diameter. A few small clots were found in the dura mater of this side, but on the right side you will see quite a number of them. The case is interesting from the fact that I found a clot of blood on the side upon which the pupil was dilated, which would indicate that there was compression of some kind. I forgot to mention another lesion on the right side of the anterior portion of the brain, at the junction of the middle and inferior frontal convolutions, about an inch long and three lines wide, presenting very much the appearance of softening."

Now, I think we have a right to know the purpose of this postmortem examination. Was it for the benefit of science? A coroner would have done a better job; he would have summoned the boys and girls of the neighborhood; the old men and women -all who knew anything about the case. He would not have hesitated to calling in the attending physician. I have known them even to put a dog on the scent, all for the sake of information. But Dr. F. starts out "sorry" he had not a clear history. Why did he not get it? Evidently he did not want it. Had he been as eager to benefit science as he was to bolster up his reputation, he would have gathered a "succinct' history. Why did he not answer the inquiry of my card? Evidently no personal feeling, for I never saw the man to know him. Then it must be professional. There he stands, with the man's brains in his hands, "sorry." Yes; a sorrowful picture!! We are sorry for him. Brains-but no "succinct and clear history!' He asks not where information may be found, and gives none himself. The fellow is to be pitied-for science; but when he can't pull the whole load, he will just block the wheels. It is not true that I treated this man for "malaria," and after that "for nothing in particular." A man that will make such a statement, without authority, must be watched. If science depends on such men, it will wait a long time for its achievements.

After making his examination of the brain, does he know what the trouble is? He stumbles over it, and the main difficulty he almost forgot to tell. The very last sentence, "I forgot: " "I forgot to mention another lesion, on the right side of the anterior portion of the brain, at the junction of the middle and inferior frontal convolutions, about an inch long and three lines wide, presenting very much the appearance of softening."

Now, I am prepared to say that my diagnosis was correct from the beginning. From drink, he suffered from cerebral hyperæmia, then encephalic hemorrhage, and, as the final result, ramollissement.

ART. V.-Direct Medication.-BY GEO. C. PITZER, M. D.

[CONTINUED FROM AUGUST JOURnal, 1884, page 368.] Gelsemium.-The green root tincture of gelsemium is the best preparation to use, but the fluid extract, made from the recently dried root, may be relied upon, and it is at least double the strength of the tincture, drop for drop.

The full effects of gelsemium are evidenced by a stiffness of the eyelids, and if the drug is pushed a little farther the patient is unable to hold the eyes open, suffers from muscular weakness, and dimness of sight and double vision when the eyelids are raised. It is rarely necessary to push the use of this drug so far as this, but upon stopping its use, or withdrawing it gradually, the toxical symptoms very soon subside, and no bad effects are likely to follow. To be sure, gelsemium might be given in quantities sufficient to produce fatal results-a general paralysis of the nerves of motion, as well as the involuntary nerves. When such symptoms arise, and danger is feared, strychnia is the best restorative. Ammonia by inhalation is a good antidote.

Gelsemium exerts a direct influence upon the nerve centres and the general circulation. Its effects upon the nervous system are to relieve irritation and relax muscular spasm. Its influence upon the circulation is to relieve active congestions; especially does it do this when there is arterial fullness about the head.

In nearly all cases of convulsions, whether in cases of children or adults, we prescribe gelsemium. From one to three drops of the green root tincture may be given to a child two years old, and the dose may be repeated every half hour, one hour or two hours, as necessary. An adult may take from ten drops to half-a-teaspoonful, and repeat as required. Where we find children suffering from or threatened with convulsions, the nervous system excited, the face flushed, pupils of the eyes contracted—no matter what the disease may be upon which these conditions depend-we give gelsemium; and in this case we fre

quently combine it with bromide of potassium. In a child two years old: B. Tinct. gelsemium, gtt. xxx.; bromide of potassium, 3j.; water, 3ij. M. S. One teaspoonful every one, two or three hours. In urgent cases the doses may be repeated every fifteen minutes, till the effects of the drugs are seen, or the patient is relieved, then the intervals between doses may be extended.

In cases of adults, especially in hysterical convulsion of women, even where violent spasms are suffered and the patient unconscious, there is no remedy, to our knowledge, that will afford relief so certainly and speedily as gelsemium given hypodermatically. The dose should be large-at least half a drachm of the green root tincture should be injected at once, and if this does not relax, and give the required relief within an hour, the dose may be repeated. This practice has not failed us in a single instance, and we can recommend it with confidence. The only objection that can be offered is this: It occasionally happens that the tincture excites more or less inflammation at the point where it is injected; but we have never known any serious results to follow its use. We nearly always inject the pure green root tincture, but sometimes dilute it with warm water, and thus render it less liable to excite local inflammation.

As a special sedative for general use in febrile complaints, we do not rely upon gelsemium. It is only where we meet with particular conditions, such as already named, that we can employ gelsemium to advantage in the treatment of fevers; but when we find these conditions, no matter whether it is a violent convulsion from active congestion, as sometimes met with in eruptive fevers, or a simple headache from the same cause, gelsemium alone, or in combination with aconite, or bromide of potassium, will give relief. If the case is one of hysterical convulsions, with great heat at the neck and back of the head, then gelsemium will cure like magic-given hypodermatically, not by the mouth. No matter what the ailment may be, if there are symptons of active congestion about the head, neck, eyes or face, gelsemium is the drug. In cases of nymphomania and satyriasis it exerts a wonderful controlling influence. And it is employed with advantage in irritated states of the bladder and ure

thra, both in the male and female. Where there is retention of urine or painful and difficult micturition from irritation of the urethral mucous membrane, we order it in full doses, and it is one of the best remedies in use for these cases.

Gelsemium has been recommended for a great many other conditions and complaints, but we are sure that its range has been very much exaggerated. But if we confine its use to the places where it properly belongs, there is no better remedy in the Materia Medica.

There are certain conditions contraindicating the use of gelsemium, viz.: where the pupils of the eyes are dilated, the pulse small, feeble or slow, and a condition indicating general nervous exhaustion, gelsemium, even in small doses, might kill. Again, in the eruptive fevers when the active stage of the disease has passed, and especially in scarlet fever, diphtheria and small-pox, and even in typhoid fevers, where the kidneys are more or less involved and their functions impaired, gelsemium, if used liberally, may cause a complete suppression of urine, and indirectly hasten

a fatal issue.

[TO BE CONTINUED.]

ABSTRACTS.

Permanganate of Potassium.

I

As this salt is so readily decomposed, yielding up its oxygen to any organic matter present, it is obviously necessary to be very careful in preparing and administering it. It should be given dissolved in pure water, or in compressed tablets or pellets. have used the compressed tablets of Messrs. John Wyeth & Brother, of Philadelphia, which contain no excipient, and are, therefore, entirely free from objection, the material being simply compressed without the addition of any foreign material. They are readily administered in this form, or they can be dissolved in pure water, whenever a solution is desired. These tablets are typically adapted to the purpose-indeed present advantages not possessed by any other possible mode of administration.

Ordinary distilled water, after standing a few hours exposed to

the air, begins to exhibit evidences of turbidity, due to the growth of an organism, a penicillum, and after some days it becomes so much clouded with organic matter as to be unfit for the solution of permanganate of potassium. River water or rain water boiled and filtered may suffice for immediate use, but whenever it can be obtained, fresh distilled water should be employed for this purpose. A pellet of this salt may be used to determine the requisite freedom from organic matter. Dropped into the water under examination, the beautiful violet color imparted to it should not be discharged. The prompt disappearance of the color signifies the presence of chemical agencies fatal to the permanence of the salt. The solution should be well diluted when taken, and should be given when the stomach is empty. A small dose repeated at short intervals, say a grain or two every half hour, until four or six grains have been taken, is preferable to the exhibition of this amount at one dose. Given in this way, and commencing the administration in about four hours after meals, the diffusion of the salt into the blood is, probably, secured. There are two periods during the day, when the administration of the remedy can be practised-the proper interval after breakfast, and after dinner or luncheon. The same considerations should govern the administration of the pellets or compressed pills, undissolved, and sufficient pure water should be taken after them.

Therapeutic Applications.-On the chemical actions of permanganate of potassium we have a sure basis on which to construct a systematic therapy. The readiness with which this salt parts with its oxygen, is urged against its real utility as a remedy, but for reasons already given it is concluded that this action does not occur with sufficient promptitude to prevent its diffusion into the blood to some. extent, otherwise we should in vain try to account for its practical utility.

Having more or less irritating quality, permanganate of potassium is contraindicated in cases of acute inflammation of the stomach. It is specially indicated in chronic gastric and gastrointestinal catarrh, accompanied by fermentative changes in the food. Eructations of gas, vomiting of a yeast-like material containing sarcina, and an acid fermentation of the starchy and