First he gives cathartic doses of podophyllin, following these with from 10 to 15 grains of ammonium chloride every two hours until the pain begins to abate. The latter is given in an aqueous solution, only chemically pure ammonium chloride being used. Under this treatment his patients become well in a very short time. Dr. Henry says he has treated cases of this character which have been in the care of other physicians for a long time with no improvement, and in a few days under the ammonium salts the patient would be free from pain. After the pain disappears there may be a sensation of numbness in the affected part for a few days. Dr. Henry expresses the hope that those who read CLINICAL MEDICINE will try this method of treatment and report results. THE TREATMENT OF TRIGEMINAL Dr. Alfred Fuchs, assistant to the K.-K. Clinic for Psychiatry and Nervous Diseases in Vienna, in an article reprinted from "Einfuehrungen in das Studium der Nerven-Krankheiten fuer Studierende und Aerzte," says: "In aconitine we have a remedy which has a specific effect in trigeminal neuralgia. To obtain success, two requirements are important. First, the employment of an effective and well-prepared preparation, and, secondly, the following of a system by which the aconitine effect is supplemented by a purgative treatment. It is not easy to obtain an effective preparation. The official tincture of aconite root (German Pharmacopeia) is unreliable. The difference in the effect of the various aconitine preparations evidently depends upon the presence, in variable quantities, of a strongly active aconitine and the less active constituents contained therein. For these reasons the dosimetric pills, made with a solid mass, are more effective. The maximum dose is variable. Under medical administration the quantity given can be properly controlled, since the intoxication symptoms, such as parasthesia of the tongue lips and hands (ulnar region), are indications for the reduction of the dose. A cumu lative effect of the drug is not to be feared, because of the catharsis which must be combined with the treatment. The effectiveness of proper active catharsis for the relief of pain in neuralgias is widely known, but is, unfortunately, little considered in practice. Gussenbauer was the first who emphatically called attention to the importance of active catharsis in the treatment of trigeminal neuralgia. "Gussenbauer's experiences with peripheral resection of the trigeminus branches were so unsatisfactory that he discontinued this practice almost entirely and enriched the therapy of trigeminal neuralgia with an evidently unessential, but really useful detail, so that this clinician's injunction to to attend to the bowels has come to be recognized as the most successful method in the treatment of neuralgias." In other words, "clean out, clean up, and keep clean." And give aconitine. This is supportive of the position which we have maintained for many years: that neuralgia is often, perhaps most often, an effect of intestinal toxemia. Remove this factor and many cases are readily cured. TREATMENT OF INSOMNIA IN A Jacobi, in Medical Review of Reviews for June, 1911, calls attention to the fact that sleepless nights are far more than inconveniences; they are dangers sapping the strength and undermining the resisting power of the patient. The fear lest he become a victim of morphinism does not weigh, in view of the fact that an advanced tuberculosis will finally terminate in one way only, and the relief and comfort awarded by morphine outweighs the oratory of a fanatic who gathers his indications and contraindications from a tract. His tuberculous patients take 1-4 grain (0.015), more or less, of morphine at bedtime. Those who are inclined to night sweats take a milligram (gr. 1-60) of atropine with it in a pill, to which, when there is constipation, a dose of aloin equal to that of the morphine dose may be added. L II Domestic Animals* OPIUM ACTION ET us see now the action of morphine upon some centers in the medulla. Injections of morphine produce vomiting frequently in the dog and the cat, which is due to a direct excitation of the medullary center. This center is first excited, but becomes paralyzed by the further absorption of more morphine, and the vomiting stops. Therefore, in poisoning with this alkaloid, emetics are contraindicated. Small and medium doses of morphine produce more energetic contractions of the heart and a slowing of the pulse. Morphine is a heart calmant. Large doses produce an acceleration first and then a progressive abatement of the heart beat. In the dog, also, the pulse is slowed-by action on the center of the pneumogastric. Contrary to this, in the horse we have always observed a strong and accelerated pulse, even after the administration of small doses. Lastly, morphine slows the respiration in both man and beast and does so even with small doses of the alkaloid, owing to a direct intoxication of the medullary center of respiration, which ceases to respond to the venosity of the blood. Animals which have received morphine have their arterial blood much darker than that of the control animals and yet their respiration is slowed. This slowing is demonstrated easily by *A lecture, with demonstrations, given to the Society of Veterinary Medicine of Brabant, July 3, 1910, by Prof. A. Van den Eeckhout. making the animals respire by a spirometer before and after the injection of morphine. Here is a trachotomized rabbit. It inspires the air through a Mueller valve and expires the air into this gasometer. The gasometer shows the animal to expire normally 370 cubic centimeters per half minute. We will now inject into this animal 2 centigrams (1-3 grain) of morphine and have another reading of the gasometer after a quarter of an hour; we shall find the quantity of air expired considerably diminished. [The gasometer showed at that time 50 cubic centimeters of air expired per half minute. Let us now study the action of morphine on the spinal cord. A normal (medium) dose of morphine acts but slightly on the spinal cord. A little larger dose excites this organ and may even provoke a veritable tetanus, like strychnine. This tetanizing action is in proportion to the animal's zoological scale. Fishes never sleep but manifest tetanic phenomena always. The frog enters the tetanic state very readily; the brain sleeps and the spinal cord is excited. The frogs which I show you here have not yet well-pronounced tetanic symptoms, the injections having been made somewhat tardily, yet some of them already show a notable increase of reflexes. In the dog after he awakes we notice at times periods of excitement, with tetanic spells. In the horse we find stiffness of the limbs and fibrillary contractions in various groups of muscles (patellar), contractions resulting from the excitation of certain medullary centers. Lastly, in infants in whom the cerebral functions are but little developed we get from morphine at times tetanic convulsions, instead of sleep, wherefore it is so dangerous to administer morphine to an infant. In resuming, we may say that morphine influences the brain according to the species of the animal; it tonifies the heart, calms the respiration, and excites the spinal nervous apparatus. Morphine also exercises a very important and specific action on the digestive tube; it diminishes the intestinal secretions and induces constipation in animals; it moderates or arrests intestinal peristalsis and puts the intestines to rest. This last action is very manifest in man. With the stomach it is the contrary; far from being subject to the same influences from morphine, just mentioned, there is a tendency for its peristaltic movements to become rather exaggerated. The action of morphine on the alimentary canal has not been explained as yet. Some presume a diminution of the excitability of the pneumogastric terminals, and of the sensory terminals in the walls of the intestines; others believe that the intestinal repose caused by morphine is the result of an inhibitory phenomenon exerted on certain medullary centers. Be this as it may, one thing is established, that morphine constipates. Magnus and Zunz have of late, from their experiments on dogs, interpreted morphine constipation in an altogether different way. They have noticed that in dogs morphine produces a spasmodic contraction of the pyloric sphincter and that it retards considerably the passage of food from the stomach into the intestine. The authors claim, therefore, that this constipation is due, above all things, to pyloric contraction and to too prolonged stay of the food in the stomach. But what these authors have observed in the case of dogs is not sufficient to explain morphine constipation in other animals, and especially in the case of the horse. We know that in the horse the stomach plays but a secondary part in the phenomena of digestion, comparing the stomach with the intestinal tract. The stomach of the horse is not very voluminous, considering that it empties itself several times during a meal. Its capacity is about the twentieth part of the capacity of the intestines and the food that passes it very rapidly takes between three and four days to pass the whole length of the intestines. A medicament therefore which acts principally on the stomach and the pyloric sphincter, and which does not. act on the intestines, would hardly be able to produce constipation in the horse. We have made a series of experiments on this animal and have found that morphine, or a preparation of opium, is always followed by constipation more or less pronounced, in the sense that the quantity of dung diminishes during the first twentyfour hours. From the anatomical disposition of the digestive canal of this animal it is probable that morphine acts principally upon intestinal peristalsis. The mechanism of the arrest or diminution of this peristalsis is as yet unknown. That morphine which constipates the horse by diminishing his intestinal peristalsis may be indicated in certain forms of colics, especially when these are accompanied by diarrhea and characterized by an exaggerated intestinal peristalsis. Lastly, let us discuss poisoning with morphine and the means of combating it. The toxicity of morphine increases in proportion to the degree which the intoxicated animal holds in the zoologic scale; it takes as much morphine proportionately to poison a frog as it does to poison a human being. When morphine has been absorbed it is almost always useless to give emetics, which can not act because the medullary centers have been paralyzed. Repeated washings of the stomach should be made and neutralizing substances such as potassium permanganate should be given by the mouth, and also mild purgatives, such as castor oil. The patient should be kept in a rather warm place to avoid chilling the congested skin. Cardiac stimulants should be given when the heart becomes feeble; artificial respiration should be resorted to whenever it be.comes necessary; and lastly atropine should be injected, hypodermically, in small doses. Although atropine is as much an hypnotic as morphine still it produces an action on the respiratory center absolutely contrary to that of morphine, exciting that center and arousing the individual put asleep by morphine. It acts also on the pneumogastric and aids the heart's action. What is the therapeutic value of morphine in veterinary practice? In the dog it is indicated as a hypnotic, as a pain calmant, as a moderator of respiration, to check bowel action and as a calmant of the intestines, in the same way as it is used in man. best to have all the patient's food prepared exclusively in a pulpy state. Milk should be given only in small mouthfuls at a time. Small doses also of sodium bicarbonate should be given to saturate any excess of gastric acids. When blood can be detected in the stools while the diet is of a nonanimal nature, then the author prescribes, to be taken on an empty stomach, four esculin tablets crushed and finely suspended in half a tumblerful of water, and the same dose repeated four days in succession. [Esculin is finely pulverized aluminum suspended in glycerin.] Of course, the diet as described above must be strictly observed. In this way, 52 patients with gastric ulcer were treated who were not confined to their beds, they In the cat it is indicated in small doses receiving esculin and a pulpy-food diet as a constipant. In the horse it may be used in calming certain vicious and especially excitable animals, but its action is uncertain. Lastly it may be used in the horse as a constipant and calmant of intestinal peristalsis in certain forms of colics and inflammations, when it is desirable to put the intestine to repose. It is on the contrary contraindicated in most cases of colic, as in colic from indigestion, from constipation, from volvulus, from gases, in all which cases evacuants are indicated. It is not useful for procuring hypnotic or analgesic effects, yet it may be used, nevertheless, as an anesthetic. ESCULIN IN THE AMBULATORY TREATMENT OF GASTRIC ULCER In practice it is not always possible to carry out a strictly constant recumbent position of the patient treated for gastric ulcer, and we are thus compelled to treat such cases ambulatorily. Professor Klemperer insists that the main indication of gastric ulcer treatment should be satisfied under such circumstances, namely, that the food be so thoroughly prepared by chewing in the mouth and mixed with the saliva that it arrives in the stomach as a thin watery gruel of finest comminution. Every coarse food is prohibited. It is and milk. They lost completely all their subjective ailments, and blood disappeared from their stools in the course of a fourweeks' treatment.-Therap. der Gegenw, 1910, No. 10, in Pharm. Zentralh., 1911, p. 476. FIBROLYSIN: ITS GOOD EFFECTS IN RHEUMATIC HEART ATROPHY Castelli reports on a case of rheumatic cardiac hypertrophy treated with fibrolysin. A 10-year-old girl suffered from this affection, showing cyanosis, tumefaction of face and extremities, weak and irregular pulse, and swelling of the liver. The usual remedies had no effect on the trouble. The author then made a trial of a hypodermic injection of 2-3 Cc. (35 minims) into the gluteal region, every other day. After ten days, the respiration and the palpitation improved. After thirty-five injections made, the body weight increased, subjective symptoms vanished, the cyanosis and edema noticeably abated, and the cardiac dulness diminished in extent, so that the patient could be discharged. The effect of the remedy may perhaps be explained by a resolution of adhesions of the pericardium.-Zentralbl. f. d. Gesammte Therap., Feb., 1911, in Pharm. Zentralh., 1911, p. 503. O A Specific Treatment for Tuberculosis UR readers will remember the interesting paper contributed by Dr. W. C. Goodwin on this subject to CLINICAL MEDICINE for January. The doctor has a further contribution on the same subject in The Medical World, for September, in which he describes his technic of administering the drugs upon which he principally depends for the successful treatment of tuberculosis, namely, calcium sulphide, sodium sulphocarbolate, and zinc sulphocarbolate. Goodwin calls calcium sulphide the most powerful general internal antiseptic now in the possession of the profession. He calls attention to the fact that it is not well absorbed in granules containing more than 1-6 grain. The dosage which he prescribes for the average patient is 1-2 grain (3 granules) every hour in the day time and every two or three hours during the night. Dr. Goodwin evidently considers intestinal tuberculosis an extremely frequent complication of the pulmonary disease, and it appears from his paper that, in his opinion, the cause of the fever peculiar to consumption is largely due to the tuberculous ulcerations in the intestines. He therefore endeavors to heal the intestinal ulcers by the direct application of sodium. sulphocarbolate, which is an intestinal antiseptic possessing a local action only. Since in the presence of food and the intestinal contents its antiseptic action is soon spent, the dosage must be increased, as it becomes necessary to reach ulcers located further along the digestive tract. The fever will show no sign of yielding even with increased dosage until the active drug reaches the site of the disturbing ulcer, when the temperature will drop almost immediately. For these reasons, Dr. Goodwin pushes the sodium sulphocarbolates to doses which are sometimes enormous, omitting the drug only when its effect has become manifest by the disappearance of fever or when the therapeutic limit, shown by increasing intestinal irritation, becoming finally a diarrhea, has been reached. The diarrhea may be controlled by the administration of the strongly astringent zinc sulphocarbolate, and Goodwin frequently employs a tablet containing 4 1-2 grains of the sodium and 1-2 grain of the zinc sulphocarbolate. For the regulation of the stools, the proper evacuation of all detritus and waste material, which is of course absolutely necessary for the healing of the ulcer, Goodwin uses compound licorice powder whenever necessary. The sodium sulphocarbolate is given at first in doses of 5 grains every hour during the day, the tablet being best chewed and thoroughly mixed with the saliva. The administration of the sodium sulphocarbolate is preceded by the dose of calcium sulphide mentioned above. After the patient has become accustomed to the remedy and his stools have been regulated, the physician is to begin the gradual increase of the sodium sulphocarbolate. In addition to the 5 grains every hour, Goodwin gives 5 grains before and after feeding, then 10 or 15 grains, carefully noting the effect on the stools, endeavoring to make the increase amount to 15 or 20 grains every day. The dosage of from 10 to 15 grains after food is |