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That paraldehyde will supersede chloral I do not believe, but that it will rank as a good reliable hypnotic, particularly where chloral and opium are contraindicated by personal idiosyncrasies, I am confident.
Another fact: Paraldehyde is not an analgesic, and in insomnia due to pain is worse than useless.
Now, a few words on urethan, another hypnotic which promises to be as valuable as paraldehyde.
Urethan puriss, (NH2, CO, C, H) is the ethylic ether of corbaminic acid ; comes in white crystals, odorless, easily soluble in water, and has a sweetish bitter taste. Its hypnotic value has been tried in cases of rheumatism, gout, catarrh, neuralgia, skin diseases with irritation, general restlessness and sleeplessness.
As a rule, the results were excellent, no unpleasant after-effects having been caused in a single instance. Urethan is an analgesic, as is shown by its action in gout, rheumatism, etc. Its action is chiefly on the cerebrum, and it has no influence on the medulla oblongata or cord. No interference with the action of the kidneys or bowels has been noticed.
The dose of the drug is 15 grains. I have used it only in insomnia of mania, and have found sleep result uniformly after the ingestion of the above-named dose. As toxic symptoms have never as yet been produced by the drug, I can tell you nothing of them, nor of the amount necessary to produce them. I have seen sleep, apparently natural, as the only result of the administration of urethan. If the promises which urethan holds out are fulfilled, it will prove an addition of very great value to our materia medica.-Journal of the American Medical Association.
RECENT STUDIES UPON THE NATURE OF SUPPURATION.There is no department of pathology in which recent investigations have been so satisfactory or led to such conclusive results as in this one.
We still find in all text-books the statement that suppuration is a stage of inflammation-i. e., that the onset of suppuration records a certain degree of intensity in inflammation ; yet this
view must now be quite altered, since it has been proved with absolute certainty that suppuration indicates, not intensity, but merely the presence of a certain factor among the causes of the inflammation, namely, bacteria, and it has been shown that without their presence no irritant, be it ever so intense, can cause the formation of a single particle of pus.
This view, originally advanced by Lister, and further developed by Hueter, had till now to be accepted with a certain amount of reserve. For though from clinical experience in the success of the modern antiseptic system of treating injuries made it appear probable, yet, experimentally, it lacked complete proof. On the one hand, certain abscesses occur in which no bacteria can be detected; on the other, certain irritants, notably turpentine, croton oil, and metallic quicksilver, applied so as to exclude apparently the access of bacteria, still caused suppuration. This latter objection has now been met. G. Klemperer, of Berlin, recently, by prolonged exposure of the irritants to heat and then application subcutaneously under stringent aseptic (not antiseptiu) precautions, injected these irritating bodies in a series of over one hundred experiments without causing any suppuration, thus completing this portion of the evidence. The exudation was always serous or fibrinous, never purulent.
The significance of the absence of bacteria in an abscess is explained by the study of abscess formation. The organisms must have been present, as at an earlier stage the purulent exudation is largely a conservation process, having as its object the annihilation and absorption of the bacteria by the exuded leucocytes. At the same time the question has been studied from another aspect -- What bacteria cause suppuration and under what conditions can they bring it about ? Modern bacterial methods have given a mathematical precision to these researches. In thousands of abscesses now examined, only about ten species of bacteria have been observed. These are chiefly micrococci, and of these, five species alone cause about pipe-tenths of all occurring abscesses. The remaining thousands of bacteria existing in certain parts of the body and in its surroundings are not pyogenic.
With regard to the conditions necessary to enable these few bacteria to cause suppuration, the conditions vary widely; some suffice by their mere presence to set it up, in others a weakened condition of the tissue is necessary. Injected into the blood, for instance, these would be harmless unless the system is injured or irritated at any point, as by the injection of the already mentioned chemical irritants. say into the peritoneum or the seat of a fractured bone. In the first case, a purulent peritonitis (Grawitz), in the latter a suppurative osteomyelitis (Ogston), is the result.
Other local conditions may affect the result, sulcutaneously or in the peritoneum the direct injection of pyogenic cocci will cause neither peritonitis por abscess, unless injected in such numbers or diluted to such bulk, as to preclude their rapid absorption and assure a prolonged contact with the tissues. This point is of extreme interest, as showing the rationale of drainage of wounds.
We have, then, simple inflammation, either serous or fibrinous, and purulent inflammation, two entirely distinct processes, and not simply one process passing gradually into the other. It is very satisfactory to note that the daring, though logical, deductions maintained from the first by Lister and his followers, that there can be no pus without bacteria, have been now fully substantiated. With regard to the chemical processes which bring about the prominent features of pus, especially its fluidity, we are still in the dark as to whether it is caused by the direct influence of the bacteria themselves upon the exudate, or by some product formed in the course of their life processes.-Canada Medical and Surgical Journal.
SUPRABUIC CYSTOTOMY.-From the proceedings in the section of surgery of the British Medical Association, we learn that Sir Henry Thompson throws the full weight of his valuable opinion in favor of suprapubic, as against other methods of cystotomy.
For the severe and exceptional conditions he considers the suprapubic operation an available and trustworthy resource.
Its superiority over the lateral mode is thus formulated :
1. Because in the suprapubic operation there are no important structures lying in the line of incision, or sufficiently near to be rendered liable to injury either by the knife or by the forceps.
2. Because the space for removing a large stone above the pubes is practically unlimited.
3. Because there is little or no danger from hemorrhage ; if it does occur it can readily be readily dealt with.
4. Because the incisions are certainly more easy to perform than those of lateral lithotomy; while the removal of a large stone, always the most difficult and dangerous part of the operation, is safe and easy by the suprapubic route.
5. Because, during the after-treatment, the urine leaves the suprapubic wound more directly and safely than it does by the long lacerated opening which forms the communication between the bladder and the perineal surface after the lateral operation for a large stone.
6. Because antiseptic dressing can be employed in the former operation and can not be made available in the latter.
7. Because in the suprapubic operation it is impossible to cut into the rectum, to inflict injury on the sexual organs, or to make an urethro-rectal or perineal fistula, any or all of which are liable to follow the lateral operation in a patient with a large stone.
The objections raised against the suprapubic method—the danger of opening the peritoneum and the risk extravasation of urine around the base of the bladder-he does not regard as valid. The risk of extravasation, he says, is small, because it can only happen as the result of unnecessary and unwarrantable interference with the tissues outside the bladder. As for the danger of lacerating the peritoneum, the experience of the modern operation demonstrates this danger as now virtually non-existent.
The writer then describes the technique of the operation at length, and adds tables of experience with the various methods. - Weekly Medical Review.
TREATMENT OF ACUTE RHEUMATISM.-Prof. Da Costa states that there are laid down two principal plans of treatment of acute rbeumatism :
I. Salicylic acid and the salicylates. These are unquestionably the most speedy remedies, but should not be employed in those cases in which much weakness exists, for it greatly increases the sweats and depression, or in those cases where tendency to cardiac complication is manifested. In these latter it has been stated to be worse than useless.
If the acid be used, which is preferable to its salts, give not less than sixty to ninety grains in twenty-four hours. Ten grains may be given in emulsion every hour for six hours, if borne well, and then the same doses may be given at intervals of two hours.
If the salicylates are used, give three drachms in twenty-four hours. If this plan acts at all, it will do so promptly; and if good results are not achieved by the second or third day, it had better be abandoned.
2. The alkaline plan. This consists in rapid saturation with the alkalies. It lessens the complications, but no good can be achieved by small doses. An ounce to an ounce and a half of either the bicarbonate or acetate of potassium must be given the first twenty-four hours, half as much the following day, and three or four drachms each day thereafter.
Employ until the urine becomes neutral or alkaline, and then diminish the dose as above named.- College and Clinical Record.
SQUIBB's EPHEMERIS.-All friends of pharmaceutical progress will note with pleasure that the publication of the Ephemeris has been resumed by Dr. Squibb. The January number (Vol. III., No. 1) has just been issued in exact counterpart of the preceding numbers. It would be difficult to find a journal which contains so much valuable matter in so unpretentious a form. Dr. Squibb's large experience and extended facilities place him among the first practical pharmacists in the world, and the example of liberality that he sets in the free issue of the journal