On the Shoulder-Tip Pain, and Other Sympathetic Pains, in Diseases of the Liver*

On the 13th, he was ordered Calabar bean, and powdered rhubarb, of each three grains, every hour. On the 14th, three grains of calomel and ten of rhubarb were added to the powder, the bowels being confined. On -the i5th, he had a violent attack of spasm, the eyes being fixed, the face livid, and respiration almost suspended. He was restored by artificial respiration. On the i6th, a grain of Calabar bean powder was ordered every half hour. He took four doses, and then felt faint. In spite of the faintness, chloroform was given with advantage, and twenty grains of hydrate of chloral were injected into the rectum. On the 20th, another attack, almost fatal, was relieved by artificial respiration with the simultaneous administration of chloroform; hydrate of chloral being at the same time injected into the rectum. On April 2nd, ten minims of tincture of cannabis Indica were ordered to be given every four hours. On the 4th, the Indian hemp was omitted. This quantity of chloral was increased to two scruples. On the Igth, the spasms were still severe. From this time they gradually ceased, and by the 29th were scarcely perceptible. On May 15th, he was allowed to leave his bed, having been nine weeks under treatment. The objects aimed at in the treatment were perfect rest and the avoidance of every source of irritation. The food was given of such a nature as could be easily digested without mastication. The injured fingers were soothed by an anodyne poultice. The Calabar bean and Indian hemp did not appear to do good. The hydrate of chloral given by the mouth and by the rectum, although it did not always prevent spasm, yet caused sleep, and thus powerfully aided in the patient's restoration to health. The relief of the spasms of the muscles of respiration afforded by the chloroform, with artificial respiration, Mr. May says is especially worthy of note; and in that opinion I believe we shall all concur; for, had not such relief been afforded, and the respiration thus enabled to go on, it is quite certain that the patient must have died; as it was, his life was spared to treatment deserving the highest praise, and reflecting the greatest credit upon those who had the care of him. I have thus brought my little work to a conclusioni, and for all its imperfections I must again ask your kind indulgence.