Reduce the iodine to a powder and introduce it into a flask with the tannic acid and 450 c.c. of distilled water, and then heat the mixture on a water-bath at a temperature not exceeding 50° C., agitating the flask from time to time until a drop of the liquid ceases to give a blue coloration with starch T. S. Then add the sugar, and when this is dissolved, remove the flask from the water-bath, allow the syrup to cool, and finally add enough distilled water to make the product measure 1,000 c.c.

The last formula is Baudoin's process (P. F. p. 784), with quantities altered to accord with the fluid system.

SANTONIN.

J. A. Munck, in the Eclectic Medical Gleaner, gives the following summary of the properties and virtues of this useful drug Santonin is the active principle of santonica or Levant worm seed (Artemisia pauciflora). It can be used in powder, but is more conveniently given in a tablet triturate, which always divides the dose accurately, one-fourth of a grain being the average dose. If a smaller dose is desired the tablet can be divided, or the dose can be increased to two or more tablets. It is not objectionable to a child and may be eaten like candy,

dissolved in water, or swallowed like a pill.

The dose of santonin is from a quarter of a grain to two grains. The United States Dispensatory gives the dose from ten to thirty grains, which is evidently excessive and dangerous. The smallest dose of any drug that will have the desired effect and afford the needed relief, is the quantity that should be used. The Eclectic method of prescribing medicines in frequent small doses is much preferable, as a rule, to giving large doses at longer intervals. An over-dose of five grains, or more, is poisonous and dangerous, as it has been known to cause convulsions and death. With ordinary caution, however, no dangerous effect is ever produced. During the past forty years in which I have used the medicine freely (and I commenced using it when I started in practice), I have never seen the slightest evil effect and regard it as perfectly safe in all cases if used in the small dose. When administered it imparts a bright saffron hue to the urine, so that it is always best to advise the mother or nurse what to expect, as they might become frightened by the sudden. change in the color of the urine, if not informed.

Santonin is known as a good worm medicine, and so it is; but this action represents only a small fraction of its real value. Its full value is too little known, for which reason I desire to call attention to the agent at this time. As a pleasant and reliable vermifuge it is the remedy par excellence and will expel both stomach and pin worms. Worm symptoms are various and numerous, but those usually present in such cases are: whitish ring about the mouth, slight swelling of the upper lip, much picking of the nose, and the uttering of shrill cries during sleep. Although these signs are all well-known worm symptoms, yet they do not infallibly denote the presence of worms; but they do always indicate irritation of some kind in the intestinal

canal, whether produced by worms or some other cause, and call for santonin. A quarter or half-grain tablet, according to the age of the child, should be given every two hours until three or four doses are taken, then followed by some mild purgative. I do not say that a physic is absolutely necessary to success, but a soft state of the bowels will naturally aid the expulsion of worms if there are any. If there be no worms in the stools it is safe to conclude that there are none and that the irritation which caused the symptoms was produced by something else than parasites. Afterwards, the medicine should be continued in less frequent doses for one or more days, when the worm symptoms will have disappeared and the child is well. Sometimes, after a vermifuge is given and no worms are seen, the conclusion is reached that the worms have been killed and dissolved in slime. Anybody who chooses to believe such a fiction is, of course, welcome to do so, but it is not in the nature of things for living matter to dissolve and disappear in that maner.

ERGOT.

Chas. C. Haskell, in the Indianapolis Medical Journal for December, considers ergot and substitutes for it. Accuracy

of dosage, the sine qua non of rational therapeutics, can generally be secured either by using certain pure principles, definite chemical compounds free from. substances which are inert or detrimentally active or by using galenical preparations which have been assayed by chemical means and adjusted to a definite standard of strength. At present it is impossible to say which of the active constituents is to be desired in the therapeutic use of ergot. Dale, the greatest authority on the pharmacology of ergot, has only recently said that careful clinical observation alone can decide whether any one of these is sufficient to produce

the typical ergot action. Possibly, as seems to be the case with digitalis, all of the active constituents are necessary. It would seem, then, that chemical investigation of ergot has not yet put us in a position to standardize accurately preparations of this drug by chemical methods. This being the case, it is not surprising to find that clinicians have endeavored to secure substitutes for ergot in obstetrical practice. As to the use of quinine, an analysis of the results, clinical and laboratory, shows that quinine evidently has a decided influence on the movements of the uterus. The effect of quinine, however, differs decidedly from that of ergot, and the indications for the use of these drugs by the obstetrician are entirely distinct. Quinine, apparently, an exaggeration of the normal uterine movements, contraction and relaxation succeeding each other in their usual relation. Ergot, on the other hand, exaggerates the contractions at the expense of the phase of relaxation, tending to produce a tonic contraction and thus I close the sinuses. It would seem then that quinine would be of value in the earlier stages of labor, when uterine inertia is present, while ergot is indicated after the completion of the third stage. Pilocarpin has been found to be of decided value in stimulating the normal uterine contractions. Pilocarpin has

causes

other actions, however, which tend to make its use as a uterine stimulant inadvisable or even dangerous. As to the bark of cotton root, further observation is necessary to establish its value as an oxytocic.

MALARIAL CACHEXY. Quinine hydrochloridi .....48 grains. Ferri pyrophos. sol. Merck...24 grains. Arseni trioxidi 1⁄2 grain. Oleoresinæ capsici 6 grains.

M. Div. in konseals. No. 24. Sig. One konseal three times daily, after meals.

THE ELECTRO-CHEMICAL (IONIC) TREATMENT OF CERTAIN GYNAECOLOGICAL AFFECTIONS.

BY SAMUEL SLOAN, M. D., Glasg., F. R. F. P. S. Glasg.

Consulting Physician, Glasgow Hospital for Women, Etc.

(Continued from the February number.)

Ionic Penetration.

SHOW you in two tubes examples of ionic penetration, compared with ordinary diffusion, through a piece. of the wall of the fresh stomach of the ox, the animal having been killed a few hours only before the experiments.

In these two specimens a solution of CuCl, has been placed on the mucous surface of each piece. In the simple diffusion case after five hours the copper had absolutely failed to enter into the mucous membrane, there being only a slight coloring on the surface, easily washed off.

In the case of the specimen under the same conditions in the other tube a current of five ma, during five hours has been passed through the copper solution and the tissue from the positive pole, the total current being thus 90 coulombs, or about five gynecological doses.

You will find under the microscope on the table a section of this specimen. The report from Dr. Leslie Buchanan, who kindly made the sections for me, is as follows: "That which was subjected to ionization is readily distinguished by having a portion of bluish-green color, highly condensed and fairly firm in comparison with the rest of the tissue. The cut surface of this condensed portion shows a greenish color to about half its thickness (the total thickness of the tissue is 6 mm.) and exposure of the cut

surface to a solution of sulphide of ammonium results in the conversion of the greenish color into a very deep brown or almost black. The portion treated simply by diffusion shows no change from the normal either in color or texture. Sections prepared for the microscope show that in the case of the ionization the metal has passed through the mucous membrane and submucous tissue and lodged in the tissue of the muscle below. The metal is exceedingly finely divided, and is manifestly lodged in the tissue, not simply deposited on iti. e., the metal is intra-cellular, not simply inter-cellular. It is evident that the mucous membrane has opposed considerable resistance to the passage of the metal, as a large amount of it is deposited on the surface of the tissue in addition to what has penetrated. In the case of the diffusion no metal is found either by the microscope, or by change of color with ammonium sulphide, in the tissue itself."

Combined Electrolysis and Ionic
Penetration.

I have here a piece of fresh meat, and I can show you by means of it an example of combined electrolysis and ionic penetration. I push an electrode of ccpper and one of platinum into the tissues, attaching the copper probe to the positive pole and the platinum to the negative. I am not placing them too far apart, since I have here only a small electro-motive-force to work with, and so I am diminishing the resistance and thus increasing the current.

We will allow the current to remain in action for about fifteen minutes, and you

will find at the end of that time that the platinum probe is easily lifted out of the tissue, for the reason formerly mentioned, whereas the copper is adherent, since the O and HC1 which have separated at the positive pole out of the NaCl and H,O of the tissue have coagulated the albumin of the meat around the electrode. If the action is allowed to continue sufficiently long a severely caustic action will be produced.

These are the results of electrolysis; but something else has taken place as well. If you examine the part where the copper was you will find that the HC resulting from the electrolytic action has gradually dissolved some of the metal, and the resulting copper ions have traveled a certain way on towards the negative pole. This is ionic penetration. If the process had been allowed to continue sufficiently long it would have. been impossible to remove the copper rod without tearing away some of the flesh. In that case, if the current be reversed for a few minutes, the copper being thus attached to the negative pole, sodium ions will come to it; the tissue will be softened and the copper can then easily be lifted out.

If by this time you are coming to the conclusion that I am over-estimating the importance of ions, let me point out to you what I mentioned in proof of the fact that in a solution of 1% or less of NaCl practically all the particles were ionized. Now the salines of our body are in concentration of about 0.9%, so that all the salts in our tissues must be present as ions; and since all vital action is accompanied by electric change, and no chemical alterations can take place without these electrically charged bodies, life must be impossible in the absence of ions.

Action of Chemicals Electrically Driven Into the Tissues.

I have said that all vital action is accompanied by electric change, and therefore by electric currents, since,

whenever there is a difference of potential in the presence of ions, a current must result. Now Pauli, in his book, "Physical Chemistry in the Service of Medicine," states that "differences in the concentration of ions brought about through (bringing about?) differences in their migration velocities constitute the source of differences in the electrical potential."

That this was true I had long hoped, since it would explain what to me had formerly been puzzling-namely, how was the chemical, which had been electrically driven into the tissues, and had then assumed an insoluble form as in the case of copper-how was this to be disposed of, and how could it in that form act therapeutically? For more than a year I have, by means of a very delicate mirror galvanometer, made. many attempts to prove or disprove this. I asked an expert in electro-physics and one in electro-therapeutics to join me in the investigation, with the result that we all came to the conclusion that this statement was not true. However much it might be true to others it, therefore, had to remain to me untrue.

Recently, however, I again attacked. the problem and discovered that, though not true, it was yet a half-truth. No matter how great might be the difference in concentration of contiguous saline solutions, no current could be observed. I noticed, however, that there was sometimes a slight deflection of the needle at the moment of insertion of the platinum wires, but this current immediately stopped when the wires were at rest in the solutions. This led me to the conclusion that the difference in concentration alone was not sufficient to cause a current. If, however, whilst the wires were at rest and dipping into solutions of widely different degrees of concentration, the fluid was then shaken, at once and on every such occasion a marked deflection of the galvanometer needle ensued. Therefore, there is a difference

of potential and a resulting current, but only when there exists at one and the same time a difference of concentration and a flow.

Since, then, this is exactly what exists in a greater or less degree throughout living organisms, there must in and around the deposited insoluble powder (`n present case the insoluble oxy-chloride of copper) be constant, though weak, galvanic currents, and consequently some degree of dispersion of the substance by galvanic action. These vital electric currents, which are continually in action, will therefore continue to carry on the work and thus cause the diffusion and final removal of this apparently inert powder by means of ionic migration.

I find that the more the disturbance of the solutions of different degrees of concentration the greater is the current generated. Every muscular movement, therefore, must assist in diffusion of the substance introduced into the tissues, even when it has been rendered insoluble by the action of the oxygen and chlorine of the tissues.

Selection of Cases and Ion.

In the selection of a suitable ion, one must be guided by the nature of the case. The object of the treatment is to remɔve sepsis and the accompanying inflammatory exudations. Cases of acute inflammation, of threatened suppuration, and, a fortiori, cases of actual pus formation, and also cases of cystic disease, are absolutely unsuitable. Apart from these unsuitable cases, however, there remains a very large number of gynecological affections hitherto treated in a more or less perfunctory manner because with very little hope of permanent benefit. Is it not possible, however, may I venture to say, is it not almost certain, that nearly all of those pathological conditions unsuitable for this treatment might have been prevented if ionic medication had been applied in time and in a thorough manner?

As to curettage, the nature of the case must determine the wisdom of doing this before trying the ionic treatment. This operation is not excluded, but I have found it, since I began the method I am advocating, very seldom necessary.

The Iodine Ion.

When the affection partakes at all of a subacute nature I prefer to start with iodine as the ionic agent. Iodine being electro-negative, the minus pole must be the active one, and the electrode there should be a carbon one, such as I show you. There is no advantage in applying the iodine wholly in an uncombined form, because, as you will observe from one of the diagrams, it at once becomes converted in Nal when it enters into the tissues. The solution I employ is a 2% one of iodide of potassium combined with 0.2% of liquor iodi.

The iodine ion will reach the cellular tissue of the pelvis by diffusion, whilst it will penetrate electrically into the protoplasm of the tissues which it has reached during the process of diffusion. I find that it can be detected in the saliva twenty-five minutes after the beginning. of the application, whereas by diffusion. alone it takes several hours to reach the mouth from the vagina.

Where there is inflammation of the tubes, the ovaries, or the cellular tissue, if no suppuration is present the iodine. ion has given me good results. I am bound to admit, however, that I do not confine the treatment to ionic applications in these cases, but usually finish off with some other form of electric energy, usually the high frequency. Therefore it may be difficult to determine the relative value of these two forms of electrotherapy. The high-frequency currents may be able to complete the cure, but I am certain they can never destroy sepsis as ionic medication can.

Of the mercuric ion I have no experience. It is said to have been very serviceable, however, in cases of malignant disease when the diseased tissue is