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The subject of the hypodermic use of remedies for systemic effect is a very important and interesting one.

not necessary for me to waste time and space in enumerating the various advantages that the hypodermic use of remedies have over all other methods with some drugs in many diseased conditions when quick or positive systemic effect is desired, or must be had.

The value of the hypodermic use of veratrum in eclampsia is very well known and gives satisfactory temporary effect if used free enough-to effect the dose and frequency of repetition being regulated according to the pulse. I will quote as follows from Potter's Materia Medica and Therapeutics, 10th Ed.: "Hypodermic injections of sodium phosphate have been used with highly beneficial results in syomgomyelitis and in unilateral astasia-abasia. Drs. Arocq

and Luton of Rheims, advocate the hypodermic use of this salt as a substitute for the organic extracts and maintain that it is equally efficient in all cases in which these extracts have proved to be of value."

It is stated that the hypodermic use of magnesium sulphate in doses to not exceed five grains, well diluted produces the same cathartic effect, as an enormous dose by stomach. The hypodermic use of apocodeine hydrochloride will act as a purgative. This remedy is very often used hypodermically for purgative effect in veterinary practice.

The hypodermic use of epinephrin for systemic effect in asthma and various other condition is of such great importance that this remedy should be carried at all times by all general practitioners.

There is an interesting article on "Treatment of Secondary Anemia of Tuberculosis with Hypodermics of Iron", by Dr. Leroy, S. Peters, Oct. 10, 1908, Medical Record, in which he says "The hypodermic injection of medicine. is fast gaining ground and bids to be by far the most sensible, if not the most perfect way of administering drugs in future." Dr. Peters claims it takes three months to get results from the internal use of iron in these cases and that results can be obtained in twenty days by the hypodermic method.

In his opinion the citrate of iron is the one best suited for anemic cases. He gives the injection in the gluteal region. There is a table in his article giving the hemoglobin on admission and after a certain number of injections. One case increased from 7.946 to 13.015 after thirty injections.

In an article "Camphor in Large Doses in Pneumonia," by Dr. L. Weber, Medical Record, Jan. 28, 1911, he reports injecting two hypodermic syringe fulls of a 20 per cent solution of camphor in oil of sweet almonds every two hours in the outer circumference of the thighs, until eight had been given each day, which was about 30 grains of camphor a day

in a case of pneumonia which recovered but no doubt would have died if it had not been used. In an article "Camphor and Pneumococci," Muench Med. Woch.. No. 36, 1909, by Dr. August Seibert, of New York, is 10cc of a 20 per cent camphorated oil to every 100 pounds of body weight are injected hypodermically every 12 hours, as soon after the initial pneumonic chill as possible. In cases of bilateral pneumonia and severe toxaemia these injections repeated every 6 to 8 hours. The camphor destroys the vitality of the pneumococci in the blood currant. Smaller doses have no effect."

Sea water has been used by subcutaneous injection in the treatment of eczema (December, 1910, Medical Review of Reviews). In infants the average dose is 20cc for a baby weighing 8 kilos, in adults, 150cc for a person weighing 60 kilos.

Cacodylate of sodium is used hypodermically in the treatment of anemia, malarial, cachexia, syphilis, neurasthenia, psoriasis, etc. It is a toxic agent and some patients do not tolerate its action very well, hence should be used with care. Arsenite of iron is used hypodermically for its iron and arsenic effect in the treatment of dry scaly forms of cutaneous diseases, especially in anemic subjects, anemia of chronic diarrhoea, anemia of malarial intoxication, chlorosis, etc. The hypodermic use of quinine and urea hydrochloride is of great value in malarial fevers, and its use should be better known by those that practice in the malarial belts.

It is not necessary for me to give the hypodermic uses of morphine as this is very well known and is very important in many cases. All physicians should carry apomorphine hydrochloride at all times. as it is an emergency remedy, and our best and quickest emetic by hypodermic use, as well as a good general relaxant in most all spasmodic conditions. hypodermic use deserves a trial in eclampsia and in convulsions of various

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kinds. On page 651, December, 1910, Medical Review of Reviews, is a note on "Sacutaneous Injection of Oxygen in Cases of Asphyxia." It states that Raymond obtained excellent results with injections of oxygen in the crises of asthma, heart failure, uremia, bronchopneumonia and lobar pneumonia. It is necessary to give the patient enough to carry them over the crisis. The writer stated: "The technique of the injection is simply after disinfecting the skin, a hypodermic needle is inserted into the subcutaneous cellular tissue, care being taken to avoid veins. To the head of the needle is attached the tube of an

Oxygen tank. The oxygen is filtered through cotton and is gently injected under the skin by compressing the bulb attached to the tube. One liter and a half of oxygen is thus injected, forming a large subcutaneous swelling, which is rapidly and completely absorbed without leaving any emphysemia. The injection is repeated several times daily if necessary. The process is not disagreeable to the patient and gives such rapid relief that the patient clamors for its repetition."

Sodium salicylate has been used hypodermically with good results in rheumatism. The technique of its use is a little lengthy and should be known before using it, and for those interested, I will refer them to "Hypodermic Injections of Salicylates in Rheumatism," by Dr. August Seibert, Medical Record, March 11, 1911.

Ether has been employed hypodermically for systemic effect which is very fleeting and also for its local effect, as in sciatica. Hypodermic injections of ether are painful, and the suffering persistent, hence should not be used only in an emergency when no better remedy is at hand. It is not my intention to mention all drugs that can be used hypodermically for systemic effect, and give their uses. for it would require a volume of good size to do this.

I have not even mentioned the hypodermic uses of many remedies that are used daily as strychnine, atropine, pilocorpine, etc.

The object of this article is intended to stimulate investigation and make this method of using drugs more popular, as it is an extremely important way of using many remedies in many conditions that will give the desired results when it could not be obtained in no other way. It should be remembered that all drugs do not have the exact same action, when used hypodermically, as when used by mouth for instance, lobelia has no emetic effect when used hypodermically in large doses. Irritating and painful hypodermic drugs should be avoided as much as possible.

If a needle is used more than once it should be thoroughly disinfected each time after using, and just before using. it. The disinfecting of the needle if used more than once is the most important aseptic precaution in the entire technique of giving a hypodermic injection. Disinfecting the skin is important, as well as disinfecting the syringe and using a pure solution. Ordinarly one application of iodine is all that is sufficient to distilled the skin, or other remedies can be used if desired. The application of an ethyl chloride spray over the part where the injection is to be given is important with some patients, especially to sensative patients, children and many that are not accustomed to hypodermics. It is often necessary to seal the puncture of the needle with collodion. I notice any alcoholic solution is bad, to run out where the needle entered, however, we do not often use an alcoholic solution.

Many patients have died when the indicated remedy was given my mouth, and not absorbed by the stomach, being deranged that could have been saved if it had been given hypodermically, and far better results could be obtained in many cases by hypodermic medication.

GALVANISM IN BRAIN TROUBLES. Galvanic electrification should exercise an important influence on the circulation and nutrition of the brain. Ermentrant has obtained good results from this medality in the treatment of hysteria, and hysterical headache. The technique is to apply a flexible pad electrode to the nape of the neck, high up, and the other electrode, a large one, moved about from part to part, taking care not to raisse it from close contact with the skin, unless the current strength has been previously tested. This treatment has a good effect on the troubles higher up, in the brain.

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RETRACTING THE ANTERIOR

FAUCIAL PILLAR.

IRO CALDERA, of Turin, Italy, in a communication to The Lancet, remarks that the numerous observations about the alarming hæmorrhages that follow the removal of the tonsils with the guillotine have contributed to extend the practice of morcellement of the tonsil with suitable forceps. This method is very easy to execute, it being possible to avoid bleeding and pain with the new chemical substances for local anesthesia. The forceps used for "morcellement" exercise not only a cutting, but also a crushing action, which reduces and hinders hemorrhage. In order to simplify the grasping of the tonsil a hook is often used, with which the faucial pillar covering its anterior surface is retracted. With the instrument usually used the faucial pillar is drawn out, but the assistant's hand masks the operation and limits the free movements of the surgeon. The writer has introduced with the best results a new type of hook. The handle is 9 centimetres in length, the shaft 10 centimetres, and the hook 1 centimetre. The end of the instrument is rounded, so as not to damage the mucous membrane. The two portions of the shaft form an angle of 80°. By the use of this instrument the assistant's hand does not obstruct the surgeon. Moreover, the angular disposition of the hook and handle allows only a moderate lateral traction to be put upon the anterior faucial pillar, from behind which the hook does not easily slip.

THE TEST TUBE AND THE STOMACH. Test-Tube Observations have their uses, even in physiological chemistry. But it must often have occurred to thinking pharmacists that what takes place in

the test-tube in physiological research is not necessarily a demonstration of the workings going on in that part of the human laboratory known as the stomach. A medical man, writing to the Chemist and Druggist of Australasia with reference to recent statements about the action of bismuth and alkalies in inhibiting the proteolytic value of pepsin, says that "while it is true that the stomach is a laboratory, it is not true that it is a chemical laboratory. From that fallacy has sprung more ridiculous therapeutics than almost any other fad of the last fifty years. When the chemist started to construct formulæ for therapeutic use. the market was soon flooded with all sorts of preparations beautiful in theory, but lamentably useless in practice. With regard to the particular case of pepsin, it may be true that in the laboratory it does not digest albumen when combined with alkali or bismuth, but it is also a fact verified beyond all doubt that the combination induces digestion of food where one or the other alone absolutely fails." Continuing, the writer says, "Certain it is from my own experience that in the case of central vomiting the food returned undigested when pepsin and acid was given, whereas a test meal with pepsin and bicarbonate of soda was digested. * * I am convinced that the best way to peptonise food outside of the body is the laboratory way, and the best way to digest it when in the stomach is in association with an

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alkali or bismuth. * ** It is possible that the alkali becomes incorporated into a true vital-chemical substance which accentuates its energy in a therapeutic sense, though this seems contrary to the clinical facts. I have prescribed in one case for some time bismuth with very little result, but when pepsin was added as a separate medicine the result was immediate."

POTASSIUM PERMANGANATE IN

AMENORRHEA.

An interesting article in the Practitioner describes the use of potassium permanganate in the amenorrhea of young women. It is stated that it may restore menstruation after the lapse of two years or longer; sometimes it may restore the discharge within a few days or the immediately succeeding period being missed the one next may appear in due course or it may take six weeks or even two months before the drug succeeds. This salt is useful also in cases of scanty, and, perhaps, delayed, menstrual flux, the interval varying from six weeks to two months. The permanganate in a case such as this brings on the period at its proper time, together with an increase in the flow. It is useful, also, when a chill prevents or delays the menstrual flow; thus, in the case of a woman who had prevented menstruation by taking a cold bath on the day when it should have appeared, the usual symptoms arising from arrest of the catamenia made their appearance: three doses of the permanganate having restored the flux, she discontinued the drug, whereupon the discharge ceased. She again returned to the medicine, and after another three doses the flow reappeared and progressed naturally. Potassium permanganate may be given daily until the catamenia appear and complete their course, when the salt should be discontinued; it should be recommenced four days before the access of the next period, and continued till the flow ceases. It is useful in girls who, on leaving the country and coming to town, suffer from arrested menstruation; also in the amenorrhea induced by sea sickness and in the case of women, between 30 and 40, generally married, who while rapidly increasing in weight suffer from a diminished menstruation. Potassium permanganate is given up to one, two or more grains in pill-form thrice daily after meals. Make the pills according to the following formula: Po

tassium permanganate, grn. 1; kaolin and petroleum cerate, in equal parts, q.s. Certain observers deny that the permanganate produces abortion, but some cases of abortion apparently due to the drug have been noted.

THE PITUITARY GLAND. Wiggers, in the American Journal of the Medical Science, asks the question:

Nature of the Internal Secretion. Has the internal secretion been determined? What is its nature? Is it a single substance or does the gland secrete a number of substances? Answers to these and similar questions have been sought by studying the effects of injections of its extracts on the muscular and nervous functions, on nutrition and development, on the secretion and composition of urine, on the flow of the digestive juices, and on the cardiovascular system, this latter supplying the most productive field for research.

Experimentation has shown that by water, glycerine, or salt solutions, a substance may be extracted from either fresh or dried glands which resist boiling, and, when introduced intravenously or intraperitoneally, causes polyuria, slow or accelerated pulse, accelerated respiration, dyspnoea and motor disturbances, such as ataxia and paralysis of the hind legs, symptoms, it will be noted, which are also characteristic of the removal of the gland. This substance is obtained only from the posterior lobe, however. The extracts thus far obtained from the anterior lobe are apparently inert even when injected in enormous doses.27 This fact seems very peculiar since it is the anterior lobe which is composed of glandular tissue and which would, therefore, be expected to furnish the physiologically active principle, and the paradox becomes still more interesting when we consider that it is this portion alone which is of vital importance.

The fact may receive several interpretations. We may imagine that the active