italicised are not so printed in the original, felt that if the meaning of the passage was that the parietal bone rounded the promontory with its protuberance to the left of the whole of the promontory, the words used in describing this movement could not but be regarded as misleading. But as this was only a question as to the meaning which the author meant to be attached to the words he used, and in no way touched his argument, it was of no practical importance. He would like Dr Wallace, however, to explain how the biparietal diameter could fail to pass through the conjugate diameter if its posterior pole passed over the promontory whilst the head was in the transverse diameter of the pelvis. Dr Wallace's reference to the figure in Sir James Simpson's paper illustrating the passage of the bitemporal diameter through the narrow conjugate must have arisen from his failing to see that the head is in that figure represented as passing base first. Dr Sloan was glad to find one of so much experience as Dr Bell regarding version in contracted pelves with suspicion; and he quite agreed with Dr Bell that it was possible for a woman to carry her child for a longer period than forty weeks. Dr Sloan referred Dr Pollock to the paper, where he would find that both turning and podalic extraction after turning were looked on by him as liable to cause lacerations and ruptures. The President had told them that the flexion which the forceps caused was an advantage, but he would remind the Society that this argument was used by Simpson against the forceps in contracted pelves. He agreed with the President that the size of the head of the child was of as much importance as the size of the conjugate, for it was simply a question of disproportion between the head of the child and the brim of the pelvis; and the decided position Dr Sloan took up regarding the question of treatment, quâ DISPROPORTION, would be found in his first proposition. Part Fourth. PERISCOPE. MONTHLY REPORT ON THE PROGRESS OF THERAPEUTICS. By WILLIAM CRAIG, M.D., F.R.S.E., Lecturer on Materia Medica, Edinburgh School of Medicine, etc., etc. PURE TEREBENE AND TERPENE.-I have received so many letters from medical men in different parts of the country giving results of their experience with pure tere bene in the treatment of winter cough, that, practically, there has been an informal collective investigation. I have before me brief notes of 94 additional cases, and in 71 of these a distinct success is recorded. In 6 of the cases of failure, a further investigation showed that there had been an incomplete diagnosis, the patient suffering from some complication, such as aneurism or aortic disease, the existence of which had not previously been suspected. In 10 cases the patients complained of nausea after taking the medicine, and in several instances when inhaled from lint it excited the cough, and apparently acted as an irritant. The explanation is that much of the pure terebene now sold is of very inferior quality, and would be more accurately described as "impure tere bene. Medicines, as a rule, do not improve by keeping, but pure tere bene is certainly an exception, for as it gets old it becomes bland and oily. It is to be feared that most of the old stock, which, in consequence of the small demand, must have been in the druggists' shops for years, has now disappeared, so that greater care has to be taken in the selection of good specimens. Much of the pure terebene now sold is crude and irritating, and quite unfitted for medicinal use. My attention has been called to the fact that there is a tere bene which is labelled "patent." I distinctly stated in my paper that the substance I employ is not a "patent" preparation. In almost every case I find the pure terebene has been given on sugar, and has not been used in the form of spray, probably from the difficulty experienced in obtaining the atomising apparatus. The combination of oil of cubebs, oil of sandal wood, and pure terebene, which I used with success, has given good results in other hands. I have had no returns of phthisis treated in this way, but most of my correspondents speak of having found pure terebene of benefit in acidity, flatulence, and other forms of dyspepsia. The smell of violets, which terebene imparts to the urine, is often referred to, and in one instance it gave rise to complications. A lady called on her lover, who was ill in bed with bronchitis, and was very angry because he would not show her his violets. She searched for them, but did not find what she had expected. I am surprised that pure terebene has not been recommended for diseases of the bladder and urethra. My experience of its employment in these cases is limited, but I have certainly found it useful in cystitis and gleet. Delicate and fastidious women sometimes object to the smell and taste of pure terebene, and I then use terpene in the form of tabloids with good results, although I do not think that it is equal to pure terebene. (William Murrell, M.D.)-The British Medical Journal, 27th Feb. 1886. THE EFFECTS OF COCAINE ON THE CENTRAL NERVOUS SYSTEM.— Dr D. R. Brower draws the following conclusions from a paper with the above title, published in the Journal of the American Medical Association, 16th January 1886-1. Cocaine in small or moderate dose is a cerebral stimulant, but produces derangement of the digestive and assimilative functions, and diminishes the elimination of waste. 2. The use of cocaine in the alcoholic and opium inebriates is not satisfactory, while it is a more or less perfect substitute, yet its use is attended with greater danger than alcohol or opium. 3. The use of cocaine in mental depression, if we carefully guard against the depressing effects of the drug upon digestion and assimilation, will often give better results than any drug hitherto used. 4. The use of cocaine in neurasthenia is a valuable addition to the treatment. 5. The drug, if administered. in large doses persistently, causes a very marked deterioration of the central nervous system, producing a profound cerebral neurasthenia, and may produce such a malnutrition of the cerebrum as to develop insanity. 6. Cocaine occasionally in doses heretofore regarded as small, produces alarming depression of the central nervous system. The Therapeutic Gazette, 15th February 1886. COCAINE IN LARYNX, PHARYNX, AND NOSE.-Dr Dessar epitomizes his experience with cocaine in the larynx, pharynx, and nose, in the following aphorisms (Deutsche Medizinal Zeitung, 7th January 1886)-1. Cocaine reduces the sensibility of those parts, even in existence of hyperæsthesia, to such an extent that the laryngoscope and rhinoscope can be employed with ease. 2. Reduction of pain, especially in operations. 3. Removal of pain and difficulty in swallowing in presence of a stenosis depending upon tumours in phthisis, syphilis, perichondritis, and tonsillitis. 4. Ischemia in case of strongly injected mucous membranes. 5. Diminution of profuse hæmorrhages. 6. Insurance of diagnosis in reflex neurosis of the nose. For purposes of examination a five per cent. solution is sufficient; for those of cauterization of the pharynx, nose, and for the removal of deglutition difficulties, a ten per cent. solution, and for laryngeal operations a twenty per cent. solution are required.―Therapeutic Gazette, 15th February 1886. EFFECT OF NITRITE OF AMYL ON THE BLOOD PRESSURE.-The influence which inhalations of nitrite of amyl exert on the arterial pressure is usually thought to be a lowering of the same. The investigations and direct measurements of Dr Schweinburg (Centralbl. für Medical Wiss., 2nd January 1886), with Basch's sphygmograph, however, brought out different results. The blood pressure was seen to rise after inhalation of the drug, at the time when the well-known symptoms, reddening of the face, sensation of warmth, pulsation of the carotid arteries, etc., set in. This apparent contradiction between the ordinary assumption and Schweinburg's researches, this observer explains by the statement, that nitrite of amyl given in large quantities, or in small but repeated doses, produces a reduction of the pressure, but after small quantities such as are exhibited for the therapeutic purposes a transitory rise takes place. Hence care must be taken in cases in which a sudden rise of pressure would be dangerous.-Therapeutic Gazette, 15th February 1886. A NEW GALACTAGOGUE.-At a recent Medical Congress in Naples, Professor Siurleo called attention to the Ditana digitifolia, a Mexican plant, as possessing remarkable galactagogue properties (Phar. Post, 28th November 1885). He mentioned several cases reported in Italian journals in which the administration of an infusion (of what parts of the plant is not stated, nor the strength) to nursing women had exercised a marked influence upon the milk glands, inducing a considerable secretion of milk, even in cases where it had been nearly or entirely suppressed. Ethereal tincture of the flowers of Ditana digitifolia made into a kind of elixir with syrup is said to have been brought out by an Italian pharmacist under the name of "Galattofore." The flowers, and especially the stamens are, in addition, credited with sudorific properties. Professor Siurleo has also directed attention to the Rhamnus alaternus and Ligustrum vulgare as plants possessing properties antagonistic to those accredited by him to Ditana digitifolia. The property of Rhamnus alaternus in diminishing the secretion of milk was reported about forty years since, though since practically overlooked, and Professor Siurleo now states that he has found the Ligustrum vulgare, though so far removed from it botanically, to possess exactly similar properties. The drug is said to be best administered as an infusion of 3 grammes (45 grs.) of leaves in 150 grammes (5 oz.) of water twice in the course of 24 hours; this dose being repeated for several days.-(Pharm. Journ. and Trans., 25th December 1885).-The Therapeutic Gazette, 15th February 1886. URETHAN.-In our December issue we gave particulars regarding the chemistry of this substance, which is the ethylether of carbonic acid (NH,CÓC,H). Since that time it has come into notice in this country, and physicians have it on trial. Regarding its physiological action we quote from the Druggists' Circular a letter by Merc of Dramstadt, who says: "Schmiedeberg first experimented by using urethan on animals; later, Jolly applied it to human beings, thereby proving it to be a hypnotic. Von Jacksch, assistant of the first Medical Clinic in Vienna, in the last few months subjected urethan to a close examination, which resulted in justifying its classification among the best known hypnotics. Von Jacksch further calls attention to the fact that all other hypnotics produce more or less of other indications causing false impressions, which properties urethan does not possess. Von Jacksch has employed this remedy in various forms of insomnia, in the dose from 0.5 to 1 gramme, even in the higher forms of phthisis, in derangement of the valvular system, and in fatty degeneration of the heart, with the most serious symptoms; in all cases it produced quiet and lasting sleep, without causing any annoying reactions. Concerning its physiological action it should be classified among those remedies acting on the brain. The irritability of the sensitive respiratory organs not being altered to an appreciable extent, it is concluded that this preparation must act without greatly influencing heavy coughing, asthmatic attacks, neuralgic pains, and the lance-like sensations of unde veloped consumption. Von Jacksch is convinced that urethan will prove a specific in the treatment of diseases of children, as the sleep produced by it very much resembles natural sleep. Urethan is administered with or without corrective in form of powder or in solution. Here it must be mentioned that urethan in small doses is not an infallible sleep-producing remedy, but its hypnotic effect, after administering it to the extent of one gramme, leaves nothing to be desired."-The Chemist and Druggist. EXTERNAL USE OF LOBELIA INFLATA.-Dr V. N. Reichard highly recommends the use of Lobelia inflata (Med. Times, 12th December 1885) as a local application for indolent sores, chronic erysipelas, and especially in incised wounds, in which latter class of cases it acts as a hæmostatic and astringent. The mode of employment of lobelia for this purpose in cases of incised wounds, no matter how great the hæmorrhage, provided, however, it does not require a ligature, is to bring the edges of the wound together, and to hold them for a few moments, while a pledget of cotton wet with tincture of lobelia is applied. Dr Reichard says that the hæmorrhage will then cease and the parts adhere, and, although lobelia may not be a germicide, it will so entirely close up a wound as to render it perfectly aseptic.-Therapeutic Gazette, 15th February 1886. PERISCOPE OF MEDICINE, CLINICAL AND PATHOLOGICAL. By G. A. GIBSON, M.D., and WILLIAM RUSSELL, M.D. THE INFLUENCE OF FLUIDS (BOISSONS) ON NUTRITION AND IN THE TREATMENT OF OBESITY.-Professor Albert Robin discusses this question. There are two views held: the one, that liquids are inactive; the other, that they are of real influence. He accepts Genth's position-that water introduced into the stomach in large quantity augments the proportion of urea and salts in the urine. But the further question is, Is this due to a more thorough washing of the urea already formed, or to an augmentation of disintegration? He thinks it is partly due to the former; and that the tissues being more thoroughly freed from the products of their disintegration, oxidation processes will be favoured. Forster found not only increase of urea, but also of sulphur compounds, which were doubtless due to the breaking up of albuminoids. The next point to settle is whether the augmentation of the urea depends on increase in organic disintegration or on an exaggeration of combustion. From Genth's experiments and his own he concludes that the ingestion of a large quantity of water augments combustion-that is, oxidation without augmenting equally organic disintegration. Obesity has two causes in the one, assimilation is augmented; in the second, destruction (désassimilation) is diminished. In the first class, water EDINBURGH MED. JOURN., VOL. XXXI.-NO. X. 6 1 |