Abstracts from Exchanges.

Prepared by A. B. Lyons, M. D., Walter P. Manton, M. D., and W R. Chittick, M. D.

OBSTETRICS.

MULTIFETAL PREGNANCY.-A peasant woman, 27 years old; has been married nine years, and has menstruated regularly every three weeks and six days since her 15th year. She has been pregnant six times; labor normal. Menses last seen Oct. 14, 1884. In February, of this year, she applied to a medical man, as the abdomen. had increased so much in size that respiration was impeded. It was ascertained that the uterus was considerably enlarged, of a rounded oval form, with the fundus at the level of the scrobiculus cordis. To the right of the linea alba feeble cardiac sounds were heard; on the left small portions of a fœtus could be felt. The birth of a dead child took place on Feb. 28, at 8:00 p. m.; a few minutes after, a second appeared, both breech presentations; and some minutes later, three more children, with their heads presenting. They were all born enveloped in amniotic sacs. The four last lived a short time. There was one placenta, weighing 585 grammes, to the periphery of which the umbilical cords were attached. All the children were females, and corresponded in size to their period of growth, each weighing about 590 grammes, with the exception of the first, which weighed 934 grammes, and was 41 centimeters in length. Several fingers and toes were missing from hands and feet.

M.

MENIERE'S DISEASE, PRESENT VIEWS CONCERNING. -Lorenz Eckert in a work reviewed (Archives of Otology Sept., 1885,) from a careful study of all reported cases. and fifteen not published, reaches the following conclusions:

I. The semi-circular canals, with their ampullæ, are the organs of the sense of co-ordinate motion, directly for the head and indirectly for the entire body.

2. The localization of sound is determined by binaural power of hearing. The semi-circular canals take no part in this, but possibly exert acoustic functions in other respects.

3. The appearance of the various symptoms of Meniere's disease is in most cases attributable to a diseased state of the terminal apparatus of the acoustic nerve in the labyrinth. It is only in rare instances that these are called forth by pathological changes in the adjoining nerve-centres.

4. Pathological changes in the conditions in the middle ear and in the surrounding structures, producing a change in the intra-labyrinthian pressure may call forth a similar train of symptoms.

5. The symptoms are induced by an irritation of the labyrinthian organs or their nerve centers. Complete destruction of the same seldom calls forth a loss of function.

6. Disturbances of co-ordinate motion may be absent in pronounced chronic or acute affections of the labyrinth.

7. Constitutional diseases, such as leukæmia, epidemic parotitis and tabes, are recognized factors predisposing to the development of Meniere's disease.

OPHTHALMOLOGY.

THE INFECTIOUS GERMS FOUND IN THE LACHRYMAL SAC AND THEIR BEHAVIOR ON EXPOSURE TO ANTISEPTICS.-Prof. Sattler, of Erlangen (Archives of Ophthal.), says he has examined the secretions of twentyeight lachrymal sacs. The secretions were collected with a sterilized platinum instrument and spread upon gelatin. Isolated cultures were seen after twenty-four hours. These contained a large number of different species of germs. The pyococcus filogens constituted about eighty per cent. of the germs. There were two varieties of this, one white and one orange. This is only slightly malignant. Several times he found some staphylococc! which seem to be the cause of those infectious forms of keratitis, which become rapidly complicated by iritis. He also found the pneumococci. Six varieties of bacteria were distinguished, one exhibiting spores.

The author says that his experiments have shown him that a solution of corrosive sublimate, 1 to 10,000, is insufficient to destroy these germs; 1 to 5,000 sufficed.

SPONTANEOUS ABSORPTION OF SENILE CATARACT.— Prof. Brettauer (Archives Ophthal.), before the Heidelberg Ophthalmological Society, reported three cases of spontaneous cure of senile cataract by absorption of the lens. The time required was from nine to thirteen years. The absorption was accompanied by the formation of numerous crystals of cholestrine. Sight was perfectly restored by the use of cataract glasses. The vitreous was clear in all cases. Prof. Becker, of Heidelberg, confirmed the foregoing statements from his own personal examination of the cases. He had also seen one case himself. Prof. Berlin, of Stuttgart, had also seen one case, as had also Dr. Dufour. Thus we have the report of six cases in which the lense was spontaneously ab

sorbed in old age so as to leave good vision, after the lens had first become cataractous.

INFECTION AS A CAUSE OF SYMPATHETIC OPHTHALMOLOGY.-Deutschmann (Le Progres Medicale) publishes the results of extensive experiments and observations made by him based upon the view that sympathetic ophthalmia was an infectious disease. The infectious agent he found to be the staphylococcus pyogens. This organism is said to produce phlegmonous osteitis if it be carried to a bone; if to the skin it causes anthrax; if it penetrate the eye it causes serpiginous ulcer with hypopion, or perforation, it effects the disorganization with phthisis of the bulb, and may be propagated along the optic nerve to the other eye and causes sympathetic ophthalmia. He injected a solution containing this organism directly into the substance of the optic nerve of rabbits, and found in the other eye evidence that the organisms had found their way thither, causing sympathetic ophthalmia. Cultures of other organisms did not result in damage to the other eye when injected into the optic nerve in a similar manner. He thinks there may be other organisms which behave in a similar manner as the first mentioned. All this enforces the speedy removal of the dead eye when there is any chance of sympathetic ophthalmia.

MATERIA MEDICA.

THERAPEUTIC USE OF HYDROFLUORIC ACID.Dr. Eugene Chevy, in a study of the therapeutic use of hydrofluoric acid, finds that,

1. The vapor of hydrofluoric acid mixed with air does not produce the ill effects hitherto feared. It may be breathed without inconvenience in the proportion of I to 1,500.

2. Hydrofluoric acid is an antiseptic and antifermentative substance. In the proportion of 1 to 3,000 it is able to arrest fermentation in milk, urine, bouillon, and accomplish their preservation.

3. The therapeutic use of hydrofluoric acid in pulmonary tuberculosis, diphtheria and in the dressing of wounds, from the results already attained, merits further investigation.

4. The agent must be employed with great care if the patient is affected with asthma, hematophilia, or emphysema.-Bulletin Gén. de Thérapeutique, Aug. 15, 1885; Med. News.

C.

HYDRO BROMATE OF HYOSCINE.-This drug is very useful in controlling the actions and excessive mental efforts of maniacal and other patients. When used for sleeplessness it gave satisfactory results, and will accomplish more than any one drug.

Dr. H. C. Wood has recently used it successfully in spermatorrhoea, but as yet the effects do not appear to be lasting.

M. Sig.-One teaspoonful after eating, three times daily, through a tube.

APPLICATION OF COLD EXTERNALLY IN FEVER."I notice that Stepha, of St. Petersburg, affirms that the application of ice bags over the super-clavicular regions. is sufficient to control the temperature in fever, owing to the fact that cold is brought into closer contact with much of the blood of the body by the large superficial veins of the neck. I have had no experience, however, of this method of reducing, but it is worthy of a trial, especially as it seems to be safer to reduce temperature in a low fever by external cold, than by our present known depressing antipyretic drugs."-Dr. H. C. Wood, in Therapeutic Gazette.

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BY A. B. LYONS, M. D., DETROIT, MICH. THICAL questions, more often than any others, lead, alike among artisans and professional men, to unprofitable and acrimonious discussions, unless care is taken to exclude wholly the personal element. The principles of ethics, indeed, admit of no debate-except that which arises from mutual misunderstanding of terms. But practically we find it difficult to apply to any conduct of our own which is not condemned by popular opinion, the abstract principle which reveals its inherent wrongfulness. We are more slaves indeed to conventional ideas—if we may so term them-of morality than we are aware. When the reformer, burning with a sense. of the injustice he sees in our daily actions, analyses for us our motives and convicts us of violation of every principle of right, we grow angry, not so much because we are pricked in our consciences--although the arrows of conviction may have pierced deeper than we knew-but because we honestly regard the man as an impracticable fanatic, who would turn the world upside down to no purpose.

When we come to practical questions, indeed, we find ourselves compelled to adopt in our conduct a policy of compromise, ethical considerations requiring two or more courses of action which are divergent or even diametrically opposed one to another.

That course of conduct which shall secure the greatest good of the greatest number-or the greatest sum of

t know good-even without the ever present bias of personal pre

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1 Single copies, 80 cents.

so to speak, to prematurely demand the repeal of regulations which must still stand in place of a conscience to the immature multitude.

It is in full recognition of some of these sources of difficulty in considering ethical questions, that I approach the subject of this paper, which I do not offer to elicit discussion, but rather as a statement of the aspect under which it appears to the members of the pharmaceutical profession.

The title of my paper is somewhat ambiguous; the term patent medicines has two entirely distinct significations. In this country there is a large class of mcdicinal preparations compounded for popular use, based generally on some well-known formula or prescription, but whose composition is the secret of the manufacturer. Although in very few instances really protected by patent, these nostrums are generally known as patent medicines.

Few physicians will be found to advocate the practice of prescribing remedies of this class. Those who manufacture these preparations are certainly not regarded with any friendly feelings by the profession, and this hostility, we need not say, is not wholly due to jealousy. The medicines are those the physician himself uses in his practice. They have, often, as definite and constant a composition as the preparations of the pharmacopoeia-albeit that composition is held a secret for the profit of the manufacturer; in some cases their effect is different from that of any combination of drugs the physician has himself been able to devise; shall the patient be deprived of the benefit he might derive from its use? It is hard to answer such a question, so bluntly put, in the affirmative. A physician certainly is not warranted in withholding from any patient any thing which will alleviate his sufferings or tend to his restoration to health. But how is the physician to know what remedies can do? Chiefly by close study of the text-books which contain accumulated stores of observation by the most acute and able physicians of generations past and present, and by personal observation. Of the patent medicine-unless his education has been a purely empirical matter- he knows only what the mendacious circulars and almanacs say, or what he hears accidentally from some one little qualified to judge of the action of remedies, and with

ference, we should find it impossible to select, and if we stop long to balance nicely our motives, we let slip the opportunity for action. In fact, the best we can do, practically, is to fix for our guidance certain arbitrary rules and regulations which form a code of artificial morals. In proportion as we advance in enlightenment, we are bound to outgrow these arbitrary codes, but it is a mistake for the few who have arrived at their majority, * Read before the Detroit Academy of Medicine, November

17, 1885.

no scientific knowledge of the effects of the known articles of the materia medica. We must know that the compounders of patent medicines have no real secrets. They are merely using the knowledge we have garnered, and if they are able to produce effects we cannot ourselves achieve in the use of remedies, we simply confess our own ignorance and incompetence.

Yes, prescribe the patent medicine, if you are convinced that it will do what no other remedy you know of can-but know that in so doing you betray unpardonable ignorance of the materia medica, and your claims as a physician rest, pro tanto, on a basis of the crudest empiricism. Another course is open. The physician who finds himself thus convicted of ignorance-as any of us may-can grapple anew with the problem in therapeutics. which has floored him, perhaps with the aid of a chemical analysis of the medicine which he has found to have the required effect.

My own judgment is, that, if the physician has such a knowledge of theoretical and practical therapeutics as raises him above the rank of a mere empiric, he can, without prejudice to his patients, leave the investigation of the merits of patent medicines to those who have more leisure than he for trivialties.

* *

But with this eomforting conclusion firmly grasped, and the perplexing question of patent medicines dismissed from your mind, you seat yourself with your medical journal, and find the most prominent thing on the title page, a cabalistic word, Oleo chyle. You turn the leaves of the advertising pages, and find other unfamiliar names, Ominico, Kaskine, Kaline, Sozone, Phosphatic Lemon Rye, Celerina, Papine, Acid Mannate, Listerine, etc., etc., etc. The nomenclature is not that of the pharmacopoeia, or of science; what can these articles be, of which the treatises on materia medica are so profoundly uncommunicative? We have only to read to be instructed. "Facts. Persons who bear the smallest doses of quinine badly can take the compound pill in full antiperiodic and antipyretic doses without the least unpleasant effect. It is an alterative tonic as well as an antiperiodic, and therefore alone a complete treatment of all forms of chronic malarial disorder. * ** We (who?) offer this as an ENTITY to the profession for use as a NEW DRUG. By the fairest tests (conducted when By the fairest tests (conducted when and by whom?) it has been proven to be as decided an antiperiodic, etc., as quinine. Formula. Kaline ext., 83; euonymin, 2; ext. cepa A., 6, and lupulin 9 in 100." We have waxed indignant sometimes over certain frauds perpetrated by men like the Rev. Jos. T. Inman— who sends to consumptives gratis a prescription the ingredients of which he alone can supply, and then charges $3.50 for a little gentian, soda and licorice, which he pretends is what the prescription calls for-and who shall say that it is not?—but when a similar fraud is attempted upon the medical profession in this brazen fashion, we fall to pondering the question whether we have really

** *

deserved the imputation of such credulity. Some of the eastern medical journals are still publishing communications relating to the use of a new "specific" for typhoid fever cohothedra compound; is it surprising that we are thought credulous?

In an advertisement which says at the end "Please mention the Medical Record," we find another new antipyretic, kaskine, described as "highly endorsed by the leading members of the medical profession," and “universally successful in Bellevue Hospital," etc. Price to physicians 70 cts. a bottle, regular price $1.00. Now, if there is any difference between such secret remedies and those offered to the laity as patent medicines, I cannot see where it lies. These are secret remedies. The pretence to give a formula, which some of them make is pretence and nothing more. The arrogant claims of the discoverers or manufacturers are those characteristic of the charlatan. I cannot forbear quoting a few sentences; is it possible that the editors of respectable medical journals exclude anything that is more arrant quackery?

"Phosphatic lemon rye "-somehow that recalls "whisky sour"-" acts on the liver and kidneys, removing all injurious matters from these important agents of the body, and restores their natural activity. It is recommended especially for ladies in delicate health, and is a healthy tonic for children.”

*

"Because of the brilliant results obtained with Sozone in his own practice, Dr. Stone [who, we are told, has used the remedy 15 years] is impelled to offer this remedy to the medical profession, etc."

"The patient and I both say, God bless the inventor of Sozone." "Sozone did much good for my patients.— A. Williams, M. D."

"We regret that we are compelled to caution the profession of the substitution of cheap and worthless compounds" for the only genuine and original lactopeptine.

I know from conversation with some of the shrewd ones among the laity that such things as these published without exciting a protest in our best medical journals, bring our profession into disrepute, and we ought to expect as much. Shall we prescribe this class of secret remedies? The smooth tongued agent brings you the sample, says a great many flattering things about your superior intelligence, and about the merits of the preparation he is trying to introduce, and if you treat him half-way civilly, he makes you promise to try the remedy. The physician is not self-assertive enough to tell the intruder that he is assuming a good deal in trying to instruct him in therapeutics; too often he accepts his statements as actually worthy of confidence. Now if he would quietly put the commercial traveller a few pertinent questions, assuming that he really does know something about therapeutics, the chances are that he would not be troubled in future by visits from this particular agent-or from any of the fraternity.

But are not these manufacturers working in the interests of the profession? If they make improvements in pharmacy, ought we not to accept them, and encourage their efforts.

Ah, you are laboring under a serious misapprehension in regard to this class of manufacturers. They are pharmacists in the same sense that the advertising quack is a physician. There is a body of united workers, striving to render the physician aid by reducing to system the art of compounding drugs, and constantly encouraging one another to new effort in perfecting that art. They do not approve of "secrets any more than physicians do among themselves-and they are anxious that there should be between prescriber and dispenser the perfect harmony which is only possible when all names have a definite and unalterable meaning, and a meaning which all physicians and pharmacists understand. The importance of this, every physician must at once apprehend. It is essential to the existence of a profession ancillary to that of the physician, and it is obvious that the organized effort of a profession like this will secure better results than a system of free competition among rival manufacturers for. the patronage, simply, of physi cians. Hence, even though a really desirable combination of remedies may now and then be offered without formula, it is the duty of the physician to discountenance its use, favoring the adoption, instead, of such combinations as legitimate pharmacy offers in abundance.

But how are we to know who are the "legitimate" pharmacists? some one asks. You have only to read. The nomenclature of legitimate pharmacy is well understood. The charlatan in pharmacy ignores this nomenclature, and by that token you can infallibly recognize him. Now and then an injudicious tyro in pharmacy may adopt for a preparation which he intends shall be legitimate, a name which by this rule condemns it. This is his misfortune, and if he finds that the name is a serious objection to his first venture, he will not repeat the experiment. Give a wide berth to all such monstrosities of nomenclature as bromo-caffeine, etc., and in general to everything the exact formula of which is not published, no matter what medical journal, or professor in a medical college, seems to give endorsement to it.

Thus far I have not said a word about true patent medicines, and that was what I had in mind to discourse upon. The object of a patent system is to encourage invention by offering the inventor the exclusive right to the use of his invention for a term of years in return for such a description of that invention as to enable anyone, after the expiration of the patent to use it. A patented

dent, and the discoverer was entitled to little credit, except that due to close observation of clinical phenomena. There sprang up, early, among physicians from the peculiar nature of their calling, an esprit du corps, which rendered it a matter of honor never to conceal any newly discovered remedial agent, or to endeavor to enrich ones self by appropriating any special right in the discovery. In these days conditions are different. We understand much better than we did formerly the physiolog ical action of drugs. Men devote themselves exclusively to the study of the action of remedies, and of substances not known to have medicinal properties.

If, as a result of a long series of investigations, these men make important discoveries in therapeutics, they certainly are entitled to their reward, and if they can gain that reward, and at the same time place in the hands of physicians a valuable new remedy, it seems to me that there is a clear gain to all parties. Such remedies will become more and more numerous in the future. What shall be the attitude of the profession towards them? I hope that they may be welcomed, if they come in the way I have described, their properties carefully studied, and all the facts published without bias. That the accounts given of these new remedies will at first be colored by personal bias is, however, certain, unless we establish as a condition for their adoption, a clinical trial in hospitals and dispensaries, under competent observers, and this is perhaps hardly practicable.

The particular article I had in mind in writing was the now well-known antipyretic, to which the name antipyrine has been given. If this agent is half as valuable as we are led to believe, it ought to be lawful for the physician to prescribe it-lawful, I mean, in the conventional sense—it would, in fact, be wrong for the physician to ignore the remedy, if it is capable of producing beneficial effects which he connot otherwise secure. It is true that the majority of those who have, as the result of physiological research, added to the list of our remedial agents, have sought their recompense solely in the satisfaction of having done more than their fellows for humanity. With all honor for this nobility of sentiment, we must not refuse the guerdon of pecuniary reward to more mercenerary workers, unless we are ready ourselves to give all our services for suffering humanity without recompense.

November 16, 1885.

SYPHILIS AND MARRIAGE.*

BY GEO. P. ANDREWS, M. D.†

very meaning of the word one which covers no secret of manufacture.

As long as medicine was almost wholly empirical in its methods-as it still is to so large a degree-the discovery of medical agents was largely a matter of acci

to syphilis relates to marriage. So far as the individual is concerned it involves but one person; if the person marries while still subject to the primary or * Read before the Detroit Academy of Medicine. +Consulting Physician to Harper Hospital and Woman's Hospital; Attending Physician to St. Mary's Hospital.