is attended with more disorder of the stomach than other cases in which the kidneys are diseased, he thought was another question. Nausea and vomiting are well known to be common symptoms of various morbid conditions of the kidneys. In the cases of alkaline urine, observed by Dr. Taylor, the sickness had not been more marked than in other renal affections. The same thing seems to be implied, if it be not directly stated, in the work of Rayer. The great reason why Rayer insists so much upon the importance of alkaline urine as a symptom of nephritis, is this, that very often there is no other obvious sign of the disease. In such cases the inflammation runs a very insidious course. A man complains of some languor, and looks a little out of health, and he may or may not have some slight aching about the loins, and these may be the only symptoms of the disease except the alkaline urine. Dr. Bird could not believe that the mere secretion of alkaline urine, when there was no irritation from a calculus, was sufficient to produce vomiting. He referred to Guy's Hospital Reports, which contained a paper by Dr. Barlow, as evidence in favour of this opinion. 7.-Materia Medica and Pharmacy. ACONITE. The most important contribution to our knowledge of the materia medica, that has appeared during the last six months, is undoubtedly Dr. Fleming's treatise on aconite.* Passing over the first two sections, which embrace the consideration of the history, botany and physical characters of the aconitum napellus; the influence of climate and culture on its properties; the respective activity of different parts of the plant; the influence of seasons on the activity of the roots and leaves; and the physiological action of the plant on vegetables and animals,--we arrive at the consideration of its physiological effects on man. The topical action is first considered. It acts as a direct sedative to the nerves of sensation, and, as might be expected, its action is most marked when applied to a surface abundantly supplied with nerves. The physiological action on man, in small or medicinal doses, is considered under the four following degrees of operation: First degree of operation.-In the course of twenty minutes or half an hour after the exhibition of five minims of the tincture, a feeling of warmth in the stomach is usually experienced, which is occasionally accompanied by a slight nausea and oppression of the breathing. After the lapse of thirty or forty minutes, this sense of warmth is diffused throughout the body, and in a few minutes more is attended by numbness, tingling, and sense of distension of the lips and tongue. There is also tingling at the tips of the fingers, and a peculiar sensation is felt at the roots of the teeth. The feeling of warmth soon disappears, but the numbness and tingling of the lips and fingers continue for a period, varying from one to three hours. Slight muscular weakness is generally experienced, with indisposition for exertion, either mental or corporeal. In about half an hour more the pulse is found to be diminished in strength; and in ano ther hour, both the pulse and the respiration have become less frequent. Thus a pulse which, in the normal state, beats seventy-two in the minute, will by that time have fallen to about sixty-four, and the respirations, supposing them to have been eighteen, to fifteen or sixteen. Second degree of operation.-Should a dose of ten minims be given at first, or a dose of five minims be succeeded in two hours by another of equal amount, these symptoms supervene more rapidly, and with greater severity. The tingling extends along the arms, and the sensibility of the surface is more or less impaired. In an hour and a half the pulse will probably have fallen to about fifty-six beats in the minute, and become smaller and weaker than before, An inquiry into the Physiological and Medicinal Properties of the Aconitum Napellus. By Alexander Fleming, M. D., President of the Royal Medical Society of Edinburgh. London, 1845. still maintaining, however, perfect regularity. The respirations will have diminished to about thirteen, presenting at the same time a slow, laboring character. Great muscular debility is now experienced; a giddiness, with confusion of sight, comes on when the erect posture is assumed. The individual sinks into a lethargic condition, evinces great disinclination to be disturbed, although he rarely falls asleep, and complains much of chilliness, particularly in the extremities, which are cold to the touch. These phenomena continue in their full intensity from three to five hours, when they gradually disappear, a sensation of languor, which lasts for several hours more, alone remaining. This is the utmost extent to which I would recommend the physiological effects of aconite to be carried, in order to obtain, with safety and success, its therapeutic action. Third degree of operation.-On the administration of five minims more, two hours subsequent to the last dose, the sense of warmth, and the numbness and tingling, again spread rapidly over the body. The sensibility of the surface is still further diminished; lancinating pains in the joints are occasionally complained of; the headache, vertigo, and dimness of vision are aggravated; the countenance grows pale and anxious; the muscular feebleness increases; the voice becomes weak, and the individual is frequently impressed with the dread of approaching dissolution. Occasionally the pulse is reduced still further in strength and frequency, perhaps falling to 40, or even 36 beats per minute, but still maintaining its regularity. More frequently, however, it rises to 70 or 80, and becomes small, weak, and probably more or less irregular. The respiratory movements are also irregular, being either short and hurried, or deep and sighing. The surface is moist, and still farther reduced in temperature. Sickness may now come on; and, if formerly present, is much aggravated, and probably attended by vomiting. These symptoms do not entirely subside for two or three days. Fourth degree of operation.-On the administration of a fourth dose of five minims, two hours after the third, the symptoms assume a more alarming character. The countenance becomes pale and sunken; froth issues from the mouth, and the prostration increases. Some thus affected have stated that they felt as if dying from excessive loss of blood. Consciousness usually remains, or there may be slight wandering delirium, as occurs also after profuse hemorrhage. The voice is whispering, or is altogether lost. The pulse becomes still smaller, weaker and more irregular, and the breathing more imperfect. The surface is colder than before, and is covered with a clammy sweat. I have seen patients recover from this state under the administration of proper remedies. When the action of the drug is carried to a fatal extent, the individual becomes entirely blind, deaf and speechless. He either retains his consciousness to the last, or is affected with slight wandering delirium, the pupils are dilated, general muscular tremors, or even slight convulsions, supervene; the pulse becomes imperceptible, both at the wrist and heart; the temperature of the surface sinks still lower than before, and at length, after a few hurried gasps, death by syncope takes place. Dr. Flemming then treats in detail the effects of aconite on the different systems of organs. We regret that we have merely space for his most important conclusions. With respect to the action of aconite on the cerebro-spinal and muscular systems, he finds: 1. That it is calmative, anodyne, and antispasmodic. 2. That it is an advisable antiphlogistic in apoplexy, phrenitis, or any disease in which the circulation of the brain is excited. 3. That it is contra-indicated in headache arising from anemia or chlorosis, and whenever there is a torpid or paralytic condition of the muscular system. 4. Its properties suggest its employment in convulsive or spasmodic diseases. The following are the practical inferences deducible from a consideration of the action of aconite on the circulation: 1. That it is a powerful antiphlogistic. 2. That it is calculated to be of great value in all cases when there is inordinate activity of the circulation. 3. That it is contra-indicated, when there is obvious mechanical impediment to the passage of the blood, particularly through the heart or lungs. It is requisite, therefore, in every case, to ascertain that no such obstruction exists before commencing its use. 4. That it is contra-indicated, whenever there is irritability of the circulation, with great diminution of power, such as occurs after severe hemorrhage. The practical inferences respecting its action on the respiratory system are these: 1. Aconite will probably be found a highly advantageous antiphlogistic in pneumonia, pleuritis, &c. 2. It seems calculated to be serviceable in spasmodic asthma. 3. It is contra-indicated in difficulty of breathing, arising from any other cause than inflammation or spasm. 4. In cases of advanced bronchitis, with excess of secretion, it would prove highly injurious, by diminishing still further the power of expectoration. After noticing the effect of aconite on the alimentary canal and secretory system, he proceeds to the consideration of the effects of the drug in large and poisonous doses. This section belongs more to medical jurisprudence than to materia medica. He concludes it with the observation, that four grains of the alcoholic extract have proved fatal, and and two grains have produced the most alarming symptoms.” Section 4th, embracing the therapeutic action of aconite, abounds in matter of the highest interest, and deserves a most attentive perusal. We could not, in justice to the author, much abbreviate it, and we shall therefore conclude our notice with a few observations on the method of administering aconite. The preparations expresssly noticed by Dr. Flemming are: a. Tinctura Aconiti. Take of root of A. Napellus, carefully dried and finely powdered, 16 ounces troy; rectified spirit, 16 fluid ounces; macerate for four days, then pack into percolator: add rectified spirit until 24 ounces of tincture are obtained. It is beautifully transparent, of the color of sherry, and the taste is slightly bitter. b. Extractum Alcoholicum Aconiti.-This is prepared by distilling, at a low temperature, the spirit for the tincture, until the consistence of an extract has been obtained. The process should be completed in a vapor bath. The color is dark brown, or almost black; it has an agreeable smell, and a bitter taste. the dose is one-third of a grain thrice daily; commencing with one-sixth of a grain. Of these two preparations, Dr. Flemming prefers the tincture, from its geater uniformity of action; the average dose is five minims three times daily, and to be increased, if requisite, by one minim each dose. c. For external use, the following formula is recommended: B-Aconitinæ Deinde adde axungiæ gr. xvj. xvj. fere optime. If, after a few applications, the ointment loses its effect, the proportion of aconitina must be increased to three, four or even eight grains to the drachm.DAY'S Report in Ranking's Half-yearly Abstract, vol. ii. 8.-Turpentine in Large Doses in the Treatment of Purpura Hemorrhagica. By Dr. J. MOORE NELIGAN, (Monthly Jour. of Med. Sci., Dec. 1845.) Dr. Neligan, whilst acting as one of the Physicians of the city of Cork Dispensary, met with eight cases of purpura hemorrhagica of the worst form; the district in which they occurred being the poorest in the city, and those attacked with the disease were nearly all of broken-down constitutions, owing to over work and insufficient nutriment. As they were of an asthenic character, he treated the first two cases which came under his care, on the tonic plan, without success; in the next case he had recourse to free purgation; but this case, which was not seen, however, until the disease was very far advanced, also terminated fatally. The fourth case, in which the individual was younger and of a more robust habit of body, terminated favorably under the free use of purgatives. "From the result of these four cases I was led," Dr. N. states, "to place but little reliance on the use of barks and acids in the treatment of this disease, and to look more favorably to the employment of purgatives. I thought, however, that still more favorable results might be expected from the administration of oil of turpentine, which, while it acts as a powerful cathartic, also possesses the property of checking hemorrhage, depending on an atonic state of the smaller blood vessels, owing, probably, to its powers as a diffusible stimulant. In consequence of those views, I employed this remedy in the four cases that afterwards came under my care while in charge of the district and they all recovered. I prescribed the oil both in the form of draught and of enema; the usual dose for adults being from one ounce to an ounce and a-half, and for children from two drachms to half an ounce, generally in combination with castor oil, to render its cathartic action more certain. "Since that time I have employed oil of turpentine in every case of purpura which has been under my care, and its use has been invariably attended with beneficial results." Three cases are related by Dr. N. in illustration, one of which is the following: William Flanagan, aged 50, a laborer, admitted into Jervis-street Hospital, July 1, 1845. The entire of the body and limbs is covered with small circular spots of various size and color; from half a line to a line in diameter, and varying in color from the florid red of arterial blood to a purplish-black hue. There are also several large, ecchymosed patches of a deep greenish-purple colour; those are situated chiefly on the right mamma, the elbows, the loins, and the backs of both legs. Firm pressure produces no effect on either the small or large spots. He complains very much of weakness, with pain in his back, which, together with a feeling of great lassitude, has, from the commencement of his illness, altogether prevented him from working. He is constantly coughing up a frothy serum, deeply tinged with blood; the gums also bled slightly, and he states that, previous to his admission into hospital, he passed bloody stools. The pulse beats about 60 in the minute, but is feeble and very compressible. The body is emaciated, and the countenance very expressive of anxiety. In early life the patient was addicted to intemperance, nevertheless he enjoyed perfect health until the first attack of the present disease, which was about six months ago. Since that time he has been repeatedly attacked with the disease, but at no time so severely as at the present. He was in an hospital during the first seizure, where he was cured of it, but it reappeared in three months afterwards; he was again admitted into the same hospital, but having been discharged before the spots completely disappeared, they in a few days began to increase in size and number, and he has never been free from them since. The great size of the vibices, together with the bloody dejections and sputa, and the complete prostration both of mind and body, compelled him at length to seek admission into this hospital. July 2d. Many new spots have made their appearance since yesterday, and the bowels have not been moved since his admission. B-Olei terebinthine iss; syrupi ii; aquæ mentha piperita 3 ii. Misce. Fiat haustus statim sumendus. 3d. Was somewhat intoxicated yesterday after taking the draught, which vomited and purged him freely, the stools being slightly mixed with grumous blood. He feels much better to-day, and eats with an appetite, which he has not done for some time. The spots are darker colored than on admission, and some new ones have made their appearance, but the sputa are not so bloody. 4th. The large blotches are fading, and turning of a yellowish-green colour, while the small spots are disappearing; sputa still tinged with blood; bowels not moved yesterday. R.Olei terebinthina 3 iss; olei lini ži; decocti hordei 3xri. Fiat enema, et statim adhibeatur. 5th. The patient is improved in every respect, with the exception of the sputa, which are more bloody; the bowels were affected only once by the enema; there is no appearance of blood in what he passed. R-Olei terebinthina 3i; syrupi 3 ss; aquæ mentha piperita ii. Misce. Fiat haustus, statim sumendus. 7th. Still improving; both large and small spots are gradually disappearing; bowels rather confined. The draught to be repeated and to have full diet. 9th. Feels quite well to-day; none of the small spots to be seen, and the larger blotches much diminished in size; has had no expectoration for the last two days; as the bowels were confined, he was ordered the common castor oil draught. 12th. Flanagan was discharged to-day quite cured, having been kept in hospital until all the stains disappeared from the skin. 9.-Variola, varioloid diseases, and vaccination. The facts Dr. L. Wagner* describes a very mild epidemic of smallpox in the district of Neufeld, near the Danube. The disease attacked 2509 out of a population of 70,000, who resided in a district containing twenty square miles. Of those who suffered from the disease, 102 only had been vaccinated, and but nine of these presented well-marked cicatrices. The disease was very mild even in those who had not been vaccinated, since the total mortality did not exceed 222 or 8-7 per cent. In all the vaccinated, the disease ran a modified course, and only one of them died. In many cases when vaccination was practised in consequence of smallpox having occurred in the house, variola appeared on the 2d or 3d day afterwards, while at the same time the vaccine vesicle ran a perfectly normal course. Dr. Woppischt gives the particulars of an epidemic of smallpox at Zeitz, in 1841, which appear to him to support the opinion of the identity of varioloid and variola. on which he founds his opinion, are that the first two cases which occurred, were cases of varioloid in two vaccinated children, the next in the same house was a case of variola in an unvaccinated child. At the commencement of the epidemic, the vaccinated suffered exclusively from varioloid, the unvaccinated from variola, but as the disease grew more prevalent, varioloid occurred likewise among the unvaccinated. Most of the cases of variola occurred in unvaccinated children under the age of 1 year, not a single vaccinated child under 7 years had true variola, and only 12 a very mild form of varioloid. Up to the age of 14 indeed, all the vaccinated children who were attacked, had a very varioloid; while persons between the ages of 20 and 40, although vaccinated in their infancy, had confluent varioloid closely resembling smallpox. From these facts, Dr. Wagner infers that the varioloid is smallpox mitigated by vaccination. This conclusion, however, is opposed to observations made apparently with equal care by Dr. Fishert of Tambach, in the Duchy of Gotha, who observed an epidemic of varioloid quite independent of smallpox, but alternating with epidemic scarlatina. He found his opinion as to the non-affinity of the two diseases, on 1st, the shorter duration of the eruption, the fact that it appeared first on the extremities, and that it was always succeeded by desquamation of the skin. 2d. The absence in its course of any affection of the conjunctiva. 3d. The invariable occurrence of erythema before the eruption, and the fact that the red spots of the early eruption, had not the central hardness of mild * Oesterr. Med. Jahrb. Nov. 1814. + Med. Zeitung, Feb. 28 and March 20, 1845. + Casper's Wochenschr., Dec. 28, 1844. |