injection of cocaine, the dose increasing until 1⁄2 a gramme, and even o of a gramme, was taken secretly daily. This produced loss of appetite, great irritability, ringing in the ears, and, from time to time, dyspnea and hallucinations of sight and hearing. These unpleasant symptoms the patient had learned to relieve by injections of morphine until he became skilled in the antagonistic use of the drugs. An attack of herpes and its neuralgic pains drove him to double his doses of cocaine until for two or three days he took a gramme, and at times 1/2 grammes daily. Then followed a condition very like delirium tremens, -tremors, lack of muscular tonicity, incontinence of urine, alterations in the nails of the fingers and toes, the greatest agitation, severe hallucinations of sight, hearing, and smell, injected conjunctivæ, a staring expression. He fired a pistol at imaginary objects, attacked his servant, and was finally placed under hospital restraint. Here he soon recovered under morphine injections of 5 centigrammes, three times daily.

RARE LESIONS PRODUCED BY BROMIDE

OF POTASSIUM.

At a recent meeting of the New York Pathological Society (N. Y. Med. Journ., November 13, 1886) DR. R. W. AMIDON presented an epileptic young woman, who had been under his care four years, taking moderate doses of bromide of potassium, - perhaps never more than 4 or 5 drachms a day. A little over a year ago she discontinued it, but recently he learned that she had been taking during the past eighteen months a mixture of the bromides amounting to 6 drachms a day. She then returned to him, and he found the ordinary acne on the face, which, although usually confined to the face and neck, perhaps occasionally reaching to the chest and shoulders, had in this patient, as in two others whom he had seen, invaded the legs, and assumed almost the pustular form. The lesion began in the ordinary way, but became indurated with rather a large base, and ran a chronic course, breaking down and forming what appeared to be a small ulcer. Vesicles, with contents which tended to become cloudy and purulent, formed in rings about the acne spot. After a time the centre of the spot took on a reparative process, and entirely healed, while the pathological changes at the periphery spread, and the vesicles became purulent, dried up, and formed a brownish scab. A section of one of these spots showed

that there had not been a true ulcer, but that the skin had simply been denuded of the cuticle, leaving the papillæ intact. He had in no case seen the true skin indurated. The disease did not seem to depend particularly upon the amount of the bromides given. The only treatment which he had seen do good was the thorough application of the actual cautery.

NEW HÆMOSTATICS.

BONAFOUX recommends the following powder, whose use in the human subject and in experiments on animals has resulted in the prompt checking of bleeding, and the rapid

obliteration of the vessel afterwards:

Colophonium,
Gum-arabic,

Charcoal, in equal parts.

DR. SPARK has used in his operations about the mouth and throat chloroform and water, in proportion of two to one hundred.

As a simple gargle, especially after the removal of tonsils, it has been very satisfactory. As a hæmostatic douche, it acts promptly, and does not impede the work of the operator.— Pharmaceutische Post, October 30, 1886.

NOTE ON THE TREATMENT OF THREAD

WORMS IN CHILDREN.

The complete cure of thread-worms in children is often very difficult. While the ordinary methods used, such as rectal injections of salt and water, infusion of quassia, and other remedies, do good for a time, yet they often fail to relieve the attendant symptoms of "worms," symptoms usually very irregular, and in some cases severe, in character. In many cases, though the irritation about the anus is relieved by injections, the irregularity of the bowels and the disturbance of sleep remain the same. This is probably due to the fact that the habitat of the worms is higher up in the large intestine, where no remedy introduced by the rectum can reach them.

In many cases DR. SIDNEY MARTIN (Practitioner, October, 1886) claims to have found that rhubarb in small doses brings away large numbers of worms, and at the same time regulates the bowels, so that the use of injections may in most cases be dispensed with. The formula which he has found most useful is as follows, varying slightly with the age of the child:

METHYLAL.

Attention has been called by SIGNOR PERSONALI (Nouv. Rem., October 15, p. 459), of the Pharmacological Institute of Turin, to the possible value as an anesthetic and hypnotic of methylal, a compound which was first obtained nearly half a century ago, but has hitherto remained without application. Methylal is represented by Roscoe and Schorlemmer ("Hist. Carb. Comp.," p. 195) as having probably the constitution CH2(OCH3)2. It is prepared by distilling methyl alcohol with an oxidizing mixture of manganese dioxide and sulphuric acid, and treating the distillate with potash lye to separate methyl formate, which passes over with the methylal. The methylal is a very mobile, volatile, colorless liquid, sp. gr. 0.3551, boiling at 42° С., and slightly reddening litmus-paper. It has an odor recalling those of chloroform and acetic ether, and a burning aromatic taste, but produces à sensation of cold when placed on the skin. When injected subcutaneously into dogs in the proportion of 0.10 to 0.15 per cent. of their weight it quickly produced anæsthesia, followed by a deep sleep, in which reflex action was suspended. Rabbits were not quite so susceptible. Recovery was rapid in consequence of the rapid elimination of the methylal, which did not appear to leave any disagreeable after-effects. It augmented slightly the heart-beats, lowered slightly the blood-pressure, and caused the respiration to become slower and deeper. Signor Personali has found methylal also to be an antidote to strychnine, a small quantity being sufficient to suspend the tetanic spasms. In the human subject it is said to relieve nervous pains of the stomach when administered as a draught, and in the form of an ointment or liniment to constitute an excellent anesthetic. Seyeral formulæ are given, among which are a liniment (oil of almonds, 35 grammes; methylal, 15 gr.), an ointment (lard, 30 gr.; wax, 3 gr.; methylal, 5 gr.), a "potion" (syrup of red currants, 40 gr.; methylal, 1 gr.; water, 110 gr.), and a syrup (methylal, 1.5 gr.; simple syrup, 100 gr.).- The Pharmaceutical Journal and Transactions, October 30, 1886.

THE PHYSIOLOGICAL ACTION OF ACETO

PHENONE.

DR. MAGNIAN denies the hypnotic effects which others have ascribed to this drug. The author gave an animal a toxic dose, with the following effects: lessening of ar

terial tension, acceleration of pulse and respiration, which became slow as the stage of intoxication became advanced.

No great alterations were observed in the gases of the blood; the amount of oxygen especially is not lessened, while the amount of urea excreted is greatly lessened. -Revue de Médecine, November 10, 1886.

Uses of HYOSCYAMINE.

An interesting discussion took place before the meeting of the New York Neurological Society on October 5, which we reproduce as reported by the New York Medical Journal of November 13, 1886:

The president, DR. C. L. DANA, stated that there were two preparations of the drug, the crystalline and the amorphous. The former seemed to be similar in property to the opiates, while the latter seemed to have neurotic properties. He had heard that hyoscyamine was employed in the asylums for the insane in New York, but not very successfully; whereas in the asylums of Pennsylvania its success had been marked. He had employed hyoscyamine in paralysis agitans, in chorea, and in a few cases as a hypnotic, and it had been employed as a hypnotic to a considerable extent in his service at Bellevue Hospital. The number of cases of chorea in which he had used it was six; in three it was noted to have been of benefit, or to have caused very rapid or very marked improveOne of the cases was marked, and had not yielded to other treatment. In three cases the results were very doubtful. He had employed it in four cases of paralysis agitans, -in two, he thought, with unquestionable benefit. In two it seemed to produce no benefit. On the whole, he thought that, unless given at rather an early stage of paralysis agitans, it did no good. The form employed in chorea and paralysis agitans was the crystalline, but he was not sure that the amorphous form would not be the better preparation in such cases. He thought we could get along perhaps as well without as with hyoscyamine.

ment.

DR. B. SACHS's experience with hyoscyamine had not been very extensive, but he had employed it in a few cases of paralysis agitans, acute mania, and the insomnia accompanying the neurasthenic condition. He had employed only the crystalline form. In contradistinction to what the president had said, that it was best to give it in the early stage of paralysis agitans, he remembered one case in which every other therapeutic agent had been tried without success, when hyoscyamine was administered in about To of a grain doses twice a day, with the effect of making the patient very much more comfortable, and of diminishing somewhat the annoying movements of the hand. In another chronic case it had been of no benefit. He had obtained no effect from the drug in allaying the excitement of acute mania. It had also been disappointing in insomnia accompanying neurasthenia. It seemed to be of more value against insomnia from mental restlessness.

DR. W. M. LESZYNSKY said that about eight years ago it was quite fashionable to use hyoscyamine in asylum practice, and he had employed it in chronic mania, acute mania, and epileptic forms of insanity. First he used the amorphous form, and afterwards the sulphate. It had been said that the latter form was easier absorbed, and produced its effects in smaller doses. The sulphate was also preferred for hypodermic use, in which manner he had employed it in of a grain doses. To patients with recurring attacks of maniacal symptoms the drug was given a few days before an expected attack, and continued until the attack was aborted. In a state of exhaustion he would regard hyoscyamine as a dangerous drug to administer; but where there was no objection to its use on that ground, he had known it to produce sleep where chloral and morphine had failed. Given to patients subject to epileptoid convulsions before menstruation, it had seemed to avert the attack. He had given it in small doses in two or three cases of chorea, and thought it produced some benefit.

DR. GRAY had been using hyoscyamine ever since it had been introduced to the profession, and he must say that for certain purposes there was no drug that he could not better afford to dispense with. The most convenient form was in tablets, of a grain each. In some people hyoscyamine would produce seemingly serious retention of urine. It might also produce disastrous results if given to persons whose general strength was below par. In an old gentleman with atheromatous arteries, hypertrophied and feeble heart, Too of a grain had caused a condition of collapse. He knew of one patient suffering with melancholia whose death had been hastened by it. He had given it in two cases of chorea, one being an exceedingly violent The child finally died in a convulsion. To that patient he could never give a

second dose of hyoscyamine, because of the alarming prostration which a first dose would cause. In another case, in which the child had to be held in bed, the drug proved an effective means of restraint, but the child was always found prostrated to a marked degree the next day. In paralysis agitans it had been very useful, and its use had come to be with him a routine treatment. He thought the reason why it had been of more benefit in his practice was that he combined with it some stimulant or tonic to prevent its depressing effect. He gave with it good food, 1 or 2 grains of quinine a day, and sometimes alcoholic stimulants. He had satisfied himself that it was the hyoscyamine in this treatment which had a restraining effect upon the movements in paralysis agitans. But it was especially in cases of mental trouble that hyoscyamine was of great benefit. In insanity with hallucinatory symptoms, especially in the early stage before the patient could be taken to an asylum, hyoscyamine would do much towards restraining him, and, it would seem, aided in cutting short the disease. He was very careful to give no more of the drug than was absolutely necessary, and he combined it with bromide of potassium, which increased its effect. He had never seen a hypnotic effect from hyoscyamine.

DR. THOMSON's experience with hyoscyamine, almost from the beginning, had rather prejudiced him against it. One of the first cases in which he had employed it was that of a judge troubled with insomnia. The next day he was unable to hold court, and had bladder symptoms, etc. He had found it useful in asthma with considerable dilatation of the right side of the heart, without bronchitis, but a congested state of the lungs. He had employed it in facial neuralgia, headaches, and various neurasthenic conditions, but had nothing definite to say about its effects. One patient with paralysis agitans was benefited by it among many with whom it was a failure.

DR. KELLOGG had used hyoscyamine in cases of mental excitement. It had not proved the sedative he had supposed it would, but it controlled muscular excitement. He had failed to get any hypnotic effect from it. He had not been favorably impressed with its after-effect in acute mania.

DR. H. S. HINKLEY had found it serviceable in allaying maniacal excitement.

DR. RICHARDS had given from 5 to 7 drops of a one per cent. solution in several cases of insomnia, without effect.

THE INFLUENCE OF FLUIDS UPON THE TEMPERATURE OF FEVER

PATIENTS.

GLAX has observed, in long clinical experience, that the consumption of abundant fluids by fever patients is followed by a rise of temperature. A retention of fluids follows their ingestion, and the lessened vascular tone and the slow capillary circulation result in a free oxidation of individual cell-elements. This occasions a rise in temperature, which ends as the fluids find exit through the kidneys.Medicinisch-Chirurgische Rundschau, December 1, 1886.

THE TREATMENT OF VARICOSE VEINS BY INJECTIONS OF CARBOLIC ACID.

been made, and great care should then be taken not to remove it suddenly. The circulation should only be permitted to return by very slow degrees. For at least a week after the operation the patient should not assume the erect position, or put his foot to the ground for any purpose whatever. The pain is very slight; besides that of the pricks of the needle, a burning sensation is felt at the seat of each puncture, lasting for ten minutes or less, and even this is not severe. Certainly no anesthetic is required. Care should be taken that the subcutaneous injection syringe and needle are "surgically clean," and to insure this they should have been placed in a I in 20 carbolic lotion for about twelve hours previously to use. The author has done as many as eighteen injections in one case, and it seems advisable to begin with the injection next to the elastic bandage; that is, the one highest on the limb. Getting the point of the needle well into the vein is not quite so easy a matter as might at first appear; at

ever.

The treatment consists in the injection of one minim of pure carbolic acid at different situations into the enlarged veins, having previously cut off the circulation from the limb by means of an elastic bandage placed above the highest point of puncture. For the latter purpose the tube of an Esmarch's apparatus is best, but a Martin's bandage or two or three yards of elastic webbing will do excellently. Before operating the patient should be directed to stand erect or to sit on the edge of his bed, with his heels on the floor, for about two minutes, in order to allow the veins to become distended. The Esmarch tube should then be passed around the thigh one and a half times, sufficiently tight to stop the superficial venous circulation, and a little time (about a minute) given for the vessels to become well filled below it, the remainder of the tube being then applied so as to cut off all circulation from the limb. Injections of pure carbolic acid, I minim each, are then made into the veins at about one inch and a half apart, as many as may be required for each case. A little pledget of absorbent carbolized cotton-wool is placed over each puncture as the needle is withdrawn, and well soaked with collodion. This is allowed to remain until in the course of time it falls off, when healing will usually be found completed. The elastic bandage cutting off the bloodsupply should not be removed in less than fifteen minutes after the last injection has

quently fail, and the injection is thus made into the surrounding tissue. The best plan is to fix the skin over the vessel by means of the left thumb, close below the point selected for puncture, and to direct the needle through the skin and coats of the vein in the long axis of the latter. Mr. Stevenson thinks that in his cases somewhere about ten per cent. of the punctures caused suppuration, a little abscess about the size of a pea forming where this occurred; but this process, as the result of the caustic action of carbolic acid, was curiously slow and almost absolutely painless. Three of his cases were done to remove the cause of varicose ulcers of the leg, which had been healed over and over again by rest in bed and different means of local treatment, but which had broken out afresh on the patient's commencing to get about again.

PATHOLOGY AND THERAPY OF FEVERS.

PROF. FINKLER considers that by our studies of the nervous system, by the large number of agents which depress temperature, and from our knowledge of infection we are able to form a reasonable hypothesis regarding the phenomena known as fever. It is proven that the heat-producing and regulating mechanism of the body is at fault; and he considers that the three stages of the fever's development are especially instructive, as throwing light on its subsequent course.

The writer believes that Pflüger's labora