Tuberculous affections of the lungs are very rarely accompanied by actual psychoses, but still there are many instances in which, during the course of the disease, there developed a distinct hypochondriacal, melancholic and even an apathic disposion, or in some other cases undue exaltation and elation—but not enough to come to the degree of even a light mania.

Delirium is not an infrequent symptom in the last stages of chronic nephritis. It may be quiet or an active delirium, and is more of the sort which we know as the "low muttering delirium." The forms of actual psychoses which depend upon uremia vary with the nature of the renal trouble, and with the individual susceptibility of the case to the non-excreted toxins.

I have seen some cases of "mania transitoria," a delirious excitement, which may come on during the second or third day after childbirth, which arises suddenly and passes off as quickly. These cases should not be mistaken for the ordinary cases of puerperal mania which lasts for weeks and even months.

In some cases of paresis symptoms of exudative syphilis introduce the disease. The patient has at first palsies of the eyes, or attacks of hemiplegia with severe pains in head, followed by convulsions. The specific exudate is found to be pressing against the convexity or against the base.

I consider the "trifacial" one of the most important nerves from a neurological point of view, since diseases of this particular nerve produce more suffering and occur more frequently in neurotic individuals than in any other nerve. For the neurologist-the trifacial is a "good thing."

I heard so much about the great results obtained by some neurologists with quinine, in some cases of vertigo, that I fell to it. I tried it in a few cases, tried it in small doses, increasing till cinchonism resulted and had the pleasure of seeing it fail in each and every case. Hydrobromic acid in the form of a syrup, given in 30drop doses, with salicylate of soda in 5-grain doses gave me some better results. I read a report somewhere, in which Hirt gave hypodermics of 10 drops of a two per cent. solution of pilocarpine with good results.

Hypochondriacal delusions relate to imaginary disease from which the patient thinks he suffers. He may be afraid to move less his bones will break. He may try not to laugh, less his face shall become paralyzed, etc., etc. As long as these beliefs do not interfere, well and good, but when they dominate the actions of the patient, they should be considered as evidence of insanity.

910 St. Johns Place, Brooklyn.

Materia Medica and Therapeutics

EDITED BY

JOHN WILLIAM FYFE, M. D.

Short Articles giving definite indications for remedies are solicited, and may be sent to DR. J. W. FYFE, Saugatuck, Conn.

Explosive.

The chlorate of potassium being a favorite remedy of many physicians of the Eclectic school it is of vital importance that we keep constantly in mind the fact that it must never be associated with any organic substance, as it is decomposed easily by a slight elevation of temperature, giving off its oxygen to the organic matter, and producing a dangerous explosion.

The above precaution is equally applicable to the permanganate of potassium.

Symposium on Treatment of Pneumonia.

Under the above caption several interesting articles on the treatment of pneumonia, written by practitioners of long experience, were published in the December issue of the Medical World. The articles were written by special request of the editor, and as they fairly well represent the three regular schools of medicine, no doubt the following abstracts from them will prove of interest to the readers of the REVIEW:

"I have found veratrin, or veratrum viride, not only effective in the initial stage, but also later on, when there have been signs of toxemia, with more or less delirium. In such instances the drug acts to favor greater elimination, with consequent riddance of the toxins. Other writers tell us that digitalis or digitalin should not be administered until the heart wavers, but it has been my observation that, administered with aconitin or veratrin, it overcomes the tendency to cardiac weakness. The use of strychnin is also decried by many, they insisting that no stimulation is required until there is a break in the

vitality. It has been my observation that this drug does well from the start. In small doses, far below the amount which would give any pronounced physiologic effect, strychnin seems to act as a synergist to other agents, in that it rather sustains the vitality of the patient and "splints" him, thus allowing no retrograde action to take place."Dr. G. L. Servoss (old school).

"In the early stages you will find aconite a most valuable aid in assisting to overcome the acute inflammation, as indicated by the dry, hot skin, chilliness, great thirst, rapid pulse and high temperature. I give the 2 x (= 1/100) every fifteen minutes for 4 or 5 doses, then every hour while awake.

"Veratrum viride (green helebore) will suggest itself after aconite, where you find great arterial excitement; full, strong, incompressible pulse (or even slow pulse, indicating exhaustion).

"In this stage the heart is showing signs of the great stress laid upon it. This remedy is my sheet anchor in the early stages, and, in fact, I use it until I have positive evidence of the indication of something else. It is a great relief to use a drug that serves so faithfully and so well in a diseased condition that so taxes the skill and ability of the physician.

"Its action on the engorged lung and in sustaining the heart through a crisis so dreaded by all, avoids the necessity of using stimulants, such as strychnia and others which are so deadly in their reaction.

"Bryonia is the soverign remedy for all inflammation that has advanced to the stage of effusion, and acts powerfully upon the serous membranes and the viscera they contain. In pleuro-pneumonia it is almost a specific. The chief characteristic symptom is the stitching, tearing pains, greatly aggravated by motion of the inflamed membrane, which is relieved by rest. I give 3 x every hour.”—Dr. W. H. Shane (homeopath).

"In the aged the vasorelaxants and constrictors so essential elsewhere descend to secondary place and occasional indications; while the pulmonary stimulants take first rank. In the front of remedies as to the relative frequency of indication I would place this group, of which sanguinaria, senega and squill are the principal members. They arouse the drooping powers of the lung, awaken sensation, and cause. the bronchi to feel and throw off the encumbering collections. The nitrate of sanguinarin, in doses of 1/10 grain, every one, two or three hours, continued until the patient is coughing sufficiently, is a remedy whose value I can scarcely exaggerate. If it occasions vomiting, so much the better; it is not depressant, and nothing more effectually frees the bronchial tract of secretions. The effect on the system in

general is powerfully stimulant, and bowels and bladder. are strengthened.

"I do not like digitalis with these cases. Its power of constricting the arterioles is so great that the danger of inducing gangrene by stopping the supply of nutrition is perilously increased. If the heart needs help, substitute spartein in full doses for the bloodroot. If pulmonary dropsy is present, with hydrostatic effusion or threatened edema, employ squill. Frequent change of position prevents that interference with the nutritive circulation that forms one of the main dangers of this condition."-Dr. W. H. Waugh (old school).

"For obvious reasons all diseases should be correctly diagnosed in accordance with the present nosologic classifications, but such diagnosis should not materially influence the treatment of a patient. He should be treated according to the specific indication for the needed drugs, regardless of the name of the disease from which he is suffering. In other words, the patient, not the disease, should be treated.

"In my practise I have found one or more of the following remedies always required in the treatment of the pathologic states usually manifested in pneumonia:

"Aconite when the heart's action is rapid, the pulse small but hard and wiry. Asclepias when there is a tight, hard cough, sharp pain and the heart lacks tone. Baptisia when the tissues are full and dusky and the tongue is full and purplish. Belladonna when there is capillary congestion. Bryonia when the pulse is hard and vibratil, or when there are sharp, lancinating pains and harassing cough. Echinacea when the tongue is full and of a dusky hue, and the tissues are of the same color. Ipecac in minute doses when there is irritation of the mucous surfaces. Jaborandi when there is high fever and the skin is hot and dry. Nur vomica when the tongue is full and pale. Podophyllin when the tongue is broad and full and covered with a dirtyyellow coating. Quinin when periodicity is a marked feature, providing the tongue is moist. Rhus toxicodendron when there is irritation of the cerebro-spinal centers as shown by a sharp stroke of the pulse. Sanguinaria when there is a tickling sensation in the throat causing almost constant coughing. Sticta pulmonaria when there is a hard, racking cough and pain in the occiput. Veratrum viride when the pulse is free, full and bounding. Cactus, as a means of sustaining the heart, should be employed in small doses from the beginning to the end of all cases of pneumonia.

"The above-named remedies, if employed in small doses in accordance with the foregoing indications, will cure a very large percentage of all cases of pneumonia. In addition to internal medication I usually have the compound powder of lobelia applied on a larded cloth to the chest. This application should be renewed every day.”—Dr. J. W. Fyfe (Eclectic).

Spigelia-Pinkroot.

This plant is also known as Spigelia Marilandica, and is found growing in many section of the United States. It is said to have derived its name from Spigelius, a Flemish botanist and physician, who discovered its medicinal properties. Spigelia is extensively employed as a means of expelling worms, especially the ascarides variety, from the human body. When used for this purpose the required dose, which need not be large, should be repeated night and morning for two days, and followed by a cathartic on the third day, to prevent any narsotic effect which might result from absorption of the drug.

It is not, however, as a remedy for worms that Spigelia is most highly valued, but as a frequently needed medicament in abnormal states of the heart, as well as in wrongs of the nervous system. In endocarditis it is employed with much benefit, and in all neuralgic affections of the heart it exerts a relieving influence. It will frequently relieve, and many times cure, choreic tachycardia, and in functional. palpitation it is a remedy of decided merit.

"Spigelia, in small doses, is a nerve sedative; in large doses a narcotic and anthelmintic. It is valuable as a remedy in functional diseases of the heart to quiet the nervous disturbance. It may be employed with certainty in the treatment of painful conditions resulting from depressed vitality, as in many forms of neuralgia due to loss of nerve energy in exhausted states of the system.”—Stephens.

Spigelia is anthelmintic, carthartic, narcotic and sedative. Indications.-Choreic tachycardia; nervous depression and irritability; burning, throbbing tensive pain in left side of face; occipital headache spreading to left side of the head; violent pulsating pain in left temple; reflex neuroses; functional diseases of the heart. Dose. Fluid extract, 10 to 60 drops; specific medicine 10 to 60 drops.

Usual Prescription.-R Spigelia, gtt. x to xxx; water, živ. M. Sig. Dose one teaspoonful every hour to every four hours.

Ambrosia-Ragweed.

This indigenous plant yields a medicament of limited, but frequently valuable activity. It is usually prepared from the fresh flowers.

Ambrosia is employed as a general tonic, with good results, and as such is especially indicated in intermittent and remittent fevers. In dysentery and diarrhea it exerts a corrective influence, and in hemorrhoids it is deemed a remedy of value. Ambrosia is also recommended as a local application in sprains and bruises.