Quackery, remedy for 66 314 Trachea, foreign body in the 173 201 201 204 224, 286 230 231 283 310 31 88 • 146 63, 137 Tracheotomy, Prof. Crosby's case of 19, 33 Ulcers, Critchetts' treatment of · Report on Medical Topography Report of the delegates from the Centre Salutatory, 49 Vaccination, 270 . 150 220 Veratria, poisoning by twenty-nine grs. 25 Wakefield's trial, 87 Western Medico-Chirurgical Journal, 6100 JAN 17 1902 LIBRARY FROM A TREATISE ON MAT., MED., AND THERAP., BY TROUSSEAU AND PIDOUX. [Translated from the French.] Chlorosis, we do not fear to say, rules the pathology of the woman; and the physician who shall not know how to recognize this affection will frequently fail in the treatment of the diseases of women. Undoubtedly, this is not the place for a pathological dissertation; yet, as we have some ideas about chlorosis which are not generally received, we are obliged to explain ourselves, that the reader may place himself at our point of view, otherwise it will be impossible for him to understand the intimate relation which unites affections in appearance very distinct, and which, entirely subordinate to the same cause, yield to the same therapeutic influence, that of iron. In its most gross form, and when it is possible for an ignoramus only to mistake it, chlorosis presents itself with the following train of symptoms: General paleness of the skin and mucous membranes, emaciation, bloating of the face and lower extremities, nervousness, hysteria, melancholy, fickleness, muscular debility, neuralgic pains-ordinarily of an irregular typeincrease or diminution of the volume of the heart, the ventricular impulse sometimes more energetic, sometimes weaker than in health; great loudness of the second sound of the heart; divers bellows murmurs in the great arterial vessels, and especially in the carotids, subclavians, &c., &c.; pulse more frequent than in health, febrile heat, dryness of the skin, thirst, panting at the least movement, dyspepsia, pyrosis, depraved appetites, gastralgia, occasional vomiting, constipation, diarrhoea when the disease has lasted a very long time; menstruation painful, irregular, scanty, discolored, wanting; leucorrhoea, menorrhagia, sterility. Such is a picture, or rather a rough sketch of chlorosis. This frightful train of symptoms ordinarily disappears with rapidity under the influence of the ferruginous preparations. In chlorosis how ought we to give iron? in what dose? for how long a time? all questions which therapeutists have scarcely touched upon, and which few practitioners have taken the trouble to examine thoroughly. We except, however, Sydenham, who has given the basis of a good treatment, but who has not sufficiently insisted upon some minutiae of great importance as a long use of this remedy has convinced us. The insoluble preparations ought to be employed in general in the beginning of the treatment. Iron filings hold the first rank. They are given in powder, in a spoonful of broth or in sweetmeats, morning and evening, at the two principal meals, in the dose of from one to two grains each time. If this dose is easily borne, it is increased gradually until it reaches from fifteen to thirty grains for each meal. It is essential that the medicine should be taken at the beginning of a meal, for if it is given in the morning fasting, as many physicians do, the patients feel a weight at the stomach-a very great loathing-and lose their appetite. When the iron filings are not borne in this way, we prescribe lozenges of chalybeate chocolate, according to the formula which we give below,* and we administer ten or a dozen of them in the course of the day. If the patient, on the contrary, bears the iron filings well, we may pass to the soluble preparations, such as the lactate, the citrate and the chlorides of iron. Those which we prefer to all others, are those which we have invented, and which we designate by the name of tartaric, or hydrochloric gaseous chalybeate waters, made with fifteen grains of tartrate or perchloride of iron dissolved in a bottle of artificial Seltzer water. For certain women, we prescribe the tartarized tincture of iron, iron water, chalybeate wine, &c. &c. &c. This treatment, which ought not to be suspended even in the menstrual period, should be continued till the symptoms of chlorosis have entirely disappeared. We stop then, to resume a month after, and persist in the same means for fifteen days or three weeks. Then we leave two months interval; after that we give the chalybeates for fifteen days; and we should do thus for a year, and even more; for, if it is easy to cure chlorosis, it is difficult to cure it so as to have no fear of relapses, if we suspend suddenly the use of the preparations of iron. Chlorosis is by some pathologists considered a disease of almost no importance; but contrary to this opinion, we believe chlorosis is a very serious *R. Ferri ox. rub. 3i. Canellæ pulv. gra. XV. Mucil. tragacan. q. 8. affection, and to which many women are subject all their lives, in this sense, that they are without cessation, in danger of a relapse; or, indeed, which is more common, they preserve with the appearance of health most of the functional troubles which are the appendages of confirmed chlorosis. It is also necessary to say, because it is a truth which one perceives in growing old in the practice, that iron, after having rapidly removed the most grave symptoms of chlorosis, sometimes becomes suddenly powerless, and leaves us disarmed in the presence of a disease which it appears, in general, to subdue with so much facility. The drug, in this case, acts with as much less certainty as the affection is of longer standing, and above all, as the relapses have been more frequent. Some patients present a singular phenomenon. For a time, longer or shorter, they bear considerable doses of iron, with a rapid improvement of the symptoms of chlorosis; then suddenly they are made uncomfortable by the medicine, and appear to be in a sort of saturated state. The physician ought then to stop it, to resume it afterward according to the mode we have before pointed out. The indication for the employment of the ferruginous preparations, plain as it may be, cannot be always easily filled by the physician. The state of the stomach, or that of the intestines-a susceptibility which it is impossible to foresee, put in the way an invincible obstacle. It is not the less necessary to have continually in view the end to be attained, sooner or later; and for many weeks, and even many months, to modify the irritability of the intestinal canal, or to accustom the economy to the impression of the chalybeates. When there is in chlorotics a disposition to diarrhoea, it is expedient not to commence by the administration of iron; above all, not to prescribe its soluble preparations. But for a longer or shorter time, the sub-nitrate of bismuth, columbo, the diascordium, powdered crabs' eyes in the dose of from 4 to 8 grains at each meal; the nitrate of silver in the dose of from 2 to of a grain, in a potion taken in the course of the day, should be given with the design of checking the diarrhoea. When we have reason to suppose that the gastric irritability is allayed, we give with these, at first, small doses of iron filings, or of some other ferruginous preparation-but little soluble-and we increase gradually the proportional quantity of the chalybeates, till we have made the patient bear from 15 to 30 grains of iron. When, on the contrary, there exists a constipation which nothing can conquer, we associate in the form of a pill, a soluble salt of iron, the tartrate, the citrate, or better, the perchloride with aloes, so as to cause to be taken gr. to 1 grs. of aloes a day, with 11, 15, or 30 grains of the chalybeate salt. These pills should be given at a meal. This precaution is of the greatest importance. The aloes has here the double advantage of acting as a laxative and as an emmenagogue. It follows that if the chlorosis is accompanied by menorrhagia, which is somewhat frequent, aloes should never be administered; but we should replace it by powdered rhubarb, or better by magnesia, which the patient should take at night before going to bed. It is an accredited opinion among physicians that chlorosis is a disease which affects only young girls, Febris alba virginum. This generally received idea is false in all points, and every day it gives rise to mistakes which have a sad influence on treatment. Chlorosis, we hasten to say, is in general a disease of youth, but it is still very common in adult age. It shows itself also with women at the turn of life; and in fine we have seen it twice after this epoch-in one woman of 52 years, and another of 57-and with both these patients the chlorosis, characterized by its peculiar symptoms, was easily cured by the chalybeates. Of Chlorosis considered in its elements. We have seen the happy influence of iron upon chlorosis, when it shows itself with the whole train of symptoms which we have above indicated; but the disease does not always show itself with this train complete, but frequently, more frequently even, it only makes itself known by its connection with some one of these symp"The symptomatic expression is incomplete," to avail ourselves of the happy language of Recamier, but, incomplete as it is, it is necessary to understand it under the penalty of never attacking the seat of the disease, and of fighting only against an accident which we may subdue for an instant, but which will soon reproduce itself with as much intensity as before, and under another form if not under the same. toms. The decoloration of the blood, and consequently that of the skin and mucous membranes, may exist alone without any other accompaniment than shortness of breath and disorders of the circulation. This form is the most simple, is easily recognized, and is cured with facility. But frequently, before the decoloration has arrived at its height, the ordinary symptoms of chlorosis, such as neuralgias, nervous troubles, disorders of digestion, &c. &c. of the menstrual flow, appear together or singly, and then the common run of physicians, who take care to judge from the sum of the elements of diagnosis, do not recognize the chlorosis which, though less complete, is not less real. Nervous accompaniments. Hysteria and convulsions frequently attack women after great losses of blood, after confinement, after suckling, and young girls who are beginning to be chlorotic. These nervous troubles yield with facility to the chalybeate preparations. The hysteric convulsions are not always so happily combated as idiopathic spasms. Always when this spasmodic state occurs in a woman of good color, vigorous, and who presents no other indication of chlorosis, it is rather increased than diminished by the use of ferruginous drugs. Neuralgia. Neuralgia is an almost constant symptom of chlorosis, to such a degree, that of twenty chlorotic women perhaps nineteen have neuralgia. |