UNDER THE CHARGE OF
American Journal of the Medical Sciences
pnorcseoB or clinical medicine in the new toes rosr-ciuuaiTE medical school and hospital: ASSISTANT visiting physician to BELLEVUE hospital. Euythrophlein. In La Medicine Moderns, 1S91, No. 49, p. 825, Prof. G. See presents a valu¬ able paper upon this little-known cardiac remedy. According to the writer the active principle of the bark of the Erythrophlosum Guinense, an African tree, is the alkaloid, soluble in alcohol and ether, and which also furnishes the hydrochlorate, which crystallizes,
... nd is soluble in water. It is about as poisonous as the amorphous digitaline of MM. Horaolle and Quevenne, and less so than the crystallized digitaline of Nativelle. Its physiology has been carefully investigated by the late M. Rochefontaine. The first symptoms of poisoning are agitation, unrest, followed by a period of depression, which precedes the efforts of vomiting, or vomiting itself. There is an increase of the intra-arterial blood-pressure, an irregularity, then a slowing of the pulse, which is remarkable for the regularity of the cardiac impulses, the energy of each pulsation, and the uniformity of the blood-pressure. This arterial pres¬ sure is not modified by the respiratory movements. Later comes a feeble and rapid pulse; the respiration causes variations in blood-pressure, which gradually falls until the heart ceases to beat. The respirations ordinarily are slower and deeper during the period of rapid cardiac pulsation; in the ter¬ minal period of poisoning they are vigorous and more frequent, stopping at the same time as the heart. One, two, or three minutes after the heart has stopped, respiratory movement may recommence, only to again cease after a few minutes. The remedy then acts both upon the heart and lungs. All authors place it in the digitalis group. Brunton believes that with aconitine and veratrine it acts in the same way upon the par vagum, and he places it among the cardiac tonics, as digitalis, strophanthus, and convallaria. With Schmiedeberg and Williams, Harnock recognizes three stages of action, viz. : 1. Increase of the cardiac systole. 2. Stoppage of the ventricle in systole, JS4 PROGRESS OF MEDICAL SCIENCE. and finally paralysis of the heart itself. 3. Later, the heart paralyzed, the pressure falls, the pulse quickens, and death occurs in convulsions, and with a great disturbance of the respiration. The author has recorded the results of its administration in nineteen wises: six, valvular or simple cardiac lesions; one, pulmonary phthisis with dry pericarditis; one, pulmonary phthisis without heart lesion; one, uraemic dyspnoea, with interstitial nephritis; six, emphysema or asthma; four cases of nervous dyspnoea with or without tympanites. The medicinal dose is from one-fortieth to one-twenty-fourth of a grain. This dose does not produce any digestive disturbance, nor but slight modification of the condition of the heart, but the respiration is profoundly, constantly, and persistently changed. The dyspnoeas, except of thermic origin, are diminished. There is a feeling of bkn-tlrc, an ease of respiration, which the patient himself remarks; the desire for air is satisfied, he breathes more freely. The number of respirations markedly diminishes, and the type is profoundly changed; the inspiration largely increases, and without effort of the accessory muscles of inspiration, the diaphragm and the scaleni and external intercostals being sufficient to greatly increase the chest capacity. It lists no action upon the blood itself, so far sts haemoglobin is concerned, according to the report of MM. Hardy and Roux; but, however, it so influences the respirator)' centres, either in the bulb or the medulla that the respiratory muscles, particularly the diaphragm, are incited to action, and this is by way of the phrenics. Gangrene from Injections of Antipvmne.