Page images
PDF
EPUB

I deem this case an interesting one. Here we had resting in contact with the sensitive lining of the bronchi, which tolerates no foreign body willingly, an oval body with its sharp sprigs pointing in every direction, and very dangerous even under a saddle; yet in spite of this my notes show that this bur remained in the air passages for twenty-two months. Other cases may show larger bodies remaining in the bronchi, but few can show one so uneven in surface and irritating in nature. I was led to make this report by others of similar nature being reported in some of the late journals.

Correspondence.

EXTRACTION OF CATARACT WITHOUT AN IRIDECTOMY.

Editor Memphis Medical Monthly:

It is a doubtful question as to whether the operation for extraction of cataract without an iridectomy gives better vision than where a section of the iris is removed, but the cosmetic effect is better, and in addition the long time necessary for the eye to accustom itself to the rays of light entering it at such a dispersion of angles, is avoided. These two points, I think, make it well worth the operator's careful consideration, between the two methods of operating, "with or without an iridectomy." Of course certain forms of cataract, the soft for instance, and fully ripened, offer better results from the latter method than do the forms of hard cataract, and more particularly so when the iris dilates nicely under the use of cocaine.

On December 29, 1889, Henry Bailey, from Lula, Miss, was brought to me by Messrs. B. and D. of this city for advice in regard to a blindness in his left eye that had developed within the last six months. Upon inspection I found a fully ripened cataract of the soft variety. Under dilatation with atropine the retina gave good perception of light. Patient is twenty-nine years of age. Could find no cause for the formation of the cataract. Gave no history of traumatism, rheumatism, syphilis, nor kidney trouble by a careful examination. I advised, as

On

the only means of restoring vision in the eye, an extraction of the abnormal lens, to which he readily assented. Monday, December 30th, with the assistance of Drs. Knox and Julius Lipscomb, I cleansed the parts about the eye thoroughly with a bichloride solution, anæsthetized the eye with mur. cocaine, which also fully dilated the iris, and removed the cataract, by Graefe's linear method, without an iridectomy. The soft lens matter came away in toto, leaving the eye perfectly clear, with immediate vision. The iris contracted nicely, and I immediately closed it with a pad soaked in a bichloride solution, and secured it in place with a roller bandage. The surroundings of the patient, from a sanitary point, were as bad as could be, being confined in a dirty boarding-house with no nurse of any experience. This fact, however, doubled my attention. On the third day, when I removed the dressing for the first time, I found the corneal wound healed, and no redness about the eye. At the end of the week, Saturday, I sent the patient home, with instructions to keep a tight bandage over the eye for a few days, and then replace with a shade for a week longer. At no time after the operation was there the slightest pain or evidence of a revertionary trouble in the eye.

At this writing, January 9, 1890, the patient informs me that the eye is well and vision good, and the eye, as far as looks is concerned, as good as the other.

Very respectfully,

-2731⁄2 Main St., Memphis, Tenn.

J. I. TAYLOR, M.D.

Miscellaneous Selections.

Cocaine in the Treatment of Yellow Fever.

James Thorington, M.D., late resident physician and surgeon in charge of the Panama Railroad Company's Hospital at Aspinwall, Isthmus of Panama, writes in the Amer. Jour. of Med. Sciences, of Feb., 1890, as follows:

In an experience of seven years' active practice on the Isthmus of Panama, where cases of yellow fever were constantly under my observation, I have tried many kinds of treatment in yellow fever, such as

1. Quinine, which I found did much more harm than good, except during convalescence.

2. Calomel, which did good only at the beginning of an attack, and much injury if used later.

3. Castor-oil and orange-tea, as recommended by the physicians in Cuba, did good in some instances.

4. The pure juice of the lime with small pieces of cracked. ice, as recommended by the physicians in the service of the Panama Canal Company, was found more satisfactory than any of the above methods of treatment.

5. Jaborandi and veratum viride, so strongly recommended by Ford (see the Reports of the St. Louis Medical Society, by W. H. Ford, A.M., M.D., 1879), although contra-indicated, I tried faithfully in several cases, but without success. Having used in vain nearly all the drugs recommended in this disease, for a time I banished medicines almost entirely, and found that

6. Good nursing, without medicinal treatment, saved some of my patients.

In looking over the notes of my cases, I find that nausea and vomiting (black vomit) and not the suppression of urine, were the cause of death in most of my fatal cases, and I argued that if I could find some means of quieting this nausea-this painful, exhausting attempt to empty the stomach, the possibilities of recovery would be greatly increased. My assistant, Dr. J. E. Jennings, suggested cocaine as an anti-emetic (see "Cocaine as an Anti-emetic in Yellow Fever," by Dr. J. E. Jennings, Medical Record, Nov. 26, 1887), and we tried it faithfully, and since then I have used it in every case, the success attending its administration being most marked and gratifying.

At least fifty per cent. of my yellow fever cases died before I commenced the use of cocaine, but since then I have treated twenty cases (four of which were reported in the above mentioned article by Dr. Jennings) and have had only three deaths, making a death-rate of fifteen per cent., or a difference of thirty-five per cent. in favor of the cocaine. The three patients who died had suppression of urine. There was a marked diminution in the amount of urine passed on the

evening of the fifth day, and violent delirium set in. Everything was done to increase the flow of urine, but the patient succumbed to suppression and death by convulsions. In previous cases similar to this, black vomit appeared in large amount before death, but in this case there was an absence of vomiting due to the action of cocaine.

My friend and colleague, Dr. F. A. Bettelheim, resident physician and surgeon of the Panama Railroad Company, at Panama, to whom the cocaine treatment in yellow fever was recommended, writes me under date of February 5, 1888, as follows:

"Six cases of yellow fever, result two deaths. I congratulate you and Dr. Jennings on the cocaine treatment; it has worked like a charm. The fact is, in three cases I gave nothing else except some enemata of chloral and potassium nitrate, and baths. The febrile reaction was well controlled by the baths and sponging, and in one or two instances enemata of antipyrin were exhibited when the temperature mounted up to 104° Fahr. I feel now that with cocaine exhibited, vomiting is an unknown quantity in yellow fever, and in addition, using the rectum for absorption of other medicaments, etc., we have made a decided move in advance. In all four cases that recovered, the albumin was over 50 per cent. In all the cases, however, the cocaine effectually stopped the vomiting."

When cocaine is used in the treatment of yellow fever, black vomit or vomiting is not a part of the disease, and what now remains to worry the physician is the danger of suppression of urine, but even here I have seen cocaine in some cases act as a diuretic.

When it is considered how depressed and completely exhausted a yellow fever patient becomes after ineffectual efforts to bring up "that lump" from the stomach, one can the more easily realize how much strength, comfort, and perfect relief is given to the patient when this factor of the disease is removed. Before using cocaine in 1887, black vomit occurred in nearly all my cases, but now it never appears when this drug has been used from the start, and rarely does it fail to check the vomiting and put the stomach at rest, even when the case has not been seen until the fifth day.

To avoid failure in the use of this drug, it should not be administered immediately after giving nourishment, as its

effect may be carried beyond the stomach, or even rejected if the patient vomits. This result also is very apt to happen if the cocaine is given in pill or tablet; it is therefore always better to give it in solution and when the stomach is empty, especially ten or fifteen minutes before food, as then the stomach is put in a condition to retain nourishment and at the same time the feeling of nausea disappears and the patient takes the milk or broth, or whatever may be offered, with confidence and relish.

It is well to instruct the patient that he must inform the nurse whenever he feels this nausea returning, so that a dose of cocaine may be given at once, even if a dose has been given only fifteen minutes before; the object being to keep the stomach quiet. I have found it necessary to give as high as one-half, two-thirds, and even a grain every half-hour or hour if the vomiting is not checked after the first or second dose of ten minims of a four per cent. solution.

I have never seen any toxic symptoms or bad effects of any kind follow the use of this drug in this disease.

Since making these observations my attention has been called to two articles on cocaine by Professor J. M. Da Costa, entitled "Observations on the Diuretic Influence of Cocaine," published in the Medical News of June 19, 1886, and "On the Use of Cocaine as a Heart Tonic and Stimulant in Typhoid and other low forms of Fever," which appeared in the Philadelphia Medical Times of February 5, 1887.

That cocaine acts as a diuretic there can be no doubt. Prof. Da Costa's report shows this, and in yellow fever this same action has not only been noted by Dr. Jennings and myself, but also by Dr. Bettelheim, when he says "in all four cases that recovered the albumin was over fifty per cent." It is scarcely necessary for me to state that the greater the amount of albumin in the urine in yellow fever, the more likely the suppression is to take place, and therefore when there is fifty per cent. the prognosis is unfavorable.

But while cocaine does act as a diuretic, and very beneficially so in this fever, yet I regret to say in this particular it has not always acted as well as I should have liked. Therefore while I have noted the diuretic action of cocaine in this

« PreviousContinue »