In re Calomel. After so much has been said, both pro and con, with regard to calomel as a therapeutic agent, one writer comes forward, in the July BRIEF, page 385, to tell us how this deadly (?) compound of mercury and chlorine is made.

Some of us learned that years ago, when we also found that the combination, "muriatic acid and black oxide of manganese," or chlorine, entered into the composition of many other substances, some of which are essential to animal life.

After entering into rather minute details as to the preparation of this valuable drug, associating it as closely as possible with its more powerful congener, he reaches the climax of his hobby in the following words: "What a remedy to be administered to suffering humanity for the cure of diseases; filling their system with a deadly poison to counteract a less poison; and this is the remedy given by the old school in nearly all diseases as far back as the renowned Paracelsus, which was about the year 1523."

To strengthen his position (thus far it lacks this essential), he quotes from Bartholow the following: "Any considerable quantity of mercury administered a sufficient time will affect the quality and composition of the blood: the red globules are diminished, the fibrine looses its plasticity, the proportion of water is increased, and various effete material, whose nature is unknown, accumulate, etc." The italics in the above quotation are mine.

Here, comment is unnecessary, as we of the "old school" will admit that mercury, like arsenic, lead, the salts of silver, digitalis, etc., is cumulative, if a considerable quantity is administered for a sufficient time, just as the great and good Bartholow points out, but would our brothers of the new school discard all of the above remedies and many more that could be added, because large doses given for a sufficient time entails deleterious consequences? Why can't we all be reasonable with regard to calomel?

Our friend says that this is a method of treatment of the dark ages. Then we

are gratified to know that those ages were not entirely destitute of one firstclass remedy, at least. We have never known an old school M. D. who used calomel to an extent injurious to his patient; neither do they rely upon it alone, but recognize in it a valuable agent in the scientific treatment of disease.

As Bartholow has been referred to as authority on this subject, we, too, will make just a few quotations from his practice.

On treatment of malarial fever, he says: "A grain of calomel, followed, in four or six hours, by a sedlitz powder, or the sedlitz powder alone, will assist in the absorption of quinia." Page 792.

On cerebro-spinal meningitis, he says: "If there is constipation a mercurial purgative may be given." Page 764.

On typhoid fever: "There is no doubt, if statistics may be depended on, that calomel, in large doses, during the first week, favorably modifies the disease." Page 701.

On yellow fever: "It is good practice to begin the treatment by a mercurial purgative." Page 723.

Many more quotations from the same author could be added, wherein he recommends calomel in the treatment of disease, but we deem that the above is sufficient to convince even the most skeptical brother in the ranks of the medical profession.

We are aware that certain theories, very beautiful on paper, have been heralded to the world in opposition to this drug, but none of them have caused it to take a back seat yet. Certain roots and herbs may be all right as a substitute for mercury, in some parts of our great country, but here in S. Fla. we need calomel in the so-called bilious diseases, or in some instances our patient will die. I am informed by a friend that it fairly knocks yellow fever out in the first round, if given at the start in large doses.

The dear old BRIEF gets better and better with each succeeding month. Bartow, Fla.

F. M. WILSON, M. D.

BACK NUMBERS.-We have a supply of the back numbers from January, and wish to state that all who want them should send before they are exhausted.

Therapeutics-Plants and their Alka

loids.

In an important paper recently read at the Academy of Medicine by that distinguished Prof. Dr. Germain Sée, he very correctly stated that in therapeutics, alkaloids and the plants from which they are derived, should not be confounded. These opportune remarks were made in regard to strophanthus and strophanthine, but he pointed out, that they might be equally well applied to a number of alkaloids and plants used daily in our practice. In fact, we well know the essentially different nature of the effects of digitalis and digitaline, of opium and morphine, of cinchona and quinine, and of the many plants from which alkaloids are derived.

Coca is indisputably that drug to which, above all others, these remarks can be applied.

Erythroxylon coca possesses, without doubt, analgesic properties, and is held as a superior local sedative, especially where pain exists in the region of the mouth and the throat (as noted and published by Prof. Charles Fauvel, long before the discovery of the local effects of cocaine), and in calling attention to the virtues of this plant, it may be stated that the beneficial effects of wine of coca have been thoroughly established in tuberculous and other ulcerations, existing on the tongue, the mouth, the lips and on the vocal cords; in all this class of cases, such a preparation is of great value, prolonging as it does the anæsthetic and sedative effects of cocaine when applied topically or when such application becomes for one reason or another impracticable, proving itself of great service to the physician by reason of its local action.

Coca differing essentially from cocaine, the action of the plant upon the general economy, and not its local action, should be borne in mind.

Coca is a most active stimulant tonic, especially when used in vinous combination. No better preparation can be employed than the "Vin Mariani," which contains all the valuable properties of the plant, combined with a generous and absolutely pure wine. This has been found to give the best results.

There are numerous conditions in which this preparation is indicated: in a general way, it is serviceable in all those various diseases, which come under the clinical head of anæmia (weak heart, chlorosis, various forms of cachectic conditions, neurasthenia, general debility, and in convalescence from fevers).

Tuberculosis, presenting essentially anæmic features, it can be readily understood that here the happiest results may be obtained by the use of the above preparation of coca, as also in the other forms of phthisis.

Although coca is not a specific in phthisis and without wishing to claim that it is a destroyer of the bacillus of Koch, it nevertheless here proves its efficacy, and, as quite recently stated in that important work, "La Phthisie pulmonaire et Laryngée," by Dr. H. Libermann, Physician in Chief to the Army of France: "The bacillus alone is not the sole factor to be considered in phthisis."

Contained largely as it is in the atmosphere which we inhale, it happily remains inert in the great majority of In other words, its victims are those in whose organism it finds a fertile field for growth and development.

cases.

All our efforts should, therefore, be in the direction of rendering this field less susceptible to the inroads of the bacillus of tuberculosis, until such time, when we may be able to act more directly upon this dangerous germ.

Among other means at our command to combat and to guard the organism against these inroads, may be mentioned, hydropathy, hygiene to the fullest extent, and climatology, which should always be taken into consideration by the physician and the patient.

All these data are of absolute importance and at the same time the physician should have at his command some agent which in all cases will by its reliable action as a diffusible tonic and stimulant, fill the following indication during treatment, namely: "The maintenance of perfect nutrition and the guarding against debility in its various forms."

The only tonic in every respect filling these indications and which it has been found may be given for an indefinite period without any unpleasant reaction

in wasting diseases, is wine of coca. The preparation known as "Vin Mariani" (prepared by Mr. Angelo Mariani, of Paris), which has been employed by the medical profession since the last thirty years is the only one which has given me uniformly good results without the unfavorable features which frequently follow in the wake of tonics and stimulants. And I attribute this to the fact that it represents all the volatile principles of the plant, thus differing essentially from those preparations made from the dried comparatively inert leaf (the volatile principles being absent) or through ignorance of the proper requirements containing a dangerous added percentage of the alkaloid cocaine.

Thus will be seen the necessity of recognizing the merits of this plant independently of its alkaloid, and the wide field it should occupy in our therapeutics. S. A. NITARD, M. D. "Le Bulletin Médical," Paris, 8 Mai, 1889.

Superfecundation-Pin Worms. Noticing an article in the July BRIEF, reported by Willis Cauble, M. D., I wish to report a somewhat similar experience which I had.

About the 1st of December, 1881, was called to see Mrs. T., a multipara, in confinement. The messenger informed me that he had called another physician, the previous day, but as she was suffering from false pains, he relieved that trouble and went hence. He also informed me that she was suffering from hemorrhage, and was subject to and threatened with convulsions.

Being a young practitioner, I hastened to her bedside with a good deal of apprehension. Upon my arrival, I made a digital examination and found a slight hemorrhage, with os dilated to about the size of a half-dollar. As she was suffering some from false pains, I administered one-sixth of a grain of morph. sulph., which relieved her considerably.

The labor progressed slowly for about four hours, when my patient took a spasm. I used chloroform, which controlled the convulsions pretty well. The friends of patient being alarmed and anxious about the termination of the case, I suggested

that they send and get another physician. In about two hours, Dr. H. arrived, when the labor was well nigh completed, the head pressing firmly upon the perineum. In due time, I delivered her of a fine, healthy boy, and after severing the cord and handing him to the nurse, I proceeded to deliver the pla

centa.

Upon taking hold of the cord and tracing it into the vagina, I came to something which I knew was not a placenta. However, I delivered it, and upon examination found it to be another foetus of about four months' development. The mother and child did well, neither requiring any further medical attention at that time. I pronounced it a case of superfecundation.

Would like to get treatment for oxyuris vermicularis, in a married man of about forty years of age, who has been afflicted with them for about ten years, and been treated by several able physicians, with only temporary relief. A. J. MCINTYRE, M. D.

Corinth, Ill.

Prevention of Conception.

The July BRIEF was received; I greatly appreciate the publication as of general utility and practical benefit to the profession.

My attention was more particularly drawn to the article of M. C. Connett, M. D., upon the "prevention of conception." The article is one of pleasurable sensations, and, even in an old medical veteran of three-score-and-ten, sends a thrill throughout the organization. His formula is certainly successful, but few are willing to take the medicine; and I think my medical friend is rather severe in his strictures when he says, "if she is so depraved and her passions are uncontrollable, so much so that she must copulate and run the risk of getting rid of the resulting foetus, I should pay no more attention to devising means for her to safely gratify her morbid passions."

I hope I may not insult the dignity of my medical friend by inquiring whether he is a Joseph, or has passed that age when animal passions become engulphed in the whirlpool of total abstinence, in those things which are so momentarily pleasurable and exciting?

I most cheerfully agree with him, that the wholesome fear of producing conception is a guard against the unrestrained indulgence of one of the "greatest and most pleasurable duties of men and women." However true this may be, there are marriages where, from malformation or other causes, a woman's life may be sacrificed from bearing children. What can be done to secure the best results for the parties? Must they part, or remain together and perhaps destroy the life of the woman? I say, prevent conception. JAMES W. PRICE, M. D.

Fort Smith, Ark.

Answers to Inquiries.

Dr. J. R. Johnson will find his case of impetigo described in my "Practice," under the chapter of skin diseases. It is either impetigo or ecthyma, and one would have to see it to determine which.

Dr. L. G. Doane asks for a cure for corns. There are many. Carbolic acid, applied occasionally until all the indurated portion is removed, is a cure. Super-nitrate of silver, applied, will enucleate them in a few days. Chloride of zinc will remove them. Iodine, in saturated solution, applied every day, will soon remove them.

Dr. A..B. Bishop's case of death, with convulsions and great tenderness of the spine, was one of spinal irritation, or spinal congestion, and needed belladonna, in doses of two to three drops, every four or six hours. The brain and spine are readily disengorged by small doses of belladonna, twice a day.

Dr. J. Mooney asks if calomel will cause abortion. In large doses it may produce hyper-catharsis, and thereby produce abortion. A lady in pregnancy (or in any other state) does not need calomel. Calomel is never indicated, as it is not curative of disease, but pathogenetic, producing disease. If a purgative is needed, we have many that are much milder and more certain to act than calomel, and then they do not poison the system. If you want a liver medicine, give cascara, with euonymin and irisin, or podophyllin. These act kindly and certainly.

Dr. R. L. Hinton asks: "Shall we bleed in pneumonia?" No, nor should we

bleed in any other disease. The life-the vital principle-is in the blood. Why take the life in disease, when the failing life is struggling against the disease? When an army is meeting an army double its own numbers, why withdraw half of its already deficient numbers? Why do it? Why? Echo says, Why? Why kill to give life? Why?

Dr. W. F. Ellard asks why a child was born dead when three coils of the cord were around the neck. Why, doctor, if you had three coils of cord around your neck, for hours, you would die too. We can not live without circulation.

Dr. Howland asks how to correct displacement and congestion and leucorrhea at the same time. It is done, doctor, by removing the relaxed condition of the uterine surface, and its muscles. Helonias and aletris internally, and a wash of hamamelis, and throw the pessary away. If the digestion is poor, give three drops of tinct. nux vomica, three times a day. It is a case of endometritis, and requires constitutional treatment, as well as local treatment.

Dr. B. D. Woodson asks the best treatment for epidemic (malarial as well as epidemic) dysentery. If it is accompanied with malarial fever, it requires quinine, gelsemium, and such antiseptics as baptisia and bryonia alba for the dysenteric poison; also aconite for the mucous lesion, and saline cathartics—as cream of tartar or the rochelle salts-to unload the upper bowels every day. If the patient can not rest, he should have a full dose of Svapnia at night. This is much to be preferred to opium. I find that whenever the patient is kept upon opium (crude) all the time, it constipates the upper bowels, and does more harm than good. Hence, I procure rest for the patient at night by giving the Svapnia, or the aqueous extract of opium; and if there is nausea and vomiting, then one to two drops of ipecacuanha, every fifteen minutes, will allay the nausea and soothe the bowels very much. If the vomiting does not yield to ipecac., then I give one drop of euphorbia coralla, every half hour, until the nausea is allayed, and then every two hours with the baptisia. The baptisia is a grand remedy for dysentery. I. J. M. Goss, A.M., M. D. Marietta, Ga.

"Shall We Bleed in Pneumonia ?" This question was asked and answered by the same writer in the July BRIEF (Vol. XVII., p. 332). He gave no theoretical or scientific answer, but answered by giving an illustrative case, believing that illustrations have more force than fine-spun theories. I believe in theories, as we can't prove very much with our "practical illustrations." There is a reason for everything; if we will spend the time and solid thought in a systematic investigation we can usually find it, too. One, nor one hundred cases of "practical illustrations" will not conclusively prove anything if they are not sustained by theory or reason. Medicine of to-day is a system of scientific reasoning of cause and effect, and not a tabulated system of formulæ and names of diseases.

The gentleman partially described a case that was very probably congestion of the lungs, which would have been pneumonia had he not aborted it, or pneumonia in the primary or congestive stage, just as you choose to call it. I prefer not to attach the name pneumonia until there is exudation of leucocytes or true inflammation present, characterized by the crepitant rale.

Pneumonia is acute inflammation of the lungs, possessing the three regular stages of acute inflammation, viz.: Congestion or engorgement; exudation or pouring out of the leucocytes; and resolution. The bronchial vessels of the systemic or greater circulation are at fault primarily, the pulmonary or lesser circulation being secondarily affected. Congestion is that stage of inflammation that is characterized by dilatation of the capillaries and stasis of the blood. There is a nonequalization of the circulation, or too much blood in the part. The physiological condition of the circulation is a state of equalization. When it becomes nonequalized, it is congestion, which was the condition of the patient under consideration. A few hours ago, the patient was normal; now he is nearly dead. Certainly a very great change has taken place. Has he too much blood? Of course not. There are not two ounces, if any, more blood in his system now than then, but it is not performing its function; it is not equally distributed, which

is the condition called congestion. Now, this is a mode of life, and in the treatment of this, as well as all other diseases, one thing must be remembered, viz.: The physiology and the mode and amount of pathological deviation. Here the physiological condition is equalization of the circulation, and the pathological condition non-equalization.

Now, what is to be done? Of course, a mere novice would say to reduce the system to a physiological state, or equalize the circulation, which is the only scientific method. I will leave the reader to

judge for himself as to whether bleeding would accomplish it or not, remembering when you think of his patient's happy recovery that he gave some veratrum viride and gelsemium.

Let the gentleman rely on bleeding alone, if he thinks it to be directly indicated. I believe in direct effects of drugs, i. e., a certain drug to control a certain pathological state, manifested by symptoms. If he desires my treatment, I will give it another time, as my space is nearly up.

Before closing, I would ask Dr. J. Mooney to please give his indications for calomel. As I have never found any indication for it yet, therefore could not answer his question.

THOS. H. STANDLEE, M. D.

Amity, Ark.

Forceps in Delivery.

Will some of the brother M. D.'s inform me what constitutes tedious labor and how soon forceps should be used?

I ask this question because I have been severely censured by the family of a lady whom I attended, for allowing her to suffer from Thursday evening (when she had false pains) until Saturday morning at one o'clock without using forceps.

The true pains began Friday evening and continued strong up to delivery. No complications. Bag of water absent. Os dilating slowly. The patient begged me to use forceps Friday evening, so to satisfy her mind I sent for my forceps, telling her that if the child was not born by morning I would deliver her.

Would I have been justified in using forceps so soon? B. W. SUMMY, M. D. Washington, D. C.