V. On the Uses of Sesquichloride of Iron in Medicine. By Dr. PLEISCHL. (Zeitschrift der Gesellschaft der Aerzte zu Wien, July 10, 1858.)

Dr. Pleischl points out the use of the sesquichloride of iron in some cases in which it has not hitherto been generally prescribed. There are two preparations of this salt in the Austrian Pharmacopoeia-namely, the crystalline sesquichloride, and the solution called oleum martis. The therapeutical operation of these preparations is astringent and styptic, and they are therefore applicable in cases of hæmorrhage and profuse secretions in the different passages, especially in the intestinal canal. Dr. Pleischl relates several cases in support of the efficacy of sesquichloride of iron in these affections.

In a case of Hæmoptysis in a young man, the attacks had been treated by alum, acetate of lead, and ice, without effect; but the hæmorrhage was speedily arrested by the administration of a mixture containing sesquichloride of iron. A second case was one of Hæmatemesis, in which the patient had lost from ten to twelve pounds of blood in three days. In this instance acetate of lead, laudanum, alum, and the internal and external use of ice, had been tried in vain; but on employing the mixture of sesquichloride of iron the bleeding ceased, and the patient recovered. The cause of the bleeding in this case was subsequently ascertained to be a granular liver. A third case was one of chronic diarrhoea in a young girl, to whom calumba, opium, and acetate of lead, had been administered without success; but after the employment of sesquichloride of iron the evacuations soon became more consistent, and in a few days the patient was completely restored to health. Another case was one of hæmorrhage from the intestinal canal, occurring after an attack of fever. There were fæcal accumulations in the lower bowel, and when these were removed with difficulty, a profuse hæmorrhage followed, and threatened to carry off the patient. The sesquichloride of iron was employed both internally and in the form of injection into the rectum, and under this treatment the bleeding ceased, and a cure resulted. As an injection, the sesquichloride has also been employed with much success in cases of uterine hæmorrhage from cancer and fibrous tumours of the uterus, and in one case of leucorrhoea, after solutions of alum and sulphate of zinc had been injected without effect, the employment of sesquichloride of iron as an injection was attended with a notable diminution of the secretion.

The sesquichloride of iron has the property of being easily absorbed and assimilated in the system, and its use is not attended, as often happens in the case of lead, with symptoms of poisoning; and moreover, in the sequelae of hæmorrhages, the use of iron is attended with the best results in the removal of anæmia.

VI. On the Therapeutical Action of Perchloride of Iron in the Treatment of Acute and Chronic Urethritis. By M. BARUDEL. (Bulletin Général de Thérapeutique, May 15, 1858.)

Dr. Barudel, in his investigations upon the therapeutical employment of the perchloride of iron, found that this agent exercised a special influence on the genito-urinary mucous membranes, for, from the period when it was administered internally, the inflamed membranes were rapidly affected, and no longer secreted the abundant puriform fluids which accompany the inflammations of the genito-urinary tract. The perchloride appears to owe its efficacy to a double action, for it possesses a hæmostatic power, which retains the blood in the capillary vessels, and opposes its escape, and also a sedative power which rapidly restores the functions of the capillary circulation to a regular mode of action. When the perchloride of iron was administered internally, Dr. Barudel found that it lowered the pulse from seventy to sixty, and even to fifty, in the minute, and he therefore was induced to employ it in many cases where it was essential to reduce vascular excitement. The duration of urethritis was certainly shortened by this medicine, and cases which ordinarily required a period of thirty or forty days for their cure were successfully terminated in eight or twelve under the use of the perchloride, which was administered internally in cases of acute and chronic blennorrhagia, and was also employed in the form of a styptic injection to the affected membrane. The employment of this treatment has never been attended, in the hands of Dr. Barudel, with any unfavourable results, so as to induce him to discontinue it, although, as is well known, a multitude of serious complications often spring up in the course of blennorrhagia.

In all the cases treated by Dr. Barudel, the treatment was identical, except in some rare instances. In acute urethritis, an injection of iodide of lead was employed, this salt being almost insoluble and exciting no pain in the inflamed mucous membrane, the solution of perchloride of iron in injections was reserved for chronic blennorrhagia, the constriction which it exercises upon the urethral canal rendering it more applicable to the chronic than the acute

affections. The internal treatment of all the cases consisted exclusively in the administration of a mixture containing twenty drops of tincture of perchloride of iron, taken every two hours. In general, at the end of three days a certain improvement was effected; but no aggravation of the inflammatory condition of the parts was ever produced by this internal and external treatment, either in the acute or the chronic cases. The cure was almost always completed in fifteen days. In chronic urethritis, the only modification consisted in the use of an injection made of tincture of perchloride of iron and distilled water; this injection was repeated three times a day, taking care that the fluid should remain at least ten minutes in the urethra. The general treatment was of a strengthening nature, wine being allowed to the patients. Dr. Barudel quotes two cases, successfully treated in the military hospital at Lyons by the means just described, and he draws the following conclusions from his researches: 1. That perchloride of iron may be used successfully, both externally and internally, in the treatment of acute and chronic blennorrhagia; 2. That this agent is endowed with well-ascertained hæmostatic properties, and possesses also a sedative action on the general circulation; 3. That several venereal affections, which resist ordinary remedies, may be safely treated by the perchloride of iron; 4. That the perchloride, given both in acute and chronic cases, appears to act, in the great majority, as a specific; 5. That the perchloride of iron is sufficient in the treatment of simple urethritis; but that when the syphilitic element is associated with this disease, mercurials must likewise be employed; and, 6. That the most important auxiliary to the internal use of iron is the employment of an injection, the iodide of lead being applicable to acute, and the perchloride of iron to chronic, urethritis.

VII. On the Inhalation of Carbonic Acid in Granular Pharyngitis. By Dr. WILLEMIN, of Vichy. (L'Union Médicale, July 15, 1858.)

The therapeutical application of the inhalation of carbonic acid has been made only in late years and principally in Germany. Bischoff and Ennemoser have made some experiments with carbonic acid, and have come to the conclusion, that when the gas is not breathed pure, nor for too long a time, it produces no unpleasant effects; but, on the contrary, that the respiration of the patients becomes more easy, and the expectoration more abundant. Germany possesses, in the present day, a great number of establishments where the inhalation of carbonic acid, more or less mixed with air or steam, is methodically practised. The gas is collected by means of an apparatus to which a caoutchouc tube is adapted, permitting the gas to be directed into the interior of the mouth, on the neck, or on any other part. At Pyrmont, a bell-glass has been placed over the spring from which the gas is disengaged, and three tubes carry away the carbonic acid. At Franzensbad a large basin has been constructed, and the patients descend into it by several steps, at the bottom of which the gas is disengaged. The superior stratum of air contains fifteen per cent. of carbonic acid; and in proportion as the patients are accustomed to this atmosphere, they approach nearer to the orifice from which the gas escapes.

The principal effect of the use of this gas, according to the German physicians, is to increase the activity of the circulation, and to depress the functions of the nervous system. The indications for this mode of treatment are thus drawn up by Lersch: it is especially serviceable in cases of dyspnoea dependent on the accumulation of mucous secretion in the pulmonary vesicles, or on emphysema of the lung. Helfft considers that this gas exercises a stimulant action upon the respiratory tract, and he recommends its use in chronic inflammation of the larynx and of the pharynx, in bronchial catarrh, and humid asthma. M. Goin recommends its use in nervous affections of the respiratory passages, as in asthma, and also in intermittent fever. The contra-indications of this inhalation are said to exist whenever any affection of the respiratory passages is accompanied by excitement of the circulating system. The German physicians unanimously forbid this treatment in phthisical cases. According to Gräfe, it is absolutely injurious when cavities are formed, these being often surrounded by a zone of inflammation. Under the influence of the carbonic acid inhalations the expectoration is diminished, and the fetor of the secretions is corrected, but the inflammation of the pulmonary parenchyma is augmented. Its use must also be avoided in hæmoptysis.

Dr. Willemin draws the following conclusions upon the inhalation of carbonic acid-namely, that when mixed with air, this gas produces a more or less active excitement of the respiratory passages, the action being analogous to that of the same gas upon the skin, the eye, &c., and this effect ought to contra-indicate its use whenever there exists a disposition to acute inflammation.

That the excitement is followed by a sedative effect, which appears to depend on a special action of this gas on the nervous system, the respiration becomes easier, the cough is allayed, the circulation is retarded, and the redness of chronic inflammation diminishes.

That continued for a longer time, or made with a larger proportion of gas, these inhalations cause vertigo, relaxation of the limbs, and anæsthesia.

That, in addition to this general action, the gas possesses an anæsthetic power over wounds and parts denuded of epidermis.

That these inhalations are especially efficacious in chronic inflammations with atony of the mucous membrane and exaggerated secretion, and in nervous affections of the respiratory passages; but that they ought to be avoided in phthisical cases.

VIII. On the Caustic Charcoal and its Chief Applications, especially in Diseases of the Uterus. (Bulletin Général de Thérapeutique, May 15, 1858.)

M. Bonnafond has given directions for making a kind of stick of caustic charcoal, calculated to replace red-hot iron in all the cases in which it is deemed advisable to employ superficial cauterization. This physician has obtained some very favourable results from this agent in the treatment of shallow ulcers, such as simple or phagedenic chancres, and in making punctated cauterization in cervical adenitis. This caustic charcoal can be applied only on parts which are dry and well wiped; but on moist tissues, or those which require the disengagement of much heat, the charcoal is inferior in its application to red-hot iron. Applied upon the skin, and left in contact with it for a variable time, according to the depth which it is desirable to give to the eschar, a slight crackling sound indicates the combustion of the epidermis, and there remains an eschar of a yellowish-white colour. M. Bonnafond's caustic consists of a mixture of gum dragon, powdered vegetable charcoal, and nitrate of potash; these materials are dissolved into a paste, which is rolled into cylinders, and afterwards dried for use. These caustic crayons are used by lighting them with a match until the charcoal is partially inflamed, and a crayon of greater or less diameter is employed, in proportion as a shallow or very superficial cauterization is required. The most useful application of these caustic crayons is made in the treatment of engorgement and granular ulceration of the neck of the uterus. The crayon possesses this advantage over red-hot iron, that it spares women the sight of the preparations for the actual cautery, while its effects are equally powerful with those obtained by the metal.

IX. On a Nervous Cough, probably caused by Chorea of the Diaphragm, cured by Tartarized Antimony in Large Doses. By Dr. NOTTA. (L'Union Médicale, July 15, 1858.)

The patient was a girl, aged seventeen, who had suffered for three years from a short, dry, and almost continual cough. She had been bled without relief. The chest was perfectly free from disease, as was ascertained by percussion and auscultation, and the uvula was well formed. Belladonna was given with considerable advantage to the patient, but the cough returned without appreciable cause. When she was examined in June, 1858, she was suffering from constant cough in the daytime, but she slept well at night; the throat, tonsils, and uvula were all healthy; there was no fever; she was well developed and stout; the chest was healthy, menstruation regular, appetite good. Belladonna was again prescribed, but without any good effect. A mixture was then ordered, containing 25 centigrammes (about 5 grains) of tartarized antimony in 115 grammes (about 31 ounces) of water, a tablespoonful to be taken every hour. The mixture caused vomiting, but the cough ceased entirely. The dose of the tartar emetic was subsequently increased to 40 and 50 centigrammes (8 or 10 grains) in the same mixture, and under this treatment the patient completely recovered.

Dr. Notta considers that the cough was produced, in this case, by a spasm of the diaphragm, resembling chorea in its nature. But whatever may have been the exact cause of the cough, he considers that the case proves the antispasmodic power of the tartarized antimony in large doses, and he recommends physicians to make experiments with this drug in other nervous affections, besides chorea, in which it has succeeded so remarkably.

X. On the Anaesthesia produced by the Passage of an Electric Current during the Extraction of Teeth. (L'Union Médicale, October 14, 1858.)

At a recent meeting of the Académie Impériale de Médecine M. Robert related the results of some experiments made at the Hôtel Dieu, in reference to the anaesthesia produced by the passage of an electric current during the extraction of teeth. One of the poles of the battery was placed in the hands of the patient, and the other was placed in contact with the instru

ment which was to seize the tooth, and the instrument itself was isolated from the hand of the operator by a wrapper of silk. Of ten cases, two were completely negative, for there was as much pain, if not more, than if the electrical apparatus had not been employed. Four cases were favourable, and the patients did not complain of any painful sensation; but it is doubtful whether there was true anesthesia in these cases, or whether the action of the electricity merely masked the pain. It is certain that a sudden surprise may prevent the pain of a slight operation from being felt. A box on the ear, for instance, given to a patient at the moment of opening an abscess will mask the pain of the knife. Of the whole ten cases, two were negative in their results, four were favourable, two were doubtful, and the remaining two were inconclusive, as the conditions of the experiment were changed. "Allow me to add," continued M. Robert, "that I have tried the electrical current in other small operations. Having occasion to open a collection of matter in the palm of the hand, I applied one of the poles of the battery along the course of the ulnar nerve, and the other in contact with the bistoury; the pain was more acute than it would have been in ordinary circumstances, and the painful shock felt all along the nerve was superadded to the pain of the puncture." M. Moreau spoke in favour of the anaesthetic operation of electricity in tooth-drawing, but M. Velpeau stated his opinion as follows. Many of the patients under the care of that surgeon were subjected to the influence of an electrical current during the performance of some minor surgical operations. One of these patients, who had previously had an abscess opened, and who said nothing, not because he felt nothing, but because be was courageous, complained of a second opening made under the influence of electricity, and declared that he not only felt the pain of the bistoury, but also the pain of the electric current, in his hand. A second patient was operated upon for a cancroid growth on his nose, and felt nothing. A third suffered much during the operation for an ingrowing toe-nail, which was performed for the second time; he declared that he suffered more than on the first occasion without electricity. A fourth complained of pain during the opening of an abscess, and said that he suffered at least quite as much as without electricity. A fifth, on whom a hydrocele was punctured, complained more than patients generally do under that operation; and the same was the case with a sixth, who had an abscess opened. "I conclude from these facts," says M. Velpeau, “and from others observed at the Hôtel Dieu, the Hôpital Neckar, and elsewhere, that there is no anæsthesia produced, and that there is some peculiarity in the American teeth in which they differ from the French teeth."

XI. Notes on some of the Principal Indigenous Tonics of India. By EDWARD J. WARING, Esq., of the Madras Medical Service. (Indian Annals of Medical Science, July, 1858.)

In a very able paper, Mr. Waring points out a number of the indigenous productions of India which are endowed with tonic properties, and which might advantageously be substituted for imported medicines of the same class. Some of the most valuable of these products can be procured for the mere expense of collection, as for example, the Colotropis gigantea, the Hemidesmus indicus, the Hydrocotyle asiatica, the Cocculus cordifolius, &c., which grow wild in the immediate vicinity of the large cities, and other medicinal herbs may be procured in most of the bazaars.

Mr. Waring divides the tonics into three classes-the alterative, the bitter, and the astringent tonics.

Alterative Tonics.-Of all the alterative tonics, sarsaparilla has long held the highest position, and no better proof of its popularity can be adduced than the fact that above 100,000 lbs. weight of the article are supposed to be annually consumed in Great Britain alone. The chief supply is derived from the Western Hemisphere; Jamaica, Honduras, the Brazils, and Vera Cruz, being the principal localities from which it is supplied, and the species which yield it being principally Smilax officinalis, S. medica, and S. papyracea. But several species of smilax are indigenous in India, the plants being found all along the foot of the Himalayas, along the Malayan peninsula, and one species being found in Ceylon, namely, the S. Zeylanica. The number of Indian species of smilax is large, the principal being the S. ovalifolia, S. prolifera, S. lancifolia, S. glabra, S. roxburghiana, S. oxyphylla, S. rigida, S. ferox, and others. The Indians generally do not attach much value to the medicinal effects of the roots of the smilax, probably owing to the absence of the sensible properties of bitterness and odour, to which the natives attribute the chief activity of vegetable products. Some exceptions however, are found, and the roots of some species of smilax are employed by the natives of some parts of India in the cure of sores and syphilitic complaints. Mr. Waring has found the roots of the S. prolifera highly valuable as an alterative, mild tonic, and diaphoretic; it was very advantageously employed in chronic rheumatism, especially when connected with a syphilitic taint, in general cachexia, in the coughs of old age, and in some obstinate cutaneous

affections. Under its use the patient rapidly gains strength and flesh, the appetite increases, the health improves, old cutaneous affections heal, and rheumatic affections disappear. It was given in some cases in combination with nitric acid or iodide of potassium; in others, it was given warm in decoction, with milk and sugar, when it can be distinguished with difficulty from ordinary tea. It should be used fresh, and it can always be had for the expense of collecting. The Smilax china was introduced into European practice in 1535, and is indigenous to China, Cochin China, and Japan. It was especially lauded as a remedy in syphilitic affections, but it afterwards fell into disrepute. It appears that this root really possesses some valuable properties, but it should be used when fresh and sound, and not in the old, wormeaten state in which it is mostly found in the present day in the Indian bazaars.

As a substitute for sarsaparilla, the natives of India employ the roots of several plants, as for instance, the Ichnocarpus frutescens and the Spermacoce hispida, the first belonging to the natural order of Apocynaceae, and the second to the Rubiaceæ. Both these roots appear to possess alterative and tonic properties. The fragrant roots, which are known under the name of "country sarsaparilla," are obtained from a small twining or climbing milky plant, the Hemidesmus indicus, belonging to the natural order of Asclepiadaceæ, being the same as the Periploca indica and the Asclepias pseudosarsa of former botanists. Mr. Waring considers this root as one of the most generally useful tonics and alteratives in India, and generally superior in efficacy to the sarsaparilla imported from Europe. In all cachectic affections, constitutional syphilis, and some of the chronic forms of rheumatism, and in debility after fevers, this remedy may be advantageously employed, and in the words of the 'Bengal Pharmacopoeia," it is in every respect a perfect substitute for sarsaparilla." The efficacy of the remedy appears to depend upon a crystallizable principle called hemidesmine. In the same natural order is another plant, or rather family of plants, which possess alterative properties— namely, the Calotropis gigantea, C. procera, and C. Hamiltonii. The parts of these plants which are used, are the root, the bark of the root, and the inspissated milky juice. Two other plants, indigenous to India, have also attracted considerable attention as remedies in leprosy, scrofula, and secondary syphilis-viz., the Hydnocarpus odoratus or Chaulmoogra, belonging to the natural order of Pangiaceæ, and the Hydrocotyle asiatica, of the natural order of Umbelliferæ. The former, or Chaulmoogra, is a tree indigenous in Sylhet, Assam, Upper Bengal, and in China; the Hydrocotile asiatica is a small, low-growing plant, common in moist localities throughout the peninsula of India, and extending to Assam, Japan, HongKong, Java, Ceylon, Mauritius, and the Cape of Good Hope. Both these plants are undistinguished by any uniform, well-marked, or sensible effect on any of the functions, and the evidence of their operation consists in producing a gradual restoration of the health, tone, and vigour of the system generally; and it may be presumed that they both act by correcting an abnormal or diseased state of the blood, perhaps acting primarily on the digestive organs. Mr. Waring's experience warrants him in stating, that the Hydrocotyle asiatica is surpassed by few remedies, not even excepting the iodide of potassium, in the treatment of secondary and constitutional syphilis, and in chronic cutaneous diseases. Among other alterative tonics indigenous to India, and deserving of notice, are the sassafras of Nepal, the Camphora glandulifera, together with the wood of the Camphora parthenoxylon; the Cacali kleinia, the fresh leaves of which are given in decoction in the class of cases for which sarsaparilla is usually employed; the Bryonia pigæa, the roots of which are used by the natives as alterative; the Chenopodium album, the leaves of which are said to be tonic and alterative; the Dalbergia sissoo, the wood of which is used in leprosy, constitutional syphilis, and many blood diseases; the Euphorbia tirucalli, the dried inspissated juice of which is given in syphilis; and the Plumbago rosea, the dried root of which is administered in secondary syphilis.

Bitter Tonics.-The two natural orders, Gentianaceae and Menispermaceæ, comprise the largest number as well as the most valuable of the bitter tonics employed in medicine; of the natural order of Gentianaceæ it is computed that about sixty-eight species are to be found in the East Indies. The most important of these is the Ophelia chiretta, which yields the wellknown chiretta of commerce. It is a valuable bitter and tonic, and an excellent substitute for gentian, and may be procured at a cheap rate in almost all the bazaars of India. Dr. Wallich pronounces it one of the most valuable medicines which the materia medica of India possesses. According to Professor Royle, another plant belonging to the natural order of Gentianacea yields a variety of chiretta-namely, the Exacum tetragonum; and bitter tonic properties are also said to exist in the Exacum bicolor, Ophelia elegans, and Adenema hyssopifolia, all belonging to the gentian family. Another Indian species of gentian deserving of notice is the Gentiana kurroo, the roots of which are used in the same way as common gentian, and another plant of the same order, the Chironia centaurioides. As a substitute for gentian, the natives frequently employ the bitter root of Picrorrhiza kurroo, belonging to the natural order of Scrofulariaceae. Of the Menispermaceous plants growing in India, the most important, perhaps, is the Cocculus cordifolius, a twining shrub, common over the greater part of India.