muscular injections. Consequently, it would seem as though the doubtful preparation of such solutions extemporaneously is not excusable.

Sterile ampules may be obtained of salicylate of mercury, each containing 0.13 Gm. (2 grains), with quinine and urea hydrochloride 1⁄2 per cent. suspended in oil. The dose is 1⁄2 to i ampule, the quinine and urea hydrochloride acting as an anesthetic. The ampules should be warmed before the solution is drawn into the syringe for injection.

Besides the salicylate, ampules of mercury succinimide may be obtained. Each ampule contains 1 mil of the sterilized aqueous solution of mercury succinimide 0.01 Gm. (% grain). The dose is one to two ampules.

These injections are usually made into the gluteal muscles, not so low down that the patient cannot sit, also the region of the sciatic nerve must be avoided. The two sides of the body are used alternately; care should be taken not to puncture a vein, therefore the barrel should be detached from the needle to see if blood flows. If blood does flow, the needle should be withdrawn and another puncture made. There should be no massage of the injected tissues.

The soluble salts of mercury should be used by preference when rapid mercurial action is desired, and in the beginning of the treatment. Later the less soluble salts may be used. The injections (salicylate salt best) should not be more frequent than once a week, as absorption is slow. The disadvantage of this treatment is the pain which is caused, and with the soluble salts the pain may begin at once and may last several hours. With insoluble preparations the pain may not begin until after an hour or two, but may last for several days.

Sometimes hard tumor masses form which absorb very slowly, depending upon whether the injection has been made close to fascia rather than into the muscle substance. Abscesses may rarely occur, and embolism has occurred.

The same general hygienic care of the mouth and of the bowels, a nutritious diet, and hot water bathing should be ordered when mercury is given by injection or by inunction,

as when it is given by the mouth. It seems to be doubtful if mercury reaches the meninges of the brain and cord, hence the advisability of both the arsphenamine and the mercury treatment for syphilis of the central nervous system.

THE SPECIFIC TREATMENT OF TETANY

Tetany has been shown to be due to disturbance of the parathyroid glands, and when the parathyroids are removed the animal develops tetany. This tetany is stopped by parathyroid gland extracts, and by the administration of calcium, best associated with the administration of cod liver oil.

Calcium.-Calcii Chloridum.-Calcium chloride occurs as a white, very deliquescent salt, has a sharp, saline taste, is irritant, and is soluble in water. This disagreeable preparation has no advantage over more pleasant salts of calcium. The dose is 0.30 Gm. (5 grains), generally administered three times a day. It must be given in solution and with some thick syrup, else vomiting will be caused.

Calcii Lactas.-Calcium lactate occurs as an odorless, tasteless powder, not very soluble in water, is only slightly irritant, and does not disturb the stomach when taken well diluted or after meals. The dose is 0.30 Gm. (5 grains), best administered in powder and taken with milk after meals.

Calcii Glycerophosphas.—Calcium glycerophosphate occurs as a fine, white powder, is almost tasteless, is practically insoluble in water, and is best administered in powder or capsules. The average dose is 0.50 Gm. (71⁄2 grains) three times a day, after meals. This is a pleasant and efficient method of administering calcium.

Liquor Calcis (Solution of Calcium Hydroxide).—Lime water is a bland, non-irritant solution, mildly antacid, and slightly constipating. It is absolutely tasteless, if taken in milk. It is often added to the milk of infants, as the alkali tends to prevent the formation of large curds in the stomach. The dose of lime water as generally administered is too small, and 2 or 3 teaspoonfuls should be added to each milk feeding, depending upon the age of the child.

Lime water is combined with linseed oil, equal parts, to form

the official Linimentum Calcis (Carron Oil), which is a soothing alkaline preparation largely used for burns.

Calcii Carbonas Præcipitatus (Precipitated Chalk) is some

times used as an antacid.

Creta Præparata (Prepared Chalk) is administered internally, mostly in the form of the official Mistura Creta (Chalk Mixture), which is given, in a dose of 15 mils (about 4 fluidrams), for diarrhea in infants. Precipitated chalk and prepared chalk are used mostly externally, and the latter is the main ingredient of many tooth powders.

Syrupus Calcii Lactophosphatis is used for marasmic children in the dose of 10 mils (211⁄2 fluidrachms); but good food and plenty of milk makes this preparation rarely needed. One quart of milk represents about 2 Gm. of calcium, and 1 Gm. (15 grains) of calcium is about sufficient for normal metabolism for twentyfour hours.

Holt, Courtney and Fales1 have determined that an excessive calcium intake dose not apparently increase the calcium absorption, the excess being excreted. They also determined that the calcium absorption by rachitic infants was much lower than by healthy infants, and that the administration of cod liver oil increased the absorption of calcium, unless diarrhea was present. This means, as has long been clinically known, that cod liver oil is a valuable treatment for marasmic and rachitic children, combined, of course, with proper food and plenty of milk.

Action. The importance of calcium to the economy (it represents about one-fiftieth of the body weight) is being more and more recognized. A child cannot grow properly when deprived of calcium, neither can an adult be normal when deprived of it. Also, anything that causes a great loss of calcium to the body causes symptoms more or less serious, due to such loss.

The seriousness of acidosis and its frequency as a terminal condition in many chronic and acute diseases has only recently been known. Even a mild form of acidosis may cause vomiting, diarrhea, and cerebral irritation, and serious acidosis will cause coma, as seen in diabetes. Prolonged privation of carbohydrates and starvation will cause acidosis and the symptoms 1 Amer. Journ. Dis. Child., Feb., 1920, p. 97.

above described. There may also be an increased temperature, rapid pulse, and tetany.

A shortage of calcium seems to cause disturbance of the parathyroid glands, and nervous irritability, sleeplessness, spasmophilia, or convulsions may occur depending upon the amount of parathyroid disturbance present. Privation of carbohydrate foods and perhaps especially of calcium may be a cause of meningism in typhoid fever and other serious infections.

The part played by the parathyroids in epilepsy is not known, but it is a fact that the less meat and the more starch in the food, the less frequent are the convulsions. The administration of calcium as well as other alkalies frequently prevents the necessity for large doses of bromides in epilepsy; a small dose of a bromide combined with alkaline treatment is often satisfactory.

The relation of the pituitary secretion to the parathyroids is not known, but in hypersecretion of the anterior pituitary an extra amount of bone is produced. This means an extra amount of calcium is utilized for bone growth.

In hyperactivity of the thyroid, whatever other treatment is instituted, the administration of calcium always quiets nervous irritability, as it seems to soothe the central nervous system.

The calcium metabolism of the mother is disturbed to her disadvantage by too frequent pregnancies, and even in a single pregnancy, many times, the mother's teeth become decayed, her hair falls out, and her finger nails become brittle, showing that she requires more calcium than she is receiving, or at least than she is utilizing, extra calcium being required for the growth of the child. Too frequent pregnancies exaggerate this condition, and lactation will use up the mother's calcium, and she requires more, and if her metabolism does not properly utilize the calcium that she receives she becomes nervous, irritable, has headaches, loses weight as well as her teeth and hair, and may have bone softening, as occurs in osteomalacia.

Whether ovarian disturbance or the extra ovarian activity in frequent pregnancies is the cause of osteomalacia, or whether the too frequent formation of the corpora lutea of pregnancy is the cause, osteomalacia certainly occurs generally only after such ovarian or corpora lutea hyperactivity. A patient with osteo

malacia requires large amounts of lime. Sometimes removal of one or one and a half ovaries has been curative.

On the other hand, normal activity of the ovaries and of the testicles may have something to do with normal calcium elimination, as at the time of life when the activity of these glands is diminished, hardening of arteries and other signs of calcification often occur.

Givens has shown that we cannot by food increase the calcium of the body without also increasing magnesium, and there is generally more calcium than magnesium excreted in the urine. Both can be increased by the ingestion of milk. Givens finds that calcium lactate always increases the urinary calcium output, but relatively not more than when milk is given. He also found that the ingestion of dilute hydrochloric acid does not much affect the calcium and magnesium metabolism.

It seems to be a clinical fact that a hyper-acid individual is more likely to have neuralgias and neuritis than when his diet is changed to one of more carbohydrate and less meat, and when he is given, alkalies; and the best alkali for nervous irritability of all kinds is calcium. If milk is well tolerated, it is one of the best means of administering more calcium, and the best medicinal way is to give calcium glycerophosphate.

Children seem to store calcium more readily than adults, probably because physiologically they need more calcium, not only for their normal metabolism, but also for their bone growth.

Only a small amount of calcium intake is actually absorbed, a large portion forming salts and passing off in the stools, and even a portion of the calcium that is absorbed is excreted into the intestines through the epithelium. The calcium excreted in the urine occurs mostly as a phosphate.

It seems to be a clinical fact that patients with active tuberculosis excrete an abnormal amount of calcium; they lose calcium which they need for the cure of the tuberculosis. Therefore milk or extra amounts of calcium should be fed these patients, and sometimes cod liver oil.

While it is unusual for ordinary diets to cause lime privation, a meat and bread diet will do this. Also, lime may be