Then, in view of these facts from such eminent authorities, and the multiplied hundreds of reported cases in which quinine was used in continuous large doses with the happiest results, how can this dread malady be attributed to the slightly irritant action of quinine upon the kidneys? Dr. Moffat says "that the whole theory of the influence of quinine in causing hæmaglobinuria rests on the fact that in the majority of cases there is a history of quinine having been taken; but this fact proves nothing, when it is remembered that in tropical countries practically everybody takes quinine."

Quinine should not be condemned merely because it is an irritant to the genito-urinary tract and produces some peculiar metabolism in the circulation, but should be administered judiciously, for the fact of that morbid condition's presence is certain evidence that quinine had been neglected when first needed, and if every person requiring quinine were to take it at the first warning, and take it intelligently, there would never be another case of malarial hæmoglobinuria.

After stating the plan of treatment I almost invariably adopt in this malady, I will briefly consider the reasons I have for pursuing such a course.

When called to a case of malarial hæmoglobinuria, I proceed in the following order, being governed somewhat by existing, conditions: If I find the patient with sick stomach or very nervous, which is usually the case, I administer an hypodermic of morphine and atropine, and repeat the dose as often as is necessary to control the vomiting, and without delay give three or four 5-grain doses of calomel and soda, and even more than this if required to get the liver active, the amount depending largely upon the quantity of morphine given. Give nitro-glycerine 1-100 of a grain every three hours and the following prescription:

Spts. of turpentine.

Copaiba, each 7 drams.

Spts. ether nitrosi, q. s., 4 oz.

Mix and direct. Teaspoonful every four hours.

Give fifteen grains of hydrochlorate of quinine hypodermically, and repeat the dose every six hours. Fifteen grains of quinine will dissolve readily in thirty minims of water. Instead of repeating the hypodermic dose, Warburg's pills (two grains each) every four hours, or 5-grain doses of quinine every four hours may be given by the mouth; the best results are obtained by administering it in solution, as in this form only will its prompt absorption

be absolutely assured. Also, after using the first dose hypodermically, 3 or 5-grain doses of quinine, preferably the sulphate, given every two hours; the time so arranged that the last dose will be given about 2 hours before the expected paroxysm, will prove effectual.

As stated above, the morphine and atropine are to quiet the patient and check the vomiting; the latter condition may require such adjuncts as 1/10th grain doses of calomel every half hour, and a mustard plaster to the epigastrium. The calomel and soda excite the emunctories to proper activity, particularly the liver.

The nitro-glycerine stimulates the heart, and dilates the blood vessels, especially the kidneys, which are prone to occlusion by the debris.

The paregoric serves as an adjunct to quinine, acts as a sedative, and promotes cutaneous transpiration.

Turpentine is diuretic and hæmostatic, and is such an ozone or oxygen carrier that it is highly useful when quinine is given.

Copaiba is slightly diuretic, and is thought by some writers to dilate the renal vessels.

Spirits of nitrous ether by relaxing the renal vessels, is diuretic, the water being increased; it is useful when a free watery flow of urine is required to wash out the tubules and passages, and relax spasm of the renal vessels.

Quinine being destructive to the malarial plasmodia, it is the remedy par excellence in this malady, but it exerts very little toxic influence upon the parasites as long as they remain within the corpuscles, and should be administered at such a time that its maximum effect will be obtained at the time of sporulation of the parasite, which occurs with the paroxysm; and as quinine has its maximum effect about five hours after taken, and its height of elimination about the eighth hour, either of the plans of administration I have adopted will meet the above exigences.

By administering the drugs above mentioned, some of the ill effects of quinine will be obviated, for instance, it lessens the ozonizing and oxidizing function of the blood, whereas turpentine has great affinity for ozone, and will readily supply this waste; and its depressant action upon the heart will be counteracted by nitroglycerine.

The quinine is given, therefore, not in the hope of averting the pending paroxysm, but for the purpose of destroying the free, young segments upon which the succeeding paroxysms depend, and in cases where quinine had been freely given before the paroxysm immediately preceding the appearance of the hæmoglobinuria, then

discontinued by its opponents, and the patients make uneventful recoveries, it is evident to my mind that the young segments were all destroyed by the quinine at the time of sporulation.

For Texas Medical Journal.

The Therapeutic Value of Animal Extracts.*

BY A. S. EPPERSON, M. D., CAMERON, TEXAS.

Under this heading are included not only the extracts of various. tissues at present utilized in therapeutics, but likewise the tissues. themselves, and all the preparations, active principles, etc., obtained from them. Of the animal tissues and their products employed therapeutically, the ductless glands whose functions are now known to be intimately associated with metabolism have by far taken the lead over all other portions of the animal organism utilized. And if they continue to increasingly engage attention, as they have of late, the time is not far distant when antitoxines will find in them a potent rival. In this attempt to interest this able body of medical men, I will not give a re-hash of my experience, though it has been limited. During the past three or four years I have not missed an opportunity to prescribe these remedies where I thought them indicated and have been well pleased with the results.

To my mind, some of these extracts form a most rational treatment for a number of the most common diseases of our every-day practice.

Extract of thyroid gland is my favorite of the animal extracts, because I found it valuable in many diseases, not only in myxedema and cretinism, but in melancholia and the mental conditions connected with the menopause, some of the cutaneous diseases, backward growth and delayed dentition in children. Children with dirty complexions, morbid appetites, coarse, dry hair and dull of intellect are benefited by thyroid extract. Neurasthenia, in both children and adults, improves under this treatment in connection with nerve tonics.

In old people, with weak hearts, it is well to give thyroid extract with great care, keeping the patient under direct supervision. I usually begin with one grain of the powder (Parke, Davis & Co.'s

*Read before the Brazos Valley Medical Association, at Cameron, Texas, May 12 and 13, 1903.

preparation), three times a day and gradually increase it to toler

ance.

It doesn't seem to be a great heart-depressant, but produces the sensation of tightness and oppression in the chest and palpitation of the heart.

I have under treatment at present a case of myxedema in a lady 51 years of age. She had been an invalid ten years. When she began taking thyroid eight months ago, her heart was very weak and at first she could take only one-half grain three time a day and has never been able to take more than three grains a day, but she improved rapidly and is at present doing her own cooking; and strange to say, she is cutting her wisdom teeth, which should have erupted twenty or more years ago. In this case the myxodema came on after an attack of scarlet fever, which caused atrophy of the thyroid gland. She lost her hearing at the same time, which she has never recovered. I have used extract of thyroid gland in obesity, but am of the opinion that we have remedies superior to it in reducing body weight and adipose tissue.

My experience with suprarenal extract has also been quite pleasing. I have found it to be an exceedingly energetic vaso-constrictor and has proven valuable in hemorrhages of internal organs, the lungs and stomach especially, intestine, kidneys, uterus also, as well as in external mucous membrane and to prevent hemorrhage in operations of mucous membrane. I have never seen the administration of this extract accompanied with harmful or unpleasant effects. My experience with other of the animal extracts has been too limited to be interesting, though preparations of the various organs, as the lungs, spleen, ovaries and mammary glands, bonemarrow, brain and nerves, liver, pancreas and testicles have all been used with sufficient success to merit the confidence of the medical profession.

For Texas Medical Journal.

The American Medical Association Plan of Reorgan

ization.*

BY JAMES HALL BELL, M. D., SAN ANTONIO, TEXAS.

I have been asked to open for discussion the question of the reorganization of the medical profession of the United States.

*Read before the first regular meeting of the Bexar County Medical Society, August 6, 1903.

preliminary note, may I, in a few words, characterize its disorganization? For more than a hundred years the profession of medicine has been conspicuously without influence in the enactment and control of legislation vitally touching its general welfare, and utterly unable or unwilling to put in operation the machinery necessary to a wise and economic administration of its own internal affairs. The general disorder and confusion everywhere visible in the profession, its internal feuds and hatreds and consequent formation of cliques in every community, the widespread prevalence of personal spites and scandals, which created suspicion between honest and capable men and drove them into professional solitude, have marred the really great achievements of medicine, crippled its followers in every material interest, and brought them into open disrepute before the world.

We have not been deliberately wicked in these respects, but criminally negligent; and I feel satisfied, in my own mind, that any one who will give the subject thoughtful and dispassionate consideration will inevitably be led to the illuminating conclusion that many, if not all, of our disorders are the results of disunion. Our profession, the greatest of all professions in its aspirations and accomplishments, has never been properly organized. To this single fact, I repeat, is justly attributable all our woes; and everyone knows, from personal observation and experience not always free from bitterness, that we have had woes in abundance.

For some years the question of the reorganization of the medical profession of the United States has been uppermost in the minds of many of the leading men of the American Medical Association. It is easier, however, to discover the existence of a defect than it is to find and apply the right remedy. It was at once apparent, for instance, that difficulties of a negative character had to be overcome; ignorance, prejudice and old fogyism faced and fought, and the old structure torn down before the new edifice could be reared in its place. It was realized, moreover, that the new building, in the face of hostile and persistent criticism, would have to be constructed on a large and lasting plan, a plan large enough to accommodate, within defined limits, every legalized practitioner of medicine in the United States, strong enough to induce all eligible men to accept it as a place of permanent residence, and so justly apportioned that every dweller therein should have his equal rights forever guaranteed. With these preliminaries generally understood, if not agreed upon, the work of actual reconstruction began.

Three years ago, at the Atlantic City meeting, the American Medical Association appointed a Committee on Reorganization. This committee drafted and presented at the Saratoga meeting, a year later, a new constitution and by-laws for the American Medical Association itself. They were adopted. The members of this committee were reappointed, this time a Committee on Organization, and authorized to frame a constitution and by-laws for State and county societies. Thirty States, approximately, our own included, have already formally adopted the constitution and by-laws proposed by this committee; they are now actively employed in