CHAPTER VIII.

ADDENDUM ON TREATMENT.

While this essay has been preparing for publication, two or three extreme cases of intermittent action of the heart have come under my care, to relieve which I have adopted, with considerable success, some new remedial measures. This modification of treatment has led, indeed, to the introduction into medicine of one or two new medicinal compounds, viz., the bromides of quinine, morphine, and strychnine. These bromides are made by the action of hydrobromic acid on the alkaloids, and they are prescribed in the form of syrup. I prescribe in each fluid drachm of simple syrup, one grain of the bromide of quinine, one-eighth of a grain of morphia, or one thirtysecond of a grain of strychnine, and I thus make the fluid drachm the single dose. In some cases I prescribe these remedies alone, in other cases I combine them, retaining the same dose of each in the combination. In cases where there is much general debility, irritability, and sleeplessness, I know of no remedy that answers so well as the syrup of the bromide of quinine and morphine. A drachm may be administered every three hours until rest is obtained, and when the effect of the medicine becomes pronounced the quietude of the heart is almost invariably secured. In cases where there is persistent debility and little excitability I prescribe the syrup of the bromide of quinine and strychnine, in drachm doses, three times a day, withholding the morphine, if there be little irritability and restlessness, or adding it, in place of the strychnine, should those symptoms arise. In other cases, where quinine is not

wanted, or is not readily tolerated, I order the syrup of the bromide of morphine alone, or combine it with bromide of strychnine.

These new points of practice are well deserving of the consideration of the profession, and a little familiarity with their application will, I feel confident, repay the trouble of subjecting them to the proof derived from experience. Another point of practice is also worthy of notice. In one severe instance of intermittency with palpitation, where morphia could not be tolerated, owing to the nausea and after depression it produced, and where quick relief was demanded, it occurred to me to apply a blister over the whole of the front part of the neck (the throat), so as indirectly to influence the sympathetics. The effect in this case was simply immediate for good. So soon as the counter-irritation began to be felt, the action of the heart became quieter, the intermittency was reduced, and sleep, which had for several nights been absent, became the welcome visitor. In a second case a sinapism applied to the throat was instantly beneficial. "I passed," said the patient, "as the sinapism took effect, from incessant restlessness, owing to the irregular action of the heart, into deep sleep, and that so insensibly and rapidly I was not conscious of going to sleep.

In both these instances the intermittency of the heart has not been renewed for several weeks, and the result of the practice is, as far as it goes, extremely hopeful. I shall be inclined, in the next intractable case that presents itself to me, to keep up counter-irritation, if necessary, for some length of time, either by repeating the process of blistering, or by the introduction of a seton, the good effects of which, as a remedy in cases of irregular nervous action, though well known to our forefathers in physic, is in these days almost unrecognized. Irritation by Faradization might also be applied with prospect of good result.

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