Exophthalmic goître as a sequel of influenza : strophanthus as a remedy, and the effect of overdoses of thyreoid extract.

  • McAdam, R.L.
Date:
1894
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Licence: Public Domain Mark

Credit: Exophthalmic goître as a sequel of influenza : strophanthus as a remedy, and the effect of overdoses of thyreoid extract. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    [N. Y. Med. Jode. tersof a syringeful should be injected. When the injection has been made, the needle, still connected with the syringe, is to be withdrawn rather suddenly; then the left forefinger is to be placed over the puncture in order to stop the slight discharge which might occur. If the patient’s neck or the operator’s hands have been soiled by the tincture of iodine, they should be washed in ammonia water. Usually nothing special occurs as the immediate result of these injections, but sometimes there is observed local heat, with tumefaction, a little embarrassment of the movements of the neck and in swallowing, and occa- sionally some painful sensations about the jaw, the teeth, or the ear of the side on which the injection has been made. These are benign phenomena, and do not last more than a day or two. They constitute no reason for not repeating the injection week- ly, as should be done. Occasionally there is feverishness, with chills, headache, depression, agitation, sleeplessness, and gastric disturbance, symptomatic of a slight degree of acute iodism, which usually does not last more than from a few hours to a day or two. The author closes with the statements that this method of treatment acts by causing absorption and a non-sup- purative inflammation, and that it is absolutely harmless and of marvelous efficacy when it is employed early and with discern- ment. v Guaiacol as an Antipyretic.—The Medical News for Janu- ary 27th publishes a portion of a lecture delivered at the Penn- sylvania Hospital on January 13th by Dr. J. M. Da Costa, of Philadelphia, entitled Clinical Remarks on the External Use of Guaiacol in reducing High Temperature iD Typhoid Fever and other Febrile Diseases. Dr. Da Costa thinks that the action of guaiacol is somewhat inferior to that of the cold bath as regards promptness, but he has observed that the reduction of tempera- ture which it produces is more lasting. He thinks it preferable to the use of cold baths, particularly in cases where proper appli- ances for administering the baths are wanting and where from the nature of the case it is particularly objectionable to move the patient. The odor of guaiacol is an objection to its use, and this Dr. Da Costa has not yet been able to overcome. Oil of bergamot has been tried, but the odor of guaiacol over- comes that of the bergamot. Cologne water and oil of sassa- fras also have been tried, but the best result has been obtained with oil ot‘ cloves. Guaiacol is to be rubbed upon the skin of the abdomen or thigh with a camel’s-hair brush over a space previously washed with soap and water. The largest amount that has been applied at once in Dr. Da Costa’s experience is sixty drops, but from the application of fifty drops he has wit- nessed effects that cause him to advise that rarely should so large a dose be used. Thirty drops he thinks about the average dose. The guaiacol is to be rubbed in slowly, and the surface to which it is applied need not be uncovered, for the applica- tion can be made under the bedclothing, and it is well to cover the surface with a piece of lint and with waxed paper. The dose should be proportionate to the height of the fever; with a temperature of 103° F. it should not exceed twenty minims at the first trial. It is not necessary to rub the guaiacol in, but if friction is not used the effect is neither so rapid nor so com- plete. The quickest way is to paint the guaiacol on the surface and then rub it in with the hand. Five minutes are enough for the purpose. The sensation, which is not unpleasant, is likened to that produced by the application of menthol. Dr. Da Co>ta thinks that guaiacol is absorbed by the skin and that it is car- ried by the circulation to the heat centers, upon which it acts as an antithermic. Apparently its action does not involve the depression that follows the use of nntipyrine, phenacetine, and other remedies belonging to the coal-tar products. Moreover, it produces less sweating. In no instance under Dr. Da Costa’s observation was there any albumin in the urine or any sign of kidney irritation detected that could be imputed to the use of guaiacol; nevertheless, he advises close examination of the urine in all cases in which the remedy is used. The Antipyretic Action of External Applications of Co- caine.—At a i-ecent meeting of the Societe des sciences medicates de Lyon, the proceedings of which are reported in the Lyon medical for January 14th, M. Gelley, a hospital interne, made a communication on the antipyretic action of cocaine applied to the skin. In Professor Teisser’s service a nurse had been directed to make applications of guaiacol to a number of fever- ish patients. Having one day used by mistake a solution of cocaine, he reported that he had taken the wrong bottle, but the patients’ temperature curves nevertheless showed a i-educ- tion. Systematic trials were then begun and M. Teisser was able to observe that a reduction of several degi-ees was pro- duced if care was taken to make the applications at a time when the temperature was no longer rising. The effect upon the general condition was apparently the same as when guaia- col was painted on. The patient experienced a sensation of re- pose and well-being, but the course of the disease was not modified. The procedure is the same as with guaiacol. A so- lution of from three quarters of a grain to a grain and a half of cocaine in a quarter of a teaspoonful of water should be used for each application, and the solution is to be applied to the upper part of the thigh. The antipyretic action of the applica- tion of cocaine is analogous to that of the application of guaia- col, but it is a little less energetic. M. Guinard reported that he had repeated these experiments on rabbits. He had resort- ed to the use of a cocainized ointment, the use of which was easiei-, but he had satisfied himself that unmedicated ointment was incapable of producing any reduction of temperature. With the cocainized ointment, on the other hand, he had caused a reduction of nearly 2° F. He thought it demonstrated that the medicaments employed acted upon the pei-ipberal nerves. The Antiseptic Action of Diaphthol.—In the Revue gene- rale de clinique et de therapeutique for January 17th there is a letter in which the writer remarks that M. Guinard has been making a critical and experimental study of diaphtbol, which is the orthoquinolinemetasulphonic acid of chemists. It is a powder, fusible at 295° C. and capable of being crystallized in the form of brilliant needles which are colored green by per- cliloride of iron, and not by contact with metallic iron. By its decomposition it sets oxyquinoline free. With an alkaline solu- tion it forms soluble diapbtbolates. The diaphtholate of sodium in a ten per-cent, solution kills the Bacillus pyogenes fcetidus and the Staphylococcus pyogenes in thirty or fifty minutes. In a five-per-cent, solution it only weakens their virulence. Diaphthol is not very poisonous. The urine of animals which have ingested it rarely undergoes ammoniaca) fermenta- tion; nevertheless, it becomes putrid. In experiments recently made, it has been ascei-taiued that the liver of these animals is preserved a long time without decomposition ; therefore it is a substance which is opposed to certain fermentations. Add to these essential qualities the fact that this remedy is well borne by the gastric and intestinal mucous membranes, and it is easy to understand the interest shown in the use of diaphthol as an internal antiseptic, and especially as an antiseptic of the urinary passages, as it is eliminated free by the urine. Bernheim’s Nutritive Enema.—The Union medicate gives the following formula: Concentrated bouillon, ten ounces; pulp of boiled meat, an ounce; Malaga wine, six drachms. Such an enema, administered every three hours, it says, is suf- ficient to maintain nutrition.