boil ten minutes. Dose, from one to two teaspoonfuls to one or two tablespoonsfuls, according to age, every one, two or three hours as may be indicated. Prepared in this manner we have a most excellent expectorant cough mixture for general domestic use, containing nothing to disturb digestion, no opium, no ipecac, as do most of the stereotyped cough mixtures in the shops. The glycerine and malt are both beneficial to nutrition, as well as expectorant; and the same may be said of all the component parts of the combination. The amount of the lemon juice may be increased, according to the preference of the patient. I am free to say that in over two hundred and fifty families of this city, where I am the physician, this cough mixture is found indispensable. In my own family nothing else has ever been found necessary to control, relieve and cure the coughs incident therein. I. N. LOVE. -Prof. John V. Shoemaker, of Philadelphia, has returned from a trip abroad. He was in attendance upon the annual meeting of the British Medical Association at Brighton. He visited Paris, Berlin, Vienna and all of the European points of interest, and reports an active interest 3. That pregnancy does not confer immunity every where present on the part of the leading from the action of malarial poisons. men in the Ninth International Congress. I. URETHAN AS A PHYSIOLOGICAL ANTIDOTE muscles became completely relaxed. The TO STRYCHNINE. II. COCAINE IN ANGINA PECTORIS. III. THE TREATMENT OF CONSTIPATION BY MASSAGE. IV. ON THE HYPODERMIC USE OF IODIDE OF SODIUM. V. INSOMNIA IN THE AGED. VI. Two NEW DRUGS, ANTIFEBRIN AND ETHOXY-CAFFEINE. URETHAN AS A PHYSIOLOGICAL ANTIDOTE TO STRYCHNINE. Some very interesting observations have quite recently been made by Professor Coze on the subject of the physiological effects of urethan, and more particularly on its antagonism to those of strychnine. The first point is its extreme tolerance when injected subcutaneously, or into the peritoneal cavity. Eight to ten grains so injected did not set up any local irritation in the frog, nor did thirty grains in the guinea-pig. No symptoms of gastric irritation were produced by from 80 to 100 grains given by the mouth in rabbits. The effect of the drug on the blood appears to consist in an increase of the amount of oxygen (4 per cent); and the nervous exhaustion which follows its use may, perhaps, be attributable to the greater difficulty with which the blood parts with its oxygen in favor of the nervous system. Its influence on the tetanus of strychnine-poisoning was shown in the following manner: A frog weighing just next day, to the Professor's astonishment, the animal was all right again. This experiment was repeated many times, with larger and smaller doses of urethan; the effects were not so lasting with doses of less than five grains, but, if the tetanus returned, it could be almost instantly arrested by a further injection. A mixture of strychnine and urethan injected together gave rise to no tetanic symptoms, but rather to muscular relaxation. On the guinea pig, the effects obtained were the same, the animal being somewhat less amenable to the action of strychnine, oneeightieth of a grain of the drug was injected. simultaneously into two guinea pigs. A quarter of an hour later, both the animals being tetanized, one of them was injected (into the peritoneal cavity) with fifteen grains of urethan; the convulsions ceased, the respiration coming down first to seventy-two and then to forty per minute. The other animal, the check experiment, succumbed in twenty minutes to the effects of the strychnine. For a rabbit weighing two and a half pounds, the minimum fatal dose of strychnine is 1-120 of a grain. Accordingly, to one weighing three pounds, successive injections were administered, amounting to one-fortieth of a grain of the sulphate of strychnine, rapidly followed by a violent attack of spasm; the animal leaped and fell down breathless and in a state bordering on asphyxia. grains of urethan was then promptly introduced into the stomach, after a few artificial Fifty the aorta. Anginal attacks occurred as frequently as eight times daily, and were of the characteristic kind. He was obliged to keep his bed, but the attacks also occurred during the night, preventing sleep. The disease had lasted two years, and had not been much benefited by oxygen inhalation. Half grain doses of cocaine were prescribed, with the result that the attacks became less frequent and shorter, eventually disappearing. The patient died subsequently of an infectious disease. Another case was that of man, aged sixty-three, with mitral disease, aortic dilatation and general arterial sclerosis. Anginal attacks had occurred during the past six months upon physical or mental exertion, and were only subdued by morphia. Here, again, cocaine acted admirably, the angina ceasing after three days' administration. In a third case the patient, aged fifty-eight, presented marked arterio sclerosis. The angina disappeared after two days' administration of one-third of a grain four times a day. The respirations. In the course of a few minutes, the tetanic rigidity began to lessen, first in the hinder part of the body, respiration became deeper, and the animal fell into a quiet sleep. Two hours later the rabbit raised its head without any convulsion, and gradually recovered. The next day, the only symptom was a little weakness in the hinder legs, and, on the next day but one, the animal had to all appearances completely recovered. The contrary experiment was also made, the urethanized animal being injected with one-fiftieth of a grain of sulphate of strychnine, without the production of tetanus. All the experiments were repeated a certain number of times, but always with the same result. In other experiments, he administered a mixture of fifty grains of urethan with one-fiftieth of a grain of strychnine, and no spasm or rigidity followed. He pushed the strychnine to onefifth of a grain without any apparent effect; and even with a quarter of a grain, although a few symptoms manifested themselves, the animal did not die. On a dog weighing twenty-fourth case, a man about forty years of age, five pounds, one-fifth of a grain of strychnine was counteracted with seventy-five grains of urethan, and in twenty minutes the animal got up and walked away with some difficulty. The next day he was all right again. Dr. Coze suggests that clinical use should be made of the drug in conditions attended with convulsions, and more especially in cases of tetanus.-British Med. Jour. COCAINE IN ANGINA PECTORIS. was one of aortic regurgitation with marked dilatation of the aorta; and the administration of cocaine speedily cut short the anginal attacks, which had become severe and frequent. Prof. Laschkewitch says that the remedy produces slowing of the pulse, which gains in volume; at the same time the quantity of urine is increased. He thinks that by combining this treatment with that by inhalation of oxygen, which acts immediately in an attack, the anginal seizure may be arrested and its reappearance prevented. SAGE. Professor Laschkewitch (The Amer. Practitioner and News) has found good results from the internal administration of cocaine (in do- THE TREATMENT OF CONSTIPATION BY MAS ses one-half to one-third of a grain three or four times daily) in cases of angina. It does not cut short an attack, but diminishes its intensity, and after a few days' consecutive administration it gradually diminishes the force and duration of the seizures until they may wholly disappear (Rev. de Méd., August, 1886). He details four cases. One was that of a man, thirty-five years of age, the subject of aortic regurgitation and dilatation of In the introductory lecture to the course of Pharmacology and Therapeutics delivered at the Westminister Hospital Medical School, Dr. Murrell referred at some length to the good results recently obtained in the treatment of habitual constipation by means of massage. The method he employs is a modification of that originally introduced by Metzger and von Mosengeil. Pétrissage of the abdomen is of essential value, the manipulations being performed in the direction of the ascending, transverse and descending colon. It is usually associated with various forms of tapotement, for the production of which, the open hand, the partly closed hand, or its radial or ulnar border, may be ployed. Vibratory movements are resorted to in obstinate cases, and it was stated that the action was usually remarkably prompt and certain. The best results were obtained in cases of constipation associated with obesity, especially when the patient was unable to take much exercise. It probably acts in three different ways: given for a long time in order to obtain even here favorable results. To prevent an undue burdening and irritation of the alimentary channel, the alternate internal and hypodermic application suggests itself wherever large doses of the iodine salt are required.-Ther. Gaz. INSOMNIA IN THE AGED. D. L. C. Dana (New York Bulletin of Clin. Soc.) has found the information contained in the text-books upon insomnia in the aged to be but very slight in amount. Insomnia was not frequent in the aged, but when it was present it was sometimes very intractable. 1. By increasing the intestinal and other In his experience iron did not relieve the ansecretions. emia of the aged so as to produce sleep. Al 2. By stimulating the peristaltic action cohol with food was another remedy, and of the intestines. 3. Mechanically, by pressing the accumulated feces towards the rectum. The treatment is well known on the continent, and will, doubtless, in time be generally recognized in this country.-Medical Press, May 19, 1886, many recommended hot gruel with alcohol before going to bed. While alcohol will relieve some cases, there are others in which the insomnia was increased. The bromides and chloral, even when given in enormous doses, often failed to give relief. Opium was another remedy. Good results have been ob tained with a combination of cannabis indica ON THE HYPODERMIC USE OF IODIDE OF So- and codeia; from five to six minims of the DIUM. Dr. Arcari, of Mailand, as we learn from the Wien. Med. Woch., No. 4, 1886, is in the habit of applying iodide of sodium hypodermically in cases in which the internal use of the drug has to be suspended on account of resulting gastric irritation. He makes two injections daily, the dose ranging from four to fifteen grains. The results obtained by Arcari in syphilis with the hypodermic employment of iodide of Bodium were quite as satisfactory as with any other mode of treatment. The quantitative examination of the urine revealed that in the cases showing favorable results of treatment, the elimination of iodine proceeded slowly and scantily, while in the cases with negative results this elimination was quick and ample. This fact led Arcari to conclude that in the latter cases larger doses had to be fluid extract of cannabis indica with onesixth to one-eighth of a grain of codeia might be used. One fourth of a grain of the extract of cannabis taken alone sometimes might be effective. As a rule, however, the combination with codeia was preferable. Hyoscyamine was sometimes useful, but in nervous fidgety persons it would sometimes produce an actual delirium. Under ordinary circumstances the dose should not be increased above one fourteenth of a grain to obtain the desired effect. The effect of these remedies, he thought, had been increased by the addition of from two to three drops of tincture of aconite two or three times a day to relieve the tension of the blood-vessels. Tincture of valerian and compound spirits of lavender sometimes acted like a charm in relieving insomnia. Large doses (Di-3') lupulin were also often effective.-New England Medical Monthly. |