Special Notices.

ANTIKAMNIA AND HEROIN TABLETS.-Our readers will find in this number the announcement of a new remedial preparation, viz., “Antikamnia and Heroin Tablets," each tablet containing grain Heroin Hydrochloride (muriate) and 5 grains Antikamnia. All members of the medical profession should familiarize themselves with this combination, and we respectfully advise our readers to look up the advertisement and send for samples. The advantages of this tablet are fully illustrated by a report of cases submitted by Dr. Uriel S. Boone, Professor of Pharmacology and Surgery, College of Physicians and Surgeons, St. Louis. We reprint three of said cases, as each has some particular feature which successfully called into use in a most beneficial manner the synergetic action of these two drugs:

Case 1. J. P., athlete. Suffering from an acute cold. On examination found temperature 101° with a cough and bronchial râles. Patient complained of pain induced by constant coughing. Prescribed Antikamnia and Heroin Tables, one every four hours. After taking six tablets, the cough was entirely relieved. Patient continued taking one tablet three times daily for three days, when he ceased taking them, and there has been no return of the cough or pain. Case 2. Ed., H., age thirty. Family history-hereditary consumption. Hemorrhage from lungs eighteen months ago. His physician had me examine sputum; found tubercle bacilli. After prescribing various remedies with very little improvement, I placed him on Antikamnia and Heroin Tablets, prescribing one tablet three times a day and one on retiring. He has since thanked me for saving him many sleepless nights, and while I am aware he never can be cured, relief has been to him a great pleasure and one which he has not been able to get heretofore.

Case 3. Wm. S., age twenty-eight. Lost twenty-five pounds in last thirty days. Consulted me July 9th. I thought he most certainly would fall victim to tuberculosis. Evening temperature 101°, with nightsweats and a very troublesome cough with lancinating pains. Prescribed ro gr. atropine to relieve the excessive nightsweats, and one Antikamnia and Heroin Tablet every four hours, with the result that he has entirely recovered and is now at work as usual.

Neither in these, nor any other of my cases, were any untoward after-effects evidenced, thus showing a new and distinctive synergetic action, and one which can not help being beneficial and useful to both patient and physician.

SANMETTO IN URETHRAL STRICTURE.-Dr. Jos. Swindell, of West Burlington, Iowa, writing, says: "I have been using Sanmetto for several years. I find nothing that suits me as well in genito-urinary diseases. I am using it right along in conjunction with treatment of urethral stricture. It soothes, checks, and prevents smarting and inflammation that is so common after passage of bougie. Its ease of administration and formula should recommend it to the profession."

ECTHOL.-Ecthol exerts a decided influence on eczema, and can be used to advantage in several different conditions. In cases of moist and inflamed lesions, with great soreness and irritation, it may be given in teaspoonful doses; and the more markedly the eruption is purulent the more decided the effect. It may also be used with manifest advantage when the patches are greatly infiltrated and the inflammation is subacute in character.—American Journal of Dermatology and Genito-Urinary Diseases.

THE Phosphates of Iron, Soda, Lime, and Potash, dissolved in an excess of Phosphoric Acid, is a valuable combination to prescribe in nervous exhaustion, general debility, etc. "Robinson's Phosphoric Elixir" is an elegant solution of these chemicals. See advertising pages.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than any thing else.-RUSKIN.

Original Articles.

USES AND ABUSES OF ARSENIC.

BY F. C. SIMPSON, M. D.

Arsenic is one of our most valuable medicines, and one that is not as popular as it should be among the profession generally. Many practitioners who do not see much of skin diseases seem to have an idea that arsenic is a remedy which can be administered in almost every lesion of the skin with advantage, and fail to recognize that, as a rule, it is contra-indicated whenever the layers of the skin are inflamed, being most useful when the epiderm is dry and improperly nourished, and of very little use when the corium is inflamed. Psoriasis is a typical disease of the former class, and in its treatment arsenic is a standard remedy. As stated above, the medicine should not be prescribed during the inflammatory stage of a skin disease. When used, it should be kept up for weeks, even months. As a result of the constant employment of arsenic when it ought not to be used, we see cases where great damage is done by its too free administration. We must also remember that the drug given in large doses is capable of producing some renal irritation as well as irritation of the stomach and intestines, and that a condition of irritability of the mucous membranes of the body generally are sometimes caused by too large a dose. Dr. Hare calls our attention to the use of arsenic as a valuable appetizer in doses of a minim of Fowler's solution with ten grains of bicarbonate soda and a tablespoonful of infusion of gentian taken before meals. I have used it this way and certainly found it a very valuable tonic. It is also use*Read before the Louisville Medico-Chirurgical Society, September 20, 1901. For discussion see p. 306.

ful in certain forms of morning diarrhea and nausea; also it is valuable in the treatment of various forms of anemia, in which case it must be given over long periods.

It is hardly necessary to remind you that it is almost a specific in the treatment of chorea, and its value as a blood tonic in malaria, and its great value in diabetes and asthma. It is held by Murray and others that it is useful in those asthmatic cases which are young, and the old with marked emphysema. It is also valuable in cases that have nasal disorders due to hyperemia of the respiratory mucous membrane. While recognizing the value of arsenic, we must not forget that it is possible for it to produce evil influences; that it is capable, when administered too long a time in large doses, of causing pigmentation of the skin, irritation of the stomach and of the respiratory tract, and, more serious still, peripheral neuritis.

In the treatment of chorea I find it of the greatest value. You must use it in increasing doses, and this is one of the few diseases in which arsenic is so valuable that you have to give it in ascending doses, even to tolerance. I find it of the greatest value in anemia; even the obstinate and often incurable cases of pernicious anemia yield better to arsenic than to any other known remedy; it is to be given in small doses and kept up for months. In the small dose you are not so likely to produce stomach disturbances. The effect of the drug in this disease is not due to its increasing the number and quality of the red blood corpuscles, but rather to its preventing or delaying their destruction in the portal circulation. By timely use of laxatives and careful watching the dosage you may easily adjust the blood-making forces.

Dysmenorrhea, frequently noticed in women with a tendency to asthina or subject to chronic skin diseases, is often cured or benefited by arsenic.

Arsenic ranks next to quinine in treatment of malaria; for instance, chronic cases, where quinine has lost its power, are markedly benefitted by arsenic.

Neuralgic headaches and anemia of malarial origin are very amenable to the drug. Fowler first reported the remarkable efficiency of arsenic in neuralgia of the intercostal and fifth pair of nerves.

It is equally as valuable in these cases, whether the disease be due to malaria or general debility. I have frequently gotten very good results in pulmonary phthisis, especially in those cases where there is excessive expectoration and slow degenerative processes. The good

effect of the arsenic is shown by the rapid improvement of their general condition, there being a lesser pulmonary secretion, a general improvement in the appetite, and increase in the body weight. It is contraindicated in phthisis where the cough is hoarse and paroxysmal, with but scanty secretions and tendency to hemorrhage. When I want to improve the nutrition of my patients, I find it the most valuable of tonics. It has not the power of increasing red blood cells, but it stops the destruction of the cell and thereby shows its great influence on the general nutrition. I do not know of any tonic that we can expect to give us better results than arsenic when administered in the proper way. In regard to the preparation used, it is just a matter of preference. I find Fowler's solution to be the most useful in a general way, and use this preparation more than any other. I believe that failure follows so many because they do not persist in its use for a long time.

LOUISVILLE.

RUPTURE OF THE UTERUS.*

BY NEVIL M. GARRETT, M. D.

On the morning of September 18, 1901, I was called to see a colored woman in labor. She was of heavy build, twenty-seven years of age, and the mother of six children, three of whom are living. Her mother, who was a midwife, said she had been having pains off and on for two or three weeks, but got worse between 2 and 3 o'clock on the 16th, at which time the membranes ruptured. She did not have hard pains at all, and was not confined to bed until the night of her death. She got worse about 3.30 on the night of the 17th, at which time she complained of being sore, but did not complain of much pain. She bled just enough for it to be noticed a short while before she died.

I was the first physician to see her, and when I arrived, about 5 A. M. on the 18th, she looked natural but was moaning, and as she did not reply when spoken to, I suspected hysteria. However, upon feeling for the radial pulse I failed to find it, and gave grain of strychnia hypodermatically. Upon external examination of the abdomen it was found to be large and soft, but the fetus could be felt.

* Read before the Kentucky Midland Society, at Georgetown, Ky., October 10, 1901.

Just as I had washed my hands and gotten ready to make a digital examination the woman died, but I proceeded with the examination and failed to find any part of the fetus presenting. My finger came in contact with something which felt like a placenta, and I thought I had a case of placenta previa. I passed my hand up and brought down one foot, and later got the other. I did not succeed in delivering the child. As the woman was dead I did not like to leave the extremities protruding from the vulva, and also wanted to make a further examination into her condition, so I pushed the child back and found what I probably at first mistook for the placenta to be the uterus, which was well contracted and felt ragged on the lower side of the cervix. The uterus was torn from the posterior vaginal wall, and rested near the anterior abdominal wall. I passed my hand into the abdominal cavity, where I could feel my finger in the abdomen with my free hand on the outside, and could plainly feel the small intestine. The child was loose in the abdominal cavity. I made no particular search for the placenta, but it was not in the uterus, as I explored that.

The time of the occurrence of the rupture is not known, but as the peritoneum was found to be inflamed upon post-mortem examination, it is probable that it had occurred when she is said to have gotten. worse, or about thirty-eight hours before, when the membranes are reported to have ruptured.

A post-mortem examination was made on the 19th, at which time the fetus and placenta were removed from the abdominal cavity, whence they had both escaped. The parietal peritoneum was inflamed, and the posterior wall of the cervix was ruptured longitudinally for a short distance. The vagina seemed to have separated from the posterior part of the cervix. The fetus had hydrocephalus to a marked degree, which was the probable cause of rupture, though it may have been due to an abnormal presentation.

FRANKFORT, KY.