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productive cough; (3) the irritated or congested respiratory mucous membrane; and (4) the atonic mucous membrane.

Perhaps the cough remedies are more abused by layman and physician alike than any other group of remedies, because to the layman a cough is a cough, and there are plenty of cough remedies on the drug store shelves that cured Jones or Smith of his cough; and because to the physician too often a cough is simply a loose or a harsh cough, nothing more than a minor symptom for which the patient demands some medicine. But often we find that what relieved Jones' harsh cough will not relieve Smith's harsh cough. This is where individuality of the case, and specific indications for or actions of drugs enter materially. A review of the actions and indications of each drug taken separately would be too tedious, as we are familiar with them, although when we are prescribing it is hard to choose the proper one, because of the multitude of remedies in this class,

So let us classify the remedies according to their action upon the respiratory system, then keeping in mind our pathology in each case, and our specific indications we may choose more accurately. Briefly, the respiratory remedies may be classified into four great divisions: (a) Drugs which influence the respiratory center in the medulla; (b) drugs that influence the bronchi and lungs; (c) expectorants; (d) anti-expectorants.

Group A is divided into two classes, those which directly increase, and those which directly depress the respiratory center. The accelerators are: Strychnine, atropine, ammonia, apomorphine, stramonium, hyoscyamus, digitalis, and emetine slightly. These are used to increase the force of the respiratory act and thus overcome difficulty, as in bronchitis, pneumonia, etc. The depressants are greater in number: Opium and its derivatives, hydrocyanic acid, conium, physostigmine, chloral, aconite, veratrum, prunus virg., bromoform, gelsemium, castanea, and the following seven which excite slightly before depressing: Alcohol, ipecac, chloroform, ether, caffeine, quinine and antimony salts. These allay cough reflexly set up by irritation of the lungs, liver, pleura, trachea, larynx, nose and pharynx.

(B) The second group, the drugs that influence the bronchi and lungs, we will split up as we go. (1) Drugs that stimulate the afferent filaments of the vagus are: Ipecac and the antimony salts internally, and the irritant inhalations as chlorine, bromine, iodine, ammonia, tobacco, etc., which are not used therapeutically for the purpose. (2) Drugs that depress the afferent nerves; these are the same as named under depressants of the respiratory center. (3) Drugs that affect the bronchial glands. These are divided into six subdivisions:

(a) Drugs that increase the bronchial secretion are: Alkalies, iodine, apomorphine, senega, squill, ipecac, benzoin, antimony salts, camphor, lobelia, jaborandi, sanguinaria, terebene, turpentine, volatile oils, asafetida, tobacco, sulphur, balsam of peru, tolu, copaiba, onion, garlic, lippia, aralia, and yerba

santa.

(b) Drugs which diminish the bronchial secretion are: Acids, opium, belladonna, stramonium, hyoscyamus, inula, agrimony, prunus and lycopus.

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(c) Drugs that disinfect the bronchial secretion are the antiseptic inhalations, and copaiba, cubebs, ammoniacum, creasote carbonate, hexamethylenamine, volatile oils and oleoresins internally.

(d) Drugs which stimulate the neuro-muscular endings of the bronchi are those which excite the afferent nerves.

(e) Drugs that depress the neuro-muscular tissues of the bronchi and relieve bronchial spasms. These may be either (1) anti-spasmodic inhalations, as ether, chloroform, amyl nitrite, smoke of stramonium, nitre paper, belladonna, etc.; (2) the depressants of the respiratory center; (3) the expectorants, or the following: Stramonium, lobelia, belladonna, hyoscyamus, sodium nitrite, nitroglycerine, grindelia, chloroform, chloral, tobacco, ether, opium, ethyl iodde, conium, cannabis indica, camphor, drosera.

(f) Drugs that act on the bronchial circulation: (1) Those that stimulate the general circulation, increase the circulation of the bronchi, as digitalis, cactus, strychnine, strophanthus, squill, alcohol, aromatic oils, ammonia, asclepias, atropine, xanthoxylum; (2) those that depress the cardiac or general circulation, diminish the bronchial circulation, as aconite, alkalies, iodides, ipecac, veratrum, antimony.

(C) The third group are the expectorants; these are the remedies which facilitate the expulsion of the sputum. They may be divided somewhat according to their mode of action :

(a) Nauseating expectorants in large doses act mechanically by expelling the mucus in the act of vomiting, or in small doses by increasing the osmosis from the inflamed mucous membrane; they generally tend to increase secretion and lower blood pressure, as tartar emetic, ipecac, apomorphine, jaborandi, alkalies, potassium iodide, sanguinaria, lobelia.

(b) Stimulant expectorants which either stimulate the bronchial glands or stimulate the expulsive muscles: Ammonium chloride, ammonium carbonate, benzoin, balsams of peru or tolu, pine tar, oil of pine, acids, squill, turpentine, nux vomica, strychnine, senega, licorice, sugars, peony, phosphorus, hydrastis, serpentaria, xanthoxylum.

(D) The fourth group includes the anti-expectorants, which diminish the amount of the water and thus dry up the secretion, and must be watched very carefully. They are acids, iron, atropine, opium, adrenalin, warm or cold dry air.

This completes the four groups, and within them are embraced practically all of the most used cough remedies, and some that are generally thought of as belonging to other classes of drugs. As a suffix to the classification we will make a few further specific remarks.

More care is needed in prescribing for acute than chronic cases, so let us note a few facts concerning acute conditions. Lippia, ipecac and cocillana relax congested tissues and lessen hypersensitiveness, Ammonium chloride, squill, senega, increase sensitiveness, aggravate the cough and increase the blood supply. Tolu, copaiba, cubeb and myrrh check secretion, give no relief to acute congestion, but restrain profuse mucous discharge in chronic cases.

In acute cases with fever and dry painful cough, bryonia, rhus, aconite,

chamomile and asclepias increase secretion and relieve congestion. To sooth pharyngeal irritation and dryness use sugar, licorice,' gums, mucilages, elm bark, flaxseed tea, petrolatum or emulsions of oils. To relieve severe tickling or sensitiveness of the pharynx or larynx use oils of cinnamon, peppermint, cloves or eucalyptus in very small doses on sugar to be dissolved in the mouth, or tablets containing any of the above or any of the following: Cocaine, carbolic acid, menthol or chloroform.

A condition which is often very annoying to the patient is that which develops after the acute stage has passed (which is perhaps sub-acute), where the mucous glands have lessened their outpour but have not returned to normal, and which results in the accumulation of a tough or tenacious mucus, with an irritable dry cough which should be productive. A condition which can not be suppressed by a narcotic, but which needs stimulation to the bronchial glands to increase their flow and loosen the mucus. Remedies here found useful are: Lemon, acetous tincture of lobelia, stillingia, sanguinaria, ammonium chloride, potassium bichromate, vinegar inhalations or mild solution slowly sipped.

Remedies which sometimes relieve cough when specifically indicated are cimicifuga, valerian, sticta, cheeken, achillea, lactucarium, saw palmetto, lycopus, calcium sulphide, calcium iodide, echinacea, collinsonia.

Don't give syrupy mixtures in acute cases, but give in plain water the indicated medicine to relieve the pathological condition of the respiratory tissues. Don't give syrupy mixtures in large doses for long periods in chronic cases; they upset the stomach and set up a long chain of complicating conditions. Syrup should be used only when the medicine is very unpleasant or when it contains some agent which has a local effect on the nerve endings of the irritated mucous membrane. When giving such cough syrups instruct the patient to swallow the medicine slowly and take no water immediately afterward. If he complains that the medicine burns his stomach have him drink some water first, but not afterward. Now that we have most of the unpleasant remedies in the colloidal specific medicine form, the using of syrup is less called for than formerly-California Eclectic Medical Journal.

RESORCIN.*

HERBERT T. WEBSTER, M.D., Santa Ana, Cal.

Resorcin has been a favorite remedy with me for many years. I have not made the extended use of it suggested in the Dispensatory, for I have regarded it as a doubtful internal medicine. It is too potential in toxic property to be considered a safe resort as a systemic remedy, and its use here is better and safer supplied by agents more reliable and less risky. My experience with it has been with its local effect alone, and here I have been well pleased with it in numerous instances. I employ it in solution. A drachm of resorcin,

* Read before the California Eclectic Medical Society.

half an ounce of alcohol, two drachms of glycerine and enough water to fill an eight-ounce vial are combined and well shaken. This is ready for use, and may be applied freely where indicated.

In stubborn eczematous and herpetic eruptions due to vegetable parasitic growth this solution is the most reliable application I have ever known. It is not adapted to scabies, due to burrowing mites, but vegetable parasitic growths yield slowly to its action in almost every instance, though its action is slow, and it must be continued patiently for a long time in many cases. Such affections are not usually painful or otherwise distressing, except as their disfiguring effects are concerned. Occurring on the face, they are mortifying to those who value a fair complexion. Such conditions are chronic, insidious in their incepton, and stubborn when established. Long-continued application of this solution will cause a gradual disappearance of such blemishes. Months and months of persistent application are necessary for success, but while other remedies are likely to fail entirely or produce unpleasant irritation, this is soothing and will almost invariably succeed in time.

While clear and colorless at first, the solution will gradually assume a yellowish-brown color, due to the influence of light; and when spattered on enameled woodwork in a bath room it leaves a permanent stain. If employed on the scalp it is likely to be scattered about, so I advise that its application be made out of doors. It may be applied to non-hirsute surfaces with a small sponge or wadded cloth.

I believe it is the best hair tonic extant. It cures dandruff in a short time, where the scalp is saturated with it, and it cures eruptions among the hair in most instances, especially if these be of a scaly character. It slowly, as the light acts upon it, imparts a brownish tint to grey hair, though it is not what one would consider a dye. Where the hair is graying in streaks it lessens the contrast and preserves the original color of dark hair. It does not wash out, nor does it impart the impression that the hair has been dyed. For years elderly ladies in my clientele have doted on this solution as an application to the hair and scalp. I recollect a young man who came to me years ago almost bald as the result of syphilis who now has a luxuriant head of hair, and it was restored in a few weeks with this solution locally and the internal use of specific berberis. I was not the first one called on to tackle this job. Several physicians had had a try at it before the case came to me. I have no idea that the treatment renewed lost hair follicles. Luckily, they only needed tne proper stimulus and the system proper treatment for syphilis.

I have learned to place much dependence upon it in all cases of devitalized hair growth. We have few remedies that compare with it where the hair becomes lusterless, brittle, and shows a tendency to fall. A few weeks' use of this solution, well rubbed in and the hair and scalp well brushed with a stiff brush afterward, will make a decided improvement in the appearance of the affected individual.

Another excellent use for it is in certain eczematous conditions about the anus. Having made hemorrhoids a specialty for many years past, such conditions have naturally gravitated my way. Many people are affected by irri

tation and itching about the anus which they suppose to be due to piles, when the condition is really an eczematous or herpetic eruption in the cutaneous folds about the anus. Usually here pruritus is intense and excruciating, causing much unrest day and night.

When I find the least evidence of cutaneous trouble about the anus in such cases my first thought is of my resorcin solution, which I advise to be applied with a soft sponge or pad of linen or cotton several times a day if necessary, to relieve the itching.

Most of us know pruritus ani is a very difficult affair to manage, and this application may fail to give relief, though I have had so many successes with it that I always give it a thorough trial where it is reasonably indicated.

Pruritus ani may originate from a variety of causes, and resorcin may not always be adapted to the case. I have relieved some bad cases by removing rectal pockets and papillæ. Sometimes it may be due to hemorrhoids located low down. Resorcin is only adapted to cutaneous complications.

I sometimes find that the glycerine is objectionable to those who use the solution as a hair dressing. Some subjects have too much oil in the hair naturally, and do not want too much glycerine in the dressing. One drachm may be used here instead of two. In fact, the glycerine may be left out entirely, though it makes the solution more permanent. The solution does not dry out so quickly.---California Eclectic Medical Journal.

Ohio State Eclectic Medical Association Proceedings of the Fifty-sixth Annual Meeting, Dayton, Ohio, May 18-19-20, 1920,

J. F. WUIST, M.D., EDITOR, DAYTON, O.

A FEW MINOR OBSTETRIC POINTS.

WESLEY VAN NETTE, M.D., CLYDE, O.

In this paper I take up subjects usually considered of lesser importance. It is attention to details that brings success, and many times attention to the little things prevent a great deal of trouble and annoyance, suffering and failure. And sometimes very unexpectedly the little things develop into mountains. It is the object, therefore, of this paper to discuss preventive

measures.

For instance, the care of the nipple before labor. Much depends on this care as to the possibility of cracked nipple and caked breast. The cracked nipple is a very painful little thing, and in this crack infection enters which is usually the cause of caked breast. Now if by some method we can prevent this trouble, that is much better than trying to cure after we have the trouble on our hands.

For a long time we were taught to harden the nipple with alcohol. This I did for a long time, and would still have the trouble, because a hardened

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