such condition that the diagnosis be made, and that surgical treatment be not too long delayed.

All inflammations of the pelvis of the kidney, of the bladder, and of the urethra are surgical conditions and require local treatment.

Hexamethylenamine.— Hexamethylenamine (urotropin), a condensation product of ammonia and formaldehyde, occurs in colorless crystals or as a white powder, and is very soluble in water. The Pharmacopoeial dose is 0.25 Gm. (4 grains); an effective dose as a urinary antiseptic is two or three times this amount. It is best given as a tablet or powder, dissolved in half a glass or more of water. It has been lauded for antiseptic and germicidal action in various parts of the body, but it has been shown that it cannot act as an antiseptic except in acid media (i.e., it cannot give up its formaldehyde except in the presence of acid), therefore it cannot act internally as an antiseptic except in the urinary tract when the urine is acid. A 0.25-gram dose may be administered several times a day, double that amount three or four times a day, or a gram (15 grains) may be administered twice a day. In acute or chronic nephritis urotropin should not be administered, and in some individuals with normal kidneys it causes irritation, and in large doses may cause hematuria. Hexamethylenamina is sold under many proprietary names, and sometimes is combined with other drugs, but none apparently has any advantage over the official hexamethylenamina. This drug should not be given in any form for any great length of time, at least not without intermission.

Methylthionine Chloride.-Methylene blue occurs as a dark green crystalline powder, is soluble in water and alcohol, and the dose is 0.10 Gm. (11⁄2 grains), in capsules, taken with plenty of water. It has been used as a genitourinary antiseptic in gonorrhea, in infections of the bladder and of the pelvis of the kidney. The drug may be administered every six hours, and, as just stated, should be always taken with plenty of water. Under its action the urine becomes blue or blue-green. It has been used with some success in malarial fever when quinine cannot be given.

This drug may cause nausea and vomiting, unless each dose is taken well diluted. If large doses have been given, it may cause backache, kidney and bladder irritation, and may even cause strangury and general depression.

DRUGS USED TO STIMULATE THE MUCOUS MEMBRANES

In chronic inflammation of the pelvis of the kidney, of the bladder and of the urethra, no one drug is more successful, in proper cases, than is santal oil. The more disagreeable copaiba, cubebs, corn silk, pichi, and numerous other lauded stimulant diuretics are no more efficient and generally not as favorable in their action as is the oil santal.

Most of the drugs called stimulant diuretics stimulate the membrane of the genitourinary tract. All aromatic oils act in this manner, and these, as well as the drugs above mentioned modify the character of the urine and prevent the growth of germs, but they more or less disturb the digestion.

Oil of Santal.-Oil of sandalwood is a volatile oil distilled from sandalwood, and occurs as a pale yellow, somewhat thick liquid having a strong odor and taste of sandalwood. It is best administered in flexible capsules containing 0.30 to 0.60 mils (5 to 10 minims), given three or four times a day, best after meals; or, if taken on an empty stomach, plenty of water should be drunk at the same time.

Santal oil gives its odor to the urine and to the breath. Large doses, and even small doses sometimes, cause backache in the lumbar region and pain down the ureters sometimes into the testicles. It not only acts as an antseptic in the urinary passages, but many times seems to stimulate a chronic inflammation to more rapid healing. It should not be used in acute inflammatory conditions.

Santal oil has also been used as an expectorant to promote more active secretion in bronchitis, when the exudate is thick and tenacious.

EMMENAGOGUES

Before giving so-called emmenagogues, the cause of the amenorrhea must be sought and pregnancy must be excluded. If the cause of the amenorrhea is systemic, the underlying con

dition must be treated. If there is anemia, proper diet and iron is the treatment. Amenorrhea is often due to endocrine gland disturbances, and a frequent cause is insufficiency of the thyroid. Thyroid feeding, ovarian feeding, and the administration of corpus luteum are all often efficient treatments. If there is dysmenorrhea, a local cause should be sought and, if found, treated.

In the many preparations, Pharmacopoeial, National Formulary, proprietary mixtures, and nostrums recommended for dysmenorrhea, the efficient ingredient is generally alcohol. The dose of each of these alcoholic preparations recommended is generally sufficient to cause alcoholic relaxation, and therefore a diminution of the pain.

In proper cases, the most efficient emmenagogues are thyroid, ovarian, and corpus luteum extracts. The use of these preparations in amenorrhea will be described in Part IV. If the patient is anemic, iron is a most valuable emmenagogue. Many times precipitated manganese dioxide in doses of 0.10 to 0.20 Gm, (about 2 or 3 grains), best given in capsule, is efficient in hastening menstruation or causing a scanty menstruation to become more profuse. It should be given for several days before the expected flow.

OXYTOCICS

Different terms have been applied to these drugs. The term "oxytocic" should be limited to those drugs that have the power to hasten parturition. The term "ecbolic" has been applied to drugs which not only increase the rapidity of natural parturition, but which may cause such contraction of the uterus as to cause abortion. Such drugs have also been termed "abortifacients." Some drugs that cause contraction of a dilated uterus cannot produce abortion.

If the uterus is unduly dilated after parturition, ergot will generally cause contraction of the uterus, often, however, interfering with desirable after pains which are necessary for the uterus to evacuate clots, etc. If chloroform has been administered during the parturition, an oxytocic is generally indicated, unless an assistant can sit at the bedside and clasp the uterus

through the abdomen until it normally contracts. If there is post-partum hemorrhage, besides the drug treatment (ergot and pituitary extract) local measures are needed, as the introduction of ice into the uterus; or the reverse, namely, very hot water introduced into the uterus.

For a dilated uterus at other times than post-partum, and when there is profuse bleeding, hydrastinine is of value, as is also quinine. Ergot frequently acts well in stopping profuse menstruation. For too frequent and too profuse uterine flow, especially in young girls, mammary extract is of value. It should be urged that drugs that contract the uterus are used symptomatically, and the cause of the increased uterine flow must be diagnosed and properly treated.

Mammary extract, in the form of tablets, given two, three or four times a day, beginning with the fourth or fifth day of the menstruation will frequently stop the flow in a normal manner, while ergot will cause sudden stoppage, with pain, and often to the disadvantage of the patient. In too frequent menstruation, if mammary extract, one or two tablets a day, is given for at least a week before the date at which the menstruation has been coming, it may postpone the menstruation to the normal period.

There is no question that ergot will generally slow any uterine flow, but it has the disadvantage of stopping the flow too soon and producing nausea in many patients. It also often raises the general blood-pressure, but not always. It should not be used after parturition as a routine practice, as it may cause contraction of the lower part of the uterus and thus shut up in the uterus blood clots and membrane, and it should rarely be used before the third stage of labor has been completed.

Quinine sulphate has often been used to cause a better tone of the uterus after parturition, and to expel blood clots. It will also, in good sized doses, cause contraction of the uterus in profuse menstruation, unless there is some more serious condition than simple dilatation present.

Pituitary extracts, namely, the blood-pressure-raising stuff from the posterior lobe of the hypophysis, best given hypodermatically, is of value (when used with care) in certain

conditions during parturition as an oxytocic. This drug always, by the way, raises the blood-pressure and stimulates the heart.

Hydrastinine Hydrochloride.-Hydrastinine is obtained by the oxidation of hydrastine, and the hydrochloride occurs as light yellowish needles or as a powder, and is very soluble in water and alcohol. This preparation is more active than Hydrastine Hydrochloridum, as a uterine contractor, hence the latter is not needed. This drug raises the blood-pressure, generally slows the heart, and sometimes causes depression. The dose by the mouth is 0.03 Gm. (1⁄2 grain), but it is often given hypodermatically. It may be given in all conditions of bleeding from the uterus, but it is not sufficiently active for the treatment of post-partum hemorrhage.

SECOND DIVISION

CLASS III

DRUGS USED FOR ACTION ON THE RESPIRATORY TRACT

As these drugs are generally used to prevent or treat colds and coughs, it is not amiss to briefly discuss the causes of colds to better understand their prevention, and to discuss the types of cough to better direct their treatment. Such a discussion is of special value, as too much faith has long been placed in the ability of the drugs of this class to prevent and cure disease of the air passages.

Colds due to adenoids, tonsil disease, nasal obstruction, sinus disease, tooth infection, too much or too little clothing, too much or too little bathing, poorly ventilated bedrooms, the inhalation of dust especially irritant dust, carelessness in using germ contaminated telephones, carelessness in using handkerchiefs and towels that have been infected by others, and the inhalation of droplets of infection sneezed or coughed into the atmosphere by those who are infected, cannot often be prevented by drugs.

Coughs due to reflex irritation, and coughs due to local irritation, such as congestion of the lingual tonsil, cannot be cured