Scopolamine.

Prof. John Uri Lloyd, Cincinnati (Med. Counselor), gives the history and chemistry of this new alkaloid:

Scopolamine, recommended by Dr. Schneiderlin, was extracted by Schmidt, of Marburg, from the Scopolia Japonica, a perennial, herbaceous plant of the natural order Solanacea, popularly known as the Japan belladonna. The first chemical analysis, made by Langgard long ago, resulted in the isolation of an alkaloid, rotoine, from roto, the Japanese name of the plant, which exhibited all the properties of the alkaloids of belladonna. Scopolamine, indeed, exerts a mydriatic and a vaso-dilatory action (i.e., it dilates the pupils and blood-vessels), but it also possesses a narcotic power, which inevitably produces a profound and dreamless sleep,

There are four alkaloids of identical chemical composition, namely, atropine, hyoscine, cocaine and scopolamine, their empirical formula being C17 H21 NO4. In other directions, however, these alkaloids are very different substances. Still, the physiological action of hyoscine and scopolamine are so nearly identical as to lead to their substitution, the one for the other. In fact, excellent authorities state that scopolamine hydrobromide is identical with hyoscine hydrobromide, but lower in price. The question arises, then, Why, if they be identical, is the price under the one name less than it is when the same substance is sold under the other name? and this I will aim to explain, as follows:

The alkaloid discovered in scopolia, and named scopolamine, is probably a mixture of the alkaloid known as hyoscine and the alkaloid known as atroscine, which alkaloids are obtained from scopolia in greater abundance than hyoscine is obtained from hyoscyamus. In other words, the alkaloid hyoscine, obtained in small amounts from hyoscyamus in a very nearly chemical condition, is obtained from scopolia in larger amounts. Hence, when it is made from the drug scopolia, it can be sold cheaper than when it is made from hyoscyamus.

The physiological action of the material sold under the name scopolamine and the

material sold under the name hyoscine are so nearly identical as to make them practically replaceable (in some directions, at least) the one for the other. In fact, the standard authorities at the present time consider them to be identical, and under refer the reader for its action to hyoscine. the word scopolamine the latest authorities

When this alkaloid unites with hydrobromic acid, it forms what may be called either hydrobromate of hyoscine or hydrobromate of scopolamine; but as the bulk hyoscyamus, the term scopolamine is natuof it is made from scopolia instead of from rally being preferred by manufacturers. This term, however, is not as well known to physicians as the word hyoscine. Hence, replaceable positions may not comprehend physicians who find these terms used in just why the substance is thus separately designated.

To sum up, hyoscine and scopolamine are chemically identical, the one having been discovered in hyoscyamus, the other having been discovered in scopolia. The hydrobromate (or hydrobromide) of scopolamine has the same ultimate composition of the hydrobromate (or hydrobromide) of hyoscine, and thus permits of the same But since atropine and cocaine are also of the same chemical composition, it will be seen that this is not an evidence of identity in therapy. In our opinion, one has no more the right to dispense scopolamine for hyoscine than to label hyoscyamus as belladonna.

name.

Tulase, Behring's New Remedy for
Tuberculosis.

Tulase, the new tuberculosis remedy of Behring, in a pure state is a clear liquid resembling thin honey, which contains all the constituents of the Koch bacillus. Behring (Pharmaceutische Zeitung) divides these constituents into three principal groups: (1) Lipoid substances such as neutral fats and waxes soluble in alcohol, ether, acetone, chloroform, etc., including also all the substances insoluble in acids; (2) those protein compounds which are extracted from the defatted tubercle bacilli with distilled water and with 10 per

cent. sodium chloride solution and which consist partly of nucleoalbumins and partly of globulins; (3) the proteids which form the principal constituents of the tubercle bacilli which have been freed from fats and from protein.

The preparation of tulase, which is a very complicated process, embraces the treatment of the bacilli with chloral, by which the TC (an. active constituent of the bacilli, so-called by Behring) of the bacilli is so changed that when the tulase is administered either by way of the stomach or by subcutaneous or intravenous injection the cells of the TC are decomposed and converted into a hypothetical substance TX. This confers immunity against tuberculosis and against hypersensitiveness to Koch's tuberculin.

Tulase is furnished only to such clinics as have physicians who are well grounded in bacteriology and who have studied for at least three months in the Marburg Institute for Experimental Therapy with a view to experimental work in the immunizing therapy of tuberculosis. Since the dosage of the tulase, the best method of application, the indications for its use, etc., are not yet definitely determined, the remedy is furnished without cost to such clinics as come within the above category. The physicians studying at Marburg are required to follow closely the methods laid down at Marburg as to registration of observations, the dosage, the method of application, the selection of the patients to be treated and the furnishing of regular reports.

In the treatment of animals which have already been infected intravenous or subcutaneous application is recommended. The dose is given by Behring as 0.01 c.c., which may be doubled at the second administration after a lapse of four days. After a lapse of two to four weeks the dose is again repeated, the same quantities being given with an interval of four days between. Tulase is put up in glass tubes, each containing 5 c.c. of either 1 or 10 per cent. solution. It is stated that tulase can be used as a substitute for tuberculin in the diagnosis of suspected cases of tuberculosis.

In view of the extravagant expectations which are entertained of the results which may be achieved from the use of tulase, Behring has in several addresses particularly warned his hearers against a tend

ency to expect too much of the preparation. He has said that the most that could be hoped for as a remedy is that by its early use young individuals may be protected from pulmonary tuberculosis. It is not to be expected that it will heal in cases where the lung tissues have already been destroyed by the ravages of the bacillus.— American Druggist and Pharmaceutical Record.

Non-Repetition of Prescription.

In answer to a question as to the effect of the request on a prescription that it be not repeated, the Journal of the American Medical Association replies as follows: "The prescription is an order on the druggist to furnish the patient with a certain medicine prepared in a certain way and of a definite quantity. If the order incorporates the directions that the prescription be not repeated the druggist has no right to refill it. This much appears to be reasonable and, we believe, legally correct. It is important in the interest of the patient himself as well as the physician that the prescription be not repeated, since it frequently consists of a remedy appropriate only to temporary conditions, which may have disappeared before the request for repetition is made, and may possibly contain drugs the continued use of which may produce a drug habit. The druggist not only ought not to refill the prescription, but he ought not to give a copy, as this would defeat the object of the prohibition of the prescription repetition. The prescription may be copied before it is delivered to the druggist."

Rapid Cure of Scabies.

The cure of itch in an hour and a half is said to be attainable by the method practiced by Saboureaud (Bulletin général de thérapeutique). The patient is

first rubbed for half an hour with black soap (green or soft soap); he then takes an alkaline bath for half an hour. After coming out of the bath the entire surface of his body is to be well rubbed with: Oil of verbena, gum tragacanth, aa, I part; precipitated sulphur, 100 parts; glycerine, 200 parts; to be well mixed. A final bath is then to be taken, lasting from fifteen to twenty minutes. The clothing and body linen must be disinfected. During the fortnight succeeding this treat

ment four baths of starch water are given. In case there should be cutaneous irritation, local applications of ointment of zinc oxide are used.

Pleurisy Treated by the Injection of Gases.

Vaquez, at the meeting of the Sociéte Médicale des Hôspitaux, said that this was done with a double end in vieweither of inhibiting a tuberculous process or of treating the infusion itself. In acute pleurisy the duration of the disease is abridged, and in case of recurrence the gas injection was the treatment of preference. Nitrogen gas is preferred, as it is not absorbed too quickly, is not injurious, and remains a long time in the pleural cavity. The author was able to demonstrate its presence eight months after the injection. The amount to be used was variable, and ordinarily equaled about half the quantity of fluid removed.

Local Analgesia.

Barker (Surgery, Gynecology and Ob. stetrics) gives the following formula for local analgesia: Aquæ destillatæ 3.50, Beucaine 0.20, sodii chloridii 0.75, adrenalin chloride (1:1,000) 075. M. S.Inject when possible along the line of the supplying sensory nerves and infiltrate the tissue thoroughly with the fluid. Adrenalin retains the eucaine in the system a longer time, the analgesia lasting three or four hours. As much as six grains of eucaine have been injected at one time, when combined with adrenalin, without bad effect.

Orphan Proprietary Medicines.

The Committee on Proprietary Goods of the North-western Druggists' Association has devised the above expressive term to designate a class of proprietaries whose manufacturers have gone out of business or otherwise neglected their product. These goods have brought out some complications in the administration of the new pure food and drug law.

The Treatment of La Grippe. Nammack, in the Medical Record, finds the symptoms which cry aloud for relief to be depression and respiratory catarrh. He usually meets these symptomatic indications by a prescription containing five

grains of ammonium carbonate, five grains of ammonium salicylate in half an ounce of aromatic wine of erythroxylon coca, N. F., to each dose. This will relieve headache, neuralgia, and stimulate the heart, respiration and kidneys.

Alum Curd.

This preparation, which is prescribed for mild inflammation of the eyes, is prepared as follows: Drop a lump of alum into fresh milk. When the curd sets the undissolved alum is removed. Powdered alum should not be used, since it cannot be separated from the curd clot.-Spatula.

Local Anesthesia.

This can be simply and effectually produced as follows: A solution consisting of adrenalin chloride 8.00, cocaine 0.30, aquæ dest. 15.00, is prepared. Lint soaked in this and folded in four layers is placed under a positive electrode and a large negative electrode is placed else. where and a current of 15 to 30 milliamperes, slowly induced, is run for a space of from five to fifteen minutes. The surface may then be washed off with ether and superficial operations be made painlessly and without loss of blood.

The Induction of Premature Labor and
Accouchement Force.

Williams (Surgery, Gynecology and Obstetrics) reports the statistics of 5,000 labor in which the delivery was accomplished as follows: Induction of premature labor by Krause's method (bougie), 11 times; accouchement forcé by Harris' method of manual dilatation of the cervix, 83 times; accouchement forcé by Champetier de Ribes balloon, 15 times; accouchement forcé by vaginal Cæsarean section, 2 times.

Of 13 eclamptic cases with undilated os in which preliminary dilatation with Goodell's or Hegar's dilators preceded the Harris method, four patients died; two deaths (uterine rupture and infection) were attributable to the operation; and the cervix was uninjured in only three instances. In seven cases in which the cervical canal was obliterated but the external os not dilated, there was one death (not attributable to the operation), but the cervix was uninjured in only two instances after the Harris method. In

II cases like the last, in which the external os was dilated to less than 4 c.m., there were no deaths from the operation, but six deep cervical tears. In two cases with open cervical canal there were no deaths, but one deep laceration. In all (83 cases) the Harris method gave a mortality of nearly 5 per cent.

In 15 cases in which the Champetier de Ribes balloon was used all of the patients recovered and the cervix was more or less torn in 9 cases. Of the 2 vaginal Cæsarean sections I case died partly as a result of hemorrhage following uterine atony and partly from the underlying intoxication.

The author considers Krause's method (introduction of a bougie) as the safest method at our disposal in any case in which immediate delivery is not urgently indicated. Its only drawback is its comparative uncertainty; in the vast majority of cases, however, labor sets in within twenty-four hours. The author does not recommend the procedure on account of moderate pelvic contraction. These patients are allowed to go to term and if

spontaneous delivery does not occur he terminates labor by forceps, pubiotomy, or Cæsarean section.

Anterior Colpo-Hysterotomy.

Of the methods of opening up unprepared genital passages for the purpose of rapid delivery, next to the employment of the dilator, anterior-hysterotomy is probably the best one at the present time. P. Jung (Deut. med. Woch.) describes this operation and its results. The operations which he deals with were undertaken in the interest of the mother's life, and include five cases of eclampsia, one of severe nephritis with total amaurosis, one of severe non-compensated heart disease, and one of complete impaction of the fetus, which was lying in the transverse position. In the last-named case there was tetanus of the uterus. The os in this case was partly dilated. Unsuccessful attempts had been made outside by the general practitioner to turn the fetus. On admission large doses of morphine and deep anesthesia failed to relieve the tetanic condition of the uterus, and it was therefore impossible to proceed to perform embryotomy. The mother's condition was extremely bad, and for this reason anterior colpo-hysterotomy was immediately performed. The dead fetus was removed after embryotomy. Of the eight cases, three mothers died, two of eclamptic coma and one with the heart disease, which was complicated by nephritis, of collapse. In all three cases the sutures had held and there was no hemorrhage, as was proved post-mortem.

Of the fetuses, three were delivered alive and well, one was dead and macerated, one was dead and had to be delivered by embryotomy, two were not viable, and one was lost as a direct result of the birth. The last-mentioned case was one of the eclampsia cases. The fetus had its head impacted in a flattened rickety pelvis, with a conjunctiva vera of 8 cm. (three inches). Delivery was conducted with forceps, and a deep depression was produced on the temporal bone. It died a quarter of an hour post partum.

is better

The operation was carried out as follows: When the vulvar orifice was too small a wide vagino-peritoneum incision was made. After division of the anterior vaginal wall by means of a longitudinal incision, the bladder was easily peeled off in the loose tissue. The anterior uterine wall never offered any difficulty, as long as one remembered not to pull too much on the Collins' forceps which held the edges of the wound apart. On two occa. sions the vesico-uterine fold was opened, but this did not matter. The child was delivered four times by forceps, three times by version, and once by embryotomy. The author thinks that it is better to turn the fetus, save when the head is too tightly impacted, and believes that he might have been able to save the one fetus had he done this instead of delivering with forceps. Any way, he regards version as the easier and more elegant proceeding. The placenta was expressed or removed manually immediately after the delivery of the fetus. The suture of the uterus was carried out with continuous catgut sutures, and when the peritoneum had been opened the upper stitches closed this as well. The bladder was sutured in its place and the anterior vaginal wall was closed with continuous catgut sutures, including the perineum, when this had been incised. The wounds healed smoothly in all cases. He considers that this operation should only be undertaken in a clinic or hospital, and not at home by the general practitioner, who will not have had sufficient practice in these kind of operations. The safer method for the practitioner is to use the dilator. For any one who has had experience in vaginal operations the procedure is quite easy.

Phantom Pregnancy in a Forty-eight-YearOld Multipara.

Krummacher (Zent. f. Gyn.) reports the case of a woman, forty-eight years old and mother of five children. Previous pregnancies normal. Periods regular down to August, 1901. September period skipped and that of October slight; again absent until a slight show appeared in January, 1902. Excepting a slight show in February, nothing developed up to the time of examination in the middle of May. Abdomen, hips and breasts enlarged. For eight weeks the woman had felt distinct

movements and knew that she was preg

nant.

Examination revealed a distended abdomen, on the right side of which lively jerking movements were visible, and proved to be located in the right rectus abdominis muscle as well as in the oblique muscles. No intra-abdominal tumor discoverable. Internal examination showed an old lacerated cervix with uterus not enlarged. Adnexa and parametrium normal. Moderate amount of colostrum in the breasts. Patient refused to reject the idea that she was not pregnant. The case was diagnosticated as one of "idiopathic (choreic) contraction of the abdominal muscle." After some argument the patient was finally convinced of her error and cured in a short time of the muscular contractions by sea baths.

Vaginal Operations for Anteflexion.

Coffey (American Journal of Obste trics, September) describes an operation for the relief of anteflexion which consists of pulling the uterus well down either with a bullet forceps or a specially constructed tenaculum invented by the author. The second step is the incision of the posterior vaginal wall as for vaginal section. The peritoneum is not opened by the author, but is pushed up far enough to expose the posterior border of the uterus; opposite the point of flexion a transverse V-shaped section is removed from the posterior wall of the uterus; this is closed by chromicized twenty-one day catgut. The uterus is replaced and the incision of the posterior vaginal wall closed. It would seem that an additional step might be added to this operation, namely, the opening of the peritoneum and the examination of the adnexa before the incision is made in the uterine wall. The author only reports five cases, which report is altogether too small a number to judge of the result.

Labor in a Case of Excessive Hypertrophy of the Cervix.

Haagu (Zent. f. Gyn.) mentions the case of a patient, a primipara thirty-four years of age, who had suffered from a prolapsed hypertrophied cervix during twenty-one years. The labor was difficult, requiring an anterior cervical section with the application of forceps. After that everything followed a normal course.