possesses the anodyne and soporific action generally ascribed to the resinous extract, although in a modified degree. It has the characteristic odor of the hemp, and has a beautiful deep amber color: it is miscible with water, and therefore there is no difficulty in combining it with other liquids, and it presents no unseemly appearance repellent to a patient.

Liquor cannabis indicæ, says the author, in all his experience gives all the beneficial effects without the drawbacks of the tincture, which are sometimes met with even when using a medium dose of it. It does not seem to interfere with the secretion of mucus from the bronchial glands, which renders it superior to opium in certain cases, while in pulmonary affections generally it acts most favorably as a soporific and anodyne.

Mr. Lees states that his greatest experience with the drug has been in the treatment of phthisis pulmonalis, and in these cases he says he can not speak too highly of it, for not only does it most perceptibly relieve the cough, but it aids the patient by its stimulating and exhilarating qualities, supplying a remedial agent in a manner which, in his opinion, no other drug can so beneficially do. In indigestion with constipation, and also in many children's affections, especially where nervous symptoms are present, it has also done good service. The author does not suppose for one moment that it will displace opium where 'severe pain is a prominent symptom, but he feels sure that in many cases it may be substituted for opium with great advantage.

The dose which he commonly employs is half a fluid dram for an adult, but it may be increased to a dram in many cases; while for children doses according to the age may be adopted, although he says he has noticed that children are somewhat less suceptible to it than adults.-New York Medical Journal.

MEDICAL ADVERTISING.-That the present century has been an age in which the art of advertising has been pushed to the most surprising limits is undeniable; nowhere has greater ingenuity been shown than in this department, and in many cases, where its use may be considered legitimate, as in most of the enterprises of the commercial world, it may be regarded as one of the factors of the enormous industrial prosperity of this epoch. Great, however, as may be its advantages from a commercial point of view, advertising has always been forbidden by every rule of professional ethics; indeed, nothing has usually been considered more degrading than for a practitioner to make use of such means to procure professional advancement. Speaking generally, few if any medical men would have any hesitation in condemning every form of advertisement as commonly met with in commercial life; the difficulty only commences when the question arises as to what is and what is not "advertising." Many practitioners of the most blameless reputation, who would shudder at the very idea of advertising in the ordinary sense, will at times allow themselves to drift into practices,. which, if not done for the purpose of advertisement, are utterly unintelli

gible; many of them, too, would be the first to criticise the action of the struggling dispensary doctor who systematically distributes his handbills by house-to-house visitation; yet when critically examined inexorable logic would compel us to confess that some of these practices are little if any better. Neither must it be forgotten that any system of professional ethics which condemns the latter and shuts it eyes to the former will inevitably be destitute of all moral sanction. Advertising, it is to be feared, is by no means entirely confined to the humbler branches of the profession, and, although equally objectionable wherever found, ought to be certainly not less condemned when in high places. The various ways in which this transgression against true professional etiquette is brought about are doubtless familiar to many of our readers, and it is needless to specify them, but one form is of such common occurrence that it is only right that some mention should be made of it. We have before us two cuttings from provincial newspapers with advertisements relating to the Northampton General Infirmary; in both of these the names of the visiting staff is published. These gentlemen no doubt would condemn advertising as most unprofessional, and would not dream of being personally guilty of such an impropriety. But we would ask them candidly to consider this matter, and, iter due reflection, to inform us in what lies the necessity for this publicatica of names.—British Medical Journal.

A CHEMICAL ANTIDOTE FOR CHLORAL POISONING.-The Glasgow Medical Journal for February publishes an article on this subject by Dr. John Dougall, of Glasgow. When chloral was first used, says the author, its hypnotic action was thought to be solely due to the generation of chloroform from it by the alkalies of the blood; its effects on the body generally were, and indeed still are, held as almost identical with those produced by chloroform. This view, however, he says, has been disputed on the grounds that the quantity of chloroform which a full dose of chloral is capable of producing is quite inadequate to cause the hypnosis and anesthesia that have been observed, also that the greater part of the chloral is exhaled from the lungs unchanged, and that small quantities of it may be found in the urine, but no chloroform. Whatever facts or theories, however, says Dr. Dougall, there may be regarding the manner of the hypnotic and anesthetic action of chloral, there can be no doubt about its chemical composition and affinities, and, in particular, that it is almost at once decomposed, at and above 60° F., outside of the body in an alcoholic solution of potash into formate of potassium and chloroform, and, as the author has proved by trial, somewhat less quickly in an aqueous solution of potash.

Assuming, he says, that a person has taken a poisonous dose of chloral, say eighty grains, and that there could with safety be given, as a chemical antidote, twenty-seven grains of potash, this amount being the quantity by weight in the formula required to decompose eighty grains of chloral; in such a case, says the author, there are strong a priori grounds for assuming

that in about fifteen minutes the chloral in the system would be entirely changed into formate of potassium and chloroform, or at least that so much of it would be decomposed that the residue would be harmless. But would not the potash, he asks, or the amount of its formate, or of the chloroform thus produced, be as lethal as the chloral? Undoubtedly twenty-seven grains of potash swallowed at once, even much diluted, would cause serious symptoms. But if even half that quantity was given in divided doses-say seven grains every hour-in warm milk, gruel, or barley-water, it seems very probable that by this means no serious irritation of the gastro-intestinal tract would result, and that in a short time so much of the chloral would be decomposed as to render the rest at least non-lethal.

The liquor potassæ of the British Pharmacopeia, says Dr. Dougall, contains about a grain of potash in sixteen minims, and the maximum dose stated is sixty minims. Hence, he says, to give seven grains of potash is equal to giving a hundred and twelve minims of liquor potassæ. He thinks it may be assumed that this quantity, highly diluted, might be given without fear of causing unfavorable symptoms. By this means twenty grains of the chloral would soon be decomposed, thereby neutralizing its power to a certain degree, if the potash is given before the patient is too far gone to be afforded relief by this means; then, if in an hour after a similar dose of potash is given in the same way, this would reduce the chloral in the system to forty grains, a quantity quite within the bounds of safety for an adult, provided there is no heart trouble.

Dr. Dougall says that he has proved by experiment what has been stated by others—namely, that the carbonates and bicarbonates of potassium and of sodium also decompose chloral; but their action, particularly that of the bicarbonates, is very slow, and, besides, a much larger quantity than of potash is required, also a heat much above that of the body. With regard to the action of formate of potassium, it merely causes a peculiar eruption of the skin, which soon disappears when the use of the drug is stopped. This eruption is well known to habitual chloral-takers, and seems to prove that chloral is decomposed in the blood as stated.

With regard to the probable effects of the chloroform which would be generated by the decomposition of forty grains of chloral, the author finds. that this quantity of chloral requires 13.5 grains of potash for its decomposition, which results in the production of 28.5 grains of chloroform, equal to 21.5 minims. As much larger amounts of chloroform (from half an ounce to four ounces) have been swallowed and recovery has followed, and as it is likely that the greater part of that which is generated in the blood by the decomposition of the chloral is exhaled as fast as it is produced, Dr. Dougall thinks that nothing serious need be feared on this point.-New York Medical Journal.

UNFAVORABLE REPORT ON ANTITOXIN.-After a thorough study in various hospitals of Berlin of the use of Behring's diphtheria serum, Passed Assistant Surgeon F. J. B. Cordeiro, U. S. N., in a report to the Surgeon

General of the Navy, concludes that so far proof is lacking of the value of antitoxin in the treatment of diphtheria. Dr. Corderoi adopts the following opinions of Kassowitz: (1) A large number of children treated with both small and large immunizing doses have within a few weeks acquired diphtheria, and some of them have died of it. We do not possess a single scientific proof that a case of diphtheria was ever prevented by the immunizing process. (2) Children who during a first sickness have been treated with large doses of serum have a short time after acquired diphtheria anew. They were not rendered immune either by their sickness or the largest doses of the antitoxin. (3) In a large number of cases children have been treated on the first or second day of their illness with the fullest doses of the antitoxin and have died. (4) It is certain that a large part of those who have died notwithstanding the serum treatment did not die from the effects of a mixed infection, but directly from the specific effects of the Löffler bacillus. (5) Heart and other post-diphtheritic paralyses are also seen in early and fully treated cases, and they occur as often as they did before the serum treatment. (6) Of a fever fall by crisis in the first twenty-four hours, and of a pronounced antipyretic effect of the serum, most observers have seen nothing or next to nothing. (7) The separation of the membranes follows in the cases that run a favorable course in the customary manner. But often there is an extension of the local process, and a renewal of the already separated membranes during and after the serum treatment.

The burden of proof lies with Behring and his co-workers. The world will eagerly and only too willingly receive this proof. We know that the former extravagant promises are out of the question, but we should be grateful to have it demonstrated that the serum can reduce the mortality by even one per cent. As yet we have not the slightest basis on which to found an expectation that fewer children will die in the future of this disease on account of the serum treatment.-Medical Record.

ASEPSIS IN CATHETERISM.-A recent number of Przeglad Chirurgiczny, the Polish surgical review, is largely taken up by Dr. S. Grosglik's article upon Asepsis in Catheterism. Reviewing the methods usually employed. for sterilizing catheters and bougies, he finds most of them to be unsatisfactory. Bacteriological experiments made by himself showed that neither mechanical cleansing nor the use of liquid antiseptics, sulphurous-acid gas or mercurial vapors thoroughly sterilized instruments which had been artificially infected with cultivations of staphylococci and streptococci. This end can only, he affirms, be gained by employing moist heat. Dr. Grosglik describes fully an apparatus, apparently simple and effective, which he has devised for this purpose. In this the instruments are sterilized in five minutes. Elastic instruments, it may be noted, are declared to be unaltered by the process. A useful bibliography is appended to this article.-London Lancet.

Vol. 19.

"NEC TENUI PENNÂ.”

SATURDAY, MAY 18, 1895.

No. 10.

D. W. YANDELL, M. D., LL.D., and H. A. COTTELL, M. D., Editors.
JOHN L. HOWARD, M. D., Assistant Editor.

A Journal of Medicine and Surgery, published every other Saturday. Price, $3 per year, postage paid.

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THEAM ERICAN MEDICAL ASSOCIATION,

The recent meeting at Baltimore (7th, 8th, 9th, and 10th instant) appears from the meager reports accessible at this writing to have been of more than average worth.

The political features which some years since threatened to disrupt the Association have been wisely laid in the background, while the scientific features are more pronounced, and in every way more worthy of the country, the profession, and the times.

The retiring president, Dr. Donald Maclean, took for his theme. "A Few Living Issues Affecting the History of Medicine."

The introduction of chloroform (after the discovery of anesthesia in America) by Sir J. Y. Simpson, of Edinburgh, the influence of Darwinism upon medical teaching, especially in the realm of heredity, the further elucidation of the doctrine by Wiseman, the rise and development of the new art of gynecology under the leadership of J. Marion Sims, the cellular pathology of Virchow, and the germ theory of disease as elucidated by Pasteur, Tyndall, and Lister were duly set forth and discussed to the point by the learned speaker.

In summing up the influence of these ideas the president said in substance:

*It was undoubtedly the inspiration derived from the Darwinian doctrine of the struggle for existence, ultimately securing the survival of the

*From the New York Medical Record's synopsis of the Address.