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their moral condition. That eriors may be taught and differences of opinion rise, I grant, but truth ultimately prevails in all earnest and honest efforts to enlighten the people. It is not ny intention at this time to argue the question, but simply to state, from my stand-point, the workings of the medical law in California. We have a law in this State purporting to regulate the practice of medicine, passed ten years ago. This law recog
. nizes three parties in medicine, or, in other words, three medical schools, the regular, homepathic, and eclectic, impowering each of them to appoint Boards of Examiners. The duties of these boards were to examine applicants and grant certificates of proficiency. This law required every physician in the State to get a certificate from some one of these boards. These certificates were to be filed and recorded in the County Court of the county in which the applicant proposed to practice medicine. Without such certificate the practicing physician cannot by law collect medical fees, and is liable to a fine of $100 for every infraction of the law. The law has been so amended that certificates are not now granted to persons except they hold diplomas from their respective medical schools. Under this law true medicine has been dragged down to a level with the isms—homepathy and eclecticism. In the eyes of the law and the people they are made equal. This practically degrades true medicine, and to me is extremely humiliating. Diplomas from these so-called schools of medicine regular medicine cannot recognize, yet the law makes you recognize them by placing you on a level with them. It is a notorious fact that homepaths and eclectics have granted certificates to almost any one. In many instances, where applicants failed before the Regular Board, they have succeeded with the others, and there is now protected by law a set of infamous quacks in this State doing a flourishing business by virtue of State legislation, protected from the odium of public opinion by virtue of their certificates which they flourish in your face, and under law claim to be your equal. Under this law true medicine has been crippled, shorn of its laurels, and its banners trailed in the dust. It has been so besmirched and burdened by legal restraints that it is incompetent to form a healthy public
sentiment. Any howling fakir on your streets, with a certificate in his hands, is a true representative of medicine in the eyes of the law. While he cannot compel you to consult with him, he can compel the people to pay him, and bis claims for public patronage are the same as yours in law.
The further tendency of this law is that it weakens and destroys all codes of ethics. Protected by law, men will soon cease to regard ethical rules and restraints of societies, and will trample upon every right sacred to medicine, and still be a physician, retaining public favor, for his magic certicfiate upholds him in his villainy. The law, in my judgment, is a bonanza to
, quacks, but a leprous scab on true medicine. I could give numbers of individual instances establishing the truth of what I say, but the limits of this paper forbids.
My judgment, drawn from observation and long experience, is that true medicine is abundantly able to take care of itself, and when you appeal to legislation, State or national, you besmirch and cripple it, and open the way for charlatans to permanently fasten themselves upon the vitals of the community.
Medicine, under the law, has no power to deal with its unworthy members, for the law grants no power to any board to make a certificate for immoral or unprofessional conduct. Made a doctor by law, he is always a doctor under the law, and practically without the jurisdiction of all honorable medicine.
As for me, I ask for no legislation, but shall trust to the inherent virtue there is in medicine to care for itself, and stand or fall by it, asking no aid from State or Church.
SORE NIPPLES.- Among the numerous remedies recommended for sore nipples, Prof. Parvin pronounces the compound tincture of benzoin the best as a local application. As the saliva of the infant is liable to be productive of fissures, etc., by its irritation, the nipple should always be carefully cleansed and dried after the nursing of the child.—Buffalo News and Surgical Journal.
PARALDEHYDE AND URETHAN-Every day sees a new remedy come to the front as a candidate for favor in the medical world. Some of them prove to be of value, and take their proper place in the armamentarium of the skillful, thoughtful physician. I desire to call attention to two new hypnotics which are awakening interest among neurologists more particularly, and which have been used in the State Lunatic Asylum.
The first is paraldehyde, a methylic ether, an exceedingly volatile liquid, somewhat resembling the compound spirit of ether of the Pharmacopæia; it has a pungent, penetrating odor, and its taste resembles that of sulphuric ether. In regard to its chemistry, method of preparation, etc., I quote from a letter of Prof. C. O. Curtman, of St. Louis, to Dr. P. O. Hooper :
Paraldehyde is the condensation of product of ordinary aldehyde and hydrochloric acid, hence (CH, CHO). It is formed by adding to pure aldehyde a small amount of hydrochloric acid, when the condensation takes place with evolution of heat. (With even a small amount of sulphuric acid, the re-action occurs with explosive violence.) The product is cooled by ice till it solidifies, is then pressed to free it from acid, etc., filtered off and finally distilled. It boils at 253.7° Farrenheit. It dissolves in 8.3 parts of water at 55.4° Farrenheit, less in hot water. Distilling with sulphuric acid reconverts it into ordinary aldehyde.”
Dujardin-Beaumetz says of it: In strychnia poisoning, delirium tremens, and uræmic convulsions, paraldehyde is superior to chloral. Cervello says: Paraldehyde affects the cerebrum, the spinal cord, and the bulbus, successively abolishi»g the reflexes, causing anæsthesia and sleep by anæmiating the brain and cord. It is eliminated by the lungs. It is not a cardiac poison.
Read before the Medical Society of Arkansas, April, 1885, by H. B. W liams, M.D., Assistant Physician Arkansas State Lunatic Asylum.
I may add, that in no instance have I seen interference with respiration result from its administration. At the lunatic asylum, we have used the drug as a hypnotic to allay excitement, and to control epilepti-form seizures in one instance. The results obtained have been very gratifying. It is administered in doses of from from 30 to 75 minims. I, however, usually give 3j. A single large dose acts better than frequently repeated small doses.
Ip simple insomnia, in 3j doses, it has acted for me like a charm, while in mania, accompanied by great excitement, the results have been almost uniformly satisfactory. When the solution is freshly prepared and is administered without more than momentary exposure to the atmosphere, sleep, in nine out of ten cases, has been produced in from three to fifteen minutes. In the few instances in which no effect followed its ingestion, it was repeated in one hour and the desired result produced. The sleep produced is sound, refreshing, and to all appearances natural ; it lasts from three to eight hours, and in my experience has never been followed by nausea, headache, anorexia, constipation, or any symptom of deranged function.
In recurrent mania attended with great excitement, restlessness, and persistent insomnia, it has seemed to me to shorten the duration of the paroxysms. In such cases it was administered nightly, and sometimes had to be repeated, but in no instance bas a tolerance been established. In one case of acute illness, where the patient was much emaciated, very weak, wildly delirious, and suffered from persistent insomnia which chloral failed to relieve, a single dose (33) of paraldehyde produced a natural sleep of eight hours' duration, from which the patient awaked refreshed and improved. On the two succeeding nights he received the usual dose, and each time with like results. On the fourth night he slept soundly without a hypnotic of any kind, nor did he require one subsequently.
Again, in a woman, the victim of chronic mania, who was also in the last stages of pulmonary tuberculosis, paraldehyde produced sleep and quietude repeatedly and without untoward effect. I have used it but once to control the paroxysms of epilepsy. The history of that case is as follows: the patient, who. has suffered from epilepsy for years, having two or three attacks weekly, suddenly had an increase in the number of paroxysms. For two days he had from one to three seizures hourly, and became totally demented. Potassium bromide in heroic doses had no influence over the seizures, while 3j of paraldehyde caused a complete cessation in less than twenty minutes ; this cessation was accompanied by a sound sleep of six hours' duration, from which the patient awakened improved in every respect.
In epileptic mania in which paroxysms of epilepsy were not numerous, I have used paraldehyde for its calmative and hypnotic effects, and in only one instance did failure result.
In that case the patient was taking fluid extract of ergot and potassium bromidium for the epilepsy. In several instances I have awakened the patient within a half hour or an hour after the ingestion of the drug, and found he would talk sensibly, but as soon as he was left undisturbed, he relapsed again into sleep.
In a case of chronic mania in a man who has a lesion of the mitral valve, compensatory hypertrophy of the heart having taken place, the paraldehyde gave most excellent results. I would state parenthetically that chloral had frequently been administered in this case without ill effects. Sometimes chloral produces a state of intoxication which forces the patient to occupy the recumbent posture, but neither allays excitement nor produces sleep. In this class of cases paraldehyde is invaluable.
The method of administering paraldehyde is important. It can be given in mucilage, syrup, or whisky, preferably in whisky. At the lunatic asylum we give one part paraldehyde in three of whisky. No difference in the action of the drug is perceptible when mucilage or syrup is used as the menstruum, instead of whisky. Whisky disguises the taste and in a great measure conceals the exhalation of the drug on the breath. This exhalation, when not obviated by whisky, is almost intolerable and continues for several hours. I have noticed it for twelve hours after the ingestion of the drug.
Paraldehyde must be kept in glass or rubber stoppered bottles, and must be taken as soon as poured out; otherwise disappointment will follow its use.