Editor MEDICAL WORLD:-Dr. A. R. Taylor asks how to frame a sheep skin so it will not wrinkle." I can not answer his question, but I think if he will get a smooth round stick like a broom handle, roll it snugly on this, then wrap with paper and put away in a drawer or on top of his book case, it will be sufficiently smooth when he has occasion to show it to gain admission to a medical association or for any other purpose.

Query. Doesn't this framing of diplomas savor of pedantry?

I. L. VAN ZANDT, M.D.

Ft. Worth, Texas.

Glandula Suprarenalis.-Adrenal.

(SUPRARENAL CAPSULE )

Editor MEDICAL WORLD: The gland lies in cattle near the forward end of the kidney, more or less imbedded in the kidIt is in the shape of two parallel lobes connected at one end, and weighs about two and one-half drams. In sheep it is loosely connected with the forward end of the kidney, is some what of a half moon shape, and weighs about one-half dram. Both kinds resemble in texture and color the kidney. There is no other small body near the kidney for which the adrenal could be mistaken. It can be easily obtained at any butcher's shop. The butcher has neither name nor use for it. The manufacturers of the preparations of the adrenals assert that they use only those from the sheep; but there is no valid reason given why those of cattle would not be just as effectiv. Some physicians have used the fresh adrenals of cattle with as good success. The name suprarenal capsule is misleading, as it is not a capsule, but a gland.

The active principle of the gland is called epinephrin and adrenalin.

Preparations of the gland, and administration:-The powder obtained from the desiccated adrenal will keep indefinitly, but is of varying strength. One grain of it represents eight grains of the fresh gland; five to ten grains of the powder, or comprest into tablets, are given internally for one dose, and should be allowed to dissolve slowly on the tongue and swallowed slowly without water. The powder should not be used locally, as it easily decomposes and may cause infection.

For external use a watery solution or extract is made from the powder. Stir

per

five to ten grains in one dram of water and let stand from one half to one hour, filter and boil in order to sterilize it. Some use the proportion of one part powder and ten parts water and call it a one per cent. solution. [This would be a ten It should cent. solution.-ED.] always be freshly prepared, as it spoils within a few hours, and preservativs like boric acid, alcohol, cinnamin, etc. should not be used, because they interfere with its therapeutic effect. The solution is applied as a spray, or more preferably, on pledgets of cotton, occasionally with the assistance of the galvanic current, which insures a more prolonged and thoro effect. A well prepared solution or extract should whiten the conjunctiva of a normal eye in less than a minute; it should not be irritating nor affect the iris nor the accommodation. The solution in doses of ten to fifteen drops is also used hypodermically, but causes local pain, swelling, tenderness and whitening of the skin in a space of two inches in diameter.

Internal and external use may be combined.

A glycerin extract, forty grains of the powder to the fluid dram, is more liable to produce nausea than the tablets.

The fresh adrenals have been given internally raw and cookt.

Epinephrin is a powder which varies from a light gray to a brownish color; solutions are made from it.

The adrenalin is in a pure crystallin form. The effect of the solution is not altered by its change to a pink color.

The adrenalin chlorid solution is clear, colorless, odorless, steril and stable, if protected from heat, light and oxidation, and non-irritating. Solutions of 1: 1,000 are strong enuf for operativ work; of 1: 5,000 and 1: 10,000 for local medication.

The normal salt solution may be used as the solvent in place of mere water.

The effect of the adrenal on the human system:-Its effect is usually very rapid but not long lasting. By applying the extract on the healthy skin for one-half hour or longer it turns it white. The aqueous extract applied to the mucous membrane of the eye or nose produces pallor and contraction within thirty to forty seconds, lasting fifteen to twenty minutes. It does not usually produce secondary dilatation of the bloodvessels or secondary hemorrhage. hemorrhage. The local application bas caused no dangerous systemic symptoms.

The powder taken by the mouth does not act as quickly as the solution locally. Moderate doses have caused vertigo, nausea, nervous excitement, rapid action of the heart and increase of respiration; large doses rapid and extreme enfeeblement, failure of respiration and circulation.

When the extract is administered hypodermically, the skin is blancht a dead white immediately and may be incised without primary hemorrhage. Hypodermic injections have caused at times livid face, great pain in chest and head and other unpleasant symptoms.

The bloodpressure is not appreciably raised, when the adrenal is administered by the mouth or hypodermically, but an intravenous injection of a minute dose of the aqueous extract produces an enormous and rapid rise of the arterial pressure and dangerous cardiac symptoms.

The use of the gland does not lead to drug habit, nor is it cumulativ.

--

The use of the adrenal in diseases: As the effect of the gland is quick but transient, it depends upon the nature of the case how much benefit may be derived from it. If its effect is needed only for a short time, as in operations on the eye or nose, or in certain dangerous attacks in heart diseases, the operation of the drug is perfectly satisfactory. But if the disease is of several days or weeks duration, as in hay fever, the adrenal only mitigates the disease temporarily, as its curativ power is exceedingly limited.

The adrenal is contraindicated in anemic conditions or where the mucous membrane possesses a low degree of vitality.

The adrenal does not coagulate the blood. As the aqueous extract, applied locally, is the most powerful astringent and hemostatic, it has been largely used in operations, especially on the eye and nose. The spray alone is not sufficient. In operations of some duration pledgets of cotton, saturated with the solution, should remain on the part for five minutes, then cocain pledgets for five minutes or longer, and then again the adrenal solution for five minutes. This makes the parts perfectly bloodless, totally anesthetic and renders a general anesthesia superfluous. The majority of the cases will show some anemia and shrinkage of the mucosa from one to five hours, in some cases longer. The cocain and adrenal solutions should not be mixt, but applied one after the

other; in this way they assist each other. There is also less danger from cocain toxemia. As there is no bleeding, the cocain is not washt out; hence weaker solutions will often answer. In shorter operations the first application of the adrenal solution may be omitted. The contraction of the blood vessels and the blanching of the mucosa take place first, and are followed by constriction of the parts, in some localities down to the osseous structure.

The healing after an operation is said to be quicker than when adrenal is not used. After operation, secondary hemorrhages, sometimes quite severe, may happen after the use of the gland.

Five grains of the powder swallowed will in three minutes reduce the congestion of the mucous membrane of the eye, nose or throat.

The gland is of no use as a hemostatic in removing adenoid tissue of the pharyngeal vault or in the excision of the tonsils, as the pledgets cannot be effectivly applied.

Regarding the internal use of the adrenal, it is like that of all drugs, viz.: some persons are very indifferent toward it and receive little or no benefit, and some are oversensitiv and experience discomfort from small doses.

The gland has been used in all kinds of inflammations and congestions irrespectiv of locality, but especially in those of the mucous membrane of the upper respiratory tract. If convalescence is obtained, its administration in small quantities must be continued for a great length of time.

The external and internal use affects beneficially catarrhal and purulent conjunctivitis, keratitis, iritis, scleritis, corneal opacities, optic neuritis, glaucoma (in lessening tension and improving vision in less than one minute), lacrimal stricture, lacrimal fistula, abscess of the sac (use injections into the duct in these three diseases), the condition after operations on the nasal duct.

If the extract is applied to the orifice of the eustachian tube in the pharynx, it lessens the congestion of the drum membrane and of the middle ear in acute and chronic catarrhal otitis media. The tinnitus is lessened and the hearing improved, but only temporarily.

In coryza and hay fever five grs. or more of the powder or tablets every two hours internally and the aqueous extract as often, locally, give relief in a short time

by opening the nose and stopping the discharge. When the patient has been made sufficiently comfortable, doses and frequency should be diminisht till fifteen to twenty grs. or two tablets a day are given. It may be necessary to continue this for six weeks or till the hay fever season is over. The gland does not cure. If dizziness or palpitation or other disagreeable symptoms appear, the suprarenal has to be omitted for a time or entirely.

A case of daily epistaxis was relieved by sprays of a 1: 10,000 solution of adrenalin chlorid.

The spraying of the extract has been of immediate benefit in tonsilitis and subacute laryngitis of singers.

The adrenal has been used in edema of the glottis, in bronchitis, congestion of the lungs, asthma, hemoptysis.

It removes hyperemia of the skin.

The extract causes no change, if applied to serous surfaces.

One tablet three times a day almost entirely removed a goiter.

Five grs. at a dose were quickly of great benefit in exophthalmic goiter. Palpitation, throbbing of the carotids, asthma after slight exertion, fast pulse and the size of the thyroid were improved.

The adrenal is the strongest stimulant of the heart, and heart diseases are favor

ably affected by the internal use; five grs. of the powder chewed show an effect in from one-half to ten minutes; the pulse grows fuller, stronger, more regular, the heart's action more rhythmical, a rapid pulse becomes less so, the breathing easier. In a case of angina pectoris five drops of a one per cent. solution hypodermically relieved in five minutes oppression, pain and anxious feeling for five hours.

In one case the extract applied to the eye every two hours caused a weak, intermittent pulse of organic heart disease to become stronger and regular with relief of the subjectiv symptoms.

An old man with arterial sclerosis, with double aortic and double mitral murmur, great weakness, pulselessness at the wrist and cold hands; five grs. of the powder produced warm hands and quite a strong pulse in ten minutes.

A case of pleuropneumonia and heart disease, hippocratic face, cold limbs, very weak pulse ten drops of a five per cent. solution hypodermically caused in a few minutes a strong pulse, warm limbs and general improvement.

The adrenal has been used in diabetes, intertrigo, neurasthenia, strictures.

In rachitis it ameliorates the general condition of the body, the perspiration, craniotabes, etc., within eight to fifteen days. The children rapidly become able to walk, run and sit upright, the bones lose their softness and the delayed teeth begin to appear. The most improvement occurs during the first eight days.

In a case of chloroform narcosis in a dog, where circulation and respiration had practically ceast, intravenous injection of the extract restored at once.

Several cases of Addison's disease have been cured or temporarily improved. The fresh glands of sheep or calves, or five grains of the powder three to six times a day were given, and ten to fifteen drops of the glycerinated extract hypodermically. Treatment five months.

The disease of the adrenal in man is followed by a progressiv asthenia, loss of digestiv power with excessiv vomiting, emaciation, great weakness and a peculiar bronzing of the skin (Addison's disease). F. G. OEHME, M.D.

Roseburg, Oregon.

[Dr. Oehme asks WORLD readers to kindly not send to him inquiries as to where to obtain the above preparations, price, etc., as in the case of thiosinamin. The preparations mentioned in the above article are prepared by Messrs. Parke, Davis & Co., of Detroit, Mich., and Messrs. Armour & Co., 205 La Salle street, Chicago; to whom readers are referred Doubtless many of our for prices, etc. readers may be able to obtain the fresh glands with but little trouble or expense.— ED.]

Does Vaccination Modify Whooping Cough?

Editor MEDICAL WORLD:-In the August number of THE WORLD (page 345) Dr. Wright asks if vaccination prevents or modifies whooping cough. Twice I have resorted to vaccination for that purpose, and with decided results. My first case was in a boy 10 years old, paroxysms very severe. In one week from the vaccination the cough was nearly cured-a truly marvelous result.

The second case, an infant of 3 months, seemed hopeless. seemed hopeless. Vaccination so modified the case as to enable us to carry it thru in good shape. SALON ABBOTT.

Franklin, Mass.

Blood Poisoning. Editor MEDICAL WORLD:-In August World, page 320, Dr Vaughan described two cases of blood poisoning from wounds with rusty nails, giving his treatment. Three months ago I had a case caused by a prick from a pin on right index finger. Patient a young lady aged 18. Result, pain and swelling of finger, chills, fever and symptoms of general blood poison, with a loss of one-fourth the soft tissues of the finger from gangrene. Treatment for finger was peroxid of hydrogen and iodoform, general treatment, full doses of calcium sulfide and nuclein solution. Patient recovered. Gave eight grains of the sulfide daily. Nuclein much better if used hypodermically.

V. E. LAWRENCE, M.D.

Ottawa, Kans.

Death from Chloroform. Editor MEDICAL WORLD: - Several years ago, being in my office about noon one hot August day, two ladies drove up in a buggy. They had come some three miles. One of them, a farmer's wife desired me to extract an aching tooth which she said had caused her the loss of her usual sleep for two or three nights. She was evidently much worn and exhausted. I prepared my instruments and was about to proceed, when she positivly objected to submit to the operation without the use of chloroform. After regarding her more closely and examining her pulse, I decided that she was not a fit subject for anesthetics, and told her that in her condition she could not inhale chloroform without great risk. On finding me firm in this conviction, she promptly left for home. In a few hours I learned that a physician from a neighboring village readily consented to extract the tooth and indulge her in her request, and that in a day or two he would call at her residence for that purpose. He did so administering the anesthetic, the patient sitting; but before he finisht the work the lady slipt from the chair to the floor a corpse. J. A. MOWRIS, M.D. Lafayette, N. Y.

Compact Emergency Outfit. Editor MEDICAL WORLD:-I made the attempt a day or two ago to condense a few remedies into a small space for my own use while away from home, and I made up this list, which practically took up no space in my satchel and would

How Shall We Meet Loud-Mouthed
Pretenders?

Editor MEDICAL WORLD:-We have in our city one so called M.D. who is able (?) to diagnose typhoid fever the very first visit, and after informing all the neighbors that it is "the worst case he ever saw," gets the patient out in a week to ten days perfectly well. It is needless to say, he has a reputation as a "fever doctor." When he feels sure any case he may have on hand will recover, he noises it broadcast what a desperate case it is; but he manages to "pull it thru." He will prescribe and give advice for twenty-five cents; and strange to say, this class of charlatans find plenty to do, and even among the better, and more intelligent classes of people. Realizing how well the American people like to be humbugged, and how well they stand by a quack of this sort, what I want to know is, how a physician can practise medicin honestly in competition with such dishonest and disreputable scoundrels? Must we as Rome does?"

W. Va.

"do

I. H.

The Communicability of Tuberculosis Between Animals and Man.

Editor MEDICAL WORLD: Since the nature of tuberculosis of the human and bovine species is being discust by our most eminent men in the profession, and since not all agree in knowledge, thought and investigation on the subject, I wish to throw out a few facts that have come under my observation.

Some years ago I attended a man, fortyfive years of age, who was suffering, and who died, from tuberculosis of the lungs. He expectorated profusely.

Whenever the man was sitting on the porch or any place outside the house, if the family cat would hear the man cough, she would hasten to his side and as soon as he had spit up the result of his coughing, the cat would eat up all the expectorated matter. The cat saved the family a great deal of labor in this way, and no one in the family interfered with this part of the cat's diet. The man of course died from tuberculosis, but the cat survived her master for some years and ultimately died from old age.

A farmer informed me that a number of his cows suffered from tuberculosis; that they were inspected, pronounced tuberculous, were killed and a post mortem proved the correctness of the diagnosis.

Many of the cows affected by the disease were young and of his own raising. In

feeding the cows when they were yet calves he secured the milk from a creamery after it was skimmed by a separator. The cows showed signs of the disease about the third or fourth year. He does not know that any person using milk, cream or butter from the same creamery was ever affected with tuberculosis. The farmer believes that the calves swallowed bovine tubercles in the milk, the tubercles remaining dormant in the young for several years, and then developing the disease.

He declared that he took the best of care concerning the cleanliness of his stables, troughs and contact.

I do not intend to prove that a bovine tubercle will not affect a human being, neither that it will; neither that a human tubercle will, or will not infect a cow; but considering the large amount of human tubercles the above named cat swallowed, I do not believe human tubercles will set up tuberculosis in the cat race.

FRANK R. BRUNNER, M.D.

Eshbach, Pa.

A Case of Diabetes Mellitus Cured With Opium.

Editor MEDICAL WORLD:-I was particularly interested in the article contributed by Dr. Holmes of Miss. on arsenauro in diabetes mellitus, August WORLD pages 331 and 332. I am sure that the Doctor must feel gratified with the results as stated by him in his three cases. However, I agree with the Editor that he probably takes a too roseate view of the results at this early date to put them upon the cured list, as they will bear watching for a year or two at least. I have faith enuf however, in his results to try arsenauro in the next case that comes under my charge. I might cite a case of successful treatment of diabetes mellitus that I had a few years ago. A laboring man 40 years old, whose mother died of that dread disease, began to fail, and to pass enormous quantities of urin. Upon examination I found the urin loaded with sugar, and all the symptoms accompanying diabetes mellitus. I placed him upon restricted diet, advised him to give up work; and for medication put him upon pulv. opium one grain three times a day, and in addition a tonic. He began to improve at once, and in a few weeks the urin was normal. The patient completely recovered, and has since engaged in all kinds of rough work, often working all day in cold and wet weather in winter,