cicatrix at the ala of the nose, which were removed. It may be added that tracheotomy was performed when she was admitted to the hospital. Journal of the American Medical Association, July 24, 1886.

PERMANGANATE OF POTASSIUM IN SNAKE BITES. DR. J. BERGER reports the following case in the St. Louis Medical Journal for July, 1886:

In

I would respectfully call the attention of the readers of the Journal to the new antidote for snake poison, permanganate potassium. For a full history of the discovery I refer the reader to the Therapeutic Gazette, vol. v., May, 1884. page 212. When I read the article referred to above, it made such an impression on my mind that I determined to give it a test the very first opportunity that offered itself. I did not have to wait long for an opportunity. August, 1884, I was sitiing on the veranda reading, when I heard my son, Frank, æt. 14, say he was snake-bitten. I at once made a solution of permanganate of potassium, and filled my hypodermic syringe. By the time he had killed the snake and got to where I was, I was ready for business. He was bitten on the thigh by a large copperhead, the fangs entering the flesh about half an inch apart. The wound was bleeding some and had commenced to swell, the swelling having extended in every direction from the bite about an inch, and was causing considerable pain. I introduced the needle of the syringe under the wound and injected 10 minims of the solution, waited a few minutes and repeated the injection. In about fifteen minutes repeated the injection again. After the first injection the swelling all disappeared and the pain ceased as soon as the smarting from the effect of the medicine was over, and the only inconvenience that was ever felt after was a small abscess that formed where the needle was introduced.

There is only one drawback to this remedy, and that is it must be used in a few minutes after the wound is inflicted to be entirely effectual.

I hope this remedy will soon become generally known and adopted as the treatment for snake bites, as it would do away with that unscientific, injurious, death-dealing practice of filling every person full of bad corn-whisky and alcohol, that is bitten by a snake.

SALICYLATE OF IRON IN CHILDREN'S DIARRHEA WITH OFFENSIVE STOOLS. DR. BRAITHWAITE, in the British Medical Journal, July 17, 1886, thus advocates the injection of salicylate of iron in that form of diarrhoea in children characterized by exceeding offensiveness of the stools:

It is commonly met with in summer, but is not strictly what is known as infantile diarrhoea, in which disease the stools are sour, but not necessarily foetid. Probably this form of diarrhoea differs from the diarrhoea of younger infants, in being caused by the growth of the ordinary bacteria of putrefaction. It is not

amenable to treatment by any astringent, nor has any alteration of diet much effect upon it. It may, however, be successfully treated by disinfecting the bowel contents by means of salicylate of iron, as in the following prescription, which is suitable for a child two years of age. Sulphate of ironi; salicylate of sodai, glycerin 3 iij, water to three ounces. The iron and the salicylate should be dissolved separ ately, and the solutions mixed. The color is darker than port wine, and the taste not unpleasant. One teaspoonful must be given every hour, until the stools become well blackened, which happens in about 24 hours; or a larger dose may be administered at longer intervals. The medicine should then be given every three or four hours, and occasionally a small dose of castor-oil, to clear the bowels well out, and to get the secondary constipating effect of the oil. I have employed this mode of treatment for many years. It was one result of a long series of microscopic observations upon the action of reagents upon the bacteria found in putrefying animal fluids, which I read before the Leeds and West Riding Medico-Chirurgical Society 11 years ago. The addition of the salicylic acid to the iron I made more recently.

In hospital practice, and among the poor, it is not so successful as it would be if it were possible to remove the child from the family living room, the air of which is usually very impure. and is made worse by the smells incidental to cooking, and the presence of a sink.

NARCEINE IN WHOOPING-COUGH.-At a recent meeting of the Société de Biologie MM. BROWN-SEQUARD, LABORDE, and D' ARSONVAL united in praising the effects of narceine in whooping-cough and chronic bronchitis with hypersecretion. Narceine, C,H,,NO,, is one of the alkaloids of opium, but exists in it to a very small amount, at most not over 0.02 per cent. Most investigators agree that in its action upon man it resembles morphine, but is milder and causes no excitement. CLAUDE BERNARD first called attention to it by his assertion that it was a safer and more agreeable drug than morphine, but had about the same sedative and anodyne effects. Narceine was carefully tried by several Philadelphia physicians, some fifteen years ago, and they concluded that it was almost inert, even in doses of from one to five grains. FRONMULLER states that he has given twenty grains with no effect. On the other hand, many Continental physicians (RABUTEAU, BEHIER, DEBOUT, EULENBURG, LINE, and LABORDE) have found that in doses of one-half to one grain it causes quietude and sleep.

The testimony heretofore has been so conflicting that doubts have arisen as to whether the same alkaloid has been used. M. LABORDE now says that a very easy test of its purity is to add to the solution a drop of muriatic acid, when a beautiful blue color is produced.

Surprisingly quick results in whooping-cough have been observed by the French physicians above mentioned. The best mode of administration is to make a solution in syrup, so that a teaspoonful represents one centigramme of the drug. This is the minimum dose for children, the average dose being from two and one

THE TOPICAL APPLICATION OF VIBURNUM PRUNIFOLIUM IN THREATENED ABORTION.DR. S. S. TODD, in the Kansas City Medical Record for July, in an article on the Treatment of Miscarriages, commends the topical use of viburnum prunifolium.

66

He says: Witnessing the good effects of the drug when given by the stomach, I was led a few years since into its use in threatened abortions by introducing into the vagina on cotton a mixture of the fluid extract of the drug with glycerin. The proportions used are one ounce of the fluid extract to two ounces of glycerin. A roll of hygroscopic cotton large enough to fill the vagina, to which a thread for removal has been attached, is properly wetted and introduced by the patient herself, being pushed well back with the finger against or in close proximity to the cervix.

The cotton is not worn during the day, but is inserted in the evening before retiring for the night and removed in the morning. The advantages of using the drug in this manner must be apparent, especially in cases where the provoking cause of uterine contraction is in the neighborhood of the cervical canal, or about the os externum. In this way I have succeeded in two or three cases, which at first sight seemed almost hopeless. In one case the woman had already miscarried four times, at three and four months, and was now in her fourth month, and bleeding profusely. She was placed upon her back for two weeks, and the use of the cotton tampon continued till the close of the fifth month. She was delivered at full time of this, her first living child. Where the case seems to warrant it, a fluid ounce each of fluid extract of viburnum and tincture of opium may be combined with four ounces of glycerin, and used in the manner given.

SALICYLATE OF COCAINE IN ASTHMA.-A comparatively new method of treatment in asthma nervosum has lately been tried by PROFESSOR MOSLER, of Greifswald. It is now well known that cocaine has not only a local action on the sensory nerve-endings, but also a central one, which, at first stimulating to the nervecentres, may, if the drug be pushed, become sedative or even narcotic. By this peripheral or central effect, it may, therefore, act in such spasmodic diseases as asthma. Early last year, BESCHORNER published two cases of this disease which were much benefited by cocaine. In three cases PROFESSOR MOSLER has obtained excellent results. All these cases occurred in young people of 23 to 25 years of age, and were uncomplicated by any organic heart- or lungdisease. The drug was given subcutaneously, in doses of 0.4 gramme, at the commencement of the attack. The first patient, who had a bad family history as regards lung-disease, and in whom the asthma had lasted 11 years, was relieved after the third injection; two more doses caused abeyance of the attacks (which occurred previously every day) for a fortnight, when the patient was lost sight of. In the second and third cases, the treatment was more

rapid in cutting short the attacks, which in the end were postponed for the three or four weeks during which the patients continued under observation. The injections caused, in one case, a slight sense of faintness and the appearance of dark spots before the eyes; but these sympsoon vanished. It is, of course, impossible to draw from these cases any conclusion as to the permanent benefit of the treatment. Extended experience will perhaps show that the drug is only a palliative. It is in the hope of inducing other practitioners to try the treatment that PROFESSOR MOSLER has published the results of his cases.-London Lancet.

แ

THE ABSORPTION OF LANOLIN COMBINED WITH MEDICAMENTS.-In a preliminary note in the Russkaia Meditzkina, No. 12, 1886, p. 207, quoted in the London Medical Record, DR. L. K. PAVLOVSKY, of Kharkov, writes that his experiments with Liebreich's lanolin (first in Russia) enables him to arrive at the following conclusions: 1. Narcotic extracts, when combined with lanolin, are absorbed by the skin "very satisfactorily," their pain-relieving action being obtained with an almost perfect certainty." The dose used was only twice as large as that for internal use. 2. Hydrochlorate of quinine is absorbed also very easily. This statement is based on four cases of intermittent fever in children, where lanolin and quinine inunctions rapidly gave the effect desired. 3. When a lanolin ointment, with iodide of potassium is rubbed in, iodine appears in the urine not sooner than two, four, or six hours after inunction, while LASSAR obtained iodine from the urine some three minutes after friction. In children, lanolin is better absorbed than in adults. 5. Washing the skin with ether considerably facilitates the absorption of lanolin ointments. 6. In general, lanolin is a substance which promises to supercede all other constituents for ointments, and even, in certain cases, to render superfluous the internal use of drugs.

4.

AN ANODYNE FOR USE IN VESICAL IRRITATION. DR. W. P. COPELAND, of Eufala, Ala., writes:

"In almost every community there are old men who suffer from enlarged prostates, accompanied with a chronic inflammation of the neck of the bladder, rendering them miserable sufferers and a care and anxiety to their friends and families. Having had the professional care of several of this class of cases, and dreading the tendency they so frequently incur by the administration of opium for the relief of pain, I resorted to various washes for injecting the bladder, resulting in my adopting a solution of benzoate of soda, ten grains to one ounce of water, with twenty to thirty drops of the green tincture of gelsemium; this is warmed and injected by the patient through a soft-rubber catheter, whenever the pain is severe, and the catheter withdrawn, leaving the medicine to be voided in twenty or thirty minutes; or where they are not able to pass anything from the bladder, the catheter is reintroduced and the medicine allowed to escape. My experience with this treatment has been so satisfactory

that I cannot refrain from giving it publicly to the profession."-Med. Record, July 17, 1886.

SPARTEINE AT HOME.-DR. THOMAS H. BUCKLER writes as follows to the Boston Medical and Surgical Journal of June 30, 1886:

The expensive sparteine lately recommended by GERMAIN SEE for cardiac weakness, is prepared from Scotch broom-spartium scoparium -the Planta Genista or emblem of the Plantaganets, which grows in many parts of the thirteen original States, on sterile soil. It was brought over here by the Scotch and English to prevent the washing of gravelly roads and gutters. It should be cut and gathered at this season, and dried like hay. Its active principle is extremely soluble in water, and two ounces of ground or contused stems to a quart of boiling water, a wineglassful for a dose, every eight hours, are equivalent to a grain and a half of the prepared gum used by DR. SEE. This remedy is useful not only in failure of the cardiac ganglia, but as a tonic to the organic and vasomotor nerves in whatever part of the body congestions occur from loss of power in them. I have used this agent in the form of infusion for half a century, and with marked advantage in many cases.-Medical News, July 17, 1886.

TREATMENT OF ASTHMA BY CAUTERIZATION OF THE NASAL MUCOUS MEMBRANE.-At a session of the Berlin Society of Internal Medicine, held May 17, 1886, DR. ZUBLINSKI presented a memoir on the subject above stated. The results obtained in his personal practice may be thus summarized:

He had encountered 143 cases of asthma complicated by diseases of the upper air-passages, in which operative treatment directed to the latter disorders was frequently productive of good results in the chief disease. The cases are classified as follows:

Asthma associated with hyperplastic rhinitis, 55 cases; 8 cured, 3 improved.

21 cases with granular proliferation of the inferior turbinated bone; 6 cured, 4 improved.

11 with similar lesions of the middle turbinate; 5 cured, 2 improved.

9 with disease of the septum and 5 with tonsillar hypertrophy; 2 cured, 1 improved.

28 with various lesions of the pharynx; 3 cured, 1 improved.-Jour. des Sociétés Scientifiques.

slowly warmed, and when dissolved is poured into the grooves and allowed to harden. The smooth part of the instrument is rubbed with glycerine before it is introduced. At the temperature of the body, the ointment melts in one minute.

THE ACTION OF PICHI ON CALCULI.—At 8 recent meeting of the Therapeutical Society. M. LIMOUSIN showed a specimen of pichi, or piché. It was a solanum, to which the Chillians gave that name. It had recently been introduced into France. In its native country it was believed to disintegrate urinary calculi. M. LIMOUSIN prepared a fluid extract of pichi, of which four dessertspoonfuls represented 30 grammes of the plant, the dose generally administered in 24 hours. M. LIMOUSIN believed that piché acted specially on the mucin, which held together the different elements of calculi. and dissolved it and lessened vesical catarrh, in consequence of the resin it contained. M. DrJARDIN-BEAUMETZ Confirmed this statement.

GUACHAMACA TOXIFERA has been examined by ROBERT (of Strasbourg, with the result of proving, to his own satisfaction at least, that this Central and South American plant is the true source of curare, or Indian arrow-poison. DR. ROBERT in this simply confirms the statement of SCHIFFER, made in 1883. The latter extracted from guachamaca, which is one of the аросупасеӕ, a very active alkaloidal poison which he called guachamanine, but which, according to his own statements, appeared to be identical with curarine.-St. Louis Med. and Surg. Jour., July, 1886.

THE INTERNAL ADMINISTRATION OF CHRYSAROBIN IN INFANTILE ECZEMA.-STOCQUART (Monatsch. f. prakt. Dermat., Jan., 1886) reports a number of cases of eczema in children, all of which were treated with small doses of chrysarobin, from a thirtieth to a tenth of a grain, or even a grain, being administered daily. The periods of cure did not exceed ten days. Theoretically, the drug is supposed to exercise a constricting action upon the capillaries of the skin.-N. Y. Med. Jour., July 10, 1886.

GROOVED BOUGIES FOR INTRODUCING MEDICAMENTS IN CHRONIC GONORRHOEA. — CASPER, in the London Medical Record, describes the following method of treating chronic gonorrhoea:

The plan of treatment recommended is the passage of slightly conical nickel-plated bougies, 25 centimetres long, and having six grooves about 1 millimètres deep, which become shallower towards the extremity of the instrument, and end at five centimètres from the point. The grooves are filled with a paste composed of cacao butter 100 parts; nitrate of silver 1 to 1.5 parts; balsam of copaiba 2 parts. The paste is

CASCARA SAGRADA IN DYSPEPSIA.-DR. TSCHELZON (Centrlbl. für die gesammte Therap.) finds that cascara sagrada causes an increased secretion of gastric juice, bile and pancreatie juice, and hence is useful in most forms of dyspepsia.-Western Druggist, July, 1886.

IODIDE OF ETHYL is recommended by DR. BARTHOLOW in the treatment of brain syphilis when a prompt action of the iodine is desired.

Vol. IV.

Original Articles.

THE PROGRESS OF PNEUMATIC DIFFEREN.

TIATION.*

BY HERBERT F. WILLIAMS, M. D., NEW YORK. In the Medical Record of January 17, 1885, is found the first report of the application of the pneumatic cabinet to diseased conditions of the lungs. This process was called Pneumatic Differentiation, and the description was entirely confined to what, in the perfected instrument shown to-day, is the first act, i. e., producing rarefaction in the cabinet about the patient and compelling him to respire the normal atmosphere. The report contains the history of sixty-two cases treated in this manner, seven of which were given in detail, and five there classed as recoveries further appear in my second paper delivered before the American Climatological Association, and published in the New York Medical Journal, October 3, 1885. Further reference to these cases will be made in a clinical report which I shall have the honor to present to the same Association during the present month. It will show these cases remaining in good health up to January of this year, a space of nearly two years in each case, and without further treatment.

DR. HOUGHTON, of Chicago, published a report entitled "Pneumatic Therapeutics" in the Journal of the American Medical Association, November 7, 1885. He advanced some new and ingenious theories suggested by the cabinet in relation to the causes of peri- and inter-vesicular deposits, and reports thirty-four cases of various pulmonary affections, twentyfive of which were classed as phthisis in different stages, four of which in the acute stage recovered and ten improved; three did not improve. DR. JENSEN, the same Journal and date, confirms one of these cases as acute catarrhal phthisis recovered.

DR. E. TIEGEL, of New York, in the Journal of the American Medical Association, in the issue of November 28, 1885, discussed the physiological action of the differential pneumatic process on the circulation. His investigations being made before the present form of cabinet was perfected, he necessarily confined his ex

* Read in the Section on Practice of Medicine at the ThirtySeventh Annual Meeting of the American Medical Associa tion.

No. 16

periments and arguments to the simple act of immersing the patient in rarefied air while breathing the normal air.

The first full description of the cabinet as perfected was give before the Section on Practice of the New York Academy of Medicine, December 15, 1885, by its inventor, DR. JOSEPH KETCHUM, in a paper entitled "The Physics of Pneumatic Differentiation," published in the Medical Record, January 9, 1886. This was accompanied by a paper from DR. E. DARWIN JUDSON, JR., in the same issue entitled "Present Status of the Pneumatic Treatment of Respiratory Diseases," in which he refers to the preceding work in this field, and shows the value and individuality of the cabinet.

In the Boston Medical and Surgical Journal, of July 16, 1885, appears an article from DR. V. Y. BOWDITCH, of Boston, entitled "The Treatment of Pulmonary Diseases by means of Pneumatic Differentiation,"

DR. F. DONALDSON, JR., of Baltimore, in the Maryland Medical Journal, of February 13, 1886, publishes an article entitled "The Pneumatic Cabinet and Pneumatic Differentiation," in which in a postscript he speaks of the cabinet as giving excellent results, and briefly reports two cases. Among other professional publications on the subject, are those of DR. W. EVERETT SMITH in the Journal of the American Medical Association, November 14, 1886, and the Medical and Surgical Reporter, of Boston, February 20, 1886, and DR. HOUGHTON in the St. Louis Weekly Medical Review, January 2, 1886. DR. SIDNEY A. Fox, of Brooklyn, read a paper before the Kings County Medical Society, February 16, 1886, in which he reported sixty-eight cases of pulmonary diseases treated by pneumatic differentiation. Many other papers have been read before County and State Societies, and are now awaiting publication in the official Journals.

In consultation and correspondence with a large number of physicians, I have found that nearly all have been looking for a method whereby we might topically medicate the lungs. In this process that result has been accomplished. MR. KETCHUM has shown that we can not only carry a medicinal agent into the remotest alveolus, but condense it there.* It now remains for patient, accurate and careful inquiry to decide whether such medication is efficacious and expedient. Have we not here *Medical Record, January 9, 1886, p. 31.

a field of immense breadth, and will it be fair to adopt the pessimistic argument that nature seeks by the expanse of turbinated bone, and the protected glottis to warm and purify the air before it meets the delicate membrane where its physiological purpose is subserved.

Our

To offset the argument that to change the humidity or temperature of the air, or to burden it with foreign matter would seem illogical and impracticable, we have, first, the result of clinical evidence; second, analogy. practical experience teaches us that the pulmonary mucous membrane and deeper tissues tolerate invasion without serious disturbance. We know how readily water is absorbed by the lungs in conditions of partial drowning. Effused blood with its various inflammatory products, may not itself occasion disturbance by its physical presence in the deeper pulmonary tissues excepting so far as it excludes air. Nothing that prudence could suggest as a remedial agent could be any more irritating than the decomposed and ichorous discharges that sometimes bathe the inter-pulmonary surfaces. Analogy shows that surgeons have for years been disregarding the physiological function of a part when disease demands interference. The serous membranes and cavities have been invaded and washed with the most irritating agents. Every mucous tract of the body has demonstrated its tolerance of violence. But it may be asked what is the effect where an agent applicable to a diseased pulmonary area is inevitably introduced into areas remaining in health? There is nothing in this question that exclusively applies to this process. Would not many of our surgical operations give doubtful evidence of our mechanical skill if kind nature did not endure, forgive and repair? When the head throbs with fever that is threatening life, do we hesitate to give an agent of the power of quinine in antipyretic doses? For a remote ache or pain is it not sometimes necessary to narcotize the entire nervous system?

Since the days of SIR JAMES Y. SIMPSON, MCDOWELL and MORTON, have we not chilled the inter-pulmonary tissues with chloroform and ether, and though as I believe by so doing we invite congestion, does it deter us when the greater necessity arises?

Again, is there anything ethereal about the pulmonary tissues that prohibits an effort to cleanse and disinfect? Indeed, in some cases it seems as though the process of repair in pulmonary tissue is as rapid as in the scalp or tongue, and perhaps for the same reason. There is a great diversity, or I may better say, confusion in the professional mind as to whether Koch's bacillus is the cause or concomitant of tubercular disease. Certain it is that a few well-known agents are capable of destroying these organisms. It is, moreover, certain that in every case of phthisis in which they are

found serious progress has been made or violent symptoms continually threaten.

There must have been a time in the history of a given case, when lung tissue rendered cogenial for the lodgment of its bacterian enemy received its first impregnation. Could we ascertain this period? Can we imagine any surer method of extermination than to introduce at the seat of lodgment a well-chosen germicide" Would we care then if the adjacent tissues were sterilized? Indeed, I think I have already demonstrated,* that by the differential pneumatic process it is possible to save healthy lung tissue from tubercular infiltration.

It is then desirable to have in our power a means by which we can medicate the lungs, and with the conviction in my mind that amounts to a certainty, I neither shrink from the possibilities of therapeutic error nor grow discouraged, because in a given case the relation between the extent of disease and a well directed remedy is insurmountable. I have certainly more than once secured results which could only be fully explained consistently with the hypothesis that a thorough and prolonged course of antisepsis had by coincidence, rather than calculation, been instituted at the time when tubercular germ life, though present, had not established an impregnable foothold. When from the contemplation of this hypothesis I refer to the constant progress of scientific inquiry. and especially the recent developments on biological analysis, I desire to record the prediction that at no distant day a system will be developed and adopted, whereby we can cer tainly sterilize a pulmonary area, and gain the mastery of tubercular disease to a degree hitherto thought chimerical. However remote the hope thus expressed, it surely affords encouragement to those advanced investigators who systematically employ the microscope as an aid to diagnosis. This method will also detect the early manifestations of grave diseases and will fortify our diagnosis against heretofore unanswerable accusations of unwarrantable conclusions.

Its

The pneumatic cabinet as a mechanical device, independent of its ability to convey a remedial agent to diseased pulmonary structure, and condense it, is itself a factor of no small moment as a salutary measure. capacity to increase expansion, to thoroughly aerate the blood, and to thereby promote assimilation and functional activity is attested by the uniform experience of those who have ob served its effect.

In patients where the correction of faulty frame developments or distortion is retarding health, this may alone confer all the benefit required. In certain conditions of instituted disease, such correction may render cure or im

* New York Medical Journal, October 3, 1885.