Report on Materia Medica and Therapeutics

PART III. SPECIAL REPORTS.

REPORT ON MATERIA MEDIC& AND THERAPEUTICS. I

By WALTER G. SMITH, M.D. ; Ex-President of the Royal College of Physicians of Ireland; Professor of Materia Medica, School of Physic in Ireland, Trin. Coil. Dubl. ; Physician-in-Ordinary to His Excellency the Lord Lieu- tenant ; Physician to Sir P. Dun's Hospital. TEE therapeutical record of the past year has not provided us with any sensational or striking innovations It may be noted with a sense of relief that fewer chemical novelties than usual have been proposed for trial, and the long list of synthetic remedies has had scanty additions made to it. There has been a lull in antiseptics, but a good many papers have been published upon drugs acting upon the nervous system, especially hypnotics. Of the newer hypnotics, trional seems likely to hold its ground, and to be deserving of approval. The "predominant partner" in the current literature of the time is "serum-therapeutics, '' which has engrossed a large share of attention. Among the novelties noticed in the present summary may be mentioned nosophen, iodoformin, argonin, urotropin, apolysin, citrophen, and saligenin.

PHARMACY. An Iohthyol Reqction.--Mr. Harold Wyatt had occasion to dispense the following prescription :--1~. Morphin~ihydrochlor. gr. iv. ; ichthyol ammon, gr. xxx. ; ung. petrolei, ad. $i. Misee; fiat unguentum. * This Report is based upon an article by the writer in the "Year-Book of Treatment " for 1896. 152 Report on Materla Medica and Therapeutics. On rubbing the morphine hydrochlorate with the ichthyol on an ointment slab, the smooth cream at first formed suddenly became clotted, drops of watery liquid separated, and the clotted portion left the tile and adhered to the spatula. By the addition of two :g~ains of powdered soap he was finally able to turn out a smooth and presentable ointment. In an attempt to explain the decomposition (for such it undoubtedly was), morphine hydrochlorate and ichthyol were heated aver a water bath uritil the ichthyol became "solid, leaving a clear aque'ous liquid containing chloride of ammonium, which was proved by the application of the usual tests. It was evidently an'instance of double decomposition, resulting in the formation of a morphine ichthyol-sulphonate and ammonium chloride. The pure alkaloid morphine gave a similar compound with the liberation of ammonia gas. When quinine hydrochlorate was decomposed by the addition of successive portions of ammonium ichthyol to a hot aqueous solution placed over a water bath until there Was on]~y a slight precipitate, on testing a drop of the aqueous liquid with Dragendorff's iodo:bismUthic alkaloid reagent a quinine ichthyol of a peculiarly brittle character was the result. The following equation probably represents the reaction :-- 'cssH3ss3os(NH4) 2 q- 2"(C20H24N202HC1,2H20) Ichthyol ammonthrn Quinine hydrochlorate equals CtsH3eS3OoH~'2 (C 2oIff24N.20~)+ 2NI-I~C1 + 4H20 quinine iehth~ol-sulphonate. From this it will~ ~be seen that alkaloids form ichthyo~s as readily as do the alkali metals, the resulting ichthyols being of a firmer consistence, and well suited to internal administration in pilular form.--(Pharm. Journ. Dec. 14, 1895). An Incompatibility.--The reporter noticed the solufort made from the subjoined prescription turned a dark red colour, which proved permanent :-~1~. Hydrargyri perchlor, gr. iv. ; resorcin, 5i. ; spit. chloroformi ; spir. ~eth. nitr., ~ $ij. M. This produced severe irritation upon the skin of the patient for whom it was ordered. The cause of the coloration is probably fbrmafion of red nitro-compound, analogous to the green nitroso-compound formed by the interaction of antipyrin and nitrous ether. Report on Materia Medica and Therapeutics. 153 Professor Emerson Reynolds informs me that mono-nitro- resorcinol, CeHa(NO2)(OH)~ is easily produced when an ethereal or alcoholic solution of resorcinol CGH4(OH)~, is treated with dilutenitric acid containing some nitrous acid. It is volatile, and crystallises from dilute ethylie alcohol in orange~red prisms, which melt at 85 ~ There is an isomer, but it is pale yeIlow andnon-wlatile.--(Pharm. Journ., Aug. 3, 1895:).

~H~PNOTICS. Sutph~al Group.--Three organic "sulphones "(i.e., combinations of SO~ with organic radicals) have now been in the hands of practitioners and pharmacologists for some time. They contain,.respectively :- Two molecules of ethyl--viz., dional (common sulphonal). Three , , trional. Four ,, ,, tetronal. So far the judgment of the profession seems to be,this :-- Sulphonal holds its ground, and is by far the most largely prescribed. Bat it is admitted to have some drawbacks. Trional is gaining irr favour, and offers some distinct advantages o~r sulphonal. Tetronal has not made much headway. Observations on man do not fully confirm Baumann and Kast's theory--i.e., that the hypnotic action increases with the number of ethyl groups in the molecule. There is no important difference in the-dose of any of these three drugs in man (cf., Studies in Therapeutics, .Brit. Med. dourn., Jan. 19, 1895). Comparative action of Su.lplwnal, Trional, and Tetronal.-- Dr. Morro, at Baumann's instigation, lms made a comparative study of these drugs :~ 1. Sutphonal accumulates in the body, and its elimination is not completed in less than three days. It resistsrmetabolism. 2. Trional is more easily and completely decomposed by the metabolism of the body than sulphorral..Hence it is not cumulative. 3. Tetronal is excreted unchanged in the urine, although not to the same extent as sulphonal. Accordingly it also exhibits a postponed and cumulative action. 154 Report on Materia Medlea and Therapeutics. These facts throw light upon the clinical action of these drugs, and explain the superiority of trional.--(Ther. Monatss aus Deut. med~ Woch., 34, 1894). The Comparative Values of: Trional, Chloralosr and Sornnal.---In patients not the subject of psychical trouble 1 to 2 grammes of trional (in weakly women, 1 gramme) prpduces a .dreamless sleep, but has the same disadvantages on administration and awakening as sulphonal ; over that drug it has one great advantage, that its use can be continued for a year without producing circulatory, respiratory, or digestive troubles. It acts most beneficially in the insomnia with restlessness of chronic mania and in alcoholic delirium, in which large doses may be given with good effect, but its depressing action is harmful in melancholia and cerebral neurasthenia especially, in which it increases the depression. It should be prescribed at intervals of two days, to avoid cumulative action. Chloralose has one great disadvantage, that it produces symptoms of intoxication, shown by an increased reflex excitability of the cord, and even convulsions, especially if the dose, which is uncertain for the individual, exceed 60 centigrammes, and less in the case of debilitated, hysterical or alcoholic subjects. The convulsipns rapidly disappear after awakening without any ulterior effect. Somnal is most beneficial in procuring sleep in acute melancholia; in other subjects it usually produces first of all slight intoxication, then sleep with pleasant dreams. After doses up to 3 grammes sleep with interruptions comes on in about half an hour, and after 5 grammes profound sleep. On awakening there are no disagreeable after-effects; this is its great advantage over other hypnotics. It has none of the motor troubles of chloralose. It is contra-indicated in dyspepsia and a tendency to diarrhoea, In their relative actions trional acts more slowly than chloralose, and the after-effect is more prolonged, and awakening is painful; chloralose before producing sleep inducesan intoxication, but the awakening is fresh and agreeable. The intoxication of chloralose is without danger, which is not the case in that rare occurrence with trional when sereere symptoms which are without danger appear; trional, however, has the advantage of being more uniform in its action~ and its minimum Report on Materis Medics"and Therapeutics. 155 useful dose is more easily found. Fatal results have been recorded after the administration of from 20 to 25 centi. grammes of ehloralose, althbugh over 60 have been given without serious symptoms being produced. Marie maintains that with chloralose the best resultsare obtained by beginning with 10 centigrammes, gradually increasing the dose to 15 or 20.--(Practitioner, Aug., 1895, from ia Presse M3d., Mar., 1895). Trional.--A great number of communications upon this drug have appeared in 1895. Spitzer (Wiener klin. Woch., No. 23, 1895) gives his experience of the use of trional in twenty-five cases of various forms of disease accompanied by pain and insomnia. In nineteen cases trionalsucceeded. In six cases trional either failed or acted only for a short time, and had to be followed by morphine; these cases were phthisis (four cases), myoma uteri and arterial sclerosis. Spitzer maintains that trional is a hypnotic not only in various mental conditions, but also in lung and heart diseases. He states that it is especially useful in intercostal neuralgia, sciatica, lumbago, and in the lancinat- ing pains of tubes dorsalis, He considers it to approach closely to morphine in its effect, and suggests it as a substitute for morphine. Sleep is obtained usually soan after the administration of the drug, and in most cases continues through the night. In no ease was any injurious effect on heart or respiration observed. In a few eases gastric disturbance took place, and sometimes vomiting after awakening; this the author considers an idiosyncrasy, as is the ease with morphine (Brit. Med. Jour., Epit., Sept. 7, 1895). Goldmann believes trional to be one of the best hypnotics we have. It is to be preferred to sulphona! on account of its prompter action, and greater freedom from injurious con- sequences. The dose should never exceed 2 grammes, and it should be administered freelydiluted with a ~ax~a.liquid.-- ( Therap. Monatsh., Nov., 1894.) Beyer's observations lead him to essentially, the same conclusion.--( Wien. mediz. Blatter, 25). Claus ( Wien. klin. Rundsehau, 1894~ No. 45) speaksof tahe value of trional in the sleeplessness of childr, en. It is mostly to be avoided in the insomnia of o~ganie nervous disease, 156 Report on Mate~ia Medlca and Therapeutics. such as meningitis, &e. It is especially useful in chorea, convulsions, and the payor nocturnus. In a ease of chorea reported by the author, with marked sleeplessness, it had the best effect. Payor noeturnus is a condition in which the child suddenly wakes up terrified and often cannot sleep again. A case of this kind is related in which trional was used with success, In one ease the child shorted some ataxia on the following morning, probably due to too large a dose of the drug. Trional is of little service when the sleeplessness is caused by pain. The doses used by the author are from 3 to 6 grains for infants from one month to one year, increased up to 15 or 20 grains for children from six to ten years. In the insomnia due to toxic influences chloral is more effective.--(,Praetitioner, from Inter. klin. Rundschau). Similar testimony fromWollenmann (Clin. Excerpts., June, 1895). Claus has further obtained excellent results with trional in thirty cases of neurasthenia, average dose 1~ grammes,--(.Wien, klin. Rundsvhau, 21~, 1895). In mental diseases Svetlin and Obersteiner speak highly of trional ( Wien. klin, Woeh., 14, 1895). Guttmann considers that among hypnotics trional offers the greatest advantages with the fewest drawbacks. H~mato-porphyrinuria as been observed after it.--(Reichs., Medic.-Anz., 8-10, 1895).

LOCA~L REMEDIES. Nosophen.mProposed as a substitute for iodoform. Seifert (Wdner klin. Woch,, March 21, 1895, p. 213) gives the results of a trial of nosophen. The latter (tetraiodide of phenolphtha-tein) is a pale .yellow powder, tasteless and in- odorous, and contains about 60 per cent. of iodine. It is insoluble in water' and adds, slightly soluble in alcohol, more readily in ether and chloroform, and easily in alkalies without undergoing change. It reacts chemically as a fairly strong acid, and forms salts with sodium, mercury, &c. It and its sodium salt are absolutely non-poisonous, and iodine is not set free ~n the organism. (a) It is specially adapted, owing to its insolubility and 'lack of odour, to the after- treatment of operations on the nares: (1) As an insufflation applied after the cautery (chemical or galvanic) it prevents suppuration and formation Of adhesions. (2) In rhinitis Report on Materia Medlva and Therapeutics. 157 sicca it causes no irritation and no secretion. (3) In rhinitis hypersecretoria it diminishes the secretion and cures the inflammation quicker than bismuth, aristol, europhen, or sodium sozoiodolate. (4) It appears to shorten the course of rhinitis acuta. (5) In one case of nasal diphtheria, where it was used, the membrane disappeared in four days. (b) In venereal diseases : (1) Six cases of balanoposthitis were cured in three days. (2) In cases of soft chancre it was equal to europhen if precautions were taken to prevent it forming a crust and retaining the secretion by first cauterising the sore with liq. ferri. (3) In hard chancre the number of cases treated was too small to form any opinion. (c) One case of traumatic weeping eczema was cured in a remarkably short time by using nosophen in powder.--(Br/t. Med. Jour., ~Epit., April 13.) ~urophen.--This substitute for iodoform is undoubtedly an agreeable and efficient remedy, and I have used it repeatedly during the past two years. De Buck and Walton (Ext. de la Flandre Mdd., 1894) treat of the surgical applications of europhen. Iodoform has some great disadvantages. It often irritates the skin, and provokes erythema, urticaria, &c. It is a bad cicatrising agent; granulating wounds dressed with it become indolent, flabby, and are slow to be covered with epidermis. Its odour is most objectionable, especially for private practice. The hitherto suggested methods of deodo- risation of it are unsatisfactolT. Lastly it needs careful watching on account of its toxicity. Iodoform poisoning is capricious and peculiar, suddenly bursting forth without prodromata in tile susceptible, causing grave cerebral distur- bances which may even be fatal. The merits of iodoform rest on its great proportion of iodine (96"47 per cent.). This, loosely fixed in the molecule, separates itself continuously in presence of organic juices, and to this nascent iodine is due its microbicidal action on infected wounds. Various iodised substances, mostly of the aromatic series, have been brought forward of recent years to obtain the advantages of iodoform without its disadvantages. Such are the sozoiodols, Iosophan, and antiseptol. Since, however, their iodine is not liberated freely, they cannot replace iodoform. Aristol and europhen present stronger claims. The latter (isobutyl-ortho-cresol- 158 Report on Materia Medica and Tl~erapeutics. iodide--28 per cent. iodine) is superior to iodoform in that it has a very slight agreeable odour, feeble toxicity, lightness (five times lighter). It possesses almost the antiseptic properties of iodoform, slowly frees its iodine in alkaline media, diminishes secretion, and opposes diapedesis of the white corpuscles. Clinical experience has shown its antivenereal and antisyphilitic value; and Jasinsky and Christmann attest its antituberculous properties. Europhen keeps wounds vety dry, favours the reufiion of sutured wounds, and the granulation and cicatrisation of open sores and cavities. The authors give twenty instances of its use. The only drawbacks noted were one case of well-marked erythema, and complaints from two or three patients of slight local smarting. It strongly adheres to everything it touches, a property which, if advantageous as regards wounds, may present inconveniences to instruments and the surgeon's hands.-- (Brit. Med. Journ., Epit., May 18, 1895.) Strauss also strongly recommends europhen. It is lighter than iodoform, and 1part of it goes as far as 5 parts of iodoform in covering a surface. Since it is readily decomposed and gives off free iodine, it should not be prescribed with starch pastes, metallic oxides, or mercurial salts. Lanolin is an excellent vehicle, and powdered talc may be added. Europher/has now been extensively employed by a large number of observers, and has found its scope in dermatology, syphilitic sores, gyn~ecology, dressing of wounds, in affections of the nose and larynx, and of the ear and eye.--( Deutsche reed. Zeit., 1894.) In America europhen ~has largely supplanted iodoform, and it is lauded by Eldredge (Cincinnati Lancet-Clinic, Mar., 1895), and Waugh (NewEngl. Med. MontMy, July, 1895). Aristol, an iodised thymol,'was first brought under notice in 1890, and still attracts some attention. Gevaert: has used it with good effect in lupus, and also recommends it in suppurating bony cavities--e.g., of frontal sinus and middle ear (Fla~drdM$d., 1894). It is said to be especially useful in burns. In phthisis its hypodermic use (in sweet almond oil) has found some to recommend it, but ,l~he results are notsufflciently encouraging, and the operation Report on Materia Medlca and Therapeutics. 159 is followed by smart pain.--(Grusdieff, Ther. Woeh., Sept. 1, 1895.) Iodoformln is stated to fulfil the condition of an odourless compound which yet contains the iodoform molecule un- altered, in the proportion of 75 per cent. It is a fine white powder, turning yellow by exposure to light. In presence of acid or alkaline fluids iodoform is liberated. The powder is absolutely unirritating, and is prepared by Marquart,--(Ther. Monatsh., Sept., 1895.) Argonln.--Under this name Liebrecht describes a compound obtained by treating the sodium eombinution Of casein with silver nitrate and precipitating with alcohol. When dried it is a white powder, easily soluble in hot water, sparingly in cold water. By careful manipulution solutions containing 10 per cent. and upwards can be prepared. Its solutions react neutral to test-paper, and must be preserved from the light. Experiments by Meyer show that Urgoriin is adisinfeetant of no inconsiderable antiseptic power. It co,trains 4"28 per cent. of silver, and is perhaps worth trying locally in affections of mucous membranes. To begin with, use an aqueous solution 1"5 per eent.--(Ther. Monatsh., Jtane, 1895.) Tannigen is the diacetyl derivative of tannin. It has been employed with good results in the treatment of chronic diarrhoea, especially that occurring in phthisieal individuals. This remedy is administered internally in doses of 3 to 7{ grains (0"20 to 0"50 gramme), and even as high as 60 grains (4 grammes) a day. Locally applied in a 3 per cent. solution in 5'per cent. of sodium phosphate solution, tannigen has rendered good service in the treatment of ehroniepharyngitis. Since Meyer and Miiller reported fa~ourably of it, Kiinkler and Drews have added their testimony ; and De Buck con- eludes that it is a prompt and valuable remedy in acute and chronic catarrh of the bowels. It can be readily' taken stirred up in 'milk (,Wivn. klin. Ru~zd~chau,J 1805. ) Iehthyol.--Recommended in gon0rrha~al':e~)id'0iymitis by Mayliinder (Pest. Med.-Chlr. P~esse, 1895);'and in acute suppurations by Liscia (Gazz. degli Ospedali~ 1895). Van :der Willigen warmly commends ichthyol in the treat, 160 Report on Materla Medlea and Therapeutles. ment of fissures of the anus. The pure drug is introduced into the anus by a brush. The contraction of the sphincter forces this into all the folds of the mucous membrane. Little pain is excited. Treatmont should be repeated daily. The patient is given liquid diet and occasionally castor oil. The first patient, who had previously been treated by every means short of operation, was cured in eight days, the other three in two or three weeks. One had already been sub- jected to operation without benefit. There was no recur- rence.--( Practltioner, Aug., 1895. from Mon. fl prakt. Derm.) Urotropin is proposed by Nicolair as a solvent for uric acid. It is prepared by evaporating an ammoniacal solution of formaldehyde. It appears as colourless crystals, readily soluble in water, and its formula is (CH2) ~ N4; i.e., iS is hexamethylenetetramine. Its solvent action upon uric acid is exhibited, not only in watery solutions, but also in the urine, and thus is superior to piperazin, lycetol, and lysidin. The drug quickly ( hour) passes out of the system into the urine, in which it can be detected by bromine water, which throws down a yellow precipitate of urotropindibromide. It also possesses antiseptic and germicide properties. In ~wo cases of cystitis, with ammoniacal urine, urotropin rendered thr urine acid. Dose, 1-1 grammes, given in water, and taken in the morning.I ( Ther. Monatsh., from Deutsche Me& Woch., 1895.)

THERAPEUTICS OF IRON, Fe~atln, proposed by Schmiedeberg, is well spoken of by several observers, e.g., yon Ziemssen, Kiindig, and Jaqnet. Dose, 15 to 30 grains, thrice daily. It not only induces a speedy increase in the number of blood corpuscles and of h~moglobin (over 5 per cent. in eight days), bu~ also leads to increase of weight and improvement in the general condition.--(Ther. Monatsh., Aug., 1895.) H~mol and Hcemogallol, proposed by Kobert, have found supporters in Germany and America, viz., Ramm, Weiss, Porter, &c., but do notappear to have been tried in England. Hcemalbumbt, introduced by Dahmen, has been reported upon by MSrs, Dollken, Spiegelberg, and Schroers. But its superiority is not clearly demonstrated. Finsen (Ugesk~'ift Report on Materla Medica and Tl~erapeutlcs. 161 for Zcege, No. 51, 1894) has succeeded in preparing a durable preparation from blood, consisting principally of dried albumins, holding a large amount of iron. It is a dark brown powde5 odourless and almost tasteless. It is prepared from the blood of the ox or pig. The albumins are separated from ~he extractives and salts by means of Panum's method, some- what simplified, and after many washings the uncoagulated albumins are centrifugalised and then evaporated at a low temperature (vacuum). At the preparation, measures are taken to destroy any micro-organisms that may be present. About one pound of hmmatin-albumin contains the albumins of about six pounds of blood. The remedy has been tried at several hospitals in Copenhagen with satisfactory results. It is well borne and easily assimilated. It does not cause s but gives a reddish colour to the motions. The dose is1 to 2 teaspoonfuls three times a day for adults. It may be taken either pure or mixed with coeoa.--(Brit. Med. Jour., .Epit., Feb. 2, ]:895.)

ANT'IPYRET~CS AND ANTINEURALGICS. Antlpyrln.~There is little additional to report. In pruritus F. Arnstein( Gaz~ta Zekarska, No. 48,1894, p. 1298), following Blaschk0's recommendation (Berlin. klin. Wochenschr., No. 22, 1891), has tried antipyrin internally (in powder, I gramme at bed time) in two severe cases, one of which was that of a woman, aged twenty-eight, with pruritus nervosus of three months' standing, while the other referred to a woman, aged sixty-six, with inveterate pruritus senilis. In both the itching quickly subsided, to disappear altogether in a couple of weeks. Both of the patients had been previously treated by various physicians and after various ordinary methods without obtaining any relief whatever.--(Brit. Mad. Journ.~ ~pit., Feb. 23, 1895.) As a hmmostatic, Roswell Park, of Buffalo (American Medical News), has found a 4 per cent. solution of antipyrin useful as a ha~mostatic in checking general oozing from a bleeding surface, and also by experiments claims for it antiseptic properties which compare favourably with most of the anilin and coal tar derivatives. By experiments on animals he has shown that it can be used with safety on the peritoneum, L 163 Re2oet on Materia Medics and Therapeutlc~. and he now employs it in general surgery. As a styptic it has the advantage of constricting the small vessels without causing any external clot, which may break down. In cases of epistaxis he has found it useful when sprayed into the nose. In this form of a spray to the nose he has found it useful in certain cases of inflammatory occlusion, and also for ordinary headaches, coryza, &c. Apolysln and eitrophen.--These are relatives of, and possible substitutes for phenacetin. As phenacetin is a combination of phenetidin and acetic acid, so apolysin and citrophen are combinations of phenetidin with citric acid. Apolysin is formed of one molecule of citric acid with one molecule of phenetidin, and citrophen of one molecule of citric acid with three molecules of phenetidin. Apolysin is a white crystalline powder, with a sour taste,. soluble in 55 parts of cold water, and very readily in warm water. Citrophen is a white crystalline powder, less soluble in water. Average dose of either, 0"5 to 1 gramme, up to 6 grammes in the day. Both act similarly to phenacetin as antipyretics and analgesics. (Benario and Seifert, Deut. reed. Woch., 1895.) Saligenin is the radical of the glucoside salicin, and by oxidation is converted into salicylic acid. Until lately saligenin was costly, as it could be prepared only from salicin. It can now be made synthetically from carbolic acid and formaldehyde. Senator is of the opinion that the action of salicin depends upon its conversion within the body more or less into salicylic acid, and Lederer now suggests that saligenln should be tried. Accordingly, Walter has tested the drug in eight cases (seven of acute articular rheumatism, and one of gout). He found that it promptly relieved pain and swelling, and led to no unpleasant bye-effects. Dose, 0"5 to 1 gramme, every hour or two, either in powder, or in dilute alcoholic solution. It is quite possible that saligenin acts as such, without invoking its conversion into salicylic acid.m(Ther. Monats., Jan. and April, 1895, from Manch. reed. Woch.). ~Salophen continues to be employed by practitioners in various parts of the world. It is recommended by Lavrand Report on Materla Medica and Therapeutics. 163 as being fully as valuable in rheumatism as salicylate of sodium, while it does not provoke the same headache, tinnitus aurium, or feeling of intoxication. It does not affect gastric digestion or give rise to nausea, as it does not decompose except in an alkaline medium (the intestine). The taste is insipid and not disagreeable. The average dose is 2 grammes (31 grains) daily, divided into four doses,--( Practitioner, 1895.) Similar testimony is borne by Waters of :New York. (New York Med. dourn., :M:ay, 1895), and by Goldschl~ger (Aerzt. Centr.-Anz.) Buck and Vanderllnden record ten instances of its anti- neuralgic and analgesic powers. :No troublesome accessory symptoms attend its use.--(Brit. Med. orourn., Epit., Jan. 19, 1895, from La Flandre Mdd.). Drews, of Hamburg, specially recommends salophen in children's diseases, and it is easily taken by young folk, either as a powder, or floated on water.~(Brit, Med. Journ., Epit., Feb. 16, 1895, from Allgem. reed. Cent. Zeit., 1894.) Mdre recently, Drews speaks highly of this drug in the treatment of the nervous form of influenza.~(Centralbl, f. innere Meal., 1895.)

CLINICAL SKETCHES, THE October issue of this illustrated periodical (published by Messrs. Smith, Elder & Co.) contains a reproduction of the well- known picture by Holbein, now in the Barber Surgeons' Hall, London, representing the union of the two guilds in 1540. It is accompanied by an interesting description, naming most of the portraits. The same number contains an obituary notice 9 with an excellent l~eness, of the late Dr. Bristowe. The other contents are varied and interesting.

ORTHO-TOLYPYRIN. C12U14~20. D~. ST. YON MU~LEN, from a considerable experience with 0rtho- tolypyrin, concludes that it is more efficacious in articular rheumatism than the salicylates. It lowers the temperature ~n on~ to three hours, relieves pain~ and produces no unpleasant effects. As an antipyretic and anti-rheumatismal remedy he considers it superior to antipyrin~ and the salicylates. Dose, 10 to 15 graias.~Les ~Youveaux Remkdes~No. 22