REMARKS.

Dr. E. M. MOORE, of Monroe County.-I know these addresses are not open for discussion, but I would like to simply confirm a remark Dr. Janeway made of the peculiar prophylactic power of vaccination where there had been exposure to small-pox; and also to confirm his own suspicion that three days is too long.

During the war we had an outbreak of small-pox in St. Mary's Hospital, in Rochester. It came suddenly, and we removed the patients as rapidly as possible, but there were still some in the ward. A young recruit nineteen years old, unprotected by vaccination, was out on leave of absence, and not knowing his whereabouts, we were unable to warn him not to return, for he was due that day. Thus it was that late in the evening he slipped into his bed without our knowledge. Therefore, he was exposed during that night to the contagion of small-pox. In the morning I saw him, and about ten o'clock I introduced some bovine matter into his arm and it took beautifully-I think I put in three points, to make assurance doubly sure. Well, he had just about fifty small-pox pustules over his body. So then, you see, he was exposed these few hours-say about sixteen-and it was just time enough for the variola to come in ahead.

A CASE OF POISONING BY TWO GRAINS OF STRYCHNIA. TREATMENT BY CHLORAL HYDRATE AND COFFEE.

By WILLIAM FITCH, M. D., of Tompkins County.

Read November 19, 1885.

I was called April 1, 1881, at 11.30 P. M., to visit Mrs. aged thirty. The messenger said that she had taken poison, but was ignorant of its character. After a short delay caused by procuring antidotes for arsenic, opium, and strychnia, I arrived at the house of my patient, which was about a distance of seventy rods from my office. I found her in a quiet frame of mind, although she said that she had taken two grains of strychnine in milk with suicidal intent. I was informed also that prior to my coming she had been seized by three or four convulsions. I immediately dissolved twenty grains of chloral hydrate in sugar and water, and ordered strong coffee with sugar and cream. Before I could administer the chloral she had tetanic convulsions of greater severity, so I was told, than any before. Her breathing was now stridulous, and she became pulseless at the wrist. Life seemed to be suspended for a short time, but she soon gasped for breath, and pulsation became perceptible. After having sufficiently rallied to take the chloral hydrate, she, within twenty minutes afterward, had another paroxysm, but it was much mitigated in severity. I then gave twenty grains of chloral in the same manner as before, followed with three or four ounces of the strong coffee. A third paroxysm ensued in twenty-five minutes thereafter, and I followed it up with twenty more grains of the chloral and another dose of coffee. A manifest improvement was soon observed, in the less rigid condition of the body generally. The fourth convulsion, which followed within twenty-five minutes, was of shorter duration and less severity. The same treatment was continued. It

now being 1.20 A. M., and while about repairing to my office to replenish my stock of chloral, she begged me not to leave, but after a full explanation she consented. Immediately after I returned she had tetanic convulsions, though of much less severity than before. I now administered thirty grains chloral again with coffee. About 2 A. M. my patient requested that the attendants leave, as closing of doors, coughing or sneezing might bring on a return of the spasms. At 3.30 A. M. she had a slight paroxysm, again of short duration. I administered thirty grains of chloral, in the same manner as before, with the best result, for the spasms returned no more. Three and a half hours after the first dose of chloral all symptoms of poison had disappeared, so that my patient slept most of the time until 7 A. M. She made a rapid recovery, experiencing not much annoyance except the muscular soreness usual to such violent contractions. I gave my patient, it will be noticed, about one hundred and forty grains of chloral hydrate in four hours, and with the most gratifying results.

Since I commenced using chloral hydrate in my practice, which was in 1870, to avoid the acrid taste and gastric irritation, which often cause vomiting, I have given it largely diluted in sugar and water, followed with coffee, if obtainable, or milk, when the patient has not taken food in three or four hours. Vomiting, I have found, seldom occurs if coffee is given immediately after the chloral.

Dr. Thomas Stevenson says, if convulsions have already set in, the use of the stomach-pump is out of the question. An emetic of warm water, with mustard or carbonate of ammonia, should be given without a moment's delay, followed by large doses of bromide of potassium; even half an ounce in one dose has been given.

In the case which I have just related, emetics would have lost valuable time for my patient, as she had taken no food since early in the morning, and the poison would have destroyed her before the antidote had produced any effect.

Also, as bearing upon the case in question, I may refer to one reported in the "Medical News," of Philadelphia, February, 1873, which is as follows:

"Dr. S. S. Turner, of Grand River, Dakota, was called at noon to see L―, age forty, who was reported to have been poisoned with strychnia by his wife. All the symptoms ascribed to poisoning by strychnia were present and well marked; quantity given unknown. Gave chloral, thirty grains; in about thirty minutes there was marked abatement in the severity of the convulsions, and improvement in vision. In thirty minutes more a violent convulsion ensued, and fifteen grains of choral were given with the effect, in a short time, of inducing freedom from convulsions, which lasted half an hour. Afterward, convulsions again returning, he gave chloral thirty grains. Relief followed quickly, and the patient remained tranquil three hours, when, slight spasms recurring, another dose, thirty grains, was administered. No further convulsions occurred. The patient slept all night, and the following day complained of muscular soreness."

In the above case, Dr. Turner gave one hundred and five grains of chloral hydrate in four hours with satisfactory results.

These doses of chloral may seem excessive, but "Dr. Joseph R. Beck records ('St. Louis Medical and Surgical Journal,' 1872) a case of traumatic tetanus in a railroad employé, to whom he gave chloral hydrate in doses of sixty grains every half hour, until seven doses were taken, when he fell asleep and slept for thirty hours without moving. When seen by Dr. B—, half an hour after he awoke, he said he felt as well as ever, with the exception of muscular soreness. He had no subsequent spasm, and no further treatment. The effects of the chloral were nil; the wounds healed rapidly. He took four hundred and twenty grains of chloral in three and a half hours."

By way of comment I may quote Dr. Kobert,' who gives a review of three memoirs of Husemann and others on this subject. The first of these, by Husemann, in collaboration with Krüger, treats of the antagonism of chloral and strychnia. The following are the conclusions arrived at: 1. There is no recipro

1 "American Journal of Medical Sciences," April, 1882. Article: "Antidotism," p. 608, from "London Medical Record," Jan. 15, 1882, in which "Schmidt's Jahrb., Jan., 1881, and "Arch. für exper. Pathol. u. Pharmakol.," Band vi, p. 335, Band ix, p. 414, Band x, p. 101, are quoted.

cal antagonism between strychnia and chloral (in the sense that the action of either poison is annihilated by the other). 2. When toxic doses of strychnia and chloral are given simultaneously, the action of the latter predominates, and the symptoms of depression are observed. 3. There is, however, a unilateral antag onism in this sense, that the animals (rabbits) poisoned with strychnia may be saved by a non-toxic quantity of chloral, but yet sufficient to induce profound sleep. A cure may be effected, even when five or six times the fatal dose of strychnia is given; but, beyond this, death supervenes, though this is retarded. 4. Small hypnotic doses of chloral are insufficient to save an animal poisoned by a quantity of strychnia appreciably greater than the fatal dose. 5. Chloral, when employed in sufficient doses, has proved efficacious in the case of men poisoned by strychnia. It is preferable to other counter-poisons, as morphia, Indian hemp, and chloroform, some of which exert their action too tardily; and others, such as curare and potassium bromide, have the defect of leaving the patient conscious, and thus exposed to the moral tortures which assail him. 6. The favorable influence of chloral in acute strychninism can not be explained by direct action upon the parts of the central nervous system, which the strychnia has placed in a state of exaggerated excitability. It may be attributed, in great part, to the lowering by the chloral of the activity of the parts which conduct the excitation to the spinal cord. It thus prevents the too frequent repetition of tetanic spasms, and diminishes the danger of death which they involve. In nearly every case, the duration and intensity of the attacks have been notably diminished. 7. In the treatment of strychnia poisoning by large doses of chloral, a considerable diminution of the frequency of the respiratory movements is constantly observed; on the cessation of such attack, nevertheless, the respiration is accelerated. There is thus a diminution of the normal temperature.

The other propositions of the article refer mainly to chloral poisoning, and the ground is taken that strychnia can not be employed in such cases as an antidote.

"Husemann," continues the article, "has sought to render