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THE NERVOUS SYMPTOMS OF COCCULUS INDICUS.
BY E. P. COLBY, M.D., BOSTON.
[Read before the Hughes Medical Club.] This remedy has acquired some considerable reputation in certain forms of dyspepsia and in sea-sickness, in both of which maladies there are other drugs which would seem to be more frequently indicated. Beyond this there has been but little use made of it by most practitioners. In fact, it is one of our littleused agents. It having been rather a favorite remedy with me for over twenty years, I have thought it not out of place to call your attention to a few of its prominent nervous symptoms, more particularly as the majority of them have been verified by its clinical results. It has been stated by Hughes that its effects must be upon and through the nervous system ; to which theory we must at once assent, as there does not appear to present any congruous series of symptoms pointing to organic disease in any other sphere. Let us first consider some of its recorded symptoms.
Effects of motion of carriage or vessel.
Total and partial spasmodic paralysis occasioned by increase of sensibility and later decrease of motor power.
Paralysis of lower limbs with insensibility of affected parts.
Alternate going to sleep of alternate hands and feet; difficulty of speech during the attack, and difficulty of reading and thinking after the attack. Migraine. Headache in those who indulge in excesses. Tabes dorsalis and affections of the cord. Vertigo, with nausea and falling down unconscious.
Vertigo when rising in bed, as if everything turned around, and inclination to vomit.
Stupid feeling, obliged to read over several times what he has previously read to understand it.
Various kinds of headache.
Noise in the ears, noise of rushing waters, with hard hearing (labyrinth ?).
From Hughes we read that poisoning from picrotoxine produces tonic and clonic spasm, with semicircular and backward movements, and rolling over on the axis of the body. This he attributes to the crura-cerebri. (Of this I will speak later.)
“Her hands tremble when eating, the trembling increasing in proportion as she lifts the hand higher up." The nausea and other symptoms, as effects of motion, can only result from action through the sensorium, whether this may be through sense of sight or through the labyrinth, and is undoubtedly reflex.
The spasmodic symptoms would show it to have a marked action upon the cord and medulla, with a preference for the motor sphere, where its action is more of an excitant than true paralytic; - i. e., the symptoms in man are more those of spasm thạn paresis. Its paralysing action when given to fishes cannot be directly applied to the symptomatology of the warm-blooded animals. It would seem to heighten the reflexes, although we have no careful physiological experiments recorded to demonstrate such as a fact. But, in evidence of this, there occurs in the symptomatology convulsions from wounds, and traumatic tetanus. These must necessarily be clinical, and in evidence only as corroborative. The symptoms of unilateral chorea would hardly be important until it can be made clear that it was a symptom produced by the drug, and to what extent. By far the greater portion of the symptoms would indicate the benefit of the remedy in hysteria, as notice, — fainting of hysterical females, paralysis of the tongue, numbness of alternate hands and feet, with difficulty of speech during the attack; the various pains in the head, migraine, dimsightedness. You will notice the peculiar symptom, spasm of the hand, as though one were writing, and also trembling of the hand when eating, with increase as the hand approaches the mouth. If these symptoms occurred in the same subject we should have all that is necessary to make out a case of that rare form of paralysis agitans with tremor on voluntary motion. There is no evidence of a condition which could be put down as multiple sclerosis. More regular as an indication, however, is the group of noise in the ears, noise as of rushing water, with hardness of hearing, vertigo, with nausea and falling down unconscious. If this were made to read noise in the ears, and as of rushing waters so that it produced deafness, vertigo, nausea, falling down, etc., we should have all that is necessary, save obliteration of bony transmission, to make out a case of Ménière's disease.
And in this relation we may also properly consider the symptoms referred by Hughes to the crura-cerebri, as the symptoms
apply with much more force to labyrinthian disturbance. In fact, with the cerebral physiology as we now know it, I do not see just how these symptoms could originate in the crura ; although they might result from irritation of some of the grey nuclei in the medulla. Fortunately for our patients, Ménière's disease is not common; and I have not had opportunity to make a clinical test of any value in this group of symptoms, but have just now one case under treatment.
One other condition you must all have met occasionally. A patient is taken “deathly sick” with nausea, and on sitting up the vertigo is almost terrifying. The countenance is pale, pulse slow and rather weak, and the skin clammy. All these symptoms gradually disappear after three to five days, never ending fatally in my experience, but still making a very troublesome
It seems to be a purely functional disturbance, and does not arise from gastric or hepatic disorder.
You find this group under cocculus, and I know of no other remedy which has given so much relief. Clinical experience is in favor of this drug in that form of occipital pain having its origin in a tired spine, and it is one of the most common forms of headache we are called upon to treat. The pain extends from the occiput, down the nape, to the lower cervical region. In such cases picrotoxine seems to be more efficacious than the entire drug
A word regarding the use of picrotoxine in epilepsy. Dr. Ramskill found that hypodermatic injections of picrotoxine, in doses of 15 to 18 mgr., would produce a fit in 20 to 30 minutes. When more than 5 mgr. were injected a sense of giddiness followed, and at 18 mgr. a fit was always produced. In another patient, giddiness and headache followed 8 mgr., and at 15 mgr. a severe epileptic fit; and in several cases the same result followed from doses of 10 to 24 mgr. In one case 10 mgr. caused giddiness and dazzling before the eyes, and in 30 minutes an aura — a sensation of something creeping up the arm to the top of the head, and numbness and twitching in the right thigh. No fit followed, but the patient was dull and stupid as after a fit.
ANÆSTHESIA WITH ETHERATED AIR. - A NEW METHOD OF
BY HORACE PACKARD, M.D., BOSTON, MASS.
At the outset I wish to state clearly that the method herein described is that used in the Junker system of chloroform administration, and, while the method cannot be claimed as a new one, it is new so far as its application to ether is concerned.
I have learned, while conducting experiments during the past
six months, that other attempts to administer ether by this method have been made, but have failed; and it has been stated by an eminent surgeon connected with one of the large hospitals of Boston that the method is impracticable, his experiments convincing him that intoxication without anæsthesia results.
In the simplest terms, the method consists in forcing air through a volume of ether, and then conducting it to the patient's respiratory tract. It has always been accepted that the anæsthetic mixture resulting from the less potent ether, in this way must be totally inadequate to produce surgical anæsthesia.
My first experiments in this direction impressed me with the falsity of this theory, for I found that the vapor which reached my nostrils was of such strength that my respiratory tract could not at once tolerate it without still further dilution. My first practical attempts to etherize patients by this method were with the crudest possible apparatus. The final development of the apparatus in its present simple and efficient form I attribute solely to the good fortune that the first two cases were very susceptible to ether anæsthesia, for my later experience showed me that, in very many cases, it was impossible with the same apparatus to carry patients beyond a state of intoxication.
In brief, the results of this method with the apparatus now used are:
First. The induction of surgical anæsthesia with from two to six drams of ether.
Second. The minimum of discomfort to the patient while taking it.
Third. The consumption of about three ounces of ether per hour.
Fourth. The very rare occurrence of cyanosis.
Fifth. Recovery with frequently no vomiting, and, when it does occur, but very little.
It will at once be seen that, by this method, there is an enormous economy in the use of ether, and that a great many of the unpleasant features of ether anaesthesia are obviated. I cannot better illustrate the importance of this last-mentioned desirable feature than by relating an experience with a boy of six years, upon whom I wired a compound fracture of the lower jaw. He objected strenuously to taking the ether, but after a few moments conversation he decided to take it voluntarily. When he found there was nothing unpleasant about it, he took it without the slightest resistance, and in a few moments was completely etherized, with the consumption of two drams. On making examination I found it desirable to defer the operation until the following morning, and the ether was at once removed. In a few moments he awakened and began to talk, and the following conversation ensued between the patient and his aunt, who was close at hand :
Auntie -- "Nice boy, good boy, took it well."
'twas kind of dusty, . 't wasn't hot,
'twasn't cold." Auntie - "How was it, dear?” Georgie — "Just middlin'."
The next morning, at the hour appointed for operation, on entering the room I said: “Well, Georgie, will you take ether for me this morning ?” He answered without the slightest hesitancy: “Yes, sir"; and allowed himself to be placed upon the operating-table and etherized, without the slightest resistance. Two or three days later, on proceeding to make some change in the dressings, he asked me if I would please give him some other.
Such an experience as this, with a child, was all so new to me that I thought it worthy of record, as being the best possible testimony of the desirable qualities of this method of anæsthesia.
I herewith append a table showing the exact amount of ether used and time consumed in all the cases so anæsthetized, with the apparatus in its present perfected state: