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pressure with the thumb failed to occlude it ; and, as soon as I removed the aneurismal clot, arterial blood gushed forth in such quantities that I became disconcerted. I called out to the assistant to hold the artery ; but this was a mistake, as it simply caused the gentleman to push his thumb downward, off the artery, and the flow of blood was then such as I had never seen before. We thrust a napkin and a bandkerchief into the wound and succeeded in checking the hæmorrhage, but the man had become faint. It was now late in the day, it was growing dark, and I was far from home. What should be done? At last it was determined to undertake the difficult operation of tying the left subclavian artery, which, fortunately, was done with entire success. But, on the fourteenth day, the usual result came; first, a little leakage of blood along the side of the ligature, and then a little more, and still a little more ; but I hesitated, and did not do what should have been done ; namely, apply a ligature around the subclavian artery higher up.
DR. FIFIELD remarked that he did not believe that the assistant could have held the artery, even if he had had it in a vise ; and on this point he again quoted from John Bell.
DR. C. B. NANCREDE, of Philadelphia, referred to a case of popliteal aneurism, in which hæmorrhage could be controlled by pressure upon the deep femoral, but not by pressure over the pubis ; and he finally was forced to tie the vessel below. He thought pressure made at the point where Dr. Moore had proposed in his case should have controlled all the collateral branches, except, perhaps, one ; and he did not think that there could have been much, if any, hæmorrhage had the plan been carried out.
DR. MOORE remarked that he did not expect to control all hæmorrhage ; but he hoped to have time to introduce the finger into the opening of the vessel.
DR. GOULEY, in closing the discussion, said that he had listened with great interest to the quotations made by Dr. Fifield from the old master, John Bell, in which he had given us one more example of his excellent memory and great erudition. He trusted that, at a future meeting of the Association, Dr. Fifield could be prevailed upon not only to be present, but also to read a paper. Dr. Gouley then said that he had reported his case for the purpose of recalling attention to the old practice of incising, and sometimes of excising, diffuse aneurisms, especially those of traumatic origin. He thought that there was not so much hope in cases of arteries diseased from old age, although he must say that his results, after tying atheromatous arteries in old people, had been very good. He had never had to contend with secondary hæmorrhage in such cases, but the prospects were much more favorable in cases of traumatism of healthy arteries. In his case of diffuse aneurism, it was not his intention to remove the sac, but to make a linear incision, turn out the clots, and then to treat the case antiseptically. By antiseptics, he did not mean all the paraphernalia of Listerism, but simple cleanliness.
CHLORATE OF POTASSA; ITS ABUSES.
By H. O. JEWETT, M. D., of Cortland County.
Read by Title, November 20, 1884.
REMEDIAL agents belonging to the class of active poisons are usually prescribed and administered sparingly, and with a degree of care and precision which precludes the probability of frequent accident or injury from their use. Not so, however, with some of those milder remedies, possessing toxical properties in a less concentrated form; and these, being popularly regarded as safe and harmless, are far more liable to misuse which may be productive of serious, if not fatal, mischief. Hence it is that a thorough acquaintance with the nature and properties of the latter may become of great practical importance. Of this class of remedies is the chlorate of potassa, an article the use of which has become so general that, in some localities, it may be found, as a sort of domestic remedy, in almost every house. It is procured in quantity and prepared in the form of a saturated solution or a powder, to be used indiscriminately, without the advice of a physician, in the treatment of nearly all acute affections of the mouth and throat, from a simple cold to the most malignant form of diphtheria. Even when prescribed by a physician, the directions for its use have sometimes been so careless and indefinite that they might better have been omitted altogether. I have known patients directed to obtain five or ten cents' worth, to dissolve it in a goblet of water, and take it freely and frequently. It is easy to see how, if the druggist be quite liberal, and if the water in which it is dissolved be of the tem
perature of an ordinary sick-room, a solution of considerable strength may be obtained which, if taken according to the above directions, may produce very serious effects.
The compressed tablets, each containing about five grains of the salt, are much in vogue; and this I consider one of the most objectionable forms in which it can be used, as in this form the patient may take much more than he intends to use. I have known a patient consume ten or twelve of these tablets in the course of a single day or night. This excessive use of the drug can scarcely fail to produce mischievous effects. It is true that this salt is so sparingly soluble in water at a moderate temperature, and the dose required is so large that, unless it be taken undissolved, fatal effects can rarely be expected.
With the few fatal cases that have been reported in the journals, you are doubtless all familiar, as also with those instances in which it has seemed to aggravate, if it did not actually induce, an incurable form of albuminuria. This is a result which might naturally be expected. The chlorate, being readily and rapidly eliminated through the kidneys, acts as a direct and vicious irritant upon the delicate and complex structure of these organs, especially when they are rendered morbidly susceptible to such influences by the presence of such diseases as diphtheria and scarlatina. The value of chlorate of potassa as an adjunct to other means in the treatment of a variety of diseases, no one will question. In solutions of proper strength, it has been found to be an excellent lotion for burns, for scrofulous and phagedenic ulcers, etc. It is also useful in the treatment of the follicular stomatitis of infants and nursing women, of diphtheria, scarlatina maligna, and many other affections involving lesion of the mucous surfaces and a general septic condition of the system.
The theory advanced by Dr. O'Shaughnessy of its oxidizing effect upon the blood is, I believe, generally discarded. Equally fallacious is the theory that its free administration may avert the tendency to membranous exudation in diphtheria and croup. As an internal remedy, its therapeutical value is far from being well established. Its modus operandi is not so well understood and the indications for its use are not so clearly defined as in the case of most of the other salts of potassa.
It is, however, no part of the purpose of this paper to discuss the therapeutical value of chlorate of potassa, my object being simply to record and emphasize some facts illustrative of the evils resulting from its injudicious and excessive use. To this, as to all other medicinal agents, applies the rule,“ ubi virtus ibi virus." It has been believed that an inordinately large dose of this salt was required to produce anything like alarming effects; but recent experience has taught us that, under some circumstances, even moderate doses may accomplish this. Much may, of course, depend upon individual tolerance or the modifying effect of other morbific causes. The toxical effects of this drug are sometimes manifested by symptoms resembling those of acute catarrh, with, perhaps, the absence of coryza as a prominent feature. If the case be severe, there may be diffused inflammation of the mucous membrane of the whole buccal cavity, the posterior nares, the fauces, and the pharynx and larynx as far as can be seen. The parts about the glottis are moderately swollen. There is hoarseness of the voice and sometimes aphonia. The uvula is infiltrated and translucent. Instead of the salivation which is sometimes present, I have often noted a deficiency of moisture, the mucous membrane having a smooth, glossy appearance.
The digestive organs also suffer, as evinced by nausea, anorexia, and diarrhæa, with griping, colicky pains. There is scanty urine and dysuria, the urine sometimes presenting the coffee-appearance and containing albumen, blood-corpuscles, and epithelium.
The most troublesome symptoms have usually continued for from one to three or four weeks, leaving the patient to suffer for a much longer time with general debility, impaired digestion, and more or less disturbance of the renal functions.
The symptoms as above described imply a case of unusual severity, yet typical in its general features. While most of those cases that have fallen under my observation have been comparatively light, the analogy was sufficient to justify my diagnosis.