We are all indebted to Dr. Burford for his picture of the great doings at Geneva, that great centre of many sorts of light and leading in the past, if they did not all lead in right directions. It is very pleasant to learn that the work of Hahnemann is bearing fruit in the lands of his early activities. Dr. Burfords brilliant report of the Congress proceedings under the lead of president Dr. Schmidt and his brilliant wife will be read with keen interest throughout Hahnemanns world.
A FLY IN THE OINTMENT.
It seldom happens on great occasions in this mundane sphere that some little rub does not occur. This time our good friend Dr. Le- Hunte Cooper was the sufferer. At a great deal of trouble he has answered the call of duty and, after various episodes which need not be detailed, arrived in time to hear all that the other speakers had been set down for which left practically no time for his own paper. So the poisonous “properties of Aluminium” returned in Dr. Coopers pocket to the land of the papers birth. But our good friend Dr. Cooper is an excellent sportsman as we all know, and enjoyed the works of his colleagues.
So if the world is to be saved from being poisoned and crippled with aluminium, it is not the Continent but this country, which must do it.
AVERTIN, OR TRIBROMETHYALCOHOL.
THE Daily Mail is responsible for this bit of medical instruction:.
A dose given while the patient is still in the ward causes him to pass into a dreamy sleep, from which he wakes, some hours later, to find the operation over.
AVERTIN AS A REMEDY FOR TETANUS.
Avertin has been used in the United States as a remedy for tetanus, but no case of this kind has yet been published in this country. Even where a fatal result is not avoided the drug would probably relieve symptoms. Daily Mail.
CHENOPODIUM WITH CARBON TETRACHLORIDE IN HELMINTHIASIS.
THE following article appeared in the British Medical Journal of February 23rd, 1924, and as it contains valuable practical observations on a department of medicine which is not too easy to master we reproduce it here.
CARBON TETRACHLORIDE AND OIL OF CHENOPODIUM IN HELMINTHIASIS.
An article under this heading appeared in the British Medical Journal of June 23rd, 1923 (p. 1048), and I write to express my agreement with the opinion of its author, Dr. J.G. Reed of Borneo, that carbon tetrachloride is even more effective as an anthelmintic when combined with oil of chenopodium. The following procedure has given good results in the Georgetown Public Hospital, British Guiana. The faeces are examined for ova of Ankylostoma duodenale and other parasites before treatment, and also three days after it.
Three ounces of saturated solution of sodium sulphate are given in the evening and next morning a dose of carbon tetrachloride, from 40 minims to 1 drachm, according to the age and strength of the patient, is administered. On the third night after this another dose of 3 ounces of the sodium sulphate solution is given. About 60 per cent. of the patients so treated experienced nausea and headache. Of 135 patients, 104 were positive as regards Ankylostoma duodenale ova; a few of them were positive also for Strongyloides intestinalis, Ascaris lumbricoides, or Trichuris trichura.
The majority of those faeces which did not contain ankylostoma ova contained those of one or other of the parasites mentioned. About 40 per cent. were found to have become a negative after a single dose of carbon tetrachloride. Some patients require several doses, and these heavily infected cases are very weak, anaemic, and oedematous. East Indians form the majority of patients requiring treatment: their faeces invariably contain ankylostoma ova, and a characteristic symptom of the condition is a purplish tongue. The following are details of three heavily infected cases;.
Case 1. An anaemic black man, aged 56, admitted with pyrexia and delirium, was found to have an enlarged liver, and the faeces contained large numbers of ankylostoma ova and embryos of strongyloides. The blood count was as follows; total red cells 760,000 per c.mm., normoblasts, megalocytes, and microcytes. present, but no malarial parasites; haemoglobin 10 per cent., colour index 0.6; total white cells 10,000 per c.mm.; differential count polymorphonuclears 70 per cent. large lymphocytes 25.5 per cent., large mononuclears 4.5 per cent.,
After two months treatment with carbon tetrachloride, amounting in all to 6 drachms, and with iron and quinine, ankylostoma ova were still present, but the anaemia was much less. The blood count was now: total red cells 4,200,000 per c.mm., haemoglobin 50 percent., colour index 0.6; total white cells 3,200 per c.mm.; differential count polymorphonuclears 53.5 per cent., large lymphocytes 29 per cent., large mononuclears 3.5 per cent., eosinophils 14 per cent. After further administration of 40 minims of Carbon tetrachloride, combined with 15 minims of oil of Chenopodium, ankylostoma ova were absent from the stools.
CASE II. A black man, aged 34, with ankylostoma ova and strongyloides embryos in the faeces. Six weeks treatment with carbon tetrachloride (4 drachms in all), iron, and quinine, resulted in an increase of the red blood corpuscles from 1,7,36,000 to 2,110,000 per c.mm.
CASE III. A Portuguese, aged 32, whose faeces contained large numbers of ankylostoma ova, and whose blood count was 1,952,000 red cells and 34,800 white cells per c.mm., only required one weeks treatment in hospital.
I am indebted to Dr. A. J. Craigen, resident surgeon, for permission to publish these notes; to Dr. F. G. Rose for the pathological examinations; and to Nurse M. Welch for collecting and tabulating the clinical records.
G. A. GRANDSOULT,.
Georgetown, British Guiana. L.R.C.P. and S. Edin., L.R.F.P.S.G.
THE DANGER OF OIL OF CHENOPODIUM.
IT will be useful to append to the above some notes from the British Medical Journal of April 19th , 1924, on the administration of Chenopodium alone.
THE DANGER OF OIL OF CHENOPODIUM.
H. Bruning (Deut. med. Woch., December 7th, 1923, p. 1492) records five cases of poisoning by oil of chenopodium four of which terminated fatally. The four patients who died were children; the fifth patient, who recovered, was a woman, aged 40 who, even six months later, still suffered from auditory disturbances. In 1919 Preuschoff collected 24 cases of poisoning by oil of chenopodium among which were sixteen deaths. The authors first patient was a child 2 1/2 years old, who was given 9 drops of chenopodium on sugar. The second patient was a boy, aged 5, who for three or four days was given 20 drops three times a day.
The third patient was a boy, aged 7, who was given three doses of a mixture containing oil of chenopodium 7, menthol 0.7, in 200 c.mm. of water; two tablespoonfuls were given on each occasion. The dose in the fourth fatal case was unknown as some of the drug was vomited. These four fatalities were the more tragic as three at least of the children proved not to be suffering from worms. The author raises four points in connection with these cases: (1) Anthelmintics should not be given unless it is definitely proved that the patient is suffering from worms. (2) The general health must be satisfactorily before anthelmintics are given. (3) No other drug should be given with the anthelmintic. (4) Oil of chenopodium should be given only on a doctors prescription.
AMNIOTIC FLUID AS A PREVENTIVE OF ADHESIONS. Following previous experimental work on animals, H.L. Johnson (New England Journ. Med., October 4th, 1928, p. 661) refers to his previous investigation into the use of amniotic fluid as a preventive of adhesions (see Epitome, January 14th, para. 41) and reports further progress. A concentrate of amniotic fluid has been prepared for clinical use; this is essentially a fractionated alcohol precipitate containing the active principle of the whole fluid, and is obtained from the fluid of cows three to five months pregnant.
As the residual proteins are discarded the use of the concentrate eliminates the fear of infection and foreign protein reaction. When employing it, the fluid is first raised to a temperature slightly above that of the body by means of a water-bath. The desired quantity is then poured into the field of operation just before closing the peritoneum, the viscera being retracted to allow the fluid to sink deeply into the cavity. Contact of the fluid with the edges of the wound is said to have no adverse effect on healing.
Human amniotic fluid is as effective as that of cows. Tables are given showing the benefits resulting from the use of the fluid in 65 Caesarean sections and 30 laparotomies. The mode of action of amniotic fluid on serous surfaces is not entirely apparent, but it seemingly hastens coagulation and also acts as a lubricant. It is not an irritating or dehydrating agent. The fluid may be applied to all serous surfaces, but it should be reserved for use in clean cases. Its effectiveness is conservatively estimated to be 70 per cent. Its effect on post-operative convalescence is an apparent shortening of the usual period of distress. British Medical Journal, December 1st, 1928.