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doubtful, he has never seen any secondary bad effects from the use of the moxa. When used in febrile affections, it generally produces an increase of the fever on the second day. In painful affections, the relief afforded is often instantaneous, and lasts many days. Generally speaking, however, it ceases about the fifth day, and it is on this day that he usually repeats the application, and so on every fifth day until the requisite number have been used. He has never used more than eight, and in most cases not more than three. In one case he used twenty-four, but then they were employed at considerable intervals during the course of two years, and the moxas were only about one-third of the usual size.
The general effects of moxa, on which the indications for its use depend, are divided by Dr. Sadler into, 1, anti-erethistic; 2, purely dynamic; 3, excitant; 4, revulsive; 5, reparative. To illustrate these, he gives the following cases, to which are appended a few more by Dr. Busch and Dr. Wrangell.
I. Anti-erethistic. 1st Case. Miss B. was attacked with violent symptoms, which left her medical attendant in doubt whether they were the precursory symptoms of measles, or connected with a spasmodic affection of the chest to which she was subject. A small quantity of blood was abstracted on the third and fourth day, and on the fifth, a moderately diffused eruption of measles appeared, accompanied by violent gastro-enteric irritation. The vomiting and purging continued in spite of every means, and on the sixth day, the pulse began to sink, and the extremities became cold. A moderately sized moxa, applied over the epigastrium, speedily arrested the vomiting, and removed the threatened danger. The child convalesced slowly, but recovered completely.
2d Case. E. von der L., aged twenty-eight, of delicate constitution, and who had been frequently ill during the winter of 1833-4, consulted Dr. Sadler on the 18th of July, 1834. He presented the usual symptoms of dyspepsia in an ag gravated form, namely, weakness, irritability, emaciation, loss of sleep, foul tongue, salivation, anorexia, diarrhoea, heartburn, pain in the chest, and dry cough. He was ordered to use a milk diet, and prescribed the nitrate of potash with laurel water in mucilaginous decoctions; but as the symptoms continued progressive, and the patient became worse, Dr. Sadler applied a moxa over the epigastrium, on the 13th of August. This produced considerable relief, and was repeated on the 17th. On the 19th, the patient felt greatly improved, and his appetite was returning. On the 29th, he was able to dispense with medicine altogether. He recovered rapidly, and is now quite well.
II. Purely dynamic: 1st Case. Herr von St., a strong healthy man, aged fifty, had laboured for several months under a violent pain in the thigh-bone, supposed to have arisen from exposure to cold. No trace of disease could be discovered on examination, and during the day the patient felt quite well, with the exception of a slight degree of languor; but at night when in bed, he was attacked at an uncertain hour with the most intolerable pain, which lasted until morning. He had tried various remedies for several months, but without effect. Six moxas, two over the glutei, and four over the most painful part of the thigh, completely relieved him. In the winter of 1832, he had a second attack, produced also by exposure to cold, and was cured again by the application of three
2d Case. A riding-master, aged forty, who had fractured his leg and thigh, and dislocated the hip-joint by a fall from his horse, consulted Dr. Sadler in December, 1835. He complained of violent pain in the hip, thigh, and calf, which frequently lasted from two to four weeks, totally preventing him from sleeping, and then became for some time much milder. His health was somewhat impaired from loss of sleep, but in other respects his constitution was good. He was completely cured by four moxas, two on the hip, one on the middle of the thigh, and one on the calf. He bore the application of the first two on the hip without much suffering, but the two following ones caused excessive pain.
IV. Revulsive: 1st Case. A shoemaker, aged forty, of emaciated cachectic appearance, consulted Dr. Sadler on the 13th of February, 1833, affected with copious expectoration of fetid purulent matter, great emaciation, and colliquative
sweats. In addition to the internal use of acetate of lead and opium, a moxa was applied on the 16th over the most painful part of the left side of the chest. A second was applied on the 20th, but he refused to submit to a third, which was to be applied five days afterwards. His improvement was slow, but evident; the expectoration became diminished and lost its fetid smell. Iceland moss, milk diet, and a residence in the country completed his cure.
2d Case. A married woman, aged twenty-two, of delicate make but sound constitution, caught cold in September 1835, while menstruating. The catamenia were arrested, and she was attacked with violent inflammatory fever, which yielded after some time to general and local depletion, but the patient remained weak and emaciated, and complained of constant pain in the lower part of the abdomen. On examination, a large fluctuating tumour was discovered in the situation of the right ovary. A large moxa was applied over the central part of the tumour, and bark with a nutritious diet prescribed. Five days afterwards, a second was applied over the fundus uteri, and the use of tonics and aperients was continued. Under this treatment, the swelling diminished greatly, the patient began to improve in health and strength, and left the hospital on the fortieth day with the moxas still suppurating. The catamenia appeared again on the 20th of December, and soon afterwards the patient was able to resume her occupation as a washerwoman. The affected ovary never returned to the normal size, but it ceased to give any inconvenience whatever.
V. Reparative. Mademoiselle J., aged twenty-two, of full habit, and subject to some irregularity of the catamenia, had laboured for two years under an affeotion of the stomach, accompanied by constant burning pain in the epigastrium, particularly after taking food, vomiting, salivation, and costiveness. During this period she had used various remedies without success, and consulted Dr. Sadler in 1832, who, having tried the usual means without any result, proposed the use of moxa. A moxa was applied over the region of the stomach, which produced so much relief that the patient came herself five times to have it repeated. Her recovery was complete and permanent.
The first two of the following cases are given by Dr. Busch, the third by Dr. Wrangell.
CASE 1. A man, aged fifty, of intemperate habits, who had been labouring for three weeks under mucous fever accompanied by diarrhoea, was suddenly attacked with inflammation of the right lung. He was leeched twice, had cupping-glasses applied several times, and a purulent discharge was kept up for a considerable time by means of blistering ointment. Notwithstanding these measures, the pneumonia ran on to suppuration, the diarrhoea continued, and hectic fever set in, attended by great emaciation and sinking of the pulse. After the application of six moxas at intervals of six or eight days, the hectic vanished, and the expectoration ceased to have a purulent appearance. The cure was completed by the use of senega, laurel water, &c. but it was nearly half a year before the patient could leave the house. Dr. Busch observes that he has never witnessed febrile symptoms after the use of moxa, but that he has seen the suppuration continue for several months, although the part was bathed with spirit ammoniæ after the operation.
CASE II. A young man of healthy constitution, was seized with complete paralysis of the lower extremities, after an attack of the prevailing epidemic fever in the spring of 1833. He had also a sensation of heat in the region of the sacrum, and violent pain increased by slight pressure, which compelled him to lie constantly on his belly, and tortured him day and night without any remission. Leeches, cupping-glasses, sinapisms, blisters, &c. were frequently employed without effect. After the application of two moxas, the feeling of heat disappeared, the motion of the affected limbs gradually returned, and two months afterwards the patient left the hospital quite well. Suppuration continued for a long time.
CASE III. A boy, aged five years, was attacked with hæmaturia; but as he appeared otherwise well, his mother took no notice of the occurrence. Some days afterwards he began to complain of pains in the thighs while walking, and his mother brought him to Dr Wrangell. Oily and mucilaginous remedies were
at first employed, but without benefit; the same results attended the use of cold applications over the loins, uva ursi, lycopodium, &c. and the urine began to exhibit a purulent deposit. A moxa was then applied over the region of the right kidney, and after some time, another on the opposite side. Under this treatment, all the unfavourable symptoms yielded, and the child got perfectly well.-Brit. and For. Med. Rev. from Zeitschrift für die gesammte Medicin. Band iii. Heft ii. and iii.
ON THE TREATMENT OF ILEUS WITH BELLADONNA CLYSTERS. BY DR. WAGNER, District Physician at Schlieben.
The following cases are given in illustration of the treatment recommended by Hanius.
Case I. On the 21st of April, Dr. Lohrenz of Schönewalde was called to visit a man, aged twenty-three, who had been complaining, since the 19th, of violent pains in the umbilical region. The pains came on periodically, and were greatly exacerbated by pressure, so that the patient screamed out when touched. He had incessant retching, his belly was hard and tense, and he had been several days without an alvine evacuation. Venesection, leeches, enemata, and various other external and internal remedies, were employed without any effect; his symptoms increased in intensity, and on the 22d, he had subsultus, syncope, and vomiting of feculent matter. His belly was tympanitic, hard and painful, his bowels obstinately costive, his pulse scarcely to be felt, his anxiety intolerable, and his body covered with a clammy sweat. Under these circumstances, Dr. Lohrenz had recourse to clysters of belladonna. One half of the lavement was first injected; and unlike the other enemata, which were almost immediately rejected, this was retained, and had a marked effect in calming the violence of the patient's symptoms. His countenance became more cheerful, and his abdomen softer, but the pupils became greatly dilated. Half an hour afterwards, the second half was injected, and produced the most decided improvement. It was speedily followed by copious evacuations from the bowels, the pulse rose, the pain and vomiting ceased, and next morning the patient felt quite restored, and has not had since that time any return of his complaint.
Case II. On the 4th of June, Dr. Wagner was called to see a labourer's wife, aged forty, of spare habit, but otherwise robust and healthy. The patient complained of a violent cutting sensation in the bowels, with obstinate costiveness and incessant vomiting. She had had repeated attacks of the same description before, but much milder, and of brief duration. On examination, he found a hernial tumour in the right groin, about the size of a walnut, and so excessively tender on pressure, that she could not bear the slightest touch. The belly was tympanitic and tender, the pulse small and rapid, the face pale, the body moderately warm. A large venesection was premised, and all the usual internal remedies (except quicksilver) tried without any effect; clysters of all kinds were employed, but proved equally ineffectual. The patient refused to submit to a second venesection or the application of leeches, and rejected altogether the proposal of an operation. On the 5th, all her symptoms were increased; her thirst was excessive, and she had fecal vomiting, with suppression of urine. In this state of things Dr. Wagner had recourse to the belladonna clysters. He infused a drachm of the root of belladonna, and an ounce of chamomile flowers (he does not state how long) in twelve ounces of water, and divided the infusion into three parts. The first part was administered by himself as soon as it was cold, and produced very remarkable effects. The nausea and vomiting instantly ceased, and half an hour afterwards, the belly was soft, without much tenderness on pressure, and the hernial tumour much less tense, though still painful. None of the secondary bad effects of belladonna were observed. On visiting the patient at noon, he found her quite easy and contented, but labouring under dilatation of the pupils. She told him that she had been threatened with a repetition of the attack about half an hour before, but that she had stopped it by
drinking a few spoonsful of the clyster mixture. In the evening, when seen by Dr. Wagner, she complained of a return of the abdominal pain and tension, and as there was no indication of the secondary effects of the belladonna, except some dilatation of the pupil, he administered the remainder of the infusion. The patient passed a quiet night, with the exception of some troublesome dreams, and, on the following morning, the abdominal symptoms were mild and inconsiderable, except that the hernial sac remained extremely tender on pressure, and the incarcerated portion of intestine could not be replaced. At noon, the soreness and tension of the belly increased again, and as no alvine evacuation had as yet taken place, and there were no apparent bad consequences from the belladonna, Dr. Wagner repeated the infusion as before. The first dose produced the usual tranquillizing effect, but no further change; and as the constitutional effects of the remedy were limited to some increase in the dilatation of the pupils, with unpleasant dreams, he administered the second portion, and, towards evening, the third and last.
On the morning of the 7th, the hernial tumour had disappeared, loud borborygmi were heard in the abdomen, and large evacuations of offensive fæces took place, but the patient, after having been annoyed the whole night with frightful dreams, was suddenly seized with such furious delirium that it required several strong men to hold her. Her eye was fixed and sparkling, the pupils excessively dilated, the conjunctiva injected, the cheeks of a fiery red, the pulse small, rapid, and scarcely to be felt, deglutition unimpeded. She saw nothing but strange phantoms, which she sought to drive away by abuse and threats, and searched for concealed enemies under her bedding, clothes, and furniture. She believed herself perfectly well, wished to resume her domestic labours, pulled on her clothes with furious violence, and would have rushed out of the house had she not been held by force. Dr. Wagner ordered enemata of vinegar, (which were followed by copious evacuations,) and gave vinegar with strong coffee internally, of which the patient drank large quantities with much desire. Cold lotions were applied to the head, and the limbs were washed with vinegar, an operation which the patient herself performed with apparent satisfaction, washing herself with vinegar from head to foot. This state of things continued until the morning of the 8th, when the patient became rational and composed, but complained of flashes of light and various other optical phantasms, with a sense of great weight and pressure in the head, and a general feeling of soreness and exhaustion, particularly in the feet. She recollected distinctly every thing she had said and done during the preceding day and night, and said that the horrible phantoms by which she was incessantly surrounded had compelled her to act and speak in the manuer she had done. On the 9th, she complained of nothing but weakness, which soon disappeared, and she recovered rapidly without any farther unpleasant symptoms.
Case III. On the 3d of July, a smith, aged fifty-nine, was attacked with enterodynia, vomiting, tympanitic swelling of the abdomen, and constipation. Dr. Wagner was called to see the patient, and found an incarcerated hernia of the left groin, about the size of a hen's egg, and extremely sore to the touch. All external and internal remedies, repeated local and general bleeding, and frictions over the abdomen with extract. belladonnæ and ol. hyoscyami, proved wholly ineffectual. Every thing was instantly vomited up, and the clysters were immediately returned. As the patient would not submit to an operation, Dr. Wagner threw up an enema, composed of a scruple of the belladonna herb, and half an ounce of chamomile flowers, in four ounces of water, which arrested the vomiting immediately, and produced such a diminution of the pain, that the patient was able to enjoy several hours' sleep. The abdominal symptoms, however, returned every six or eight hours, and were four times allayed by the use of the same enema. On the 5th, return of the pain and tenderness; Dr. Wagner was afraid to have recourse to the belladonna, as, in addition to great dilatation of the pupils, frightful dreams, sinking and acceleration of the pulse, and dryness of the tongue, had taken place; and he prevailed on the patient, after much entreaty, to submit to the operation. This was performed successfully by Dr. Weistand, on the 6th, and in fourteen days the patient was quite well.
Case IV. On the 5th of July, Dr. Wagner was called to a woman, aged forty-seven, who was said to have been labouring for two days under violent pains in the abdomen, obstinate constipation, and incessant vomiting. On mak ing an examination, he found an incarcerated femoral hernia of the right side, about the size of a small walnut, and excessively tender to the touch; diffused abdominal tenderness, and tympanitic distention. Bleeding, leeching, frictions over the abdomen with belladonna and hyosciamus, and various other remedies, were employed without any effect; and the symptoms assumed a very alarming character. As the patient refused to submit to an operation, Dr. Wagner had recourse to the belladonna clysters, which produced the usual tranquillizing effects, but the hernia remained irreducible, and the patient began to exhibit some of the symptoms of poisoning, as dilatation of the pupils, sparkling of the eyes, a fiery red colour of the cheeks, and acceleration of pulse. Blood was now drawn from the arm, small doses of calomel and laxative salts given internally, and the belladonna clysters continued, until six lavements (each composed of i. of belladonna to 3iv. of water) were used. The hernia, however, remained irreducible, and as the patient would not submit to an operation, Dr. Wagner discontinued his visits on the 8th. On the 9th, however, the greater part of the hernial tumour had disappeared, the patient had several copious stools, and in the course of two days, found herself quite well.
[The foregoing cases show that belladonna, like tobacco, is a remedy of great efficacy in subduing symptoms of ileus connected with incarcerated hernia. It has also the advantage of relieving pain, without substituting for it the horrible sickness and sinking of the vital powers, which results from the use of tobacco. Two facts, however, connected with the history of belladonna, will always tend to diminish its applicability; namely, its tendency to acoumulate in the system and then explode with fearful violence, and the well known fact, that its specific powers vary in a remarkable degree according to the place in which it grows.] Journal de Pr. Heitkunde. August, 1836.-Brit. & For. Med. Rev.
PREGNANCY WITH IMPERFORATE UTERUS.*
REPORTED BY MR. TWEEDIE.
Eliza P, aged 23 or 24, an Irish woman, residing at No. 105, Little Suffolk-street, Southwark, a patient of Guy's Lying-in Charity, was taken in labour, with her first child, on the 14th or 15th of November, 1836. Mr. Roe, the gentleman to whom the case had been entrusted, was called to her at seven o'clock in the morning. He was informed that she had been in strong pain since the preceding evening, but there had been no shew as yet. Mr. Roe observed the pains to be very urgent and very powerful; but although he remained several hours with her, he had not succeeded in discovering the os uteri.
Puzzled with this novelty (for he had attended a great number of confinements), he requested me to visit her. It was now two o'clock; the patient was on her bed. On examination I found a firm, uniform, globular mass, forcing down into the vagina at every pain (which was of great force), but no irregu larity upon its surface could be detected; and a very careful examination of the entire vagina, whose extremity was easily reached at all points, failed in detecting the os uteri. As her bowels had been confined for two days, Mr. Roe had administered a dose of castor oil; so he waited a few hours to see what nature would do, as well as to afford the oil time to operate.
In the evening I again met Mr. Roe, to see the patient. Labour-pains had persisted, and were of unusual severity; the castor oil had acted once. A most careful investigation of every part of the vagina failed to detect any os uteri At the upper part of the canal, at each pain, there was forced down this tight,
• Guy's Hospital Reports, for April.