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At the heart of general practice since 1960

140 years ago: Clinic of the month

Extracted from The Practitioner 1868

Extracted from The Practitioner 1868

Treatment of Pneumonia in the Boston City Hospital

Dr. Borland gives a careful tabular statement of the particulars of 90 cases of pneumonia which have occurred in this hospital since its opening in 1864. The average age of the patients was 31 years; the average duration of the disease was 39 days. Twelve died – a mortality of 7 per cent. The treatment was as follows:– Milk always by bedside for the patient to drink at will. Beef-tea and wine-whey given alternately, regulating the frequency by the severity of the case. In the most severe cases the patient gets from six to twelve ounces of sherry, or (in greatly debilitated cases) milk-punch or brandy. As soon as possible the alcohol is withdrawn, and replaced by soups, &c. As soon as the patient gets at all an appetite back he is given a liberal animal and vegetable diet. A "jacket" of hot poultice to the chest was often used. Calomel and antimony were only employed in six cases (all of which recovered), and bleeding was never practised. These results are good and creditable, as the tables show that there was no lack of severe cases.

Modification of Lister's Carbolic Acid Dressing

We learn that Professor Lister has recently modified his plan of dressing wounds, by omitting the use of the plate of block-tin, and proceeding as follows:– The vessels having been secured by torsion, he washes out the wound with carbolic acid and oil, and then closes it with the continuous metal suture. He puts a pad of oiled lint at the tail of the wound to soak up discharge; over the wound he puts one piece of lint, soaked in oil and acid, which remains in situ; over this again a second similar piece, which is regularly changed. He uses no "putty;" but over all he puts a plaster made with a mixture of litharge and carbolic acid: this is not adhesive, but requires to be kept in place with ordinary strapping and bandage.

Convenient Vehicle for the Application of Nitrate of Silver

At University College Hospital, they have adopted the plan of dissolving nitrate of silver in nitrous ether; it can then be spread with a camel's-hair brush over a surface, and the ether immediately evaporates.

Hysterical Vomiting

In a clinical lecture delivered at Charing Cross Hospital, Dr. Hyde Salter discusses the treatment of hysterical vomiting, and he concludes that almost all forms of drugs are useless in this affection. He thinks that there is but one remedy in these cases, and that is "the induction of maternity." "When the subject of such symptoms marry, all vomiting ceases, or rather the particular kind of vomiting they suffer from is exchanged for another and more temporary and tractable kind of sickness." Dr. Salter evidently assumes that maternity is the invariable consequence of marriage! (See Lancet, July 11.)

Treatment of Uterine Cancer by Carbolic Acid and Glycerine of Tannin

Dr. W. Playfair, Assistant Obstetric Physician at King's College Hospital, sends us a note, in which he reports the encouraging success which he has obtained from the application of this treatment. He mixes glycerine of tannin and carbolic acid in equal proportions, and applies a pledget of cotton wool, soaked in the mixture, to the cervix uteri. In the first case in which he applied it there had been irregularly recurring haemorrhage; the application of perchloride of iron checked this, but four months later the bleeding recurred, and the disease was now found to have made great progress, the cervix being extensively infiltrated with malignant deposit, and general cachexia having appeared. The new remedy was now applied on the cotton wool, which was drawn out of the vagina with a string, and resoaked, twice a week; the vagina was also washed out twice daily with a tablespoonful of the mixture in a pint of water. Foetor entirely disappeared, and the haemorrhage has never recurred; the patient has gained flesh, and her complexion has improved. Similar success in removing foetor and restraining haemorrhage has attended Dr. Playfair's application of the remedy in several subsequent cases of malignant uterine disease; and though this be only a palliative measure, yet it is no trifling matter to produce such a considerable improvement in the health and comforts of such patients.

Treatment of Post-nasal Catarrh

Dr. Horace Dobell, Senior Physician to the Royal Hospital for Diseases of the Chest, sends us a note on this subject. "After trying a great number of applications in the form of spray, injection, gargle, lotion, inhalation, snuff, and lozenge, I have come to the conclusion, that the best for the majority of cases is the combination of a medicated snuff and a medicated lozenge.

"The snuff consisting of camphor, gr. ij.; guaiacum, gr. j.; tannic acid, gr. 1/2; hydrochlorate of morphia, gr. 1/36; tincture of benzoin, m ij.; white sugar, gr. xix. ; acacia gum, gr. ij.

"From three to four lozenges should be taken each day, one of which should be taken at bed-time, and one on waking in the morning. The snuff should be used once in the morning, once in the evening, and once or twice in the day, and it is best applied by means of a little elastic tube, one end of which is charged with snuff, and pushed into the nostril, the other end being put into the mouth, and the snuff blown up the nose with a sharp puff. I ought to add that the snuff must be discontinued should a fresh attack of nasal catarrh happen to set in, but its use must be resumed on the subsidence of inflammatory symptoms. The lozenges should be continued throughout."

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