hours a teaspoonful of the following solution: Muriate of cocaine (1·15), rectified spirits of wine (in sufficient quantity), and distilled water (1500), beginning the administration on starting. That it had a prophylactic effect seemed clear, for in spite of very rough weather for a period of 48 hours, both the individuals were for the first time in their lives free from sickness, and enjoyed a very good appetite the whole time. To a child six years old, who began to be attacked with sea-sickness on rising in the morning, the treatment was so effectual that it was able to play about during the day in spite of the storm. The child took one teaspoonful in two doses during the first half-hour, and then half-a-teaspoonful every three hours. Another case was that of a girl, 18 years of age, who had been sick for 24 hours before the drug was given. The case being a severe one, she had a double dose every half-hour, with "truly magical effect;" for after the second dose the patient was able to assume a half-sitting posture, and after the sixth dose she jested and began to complain of hunger. During the rest of the voyage she remained well, although there was inuch rolling of the vessel. Similar good results attended the use of the drug in three milder cases; and had it not been that his supply ran short DR. MANASSEIN would have been able to make more extended observations. Still, from the experience of these few cases he thinks it justifiable to infer that in the drug we have a certain and harmless remedy against sea-sickness. In the same communication he mentions that he had found "cocainum muriaticum" of great service in arresting the collapse of two severe cases of simple cholera, and thinks it desirable to try its action in Asiatic cholera.-London Lancet.

COCAINE IN VENEREAL AND SYPHILITIC DISORDERS.—The experience of BONO with cocaine in affections of the genital system (as published by the Gazz. delle Cliniche, ii, 1885) can be conveniently epitomized as follows:

1. An injection of a few drops of a two-percent. solution of cocaine removes promptly the pains felt in acute gonorrhea during micturition and erection. The injection has to remain in the urethra for at least five minutes, and to be repeated four or five times daily.

2. This cocaine-injection is unrivaled in rendering caustic injections or the introduction of the catheter painless.

3. The burning pains of blenorrhoea in women yield invariably to small cotton tampons saturated with a two-per-cent. solution of cocaine, to the application of a five-per-cent. solution of cocaine, or to the application of a five-percent. cocaine ointment.

4. Cocaine facilitates the examination of urethra and bladder with the bougie and the endoscope.

5. It allows of a painless cauterization in balano-prostatitis.

6. Pointed condylomata can be painlessly cauterized, excised, or scraped out with its aid.

7. In cauterization and excision of primary syphilitic affections, cocaine evinced every desirable analgesic virtue of a sufficiently long duration.

8. Taken internally during an anti-syphilitic

treatment, cocaine did not present any appre ciable effects.

9. Its local effects are highly beneficial in syphilitic tonsilitis and in stomatitis mercurialis, and difficulties of deglutition.

BONO refers also to its analgesic properties in acute painful eczema, pruritus vulvæ, sore nipples, and burns.

As BONO's observations were confirmed by BLUMENFELD, FRÆNKEL, PICK, and NEISSER they are entitled to attention and confidence.— Therapeutic Gazette.

VOMIT

ICE TO THE SPINE IN OBSTINATE ING. DR. WM. L. DAVIS, in the Mississipi Valley Med. Mo., says: I was called to a patient, æt. 47, the mother of nine children, suffering from a severe typhoid fever with intractabie vomiting, which had persisted for several days. All of the ordinary means failed to control the condition of the stomach, and even pellets of ice were instantly rejected. High temperature characterized the fever, and every effort was made for its reduction, believing that it had much to do with the production of the nausea and vomiting, but the latter prevented the medication indicated for this purpose.

Menstruation had been normal for some time. except the epoch just preceding the attack of the fever, which, although the flow made its appearance, was but limited in quantity From the age of the parent and the number of children she had borne, I was inclined to the belief that the climacteric was a factor in the gastric derangement. Thinking, therefore, that the vomiting might depend upon reflex disturbance of uterine origin, or ill-defined spinal derangement, I applied ice in considerable quantity to the lowest part of the spine. The vomiting ceased instantly, and a profuse perspiration followed. The use of the ice was persisted in only as the indications appeared to demand it. Taking the hint from this, however, cool sponging was instituted with marked benefit, so that the use of the extreme cold to the spine was only of occasional necessity. With the exception of anodyne injections to produce rest at night, little other treatment was ordered. The subsequent progress of the case was satisfactory, and an ultimate recovery complete in about the average time.

The history of the case since her getting up has not confirmed my conclusions in regard to the menopause.-Peoria Med. Mo., September, 1885.

OIL OF EUCALYPTUS AND OIL OF TURPENTINE IN MEMBRANOUS CROUP.-DR. F. A. JOHNSON, in a letter to the editor of the Cal Med. Journal, narrates the following case:

Allow me to briefly report a severe case of membranous croup cured by me without tracheotomy. To perform this very hazardous operation would have been certain death to my little patient, on account of vascularity of the thyroid gland; I preferred to let the patient die a natural death. Feeling that all was not done that could be, and having but a few moments to work in, I took an atomizer, charged with oil eucalyptus and oil turpentine ää. q. s. and with the mouth well opened I sprayed the mouth and throat with this mixture every 15 minutes for at least two hours, and from the

first the patient breathed easier.

At the same time I gave my patient brandy and carbonate of ammonia ää., one teaspoonful as often as every 15 minutes, alternated with the spray. At the end of two and one-half hours the little sufferer was running about the room. I had discovered, several weeks previous, that the two oils would dissolve India-rubber, and made a record of the fact that if I ever had a case of this terrific disease, or of diphtheria, I would give the two drugs a trial. I will here state that as powerful and volatile as the two drugs are, they have no bad effect upon the mucous membrane, but will dissolve the membrane very rapidly. Try it, my brother physicians, and report your success in your respective medical journals.

I do believe, beyond a doubt, that by a judicious use of these two oils, diphtheria and membranous croup can be cured without the use of the knife.

PYROGALLIC ACID AND COLLODION AS A REMEDY FOR PSORIASIS.-DR. GEORGE T. ELLIOT, in the New York Medical Journal of September 5, 1885, recommends the following formula in the treatment of psoriasis:

В Acidi pyrogallici, 3 jss-3 ij. Acidi salicylici, 3 ss. Collodii flex, 3ij.

M. et ft. sol.

Keep in a dark-colored bottle.

The results obtained in treating psoriasis with the pyrogallic collodion have been in every way satisfactory. A great change could be seen in the lesions after a few applications. There was an absence of scales and a diminution in the hyperæmia, and the plaques and spots appeared less elevated. The time which was required in curing the psoriasis by means of this solution has naturally varied according to the extent of the disease and the length of time which it had existed. Any rule in regard to it could scarcely be made. The quickest results obtained were in psoriasis guttata, and the slowest in a case of psoriasis nummularis of long standing. In cases where the eruption is universal, or nearly so, it is of course advisable to treat the various portions affected seriatim. The result will be just as satisfactory; only the time required will be a little louger.

In one other form of skin disease, herpes tonsurans, DR. ELLIOT has used this solution of pyrogallic acid, and with most gratifying success. Its effect upon the lesions has been surprising, two applications having been sufficient in the majority of cases to effect complete cure. Am. Jour. Med. Sciences.

TREATMENT OF HABITUAL CONSTIPATION. -DR. MURRELL, the eminent therapeutist, thus commends the virtues of Friedrichshall water in the treatment of habitual constipation:

"I have recently been using the Friedrichshall water in a variety of cases, in hospital practice, and I find it to possess the same valuable therapeutical qualities which explain and enhance its long-established reputation as a favorite aperient in habitual constipation, and

in the wide range of cases in which it is desirable to employ a laxative of mild character, and fitted for continued use. Friedrichshall has a special constitution, which secures to it marked preference over the ordinary sulphate of magnesia waters, and over the ordinary in general use. Its special advantages are probably largely due to its combination of chlorides with sulphates. It is not merely a saline aperient, but it has valuable properties in influencing tissue-change and promoting excretion of acid. Thus it is attended with excellent results in cases of congestion of the liver and kidneys, as a corrective of the digestion, and as what may be familiarly described as a tonic-aperient. Friedrichshall realises in practice the valuable curative powers ascribed to it by the eminent German physician with whom it has long been a standard prescription. I hope, shortly, to publish, in a more detailed form, the results of clinical experience, which indicates the special advantages of Friedrichshall to which I refer." -British Med. Journal.

THE CURE OF PULMONARY GANGRENE BY THE INHALATION OF AIR IMPREGNATED WITH CARBOLIC ACID.-DR. CONSTANTINE PAUL, at the recent meeting of the Congress for the Advancement of Science, called attention to the efficacy of carbolic inhalations for the cure of pulmonary abscess.

Seven cases were reported in which the remedy was successfully applied, no failure being recorded. DR. PAUL, in considering the value of the proposed remedy, compares the results obtained with those secured by the inhalation of aromatics, etc., which are eliminated entirely through the pulmonary and bronchial apparatus. These, with the exception of eucalyptus, are pronounced valueless, because not possessing the power of checking putrefaction in the pulmonary tissue.

As a probable explanation of the method by which the carbolic acid acts in checking the putrefactive process, M. PAUL refers to the results obtained by various bacteriologists, who have found this agent efficient in the destruction of bacteria.

In view of the fact that pulmonary gangrene is regarded by most authorities as almost constantly fatal, M. PAUL considers the results obtained as noteworthy, and that the method is an acquisition to the therapeutics of the disease, and worthy of further trial.-Gazette Médicale de Paris, August 29, 1885.

SALICYLATE OF COCAINE IN THE TREATMENT OF TRIGEMINAL NEURALGIA.-SCHNEIDER ("Allg. med. Ctrl-Ztg;""Ctrlbl. f. d. ges. Therap.") relates the case of a woman in her third attack of neuralgia of the second and third branches of the trigeminus. The first attack, five years before, had been treated successfully with large doses of quinine. The second attack lasted almost six months; quinine was of no avail, but the pain gradually disappeared under the use of morphine and iron. The third attack had continued four weeks when the author injected salicylate of cocaine experimentally. The effect was extraordinary; six grains of the salicylate, injected into the cheek, caused the pain to disappear

entirely, and occasioned a general feeling of well-being wholly free from any unpleasant collateral phenomena. The injection itself was painless and did not give rise to irritation. The patient was enabled to sleep at night, although before the pain had been most severe at night. Eight such injections were given in the course of six days, and after that there was no pain except at the site of the injections, which was overcome by three applications of galvanism with the anode applied to the seat of the pain and the cathode to the back of the neck.-N. Y. Med. Journal, Septembert 5, 1885.

CANCER REMOVED BY A RUBBER BAND.SAMUEL KNAGGS, M. R. C. S., in the British Medical Journal, says, I will mention a simple method which I have found useful in removing cancerous masses. It is only intended for temporary relief, but it gives very little pain and produces much subsequent comfort. It consists in the application of a thin strip of India-rubber around the base of the growth. This thin rubber band having been stretched three or four times around the base, but not so tightly as to cut through, the ends are tied with silk, when at full tension, as closely as possible to the tumor, and gradual progressive contraction takes place. It checks hemorrhage, relieves pain, adds greatly to the comfort, and somewhat to the life of the sufferer. The strangulation of hemorrhoids is also, I think, more pleasant and quickly effected with this ligature than by ordinary thick silk. It is a little more difficult to manipulate, and is more readily applied behind a strong tenaculum, which has transfixed the base of the pile. Encircling nævoid masses with a similar temporary ligature at the base allows their being dissected out with very little loss of blood.-N. Y. Med. Times.

BENZOATE OF SODA IN THE SUMMER DIARRHOEA OF CHILDREN.-DR. GUOSTA believes the diarrhoea occurring in infants in hot weather to be a zymotic disease due to the presence of a special microbe produced by defective diet, bad hygiene and excessive heat being predisposing

causes.

The remedy he prescribes for the condition is benzoate of soda uncombined with any other remedy, if the affection is recent, in children of from six months to two years.

After the administration of a purgative, such as calomel or jalap, from 60 to 90 grains of benzoate of soda dissolved in about three ounces of water, administered in 24 hours, for two days. The third day a slight purgation with magnesia is followed by further administration of the benzoate of soda.

During the treatment the child is rigidly dieted, and nourished simply upon lemonade and a few spoonfuls of wine. Milk and bouillon are prescribed, the child, however, being allowed to nurse four times in 24 hours.-Journal de Médecine de Paris, August 23, 1885.

THE TREATMENT OF GALL-STONE BY THE ELASTIC BANDAGE.-DR. QVISLING states (Tidskrift for Prakt. Medicin, quoted in Nordiskt Mediciniskt Arkiv., Band xvi., Häft 4,)

that in seven cases of gall-stone (two men and five women) he has seen good results follow the use of MARTIN'S elastic bandage. Its action depends on the immobilization of the abdominal organs, by which the calculus is prevented from irritating the mucous membrane, and from causing reflex contractions of the museular coat of the gall-bladder. The bandage is applied rather firmly over the upper edge of the hepatic dulness, as far down as the crest of the ilium, a piece of flannel being placed under it. It may be removed at night, if desired by the patient. Its use should be persisted in until the patient appears to be definitely cured. -Medical and Surgical Reporter, August 29,

1885.

POWDERED BORACIC ACID IN (TORRHŒA.— A scrofulous boy aged three, after a cold had earache, inflammation, perforation of the drum. and otorrhoea. DR. G. E. BLACKBURN, other measures having failed, adopted the following: "After carefully cleansing the ear by wiping it out with absorbent cotton, I inserted a specu lum, poured in boracic acid, and gently packed it down with a soft pine stick just large enough to slip easily through the tube. This I continued to do until I had filled the canal. when I placed a small pledget of cotton in the ear. This packing was washed out by pus in forty-eight hours. I repeated it. Again in four days I had to repeat it. The result was a complete success. In three weeks I removed the hardened mass by using warm cosmoline, and now the membrane is entire. Hearing, so far as I can judge, is restored, and the patient cured."-Clinique; St. Louis Periscope, September, 1885.

OLEATE OF MERCURY IN HEPATIC CONGES TIONS.-Especially among hard drinkers do we frequently observe those obstinate congestions of the liver that seem unwilling to yield to the usual remedies. DR. C. A. BRYCE writes about such cases in the Southern Clinic for September. The patients cannot eat, sleep, sit still, walk about or lie down-they have headache, a terrible taste in the mouth, and in fact are thoroughly miserable, and had rather be dead than alive. Upon examination, the liver is found considerably enlarged. There may be constant pain over the liver, persistent pain, or even intestinal hemorrhage. In such cases, DR. BRYCE has had most satisfactory results from the use of oleate of mercury in the form of a twenty-per-cent. ointment, rubbed well into the skin every night.-Medical and Surgical Reporter.

A NEW CARDIAC SEDATIVE.-DR. G. BUFALINI gives an account in the Gazzetta degli Ospitali, of August 12, 1885, of some experiments with coptis teeta or mameeran upon the heart of the frog. This plant is a native of China, belonging to the family of ranunculaceæ, and is used as a stimulant of the digestive functions. The author found its effects upon the heart to consist principally in a slowing of the pulsations, leading finally to complete ar rest of cardiac action in systole. And he, therefore, classes it in the same pharmacological group with digitalin.-Medical Record, Sept. 19th, 1885.

Vol. III.

Original Articles.

THE CHOICE OF REMEDIES.*

BY LAURENCE JOHNSON, M.D., NEW YORK. Twenty years ago there was much less faith in the efficacy of drugs in the treatment of diseases than there is to-day. One of the most prominent medical teachers and authors was wont to say in those days, that medicine was worth all the study given to it, if for nothing else than to enable the practitioner to make a diagnosis and prognosis. And this remark meant far more than appeared in the mere words uttered, for while the carefullest attention was paid to the diagnosis, clinical history, prognosis, and pathological characters of disease, the treatment was dwelt upon in such general terms as to mean anything or nothing. In other words, disease was considered principally from the natural history standpoint, and the catalogue of self-limited affections, with I whose natural course the physician should not meddle, grew to uncomfortable proportions.

It is unnecessary to discuss the causes of this particular form of medical scepticism. That it = existed cannot be questioned; and that its ex=istence operated as an obstacle to the success of men educated with that lack of faith, is equally capable of demonstration.

Naturally this heresy, like many others which for a time have ruffled the current of popular belief, did not long survive; but none the less, like some other heresies, it led to a train of evils that long outlived the cause which produced them. A generation of medical men went forth to unlearn the false precepts of their teachers by the hard road of practical experience. One cannot but smile at the pitying contempt which the recent graduate of twenty years ago had for the simple faith of the old practitioner, who actually believed he could with drugs moderate the course of pneumonia or cure a rheumatism. Yet such was the fact. This evil was, however, of a somewhat personal character and served chiefly to handicap the = individual practitioner. The faith of the public remained unshaken, and he who ministered most successfully to the public was most substantially rewarded. In reviewing this subject

*Read before the Section in Practice of Medicine of the New York Academy of Medicine, Oct. 20, 1885, and published in the Medical Record, Oct. 31, 1885.

No. 21.

in the light of personal experience, bearing in mind also the experience of professional friends with whose history I am familiar, I am fully convinced that to this sceptical training more than to any one cause, are due many of the difficulties encountered in the early years of practice.

But other evils followed. If drugs were of doubtful efficacy, they could not be dispensed with. As already remarked, the public faith remained unshaken. The public, when sick, would have drugs. The theory of the selflimitation of disease, together with the apparent financial success of homeopathic practitioners, who, it was believed, administered pleasant-tasting or altogether tasteless medicines, while the disease ran its natural course toward recovery or death, pointed the politic road-that of making medicines as palatable as possible. And here seems to me to be the origin of one of the greatest evils from which we, as a profession, and our patients are suffering. From striving to render remedies more and still more palatable, efficiency has been largely sacrificed to elegance, and unless the tide be stemmed in some way the whirligig of time will again bring around an era of scepticisin, based, however, upon a more substantial foundation. While I would not for a moment decry elegant pharmacy, within reasonable limits, I do most vehemently protest against its abuse, as at present so largely practised. Granting for the sake of argument that the proprietary pills, elixirs, and other compounds so largely used are compounded in accordance with their published formulæ, it cannot be doubted that their use begets in the physician a routine practice altogether at variance with the intelligent exercise of his calling; and the more skilful he may be in diagnosis, the greater is the contrast of his treatment. But in very many instances, at least, these preparations do not contain what is claimed for them. This has been shown again and again by chemical analysis.

Then how shall we be guided in the choice of remedies to use in the treatment of disease? This question seems to me easily answered in words, though practically it requires more thought than has been our custom to bestow upon it. In the first place, we should bestow upon materia medica and therapeutics the same careful study as is commonly given to other departments of medicine; the same care

ful attention to details as, for instance, is exemplified in practical, and consequently, successful antiseptic surgery. Knowing first the remedies within onr reach, not by name merely, but having a practical familiarity with them as individuals, an intelligent appreciation of their properties and effects, and of their comparative relations to each other, we shall be prepared to use them intelligently.

But one may say, this of itself would require the study of a lifetime. By no means. Let one but learn to distinguish the wheat from the chaff, and the materia medica will, so far as he is practically concerned, soon shrink to comparatively small proportions. Suppose the practical surgeon were to provide himself with all the instruments which have been used since surgery began to be practiced, how many of them would be employed to-day?

Our materia medica is certainly anomalous. Every root and herb at any time employed, from HIPPOCRATES down, must needs be included, together with almost every chemical which man's ingenuity or nature's fertility has provided. But how many of them are used? How many are worthy of use? Hardly a larger number than of surgical instruments. So while in surgery the antiquated are labeled and placed in museums, in materia medica the good and the bad, the useful and the demonstrably useless are left side by side as if for use together.

While everyone is familiar, at least in a general way, with the articles of standard worth of the materia medica, few have paid sufficient attention to the subject to enable them to pass a decided judgment upon the great number of useless and inefficient ones; and it is in behalf of these little-known drugs that our credulity is most frequently appealed to by blind enthusiasts or designing speculators.

The properties, uses, and limitations of the mineral preparations of the materia medica are pretty well recognized and understood. Take the preparations of iron, for instance. Everyone recognizes that though iron in any form is a tonic, yet there is a wide difference in the applicability of different preparations to different conditions. The same may be said of mercury, potassium, or sodium. The facts regarding these minerals are firmly fixed in our minds, simply because the knowledge of them is classified. Now, if the same plan be pursued with drugs of vegetable origin, our knowledge of them would be just as readily available. general way, the individual plants comprising a great natural family, may be said to be as nearly related to each other as are the different chemical compounds of iron to each other. Take, for instance, the order Solanaceae, which furnishes us, among others, belladonna, stramonium, hyoscyamus, and tobacco. In these

In a

four plants we have about all the efficiency that this order is likely to afford us in the way of narcotic agents. Each one of these has a sphere of applicability almost entirely its own. This fact being conceded, why waste time and energy in fruitless experimentation in search of possible new agents in the order?

Take, as another instance, the great order Labiata-the mint family. We are all, I trust. reasonably well acquainted with the properties. uses, and limitations of peppermint. Well now, this plant in itself represents all the medicinal activity of the entire order-a very large one. Other plants have different flavors. and may on this account be more or less agree able to some persons, but their medicinal action is entirely similar if not absolutely identical. And yet it is not uncommon to find specific effects attributed to plants of this order, and some men believe it. The Crucifera the mustard family, affords another instance of similar character. Mustard seed represents al that is to be extracted from the order; all the rest may be dismissed without thought or hes tation. And so one may pursue this course through the vegetable materia medica, exclud ing, without hesitation, scores upon scores of drugs which but encumber his path.

When one has gone through the materia medica in this manner, and excluded the articles which reason and common sense convince him are beneath his notice, he will be ready to make his choice from those which remain, of the remedies to use. And here I would not wish to be misunderstood. For my own pur pose I exclude a large number of drugs, not because they are altogether valueless, but be cause there are others much more efficient, and it seems to me that we should choose for our use only the best attainable. To illustrate. the number of vegetable tonics is very great. Almost anything bitter is possessed of tonie properties. Now, almost any vegetable bitter may be used in such a manner as to cure intermittent fever. The bark of the flowering dogwood, magnolia, tulip tree, or willow will do it. as will also tansy, wormwood, or boneset, but what man of sense would think of employing any of them when cinchona or its derivatives are attainable?

I believe it was SAM PATCH who died while making an effort to prove "that some things can be done as well as others." It seems to me there is considerable Patch-work in medicine of a similar character, only it is not the operato? who dies in the experiment.

But, some one may say, such a course as the would commit a man to contentment with his present choice of remedies for the balance o his professional life. Not at all. By accepting the verdict of his predecessors as to the worth lessness of certain drugs, he in no way binds himself to reject new discoveries with claims