terizes the aged physician, whose life has been spent in an ofttimes ineffectual warfare against disease, with these defective medicines. This delusion regarding the value of medicines as curative agents, can unquestionably be traced to an oversanguine confidence of youth, engendered by the positive statements of teachers and authors, followed by the disastrous results obtained too often by the administration of inferior or adulterated substances, recommended for the cure of disease. Drugs furnished by the mineral kingdom may be obtained pure with much greater ease; nevertheless some of these are notoriously impure, while many other substances such as volatile oils, etc., owing to the leniency of the law, are so adulterated as to be practically devoid of medicinal activity. What, it might be asked, is the remedy for this condition of things? Primarily it will become incumbent on the profession to establish a standard of strength for all the preparations made from drugs having known active ingredients. This being done, all deviations from the standard should render the manufacturer amenable to the law; and finally, all persons convicted of adulterating officinal preparations, made from drugs derived from the vegetable or animal kingdoms, as well as of chemicals used as remedial agents, should be dealt with with a severity little short of that ac corded murderers. To bring about this needed reform, the proper undoubtedly be to place the manufacture of all medicines under the same restrictions that hedge the practice of medicine and pharmacy. Physicians must furnish evidence to the authorities of fitness to practice their high calling. Pharmacists must con form to the same law, but any manufacturer, so disposed, may flood the market with inferior pharmacopial preparations with perfect immunity. It is a matter of every-day experience that the price of valuable remedies varies in open market as much as one hundred per cent. The question that confronts you, gentlemen, is, are your prescriptions compounded with these cheap preparations? The mere fact that they are in the market indicates that there is a de mand for them. There is but one solution to this deplorable condition of the drug trade, namely, to place it under governmental supervision. Every bottle of medicine in the retail drug store used in compounding prescriptions, should bear the government's stamp of genuineness. Without stringent precautions of this nature, the physician will continue to do battle 'gainst the scythe of death with a leaden sword. HYDRIODIC ACID. BY JOHN V. SHOEMAKER, A. M., M. D., PHILADELPHIA. Fany alterative is more in demand than the iodides, it would puzzle therapeutists to agree upon its name. Many obscure deviations from health exist, amounting not always to pronounced disease which will not give way to simple tonics or to depurants of the purgative order. These maladies are the bane and torment of a busy doctor, and many times he gets them out of his list by the use of iodides. Then again, when well-defined cases of scrofula and syphilis are under our care, the value of a good alterative is pre-eminently a a question of moment. Unfortunately, the iodides in large or long-continued doses have a tendency in many instances to inaugurate stomach disorders, and yet the absolute need of the remedy is apparent. What then shall we do? We can have recourse to hydriodic acid. For years this agent was officinal in the Dispensatory, but it was dropped because of its unstable character, which made it not only unpleasant, but unsafe to administer. For almost ten years the acid was not obtainable, until in 1878, when Mr. R. W. Gardner, of New York, introduced the agent in the form of a syrup, which the best tests have shown to be unalterable by any ordinary exposure in the sick-room, unless in hot weather, when, of course, it should be excluded from either extreme light or heat. Sufficient time has now elapsed to demonstrate that the claims made for the syrup are well founded, and that it replaces the salts of soda and potassa in an entirely satisfactory manner. An important addition in the form of the syrup of hydriodic acid has therefore been made to current therapeutics. By the use of this syrup we obtain, in a palatable form, iodine in its most effective state. Mr. Gardner has shown that: "When not decomposed, hydriodic acid is of a light-yellowish color, is perfectly non-irritant, gratefully acid to the taste, aud rendered still more acceptable if combined, as in this preparation, with sugar. "In chemical composition it consists of one equivalent each of iodine and hydrogen (III). As the equivalent of iodine is 127, and that of hydrogen 1, it follows that the proportion of hydrogen present as compared to iodine is less than 1 per cent. (78-100 of 1 per cent). Absolute hydriodic acid is, therefore, nearly pure iodine. If affords the most natural and effective means of assimilating iodine, as the hydrogen with which it is combined is one of the largest elementary constituents of the body. The combination renders iodine more assimilable, therefore, because in physiological harmony, while it is medicinally more active, and deprived of its objectionable irritant properties, and changed from a most disagreeable to one of the pleasantest of remedies." One fluid ounce of this syrup contains 6.66 grains of iodide converted into hydriodic acid. Its action will be found more efficient in equivalent doses than iodide of potassium, while it produces none of the unpleasant effects of the the latter, such as loss of appetite, soreness in the fauces, nausea, etc. Physicians who use iodide of potassium largely will appreciate this, because it is more active than iodide of potassium, and should be given, in smaller relative doses, thus not interfering with digestion. Its effect upon mucous surfaces is more marked than with other forms of iodine, while it is effective in smaller relative proportions, and when required it is so free from irritant action that it may be given to the youngest infant. Our chemist just quoted further adds that Hydriodic Acid has a characteristic subacid taste, and if the syrup contains about 6.66-100 grains in one fluid ounce, it will taste like lemon syrup, or lemonade. Consumers of the syrup can be guided as to any deleterious change in it by noting the color. When decomposition has occurred in syrup of Hydriodic Acid, it becomes first red and finally black. This is owing to the very feeble chemical affinity existing between its elements, and is caused by the gradual oxidation of the combined hydrogen into water (HO) and the con sequent freeing of iodine, which passes at once into solution in the remaining Hydriodic Acid. In this condition it is unfit for medical use, because the irritant action of free iodine is again restored. It will be seen that this change is inherent though it may be delayed. After this change has commenced, however, it is progressive, and the preparation cannot be restored to its former condition. The best method of preventing this change is to keep the syrup in as cold a situation as possible, in a refrigerator if convenient, during warm weather, and carefully excluded from air by keeping it well corked. The syrup of Hydriodic Acid is especially serviceable in asthma, hay fever, acute and chronic rheumatism, chronic bronchitis, and in many chronic congestions of the mucous tract. Probably the greatest value to the practitioner of syrup of Hydriodic Acid will come from its employment in syphilis, particularly in the latter stages. The stomach is often rebellious at this time, for it has most likely been surfeited with mercury. Many cases drag along under iodine because not enough of it can be borne, and mercurials frequently are not only useless, but at times injurious. Instances such as those related bear admirably large doses of syrup of Hydriodic Acid. Such cases have come under my observation in which the patients were at a standstill, who at once brightened up and rapidly improved under the use of the syrup of Hydriodic Acid. If thought desirable the biniodide of mercury (the red salt) can be combined with the syrup, but the protiodide cannot be used at the same time, because it (the green salt) would be converted into the former salt, and unless care was taken the unexpected activity of the syrup thus prepared would exceed the prescriber's expectations, and possibly injure the patient. In syphilis the syrup can be pushed, if needed, until the characteristic saturation is evident, or when the metallic taste becomes pronounced and we know that iodism is near at hand. It is advisable, however, not to carry the administration so far. In rheumatism the syrup may substitute the alkalies and may cut acute attacks short sooner than the ordinary drugs that are usually prescribed. It is certainly a useful article in chronic muscular rheumatism. It has done good service in my hands in sciatica. It may be administered during acute rheumatic attacks without reference to the fever, and in moderate doses, say a teaspoonful or two every two hours. Of course, it will not act promptly and effectually in all cases, for rheumatism is notoriously fickle as related to curative agents. In bronchial disorders small and frequently repeated doses are better than large ones. It may be administered in this latter affection in from twenty to thirty drops every two hours. The syrup has been recommended in chronic arsenical poisoning, several cures being noted. In lead poisoning it has also been serviceable. In obesity the steady administration of the syrup of Hydriodic Acid with suitable regimen has a very happy effect. We are not too well supplied with agents of repute in this disagreeable complaint, hence a note on this point in reference to its use in this respect is of utility. Many skin diseases are benefited by the syrup of Hydriodic Acid. In connection with cod-liver oil it is valuable in some varities of eczema, particularly in children. It is especially efficacious in the form known as scald head, which is often so obstinate and unyielding to many remedies. Scrofulous persons (those predisposed to glandular troubles) receive decided benefit from its use. The red-eyed children, those having recurrent granular lids, with repeated attacks of mild conjunctivitis, derive great relief from syrup of Hydriodic Acid. A case of amyloid liver with fatty heart, in the practice of Dr. F. A. Burrall, of New York, was notably aided by the syrup of Hydriodic acid, and he indorses it in glandular troubles generally. Dr. Blackwood, of Philadelphia, has employed it largely in his practice, and reports cases of exophthalmic goitre, lumbago, and uterine catarrhs which were cured by the syrup. It is desirable that Hydriodic Acid should be given by itself; inasmuch as it is very susceptible to chemical action, combinations with other remedies might act injuriously upon it. Metals and alkalies are incompatibles, so also are oxidizing agents, as, for instance, acids, permanganate and chlorate of potassium. These would form iodic acid, which would be highly injurious to the patient. If intolerance becomes apparent, as occurs with all really active medicines, after a more or less extended use, the syrup should be dropped for a week or ten days, when most likely the stomach will have recovered its tone and it may again be administered. Unlike many remedies which, when once objected to in this way, are never likely to be good again, the syrup is just as palatable and equally efficient when taken up after a vacation (so to speak) as when first given, which is an important characteristic of this remedy. Although syrup of Hydriodic Acid is used by many practitioners, we call attention to it believing that a wider knowledge of it is desirable, and feeling certain that a careful trial by physicians at large will add to their armamentarium an important remedial agent, and that they will learn to appreciate its value as we have, by its employment in a wide circle of disease for many years. THE DIAGNOSIS OF URETHRAL STRICTURE OF LARGE Read at Allegheny County Medical Society, BY R. W. STEWART, M. D., M. R. C. S., A PROMINENT authority on genitourinary diseases says: "The least contraction at any point in the urethral canal has been demonstrated as capable of causing the indefinite continuance of an urethral discharge and even of establishing it de novo without venereal contact." The same authority also says, "Chronic urethral discharges, commonly called gleet, is the signal which nature hangs out to notify the intelligent surgeon that an obstruction to the normal working of the muscular apparatus of the urethra has occurred; that plastic material laid down in the antecedent inflammatory condition has begun to contract the normal urethral calibre, whether it be 20 or 40 millimetres in circumference, and that nothing short of a complete restoration of the normal calibre of the canal will afford a permanent cure." (Otis," Stricture of the male urethra," pages 20 and 75.) Those who are accustomed to the treatment of urethral diseases are aware that the treatment of gleet constitutes perhaps the most important as well as the most troublesome part of urethral surgery, and if, as there are good reasons for believing, the successful treatment of gleet consists in the majority of cases, of the removal from the urethra of some contraction in its calibre, which keeps the adjacent mucous membrane in a condition of chronic inflammation it will be evident how important it is that some means should be placed at our disposal by which urethral stricture may be readily detected and accurately located. For this purpose various instruments have been devised; those in general use are the blunt pointed steel sound, the bulbous bougie and the urethrometer. The blunt pointed steel sound, as recommended by Sir Henry Thompson, is doubtless useful for the detection of stricture of small calibre through which only small instruments will pass. But these strictures are not those with which we have most to contend with; it is the stricture of large calibre, through which a medium sized steel sound will pass without, perhaps, a noticeable obstruction. The blunt pointed steel sound is certainly inadequate as a means of detecting strictures of large calibre, and in the presence of superior instruments should be relegated to obscurity. The bulbous bougies are, in many respects, superior to the steel sound, but to their use may be urged several serious objections, which they have in common with the steel sounds. It is necessary to have a complete set of bougies, as each bougie only gauges a particular size. While there is more than one contraction of the urethra, should the posterior contraction be less than the anterior, the bulbous bougie will not indicate its presence until the anterior contraction is dilated sufficiently to pass an instrument the size of the posterior stricture, and a contraction of the meatus so commonly found, renders them useless until the meatus is cut. Another objection to these instruments is the necessity of trying bougie after bougie until the proper size is obtained. To obviate these objections the urethrometer was devised. There are several varieties of this instrument, all agreeing, however, in their general construction and method of using. This instrument has a bulbous extrem ity, which can be expanded to any desired extent by means of a screw at the handle. An index at the handle indicates in millimetres the size of the ex panded bulb. The uretrometer is free from the objections of the previous instruments, in the fact that it can be adjusted so as to measure any stricture of large calibre, and that a contracted meatus or a narrow anterior stricture forms no obstacle to the detection of deeper strictures. It must be admitted that the urethrometer is an improvement on the sound and the bougie, but it is perhaps better in theory than in practice, for in practice it has serious objections. Following the instruction of Professor Otis we introduce the urethrometer down to the bulbo-membranous junction and by means of the screw at the handle expand the bulbous extremity "up to a point which is recognized by the patient as filling it (the urethra) completely, and yet easily moving back and forth. The index at the handle then shows the normal circumference of the urethra under examination." This is all beautiful in theory but very dif ferent in practice; if we rely on the patient's feeling his urethra filled by the bulb we rely on a very unstable guide, because one patient may consider his urethra filled as soon as it is touched by |