L. Lewin, John Tweedy
1888 The Lancet  
346 age, had no fever, and no loss of appetite. Percussion over the abdomen elicited at the left hypochondrium an unmistakable metallic sound as of pieces of money in contact. With the stethoscope thd rattle of the coins on movement was very distinct. The doctor ordered rest and this pill: Extrait d'opium, 10 centigr.; extrait de belladonne, 0'5 centigr.; 10 pil.; & a g r a v e ; prendre une toutes les heures. Next day he found in the fasces three coins, but at the same time a tumour presented
more » ... a tumour presented itself in the rectum and caused great pain. The exploring finger found, in the rectal pouch, a cylindrical tumour formed by a fold of intestine, hard, and containing some of the pieces. Neither manipulation nor enemata succeeded in emptying this pouch, and Dr. Siotis returned to the pills. On the following day four coins were evacuated, and the tumour vanished, while pain was now felt in the right iliac fossa. Percussion here brought out a clear metallic ring. The order was now: Huile de croton, 2 gouttes; huile de ricin, 10 grammes ; sirop, 50 grammes. Active purgation followed this dose, but not one coin passed, and the pain increased, so the opium and belladonna pills were resumed. Next day two pieces were passed. The metallic sound was gone, but still pain remained. The patient was advised to continue the pills, and was not again seen by Dr. Siotis for twenty days, when he met him casually, and was informed that the rest of the pieces had passed, and that he was perfectly well. The points of interest in the case, as Dr. Siotis observes, are : (1) The large number of pieces swallowed ; and (2) the uselessness, to say the least, of active purgation, and the satisfactory results that followed on the administration of opium and belladonna. I have thought the case would be of interest in confirming the practical treatment usually followed in cases of foreign bodies in the intestines: withhold purgatives, and use antispasmodics and sedatives. We may also, by observation of such cases, gain some knowledge of the way the intestines move and act under the influence of strovg purgatives, on the one hand, and antispasmodics on the other, and so learn something to help us in the treatment of some forms of constipation and obstructed bowel. I am, Sirs, yours obediently, WE have received the following letter from Dr. Lewin, ] which we reproduce, together with a translation:j SEHR GEEERTER HERREN,—Ich lese in der letzten Nummer ] der LANCET einen Bericht des Herr Dr. Tweedy iiber Erythro-] phlceine, der mich nothigt, obwohl dieses nicht meiner sonstigen Gewohnheit entspricht, darauf folgendes zu erwidern. ] Iedes Wort, das ich iiber die anaesthetische Wirkung des Erythrophloeine habe drucken lassen, ist absolut wahr. Herr Dr. Tweedy hatte besser Gethan ehe er diesem Mittel die anaesthesirende Einwirkung abspricht an einem Hunde einen Versuch mit einer Losung von 0.05 grm. : 100'0 Wasser anzustellen, und er wiirde sich iiberzeugt haben, dass er ! voreilig ein Urtheil abgegeben hat. Ich kann andrerseits bervorheben, dass die anaesthesirende Wirkung hier in Berlin auch am menschlichen Auge erzielt worden ist. Mich als Pharmakologen interessirt diese praktische Verwendung erst in zweiter Reihe. Mir geniigt es wiederum eine Substanz nachgewiesen zu haben, die an lebendem thierischen Gewebe Empfindungslosigkelt erzeugt. Dadurch wird die Wahrscheinlichkeit groesser dass auf chemischem Wege gewisse Punkte gewonnen werden koennen, die den bisher bekannten, local anaesthesirenden Stoffen gemeinsam sind. Dass das jetzt kaufliche Erythrophleeine einer Verbesserung fahig ist daran z weifle ich nicht. Denn es finden sich in diesen Praeparaten Beimengungen, wie nicht hineingehoren. Aber ein verunreinigtes Praeparat wie Herr Tweedy in Haenden gehabt hat, das naemlich Pupillenerweiterung macht, habe ich nie geseheiu. Ich kann bestimt versichern, dass die Pupillen in alien meinen Versuchen unveraendert blieb, und kann hinzufiigen, dass sich dies auch bei Versuchen, die hier in Berlin an Menschen angestellt wurden, ergeben hat.-Ich bin Ihr ergebenen, Hinversinst., Berlin, Feb. 5, 1888. word that I have published about the anaesthetic effects of erythrophlœine is absolutely true. Mr. Tweedy would have done better if before denying the anassthetic effects of this substance he had experimented on a dog with a solution of '05 gramme to 100 of water, and then he would have had to admit that he had formed too hasty a judgment. I can further prove that the anaesthetic effect on the eye of man has been obtained in Berlin. To me as a pharmacologist this practical use holds only a high secondary position. It suffices for me that again we have discovered a substance having ancesthetic effects on animal tissues. Thereby is the probability rendered greater that certain features, common to substances producing local anaesthesia, may be discovered by chemical methods. I have no doubt that the erytbrophlœine of commerce is susceptible of improvement, and that foreign admixtures are to be found therein. But such a very impure preparation as that used by Mr. Tweedy-which, to wit, caused dilatation of the pupil-I have never seen. I am quite sure that in all of my experiments the pupils were unaltered, and I may add that the same result obtained in experiments made on man in Berlin. 1 am, Sirs, yours sincerely, -DR. L. LEwIN. DR. L. LEWIN. To the Editors of THE LANCET. SIRS,—I thank you for the courtesy of sending me a copy of Dr. Lewin's letter relating to my communication to THE LANCET of the 4th inst., on Erythrophlceine. Will you kindly extend the favour so far as to allow me to add a few words of comment and explanation? I would remind you that I was careful not to throw doubt on the results which Dr. Lewin alleged he had obtained. I merely declared that with solutions procured from a trustworthy source I had been unable to obtain similar results, and more particularly that I had not only failed to observe appreciable anæsthesia, but had, in all cases, noticed decided dilatation of the pupil. In noting these differences I wished to express myself with reserve, saying: " In the face of these opposite results it would perhaps be well to assume that erythrophlceine has not yet been obtained in a simple and definite form, and that there is more than one active principle present in the substance now in the market." The solutions I used in my first experiments, and which Dr. Lewin condemns as "very impure," were, I am informed, made from a preparation by the well-known pharmaceutist Merck; but having ascertained shortly after the publication of my note in THE LANCET that this particular specimen was not recent, 1 asked Mr. Martindale to make me a 0'125 per cent. solution of the best and most recent preparation obtainable. This he did on the 9th inst., again using Merck's. This solution was clear, the former ones having been somewhat opalescent. I have made many experiments with the fresh solution, and, with one exception, have obtained results substantially the same as those described in my letter of the ! 4th inst.-viz., considerable smarting on application, lasting from ten to thirty minutes, great blurring of the sight not dependent upon changes in the accommodation, pronounced circular spectrum halo around a naked light, and very slight anœsthesia, if any. The only difference was that while the former solutions produced decided dilatation of the pupil, the later caused a little contraction. Mr. E. T. Colhns, the senior house-surgeon at the Moortields Ophthalmic Hospital, who again, at my suggestion, made independent observations, has obtained substantially the same results as myself. Unless we are to assume that erythrophlceine is capable of producing one effect in Berlin and the opposite effect in London, the contradictory results obtained by Dr. Lewin and myself are only to be explained in one of two ways: either we have not employed specimens having identical physical and chemical properties, or our modes of investigation and of interpretation are strangely at variance. It is, perhaps, only right to add that even in Berlin professional opinion is by no means unanimous as to the anaesthetic virtues of erythrophloeine. At a meeting of the Berlin Medical Society held on the 8rh inst., Dr. Oscar Liebreicb sharply criticised Dr. Lewin's statements, and warned pharmacologists against using erytbrophloeine, which, he , said, was never to be compared with cocaine.
doi:10.1016/s0140-6736(02)28042-3 fatcat:zt4arajgzrbf3ii26mrmudrshq