by F. Winckel, M.D., and DISEASES OF THE VAGINA, by A. Breisky, M.D. New York; William Wood & Co.

A PRACTICAL TREATISE ON THE DISEASES OF THE HAIR AND SCALP. By G. T. Jackson, M.D. New York: E. B. Treat, 771 Broadway.

THE CURABILITY OF INSANITY. By John S. Butler, M.D. New York and London: G. P. Putnam's Sons.

THE VEST-POCKET ANATOMIST. By C. Henri Leonard, A.M., M.D. Detroit: The Illustrated Medical Journal Company.

MANUAL OF THE UNITED STATES HAY-FEVER ASSOCIATION FOR 1887. AMERICAN MEDICINAL PLANTS. Fascicle VI. By Charles F. Millspaugh, M.D. New York and Philadelphia: Boericke & Tafel.

THE CAUSES AND PREVENTION OF INFANTILE DIARRHEAL DISEASES. By F. R. Campbell, A.M., M.D. Reprint from "Buffalo Medical and Surgical Journal." A REVIEW OF THE MOST IMPORTANT ADVANCES IN SURgery, Medicine, and PHARMACY IN THE LAST FORTY YEARS. By C. W. Moore, M.D. Reprint from "Pacific Record of Medicine and Surgery."

THE RADICAL CURE OF RETRO-DISPLACEMENTS OF THE Uterus, and PROCIDENTIA, BY ALEXANDER'S OPERATION AND MEDIAN COLPORRHAPHY. By J. H. Kellogg, M.D. Reprint from "Transactions of the Michigan State Medical Society."

PERSONAL AND NEWS ITEMS.

E. R. MILLER, M.D., has located at 21 West Street, Leominster, Mass. A. C. REED, M.D., has located at So South Main Street, Clinton, Mass. THE SOUTHERN HOMEOPATHIC MEDICAL ASSOCIATION will hold its fourth annual meeting in New Orleans, Dec. 14-16, 1887.

COMMENCING Sept. 14, Dr. H. K. BENNETT's office hours in Boston will be on Mondays, Wednesdays, and Saturdays, from 12.30 to 4 P.M.

BENJAMIN A. BRADLEY. M.D., has removed from 426 John Street, Cincinnati, O., to his new office and residence, 100 Auburn Avenue, Mount Auburn, Cincinnati, O.

THERE will be a vacancy on the resident staff of the Homœopathic_Hospital, Pittsburg, on Oct. I next. Application should be made at once to Dr. J. H. M'Clelland, chairman of the executive committee, 411 Penn Avenue, Pittsburg, Penn.

This hospital with its large dispensary affords extraordinary opportunities for the acquirement of practical experience. Each resident serves successively in the medical, lying-in, and surgical wards.

DR. ALONZO BOOTHBY returned from his summer in Europe per steamship "Pavonia," sailing from Liverpool, Aug. 23. Dr. Boothby may be found by friends and patients at his residence, 260 Clarendon Street, at the usual hours. We learn with satisfaction that his vacation has proved a pleasant and profitable one.

MELLIN'S FOOD is a dry powder made from wheat and malted barley. By a careful, scientific process the indigestible portions of the grain are extracted, and the entire starch property is converted into dextrine and grape-sugar by the action of the malt diastase. Thus the greater part of the work of digestion is performed before the food reaches the stomach.

DR. SAMUEL WORCESTER left New England on Aug. 16, for his new home in El Cajou, San Diego County, Cal., where he proposes to engage in the practice of his profession, and also interest himself actively in fruit-growing. He will have an office for consultation in the city of San Diego. Dr. Worcester is well known to the profession as the author of a standard work on Insanity, and also as the lecturer on Insanity and Nervous Diseases in Boston University School of Medicine for several years past. The best wishes of his Eastern colleagues will follow him to his new home.

THE

New-England Medical Gazette.

No. 10.

OCTOBER, 1887.

VOL. XXII.

Contributions of original articles, correspondence, personal items, etc., should be sent to the publishers,

Boston, Mass.

EDITORIAL.

STENOCARPINE: A RIVAL TO COCAINE.

"steno

THE new local anesthetic and mydriatic known as carpine" is made the subject of an interesting series of "observations" from the pen of Dr. Edward Jackson. of Philadelphia, and appearing in a recent issue of the "Medical News." Dr. Jackson, after careful study and experimentation, is inclined to the opinion, which he expresses with commendable caution and conservatism, that "stenocarpine" will prove "a local anesthetic more powerful than cocaine, and a mydriatic more powerful than, yet as brief in its action as, homatropine," and therefore may lay just claim to investigation as "a new drug and one of great practical importance." Since experimentation would seem to suggest that, like cocaine, this new local anesthetic has a usefulness wider than the sphere of any single medical specialty, we feel sure that our readers will follow with interest the following selections from Dr. Jackson's observations upon it.

"The discovery has now been announced of an alkaloid, said to be obtained from the leaves of a tree common in Louisiana, which certainly equals, and perhaps surpasses, cocaine in its power to abolish the sense of pain in the part to which it is applied.

"The story of the discovery is, that Mr. M. Goodman, V.S., having applied to the fetlock of a horse a poultice made, by chance, of these leaves, subsequently made a free incision into the part without eliciting any evidence of pain. He furnished some of the leaves to Dr. Allen M. Seward, who obtained therefrom an alkaloid, a two-per-cent solution of which caused

local anesthesia in the eye of a cat. Some of this solution was placed in the hands of Dr. J. Herbert Claiborne, who found that it produced anæsthesia in the eye of the rabbit and of man, also of the mucous membrane of the nose, and of the skin; that it produced wide dilatation of the pupil, and in some cases a diminution of intra-ocular tension, and slight dulling of the sensibility of the tympanic membrane. Dr. Claiborne published an account of the drug, and the results obtained from its application, in the 'Medical Record' of July 30, 1887.

"After this Dr. H. Knapp experimented with it, applying the same solution to the mucous membranes of the eye, nose, throat, urethra, and rectum, producing anesthesia in all of them. Hypodermatically it produced local anesthesia of the skin, and a drop applied to the glans penis had the same effect; but in Dr. Knapp's hands external application to the healthy skin gave uniformly negative results. This I shall refer to presently. The injection of it into the cellular tissue of rabbits caused 'violent attacks of tetanoid convulsions in which opisthotonus was a prominent feature,' recurring every ten to forty seconds, for some fifteen minutes, but followed by complete recovery within an hour. The amount of the solution thus used to produce these symptoms varied from five to twenty-five minims. Ten minims injected directly into a vein of a rabbit's ear caused fibrillary convulsions, or tremors, of the front part of the body, and death in ten seconds. The picture furnished by these experiments bears the greatest resemblance to that of strychnine poisoning.' But 'chemical tests for the detection of strychnine,' applied to the drug, 'proved negative' (Medical Record, Aug. 13, 1887).

"After reading Dr. Claiborne's account of it, I obtained some of this two-per-cent solution of the drug. It was clear, of a faint brown tint, and had a taste distinctly bitter, but nothing like the intense bitter of quinine or strychnine. A few seconds after its application to the tongue and lips there was a peculiar sensation of numbness precisely similar to that produced by cocaine, but more intense than that caused by the four-per-cent solution of the latter drug. No application I have yet made to the human subject has produced constitutional symptoms, but not over four minims of the solution have been used in any one case."

Here follow in detail a series of experiments as to the effect of stenocarpine upon the eye, as made by Dr. Jackson upon himself and upon sixteen other persons, seven males and nine females, ranging in age from five to fifty-two years. In every case the drug (used in instillation of a two-per-cent solution)

"caused the same anæsthesia; complete within one, two, or three minutes, and passing off mostly within a half-hour. In all, the palpebral fissure was notably widened, the pupils widely dilated and fixed, and the power of accommodation very nearly or quite abolished by a single instillation. When the instillation was repeated, the accommodation was always

entirely abolished. When no other mydriatic was used, recovery of the accommodation and pupil was almost complete at the end of three days; that is, it had reached that stage where it is commonly spoken of as complete, and where its incompleteness cannot be detected except by comparison with the fellow eye kept in a normal condition. Dr. Claiborne speaks of recovery, in the trial made by him, as complete on the third day.

"In three cases the drug was used to paralyze the accommodation, for the purpose of determining the refraction. In all it answered the purpose satisfactorily, and in one the subsequent use of duboisine revealed no additional hyperopia.

"In four cases it was used simultaneously with duboisine (after the methods given for cocaine in my paper on that drug in the 'Medical News' of Aug. 27, 1887); in three cases it was so used with homatropine, and in one with hyoscyamine; and in all it caused a wider dilatation of the pupil, a dilatation very noticeably wider than did the other mydriatic.

-

"In no instance could I satisfy myself that it produced any change in the degree of intra-ocular tension, although I sometimes suspected it slightly decreased it. In no case did I perceive those corneal changes which I have noticed after the equally free use of a four-per-cent solution of cocaine, and which are described in the paper above referred to. In these normal eyes, and in three eyes suffering from acute catarrhal conjunctivitis, there seemed to be less blanching of the conjunctiva than I would expect to see from the same use of a four-per-cent cocaine solution."

Hypodermically injected, one and a half grains of the solution caused instant and complete local anesthesia over an area about four by eight millimetres in extent. The anesthesia disappeared in about half an hour. Applied externally to the skin, it gave satisfactory results only as long as the surfaces under experimentation were kept continually moist with the solution, during which time there was complete insensibility to pain. "In this respect," Dr. Jackson says,

... "my observations are directly opposed to those of Dr. Knapp, and in accord with those of Drs. Claiborne and Seward. I think Dr. Knapp's experience may be accounted for in one of two ways. First, the anesthesia, although absolute, is, in my experience, very superficial. By plunging the point of the needle somewhat deeply, one may feel it pass from the layer anesthetized into one in which it causes the usual degree of pain.

"To make a painless incision in tissues anæsthetized in this way, one must do it by repeated superficial cuts with the knife, keeping all the time the cut surface bathed with the solution. Possibly Dr. Knapp made his first incision, or plunged his needle, too deeply, passing into the underlying tissues still acutely sensitive. But it is more probable that he entirely prevented the absorption of the drug by preliminary treatment of the skin,

adopted doubtless for the purpose of facilitating it. He washed the skin with soap and water. The writer tried washing the flexor surface of his fore-arm with soap and water, and then immediately applied the drug in the way above described. After half an hour no anesthesia had been produced, although the surface was covered by the sticky residue left by the drying of the solution. The rationale of this is very simple: a portion of the free alkali of the soap probably remained adherent to the skin, and promptly precipitated the alkaloid from the portion of the solution that came in contact with it. Such a solution is very sensitive to the action of a free alkali. The simple blowing upon this solution, or a similar solution of cocaine, of air containing free ammonia, quickly renders it milky with such a precipitate. In the trial mentioned, when the solution of the drug had failed to produce anææsthesia at the end of the half-hour, I stopped its application, and placed on the surface covered with its residue, a dilute acid solution, and in ten minutes had quite a notable anæsthesia.”

Upon frogs, stenocarpine was found to act as a violent depresso-motor poison. The relatively smallest fatal dose given was one grain of the solution to a frog weighing 310 grains. The largest was two grains to a frog weighing 240 grains. This frog, it is worthy of note, had previously recovered after receiving four grains of a four-per-cent solution of cocaine.

"In every case in which the drug caused death, the heart continued to beat steadily, often for hours, after all other evidence of life had ceased. When, however, the chest was opened, and the heart was bathed in the solution, its action immediately became slower, then more feeble, and presently ceased."

In comparing the powers of this new drug with those of cocaine, Dr. Jackson concludes:

"It seems to me, from a careful review of my experience with it, that this drug does possess certain powers, in degree at least, peculiar to it. My impression, from my present experience, is that the solution used, said to be a two-per-cent solution, is a more powerful anæsthetic than the four-percent solution of cocaine. It certainly has a more powerful influence on the frog. The frog killed by two grains of this solution had withstood the action of four grains of the four-per-cent cocaine solution. And in a series of some thirteen parallel experiments performed on frogs with these two drugs, cocaine always showed itself the less powerful. Yet this new drug has seemed to exert less influence on the local circulation, and the nutrition of the cornea, than cocaine.

"Then, too, cocaine has but little power of paralyzing the accommodation, while this new anæsthetic-mydriatic has a much greater power in this direction. Still the recovery after the use of the new drug is more rapid than