mal. In an individual, who tried to commit suicide, a dose of 25 grains of cocaine caused no disagreeable result. The dose by which death can be produced must lie, therefore, very high; at least if the preparation used was pure cocaine.

The effective dose of my soluable muriate of cocaine appears to be in man about one grain (0.05 gramme).

After hypodermic injections of a diluted cocaine solution, a feeling of heat appears at first, then the site of the injection becomes insensible and red, and after about thirty minutes everything has disappeared. When placed on the tongue cocaine paralyzes the nerve-action.

Recently Dr. Th. Aschenbrandt recommended cocaine highly, especially in cases in which the body is weakened by diarrhoea. Within a few months past Dr. E. V. Fleischl and Dr. S. Freud, in Vienna, experimented with cocaine. The former states expressly that cocaine in hypodermic injections is of enormous value in morphine habit. This fact alone is likely to secure for this remedy a lasting place in the pharmacopoeia.

The muriate of cocaine has been used by these investigators in an aqueous solution in doses of from one to two and a half grains and as high as seven and a half grains pro die.

Cocaine is a stimulant which increases the active properties of the body for some time, without being dangerous. Its effect is more invigorating than that of alcohol. Its usefulness in long marches, ascension of mountains, etc., is evident. Whether it will have the same invigorating influence on mental work, is an open question, as, also, whether the alienists will be able to make continued use of it, in order to stimulate the action of the nervecentres. It has been used hypodermically for months in melancholic individuals in doses varying from grain to grains 2, and with some success.

Cocaine is a stomachicum; after debauches in eating and drinking it causes rapid restoration and normal appetite. (Dose grain to grain ). In atonic weakness of the digestion and nervous disorders of the stomach a lasting restoration may gradually be reached by cocaine. It is of great value in cachexia, in phthisis, grave anemia and consuming fevers. It is further stated, that in continued use of mercurials, cocaine prevents mercurial cachexia.

The greatest future for cocaine lies undoubtedly in its usefulness in the treatment of morphine habit and alcoholism. As the morphine is gradually withdrawn, the doses of cocaine are increased; when morphine is withdrawn at once about grains 2 (0,1 gramme) are injected as soon as the craving for morphine shows itself. Keeping such patients in special homes is, therefore, unnecessary. Dr. Freud, who saw one such case get well after a ten day treatment with cocaine (grains 2 subcutaneously three times a day), thinks that there exists a direct antagonism between morphia and cocaine.

Cocaine has also been recommended as an aphrodisiacum, and Dr. Freud has experienced a marked sexual irritation after the use of cocaine.

I desire to say that all the statements made refer to my preparation, cocainum muriaticum solub. Merck. I have no doubt that the other cocaine salts will be found to be of equal efficiency. Ecgonine is being tried with regard to its physiological action, and I shall report on it later on.— -Medical Review.

On Uterine Hemorrhage and a New Method of Treatment.

Richard Richardson, L. R. C. P., Rhayader, read, in the Section of Obstetric Medicine of the British Medical Association, the following: The treatment which has been most successful in my hands during a period of twenty years, and which can be easily applied without any apparatus, consists in iron alum, when applied in crystals of the size of a hazel-nut, or even larger in a severe case. It is to be introduced with the finger up to the os uteri (and not into it), and there allowed to remain. The uterus will at once contract, a firm coagulum is formed, and the hemorrhage at once ceases. Iron alum is also antiseptic, as I have removed clots on the fourth and fifth day after its application which were quite free from any disagreeable odor. In a case of very severe hemorrhage, two or three days afterward, I inject a little warm water (to which may be added, if you like, a little Condy's fluid) and remove the clots. It is perfectly free from danger, and I have never known it to fail.

CASE I. My first application of iron alum was in the case of a woman, aged forty-three, troubled with metrorrhagia for about

nine days, and recurring every two or three days; she was the mother of six children, the youngest of whom was four years old; the catamenia had appeared very regularly since she weaned her last. She was sure she had not aborted, as she was "poorly" a fortnight antecedent to the hemorrhage, which was the proper time for menstruation. On examination, I discovered a granular ulceration of the cervix; I treated her with quinine, digitalis, gallic acid, and sufficient dilute sulphuric acid to dis. solve the ingredients. She was ordered to remain in a recumbent posture, with cold cloths applied to the vulva. In three days the hemorrhage again came on. Two days subsequently to this I determined to try iron alum, and introduced a small crystal of the size of a pea; the bleeding ceased at once. the following day I examined the patient, finding two or three clots in the vagina which were perfectly dry, and which crumbled between the fingers on rubbing them; I injected warm water and examined the os, which was now nearly free from all granulations. Another piece of iron alum was applied, and there was no recurrence of the discharge. On the fourth day the granular ulceration had thoroughly healed, and the patient was cured. For some time she was very anemic, and required iron tonics; but she soon recovered her strength, and has been well up to this time.

On

I

CASE II.—An abortion happening to Mrs. W., who had given birth to two children previously to this, the youngest being two years old; she was now advanced three months in pregnancy, and awakening one night found herself saturated with blood. found her in the following state: the napkin and sheets were completely soaked in blood; pulse, 120; lips blanched; cheeks pallid. The os uteri was very little dilated, and pains were coming on at long intervals. I applied a crystal of iron alum of the size of a nut to the os; the discharge stopped. Ergot and opium were administered every two hours. On the second day there was no pain, and no reappearance of the discharge. The patient slept well during the night; there was no internal hemorrhage; the os was not dilated; pulse, 96; ergot was ordered to be continued every two hours. On the third day there was a good deal of bearing-down pain, but no hemorrhage; ergot was

ordered every quarter of an hour. Two hours afterward the ovum was expelled complete, and appeared like an old clot; there was no hemorrhage. The patient soon convalesced.

CASE III.-The next case was one of menorrhagia in a lady, aged forty, the mother of six children, the youugest being four years old. Her last two periods were excessive, lasting seven or eight days, with a slight mucous discharge for some days afterward. I was sent for on the sixth day; she then had a copious discharge of blood. On examining her with the speculum, I found she had endo - cervicitis. I applied the iron alum with perfect success, and prescribed quinine and iron. During the next monthly period she had the same treatment on the fourth day. From that time she quite recovered, and six months later was pregnant. She went to the full term, had a natural labor, and gave birth to a daughter. The patient recovered rapidly.

From that time to this, I have used the remedy in all cases of uterine hemorrhage, where an immediate styptic was required, in accidental, unavoidable, and post-partum, as well as in secondary hemorrhage. I shall briefly quote two or three extreme cases to prove its value.

CASE IV. I attended Mrs. J. in a previous labor, when she had a frightful post-partum hemorrhage. I then had to inject liquor ferri perchloridi three times before the bleeding stopped. The second time I attended her, and used every precaution during the labor; the hemorrhage appeared notwithstanding, as soon as the placenta was expelled. I injected the perchloride of iron once, but with no effect; I therefore introduced a good-sized crystal of iron alum, which stopped the flow at once. I should have remarked that this patient showed all the symptoms of embolism in her first labor, which placed her in extreme danger for twentyfour hours.

CASE V.-Another case was that of Mrs. P., who lived four miles distant in the country. The child was born before the messenger started, he bringing the intelligence post-haste that the woman was flooding to death. After a hurried journey, I found the patient quite moribund, pulseless at the wrist, cold and completely blanched. The placenta was expelled, and the bed

thoroughly saturated; there even was, a pool of blood on the floor under the bed, the blood having percolated through every thing. I applied the iron alum at once, and injected sulphuric ether hypodermically into the arm, repeating this in ten minutes. A quarter of an hour afterward the pulse became perceptible in the large vessels. I gave her brandy and milk every half-hour. She had no further hemorrhage: the binder was applied, and I left the woman, with the caution that her head should not be raised from the pillow. Her convalescence was slow, and it was a long time before she recovered her color.

CASE VI. I shall here give a short description of a case of secondary hemorrhage, occurring with Mrs. P., who lived ten miles away. I was sent for in her first childbirth. When I arrived the child was born and the placenta delivered. I asked the nurse where the placenta was; she said, "it is buried." I always like to inspect the placenta, thus knowing whether it is all come. The patient seemed to be going on well; no hemorrhage; there was no pain; the pulse was 78; and the binder was properly applied. On the sixth day, I was sent for in great haste, as the woman was flooding frightfnlly. On my arirval I found the patient very weak from loss of blood. I applied iron alum, and prescribed quinine and ergot. Three days afterward a small piece of placenta was expelled, together with an old clot of blood; the woman gradually recovered.

I have a record of eigty-two cases of uterine hemorrhage where this remedy was applied without a single failure: menorrhagia, ten cases; metrorrhagia, eighteen; abortions, fifteen; accidental hemorrhage, seven; unavoidable hemorrhage, four; post-partum hemorrhage, twenty-two; secondary hemorrhage, six.

In post-partum hemorrhage, it is advisable always to clear the uterus of clots, or any portion of placenta, before applying the crystal; also, in accidental hemorrhage, when there is detachment of placenta, should the case appear to be one where there is no chance of carrying it to full term, the membranes ought to be punctured, and the iron alum applied in the usual way. There is no fear of any very great hemorrhage coming on afterward; in a slight case the iron alum will stop it; but, if the hemorrhage