2. The the operation, that the next day shen Rush's Medical Inquiries there are asked to be galvanized again; but some very pertinent and useful remarks as we happened to touch, by mis- on this subject. He lays it down as a take, with the thread which served settled point, that, as a conductor to the negative fluid, an element at a great distance from the first element, she felt so great a shock, and such severe pain, that the needles were torn out from their situation, and we had considerable difficulty in persuading her to place herself again in the galvanic circle. The operation was prolonged for half an hour, and six sittings sufficed to cure, completely, a disorder which had for years resisted the most powerful remedies that could be employed. Messrs. Bailly and Meyraux state, that galvanism, combined with acupuncturation, had been employed with the most decided success in a great number of cases, the details of which they intend shortly to lay before the public. The pain produced by the operation is inconsiderable, and the galvanic fluid possesses the singular property of never inflaming the part which it penetrates. What then, they exclaim, is the nature of this fluid which burns and melts metals, which puts charcoal in a state of incandescence, and which trayerses the living tissues of the body, in which it increases sensibility and contractibility in so marked a manner, without leaving a trace of disturbance behind it? The phenomena are altogether inexplicable. DISEASE PRODUCED BY DRINKING COLD At this season of the year there is no subject on which a few words may be said with greater promise of advantage, than the means of relieving the disorder usually produced by drinking cold water in hot weather. No summer passes without many lives being lost by this cause; and none should be allowed to arrive without something to remind the profession in what way the evil may be best averted. "Three circumstances generally from drinking cold water. concur to produce disease or death 1. The water is extremely cold. And, 3. A patient is extremely warm. large quantity of it is suddenly taken into the body. The danger from drinking the cold water is always in nation which occur in the three cirproportion to the degrees of combicumstances that have been mentioned. In a few minutes after the patient has swallowed the water, he is affected with dimness of sight, he staggers in attempting to walk, and unless supported, falls to the ground; he breathes with difficulty; a rattling is heard in his throat; his nostrils and cheeks expand and contract in every act of respiration; his face appears suffused with blood, and of a livid colour; his extremities become cold, and his pulse imperceptible; and unless relief is speedily obtained, the disorder terminates in death in four or five minutes. More frequently, patients are seized with acute spasms in the breast and stomach. These spasms are so painful as to produce syncope, and even asphyxia. They are sometimes of the tonic, but more frequently of the clonic kind. In the intervals of the spasms the patient appears to be perfectly well. The intervals between each spasm become longer or shorter, according as the disease tends to life or death. It may not be improper to take notice, that punch, beer, and even toddy, when drank under the same circumstances as cold water, have all been known to produce the same morbid and fatal effects." Thus far the account corresponds with the cases which have fallen to our observation. to As it regards the method of removing these unpleasant symptoms and prevent ing their fatal result, Dr Rush says he knows but one remedy, and that is LiaUID LAUDANUM. True, it is an important and indispensable remedy, and we have frequently been told by patients after their recovery that they felt they must have died had they not taken the laudanum. It seems, as they say, go to the right place at once, and effect just the purpose most desired. External auxiliary means are also necessary to expedite the removal of the disease. The body, and more particularly the extremities should be wrapt in hot blankets, and warmth and friction unceasingly applied to the hands and feet. As soon as practicable, the laudanum combined with æther should be administered in a large dose. As much should be given at a dose as can be taken in safety, and the same repeated every half hour till its effects become obvious. A little Spirit of Peppermint may be given occasionally, or Aqua Ammoniæ, as the judgment of the practitioner may direct. In addition to these means we would recommend that the water be abstracted from the stomach as soon as possible, by the stomach syringe. When spasms are induced by any hard or indigestible substance which has been eaten, we all know the immediate benefit afforded by an emetic. By the use of the stomach syringe nearly the same result may be expected by the removal of the offending cause of the disease in question, although here the cause will have operated so far before we can see the patient, that the means pointed out will be required. The syringe also will prevent the water from continuing its action and gives us a fair field of action. To prevent the evil we have spoken of, we beg leave to refer the reader to the following remarks of Dr Rush. "If neither the voice of reason, nor the fatal examples of those who have perished from this cause, are sufficient to produce restraint in drinking a large quantity of cold liq uors, when the body is preternaturally heated, then let me advise to, 1. Grasp the vessel out of which you are about to drink, for a minute or longer with both your hands. This will abstract a portion of heat from the body, and impart it at the same time to the cold liquor, provided the vessel is made of metal, glass, or earth; for heat follows the same laws, in many instances, in passing through bodies, with regard to its relative velocity, which we observe to take place in electricity. 2. If you are not furnished with a cup, and are obliged to drink by bringing your mouth in contact with the stream which issues from a pump, or a spring, always wash your hands and face previously to your drinking, with a little of the cold water. By receiving the shock of the water first upon those parts of the body, a portion of its heat is conveyed away, and the vital parts are thereby defended from the action of the cold. INFLAMMATION. Sedatives in Inflammation. By the term sedatives, we mean such applications to the body, as tend to diminish arterial action. Bloodletting and other means of weakening the system, have this effect indirectly. But there are some remedies which are supposed to act as sedatives in a more direct way to the system at large, as well as locally, and which we are now to consider. To this head belong cold, variously applied; diluted acids; certain neutral salts, as nitre, acetate of ammonia, and nitrate of potass, or the common saline draught; preparations of lead; and the digitalis. These require to be separately noticed. General sedatives appear to be useful only when pyrexia or a febrile state accompanies the inflammation; nor indeed, even in this case, on all occasions; for it has been observ ed that inflammation is sometimes acid; and it was anciently much in use for the purpose diluted in water, under the name of oxycrate. best treated by general stimulants under he name of sudorifics, which of course tend rather to increase febrile action at first. Where this is not the object, sedatives may be properly employed. Cold, in order to act as a sedative, must be applied steadily and uniform ly, and in a moderate degree only; so as not to excite a very powerful or painful sensation; for then it acts rather as a counter-irritant. It may be applied to the lungs and skin, by the admission of cool air; or where the heat is greater, the skin may be moistened from time to time with either cold or tepid water, according to the season or the feelings of the patient; for in either case the evaporation that succeeds will carry off the excess of heat from the body. Cold drinks, or even ice, may be administered for the same purpose. The application of cold in either of these ways, makes an important part of the treatment of fevers in general, both common and specific, and is a great improvement in modern practice, for which we are principally indebted to Sydenham. It has contributed, more than almost any thing else, to lessen the mortality of fevers, especially the small pox and scarlatina. In the application of it for this purpose, care should be taken not to produce sudden constriction of the extreme vessels on the surface; and this caution is particularly necessary in measles, and in pulmonic inflammation in general. Diluted acids very generally produce a refrigerant or cooling effect, which must be considered as the result of diminished arterial action. The natural appetite for these in a febrile state of the system, is a sufficient indication for their use. Those ac ids are perhaps to be preferred that are not liable to go into fermentation, as the mineral acids, as we call them. On this account, vinegar is preferable to the recent vegetable Tneutral salts have been probably much overrated in this respect. Nitre has been always called a cooling remedy. But this has probably arisen from the peculiar impression it makes on the tongue, which howtion of its effect on the system. The ever is but an unsatisfactory indicaacetate of ammonia and the common saline draught, serve little other pur. poses than to fill up a void, and to amuse the patient with the idea that something is doing for his relief-a point, by the bye, that must not wholly be lost sight of in practice. Lead, from its deleterious properties, is very ill adapted to general use, though probably a powerful sedative. I have often experienced its good effects in this way, in relieving hectic fever'; and provided it is used in moderate quantities, as a grain or two of the super-acetate, and continued for a few days, it may be employed with perfect safety. The digitalis, by its power of restraining the velocity of the circulation, is often of great service in diminishing febrile heat; but it has other effects which render it an equivocal remedy. Probably, however, it is the best we possess in hectic fever. Narcotics in Inflammation. Opium is either very serviceable, flammation, according to circumor the contrary, as a remedy for instances, and the judgment and discrimination with which it is employed; but it is more frequently used with ill effect, than the contrary. The temptation to have recourse to it is so strong, on account of its tendency to relieve pain and to procure sleep, that it is very often misapplied; for it seldom can be properly employed for these purposes simply. Pain and want of sleep may proceed from causes that do not admit of the use of opium. It is disadvantageous also in another respect. We often form our opinion of the state and progress of inflammation from the degree of pain the patient is suffering. Now opium may render him insensible to the pain by stupifying him, without at all diminishing the inflammation, and often even with the effect of aggravating it. Now we shall best understand the use of opium in inflammation, by first considering its general effects in the system. This medicine exerts its primary and specific operation on the brain and nervous system altogether. There are very good proofs from observation, of its increasing the arterial action of the brain, to which, therefore, it is to be considered as a stimulus; and it is not improbable that it excites, and subsequently disturbs, the sensorial functions, as a consequence of this excited arterial action. Its effects on the rest of the system appear to arise out of this previous change induced by it in the condition of the brain. These effects differ at different times, according to the state of general strength and irritability, and perhaps other circumstances that are not sufficiently known. In recent and active inflammation of the brain itself, whether it be that variety we term phrenitis, or that which is called idiopathic fever, opium is highly injurious, and especially in strong and young subjects. But in a very advanced stage of those diseases, where the general vascular action throughout the system is much reduced, either from the continuance of the disease or the use of remedies, opium appears to be of great service and the same observations apply to other inflammations. In those inflammations that naturally terminate by increased secretion, as of the mucous membrane, opium is improper till the secretion is established. On this ground it is generally injurious in pneumonia, as tending to prevent secretion and consequent expectoration. It may be considered a : pretty general rule, that where blood. letting is required opium is inadmissible. Bloodletting, however, may render opium proper where it was not so previously. Where irritability is in excess, which is generally indicated by a very frequent pulse, opium is sometimes useful, even in the early stage of the disease; but it often requires to be preceded by a moderate loss of blood. This furnishes a sort of exception to the general rule. (To be continued.) COLD AFFUSION IN SMALL POX. BY MR FOSBROKE. Whether the use of cold affusion in small pox is entirely new, I know not, but, at all events, it can have been but very seldom practised. A woman in Sherborne-street, named Somers, requested me to see her child on account of very unfavourable symptoms manifested in the second stage of the disease, about the period of the maturation of the pustules. The fact was, it was a case of very severe regular small pox, in which the pustules on the face and lower extremities were so close, as in many places to coalesce. These parts were very much swol len, the soreness of the fauces was very great, and the heat of the skin excessive. On account of my attendance upon a sick child, belonging to another family, on the first floor, I became a casual observer of this case, from day to day, and, for this reason, was applied to at the period just intimated. The child, at this period, was labouring under a greater degree of restlessness and irritation than at any former period of the disease; the pustules had acquired the fullest size, but in common with the spaces betwixt them had assumed a bluer and more bloodless hue than at any time previously. The throat was exceedingly painful, and the development of heat on the skin, though now at times diminished, was very great.* I have ever considered Sydenham's observation, that the danger of small pox, in this pustular stage, is proportioned to the number of pustules, as correct, though the theory by which the effect is explained is a mere humoral imagination. He likens them, in the impressions which they excite, to so many phlegmons or imposthumes. My own opinion is, that the danger or severity of the disease is in the ratio of the number of pustules, and injury done to the cutis, according to the depth to which they penetrate. These effects will be at the height, when the pustules have reached their fullest magnitude and ripeness. Upon this view of obvious analogies, I recommended the immediate use of the cold affusion with the sponge, and its repeated application, if relief was communicated. Of course my prescription was amazingly deprecated by the viellesse of the neighbourhood, but, luckily, having to deal with an agent in the mother with more medical knowledge than one in five hundred of the different orders of persons in this town, the proposition was immediately acceded to and fulfilled. The general irritation, heat of surface, and increasing debility, were so immediately alleviated, that the ablution was renewed repeatedly, and the boy is now recovered. Af ter the first time he demanded the reapplication himself several times a day. The second son, after recovering from an affection of the bowels, fol The mother says, that the heat of the surface at the time she applied the vinegar and cold water, conveyed a burning sensation to her touch. An amazing quantity of heat, in this form, is concomitant with the eruptive stage in severe cases of small pox. In many places the heads of the pustules had been scratched off, and the constantjactitation of the patient evinced how much irritation they had excited. lowed by one pustule on the nates, similar to vaccina in all its stages, but probably herpetic (for there is a great general relation betwixt these two,) was seized with fever, quick pulse, and an eruption of shining vesicles, small but thickly seated, on the abdomen. Finding the heat of the skin almost burning to the feel, and suspecting that the variolous eruption would follow, I ordered the cold affusion with vinegar and water. This was tried at the time and frequently since with complete relief. Variolous eruptions have appeared in the mild distinct form. The patient is up all day and the ablutions are continued, though he expresses dislike of the chilliness occasioned by them. As the pustules have advanced to maturation, however; be has called for the affusion. In certain "Medical Transactions," published formerly in London, I once read of the case of a man, who being delirious in severe small pox, after the appearance of the eruptions, jumped into a pond of water, and immediately grew better and recovered. I shall persist in the practice of cold ablution, with attention to the principles of Dr Currie,* and even try the sp. tereb. and those remedies which are applied to burns, if there shall be occasion. Caustic applications have lately been used by the French as a novel practice. It is very long since Dr Jenner (Essay on Artificial Eruptions) recommended them. AMPUTATION OF THE NECK OF THE UTERUS.-M. Lisfranc mentioned a case in which he had lately taken away the neck of the uterus; this part was much enlarged, and in a well-marked carcinomatous condition. A slight hæmorrhage, that required no extraordinary measures for its suppression, persisted during several days. The woman was speedily convalescent, and at a later period was in the enjoyment of perfect health.-Archives Generales de Medicine. * I have found it very kindly in hysteria. |