RECENT PROGRESS IN THERAPEUTICS. 
By ROBERT AMORY, M. D. 
[Reprinted fkom The Boston Medical and Surgical Journal, March 16 and 23, 1876.] RECENT PROGRESS IN THERAPEUTICS. 
ROBERT AMORY, M. D. 
Jaborandi.1— The action of this drug has been explained by M. Gubler 
as follows: Jaborandi acts directly upon the cells in the salivary glands. 
From the very moment of its ingestion, these secretory cells are excited, 
and immediately a stimulation of the distal ends of the centripetal 
nerves ensues. This stimulation is transmitted to the reflecting centres, 
whence it returns to the glandular vaso-dilator nerves (yaso-dilatateurs 
glandulaires), whose function of keeping the vessels in a state of con- 
traction then ceases, and these latter distribute to the secreting organs 
all the liquid demanded by their increased activity. M. Yulpian offers 
an objection to this theory on the ground that jaborandi is probably 
eliminated by the liver, and not by the salivary glands. This objection 
is based on the analyses made by E. Hardy. Other objections to the 
theory of M. Gubler are derived from physiology : after section of the 
lingual nerve above the place where its filaments are sent off to the 
glands, and again, after section of the pneumogastric nerve and of the 
cervical ganglion at the base of the skull, M. Carville has seen jabo- 
randi produce a secretion of saliva from the submaxillary gland in as 
active a manner as in those experiments with these portions of the 
nervous system intact. Neither reflex vaso-dilating excitation nor 
the influence of the nervous system is necessary to induce the flow of 
saliva from the submaxillary glands. M. Vulpian attributes the flow 
of saliva and sweat to the fact that jaborandi paralyzes in the salivary 
and sudoriparous glands the distal end of the fibres coming from the 
sympathetic nerve. 
Mr. Langley describes the action of jaborandi on the heart in the fol- 
lowing words : 2 “ If a few drops of the glycerine solution, or if one 
of the exti'acts, be injected under the skin of a frog or toad, the heart 
will become red and dilated, and the beat slower. These characters 
increase till the heart is of a dark red color, very much distended in 
diastole. I have invariably found that the ventricle stops beating before 
the auricles. According to Vulpian,3 the auricles are the most readily 
1 See the Journal for September 16, 1875 ; Revue des Sciences medicates, vi. 590 ; Baier 
artzliches Intelligenz-Blatt, xii. 16 ; Berliner medicinische Wochenschrift, xii. 18. 
2 Journal of Anatomy and Physiology, October, 1875, page 187. 
8 London Medical Record, July, 1875. 4 
Recent Progress in Therapeutics. 
affected ; this certainly is not the case if it be taken to mean that the 
auricular beats are the first to cease. It does, however, not unfre- 
quently happen that the auricles are the first to show the effects dis- 
tinctly, beating only in every alternate heart-cycle. This has been 
most frequently observed after the aqueous extract has been given. At 
a later stage the heart-beats generally become very irregular, at one 
time the auricles contracting only in every alternate heart-cycle, at 
another the ventricle, then perhaps a complete stoppage of both occur- 
ring, followed by a few normal beats. Moreover, in point of energy the 
different parts of the heart-beat seem to be independent of one another ; 
at one time the auricles contract feebly and the ventricle strongly, at 
another exactly the contrary. But with all these variations the ven- 
tricle has always in the many animals I have examined been the first 
to finally cease contracting. . . . Atropia sulphate quickly restores the 
heart-beat, but with less and less readiness as the heart has been stopped 
for a longer time. The restored beats are at first feeble, then get 
stronger till an almost or quite normal beat takes place. The auricles 
show this effect most strikingly, and not unfrequently the auricular beat 
will be resumed on injection of atropia sulphate, but not the ventric- 
ular.” 
The preparations of this drug used by Mr. Langley contained alcohol 
and glycerine ; and, in order to prevent any misunderstanding in regard 
to the effects induced by these preparations, he eliminated from his re- 
sults the effects which were caused by administering alcohol and glyc- 
erine alone. He remarks also that the aqueous extract of the alco- 
holic residue appears to have all the properties of the alcoholic extract. 
Having shown by his experiments that there is an initial exalting 
influence of the inhibitory action of the sympathetic nerve after the 
exhibition of this drug, and that this is succeeded by exactly the contrary, 
or a paralyzing effect, Mr. Langley offers a partial explanation of these 
contradictory results, and suggests that the alkaloid pilocarpine is not 
the only substance which contains the active principle of jaborandi, 
because this exalted inhibitory action of the sympathetic nerve on the 
heart’s pulsation does not follow the use of nitrate of pilocarpine. 
“ Nor is there any stoppage of the heart’s action by an increased stim- 
ulation of the pneumogastric [by means of a Du Bois Reymond induc- 
tion coil], if the strength of the shocks be increased. Two or three 
drops of a five per cent, solution of nitrate of pilocarpine are sufficient to 
produce this state. Further, it will be found that stimulation of the sino- 
auricular line will no longer stop the heart. Here then we have a sub- 
stance which, as it is usually expressed, paralyzes the inhibitory fibres of 
the pneumogastric. Now this substance is contained in jaborandi in very 
small quantity, and consequently, when jaborandi is given, the pilocar- 
pine contained in it requires some length of time before it can produce Recent Progress in Therapeutics. 
5 
its proper effects ; hence it is not until a late stage that we find the in- 
hibitory fibres paralyzed.” 
Experimenting still further by placing an extract of jaborandi in 
direct contact with different portions of the heart tissue, Mr. Langley 
observed that the muscular tissue thus in immediate contact with the 
extract ceased its efforts at pulsation and became pale and contracted. 
This tonic contraction ensued after the topical application of the aque- 
ous as well as of the alcoholic extract, and consequently could not be 
attributed to the action of alcohol. Moreover, after wiping away the 
jaborandi extract from the ventricle, after this phenomenon had been 
observed, and then sponging that organ with atropia solution, “ its pale, 
contracted condition gave place to one of flaccidity.” Reasoning upon 
the basis of his own experiments and of those by Vulpian on striated 
muscular fibre, Mr. Langley rejects the theory that jaborandi acts 
through the pneumogastric or any other nerve-fibres, and proposes as a 
simpler theory “ that jaborandi (and therefore of course atropia also) 
acts directly on the whole neuro-muscular cardiac tissue, in what exact 
manner must be left for future inquiry.” 
Some of the practical points of the effect upon the circulation de- 
rived by Mr. Langley from his experiments are as follows : “ Jaborandi, 
in whatever form injected, causes a slowing of the rate of heart-beat 
(whether the vagi are cut or no) and a fall of blood-pressure. 
“ The fall of blood-pressure does not depend solely on the lessened 
rapidity of the heart’s beat. By injecting slowly, often the first effect 
visible is a fall of the blood-pressure without an appreciable slowing of 
the pulse. The fall then resembles in a remarkable degree that caused 
by stimulation of the central end of the depressor. . . . Moreover, 
when atropia is given, the blood-pressure does not rise to its former 
level, although the rapidity of beat be restored. Jaborandi given after 
atropia still causes a fall in the blood-pressure, though not so consider- 
able as in the absence of atropia.” 
Dr. Craig states 1 that erroneous impressions prevail as to what por- 
tion of the drug contains the active principle ; Rabuteau, of Paris, 
concluding that it resides in an alcoholic residue from an aqueous solu- 
tion, and Mr. Martindale attributing it to the “ dregs ” (pieces of the 
stem, leaves, and petioles), the strained solution producing but little 
effect. Dr. Craig had prepared for his use in clinical experiments a 
substance called pilocarpine ; but he does not give the method of its 
preparation. This substance, he says, “ is of a semi-fluid consistence, of 
a yellowish color, and possessed of an agreeable odor. It is soluble in 
water, and is very active. One grain of this pilocarpin is nearly as 
active as one drachm of the leaves.” Dr. Craig used small doses of 
the infusion everv few hours, and in several cases of fever character- 
1 Edinburgh Medical Journal, January, 187G. 6 
Recent Progress in Therapeutics. 
ized by a dry tongue and a parched mouth he was enabled to restore 
the flow of saliva and to keep the month and tongue moist. “ He has 
never found jaborandi affect much either the heart’s action or the tem- 
perature of the body, and he has watched carefully for the disturbance 
of the vision observed by Mr. Martindale and others, but as yet has 
failed to observe it. He believes that many of the untoward results 
ascribed to jaborandi are due to the fact that dregs havfe. been swallowed 
in addition to the strained infusion.” 
Dr. Craig believes it to be a very valuable drug for removing pleu- 
ritic effusions. 
According to MM. Eochefontaine and Galippe, the bark is the most 
active portion of jaborandi. MM. Hardy1 and Vulpian2 also note 
that the active principle of the plant is an alkaloid which can easily be 
separated from an infusion of the leaves and bark. This alkaloid, pilo- 
carpine, may be isolated by means of phospbo-inolybdic acid, or by am- 
monia. Hardy and Vulpian found that its effect on the heart and sali- 
vary glands was similar to that caused by the infusion of the stems and 
leaves of jaborandi. The proportion of this alkaloid in jaborandi is but 
0.75 per cent. 
Cholagogue Action of Aloes, Podopliylline, Rhubarb, Calomel, and other 
Cathartic Medicines. — In the report of a committee of the British 
Medical Association in regard to the amount and character of the bile 
which flowed from permanent biliary fistulae in dogs that were subjected 
to a fixed diet and to the administration of various substances, it is 
stated3 that “spontaneous diarrhoea, dysentery,and purgation, produced 
by pilula hydrargyri, calomel, corrosive sublimate, and podopliylline, al- 
ways diminished the solid constituents of the bile, and, with one excep- 
tion, the fluid portion of the bile also.” 
Rohrig4 observed that in fasting animals subjected to the calming 
action of curare, croton-oil in large doses increased the secretion of bile, 
and that colocynth, jalap, aloes, rhubarb, senna, and magnesia sulphate 
likewise had some effect in increasing the flow of bile, the amount of 
influence from each being in the order above stated; moreover, the 
use of calomel rather tended to promote the flow of bile if given 
during the secretion, but would not originate the secretion after it had 
ceased. In commenting upon these results Dr. Rutherford and M. 
Vignal 5 observe that “ Rohrig’s statement with regard to calomel does 
not much -differ from that made by Hughes Bennett’s committee, and 
he made no experiments with podopliylline and taraxacum, nevertheless, 
1 Gazette medicate, iv., 1875, page 309. 
2 Le Progres medical, 1875, page 229. 
3 British Association Report, 1868, page 229. 
4 Experimentelle Untersuchungen iiber die Physiologic der Gallenabsonderungen, Striek- 
er’s Jahrbiicher, 1873, page 240. 
s Journal of Anatomy and Physiology, January, 1876. Recent Progress in Therapeutics. 
7 
lie did find that certain purgative agents, when given to animals that 
are fasting, increased the biliary secretion, while the committee found 
that in non-fasting animals, purgative action induced by podophylline, 
calomel, etc., diminished the amount of water and solids of the bile 
secreted in the twenty-four hours.*' 
Not being satisfied with the condition of the subject, Dr. Rutherford, 
who was the reporter of the committee of the British Association, has 
performed, with the aid of M. Vignal, some additional experiments upon 
dogs that had in nearly every instance fasted about eighteen hours. 
These animals were curarized and artificial respiration established, after 
which the abdomen was opened along the linea alba, and a glass canula 
inserted into the biliary duct near its junction with the duodenum. The 
bile was then allowed to flow into a fine cubic-centimeter measure, and 
a record was kept of the quantity secreted every fifteen minutes. In 
many cases this bile was analyzed, and the alimentary canal was ex- 
amined post mortem. The errors which are liable to occur from 
mechanical obstruction to the flow of bile or from an irregularity in the 
movements of artificial respiration were eliminated as carefully as pos- 
sible. Curare was used on account of its property of paralyzing volun- 
tary movements, and with proper care and doses the biliary secretion 
was not apparently affected by this medicinal agent. As a still further 
caution, the animals were allowed to recover from the surgical opera- 
tion, before the regular record was taken. The curare solution (one 
minim to each milligramme of water) was always injected into the jugu- 
lar vein. 
Controlling experiments upon the curarized dogs, in which no other 
medicine was administered, were first made in order to establish the 
proper rate of secretion and the character of the bile. It is to be 
noted that in these experiments the composition as well as the quantity 
of the bile was nearly constant. The results of the experiments on the 
various cholagogues may be thus summarized : — 
(1.) Croton-Oil in almond-oil (fifteen grains to sixty minims, six 
grains to sixty minims, three grains to sixty minims) showed very little, 
if any, increase in the amount of bile secreted during two or three 
hours after its injection into the duodenum. In the experiment with 
the largest dose, the autopsy revealed impending purgation in the 
small intestines, whilst in that in which the smallest dose was given 
there was no evidence of purgation. 
(2.) Water injected into the duodenum appeared to have no effect 
upon the biliary secretion. 
(8.) Podophylline in an aqueous solution (of a strength varying 
from six grains in nine centigrammes of water to ten grains in ten 
centigrammes of water) caused an increased flow of bile, commencing one 
hour after the injection into the duodenum and attaining its maximum 8 
Recent Progress in Therapeutics. 
in three or four hours; but at the end of six hours the flow became 
perceptibly less. This drug produced au increased vascularity in the 
upper portion of the small intestine, and also other evidences of slight 
purgation. Presuming that the slight purgative effect was due to the 
insolubility of podophylline in water, other experiments were made with 
this drug dissolved in bile. This caused a very serious purgation, and 
a very rapid increase in the amount of bile, but in an hour and a half 
afterwards this increase was succeeded by a very rapid diminution. 
An analysis of the bile secreted after the podophylline showed that the 
especial bile-solids were not diminished, whilst the amount of mucus 
secreted was materially lessened. In short, the action of podophylline 
may be summarized thus : (1.) When injected into the duodenum of a 
fasting dog, it increases the secretion of bile. (2.) “ When the bile is 
prevented from entering the intestine, podophylline acts less powerfully 
and less quickly than when bile is introduced.” (3.) A severe purga- 
tive action diminishes the amount of bile secreted. (4.) Purgation 
from podophylline is probably due to a local action. (5.) “ The bile 
secreted under the influence of podophylline, although it may be in 
increased quantity, contains as much of the special biliary matter as 
bile secreted under normal conditions.” 
The action of aloes was as follows: “ (1.) Sixty grains of the extract 
of Socotrine aloes, when placed in the duodenum, powerfully stimulated 
the liver. (2.) Under its influence the liver excreted a greater quan- 
tity of biliary matter in a given time, although the bile was rendered 
more watery. Coincident with the marked action on the liver, there 
was only a slight purgative action.” 
Rhubarb was shown to be a very remarkable hepatic stimulant, doses 
of from seventeen to thirty grains never failing to increase the biliary 
secretion within half an hour after administration, and far less intes- 
tinal irritation occurred than after the use of aloes and podophylline. 
The percentage-amount of the special biliary matter was not dimin- 
ished by rhubarb. 
Senna was shown to be less powerful than rhubarb as an hepatic 
stimulant, and rendered the bile more watery. 
Colchicum acted as a hydro-cathartic, and increased the amount of 
biliary matter excreted by the liver, but rendered the bile more watery. 
Taraxacum and scammony were very feeble hepatic stimulants. 
Calomel gave the following results: “ (1.) An increase of the biliary 
secretion followed the administration of two successive doses of ten 
grains of calomel in one case. Diminution of the secretion was the 
only result of the same doses given under similar circumstances in two 
other cases, and it was the most definite result of the administration of 
four successive doses of three grains in another case. (2.) In all the 
four experiments the calomel had a purgative effect. (3.) Analysis of Recent Progress in Therapeutics. 
9 
the bile secreted during calomel-purgation showed that notwithstanding 
a diminution in the quantity of bile secreted, the percentage-amount of 
solids had become less.” 
Gamboge, a hydro-cathartic, diminished the secretion of bile, thus 
acting in a contrary manner to colchicum, which is also a hydro-cathar- 
tic. 
Castor-Oil has scarcely any effect on the hepatic secretion, and this 
result was similar to that obtained by Rohrig. 
Thus it will be seen that podophylline, rhubarb, aloes, and colchi- 
cum are the most active stimulants of the dog’s liver; and, moreover, 
Dr. Rutherford states that “ the increased discharge of bile was not 
owing to contraction of the gall-bladder, for this in all cases had been 
well-nigh emptied by digital compression, after which the cystic duct was 
clamped at the beginning of the experiment.” In comparing these ex- 
periments on fasting animals with the experiments of Hughes Bennett’s 
committee on non-fasting animals, Dr. Rutherford further states that 
the above substances excite the liver to secrete more bile. If purga- 
tion result, the absorption of biliary matter and of food — if digestion 
be taking place—from the intestine is probably diminished. Thus by 
the twofold operation of increased hepatic action and diminished ab- 
sorption of biliary matter from the intestine, the composition of the 
blood as it passes through the portal system is probably rendered more 
pure. He moreover suggests a point of great practical interest: namely, 
“ That powerful purgative action tends to diminish the biliary secre- 
tion.” It must be borne in mind that the foregoing experiments di- 
rectly apply to the healthy dog only. 
Hypodermic Injection of Hot Water for the Relief of Pain. — Dr. 
Griffith 1 accidentally discovered that the hypodermic injection of hot 
water following an injection of a small dose of morphine would relieve 
pain. He gave these injections to several patients who had been in the 
habit of taking morphine, and the procedure resulted in “ the great im- 
provement of their health and the weaning them from the baneful poi- 
son.” When this plan failed he would inject a small dose of morphine 
first, and follow that up with the use of hot water in two, three, or four 
hours. For the cure of sciatica and deep-seated pain, he found the hot- 
water injections most beneficial. In some instances “ he pushed the 
needle up to its very end into the tissues, and forced in the water amongst 
the muscles, and then withdrew the instrument immediately afterwards, 
placing the tip of the finger on the perforation point, and, by a rolling 
movement, dispersing the fluid in its bed.” He frequently has cut short 
acute attacks of lumbago, sciatica, and the pain resulting from a sudden 
strain or fall. 
Salicylic Acid. — This substance, which formerly was obtained from 
1 British Medical Journal, December 4, 1875. 10 
Recent Progress in Therapeutics. 
wintergreen, has recently and at a comparatively small cost been sep- 
arated from phenol by a process devised by Kolbe,1 who determined its 
physiological action also. “ Given in large doses, six grammes in two 
days ” (92.76 grains), “ salicylic acid produces singing in the ears, and 
passes out in the urine, partly as salicyluric acid, partly unchanged; it 
may also be detected in two hours, and even after twenty hours, in urine, 
although the dose may be only 0.3 gramme (about five grains). Owing 
to the fact that it is easily decomposed into phenol and carbonic anhy- 
dride, it acts antiseptically, preventing fermentation and decomposition.'’2 
Its presence in the urine may be detected by chloride of iron and the 
precipitation of iron by phosphoric acid, which shows a violet reaction. 
It seems to arrest or interfere with the action of fermentation and the 
decomposition of the organic ferments. Although, outside of the body, 
the admixture of a one per cent, solution of salicylic acid may arrest 
the action of ptyaline on starch, and interfere with the digestive action 
of pepsin,3 Kolbe observed in his experiments that the ingestion of fif- 
teen or twenty grains was not followed by symptoms of dyspepsia. 
At the Berlin Medical Society,4 after the reading of a paper by Sen- 
ator on the Antifebrile Action of Salicylic Acid, a good deal of discus- 
sion ensued upon the mode of administration, most of the speakers con- 
sidering the forms of powder or emulsion undesirable, while the quan- 
tity of water required, on account of the great insolubility of the acid, 
was also objectionable. Glycerine was generally recommended, and it 
was stated that fifty parts of this and fifty of water constituted a vehicle 
that held the acid in permanent solution.5 Salicylic acid is easily sol- 
uble in ten parts of cold alcohol ; if water is added to this alcoholic so- 
lution, the salicylic acid will fall down in the form of a milky-white, fine 
precipitate ; but if a small quantity of glycerine (equal in amount to 
the alcoholic solution) first be added, water may then be superadded 
without any separation of solid matter. In this form, the author of this 
report has administered the medicine to a child fourteen months old, who 
had secondary diphtheria as a complication of measles. A solution con- 
taining half a grain was administered every three hours, and was fol- 
lowed in twelve hours by the entire disappearance of the false mem- 
brane, and a reduction of the temperature two and a half degrees P. 
Apparently no irritation of the intestinal tract followed its use, though 
the use of the medicine was continued for three days, and gradually 
discontinued. Amelioration of very bad symptoms of the disease con- 
tinued. No other medicinal agent was used. One very offensive liquid 
fiscal dejection occurred twenty-four hours after the first dose was given, 
but subsequently the discharges became natural. 
1 Journal fur praktische Chemie, x. 89, 1875. 
2 Watts’s Dictionary of Chemistry, 1875. 
* Miller, Philadelphia Medical Times, 1875, 377. 
4 Berliner klinische Wochenschrift, August 16, 1875. 
5 Medical Times and Gazette, September 18, 1875. Recent Progress in Therapeutics. 
11 
Paul Furbringer1 observed that this drug produced no change of tem- 
perature in ten rabbits (one-centigramme doses), and in six men, 
(twenty-five centigramme doses), all of whom were in good health. In 
the septic fever produced by the inoculation of putrid liquid he noted 
the range of fever until it disappeared. Some days later, when the 
animals had recovered, he repeated the inoculation and administered the 
salicylic acid; this was followed by a diminution in the fever, commenc- 
ing from two to six hours after the first dose. In the treatment of fever 
associated with phlegmasia, the. results of the administration of salicylic 
acid were negative ; whilst, on the other hand, in fever depending upon 
suppuration a notable defervescence followed the ingestion of this sub- 
stance. 
On account of its imputed property of preventing the development of 
ferments, K. Fontheim2 employed salicylic acid in those diseases which 
are characterized by a morbid development of inferior organisms, espe- 
cially in diphtheria. Until the close of October, 1875, he used in this 
latter disease the local application of sponges soaked in alum or carbolic 
acid, with the result of five deaths out of a total number of one hundred 
and seven cases of diphtheria; the most obstinate of these cases lasted 
from nine to fifteen days, and the most favorable from three to seven 
days. Since last October he has used topical applications of salicylic acid 
instead of carbolic acid; of the thirty-two cases of diphtheria treated in 
this way, the most severe lasted eight days, and the most favorable only 
three days. He concludes that the salicylic-acid treatment cut short the 
disease. The strength of his solution was two parts of salicylic acid 
dissolved in sufficient alcohol, and two hundred parts of water then 
added. The use of this solution as a gargle was a successful prophy- 
lactic against diphtheria to those exposed to contagion.3 
The experience of Wagner4 points to the same conclusion, and he 
states, moreover, that for the purpose of disinfecting the contents of the 
stomach and intestines it is far superior to other agents, for none of 
the latter can be prescribed in such large doses. But, on the other 
hand, Schuler concludes, from his experience in a limited number of 
cases treated respectively by carbolic acid 'and salicylic acid, that the 
former substance is more successful than the latter in the cure of diph- 
theria.5 Ziirn 6 administered one gramme of salicylic acid to dogs every 
day for several days, giving the last dose just before they were killed, 
1 Untersuchungen iiber antifebrile Wirkung der Salicylsaure, in Sonderheit iiber die tem- 
peraturherabteigteude Kraft bei septischen Fieber; and Revue des Sciences medicales, July 
15, 1875. 
2 Journal fur praktische Chemie, xi. 211,1875. 
3 See also the Journal, February 10, 1876, page 151. 
4 Fraktische Beobachtungen iiber die Wirkung der Salicylsaure, in the Journal fiir prak- 
tische Chemie, ii. 57. 
6 Journal, February 10, 1876, page 152. 
0 Journal fiir praktische Chemie, ii. 215. 12 
Recent Progress in Therapeutics. 
and observed, post mortem, no inflammation of the intestinal mucous 
membrane. The medicine was dissolved in from one hundred to two 
hundred parts of water. This same solution destroys the life of acari 
and other similar parasites in from twenty to twenty-five minutes. A 
very dilute solution of this acid does not destroy germs of fermentation 
so readily as its concentrated solution. 
Steplsanides1 has used this medicinal agent in very small doses 
(amount not stated) in a potion with laudanum for the cure of an ob- 
stinate attack of dysentery which would not yield to the usual treat- 
ment ; he obtained complete success. He used at the same time enemata 
containing the same substance and a few drops of laudanum. This 
method of treatment was based on the theory that dysentery was a diph- 
theritic or parasitic disease. 
Its use in polyarthritic rheumatism in Traube’s clinic by Strieker has 
been presented to the readers of the Journal,2 and in an article by Dr. 
Putnam,3 and is still further confirmed by Senator.4 The latter also 
prescribed with success salicylate of soda in doses of from seven and a 
half to ten grammes, either all at once or in divided doses at short in- 
tervals. Yet this treatment did not prevent relapses or local inflamed 
joints; in two such cases subcutaneous injection of carbolic acid had a 
marked benefit. Katz5 also confirms Strieker’s observations. 
Hypodermic Inj ection of Carbolic Acid for Polyarthritic Rheumatism. 
— Senator6 has used a three per cent, solution of carbolic acid injected 
into the subcutaneous cellular tissue in the inflamed joints in twenty- 
five cases. In one hundred and fifty separate injections, no pain, in- 
flammation, or abscess occurred, but he never employed more than 
three simultaneous injections, and nine centigrammes was the largest 
amount injected at one time ; the treatment lasted six and eight days, 
with intermissions of several hours between the injections. The re- 
sult of this treatment was relief to the pain and diminution of the 
swelling; it was more uncertain in the metacarpal and phalangeal 
joints, but in the larger joints, especially the shoulder, one injection 
was generally sufficient. Relief followed in an hour, and the more 
acute the disease the greater the relief. Little if any benefit occurred 
to chronic cases. The same treatment was applied to myalgiae. 
Neither recurrence of the symptoms, abatement of the fever, nor in- 
duction of perspiration was effected by this treatment, but only transi- 
tory and palliative relief to the local inflammation. 
1 Wiener medizinische Presse, April, 1875. 
2 Journal, February 10, 1876, page 164. 
8 Journal, February 24, 1876, page 212. 
4 Berliner klinische Wochenschrift, No. 6, 1876. 
6 Deutsche medicinische Wochenschrift, No. 4, 1876. 
6 Berliner klinische Wochenschrift, No. 6, 1876. 13 
Recent Progress in Therapeutics. 
Aconite and Aconitia (Aconitine').1 — The variability in the strength 
of aconite and its preparations has become so well known that M. Oul- 
mont has undertaken a revision of the pharmaco-dynamical and thera- 
peutical properties of this medicament. His experiments were conducted 
on dogs and confirmed by clinical observations in human beings ; he 
deduces the following conclusions : — 
(1.) The activity of aconite varies, according to the portion of the 
plant selected ; 
(2.) According to the country in which the plant grows, and period 
of growth (more active before flowering than after) ; 
(3.) According to the method of preparing the medicine. 
Generally speaking, the leaves, stems, flowers, and seeds have an un- 
certain action, and may in some instances have no action whatever. The 
root contains the active principle, the activity of which varies according 
to the country from which the root is gathered. Cnltivated aconite has 
less activity than that gathered from the mountains ; of the latter, that 
gathered from the Swiss mountains is more active than that from the 
Vosges mountains (Alsace). Alcoholic tinctures of the flowers and stems 
may be given to animals in doses of thirty or forty grammes (about eight 
ounces) without any appreciable effect. On the other hand, alcoholic 
tinctures of the fresh root should be prescribed only in small doses, on 
account of its inequality of action, which is in proportion to the water 
of vegetation present in the roots. Tinctures, both of the leaves and 
of the roots, have an unequal and uncertain action. The extract from 
the Vosgian aconite has a uniform strength ; two or three centigrammes 
can be daily and gradually increased to fifteen centigrammes without 
fear of accident. But that from the Dauphine district (near Savoy) 
should not be used, on account of the difficulty of fixing a safe dose, 
and also on account of its violent activity. 
Aconitia can hardly be said to represent the active principle of 
aconite, and on account of its variability in strength and the violence 
of its effect, if it is ever used internally, it should be very cautiously 
administered. 
Franceschini 2 made some experiments on animals under the advice 
of M. Laborde. He used a substance called nitrate of aconitia (azotate 
d'aconitine). Aconitia in its amorphous state is insoluble and incapable 
of combining in the form of a salt; moreover, the local action of the 
alkaloid is so painful that its internal administration by the mouth 
seems forbidden. The production of crystallized aconitia by Duquesnel 
presents the opportunity of employing this substance in solution by the 
hypodermic method. Franceschini used the following formula: — 
1 Oulmont and Laborde, Aeade'mie de Me'decine, December 14, 1875; Gazette hebdoma- 
daire de Medeciue et de Chirurgie, December 17 and 31, 1875. 
2 Th&se Doctorat, No. 369, Paris, 1875. 14 
Recent Progress in Therapeutics. 
Nitrate of aconitia 10 centigrammes. 
Distilled water 10 cubic centimetres. 
The aqueous solution was hastened by the previous addition of a few 
drops of alcohol, and by adding the water gradually. He also used 
internally, by the stomach, granules of nitrate of aconitia in doses of 
half a milligramme ( of a grain). 
With regard to the effects of nitrate of aconitia, it was observed that 
in the lower animals there was at first (two or three minutes after the 
injection) a slight exaggeration of the phenomena of general sensation 
as shown by irritation of the nerve trunks ; but the cutaneous sensation 
(bottom of the hind feet) diminished very rapidly. Even with such 
minute doses as one quarter of a milligramme the diminution of sensa- 
tion was quite marked, and the point of a bistoury was thrust into the 
paw of a dog used for the experiment, without producing the slightest 
cry or reflex action. The period of exaggerated sensation was followed 
by that of amesthesia, as soon as the drug was absorbed by the circula- 
tion. 
In the human subject, after an injection of one fourth or one half 
milligramme a burning sensation was experienced, and the skin surround- 
ing the puncture became red ; this redness persisted for at least one half 
an hour, and then the peculiar acrid taste of aconite was perceived in the 
tongue, as well as the tingling of the lips, a sensation which extended 
to the extremities and finally over the whole surface of the body. On 
repeating the doses of one fourth to one half milligramme every three 
or four hours, the phenomena of irritation were less pronounced, and 
the therapeutical effects were more marked. Though aconite is elim- 
inated somewhat with the urine, yet a portion is apparently destroyed 
or decomposed in the system. Great pallor of the skin of the ear of a 
rabbit followed the subcutaneous injection of one fourth of a milligramme, 
and the blood-vessels appeared almost devoid of blood and their interior 
calibre seemed abolished. After section of the great sympathetic in 
the neck, though the vessels were enormously distended, this pallor 
was as marked as before the section. The author of this thesis remarks 
that his experiments confirm in every particular the deduction of Pro- 
fessor Gubler, that “ the marked disturbance in the functions of sensation 
leads to the conclusion that aconitia acts principally upon the nerves of 
sensation, whose functions it suppresses or reduces ; but if anaesthesia is 
produced, the circulation is simultaneously calmed, the calibre of the 
capillaries is reduced, and the temperature is lowered.” 1 
Deshaye 2 gives a detailed account of twenty-eight cases of typhoid 
fever treated with the alcoholic tincture of aconite at the Hotel Dieu 
1 Journal de Therapeutique, January 10, 1876, page 24.' 
, 2 Gazette hebdomadaire de Medecine etde Chirurgie, September 24, and October 1 and 15, 
1875. Recent Progress in Therapeutics. 
15 
de Rouen. In addition to these cases he cites twelve others treated by 
him outside of the hospital, and ten cases treated by Levasseur, a total of 
fifty cases, two only of which ended fatally. These fatal cases occurred 
after pneumonia, which came on in one instance after exposure at an 
open window during convalescence, and no perforation of the intestines 
could be detected at the autopsy of either case. The theory of the use 
of aconite in typhoid is based by Deshaye on the fact that the severe 
fever is due to an inflammation, and that aconite controls the elevation 
of temperature on the antiphlogistic principle. He repudiates the idea 
of its being a specific sine qud non of typhoid fever, and cautions against 
its use in those cases which are characterized at the outset by severe 
adynamia and prostration. An improvement and sometimes complete 
subsidence of the temperature were noted in from ten to twenty days 
from the commencement of the treatment, and an abatement occurred 
within twenty-four hours after the first dose. On the subsidence of the 
fever, quinine was employed. 
Among the immediate effects of the treatment, Deshaye mentions 
profuse perspiration, abundance and limpidity of the urine, speedy ap- 
pearance of the rose-spots and sudamina, moisture of the tongue and 
mouth, and a peculiar furfuraceous desquamation of the skin. With 
regard to the rose-spots, he quotes Grisolle as saying that these are not 
critical and have no prognostic value ; and that a few hours after the 
administration of aconite a new and more confluent eruption occurs, 
coincident with more favorable symptoms. A liquid diet of beef-tea or 
veal broth was given, with the free use of ice. The aconite was admin- 
istered at the very outset. The form of potion was — 
Aquae destillatae 120 grammes. 
Tincturae aconiti 1 gramme. 
Aquae aurantii florum . q. s. M. 
Dose, one teaspoonful, p. r. n. 
The author does not claim this as abortive, but as antiphlogistic 
treatment. 
Electricity in Intestinal Obstruction. — M. Fleuriot reports1 several 
cases of successful treatment in obstinate constipation and intestinal ob- 
structions by the application of one electrode to the anus and the other 
to the abdomen. 
Theory of the Action of Compressed Air? — Dr. Schnitzel' observes 
that the inspiration of compressed air and its expiration into a rarefied 
air increases the force of the heart’s impulse, and consequently that 
the blood is driven into the arteries with increased pressure ; on the 
other hand, the reflux of the venous blood towards the right side of the 
heart is slightly obstructed. Thus the general effect of the use of com- 
1 Thkse inaugurate, Paris, 1875, No. 3, and Revue des Seiences medicates, January, 1876. 
2 Wiener Klinik, July, 1875, page 165. 16 
Recent Progress in Therapeutics. 
pressed air as above described would be an increased amount of blood 
in the larger circulation, and its diminution in the lesser or pulmonary 
circulation. The inspiration of lftrefied air causes a contrary effect: 
a diminution of blood in the larger or systemic circulation, and its in- 
crease in the lesser or pulmonary circulation. These results are modi- 
fied, however, by the larger amount of oxygen absorbed by the inspiration 
of compressed air, and again by the larger product of carbonic acid pro- 
duced by the expiration in a rarefied air. Another element still further 
complicates the result: the effect of pressure exercised upon the capil- 
lary circulation. 
The therapeutical applications of the inhalation of compressed air are 
summarized by Dr. Schnitzer : the respiratory force may be increased, 
the pulmonary capacity may be enlarged and its ventilation promoted. 
The therapeutical indications are applicable to the following patholog- 
ical conditions : (1) General feebleness of the respiratory organs ; (2) 
chronic bronchial catarrh ; (8) pulmonary catarrh and the first stage 
of phthisis ; (4) emphysema ; (5) nervous asthma, in which there is no 
organic lesion of the heart or lungs.