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2. Alum Gargles.--We have shown elsewhere that the true astringents belong to the class of coagulants, that is to say, the class of chemical agents capable of entering into chemical combinations with the albuminous elements of the blood, and forming with them an insoluble compound. In applying this principle to alum, we showed how this substance, penetrating into our tissues, is first decomposed by the alkalis of the blood, so as to form an insoluble sub-salt, which is deposited in the organic tissues, filling their network, and, so to speak, tanning them. We pointed out how a new portion of alum, being no longer modified by the alkalis already saturated, then acts, by fluidifying the albumen, in stimulating exhalation; and how, lastly, this alun-albuminous fluid, taken into the circulation, again becomes solid when it finds itself in presence of all the alkalis contained in the mass of the blood—and in this way we explained the agency of large doses of alum in arresting hæmorrhage. Thus, in a small quantity it is a very precious local astringent; in a larger quantity it becomes an energetic local fluidifyer; and, after absorption, a general hæmostatic of undoubted efficacy

We omitted to state why we thought this substance should not be combined with mel rose, which it so commonly is. It always contains a marked quantity of the proto-sulphate of iron by reaction on which the tannin of the mel rosa produces a greenish precipitate. This, besides being disagreeable in appearance, leads the patient to the belief that the properties of the medicine have become deteriorated. Preferable combinations are the following:

1st. Astringent Gargarism. Alum ..

^ a part. Distilled water

150 parts. Syrup of mulberries }of each 25 parts.

Poppies For aphthous affections, mercurial stomatitis, and generally in all the diseases of the throat in which astringents are indicated.

2. Detersive Gargarism. Alum

20 parts. Distilled water

100 parts. Syrup of mulberries } of each 30 parts. . In hoarseness, in aphonia, and in those affections of the pharynx characterized by great dryness, and in which it is desired to excite the excretion of the mucosities. It is in this same dose—that is its fluidifying dose-that alum should be given for the prevention and cure of pharyngeal diphtheritis.

Most practitioners, I may remark, administer alum in too small a proportion for the removal of acute hoarseness, and especially in the aphonia of singers. Theory and practice alike show us that these cases require strong gargles.Mialhe, l'Union Medicale, No. 34.

3. Astringent Collyria.- Many practitioners are in the habit of prescribing mu. cilages of gum, psyllium, and especially of quince, with the different medicinal agents which constitute the base of their astringent collyria. It is a bad prac. tice, since all true astringents necessarily belong to the class of bodies which coagulate the serum of the blood, and all substances which coagulate albumen also coagulate gum and the liquids which contain it; whence it results that the addition of mucilage to a salt of alum, zinc, copper, lead, silver, &c., necessarily gives rise to more or less of an entirely insoluble precipitate, which can in nowise advantageously act upon the mucous membrane of the eye. Such a combination is worthy of the period which gave rise to it. It belongs to that epoch in therapeutics in which practitioners were persuaded that all agents capable of 1847)

Disguise of the Taste of Medicines by Coffee.

555

modifying the living economy were endowed with absolute curative properties, having nothing in common with the action they exercised on our organs, an action wbich they considered as generally hurtful and never useful. À fundamental error which time and experience have happily done justice to !-Mialhe, l'Union Medicale, No. 40.

4. Sedative Cataplasm in Puerperal Arthritis. The following is the means of treatment adopted by M. Trousseau in that special form of articular phlegmasia which is frequently observed during the puerperal state at the Hôpital Neckera means whence he declares he has derived the greatest advantage. It consists in the application of a cataplasm formed as follows:-As much bread as is required is boiled in camphorated brandy, and upon the cataplasm so formed a layer of camphor, consisting of about two or three drachms, is powdered over the poultice, and the whole moistened with a solution of the like quantity of extract of belladonna. It is to remain on for five or six days, and then to be renewed. Generally, on the very first night, the pain lessens, and after some days completely disappears. The resolution of the swelling is hastened, though much less rapidly.-Bulletin de Therapeutique, Feb.

5. Disguise of the Bitterness of Medicines by means of Coffee.-Medical men are perhaps scarcely sufficiently alive to the desirableness of masking the nauseousness of the abominable compounds they are forced to meddle with. It is not always desirable to do so, medicines of the anti-spasmodic and anti-hysteric class owing a proportion of their efficacy to their pastiness; while, again, it certainly is questionable whether the bitter taste of many medicines can be removed without impairing the value of the principle upon which this depends. However this may be, the statement of a M. De Vouves, a medical student at Paris, that the bitter taste of Quinine may be completely masked by Coffee, has excited considerable attention. M. Dorvault, Pharmacien, in a communication to the Union Medicale, furnishes the following formula, as, after repeated trials, being found to be the best for securing this object. Take of ground fresh-roasted coffee 10 parts, boiling water 100 parts. Treat it by displacement, strain and add Sulphate of Quinine 1 part, Sugar 15 parts—these two last having been previously well mixed together. The mixture must be well shaken when administered. For children milk may be added. He sums up his paper with these conclusions. 1. A solution of coffee annihilates completely, instantaneously, within wide limits, the bitterness of Quinine. 2. The disappearance of this taste is due in part to the transformation of the dissolved portion of the salt into a sort of tannate, and in part to other principles of the coffee. 3. Of all tanniferous substances coffee is most apt for this effect. 4. The therapeutical action of the medicine does not seem to be diminished.-L'Union Medicale, No. 32.

93

In another number of the same Journal, a M. Combes, a student in pharmacy, communicates the successful issue of a long series of trials upon the power coffee possesses in masking the bitter taste of sulphate of magnesiama taste far more nauseous to most persons than is that of quinine. The following is his formula for an ordinary dose of about an ounce of the salt.

Sulphate of Magnesia .. 30 parts.
Ground Coffee..

10
Water

.700 or 800 Boil them briskly together for two minutes in an untioned vessel. Remove from the fire, and having allowed the mixture to infuse for a few minutes, strain it. Sugar it and drink it hot or cold, according to taste. To ensure the effect, the coffee must be boiled with the salt as directed above; adding the latter to it afterwards or to an infusion does not suffice. If the quantity of the sulphate be much increased, and it is yet desired not to add more coffee than the above, that will suffice if, while the Auid is boiling, a grain or two of tannin be added. --L'Union Medicale, No. 95.

The Bulletin de Therapeutique signalizes another use of coffee in disguising the taste of Purgatives for Children ; MM. Guersant and Blache frequently employing it for this purpose. A weak decoction of coffee is made, to which some milk and sugar are added, care having been taken while boiling the coffee, to put in a few follicles of senna. If it is given to the children with a little bread, they will generally take it with avidity. This medicine generally acts freely upon children, and thus administered does not induce the violent griping it sometimes does in the adult. (As a matter of taste, we think the senna tea and prunes of our grandmothers is a more delicious preparation.)

6. The Emplogment of Tonics in Acute Disease.—M. Legroux, in a recent lecture at the Hôpital Beaujon, adverted to his successful treatment of some examples of acute disease by means of Tonics. He observed that, “in order properly to avail ourselves of the indications furnished by diseases, we should take into account their foundation (fond) and form ; their mode and their nature. The form is the disease itself, which offers its general indications; the foundation is the idiosyncracy of the individual, which may modify and completely change the indication. The mode indicates the description of morbid process, but nowise its etiological nature, which in its turn furnishes new indications.

“ It is especially in relation to tonics that the indications and contra-indications springing up between the relations or opposition which exist between the foundation and the form should be studied. And first, it is important to distinguish true from apparent adynamia. Prostration of strength with a good coloration of the skin, and sometimes with cyanic congestion of the face, occurring in a wellfed subject, having a small sub-inflammable pulse, but with a notable and persistent elevation of temperature, do not represent true adynamia. But if the patient is enfeebled by age, bad regimen, prior diseases, spontaneous or provoked deperditions; if he yields under an attempted antiphlogistic treatment; if the skin is cold ; if the pulse in spite of its frequency is small and ‘subinflammable,' if there are cold sweats, and on the assuming the erect posture a tendency to syncope, then the adynamia is real. In that case, whether the disease be a phlegmasia internal or external, an erysipelas, a pneumonia, or what not, we must abandon the form for the fundamental; and broths, wine, or quinine sometimes in such cases perform wonders. The tonic medication becomes antiphlogistic. It is especially indicated in persons habituated to the immoderate use of spirituous drinks, and whose idiosyncracy ill accommodates itself to active antiphlogis. tic measures.

The action of tonics under these circumstances may be easily understood if it is remembered that the capillary circulation in inflammations requires a certain degree of activity to effect the resolution of engorgements; and that a stimulant of a different character to that which has induced the congestion, and capable even itself of inducing the like in healthy tissues, will cause the disappearance of this. At the surface of the body we frequently find ourselves obliged to animate by topical applications languid inflammations; while the internal therapeutics opposed to the majority of the chronic inflammations of the lymphatic system are composed of stimulating medicinal substances.

One word as to rheumatism in particular. Suppose we have to do with a patient enfeebled by the duration of the disease, or by great deperditions. He may be pale, anæmic, wasted, tortured by cruel sufferings, his limbs rendered stiff by prolonged congestions, admitting of no movements, and his digestive organs being the seat of more or less acute pains, the stomach seeming to revolt at the slightest aliment. In these cases, again, the foundation is to be attended to before the form. We must restore the constitutional poivers by ferruginous 1847)

Papular Diseases of the Skin.

557

preparations and by substantial food, which will be perfectly well tolerated by stomachs that reject all insipid or non-azotized substances.

After adverting to the use of tonics in typhoid fever, Dr. Legroux concludes:

“ It is one of the most serious errors to dichotomize" medical substances according to their properties; for their action is almost always complex. Stimulant and tonic at a slight or moderate dose, they may become great debilitants, or fatally hyposthenisant in larger doses. Wine is certainly the most powerful hyposthenisant we have ; but in large quantities it debilitates and kills. In therapeutical doses arsenic is a tonic; but kills by hyposthenisation in a larger one. Quinine renders us high services as a tonic, but it is a hyposthenisant in large doses. The tonic medication then, cannot be regarded as simple in its effects. If it raises the fallen strength of a patient, so, on the other hand, may it moderate the febrile element, which is not incompatible with true adynamia.-L'Union Medicale, No. 86.

M. CAZENAVE ON PAPULAR DISEASES OF THE SKIN.

The skin is a compound of very distinct organs, of the apparatus of different functions, some being entirely independent of each other, and others more or less connected in their physiological actions. Hence we might naturally be led to expect that each of these organs or apparatus would have its special lesion, giving rise to a special train of symptoms. The determination of such elementary lesion is by no means a matter of mere curiosity. The knowledge of the seat may lead, through the conditions of physiological pathology, and especially by the sympathies it discloses, to the demonstration of its cause, the appreciation of its nature, and the choice of its treatment.

If there is a form of disease of the skin in which the conditions of seat are in harmony with pathological observation, in which we can render an exact account of the phenomena observed by the anatomical composition of the affected tissue, it is beyond all doubt the papular form. Two very distinct characteristics distinguish eruptions of this class: the presence of small, full, solid, projecting elevations; and a more or less severe, but constant pruritus. The elevation is nothing else than the anormal development of the papillæ itself; a development which is easily appreciable from that permanent condition of “goose-skin” observed at the inner portion of the limbs of some persons, to the large papulæ of prurigo. If we bear in mind the nervous and vascular conformation of the papillæ we easily explain the various phenomena. Of these the pruritus is the dominant one, and it is a purely nervous symptom. In most cases the papillæ preserve the colour of the skin, and the vascular net-work takes no other part in the disease than as a slight congestion consequent on the hypertrophy of the papilla. In some forms indeed, as prurigo vulvæ, &c. the minutest examination fails to detect any enlargement whatever. Under other circumstances, the papillæ put on all the characters of a true inflammation; and in others the nervous and vascular elements may be found conjoined, as in lichen agrius. When the papular disease becomes chronic, and the papules become hard, dry and parchment-like-sometimes preserving a remarkable size, and no less remarkable thickness--the epidermic element is especially involved.

In examining into the intimate nature of these diseases, we remark their great affinity to other nervous diseases, with some of which they sometimes alternate. It is usually in women and sensitive individuals, in persons of a fine delicate skin, and at the periods of life when the nervous system is in highest activity, that these diseases are most frequent; and it is rare not to find them preceded or accompanied by other nervous disturbances, such as gastralgia, neuralgia, or uterine disNEW SERIES, NO. XII.-VI.

pp

orders. Moreover, the accessions of pruritus sometimes assume a periodicity only met with in the neuroses.

The papular eruptions present themselves under two distinct forms. In the one the papilla is often notably developed, but without any true inflammation; the nervous element and the epidermis of the papilla being alone interested. This is prurigo, an affection characterised by more or less intense pruritus, and by papulæ of different size, without change of colour of the skin, isolated, distinct, and accidentally tipped with little black crusts of coagulated blood; and when the disease has existed for a long time, by great thickening and condensation of the altered structure of the skin. In the other there may be less swelling than in the former, but there are also redness, and new products of inflammation, the whole elements of the papillæ being now affected. This is lichen, a disease often characterised by intense pruritus, accompanied by solid, full, papulæ, generally very small, agglomerated, and sometimes confluent. They are generally red, and may go on to ulceration, the secretion of a sero-purulent fluid, scales and even crusts, and later to a thickening of the skin, which takes on a peculiar yellowish tinge. In point of treatment the distinction of the two forms is not so important as might be supposed. All depends upon the morbid predominance of this or that element. If the exaggeration of the sensibility is very predominant, antispasmodics are given, hygienic precautions adhered to, and especially a nonstimulant regimen ordered. M. Cazenave has tried a great quantity of substances but has found most benefit from the use of Extract of Aconite (1 to 2 grs. per diem), which, together with a few baths, has frequently enabled him to triumph over even general papular eruptions. Topical applications are seldom required, save when the epidermis has become hypertrophied. In the acute stage of papular eruption, which is represented by the varieties of lichen, the application of topics, and especially of ointments, is generally hurtful. M. Cazenave has seen, under the use of the simplest ointments, simple lichen become violently inflamed and go on to ulcers. In the chronic state, however, constituted by prurigo, ointments are usually well borne, and advantageously modify the disease in most cases, although they do not procure its cessation. When there is distressing pruritus topical applications are essential, those of a narcotic character being often useful in irritable subjects. In other cases tar-water, alkaline lotions (subcarb. potass 8 to 12 parts to 500 of water), or sulphuretted lotions (sulphuret of potass 4 p. wtaer 300), are most so.

In chronic eczema, and especially in pruritus without eruption, M. Cazenave has found the formula recommended by Biett (Cyanuret of Potass gr. x., Emulsion of Bitter Almonds, 3vj.), frequently very useful. In spite of all means, the itching often remains with provoking obstinacy. It may be allayed sometimes by camphor (Camphor 30 p., Lettuce water 500) when it is very intense. But of all topics mercurial lotions usually best counteract this. In the dreadful suffering arising from pruritus vulve, a little of the following may be employed. Bichlor. Hydr. gr. iv., Spt. Menthe Zss., Aq. dest. Zvj. ---L'Union Medicale, No. 98.

TREATMENT OF OBSTINATE Hiccough BY PROLONGED COMPRESSION

OF THE EPIGASTRIUM,

Dr. Boyer relates three cases of prolonged and alarming hiccough, which, having resisted all the usual means employed for its relief, were relieved by the application of pressure, a practice first suggested by Bordeu and since revived by M. Rostan. A large pad is laid on the epigastrium, and bound forcibly on by means of a towel or bandage. It generally causes instant relief, but if discontinued too soon the hiccough returns. It is usually necessary to wear it for twenty-four hours, before it can be safely removed.- Revue Medico-Chirurgicale, July.

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