MEDICAL MISCELLANY. stomach alone or exists as a complication or Cocaine in Gastric Affections. BY WM. E. SHASTID, A. M., M. D., WICHITA., PROFESSOR OE ANATOMY AND CLINICAL SURGERY, WICHITA MEDICAL COLLEGE, SURGEON TO THE WICHITA HOSPITAL. Occasionally there will be found cases in the practice of every physician, in which, the stomach is so affected with nausea, that it resists almost all remedies, exhibited for its relief. There may be good reasons, in some of these, for not wishing to employ morphia hypodermically and after using local applications of mustard plaster, giving internally lime water, creosote, carbolic acid, bismuth, etc., and finding that not one of these relieves the obstinate condition, we cast about us for a more satisfactory remedy. In this exigency, nothing appears to be of more value, when the stomach can retain anything at all, than muriate of cocaine, in small, frequently repeated doses. Most cases are relieved by 25 to grain tablets of cocaine adminstered every two hours. One fiftieth of a grain usually produces a soothing and quieting effect upon the nerve filaments which form a network in the mucous membrane of the stom ach. 20 symptom of other diseases. I shall briefly enumerate several cases, in which this remedy has shown itself as possessing signal efficacy. M. C., age 12 years, has been subject for several years, to attacks of severe vomiting. produced by "biliousness." These attacks seem to occur at an average of about six weeks apart. After having committed some indiscretion in eating, intense nausea would follow and a part of the contents of the gall bladder would finally find its way to the stomach and produce a much more nauseated condition of that viscus, than ever. These attacks would last for some four or five days at a time and the only remedy, which seemed of value for quieting the stomach was small doses of calomel, until cocaine was tried. Cocaine, in tablets of grain, was given and acted in this case almost like magic and then by keeping the stomach quiet and the judicious employment of a diet of milk, these attacks were shortened to twenty-four hours and the vomiting entirely obviated. a L. L., age 18 years, had typhoid fever with very severe gastritis as a complication. Could retain scarcely any thing in the stomach, even milk or water seemed to superinduce violent attacks of vomiting. He had suffered many years with dyspepsia of an aggravated type. In this case grain doses of cocaine were given ten to fifteen minutes before the time of administration of medicine or food and the drug acted so nicely, that it was then given continuously every two hours, not only for its local effect but for its stimulating effect on the nervous system. This remedy was the one which acted best and in this case was If food or medicine is to be given at any specified time, it is well to administer the cocaine from five to fifteen minutes beforehand, in order that its quieting effect may be fully realized, before the food or medicine comes in contact with the stomach's irritable far superior to morphia, given subcutaneouswalls. ly. A very pleasant and agreeable way to give M. M., age 1 year, had had summer comthis remedy, is in the form of the tablets as plaint. At times during his sickness, has sufprepared by Messrs Parke, Davis & Co., and fered from violent vomiting and retching. Mr. John Wyeth. They are quite accurate in His mother informed me that she could cerdosage, pleasant to take and reliable as to the tainly tell when the attacks were impending. quality of the drug. Children take them as I ordered grain muriate of cocaine, as usual, easily as adults and, I believe that if they are about the time she expected the "spells" to not immediately rejected and time can be had begin. In the first instance, after it was tried for their comfortable solution, we have at our she succeeded in her attempt and the little command one of the best remedies in gastric fellow not only avioded his spells of vomiting troubles, whether the disease involves the but also seemed to be much improved in The strength. This treatment was continued and greater portion of the fluid contents. the troublesome symptom of vomiting there- following case occurred in my practice in 1883: after did not put in an appearance. I think Mrs. M., age 23, American; second pregnancy. that in his case the cocaine, even had a bene- I was called to see her March 3, at 7 a. m. ficial effect upon the duration of the disease; Labor pains had been coming on since 2 a. m. limiting it somewhat by its stimulating proper- Digital examination showed the os dilated ties and soothing effects, so that other medica- about the size of a silver half dollar. Another tion could be employed with ease and cer- examination was made in two hours. The os tainty. had dilated to about the size of a silver dollar. During the pain the bag of water presented at the os but the head presented at the superior strait (a vertex presentation.) About noon Of course in some cases, like other remedies, a large amount of fluid escaped. Upon exit fails in producing as good results as one amination the membranes were found with a would desire, but I think as far as my exper- rupture large enough to admit two fingers and ience with it is concerned, it acts better than the head pressing well against the lower uterthe majority of remedies given per orem for ine walls but when the pain ceased the head the relief of nausea and vomiting. I think would recede and never was completely enwith others, that it may be employed advan- gaged. Fluid escaped with every pain and tageously in the vomiting of pregnancy in when on the chamber at those times the many cases. The above three cases will illustrate sufficiently, the way in which this remedy may be employed and what its effects are. amount was excessive. It appeared to me In recurring gastralgia, due to an irritable that the amniotic fluid had all escaped, and I condition of the gastric nerves, it is a good prognosed a dry labor. About 3 p. m. the remedy, providing the proper dosage is ob- pains ceased and the patient being comfortaserved; larger doses than 2% to 5% grain being ble I made some calls, directing them to send required. Nothing is better in carcinoma of a message when the pain returned or some the stomach than from % to 4 grain doses unpleasant symptoms came on. Not receiving of cocaine given before food in order to pre-word from them as directed, I supposed vent that viscus from expelling it. another physician had been called, and dismissed the case from my mind. In ulcer of the stomach it is also very good but my experience in this malady is limited. Continuing our application, we should expect to find many other stomach troubles, directly benefited by its use. So that in summing up our knowledge of cocaine in this phase of its therapeutic activity, we should all be justified in keeping at hand a bottle of tablets and give them a fair and impartial trial in cases of gastric disorder. Rupture of the Membranes. In twenty-eight days I was called again and delivered the woman of a healthy, well formed child. The pains had not returned until the time mentioned, and they saw no reason why they should trouble me. The next day after my first visit the woman was up, and attended to her household duties as usual for the four weeks. There was a slight watery discharge from the vagina at times, supposed to be amniotic fluid, and the membranes on the first digital examination were found ruptured at THE ESCAPE OF THE AMNIOTIC FLUID TWEN- the old site and felt ragged. After the placen TY-EIGHT DAYS BEFORE DELIVERY. ta was delivered the site of rupture showed plainly at those points by the broken down In the University Magazine for September, shreddy edges of the membrane. She had a 1890, F. Perry, M. D., of Block Island, R. I., good getting up. I may be censured for leavreports two cases of premature escape of ing the patient in the condition described but liquor amnii without immediate induction of I did not know what else to do. I went away labor. In one case the uterus remained qui- to accumulate wisdom thinking I would be escent seven days after the escape of the called in a few hours. Being disappointed in this I concluded they had done right in call- two days, when it was removed. The patient ing in some one who did know and hence was doubly disappointed in being called the second time. You have been there brother! Tesico-Rectal Fistula. A case of this rare form of fistula came under my observation one year ago. The patient, Mr. H., age 32, had twelve years before been operated upon for stone in the bladder, which was removed through the perineum. was then instructed to pass his urine every two hours, day and night, which he did for several days, all of it passing through the urethra, or through the perineal fistula. No urine escaped at any time through the rectal fistula. Union by first intention took place. The sutures were removed after the seventh day, and after another week the perineal fistula was treated by the galvano cautery. A platinum loop was passed into the fistula up to the point After the operation he found that as much where it opens into the urethra and was heatof his urine passed per rectum as through the ed to a cherry heat, and then withdrawn perineum, none was voided per urethram. cauterizing the fistulous tract from one openThis continued until the perineum healed ing to the other. which it did with the exception of a perineourethral fistula. Since which time almost all the urine has passed through the rectum. This was repeated during the week following, when healthy granulations were formed which united and closed the fistula. The patient was discharged, cured in less than a month from the time his treatment was begun and he has coutinued well until the present time, one full year. After some months he returned to the surgeon who had operated upon him, for the treatment of his fistula. This treatment was by the use of caustics and was continued for quite a while but proved unsuccessful. The This case was reported because of the raripatient afterwards applied to many physicians ty of vesico-rectal fistula. How it was pronone of whom gave him any hope of relief and he became a chronic invalid from the proctitis and tenesmus induced by the presence of urine in the rectum. Last year he applied to me for treatment, I had him placed in Christ's hospital and dilated the sphincter. I also treated his proctitis with antiseptic and astringent irrigation. In the course of a week he was thought to be in a fit condition for operation which was performed under antiseptic precautions. The patient etherized, a Sims' speculum inserted and a rubber balloon or pessary passed up into the rectum, and inflated. This gave a good view of the fistula which was about 3/4 of an inch in length in a direction longitudinal with the rectum. The bladder was, of course, collapsed, it had not been distended for years, the trigone was consequently very narrow and the ureters found very close together, one on either side of the fistula. The edges of the fistula were denuded, extreme care was taken to not open either ureter. Fine silver wire sutures were used to bring the edges of the fistula into apposition. A catheter was then inserted, tied in and allowed to remain for duced is unknown. It is possible that the stone may have caused ulcerations which opened into the rectum at the time of the operation, or a portion of the vesico-rectal wall may have been crushed in the forceps, or possibly, a knife may have been thrust on through into the rectum. However produced it immediately followed the operation. J. C. MCCLINTOCK. Creosote in Phthisis. Now that creosote is gaining such favor in the treatment of phthisis it may not be ill timed to offer some suggestions as to the most available forms for administration. The dilute mixtures seem to be more satisfactory than the more concentrated forms. While it is more convenient and less unpleasant to the taste when prepared in the form of pill or capsule, our experience has been that in this form it is frequently very irritating to the stomach and more likely to be followed by disagreeable eructations. A combination which can be recommended, at once for its simplicity, convenience and efficacy, is made with glycer ine in the proportion of 8 to 16 drops of the purpose of assisting women who desire to creosote to an ounce of glycerine. A tea- obtain a technical education in Pharmacy and spoonful of this may be taken in a half ounce of wine or brandy every four hours. It is not unpleasant to take and we have no reason to complain of its effect. Chemistry. Its projectors pledged themselves to "Woman's Rights" only so far as the right to earn a livelihood by any and every occupation from which they are not precluded by their sex, and they sincerely believe that this is one of the occupations for which woman is eminently fitted. We are desirous to bring this institution more prominently before the public, in order that a greater number of persons may take advantage of the facility offered, but have no funds at our command for advertising. Should you think favorably of our efforts, we should be under many obligations if you would publish in your paper the enclosed clipping from an editorial of the Courier-Journal of this date. Very respectfully yours, THEO. HARRIS, REV. E.T. PERKINS, D.D., RT. REV. THOMAS U. DUDLEY, D. D., LOUISVILLE, KY., Aug. 25, '90. For those patients who have long spells of coughing, often followed by vomiting and where, there is much laryngeal irritation we have found an inhalation of creosote in vaseline to act charmingly. This may be very conveniently given with the DeVilbiss' spray tube. The tube cup should be three-fourths WOMAN'S SCHOOL OF PHARMACY. filled with a pure vaseline, free from acid, and The Louisville School of Pharmacy will befrom 4 to 6 drops of creosote added, then gin its seventh annual session September 30. warm over a lamp till all is melted. Now by It is a pioneer in the work of educating having the patient close the mouth over the women as chemists, and pharmacists and the spray point the oil is finely atomized and easily only institution specially devoted to this work. It has an able corps of instructors, and a cominhaled. For producing the spray, a condensed plete and well equipped pharmaceutical and air apparatus is preferable, but a good rubber chemical laboratory. Its course of instrucbulb will answer nicely. We have been much tion is thorough. Its graduates rank high in gratified with the results of this treatment their profession, and their services are sought finding after a few days, the cough greatly for as assistants in first-class pharmacies and diminished in frequency and persistance with no nausea following, the expectoration free and easy and an absence of the offensive odor. By the improvement in the cough the excessive irritation of larynx is also diminished. Warm inhalation are much better than cold ones and we prefer the ung-vaselini to any of the fluid preparations, for the reason that cooling upon the surface of the membrane it adheres more closely than the lighter oil. W. E. McVEy. To the Editor of the Kansas Medical Journal. DEAR SIR:-The Louisville School of Pharmacy for Women was established in 1884 for chemical laboratories. We are informed that there has been more applications for graduates during the past year than the total number licensed since the opening of the school. Its regents and faculty give all assistance in their power to earnest students in limited circumstances during their scholastic course, and in obtaining situations after graduation, and also the necessary pecuniary assistance to those who show an aptitude for and desire to enter business on their own account. Full information and catalogue can be obtained of Dr. Wiley Rogers, Secretary of the State Board of Pharmacy of Kentucky and Professor of Pharmacy in this institution, or Dr. J. P. Barnum, Dean. JUST READY. A NEW MEDICAL DICTIONARY. 8425 A Compact, concise Vocabulary, inclnding all the Words and Phrases used in Medicine, with their proper Pronunciation and definitions. BASED ON RECENT MEDICAL LITERATURE, By GEORGE M. GOULD, A. B., M. D., Ophthalmic Surgeon to the Philadelphia Hospital, Clinical Chief It is not a mere compilation from other Dictionaries. The definitions have been made by the aid of the most recent standard text books in the various branchesof Medicine. It includes, Several Thousand New Words not Contained in any Similar Work. It contains TABLES of the ABREVIATIONS used in Medicine, of Square 8vo, Hf. Morccco, wtih Thumb the ARTERIES, of the BACILLI, giving the Name, Habitat, CharacterIndex, as above..... istics, etc., of GANGLIA, LEUCOMAINES, MICROCOCCI, MUSCLES, Plain Dark Leath., without thumb index........ ...3 25 NERVES, PLEXUSES, PTOMAINES, with the Name, Formula, Physiological action, etc., and the COMPARISON OF THERMOMETERS, of all the most used WEIGHTS AND MEASURES of the world, of the MINERAL SPRINGS OF THE U. S., VITAL STATISTICS, etc. Much of the material thus classified is not obtainable by English readers in any other work. FROM PROF. J. M. DACOSTA. "I find it an excellent work, doing credit to the learning and discrimination of the Author.' * Complete circulars and sample pages upon application. P. BLAKISTON, SON & CO, Medical and Scientific Books, 1012 WALNUT STREET, PHILADELPHIA, PA. PRESCOTT & ALLEN, Correspondence Solicited. 118 East Seventh St., Topeka. SANITARY A Full Line of Gas and Electric Fixtures. OF THE UNITED STATES. The second edition will contain the names of about 100,000 PHYSICIANS IN THE UNITED STATES, arranged alphabetically, also arranged by States and Cities, showing school practiced, date and college of graduation and post-office address. Lists of Medical Colleges, Medical Societies, Hospitals, Sanitariums, Asylums, Mineral Springs, Boards of Health, Medical Journals, Medical Departments, U. S. Army, Navy and Marine Hospital Service, and Pension Departments. It is the only National Directory of Physicians published, and if you wish a work of the kind for reference, or desire to circularize the profession you cannot procure as complete and PLUMBERS, reliable a list from any other source. R. L. POLK & CO., Publishers, |