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expectorant medicines, which often disturb the digestive organs; oxygenates the blood; promotes absorption; relieves dyspuæa ; gives impetus to pulmonary circulation; reduces temperature in fever; and desiccates the fluids in the air-passages.

Beneficial effects may be derived from it in croup, diphtheria, bronchitis, asthma, tuberculosis, whooping-cough, asphyxia, chloroform poisoning, shock, foreign bodies in the air-passages, and many other obstructive lesions of the pulmonary organs.

By inflation, vapors and gases may be introduced into the airpassages, and it is believed that experiments in this line will open up a new field of usefulness and brighten hopes for the helpless sufferers from croup and diphtheria.

A recent distressing case of membranous croup suggested to my mind the propriety of inflating the lungs through a large aspirating needle or curved trochar passed into the trachea, as a substitute for tracheotomy, or to prolong life until that operation could be performed, and it occurred to me also that foreign bodies in the larynx and trachea could be expelled by the same operation. An inflator for such purpose should have two hand-balls so as to force into the lungs a sufficient quantity of air to substitute what would be taken in by the inspiratory act.

Expiration would necessarily follow inflation from the elasticity of thoracic walls through an orifice too small to permit inspiration. The internal pressure of a large volume of atmosphere upon the strictured larynx would render it more patulous, and probably detach and expel any false membrane present. The main difficulty would be in preserving the natural rhythm of the respiratory movement. This simple and harmless operation would be justifiable in chloroform poisoning, asphyxia from drowning, and other causes.

The instrument may be made small enough to be carried in the pocket. The instrument I have used is imperfect. It should have a shield to close the mouth and nostrils and a much larger and more elastic air-bulb.

The economic advantages of inflation especially commend it to the poorer classes, and its harmless nature and prompt action suggest the propriety of using it as a substitute for medicinal expectorants in cases of enfeebled digestion and irritable stomach. It is hoped that its use in persons of weak lungs may assist in developing these organs, and perhaps operate as a preventive of

tubercular deposit. It is not urged as a remedy for tuberculosis, as all remedies therefor are justly regarded with suspicion, and the burden of proof in their favor must be submitted to many generations, but the faithful physician should never cease to contend with the malady so long as there is a hope of suc

cess.

THE ELECTRICAL TREATMENT OF EXOPHTHALMIC

GOITRE.

By A. D. ROCKWELL, A.M., M.D.,

NEW YORK.

In the New York Medical Record for Oct. 1879, I detailed four cases of exophthalmic goitre that I had treated by the galvanic current. Two of these cases were complete successes, one approximately so, and one was a failure. To-day I desire to present to this Association some further experiences in the same direction.

Exophthalmic goitre is so comparatively infrequent, and its pathology so imperfectly understood, that its therapeutics has necessarily been more or less uncertain and unsatisfactory. When, therefore, the use of electricity is suggested, the question that first arises in the minds of those who have but little practical experience in methods of electrical treatment, relates to the kind of current, and the details of its application.

In regard to the current, every physiological consideration and all experience point to galvanism as pre-eminently indicated, and yet I must bear testimony to the fact that the faradic current is not altogether useless. The applications, however, must not be local, but general, after the method of general faradization, and, in a certain proportion of cases, where there is anæmia, with marked nervous irritability and physical weakness, benefit will certainly follow, provided, always, that the operator will take sufficient time and trouble to appreciate the various steps of the process, and make his applications practically efficient. The method, though many times fully described, is— unfortunately—seldom made use of properly, or with any degree of thoroughness. In the use of the galvanic current upon which we are mainly to rely, I have obtained good results by placing the cathode over the cilio-spinal centre, above the seventh cervical vertebra, and the anode in the auriculo-maxillary fossa, grad

ually drawing the anode—after a few moments of stable treatment-along the inner border of the sterno-eleido mastoid muscle, to its lower extremity. The second step in this process consists in removing the anode to the position occupied by the cathode, and placing the latter over the solar plexus, using for a minute or so longer a greatly increased strength of current. In one case, failing, after considerable effort, to accomplish more than a very moderate degree of amelioration of the symptoms, I made use of currents that were rapidly increased and diminished every few seconds (as described in Case No. 2), with very great benefit. Subsequently to this I came across a case published originally by Dr. Ancona in the Giornale Veneto di Scienze Mediche, and which had strangely escaped my notice, where an obstinate and severe example of Graves' disease had been cured by direct interruptions of the current, the electrodes being placed on either side, just below the angle of the lower jaw. The cure was accomplished only after the administration of 100 applications. The causation of the disease is undoubtedly centric, and, in many cases, structural changes of the sympathetic nerve must underlie all the observed symptoms.

On the other hand, the rapid recoveries that have been known to follow the administration of certain methods of treatment, render it in the highest degree probable that the symptoms may depend as well on functional causes alone.

The onset and course of this disease are so clearly described in our recent text-books, that it seems entirely unnecessary to attempt any detailed description of its numerous symptoms other than will be found in the accompanying cases. One fact, however, in my own experience, that will be noted as the cases are read, strikes me as worthy of a moment's attention, and that is, the frequency with which the disease was met in its incomplete form. By this is meant the cases where some one of the three cardinal symptoms were either absent, or only slightly developed. In three cases, the eyes were very little, if at all, affected, while the cardiac palpitation and thyroid swelling were very decided. In one case, the pulse was but 88, while the other two symptoms were distinctly present. In every case, however, that has fallen under my observation, the thyroid was more or less enlarged; yet Trousseau and others report cases—which they

| British Med. Journal, Dec. 15, 1877.

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