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twice seen it rather hot and dry, with the pulse somewhat increased. An elderly physician told me that he had noticed in this state a tendency to profuse perspiration, which seemed really to be a sort of “cold sweat.” The eyes, when the little patient is undisturbed, are generally closed, and if half open, they have a dull and glazed appearance; if it is roused, they become as bright as ever. The tongue and the state of the excretions, depends, of course, much upon the cause of the disease, whether diarrhæa is or is not present; but when the debility is very apparent, the tongue is pale and flabby.
All this description must certainly be varied in the different cases, and often the attack will be so slight as to be passed over unnoticed ; but still, any one will see the close resemblance which it can bear in young children to hydrocephalus, and how important it is to be aware of its presence at the formation of the diagnosis.
Those among whom we the oftenest encounter this train of symptoms, are the children of the poorer classes—among those who want food and who have to eat what they do receive of an inferior quality. The same influence is apparent among nurslings, from the poor quality or lack of the mother's milk, which arises from the same lowering cause being extended to her. The children may be fat, but it seems to be an unhealthy plumpness; there is a doughiness in the flesh, a puffy appearance about the eyes and checks; the circulation seems languid, and they are pale, and anæmic. They are like what are known sometimes under the sweeping description of scrofulous-looking children. The head is often large; and this fact, with the difficulty which they seem to experience in keeping it erect, might lead to the inference that there was effusion.
The uncomplicated disease cannot be said to be ever a sole cause of death, and it is this which gives it its strongest right to be called only a symptom. When death has occurred and we have had this as one of the complications, it is generally from the diarrhoea, or a state of debility carried to excess; the little patient "fades out," but preserves to the last the symptoms before given. At an autopsy which I attended a few years ago, upon a child of about five or six years of age, in whom the symptoms had been strikingly well defined, and who died very suddenly of cholera infantum after the disease had continued some time, it was entered in a note-book from an observation made by others present, that " the brain seemed softer and whiter than usual, but there were no signs of inflammation or effusion." It is probable, however, that there could be found by post-mortem examinations, no morbid effects whatever to account for the death.
The treatment required in these cases is that demanded to combat the debility; we must endeavor to build up the system, to restore the strength, improve the digestion, and counteract the depressing effects of serious fluxes, and stop a diarrhoea, if it exists. The diet should be nourishing, and even a little stimulating; good breast-milk must be procured for those nursing, while broths and animal teas will be required by those more advanced. Wine seems to be a useful adjuvant, if the effects are carefully watched, and if it is administered in judicious quantities. Carbonate of ammonia, and the compound etherial spirits, are much used. But the most useful of all, and the one the most highly recommended, seems to be some preparation of iron, given in whatever form, with the admixture of the vegetable tonics and bitters. A most striking change for the better can be seen in a short time after its use is commenced. Where an exceedingly comatose condition exists, some have recommended the application of blisters and sinapisms to the neck, with the use of some stimulating liniment to the spine and lower extremities. But I think that the most reliance is to be placed on the diet and tonics, with a daily immersion for a short time in a tepid bath, to which, perhaps, a little muriatic acid or mustard has been added, but these do not seem very essential. For checking the diarrhoea, the acetate of lead (so much extolled by Condie), with some of the vegetable astringents, seems to fulfill every want. Opium, in any of its forms, is certainly to be shunned; the tendency to coma, which is so evident, being in itself a sufficient warning against its use. As this affection may sometimes be taken for meningitis, and depletion employed, the mischief that will result may be incalculable.
To sum up the treatment, it seems best to avoid all depleting and reducing remedies. Satisfy the mind that there is no inflammation; and then, throwing aside blood-letting, purgation, calomel, and opium, endeavor to bring the system back to its normal healthy condition, by pure air, good diet, and the judicious use of the bath.
251 Fourth Avenue.
Case of Poisoning by Aconite. By Oswald Warner, M. D., Senior
Assistant Surgeon to Bellevue Hospital.
To the Editors of the New York Medical Times :
GENTLEMEN, I place at your disposal the following account of a case of poisoning by aconite. It is one in which I have felt much interest; and, inasmuch as contradictory symptoms are given by differenauthors in relation to the action of this poison, it may not be uninterestt ing to your readers.
Agnes C-, age 20, a patient in Bellevue Hospital, on Wednesday evening, January 17, 1855, at about a quarter past 7 o'clock, took a quantity (not accurately ascertained) of a mixture of equal portions of tinct. aconite and chloroform, which had been prescribed for another person, to relieve the pain of toothache. At some previous time she had been breathing it for the chloroform, not knowing what else it contained, had spilled some and then poured in water to avoid detection. I was called to see her about half an hour afterwards, not knowing what she had taken.
I found her in bed, in a partially insensible condition, yet easily roused, and giving rational answers to all questions. Her respiration and pulse were not yet much disturbed ; pupils largely dilated, and almost insensible to light; with an almost entire loss of sensation. She was rather restless, and complained of a prickling sensation over all parts of her body. I immediately gave her an emetic of zinc. sulph., gr. XX., followed by as much warm water as she could be made to drink. In about half an hour, this produced free vomiting; previous to which, from the sinking of the pulse and sighing respiration, it became necessary to give stimulants. While waiting for emesis to take place, I learned, by her own answers (she at first denied having taken any thing) and from other patients, where the vial from which she had taken the mixture had been placed. Having found this, and examined the prescription book, I learned what had been taken. After the vomiting, it again immediately became necessary to give stimulants. The skin, except on the face and arms, was about of the natural temperature, yet she complained much of being cold. Hot bricks were applied to the feet, sinapisms to the spine, stomach, and inside of the thighs, and the hot air-bath was administered. The stimulants (brandy and carb. ammon.), were continued by the mouth, and frequent injections of brandy, carb. ammon. and sulph. æther. were given. From this time until half-past 12 o'clock
convulsions frequently occurred, previous to the coming on of which she would suddenly exclaim, "It is growing dark, I can't see," and then with a wild stare, the teeth firmly set and the pulse imperceptible, the convulsion would commence. Active flaggellation on the arms and face, with a slipper, seemed to be the best means of rousing her sufficiently to take more of the stimulants, which would almost immediately raise the pulse and bring her to consciousness. At first carb. ammon. was given by the mouth with the brandy; but being almost immediately rejected by vomiting, it was discontinued, and given only by injection. After a time it was resumed, without producing the same unpleasant effects.
From the time when I first saw her until half-past 12 o'clock, she took, by the mouth and by injection, two and a half pints of brandy, with 3 ij. of carb. ammon. Although a part was rejected by vomiting, yet I think I may safely say that one and a half pint of brandy remained in the stomach. The injections were not long retained, and caused free evacuation of the bowels. During the last half hour, she showed some signs of intoxication.
All this time, except when convulsed, she was partially sensible, and seemed to know and take some notice of what was taking place. After half-past 12 o'clock, the pulse, with slight intermissions, rose permanently, and no more stimulants were administered. By 3 o'clock, she was so far recovered that it was thought safe to leave her. The pupils had contracted down to their natural size, respiration was quiet and natural, and the prickling sensation had gradually passed off. Next morning she was as well as usual, except a slight oesophagitis, with diarrhea. The latter abated during the day, and the former in three or four days. Her memory of the circumstances as they occurred is quite distinct, and I will now give lfer own account of them.
She says that she took about a tablespoonful of the diluted mixture (knowing that it contained chloroform), to produce sleep. For about half an hour, she was walking around the ward, with only a slight sensation of burning in the cesophagus and stomach, and a little dizziness. She then felt sleepy, and went to bed. Immediately after this, her tongue began to feel as if much swollen. Also the prickling sensation, before mentioned, began in the tongue, throat, checks, and feet; this gradually spread over all parts of the body. She had ringing in the ears, and, though somewhat restless, a disposition to sleep soon ensued. These sensations, she says, “were neither pleasant nor painful."
She remembers when I first went into the ward, the questions I asked and the answers she gave, being compelled to drink brandy against her will, feeling and frequently saying that she was intoxicated. At times the room seemed to grow dark, and very unpleasant sensations occurred, which she can only describe by saying that “she thought she was dying.” It was at these times that the convulsions occurred, during which she can only remember being continually slapped with the slippers. After 3 o'clock she remained entirely sensible, and remembers all that took place.
BELLEVUE HOSPITAL, March 1st, 1855.
Case of Paralysis successfully treated by Electricity. By G. HUFF,
M.D., Lexington, Kentucky. A lady, 26 years of age, of lymphatic temperament, with light auburn hair, fine and white skin, had enjoyed uninterrupted health from infancy up to the age of twenty-one years, when she married ; after which her health became impaired. Soon after this event a distortion of the spine manifested itself, ultimately involving the bodies of several vertebræ in the disease, from the third cervical vertebra to the second dorsal inclusive. There was caries of the vertebral column, which had extended to several vertebræ, as the distortion was a gradual bend or curve; the caries of the vertebral column must have been rather superficial, as luxation of the sixth cervical vertebra had taken place, and the tissues surrounding the carious vertebra were infiltrated with a bony substance, and the soft part of the vertebra was very much indurated. The opinion expressed on consultation was, that the sixth cervical vertebra pressed gradually upon the spinal cord, as the convulsive movements of the muscles indicated. The patient felt a weakness of the lower extremities, and was compelled to bend her limbs very gradually, and exercise them with a very slow motion, until it resulted in the total loss of the functions of the nerves, both of motion and sensation, below the shoulders, including both the lower extremities. Her friends were assured that the case was past remedy, and, as such, it was presented to a medical class. As she had the free use of her arms, I was led to give the case a careful examination, and did not coincide in the opinion that the pressure was upon the spinal marrow, as symptoms seemed to indicate. Compression upon the spinal marrow is not the only cause of dis