PNEUMONIA. Dr. J. A. Reagan, in the Southern Clinic, says that he has found the following prescription very effective in early pneumonia : B Fld. ext. jaborandi, Sweet spirits of nitre, 3j. 3j. comp. tinct. lavender. The most experienced imbiber will fail to recognize the liquor."— Medical World. TUBERCULOSIS. Dr. J. Hunter Peak, of Louisville, Ky., re M. Sig. One teaspoonful every hour until ports, in the Louisville Medical Monthly, a the patient perspires freely. CORYZA OF CHILDREN. Dr. J. Madison Taylor uses, in the ordinary coryza of children, the following prescription, known as pil. atropinæ comp. :— B Atropine sulphate, . Morphine sulphate, . Quinine sulphate, good result from the use of an emulsion thus composed : Olei cinnamomi, M. ft. emul. Sig. Shake before using, and take a tablespoonful fifteen minutes before meals. UNGUENTUM VEGETABILE. This name has been given to an ointmentbasis introduced by Koch and Becker, consisting of an emulsion of vegetable-wax, oil, borax, and water. It is recommended on account of its durability, antiseptic action, and capacity for taking up water.-Pacific Record of Medicine and Surgery. MOYRAPUAMA AS AN APHRODISIAC. Dr. C. Rebourgeon, in the New York Therapeutic Review, states that moyrapuama, from two words in one of the native languages of Brazil, signifies the straight or rigid tree. It is an almost leafless shrub, which grows in the southern and southwestern parts of the State of Para, upon the slopes of Columbia, and the tract of the Rio Negro. In Brazil it is considered as a tonic of the nervous system, and a most energetic aphrodisiac. It is difficult to obtain a supply of moyrapuama, as the tree is not easily found, being at best rather scarce, and growing amid the tangled vegetation of virgin forests, where only the natives are able to find and recognize it. Some have sought to classify it botanically, and have held it to be a liriosma of the family of Oleaceæ. Kleesattel, of Stuttgart, has written a thesis on this subject, and Drs. Husemann, of Göttingen; Pekott, of Rio de Janeiro; and Rees, of Erlangen, share this opinion. On the other hand, Mr. Glazion, of Rio, a distinguished botanist, and Dr. Clem ente Malcher, of Para, place moyrapuama | teaspoonful doses of syrup of hydriodic acid, among the Acanthaceæ. three times a day, in conjunction with a prescription containing potassium bromide and fluid extract of ergot. This treatment not only controls excessive menstruation, but it interferes with the nutrition of the fibroid, and there is necessarily a consequent diminution in the size of the tumor, as was noted in three cases within the year.-Philadelphia Polyclinic. Several scientists have investigated the therapeutical properties of this substance, among them Hartwig, of Brunswick; Holfert, of Berlin; Heger, of Vienna; Keszler, of New York; Goll, of Zurich; Pfaff, of Strassburg; and Kleesattel, of Stuttgart. They have all considered it as an energetic tonic and stimu. lant of the weakened nervous system, and employed it in paralysis, rheumatism, dyspepsia, and especially in impotence, stating that it removed its causes without harming the patients. Kleesattel states that he has cured nine cases in which damiana (Turnera aphrodisiaca) entirely failed. M. Sig. Take 2 tablespoonfuls twice a day An analysis of the root by Dr. Rebourgeon (in dysuria senilis).—Prescription. gave the following result :— The glucoside of moyrapuama was isolated, decolorized, and obtained in the form of a white powder. Physiological experiments prove it to be the active principle of the drug. An interesting point is the very slight toxicity of this substance. In animals, who showed a very active response to the action of the drug, it was necessary to employ one gramme of extract or one centigramme of glucoside per kilogramme in order to cause death, by intra-venous injection. In pregnant females, toxic doses brought about immediate abortion. In cold-blooded animals the injection of a cubic centimetre preserves for several hours the movements of the lungs and heart, after the latter has been laid bare, and the reflex action is continued for a long time after death. It would hence appear that the use of this drug is decidedly indicated in neurasthenia in general, and particularly in the neurasthenic conditions of digestion and circulation, and the asthenia of the uterine and genital organs, with impotency. (Moyrapuama may be found in America at Ch. N. Crittenton Co., 115 Fulton Street, New York.) UTERINE FIBROIDS. In the treatment of women who refuse operative measures, Dr. Bloom recommends PARAFORM. According to Aronsohn, when formaldehyde is heated for a sufficient length of time in a watery solution, it passes into a solid, white, crystalline polymer, insoluble in water. This is paraform. It is a very strong intestinal antiseptic. For this purpose it is said to be superior to beta-naphthol, iodoform, salol, dermatol, and benzo-naphthol. It has a strong inhibitory action on the propagation of bacilli. One grain of paraform will completely sterilize 200 grammes of urine.-Western Druggist. BOROFORMIATE AND AMMONIO-BOROFORMIATE OF ALUMINIUM. The boroformiate of aluminium is an hygroscopic salt crystallizing in large scales, which glisten like mother-of-pearl. They dissolve completely, though slowly, in water. aqueous solution has a sweet and astringent taste, and does not coagulate albuminous solutions,— a property which is common to it with other solutions of aluminium. It is prepared by adding a mixture of 2 parts of formic acid, I part of boric acid, and 6 or 7 parts of water to as much freshly-precipitated and carefully-washed alumina as can be dissolved by the aid of heat. After allowing the mixture to settle it is filtered, and the solution may be used either directly, after having determined exactly its concentration by evaporation and weighing the residue, or allowing the boroformiate of aluminium to crystallize. According to J. Martensen boroformiate of aluminium contains 33.5 per cent. of alumina, 14.9 per cent. of formic acid, 19.68 per cent. | salophen, the molecule of which contains of boric acid, and 31.92 per cent. of water. The boroformiate of aluminium has been for more than a year used in the Prince Oldenburg Children's Hospital of St. Petersburg, where it has supplanted all other preparations of aluminium. Ammonio-boroformiate of aluminium is obtained by saturating a solution of boroformiate by ammonia and evaporating the clear fluid. Experimenters have not yet succeeded in crystallizing this combination.-La Medecine Moderne. MORPHINOMANIA CURED BY GRADUALLY IN- M. J. Luys reports the case of Dr. X., who SYMPTOMATIC TREATMENT OF INFLUENZA. Dr. Claus, editor of La Flandre Médicale, has recently written an exhaustive article on the symptoms of influenza, in which he points out that it is an error to assume that nervous individuals are most susceptible to the neuralgic pains of influenza. He recognizes the existence of a relationship between migraine and arthritis, one of the reasons given being that the antirheumatics-at the head of which he places salicylate of sodium—are equally good antineuralgics. more than one-half of salicylic acid. Inasmuch as salophen is not decomposed until it reaches the intestines, it is therefore free from the gastric disturbances which are produced by the salicylate, while it acts as effectively as the latter. For these reasons Claus employed salophen with especially good success in the migraine of arthritic origin. In twenty cases of influenza attended with variable neuralgic pains (sciatica, intercostal neuralgia, cephalalgia, and other symptoms), remarkable amelioration was at once noted after the administration of 1.0 to 2.0 grammes of salophen. In the majority of cases recovery ensued within the course of two days. The very favorable effects of this preparation, which stamps it as an antipyretic and antiarthritic par excellence, gives it a leading position among specific remedies recommended for the treatment of the symptoms of influenza; for salophen embodies the advantages of the salicylate of soda, without possessing the disadvantages of the latter. As regards dosage, o 5 gramme was administered and repeated every two hours until relief of the pains had been effected. ANOTHER NEW ANTISEPTIC. It is said in recent therapeutic reports that the salicylate of cadmium has a more energetic action than other salts of this metal. It gives good results in the treatment of purulent ophthalmia, in vascular engorgement of the cornea, as an astringent in mucous discharges, against syphilides, etc. Chemically-pure salicylate of cadmium is a white salt, occurring in splendid tabular crystals, with plain face and rounded sides. It has a sweetish taste at first, then styptic. It melts above 300°, dissolves in 24 parts of water at 100°, in 68 parts at 23°, and in 90 parts at zero. It is soluble in alcohol and ether, more readily in warm; very soluble in hot glycerin, but is insoluble in chloroform and benzin. 4 After reviewing the majority of new remedies which have been recommended for the treatment of the symptoms of influenza, he expresses the opinion that among these the The salt has the formula (C,H,OHCOO),salicylate of soda has proved the most service- Cd, and has 24 parts per 100 of metallic cadable. It is conceded that this drug has a number mium. It may be prepared either by acting of disagreeable after-effects, which frequently on hydrated oxide or carbonate of cadmium form an obstacle to its employment; notwith- with salicylic acid, or by precipitating salicystanding this, so long as no substitute was at late of barium with sulphate of cadmium; the hand, the physician was restricted to the use latter method is more complicated and the of this preparation. product is not so pure.—Journal of the AmerRecently a substitute has been found in ican Medical Association. THE Medical Bulletin. JOHN V. SHOEMAKER, A.M., M.D., Editor. Philadelphia, May, 1895. HERPES OF THE LARYNX. is well known that lesions analogous I to those of the skin often appear upon mucous membranes. Our knowledge of the identity of affections of the external and internal integument has been greatly advanced of late years by the report of numerous cases in which the mucous membrane has exhibited eruptions precisely similar to those which more commonly appear upon the skin. As a contribution to this interesting study, we take pleasure in calling the attention of our readers to a valuable paper by Dr. Brindel, based upon the observation of three cases occurring in the clinical service of Dr. E. J. Moure, and published in our excellent contemporary, the Revue de Laryngologie, d'Otologie, et de Rhinologie.* The fact that herpes might attack the larynx was, until within a few years, either denied or overlooked, although it has frequently been observed upon other mucous membranes. It would seem to be a very rare localization, as only nineteen cases have been placed upon record. Fernet, in 1878, was the first writer to publish the history of a case. Other observations have been subse quently reported by Rudolf Meyer, Beregszaski, Gottfried Scheff, Davy, Chapman, and Stepanow. It is conjectured by Dr. Brindel that, not withstanding the paucity of reported cases, herpes of the larynx, without being frequent, may well be more common than has heretofore been supposed. The affection is very liable to come under the care of the general prac titioner, and to escape unrecognized in default of a laryngoscopical examination. The "De l'Herpes du larynx." Par A. Brindel, premier interne et lauréat des hopitaux. Revue de Laryngologie, d'Otologie, et de Rhinologie, March 15, 1895. usual cause of the disease is, according to the writer quoted, cold, and it is generally accompanied by herpetic fever. Constitutional symptoms, as chills, fever, anorexia, vomiting, headache, furred tongue, are ordinarily well marked. Although often associated with herpes of the mouth, throat, nose, or face, the sole manifestation of the disease may be confined to the larynx. As the characteristic feature of herpetic laryngitis consists in a limited inflammation of the mucous membrane of the organ, with the production and evolution of a vesicle in the the inflamed part, we find that it ex presses itself by difficulty of respiration and deglutition. The patients early complain of dryness of the throat, trouble in swallowing, side of the larynx, together with disagreeable pain caused by pressure upon the neck at each prickling sensations in the larynx, aggravated by breathing, and which often produce painful, coughing paroxysms. Respiration is sometimes difficult. The glands of the neck are not swollen. The dyspnoea is generally slight, but hoarseness is often decided. Aphonia is frequent, supervening rapidly, and depending, like the The hoarseness and aphonia, especially if they dyspnoea, upon the parts of the larynx attacked. continue for several days, are the most distressing symptoms to the patient, causing him to demand a laryngoscopic examination, and this inspection alone enables one to diagnosticate herpes. The mucous membrane is seen to be red in spots, swollen, and studded here and there with small, discrete, opaline vesicles, occupying the centre of the inflamed spots. These vesicles, in certain cases, manifest themselves on the first day of the malady; in others they do not appear until the sixth or seventh day. In this as in its other localizations, herpes often proceeds by successive crops, so that the complete evolution of the vesicles may be witnessed. Unbroken and ruptured vesicles with punctiform erosions are seen at different places. Within a few days-three, four, or eight at most-the redness and swelling of the mucous membrane begin gradually to subside, and, coincidently, the functional difficulties disappear. The vesicles are, ordinarily, few in number, ten being the minimum, and their sites of elec tion are the posterior surface and free border of the epiglottis (in about two thirds of the cases), the arytenoid mucous membrane (in two fifths), the vocal cords and aryepiglottic folds (in one-fifth). The ventricular bands are less often involved. In two-thirds of the recorded cases one of these parts only, to the exclusion of others, was the seat of vesicles. In one case the laryngeal mucous membrane was invaded in its different regions. The evolution of herpetic laryngitis is rapid. Its duration does not exceed fifteen days or three weeks. The larynx returns completely to its normal condition, and entirely recovers its functions. One attack does not confer immunity. The prognosis is favorable, notwithstanding the severe nature of its early symptoms. It is possible, as one of the cases observed by Dr. Brindel demonstrates, that herpes of the larynx may co-exist with a genuine laryngitis, each affection being independent. epithelium, and its little white spots and the presence of many similar spots upon the mucous membrane of the mouth are, after all, a different picture from that of herpes. Painful dysphagia is sometimes the only symptom of laryngeal herpes. As this manifestation may be caused by an acute folliculitis of the base of the tongue, the latter condition should always be carefully eliminated by an examination of the buccal cavity prior to laryngoscopy. Pemphigus, which may occur in the larynx, as upon other mucous membranes, bears some resemblance to herpes. The lesions of the former, however, exceed those of the latter in size, are bullæ in place of vesicles, and pemphigus of the larynx is almost invariably accompanied by the same eruption in the pharynx and upon the skin. The constitutional treatment of laryngeal herpes is that of herpetic fever, of which it is but one of the manifestations. Locally, gargles containing borax and a bromide or carbolated or borated pulverizations are recommended. From his study Dr. Brindel deduces the following conclusions: 1. Special treatises should devote a new chapter to a disease hitherto but little known, -herpes of the larynx. 2. This affection, which is less rare than has been supposed, is only an isolated or associated localization of herpetic fever. 3. Its most frequent situation is upon the posterior surface of the epiglottis and the vicinity of the arytenoids. For diagnosis the laryngeal mirror is indispensable. Herpes needs to be distinguished from simple acute laryngitis. The latter also begins abruptly, but general symptoms are absent or much less marked. In acute laryngitis the mucous membrane is bright red in all its parts, instead of in spots, as in herpes. Laryngeal diphtheria, also, has several points in common with herpes. The pseudomembranous form of herpes described by Davy must, for the present, be regarded as hypothetical, and it is difficult to conceive that such lesions should be so large and confluent as to demand surgical intervention. The course of laryngeal diph- 4. It is characterized anatomically by the theria is well known. The rejection of false evolution, in those regions, of herpetic vesicles membrane by coughing, the progressive aphonia, surrounded by an inflammatory zone, and the increasing dyspnoea, and the concomitant clinically by the symptoms of herpetic fever on cervical adenitis will prevent confusion with a the one hand, and on the other by painful disease characterized by red spots surrounding deglutition, hoarseness, and sometimes aphonia, a vesicle, and in which an herpetic eruption-all symptoms susceptible of being more or often co-exists upon other mucous membranes. less associated, and which are in relation with Acute tuberculous laryngitis might be con- the localization of herpes. founded with herpes, but its rapid course, the ulcers which soon form, and the occurrence of tuberculosis in other organs, particularly the lungs, should suffice to differentiate the two diseases. Thrush bears some resemblance to herpes, but thrush only attacks pavement 5. The invasion is sudden, the progress rapid, and the cure complete. Recurrence sometimes takes place. 6. In rare instances, if ever, herpes of the larynx is accompanied by symptoms analogous to those of croup. |