sometimes has such a calmative effect that patients who before refused food now take it freely. The suggestion is worth noting by asylum physicians. 67 Jan.30 295 B.47,H.1,'90 9 No.5 Voisin treats sitiophobia by first washing out the stomach through the stomach-tube, and then introduces food through the same tube. He thinks there is, in most cases of refusal of food, a catarrhal state of the stomach at the bottom of the hallucinations. Svetlin 2102 also urges that, in cases of refusal of food, forced feeding through the stomach-tube should be early resorted to, in order to avert inanition and its dangers. Stewart gives sulphonal dissolved in a large quantity (6 ounces-180 grammes) boiling water, then adding enough cold water to enable the patient to swallow it. Vorster 410 uses sulphonal to secure sleep and motor sedation, which was obtained in the following states: The stages of excitement in secondary delusional insanity, whether acute or chronic; of acute, periodic, and chronic mania; of senile dementia; of general paralysis, of idiocy, of epilepsy. In most cases 30 grains (0.97 gramme) per day were sufficient; in a few cases 45 and 60 grains (2.93 to 3.89 grammes) were given for a short time. The dose was usually 7 to 15 grains (0.48 to 0.97 gramme). Toxic effects were motor paresis, first of the legs, then of tongue and arms; and sensory, somnolence, depression of general sensibility, and abolition of superficial reflexes. No effect on circulation or respiration was observed. In 2 cases there was a skin eruption. B.47,H.1 166 July Näcke found chloralamid, in doses of 15 to 45 grains (0.97 to 2.93 grammes), an effective hypnotic, as certain in its action as chloral; slower, but certainly safer. Weatherly highly recommends hyoscine, grain (0.00065 gramme) twice a day in cases of acute mania, irritability of the insane, the tremor of disseminated sclerosis, chronic alcoholism, paralysis agitans, and general paralysis. He calls the drug a mental alterative. In hysterical mania it is contra-indicated. B.48,H.1,2 357 Oct.15 Preininger 314 and Lewald tested sulphate of duboisine in states of exaltation, and found it effective in a large proportion of cases. The maximum dose, given hypodermatically, is 2 milligrammes (grain). Smaller doses often fail, while larger doses are liable to induce symptoms of poisoning. When given by the mouth, the effect is uncertain. Most patients complain of dryness of the mouth and throat, which persists during the following day. Oct. Marandon de Montyel 152 has carefully studied the effects of chloralamid and antipyrin in insanity, reaching an unfavorable judgment upon both drugs. The hypnotic action of chloralamid is too mild to be effectual in most cases of insomnia of insanity. Antipyrin, while producing its usual analgesic effects in headache and neuralgia, had no other marked beneficial action. Obersteiner, of Vienna, corresponding editor, gives a summary of the therapeutic observations in insanity made under his direction by Krues. Chloral is regarded as the best hypnotic. Sulphonal requires care and cannot be given continuously. Paraldehyde loses its effects after a time. Urethan is too weak in its action. Cannabis Indica is occasionally useful. The methodical use of opium is often successful in melancholia. Hyoscine is effective as a quieting remedy, but dangerous. In the convulsions of general paralysis, chloral is the best remedy. Breslauer reports 7 cases of poisoning by sulphonal, in 5 of whom death resulted. There is obstinate constipation, probably due to accumulation of insoluble sulphonal in the intestines; petechiæ and livid patches appear on the skin; the urine is characteristically brownish red. At times death is sudden, even after apparent improvement. Schuber and Wiltrout in a series of cases, with good from drachm to 1 drachm no disagreeable after-effects. usually fails. Aug. Feb.28 May 15 have used somnal as a hypnotic effect in a majority. The dose is (1.94 to 3.89 grammes). It has In cases of great excitement it Roubinovitch has used sulphonal as a hypnotic with considerable success in various forms of insanity. In nearly all cases success was obtained. Doses of from 12 to 45 grains (0.78 to 2.93 grammes) usually produce sound sleep in from two to four hours after administration. Cumulative effects may be produced if large doses are given on successive days. The author advises a large dose on the first day, to be followed by one-fourth of this dose on succeeding days. It is best given, in soup or tea, with the evening meal. DISEASES OF THE BLOOD AND SPLEEN. BY FREDERICK P. HENRY, M.D., AND ALFRED STENGEL, M.D., PHILADELPHIA. 2 BLOOD. 178 Apr.16 SEVERAL important contributions have been offered on the subject of the specific gravity of the blood. Schmalz has made a long series of observations in health and disease. He objects to the method of Roy, on the ground that it is tedious and requires too much blood, and prefers a capillary tube, accurately graduated to contain 0.1 cubic centimetre (1 grains), which is used as a pyknometer. From 55 experiments on his own person, he concludes that the specific gravity remains fairly constant at all hours of the day. In chlorosis, the density falls in proportion with the hæmoglobin; in anæmia and debilitating conditions, the specific gravity usually is low. Lloyd Jones, on the other hand, as well as Monckton, uses modifications of Roy's method to determine the density of the blood. This is done by preparing a series of mixtures of glycerin and water of known specific gravity, and then blowing blood from a capillary tube, bent at a right angle at the end, in such a way that, by noting whether the drop sinks, rises, or moves horizontally, the relation of the blood and the testliquid can be judged. By successive trials the exact density is learned. These observers are likewise of opinion that the specific gravity varies during the day. Jones finds that the density also varies largely in different parts of the body and in different people. In general, the specific gravity is lower in those of poor physique and in women. Changes in density Monckton finds to be due to changes in the plasma or the number of corpuscles. Daland contributes a long paper on the volumetric estimation of red and white blood-corpuscles by means of the "hæmatokrit," an instrument first suggested by Blix. The corpuscular richness is determined by causing the red and white corpuscles in diluted blood to move to one end of a small tube, which is made to revolve rapidly by means of a crank, and then reading on a scale the length of tube occupied by the corpuscles, and multiplying this by a determined factor. According to Daland's description, the accurate estimation of red corpuscles is easily and quickly accomplished, but the white corpuscles cannot be counted with any accuracy on account of their scarcity. There is too little gained by this instrument to offset the disadvantages of being required to make separate microscopical examinations to learn the appearance of the corpuscles, to count the white corpuscles, and that of adding another instrument to our paraphernalia. In his investigations Daland incidentally touches on several interesting points. He finds that a 2.5-per-cent. solution of bichromate of potash is the ideal diluting fluid preventing coagulation and change of shape of the red corpuscles, hardening the leucocytes, and not decomposing. These are certainly advantages possessed by few, if any, other fluids. His observations of the accuracy in practical estimations of the blood are highly interesting in showing an average difference of 748,825 red corpuscles per cubic millimetre between the counts of himself and a colleague for the same diluted blood. This figure is much higher than we should have expected. 410 Oct., "00 Groslik investigated the effect of saline injections on the condition of the blood of animals in health, after section of the vagi and after curarization, and found much less hydræmia than might have been expected. The effect was more marked after section of the vagus and after curarization. Rumpf312 finds the alkalinity of the blood to vary largely in health, being usually less marked in women and children than in men. In anæmias and cachectic conditions it is likewise lowered, in proportion to diminution of the specific gravity and the number of red corpuscles in the former. Several interesting communications have been made on the formation and physiology of the blood. Mackenzie, J.10 et in the Lettsomian lectures, deals with the question of the origin of the corpuscles. He finds, in the venules of the bone-marrow, the erythroblasts described by Bizozzero, and, like this observer, found them always to contain hæmoglobin. The red corpuscles always (at least in birds) are derived from pre-existing red corpuscles within the venules and by mitosis. In the adult human the 2 July 4 spleen plays no part in blood formation. Braunschweig, 2064 in a series of experiments, determined that the thymus gland plays no part in the regeneration of the blood, whereas Grünberg 2065; 844 found that there is active formation of leucocytes in the lymphglands by mitosis, and possibly, also, of red corpuscles in cases of special need. The method of formation of the latter is not known, but probably they arise from the endothelial lining of the lymphpaths. Löwita investigated the question of division in white. corpuscles. As a rule, this is by amitosis, sometimes by a method midway between amitosis and mitosis, or, again, by mitosis. Höhlein 2066 extended the observations of Schwartz and Hoffman in regard to the action of spleen-cells on hæmoglobin. He found that he could first decolorize hæmoglobin by means of spleen-cells, and then re-color by fresh cells, an albumen called cytoglobin being formed in this reaction. 25,'90 3 The effect of altitude on the condition of the blood is of great importance. Muntz,, found that the density is increased at elevations; and Viault, that at 4392 metres elevation, at Morococha, his own blood contained 7,000,000 red corpuscles per cubic millimetre. From the investigations of Wertheimer, it seems that biliary coloring matters are unchanged in the blood, since, by injecting into animals pigments which are abnormal to those animals, he could, by the spectrum, detect them in the urine, unchanged. Ranking investigated "surra," a disease of horses in India, and, from appearances in the blood like those of malaria, concludes that this is a malarial disease. Zumpft, found the dry residue of the blood to be diminished in anæmia, irrespective of its variety. 90 Sept. CHLOROSIS. Nos. 42,43,00 Etiology. We are very little nearer a definite knowledge of the real cause and nature of this disease than in the past, as the great variance in the opinions of writers proves. Kahane 23, holds that the attempts to establish a mycotic form of chlorosis have wanted proof, and that writers in general underestimate the importance of the relation of blood to blood-vessels. He believes with Virchow that the true nature of the disease is one of hypoplasia of the vessels. On the other hand, Schücking is of belief that the condition of the vessels is secondary to, and dependent on, that of the blood. 84 Schubert and Scholz, also assign to 6 69 Mar.26 |