Dr. McCall Anderson gives the following as the most to inflamed surfaces that he has ever Bismuth oxide, 25.0 ; acid oleici, 200.0 ; ceras alb., tried 225.0 ol. ; rosse, 0.25. 75.0; vaseline,
valuable application
THE INDIAN MEDICAL GAZETTE
260
Spstpcts
and
(fetraqts.
REMARKS ON A FEW ARTICLES OF THE INDIAN MATERIA MEDIO A. By Edward J. Waring, c.i.e., m.d., Retired
Surgeon-Major,
U. M. Indian
Army,
Within the last few years, considerable attention has been paid to the subject of the Iudian materia medica. The writings of Fleming, Roxburgh, Ainslie, Royle, O'Shaughnessy, Wise, Bidie, Khani Lall Dey, Moodeen Sheriff, and others (amongst whom I think I may venture, without laying myself open to the charge of egotism, to include myself) have succeeded in awaking medical officers and other practitioners in the East to the important fact that around them, on every side in the vast Indian continent, from the Himalayas to Cape Comorin, there are available, at almost nominal prices, often at the simple cost of collection, remedies as powerful and efficient as the more costly imported articles, the supply of which, from the very nature of things, is necessarily limited, and at times precarious. The spirit of inquiry thus set on foot resulted in many indigenous drugs being subjected to clinical trials in European hospitals and elsewhere, where their effects could be carefully watched; and their alleged efficiency having been satisfactorily proved, they in due time were admitted into the officinal list of the British Pharmacopoeia ; of this we have examples in Indian hemp (cannabis sativa), chiretta, hemidesmus Indica, segle marmelos, and kamela. On satisfactory, though not perhaps on equally conclusive, evidence, no fewer than forty other articles were admitted into the officinal list of the Indian Pharmacopoeia issued by the Indian Government in 1868. Some of these latter have since found their way into Europe, and are at present under trial in the hands of British and continental practitioners ; for example, chaulmoogra-oil, sandal-wood oil, gurjan balsam, anacardium, (cardol), etc. What the verdict will be, remains to be seen. To enter on the consideration of Indian materia medica general is beyond my intention, and, indeed, beyond my powers. All that I purpose to do, on the present occasion, is to offer some brief suggestions on a few articles which appear to me worthy of more attention than has been paid to them, and which seem to hold out the prospect of proving valuable therapeutic agent. in
Caruh (Ptychotis) Ajowan.?The first of these to which I would direct attention is the fruit of carum (ptychotis) ajowan, D. C., an umbelliferous plant common under cultivation throughout India, sold in the bazaars under the name of ajwain or ajvain (Bengal) and o'mam or o'mum (Tamul). Under the name of ajava-seeds, they were brought to the notice of the profession in Europe in 1773 by Dr. Percival (Essays, vol. ii, p. 226), but they fell into unmerited neglect. My own impression is that they are the most powerful of all the umbelliferous carminative seeds, and that they may well replace others in practice. Dr. G. Bidie and Mr. J. J. Wood, both of the Madras Medical Service, have borne strong testimony to their value ; the latter regarding them as combining the stimulant quality of capsicum or mustard with the bitter property of chiretta and the antispasmodic virtues of assafoetida. An essential oil (of which they contain about 5 per cent.) and a distilled water, are officinal in the Pharmacopoeia of India. Greatly increased interest attaches to this article from the recently discovered fact that its stearoptene, sold in the bazaars of the Deccan, Scinde, etc., under the Hindustani name of ajwain-ka-pheul, is identical with thymol, whose claims as an antiseptic and germicide have of late attracted much attention. The fruit, indeed, is now a recognised source of this valuable antiseptic agent. Without attempting to enter upon its therapeutic uses generally, I would point out two diseases in which it seems very desirable that trials should be made to test_ its powers. 1. Cholera. Here Anglo-Indian testimony is already strongly in its favour, but we want more than public opinion; we want facts based on scientific observation, and it is hoped that this may be accorded to it by our professional brethren in the East. The antiseptic
[Aug.,
1885.
properties of its constituent, thymol, conjoined with its powerful diffusible stimulant action, indicate the probability of its proving of the greatest service in this disease. 2. Dipsomania. All I desire here is to draw serious attention to the following words of the late Mr. J. J. Wood, with reference to ajvain or o'mam seed. "On account of its bitter, biting or pungent, yet pleasant, taste, and the sensation of warmth it creates in the stomach, it has been constantly recommended of late years to those afflicted with
the desire for alcoholic drinks. It does not, of course, inbut it is no mean substitute for the ordinary stimulant in removing almost immediately, the sensation of ' ' gnawing' or sinking at the pit of the stomach' which the frequent use of spirits invariably brings on. And I have been assured that it has been the means of rescuing many otherwise sensible and useful men from slavery to the habit of spirit-drinking." Sincerely is it to be hoped that those in this country who have charge of inebriates or dipsomaniacs will make trial with this remedy.
toxicate,
Plant AGrO Ispaqhula.?Another seed commonly met with in all Indian bazaars, which seems to me to merit more attention at the hands of European practitioners than is generally paid to it, is that of plantago ispaghula, roxb, sold under the name of ispaghul (Hind.), and ishappukolvirai (Tamul). When these seeds are immersed in water, the cells composing the epidermis swell and elongate, and On insoon burst, leaving only fragments of their walls. fusion, mucilage is so abundantly yielded by. them, that 1 part of them with 20 of water forms a thick tasteless jelly. Fleming, Ainslie, and other early writers on Indian materia medica, spoke of their usefulness as a demulcent in catarrhs, renal affections, dysuria, etc., but it is to their use in intestinal affections that I would particularly direct attention. The late Mr. Twining, in his Diseases of Bengal (vol. i, p. 212). speaks highly of them ; and in the chronic diarrhoea of Europeans, who have been long resident in India, he states that he found ispaghul seed to answer He found that it also better than any other remedy. sometimes cured the diarrhoea of European and native children after many other medicines had failed. The dose of the seeds for an adult is two and a half drachms, with half a drachm of sugar-candy. They are administered whole, and in their passage through the intestines, they absorb as much fluid as makes them swell ; and by the time they reach the central and lower portions of the canal, they give out a large amount of bland mucilage, and this they continue to do until they have passed over the whole of the intestinal tract. If the frequency of the dejections be restrained by anodyne injections, and by using only a small quantity of food, the demulcent action of these seeds is thought to be increased. It is said that a slight degree of astringency, and some tonic property, are imparted to the seeds by subjecting them to a moderate degree of heat, so that they shall be dried and slightly browned. A lady in London, the wife of a retired general officer, shortly since related to me the case of a friend of hers who had been obliged to return home from Bengal for chronic dysenteric diarrhoea. The case was treated by some of the leading The lady, remen in England without deriving benefit. membering her Indian experience, sent out to Calcutta for a supply of ispaghul seeds, gave them after native fashion, as above, and effected a cure ; or, at any rate, the patient recovered. It may, of course, have been merely a coincidence, but, taken in conjunction with the reports of Mr. Twining and others, it is worthy of note. Scopolia Luridus.?The third article to which I would a solanaceous plant of Nepaul and the Himalaya, scopolia luridus Dunal. (Anisodus luridus, Linn.), which, as a mydriatic, appears to be equal, if not superior, in power to belladonna. It was introduced into Europe in 1824, and is now cultivated there in gardens. The leaves, which are of a pale green colour, emit, especially when bruised, a peculiar tobacco-like odour. A tincture prepared with them, in proportion of one ounce to eight ounces of alcohol, administered to different patients, was found to produce extreme dilatation of the iris, and this, in two instances, to such an extent as to cause blindness, which only disappeared when the medicine was discontinued. The largest dose given was twenty drops of the above tincture during the four-and-twenty hours. (See further details in vol. ix of Braithwaite's Retrospect, p. 119,
direct attention is
INDIAN DRUGS.
Aug., 1885.]
2G1
pital; three months afterwards, he was reported to be its quite well. This is a single case, it is true, but it is very power as a mydriatic is equally well marked. The late Sir suggestive. Dr. Evers concludes his remarks by quoting a H. Christison {Indian Medical Gazette, September, 1868) passage from Holmes's System of Surgery (vol. iii, p. ol2), " with that bold self-sacrificing spirit which characterized as to the importance of the discovery of a fluid of great many of his investigations, made trials with this plant in coagulating power devoid of irritant properties," applicable his own person. lie introduced about the fourth of a drop to the treatment of aneurysms. Is such a fluid to be found of juice from a leaf-stalk into his left eye, and found that in the fresh milky juice of jatropha curcas? it immediately dilated the pupil with all the energy of Andromeda Leschenaultii.?The next plant to which I belladonna. In forty minutes, the dilatation was complete. This effect passed off more slowly than when produced by would call attention is one which, as far as I am aware, has belladonna. When he made a similar trial with the root- no medicinal properties assigned to it by native practijuice of belladonna, he found that the pupil was restored to tioners, and yet it is probably destined to play an important its natural size in four days ; but the dilatation produced part in the future of Indian materia medica, namely, by this plant was still perceptible at the end of eight days. Andromeda Leschenaultii D. C., Nat. Ord. Ericaceas, growing in great abundance on the higher ranges of the NilCommenting on these facts, Sir R. Christison naturally asks, gherries. In 1867, Mr. Mclvor, of Ootacamund, requested why should India depend upon Europe for one of the Mr. Broughton, the Government quinologist, to examine an armamenta chirurgise when it has one as good, if not better, of indigenous growth 1 And he goes on to suggest that essential oil obtained by him from this plant, and it was trials should be made with it to ascertain whether it would pronounced by him to be identical in composition Avith the have the same effect as henbane and belladonna in correct- Canadian oil of winter-green, Gaultheria procumbens, as was found to contain less of the peculiar ing the acrimony of resinous cathartics, and the same sin- Willcl. but, oil itwhich forms a natural and considerable gular effects as these drugs when administered in large hydrocarbon of the constituent Canada he was led to recognize it oil, doses. He concludes by expressing a hope that our breas somewhat superior in quality to the latter. This Androthren in the East will soon settle these points by actual like its Canadian meda is an congener, oil, impure salicylate experience, a hope which I beg most emphatically to of methyl ; and Mr. Broughton, acting on his knowledge of re-echo. the fact that methyl-salicylic acid would, under suitable Jatropha Curcas.?Another subject, which appears to treatment, yield carbolic acid, instituted a series of experime well deserving notice at the hands of the therapeutist, ments which resulted in his preparing considerable quanis the styptic or hemostatic virtue of the milky juice tities of pure carbolic acid, equal to the purest kind English phvsic-nut, Jatropha Curcas Linn., a widely dis- obtained from coal-tar. The cost of preparation was from tributed plant throughout the tropical portions of both five rupees to seven rupees per pound. Mr. Broughton, The of this hemispheres. styptic properties juice were first in the conclusion of his able report on this subject brought to notice by Baboo Udoy Chand Dutt (Indian to the Madras Government (January, 1871), observes that Medical Gazette, October, 1874, page 200) in 1874 ; and he the carbolic acid obtained from this source has certain furnishes two illustrative cases?one, a bleeding vessel advantages over the coal-tar acid, consequent on its within the cavity of an open abscess; the other, haemorrhage extreme pui'ity. It is less deliquescent, and cannot possibly following an incision made for the purpose of be open to the suspicion of contamination with certain broken piece of bougie from the urethra?in both of whfch other products of coal-tar, which possess injurious qualities. the local application of the fresh juice had the effect of It would not be advisable, he adds, to prepare carbolic acid immediately arresting the bleeding, although, in the first from this source, when the comparative cost shows that the case, pressure, alum, turpentine, and perchloride of iron gain must be very small or non-existent; but it is well had failed to effect it. He states that " it does not cause worthy of record that, should circumstances render the ' pain nor act as a caustic, but that it simply curdles' (that supply of the English product difficult, or uncertain, as in and the covers the surface blood, is, coagulates) bleeding the case of war, or increased English price, a practically with a tenacious fluid." Further evidence of its hemostatic inexhaustible source exists in this country (India) from Mr. is adduced B. Evers Medical by (Indian properties which this indispensable substance in its purest state can be Gazette, March, 1875, page G6), of the Bengal Medical obtained at a slight enhancement of the present price. Service, who furnishes " also a highly interesting account Interesting and important as this Andromeda oil is as a of a pulsating tumour a varicose aneurysm," situated just above the internal malleolus, which was cured (?) by the source of carbolic acid, it is even more so, as the probable subcutaneous injection of a drachm of this juice. The case source of another valuable therapeutic agent, namely, is so suggestive that I venture to appeal it, slightly salicylic acid, of which one of the recognized sources is the winter-green or gaultheria oil, which, as just abridged: mentioned, is identical in composition with our present Hemostatic Powers of Jatropha Curcas.?Bugloo, article. On this subject, the following remarks of Mr. aged 2o, was admitted, October 3rd, 1874, suffering from a Martindale, in his very useful little work, The Extra large open abscess in the heel of the right foot, the result of Pharmacopoeia (page 25), may not be out of place. He did not complain so much of the pain as of " an injury. Commercially, the acid prepared from oil of winter-green, frequent hemorrhage from the abscess. On removing the the natural salicylic acid of Mr. J. Williams, is the purest. at once occurred. covering, hemorrhage (evidently venous) Oil of winter-green is an impure salicylate of Methyl. On examination, there was found, immediately above the When treated with caustic potash-solution, and the volatile internal malleolus, a pulsating tumour, about the size of a matters distilled off, an impure salicylate of potash retibial at the on Pressure artery posterior pigeon's egg. mains ; this is decomposed by hydrochloric acid, and the once arrested the bleeding ; the superficial veins in the salicylic acid obtained purified by dissolving, and crystallizneighbourhood were enlarged, and a faint thrill was ing finally from weak spirit. It is in crystals resemdetected in them ; hence it was diagnosed to be a case of bliug those of strychina, and larger than those prepared Pressure by the tourniquet or otherwise venous aneurysm. from carbolic acid. This process, applied to Andromeda oil, arrested the hemorrhage temporarily; and, on the 12th, it would, in all probability, yield similar results. It is to be was determined to make a trial with the milky juice of that the subject may soon be taken up by the medihoped the jatropha. as advised by Baboo Udoy Chand Dutt. A cal authorities in India. In the meanwhile, it seems very drachm of the fresh juice was then injected into the desirable that the oil itself should be subjected to trials as a tumour by means of the hypodermic syringe, the nozzle of carminative, and antiseptic. stimulant, for about ten which was allowed to remain in the tumour of blood a Hydrocarpcs Inebrians.--Another oil to which I would single drop minutes; and, on withdrawal, obtained by expression from the escaped through the puncture ; a small piece of dry lint direct attention is that No ill effects seeds of hydrocarpus inebrians, Vhal, a tree, Nat. Ord. and sticking-plaster were then applied. Bixniaj, inhabiting the western coast of the Peninsula. It followed. The result, however, so far as the tumour and hemorrhage was concerned, is described as astonishing : is the Neeradimootoo of Ainslie (Mat. lad., vol. ii, p. 235). in twenty minutes, the pulsation was so faint as hardly to Botanically, it is closely allied to Gynocardia odorata, It. Brown, a tree belonging to the same natural order, inbe detected, and, by evening all pulsation had ceased, and a habiting Northern and Eastern India and the Malayan good firm coagulum had formed. Four days subsequently, Peninsula, the seeds of which yield eliulmoogra-oil. lately the patient left the hospital without permission, considering that there was no further need for his staying in hosfrom Qaz. Med., November 4th, 1843.)
Locally applied,
?
extracting0a
|
?
^
262
THE INDIAN MEDICAL GAZETTE.
to notice as a remedy in leprosy and skin-diseases. It is in the same class of cases that oar present article is most esteemed ; indeed, in Travancore it holds a first place, in native opinion, as a remedy in leprosy, and one of the most intelligent native gentlemen I liave ever met with (since deceased), himself suffering from leprosy, assured me that he had derived more temporary benefit from Neeradimootoo oil than from any other medicine. Ainslie places the dose at half-a-teaspoonf ul twice daily ; but it would probably be better to commence with a smaller dose, and increase it as the stomach will bear it, for he states that it is apt to nauseate a good deal at first. In Ceylon, where the tree is indigenous, the fruit is said to be used for intoxicating fish : hence probably its specific name.
brought
Sa.RA.CA. Indica.?I take advantage of this opportunity to mention another Indian drag, which, as far as I am aware, has not hitherto been subject to trials by any European practitioner in the East, but which has recently been brought specially to my notice by H.H. the Maharajah of Travancore, F.L.S., himself a most intelligent observer, namely, the bark of Saraca Indica Linn, the Jontsia Asoka of Roxburgh (Asok, Hind., Benj.). He mentions the case of a recurring hasmorrhoidal tumour, in a member of his own family, in which it proved signally successful after European remedies had failed. In his letter, His Highness speaks of it as " specially useful in diseases of women connected with menstrual irregularities "; and he adds : " If you can bring this substance to the notice of the medical profession, you will be doing a real service." The only book in which I can find this drug noticed is Udoy Cliand Dutt's Materia Medio a of the Hindus (page 113). where it is stated that the bark is much used in uterine affections, especially in menorrhagia. It is to be hoped that trials will be made with it to test its
alleged efficacy. Coscinium Fenestratum.?Should it ever be desirable to introduce into European practice an elegant, cheap, and efficient bitter tonic, I can testify from experience that such may be found in the woody stems of Coscinium fene-
stratum, Colebrook, a large menispermaceous climbing plant, inhabiting the forests of Malabar and Ceylon. It is met with
in the bazaars of Southern India under the Tamul name of Mara Munjil. It occurs in the form of cylindrical woody stems, of variable length, from one to four inches in diameter, of a bright greenish yellow-colour, and pure bitter taste. Thirty years since it was imported into England from Ceylon, under the name of Calumbawood, and, analyzed by Mr. Perrins (Pharm Joum., 1853, pp. 180, 500), was found to contain berberine. From my own trials with it at the Trevandrum Charity Hospital, I came to the conclusion that it was a good substitute for calumba. and efficient in all cases requiring a pure bitter tonic. It was prescribed in the form of infusion and tincture, of the same strength as the corresponding preparations of calumba. Petroleum.?To the indigenous medical products of India, derived from the inorganic kingdom, comparatively little attention has been paid ; yet some of them seem well worthy of notice. Foremost araougst these is petroleum, which is met with on the surface of certain lakes in Assam, Burmah, and in the volcanic islands on the Arracan Coast. Passing over its alleged successful employment in beri-beri, chronic rheumatism, skin-diseases, etc., I would, in this place, call especial attention to it as an efficient agent in antiseptic surgery. In this character, it was first brought to notice by Sir Joseph Fayrer (Indian Medical Gazette, September 1869), who, after trials with it in twenty cases, came to the conclusion that it possesses some, if not all, of the advantages assigned to carbolic acid. He used it pure, or diluted with equal parts of glycerine or oil; and he states that, whilst it certainly has some deodorizing power, it appears also to have that of limiting suppuration, and of restraining the development of septic miasmata in the discharges. It is to be hoped that Sir Joseph will increase the debt the profession already owes him by continuing his researches, and that others will follow in his wake. I would also venture to suggest that experiments should be made with the Indian petroleum, with the view of ascertaining whether, under suitable, treatment, it will not yield vaseline of as pure a quality as that obtained from the American article. Should such prove to be the case, and if it could be manufactured at a small cost, the importance of the fact, in relation to the pharmacy and practical surgervof the East, would be self-evident.
[Aug,.
1885.
Iu conclusion, I will only name three inorganic substances, with the chemical nature and medicinal properties
of which it is very desirable to become better acquainted : 1, Senda-lon or sende-nimak, the rock-salt of the bazaars ; 2, Bit-loban or kala-nimak, literally black salt ; and 3 Salajet or alum-earth of Nepal. These articles are held in high esteem by native practitioners, and are evidently possessed of no mean medicinal powers. Some particulars with regard to the two latter will be found in a paper by myself in the fourth volume of the Madras Quarterly Journal of Medicine (pagp 239) ; and others, especially in reference- to rock-salt, are given in Moodeen Sherriff's valuable Supplement to the Pharmacopoeia of India (pp. 71. 216, 107, 354). Should these crude suggestions lead to any practical result, the object iu view will be fully attained.?Brit. Med. Jour.
The Treatment op Abortion.?Schwarz, of Halle, has written a very comprehensive treatise ( Volltmanri's Sammi ung Itlinischer Vortrage, No. 2il) ou this subject, in which he first speaks briefly of the prophylaxis, and then considers in detail the treatment of abortion already in progress. When there exists a pre-existing tendency to abortion, Schwarz believes that only in the rarest instances can premature expulsion of the ovum be averted by continuous lying in bed. by giving up the usual occupation, aud by the careful avoidance of all external circumstances and conditions usually considered prejudicial to the pregnant state ; the reason being that only exceptionally are the effective causes of abortion external, but in the great majority of cases are to be found in abnormalities of the internal reproductive organs, or in general affections, especially syphilis. The most favourable time, therefore, for the successful exhibition of prophylactic treatment is before impregnation has taken place, attention being directed to the correction of structural anomalies, malpositions of the uterus, especially backward displacements, and inflammation of the endo- and peri-metrium. Schwarz calls especial attention to another factor which he has found to be a frequent cause of abortion, namely, deep lacerations of the cervix, and he points out the importance of repairing such lacerations as a prophylactic measure. After conception has taken place Schwarz believes there is but little opportunity for active prophylaxis, except in correcting uterine displacements and in the treatment of syphilis. Coming then to the treatment of already impending abortion, Schwarz endeavours to lay down certain rules by which it may be determined whether He thinks or not the abortion can probably be prevented. the condition of the cervix affords one of the surest signs : if the cervix permits the passage of the finger through the internal os, if also the lower pole of the ovisac is within reach and is forced down into the upper part of the cervical canal, or if, in the case of primiparas, although the external os is still impassable, the cervix is already taken tip and forms with the uterine body a common cavity, then the expulsion of the ovum is beyond question. A foul vaginal discharge, indicating the probable death of the ovum ; or a considerable hajmorrhage lasting several days, especially if accompanied by dull or cutting pains iu the sacral region, are almost infallible signs. If a reasonable hope of preventing the expulsion of the ovum exists, the end is to be sought by enforcing the greatest possible bodily and mental rest, and by the free use of opium. If, however, abortion is inevitable, expulsion of the ovum should be hastened as much as possible, with the view of keeping the attendant daugers within bounds. The dangers against which in abortions one has to contend are hasmorrhage aud septic degeneration of the ovum. If the ovisac has not ruptured, Schwarz recommends the cervico-vagiual tampon as an absolutely sure means of arresting the severe hasuiorrhage which almost without exception accompanies the expulsion of the ovum in the first half of pregnancy. As soon as the haamorrhage shall have been controlled, the tampon should be removed, and the vagina cleansed and disinfected. A cotton wad sprinkled with iodoform should then be placed against the cervix and held in position with a vaginal tampon. Thus protejted against hajinorrliage and septic infection the patient can be left for from eighteen to twenty-four hours: the tampon usually increases the pains and thus promotes the dilatation of the cervix and the explnsion of the ovum. If, however, by this treatment incousider-
TREATMENT OF ABORTION?INFANT FEEDING.
Aug., 1885.]
able progress is made. Schwarz is accustomed to administer an intra-cervical douche to [the amount of two or three litres of a cold antiseptic fluid, using for the purpose a catheter suitably bent and provided with lateral openings. The object of the douche is not so much to dislodge the ovum as to awaken uterine contractions, and the author has found cold irrigations more effective than hot, which latter have sometimes apparently produced paralysis of the uterine muscle. If alternate use of the tampon and the cold irrigation does not effect the desired result, Schwarz then resorts to laminaria tsnts carefully disinfected and sprinkle 1 with iodoform. Should, however, this method appear too telious on account of the invasion of fever or beginning degeneration of the ovum, or if for any reason the uterine contractions are not sufficiently powerful to expel the ovum, Schwarz recommends the dilatation of the cervix with Fritsch's dilators, the separation of the ovum with the finger, and removal with finger or forceps as appears most convenient. If at the time that treatment is to be instituted the ovisac has ruptured, an entirely different method is to be pursued. Rupture of the sac, if not positively recognised by escape of the liquor amuii and expulsion of the foetus, can be diagnosticated with great probability from the diminished size and elasticity of the uterus. In cases of ruptured ovisac, then, the tampon is not to be used, unless provisionally, on account of the danger of concealed htemorrhage, especially in abortions after the fourth month, and of septic infection from degeneration of retained blood clot or decidua; but if the cervix is not already passable for the finger, it should be immediately dilated manually or instrumentally, and the uterus speedily emptied of its contents. When there exists pelvic effusion or recent inflammatory action, this should be done with the greatest gentleness, and all instrumental interference avoided if possible. The curette is oftan of the greatest service, especially in cases in which persistent haemorrhage points to the probable retention of a bit of decidual or placental tissue: the value of subsequent styptic injections of iron or iodine is pointed out by Schwarz. together with many valuable suggestions as to detail in the treatment of this anxious class of cases. (Boston Mecl. and Surg. Journ., Jan. 29, 1885.) Infant Feeding in Illness.?The following useful observations, by Dr. Keating, occur in the Archives of Pe-
diatrics :?" If
a
child is
so
weak and exhausted that it
will not digest the mildest form of prepared food, and it is impossible to obtain the breast, it is useless to weaken the condensed milk, or whatever we use, to such a degree as to
make it absolutely valueless as a nutrient. The proper to do is to give some form of food which requires but little action of the digestive juices, or to prepare the food so that it is partially digested beforehand. I have used for some time, with great advantage, egg-albumen dissolved in water as a food for sick children when the stomach is intolerant of ordinary milk food. I have also observed that gum-arabic water will nourish for a surprisingly long time, and allay irritability. Barley food would be valueless iu a case'of this kind, and pure cow's milk, diluted to resemble as closely as possible the mother's milk, would be regurgitated. In such cases the preparation of milk which has undergone partial digestion by the paucreatic fermeut, in an alkaline condition, I have found most useful. The preparation is one which must be made with a care, and according to the following directions: Into clean quart bottle put a powder of five grains of extractum pancreatis, and fifteen grains of bicarbonate of soda, and a gill of water; shake, and then add a pint of fresh milk. Place the bottle in a pitcher of hot water, or set it aside in a warm place for an hour or an hour and a-halt, to keep the milk warm, by which time the milk will have become well peptonised. When the contents of the bottle acquire a greyish-yellow colour, and slightly bitter taste, then the milk is thoroughly peptonised?that is, the casein of the milk has been digested into peptone. Great heat or cold ?will destroy this digestive action ; so, to prevent all further action when you think that digestion has proceeded far enough, at once place the bottle on ice, or into a vessel of it may boiling water long enough to scald the contents, and then be kept like ordinary milk. The mother should be warned to frequently taste the milk during its digestion, and as soon as the bitter taste is in the least apparent, the
thing
263
bottle should be placed
on the ice for cooling, as iu these it is sufficient to partially peptonise the milk. I mention these facts, particularly as, strange to say, I have always failed with it in hospital practice, whereas iu private I have had some excellent results, owing I think, to the extra care in preparation. Whey is another admirable alternative in these cases. It may be made with wine, when there is great weakness ; but mothers do not often kuow how to make wine-whey. The proper method is. when the milk is boiliug, "to put iu a wine-glassful of sherry, say, to the pint; and if the curd does not separate, then add more wine until it does. As soon as you notice separation of the curd, add no more wine, but let the mixture boil for a time, until the whey and curd has become thoroughly separated consuming about five minutes. This should be thoroughly strained. It has been recommended to use lime-water in the feeding of infants and young children. I am opposed to its indiscriminate use. I have seen children who could not tolerate even the weak preparation of the pharmacopoeia. Undoubtedly at times it may arrest vomiting, as we all know, both in children and adult practice, but I much prefer, when it is necessary, to use an alka'li?and if you use cow's milk raw for a young babe, it is always advisable to see that it is made alkaline?to do it with a small quantity of bicarbonate of soda. I have one word of caution to give you iu regard to the use of sue king-bottles. They are certainly useful as labour-saving machines iu early infancy, and when thoroughly cleansed and carefully watched are no doubt indispensable ; but I'have long come to the conclusion that if you can persuade the mother and nurse to take the time and feed the child that is old enough to manage by the cup or spoon, the word colic will seldom meet you in your pi-actice. I am convinced that in institutions for foundlings, if it could be possible to discard the bottle, the percentage of deaths would be much diminished."?Lond. Med. Times.
cases
...
Artificial Anus Cubed by Entebotomy.?Dr. Cannizhas reported the following case : S. P , aged sixty-seven, for some years had had a reducible right ingui^ nal hernia. Symptoms of strangulation supervened, and a surgeon, after ineffectually applying taxis, advised operation. The patient objecting, the hernial coverings sloughed, and an artificial anus was establishel in the right groin. When Dr. Cannizzaro operated on the 1st of last October he found the septum or spur very well marked. Having grasped it in its whole depth within the Wales of the enterotome, he tightened the screw until the patient complained of pain in the part and at the epigastiium. The instrument was immobilize! with a spica bandage and compress. During the first day the patient was much depressed, aud inclined to vomit. The dressing, changed each day, contained fecal matter ; each day also the screw was tightened until the patient complained of pain. Chicken-broth, eggs, and wine were taken freely. During the fifth night the bowels acted abundantly twice and naturally. On the sixth and seventh days very little fecal matter was foUnd around the dressing, and on the eighth day the enterotome was observed to be very movable. It could not then be detached, but it came away with the dressing on the ninth day after operation. The wound was then washel with carbolized water, its surroundings brushed with collodion, and a compressing bandage applied. From this date the patient continued to evacuate per anum ; in reapplying the bandage daily, care was taken to approximate the edges of the wound, which gradually healed, the patient leaving the hospital cured, iu excellent health, on t ie 15th of November, just forty-five days after the operation.?Hi cist a Internazionale di Medicina e Chirurgia.?N. Y. Med. Record. zaro
Poliomyelitis
Anterior
in
Adults?Dr.
Gustavus
Eliot, of New Haven, records, in The American Journal of the Medical Sciences for January, a carefully note 1 case of poliomyelitis anterior occurring in an adult. The progressive development of muscular weakness, unattended bv febrile symptoms, but accompanied by diminution of the size of the limbs, by abolition of the patellar tendon reflex, and by sensations of numbness, yet without loss of tactile sensation, and without interference with the function of either the rectum or bladder, rendered the diagnosis clear
THE INDIAN MEDICAL GAZETTE.
264
A large proportion of the reports of which have been published contain little or no information concerning- the details of treatment, and in manyothers the multiplicity of drugs prescribed renders any reliable conclusions in regard to the effect of each almost impossible. Bromide of potassium, belladonna, strychnia, ergot, and iodide of potassium have been most often employed, and most praised. Counter-irritation, baths, rubbing and exercise, and electricity are also included as important elements in most plans of treatment. From a careful study of the results of various plans of treatment as reported by various observers, Dr. Eliot deduces the Counter-irritation and following conclusions :?First. ergot should be employed early iu every case. Second. Massage and electricity should be used as soon as there is any evidence of improvement. Third. Little, if any, effect can be expected from iodide of potassium. Fourth. Belladonna and the bromides should be used only with extreme caution. Fifth. Strychnia should be entirely avoided. and
cases
indisputable.
The Use op Cold in Midwifery.?Dr. Grognot (" Bull, gen. de therap.") speaks highly of the emmenagogue properties of external applications of cold. Being convinced that the uterine contractions induced by ergot, faradization, and message were transitory and inefficient, he was led to try the effect of cold, which he regards as superior to either of the other agents. He summarizes the advantages of cold as follows :? 1. If cold is applied during labour, the contractions become stronger. 2. There is no danger either to the mother or to the child. 3. The agent is always at hand, and requires no instruments for its application. 4. Cold can be used in every stage of labor, for the expulsion of the placenta as well as for that of the fcetus.
[Aug.,
1885.
valuable application
THE INDIAN MEDICAL GAZETTE
260
Spstpcts
and
(fetraqts.
REMARKS ON A FEW ARTICLES OF THE INDIAN MATERIA MEDIO A. By Edward J. Waring, c.i.e., m.d., Retired
Surgeon-Major,
U. M. Indian
Army,
Within the last few years, considerable attention has been paid to the subject of the Iudian materia medica. The writings of Fleming, Roxburgh, Ainslie, Royle, O'Shaughnessy, Wise, Bidie, Khani Lall Dey, Moodeen Sheriff, and others (amongst whom I think I may venture, without laying myself open to the charge of egotism, to include myself) have succeeded in awaking medical officers and other practitioners in the East to the important fact that around them, on every side in the vast Indian continent, from the Himalayas to Cape Comorin, there are available, at almost nominal prices, often at the simple cost of collection, remedies as powerful and efficient as the more costly imported articles, the supply of which, from the very nature of things, is necessarily limited, and at times precarious. The spirit of inquiry thus set on foot resulted in many indigenous drugs being subjected to clinical trials in European hospitals and elsewhere, where their effects could be carefully watched; and their alleged efficiency having been satisfactorily proved, they in due time were admitted into the officinal list of the British Pharmacopoeia ; of this we have examples in Indian hemp (cannabis sativa), chiretta, hemidesmus Indica, segle marmelos, and kamela. On satisfactory, though not perhaps on equally conclusive, evidence, no fewer than forty other articles were admitted into the officinal list of the Indian Pharmacopoeia issued by the Indian Government in 1868. Some of these latter have since found their way into Europe, and are at present under trial in the hands of British and continental practitioners ; for example, chaulmoogra-oil, sandal-wood oil, gurjan balsam, anacardium, (cardol), etc. What the verdict will be, remains to be seen. To enter on the consideration of Indian materia medica general is beyond my intention, and, indeed, beyond my powers. All that I purpose to do, on the present occasion, is to offer some brief suggestions on a few articles which appear to me worthy of more attention than has been paid to them, and which seem to hold out the prospect of proving valuable therapeutic agent. in
Caruh (Ptychotis) Ajowan.?The first of these to which I would direct attention is the fruit of carum (ptychotis) ajowan, D. C., an umbelliferous plant common under cultivation throughout India, sold in the bazaars under the name of ajwain or ajvain (Bengal) and o'mam or o'mum (Tamul). Under the name of ajava-seeds, they were brought to the notice of the profession in Europe in 1773 by Dr. Percival (Essays, vol. ii, p. 226), but they fell into unmerited neglect. My own impression is that they are the most powerful of all the umbelliferous carminative seeds, and that they may well replace others in practice. Dr. G. Bidie and Mr. J. J. Wood, both of the Madras Medical Service, have borne strong testimony to their value ; the latter regarding them as combining the stimulant quality of capsicum or mustard with the bitter property of chiretta and the antispasmodic virtues of assafoetida. An essential oil (of which they contain about 5 per cent.) and a distilled water, are officinal in the Pharmacopoeia of India. Greatly increased interest attaches to this article from the recently discovered fact that its stearoptene, sold in the bazaars of the Deccan, Scinde, etc., under the Hindustani name of ajwain-ka-pheul, is identical with thymol, whose claims as an antiseptic and germicide have of late attracted much attention. The fruit, indeed, is now a recognised source of this valuable antiseptic agent. Without attempting to enter upon its therapeutic uses generally, I would point out two diseases in which it seems very desirable that trials should be made to test_ its powers. 1. Cholera. Here Anglo-Indian testimony is already strongly in its favour, but we want more than public opinion; we want facts based on scientific observation, and it is hoped that this may be accorded to it by our professional brethren in the East. The antiseptic
[Aug.,
1885.
properties of its constituent, thymol, conjoined with its powerful diffusible stimulant action, indicate the probability of its proving of the greatest service in this disease. 2. Dipsomania. All I desire here is to draw serious attention to the following words of the late Mr. J. J. Wood, with reference to ajvain or o'mam seed. "On account of its bitter, biting or pungent, yet pleasant, taste, and the sensation of warmth it creates in the stomach, it has been constantly recommended of late years to those afflicted with
the desire for alcoholic drinks. It does not, of course, inbut it is no mean substitute for the ordinary stimulant in removing almost immediately, the sensation of ' ' gnawing' or sinking at the pit of the stomach' which the frequent use of spirits invariably brings on. And I have been assured that it has been the means of rescuing many otherwise sensible and useful men from slavery to the habit of spirit-drinking." Sincerely is it to be hoped that those in this country who have charge of inebriates or dipsomaniacs will make trial with this remedy.
toxicate,
Plant AGrO Ispaqhula.?Another seed commonly met with in all Indian bazaars, which seems to me to merit more attention at the hands of European practitioners than is generally paid to it, is that of plantago ispaghula, roxb, sold under the name of ispaghul (Hind.), and ishappukolvirai (Tamul). When these seeds are immersed in water, the cells composing the epidermis swell and elongate, and On insoon burst, leaving only fragments of their walls. fusion, mucilage is so abundantly yielded by. them, that 1 part of them with 20 of water forms a thick tasteless jelly. Fleming, Ainslie, and other early writers on Indian materia medica, spoke of their usefulness as a demulcent in catarrhs, renal affections, dysuria, etc., but it is to their use in intestinal affections that I would particularly direct attention. The late Mr. Twining, in his Diseases of Bengal (vol. i, p. 212). speaks highly of them ; and in the chronic diarrhoea of Europeans, who have been long resident in India, he states that he found ispaghul seed to answer He found that it also better than any other remedy. sometimes cured the diarrhoea of European and native children after many other medicines had failed. The dose of the seeds for an adult is two and a half drachms, with half a drachm of sugar-candy. They are administered whole, and in their passage through the intestines, they absorb as much fluid as makes them swell ; and by the time they reach the central and lower portions of the canal, they give out a large amount of bland mucilage, and this they continue to do until they have passed over the whole of the intestinal tract. If the frequency of the dejections be restrained by anodyne injections, and by using only a small quantity of food, the demulcent action of these seeds is thought to be increased. It is said that a slight degree of astringency, and some tonic property, are imparted to the seeds by subjecting them to a moderate degree of heat, so that they shall be dried and slightly browned. A lady in London, the wife of a retired general officer, shortly since related to me the case of a friend of hers who had been obliged to return home from Bengal for chronic dysenteric diarrhoea. The case was treated by some of the leading The lady, remen in England without deriving benefit. membering her Indian experience, sent out to Calcutta for a supply of ispaghul seeds, gave them after native fashion, as above, and effected a cure ; or, at any rate, the patient recovered. It may, of course, have been merely a coincidence, but, taken in conjunction with the reports of Mr. Twining and others, it is worthy of note. Scopolia Luridus.?The third article to which I would a solanaceous plant of Nepaul and the Himalaya, scopolia luridus Dunal. (Anisodus luridus, Linn.), which, as a mydriatic, appears to be equal, if not superior, in power to belladonna. It was introduced into Europe in 1824, and is now cultivated there in gardens. The leaves, which are of a pale green colour, emit, especially when bruised, a peculiar tobacco-like odour. A tincture prepared with them, in proportion of one ounce to eight ounces of alcohol, administered to different patients, was found to produce extreme dilatation of the iris, and this, in two instances, to such an extent as to cause blindness, which only disappeared when the medicine was discontinued. The largest dose given was twenty drops of the above tincture during the four-and-twenty hours. (See further details in vol. ix of Braithwaite's Retrospect, p. 119,
direct attention is
INDIAN DRUGS.
Aug., 1885.]
2G1
pital; three months afterwards, he was reported to be its quite well. This is a single case, it is true, but it is very power as a mydriatic is equally well marked. The late Sir suggestive. Dr. Evers concludes his remarks by quoting a H. Christison {Indian Medical Gazette, September, 1868) passage from Holmes's System of Surgery (vol. iii, p. ol2), " with that bold self-sacrificing spirit which characterized as to the importance of the discovery of a fluid of great many of his investigations, made trials with this plant in coagulating power devoid of irritant properties," applicable his own person. lie introduced about the fourth of a drop to the treatment of aneurysms. Is such a fluid to be found of juice from a leaf-stalk into his left eye, and found that in the fresh milky juice of jatropha curcas? it immediately dilated the pupil with all the energy of Andromeda Leschenaultii.?The next plant to which I belladonna. In forty minutes, the dilatation was complete. This effect passed off more slowly than when produced by would call attention is one which, as far as I am aware, has belladonna. When he made a similar trial with the root- no medicinal properties assigned to it by native practijuice of belladonna, he found that the pupil was restored to tioners, and yet it is probably destined to play an important its natural size in four days ; but the dilatation produced part in the future of Indian materia medica, namely, by this plant was still perceptible at the end of eight days. Andromeda Leschenaultii D. C., Nat. Ord. Ericaceas, growing in great abundance on the higher ranges of the NilCommenting on these facts, Sir R. Christison naturally asks, gherries. In 1867, Mr. Mclvor, of Ootacamund, requested why should India depend upon Europe for one of the Mr. Broughton, the Government quinologist, to examine an armamenta chirurgise when it has one as good, if not better, of indigenous growth 1 And he goes on to suggest that essential oil obtained by him from this plant, and it was trials should be made with it to ascertain whether it would pronounced by him to be identical in composition Avith the have the same effect as henbane and belladonna in correct- Canadian oil of winter-green, Gaultheria procumbens, as was found to contain less of the peculiar ing the acrimony of resinous cathartics, and the same sin- Willcl. but, oil itwhich forms a natural and considerable gular effects as these drugs when administered in large hydrocarbon of the constituent Canada he was led to recognize it oil, doses. He concludes by expressing a hope that our breas somewhat superior in quality to the latter. This Androthren in the East will soon settle these points by actual like its Canadian meda is an congener, oil, impure salicylate experience, a hope which I beg most emphatically to of methyl ; and Mr. Broughton, acting on his knowledge of re-echo. the fact that methyl-salicylic acid would, under suitable Jatropha Curcas.?Another subject, which appears to treatment, yield carbolic acid, instituted a series of experime well deserving notice at the hands of the therapeutist, ments which resulted in his preparing considerable quanis the styptic or hemostatic virtue of the milky juice tities of pure carbolic acid, equal to the purest kind English phvsic-nut, Jatropha Curcas Linn., a widely dis- obtained from coal-tar. The cost of preparation was from tributed plant throughout the tropical portions of both five rupees to seven rupees per pound. Mr. Broughton, The of this hemispheres. styptic properties juice were first in the conclusion of his able report on this subject brought to notice by Baboo Udoy Chand Dutt (Indian to the Madras Government (January, 1871), observes that Medical Gazette, October, 1874, page 200) in 1874 ; and he the carbolic acid obtained from this source has certain furnishes two illustrative cases?one, a bleeding vessel advantages over the coal-tar acid, consequent on its within the cavity of an open abscess; the other, haemorrhage extreme pui'ity. It is less deliquescent, and cannot possibly following an incision made for the purpose of be open to the suspicion of contamination with certain broken piece of bougie from the urethra?in both of whfch other products of coal-tar, which possess injurious qualities. the local application of the fresh juice had the effect of It would not be advisable, he adds, to prepare carbolic acid immediately arresting the bleeding, although, in the first from this source, when the comparative cost shows that the case, pressure, alum, turpentine, and perchloride of iron gain must be very small or non-existent; but it is well had failed to effect it. He states that " it does not cause worthy of record that, should circumstances render the ' pain nor act as a caustic, but that it simply curdles' (that supply of the English product difficult, or uncertain, as in and the covers the surface blood, is, coagulates) bleeding the case of war, or increased English price, a practically with a tenacious fluid." Further evidence of its hemostatic inexhaustible source exists in this country (India) from Mr. is adduced B. Evers Medical by (Indian properties which this indispensable substance in its purest state can be Gazette, March, 1875, page G6), of the Bengal Medical obtained at a slight enhancement of the present price. Service, who furnishes " also a highly interesting account Interesting and important as this Andromeda oil is as a of a pulsating tumour a varicose aneurysm," situated just above the internal malleolus, which was cured (?) by the source of carbolic acid, it is even more so, as the probable subcutaneous injection of a drachm of this juice. The case source of another valuable therapeutic agent, namely, is so suggestive that I venture to appeal it, slightly salicylic acid, of which one of the recognized sources is the winter-green or gaultheria oil, which, as just abridged: mentioned, is identical in composition with our present Hemostatic Powers of Jatropha Curcas.?Bugloo, article. On this subject, the following remarks of Mr. aged 2o, was admitted, October 3rd, 1874, suffering from a Martindale, in his very useful little work, The Extra large open abscess in the heel of the right foot, the result of Pharmacopoeia (page 25), may not be out of place. He did not complain so much of the pain as of " an injury. Commercially, the acid prepared from oil of winter-green, frequent hemorrhage from the abscess. On removing the the natural salicylic acid of Mr. J. Williams, is the purest. at once occurred. covering, hemorrhage (evidently venous) Oil of winter-green is an impure salicylate of Methyl. On examination, there was found, immediately above the When treated with caustic potash-solution, and the volatile internal malleolus, a pulsating tumour, about the size of a matters distilled off, an impure salicylate of potash retibial at the on Pressure artery posterior pigeon's egg. mains ; this is decomposed by hydrochloric acid, and the once arrested the bleeding ; the superficial veins in the salicylic acid obtained purified by dissolving, and crystallizneighbourhood were enlarged, and a faint thrill was ing finally from weak spirit. It is in crystals resemdetected in them ; hence it was diagnosed to be a case of bliug those of strychina, and larger than those prepared Pressure by the tourniquet or otherwise venous aneurysm. from carbolic acid. This process, applied to Andromeda oil, arrested the hemorrhage temporarily; and, on the 12th, it would, in all probability, yield similar results. It is to be was determined to make a trial with the milky juice of that the subject may soon be taken up by the medihoped the jatropha. as advised by Baboo Udoy Chand Dutt. A cal authorities in India. In the meanwhile, it seems very drachm of the fresh juice was then injected into the desirable that the oil itself should be subjected to trials as a tumour by means of the hypodermic syringe, the nozzle of carminative, and antiseptic. stimulant, for about ten which was allowed to remain in the tumour of blood a Hydrocarpcs Inebrians.--Another oil to which I would single drop minutes; and, on withdrawal, obtained by expression from the escaped through the puncture ; a small piece of dry lint direct attention is that No ill effects seeds of hydrocarpus inebrians, Vhal, a tree, Nat. Ord. and sticking-plaster were then applied. Bixniaj, inhabiting the western coast of the Peninsula. It followed. The result, however, so far as the tumour and hemorrhage was concerned, is described as astonishing : is the Neeradimootoo of Ainslie (Mat. lad., vol. ii, p. 235). in twenty minutes, the pulsation was so faint as hardly to Botanically, it is closely allied to Gynocardia odorata, It. Brown, a tree belonging to the same natural order, inbe detected, and, by evening all pulsation had ceased, and a habiting Northern and Eastern India and the Malayan good firm coagulum had formed. Four days subsequently, Peninsula, the seeds of which yield eliulmoogra-oil. lately the patient left the hospital without permission, considering that there was no further need for his staying in hosfrom Qaz. Med., November 4th, 1843.)
Locally applied,
?
extracting0a
|
?
^
262
THE INDIAN MEDICAL GAZETTE.
to notice as a remedy in leprosy and skin-diseases. It is in the same class of cases that oar present article is most esteemed ; indeed, in Travancore it holds a first place, in native opinion, as a remedy in leprosy, and one of the most intelligent native gentlemen I liave ever met with (since deceased), himself suffering from leprosy, assured me that he had derived more temporary benefit from Neeradimootoo oil than from any other medicine. Ainslie places the dose at half-a-teaspoonf ul twice daily ; but it would probably be better to commence with a smaller dose, and increase it as the stomach will bear it, for he states that it is apt to nauseate a good deal at first. In Ceylon, where the tree is indigenous, the fruit is said to be used for intoxicating fish : hence probably its specific name.
brought
Sa.RA.CA. Indica.?I take advantage of this opportunity to mention another Indian drag, which, as far as I am aware, has not hitherto been subject to trials by any European practitioner in the East, but which has recently been brought specially to my notice by H.H. the Maharajah of Travancore, F.L.S., himself a most intelligent observer, namely, the bark of Saraca Indica Linn, the Jontsia Asoka of Roxburgh (Asok, Hind., Benj.). He mentions the case of a recurring hasmorrhoidal tumour, in a member of his own family, in which it proved signally successful after European remedies had failed. In his letter, His Highness speaks of it as " specially useful in diseases of women connected with menstrual irregularities "; and he adds : " If you can bring this substance to the notice of the medical profession, you will be doing a real service." The only book in which I can find this drug noticed is Udoy Cliand Dutt's Materia Medio a of the Hindus (page 113). where it is stated that the bark is much used in uterine affections, especially in menorrhagia. It is to be hoped that trials will be made with it to test its
alleged efficacy. Coscinium Fenestratum.?Should it ever be desirable to introduce into European practice an elegant, cheap, and efficient bitter tonic, I can testify from experience that such may be found in the woody stems of Coscinium fene-
stratum, Colebrook, a large menispermaceous climbing plant, inhabiting the forests of Malabar and Ceylon. It is met with
in the bazaars of Southern India under the Tamul name of Mara Munjil. It occurs in the form of cylindrical woody stems, of variable length, from one to four inches in diameter, of a bright greenish yellow-colour, and pure bitter taste. Thirty years since it was imported into England from Ceylon, under the name of Calumbawood, and, analyzed by Mr. Perrins (Pharm Joum., 1853, pp. 180, 500), was found to contain berberine. From my own trials with it at the Trevandrum Charity Hospital, I came to the conclusion that it was a good substitute for calumba. and efficient in all cases requiring a pure bitter tonic. It was prescribed in the form of infusion and tincture, of the same strength as the corresponding preparations of calumba. Petroleum.?To the indigenous medical products of India, derived from the inorganic kingdom, comparatively little attention has been paid ; yet some of them seem well worthy of notice. Foremost araougst these is petroleum, which is met with on the surface of certain lakes in Assam, Burmah, and in the volcanic islands on the Arracan Coast. Passing over its alleged successful employment in beri-beri, chronic rheumatism, skin-diseases, etc., I would, in this place, call especial attention to it as an efficient agent in antiseptic surgery. In this character, it was first brought to notice by Sir Joseph Fayrer (Indian Medical Gazette, September 1869), who, after trials with it in twenty cases, came to the conclusion that it possesses some, if not all, of the advantages assigned to carbolic acid. He used it pure, or diluted with equal parts of glycerine or oil; and he states that, whilst it certainly has some deodorizing power, it appears also to have that of limiting suppuration, and of restraining the development of septic miasmata in the discharges. It is to be hoped that Sir Joseph will increase the debt the profession already owes him by continuing his researches, and that others will follow in his wake. I would also venture to suggest that experiments should be made with the Indian petroleum, with the view of ascertaining whether, under suitable, treatment, it will not yield vaseline of as pure a quality as that obtained from the American article. Should such prove to be the case, and if it could be manufactured at a small cost, the importance of the fact, in relation to the pharmacy and practical surgervof the East, would be self-evident.
[Aug,.
1885.
Iu conclusion, I will only name three inorganic substances, with the chemical nature and medicinal properties
of which it is very desirable to become better acquainted : 1, Senda-lon or sende-nimak, the rock-salt of the bazaars ; 2, Bit-loban or kala-nimak, literally black salt ; and 3 Salajet or alum-earth of Nepal. These articles are held in high esteem by native practitioners, and are evidently possessed of no mean medicinal powers. Some particulars with regard to the two latter will be found in a paper by myself in the fourth volume of the Madras Quarterly Journal of Medicine (pagp 239) ; and others, especially in reference- to rock-salt, are given in Moodeen Sherriff's valuable Supplement to the Pharmacopoeia of India (pp. 71. 216, 107, 354). Should these crude suggestions lead to any practical result, the object iu view will be fully attained.?Brit. Med. Jour.
The Treatment op Abortion.?Schwarz, of Halle, has written a very comprehensive treatise ( Volltmanri's Sammi ung Itlinischer Vortrage, No. 2il) ou this subject, in which he first speaks briefly of the prophylaxis, and then considers in detail the treatment of abortion already in progress. When there exists a pre-existing tendency to abortion, Schwarz believes that only in the rarest instances can premature expulsion of the ovum be averted by continuous lying in bed. by giving up the usual occupation, aud by the careful avoidance of all external circumstances and conditions usually considered prejudicial to the pregnant state ; the reason being that only exceptionally are the effective causes of abortion external, but in the great majority of cases are to be found in abnormalities of the internal reproductive organs, or in general affections, especially syphilis. The most favourable time, therefore, for the successful exhibition of prophylactic treatment is before impregnation has taken place, attention being directed to the correction of structural anomalies, malpositions of the uterus, especially backward displacements, and inflammation of the endo- and peri-metrium. Schwarz calls especial attention to another factor which he has found to be a frequent cause of abortion, namely, deep lacerations of the cervix, and he points out the importance of repairing such lacerations as a prophylactic measure. After conception has taken place Schwarz believes there is but little opportunity for active prophylaxis, except in correcting uterine displacements and in the treatment of syphilis. Coming then to the treatment of already impending abortion, Schwarz endeavours to lay down certain rules by which it may be determined whether He thinks or not the abortion can probably be prevented. the condition of the cervix affords one of the surest signs : if the cervix permits the passage of the finger through the internal os, if also the lower pole of the ovisac is within reach and is forced down into the upper part of the cervical canal, or if, in the case of primiparas, although the external os is still impassable, the cervix is already taken tip and forms with the uterine body a common cavity, then the expulsion of the ovum is beyond question. A foul vaginal discharge, indicating the probable death of the ovum ; or a considerable hajmorrhage lasting several days, especially if accompanied by dull or cutting pains iu the sacral region, are almost infallible signs. If a reasonable hope of preventing the expulsion of the ovum exists, the end is to be sought by enforcing the greatest possible bodily and mental rest, and by the free use of opium. If, however, abortion is inevitable, expulsion of the ovum should be hastened as much as possible, with the view of keeping the attendant daugers within bounds. The dangers against which in abortions one has to contend are hasmorrhage aud septic degeneration of the ovum. If the ovisac has not ruptured, Schwarz recommends the cervico-vagiual tampon as an absolutely sure means of arresting the severe hasuiorrhage which almost without exception accompanies the expulsion of the ovum in the first half of pregnancy. As soon as the haamorrhage shall have been controlled, the tampon should be removed, and the vagina cleansed and disinfected. A cotton wad sprinkled with iodoform should then be placed against the cervix and held in position with a vaginal tampon. Thus protejted against hajinorrliage and septic infection the patient can be left for from eighteen to twenty-four hours: the tampon usually increases the pains and thus promotes the dilatation of the cervix and the explnsion of the ovum. If, however, by this treatment incousider-
TREATMENT OF ABORTION?INFANT FEEDING.
Aug., 1885.]
able progress is made. Schwarz is accustomed to administer an intra-cervical douche to [the amount of two or three litres of a cold antiseptic fluid, using for the purpose a catheter suitably bent and provided with lateral openings. The object of the douche is not so much to dislodge the ovum as to awaken uterine contractions, and the author has found cold irrigations more effective than hot, which latter have sometimes apparently produced paralysis of the uterine muscle. If alternate use of the tampon and the cold irrigation does not effect the desired result, Schwarz then resorts to laminaria tsnts carefully disinfected and sprinkle 1 with iodoform. Should, however, this method appear too telious on account of the invasion of fever or beginning degeneration of the ovum, or if for any reason the uterine contractions are not sufficiently powerful to expel the ovum, Schwarz recommends the dilatation of the cervix with Fritsch's dilators, the separation of the ovum with the finger, and removal with finger or forceps as appears most convenient. If at the time that treatment is to be instituted the ovisac has ruptured, an entirely different method is to be pursued. Rupture of the sac, if not positively recognised by escape of the liquor amuii and expulsion of the foetus, can be diagnosticated with great probability from the diminished size and elasticity of the uterus. In cases of ruptured ovisac, then, the tampon is not to be used, unless provisionally, on account of the danger of concealed htemorrhage, especially in abortions after the fourth month, and of septic infection from degeneration of retained blood clot or decidua; but if the cervix is not already passable for the finger, it should be immediately dilated manually or instrumentally, and the uterus speedily emptied of its contents. When there exists pelvic effusion or recent inflammatory action, this should be done with the greatest gentleness, and all instrumental interference avoided if possible. The curette is oftan of the greatest service, especially in cases in which persistent haemorrhage points to the probable retention of a bit of decidual or placental tissue: the value of subsequent styptic injections of iron or iodine is pointed out by Schwarz. together with many valuable suggestions as to detail in the treatment of this anxious class of cases. (Boston Mecl. and Surg. Journ., Jan. 29, 1885.) Infant Feeding in Illness.?The following useful observations, by Dr. Keating, occur in the Archives of Pe-
diatrics :?" If
a
child is
so
weak and exhausted that it
will not digest the mildest form of prepared food, and it is impossible to obtain the breast, it is useless to weaken the condensed milk, or whatever we use, to such a degree as to
make it absolutely valueless as a nutrient. The proper to do is to give some form of food which requires but little action of the digestive juices, or to prepare the food so that it is partially digested beforehand. I have used for some time, with great advantage, egg-albumen dissolved in water as a food for sick children when the stomach is intolerant of ordinary milk food. I have also observed that gum-arabic water will nourish for a surprisingly long time, and allay irritability. Barley food would be valueless iu a case'of this kind, and pure cow's milk, diluted to resemble as closely as possible the mother's milk, would be regurgitated. In such cases the preparation of milk which has undergone partial digestion by the paucreatic fermeut, in an alkaline condition, I have found most useful. The preparation is one which must be made with a care, and according to the following directions: Into clean quart bottle put a powder of five grains of extractum pancreatis, and fifteen grains of bicarbonate of soda, and a gill of water; shake, and then add a pint of fresh milk. Place the bottle in a pitcher of hot water, or set it aside in a warm place for an hour or an hour and a-halt, to keep the milk warm, by which time the milk will have become well peptonised. When the contents of the bottle acquire a greyish-yellow colour, and slightly bitter taste, then the milk is thoroughly peptonised?that is, the casein of the milk has been digested into peptone. Great heat or cold ?will destroy this digestive action ; so, to prevent all further action when you think that digestion has proceeded far enough, at once place the bottle on ice, or into a vessel of it may boiling water long enough to scald the contents, and then be kept like ordinary milk. The mother should be warned to frequently taste the milk during its digestion, and as soon as the bitter taste is in the least apparent, the
thing
263
bottle should be placed
on the ice for cooling, as iu these it is sufficient to partially peptonise the milk. I mention these facts, particularly as, strange to say, I have always failed with it in hospital practice, whereas iu private I have had some excellent results, owing I think, to the extra care in preparation. Whey is another admirable alternative in these cases. It may be made with wine, when there is great weakness ; but mothers do not often kuow how to make wine-whey. The proper method is. when the milk is boiliug, "to put iu a wine-glassful of sherry, say, to the pint; and if the curd does not separate, then add more wine until it does. As soon as you notice separation of the curd, add no more wine, but let the mixture boil for a time, until the whey and curd has become thoroughly separated consuming about five minutes. This should be thoroughly strained. It has been recommended to use lime-water in the feeding of infants and young children. I am opposed to its indiscriminate use. I have seen children who could not tolerate even the weak preparation of the pharmacopoeia. Undoubtedly at times it may arrest vomiting, as we all know, both in children and adult practice, but I much prefer, when it is necessary, to use an alka'li?and if you use cow's milk raw for a young babe, it is always advisable to see that it is made alkaline?to do it with a small quantity of bicarbonate of soda. I have one word of caution to give you iu regard to the use of sue king-bottles. They are certainly useful as labour-saving machines iu early infancy, and when thoroughly cleansed and carefully watched are no doubt indispensable ; but I'have long come to the conclusion that if you can persuade the mother and nurse to take the time and feed the child that is old enough to manage by the cup or spoon, the word colic will seldom meet you in your pi-actice. I am convinced that in institutions for foundlings, if it could be possible to discard the bottle, the percentage of deaths would be much diminished."?Lond. Med. Times.
cases
...
Artificial Anus Cubed by Entebotomy.?Dr. Cannizhas reported the following case : S. P , aged sixty-seven, for some years had had a reducible right ingui^ nal hernia. Symptoms of strangulation supervened, and a surgeon, after ineffectually applying taxis, advised operation. The patient objecting, the hernial coverings sloughed, and an artificial anus was establishel in the right groin. When Dr. Cannizzaro operated on the 1st of last October he found the septum or spur very well marked. Having grasped it in its whole depth within the Wales of the enterotome, he tightened the screw until the patient complained of pain in the part and at the epigastiium. The instrument was immobilize! with a spica bandage and compress. During the first day the patient was much depressed, aud inclined to vomit. The dressing, changed each day, contained fecal matter ; each day also the screw was tightened until the patient complained of pain. Chicken-broth, eggs, and wine were taken freely. During the fifth night the bowels acted abundantly twice and naturally. On the sixth and seventh days very little fecal matter was foUnd around the dressing, and on the eighth day the enterotome was observed to be very movable. It could not then be detached, but it came away with the dressing on the ninth day after operation. The wound was then washel with carbolized water, its surroundings brushed with collodion, and a compressing bandage applied. From this date the patient continued to evacuate per anum ; in reapplying the bandage daily, care was taken to approximate the edges of the wound, which gradually healed, the patient leaving the hospital cured, iu excellent health, on t ie 15th of November, just forty-five days after the operation.?Hi cist a Internazionale di Medicina e Chirurgia.?N. Y. Med. Record. zaro
Poliomyelitis
Anterior
in
Adults?Dr.
Gustavus
Eliot, of New Haven, records, in The American Journal of the Medical Sciences for January, a carefully note 1 case of poliomyelitis anterior occurring in an adult. The progressive development of muscular weakness, unattended bv febrile symptoms, but accompanied by diminution of the size of the limbs, by abolition of the patellar tendon reflex, and by sensations of numbness, yet without loss of tactile sensation, and without interference with the function of either the rectum or bladder, rendered the diagnosis clear
THE INDIAN MEDICAL GAZETTE.
264
A large proportion of the reports of which have been published contain little or no information concerning- the details of treatment, and in manyothers the multiplicity of drugs prescribed renders any reliable conclusions in regard to the effect of each almost impossible. Bromide of potassium, belladonna, strychnia, ergot, and iodide of potassium have been most often employed, and most praised. Counter-irritation, baths, rubbing and exercise, and electricity are also included as important elements in most plans of treatment. From a careful study of the results of various plans of treatment as reported by various observers, Dr. Eliot deduces the Counter-irritation and following conclusions :?First. ergot should be employed early iu every case. Second. Massage and electricity should be used as soon as there is any evidence of improvement. Third. Little, if any, effect can be expected from iodide of potassium. Fourth. Belladonna and the bromides should be used only with extreme caution. Fifth. Strychnia should be entirely avoided. and
cases
indisputable.
The Use op Cold in Midwifery.?Dr. Grognot (" Bull, gen. de therap.") speaks highly of the emmenagogue properties of external applications of cold. Being convinced that the uterine contractions induced by ergot, faradization, and message were transitory and inefficient, he was led to try the effect of cold, which he regards as superior to either of the other agents. He summarizes the advantages of cold as follows :? 1. If cold is applied during labour, the contractions become stronger. 2. There is no danger either to the mother or to the child. 3. The agent is always at hand, and requires no instruments for its application. 4. Cold can be used in every stage of labor, for the expulsion of the placenta as well as for that of the fcetus.
[Aug.,
1885.
