"Adequate differentiation should be made between the several grades of attendance upon the sickroom so that the people may employ whom they choose and know what they are paying for.

"By the above means carried to greater perfection, especially the hourly system, the problem of how the great middle class is to obtain. the good service of nurses can be practically solved. The splendid growth which your profession has made, though still in its infancy, is a sure guarantee that it will in time fully meet the difficulties in question. A better co-operation between nurses and physicians is essential to speed the necessary reforms." Berwyn, Ill.

Apomorphine Hydrochloride.

BY SEWARD FYFE, M. D.

This drug is the hydrochloride of an alkaloid obtained from morphine. It consists of grayish-white crystals, has a slightly bitter taste and acquires a greenish tint on being exposed to air. It is soluble in about forty parts of water. It should be kept in amber-colored vials.

As an emergency remedy apomorphine fills an important place, and should be included in the medicine case of every general practitioner of medicine. It may not be as frequently needed as many other drugs, but cases are occasionally seen in which it is an absolute necessity-cases which might result fatally before the needed corrective effect could be secured from other and more frequently employed drugs. In nearly all cases in which prompt emesis is necessary apomorphine is the most efficient drug with which I am acquainted. In from five to twenty minutes after its administration-depending upon the quantity used and the manner of employment-copious vomiting occurs, and in some instances the vomiting is repeated several times, at intervals of fifteen to twenty minutes. The emesis is preceded and attended with but slight nausea and followed by very little depression.

Apomorphine is a direct or systemic emetic, and in so far as its systemic action is concerned, it should always be remembered that it is a derivative of morphine and employed with the necessary caution. One of its great merits, in addition to its rapidity of action, is the ease with which it can be administered in cases where swallowing is difficult or impossible. It is, therefore, useful in many cases of poisoning. In opium or morphine poisoning, however, it is contra-indicated. An occasional case of poisoning is seen in which the vagus is so blunted by the poison that apomorphine fails to produce vomiting. In acute inflammation of the stomach, whenever an emetic is required, this agent is preferable to most other drugs. When given as an emetic apomorphine should always be administered hypodermically, and the solution should be freshly prepared. Like some other systemic emetics-ipecac, for instance-apomor

phine, in very minute doses, will often relieve vomiting. As an illustration of the efficient action of this drug I will mention one of the cases which occurred in my practice.

I was recently called to see a woman who was said by her son to be dying. On arriving at her bedside I found that she was but partially conscious and apparently suffering intense pain, and her abdomen was very much distended. She was unable to answer any questions, but I learned from the family that during the afternoon and evening she had eaten several large apples, and that her teeth being bad, she probably had not thoroughly masticated the apples. I at once administered hypodermically 1-10 of a grain of apomorphine. In less than five minutes she vomited one quart of undigested food, including large pieces of apples. During the next half hour she vomited twice, and then said that the pain had gone, and that with the exception of feeling a little weak, she was as well as before eating the apples.

In acute bronchitis I have found apomorphine, in doses of 1-30 of a grain, given by the mouth, a very useful drug. It is also an efficient means of relieving the dry, hacking cough which often accompanies chronic bronchitis, chronic catarrhal pneumonia and tuberculosis. When used as an expectorant it should always be given by the month. In administering this drug to children considerable caution should be exercised, as they do not always bear it well.

Large doses of apomorphine stimulate the brain, and have even caused delirium. It has often caused unconsciousness, and in some cases convulsions have been produced by very large doses. Small doses have no marked effect upon the circulation, but full doses increase the rapidity and force of the heart's action. Toxic quantities of the drug depress the circulatory system or paralyze the cardiac muscle. Small doses do not effect the respiratory movements, although the secretion from the bronchial membrane is increased. Full doses increase and deepen respiration, but toxic doses cause a depression like that caused by morphine. Apomorphine is readily absorbed, and is excreted through the gastro-intestinal tract, as well as by the broncho-pulmonary membrane, the kidneys and the skin.

The symptoms of poisoning by apomorphine are violent vomiting, delirium or convulsions and cardiac and respiratory depression, death resulting from asphyxia. The approved treatment for poisoning by this drug is the same as that employed in poisoning by morphine.

The maximum doses of apomorphine hydrochloride are as follows: 1-20 to 1-10 of a grain by the mouth; 1-25 grain to 1-16 grain hypodermically; 1-30 grain as an expectorant; 1-10 grain as an emetic.

Some Uses of Thuja.

BY SAMUEL A. LEWIN, M.D.

In presenting this paper on "Some Uses of Thuja" I do so in the hope that some of you present will find sufficient interest in this drug to subject it to extensive experimentation and make, if possible, a scientific study of its therapeutic properties along the lines suggested by my experience with it.

I do not attempt to present here the therapeutic action of a drug scientifically demonstrated in the laboratory and at the bed side. I simply present here facts gathered from my rather large experience with this drug in my daily practice.

I first used this drug during my last year in college, soon after I heard a lecture on "the action and uses of Thuja" by Dr. Boskowitz.

I was called upon to treat a case of Chancroids, of several weeks' duration, that involved almost the entire circumference of the prepuce. Knowing that the case had been treated for some time by another physician with the routine remedies, without much benefit, I tried Thuja as an experiment. I applied the oil with a cotton swab daily for several days. I observed that after one or two applications the awful odor of decomposition, which is always present in this type of Chancroids, had disappeared, the discharge from the ulcers having almost entirely ceased. After several treatments the ulcers coalesced, forming one continuous ulcerated area, taking in the diseased tissue as well as the apparently healthy tissue separating the ulcers.

My impression was that the condition was getting worse and the infection spreading, but after a few more applications of the oil all the diseased tissue came away as though peeled off, leaving a healthy, granulating surface, which healed up in a few days by the application of a 10% Thujo Ointment, leaving no scar.

My next experience with Thujo was with a phagedenic ulcer of a latent Syphilitic. The patient, a man, had Syphilis for some years past and had been treated by injections of Mercury Bichloride. His statement was that the sight of one of the injections became infected, producing a sound, which refused to heal despite the efforts of the physicians he consulted. Upon examination I found a wound large enough to admit my thumb, about one inch deep. The edges and walls were covered with what appeared healthy skin, but the floor had a glazed, glaring appearance and some fluid, apparently serum, oozed from it. I filled this wound with Oil of Thuja, packed it with gauze saturated with the oil and covered it up with dry gauze and plaster. I repeated this treatment daily for a few days and then every other day. Within a comparatively short time the

wound filled up and healed, leaving a scar that was hardly noticeable.

These two experiments, though very gratifying, were but isolated cases, nevertheless, it was sufficient to prove to me that Thuja possessed great power to arrest decomposition and necrosis and bring about healthy repair.

I have used this drug on more than a hundred patients and cannot speak too enthusiastically about it. I apply it in every case of Chancroids, in venereal ulcers and abrasions, both specific and non-specific.

I have used it very successfully to remove the odor and stop the discharge from Venereal Warts. It will not remove the warts, but it will remove the odor and the discharge.

In patients, whose prepuce is very tight, the smegma collects and decomposes, producing a very disagreeable odor, often, too, it will cause ulcerations and sometimes adhesions. The Thuja Ointment will remove the offensive odor and discharge, will cure the ulcers and prevent adhesion.

In the treatment of Hydrocele I have used Sp. Tr. Thuja following the withdrawal of the fluid from the sack, and after observing the results obtained in eleven cases, can say unreservedly that there is nothing better in our Materia Medica to prevent a recurrence. The severe pain and danger of using Carbolic is eliminated. In incontinence of Urine, frequent urination and dribbling when due to posterior Urethritis, Cystitis or mild prostatic hypertrophy of the aged, I always rely on Sp. Tr. Thuja and obtain the most satisfactory results.

In treating pruritus ani that is not due to anal fissure, and in the treatment of moist and dry Eczema on any part of the body, the Thuja Ointment gives almost immediate relief from the severe itching.

In connection with this drug I want to report a case that will interest you and I hope will lead some of you to experiment with Thuja in treating neoplasms. I believe the Sp. Tr. Thuja can be used hypodermically.

Mrs. S., age 70, came to me for treatment for a growth on the upper part of the left side of the face near the external canthus. She claimed to have been operated for an abdominal tumor several years ago. The present growth started about three years ago as a small, painless wart, gradually and very slowly progressing to its present size, which was about 21⁄2 inches long and about 2 inches. wide.

She received several X-Ray treatments at a hospital in this city, which at first seemed to arrest the progress of the growth and dry it up. She failed to go back for the treatment and after several

weeks the growth began to get larger and discharge a foul-smelling fluid. When I saw her the mass seemed to begin breaking down and ulcerate.

I wiped off the discharge as best I could and applied Oil of Thuja and covered it up with gauze. The woman being out of town I prescribed for her Oil of Thuja and the ointment and advised her to use it twice daily and report to me every week.

After about a month's treatment the discharge had altogether stopped and the mass was reduced to less than half of its original size.

The woman dropped out of sight, and I do not know what eventually became of her.

I believe that that woman had an Epithilioma and that the Thuja at least arrested its progress. N. Y. City.

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.

The Study of Therapeutics.

In persuing this study it will be well to constantly bear in mind: (1) That causes of disease act upon a living body, and that such action invariably impairs its life. (2) That causes of disease must be removed whenever it is possible to accomplish such removal without still further impairment of life. (3) That disease itself is a wrong in the life of the individual, and that it is as much a part of him as is healthy life at other times. (4) That disease is opposed by remedies which influence the organism toward healthy or right performance of functions. (5) That remedies may be divided into two classes; namely, those which remove causes of disease, and those which restore vital processes.-Dr. John M. Scudder in Fyfe's Diagnosis and Medication.

Specific Medication.

A few years ago, in writing to Ellingwood's Therapeutist, Dr. Bishop McMillan gave a definition of Specific Medication which I have never seen surpassed or even equaled. In part Dr. McMillan said:

"There should be a definite limitation placed on the term, 'specific medication.' There are many articles in the Eclectic journals prais