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“The habitual use of tobacco by smoking, chewing, or snuffing, if indulged in moderately, is not generally productive of any obvious injury to the health; but in some individuals of nervous temperament, or great susceptibility of the nervous system, it cannot be employed even in small quantities without injury. In excess I have no doubt that it is often very injurious, greatly impairing the vigour of the nervous system, and of the health generally, and probably shortening life, if not directly, at least by rendering the system less able to resist noxious agents. The effects most frequently induced are dyspepsia, defectice nutrition, paleness and emaciation, general debility, and various nervous disorders, of which the most frequent are palpitations of the heart, hypochondriacal feelings, and neuralgic pains, especially of the head and eyes. Very great habitual excess seems to be capable of directly inducing a condition similar to that induced by the omission of alcoholic drinks in the case of the drunkard; a condition prominently marked by muscular tremors, obstinate wakefulness, and hallucinations. The late Professor Chapman informed me that he had witnessed several cases of delirium resulting from tobacco, closely resembling delirium tremens, which ceased upon the omission of the drug. This fact very strongly illustrates the opposite effects of tobacco and alcohol; a condition being produced by the direct influence of the one, very analogous if not identical with that resulting from the omission of the other; even insanity has been ascribed to the abuse of tobacco. Snuffing appears to be less injurious to the general health than either smoking or chewing; but there can be no doubt that it is more or less hurtful in excess, and at all events it is apt to occasion diminished susceptibility of the sense of smell, and a disagreeable alteration of the voice."
The work before us differs in many respects from those devoted to the same subjects in our own country, in containing accounts of many drugs which are little, if at all, known amongst us. Many plants are employed in the United States not contained in our Pharmacopoeia, and although the effects of perhaps the majority can be obtained by the use of such as we possess, still there seem to be some essentially different; we will select one of these, and quote Dr. Wood's remarks upon the action which it exerts upon the system : the plant we have chosen is the Veratrum viride, or the American Hellebore, called also the Swamp Hellebore, the rhizome of which is officinal in the United States' Pharmacopeia.
"Locally applied, American hellebore is capable of producing irritation, rubefaction, and even vesication of the surface. Snuffed into the nostrils in the form of powder, even much diluted, it acts as an errhine and sternutatory. Its acrid impression on the mouth and fauces, when chewed, has been already mentioned. When swallowed, it is apt to cause uneasiness in the epigastrium, which, when the dose is sufficiently large, is followed by nausea and vomiting, the latter effect being often protracted, and attended with much retching, and sometimes with hiccough. Dr. Osgood noticed in his own case, that the vomiting was effected by a spasmodic contraction of the stomach itself, without participation of the diaphragm and abdominal muscles, and in another individual was preceded by a sensation as of a ball rising in the cesophagus, the result, no doubt, of a spasmodic contraction of that tube. The antecedent and attendant nausea does not seem to be severe, though the prostrating effects on the system, as will be more particularly noticed directly, are often very striking. The emesis is usually later in occurring from this than from other emetic medicines, three-quarters of an hour or more not unfrequently elapsing after its exhibition before this effect is experienced. Afact which, considering the drastic properties ascribed to veratrum album, was not anticipated, but which appears to have been confirmed by almost all who have reported their
experience upon the action of the medicine, is that it seldom, if ever, purges. The remarks hitherto made have reference to its local operation, its effects on the system are even more striking. From doses insufficient to vomit, along with the epigastric uneasiness, or independent of it, there are sometimes feelings of chilliness and considerable diminution in the frequency and force of the pulse, with a sense of weakness in certain muscles, or want of due command of them, which are probably the results of a direct sedative influence upon the nervous centres. As a proof that it is not from the depressing influence of nausea that the reduction of the pulse takes place, Dr. Norwood states that he has reduced it as low as thirty-five in a minute, without the least nausea and vomiting. He also speaks of a feeling of numbness and tingling which he had experienced about the joints previously to vomiting, as well as during and after that process. We are told by Dr. Osgood that the farmers in New England, in order to protect their crops from birds, were in the habit of scattering in their fields grains of corn which had been soaked in an infusion of the root of the American hellebore. Soon after eating this grain, the birds became incapable of running or flying, so that they were readily caught; but if left undisturbed for a time, they recovered from the paralyzing effect, and flew away.
"When the medicine is carried so far as to produce nausea and vomiting, its depressing effects on the circulation and nervous system are often very striking; the pulse falls from 75 or 80° down to 35 or 40°, and at the same time becomes small and feeble, and occasionally almost imperceptible. The surface is pale, and covered with a cold sweat, the patient at the same time experiencing a sense of chilliness, and sometimes of tingling or numbness : headache, vertigo, dimness of vision, with dilated pupils, faintness, a feeling as of stiffness of certain muscles, and a want of command over them, are other symptoms evincive of the sedative operation of the medicine. These signs of prostration are sometimes so great as to become alarming, although I have seen no account of fatal poisoning.
“All agree in the statement that the general depressing effects on the nervous system and circulation are attended with stimulation of the secretory functions. The salivary, pulmonary, biliary, and urinary secretions are increased, it is asserted, by doses insufficient to occasion nausea and vomiting; and during the existence of this condition, the same effect is produced upon the function of the skin."
From this account, it would seem that the American hellebore possesses powers unlike either the Veratrum album or the Colchicum autumnale; and we know that, although the two latter belong to the same botanical natural order, yet they differ much in their physiological action, both containing very potent yet different active principles. May we not therefore possess in the American plant a new therapeutic agent possessing powerful and valuable properties?
We can most heartily and sincerely recommend Dr.Wood's Treatise on Therapeutics and Pharmacology' to the notice of gentlemen engaged in the practice of medicine, feeling convinced that they cannot fail to derive much benefit from its perusal. The work has no great pretensions to originality, or of containing any very special or profound inquiry; but while it supplies the general information which we look for in a book of this kind, it also embraces the results of the careful observations of a highly-educated and talented physician during a long and successful professional career, which give the work a peculiar and valuable stamp.
ART I.-On the Diseases of Women; including those of Pregnancy and
Childbed. By FLEETWOOD CHURCHILL, M.D. Trin. Col. Dublin,
M.R.I.A. Fourth Edition.—Dublin, 1857. The present edition of Dr. Fleetwood Churchill's well-known treatise fully supports the reputation of the original work, and contains, in a condensed and well-arranged form, an admirable résumé of the present state of professional opinion and practice in regard to the several diseases upon which it treats. As compared with the former edition, many alterations and additions have been made : some new chapters have been added, others have been either pruned down or expanded, and much new matter has been introduced in several parts of the work. In its present form, we have no hesitation in stating, that we regard it not only as an admirable text-book, but as one of the most comprehensive and systematic treatises on the diseases of females which has ever issued from the medical press of this country.
Of the new chapters introduced, we find one respectively upon Urethritis, Occlusion of the Vagina, Pelvic Abscess, Occlusion of the Os Uteri, and Ovarian Irritation in the Non-Puerperal Female ; and upon Tetanus, Convulsions, Paralysis, and Arterial Obstruction in Puerperal Women. We have in a recent number given an epitome of what is known respecting the two latter diseases-viz., tetanus and arterial obstruction--and need not further allude to them here : but the subject of paralysis is one which has scarcely received adequate attention; and as it is very fully treated of by our author, we subjoin a brief summary of the chief facts and conclusions to which he has arrived respecting it.
The literature of our profession, we may premise, is singularly barren on the subject of this disease. Neither the works of the principal obstetric writers, nor those on the diseases of females, or the practice of medicine generally, contain more than the most meagre and cursory information respecting it. Our author has, however, collected thirtyfive cases of the disease from various friends and authorities, and from them the following statistical facts and conclusions are deducible.
Of the 35 cases, there were 18 of complete, and 1 of partial hemiplegia ; 4 of paraplegia, in 2 of which one leg only was affected ; 6 of facial paralysis; 5 of amaurosis; and 3 of deafness.
Of the 35 cases, in 23 the attack occurred during pregnancy, and in 12 either during or after labour. Of the former, 13 were cases of hemiplegia; 1 of paraplegia, which had occurred previously; 4 of facial paralysis ; 2 of amaurosis; and 3 of deafness. The seizure took place at variable periods of gestation, but more frequently in the later than the earlier months. Of 20 cases, 12 appear to have been cured before or by delivery, and in 8 the disease continued for a longer or shorter time afterwards. Of the 23 cases only 1 died, and in this it is evident that death was rather owing to disease of the brain of longer standing than the pregnancy, than to the paralysis, which increased during the process. In 3 cases only was the paralysis preceded by convulsions, and in the majority it does not appear that there were any premonitory symptoms, such as headache, or any other circumstance calculated to excite apprehension, before the paralysis supervened.
Of the 12 cases that occurred during or after labour, in 3 only did the paralysis take place during labour, and of these 2 were cases of convulsions. In all the others, it not merely succeeded labour, but, in the majority, after a considerable interval. Of these 12, 5 were cases of complete hemiplegia ; in 1 only the arm was affected; I was a case of complete paraplegia; in 1 the right and in 1 the left leg was paralyzed; 2 were examples of amaurosis, 1 of facial paralysis; and in 3 only of the cases of hemiplegia the face participated in the attack. Other peculiarities might be added, but it is more important to observe that in the majority it took place without warning and without any obvious cause. The paralysis gradually subsided in most cases, but 3 proved fatal.
In speculating upon the nature and cause of the disease, our author dwells upon the fact, that in most of the cases the attack occurred without warning and without apparent cause. In only one case, for example, did it appear to depend upon any external influence-upon cold, exposure, violence, &c., or upon mental distress; and in few, if any, was there evidence of previous cerebral congestion or disease of any organ. Other causes are instanced, but their operation is assumed to be more than doubtful in the production of the disease; and, upon the whole, our author leans to the opinion that the kidneys play a more important part in the causation of these affections than has been suspected, and that the subject deserves more attention than it has received.
“For," he observes, “ we find that in cases of convulsions terminating in paralysis, we may have albuminuria ; in paralysis before delivery, without convulsions, we may have albuminuria; in paralysis occurring after delivery, we may have albuminuria ; and further, that in the slightest cases, both the convulsions and paralysis diminish with the decrease of albuminous secretion. Whether, therefore, the paralysis be caused by the state of the kidneys, or the renal congestion and paralysis be both the result of some morbid matter in the blood circulating through the system, it is clear that a new element may be added to those which have usually been considered as giving rise to paralysis.”
This view suggests to our author the necessity of directing our attention to the relief of the renal malady, and the restoration of the kid
neys to such a state of efficiency as may enable them to remove the morbid constituents of the blood. We will not enlarge upon this part of the subject, but submit that the researches in question fully prove that a relationship exists between certain forms of paralysis and pregnancy on the one hand, and albuminuria on the other. Whether, however, this is fixed or casual, accidental or constant, is a matter which we are at present unable to decide, and which must therefore remain to be determined by further and more extended inquiries.
Of the additional chapters introduced into the sections on the diseases of the non-puerperant female, in this edition, the most original is probably that on ovarian irritation—a form of disease which our author believes to be very common, although little noticed in medical works. It is characterized by uneasiness or pain in one or both iliac or inguinal regions, but most frequently the left-probably from the propinquity of the left ovary to the rectum, and its exposure to any irritation thence arising. The pain may be a constant dull aching, or it may be acute, or occurring in paroxysms, and is greatly aggravated by standing and generally by walking. No tumour is perceptible in the seat of pain; but there is generally much tenderness, and in some cases great irritability, of bladder. Hysterial paroxysms are by no means unfrequently coincident.
We will not enlarge upon this subject beyond referring our readers to the author's opinions and practice in regard to it as embodied in the chapter referred to, and observing that we have long been cognisant of the existence of such a disease. We believe it is not at all unusual to meet with cases in which one or both ovaries are in a state of morbid sensibility-in which the ovarian region is exquisitely tender on pressure, in which there is no evidence of vascular or organic disease, and in which the symptoms subside under treatment addressed solely to the relief of an exalted or perverted state of the sensibility of the organ. We have regarded this lesion of the ovaries as analogous to that of the uterus known as the “irritable uterus," and have been led to consider both as being generally dependent upon various sources of irritation secondarily reflected from a distance upon the uterine and ovarian organs. We may remark that, in the practice of our author, the most successful treatment for the ovarian affection has consisted in the introduction into the upper portion of the vagina, by means of the speculum, of a pessary containing two grains of opium, half a drachm of white wax, and a drachm and a half of lard—the patient being directed to remain in bed during the remainder of the day.
There is one omission which we would advert to in the work-viz., the comparative absence of information upon the subject of syphilitic affections of the uterine organs. We believe that a chapter might have been advantageously introduced, embodying the various facts which have been collected on this subject by various writers; and we would recommend it to our author as worthy of his consideration in the preparation of another edition of his work. In Nos. 98 and 99 of the Association Medical Journal’ (New Series), an elaborate paper will be found, by Dr. F. W. Mackenzie, embodying the results of a