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in Paris had recurred during his preparation for his examinations, but had been attributed to his nervous excitement at that time. It now assumed the character of a severe dysentery, and after three weeks of great suffering and brave struggle he died on the 27th of March, 1833, being then in his twenty-fifth year. Thus Fate prematurely cut the thread of life of the most promising spirit in medicine that America has yet seen among her many distinguished sons.

To you, as medical students, I commend as a precious heritage and a worthy ideal, the life of James Jackson, Junior. In this brief and inadequate account of his life, I have endeavored to acquaint you with one, who lived a pure life, who "shed a morning gladness about him;" who lived for the love of truth, and who, by his diligence and zeal, while yet a student, discovered one of the most important physical signs of pulmonary tuberculosis, and made valuable contributions to the pathology of cholera and the symptomatology of emphysema. Greater than these, was the influence he exerted upon American medicine through his immediate influence upon the rising members of the profession of his generation. To this influence is due in large measure the spread in this country of Louis' principles the habit of thorough observation of the phenomena of disease in the living and in the dead.

To few of us is such a heredity and environment as that of Jackson given, and but rarely does such a gifted spirit appear. But to all of us is this one thing given-the opportunity for the seeking of truth and for the loving of truth.

NOTE. For the greater part of the material used in the preparation of this address, the writer is indebted to the " Memoirs of James Jackson, Junior," by his father (1835).

THE COMPARATIVE VALUE OF SOME DRUGS.*

BY WILLIAM H. BALDWIN, M. D., QUINCY, MICHIGAN.

THE adoption of this title might seem an assumption that drugs are efficacious in the treatment of disease, but in this day of scientific research, when claims must be investigated thoroughly, and at least a plausible theory given for their action, assumptions count for little, but proofs create the value, therefore let us determine first whether drugs have a value as medicinal agents, and, if so, we will compare some of them, and ascertain their relative worth in the domain of disease.

I am aware there are many medical infidels among us; they are prone to ascribe the value of drugs to their suggestive impression and their therapeutic effect to imagination.

This idea seems to prevail among the surgical brethren more than in any other specialty. As soon as a man becomes a surgeon, he loses sight of drug theraphy. If engaged in conversation about a case of tonsillitis he will say "remove them;" if the case is one of piles he will

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say "operate;" if it is cancer he will call you a quack if you suggest anything but the knife; and if consumption is the topic of consideration he will wink his eye and say "he'll die."

In my last ten years' experience I have operated on a number of boils without the loss of a single patient; I have lanced a few felons with one hundred per cent of recoveries; I have even removed corns and obtained healing by first intention frequently, yet, withal I have never lost my confidence in drugs, but have gained more faith in their virtue, together with a greater knowledge of their use and therapeutic effect, and I wish to reiterate what has already been stated before this association, that for every disease there is in nature, discovered or undiscovered, a remedy that will cure or alleviate. Whatever nature lacks in reparative power she furnishes in a restorative; whatever her defects may be, a remedy is afforded.

It is our province to search for these means and appropriate them, and how successful we have been in smallpox, malaria, diphtheria, and syphilis, we all know. It is nature that scatters the seed that grows the gigantic forest, but it is the hand of man that plants the grove with its symmetric beauty.

Have drugs a value? Let us see. A person comes to a physician, complaining of a dull headache; his tongue is coated a dirty-brown, which is not caused by tobacco; he falls asleep upon the least provocation; he is irritable; he cannot work because he is not able. After interrogating all his organs, the decision is reached that he is bilious. A couple of cathartic pills are prescribed, and after a few hours behold the change! His cheek again assumes a ruddy hue, the world, which to him was dark and devoid of pleasure, again awakens his interest, the sun resumes its normal brilliancy, and the man is well again. Was it imagination? Was it suggestion? No! it was two compound cathartic pills which cured him. Some may say it was nature assisted by the pills, but I claim the pills cured him. Again, a person comes to a physician with his hand over his eye. He complains of severe pain referred to temple or forehead, and his vision is more or less impaired. Upon examination a marked injection of the pericorneal blood-vessels is discovered and a rosy zone encircles the cornea; in other words, the patient has an inflammation of the iris. The physician instils a solution of atropin, the pupil dilates, the pain ceases, and the patient rapidly 1ecovers. Did suggestion dilate that pupil? Was it imagination? No! it was atropin. The physician is confronted with an acute gastralgia. The countenance of the victim is blanched, and a cold, clammy sweat suffuses him; he is writhing in agony. A hypodermic injection. of morphin relieves him in a few moments, and no amount of persuasion could induce patient or doctor to believe the effect due to suggestion. And so it is. The remainder of medicine is just as rational if we understood it as well as we do in the illustrations given. Constipation and cancer would be cured as easy could we but locate the remedy, and the medical pulse is today beating in joyous suspense, for

the intuition is that we are now standing upon the threshold of a dawning day of enlightenment regarding heretofore incurable scourges.

Having at least established the fact in our own minds that there is a value in drugs for the cure of disease, we will now notice some of their comparative values. Let us first notice the preparations of opium, the monarch of the pharmacopeia. Opium is a very complex substance, made up of numerous principles which differ remarkably among themselves. In general terms it may be stated that morphin differs from opium in that it is less stimulating, less convulsant, more decidedly hypnotic and anodyne, is less constipating and affects the contractility of the bladder more. Morphin has less diaphoretic properties and produces much more pruritis than opium. Therefore in dysentery and certain forms of heart disease opium should be employed, but when pain is the principal indication or a profound state of narcotism is desired morphin should be used. Codein corresponds to morphin, but is feebler, four grains of this derivative being equal to one grain of morphin. It has anodyne and hypnotic qualities, produces sleep freer from disturbance, and the after effects are less disagreeable, but a decided influence is noted on the pneumogastric. This effect was beautifully demonstrated in a case of codein addiction, in which the patient consumed twenty grains of codein sulphate per day. Upon the discontinuance of the drug the pain was much less than from the withdrawal symptoms of morphin, the nervous symptoms seemed equally as great, but the difficult respiration was the predominant feature, the breathing becoming distressingly laborious. Codein is safer for children, is less constipating, and will produce sleep and quiet restlessness in typhoid and kindred conditions better than morphin. While, because not so intoxicating, it is practically free from habit-forming, yet its continued use will produce withdrawal symptoms analagous to other opium preparations. The same may be said of heroin and narcein, but in greater degree.

We will now consider that much-abused drug, quinin. The different preparations and alkaloids of cinchona differ but little in therapeutic value, doing so only by way of the amount of the alkaloids they contain, the effects of which are practically the same. The crude barks contain more of the bitter principle, which, being astringent, are more constipating. The discussion of this drug will consequently bear upon its value as compared to some other drugs. Of all the drugs of the pharmacopeia which have been sadly abused and misused this one heads the list. It dwells in the humble cottage of the lowly and abides in the palace of the lordly. It is prescribed for the baby and is given to the decrepit grandsire. It is given for piles and for toothaches, for corns and for headache, some doctors, even, especially some of the older ones, thinking no prescription is complete without it-a few grains of quinin on general principles. Not long ago I overheard a lady remark that there was no use sending for a certain doctor because quinin is all he will give, and she had taken enough of that. This drug received

its reputation during malarial times when nearly everyone, sick or well, was the entertaining host of the germs of that disease, and I admit that in those days a few or many grains of quinin was good practice, but those days are past in southern Michigan, and consequently with their departure the value of quinin as a medicinal agent greatly depreciated. Its indications have become limited but such uses as it retains cannot be overestimated. In malaria, for instance, it is a specific unquestioned. In some forms of septic infection it usually exerts a marked action for good by reason of its power to enter the blood stream unchanged and there produce its antiseptic effect. That it possesses the power to increase the contractions of the uterus during the first stage of labor I have been able to demonstrate in a goodly proportion of cases, and in small doses the bitter principle acts as a stomach tonic, increasing the appetite and digestion. Otherwise as a tonic it is a dismal failure, and, that it should not be used as such is demonstrated by experiment, for we find that it acts on the hemoglobin of the blood impairing its power to transport active oxygen or ozone into which the ordinary oxygen of the air is converted. Bintz has shown that so small a quantity as one part to twenty thousand exerts this action to considerable extent. The same authority has shown that quinin inhibits or lessens the activity of the white blood corpuscles, and indeed destroys them or arrests their production, for in cats poisoned by this agent the number of white corpuscles was found to be considerably less than in unpoisoned animals. Baxter and Cutter made extensive experiments and established the fact that the ameboid movements of the white corpuscles were greatly lessened. Hence it is called a protoplasmic poison. It also arrests the migration of the white corpuscles, and when we are aware that the white corpuscles of the blood are the scavengers of the human body, constantly yielding their lives to free us from poisonous accumulation we can arrive at a conclusion of the damage done by the wholesale indiscriminate use of the drug. As a stomach tonic it is greatly exceeded by any of the other bitter tonics which do not possess its disadvantages.

As a tonic, one dose of strychnin is worth a dozen of quinin. Strychnin produces a clear eye, a clear brain, a steady nerve; quinin produces a dull eye, a heavy brain, and no effect on the nervous system. Every dose of quinin given in typhoid, la grippe, or pneumonia, retards the convalescence of the patient, because it retards reconstructive metamorphosis, a thing not desired in these virulent tissue-destroying diseases.

Remedies for the heart are divided into tonics and stimulants. Cardiac tonics are those drugs which stimulate the heart muscle itself. Stimulants are those agents which increase the force and freqeuncy of the pulse. Among the stimulants are ether, alcohol, heat, ammonia, atropin, cocain, camphor, chloroform and nitroglycerin. Among the tonics are digitalis, strophanthus, cimicifuga, caffein and strychnin. While time will not permit me to compare all of them, I wish to call

attention to some fallacies in prescribing remedies for that important organ, the heart. To some practitioners the term heart disease means digitalis. The harm done by the indiscriminate prescribing of this drug is only limited by the inefficiency of it, and the fact that many of the conditions diagnosed as heart disease are not diseases at all but only functional disorders. The truth is that few cases of heart disturbance, even if disease really exists, call for this drug which are not, if given a good drug and in sufficient dosage to produce effect, injuriously if not seriously affected. Let us see how it acts. We find by referring to authority that it prolongs the diastole, and increases the vigor of the systole caused by a contraction of the arterioles, which increases the resistance in front from a narrowing of the calibre of the blood-vessels. It is indicated when the action of the heart is weak and rapid and arterial tension low, and is contraindicated when the heart is vigorous and arterial tension high. It should not be used in fatty degeneration, simple hypertrophy, or aortic stenosis. Strophanthus is a much better all-around drug, for, instead of strengthening the heart by putting more work upon it, it strengthens by stimulating the heart muscle itself. It strengthens the interval between the contractions, and increases them. I have found a combination of digitalis and strophanthus to be an effective one, using enough of the former to give tonicity to the arterioles but not increase the blood pressure. A combination against which I wish to protest is made up by every tablet manufacturer, and included in the armamentarium of nearly every physician who dispenses his own drugs. It is composed of digitalis, strophanthus, and nitroglycerin. We have briefly reviewed the physiologic action of digatilis. Nitroglycerin has just the opposite action. It increases the beat of the heart and dilates the arterioles, and therefore is physiologically incompatible. The reason why results are obtained from that combination is because the digitalis is inert or the nitroglycerin, the action of which is fleeting, has spent its force before that of the digitalis takes place, or the combined action of the nitroglycerin and strophanthus is sufficient to overcome the other. But what brain could ever conceive a case wherein both these drugs could be indicated is one of the ever-occurring conundrums of medical practice.

THE TREATMENT OF EXTERNAL OPERATION-WOUNDS.* BY FRANK B. WALKER, PH.B., M. D.. DETROIT, MICHIGAN.

DEMONSTRATOR OF OPERATIVE SURGERY IN THE DETROIT COLLEGE OF MEDICINE.

THE treatment of operation-wounds begins with their making. Leaving out of account the length and depth of incisions in their effect upon the healing process, it is a fact of common observation that a smooth, clean cut heals more quickly and leaves less scar tissue than a succession of hacks. It is important for most surgeons also that the skin incision be not shorter than the deeper wound, since otherwise dead *Read before the WAYNE COUNTY (Detroit) MEDICAL SOCIETY.