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NITRO-GLYCERINE — A SUBSTITUTE FORALCOHOL IN CASES OF EMERGENCY.

BY JOSEPH B. BURROUGHS, M.D.,PRESIDENT OF ONTARIO COUNTY MEDICAL SOCIETY, NEW YORK STATE.

(Concluded from p. 1239.)

I WILL now proceed to report a few cases in which I haveused nitro-glycerine with benefit.CASE 1. Neuralgia of the Heart (Angina Pectoris).-

M. B-, aged thirty-five ; occupation, painter. The firstattack was slight : but pain returned very severely the fol-lowing night, and every night for a week. The usualremedies were given, also remedies for lead poisoning, butthe pain usually lasted until the night was spent. On thesixth night I gave one drop of a 1 per cent. solution of

nitro-glycerine, with the result of stopping all pain anddifficult breathing in ten or fifteen minutes. One drop wasgiven three times daily for a week, when, as no pain hadbeen felt after the first dose, the remedy was discontinuedDuring the following two years he had several attacks, buteach time was relieved at once by the same treatment.CASE 2. Nausea and Faintness (ltirinq a Minor b’tcrgz:ead

Operation.-A young business man, while lowering a barrelof kerosene into the cellar, had two fingers of one hand tornnearly from his hand by being jammed between the edge ofthe barrel and the stone wall. While dressing the wounds,although he was reclining upon a couch with an abundanceof fresh air in the room, he suddenly became deathly pale,dizzy, and sick at his stomach. Brandy or ammonia mighthave been given, but in less time than it would havetaken to mix them with water I had dropped upon histongue one drop of nitro-glycerine, which sent the bloodrushing back to his brain and permitted me to finish thedressing.CASE 3. Spasmodic Asthma.-This was quickly relieved

with one drop of nitro glycerine, to the great surprise of thepatient, a labourer, who was able at once to resume hiswork. Asthma, accompanied with a bronchial catarrh froma cold is not so readily relieved as the simple spasmodicasthma. This will be apparent to all who have studied thepathology of the disease.CASE 4. Headachc in the anæpmia has been quickly

relieved by the remedy.CASE 5. Rapid Prostration in Typhoid lever (Erzterze

Fever).-Mr. R-, aged forty years, a carpenter, keptabout his work until the severe headache and fever(102° F. when he ceased working) compelled him to goto bed. The fever ran a severe course until the twenty-third day. Convalescence was slow for a week, when severehiccough began, lasting several hours. The next daymalarial fever manifested itself by the temperature runningup to 104.5°, accompanied by severe vomiting and purgingof bilious matter. Wild delirium in a few hours wasfollowed by low mutterings and extreme prostration. Thetemperature and pulse fell rapidly, the pulse becomingremittent. Unless brandy were speedily given, it seemed tome he would die. The first spoonful given him he spat outwith a cry that he was on fire, and refused to take more.I then gave him one-fourth of a drop of nitro-glycerine inwater every fifteen minutes for two hours, causing thepulse to become full and regular. The delirium graduallysubsided, and in twenty-four hours the mind was clear.Ultimately he recovered.CASES 6, 7. Hysterical Aphonia. - These two cases of

hysteria-one a man of forty, and the other a woman oftwenty-six-are so nearly alike that the description of onewill answer for both. They were suddenly attacked withrigidity of every muscle ; were unable to speak or to move;respiration 60 per minute, short, superficial ; pulse 40,and almost imperceptible; a terrible feeling of pain and ]pressure over the heart. They usually remained in this con- 1

dition several hours, as the woman did the first time I was ^called to her bedside. A week later, being again called to 1attend the woman, I administered one drop of nitro- .

glycerine at once. In a few minutes the heart beat was 76, 1and full; the muscles began to relax; the respirations came 1in long deep sighs; and in fifteen minutes she was as well as Iusual, except a little weak. I i

CASE 8. Acute Alcoholism.-The patient, who was overforty years of age, had been drinking heavily for somemonths, although at the time he applied for treatment ;hcassured me that he had not drank one drop for some months.His feeble pulse and shaking body seemed to indicate that heneeded, with the tonics and food, something to take theplace of his accustomed alcoholic drinks. I’ gave him onedrop of nitro-glycerine. In a few minutes the blood wascoursing more freely; but the weakened cerebral vesselswere unable to keep their ordinary calibre under this drug.As a result of the expansion of the cerebral vessels therefollowed one continual piercing pain in the head. Nothinggave him relief until I directed him to clasp his handstightly around the back of his neck, with his thumbs placedfirmly over the throbbing arteries of .the neck (carotid). ).Entire absence from all pain was instantly had, and lasted,as long as the pressure was maintained. In an ho’m’ hebegan to feel relief without the pressure of the thumbs. Inow avoid the use of nitro-glycerine where I suspect theperson has recently been drinking. In all such cases 1 havehad success in removing desire for alcohol by giving on"-thirtieth of a grain of strychina, combined with iron andchlor. ammonium (the iron is better borne when combinedwith the ammonium), given every three to six hours asrequired.CASE 9. Opittium-poisoning. -One of the most interesting

cases I have treated with nitro-glycerine was in the earlysummer of 1884. An elderly lady swallowed by mista-ke alarge quantity of laudanum. In less than thirty minutesshe was unconscious. Arriving shortly after sleep had setin, I found the jaws set firmly, while the rest of the bodywas limp. Pulse feeble and rapid. Respiration alreadydown to 8 per minute. Hypodermic injections of atropiabrought the respirations after an hour up to 9, and inanother hour up to 10. The pulse, on the other hand,gradually grew more feeble. I discovered the cause of thisto be that there existed a pronounced case of mitral il1sutl"-ciency (I learned later that the heart disease was of twelveyears’ progress). Three hours later the respirations were14 per minute. In all other respects the patient wasrapidly nearing the close of life. The sleep was as deei: ;all parts of the body were relaxed; the limbs were cold npto the body; the pulse could hardly be felt at the wrist.The limbs were rubbed with hot applications, while I iE-jected several syringefuls of pure alcohol (90 per cent.) intoher arm, in the hope that the alcohol might keep the heartbeating. Another hour and we had to go to the neck tofeel any pulsation. I now dropped between her parted lipsthree drops of nitro-glycerine, 1 per cent. solution. Withina few minutes her pulse was bounding full at the wrist.Ten minutes more, and she stirred for the first time sinceswallowing the laudanum. In half an hour she was talkingto us, asking to be let alone, as she desired to sleep:while the friends were insisting on her drinking strongcoffee. The next day the only evil effect felt was a severeheadache. This is, I think, the first case of opium;-poisoning treated with nitro-glycerine.CASE 10. Urceinic Coma.-Mr. S-, aged forty-five, by

occupation a tin pedlar, had been afflicted with Bright"disease during the last six years, and catarrh of the bladderfor a longer time. The present aggravation of his kidneydisease was ushered in by a severe chill at night. He awokewith a pain in his back so severe that I was sent for, butwas unable to reach his bedside until 2 o’clock the next daB.By this time he was in so deep a stnpor as to be arousedwith difficulty even for a inoment, His body was cold andclammy; pulse 100, very feeble, thin like a silk threat..From his bladder was obtained one ounce of heavy urine.Having been placed in bed, he was then surrounded withglass fruit jars filled with hot water, these being renewedevery half-hour. One drop of nitro-glycerine was given 1m"every fifteen minutes for one hour, and then ordered t" !!-

given every hour until I returned four hours later. _Myobject in giving the nitro-glycerine in this case, where we hadthe pulse 30 beats above normal without the remedy) wasnot to strengthen the heart (much as that was desired), butthat we might relieve the congested kidneys by openingwider the arterioles throughout the body, and thus enlarge the blood reservoir outside the kidneys. The engûlg1lvessels of the kidneys were already extended to ther-itmost, and hence would not come under the influen, of:,he nitro-glycerine. Four hours later I found him with1-iis mind clear, he greeting me cheerfully as I entered it-:,;

’oom; pulse 100, but full ; body dripping with perspir.,

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tion ; kidneys had excreted a pint of urine ; very little painin his back, but "a sore feeling on his sides and arm." Anexamination of the place indicated revealed that the coma(stupor) had been so deep as to deaden all sense of feeling,and while in this state one of the bottles of hot waterrolled against his side and arm, burning them nearly to ablister.CASE 11. Nephritis.-In several cases of chronic inflam-

mation of the kidneys I have seen benefit result from theuse of nitro-glycerine. In one case of a year’s standing,the urine in two years became free from casts and even thefaintest trace of albumen, and has remained free. Thepatient has been apparently a healthy man during the lastfive years.CASE 12. Death-beds.- When we are called to rescue

persons suddenly stricken with death, there is frequentlythe question in our mind : Is this death or only theapproach of death ? If the case before us is not death, butis the last faint throbbing of the heart, too feeble to benoticed by even trained ears, then nitro-glycerine, in the

rapidity of its action, might cause an over-burdened heart tosuddenly leap into new life. In one case, where the heart

was growing rapidly feeble, the pulse ceasing, nitro-glycerine caused the heart to be relieved, the pulse to

return, the patient to revive and live until the next day,when, while speaking to some friends, the heart suddenlyceased beating.Drowning.-Cases are frequently reported where persons

apparently dead from drowning are brought to consciousnessagain, after hours spent over them in applying heat to thebody and forced respirations. In all such cases nitro-

glycerine would be of great benefit, the heat to the bodyand the expansion of the chest not being neglected.Manchester, New York.

THE RESULTS OF TEN YEARS OF COMPUL-SORY NOTIFICATION OF INFECTIOUS

DISEASES IN JARROW.

BY A. CAMPBELL MUNRO, M.B., D.Sc.,MEDICAL OFFICER OF HEALTH FOR SOUTH SHIELDS AND JARROW.

THE question of the compulsory notification of infectiousdiseases must now be regarded as within the domain ofpractical politics. And yet, if one may judge by indications Ifurnished by the medical press, the average opinion of theprofession on the subject is still in a state of flux. This is

not, perhaps, to be wondered at, considering the veryconflicting statements as to the utility of the system whichhave appeared from time to time. On the one hand, we areassured by experienced hygienists that the general intro-

It appears to me that two large fallacies, in the main,underlie these specious figures. Firstly, comparisons areusually instituted in cases in which the duration of the ex-periment (of notification) has been much too short to permitof any reliable conclusions, dealing, as they do, with aquantity so fluctuating in its incidence, over short periodsof years, as infectious disease. And, secondly, comparisonsare made between towns which, apart from notification, areunder the most dissimilar sanitary conditions, and withoutmaking allowance for the altered circumstances in differentcases. In my opinion, the only reliable method of procedureis to take individual towns which have had the system inoperation over a period of time sufficiently long to furnish asafe basis of comparison, and to compare their mortalitystatistics for this period with those of a sufficiently longperiod prior to the introduction of the system. By such amethod alone, I submit, conducted with due regard to therecord of associated conditions external to the experiment,can we arrive at any unimpugnable conclusions. It happensthat the borough of Jarrow, having been one of the firsttowns in the kingdom to adopt the system, has now had tenyears’ experience of its operation--the necessary powerswere obtained in the Jarrow Improvement Act, 1878, andthe system came into operation in the end of the same year.There are now, therefore, on record, and available for pur-poses of comparison, the figures for these ten years, and forthe eight years immediately preceding the introduction ofthe system. What, then, do these figures tell us ? Thesubjoined table furnishes the reply; the actual figures for allthe years are given in my annual report for 1888.Thus the mean death-rate of the borough has fallen from

25’193 per 1000 of the population in the first period to20’810 in the second-a decline of 4’383, or equal to 17 percent. The death-rate from the seven principal zymoticdiseases, however, has fallen from 6’904 in the first periodto 3’749 in the second-being equivalent to a decrease of noless than 45 per cent. Otherwise put, the decrease in thezymotic mortality constituted 71 per cent. of the decreasein the death-rate from all causes. But the analysis maywith advantage proceed further. It may be asked, Whatdo the figures tell of those zymotic diseases to which alonethe system of compulsory notification applies ? The zymoticdiseases notifiable over the whole period of ten years, as setforth in the Jarrow Improvement Act of 1878, were " small-pox, cholera, and fever "--the latter designation, of course,including scarlet fever, typhus fever, and enteric fever.The mean death-rate from small-pox in the first period was,to put it less fractionally than in rates per 1000, 15’31 per10,000 of the population ; in the second period it was ’36-a decrease of 14’95, or no less than 97 per cent. If it beobjected that the first period included the epidemic year1871, I reply that to the system of notification it is verylargely due that we have not had an epidemic year in thepresent decade ; we have had a sufficient number of intro-

Borough of Jarrozv mean Death-rates for the years 1871-78 and 1879-88.

These rates are stated, for greater clearness, per 10,000 of the population.

duction of such a system is necessary in order to dealeffectively with the important class of diseases which are ispecifically designated "preventable"; that its generalintroduction is bound to lead to a steady and progressive !diminution in the prevalence of, and fatality from, these diseases. On. the other hand-not to speak of attemptswhich are made to arouse what I regard as a morbid andperverted feeling of esprit dc corps over the matter,--we aretold that compulsory notification inevitably leads, not to adiminution, but to an actual increase in the prevalence ofinfectious diseases. And figures are quoted in support ofthis almost unreceivable proposition, until, indeed, one isinclined to accept the popular saying that " figures will proveanything," even, as has been suggested, to the existence ofan etiological relation between poultices and whitlows!

ductions of the disease to have furnished forth several"epidemic years." There have been no deaths fromcholera, other than "English cholera," during either period.The mean death-rate from scarlet fever in the first period was17’87; in the second period 6 ’72--a decrease of 11-15, or 62per cent. The mean death-rate under the heading " fever"(including typhus and enteric fever) was 7 ’81 in the firstperiod, as compared with 2-65 in the second-a decreaseof 5-16, or 66 per cent. In brief, the decrease in themortality from the notifiable diseases-31’26 per 10,000 ofthe population-was equal to 99 per cent. of the totaldecrease (31’35) in the zymotic mortality. I do not think itis possible materially to weaken the effect of these figuresby any reasonable method of criticism or analysis. It may,indeed, be remarked that the death-rate from diarrhoea as