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of the malady, the time at which the medicine is administered, and the constitution of the patient. Now, my own experience, together with that of a number of physicians with whom I have conversed on this subject, induces me to believe that it is rarely necessary to administer more than 16 grains, in the intermission of a disease or in the remission of a fever-this quantity having proved, in a majority of cases, entirely adequate to arrest periodicity in any form. In some cases eight or ten grains will be quite sufficient. As regards the mode of exhibition, I greatly prefer the solution, not only because it is thus more easily absorbed, and more speedily produces its effect upon the system, but also because you are enabled to give the entire dose two or three hours before the expected paroxysm, and thus obviate the necessity of disturbing the patient's rest, which is generally done where the pilular form is preferred. The only instances which forbid the employment of the solution, are those of weak, nervous individuals, laboring under great gastric irritability. Now, inasmuch as I object to the use of quinine as a tonic, because there are other medicines which more ably subserve this purpose, and inasmuch as I entirely condemn its use as a sedative, owing to its deleterious action on the brain, I will cite a few cases which have come under my observation, proving its great power as an anti-periodic, not so much with the hope of presenting anything new to the profession, as with the desire of restricting the use of quinine within its clear, undoubted and rational sphere of action.
Case 1.-C****, æt. 35, was seized on the evening of the 29th of August with severe inflammatory rheumatism, involving the knee and ancle joints of the left leg. I saw him in the course of the evening; there was great constitutional disturbance; pulse 115, hard and bounding; tongue coated; constipation ; local pain intense. I immediately bled him to the extent of 3 xij; gave the following:
R Hyd. chlorid. mit. pulv. jalapæ, aa. gr. v, morphia sulph. gr. $, and had the limb wrapped in flannel wrung out of hot vinegar.
Aug. 30.—Had not slept; pain lessened; medicine had acted once ; pulse 112. Ordered six cut cups to the lumbar spine, and R Magnesia sulph. 3 ss, magnesia carbonat. vin.
rad. colch. aa. 3 i, syp. aurant, cort. 3 ss, aq. carbonate 3 vi, M. S. 3 i sum. ter die.
Aug. 31.—Better in the morning, but again seized at night with all the symptoms as violent as at first; repeated the cups to the spine, directed the colchicuin and magnesia to be continued, and gave an anodyne.
Sept. 1-Did not sleep until towards morning, when the pain abated, and the pulse fell to 100, but rose again in the evening to 112, with a recurrence of the pain. Seeing this disposition to remit, and learning moreover that he had been exposed to the influence of malaria, I determined to use quinine. On the following morning I gave him, R Quinia sulphat. gr. xv, aq. camphora 3 ij, tinct. digitalis gtt. xv, syp. zingiber 3 ij,
M. Fiat haust. Had no rise of fever. Sept. 3—Pulse 75, skin cool and perspirable ; tongue clean; complains only of a little soreness in the affected joints.
Sept. 6—Quite well.
Case 2.-F****, colored woman, æt. 28, seized on 7th of August with complete retention of urine, which at first I was disposed to attribute to “retroversio uteri” or “prolapsus." An examination convinced me that neither was the case, nor was there any derangement of the pelvic viscera. She was relieved by the catheter, and took the following: Ķ Fol. uvæ ursi, 3 ij; fol. diosmæ 3 ss.; bac. junip. cont. 3 ij; aq. bullient Ojss; strain and add soda bicarbonate 3 ij; S. Wineglassful every two hours. Aug. 8—Retention continues; relieved by the catheter; secretion abundant; took R. Tinct. ferri chloridi 3 ss. S. gtt. x, quater die. August. 9—Quite well. August 10-Retention again relieved by the catheter; ordered the drops to be continued. August 11–Micturition easy; secretion copious. August 12—Complete retention. Here was a remarkable case of periodical" retention. On the following day I gave her R Quiniæ sulphat. gr. xij; aq. distillat. 3 ij; acid. sulph. gtt. ij; tinct. digitalis git. x. M. Since which time there has been no recurrence of this troublesome affection.
Case 3.-Sept. 19—Called to see Mrs. G****, æt. 21 ; found her with facial neuralgia, which had tormented her for several weeks—face much swollen, great tenderness on pressure; wished to have the nerve divided, which I declined doing. Applied a solution of camphor in chloroform locally, with considerable relief. Sept. 21-Pain as violent as ever; ordered R: Pulv. rhei. gr. x; magnesia cal. 3 j, and the following cerate : R Morphine sulph. gr. ij; cerat. simp. 3 i. Sept. 22– Swelling, pain and tenderness greatly diminished. No fever; appetite good. Sept. 23—Pain agonising; skin hot and dry; tongue coated; ordered a mercurial cathartic and continued the cerate with warm applications. Sept. 24—Pain dull; skin cool and moist, pulse 80. Gave R Magnesia sulph. 3 ss. quiniæ sulph. gr. xv ; aq. distillat 3 ij; acidi sulph. gtt. ij; tinct. digitatis gtt. x ij. M. Sept. 25—Slept well; pain gone, and up to this time has had no return of this painful malady.
Case 4.-Mr. M****, attacked with symptoms of acute dysentery on the 18th of October, which, however, did not confine him to his bed. Applied to me on the 21st-could not trace the disease to errors in diet-ordered a laxative, and then
gave the following: R Pulv. opii. gr. vi; plumbi acetat. gr. x ij; acidi tannici gr. xxvi; mel opt. q. s. ut. fiat. mass, in pill xij. Dividenda, Š-One every three hours. Saw him again on the 27th; had been twice temporarily relieved by the pills; was now troubled with rise of fever every night, great tormina and tenesmus, with spasm of the rectum. All of these symptoms subsided entirely during the day. At 4 o'clock in the afternoon he took R. Quinia sulphat. gr. xij; aq. camph. 3 ij; tinct. digitalis gtt. x. M; and at night the following enema: R Mucil acaciæ 3 ij; tinct. opii. 3 1. M. By these means the fever was prevented, the spasm allayed and the dysentery cured.
These cases amply suffice for the purpose of illustration.
It will be seen that in the treatment of the above cases I have employed digitalis and camphor in combination with quinine; the object of this being to prevent the disagreeable nervous sequelæ which follow the use of quinine alone. For this I am indebted to my friend Dr. Worsham, of Dinwiddie; and my own experience fully corroborates the truth of his statement.
Remarks on the Fluid Extract of Ergot.
BY JOSEPH LAIDLEY, PHARMACEUTIST, OF THE CITY OF RICHMOND.
Ergot is an agent of so extensive therapeutic application, and of such asserted value in the treatment of some of the most delicate and critical cases which come under the obstetrician's care, that it becomes a matter of the most serious importance to secure the medicine in such a form as will render him confident that the remedy possesses all its active properties perfect and unimpaired. It is to bring before the notice of the medical profession such a preparation—the fluid extract of ergot—that this article is written. As a pharmaceutist, it does not become the writer to dwell upon the medical properties of the drug. His legitimate business is to gain a knowledge of the chemical characters so far as they are known, and satisfy himself of the purity of his drugs, and to prepare, in conformity with this knowledge, a preparation which will fully represent the drug, and will retain its virtues unaltered for å reasonable length of time.
Ergot has, owing to the inefficacy of its preparation, generally been administered in substance; but to this form there
are objections, viz: the bulk and nauseousness of the dose, the uncertainty that the ergol was good before powdering, that the powder was recently prepared ; and often is the inconvenience of powdering it while the patient is waiting experienced. Ergot is exceedingly prone to undergo change. It cannot be fresh at all seasons of the year; and unless it be very carefully preserved, it soon attracts moisture, swells up, becomes softer, and then suffers greatly from the attacks of insects; in proof of which, Pereira mentions that in four months seven and a half ounces of foecal matter from these were formed in seven pounds of ergot—(Pereira, Mat. Med. vol. 2, p. 67.)
When we remember that the acarus which preys on ergot is only one-fourth the size of the cheese mite, it will be evident that the number of insects necessary to produce so much excrementitious matter in so short a time must have been very great.
For preserving the powder various methods have been suggested, but they are mostly either so troublesome or expensive as to be now seldom resorted to. Having thus considered the difficulties of preserving ergot itself, the importance of having a good preparation of it that will keep becomes manifest.
The preparations heretofore employed have been the (solid) extract, decoction, injection, tincture, syrup, compound powder, pill
, wine and the oil. Pills and the extract are only suitable for administration in such cases as require the continued use of the medicine; being solid, they do not exert their influence speedily enough for cases of labor; besides, not one of the above preparations
fully represents ergot. We are as yet unacquainted with the active principle of this medicine. It was supposed to be the oil; but this view has been shaken by the fact that the oil, when obtained by simple expression, is inert; but when procured by treating ergot in powder with ether, and allowing the latter to evaporate spontaneously, the resulting oil possesses in some degree at least the properties of ergot, shewing that the oil, when obtained by means of ether, probably contains some of the active principle dissolved in it, but is not itself that principle. Again, it was thought by others that in the extract (sometimes, but erroneously termed ergotine) resided the active principle; but this view has given place to the belief that while it possesses some activity, yet it is not the active principle. While this subject is invested with so much doubt, there seems to be but one proper course to pursue in making a preparation of the drug—that is, to make a medicine that will exactly represent ergot in its natural form. This the author has done. He was desirous of offering to the obstetrical practitioner a medicine that will relieve the latter of the difficulty he has labored under when prescribing ergot, caused by the uncertainty of the drug itself, (owing to age or other cause,) or of weak preparations made from, probably, an equally uncertain article. In fulfillment of this desire the fluid extract is offered. It is prepared by treating fresh and good ergot in powder first with ether, allowing the latter to evaporate spontaneously, thus securing all the oil; then with alcohol, and lastly with water; the last two liquids are evaporated below 2120 until the fluid measures one-third as many fluidounces as the ergot employed weighed in troy ounces; sufficient sugar is added to preserve it, and the oil is then thoroughly incorporated, and sufficient water added to render it of such strength that one fluidrachm (one teaspoonful) will represent 40 grains or about two doses of ergot.
Prepared as above, fluid extract of ergot is in the form of a concentrated syrup, possessing the advantages of being pleasant to take, of being always ready for use, thus avoiding the delay sometimes attendant upon administering a medicine where delay is so hazardous as in labor. The smallness of the dose is another recommendation in its favor. The writer believes that it will keep unchanged for a long time. Some in his possession, after having been kept for about two months in a moderately warm situation, is entirely unchanged. Some of this preparation was furnished to Dr. C. S. Mills of this city, who tested it in a case of labor about the middle of No vember. He informs the writer that it proved entirely satisfactory; its action was almost immediate and produced no nausea.
A Case of Polypus Uteri successfully removed with the
double canula and ligature.
BY JOHN P. METTAUER, M. D., L. L. D. Professor of the Principles and Practice of Medicine and Surgery, &c. in the
Medical Department of Randolph Macon College, Virginia. The subject of this case was ætat. about 31, originally of good constitution, rather tall and fleshy and healthy. At the age of 20, her catamenial flows manifested a disposition to become mennorrhagic, and this tendency progressively increased until her marriage, which took place in her 25th year. The catamenial fluxes became so profuse ultimately before her marriage, as to enfeeble the health in marked degree. After marriage, and during the first pregnancy, the health improved greatly, and the term of uterogestation was completed without anything untoward taking place. Her recovery, too, after confinement, was fortunate, nothing having intervened