The experience of 42 cases of goitre treated by operation suggests that: medical treatment should not be neg lected in cases of goitre. Cases which tend progressively to increase should al ways be submitted to operation before they grow to a huge size, and before their deep connections become compli cated. The operation of removal of one lobe and the isthmus is practically al ways followed by atrophy of the cor responding lobe. The operation is free from special risk, if done properly, and with the assistance of an experienced anmsthetist. Large old adherent goitres will still remain difficult and dangerous to remove, and it is the duty of every practitioner to urge this upon his pa tients and submit them to operation while removal is yet comparatively safe and easy. A. Marmaduke Shield (Edin burgh Med. Jour., July, 1901).
GOLD.—Metallic gold is not official iu the U. S. P. Only one preparation is recognized: the chloride of gold and sodium (auri et sodii ch]oridi, U. S. P.), grain.
The best vehicle with which to com bine gold and sodium chloride in capsule is tragacanth or guaiae resina; neither of these decomposes it. The time for administration should be one hour after eating, or, better still, one hour before eating. The ideal method for admin istration is by hypodermic injection, the solution used being made with equal parts of aqua destillata and glycerine. Daniel R. Brower (Jour. Amer. Med. Assoc., Oct. I, 'OS).
The following method is recommended for making permanent gold prepara tions: A mixture of S parts of 1-per cent. solution of gold chloride and 2 parts of formic acid is boiled three times, then cooled. Very thin pieces of tissue are put into the cooled mixture, which must be kept in the dark. After one hour the tissue is washed in distilled water and then placed in a mixture of 10 parts of formic acid and 40 parts of the distilled water and exposed to dif fuse daylight. The reduction occurs in from 24 to 4S hours, when the violet tissue is transferred to 70 per cent., and after 24 hours to 90 per cent., alcohol and kept in the dark for at least a week. It is then ready for the final manipula tions, and may be teased and mounted in acidulated glycerol or cut into sec tions. E. L. BilLstein (Amer. Med., June 15, 1901).
Physiological Action. — The chloride of gold is a caustic irritant. In small medicinal doses the preparations of gold sharpen the appetite and promote diges tion. If long continued, symptoms of overstimulation follow their use. Con stipation is usually present. The mental
functions become more active. Increased venereal desires are attributed to the use of gold. In men priapism is not uncom mon. In women the menses are in creased.
Poisoning by Gold.—The acute form of poisoning follows the ingestion of a tonic dose and manifests itself by a vio lent gastro-enteritis, accompanied by cramps, convulsions, trembling, insom nia, priapism, and insensibility. In the chronic form, there develops a fever ac companied by sweating, a very abundant flow of urine, and salivation, without tenderness or ulceration of the gums. Epigastric heat and oppression, headache, dryness of mouth and throat, with gastro intestinal irritation.
Treatment of Acute Poisoning by Gold. —The principles of treatment are the same as poisoning by corrosive sublimate. The contents of the stomach should be evacuated after the free administration of albumin, eggs, milk, and flour. Ex ternal heat should be applied and stim ulants administered by the mouth, the rectum, or by hypodermic injection. Morphine is useful if shock be present. Atropine will diminish the salivary se cretion, and astringent (tannin) or dilute acid mouth-washes will relieve the sali vary symptoms.
Therapeutics. — The preparations of gold are not as much in favor as formerly.
Nervous dyspepsia is relieved by small doses to grain) given three times daily. Mills regards it as a valu able tonic in hysteria and other disor ders dependent upon depravity of the nervous system.
NEPHRITIS.—In diseases of the inter nal organs associated with sclerosis, as nephritis, cirrhosis of the liver, etc., the persistent use of gold and sodium chlo ride has given excellent results. In con tracted kidney a pill of chloride of gold has been recommended by Dana.
PHTHISIS.—Gibbs and Shurley, of De troit, laboring under the impression that gold and sodium chloride possessed bac tericidal powers in this disease reported a number of cases in which satisfactory results were obtained.
SYPHILIS.—In old secondary and ter tiary cases where mercurials and the iodides have been long in use, gold will yield beneficial results, as in gummata, syphilitic pharyngeal ulcerations, spe cific ozmna, etc. Ingals has found chlo ride valuable in syphilitic laryngitis. Hale White finds the sodium chloride preferable to corrosive sublimate in the tertiary form, especially when the osse ous system is involved.
EFFIISIONS.—Gold has yielded good results in ascites due to chronic hepatitis, post-scarlatinal dropsy, and in ovarian dropsy.