M. Sig. Give one teaspoonful every three hours until delirium abates, then to be continued every six hours, to keep the patient quiet and procure sleep. The medicine acted like magic in controlling the mania; it was continued eight days (to the fifteenth of the disease), when a new phenomenon appeared-a small ecchymosed spot on each foot, on the instep, about the size of a nickel five-cent piece. The spots appeared to have been bruised by the points of the thumbs of the hands of the nurse, who had been bathing his feet. At that time I gave it no further thought. In the afternoon of the same day was called in a hurry; found the patient sinking and very weak. The spots on the feet had spread to the knees, having the look and smell of gangrene of the dermic tissue. I gave stimulants and antiseptics internally; applied smart-weed, steaming hot, to the extremities to arouse the circulation, the application to be renewed every hour till the parts should become warm; then the smart-weed to be taken off and a poultice applied, composed of linseed meal, prepared with a decoction of fresh roots of the baptisia tinctora as strong as could be made, to be removed as often as every two hours, while there was any of the cadaverous smell or dark color remaining. I called next morning; patient was much improved in every way; the extremities were warm; the color nearly all removed, except a slight orange tinge on the limbs, and a slough of the derma on the instep of each foot about two inches in diameter. I concluded that the gangrenous condition was the sequel of the long-continued use of the ergot, so I promptly discontinued it, and prescribed antiseptic tonics. The patient rapidly improved and made a good recovery. My object in presenting the above case is twofold: First, the use of hydrobromic acid, with ergot, in controlling cerebral excitement and mania, which it appears to control with certainty and promptness equaled by no remedy now known. Second, the danger of its long-continued use in producing capillary congestion and gangrene, as in the above case.

I have given as briefly as possibly the main features of the case, and, in conclusion, will only say that, in controlling all cerebral excitement and, determination of blood to the brain,

even in concussion, I have found no remedy equal to the above prescription in any and all cases where the "regular" would use his lancet.

CONCENTRATED EXTRACTS.

PRACTICAL MEDICINE.

"Pilocarpin in Intermittent Fever" is the title of a contribution which in preciseness of statement and sterling merit ranks very high. Dr. G. Griswold publishes in the August number of the New York Medical Journal his results on this topic. He calls attention, first, to some of the peculiarities of malaria not heretofore unknown, but often lost sight of. One of these observations is quite worth while reproducing, namely, that some periodic disorders, evidently due to a previous malarial infection, may be recognized by the use of the thermometer. Such annoyances as periodic headache, cachexia, and so on, sometimes depend upon a renewed outbreak of intermittent fever, not recognized as such by the patient, on account of the lack of other subjective symptoms.

The results with pilocarpin may be stated in the author's own words, which seem to us well-justified conclusions from his observations: I. The muriate of pilocarpin, administered hypodermically, will promptly cut short the chill of malarial intermittent fever. II. In a large proportion of cases so treated, the paroxysm aborts, terminating in the sweat caused by the pilocarpin, there being no hot stage. III. Such an abortion of a paroxysm is in itself sufficient to effect a cure in many cases. IV. Such abortion of a paroxysm is a valuable adjuvant to treatment with quinine during the intervals. V. A dose of pilocarpin sufficient to produce this effect acts gently, without causing exhausting diaphoresis or unpleasant ptyalism. VI. The promptness with which an adequate dose of pilocarpin interrupts a chill is suggestive of its possible efficacy in cases of pernicious intermittent fever, where prevention of the full development of a paroxysm is often of the first importance. In six cases on which these conclusions were originally based, the injection was made during the chill. In five of

them the paroxysm was at once aborted. In the sixth instance, a very large man, the usual dose, one-fifth of a grain, produced neither sweating nor did it influence the chill. "In seventeen cases, pilocarpin was given before the chill. In five of these, the medicine was administered hypodermically; diaphoresis resulted in from two to five minutes, and in every case, the chill was prevented. In one of these cases a second dose was required two days afterward, which was again successful. Quinine was given in three instances, in small doses, (3 to 5 grains three times a day). In the twelve remaining cases, the muriate of pilocarpin was given by the mouth. In two instances, the medicine failed to act, no diaphoresis being produced; in these cases, the impending paroxysms were not prevented, but went through their usual course. In ten instances, diaphoresis, more or less marked, resulted in from ten to twenty minutes after the pilocarpin was taken; in all these cases, the paroxysm was averted. In three of these twelve cases, including the two in which no diaphoresis was produced, it was found necessary to use pilocarpin again. About half of the twelve patients took quinine."

The author is in favor of the hypodermic method, using onefifth to one-sixth of a grain, according to the size of the patient. By the mouth, as much as one-fourth of a grain may be necessary. In a large experience based not merely upon those cases referred to, he has seen that the effect depends upon the diaphoresis produced. Hence he assists the sweating with warm coverings and warm drinks. He has also observed that the more the sweating is encouraged, the less salivation occurs. He does not exclude quinine from the therapeutic plan, but places his immediate reliance upon pilocarpin, which need only be given when the prodromata of the attack are felt. No good results seem to follow the administration of pilocarpin during the hot stage. In some cases, the diaphoretic treatment succeeded when quinine had failed. the words of the author, "vague and ill-defined malarial manifestations, headaches, neuralgia, etc., are very successfully treated by the administration of pilocarpin a few minutes before the time for their occurrence; the effect will be most

In

satisfactory, when the disturbance in question is attended with some rise of temperature, and is distinctly periodic."-Chicago Med. Rev.

REMEDIES FOR HEADACHE.

The following recipes and suggestions for the treatment of different forms of headache are collected from a variety of trustworthy sources :

Two grains citrate of caffeine, in capsule, taken every halfhour, is a very effectual remedy in nervous and sick headache. One or two doses are often sufficient to give complete relief. The only objection to its use is sleeplessness, which sometimes results if it is taken in the evening. It is preferable to guarana as being hardly ever rejected by the stomach.

The following, according to Dr. W. W. Carpenter, is very effectual in most forms of headache:

Muriate of ammonia, 3 drachms; acetate of morphia, 1 grain; citrate of caffeine, 30 grains; aromatic spirits of ammonia, 1 drachm; elixir of guarana, 4 ounces; rose water, 4 ounces. Mix. Dessert spoonful every ten or twelve minutes.

In nervous headache, Dr. W. A. Hammond states the value of various drugs as follows:

Oxide of zinc is of great value. Ordinary dose, 2 grains three times a day, after meals; maximum dose, 5 grains. It is best given in form of pills.

Nux vomica is preferable to strychnia. The dose is grain, after meals. If the patient is chlorotic, it is well to combine a grain of reduced iron and grain sulphate of quinine.

Bismuth, in the form of subcarbonate, will often take the place of oxide of zinc. Dose, 2 grains, after each meal. Bismuth probably aids digestion more than any mineral tonic, and is of use when there is gastric disturbance.

The bromides are serviceable when the nervous system has been irritated; when it is exhausted, they do harm.

Phosphorus is very useful in most forms of nervous headache. The best results are obtained from dilute phosphoric acid, in doses of 30 drops, largely diluted, three times a day, after eating, or phosphide of zinc, grain, in pill, three times a day.

Arsenic, as a nerve tonic, stands next in value to zinc. Dose, 5 drops, three times a day, after meals.

Galvanism is sometimes valuable, but by no means a specific. The constant current should always be used, being careful to avoid too great intensity, lest amaurosis be produced.

Dr. T. Lauder Brunton, editor of the London Practitioner, says:

The administration of a brisk purgative, or small doses of epsom salts, three times a day, is a most effectual remedy for frontal headache when associated with constipation; but if the bowels be regular, the morbid processes on which it depends seem to be checked, and the headache removed even more effectually, by nitro-muriatic acid, diluted, 10 drops in a wineglass of water, or bicarb. soda, 10 grains, in water, before meals. If the headache be immediately above the eyebrows, the acid is best; but if it be a little higher up, just where the hair begins, the soda appears to be the most effectual. At the same time that the headache is removed, the feeling of sleepiness and weariness, which frequently leads the patient to complain that they rise up more tired than they lie down, generally disappears.

A writer in the London Lancet remarks:

At the Middlesex Hospital, female patients who have suffered many years from sick headache, evidently of an hereditary character, have been greatly benefited, if not cured, by the administration of ten minimum doses of tincture of Indian hemp, three times daily, between the attacks. This is well worthy of trial in those cases of never-living, ever-dying, martyrdom-like suffering.

In headache due to determination of blood to the head and in fever, the following simple treatment is to be commended :

Put a handful of salt into a quart of water, add an ounce of spirits of hartshorn and half an ounce of spirits of camphor. Cork the bottle tightly, to prevent the escape of the spirit. Soak a piece of soft cloth with the mixture and apply it to the head; wet the rag fresh as soon as it gets. heated.