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thors often put stuff in their books more But what we want is to know that a to fill up than to benefit people who try to certain procedure not only ameliorates but follow them? Haven't the books often cuts short certain conditions. When we said that certain remedies are beneficial, know that certain results follow the use of and haven't we given them day after day certain remedies every time, we can go to or week after week without the slightest the bedside with a certain knowledge that improvement in the patient? Don't we we can give relief when most needed. Afforget sometimes that the authors are only ter innumerable cases of good results along men? That we are also men? That we certain lines, our confidence in the applihave as good right to think and apply our cation of drug medication to the treatment selves and find out for ourselves as they? of disease grows stronger and stronger, And it is easy to write and easy to get it and we feel that there is indeed something printed and easy to make mistakes? But in the practice of medicine better than the what I insist on is that if an author says nihilistic teaching of some of the authors. a certain thing, and our observation says It is a great pleasure to see uniform and the opposite, we shall not follow him but positive action from certain lines of treatfollow our own sense. An author may not ment. It puts renewed and higher aspiranecessarily have had better opportunity for tions into our work. It makes us feel that application of therapeutic measures than we ours is not a cold abysmal gulf of uncerhave. Our minds have as good right to tainty; it makes us optimists. It gives us do some clinical experimenting as an au- energy for renewed efforts. Finally, nothing thor or any one else. It is our duty to
adds to our high ideals so much as do the gainsay any author's dictum if from our
positive permanent results worked out from actual observation we prove him to be mis
our application of therapeutic measures to taken. And it is our duty to add our mite
the treatment of disease. to the sum total of clinical knowledge if we have anything of special value to offer to our fellow practitioners. I have no
PHYSOSTIGMINE. doubt that we all have some specially good formulae that would be of great value to
W. C. ABBOTT, M. D., the rest of us if we were not too modest
Chicago, I11. to present them to the profession.
Eserine or physostigmine is one of the I would like to earnestly protest against
most interesting alkaloids in the entire list. the common practice of ascribing great
Its qualities are so distinct and so imvirtue to certain lines of treatment in
portant that it would be widely employed ephemeral cases. There is such a
were these better known. With the obtremendous tendency for a person to get
ject of calling attention to the properties well without treatment that if he is let alone, he will often get well as quickly
of this valuable agent I present the folwithout treatment as with it. Too many
lowing resume of its literature. times we see some treatment highly ex- Physostigma contains at least two other tolled, whereas, if the patient had been alkaloids, one of which is only known to given rest and food and light, he would "resemble strychnine,” the other exerting have recovered equally as soon.
an action similar to that of eserine. Since
these exist in varying proportions it is evi- physostigmine induces paresis of the dent that they seriously modify the action pharyngeal constrictors by a local action. of the plant-drug, imparting a degree of Harnack considers the effect manifested uncertainty to it altogether out of place a direct action on the secretory gland cells when dealing with so powerful an agency. and the muscular fibers, but others attribute For this reason the crude preparations it to an action on the peripheral nervescarcely made any impression on practice, endings. but the profession began at once with the Physostigmine commences to display an alkaloid, there being none of the "habit evident action within five minutes, and by obstacle” in its way. But in proportion that time may be detected in the urine, to the quantity of calabarine that may by which it is mainly eliminated. The chance to be present, physostigma is more maximum of action occurs in thirty minstimulant and less sedative than physostig- utes and subsides within an hour unless mine.
sustained by repeated doses. Van RenGiven in small doses-gr. 1/100 or less terghem took gr. 1/100 every hour for five to an adult-physostigmine exerts a pre- doses during the forenoon. By noon he liminary stimulant action, causing muscu- felt slight vertigo, anorexia, non-painful lar twitching and increasing the irritability gastric and intestinal peristalsis, coolness and the force of the muscular fibers. The of surface, at 12.30 energetic bowel movepulse is slowed and vascular tension raised, ments and vomiting without nausea, pulse respiration accelerated. The most de- reduced from 79 to 64, sweating, and by cided effect is manifested on the muscula- 2.30 all symptoms had passed away. ture of the stomach, intestines, bladder, In one case when marked depression ureters, uterus and bronchi, all which are followed a hypodermic dose of gr. 1/50, stimulated powerfully. The tears, saliva, relief followed promptly and permanently perspiration, mucus and pancreatic juice when the patient took a little glonoin, are increased. The pupil is contracted atropine and strychnine. The symptoms but the eye accommodated for near vision. closely resembled those following an over
In larger doses physostigmine slows and dose of muscarine. weakens respiration, slows the heart still From this review of the physiologic acmore and relaxes vascular tension, de- tion of physostigmine we see why it failed presses the nerve centers, and kills by in epilepsy, chorea and tetanus, aggraparalyzing the center of respiration. The vating the convulsive tendency in each. In action on the heart is a direct one and is cases of strychnine poisoning animals die not exerted by stimulating inhibition. sooner if treated with physostigmine. The Marked sedation approaching collapse has control of the central nervous system is followed single hypodermic doses of gr. weakened in these maladies, and the only 1/50. The general muscular force is de- benefit arises from the increase of eliminacidedly weakened but the action on the tion. involuntary muscular fibers and on secre- In the treatment of the morphine habit tion is increased. The temperature is Dr. Waugh has obtained decided benefit slightly lowered, more especially that of from physostigmine in cases where the the surface. When taken by the mouth pupil is dilated after the morphine has
been stopped, but only then. The alka- cramp, obstinate hiccough; and Ringer loid so completely replaces morphine then and Murrell reported temporary improvethat the patient can not detect the sub- ment or arrested progress of paraplegia atstitution. Yet this effect can be secured tributed to myelitis. They also found imonly from doses of not above gr. 1/100 provement follow its use in locomotor twice each 24 hours, and the relief does ataxia. Murrell succeeded with it in not endure more than an hour, after each controlling the night-sweats of phthisis. dose. It affords an interval of perfect De Giovanni combined it with ergotin for
renal hemorrhages, with benefit. Physostigmine is the best remedy for In bronchitis, pulmonary congestion and flatulence due to intestinal paresis, and pneumonia, Shoemaker found physostigfor intestinal torpor. It has recently been mine useful by lowering the excitability of employed to clear the bowels before and the vagus and the activity of the heart after operations in the abdominal cavity, and respiration. Its tonic action on the with excellent results. Dr. John L. bronchial musculature renders it of value Sagerson reports its use in two cases of in some cases of asthma and emphysema. fecal vomiting; in one it acted well but Experiment has demonstrated a decided the patient was too far gone for recovery; antagonism between physostigmine and in the other "the change was wonderful,” atropine on the one hand and pilocarpine and recovery ensued which was attributed on the other. Either of these might be mainly to this remedy. Subbotin found it utilized as antidote in case of poisoning, useful in in fecal impactions. With it but atropine is preferable.
The speedy Maschka cured a case of diarrhea with elimination of physostigmine renders fatal flatulence due to intestinal catarrh. With poisoning impossible if respiration can be atropine to combat intestinal inhibition sustained. and strychnine to incite the nervous cen
The contradictions in the early reports ters, physostigmine is a valuable remedy upon this agent were due, as Wood justly för intestinal torpor, and if not misused states, to the presence of varying quantiin too large doses plays an important part
ties of calabarine in the samples tested. in curing this condition and the many ills
Those of later date are to be attributed to dependent thereon.
the undiscriminating manner in which the Shoemaker finds this combination use- alkaloid has been employed in any and all ful for the digestive troubles of women at cases and conditions of any given disease. the change of life; and in dilatation of Take epilepsy, for example—the primary the stomach. He denies its deleterious ac- stimulant action of small doses at the betion in tetanus, and says more than half ginning of a paroxysm would ensure its the cases recover under it. It should be occurrence; whereas the eliminant effect pushed to full effect. In chorea, epilepsy would tend to prevent subsequent exand progressive paralyses, great improve- plosions. Cases requiring depression of ment has followed its use. It has been ap- spinal activity and reflex excitability would plied successfully in infantile convulsions be benefited by this potent agent; while after chloroform had failed; and in tic, the lessening of cerebral control it induces twitching of the
of the orbicularis, writers' would make worse such cases as strych
nine would benefit. Until remedies are The malady occurs frequently. Sex, applied with a nice comprehension of the age
race constitute no exception. exact pathologic disorders of function Among the causes we may mention traupresented by each case we may expect matism, emotion, fright and worry.
Its such contradictory views.
etiology is that of hysteria.
In a great Since physostigmine is a remedy that majority of cases the patient becomes sudgets to work so speedily and is so quickly denly mute, rarely it arises out of aphonia eliminated it is especially one well suited insidiously. The patient cannot articulate for the intensive method of dosage, a min- and while he simulates an effort to speak, ute dose being administered every ten to as a matter of fact, he makes no attempt. thirty minutes until the exact desired ef- His lips are perfectly immovable. Charcot fect has been secured. It partakes of the nicely puts it when he says: “The hysterisafety of veratrine, aconitine, gelseminine cal mute is muter than mute, for the deafand pilocarpine in that it can not accumu- mute can articulate some sounds, but the late.
hysterical mute can do apparently nothing."
On examining the larynx we find no A CASE OF HYSTERICAL MUTISM.1
paralysis. In a paralysis we can observe some whispering, here not even this is a
possibility. They feel a heavy tongue, MARCUS NEUSTAEDTER, M. D., Ph. D., that some impediment is in the buccal Attending Neurologist New York University and cavity. Bellevue Hospital Medical College; Clinic Alongside of hysterical mutism we find and Out-patient Department Bellevue
some or many stigmata of hysteria, such as Hospital, New York.
anaesthesia, dyschromatopsia or achromaAlthough this affection is known to us
topsia, concentric diminution of visual under this terminology ever since science
fields or reverse color field vision, globus treats of hysteria, it has been frequently hystericus, etc. The intelligence of the mistaken, as in my own case, for a variety patient is entirely intact, he understands of diseases. Charcot was the first one to everything. The duration of this disease call attention to this disease as a path
varies. In some it lasts days, in others ognomonic sign of a functional disorder
weeks or months. Oppenheim speaks of and not as it was hitherto understood to
cases reported lasting years. The cure is be a pure simulation; but to Krieshaber
spontaneous. Treatment is suggestive and Kussmaul
the scientific only. This I shall illustrate in my case, analysis of the modus operandi of the which, on account of its peculiarity, I causes and progress of the disorder. Car- thougat worth while reporting. taz under the direction of Charcot cata- M. G., male, 40 years old, Austrian, logued the first twenty reported cases and married, tailor. Wife insane for the last after him Mendel, Dubois, Dutil, Gott
years. Family history negative. stein and others reported similar cases. Patient denies alcoholism or syphilis but *Presented to the
smokes heavily. With the exception of ion of Neurology and Psychiatry of the N. Y. Academy of Medicine,
pneumonia which he contracted ten years April 11th, 1910.
ago, while at work, he claims to have been mute. He at once came to me and restruck between his shoulder blades, taken ceived his galvanization of the vagi and quite unawares. This shock suddenly began to speak at once. This time his rendered him mute, from which he recov- larynx and vision were examined. The ered after four hours. He felt as though examination of the larynx proved that it the tongue was like a "heavy stone in his was normal, but he has a concentric dimimouth.” Two years after this accident he nution of his field of vision and a dyschrohad a quarrel, during which he became matopsia to blue and green. mute for one day, again recovering spon
111 Second St., N. Y. taneously. About two years after this quarrel, he again quarreled and became THE SERUM TREATMENT OF GONmute. This time the condition lasted two
ORRHEAL ARTHRITIS.1 days, from which attack he recovered spontaneously. A year ago he had some
ROBERT H. HERBST, M. D., difficulty with his employer and after a
Chicago, Illinois. violent quarrel became mute for fourteen
Instructor in Genito-Urinary Surgery, Rush days. This time I was called in to see Medical College, Chicago and Chicago him. I was told that the man was dying,
Polyclinic. that he did not partake of any food for There is very little to add to the serum two days and did not drink any water for treatment of gonorrheal arthritis since my a day, that in one hospital the case was
publication in 1909. I will take a few diagnosed as a cerebral hemorrhage and in minutes, however, in order to discuss another as a laryngeal tuberculosis. The
some points which I think are extremely patient was lying in bed in an asthenic important in the treatment of gonorrheal condition, refusing to move and perfectly joints with anti-gonococcic serum. In a mute. No focal signs or symptoms of an given case of arthritis, coexisting with or organic condition were discovered. Com- following, a gonococcus infection in some plete anaesthesia of the head and neck
other part, usually the urethra, we must was present and upon being commanded endeavor to determine whether the joint to rise from bed, he at once responded. A trouble is caused by the invasion of the glass of water was handed to him, which joint or its membranes by the germ, or he drank with relish, after I had placed merely by its toxins. If the former cona strychnine tablet upon his tongue—this dition exists, namely, that the joint or its I did in the nature of a suggestion. After membranes are invaded by the germ, antithis he was able to say “yes.” On the gonococcic serum has been worthless in next morning the patient was brought to our hands, just as it has in the treatment my office where I assured him most em- of all other infections with the gonococcus, phatically that he would speak within a few such as urethritis, prostatitis, epididymitis, minutes. An application of the galvanic and so forth. As far as I know, clinicalcurrent along the course of the vagi in the ly these two conditions are difficult to difneck made him speak at once. From that
*Read before the Chicago Orthopedic Society, time on he was well until a week ago,
March 10, 1910.
?Illinois Medical Journal, June, 1909, pp. 643, when after a quarrel he again became etc.