Compliments of the Author. REPRINT FROM PROGRESS A Monthly Magazine for Students and Practitioners of Medicine. TERMS, $2 per annum, in advance. Address 235 and 237 Third Avenue. "I HOLD EVERY MAN A DEBTOR TO HIS PROFESSION; FROM THE WHICH AS MEN OF COURSE DO SEEK TO RECEIVE COUN- TENANCE AND PROFIT, SO OUGHT THEY OF DUTY TO ENDEAVOUR THEMSELVES, BY WAY OF AMENDS, TO BE A HELP AND ORNAMENT THEREUNTO. THIS IS PERFORMED, IN SOME DEGREE, BY THE HONEST AND LIBERAL PRACTICE OF A PROFES- SION ; WHEN MEN SHALL CARRY A RESPECT NOT TO DESCEND INTO ANY COURSE THAT IS CORRUPT AND UNWORTHY THEREOF, AND PRESERVE THEMSELVES FREE FROM THE ABUSES WHEREWITH THE SAME PROFESSION IS NOTED TO BE INFECTED ; BUT MUCH MORE IS THIS PERFORMED, IF A MAN BE ABLE TO VISIT AND STRENGTHEN THE ROOTS AND FOUNDATION OF THE SCIENCE ITSELF; THEREBY NOT ONLY GRACING IT IN REPUTATION AND DIGNITY, BUT ALSO AMPLIFYING IT IN PROFESSION AND SUBSTANCE."-BACON. Vol. II. LOUISVILLE, KY., JANUARY, 1888. No. 7. GENERAL MEDICINE. (or diluted with water), it is pungent, disa- greeable to the taste, irritating to the phar- ynx, offensive to the stomach and altogether repugnant to the majority of patients. As an elixir it is not specially unpleasant and from its effects, is a solace to the patient. Excellent elixirs of paraldehyde are made by the local druggists of this city, represent- ing in strength io per cent, and 25 per cent., the former contains 45 minims of pure par- aldehyde to the ounce of elixir, or about minims to the drachm; the latter 2 drachms of pure paraldehyde to the ounce, or 15 min- ims to the drachm, giving very convenient preparations for administering in definite quantity. When given, diluted with water, the elixir is palatable, non-irritating to the pharynx and stomach and is not followed by any of the disagreeable effects of other ano- dynes and hypnotics. Above all, it is a safe remedy-no danger of active or passive congestion of the brain, liver, kidneys or lungs, no risk of sudden or premature death from heart paralysis. In the writers personal experience, elixir of par- aldehyde is a heart tonic, diuretic, anti-con- stipative, non-irritant, without nausea, acts promptly and positively in a few minutes, produces a quiet, calm, natural-like sleep- no disturbed dreams, incubus, phantoms, hallucinations, or depressions. The great- est pleasure is to awake in the morning- not feeling that any medicine had been taken to produce sleep-with a clear head, a relish for a good breakfast and a stomach ready for vigorous digestion. In this age of poly- pharmacy, noted for the multiplication of new remedies, the ap- plication of old reme- dies, resuscitated from years of quiet repose, in new combinations warranted, by a mul- tiplicity of testimoni- als voluntarily contrib- uted from all quarters of the globe, to cure all diseases now pres- ent and to come, it is gratifying that the medical profession has in Elixir Paraldehyde a remedy that will take the place of many old, and set aside many of the so-called new remedies which might with justice be called proprietary medicines, designed orig- inally for the regular profession; but which, through flaming advertisements, circulars, and physicians' certificates are to be found in the homes of the people, who know little of their import, effect or application to the relief and cure of disease. Paraldehyde, as a therapeutic agent, was first brought to the notice of the profession in 1883, Chemical composition C6 O3. It has an ethereal taste and odor, in its pure state, ELIXIR PARALDEHYDE. The Coming Remedy, as a Substitute for Opiates and Anodynes. BY S A. B. COOK, ' A. M., M. D. Formerly Professor of the Surgical Diseases of the Genito-Urin a ry Or- gans and Rectum, University of Louisville. Late Professor of the Sci- ence and Art of Surgery and Clinical Surgery, Kentucky School of Medicine, and Louisville Med- ical College, etc., etc. LOUISVILLE, KY. Read to the Louisville Medical Society, De- cember 22, 1887. PROGRESS Elixir paraldehyde is not alone a pure and simple hypnotic, applicable only to the ce- rebral excitement of the insane and mild cases of restlessness from trivial causes. The remedy has a wide range of usefulness in its application to the relief of valetudina- rians, that cannot perhaps be claimed for any other medicine at present known to the vo- cabulary of our materia medica, the relief being obtained without unpleasant or detri- mental sequels. In a case of cardiac asthma, with valvular disease of the tricuspid, the sequel to acute rheumatism 15 years ago, three ounces of the 25 per cent, elixir were taken within twenty hours with more relief to the distressing dyspnoea than all other remedies. In an- other test case of asthma of several years standing, the patient had taken every asth- matic remedy alone and in combination, including inhalations, proprietary and quack compounds-$25.00 worth of a secret prep- aration, largely advertised, made in Cincin- nati-without relief. About two months ago I ordered for this patient 25 per cent, elixir paraldehyde in half tablespoonful doses to be increased to one tablespoonful if nec- essary ; the half dose, repeated once or twice during the night was sufficient during the mild weather; when the damp, chilly weath- er set in, he took a tablespoonful and re- peated the dose during the night when called for, it has given him more relief than any remedy he has ever taken. Since he com- menced its use he has not lost a day from business; heretofore with an atmosphere sim- ilar to that we have had the past month, he was confined to the house from one to two weeks at a time. So far there has been no occasion to increase the dose. Other milder cases have realized similar benefits, the at- tack being cut short and followed by quiet sleep. In October last I was called in con- sultation to see a case of puerperal eclampsia, about twenty hours after convulsions com- menced. The patient was a healthy, stout, fleshy woman of medium stature, age 28 years, in the seventh month of pregnancy with second child-first child full term and normal labor. I saw her in the second at- tack of convulsions which occurred at an in- terval of 48 hours after the subsidence of the first attack. The family physician had the previous night given two hypodermic injec- tions of morph, sulph. gr. $, atropia, gr. and an enema every four hours of half drachm each of chloral hydrate and bromide of potassium. During the day she had an- other hypodermic injection, and 90 grains each of chloral hydrate and bromide of pot- assium by enema and one pint of blood had been drawn from a large orifice. I saw her at 6 o'clock p. m.; she was then in a convul- sion, and was informed they had been very frequent during the day. When, the convul sion subsided, no foetal heart-sound could be heard, and none had been heard from the occurrence of the first convulsion four days previous, there was no* dilatation of the os uteri, the urine was very scanty, scarcely two ounces being secreted during six hours, re- action acid, specific gravity 1042, albumen fully 75 per cent. At my suggestion all other remedies were abandoned and 25 per cent, elixir paraldehyde was given every four hours in tablespoonful doses and continued until foetus was delivered, then three times a day for two days, then only one dose at night or when very nervous, in all about 20 ounces of the elixir were taken. Five.days after I saw her digital dilatation of the os was commenced and the following day she was delivered of a still-born foetus. She made a good recovery. She had no convulsions af- ter the administration of elixir paraldehyde was commenced. Two weeks after delivery the urine was normal in quantity with a mere tiace of albumen. While a single successful case is not suffi- cient to claim par excellence for a remedy comparatively new and untried, it is fair in this instance to give the credit to the treat- ment employed. Two attacks had occurred at an interval of two days, the convulsions had, to some extent, been modified but not controlled by the treatment. As long as PROGRESS the exciting cause-albuminous urine and a dead foetus-remained, the natural infer- ence would be that the convulsions would have recurred, until delivery was effected, had they not been prevented by the remedy used. In September last I used the elixir in a case of complicated pneumonia with happy results. The patient was feeble and spanae- mic after her fifth accouchement, when called to visit her, she had an obstinate case of bil- ious remittent fever with a temperature rang- ing from ioi° to 105 in a few days, from exposure to damp night air, she contracted double pneumonia, which in a few days was complicated with acute diarrhoea, the fever being still persistent, on three occasions she was supposed by her friends to be dying. She had persistent cough which did not yield to opiates. I gave her 25 per cent, elixir paraldehyde in two drachm doses with direc- tions to repeat in one hour or any time dur- ing the night until quieted; the remedy gave her the first nights' quiet sleep she had had for weeks-never more than two doses were taken during the night-from that time improvement was manifest. She convalesced rapidly from the complication of diseases. I have, for months, used the elixir, to the •exclusion of opiates and anodynes, in expec- torant mixtures for adults and children, in pneumonia, bronchial and pulmonary ca- tarrh with much satisfaction. Personally I have used the elixir alone in bronchial catarrh and annoying night cough to which I am subject in sudden changes of atmosphere, or sleeping in a room of lower temperature than accustomed to breathe dur- ing the day; no remedy used in thirty-five years has given me similar relief. I have used the medicine in the opium habit with good results, and in one case of long standing there is reason to believe the habit has been abandoned; the patient used the 25 per cent, elixir in tablespoonful doses, the continued use did not necessitate an in- crease of the dose. In nervous cough from irritation of the respiratory mucous membranes, fauces and vocal apparatus it surpasses all other reme- dies; diluted with warm water it can be used locally in accessible mucous membranes as a gargle or spray, either alone or in connec- tion with internal use. It is a boon to the patient in the wakefulness during the course of and convalescence from idiopathic and symptomatic fevers, and from its action it ought to give good results in whooping- cough and the eruptive fevers of childhood. Patients afflicted with phthisis pulmonalis express a decided preference for the new hypnotic. It is unnecessary to speak of its value in the treatment of delirium tremens. It has been largely used by the superintend- ents of some Insane Asylums with decided benefit; but the writer has had no experi- ence in this special class of practice. I have prescribed the elixir in insomnia, nervousness, restlessness or wakefulness whether hysterical or from indigestion, or cerebral excitement, or brain exhaustion from anxiety, loss of rest or overwork. Pa- tients, who heretofore had used heart seda- tives, opiates, alcoholic stimulants, the bro- mides, bromidia, chloral, chloroform, et cet- era, universally give preference to elixir par- aldehyde. During the past week I have given the 25 per cent, elixir in two drachm doses to an old lady, dyspeptic and nervous, to allay the muscular pain incident to lying in a fixed position with fracture of the neck of the femur. The morphia she had taken previously caused a disturbed rest, obtund- ing sensibility without producing sound sleep, followed by distressing nausea and vomiting; after the change was made, nau- sea ceased and sleep was tranquil. To allay the nervous irritation which causes erotic dreams and seminal emissions, and in vesi- cal irritation or inflammation accompanied with frequent and painful micturition, I pre- fer the elixir to the bromides, chloral and other remedies formerly used. In my experience the remedy rarely causes excitement, soon after being taken the patient tails into a quiet, calm sleep, PROGRESS of cases is not inter- ght, if necessary the pro re nata. d as an axiom that a nedies, which may or 'sent or future, should trovided another is at 1OCUOUS. nd hypnotics are given iduce sleep, or both, e various causes and kinds of pam, ineic is a class of pains acute, severe, .harassing and distressing, the result of irritation in the periphery of the nerves, whether distributed to the cutaneous, mucous, serous, muscular or hard tissues of the body. The suffering, expressed by the patient in words or groans, is not the result of inflamed nerves, and does not demand opiates, chlo- ral, etc., for relief. While heart sedatives, opium, anodynes, chloroform, chloral, etc., have now and will have their special offices to perform in the treatment of disease, it must be acknowledged they have been un- necessary, sometimes recklessly used. Many patients have become addicted to the habitual use of these drugs for the relief of imaginary ailments, or for the excitement and succeeding lull and insensibility which follow their use-a habit which clings to the user like a demon of destruction, goad- ing its victim to premature death. Assuming the fact that a large class of pains are the result of nerve irritation from local disease, have we not in elixir paralde- hyde a safe substitute for the class of drugs before mentioned? The writer has used the remedy in cases where formerly opiates and anodynes were deemed indispensable, with results satisfactory to the physician and ben- eficial to the patient. Can it be hoped that others will record a like experience ? It may not be improper, in conclusion, to remark that the physician should see that the elixir is rightly prepared. It cannot be made by adding the pure paraldehyde to a simple elixir, like oil and water it needs a solvent to secure union and permanency. Its use should be limited to medical pur- poses and only taken when ordered by the family physician.