Reviews and Notices of Books

1854 The Lancet  
130 is sometimes high-coloured, and stains his linen. He appears to me now to be inactive and indolent. His appetite is generally good, and he eats nzeat suppers, but his digestion is imperfect. He has never suffered from worms, but frequently is annoyed with itching of the nose, with a sense of weight at the posterior nares, and at the same time has considerable irritation about the rectum. He always becomes pale before the fits occur. Ordered mercurial pill, twelve grains; compound colocynth
more » ... compound colocynth pill, half a drachm ; extract of henbane, one scruple ; to be divided into twelve pills, two to be taken occasionally at bedtime. Sulphate of zinc, twelve grains; extract of camomile, two scruples; divide into twelve pills ; one to be taken twice a day. To take a dose of cotyledon mnbilicus daily, immediately after the first fit. Whenever he looks particularly pale and feels the irritation in the nose and rectum, apply a mustard poultice to the nape of the neck, and administer an ounce of purified spirits of turpentine inhalf a pint of warm gruel, as an enema, to be retained as long as possible. Diet, meat once a day, with a proportion of green vegetable; no ham; no bacon ; one pint of beer; cocoa and coffee; no tea. To walk one or two miles every morning; before or immediately after breakfast, and the same distance at least in the afternoon or evening. To pay great attention to the skin. He has never before been advised to take systematic exercise. Dec. 9th.-His countenance is brighter; he is less nervous; his head less oppressed; his appetite still good; and he digests his food better; he walks with greater ease, and begins to enjoy the exercise. The pills seem to give him vigour, and he feels stronger. His pulse is decidedly more firm; the tongue cleaner. Two days since, not feeling so well, with irritation about the nose and rectum, the turpentine enema was administered, and he " soon felt warm all over, and decidedly relieved." He has not taken the cotyledon umbilicus, but as this was about the time for his usual attacks, I was particularly anxious, and therefore recommended him to take, every morning before breakfast, one teaspoonful of Hooper's fluid cotyledon umbilicus, and ordered sulphate of zinc, twentyfour grains; extract of camomiles, half a drachm; divide into twelve pills, one to be taken twice a day. To watch narrowly for the coldness of the nose; for the nasal and anal irritation; forthe pale and livid countenance; and, on the first approach of these symptoms, to rouse the system by the turpentine enema. In diet as before, with the same systematic exercise.' Jan. llth, 1853.-He has been taking his medicines regularly as prescribed; walks daily two or three miles before breakfast, and the same distance in the afternoon; has had no attack whatever; has had recourse to the enema once since I last saw him. He complains of the expense of Hooper's cotyledon umbilicus. I believe he paid £1 4s. 6d. for the last medicines ordered by me ! I therefore recommended him to go to Davenport's, in Great Russell-street, who has given great attention to the preparation of vegetable juices and extracts; and I at first ordered two drachms of extract of cotyledon umbilicus, divided into twenty-four pills, two to be taken daily before breakfast. But from a subsequent communication with Mr. Davenport, at the next visit, on the 2nd of February, I substituted for the pills the following : juice of the cotyledon umbilicus, a pound, as prepared by Davenport; a teaspoonful to be taken every day before breakfast, in a wine-glass of water; persisting, twice daily, with the zinc pills, and taking occasionally one or two of the aperient pills, not neglecting the turpentine injection. June 13th.—Since the last visit, I have seen Mr. Pseveral times, and the change is indeed most remarkable. He is active, happy, cheerful; his whiskers, before neglected, now well trimmed; his gait erect and firm; his eye intelligent; and, having had no attack since last October, he now considers himself tured. He has, however, not relaxed in regularly adhering to the prescribed rules up to this period, and has never allowed more than a fortnight to elapse without using the turpentine injection. Nov. 21st.-I have this day received a letter from him, stating that he is quite well, and wishing to know if he may leave off all remedial means. He has had no return whatever of the fits. He takes two of the aperient pills once a week; the cotyledon, one teaspoonful twice a week before breakfast, with a zinc pill on the same day. He has only used the turpentine injection twice or three times since July. Previously to being placed under my care, the fits had been gradually augmenting in number and severity; the paroxysmal attacks being of the most destructive and violent character, with suffocative respiration and horrible convulsions, continuing, with but slight intermissions, for six, fourteen, and even twenty-four hours; the disease evidently gaining ground, devastating his system, and shattering his intellect ; absorbing five, six, and even seven days, to partially recover from the consequent prostration; his very memory and judgment being continuously impaired. I was requested by some medical friends, in this, as in some other cases, to try the effects of one remedy at a time; but when a cure is actually progressing, I should do so with much reluctance. The cotyledon, for instance, given alone, often fails; but when coincidentally exhibited with zinc, succeeds, even where zinc, previously administered alone, had also failed, as instanced in this case. I would invite attention particularly to such points; also to the continuous and systematic use of large doses of the mineral acids, thereby altering the very character of the urine and the blood; recommending, also, in many cases, to try the full effects of producing a reflex action by stimulating the rectum. Epilepsy does not depend upon one specific cause, and consequently no specific can ever be expected for its cure. A rational investigation must be made as to whether there is exalted sensibility or atonic lethargy; whether there is congestion or repletion; whether each organ regulates its function.: and it is by properly appreciating and by minutely attending to each symptom, that a cure can reasonably be expected. This case is highly instructive. I would not place too much confidence in any one of the remedial means employed, but I would strongly refer to the sulphate of zinc, to the aperient with the mild mercurial, to the turpentine enema, to the nutritious but not over-stimulating diet, to the diminished evening meal, and to the systematic exercise. Tavistock-square. Dpn-1H53. application of collodion to entropium, reminds me of a case I had some two years ago, in -which a permanent cure was effected by similar means, but with the addition of afree division of the external commissure of each eye. William S-, aged forty, came to the Atcham Union Workhouse, suffering from inversion of the eyelashes, the result of chronic external ophthalmia probably. The ophthalmieapertures were much diminished from contraction of the ciliary margins, and artificial union of the external canthi, so that on the action of the orbicular muscles, the tarsi were completely buried amid the folds of the conjunctivæ. The eyes were deeply injected, and the cornea very hazy. For the last ten years he had been in the habit of pulling out the lashes, and occasionally in doing so he states they were broken, and consequently became much more irritating. He is willing to endure anything calculated to afford the slightest chance of relief. The treatment consisted merely in the free division of the outer commissure of each eye ; eversion being caused and maintained by the daily application of collodion to the eyelids until the wounds were healed, which in the course of a short time produced a perfect cure. The eyes, on the removal ofthe irritation, very soon recovered themselves, and the man's personal appearance was improved to an incredible degree. Shrewsbury, Jan. 1854.
doi:10.1016/s0140-6736(02)40213-9 fatcat:ajrygwujlfaqlhs3azzm2yr37u