should explain the beneficial effects of iodide of potassium by supposing that it gradually drives out the chloride of sodium in the syphilitic growth, and takes its place. Being unfavorable to the processes of growth and multiplication of bioplasm the living particles cease to multiply and die, and the products of their death are first absorbed and then excreted by the emunctories.

The processes referred to are, no doubt, very slowly performed, and what is required is the continuous operation of the drug for a considerable period, and under circumstances favorable to combination, especially in a very diluted state. It is doubtful whether any advantage is gained by strong solutions. It is rather by frequent doses of the remedy in a very dilute state that we should expect benefit would result. It is by the free percolation of weak solutions through the tissues that imperfectly soluble substances are gradually removed from the seat of their deposition, oxidized and otherwise chemically changed, and at last excreted from the body dissolved in water. It has, of course, been often suggested that in such a disease as pneumonia, when carbonic acid accumulates to a dangerous extent in the blood, advantage would follow the inhalation of pure oxygen or a mixture containing a higher percentage of that gas than common air. But not only is there an impossibility of the gas being absorbed by the blood, in consequence of the congestion of the capillary vessels specially concerned in that process, while in many the blood is probably actually stagnant, but the blood itself is in a condition unfavorable to the process, the red blood corpuscles and other constituents of the blood concerned in taking up oxygen being altered, and in a state capable of absorbing less, not more, than the normal quantity taken up in a given time.

It is the fashion now-a-days to condemn such remedies as acetate of ammonia and citrate of potash, but I cannot help thinking if those who express themselves thus confidently would themselves only take one or other remedy for a time, when they happen to be suffering from, say an ordinary cold, they would change their opinion. The exceeding confidence with which many condemn this and praise that drug, without ever having taken it or studied its action in others for a sufficient time and

under sufficiently varying circumstances to enable them to judge as to its usefulness, is very remarkable and interesting as one of many curious examples of narrowness combined with the conviction of personal infallibility which we often meet with. Suchlike ridiculous dogmatic assertions may enhance the repute of an individual, but they do not further the true interests of medicine, nor are they of any advantage to the sick. Some are giving up in contempt methods of treatment which have been proved to be of unquestionable service, and substituting for them things which are puffed into notoriety and credited with properties which neither they nor any other substances in nature possess. I think our very serious attention should be given to the treatment of pneumonia and some other acute diseases as advised and carried out by some during recent years. Not only are stimulants not given in cases where there is marked tendency to death from distention and dangerous stretching of the right ventricle and failure of the heart's action, but aconite in frequent, and in some cases in what I should consider to be dangerous doses, is given. Although as strongly opposed to the use of alcohol in the healthy state as any one can be, I feel quite convinced that patients may be lost in consequence of alcohol being withheld at a critical moment. Possibly alcohol may be required only for a very short period, but in many cases there is a point in the disease when the heart begins to flag and the circulation in the capillaries becomes very slow. Sometimes the blood accumulates in the right side of the heart, the muscular tissue of which may be paralyzed by the stretching. The capillaries even of the surface become distended with a dark blood which hardly moves through the vessels. The tint of the surface of the body becomes dusky, the lips blue, and the face partly livid partly pale. If these changes go on to actual stagnation of the blood, the patient must die, but if a short time before stagnation of the blood occurs stimulants be given in decided quantities, the heart is stimulated to contract more vigorously, the blood is driven through the vessels, and the patient is saved. In such a case the brandy should be given in dessert or tablespoonfuls, and not diluted with more than twice the quantity of water, because the contact

with the mucous membrane of a tolerably strong solution stimulates the afferent nerves distributed to the mucous membrane of the stomach, and by reflex action the heart is excited to contract more vigorously, and from that time improvement is manifest, and the patient may soon become convalescent. If, on the other hand, no stimulant be given at this critical period of the case, the heart gets weaker and weaker, and the patient succumbs. If, however, the practitioner or the patient, or both, are determined that alcohol shall not, on any account, be given, I do hope that ammonia, and in very decided doses, will be substituted for it. Three or four times the quantity usually prescribed may be taken with advantage-of course, properly diluted. The solution should not be stronger than ten grains of the carbonate of ammonia to one ounce of water, but this may be given once in an hour or oftener. The quantity of ammonia that may be taken with benefit in some maladies is enormous. On page 102 will be found an interesting statement on this matter.

Excess of Sulphates; Action of Liquor Potassæ.The proportion of sulphates varies often, but not always, according to the amount of the urea formed. In diseases characterized by violent nervous and muscular action, we usually find an increased amount of sulphate in the urine. In chorea, the increase of the sulphates and urea is often very remarkable; but there are conditions in which the increase of the sulphates does not appear to be associated with the formation of urea to a cor respondingly large amount. Dr. Parkes has shown, by some very careful experiments on four cases, that in rheumatic fever the sulphuric acid is greatly increased. In one case, 521⁄2 grains of sulphuric acid and 51⁄2 grains of unoxidized sulphur were excreted in twenty-four hours. The urea The urea was not, however,

increased in the same degree. This increase of sulphate is not observed in typhoid fever and scarlatina. It does not, therefore, depend merely on increase of temperature. Dr. Parkes suggests that in the blood, in acute rheumatism, there may exist a material richer in sulphur than albumen. Potash increases the tendency of this substance to undergo disintegration; and hence, whenever liquor potassæ is given, the proportion of sulphates in

the urine is augmented. ("The Influence of Liquor Potassa on the Urine in Rheumatic Fever." Med.-Chir. Review, Vol. XIII, p. 248.) An increase in the quantity of sulphate in the urine, in cases of rheumatic fever, is noticed in some of Dr. Bence Jones' analyses. In one case, on the fifth day, the urine had a specific gravity of 1.026, and yielded 11.89 grains of sulphate of baryta.

In many cases of skin disease I have found the relative proportion of the sulphates to be considerably augmented. This is well illustrated in the composition of the urine of a boy suffering from eczema.

It must not be forgotten that a great increase of the sulphates in the urine takes place if sulphates be taken as medicine. Sulphates of soda and magnesia are those which are most commonly given, and the proportion found in the urine is by this means frequently doubled or trebled, and the increase continues for some days after the sulphates are taken.

Sometimes the sulphates themselves, on the other hand, instead of sulphur being oxidized, seem to be deoxidized in the organism, with the setting free of very appreciable quantities of compounds rich in sulphur. It is not uncommon for patients who are taking waters containing sulphates, as well as those in which hydrosulphuric acid predominates, to discover that any silver they have about them has been completely blackened, from the formation of a film of sulphur upon the surface. This setting free of sulphides may continue for a considerable period of time. I have known the process to continue over several weeks, but have not been able to get any satisfactory explanation of the fact. If we could ascertain the causes of the change, and bring it on at will, it might be advantageous in the treatment of scabies, and possibly of many conditions depending upon the presence of animal or vegetable parasitic organisms. In taurine and cystine large quantities of sulphur exist, and it may be to some change in the former of these compounds which is constantly produced in the organism, that the chemical changes resulting in the formation of free hydric sulphide or hydrosulphuric acid, or compounds which readily yield it, are due.

Excess and Deficiency of Alkaline Phosphates.—I have adduced evidence which indicates that the greater part of the phosphoric acid eliminated is carried into the organism in the food. Dr. Ralfe has shown that "alkaline phosphates are retained in the system when the alkaline carbonates are withdrawn, and discharged when these are again supplied.” (“Inquiry into the Pathology of Scurvy," by C. H. Ralfe, M.A., M. D., Lewis, 1877.) A certain proportion, however, of the phosphoric acid, there can be little doubt, is formed in the body by the oxidation of the phosphorus of albuminous textures. Contrary to what has been most positively affirmed, it is probable that the amount formed in the nervous textures is exceedingly small. In diseases generally, the alterations which have been observed in the quantity of phosphate removed in the urine are to be attributed mainly to the altered diet of the patient. It is, however, but reasonable to suppose that, in some conditions of the system in which a more than usual disintegration of tissues rich in phosphorus takes place, more phosphoric acid would be produced in the organism than in health. This excess should be found in the urine in the form of alkaline phosphate, and it was said the amount corresponded to the activity of the changes taking place. Then it was assumed that by ascertaining the proportion, we should be able to form an estimate of the quantity of phosphorus oxidized-and therefore of nerve tissue disintegrated.

Those who labor to prove this, and further that all the changes in the body are the direct result of certain chemical decompositions, have not hesitated to appeal to the results of the observations referred to above in favor of their theory. Some years ago it was accepted as a settled point, that the quantity of phosphate in the urine varied according to the amount of nervous tissue disintegrated; and it was too hastily assumed that the quantity of work done by the brain varied in direct proportion to the activity of the chemical changes going on in the nervous tissue. But it has never been shown that the quantity of phosphate depends upon and varies according to the activity of the changes in question. The problem is much more intricate and more difficult of solution than at first appears.