COLCHICUM AUTUMNALE. BY JOHN ÅLBERT BURNETT, M. D., Greenwood, Arkansas. [Written for the MEDICAL BRIEF.] Meadow saffron is the common name of colchicum. It has an alkaloid, called colchicine, which is reliable. The average dose of the fluid extract of colchicum is three drops, and the average dose of colchicine is 1-128 grain. These doses can be increased considerably, as much as ten drops of the fluid extract can be given, but it will make a patient extremely sick, and this amount should never be used except in rare cases and with good judgment. It is not necessary to give more than five drops in most cases. In rheumatism, especially the subacute and chronic forms, in large, robust patients that are constipated, large doses of colchicum will be of great value, and in similar conditions of sciatica and lumbago it is reliable. I consider colchicum one of the best internal remedies in rheumatism in cases where harsh treatment can be used. Some physicians use it with jaborandi and cimicifuga. Colchicum is better adapted to subacute and chronic cases of rheumatism, but will give good results in many acute cases. Many physicians only use it after sedation has been produced when the pain is tearing, and aggravated by heat. I am fully aware of the fact that in acute cases, where there is considerable pain and fever, and no constipation, that the following would be a better remedy. R. Sodium salicylate Acetphenetidin M. ft. chart. No. xxii. Sig: One every four hours. I drachm. I drachm. The sodium salicylate should be from oil of wintergreen. Large doses of colchicum act as a drastic purgative, diaphoretic, emetic, diuretic, gastro-intestinal irritant and cardiac depressant. Full doses act as an emeto-cathartic, producing watery discharges, severe griping, great nausea and weakness. It is said to cause death from exhaustion when a sufficient amount is given. Its influence on the excretion of uric acid and urea is a debated subject, but, in my opinion, it must have some influence in this direction. It is admitted that it certainly unloads the portal circulation, and increases the flow of bile. It has been used in ascites from obstructive diseases of the liver. Some forms of cerebral congestion, gonorrhoea and chordee have been treated by colchicum. This is a remedy that should not be continued long in the treatment of any disease, unless very small doses are given. EPHEMERAL FEVER. BY H. C. SARCAR, M. D., Tollygunge, India. [Written for the MEDICAL BRIEF.] In the chapter headed Ephemeral Fever and Simple Continued Fever, in Dr. William Pepper's American Text-book of the Theory and Practice of Medicine (Vol. 1, page 6. Ed., 1903.) occurs the following: "When the affection lasts only from twenty-four to seventy-two hours, it is called ephemeral fever, while the duration of simple continued fever, or febricula, is more commonly from seven to twelve days, though it may not exceed four or five." From this it would appear that according to the learned Doctor febricula is a synomyn for, and the same as simple continued fever, but quite distinct from ephemeral fever. Dr. Ailken, however, in his learned Science and Practice of Medicine (Vol. 1, page 637, Ed., 1880,) has given the, French fièvre ephémère and Italian febbre efemera, as equivalents of febricula, which is the same as the Latin and German names of the disease. It is remarkable that the Italians have two names for the malady, viz.: Febbricola and febbre efemera. Neither in English nor in the continental equivalents do we find febricula to indicate simple continued fever (vide ibid, page 635). When two such doctors as aforesaid differ, may I ask the favor of yourself and your readers to decide whether Dr. Pepper is justified in his description, or Dr. Ailken is correct in his synonyms? In this connection I should be much obliged for reports whether chills are invariably present (as stated by Dr. Ailken), or rare (according to Dr. Pepper), at the commencement of ephemeral fever. In my experience of about a quarter of a century, chills are invariably present in such cases, and the disease is, as all know, very common in a tropical country like ours. I have never found or heard of herpes ever appearing here in any case of ephemeral fever where the patient had not indulged in some acid comestibles. ATONIC AMENORRHEA. Amenorrhea, due to deficient supply of blood-atonic, as it is called by some may be greatly benefited (Am. Jour. of Clinical Medicine), by the use of syrup of iodide of iron (syrupus ferri iodidi, U. S. P.). It is best administered in doses of one c.c. (fifteen minims), one hour after each meal, rather than at meal-time, when the iron is apt to unite with the tannic acid of the tea or coffee drunk, and thus form ink, which is of no value, since tannate of iron is insoluble. CURRENT MEDICAL LITERATURE. Pharmacological Study of Cannabis Americana (Cannabis Sativa.) E. M. Houghton and H. C. Hamilton (The Therapeutic Gazette, January 15, 1908) show that there has been a fallacious belief on the part of American medical practitioners that the native hemp will not give therapeutic results akin or as good as the cannabis from India. Accordingly, they undertook an investigation of the physiological effects of nine different samples of American cannabis sativa, samples being obtained from Minnesota; from Mexico, grown in 1904, in 1905, in 1906; from Kentucky, grown in 1906: from Detroit, Mich., grown in 1907; from Kentucky, grown in 1907. From these samples fluid extracts and solid extracts, prepared according to the U. S. P., were tested upon dogs. It was found from these experiments that cannabis sativa, when grown in various localities in the United States and Mexico, is fully as active as the best imported Indian-grown cannabis sativa, as shown by both laboratory and clinical tests. An interesting observation in these experiments was the fact that the investigators were never able to give an animal a sufficient quantity of a U. S. P. or other preparation of the cannabis (Indian or American) to produce death. A Method of Reducing Displaced Internal Semilunar Cartilage. H. G. Jacob (British Medical Journal, March 7, 1908) says that in this condition, which usually occurs in consequence of a twist of the kneejoint, while in a state of flexion or fixation, the cardinal symptom is inability to extend the joint fully, any efforts in this direction being attended with pain; if reduced, the cartilage remains nipped between the tibea and the femur, the patient's walk being a limp, with the knee semi-flexed, while sooner or later synovitis is certain to occur. The method sometimes recommended is to forcibly extend the knee, but without an anesthetic. this is barbarous in the extreme, and even with one is apt to be followed by a severe synovitis. Jacob claims the following method is successful, practical and painless, and, if the patient has not made unavailing efforts to reduce the displacement or has not endeavored to walk, practically unattended with synovitis. The patient lies on a bed or couch, the surgeon standing on the other side of the limb affected, with his face towards the patient's feet. The patient then raises his leg off the couch in the semi-flexed condition, the surgeon grasps the patient's leg in both hands, and, using his own thigh as a fulcrum, by means of a steady pulling motion draws the patient's leg outwards, while the surgeon's thigh keeps the femur in a fixed position; directly this movement is effected, the patient must steadily extend the limb, and the displaced cartilage will probably go back with a slight click; if the first movement of extension is not successful, the maneuver must be repeated without any hurry or unnecessary force, and, after a few attempts, the cartilage can usually be felt to slip in without pain or inconvenience. The rationale of this procedure is that the levering outwards of the patient's leg reduces the resistance to the backward passage of the semilunar cartilage, which then slips back into place by the aid of gravity. In view of the frequency of accidents of this character, this procedure is recommended on account of its extreme simplicity, the absence of pain, and freedom from after effects. A Study of 400 Cases of Epithelioma, in Private Practice, With Remarks on Treatment and Results. L. Duncan Bulkley and Henry H. Janeway (Medical Record, March 21, 1908) record some 417 cases of carcinoma occurring in the practice of one of the writers during a course of over thirty-five years. An analysis of these cases shows some interesting facts, to-wit, the disease appeared in males much more frequently than in females, 274 to 143, or almost two to one.. As to location, the most frequent site was the nose, the cheek coming next, then the lower lip, and upper lip. Observations as to the duration of the disease are difficult to make, but there is a general agreement as to the obstinacy of the condition. Concerning the varieties of epithelioma, there are two distinct kinds, conveniently classified, according to Krompecker, (1) epithelioma basocellare, and (2) epithelioma spinocellare, referring respectively to the layers of the skin from which the particular variety is supposed to originate. The conclusions arrived at by Bulkley and Janeway are interesting, and are as follows: I. The most frequent form of cancer which the dermatologist is called upon to treat is, both pathologically and clinically, quite a different. growth in its relatively benign course, from the usual conception of cancer. 2. It occurs chiefly about the face, where radical operative procedures are apt to produce serious deformities, which may materially add to the patient's discomfort. 3. While the experience of thirty-five years indicates that many cases may be permanently cured by caustic pastes, these are at times disapppointing, and may lead to an aggravation of the trouble. 1 4. The curette can not be depended upon alone, but requires additional destructive agents to the base left after operation. 5. By the proper use of the X-ray we have a safe, and in cases that have not been grossly neglected or maltreated, a sure method of cure, with the least amount of deformity. 6. In cases where knowledge and experience show that these lighter measures are not likely to avail in checking the course of the disease, recourse should certainly be made to complete surgical removal, as this has been shown to be permanently successful in a reasonable proportion of cases. Abscess of the Lung Cured by Incision and Drainage. C. H. Cattle and J. R. Edward (British Medical Journal, March 7. 1908) report a unique case of abscess of the lung cured by incision and drainage. The patient was a man, aged thirty-six years, who, after an attack of pleuro-pneumonia, in July, 1907, continued to cough up, first, pinkish, tenacious sputum and, later, inodorous purulent sputum. Upon coming under the observation of Cattle and Edward, in September, 1907, he was emaciated, respirations twenty-eight, hectic condition, with a temperature ranging from 98° to 102° F. No tubercle bacilli were found. Expectoration of this purulent material continued, and the patient could only lie comfortably in one position, i. e., on the right side, with the head near the edge of the bed. The heart sounds were normal. Movement over the left lung was impaired; deficient resonance over the entire left lung, most marked at the lower part of the axilla, and near the angle of the scapula. Breath sounds were weak, especially near the angle of the scapula. There were scattered crepitations over the left side, which were amphoric and distant. The right lung showed some dullness, but not nearly as much as the left. Attempts, at that time, to find pus by means of the exploratory needle plunged into the lung, were fruitless. Yet, on December 10, 1907, the exploring needle was again used, and a syringeful of pus obtained. On December 14, 1907, under chloroform anesthesia, pus was again located with the needle, near the angle of the left scapula. A piece of the eighth rib was excised, the pleura incised and indurated lung substance met with; passage of the needle downward and forward resulted in pus being found at a depth of two and one-half inches from the surface of the lung. Dressing forceps were passed along the side of the needle, the blades were opened up and, after some difficulty, owing to the dense character of the indurated lung tissue, sufficient space was made to allow a free drainage of pus to ensue, at least a pint of pus finally escaping. A rubber drainage tube was then inserted, reaching to the bottom of the wound thus made in the lung. Uneventful recovery took place in about thirty days. |