Scientific American Supplement, No. 415, December 15, 1883 by Various

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We may conclude from this reference to what has been done in the last
few years, that the reproach mentioned in first speaking of the
alkaloids as a class, that almost nothing was known of their
constitution, will not long remain, and that as their molecular
structure is laid bare in these studies now being made, keen-sighted
chemists will effect their artificial formation. When these most
valuable compounds can be made by exact methods, in a state of entire
purity, and at a cost much below that paid for the present extraction of
them from relatively rare plants, organic chemistry will have placed all
of us under obligations as great as those owing any branch of science,
no matter how practical we call it.--_Amer. Jour. of Pharmacy_.

* * * * *

ON THE TREATMENT OF CONGESTIVE HEADACHE.

By J. LEONARD CORNING, M.D., New York.

If we examine the literature of our theme, we are astounded by the
apparently hopeless confusion in which the whole is involved. Everywhere
attempts at ill-founded generalization are encountered. We are compelled
to admit, after perusing long debates in regard to the relative merits
of various therapeutic measures, that those who were foremost to
disparage the treatment pursued by others were totally ignorant of the
fact that those same symptomatic manifestations which they were
considering might be owing to entirely different causes from similar
conditions described by others. Hence a commensurate modification in
therapy might not only be admissible, but eminently desirable. It is
more especially of recent years that a laudable attempt to differentiate
the various etiological factors involved in different forms of headache
has been made. In 1832 Dr. James Mease, of Philadelphia published a
monograph on "The Cause, Cure, and Prevention of the Sick Headache,"
which is substantially a treatise on the dietetics of this particular
form of headache. The work, however, is conspicuously lacking in those
philosophical qualities which are so necessary to a true understanding
of the questions involved. Dr. E.H. Sieveking published in 1854[1] a
most interesting paper on "Chronic and Periodical Headache." The views
therein expressed are remarkable for their succinct and thoroughly
scientific elucidation of the two great physiological principles
involved in the consideration of by far the greater majority of
instances of cephalalgia. I refer namely to the importance ascribed by
this eminent physician to the fluctuations of the blood-stream within
the cranial vault. In speaking of this subject Dr. Sieveking says:
"Nothing is of more importance in reference to the pathology and
therapeutics of the head than clear and well-defined notions on the
physiological subject of the circulation within the cranium; for, among
the various sources of medical skepticism, no one is more puzzling or
more destructive of logical practice than a contradiction between the
doctrine of physiology and the daily practice of medicine."

[Footnote 1: On Chronic and Periodical Headache, by E.H. Sieveking,
M.D., _Medical Times and Gazette_ London, August 12, 1854.]

What Dr. Sieveking said in 1854 holds equally good to-day; and, indeed,
the position then taken has received substantial indorsement through the
positive results of more recent experimental physiology. Conspicuous in
this connection are the inductive researches of Durham, Fleming, and
Hammond, touching the modifications in the cerebral circulation during
sleep and wakefulness. By these experiments it has been conclusively
proved that the amount of blood in the brain is decreased during sleep
and increased during wakefulness. More, recently I have had occasion to
confirm the experiments of Fleming in this direction, and have published
the results of those researches in various papers and articles.[1] "What
Hippocrates said of spasm," says Dr. Sieveking, "that it results either
from fullness or emptiness, or, to use more modern terms, from hyperaemia
or anaemia, applies equally to headache; but, to embrace all the causes
of this affection we must add a third element, which, though most
commonly complicating one of the above circumstances, is not necessarily
included in them, namely a change in the constitution of the blood."
While I agree with Dr. Sieveking as regards the importance to be
ascribed to the first two factors--cerebral hyperaemia and anaemia, in the
production of the group of symptoms known as "headache,"--I fail to
perceive why especial prominence should be given to the third condition
mentioned by Dr. Sieveking. Indeed, I am quite unable to imagine how the
periodical, and more especially the intermittent form, of headache is to
be explained by what Dr. Sieveking describes rather ambiguously as a
"change in the constitution of the blood." It is quite evident,
admitting that such a change is capable of producing an amount of
cerebral irritation sufficient to develop well-marked cephalalgia, that
the latter must of necessity be within certain limits continuous. This
is not the case, as the causative factor is constant and not
fluctuating. I am, therefore, not prepared to accept this third
causative factor without question. Nevertheless I am perfectly willing
to admit that other factors besides cerebral hyperaemia and anaemia may
produce the functional variety of headache. There would seem to be ample
ground for ascribing great causative importance to excessive irritation
of the brain plasma itself. Hence those forms of headache which while,
being unaccompanied by any especial circulatory derangements, succeed,
oftentimes, with relentless regularity upon any considerable degree of
mental work. It is not my purpose to discuss the treatment of the
multifarious forms of cephalalgia on this occasion, did time permit. As
regards the so-called "neuralgic" variety I content myself by referring
to the admirable work on "Neuralgia and Kindred Diseases of the Nervous
System," by Dr. John Chapman of London, in which will be found many
interesting facts bearing on the question. Accepting the propositions,
then, that the more adjacent causes of headache are (1) cerebral
hyperaemia, (2) cerebral anaemia, and (3) irritation of the cerebral
plasma itself, let us now consider how these morbid factors are most
scientifically and speedily met at the bedside; and how, more
particularly, those distressing conditions of engorgement, which are so
baneful an item in the causation of a certain form of cephalalgia, are
best overcome.

[Footnote 1: _Vide_ Carotid Compression and Brain Rest, by J.L. Corning,
M.D. New York: Anson D.F. Randolph & Co.]

Two years ago I began a series of experiments on epileptics and maniacs,
which involved the application of protracted pressure to the common
carotid artery on both sides. In the course of these experiments the
thought suggested itself that suppression of the carotids might prove a
salutary means of reducing that form of cerebral congestion which is so
prolific a source of headache and vertigo. Accordingly I made a
protracted series of experiments with carotid compression upon those
suffering from congestive headache, and I can only say that I have been
so far pleased with the uniformly good results obtained, that I have
felt it a duty to call the attention of the profession to a procedure
which, for obvious reasons, possesses all the advantages of local
depletion by leeching or cupping, without the manifest disadvantages of
either of these methods. The instruments which I have devised as
substitutes for the primitive procedure of digital compression of the
carotids have already been described in former communications. It is
only necessary to say that the implements in question are of two kinds;
one, the "carotid fork," is an adjustable instrument, which being held
in the hand of the operator permits him to exert any degree of pressure
upon both carotids for any desired length of time. The other instrument,
which I have designated as the "carotid truss," for lack of a better
name, is a circular spring provided with adjustable pads at each
extremity. The spring is placed about the neck of the patient, and by
suitable appliances the pads at the extremities can be placed directly
above the trunks of the two common carotid arteries. By turning the
screws to which the pads are attached the desired amount of pressure can
be applied to the arteries, and the apparatus can be worn for any length
of time by the patient.

With these instruments I have frequently succeeded in arresting the most
obstinate form of congestive headache in an incredibly short time (on
one occasion in about five minutes). Where, however, the headache is of
manifestly nervous origin and uncomplicated by any especial circulatory
derangements, I have never been able to achieve notable results with
this method. Indeed, pressure upon the carotids is an excellent method
of differentiating the congestive form of headache from the nervous
varieties of head pains.

Of galvanism this much may be said, that it is one of the most valuable
methods which we possess for treating the form of headache under
consideration, for not only does it cause contraction of the smaller
arteries, but it also exerts a soothing influence upon the plasma of the
brain itself.

A powerful therapeutic agent, and one which has been more or less
extensively employed in the treatment of various forms of head and
spinal symptoms, is cold.

A very excellent method of applying both cold and galvanism to the head,
at the same time, is afforded by a species of refrigerating electrode,
designed by myself for this purpose. The apparatus in question consists
of a concave sponge electrode, the concavity of which corresponds to the
convexity of the external aspect of the cranium. Above the electrode is
a chamber of metal or India-rubber, designed to contain ice. The whole
is secured to the head of the patient by a single chin-strap, and
connection established with an ordinary galvanic battery by means of an
appropriate clamp and insulated cord. The indifferent pole is applied
over the sternum or other convenient point. Care should be taken not to
employ too strong currents, as otherwise vertigo and other unpleasant
symptoms may be produced. An application of from five to ten minutes is
usually sufficient to arrest the head-pain. As an additional security it
is well to recommend the patient to take a hot foot-bath, and to remain
as quiet as possible for twelve hours succeeding the treatment. In
hyperaemic headache cupping and blood-letting have been recommended; but
as a rule both procedures are not only unnecessary but positively
inadmissible, as exclusion of the superfluous amount of blood by
compression upon the carotids, followed by a corresponding dilatation of
the peripheral circulation by means of the foot-bath, will almost always
be sufficient to cause a permanent cessation of the symptoms. Among the
internal remedies which may be employed with good effect in certain
cases are aconite, bromide of potassium, and Indian hemp. The inhalation
of from five to ten drops of chloroform is an excellent expedient in
some instances. Chlorodyne, which is nothing more than a mixture of
sedatives, often works well, and indeed frequently excels other
remedies. The regulation of the heart's action is also of very great
importance in these cases, and the physician should have no hesitancy in
resorting to such remedies as digitalis and belladonna for the purpose
of reducing the tension in the domain of the cerebral circulation. As a
matter of course the digestive functions should be carefully looked to;
the bowels should be kept open; and in all cases where there are
indications of a congestive origin, alcohol in all forms should be
absolutely forbidden.--_Med. Record_.

* * * * *

THE USE OF THE MULLEIN PLANT IN THE TREATMENT OF PULMONARY CONSUMPTION.

[Footnote: From a paper published in the _British Medical Journal_.]

By F.J.B. QUINLAN, M.D., M.R.I.A., F.K.Q.C P., Physician to St.
Vincent's Hospital, Dublin.

From time immemorial, the _Verbascum thapsus_, or great mullein, has
been a trusted popular remedy, in Ireland, for the treatment of the
above formidable malady. It is a wild plant--most persons would call it
a weed--found in many parts of the United Kingdom; and, according to
Sowerby's _British Botany_, vol. vi., page 110, is "rather sparingly
distributed over England and the south of Scotland." In most parts of
Ireland, however, in addition to growing wild it is carefully cultivated
in gardens, and occasionally on a rather extensive scale; and this is
done wholly and solely in obedience to a steady popular call for the
herb by phthisical sufferers. Constantly, in Irish newspapers, there are
advertisements offering it for sale; and there are, in this city,
pharmaceutical establishments of the first rank in which it can be
bought. Still it does not appear in the Pharmacopoeia; nor, as far as I
know, has its use received the official sanction of the medical
profession. Some friends with whom I talked over the matter at the
Pharmaceutical Conference at Southampton last August, suggested that it
would be desirable to make a therapeutical research into the powers of
this drug, and ascertain by actual experiment its efficacy or otherwise.
Having partially accomplished this, I am anxious to very briefly set
forth what has been done, in order that others may be induced to
co-operate in the work.

"There are five mulleins, all belonging to the parent order of the
Scrophulariaceae; but the old Irish remedy is the great mullein, or
_Verbascum thapsus_, a faithful delineation of which will be found in
Plate 1, 437, vol. vi., of Sowerby. It is a hardy biennial, with a thick
stalk, from eighteen inches to four feet high, and with very peculiar
large woolly and mucilaginous leaves, and a long flower spike with ugly
yellow and nearly sessile flowers. The leaves are best gathered in late
summer or autumn, shortly before the plant flowers. In former times it
appears to have been rather highly thought of, particularly as a remedy
for diarrhoea; and Dioscorides, Culpepper, and Gerarde favorably allude
to it.

"Having been furnished with a good supply of fresh mullein from a garden
near this city, where it is extensively grown, I commenced operations.
As it proved useful, subsequent supplies were procured from our
drug-contractor.

"The old Irish method of administering the mullein is to place an ounce
of dried leaves, or a corresponding quantity of the fresh ones, in a
pint of milk; to boil for ten minutes, and then to strain. This strained
fluid is given warm to the patient, with or without a little sugar. It
is administered twice a day; and the taste of the mixture is bland,
mucilaginous, comforting to the praecordia, and not disagreeable. I
resolved to try this method, and also the watery infusion; and,
moreover, the natural expressed juice fortified with glycerin. This
latter preparation was carefully made for me, from fresh mullein leaves,
by Dr. John Evans, chemist to the Queen and the Prince of Wales.

"Some phthisical sufferers, of whom there are here, alas! too many, were
now admitted from time to time into St. Vincent's Hospital. They were
admitted in all stages, from an early one to the most advanced. On each
admission the case was carefully examined; the history, symptoms, and
physical signs were exactly noted; and the patient was weighed on a
stage balance with great accuracy. The patient was put as much as
possible on the mullein treatment only. For obvious reasons, no
cod-liver oil, koumiss, or other weight producer was given; the patients
got the diet suitable to such sufferers; and, if the special symptoms
became troublesome, received appropriate treatment. As much as possible,
however, they were left to the mullein--a proceeding which was entirely
satisfactory to themselves. In addition to the admission weighing, they
were carefully weighed every week, and care was taken that this should
be done as nearly as possible on the same day and hour, with the same
clothes, and, in fact, as much as could be under the same conditions. In
securing this the patients anxiously co-operated; and it was frequently
amusing, but sometimes painful, to watch the satisfaction or chagrin
with which the weekly result was received. I must here tender my
acknowledgments to our zealous, attentive, and accurate house surgeon,
Mr. Denis P. Kenna, by whom this important, but tedious, duty was
discharged."

Dr. Quinlan then refers to several cases, in which the mullein plant has
been tried as a remedy for consumption, and remarks that these cases,
although too few to justify any general conclusion, appear to establish
some useful facts. The mullein plant boiled in milk is liked by the
patients; in watery infusion it is disagreeable, and the succus is still
more so. The hot milk decoction causes a comfortable (what our Gallic
neighbors call _pectorale_) sensation, and when once patients take it
they experience a physiological want, and when the supply was once or
twice interrupted, complained much in consequence. That it eases
phthisical cough there can be no doubt; in fact, some of the patients
scarcely took their cough mixtures at all--an unmixed boon to phthisical
sufferers with delicate stomachs. Its power of checking phthisical
looseness of the bowels was very marked, and experiment proved that this
was not merely due to the well known astringent properties of boiled
milk. It also gave great relief to the dyspnoea. For phthisical night
sweats it is utterly useless; but these can be completely checked by the
hypodermic use of from one-eighteenth to one-fiftieth of a grain of the
atropia sulphate; the smaller dose, if it will answer, being preferable,
as the larger causes dryness of the pharynx, and interferes with ocular
accommodation. In advanced cases, it does not prevent loss of weight,
nor am I aware of anything that will, except koumiss. Dr. Carrick, in
his interesting work on the koumiss treatment of Southern Russia (page
213), says: "I have seen a consumption invalid gain largely in weight,
while the disease was making rapid progress in her lungs, and the
evening temperature rarely fell below 101 deg. Fahr. Until then I considered
that an increase of weight in phthisis pulmonalis was a proof of the
arrest of the malady." If koumiss possesses this power, mullein does
not; but unfortunately, as real koumiss can be made from the milk of the
mare only, and as it does not bear traveling, the consumptive invalid
must go at least to Samara or Southern Russia. In pretubercular and
early cases of pulmonary consumption, mullein appears to have a distinct
weight-increasing power; and I have observed this in several private
cases also. Having no weighings of these latter, however, makes this
statement merely an expression of opinion. In early cases, mullein milk
appears to act very much in the same manner as cod-liver oil; and when
we consider that it is at once cheap and palatable it is certainly worth
a trial. I will continue the research by careful weighings of early
cases; and will further endeavor to ascertain whether the addition of
mullein to the cultivating solution prevents the propagation of the
phthisical bacillus.

* * * * *

ACTION OF MINERAL WATERS AND OF HOT WATER UPON THE BILE.

Lewaschew and Klikowitch, from experiments upon dogs, conclude that the
use of ordinary alkaline mineral waters was to increase the quantity of
bile and to make it more fluid and watery. This increased flow is
beneficial in clearing out any bile stagnating in the gall-bladder. A
subsequent increase in the quantity of bile indicates a greater flow of
bile into the gall-bladder, and this also is of service in emptying out
any stagnant bile, and restoring the normal condition when this is
disturbed. Artificial solutions of alkaline salts were found to have a
similar action to the natural mineral waters, and, as with them, the
action varies according to the concentration of the solution.
Bicarbonate of sodium has a quicker, more powerful, and more lasting
effect on the composition of the bile than the sulphate of sodium, and
weak solutions than strong ones. Vichy was more efficacious than
Carlsbad water. Hot water was found to have an effect on the bile much
like that of the mineral waters.

* * * * *

VIVISECTION.

Although Magendie is rightly considered the true initiator of
experimentation upon living beings, the practice of vivisection is as
old as science itself.

Galien, the physician of Marcus Aurelius (in the second century of the
Christian era), dissected living animals, and yet he is regarded as
having merited his name (_Galenus_, "gentle") from the mildness of his
character. Five centuries before him, under the Ptolemies, Egyptian
experimenters had operated upon condemned persons. So, then, vivisection
is not, as usually thought, a diabolical invention of modern science.

[Illustration: Fig. 1-5 APPARATUS USED IN VIVISECTION.]

In all ages the necessity has been recognized of operating upon animals
that are nearest allied to man, such as the monkey, the hog, and the
dog, and who share with the king of creation the privilege of eating a
little of everything. Claude Bernard, however, had another way of
looking at things. It is true that he especially made researches into
the general laws of physiology, the secret of the vital functions, and
the operation of the various organic systems that constitute living
matter, but his immediate object was not to furnish weapons for the art
of curing. He left to physicians and surgeons the care of drawing
conclusions from his great work in biology, and of acting experimentally
upon animals allied to man in order to found a rational system of
therapeutics. So he preferred to operate upon beings placed low in the
animal scale--the frog especially, an animal that has rendered him
greater service than even man himself could have done. Cold-blooded
animals offer, moreover, the advantage of being less impressionable than
others, and the experiments to which they are submitted present more
accurate conclusions, since it is not necessary to take so much account
of the victim's restlessness. And then it is necessary in many cases to
choose subjects that possess endurance. The unfortunate frog, so aptly
named "the Job of physiology," becomes resigned to living under most
dreadful conditions, and when, through sheer exhaustion, he has
succumbed, his twitching limbs may still he used as an object of
experimentation for twenty-four hours. Thanks are due to nature for
giving so extraordinary a vitality to the tissues of a modest
batrachian! We owe to it the famous experiment of Galvani that led Volta
to the discovery of the pile and what followed it, the astonishing
conquests of electricity and those more marvelous ones still that are
now in their dawn. Science is much indebted to the frog, and may the
homage that we pay him help to alleviate the sufferings that have been
imposed upon this brave animal!

[Illustration: Fig. 6-8 APPARATUS USED IN VIVISECTION.]

The simple fact that we have just enunciated pleads loudly enough for
the cause of vivisection to make it useless to defend it. No one,
however, has risen to ask for an absolute proscription of it, but it is
only desired that the abuse of an abominable practice shall be curbed.
Does the abuse exist? That is the question, and it may be answered in
the affirmative. Yes, we do sometimes impose useless sufferings upon
animals. It is a culpable folly, a beastly cruelty, to constantly repeat
barbarous experiments with the object of exhibiting a well known
physical fact, a hundred times verified and always the same, when it
would only be necessary to enunciate it. But this is not the place to
expatiate upon the subject. After proclaiming the utility of
vivisection, we give it as our opinion that the practice of it should be
confined within narrow limits. It is not too much to ask that it be
confined to the privacy of laboratories, with the exclusion of visitors,
and to require from students a diploma guaranteeing their knowledge and
giving a programme of researches to be made. It is useless to seek in
the living what a study of the corpse reveals in all its details.

[Illustration: Fig. 9-11 APPARATUS USED IN VIVISECTION.]

And now, after these preliminary remarks, we present herewith a series
of cuts representing the various apparatus used in the practice of
vivisection, which are taken from a recent work by Claude Bernard. Fig.
1 shows the mode of muzzling a dog with a strong cord placed behind an
iron bit. Fig. 2 shows a method of tying a dog. Fig. 3 is a vessel in
which hares or cats are placed in order to anaesthetize them. Fig. 4
shows the mode of fixing an animal on its side, and Fig. 5 the mode of
fixing him on his back. Fig. 6 shows a dog fixed upon the vivisecting
table, and Fig. 7 a hare secured to the same. Fig. 8 exhibits the
general arrangement of a vivisecting table, properly so called. Fig. 9
shows (1) an anaesthetizing muzzle applied to a dog, and (2) the
extremity of the apparatus in section. Fig. 10 shows how the muzzle is
applied for anaesthetizing, and gives the details of construction of the
chloroform box. Fig. 11 exhibits the arrangement of the apparatus used
for holding the animal's jaws open upon the vivisecting
table.--_L'Illustration_.

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