The Dose of Atropia for Subcutaneous Injection.—I wish to answer the query of Dr. Sisson in the Practitioner of last month with every caution, but I have formed a strong opinion on the subject in question. A “Country Practitioner,” who wrote to this journal in February, states that he used to give hypodermic injections of more than ⅕ grain of atropia daily, to the same patient, for years. Now I stated in my paper in this journal (July 1868), that such doses as these are utterly unsafe, and I retain that opinion. Supposing that the sulphate of atropia was good, which it is very possible it was not in the “Country Practitioner’s” case, I can affirm, from my own knowledge, that there are many patients to whom such a dose would be dangerous and probably fatal, if it were really fairly introduced into the subcutaneous tissue. I have seen uncomfortable atropism from the injection of less than 1
100 grain: a case occurred to me only a week or two since. It is therefore unadvisable to begin, at any rate, with large doses. With a large experience of subcutaneous injection, I am enabled to say with confidence that 1
60 or 1
50 grain doses are what are best borne by the majority of persons; that sometimes, but not often, it is necessary to go as far as 1
30 grain; and that not unfrequently patients will not bear as much as the 1
60 without uncomfortable atropism. Hence my recommendation to practitioners to commence, experimentally, with such a small quantity as the 1
120 grain.—F. E. Anstie.

Strychnia as a Remedy in a Severe Case of Nervous Hyperæsthesia.—Mr. H. A. Allbutt, of Leeds, writes to us:—“The following case may be of some interest to the readers of the Practitioner, as in some of its symptoms it presented some curious phenomena. Mrs. A——, a married lady, about thirty-six years of age, consulted me in last November for lameness, and great pain and difficulty in walking, with obscure pains in her back and sides, severe palpitation, restless nights, loss of appetite, and great nervousness. She often, too, complained of dimness of vision, and the thumb was at times flexed across the palm of the hand in a spasmodic manner. In addition to these symptoms, she suffered from prolapsus uteri and menorrhagia. The difficulty and pain in walking were, however, the most prominent features of the case. She could not raise her feet the height of a step, and her locomotion was most curious, consisting of a sort of corkscrew motion, or twisting of the foot and thigh each step that was taken. This had been going on for three years, sometimes better and sometimes worse, but on the whole she was gradually getting worse. I learned from her that when younger she had been of a strong, healthy nature, and suffered from little illness till her marriage. She seems to have suffered severely during her various confinements from floodings, &c., and from the time of her last confinement she has been affected more or less in the manner described. In regard to the cause of this condition, I am of opinion that her nervous system had been much weakened, and thrown into an excitable condition by the shocks of labour and by the floodings at those times. In this opinion I was borne out by Dr. Allbutt, of Leeds, who saw the case with me. The treatment at first consisted of the various preparations of steel, of which I found the ferri ammon. cit., combined with bromide of potassium, to be the best. Tannic acid pessaries were also ordered to be introduced into the vagina for the relief of the prolapsus uteri, and a hypodermic injection of morphia was given every night for three weeks. Under the influence of these remedies she improved in her general health, and the lameness was improved in a slight degree; in fact, she seemed to arrive at a certain standard of health and to advance no further. I was now induced to try strychnia, in the form of pills, combined with carbonate of iron. The dose was 1
20 gr. twice a day. The effects were marvellous. The lameness is fast disappearing, and she is able to walk out of doors, which she has not done for fifteen months. I firmly believe she will be quite cured if the treatment is persevered in.”

Muriate of Ammonia as a Remedy.—Dr. Cholmeley has kindly sent us a note, the manuscript of which, by an unfortunate accident, has been mislaid. The substance of his remarks is as follows:—He confirms the observations of Dr. Anstie, in a paper in the December number of the Practitioner, as to the great efficacy of the muriate of ammonia as a remedy for neuralgic and myalgic pain. But Dr. Cholmeley goes on to say, that with regard to a matter on which Dr. Anstie spoke more doubtfully,—the efficacy, namely, which certain authors have ascribed to this drug as an emmenagogue,—he has formed from a large experience a decided opinion in favour of the utility of this medicine. He is convinced that in a very large number of cases of absent or suppressed menstruation, muriate of ammonia acts in a very direct and powerful manner in establishing or restoring the flux. Dr. Cholmeley has now experimented with the muriate, in doses of 10 to 20 grains, in so large a number of hospital and dispensary patients, that he cannot suppose there is any room for fallacy in this conclusion.

[Since the date at which the paper referred to by Dr. Cholmeley was written, we have had occasion to employ the muriate of ammonia in two cases of amenorrhœa, with apparently very striking and direct results of a curative kind. As yet, however, we must confess ourselves unable to lay down any definite rule as to the class of cases to which it is applicable with the best chance of success, beyond a general idea that it acts best in persons not anæmic, but possessing a weak and mobile nervous system.—Eds. Pract.]

Ether Spray in Operations about the Anus.—Dr. John Barclay, of Banff, writes to us as follows:—“I write to corroborate what was written by Mr. Alexander Bruce, in the Practitioner for last month, concerning the employment of ether spray in operations about the verge of the anus. I have experience of it in two cases. The first was the slitting up of a hæmorrhoid containing a clot, and when the ether spray was directed on the part the patient screamed in intense agony, comparing it to nothing else than the introduction of a red-hot iron. The pile was opened without it, and the patient said the cutting was as nothing compared with the spray. The second case was very similar to this, and the result here was the same. So that I never dream now of recommending the freezing by ether in operations in that region. I may remark that it is a curious thing ice never seems to give pain when so employed.”

Treatment of Hæmorrhoids.—Mr. J. Christophers, of Wadebridge, Cornwall, sends us the following note:—“The pain and risk attending operations for the removal of hæmorrhoids, whether by knife, ligature, cautery, or caustic, render valuable any less heroic mode of treatment, whereby the necessity for using the means alluded to may be dispensed with, or even rendered less frequent. The term hæmorrhoid or pile being used to signify a tumour caused by enlarged or varicose veins at the lower part of the rectum, the definition of the disease would seem to indicate its treatment—pressure and support. The benefit resulting from pressure on tumours, and from pressure and support applied to varicose veins situated on the surface of the body, is manifold and manifest. The same good results often attended pressure internally applied in cases of hæmorrhoids, and frequently in cases of prolapsus also. Occasionally after having introduced the finger into the rectum, in cases of hæmorrhoids, for the purpose of exploration, I have heard with surprise the patient affirm that the examination had temporarily relieved the severity of his pain. Continuous pressure exercised by means of the rectum plug, of a size, form, and material suited to these cases, in many instances, affords immediate relief, and often effects ultimate cure; the rectum plug being nothing more than a simple cone or peg, terminating in a short stem or disk, having a hole bored through its long diameter formed of metal, ivory, wood, membrane, or of other material capable of inflation. Any of these substances answer the purpose, some being suited to one kind of case, some to another. Those formed of wood have in my hands answered well, and have often achieved a success that has exceeded my expectations. The shape and size best suited to individual cases experience soon teaches. A not unfrequent obstacle in treating cases by the rectum plug will be found to consist in the intolerance by the rectum in some patients at first of its presence; perseverance in its use gradually and surely overcomes this difficulty. After a short probation all discomfort ceases, and the plug can be worn by day and by night, sitting, riding, walking, or standing, with the best results, and that not only in cases of hæmorrhoids, but in bad cases of prolapsus also. So much is this the case that many who have worn a rectum plug, though with difficulty at the beginning, give up its use, even when the malady that demanded its application is cured, with reluctance and regret, saying that they derive comfort and support from its presence. These circumstances induce me to think that this safe and simple means of treating hæmorrhoids has been too much neglected, and for this reason I venture to bring it under the notice of the Practitioner.”