Vol. 60, 1909 - University of North Carolina at Chapel Hill

198 THE CHARLOTTB MEDICAL JOORNA).
Disappearance ol a Tumor (Sarcoma?) sparingly. Alcohol, strong- tea and coffee
Following Injections ol Coley's Fluid.— must be avoided. Rest in bed is essential.
Ashdowne, according to The London Medi- From the first attack of angina the patient
cal Lancet, reports such a case in a woman, should be sent to bed as if he had an aneur^
forty-five years of age. She had a fusiform ism, so as to reduce the work of the heart
swelling of regular outline and well defined as much as possible. The pressure should
limits in connection with the lower part of be reduced as low as consistent with health
the right humerus with no suspicion of by vaso-dilators, in cooperation with the
fluctuation or egg shell crackling about it, measures just described. The value of the
the skill and muscles were not implicated, nitrites in reducing aortic pressure is well
but the superficial veins were a little promi- known, and although their action in this
nent and there was an enlarged gland in the resjiect is transient, it seems beneficient to
right axilla. The arm was wasted and the reduce tension even for short periods, and
muscles were weaker than those of the op- so give the heart a chance to recover. Osier
posite side; the movements of the elbow urges the use of large doses of nitrites, and
joint were unimpaired. Pain was only com- has given as much as 3U minim doses of
plained of when using the arm or on apply- liquor trinitrini three times daily. Sir W.
ing firm pressure. No other bone abnorm- Gowers thinks that the prolonged use of the
ality could be made out. There was no nitrites has a "steadying effect on the vasohistory
of injury or of fracture, and the motor centre. " The value of the iodides
question of syphilis was carefully gone into, in arterial diseases, arterio-sclerosis, aneurbut
no evidence of it could be obtained, ism, and angina pectoris is well recognised.
Treatment with Coley's fluid was given.
The author began with half minim doeses
andiiicreasedthemby quarter, half, and one
minim until a maximum of nine minims
They should be given in doses of 3 to 5
grains thrice daily, unless there be a defi-
nite syphilitic history, when larger dose is
required, 15 to 20 grains. This should be
was reached; the first injections were given continued for six months, with such tempointo
the arm outside the limits of the growth,
but the later ones were injected into it, and
rary suspension as any intolerance of the
patient may indicate. In the paliation of
twenty-three injections in all were given,
They were followed by pain and swelling
the attacks the nitrates are the chief remedy.
To block the reflex by which the heart
at seat of injection, with general malaise, is inhibited he uses atropin continuously
headache, nausea, vomiting, and pains in until the liability to an attack seems to
the limbs and joints followed by the appear- have vanished. As tolerance is established
ance of subcutaneous haemorrhages resem- the dose must be increased accordingly,
bling bruises, but with only slight rise of Morphia also probably blocks the dangertemperature
and increase of pulse
These after effects were unpleasant.
rate,
The
ous reflex path, and should be used in doses
of not less than one quarter of a grain hyswelling
disappeared and the structure and podermically, or if there be any hesitation
outline of the bone resumed its normal ap- about giving this dose, one-sixth ef a grain
•
pearance.
can be given, and this repeated in about ten
minutes.
Treatment of Angina Pectoris.— Allbutt
(Folia Therapeutica) believes that of all Male Characteristics Developing in a i
the dangerous maladies this is the most Girl.— In The Med. Press, London, Thumamenable
to treatment. There are three ^ni reported the case of a girl, aged 17
objects to be attained in treatment : First, years, who first menstruated at the age of
if possible to mitigate the lesion of the at- fifteen, but not again. At that period
tack; second, to reduce the stresses; and luxuriant beard began to develop; hair als
thirdly, to block the inhibitory influence on grew on the breast and on the linea alba,
ihe heart. To combat the local condition and the voice became deeper, but the figure
directly we may use antidotes, such as sali- remained feminine. The external genitals
cylates if there be rheumatic condition; were those of a female, the uterus was nor-s;
iodides and mercury if syphilitic; also spe- nially developed, and the ovaries could bej
cific treatment for gout, if that be present, plainly felt under an anaesthetic as smallj
The toxins of other diseases, such as influ- liard substances. The girl died from sepsis
enza, cannot be directly neutralized. To commencing in a panaritium. The autopsy
reduce the tension, gentle and frequent mer- showed well-developed maminse, female
curials, such as calomel, with laxative min- genitals and a feminine pelvis. The ovaeral
waters, calomel, salicylates, iodides, ries were small and hard without any trace
and strict diet may be employed. Flatu- of ovulation. The right supra-renal body
lence and catarrhal states of the stomach contained two brown nodules, and the left
must be relieved. Meals must be restricted was converted into into a tumor as a large
in quantity, carbohydrates must be used as a man's fist, which proved to be a struma