remedy in cholera morbus, cholera infantum, diarrhoea, dysentery, or any looseness of the bowels, or in tendency to vomiting from any cause, and it has, as yet, never failed me in a single instance. About the middle of last summer, I had a little patient, two and a half years old, who suffered from the most obstinate diarrhoea I have ever met with. This diseased condition had existed for four weeks when I first made trial of the coto. I prescribed half-drachm doses of the elixir every hour, and, the same evening, was informed that the child was well. The cure was permanent. I then kept a record of the first dozen cases, which I here give: Mamie Welch..... 2 yrs. Dysentery..... Mrs. Welch...... Mr. Welch....... 26 30 3 wks.. 4 d'ps "Cholera morb 36 hrs.. 15 66 "Cholera morb. 12 66 15 66 Willie Simonds... 11 mos. Cholera infan. 66 3 66 Frank Small...... 28 yrs. Cholera morb. 12 12 12 15 66 15 Fred Stimel.. 3 66 25 Cholera infan. 8 10 28626624222 12 66 15 66 15 26 15 Mrs. Small. Mr. Saunders..... 28 Mrs. Saunders... 30 Diarrhoea...... "Hepatitis..... The case of Mrs. Stimel was complicated, with inflammation of the stomach and a constant tendency to vomiting, which was almost immediately overcome by the coto. In the case of Mrs. E- an overdose was taken by mistake, and the effect of the remedy was almost toxical, lasting for several days, and most effectually locking up the secretions. My experience leads me to differ from those who state that there are no injurious effects from an overdose. In a case of perforation of the intestines from a stab, where there was a strong tendency to vomit, from the combined effects of morphine and improper food, ten-drop doses of the elixir of coto quickly relieved this condition. This remedy appears to me to be a nerve sedative. In large doses, it paralyzes. In the case of Mrs. E, four hours. after the second overdose, there was inability to sit, or hold a saucer; also, intense pain in the back and head, eyes nearly closed, and she was scarcely able to articulate. In all forms of laxness of the bowels or vomiting, this remedy has proved a specific, relieving these morbid conditions in a remarkably short time. SELECTED. Cascara Amarga-Bark Honduras-Genus PicramniaA New Alterative Tonic. BY PROF. A. ATKINSON, M. D., BALTIMORE, MD. About four years ago, a sample of bark was sent from Mexico to a gentleman in Baltimore City, with the request that he would try it himself and give it to some of his medical friends here so as to get their views of its mode of action. The decoction of the bark had been found very efficacious in the treatment of scrofulous and syphilitic diseases in the tropical section where it was gathered: A fluid extract was prepared and distributed to a limited number of physicians, some of whom administered it with good effect in the above-named affections. After considerable delay, samples of the bark of the tree and of the leaves were procured, together with a description of the tree, its growth, its whereabouts, etc. The bark, taken at random from some of the samples, as seen at this writing, is firm and heavy, of a brownish-gray color, in some specimens the brown predominating, though we find all the shades of light and dark brown, dashed now and then with a grayish silver hue. The outer layer of the bark is striated and much divided up by longitudinal fissures. The true or inner bark of the trunk varies from one-quarter to three-eighths of an inch in thickness, while that of the branches thins down to the thickness only of writing-paper. The freshly cut edge of the dried bark is hard, and of the color of liquorice powder, while the color of cut bark after being softened in water has a greenish-yellow tint. The fibers of the cut bark are as dense as those of the common hickory bark. In taste, the chewed bark imparts a moderate degree of bitterness with a slightly yellow saliva. The pieces of bark vary from five to six inches in length. The leaves are of a dark green-are ovate-lanciform and from one and a half to three inches long, while the greatest width does not exceed one inch. The twigs have alternate leaves and one terminal leaf, rather longer than those on the sides of the twigs. Botanical specimens of Cascara Amarga were submitted to Dr. Vasey, of the Department of Agriculture at Washington, for examination, resulting in the opinion that it belonged to the genus Picramnia, of which there exist some twenty species. Owing to the fact that there is in the Governmental collection but two species, it was impossible to determine the exact variety. The fluid extract was the preparation used in several cases of chronic skin affections, and in the eruptions of the advanced stages of syphilis, more especially in those cases where the pustular variety of syphiloderm prevailed mostly, and where debility was one of the points to which treatment was to be more decidedly applied. In these conditions of debilitated system, the agent had a good effect in restoring the appetite, which in some of the cases was wanting to such an extent that the patient had become enfeebled and nervous, while the chronicity of the disease seemed to have been fully established. In one case especially, great good resulted from the prolonged administration of the fluid extract (for two months) in fortydrop doses three times a day. Here no other agent was used, as the patient's stomach rebelled against such remedies as would naturally suggest themselves. This was a case of gummy tumor of the leg-just over the body of the tibialis anticus muscle, and to the right of the spine of the tibia. This patient was in fair health, but had a very irritable condition of the stomach. His avocation necesHe had one large sitated constant standing at the counter. cicatricial patch on the same leg, just above the seat of the present trouble, as the result of an old gummy tumor, which had softened some years before. The periosteum was tender and somewhat swollen. The patient said that many years before (twelve years at least), he had what physicians called secondary syphilis, though the eruptions were few and no trouble had been observed about his throat. He had suffered with this painful tumor of the leg as much as two months before applying for relief-the pain apparently being augmented from his having to keep the erect position all day. He had applied sundry salves which had been suggested, but all to no purpose. He was put on the iodide of potassium, eight-grain doses, three times a day, to be taken in one teaspoonful of compound tincture of cinchona bark, either in cold coffee or sweetened water. In a couple of days he experienced so much irritation of the stomach that the iodide was stopped. This, he said, had repeatedly injured his stomach. He gave it a fair trial, nevertheless. I then put him on five-grain doses of the iodide of sodium three times a day in the tincture of cinchona bark. This, in turn, soon nauseated him; so, to test the stomach fairly, I directed simply the compound tincture of Peruvian bark, which I found he stood very well, but, as this had no alterative properties, I tried the iodide of sodium again in the fluid extract of Cascara Amarga bark. Again he was nauseated, and I determined to use the fluid extract without the salt. This I prescribed in doses of forty drops three times a day, to be taken in plain or sweetened water. He kept up the fluid extract for two months-using a salve compounded of twenty grains of calomel in one ounce of vaseline, to be rubbed over the tumor. He took about one pint of the fluid extract, and his appetite improved at once during its administration, and his strength correspondingly increased. The gummy tumor was red and painful, and indeed threatened to slough at the time he began the use of the Cascara Amarga, and, though he was constantly on his feet, the redness gradually disappeared, and the pain and heat left entirely. It is now more than one year since he ceased to use the medicine, and there has been no return of the trouble in any way. In this case, there certainly was shown the tonic effect of the drug, while the favorable change accomplished, seems to have been through its alterative influence. A similar case occurred in the person of a young gentleman who had been a victim to secondary syphilis when the writer first knew him, though he did not treat him for many months after. When first seen, this patient had numerous spots on the forehead and arm, of the scaly nature, which is so hard to break up. As he did not apply for treatment, nothing was said to him about it. After some months, however, he did apply for treatment for a large lump on the leg which became very painful, and which, from the intense redness, appeared as if ready to suppurate. On examination, I found the threatened abscess was a gummy tumor over the right tibialis anticus muscle, which for a month past had been very painful. He had been the subject of syphilis about two years before, and had passed through the usual manifestations of secondary stage of the disease on the skin. He had been troubled three months before with a small tumor the size of a hazel-nut on the back of his neck, which had been excised by a physician. Happening to see the tumor before its removal, I thought it gummy in its nature, but gave no opinion, as he had agreed with a physician to remove it. It is well to add, too, that he had some months before suffered from a lump on the leg similar to the one first spoken of, and which had opened, giving him much worry before it healed. At the time he first consulted me, he had several syphilitic tubercles on the front of both arms. I at once put him on a preparation of sarsaparilla and guaiacum with the biniodide of mercury, but he did not continue the mixture long, as some druggist had given him a bottle of the fluid extract of Casara Amarga, with the assurance that it would cure him. This he said he preferred taking to the mercury. He seemed to improve on the Honduras, and as I succeeded in getting an additional supply of it for him, free of cost, he continued it until he had taken a pint. This occurred fully a year ago, and he has had no return of any of the symptoms since. The gummy tumor subsided without suppuration, but remained tender for some time, and even when I saw him, a short time since, he informed me there were two dark spots where the * lumps had been. I feel sure if he had kept up the biniodide `with the Cascara Amarga, his recovery would have been more rapid. |