unless the tests have been made to show that the donor's blood is not destructive to the recipient's blood, serum from a donor may be injected without such an examination. At the present time transfusion has become so successful that, when possible, it should be the treatment for a hemophiliac or for one who has a serious hemorrhage, unless more simple treatments are quickly successful.

At times profuse bleedings occur on account of endocrine gland disturbances, and sometimes the administration of thyroid extract is successful in stopping such bleedings, and at other times suprarenal extract is successful.

Coagulose, which is a dried product prepared from horse serum, comes in ampules, ready for use. It may be placed dry on a bleeding surface, or it may be dissolved in sterile water and injected subcutaneously. The whole contents of the ampule, representing about 10 mils of the fresh serum, may be injected and repeated, every few hours if deemed advisable.

Gelatin may be dissolved and given for hemorrhage from the stomach and intestines, and may be of some value, when absorbed, for other forms of internal hemorrhage; but to inject preparations into the muscle tissues, even if sterile, is inadvisable. If gelatine is used for injection purposes it must be thoroughly sterilized, as it may contain the germs of tetanus.

Thromboplastin solutions for injection come in sealed vials containing 20 to 25 mils of the solution. These preparations are likely to deteriorate, and therefore should be kept where they are cool, like other serum products, and should be dated.

CLASS VIII

DRUGS USED AS SPECIFICS

COLCHICUM IN THE TREATMENT OF GOUT

The cause of gout is unknown, but it is of interest to note that as arthritis deformans, which is due to some focal infection, is more and more frequently recognized, gout is becoming less frequent. However, there is a disease or a condition of gout, and the tendency to gout is inherited.

At the present time gout need not be listed with the infections, but rather with the metabolic disturbances, and it seems to be due to some mistake in the nitrogen metabolism somewhere from intake to output.

It also seems to be a fact that the more purins ingested, the more the gouty symptoms in gouty patients. However, uric acid is not a cause of gout, and "uric acid diathesis" and "uricacidemia" are not good terms. Still, in acute gouty disturbances the uric acid output is likely to be diminished, and relief occurs when the output of that substance is increased.

It is not necessary here to discuss the relationship of the liver to gout, except to note that urea is largely formed and uric acid largely destroyed in that organ, and a disturbance of the liver might be a cause of gout. Also, doubtless the suprarenals and the thyroid take part in nitrogenous metabolism, and generally in gout intestinal mal-function is in evidence. Also the gonads play some part in the development of gout.

As to food for gouty patients it is necessary only to state that the purins should be removed from the diet, except that meat may be allowed once a day. Some gouty patients are always disturbed if they ingest certain purins, and a gouty patient perhaps generally has a higher percentage of uric acid in his blood than is the normal average.

To properly treat gout we must carefully study the functions of each organ, and study the nitrogen and uric acid excretion in the urine on a known diet. The foods and liquids found to cause the least disturbance (to be the best digested and the best excreted) should be the diet for each particular patient. Whatever acute conditions are present should of course be treated. In other words, there is no one way to treat or manage chronic gout, and a food that is inadvisable for one patient might be perfectly well taken care of by the next patient. Even to order an increased amount of water drunk may be a mistake for some patients, although more water than these gouty patients ingest is generally advisable. It is not proposed to discuss the whole treatment of gout, but only the value of colchicum in the treatment of that disease.

Colchicum is of very little value in chronic gout, and in acute gout its greatest value may be due to its purgative properties. In subacute and chronic gout salicylates are not very satisfactory, although they may be of some value. Cinchophen (atophan), Acidum Phenylcinchoninicum, to increase the output of uric acid may be of great value, and pushing alkalies to increase metabolism and decrease acidity is often of value.

Colchicum Seed-Administration.-Colchicum seed is best used in the form of the official tincture (Tinctura Colchici Seminis, a solution representing 10 per cent. of the drug), the dose of which is 2 mils (1⁄2 a fluidrachm). It should be given in sufficient dose to cause slight purging; too much purging should be prevented by proper treatment. Colchicum should always be administered in a liquid preparation.

The alkaloid of colchicum is official as Colchicina (colchicine). This alkaloid occurs as pale, yellow scales or powder, is soluble in water, and the dose is 0.0005 Gm. (120 grain). Pearls or capsules of this drug may be obtained in which the alkaloid is dissolved in oil of wintergreen. Such a preparation is much used in subacute gouty conditions. This is a very active alkaloid, and may cause some depression.

Action. When taken internally solutions of this drug may cause some gastric irritation, but if diluted, the bitter taste may increase the appetite. It is rapidly absorbed; may increase the secretion of the salivary glands and other digestive secretions; increases peristalsis; and in large doses acts as a purgative. It may slightly depress the nervous system, slow the heart, and lower the blood-pressure. The output of urine is often increased under the action of colchicum, and, if there is increased temperature in an an exacerbation of gout, perspiration may be caused by the full action of this drug. It is excreted partly through the intestines and partly through the kidneys.

Over-action. The only over-action of colchicum is purgation and some circulatory depression, though there may be vomiting and abdominal pain. If such a condition is not properly treated, collapse might occur.

Toxic Action. Rarely serious poisoning may occur from a very large dose of colchicum. The main symptoms are gastroenteritis with bloody stools, intense colics, and collapse. The condition is difficult to cure, but fortunately such poisoning is exceedingly rare.

Treatment of Poisoning. The treatment of poisoning is to give an emetic if it is considered that part of the drug is still in the stomach, and to hasten the movement of the drug through the intestines by a saline purgative, and later to stop the peristalsis and colic by a hypodermic of morphine and atropine. The usual soothing treatments should be given to the gastrointestinal canal. Of course, if prostration is present it is inadvisable to give emetics or purgatives. In that case, tannic acid should be given, and supporting treatment, as caffeine, atropine, and perhaps strychnine.

Uses.-There is no therapeutic use for colchicum except in gouty conditions, and, as stated, it is of little value in chronic gout. Also when joints are acutely inflamed, due to gout, it is a question if free purgation and the administration of salicylates will not be of as much benefit as colchicum. Colchicum should never be administered, if there is acute gastric or intestinal inflammation, neither should it be pushed in debilitated patients.

Although it has been thought that the preparation of the root is better than the preparation of the seed, also that the wine of the root is the best preparation, it is probable that colchicum is colchicum, and if a good preparation of the seed is given in sufficient amount, the action must be the same as with any other form of colchicum.

At times alkalies seem to be of value in gout, and the best is potassium citrate. There is absolutely no use for lithium, either as a drug, or in waters containing lithium. They have no solvent properties on uric acid or urates or any other concretions. The multitude of "anti-gout" preparations, mostly supposed to contain lithium, and all supposed to prevent the formation of uric acid and increase the output of uric acid, are all inefficient, useless remedies. The best preventive of the formation of concretions is distilled water.

SALICYLIC ACID IN THE TREATMENT OF RHEUMATISM

While salicylic acid is not a real specific for acute rheumatism, it is the most efficient drug that we possess for modifying the joint pains, safely reducing the temperature, and promoting eliminating perspiration in that disease.

As there are many joint disturbances that are misnamed rheumatism, it may be well to first define what is rheumatism, and especially the kind of rheumatism that is best treated by salicylates. Acute rheumatism, rheumatic fever, is an infectious disease, probably rarely contagious, caused perhaps by several germs, characterized by inflammation of the structures in and around joints, namely, arthritis, and with a very decided tendency to cause inflammation of the heart. So-called subacute rheumatism is simply a mild attack of acute rheumatism without much fever, without the tendency to migrate from joint to joint, but with the same tendency (only not as decided) to affect the heart. Chronic arthritis, arthritis deformans, and gouty arthritis are entirely different conditions, in which the salicylates are not of much value.

The infection of acute rheumatism most frequently enters the body through the tonsils, hence infected tonsils are a menace. Recurrent follicular tonsillitis makes the individual likely to develop acute rheumatism at any time. Children and youth, who are more likely to have enlarged and diseased tonsils, are the ones most likely to have this disease and chorea, a closely allied disease. Chorea, as well as inflammatory rheumatism, frequently causes the serious complication of endocarditis. Also both acute and chronic endocarditis may develop in children and adults from infected tonsils and teeth without any joint trouble appearing; hence the menace of these focal infections. It may here be interpolated that the greatest menace in the United States to-day is that of crowned, bridged, and pivoted teeth. Arthritis deformans is due to infection, mostly from the mouth.

The germs that cause rheumatism and chorea are not pusforming, hence the infected joints and tissues do not suppurate. It has been thought that one attack of rheumatism predisposes to another, probably because the focal infection has not been