Allnatt, R. H.

English

ZENODO

62625th.-The gums being slightly affected, the blue pill wasordered to be given only twice a day.30th.-The system being now evidently under the influenceof mercury to as great an extent as appeared desirable, theblue pill was ordered to be given at night only. The sight hascontinued uninterruptedly and rapidly to improve, insomuchthat he is able to distinguish one object from another, as apencil-case from a pocket-knife. Ordered to be cupped to sixounces.Jan. 4th.-Is able to read some large printed letters on aboard in the ward, when held close to the eyes.14th.&mdash;Can now make out the ordinary type of an octavovolume, although with some difficulty. Little obvious im-provement now took place until the26th.-When he was ordered cupping to four ounces.Feb. 3rd.-The cupping having been apparently attendedwith much benefit, it was repeated.12th.&mdash;Was again cupped. He was then able to read withcomparative ease.18th.&mdash;Discharged, being able to see perfectly.A month afterwards, this patient came to the hospital asdesired; from the time he left, he has been employed inploughing. He can read the smallest type; in short, the sightof the eye is fully restored.ON THEACTION OF AMMONIA IN HOOPING-COUGH.By R. H. ALLNATT, M.D., London.IN the review of Dr. Aberle’s work on " Tussis Convulsiva,"(THE LANCET, present volume, p. 551,) allusion is made to thetreatment adopted by Dr. Wachtl, of Vienna, who recom-mends the employment of the ammoniated tincture of cochi-neal ; and you ask, " how far might the ammonia contributetowards the good effect of the mixture!"The immediate cause of the spasmodic action of the glottis,which occurs in this disorder, after the febrile action has, to acertain degree, subsided, appears to me to arise from morbidirritability of the stomach, which engenders an irritating. secretion; which secretion, involving the bronchial tubes,trachea, and fauces, spurs their exhalent vessels to inordinateaction. The excretions of the stomach, in this stage of thedisease, if tested, will be found, almost invariably, to be ofextreme acidity, sometimes so intense, as to excoriate in theirpassage the &oelig;sophagus, and roughen the teeth, as effectuallyas would a dose of dilute hydrochloric acid. Emetics, sogreatly extolled for their virtues in subduing the paroxysmsof hooping cough, act as temporary alleviants, by ridding thestomach of its acrid secretion; but the relief is transient, be-cause the organ speedily resumes its disordered action.Many years ago, during a temporary visit at a populous townin the west of England, while the hooping-cough raged as anendemic to an alarming extent, many children falling victimsto its attacks, I had an opportunity of testing the merits ofpractice founded upon the views I have here taken, and theresult fully justified my anticipations, as the cases, howeverurgent, were rapidly and permanently relieved.Dr. Wachtl, by his ammoniacal mixture, is stated to have"cured nine cases in from three to eleven davs," and I fullybelieve the assertion to be quite consistent with truth. Theliquor ammoni&aelig;, the active ingredient of the formula, neu-tralized, in some degree, the acid matter with which it camein contact, and hen, e arose the benefit; but we have otheralkalies, less stimulating in their action, and much moreeffectual, than ammonia.After preliminary purgation with calomel, (conjoined withantimony, if the febrile symptoms run high,) and an occasionalemetic to clear the stomach, nothing in my experience is soefficacious as small and repeated doses of the carbonate ofpotassa. The following combination has been extensivelydistributed to the poor in seasons when hooping-cough hasraged as an epidemic, and I can attest the almost invariablesuccess which has attended its administration&mdash;what portionof the merit is due to the cochineal I do not know:&mdash;Take ofcarbonate of potassa, one drachm; cochineal, ten grains ; boil-ing water, half-a-pint. For an infant, one teaspoonful to betaken thrice dnily, the dose increased according to age.In violent cases, much benefit will often accrue from thesimultaneous employment of the following liniment, which isto be well rubbed, morning and night, over the whole courseof the spine:&mdash;Hartshorn, and oil of amber, of each half auounce. Mix for a liniment.Suffolk-place, Pall Mall East, May, 1846.LIABILITIES OF THE MUSCLE IN DISEASE.AMONG the most frequent and remarkable, are the effects ofrestless, irregular contraction, that follow in the fibre, fromhabitual excess in the use of fermented liquors, the deliriumtremens of modern nosology. Great exception has been takento this compound phrase, which, nevertheless, is wide and-true, expressing, as it does in this disorder, the intimaterelation, by symptoms, between the cerebral and the self-motive functions-the close, constant, and mutual dependenceof mind and muscle. Here, in the King’s ward (May 18th) is.an instance of the disease in question,-severe, well markedfor the most part, but incomplete, for the muscles are at.rest,-delirium tremens without the tremor,-a solecism inlanguage,-in practice, as you see, a fact. This it is to makethe patient our teacher-this is bed-side physic. Clinicalmedicine is in this way especially corrective, by what it missesor denies. It remarks, in the contest of symptoms, on all whichthey want to be complete. How often have we verified thismethod of study in our wards! Acute rheumatism, or gout,prevailing in the system for days together, constitutional butnot arthritic,-idiopathic erysipelas, not acknowledged as such,because not yet determined by swelling, redness, and vesica-tion, to the skin; scarlet fever’ of approved character and-severity, catching and caught, yet undistinguished by a rash.The patient, (E. N-, of middle age, a confirmeddrunkard,) when we first saw him in the surgeons’ ward, theday before yesterday, (May 16th,) had been without sleep formany successive nights. His manner was much excited, andhe was passing everything under him as he lay in bed ; at thesame time, he declared himself perfectly well, and was re-peatedly asking for his clothes, that he might get up and go-home to his wife. This afternoon, as you see, in manner andappearance, he is comparatively well, having been quiet, withsleep, for the last two nights ; he is, however, still under theinfluence of the disorder, being unable, as he assures us, tocommand either the rectum or the bladder in the regulationof their excretory functions. I attribute the improvement inthis man’s condition principally to a suppository of one grainof extract of opium, with ten grains of extract of gentian,twice administered since our last visit. He had previouslyswallowed twenty minims of laudanum in an ammoniatedsaline draught, every six hours, from May 7th to May ICth,with no relief, but rather with aggravation of all his symptoms.On the latter day, he commenced taking a draught&mdash;com-pound spirit of sulphuric ether, a drachm; compound tinctureof camphor, two drachms ; sesquicarbonate of ammonia, sixminims, in pimento water-at the same interval of six hours;so that he has taken considerably less opium in the lastforty-eight hours than in any similar period of time duringhis illness.In this, as in other inveterate cases of delirium tremens, itwould seem that the nervous sympathies of the stomach wereexhausted, and its absorbing faculties impaired, by the con-tinual reaction of beer and alcohol upon its living surface-Opium, it is notorious, may, in such cases, be swallowed in verylarge doses, and for weeks in succession, with no effect thatcan be appreciated on the muscular or other symptoms of thepatient. It is, indeed, as if the stomach supplied from itsown secretions an antidote to the drug. Surely, then, withsi-ich open evidence of perverted function in the great organ.of assimilation, it is but in common sense that we shouldapply our specifies&mdash;if such there be-to other surfaces, andin other ways,-to the skin, the lungs, or the rectum,-by inunction, inhalation, or suppository. If this be theory,there is no harm in it; and it is, moreover, confirmed by suffi-cient experience. In my practice out of this hospital, I haveobtained, in many instances, the best effects from opium, usedin contact with the bowel, when no good came from it as adraught or pill in the stomach. And the suggestion may be’of practical use in the treatment of the more violent forms ofmuscular disorder, by which, as in hydrophobia, deglutition is,prevented. In a case of traumatic tetanus, to which, whileunder the care of Mr. W. Scott, of Bromley, I was summonedlate on a winter night in 1844, it was agreed between us thatthe opium, which up to that period had been in various waysadministered, should thenceforward be entirely discontinued-that the port wine, sherry, and brandy, already prescribed,should be given, as before, in large and frequent quantities, andthat suppositories of quinine, camphor, and ammonia, shouldbe repeatedly introduced to the lower bowel. The case wasof the worst kind, and did well. We kept the stomach forthe wine, employing the rectum for the physic. On a carefulreview of all the circumstances, I attribute this patient’s re-covery, in great measure, to the continued use of the tonic and.

On the Action of Ammonia in Hooping-Cough.

https://zenodo.org/record/1701114/files/article.pdf

On the Action of Ammonia in Hooping-Cough.

Abstract

Similar works

Full text

Available Versions

ZENODO