boiling it down to 500 mils. This strained solution is then injected into the rectum which has been previously washed with a weak soap and water enema. This treatment must be repeated for many days. Injections of glycerin and water have also been used, and also bisulphate of quinine solutions, in about 1 per cent. strength, are often successful. The bowels must move, daily, with some simple laxative, as senna, and it may be well to give a few doses of spigelia, as above suggested for round-worms. The local eczema should be treated with a weak phenol ointment. Infants and young children should be so clothed that their fingers cannot become contaminated and make re-infection possible.

Hook-worms.-This very common cause of general debility and anemia in the Southern States can be completely cured, and will probably gradually be eradicated. The treatment is with thymol or worm-seed oil. The preparatory treatment is much the same as has been described under the treatment of tapeworm. After the bowels have freely moved in the morning, one-half the dose decided upon is given, and the other half is given in two hours. The dose of thymol must be large to be effective, and the adult dose should be 3 or 4 grams (45 to 60 grains). The dose for children should be computed from this adult dose; a ten-year old child should receive half the dose; a five-year old child one-quarter of the dose, etc. Ferrell believes that thymol acts better when combined with an equal part of sugar of milk. It is best administered as a powder, in capsules, and the capsules should be uncapped at the time of swallowing. Two hours after the last dose of thymol, half an ounce to an ounce of Epsom salt, or Rochelle salt, should be taken, this to be repeated if the bowels have not moved in four hours. The danger from thymol lies in its absorption, and the longer it remains in the intestine, the more likely is absorption to occur. When the patient is reclining he should lie on his right side to facilitate the passage of the thymol into the intestine.

Wormseed oil has been shown to be as effective as thymol in eradicating hook-worms, and it is not as poisonous a drug. While wormseed oil does not kill the hook-worms, it seems to stupefy them, and if, after a short action of the wormseed oil,

a brisk cathartic is given, the worms are passed out of the bowels. While castor oil or any other kind of oil must not be used as a cathartic after thymol treatment, castor oil may be given as a cathartic after wormseed oil has been administered. The dose of wormseed oil suggested is one drop for every year of the age of the child up to fifteen years. It may be given on granulated sugar. This dose may be repeated every two hours for three doses, and two hours later the child receives a full dose of castor oil. The preparatory treatment is the same as when other anthelmintics are used; i.e., a starvation period, then purging, and later sustaining treatment.

As it is difficult to eradicate hook-worms at one treatment, the anthelmintic may have to be repeated several times at sixday intervals. Whenever depression occurs from these treatments, coffee, caffeine, atropine, and other cardiac stimulants may be needed. Throughout the treatment the patient should be under the careful observation of the physician.

Thymol is a phenol, and occurs as colorless prisms, practically insoluble in water, very soluble in alcohol, and has a pungent, aromatic taste. It is often added to gargles and sprays, in weak solutions, for its antiseptic action, and has been used as a bowel antiseptic, but it should not be used internally except for the specific purpose of eradicating hook-worms, as it is a drug which may readily cause poisoning. The poisoning that it causes is typically of the phenol type; it may cause nausea, vomiting, sweating, dizziness, and collapse. It may cause the urine to become dark or greenish, and it is more or less irritant to the kidneys. The intestinal antiseptic dose is 0.10 Gm. (about 2 grains), best given in capsules. The Pharmacopoeia gives the anthelmintic dose as 1 gram (15 grains), but in the treatment of hook-worm disease much larger doses must be given, as above described.

Carvacrol is produced from spruce turpentine, is similar to thymol, and costs much less. Before this drug is used internally as a substitute for thymol in hook-worm disease it must be more thoroughly investigated.

Oil of Chenopodium (Wormseed Oil) is a pale yellowish liquid, having a disagreeable taste and odor. This oil has been

used to expel round-worms, but more especially, as just stated, for the eradication of hook-worms. It has no other uses. The United States Pharmacopoeia gives the dose as 0.2 mil (3 minims). The dose may be considered, as above described in the treatment of hook-worm, about 15 drops for an adult for any one day.

At times oil of chenopodium may show no serious symptoms on the day of its first administration, but when it is repeated several days later there may be found an increased hypersusceptibility to it. This is especially true if the individual is under-nourished. A cachectic child or older patient should probably not receive the second treatment from the oil of chenopodium unless his nutrition has improved, and he has taken a goodly amount of food. Castor oil given before and after the administration of wormseed oil has seemed to prevent toxic action from the latter. Also, plenty of water should be taken with the oil to insure its rapid passage from the stomach to the intestine. Amebic Dysentery. Fortunately, this disease is not frequent in all parts of this country, but it is common in the tropics.

The specific treatment of amebic dysentery is the administration of ipecac and emetine. The ipecac is administered by the mouth, perhaps best in the form of emetine bismuth iodide, as the ipecac in the intestines better eradicates the ameba that are on the surface of the intestinal walls than does the dose of emetine given hypodermatically. Emetine given hypodermatically will kill the ameba that are deeper in the tissues of the intestinal walls. When ipecac is administered by the mouth in a form that is insoluble in the stomach, it is not necessary to precede the dose with opium or morphine, but in a form that is irritant to the stomach, vomiting will be caused unless a hypodermic of 1% to 1% of a grain of morphine has been previously administered. The Pharmacopoeial hypodermatic dose of this preparation is stated to be 0.02 Gm. (1⁄2 grain), but when this is to be repeated, as in amebic dysentery, the dose should be smaller, perhaps about 0.01 Gm. given once or twice a day, hypodermatically, for three or four days, and then once a day for a week, this combined with the administration of some form of ipecac by the mouth.

It should be noted that emetine in too large doses may cause some paralysis and heart weakness, and may cause death.

The best preparation for administration by the mouth is perhaps emetine bismuth iodide, which may be administered in 0.05 Gm. (about 1 grain) doses three times a day, for two weeks. According to Sollmann1 this preparation is but slightly soluble in the stomach, and seems to be freely soluble in alkaline media. Therefore it is soluble in the intestine.

Emetine Hydrochloride is the hydrochloride of the alkaloid emetine, which is obtained from ipecac. It is a yellowish crystalline powder, is soluble in water, and is used mostly hypodermatically as a specific in amebic dysentery. Its value in pyorrhea alveolaris has not been proved. The single dose is 0.02 Gm. ( grain) hypodermatically.

Emetine Bismuth Iodide, N.N.R. is a complex iodide of emetine and bismuth, containing not far from 20 per cent. of anhydrous emetine and about 20 per cent. of bismuth. It rarely causes vomiting, and is a good method of administering ipecac for intestinal action. The dose is 0.20 Gm. (3 grains), given either in a single or in divided doses for several days, well administered in capsules.

Alcresta Ipecac. This is an emetinated fullers' earth. It has been shown by Sollmann that the alkaloids of alcresta ipecac are insoluble not only in the stomach but in alkaline media. Therefore they may not be dissolved in the intestines.

Caution. Emetine in any form should always be used with care, as it may cause poisoning.

It should be emphasized that the ipecac and emetine treatment of amebic dysentery does not heal the ulcers in the intestines, and after the ameba have been eradicated, this surgical condition requires further treatment.

Leukemia. Benzene (Benzol) has been recommended and used in leukemia, as by its administration the number of white corpuscles is reduced. This is especially true if the roentgenray treatment is used coincidently. Several preparations may be obtained, and the dose of "benzene, medicinal," according to

1 1 Journal A. M. A., Oct. 11, 1919, p. 1125.

I

New and Nonofficial Remedies, is 0.5 to 1 mil (8 to 15 minims) given four times a day, best in emulsion. Treatment with this drug is not without danger, and the condition of the patient and the condition of the blood must be watched. Its permanent value in this disease has not been proved.

SECOND DIVISION

CLASS I

DRUGS ADMINISTERED INTERNALLY FOR THEIR ACTION ON THE SKIN

DRUGS USED TO STIMULATE THE ACTIVITY OF THE SKIN

The surface of the body is dry, scaly and harsh in various chronic diseases of the skin, and it is also dry in hypothyroidism, in chronic nephritis, and in diseased conditions of the liver. Any treatment that improves the systemic condition will improve the condition of the skin. Many times a dry skin—a skin that does not normally perspire-will be improved by the administration of thyroid extract, if such medication is not contraindicated. Arsenic is also a stimulant to the skin, but it should not be given if there is disease of the kidneys or liver. The majority of dry skins, not due to organic diseases, are due to sub-thyroid secretion.

A description of the action of arsenic and of thyroid gland extracts will be found on pages 382 and 406 respectively.

DIAPHORETICS

It is desirable to increase the perspiration in fever, after chilling, and in some toxemias. The so-called antipyretic drugs all promote perspiration, and especially valuable for this activity is antipyrine. Alcohol, by dilating the peripheral bloodvessels, is a promotor of perspiration.

Of all methods to promote perspiration, the best are body baking, electric light cabinet baths, Turkish baths, ordinary hot baths, and strenuous exercise. Turkish baths and exercise are especially valuable in reducing obesity by causing perspi