Special Notices.

COCA ERYTHROXYLON. We need not enter into a full description of the history of the Erythroxylon Coca, as we believe that most medical men are fully acquainted with the principal facts concerning the plant. We may, however, recall to mind that the leaf is the only part of the plant used. Very much depends, therefore, upon the plucking of the leaf, and the time at which it is plucked; the subsequent care of the leaf being matter of considerable importance, and affecting very materially the preparations made from it. M. Mariani was the first in Europe who took up the study of the plant, and over 35 years ago commenced manufacturing for the medical profession the various specialties associated with his name, viz: "Vin Mariani,” “Elixir Mariani," "Pâte Mariani," "The Mariani," "Pastilles Mariani," etc., preparations which are known all over the world, and which have acquired their well-known reputation by their purity and efficacy. The stimulating and strengthening property of the leaf in its natural state has been tested by experienced travelers and botanists during several centuries, and it is this invigorating property which the physician wishes to bring into use, and which he is enabled to do in a palatable form by means of "Vin Mariani,” this wine being indicated where there is great depression, long continued exhaustion, and where a special stimulative action is desired. "Vin Mariani" is agreeable, palatable, imparting by its diffusibility an agreeable warmth over the whole body, and exciting functional activity of the cerebro-spinal nerve centres. We have frequently prescribed this wine, and we can, from practical experience, recommend it.—The Provincial Medical Journal, London, Eng.

I HAVE pleasure in stating that I have used Peacock's bromides extensively, both in private and hospital practice, and have found it of great and trustworthy value in the treatment of diseases of women, more especially about the climacteric; it frequently greatly diminishing the severity and frequency of those neurovascular symptoms as hot blooms," especially when combined with Sig. trinitrini B. P. (M 1⁄2 to MT); those distressing symptoms of depression and restlessness are much benefited by its exhibition. Its great advantage over the prescribing of the simple salts is in the disguising of their saline taste and the presence of carminitines certainly gets over the very real objections that previously existed to prescribing large doses of the bromides, and I am confident that Bromism is less soon produced when Syr. Brom. Com. Peacock's is given.

BRISTOL, ENG.

J. COURTNEY MACWATTERS, M. D.

THE PROMPT SOLUTION OF TABLETS.-We are glad to know that the Antikamnia people take the precaution to state that when a prompt effect is desired the Antikamnia Tablets should be crushed. It so frequently happens that certain unfavorable influences in the stomach may prevent the prompt solution of tablets that this sugtion is well worth heeding. Antikamnia itself is tasteless, and the crushed tablet can be placed on the tongue and washed down with a swallow of water. Proprietors of other tablets would have had better success if they had given more thought to this question of prompt solubility. Antikamnia and its combination in tablet form are great favorites of ours, not because of their convenience alone, but also because of their therapeutic effects.-The Journal of Practical Medicine.

MR. JOHN B. DANIEL: Dear Sir-I send you per registered mail currency for last shipment of Concentrated Tincture Passiflora. I consider it one of the best Nervines and Antispasmodics I have ever used. I tried it in case of an infant, three months old, with convulsions, and it acted like a charm.

Baldock, S. C., June 12, 1897.

Very respectfully,

W. S. HAVENER, M. D.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than any thing else.-RUSKIN,

Original Articles.

ORTHOFORM AND EXTRACT SUPRARENAL GLANDS.*

BY W. CHEATHAM, M. D.

Professor of Diseases of the Eye, Ear, and Throat in the Louisville Medical College.

Cocaine and other local anesthetics, on account of their toxicity, are not safe applications for burns and wounds. In orthoform, a more recently discovered drug, which is prepared from cocaine, the latter being as we know benzoyl-ecgonin-methylether. Einhorn and Heinz, after many experiments by which they developed forty or more substances, claim to have found in orthoform, which is the methylether of para-amido-methoxybenzoic acid, a safe local anesthetic for large ulcers, burns, and abraded surfaces.

It is a white crystalline powder without odor or taste or but little taste. It is only slightly soluble in water, which is one of its virtues, as it will stay in contact with the raw surface and dissolve slowly. The hydrochloride is soluble in water, but being acid in reaction, is not so suitable for local application, and not at all for injection hypodermatically. The anesthesia occurs only when it comes in contact with mucous membrane or abraded surfaces, and then only where the powder touches; it is consequently better to use it in a very fine powder or as an ointment. Used in the eye as a powder it reddens the conjunctiva a little first, produces slight pain, then anesthesia. It is said to be absolutely non-poisonous. Large doses have been given with no bad result. It is "energetically antiseptic." It not only prevents putrefaction, but checks it after it has begun. Its anesthetic proper

Read before the Louisville Medico-Chirurgical Society, June 17, 1898

For discussion see p. 139.

ties, or rather anesthesia from its use, lasts for hours; it is said to last thirty-six or forty-eight hours. It has been used with excellent results in transplantation operations, or in many operations or traumatic cases in which the ends of the nerves can be reached; not of any service in closed wounds; it has been used with excellent results in burns of the third degree, ulcers, excoriations of the nipple, anus, vagina, etc. In painful moist eczemas, ulcerations of the tongue and of the throat, it gives excellent results, especially in cases of tuberculous ulceration of the throat with painful deglutition. Orthoform in form of hydrochloride in spray, or a weak cocaine solution, can first be used to produce local anesthesia, then insufflation of the powdered orthoform, which at first is a little painful, but which is said to continue the anesthesia for many hours, thus relieving the distressing symptoms seen in such

cases.

In ulceration of the stomach the hydrochloride is indicated. In ulceration of the intestinal tract lower down it could be used, I should think, by covering it with salol, so as to not be absorbed until it reached the part.

In the nose I think it better to use it in the form of an ointment, as the powder would soon be washed away or blown out. I have used it with great success in three severe cases of rose fever; in two cases, combined with extract suprarenal gland, the result was excellent. I have used it in form of an ointment, from ten to twenty per cent, with lanoline on vaseline cerate with great relief when cocaine had failed.

At the Munich Surgical Clinic the observations hitherto made on wounds of various kinds, on burns of second and third degree, on ulcers (luetic, varicose, carcinomatous, etc.), on dental caries, etc., may be summarized as follows:

1. Loss of sensation commences on the average three to five minutes after application, whether as powder or ten or twenty per cent ointment.

2. The anesthetic action continues on the average for about thirty hours, in many cases even for three or four days. Only in one case did the action last scarcely two hours, the powder being carried away by copious secretion.

3. Diminution of secretion is always observed, a feature which is very valuable, for instance, in transplantations, where the grafting of the transplanted skin is promoted. The reduction of very copious and

troublesome salivation in a case of inoperable cancer of the cheek was also noted.

4. Non-poisonousness is demonstrated by the fact that in a case of carcinoma two ounces weekly were applied without any bad effect.

5. As regards antiseptic qualities no special experiments were made on patients, but no bad influence on wounds was experienced. Purulent discharge was never occasioned, but when present ceased shortly after application of the powder.

A few moments ago I mentioned the extract suprarenal gland used with orthoform. I wish to speak of the suprarenal gland extract only as to its local use in the eye and nose. Its action is upon the vaso-motor system; it is a strong astringent. It blanches congested or inflamed tissue quickly; for this reason and for its anesthetic properties it is a great adjunct of cocaine, which we know has little or no effect upon inflamed tissue. Constringe the vessels though with the suprarenal gland extract, and cocaine acts nicely. The suprarenal gland extract also seems to penetrate deeper as tenotomies of the eye muscles. Iridectomies and operations in which cocaine alone does not prevent pain entirely give but little pain when the two medicines are combined. The best form in which to use it is a solution of ten grains of the dried extract in half an ounce of water. The aqueous solutions degenerate in light and air, so should be made fresh daily. The dried glands keep indefinitely almost. Phenic and boric acids preserve the solutions some. I have used the solution with and without cocaine with good result.

We all know the bad effects of cocaine used in the nose and the danger of its use becoming a habit. I have used instead in rose fever, as I before mentioned, orthoform with extract suprarenal gland or the extract alone in vaseline. It does not form a solution, only a mixture. I warm this in a De Vilbir's spray and use it in the nose. Orthoform does not shrink the engorged turbinal tissue but little, but the extract suprarenal gland does. It checks excessive secretion; it acts beautifully in rose fever or acute coryza from any cause. Internally its action is said to resemble that of digitalis very closely.

The following letter has been received from Parke, Davis & Co. in. response to request from one of the Louisville druggists:

We are in receipt of your favor of the 10th June, inquiring whether it would be possible to prepare a concentrated suprarenal gland solution in vaseline or alboline oil.

We regret to inform you that such a preparation is not feasible. We have prepared of late on several occasions a liquid preparation of the suprarenal gland for local application in eye diseases (conjunctivitis, etc.). Thinking that your friend might be able to use a concentrated watery solution, we take pleasure in sending you a small sample. This solution is a rather concentrated one, one part being equal to about twelve parts of the fresh suprarenal gland. The solution contains one per cent boric acid. We have prepared several lots of this suprarenal gland solution, but have so far been unable to prevent a slight precipitation after standing for some time. This, however, is not due to deterioration. When protected from light in a cool place the preparation will keep for some time. Heating does not destroy its activity, yet we have found that repeated heatings have at least some weakening effect. It might also interest you to learn that alcohol, although not changing the active principle chemically, almost entirely destroys the physiological properties. For this reason we are inclined to believe it will be impossible to prepare an active preparation of the suprarenal gland that will be miscible with mineral oils. We have tried to bring the solution to dryness. The residue, however, is of such a hygroscopic nature it prohibits us from marketing the product in a dry form. You will please understand that this product is merely an experimental one and that it is not listed among our regular preparations.

LOUISVILLE.

PATHOLOGY AND DIAGNOSIS OF DIPHTHERIA.*

BY CHAS. W. AITKIN, M. D.

Since Klebs, in 1883, and Loeffler, in 1884, called attention to the specific bacillus of diphtheria, numerous observers have worked over the same ground and established the main facts set forth by these gentlemen. The germ is claimed by many to be found in all cases of diphtheria; it is limited to the false (?) membrane, and found most abundantly in the superficial parts of the membrane during all stages of the disease, and "it may continue to live upon the mucous surface of the mouth in a precarious existence for several weeks after the fever has disappeared."

A majority of competent observers conclude that the bacillus is not found in any other disease. No doubt much confusion has arisen from the fact that organisms are found in the mouths of healthy individuals which give the same results per culture and having a marked resemblance in form, yet not possessing any pathogenic power. The true

*Read at the May meeting of the Kentucky State Medical Society, 1898.