act Medications, 
part r. 
By Prof, Dujardin-Beaumetz. REASONS FOR PRESCRIBING 
Fairchild’s Pepsin. 
It is the most active, gives the greatest value for the price asked. 
One grain will digest more albumen than will a grain of any other 
pepsin made. We do not care by whose test, what the proportions of 
albumen, water, and acid, only let the conditions be the same for all. 
It is positively guaranteed to be permanent. It will not get soft or 
sticky, or deteriorate in value, because it is not a peptone. It is free 
from all the well-known characteristics of peptone. It is not made by a 
patented or pirated process. 
If you prescribe pepsin in scale or powder, and it becomes sticky, 
you may be sure that it is not Fairchild’s. Investigate the matter, place 
the blame where it belongs. 
There are pepsins “made to sell” under the title of scales—products 
which are inferior and dissimilar to Fairchild’s pepsin in scales. They 
are peptones made by a patented process, and sold under cover of a title 
first and properly used only by Fairchilds to describe their original true 
pepsin in the form of scales. 
The druggist is told, “They are just as good as Fairchild’s. If 
Fairchild’s is not specified, put in mine.” But claims and pretensions, 
however colossal, cannot make peptones permanent. 
There is no soluble or peptone pepsin equal in activity to Fairchild’s, 
none which will keep in all weathers and all conditions as Fairchild’s 
will. 
FAIRCHILD BROS. & FOSTER, 
2*Tew "SToris. New Medications. 
PROFESSOR DUJARDIN-BEAUMETZ, 
Member of the Academy of Medicine and of the Council of Hygiene 
and Salubrity of the Seine; Physician to the Cochin Hospital; 
Editor-in-Chief of the Bulletin Glnlral de Thlra- 
peutique, Paris, France. 
TRANSLATED BY 
E. P. HURD, M. D., 
Member of the Massachusetts Medical Society; Member of the Climato- 
logical Society; Member of the Society de Mldicine Practique, 
(Paris. France). One of the Physicians to the Anna 
Jacques Hospital, Newburyport, Mass. 
VOL. II. 
SECOND EDITION. 
Revised and Corrected, with Additions and Illustrations 
1890. 
GEORGE S. DAVIS, 
DETROIT, MICH Copyrighted by 
GEORGE S. DAVIS. 
1890. TABLE OF CONTENTS. 
CHAPTER. PAGE. 
VIII. Antiseptic Pulmonary Medication I 
IX On Antiseptic Pleural Medication 23 
X. On Antithermic Medicaments . 34 
XI. On New Antithermic Medicaments 47 
XII. Indications for the Antithermic Medications 62 
XIII. On the New Hypnotics 75 
XIV. On New Analgesic Medications 96 
XV. On Local Anaesthetics. * 116 NEW MEDICATIONS. 
PART II. 
CHAPTER VIII. 
ON ANTISEPTIC PULMONARY MEDICATION. 
Gentlemen: One may affirm without fear of 
being accused of exaggeration, that antiseptic pulmo- 
nary medication, such as we may ideally imagine it to 
be, is destined to have a high place in the therapeutics 
of the future. In fact, in all that concerns the con- 
tagion of diseases, the air is the most important factor, 
and whoever shall succeed in depriving the atmosphere 
of its germs, will render the greatest possible service 
to medicine and hygiene. 
Thanks to the brilliant discoveries of Pasteur, 
and to Miquel’s patient investigations, we know to- 
day by scientific means, not only the number of the 
micro-organisms which flit about in the air, but also 
the divers varieties of these microbes, which belong 
especially to the genera micrococcus, bacillus, and 
bacterium, but more particularly to the first of these 
genera. 
Microbiologists have even gone further; they 
have commenced the study of these different schizo- 2 
phytes from a botanical point of view, as well as from 
a physiological; and there is one fact which we have 
learned from these studies, namely, that when the 
bacteria thus collected from the air have been culti- 
vated in suitable media and inoculated in animals they 
have given rise to nothing but negative results, and it 
has not yet been possible to reproduce in animals 
contagious diseases by the introduction of these micro- 
organisms. But, as Miquel has justly remarked, these 
results should be accepted with the greatest reserva- 
tion, and one may well ask if the procedures put in 
usage for the collection and cultivation of the schizo- 
phytes may not be sufficient to destroy their virulent 
properties. 
As you might have foreseen, the greater part of 
these micro-organisms—that is to say, eighty per cent. 
—are aerobiotic—i. e., they have need of oxygen to 
live and develop. 
As for their number, I showed you in one of my 
late lectures that this varies according to the localities 
where they are collected, and that the purity of the 
air is in inverse proportion to the microbes it contains. 
While in high altitudes you find but very few microbes 
to each cubic metre of air, it is by the thousands that 
you meet with them in our hospital wards; and when 
you reflect that a man breathes through his lungs in 
twenty-four hours ten cubic metres of air, you can 
form an estimate of the prodigious number of micro- 
organisms which penetrate by this channel, which 3 
forms the most easy and rapid mode of entrance into 
the organism of infectious or medicinal principles. In 
fact, substances which penetrate by the lungs, are 
carried almost directly to the left ventricle, and thence 
are distributed through the entire organism, and this 
explains the interest which Claude Bernard took in 
the method of tracheal medicinal injections in cases 
of urgency. 
I am well aware that, by a lucky anatomical con- 
formation, man breathes only exceptionally by the 
mouth, and that the air penetrates chiefly by the nasal 
fossae, which, by their anfractuosities, act the part of 
the filtering.apparatus employed by Pasteur to purify 
the air, but this infiltration is often very incomplete, 
since it is by the pulmonary passages that the con- 
tagious and infectious diseases are chiefly transmitted. 
I cannot here, in this purely medical lecture, dis- 
cuss in its entirety the subject of antiseptic pulmonary 
medication, which, by its developments, constitutes 
one of the grandest chapters of modern hygiene. 
I shall only refer in this connection to the divers 
experiments in which you took part on the occasion 
of the recent cholera epidemic, when Dr. Roux and 
myself, under the direction of M. Pasteur, showed 
that of all the antiseptic gases, the most effective is 
sulphurous acid, and this chiefly by reason of its 
power of penetration. We proved that in the propor- 
tion of twenty grammes to each cubic metre of space, 
sulphur in undergoing combustion destroys the micro- 4 
organisms contained in a liquid, and that in the 
proportion of forty grammes to each cubic metre it 
destroys the same micro-organisms in a state of desic- 
cation. But in such media man cannot live, and what 
we want especially to find, is some safe disinfectant, 
whether liquid or gaseous, which will destroy the 
schizophytes, while permitting man to sojourn in the 
medium where this disinfection is practiced. 
I know that researches in this direction are being 
earnestly pursued, and that hope has been entertained 
that we may find in ozone one of these parasiticide 
agents, but thus far experiments have not given results 
confirmed with all the scientific rigor which such re- 
searches demand. Others, going back to a notion 
already put in practice in the Middle Ages, have 
thought that the introduction of these micro-organisms 
into the economy might be avoided by the application 
of protective masks or respirators, such as are used in 
work-shops and factories where the air becomes im- 
pregnated with noxious dust; the breathing air being 
filtered through layers of cotton. I will not dwell 
longer on this point, desiring merely to hint at this 
side of antiseptic pulmonary medication. But there 
is another aspect of the question on which I desire to 
dwell longer, it is that which concerns the destruction 
of certain micro-organisms which are the efficient 
cause of pulmonary affections, and I wish in particular 
to say something about the action of antiseptic sub- 
stances on the microbe of tuberculosis. 5 
When at the end of 1882 Koch, in his remarkable 
communication, demonstrated the microbiotic nature 
of phthisis, he by this discovery revolutionized the 
history of tuberculosis, and gave a striking experi- 
mental confirmation of the theory advocated many 
years before by my learned colleague and friend Dr. 
Villemin. 
When Villemin in 1865, in his brilliant work on 
tuberculosis, announced that this disease was virulent, 
contagious, and inocuable, he raised in the medical 
world a real tempest, which was not allayed at the 
time of Koch’s researches, and many of the most emi- 
nent physicians disputed several of the terms of Ville- 
min’s definition. To-day all disputation has ceased 
before experimentation, and everybody is agreed that 
the bacillus tuberculosis is the real contagious agent 
of this disease. 
But the application of Pasteur’s views was destined 
not to be limited to tuberculosis; these views were 
soon to modify and revolutionize a disease which has 
been considered as a type of inflammatory diseases. 
On the 19th of November, 1883, Friedlander, com- 
pleting the first researches which he had made in 
1882, showed by decisive experiments that there ex- 
ists a schizophyte proper to pneumonia, and a few 
days later, namely, November 30th, Talamon, at the 
Anatomical Society, made known the result of his 
searches, and showed that if he did not absolutely 
agree with Friedlander respecting the form of the 6 
bacillus observed, he none the less considered it as 
the causal agent in pneumonia. 
These experimentors thus gave justification to 
the tentatives made in 1878 by Klebs, who, under the 
name of monas pulmonale, had described a microbe 
peculiar to pneumonia. 
This discovery of a micro-organism as cause of 
certain pulmonary affections, ought to be utilized by 
therapeutics; and just as in basing myself on new ex- 
perimental researches I endeavored to establish an 
antiseptic intestinal medication, so also I would ven- 
ture to suggest the first principles of an anti-microbic 
pulmonary medication. 
Let us see first what data experimentation can 
furnish us, and here I shall take as my basis the labors 
recently undertaken in France, and, in particular, the 
able researches of Hippolyte Martin, who has per- 
formed experiments of the greatest interest on tubercle 
and inoculation by tubercle. 
Hippolyte Martin first established the fact that 
inoculation constitutes the best means of recognizing 
the real nature of tubercle. When, in fact, you inocu- 
late in animals—guinea-pigs or hares—foreign bodies, 
or septic matters, you determine in these animals 
granulations more or less generalized in all the viscera, 
and which macroscopically and microscopically are 
identical with tubercles. But that which enables us 
to distinguish pseudo-tubercles from true tubercles, is 
that the former have no power to produce tuberculo- 7 
sis in other animals, while, on the contrary, true tuber- 
cle indefinitely reproduces the same disease in animals 
in which it is inoculated, so that even before the dis- 
covery of Koch’s bacillus (as early as 1881), Hippo- 
lyte Martin had been able experimentally to demon- 
strate the proposition: Tubercle alone engenders tubercle. 
From these experiments this capital fact is put in 
clear light: That when you would judge of the real 
value of antiseptic substances in the destruction of 
the bacillus of tuberculosis, it is not sufficient to prac- 
tice one inoculation alone, which may cause the pro- 
duction of pseudo-tuberculous granulations, but the 
inoculations should be in series—i. e., the product of 
one inoculation being inoculated in another animal, 
and so on; and all experimentors who have not taken 
care to avoid this source of error, must expect to see 
their results called in question. 
Repeating the experiments of Arloing, of Corne- 
vin, and of Thomas, who had made trials of the dif- 
ferent antiseptic agents to antagonize the anthracoid 
bacteria, Hippolyte Martin, in his turn, experimented 
with these antiseptics against the bacillus tuberculo- 
sis. This was his procedure: He crushed and 
pressed portions of viscera studded with tubercles, 
* Hippolyte Martin on Transformation of True or Infec- 
tious Tubercle into an Inert Foreign Body under the influence 
of High Temperature and Various Reagents. Arch de Phys., 
1881, p. 93; Revue de Med., 1882, t. ii, p. 905, and 1883, t. iii, 
p. 209. and the juice which he squeezed out was put in con- 
tact with the fresh amniotic liquor of a sheep, and to 
the whole was added a given quantity of the medica- 
ment to be experimented with; in this way trials were 
made with salicylic acid, bromine, carbolic acid, 
creasote, quinine, and corrosive sublimate. These 
mixtures were injected into the peritoneum of guinea- 
pigs, and on the death of the animals the inoculations 
were continued in order to ascertain the real value of 
the granulations which were found at the autopsy. 
In the case of salicylic acid, solutions of five-per- 
cent. were powerless to destroy tubercle. Bromine in 
solution, i per 10,000, and 1 per 1,000, proved to 
be inefficacious; at 11500 the action was more marked, 
but in this strength the solutions are caustic. In the 
case of phenic acid, solutions of 1:1000 had no effect, 
and even those of 3:100 or 6:100 had a doubtful ac- 
tion, although caustic effects were manifest. Creasote, 
so much vaunted in tuberculous affections, failed to 
destroy the bacillus of tuberculosis, even in the pro- 
portion of 1 per 1,000; and it was the same with qui- 
nine. In fine, corrosive sublimate, which has justly 
been considered as one of the most powerful antisep- 
tics, proved itself without action upon the micro- 
organism of tuberculosis even in the proportion of 1 
per 1,000. 
What do all these experiments go to show? This, 
surely, that the tuberculous element offers an extra- 
ordinary resistance to all antiseptic agents, and that, 
8 9 
in order to destroy it, you must at the same time de- 
stroy the living tissues which are its habitat.* In these 
experiments we must, in fact, carefully distinguish the 
antiseptic from the caustic action. When you destroy 
by a physical or chemical agent the elements of a 
tissue, you thereby abolish its virulent properties; this 
is, for example, what happens by heat. Hippolyte 
Martin, in fact, obtained destruction of the tubercle 
bacillus by heat, and true tubercle was transformed 
into an inert body when the temperature of 84°C. was 
exceeded, and this result was the more certainly at- 
tained by a temperature of ioo° C. and above. 
In a manuscript note, which Hippolyte Martin 
has kindly put into my hands, he signalizes the favor- 
able effects of hydrofluoric acid, which in the propor- 
tion of i per 3,000 and, perhaps, of i per 4,000, ap- 
pears to be destructive to the parasite of tubercle. 
But we must not, at the same time, forget the extreme 
causticity of this acid, which acts much more as a 
destroyer of tissue than as a veritable antiseptic. 
However, all the experimentors have not arrived 
at the same conclusions as Hippolyte Martin. Thus 
it is that Vallin, in the interesting communication 
* Koch, in his paper on “ Bacteriological Research,” read 
at the Tenth International Congress, held in Beilin, August 
4-ioth, 1890, announced that he had found a means of arrest- 
ng tuberculosis. It is to be hoped that some discovery of im- 
portance has been made in this field of inquiry. Dr. Koch has 
not yet made known the means employed. Translator. 10 
made this year to the Academy of Medicine, has 
shown that burning sulphur, in the proportion of one 
ounce to the cubic metre, destroys the virulent prop- 
erties of tubercle juice. Corrosive sublimate, in the 
proportion of i per 1,000, has the same action, but in 
that of i per 2,000 it is inefficacious, while nitrosyle, 
in the proportion of 66 centigrammes per cubic metre, 
also causes sterilization of tubercle juice. Vallin’s 
procedure was a little different from that of Hippolyte 
Martin; he made use of strips of filter paper soaked 
in distilled water; between these strips tuberculous 
products were crushed, then the paper was dried in 
the open air, and submitted to the action of divers 
disinfecting agents; they were finally soaked again in 
distilled water, and the liquid obtained by expression 
was injected into the peritoneum of guinea-pigs. 
A physician of Allevard, Dr. Niepce, has lately 
affirmed that sulphuretted hydrogen destroys the 
bacillus of tuberculosis in the sputa of phthisical 
patients, and that the sputa thus acted upon become 
powerless to induce tuberculosis in animals. 
A graduate of the school of Montpellier, Dr. 
Pilate, has repeated, with the aid of Drs. Cavalier and 
Mairet, the experiments of Niepce, and he affirms 
that of all the agents with which he has experimented, 
such as mercuric iodide, corrosive sublimate, helenin, 
thymol, iodine, carbolic acid, boric acid, the most 
active is sulphuretted hydrogen. Dr. Sormani and 
Brugnatelli claim to have obtained an antibacillary 11 
action with a certain number of liquids, and even in 
feeble doses. On the other hand, the experiments 
made in 1883 by Coze and Simon are absolutely con- 
firmative of those of Hippolyte Martin. These ex- 
perimentors have divided their researches into three 
groups. In the first series they mix forty centigrammes 
of phthisical sputa, in which they had previously 
noted the presence of bacilli, with different antiseptic 
substances; then, after forty-eight hours’contact, they 
injected these mixtures in guinea-pigs in the region 
of the groin. 
In a second series of experiments they injected 
only tuberculous matter; then they practised immedi- 
ately afterward, and for several days in succession, 
antiseptic injections in the region of the first tuber- 
culous inoculation. 
Finally in the third series of experiments, they 
endeavored to see if they could arrest the develop- 
ment of the disease in animals already the subjects of 
tuberculous evolution. 
They thus, in their three series of experiments, 
made trials of bichloride of mercury, eucalyptol, sul- 
phuretted hydrogen, creasote, helenin, thymol, etc. 
The last two series of researches gave nothing but 
negative results, and as for the first, creasote alone 
seemed to them to retard the local development of 
tuberculosis. 
What conclusion shall we draw from these ex- 
perimental researches. Must we admit that in man 12 
the bacillus tuberculosis resists all our therapeutic 
measures ? Such a conclusion, gentlemen, would be 
altogether too premature. These experiments show 
us that in animals such as the guinea-pig and hare, 
which present a singularly favorable soil for the de- 
velopment of tuberculosis, our medicinal agents prove 
themselves impotent to destroy the bacillus. But this 
is not the case with animal species which offer abetter 
resistance to the bacillus—the dog, for instance—and 
here we see the bacillary inoculations often fail. It is 
the same with man, and before the discovery of Koch 
(as well as since)we were in possession of unimpeach- 
able observations showing the cure of bacillary phthi- 
sis. So, while recognizing the useful indications fur- 
nished by experimental researches, we must, in order 
to appreciate their just value, turn to clinical observa- 
tion. 
The discovery of the bacillus, and the experi- 
ments which we have just mentioned, indicate to us 
the therapeutic paths which we are henceforth to 
pursue, and which comprehend two principal lines 
of investigation:—The one, by which we are to en- 
deavor through medicinal means to oppose the multi- 
plication of bacilli, and the other, by which we seek 
through hygienic means so to modify the culture 
medium, that it shall be unfit for the habitat of the 
bacilli. 
Prof. Germain See, in his work on Bacillary 
Phthisis, has insisted at great length on the new de* 13 
parture which ought to be taken by the therapeutics 
of tuberculosis since Koch’s discovery, and what con- 
ditions shall be fulfilled by the antivirulent agent, 
which he calls necrophytic. 
In the first group of agents, we have chiefly 
medicinal inhalations, and medicaments which are 
eliminated by the lungs. 
Among the medicinal inhalations, it is substances 
such as iodine, iodoform, eucalyptol, corrosive subli- 
mate, phenic acid, etc.—in a word, the least irritant 
antiseptic agents —which should be recommended; 
and our late venerated master, Piorry, seemed to 
have had prevision of its parasiticide power, when, 
with such persistence, he insisted on the utility of 
iodine inhalations in tuberculosis. I believe, also, 
that iodoform, so much vaunted these late years, may 
be utilized in these inhalations, being not only a very 
active antiseptic agent, but also a powerful sedative. 
You know how these inhalations are practised. 
They consist in aspirating a current of air through 
medicinal solutions, and breathing the air thus medi- 
cated. A wash-bottle with two tubes communicating 
with the exterior (one tube dips beneath the liquid), 
answers the purpose. You can, if you prefer, use the 
inhaler of Le Fort, or Lille, in which the air pene- 
trates to the liquid through holes in the sides. Le 
Fort puts into his bottle the following mixture: Cam- 
phor, 8 parts; tar, 4 parts; tincture of iodine, 4 parts; 
Hoffman’s anodyne, 1 part. You may also employ 14 
some of the more complicated inhalers, in which the 
air is not aspirated by the patient, but projected upon 
him by a ventilator operating by clock-work, as in 
Haro’s apparatus.* Haro uses iodoform principally, 
in the pulverization of which it is necessary that the 
temperature of the mixture should be kept raised. 
You have seen me use in one of our wards an inge- 
nious vaporizer devised by M. de Linieres. This 
vaporizer, which is put in operation by a rotary move- 
ment, projects into the ward vapor of water charged 
with iodoform; hut it will take us many months to 
estimate at their just value the effects of these vapor- 
izations of iodoform upon our tuberculous patients. 
And now, while on this subject of antiseptic inhala- 
tions, I ought to speak to you of the experiments 
being performed at the present time by my pupil, Dr. 
Chevy, with hydrofluoric acid, experiments which have 
been made the subject of his inaugural thesis. 
Struck by the results indicated by Hippolyte 
Martin, demonstrating the remarkable antibacillary 
action of hydrofluoric acid in tuberculosis, it occurred 
to me to employ this acid in inhalations; Dr. Bergeron 
had pointed out the extraordinary effects which he 
had obtained from the vapors of this acid in the treat- 
ment of diphtheria, while Chevy and myself were 
* Haro: On a New Kind of Inflations Practised at 
Amelie les Bains; Bull, de Therap., t. cvi. p. 408. 
Le Fort: On a New Inhaler, and its Action in Pulmo- 
nary Affections; Bull, de Therap., t. ci. p. 343. 15 
showing that animals might live without inconven- 
ience in an atmosphere containing i part of hydroflu- 
oric acid to 1155 parts of air. 
Moreover, a careful investigation made in the 
great establishments where hydrofluoric acid is used 
for etching on glass, enabled us to determine, not 
only that an atmosphere thus charged with hydroflu- 
oric vapors is not injurious to the workmen, but that, 
on the contrary, individuals suffering from chest affec- 
tions had experienced favorable effects therefrom; on 
this point the overseers of the works are unanimous. 
We have since then been experimenting by 
placing our patients in a special ward, of a capacity 
of about twenty-two cubic metres, in which apart- 
ment we vaporized one grain of pure hydrofluoric 
acid (which would give the proportion of about 1 part 
to 25,000); the liberation of the hydrofluoric acid is 
obtained by placing the liquid in a small leaden cup 
heated in a sand-bath. Our tuberculous patients re- 
main an hour in this atmosphere. I can say nothing 
as yet of the results which this experimentation may 
give; before formulating any positive conclusions, 
these trials must be continued for months, and even 
years. 
What I can, however, affirm, is, that in the im- 
mense majority of cases these inhalations of hydro- 
fluoric acid have not been at all inconvenient to our 
patients. Some of them have experienced a little irri- 
tation in the throat, due to the local action of the acid, 16 
but the majority have derived a certain benefit in the 
way of diminution of the cough and expectoration. I 
am inclined to think that these inhalations, in their 
application to the treatment of tuberculosis, constitute 
a remedy of much promise. 
But permit me, since I am now on the subject of 
hydrofluoric acid, to say, that of all the antiseptics 
known, this is, perhaps, the most powerful, and in the 
experiments which Chevy and I undertook, it required 
but infinitesimal quantities to arrest fermentation. 
I now come back again to my subject, and mention 
among the means to employ in the treatment of 
phthisis, antiseptic sprays. 
In my opinion these latter are very much inferior 
to the inhalations, for it is only exceptionally that 
these pulverizations penetrate to the interior of the 
lungs. Dr. Miquel, however, claims to have obtained 
good results in tuberculosis from pulverizations of the 
following mixture: Biniodide of mercury, i part; 
laudanum, 20 parts; distilled water, 2,000 parts. 
In order to obtain a more immediate action, it 
has been advised to inject the antivirulent solutions 
directly into the pulmonary parenchyma. The prac- 
tice has been attempted in Germany by Heller, who 
has thus made, in three patients affected with phthisis, 
intra-parenchymatous injections of corrosive sublimate 
in solution. 
* Chevy : Thfese de Paris, 1885, and Bull, de Therap., 
April 15, 1885. 17 
In France, Prof. Lepine and his pupil, True, have 
repeated these experiments. They employ alcohol at 
90° containing a variable proportion of cresote, 2 to 4 
per cent.; they use for these injections the syringe of 
Pravaz with the No. 1 needle of Dieulafoy’s aspirator, 
and have already performed twenty-five injections 
on fifteen patients, introducing each time into the 
parenchyma of the lungs a quantity of the cresote 
solution varying from a few drops to fifteen or twenty 
cubic centimetres. 
The results thus far have been uncertain, and in 
patients affected with advanced lesions they have 
observed hardly any symptoms of amelioration. 
Therefore, Lepine and True speak very reservedly 
respecting the definite curative value of these paren- 
chymatous injections, and, for my part, I think that 
these injections are liable to be more dangerous than 
useful. 
Internally, it is still to such medicaments as 
creosote, the turpentines, the sulphur preparations, 
that you will resort; these may render service by their 
elimination by the pulmonary passages. Rut what- 
ever parasiticide action these agents may be supposed 
to possess, they must still yield the palm to the modi- 
fiers of nutrition, which render the organic soil unfit 
for the microbes. 
Until by a more exact acquaintance with the 
bacillus and the conditions of its culture and develop- 
ment we shall be able, as in the case of anthrax, to pre- 18 
pare an attenuated virus which, by its inoculation in 
man, shall preserve him from being the prey to these 
bacilli, we must direct all our efforts to create in in- 
dividuals predisposed to tuberculosis a soil unfavor- 
able for the culture of the bacillus. To obtain this 
result we must utilize two factors; air and alimenta- 
tion. 
Although we have not very precise data respect- 
ing the action of the air under different degrees of 
pressure on the micro-organism of tuberculosis, and 
researches are needed before we can come to any 
definite conclusion on this point, we have very good 
evidence that high altitudes are unfavorable to these 
bacilli, and even destroy them. The law established 
by Jourdanet, that at certain altitudes phthisis does 
not exist, finds a certain confirmation in this fact, that 
the higher you go, the fewer the microbes you find in 
the air. 
As for alimentation, the method first brought 
into vogue by Debove has proved to be of the highest 
utility, and it is to-day generally admitted that, in 
certain cases where the integrity of the digestive tube 
is complete, one may, by super-alimentation, obtain 
amelioration and even cure in pulmonary consump- 
tion. The important communication of Broca and 
Wins* has given us many conclusive observations to 
this effect, and my pupil, Dr. Pennel, published in 
* Broca and Wins: Bull, de Ther., 1883, t. cv., p. 289. 19 
1882 a series of cases where the beneficial action of 
forced feeding was most manifest,* and I am aston- 
ished that the homoeopathic- physicians who often 
give such scrupulously nice attention to the details of 
their hygienic treatment, have rejected, as Jousset has 
done, the employment of super-alimentation, by pow- 
ders of meat, for a vegetarian regimen. 
I cannot here enter into the details of this super- 
alimentation; you know that, by reason of recent im- 
provements in the manufacture of meat powder, we 
can now give the latter in chocolate and in syrups, a 
consequence of which is that we do not now employ 
gavage in pulmonary complaints, reserving it ex- 
clusively for patients affected with dilatation of the 
stomach or persistent vomiting of food. Here, too, I 
have abandoned the stomach tube which I formerly 
used, and which goes by the name of “gaveuse,” for 
the tube of Debove, which, owing to its resistence 
and small volume, is introduced without the least 
difficulty. 
What I can affirm, is that in tuberculous patients 
that have profound and obstinate anorexia, or that 
vomit their food under the influence of the least effort 
of coughing, gavage will sometimes give you excep- 
tionally good results. Under its influence the appetite 
returns, the strength improves, and what is a singular 
fact, and one not well explained, is that while all food 
*Pennel: Alimentation in Phthisis, Bull, de Ther., t. 
cii.. p. 85. 20 
introduced by the mouth is vomited, the alimentary 
mixtures introduced directly into the stomach by the 
syphon are well supported. I assign then a preponder- 
ant role to super-alimentation in the antiseptic treat- 
ment of tuberculosis, and this, because it constitutes, 
in my opinion, our most powerful means of modifying 
the culture soil. 
As you see now, if Koch’s discovery has not al- 
ready revolutionized the therapeutics of pulmonary 
phthisis, it has nevertheless enabled us to give a 
scientific explanation of the modus operandi of the 
greater part of the medicinal agents which we use, 
and for this very reason it constitutes a step in pro- 
gress, both from a therapeutic and a prophylactic 
point of view. This great fact of the contagiousness 
of tuberculosis is to-day admitted without dispute, 
and we see on all sides hygienists as well as physicians 
endeavor to establish on a scientific basis the hygiene 
of the tuberculous. When you reflect that at this 
very time (December, 1885) scarcely three years have 
elapsed since the discovery of the microbe of tubercu- 
losis, and consider the large number of scientific re- 
searches and the already voluminous literature to 
which it has given rise, you cannot fail to entertain the 
hope that the day will come when, better enlightened 
as to the life history and mode of development of the 
bacillus, we shall be able to destroy it in the living 
organism, or at least attenuate its effects. 
Translator s Note.—In a “ conference ” on “ New Anti- 21 
septic Methods of Treating Pulmonary Diseases ” (Therapeu- 
peutic Gazette, Nov., 1887), Duiardin-Beaumetz speaks of sub- 
cutaneous injections of phenic acid in phthisis, gaseous rectal 
injections of sulphuretted hydrogen, liquid vaselin, and inhal- 
ations of sulphurous acid. 
The phenic acid injections may be made directly under 
the skin, or the needle may be plunged deeply into the soft 
parts, and even to the seat of the lesion when the injection is 
made in the region of the thorax. A two per-cent, solution is 
used; of this a hypodermic syringeful is injected, but the syr- 
inge must be larger than the ordinary kind; it should hold at 
least a fluid drachm. The phenic acid should be pure, and the 
solution should be made in glycerin rather than in alcohol. 
The best place for the injection is the anterior part of the 
chest, under the clavicle. The number of punctures should 
vary from two each week to two each day, according to the 
gravity and course of the disease. Under no circumstances 
should they be too often repeated, on account of the dangers 
of carbolic acid poisoning. In spite of some disasters, the in- 
jections of phenic acid have given quite favorable results in a 
certain number of cases. Almost always the appetite is im- 
proved, and the cough, expectoration and night sweats dimin- 
ished. 
The gaseous rectal injections, first proposed by Bergeron 
of Lyons, have at this date gone completely out of vogue. 
The liquid vaselin is now largely employed in the thera- 
peutics of pulmonary complaints under the name of “ liquid 
albolen.” A peculiar kind of hand atomizer, now sold by all 
the principal pharmacists, is much used for the purpose. 
Liquid vaselin is also a handy vehicle for hypodermic injec- 
tions; it dissolves eucalyptus, iodine, chloroform, bromine 
sulphide of carbon, terpinol, and a variety of other substances. 
Dujardin Beaumetz prefers the combination of medicinal 
liquid vaselin with eucalyptus in the forms of tuberculosis 22 
with abundant bronchial secretion; it rapidly diminishes the 
cough, expectoration, and oppression. His formula is as 
follows: 
3 Pure eucalyptol, 5 parts, 
Medicinal liquid vaselin, 20 parts. 
M. 
Equal parts of eucalyptol and liquid vaselin may be 
used, and injections of a syringeful night and morning never 
cause any local irritation. 
Inhalations of sulphurous acid are sometimes of benefit 
in phthisis. A quantity of sulphur is burned in a confined 
apartment (20 grammes per cubic metre), and, after waiting 
twelve hours, the patients are admitted, and made to sojourn 
in this room several honrs. “Under the influence of this 
treatment, we observe a speedy change in the expectoration, 
the cough diminishes, and the patients sleep much better.” 
These inhalations are not contraindicated in haemoptysis. CHAPTER IX. 
ON ANTISEPTIC PLEURAL MEDICATION. 
Gentlemen: In the last chapter I stated the 
basis on which henceforth antiseptic pulmonary medi- 
cation should be founded, and in that connection I 
insisted particularly on the importance of the anti- 
microbic treatment of tuberculosis; to-day, in order 
to complete the subject, I wish to say a few words 
about the application of the antiseptic method to 
pleural affections; this will be the subject of this short 
lecture. 
Two quite modern methods of a surgical order 
have profoundly modified the treatment of pleural 
affections, viz.; aspiration and pleurotomy. 
Since Dieulafoy, by his invention, rendered easy 
for us the method of aspiration, one of the first appli- 
cations of this method was addressed to pleuritic 
effusions, and for the first few years it was the custom 
to puncture and aspirate in all cases of pleuritic ex- 
udation, small as well as large. Physicians were heard 
to maintain, as did my regretted master, Behier, that 
we ought by an early aspiration to withdraw the liquid 
from the chest as soon as the physical signs enable us 
to recognize the least effusion. 
This enthusiasm of the onset was not allayed till 
Ernest Besnier showed us, by figures that could not 
be gainsaid, that the mortality of pleurisy since the 24 
practice of aspiration was introduced, instead of being 
lessened, was increased. While recognizing that in 
this increase of mortality there is doubtless another 
factor, namely, a greater intensity of the disease, good 
clinical observers nevertheless regard it as probable 
that the abuse of aspiration punctures may have had 
a share in this result. Those who adopted this view 
based themselves principally on the ideas which to- 
day dominate surgery; I allude to the possibility of 
the penetration of certain micro-organisms by the 
punctures. So, in order to render this little operation 
free from all danger, it was proposed to perform it 
according to the strictest rules of antiseptic surgery, 
and hence we have seen Debove subject the trocars 
and needles of the Potain aspirator to heat of above 
ioo° C. before using them. 
The complication of this latter manoeuvre has 
rendered aspiration somewhat more difficult, but 
whether this preliminary measure be carried out or 
not, it is the rule to-day to wash all parts of the Potain 
aspirator with strong solutions of phenic acid, and to 
carefully fire the trocar by dipping it in alcohol and 
setting fire to the alcohol; finally, to use carbolated 
vaselin to grease the instrument with. 
But the antiseptic method has been especially 
applied to pleurotomy, and it must be conceded that 
it has in many points modified this operation. But, 
before describing these modifications, I wish to say a 
few words about a little harmless measure which will 25 
enable you to recognize the reality and the nature of 
a pleural exudation; I refer to the employment of your 
hypodermic syringe. 
When you are in doubt as to the presence of an 
effusion or its nature, it will be sufficient to make with 
your syringe a puncture in the pleural cavity 
through an intercostal space, and then draw up a 
syringeful of liquid—provided there be any liquid 
there. This aspiration will give you useful informa- 
tion, and it can cause the patient little pain and can 
do him no harm whatever. 
Since Moutard Martin taught us the rules of 
pleurotomy, this operation has been one of ordinary 
practice, and I have already shown in the second vol- 
ume of my Clinical Therapeutics the marvellous re- 
sults which may be obtained from it, citing the statis- 
tics of the surgeon who, out of 70 cases of purulent 
non-tuberculous pleurisy, obtained 57 cures. Bear in 
mind that with reference to these purulent tubercul- 
ous or non-tuberculous pleurisies, we have to-day a 
sure means of verifying our diagnosis, and thereby 
establishing a sure prognosis. I refer to the finding 
or not finding of tubercle bacilli in the purulent effu- 
sion. 
I cannot, in this chapter, trace anew all the steps 
of the operation, for the details of which I shall have 
to refer you to the work above mentioned. I shall 
here only point out the modifications which have re- 
cently been made in the operation, to the sum of 26 
which has been given the name of antiseptic pleur- 
otomy. 
But whether it be antiseptic pleurotomy or pleu- 
otomy as it was formerly practised, with which we 
have to do, it is a certainty that the operation can be 
performed to-day almost without pain. You know 
that in consequence of our not being able to chloro- 
form patients on whom pleurotomy is performed, we 
have been advised to employ local anaesthesia in the 
form of ether spray, but this way of obtaining anaes- 
thesia has the disadvantage of determining severe 
pain when reaction sets in, and of provoking haemor- 
rhages, which are sometimes profuse and quite diffi- 
cult to arrest. 
To-day we are in possession of a means which 
enables us to complete all the steps of the operation 
without pain. It is, as you will readily guess, hydro- 
chlorate of cocaine. I have just applied this method, 
and with perfect success, on two of my patients on 
whom I have operated for empyema. This is my 
mode of procedure: I have at hand a two-per-cent, co- 
caine solution; I trace out with a pencil a line which I 
am to incise, and I introduce the needle of my hypo- 
dermic syringe successively at both extremities of this 
line, and throw into the cellular tissue two injections, 
and I take care, by pressure with my finger, to spread 
the liquid as thoroughly as possible over the region 
which my bistoury is about to traverse. I wait five or 
six minutes, and proceed to the incision of the tissues. 27 
The cutting is absolutely painless, and it is not till 
you have reached the deep parts of the inter-costal 
space that any pain whatever is felt, and this is slight. 
You will then be likely, henceforth, to resort to 
this simple expedient under such circumstances; and, 
since I am on the subject of subcutaneous injections, 
permit me to say that you can, by the same means, 
allay the fits of coughing, so painful and so fatiguing, 
which the patient experiences when you have given 
exit to an effusion, but this time it must be morphine, 
not cocaine, which you inject. It is a good plan to 
have this injection ready and inject it as soon as the 
pleura is incised, and the patient begins to cough. 
I come now to the more important part of this 
lecture, namely, antiseptic pleurotomy. 
Empyema, whatever may be the mode of treat- 
ment employed, can end in cicatrization and restora- 
tion ad integrum only by the jutaxaposition of the 
two contiguous layers of the pleura, and this jutaxa- 
position can be effected only by the lung being main- 
tained in contact with the costal parietes which re- 
main fixed, or by the continued application to the 
pulmonary pleural surface, the lungs being more or 
less confined to the vertebral column—of the supple 
and elastic costal wall. From this first fact two im- 
portant prognostic conclusions result; first, the more 
movable the costal wall, and the more recent the false 
membranes, the greater the chances of cure. In ac- 
cordance with this first conclusion we explain the al- 28 
most constant recovery of young children from puru- 
lent pleurisy, and the increasing rarity of recovery as 
the patient advances in years. 
Estlander, by a bold and ingenious process, has 
proposed to remedy in aged patients the evil alluded 
to by resection of the ribs, and thus opposing a mobile 
wall to the pleural abscess. In France, Bouilly, Perier, 
and Berger, have resorted to this operation with more 
or less or success. I say more or less, because in the 
two cases which I was enabled to observe, there was a 
considerable amelioration, but the patients remained 
ever afterwards subjects of a pleural fistula. 
Nevertheless, by the side of these partial suc- 
cesses, it is but fair that we should mention the bril- 
liant results which this operation has had on one of 
our most talented and brilliant surgeons, who to day 
owes to it his complete restoration. 
The second conclusion pertains especially to the 
lungs, and we ought whenever possible to open the 
pleural abscess before the organization of false mem- 
branes has fixed the lung to the vertebral column by 
firm and resistant bands. Therefore all physicians 
and surgeons who have counselled antiseptic pleuro- 
tomy have insisted that it should be done early—that 
is to say, as soon as the presence of a purulent effusion 
has been satisfactorily determined. This is a condi- 
tion essential to the success of the operation, as in 
these cases you can obtain, so to speak, reunion of 
the costal and pulmonary pleurae by first intention. 29 
It is essential then, in order that the operation 
may give the results which we have a right to expect 
from it, that is to say, complete and permanent cure 
of the empyema in a space of time varying from three 
to five weeks, that we have young subjects to deal 
with whose thoracic walls are supple and elastic, or at 
least that we have to do with empyema at its onset. 
When, on the contrary, you open the pleural abscess 
at a very late period, or when your subjects are aged 
people whose costal cartilages are ossified, the anti- 
septic method is no longer applicable, and you ought 
to resort to the ancient mode of operating; and even 
then there will always be reason to fear that the 
patient will carry a discharging pleural fistula the rest 
of his life. 
The rules of antiseptic pleurotomy have been 
well laid down in France by D£bove, Lucas Cham- 
pionniere, and especially by my former pupil and 
present colleague, Dr. Moizard, who is one of the 
most earnest advocates of this form of pleurotomy. 
You will find, moreover, in a work published by 
Hache, and in the theses of M’lle Kraft, Guinard and 
Le Couedic, all the material needful for the study of 
this question.* 
* Moizard, De la pleurotomie septique et antiseptique 
(Revue des maladies des enfants, 1884), Mile Kraft, Traitement 
de l’empyeme par la pleurotomie antiseptique (These de Paris, 
1884, p. 153). Guinard, Du meilleur mode de traitement de la 
pleuresie purulente (These de Paris, 1884). Le Couedic, De la 
pleurotomie antiseptique (These de Paris, 1885). 30 
These rules consist in performing the dressings 
according to the most minute requirements of anti- 
septic surgery; the operation should be done in a 
Listerian atmosphere; all the sponges and drainage 
tubes must be soaked in a strong solution of carbolic 
acid; and when once the operation is terminated, 
Lister’s dressing should be employed in its entirety— 
that is to say, protective, phenicated gauze, mackin- 
tosh, salicylated wadding, etc. As a free and com- 
plete flow of pus is desired, it is the rule in these 
cases to make the incision as low down as possible— 
that is to say, just above the upper border of the sev- 
enth rib. The incision is made as in the ordinary 
operation, layer by layer, and care is always taken to 
follow the upper border of the rib below. When once 
the pleura is opened, the operator introduces his 
finger into the pleural cavity, and, with his finger as 
his guide, he enlarges the opening into the pleura 
with his probe-pointed bistoury. 
When once the pus is evacuated, you wash out 
the pleural cavity with a saturated solution of boracic 
acid, continuing the irrigation till the liquid returns 
perfectly clean from the chest. Some surgeons rec- 
ommend that the first lavage be followed by a second 
made with a solution of chloride of zinc or corrosive 
sublimate; I do not see much advantage in this sec- 
ond washing, and I never resort to it. But among 
the antiseptic solutions which are put into usage, 
there is one which you ought absolutely to discard; I 31 
allude to carbolic acid. You have had opportunities 
to see in my hospital service the disastrous results 
produced by these carbolized lavages of the pleura, 
which have produced a veritable poisoning, with re- 
frigeration, and grave symptoms which have hastened 
the end of the patient. 
You then place in communication with the puru- 
lent cavity a drainage tube, which you have taken 
care to fasten by a string or tape passed around the 
waist. A propos of these drainage tubes, you know 
that I employ a flute-like arrangement constructed by 
Galante, called the flute of Pan, which consists of a 
series of drainage tubes cut at different lengths, and 
kept in position by a disk which closes the opening 
into the chest. 
This flute of Pan, applicable to the ordinary cases 
of pleurotomy, is not adapted for antiseptic pleuroto- 
my, and you will have to be content with a large 
drainage tube, or it maybe a series of drainage tubes, 
which you leave in the opening you have just made, 
but which you must have care to fix firmly by passing 
through them a stout thread which is made fast to 
the chest; the necessity of this is apparent from the 
fact that a certain number of cases are on record 
where these drainage tubes, owing to the efforts of 
respiration and the movements of the patient, have 
fallen into the pleural cavity. 
You then apply over the whole a complete Lister 
dressing, which you cover with a certain quantity of 32 
wadding; then (and this is the capital point) you dis- 
turb the dressings but rarely, and, what is essential, 
you refrain from further washing out the pleural 
cavity. It is not till three or four days after, and ac- 
cording as the patient is more or less inconvenienced 
by the liquid which flows from the chest (unless, in- 
deed, the pus earlier takes on a putrid odor) that you 
remove the old dressing and put on a new one, which 
in its turn is designed to be left on for three or four 
days. It is understood that each of these dressings 
should be made in a carbolized atmosphere, and with 
all the precautions of the antiseptic method. At each 
dressing you remove the tube, and you take care to 
shorten the drainage tube as fast as the cavity con- 
tracts. 
In following these rules, if you have a patient 
who fulfills the conditions which I have enumerated 
above, you may expect to obtain a definite cure, and 
without fistula, in a space of time which varies from 
three to five weeks. If you will take the trouble to 
refer to the statistics, those, for instance, furnished by 
M’lle Kraft, you will see that out of 19 cases of pleu- 
rotomy in the adult, in 12, where the pleurotomy was 
followed by repeated lavages, there were two deaths, 
while in the seven cases treated by only one lavage, 
there were seven recoveries. Hence this lady claims 
that the operation for empyema by early pleurotomy, 
rendered completely antiseptic and followed by only 
one lavage, is an operation of so little gravity that 33 
one may resort to it with almost absolute certainty of 
cure. 
I fear that this is a complete over-statement of 
the case; the one lavage which plays the most im- 
portant part in antiseptic pleurotomy, entails a result 
which does not at all depend on the method employed, 
but rather on circumstances inherent in the patient 
himself, and whenever the pus becomes foetid, all the 
advocates of this method recommend to return to re- 
peated washings of the pleural cavity with antiseptic 
liquids as we were formerly in the habit of doing. 
When recognizing that antiseptic pleurotomy 
ought always to be applied at the onset of empyema, 
in order that cicatricial union may be obtained of the 
pus cavity, which is an immense advantage, it must 
be admitted that in a great many cases this union is 
impossible, and that the best be can do is repeatedly 
to wash out the pleural cavity. Such are the points 
to which I desire to call your attention concerning 
antiseptic pleural medication. CHAPTER X. 
ON ANTITHERMIC MEDICAMENTS. 
Gentlemen:—I intend to-day to begin the study 
of antithermic medication, and shall devote to it 
the three following lectures. In the first I shall con- 
sider the antithermic medicaments which have been 
in vogue down to the last few years. In the second 
I shall take up the study of resorcin, antipyrin, kair- 
in, and thallin. In a third and final lecture, I shall 
examine the indications and contra-indications for 
the antithermic medication. 
Since the year 1834, when Runge first extracted 
phenic acid from coal tar, chemists have obtained by 
analyzing the residual products of the fabrication of 
coal gas derivatives of a constantly increasing import- 
ance, so that we may now say that this illuminating 
gas, which was formerly considered as the most im- 
portant element in the destructive distillation of coal, 
is now regarded from an industrial point of view as 
only a secondary product. The coloring matters, 
anilin and its derivations, the phenols and oxyphenols 
constitute, in fact, to-day one of the most important 
branches of the chemical arts. 
Medicine has largely profited from this group of 
bodies, early finding there medicaments that are 
powerfully antiseptic. Then, when clinicians ven- 
tured to make trial of these medicaments internally, 35 
it was observed that all, or almost all, have the 
curious property of depressing the temperature in a 
very marked manner, and this has enabled us to con- 
struct a new class of remedial agents, the antithermic 
medicaments. 
But in order that you may well grasp the intimate 
action of these various medicaments, it seems neces- 
sary for me to sum up in a few words the various 
hypotheses that have been made respecting fever and 
hyperthermia in general. 
Fever, as you know, is essentially characterized 
by two cardinal symptoms: Augmentation of the 
pulse, and augmentation of the heat. Since the in- 
troduction of the thermometer into the study of dis- 
eases, the second of these symptoms has become of 
increasing importance, and to-day we relegate the 
study of the pulse to an absolutely secondary rank. It 
is, then, this hyperthermia which constitutes the char- 
acteristic, dominant fact of fever, and from this it 
borrows its name (febris, from fervere—“to glow with 
heat, to boil.”) 
Many theories have been put forth to explain this 
febrile hyperthermia, and when you take a general 
view of them, you see that they can all be grouped in 
two great classes, in the one, physiologists have 
hypothecated an augmentation of the combus- 
tions of the economy; in the other, on the con- 
trary, this augmentation of combustions is not ad- 
mitted. To-day, despite the recent experiments of 36 
Charcot, and those more recent still of Maurel, every- 
body is agreed in admitting that there is this increase 
of combustions, and if there be any contradiction in 
the results obtained on this point by different physiolo- 
gists, it is because the latter did not place themselves 
in the same conditions of experimentation. 
You know, gentlemen, the most expeditious and 
clinical means for determining the activity of combus- 
tions taking place in the economy. I refer to the 
quantitative analysis of the urea. In order that you 
may appreciate by this process the increase of com- 
bustions in febricitates, you must compare the quan- 
tity of urea excreted in twenty-four hours by a fever 
patient, not with that excreted by a man who is on 
full diet, but with that eliminated by a person fasting, 
since febricitates take little or no food. When this 
kind of comparison is made, it is seen that there is 
always augmentation of urea production in fever. 
Moreover, the experiments of Liebermeister show 
that there is also augmentation in the carbonic acid 
exhaled. Lastly, the application of calorimetry proves 
in a sure manner that the febricitate evolves more 
heat than the healthy man, and that the production of 
heat is in direct relation with an augmentation in the 
chemical combustions in the organism. Therefore the 
theories of Traube and Hunter, who teach that febrile 
hyperthermia is due solely to modifications in the 
capillary circulation, ought to-day to be abandoned. 
But to say that fever is due to augmentation of 37 
the combustions of the economy, is not to solve the 
problem, but simply to remove it farther back; hence, 
physiologists have tried to penetrate more deeply 
into the matter. First of all, Leibermeister has 
shown us that in fever there is modification in the 
regulation of heat. What is this organic power of 
heat regulation? It is this: We can by artificial means 
augment the temperature of the organism, but as soon 
as these means cease to act, the bodily temperature 
always comes back to the normal, i. e. to 370 C. 
Hence, then, man in the physiological state tends al- 
ways to maintain his temperature about a uniform 
standard, while in fever the bodily heat is regulated 
by an abnormal standard. 
This study of the relation of the temperature in 
fever is important, but it does not absolutely resolve 
the difficulty, and we ought to know how this abnor- 
mal regulation comes about. Here two great causes 
have been invoked: Some would place in the nervous 
system the starting point of this trouble; others have 
located it in the blood; in other words, we have the 
nervous theory of fever, and the humoral theory. 
Basing himself on his remarkable experiment of 
the section of the great sympathetic in the hare, an 
experiment which, as you know, leads to a very marked 
augmentation of temperature in the ear on the side 
where the nerve was cut, Claude Bernard inferred that 
the great sympathetic is the moderator of the chemi- 
cal combustions of the economy, and fever was, in his 38 
estimation, but one of the manifestations of paralysis 
of this portion of the nervous system. Tsheschichin 
in acting on the pons varolii of hares, determined 
augmentation of the temperature of the body, and 
hence located in the mesocephalon the heat centre 
of the economy. Vulpian does not acknowledge 
as the special seat of calorification either the 
great sympathetic or the mesocephalon, but he thinks 
that every modification effected in the nervous 
system, whether by direct or indirect causes, may 
influence the combustions of the economy and 
thereby produce fever. So much for the nervous 
theories of fever. As to the humoral theories, every 
one is agreed in admitting the prominent part belong- 
ing to the blood in the febrile process. But some 
affirm that the blood-disorder is primary, others that 
it is only secondary. The study of new antithermic 
medicaments has not enabled us definitely to decide 
this question. On the contrary, you will see that if 
there are medicaments which depress the temperature 
by acting on the nervous system, there are still others 
which produce the same effect by profoundly modify- 
ing the blood globules. 
Taken in their aggregate, the antithermic medi- 
cations may be divided into two groups. In one the 
temperature is lowered by abstracting, through physi- 
cal means, the heat which is generated by the phe- 
nomena of combustion taking place in the economy; 
in the other, it is by acting directly on the blood 39 
or on the nervous system that this heat-fall is pro- 
duced. 
The first group is typically represented by the 
cold bath treatment of pyrexia. You will allow me to 
be brief on this head; this question has been recently 
discussed at length before the Academy in connection 
with the treatment of typhoid fever by the method of 
Brandt, a discussion in which I took an active part; 
and I have, moreover, stated in the third volume of 
my Clinical Therapeutics * what I think of this method. 
Events which have since taken place have in no way 
shaken my conviction, and I persist in believing that 
the employment of the cold bath as an antithermic, 
and in particular in the treatment of typhoid fever, is 
destined to be virtually abandoned. Moreover, to ab- 
stract heat from the economy by physical means does 
not in any way oppose heat production. 
I come now to the second group of antithermic 
medications, and what I have to say to-day will per- 
tain to certain members of this group. These medi- 
caments are subdivided into two classes; those which 
act directly on the blood, and those which act on the 
nervous system. 
Among the medications which directly influence 
the blood, must first be mentioned blood-letting. If 
formerly the medical profession urged and applied 
with so much rigor the antiphlogistic method, it is be- 
cause it produced in inflammatory diseases and in 
* Published by Geo. S. Davis, Detroit, t888. Part III. 40 
pyrexia the following double effect: It raised the 
pulse and lowered the temperature; in a word, it 
combated one of the most perceptible manifestations 
of inflammatory diseases—the fever. 
Consider what takes place in the course of 
typhoid fever when there ensues an intestinal haemor- 
rhage of medium intensity. The temperature falls 
almost immediately, and on the fever chart you see 
this haemorrhage marked by a notable depression of 
the temperature, which is continued on the following 
days—a depression absolutely like that produced by 
the administration of an antithermic medicament, such 
as sulphate of quinine, salicylic acid, salicin, etc. 
I pass now to the study of the internal medica- 
ments capable of lowering the temperature, but before 
giving a more complete account of those later anti- 
thermics, kairin, thallin, resorcin, and of those which 
preceded them in the order of their discovery, such as 
phenic and salicylic acids, I ought to say a few words 
about two medicaments long employed in fevers and 
phlegmasias: I refer to tartar emetic and quinine. 
Tartar emetic is a powerful antiphlogistic, and, 
like blood-letting, it depresses considerably the tem- 
perature, determining an aggregate of symptoms very 
similar, from a thermic point of view, to what we see 
manifested in the third stage of cholera, whence the 
name of stibian cholera, which has been given to this 
symptomatic aggregate. Such a depression was not 
to be obtained without danger, and numerous were 41 
the observations during the time of furor for the ad- 
ministration of tartar emetic, where irremediable dis- 
orders on the part of the digestive tube were noticed. 
To-day the antiphlogistic medication by tartar emetic 
is pretty well abandoned, and you will see as I go on 
that we possess means far more energetic and far less 
dangerous for bringing down the temperature. 
If quinine remains still the medicine par excel- 
lence for morbid intermittency, and for fever and 
ague, it has shown itself inferior as an antithermic to 
the medicaments of which I am about to speak. To 
obtain appreciable antithermic effects in pyrexias, one 
is obliged to give large doses of quinine; and, as 
Broqua of Mirande remarked in 1840, and still later 
Boucher of Villijosy, and Monneret, when you wish, 
in typhoid fever for instance, to bring down the tem- 
perature by sulphate of quinine, it is by grammes or 
scruples rather than by grains that you must admin- 
ister it. These massive doses of quinine are not 
without danger; besides the encephalic disorders 
which they produce, there are sometimes engendered 
under their influence, as Laborde has shown, grave 
cardiac lesions characterized by a veritable myocardi- 
tis, such as is often developed in typhoid fever and 
other infectious and virulent diseases, as has been 
noticed by Huchard, Desnoy, and Hayem. 
How does quinine act in depressing the tempera- 
ture ? Two hypotheses have been invoked. Accord- 
ing to the one, the cinchona alkaloids have an anti- 42 
septic action, and in this way they oppose fever which 
is essentially a fermentation; it is, moreover, worthy 
of note, that a great number of antithermic substances 
are antagonistic of fermentation. What I say of 
quinine I may also say of phenic acid, salicylic acid, 
resorcin, etc. 
The other hypothesis, much the more probable, 
is that the salts of quinine depress the temperature by 
acting directly on the thermogenetic centres of the 
cerebro-spinal axis. The effects of quinine on the 
nervous system are not at all doubtful, and the buz- 
zings in the ears, the attacks of vertigo, and the 
cardiac disturbances sufficiently indicate that the 
cerebrum, and especially the upper parts of the cord 
where the heat centres have been located, are im- 
pressed by the salts of quinine. 
I ought not to omit digitalis, which not only di- 
minishes the number of the pulsations, but has a 
manifest action on the temperature. Hirtz and his 
followers have long insisted on the antithermic, or 
rather on the antipyretic value of digitalis which they 
have administered in the pyrexias, and especially in 
typhoid fever. This method of treatment which 
Wunderlich advised as early as 1862, and which Hirtz 
tried in France in 1869, consisted in giving to typhoid 
fever patients hourly doses of a tablespoonful of an 
infusion of 12 to 15 grains of digitalis leaves in a gill 
of water. Save the case of the followers of Hirtz 
who have continued this treatment, it seems to have 43 
been almost completely abandoned, and I believe that 
this abandonment is justified, for the reason that digi- 
talis is a dangerous antithermic medicament by reason 
of its emeto-cathartic action, and its liability to par- 
alyze the heart in the large doses required in order to 
bring down the febrile heat. 
In fact, in the dose of 15 grains a day digitalis 
may produce toxic effects, and bring about a veritable 
asystolia, and this is the more likely to ensue from the 
fact that in typhoid fever, as in other infectious dis- 
eases, the heart, as we have just seen, is softened in 
its muscular texture. 
It is on account of this same debilitating action 
on the heart that we should discard from the antither- 
mic medication aconitia and veratriinum; these medi- 
caments indeed depress the temperature, but in order 
to obtain this effect we have to evoke the toxic action 
of these alkaloids, and this is likely to be attended 
with dangerous results. It is not so with the medi- 
cament which I am next to mention, salicylic acid, 
which belongs to the aromatic series from which are 
derived all the antipyretics whose uses I am about to 
set forth. 
Salicylic acid was the first medicament of this 
series to be applied to the treatment of pyrexias. 
The first experiments with this acid were made in 
1874, by Bass, and one year later (1875) Reiss pre- 
scribed it in typhoid fever. This was a partial return 
to the first uses made of salicin, which was dis- 44 
covered in 1827 by Leroux, of Vitry-le-Francois, and 
which was for a time administered in fever and ague. 
The year following (in 1876) Strieker made trials of 
salicylic acid in acute rheumatism, and founded the 
principles of the salicylic medication, which gives 
every day such remarkable results in this painful 
affection. 
Salicylic acid is antithermic, and the most active 
and least dangerous medicine of the kind. To bring 
down the temperature with salicylic acid, pretty large 
doses are requisite, of the acid or of salicylate of soda, 
and from an antithermic point of view the first is far 
preferable to the second. 
You must, as I said before, administer 1, 2, 3, 4, 
and even as much as 7 grammes a day in powders of 
one-half gramme every hour. This is Vulpian’s and 
Hallopeau’s way of giving it, who are very earnest 
advocates of the salicylic medication in typhoid fever. 
The physiological effects of salicylic acid are very 
similar to those of sulphate of quinine, and it is proba- 
ble that it is by acting on the thermogenetic nervous 
centres that salicylic acid brings down the temperature. 
But the same evils which we have ascribed to quinine 
when given for antipyretic effect apply to salicylic 
acid. The cerebral disturbances which the latter 
occasions are quite as annoying and as harmful as 
those of quinine, and despite the power which sali- 
cylic acid possesses as an antithermic, I am per- 
suaded that if it occupies the first rank in the thera- peutics of acute rheumatism, it deserves but a second- 
ary place in the treatment of febrile hyperthermia; as 
for its action in intermittent fevers, this is well nigh 
nil. 
Phenic acid was employed in fever before sali- 
cylic acid, but it* was not till after the year 1880 (that 
is to say, since the labors of Desplats of Lille,) that 
any real scientific trials were made with it in fevers, 
and in typhoid fever especially. Skinner in 1873 did 
indeed advise phenic acid in the treatment of fever; 
Pecholier in 1874, and Tempeste in 1877, had also 
administered it; but all in such feeble doses that it is 
hardly probable that it was for an antipyretic effect 
that it was exhibited. 
Phenic acid is a very powerful antithermic, and 
we have seen relatively small doses of thirty grains 
produce a fall of several degrees. These falls of 
temperature are accompanied by grave symptoms; the 
skin is covered with sweat, the respiration is op- 
pressed, there is a general depression of the forces 
of the economy, all of which symptoms render phenic 
acid a dangerous medicament, for it owes its anti- 
thermic effects to its action on the nervous system and 
on the blood globules. It is, in fact, by diminishing 
the respiratory power of the blood, that phenic acid 
depresses the temperature, and we ought to banish 
from therapeutics those sanguineous antithermics 
which notably augment the blood alterations which 
characterize all the infectious pyrexias. Hence it is 
45 46 
that phenic acid as an antithermic is to-day aban- 
doned, and for this reason that we have found anti- 
thermics just as powerful which are attended with far 
less danger. This is a matter which I hope to show 
you in the next lecture will be devoted to the new 
antithermic medicaments. CHAPTER XI. 
ON NEW ANTITHERMIC MEDICAMENTS. 
Gentlemen:—In my last lecture I spoke of the 
antithermic properties of quinine, phenic acid, and 
salicylic acid. To day I shall conclude the subject 
by a brief reconsideration of resorcin, kairin, anti- 
pyrin, and thallin. 
Resorcin, which two Vienna chemists, Hlassi- 
wetz and Barth, discovered several years ago among 
the products of fusion got by treating galbanum with 
potash, has since then been obtained by Koerner by 
way of synthesis, and to-day makes a part of the group 
of phenols. It presents itself when pure under the 
aspect of beautiful silk white needles, very soluble in 
water, and gives rise, like salicylic acid, to a remark- 
able violet coloration in presence of perchloride of 
iron. In contact with sulphuric acid and phthallic 
acid it gives origin to fluorescin, of which several 
drops suffice to render water singularly fluorescent. 
From this combination with phthallic and sulphuric 
acids results a variety of beautiful colors, which cause 
resorcin to occupy an important place in the fabri- 
cation of coloring matters. This substance is emin- 
ently antagonistic to putridity and fermentation. 
Since 1877, Dr. Andeer, who has studied the question 
of resorcin under all its phases, has made known the 
numerous applications which may be made of this 48 
body in therapeutics, and I myself, in 1880, was the 
first to make trial of this medicament in France, and 
you will find in the thesis of my pupil, Dr. Callias, the 
results of our researches.'*' 
The analogy which exists between resorcin and 
phenic acid led to the use of the former in fevers, and 
especially in typhoid fever. 
In Germany there has been much said in praise 
of resorcin as an antithermic. Licehthein affirms that 
when administered in a massive dose of 30 to 60 grains 
it causes a very marked fall of temperature in typhoid 
fever. The observations which I have made have not 
given me results so advantageous, and neither in ar- 
ticular rheumatism nor in typhoid fever have I ob- 
served any considerable fall in the temperature. It is 
* Hippccrate Callias, De la resorcin et de sou emploi en 
therapeutique (Th&se de Paris, 1880). Dujardin-Beaumetz, 
Bulletin de therapeutique (June and July, 1881). Revue de 
Hayem, 15 Jan , 1881, No. 62. Ramonet, Traitment de la 
fi&vre typhoide par l’acide phGnique (Archives de medecine de 
April, 1882). J. Andeer, Eilenten Studien uber das Resorcin 
zur Einfiihrung desselben in die praktische mcdicia, Wurtz- 
burg (A. Stubdr’s Buch et Kunstahlung, 1880). Lichthein, 
Blatter fur Schweiger Artzfe (Correspondanz, No. 14, 1880, 
Tribune med., Nos. 628 et 630, 1880). Dr. W. Murrel (of 
London), a Case of Poisoning by Resorcin (Medical Times 
and Gazette, 22 October, 1881, p. 486). Dubois-Raymond, 
Archives de 1879. Supplement B. D. S., 61; L. Brieger 
zur Kenntniss des physiologogischen, Verhaltens des Brenz- 
catechtn, Hydrochinon und Resorcin und ihrer Entstehung im 
Tierkcerper. 49 
true that I gave the resorcin in fractional doses of 8 
grains without ever exceeding the total quantity of 
half a drachm a day. 
My colleague Desnos has repeated at the Charity 
these experiments to ascertain the antithermic powers 
of resorcin, and the results at which he has arrived, 
and which you will find recorded in the thesis of Dr. 
Peradon, confirm in part the conclusions which I had 
formulated. He has in fact remarked that resorcin 
has almost no action when administered internally in 
acute rheumatism, but in typhoid fever, when it is 
given in massive doses of from half a drachm to a 
drachm repeated two or three times a day, so that 
from a drachm and a half to two drachms shall 
have been given in the twenty-four hours, you obtain 
a real fall in the fever, but the action is very tran- 
sient. 
But what led me to abandon resorcin in the 
treatment of rheumatism and typhoid fever is not only 
its want of power, but also the toxic phenomena which 
I have observed. Resorcin is not only an irritant 
medicament, it is also a poison, and in the experiments 
which I made with Callias, we found that when we 
arrived at the dose of 30 centigrammes for each kilo- 
gramme of the weight of the body, we determined in 
the dog convulsive phenomena, and death when the 
dose reached 90 centimetres per kilogramme of 
weight. In the animals which succumbed to the 
effects of resorcin we noticed visceral congestions, 50 
and in particular very intense pulmonary congestions, 
as in the case of animals poisoned by phenic acid. 
Man seems more susceptible to the action of re- 
sorcin than animals. Murrel has observed a case 
where 50 grains of resorcin administered in one dose 
determined grave symptoms of poisoning, from which 
the patient, however, recovered. 
Hence, while recognizing that resorcin is less 
toxic than carbolic acid, I conclude that it is a dan- 
gerous antithermic, for I found in my patients affect- 
ed with typhoid fever and treated by resorcin, the 
same depression of the forces, the same adynamia, 
the same pulmonary congestions, which I had signal- 
ized in those to whom carbolic acid had been admin- 
istered. I have therefore abandoned this medication, 
and I believe that even in Germany resorcin is little 
employed internally; it remains, on the contrary, a 
precious medicament for external use in the treatment 
of ill-conditioned wounds. 
Kairin, which Fischer, of the University of Mu- 
nich, discovered in 1882, was applied to therapeutics 
by Filehne, of Erlangen, and has been especially 
studied in Germany by Guttmann, by Gottlief Merkel, 
and in France by Dr. Hallopeau and his pupil Dr. 
Girot, who has devoted his inaugural thesis to this 
subject.* 
*Guttmann, Berliner Klinische Wochenschrift, No. 31. 
Gottlief Merkel, Deutches Archiv. fur Klinische Medicin. 
Filehne, Berliner Klinische Wochenschrift, i6e numero. 51 
Kairin is a derivative of quinolin; it is the 
methyluret of oxyquinolin. This quinolin, as you 
know, has but one very remote point of contact with 
quinine. It was obtained from coal-tar by Runge in 
1873. Gerhardt obtained it by distillation of certain 
alkaloids—quinine, strychnine, cinchonine, with po- 
tassa—and the derivatives of this quinolin have 
been especially well studied in France by CEschener 
of Coninck. 
I shall not enter into this very complex and pure- 
ly chemical question of the quinolin series and of its 
derivatives; this I leave to my laboratory chief, Dr. 
Bardet; it is sufficient that I should tell you that 
chlorhydrate of kairin presents itself under the form 
of a crystalline powder of a straw-yellow color. Its 
price is relatively high. It is soluble in water, and its 
solution has a bitter and disagreeable taste. Hence 
it is that it is administered in wafers or capsules. 
Filehne advises to give every hour one of these 
wafers containing half a gramme of kairin-chlorhy- 
drate. At the end of four doses—that is to say, at 
the end of four hours—the fever-fall is two or three de- 
grees. Under the influence of these doses the patient 
sweats, feels depressed, and his urine takes on a black 
Girat, Contribution a l’6tude physiologique et therapeutique 
du chlorhydrate de kairin (These de Paris, 1883, No. 230). 
Hallopeau Sur un nouvel antipyretique, le chlorhydrate de 
kairin (Soc. med. des hop., 23 mars 1883, et Bull, de tber., 
1883, t. civ. p, 241). 52 
color, like that of individuals who have taken large 
doses of phenic acid. When the administration of the 
kairin is stopped, the patient rapidly recovers the 
temperature which he had before taking the medicine, 
and this new thermic elevation is preceded by an in- 
tense chill. 
The transient duration of the antithermic action 
of kairin, and the production of the chill, is not the 
only inconvenience of this medicament. There is a 
much more series evil resulting from it, for kairin acts 
on the red globules and on the oxyhaemoglobin, which 
it destroys. In their experiments on animals, Hallo- 
peau and Gerard had noted a modification in the color 
of the blood, which took on the color of sepia, and 
they had remarked numerous sub pleural ecchymoses. 
These accidents always occur when too large 
doses of kairin are administered, and it is a medica- 
ment which causes the death of a dog when doses are 
given which equal one gramme per kilogramme of the 
weight of the animal. 
Kairin is then an antithermic substance, but one 
which acts by diminishing the respiratory power of the 
blood, and by destroying the haemoglobin. In some 
recent researches, Brouardel and Paul Loye have con- 
firmed this view, and have shown that thallin and 
kairin have a similar action—that of destroying the 
haemoglobin. Moreover, contrarily to what takes 
place in the case of the other antithermics, kairin and 
thallin have no action on the fermentations. 53 
Kairin then ought to be discarded from thera- 
peutics. It is a dangerous medicament, because it 
produces its antithermic effects by destroying the 
haemoglobin and by profoundly altering the blood— 
circumstances which should be especially avoided in 
the infectious febrile diseases. 
Thallin has many points of contact with kairin, 
belonging, like it, to the quinolin series. It is the 
tetrahydroparamethyloxyquinolin. I do not know 
what is the value of this chemical appellation, but 
protest against any such barbarous scientific nomencla- 
ture. The name of thallin (thallus—“a green brach”) 
was given to it by Skraup, its discoverer, by reason of 
the emerald-green color which it assumes under the 
influence of of iron. 
The sulphate and the tartrate of thallin are the 
salts in medicinal use. The sulphate is very soluble 
in boiling water, and in five times its weight of cold 
water. Thallin, as has been shown by Jacksch, of 
Vienna, lowers the temperature in the dose of from 
25 to 50 centigrammes, and this without provoking 
sweating.* Huchard has confirmed these facts, and I 
have myself been able to observe the antithermic ac- 
tion of thallin. Unhappily, thallin, like kairin, lowers 
the temperature not by acting on the thermic centres, 
but by diminishing the respiratory power of the blood 
and dissolving haemoglobin, and the researches of 
*Huchard, Sur un nouvel antipyretique: la thallin (Union 
M6dicale, No. 2, Jan. 3, 1885, p. 13). 54 
Brouardel and of Paul Loye seem to us demonstrative 
of this fact.* 
Thallin is the most powerful of antithermics, 
and we have seen Jaccoud, with doses of one gramme 
administered every half hour in divided doses during 
the 24 hours, obtain, in a tuberculous patient, a fever- 
fall of five degrees, so that the temperature of the 
patient was reduced to 32.40, and strenuous efforts 
were required to arouse him from the state of collapse 
into which he was plunged. It is necessary, then, to 
give it only in very small doses of not more than four 
grains. 
As in the case of kairin, it is to a chemist of 
Munich, Ludwig Knorr, that we owe the discovery of 
antipyrin, and, again, it was of Erlangen, 
who was the first to experiment with it. The chem- 
ists are not yet agreed as to the exact name which we 
ought to give to antipyrin. Some think that it should 
be called dimethyloxyquinizinj others, on the contrary, 
call it methylated oxymethylquinizin. 
Antipyrin presents itself under the form of a 
reddish-gray crystalline powder, very soluble in water, 
and with a slightly-bitter savor, which is not unpleas- 
ant to the taste. It may be given by the mouth, by 
clysters, or by hypodermic injections. When given 
by the mouth, it is in sweetened water, rendered 
* Dr. Rudolf von Jacksch, assislent der Medizinische 
Klinik in Wien, Thallin, ein neues antipyreticum (Wr. Med. 
Wochenschr., No. 48, 1884). aromatic by a little peppermint or lavender, that you 
can best prescribe this medicament. 
The physiological and toxic actions of antipyrin 
have been well studied in France and in foreign lands. 
In France it was Huchard who was one of the first to 
make known to us the therapeutic and toxic use of 
this substance, and you will find in the thesis of his 
pupil Arduin the principal facts resulting from this 
study.* 
Antipyrin is toxic, but it is much less so than 
resorcin, which again is less toxic than phenic acid; 
and while it takes less than one gramme of resorcin 
per kilogramme of weight to kill a hare, more than 
i Yz grammes of antipyrin is requisite to produce the 
same fatal effect. The symptoms of poisoning are, 
however, almost alike in both cases; these are of 
tetanic and paralytic character, exactly resembling 
those which characterize strychnine-poisoning. It is 
not, then, doubtful that antipyrin acts on the cerebro- 
spinal axis, and it is probable in modifying the ther- 
mogenetic centres that it depresses the temperature. 
This medicament has little action on the circula- 
tion. Some affirm that it augments the arterial ten- 
sion; others, on the contrary, that it lowers it; but 
everybody is agreed in recognizing the little influence 
that it has on the number of the pulsations. But, un- 
like kairin, it does not seem to modify the blood, and 
55 
*Arduin, Contribution a l’etude physiologique de l’anti- 
pyrin (These de Paris, Feb., 1885). 56 
in particular the haemoglobin. In fine, always, with 
reference to this action on the circulation, do not for- 
get to note the curious haemostatic effects which 
Henoque has attributed to antipyrin — a haemostatic 
action which seems to be superior to that of ergotin 
and perchloride of iron. It is well to remember this 
fact a propos of the treatment of certain hemorrhages, 
and in particular of haemoptysis. 
Antipyrin is eliminated by the kidneys, and this 
elimination is easily recognized by the aid of perchlo- 
ride of iron, which gives rise to a reddish-purple color 
in the urine. This medicine diminishes the urine; and 
I have been able to observe this diminution in a pa- 
tient affected with simple polydypsia, to whom I had 
administered it. It has also a notable action on the 
perspiration, which it augments, and this is ever a dis- 
advantage in administering antipyrin to tuberculous 
patients. In fine, I shall have finished what concerns 
the physiological action of antipyrin when I have 
stated that, like the phenols and oxyphenols, it is an 
antagonist of fermentation. 
In what dose should antipyrin be administered ? 
If we follow the precepts laid down by Filehne, we 
should thus give it: To an adult febricitate two 
grammes of antipyrin in one dose. This produces at 
once a fall in the pyrexia of one or two degrees; then 
at the end of four hours, at the moment when the tem- 
perature tends to regain its former height, you repeat 
the dose of two grammes, then, four hours after, when the fever again begins to rise, you give one gramme, 
and thus obtain a thermic depression which may last 
for 24 and even 48hours. This is the practice first 
followed in France, but we have had to abandon it in 
the case of tuberculosis by reason of the profuse 
sweating which this mode of treatment causes. 
Huchard has proposed to diminish the dose to 50 
centigrammes, which he would give only every other 
day. Darenberg gives much larger doses, even six 
grammes a day, to his tuberculous patients. But this 
question of dosage is entirely relative to the nature of 
the febrile process, and I ought, in this connection, to 
give you more precise information. The study of the 
new antithermics has, in fact, shown us that, accord- 
ing to the nature of the fever, the hyperthermia pre- 
sents a variable resistance to the same antipyretics; so 
that, with an equal temperature of forty degrees in a 
tuberculous patient and in a typhoid fever patient, 50 
centigrammes of antipyrin will cause a fall of tem- 
parture in the first, while in the second it will be 
without effect. 
However this may be, we may give antipyrin 
either in the period of apyrexia, or during the fever. 
In the first event, we prevent the return of the hyper- 
thermia; this is the practice which Darenberg has 
adopted, who gives to his tuberculous patients fifteen 
grains of antipyrin before the onset of the fever, i. e.} 
before the thermometer has attained 37.50 C.; then he 
gives another dose of 15 grains whenever, in the 
57 58 
course of an hour, the temperature rises more than 
three-tenths of a degree. 
The other method consists in giving antipyrin 
during the fever. Ordinarily it is at the end of half 
an hour that the fall is produced, a fall which is gen- 
erally preceded by a marked sudoral period. At the 
end of four hours, according to the febrile process, 
the temperature tends again to rise. Hence it is 
difficult to lay down precise rules for the administra- 
tion of this medicament, and it is necessary to de- 
pend strictly on the thermic curve, and whenever the 
thermometer tends to overpass certain limits, say 
38,39 and 40 degrees, give a new dose of antipyrin, 
which should vary, according to the intensity of the 
fever, from 7 to 15 grains. 
At the same time we can affirm with assurance 
that antipyrin may be given without any harm in frac- 
tional doses up to one one and a half and even two 
drachms in the twenty-four hours. 
Acetaniud (Antifebrin).—The introduction of acetan- 
ilid into therapeuti s is due to Cohn and Hepp, in 1886, who 
first made known its antithermic properties, and called it anti- 
febrin. Acetanilid is obtained by the action of glacial acetic 
acid on anilin. It is a substance of a beautiful pearly white 
color, of slightly pungent, not disagreeable, taste. Very crys- 
tallizable. It is but very slightly soluble in water. Its chem 
ical formula is C8H9NO. 
Cohn and Hepp were among the first to test this new 
antithermic in fevers, and in forty-five cases (typhoid fever, 
acute rheumatism, erysipelas, septicaemia, etc.) they found that doses of one-half to one gramme administered every hour till 
the effect sought was produced, rapidly brought down the tem- 
perature several degrees. The digestive system was never dis- 
turbed by the medicine. Since then the new antipyretic has 
been much tested in all parts of the world, and has been found 
to have effects much like those of antipyrin in about half the 
dose of the latter. It can hardly, however, be considered a 
safe antipyretic on account of the cyanoses which it sometimes 
provokes. 
In this country, the profession has had a large experi- 
ence with acetanilid as a febrifuge, and the verdict has gener- 
ally been in its favor as against antipyrin; it certainly does not 
deserve condemnation on the score of greater danger. More- 
over, acetanilid is not the product of a monopoly, and is cheap. 
Antipyrin is a patented medicine, and for that reason should 
be tabooed by the profession, if reliable substitutes not pat- 
ented can be found.—Trans. 
Phenacetin.—Discovered in 1887 by Kast and Huis- 
berg. The phenacetins are three in number,—Orlhophenacelin, 
melaphenacetin, and paraphenacetin. The general formula is 
as follows: C10H13N.O2. Orthophenacetin and paraphenace- 
tin are medicinal. 
Phenacetin, like antifebrin and antipyrin, is both anti- 
pyretic and analgesic. In five grain hourly doses, like ace- 
tanilid, it has been found to produce decided antithermic 
effects in five patients, the temperature in the course of two or 
three hours falling two or three degrees. No toxic effects have 
been noted in connection with its medicinal uses. Like the 
other antipyretics when given in fevers, it in no way influences 
the course of the disease. 
Phenacetin insoluble in ordinary menstrua, is most’ con- 
veniently given in tablets or capsules. From extensive trials, 
it would seem to be as gqod an antipyretic as antipyrin; it 
is safer; the dose is one-half less; more expensive than acetan- 
59 60 
lid, it is less so than antipyrin. Thus far the sale of phenacetin 
is controlled by a patent, a fact to be deplored.—Trans. 
Chloralamid.—Chloralamid or chloral-formamid, is a 
synthetical product derived from chloral anhydrid and forma- 
mide; it forms colorless crystals, and is said to be soluble in 
9 parts of water and 1% parts of alcohol. The taste is mild, 
slightly bitter but not astringent. It is incompatible with 
alkaline solutions. 
Paterson was one of the first to introduce this new drug 
to the profession as a hypnotic of considerable power. He 
gave it in 14 cases of insomnia, including simple sleepless- 
ness, and that resulting from phthisis, heart disease, enteric 
fever, etc. The doses ranged from 15 to 45 grains disolved in 
warm water with the aid of a little alcohol. The sleep was 
generally sound and refreshing, with few or no unpleasant 
after effects. It is especially in the insomnia of phthisis that 
its influence was found satisfactory. It also had a favorable 
effect in checking excessive night sweating. It was found not 
incompatible with organic heart disease. Doses of 40 to 50 
grains have sometimes produced some giddiness and stomach 
sickness. Pharmacists sell this new drug in five and ten grain 
tablets.—Trans. 
Amylen Hydrate.—Still another new hypnotic has 
lately been introduced to the profession by Prof. Von Mehring. 
This substance which goes by the name of Amylen hydrate be- 
longs to the group of the tertiary alcohols. It was discovered 
by Wartz, and is a complex product of the laboratory. It is a 
clear colorless liquid with a penetrating odor resembling cam- 
phor, oil of peppermint and paraldehyd. Von Mehring’s first 
observations were made on sixty different individuals, in doses 
varying from 3 to 5 grammes. The affections in which he 
employed it were of the most varied character,—sleeplessness 
from nervousness, in delirium tremens, phthisis, and in conva- 
lescence from various acute diseases. It generally proved 61 
very efficacious. Like chloral, it proved unreliable in sleep- 
lessness'due to pain. 
It is said to be free from danger, and is more pleasant 
than either chloral or paraldehyd, though weaker as a 
hypnotic than chloral. It does not depress the heart or re- 
spiratory centres, as chloral does. Since Von Mehring’s ob- 
servations, this new drug has come quite extensively into use. 
A safe commencing dose is half a drachm,—Trans.] 
Now that you are acquainted with these different 
therapeutic agents, I shall, in the next lecture, set 
for the benefits and advantages which you may de- 
rive from these different medicinal agents. CHAPTER XII. 
INDICATIONS FOR ANTITHERMIC MEDICATION. 
Gentlemen: Fever, as we have said, is charac- 
terized by an augmention of the pulse and tempera- 
ture, and we have proved both of these phenomena 
to be due to an increase of the combustions of the 
economy. Is this hyperthermia attended with danger, 
and is it necessary to endeavor to bring back the in- 
ordinately high temperature to a lower figure ? First 
of all, you must be aware that to reduce the tempera- 
ture and to combat the hyperthermia is not to annihi- 
late the fever, nor even to reach the cause which has 
provoked it. To depress the temperature of a man 
affected with pneumonia is not to cure the pneumonia. 
To cause typhoid fever so to undergo evolution that 
the temperature shall never rise above 38° C. (ioo° 
F.), and to maintain the heat-curve on a horizontal 
line—-which is quite possible at the present day, thanks 
to the antipyretics of which I have spoken, is not to 
cure the fever; and this is so true that it is a fact that 
by the employment of the antithermic medication we 
do not diminish by one day or one hour the duration 
of the febrile malady. The antithermic medication, 
then, influences only one of the elements of the fever. 
I share in this regard the views of my colleague 
and friend, Dr. Huchard, who has said that in clinical 
practice we ought to have no antithermic medicaments, 63 
but rather such as are anti-hyperthermic, meaning by 
these words that it is only against the excessive eleva- 
tion of the temperature, and not against the fever, 
and the determining cause of the latter, that we 
should make use of the medicaments whose history I 
have traced for you. 
Has the hyperthermia, then, any danger by itself ? 
Here there have been adduced, in order clearly to set 
forth the dangers of hyperthermia, three orders of 
proofs; the first derived from observation of the fever 
itself, the second from pathological anatomy, the third 
from physiological experimentation. 
i. As tor the proofs derived from observation 
of the fever itself, the German school has maintained 
that it is to the elevation of the temperature that are 
to be referred on the one hand the augmentation of 
the pulse and the increased frequency of the respira- 
tions, and on the other, the aggravation in the general 
symptoms and the delirium; that, in a word, all the 
grave symptoms of the disease result from the sole 
fact of the hyperthermia. To give a more certain 
proof of this affirmation, the German physicians have 
pretended that it is sufficient to bring down the tem- 
perature to cause all these grave symptoms to disap- 
pear. There is here, it must be admitted, an evident 
overstatement; and it seems to me difficult in clinical 
practice thus to separate the hyperthermia from the 
other grave symptoms which accompany it. All these 
phenomena constitute a complete syndrome which 64 
affirms the gravity of the disease; and if the state of 
the forces is enfeebled, if delirious manifestations 
supervene, it is not only because the temperature is 
raised, but also because the general condition is 
aggravated. 
Take a case of infectious pneumonia. You can 
artificially depress the temperature, but you cannot 
by that diminish the gravity of the disease, and the 
patient may even succumb with a temperature almost 
normal. Observe how it is in typhoid fever; you will 
see patients who bear their disease very well with 
temperatures elevated to 40° C. or above, and this 
without delirium; others, on the contrary, present an 
ataxo-adynamic state of the greatest gravity, with de- 
pression of the forces, despite a temperature very 
little above the normal. 
Even when we interfere with our antithermic 
medicaments, we obtain a fall of the temperature, it 
is true; but as we combat only one element of the 
disease, we do not cause disappearance of the latter, 
which, according to the type, remains grave or benign. 
I am well aware that in speaking thus I am setting 
myself against the views of Brandt and his school, 
which assert that by employing the method of cold 
baths from the commencement of the hyperthermia 
you will reduce all forms of typhoid fever to a similar 
benign type. Now that we possess antipyrin, which 
is much more powerful than cold baths to reduce the 
temperature, we shall be in condition certainly to de- 65 
termine if the statement of the physician of Stettin 
is correct; but what I can affirm, as a conclusion from 
the few cases of typhoid fever which I have already 
treated with antipyrin, is that, while lowering the 
temperature, this medicament has no influence on the 
march of the disease. 
So then, from a clinical point of view, the hyper- 
thermia is not the sole element of the fever, and it is 
not correct to say that it holds under its dependence 
the other grave manifestations. 
2. Let us see if the anatomical proofs are more 
convincing. 
Liebermeister and his school have taught that 
the febrile hyperthermia entails grave lesions in the 
economy which affect the liver, the kidneys, and in 
particular the heart and the muscles. These last 
lesions, as you well know, have a marked importance; 
it is, in fact, certain that those curious alterations 
described by Zenk, which pertain especially to the 
respiratory muscles, as well as the cardiac degenera- 
tions, are a frequent cause of death in typhoid pa- 
tients, but are they indeed the result of elevated tem- 
peratures ? If it were so, you would understand the 
importance of actively interfering to combat the ele- 
vation of temperature. Unfortunately, there is 
nothing demonstrative in this respect. 
Prof. Hayem, in his interesting researches on 
the symptomatic myosites,* has shown that it is 
* Hayem, Arch, de Phys., Paris, 1870. 66 
especially in the febrile infectious diseases that these 
profound disorders of the nutrition of the muscular 
fibres are produced, and that in these anatomical 
modifications the general empoisonment of the 
economy plays a more considerable part than the 
hyperthermia. One may even go further to-day, I 
believe, and say that the proto-organisms (microbes), 
which constitute the very essence of these diseases, 
must be the principal efficient cause of the sympto- 
matic myosites. 
Vallin has, however, shown us by direct proof, 
that in an individual suffering from typhoid fever of 
apyretic form, and whose temperature never exceeded 
37.6° C., there existed a very extensive vitreous 
degeneration, with ruptures and haemorrhages of the 
muscles of the abdomen and thigh, showing conclu- 
sively that there are grave typhoid fevers which are 
almost apyretic. As you then see, the anatomical 
proofs are not more demonstrative than the clinical 
proofs. Let us now examine the evidence which 
physiological experimentation has to offer. This 
evidence seems at first sight to be convincing. 
3. Physiologists have shown that when by artifi- 
cial means you raise the temperature of the animal, 
death supervenes when the temperature exceeds by 
four or five degrees the normal figure. Claude 
Bernard, in his celebrated experiments made on 
different animals, has shown that death takes place in 
the bird when the temperature attains 48° to 50° C.; 67 
in mammals when it reaches 38° to 40° C.; and in 
cold-blooded animals when the thermometer indicates 
370 to 40° C. The toxic scene is almost always the 
same in animals; that is to say, you see the circulation 
and respiration accelerated, convulsions supervene, 
and the animal dies suddenly, with an outcry. 
Vallin, who has studied experimentally the phe- 
nomena of insolation, has divided into three periods 
the characteristic symptoms. In the first there is 
acceleration of the circulation and respiration; in the 
second period the respiration becomes retarded and 
sighing, and there is prostration; the third period is 
characterized by convulsions, coma, and death. 
The post-mortem appearances in animals which 
have thus succumbed to artificial augmentation of 
heat are characterized by the early supervention of 
cadaveric rigidity, by the loss of electric excitability 
on the part of the muscles of the economy, and, lastly, 
by the black and tarry aspect of the blood, which 
loses almost all its oxygen. 
Such are the results of experimentation. Are 
they completely applicable to the human subject? I 
do not think so. There is in fact a very great differ- 
ence between the fever patient whose temperature is 
augmented by the acceleration of the combustions of 
the economy and the animal whose temperature has 
been raised artificially. Recall to mind what I said 
to you in a recent lecture a propos of the theories of 
fever relative to the regulation of the temperature. 68 
Liebermeister has well shown that the very essence 
of the febrile process is the regulation of the tempera- 
ture of the body by a standard more elevated than 
the normal; nothing like this takes places in experi- 
mentation on animals, and as our colleague Peter 
lately very cleverly said, Claude Bernard in his cele- 
brated experiment on pigeons* performed a cooking 
experiment rather than one in experimental physio- 
logy, since he really heated his pigeon up to the 
roasting-point. It will not do, then, I repeat, to de- 
duce from these experiments conclusions applicable 
to the febrile process, and they ought to be exclu- 
sively applied to the explanation of insolation, coup 
de soleil. 
You see, then, that if hyperthermia is a grave 
symptom in the course of febrile affections, it would 
be a mistake to believe that in bringing back the 
temperature to the normal, you cause all the unto- 
ward symptoms to disappear. Nevertheless, this 
hyperthermia ought to engage your attention like all 
the other symptoms accompanying the febrile process, 
and just as we endeavor to raise the state of the 
general forces, it is our duty, when the temperature 
overpasses a certain level, to bring it down to a lower 
figure; and taken in this acceptation, the antithermic 
medication ought to find a place by the side of calma- 
tive and tonic modes of treatment which we employ 
in the clinical management of pyrexias. 
* Claude Bernard, La Chaleur Animale, Paris, 1874. 69 
Within certain limits the divers fevers respond 
differently to the different antithermic medicaments, 
and this is one of the most interesting points in the 
history of antipyretic medication, insomuch that of 
four individuals having a temperature up to 40° C., 
and who, if you were to judge by the sole inspection 
of the temperature, were having the same kind of 
fever, but one of whom is affected with intermittent 
fever, another with acute rheumatism, the third with 
the hectic fever of tuberculosis, the fourth with 
typhoid fever, none of these patients would experi- 
ence just the same effects from the same antithermic 
medicines. In the case of the first, it is sulphate of 
quinine which would act the most effectively; in that 
of the second, it is salicylate of sodium which should 
be employed; in that of the third, antipyrin in small 
doses will give the best results (such doses, for in- 
stance, as 7 to 15 grains a day), while, on the other 
hand, these small doses will be insufficient to reduce 
the temperature in our fourth patient affected with 
typhoid fever, and to bring down the pyrexia in this 
patient, we shall have to give much larger doses. 
This is a very important point, on which I cannot too 
much insist, and which shows the specialization of the 
different antithermics whose history I have traced. 
As for antipyrin, its elective action is seen 
particularly in the fever of tuberculosis, and we have 
here a result which is very remarkable, for up to the 
time of the discovery of this medicament we were 70 
almost impotent against this hectic fever. Sulphate 
of quinine, even in doses of 12 to 15 grains, scarcely 
reduces this fever, while producing phenomena of 
cerebral excitation, and this is why Jaccoud proposed 
to substitute it for salicylic acid. The disadvantages 
of the latter medicine are considerable, for in large 
doses it produces, like quinine, vertigo and cerebral 
complications, while in small doses its effect is almost 
nil. 
Antipyrin moreover, when given in the doses 
indicated by Filehne, namely, 75 grains in three 
doses—30 grains at first, then two hours after, 30 
grains, then after two hours 15 grains — has the 
inconvenience of determining profuse sweats which 
exhaust the patient. But now that we employ the 
method laid down by Huchard, namely, to give only 8 
grains every day, or every two days, we derive from 
this medication a real benefit. The patient does not 
experience that poignant heat of the skin which char- 
acterizes the larger doses, his sleep is better, his sweats 
are lessened, and the antithermic medication coupled 
with superalimentation, and with medicaments which 
modify the expectoration, enables the patient to live 
longer and to struggle to some advantage against his 
disease, even if the case be incurable. 
Daremberg nevertheless employs a different 
method in the administration of antipyrin. He gives 
it especially in the apyretic period, and he exhibits it 
not to combat a febrile paroxysm already existing, 71 
but to prevent one from coming on. He administers 
as much as 90 grains of antipyrin a day in fractional 
doses of 15 grains. He affirms that by this means he 
not only absolutely arrests the fever, but also avoids 
the depressant and sudorific effect of the medicine.* 
Antipyrin is also applicable in those ephemeral 
fevers, often so intense, which accompany amygdalitis, 
or quinsy. You are all familiar with this febrile state, 
which is sometimes so grave and alarming. The skin 
is burning hot, and the temperature sometimes exceeds 
40° C- There is agitation and even delirium, and as 
local signs you notice nothing but a little redness in 
the fauces. Here also antipyrin will give you good 
results. It brings down the temperature, and by the 
perspiration which it produces, it alleviates the dry- 
ness of the skin. 
In pneumonia you can also make use of antipy- 
rin when the temperature becomes too high. In fine, 
among the eruptive fevers I will mention scarlet 
fever as a disease where the powerful antithermic 
action of this medicament will find its indications in 
the anomalous and hyperpyrexial forms. 
As for quinine, it will remain the antithermic 
medicament par excellence of morbid periodicity; for 
despite the action so marked and powerful of the new 
antithermics, they seem to have only an uncertain 
* Daremberg, on Antipyrine in the Fever of tuberculosis. 
(Bull, de Ther., July 30, 1885). 72 
effect in intermittent fever. There have, indeed, been 
several trials made of late with resorcin and quinolin, 
but notwithstanding the favorable results obtained, 
especially with the latter medicament, quinine still 
remains the most powerful remedy against fever and 
ague. 
As for the fevers of rheumatic nature, it is salicy- 
lic acid, or rather salicylate of sodium, which you 
should employ. Here the medicament has not only 
an antithermic action, but also an analgesic action of 
the most marked kind, and constitutes a real specific 
medication in acute articular rheumatism. Bernheim 
of Nancy has indeed maintained that antipyrin gives 
the same results as the salicylic medication in acute 
articular rheumatism, but the few trials which we have 
made in our hospital with antipyrin in rheumatism 
have not confirmed the statements of the professor of 
Nancy; and while we have obtained quite favorable 
results from this remedy, they are nevertheless inferior 
to those obtained from salicylate of sodium. 
Perhaps we should make an exception in the case 
of rheumatism of hyperpyretical type, or cerebral 
rheumatism, where possibly thallin, which proves so 
powerful in small doses, may be indicated. As for 
typhoid fever, J recognize the fact that the new anti- 
thermics, while enabling us to bring back the temper- 
ature to the normal, do not modify the march of the 
disease, and in very many cases wThere we have em- 
ployed antipyrin in the treatment of typhoid fever 73 
we have indeed depressed the temperature, but as 
soon as we left off the administration of the medi- 
cament the hyperthermia reappeared with a new 
intensity, and the grave forms continued grave. 
For my part, till something better is found, I 
prefer baths in typhoid fever to all these medicaments. 
I do not, indeed, mean cold baths, after the method 
of Brandt, but tepid baths. I have for more than ten 
years extolled the advantages of these baths over cold 
baths, and my opinion is every day being confirmed. 
I administer these baths at a temperature of between 
350 to 36° C. (950 to 970 F.), so that there shall be at 
least three degrees of difference between the temper- 
ature of the patient and that of the bath, and I prolong 
the, bath half an hour, three-quarters of an hour, 
according to the strength of the patient, which I sup- 
port by giving at the same time alcoholic stimulants 
and broth. 
I obtain from these baths thus administered a 
triple effect: They keep the skin cleansed; they cause 
an abatement of the nervous symptoms, producing 
repose and calm; and they have an undoubted anti- 
thermic action. 
The application of new antithermics to typhoid 
fever well shows that the fever is not the only enemy, 
and that in reducing the temperature alone you only 
attack the disease in one of its phases; and that if, in 
my opinion, the cold baths, and, better still, warm 
baths, are preferable, k is because their effects are 74 
complex, and are addressed rather to the troubles of 
the nervous system than to the hyperthermia. 
Such are the considerations which I desired to 
present to you respecting the antithermic medication. 
In the next lecture I shall show you the progress 
which therapeutics has made in calming and removing 
pain; in other words, I shall set forth the new anaes- 
thetic and hypnotic medications. CHAPTER XIII. 
ON THE NEW HYPNOTICS. 
Gentlemen: “It is a divine work to relieve 
pain,” says Hippocrates; and, in accordance with this 
verity, the efforts of physicians have in all ages been 
put forth to mitigate the sufferings incident to the 
diseases of humanity. This is often the chief duty of 
the medical man as he finds himself in the presence 
of a fatal malady. 
To-day the means for alleviating pain may be 
divided iuto four great groups: x, Hypnotics, which 
produce sleep, and thus bring the desired repose and 
calm: 2, Analgesics, which are addressed principally 
to the element of pain: 3, Anaesthetics, which extin- 
guish sensibility, in whole or in part: 4, In the last 
group are placed medicaments which diminish the 
excitation of the nervous system, and which have 
been of old described under the name of sedatives and 
antispasmodics. 
Each of these groups has received precious addi- 
tions the past few years, and I propose now to devote 
my attention to the study of the first, namely, the new 
hypnotics. 
Hypnotics (from V7rrooo, I sleep) are medicines 
which produce sleep; and in order that the way these 
substances act may be understood, I shall briefly sum 
up the physiological phenomena which take place 
during sleep. 76 
Many theories have been put forth as to the 
physiology of sleep, but at the present day most 
physiologist are agreed that the proximate condition 
of sleep is a diminution in the cerebral circulation—a 
real transient anemia of the brain. It is well known, 
since the researches of Quetelet, and especially of 
Milne-Edwards, whose recent loss science deplores, 
that the general circulation is retarded during sleep, 
that the number of pulsations is reduced, and that 
the combustions of the economy are slowed. The 
cerebrum participates in this diminution of the circu- 
lation, and we have a certain proof of this in the 
various experiments made by Hammond and Durham, 
according to which, in dogs whose crania had been 
trephined, examination of the brain during sleep re- 
vealed a considerable diminution of the intracranial 
circulation. 
These facts were confirmed in 1877 by Salathe, 
who showed, in his thesis on the movements of the 
brain, that during sleep there is a notable lessening 
of the cerebral expansion—an expansion which you 
well know is in direct relation with the arterial irriga- 
tion of the encephalon. Finally, these facts have 
been verified by the remarkable experiments of Mosso. 
This physiologist has been able, in the case of a 
woman whose cranium had in part been destroyed by 
syphilitic necrosis, to register the expansive move- 
ments of the brain, and his researches have demon- 
strated these two important facts: That every intel- 77 
lectual effort augments the circulatory activity of the 
brain, and that it is during sleep that these movements 
of expansion attain their minimum. 
Hence, then, every medicament which has for its 
effect slowing of the cerebral circulation may become 
a hypnotic, while, on the contrary, medicaments which 
congest the encephalon cannot be ranked in this cate- 
gory. It is understood that in the hypothesis which 
I have invoked to explain sleep, the anaemia and the 
congestion of the cetebrum must not exceed certain 
limits, for when the cerebral anaemia is extreme it 
produces convulsive paralytic phenomena; and on the 
other hand, when the congestion is too intense, there 
supervenes a state of sopor which simulates natural 
sleep. 
But, it may be asked, what are you going to do 
with opium and its alkaloids, which are known to be 
provocative of cerebral hyperaemia; are they not hyp- 
notics ? I reply without hesitation, that I consider 
opium much more an analgesic and stimulant than 
hypnotic. In my opinion, opium does not cause sleep, 
despite the virtus dormitiva imputed to it by the medi- 
cal undergraduate in the immortal comedy of “ Malade 
Imaginaire.” I know that in affirming this view I 
oppose traditional beliefs, but the more I study this 
question of opium, the more I am disposed to main- 
tain my opinion. 
Opium and morphine taken in therapeutic doses 
do not determine true sleep; they produce a special 78 
state of drowsiness, of reverie, and even of beatitude, 
but during which the cerebral functions, powerfully 
excited by the congestion determined by the opiate, 
continue to be active, and often in an extraordinary 
degree. These properties of cerebral excitation invest 
this drug with a powerful charm, and constitute the 
main motive to that modern vice described under the 
name of morphinomania. I appeal in this connection 
to all who have ever made use of opium, and it will 
be found that the greater number will testify that they 
have found in this drug not a sleep-producer, but a 
potent calmer, under whose influence every painful 
consciousness is allayed. 
Two new medicaments deserve especially to be 
studied among the hypnotics—chloral and paralde- 
hyd. I shall be brief respecting the first of these 
substances, for we are all now quite familiar with that 
admirable medicament which Liebreich introduced 
into therapeutics in 1869; to-day it is by the thousands 
of kilogrammes that chloral is used. I must, how- 
ever, call attention to the fact that this drug is an 
irritant, and in 1871, during my researches with 
Herne, which enabled us to affirm the antiseptic pro- 
perties of chloral, we had a good deal to say about 
the caustic action of this body. It is not, then, sur- 
prising to encounter in persons who make an abuse of 
chloral (for there are chloralics as well as alcoholics) 
gastric troubles precisely similar to those determined 
by the alcohols. 79 
It is, then, always necessary to dissolve chloral in 
a great quantity of menstruum, and I have generally 
been accustomed to order this medicine in egg and 
milk emulsion. Despite these precautions, chloral is 
often badly supported; in this event, I recommend its 
introduction by the rectum, and have found it well 
tolerated when given in the form of enema, the dose 
of the hypnotic being rubbed up with a small cup of 
egg and milk. As for the administration of chloral 
by the hypodermic method, this mode ought to be 
reserved for cases of extreme urgency, such as strych- 
nine-poisoning and puerperal convulsions, for the 
irritant action of these injections frequently deter- 
mines eschars more or less extensive. 
Many have been the hypotheses framed to explain 
the action of chloral; some authorities basing them- 
selves on such experiments as those of Personne, who 
found chloroform in the blood of chloralized animals, 
have maintained that it is by being decomposed into 
chloroform and formic acid that chloral acts. Others, 
on the contrary, have asserted that it exerts its power 
by properties of its own, not by the products of its 
decomposition. I quite agree with this view, and 
have no doubt that it is by acting directly as chloral on 
the nervous elements of the brain and spinal cord that 
this drug determines its hypnotic and anaesthetic phe- 
nomena, and I invoke in support of this opinion the 
experiments which I performed a dozen years ago, 
and which I now reproduce before you. 80 
You see before you a hare, under whose skin 
we will now inject a solution containing 45 grains of 
chloral. The animal, after uttering several outcries 
determined by the local caustic action of the solution, 
falls rapidly into a state of anaesthesia, absolutely 
similar to that caused by chloroform, and this con- 
dition lasts till the chloral ceases to be eliminated by 
the urine unchanged. How are we to explain the 
speedy total anaesthesia of this animal, if the theory 
of the breaking up of the chloral into formic acid and 
chloroform is adopted, a decomposition which re- 
quires a long time for its accomplishment, and which 
produces so feeble a liberation of chloroform that any- 
thing like profound anaesthesia would be impossible 
with such doses? But, while acting in the form of 
unchanged chloral on the nervous elements, this sub- 
stance has the same action as chloroform—that is 
to say, it produces anaemia of the brain. In this 
regard the experiments of Hammond are absolutely 
demonstrative. Chloral, then, must be classed among 
the true hypnotics— that is to say, among the medica- 
tions which produce sleep by anaemiating the cerebro- 
spinal axis. 
But by the side of these hypnotic properties it 
will not do to forget that chloral has an action on the 
heart, and, as Gubler has said, it is a cardiac poison 
in large doses, and in chloralized animals the heart is 
found in diastole. These three chief effects of 
chloral; its property of decongesting the cerebro-spinal 81 
axis,which renders it hypnotic, its action on the heart, 
and, lastly, its irritant effects on the stomach, ought 
to serve, as our guide in the therapeutic application of 
this admirable medicament. In all the pyrexias of 
congestive form chloral will prove itself superior to 
opium as a sleep-producer; also in typhoid fever, in 
pneumonia, in alcoholic delirium, it is to chloral that 
we should resort to calm the agitation of our patients. 
In cases of rebellious insomnia in neuropathic patients, 
chloral is the hypnotic to choose. On the other hand, 
chloral should be interdicted to persons suffering from 
cardiac affections, and in particular to those that have 
aortic stenosis or insufficiency; here opium is far 
superior. We should also refrain from prescribing 
chloral for patients affected with stomach disorders, 
for its irritant local action singularly aggravates the 
dyspepsias, especially those of irritative form. Finally, 
in diseases of the larynx and pharynx, the administra- 
tion of chloral by the mouth becomes very difficult, by 
reason of the sensation of burning in the back of the 
throat which attends the swallowing of the potion. But 
here again we can employ the enema of chloral, which 
is one of the best modes of introduction of this medic’ 
ament. 
Chloral, again, proves a good medicament in cer- 
tain forms of poisoning, especially in strychnine- 
poisoning, delirium tremens, and the uraemic poison- 
ing of eclamptic form. In all these maladies it gives 
good results, but inferior, nevertheless, to those ob- tained by paraldehyd, of which I am now going to 
speak. 
The aldehydes, taken in their aggregate, consti- 
tute to-day a special group of considerable size, to the 
study of which my colleague and friend, Dr. Bourgoin, 
has devoted an entire volume.* They are, as we all 
know, dehydrogenated alcohols, or, better still, the 
hydrides of alcoholic acid radicals. We shall here 
occupy ourselves only with ethylaldehyd, or, as it has 
been called, acetic aldehyd, or, better still, hydride 
of acetyl, having for its formula C8H40, the formula 
of ethyl alcohol being CaHgO. 
Paraldehyd is a body which is constituted by the 
union of three atoms of aldehyd, and has for its 
formula C6Hia03, or, preferably, 3 (C3H40). Paralde- 
hyd, when kept at a temperature of io° C., is a solid 
crystalline body, which melts above the temperature 
just given. This fusion-point enables us to distinguish 
the pure paraldehydes from those that are not pure. 
In commerce two kinds of paraldehydes are to be 
found—the one liquid at o°, the other solid at io° C. 
It is to this last alone that the name of pure paralde- 
hyd belongs.* This paraldehyd pure, is soluble in 
alcohol and in water; ten parts of water dissolve one 
part of paraldehyd, and this degree of solubility en- 
ables us to formulate the different preparations of 
which I am going to speak, and among which I shall 
82 
* Bourgoin, Des Aldehydes (Encyclop. Chemique, 1885). 83 
signalize here especially two formulas which have 
been proposed by Yvon, the one a potion, the other 
an elixir. The potion is as follows: 
Paraldehyd, 2 grammes ( 3 ss); 
Linden [or camphor] water, 70 grammes (1 ii and 
3 iiss); 
Tincture of vanilla, gtt. xx; 
Syrup of wild cherry, 30 grammes ( § i). 
M. 
The formula of the elixir is as follows: 
Paraldehyd, 10 grammes ( 3 iiss); 
Alcohol at 90°, 48 grammes (§ i and 3 ivss); 
Tincture of vanilla, 2 grammes ( 3 ss); 
Water, 30 grammes (§i); 
Simple syrup, 60 grammes (1 ii). 
M. 
A tablespoonful of this elixir contains one gramme 
(15 grains) of paraldehyd. The potion may be given 
in the same dose. In my own practice I generally 
use the following formula, which is the same as that 
of solutions of iodide and bromide of potassium: 
Paraldehyd 15 parts (or 3 iij). 
Water, 350 parts (or § vi). 
Each tablespoonful contains one gramme of par- 
aldehyd, and I give the solution with some kind of 
liquor—rum, whiskey, or kirsch. Paraldehyd has a 
quite special disagreeable odor, which resembles 
the smell of a tippler’s breath; and it is by mixing it 
* Yvon. 84 
with alcoholic liquors of pronounced taste (like kirsch 
or rum) that you best get rid of this taste and odor. 
Dr. Desnos makes use of mucilage of gum sweetened 
with gooseberry syrup for vehicle. 
Paraldehyd has also been given in the form of 
enema, especially in insane asylums, and Keraval and 
Nerkam have employed the following formula: 
5 Paraldehyd, 2 grammes ( 3 ss); 
Yelk of one egg; 
Infusion of marshmallows, 120 grammes (§ iv) 
M. 
These physicians claim that enemata of paralde- 
hyd are superior to enemata of chloral, and accord- 
ing to them the active dose by enema would appear 
to be one-half less than by mouth. These same 
practitioners have employed paraldehyd in subcu- 
taneous injections (always in insane patients). Their 
formula is as follows: 
3 Paraldehyd, 1 part; 
Cherry-laurel water, 1 part; 
Distilled water, 3 parts. 
M. 
Each gramme of this solution represents 2» 
centigrammes (3 grains) of paraldehyd. These in- 
jections, according to their statement, have always 
been safe, though very painful. The experiments 
which I have made with paraldehyd in subcu- 
taneous injections have almost always determined in 
my patients not only pain, but inflammatory indura- 85 
tions, and even abscesses. I think, therefore, that 
we ought absolutely to banish from therapeutics sub- 
cutaneous injections of paraldehyd. 
In what dose should paraldehyd be administered? 
Ordinarily we may obtain the desired effect by giving 
from two to three grammes, and this in one dose. But, 
before going further, it is necessary to know the phys- 
iological action of this substance. 
In 1878, in our experimental researches under- 
taken to ascertain the toxic power of the alcohols (I 
allude to the labors of Audige and myself), we took 
care not to omit the aldehydes; and resuming the ex- 
periments already made by Lussana and Albertoni in 
1874, we showed that in the dog we could cause death 
with extreme rapidity when we introduced under the 
skin of this animal from r.6o gramme to 2 grammes 
of paraldehyd per kilogramme of the weight of the 
body, and that in less doses we produced a very 
speedy and profound intoxication; and therefore we 
have assigned to paraldehyd an important part in the 
poisoning produced by badly rectified or impure alco- 
hols, which contain always notable quantities of this 
substance. 
Since the introduction of paraldehyd I have de- 
sired to take up anew this study, and see if any useful 
therapeutic applications could be derived from it. 
Acetic aldehyd cannot be employed of itself. This 
substance is so volatile that when you introduce a 
teaspoonful of it into the mouth it immediately be- 86 
comes vaporized and cannot be swallowed. I then 
undertook to employ a solid and stable combination 
of aldehyd, the aldehydate of ammonia, a crystalline 
and perfectly soluble body; but the aldehydate of am- 
monia is irritant and caustic, and when injected under 
the skin or introduced by the mouth it produces by 
its causticity such disorders that it cannot be em- 
ployed. 
Paraldehyd was introduced into therapeutics by 
Cervello in 1883; then appeared successively the 
labors of Albertoni and of Morselli in Italy, of Gugl 
and of Peretti in Germany, of Masius in Belgium, 
and, finally, my own studies in this country; and you 
will find in the remarkable thesis of my pupil, Dr. 
Coudray, defended April 25, 1884, the principal con- 
clusions at which we arrived. Still more recently our 
colleague and friend, Dr. Desnos, has communicated 
to the Academy of Medicine the results of his experi- 
ments.* 
*Cervello, Paraldeide come antagonista della Stricnina 
(Arch, per le Scienze Mediche, t. vii. 6); Ueber die physiolog- 
ische Wirkung des Paraldehyds und Beitrag zu den studien 
ueber das Cnloralhydrat (Arch. f. experim. Pathol, und Phar, 
macologie, t. xvi. cah. 3 et 4); Sull’aziohe fisiologieca della 
Paraldeide contributo alio studio del Cloralio idrato (Arch, per 
le Scienze raediche, t. vi., No. 12). Albertoni, Archives 
italiennes de biologie, t. iii, fasc. 2. Morselli, Irrenfreund, t, 
xxvi. 3, 1883. Bergesio, Rivista sperimentale di freniatria e 
di medicina legale 3e fascicule, 1882. Peretti, Ueber die 
schlafmachende Wirkung des Paraldehyds (Berl. Klin. Woch- 87 
We experimented with paraldehyd on different 
animals—frogs, hares, guinea-pigs, and dogs—intro- 
ducing the toxic agent under the skin. When in the 
dog the dose of 2 grammes per kilogramme is attained, 
death is rapidly caused, with complete anaesthesia and 
loss of all the reflexes; and if the phenomena which 
manifests themselves are attentively observed, it will be 
seen that paraldehyd affects successively the cere- 
brum, the spinal cord, and the bulbus. This loss of 
the reflexes produces a double action on the circula- 
tion and on the respiration; there is a retardation 
in movements of the heart and diminution in the 
arterial tension, as well as in the respiratory move- 
ments. Paraldehyd, then, produces effects similar 
to chloral and chloroform, which cause sleep and 
anaesthesia by anaemiating the cerebro-spinal axis. It 
is, then, a hypnotic in the true sense of the word. 
The sleep determined by paraldehyd is very like that 
produced by chloral; it is generally calm, but in many 
cases it is preceded by a period of excitation or 
agitation resembling alcoholic intoxication. 
enschrift, No. 40, 1883). Gugl, Ueber Paraldehyds als schlaf- 
mittel (Zeitschrift f. Therapie, 1883, ier aout) Berger, 
Breslauer aertzl. Zeitschr., t. v. 6, 1883. John Brown, On the 
Therapeutic and Hypnotic Employment of Paraldehyd (Brit. 
Med. Journ., May 19, p. 956, 1883). Langreuter, Arch. f. 
Psych. Nervenkrankheiten, xv. fasc. 1. Coudray, De la 
paraldehyd (These de Paris, 1884). Desnos, De la paral- 
deoyd (Bull, de ther., t. cix., 1885, p. 52). 88 
To return to the physiological action. Despite 
the affirmation of Quinquaud and of Henocque, who 
have maintained that paraldehyd acts on the haemo- 
globin, causing the production of methaemoglobin, the 
experiments of Hayem tend to show that this view is 
erroneous, and that paraldehyd has little or no action 
on the coloring principle of the blood-globules. 
But there is one point pertaining to these physi- 
ological studies which is exceedingly interesting, and 
which has been put in clear light by the Italian 
experimentors, and confirmed by the experiments of 
Coudray. I refer to the antagonism which exists be- 
tween strychnine and paraldehyd. The experiment 
which I am going to peform before you will enable 
you to understand this antagonism. 
You see before you two hares. In one of them 
we inject 2 grammes of paraldehyd into the cellular 
tissue, the other receives none. A little strychnine is 
now introduced in the same way. The hare is ex- 
tremely sensitive to this poison, and 1-300 of a grain 
is sufficient to cause death. Under the skin of the 
hare which has received no paraldehyd 1-60 grain 
of strychnine is now injected. This animal immedi- 
ately falls into the tetanic convulsions which charac- 
terize this species of poisoning, and shortly succumbs. 
In the hare that was dosed with paraldehyd, 1-12 of 
a grain is now injected (we may even go so far as 
one-tenth without causing death). You see that no 
serious results follow, proving that the hare that is 89 
treated with paraldehyd will bear doses thirty times 
larger than the fatal toxic dose. It is the same with 
the dog; an animal of middling size will succumb 
when you administer to it 1-30 of a grain of strychnine. 
When it is under the influence of paraldehyd you 
may give it t-6 of a grain without producing death. 
How are we to explain this antagonism? 
This question deserves a brief consideration. 
We can give a physiological explanation, based on a 
curious experiment of Claude Bernard and Paul 
Thenard. They etherized hares, then injected' an- 
hydrous Prussic acid under the skin. Whenever the 
animal was plunged into the anaesthetic sleep they 
could give him quite large doses of Prussic acid with- 
out producing poisoning; but toxic symptoms appeared 
as soon as the animal recovered consciousness and sensi- 
bility.* The experiment to which I have just alluded 
may be tried with chloral or chloroform, and we shall 
see that the results are the same as with paraldehyd. 
We may even go farther, and affirm that between 
alcohol and strychnine there is the same antagonism; 
and the experiments of Amagat, of Luton, and of 
Jaillet have proved that if by strychnine one may pre- 
vent the grave accidents of acute alcoholism from 
being produced, conversely the phenomena of strych- 
nine poisoning may be prevented by giving sufficient 
doses of alcohol. 
* Dujardin-Beaumetz, “Clinical Therapeutics,” p. 15 (pub- 
lished by Geo. S. Davis, i885 ) 90 
Physiological researches have shown that all these 
medicaments—chloroform, ether, chloral, alcohol—act 
directly, unchanged, on the nerve-cell; and in some 
of my experiments I have indubitably shown, both in 
men and animals, the presence of undecomposed 
alcohol in the cerebral substance. We know, also, 
that strychnine has a marked action on the central 
elements of the cerebro-spinal axis; so that one may 
say that when a nervous element is impregnated by a 
medicament, it refuses, within a certain limit, to re- 
ceive the impression of another medicament; and it 
is thus that we can explain in a physiological and 
scientific manner the antagonism which exists between 
the different substances which I have just enumerated 
and strychnine. 
But it seems to me that we may go further, and 
explain the tolerance and intolerance of a certain 
number of medicinal substances. Medicines which 
have an elective action on the nervous system ought, 
in order to produce their effects, to act on the nervous 
elements in a perfectly healthy state; and it is suffi- 
cient there shall have been cellular impregnation by 
another medicament, or a molecular modification, 
however inappreciable, in order that the natural effect 
of a drug shall not be felt; and it is in this way, in 
my opinion, that we are to explain the astonishing 
tolerance which certain inebriates manifest to sub- 
stances of the most toxic nature. It is for this reason 
that in delirium tremens one may give immense doses 91 
of opium, or of strychnine, etc., without dangerous 
results. Likewise maniacal patients, for similar 
reasons, often show a strange tolerance for certain 
poisons. I will take as example the treatment of cer- 
tain forms of madness by preparations of morphine. 
There are, in fact, cases where physicians will not 
hesitate to inject at once several grains of this alka- 
loid, and this without any bad effects. 
In a similar way I would explain the tolerance 
and intolerance of medicines which some neuropathic 
patients present, and which Huchard has character- 
ized by the happy term, therapeutic ataxia. We in 
fact see our hysterical patients suffer toxic symptoms 
from minute and almost homoeopathic doses of certain 
medicaments, and bear without injury very large doses 
of other extremely powerful medicines. But let us 
return to paraldehyd, and consider the uses which 
may be made of this medicinal agent. 
Paraldehyd, compared with chloral, has these 
advantages over the latter: it is less irritating, and 
for this reason it is better tolerated by the stomach 
and pharynx; it is not a cardiac poison, and, more- 
over, it works better than chloral in strychnine-poison- 
ing, but it is less analgesic than chloral—that is to 
say, it calms pain less; therefore, whenever the 
insomnia is caused by pain, paraldehyd will show 
itself inferior to chloral, and especially to morphine. 
On the other hand, In nervous insomnias, and 
especially in those produced by the abuse of alcohol, 92 
paraldehyd is much superior to chloral, and I have 
many times seen in my hospital service the great 
benefit which may be derived from paraldehyd in the 
disorders arising from inebriety. 
Much use has been made of paraldehyd in the 
various forms of mental alienation. In France it is 
Dr. Keraval and Dr. Nerkam who have made the 
greatest number of trials with it in maniacal diseases. 
They have shown that parldehyd is an excellent 
hypnotic in certain forms of insomnia with restlessness, 
and which are so common in the course of cerebral 
affections. They have also noted good effects in the 
convulsive neuroses, and in particular in the epileptic 
crises and multiple manifestations of hysteria.* I will 
add that in many cases of morphinomania I have been 
able to replace the morphine injections to which the 
patients were habituated by paraldehyd in the dose 
of three or four grammes a day. 
It has been affirmed that chloral is superior to 
paraldehyd in the fact that the latter drug sooner 
loses its effect on patients than the former drug. My 
observations do not bear out this view and I have 
seen patients who for months have always obtained 
the same effects from the same doses. I might cite, 
for instance, the case of a Mexican affected with 
* Keraval et Nerkam, Action hypnotique et sedative de la 
paraldehyd dans les differentes formes d’alienation mentale 
(Soc. medico-phychol., Mai, 1884); Nerkam, Thfese de Paris, 
1884. 93 
chronic icterus, who has for more than a year been 
relying on a 3-gramme dose of paraldehyd to get his 
sleep at night, and who never has been obliged to 
increase the dose; and it is the only agent which we 
have found capable of safely combating the torment- 
ing itching which deprives him of sleep, all other 
hypnotics having failed in consequence of determining 
ill effects on the part of the liver or stomach. I think, 
then, that paraldehyd does not lose its remedial 
power as soon as has been represented, and among 
the hypnotics it is one of those that may be the longest 
continued with the least inconvenience. Paraldehyd 
seems, then, to me to be especially indicated in 
strychnine-poisoning, and 1 believe it perfectly appli- 
cable to the treatment of eclampsia. 
Urethan.—Urethan, as you see, presents itself 
under the form of white transparent crystals, having 
a fresh savor, resembling that of acetate of potash; it 
is soluble in alcohol, ether, and water. Its chemical 
composition is quite complex; it is considered as a 
carbamate of ethyl. Carbamic acid is a hypothetical 
acid which has not yet been isolated, aud which has a 
resemblance to urea, whence the name urethan given 
to the ethyl compound, of which the chemical formula 
is C3 HN, 02. 
Urethan was introduced into therapeutics by 
Schmiedeberg, of Strasburg, and it has been the sub- 
ject of experimentation by von Jacksch of Vienna, 
Riegel of Giessen, and by Huchard and Eloy in 
France. Urethan seems to be little toxic, and we may 
give to a hare as much as three grammes without pro- 
ducing any other effect than a general lethargy. In 
man it requires three to four grammes to obtain a 
hypnotic effect. 
By reason of its solubility, urethan is easily ad- 
ministered. Huchard’s potion, which is a favorite 
mode of administration, is as follows: 
Urethan, 3 i. 
Dill water, \ i. 
Syrup aurantii cort., § ss. 
M. 
Sig.: One dose, for a sleeping draught. 
A solution may be prepared in water, as follows: 
Urethan, i part. 
Water, 5 parts. 
M. 
Each teaspoonful of this solution represents 15 grains 
(1. gramme) of urethan. 
In fourteen patients to whom Huchard gave ure- 
than he obtained sleep in almost every instance in the 
dose of 45 to 60 grains, and this especially in the 
insomnia of the tuberculous. In the trials which I 
have made with urethan in Cochin, I have obtained 
also good effects; but these have been less constant 
than in Huchard’s patients, and in three cases, instead 
of inducing sleep, I have seen severe nervousness and 
restlessness follow the administration of urethan. 
This medicine, not being toxic, may be given to in- 
94 fants, and in a two-months old babe Huchard procured 
sleep with a dose of three grains. 
Although we do not yet know the physiological 
action of carbamate of ethyl, we can affirm that it is a 
hypnotic, but it is not an analgesic, and when the 
insomnia is caused by pain it is without effect. 
[Sulphonal.—Since the first edition of this work, a new 
hypnotic has been discovered to which the name sulphonal has 
been given. 
The chemical name di-ethyl-sulphon dimethyl-methan. 
The process of fabrication is very complex, and is described in 
the Therapeutic Gazette for 1888, page 377. 
Sulphonal crystallizes in large colorless tables, and is 
perfectly devoid of odor and taste. It is rather insoluble in 
water, requiring twenty parts of boiling and one hundred parts 
of cold water for its solution. It is quite soluble in alcohol, 
not affected by strong acids, and is an extremely stable body. 
Sulphonal can hardly be called toxic in ordinary doses. 
It is an extremely valuable hypnotic. The dose is ten to sixty 
grains, taken an hour or two before bedtime. 
In my own practice, I have seen reasons to be much 
pleased with the effects of this new hypnotic. It produces 
sound and refreshing sleep, much more like natural sleep 
than the sleep of chloral, and I have seen no pleasant 
after-effects; not even the giddiness of which some writers 
have spoken. I have given it to children for insomnia due to 
hyper-excitability of the nervous system due to teething and 
other cause, and seen it work admirably. The dose for an 
infant in one or two grains. Five grains may be given to a 
five-year-old child. For adults, a ten-grain dose is sometimes 
sufficient to restore the normal sleep. In my own person, I 
have known ten grains to give six hours’ sound sleep, and the 
sleep is so refreshing that to me sulphonal is the ideal 
hypnotic. It is understood that sulphonal does no good in the 
insomnia due to pain. 
It is a pity that the drug is under the ban by being a 
patented medicine.—Trans.] 
95 CHAPTER XIV. 
ON NEW ANALGESIC MEDICAMENTS. 
My last lecture was devoted to medicaments 
which produce sleep (hypnotics); to-day I propose to 
speak about analgesics, that is to say, medicinal sub- 
stances which antagonize pain. I shall dwell more 
particularly in this lecture on the new analgesics; 
aconitine, napelline, gelsemium and gelsemin, piscidia, 
and finally on the local anaesthetics such as subcuta- 
neous injections of chloroform and pulverizations of 
chloride of methyl. 
The type of analgesic medicaments is morphine, 
and if opium and its derivatives are considered as 
hypnotics, it is because they give repose by banishing 
all painful sensations. I cannot here enter into the 
subject of subcutaneous injections of morphine, which 
I have treated at length in my Clinical Therapeutics. 
However, the older I grow, the more chary I become 
in the use of morphine, for despite the marvellous 
properties of this alkaloid, which is far the most active 
of analgesics, its dangers and disadvantages are such 
that I reserve its employment for exceptional cases 
only. 
In fact, the superiority of morphine constitutes 
one of its most serious evils. Let me explain: When- 
ever a patient has once made use of morphine, there- 
after all other analgesics seem inefficacious and unsat- isfactory, and he looks continually to the same 
medicament for the relief which he has experienced, 
and when the pain is entirely gone he will have be- 
come so accustomed to his morphine that he will 
with difficulty, if at all, free himself from the habit. 
This is the history of almost all cases of morphio- 
mania; at the beginning it is for a neuralgia, a mild 
attack, perhaps, for which the patient has recourse to 
the injections of morphine, and little by little he be- 
comes habituated to the poison, and when he is once 
a victim to this vice, it will be very difficult to make 
effectual opposition to it. 
Do not, then, resort to these injections except 
when you have to do with intense pain caused by 
cancer or in the last periods of pulmonary diseases; 
here morphine is really advantageous, enabling us to 
prolong the life of these unhappy beings and make 
them tolerably comfortable. In all these cases never 
allow the patient to make the injection himself, and 
only resort to them when the pain becomes too severe, 
and not till you have employed all the other means in 
your power. 
Aconite, after morphine, is one of the most power- 
ful analgesics, and the subject of aconite and aconitine 
deserves to arrest your attention for a few moments, 
illustrating, as it does, how complex is the application 
of medical plants to medicine, and how cautious we 
should be in deducting positive conclusions from any 
97 observed sequences in the therapeutic use of these 
agents. 
For a long time, practitioners in this country 
made use of preparations from aconite leaves, and the 
results obtained were very problematical. Oulmont, 
in showing us that the active principles of the plant 
vary according to its origin and the parts used, made 
apparent the cause of the seeming inertness of these 
aconite preparations, for the leaves contain very little 
of the active principles, while the roots are largely 
impregnated with them. Hence it is that in England, 
where the Pharmacopoeia sanctions the usage of the 
root alone for the officinal preparations, very energetic 
results have been obtained from these latter. Du- 
quesnel, in extracting from these aconites a definite 
crystalline principle, added still more to our knowl- 
edge of this plant, and his studies, in connection with 
Laborde, of aconite and aconitine have been of great 
value. 
There exist two great varieties of aconite, the 
one growing in Europe, the other in Asia; the French 
aconite may be subdivided into the Aconitum anthora 
and the Aconitum pyrenaicum with yellow flowers, the 
Aconitum Napellus with blue flowers; the type of the 
Asiatic aconites is the Aconitum ferox. 
When you analyse these different plants, you find 
that they contain a crystalline aconitia, an insoluble 
amorphous aconitia, and another which is soluble, to 
which Duquesnel has given the name of Napelline. 
Moreover, in the Asiastic aconites, there is found an- 
98 99 
other crystalline alkaloid, pseudo-aconitina, and an 
amorphous alkaloid, amorphous pseudo-aconitina. Fi- 
nally, what is still more astonishing is that, according 
to the origin of the aconites, these alkaloids behave 
differently with respect to polarized light. 
You see before you two solutions of crystallized 
nitrate of aconitia; the one comes from the Aconitum 
Napellus, gathered in Dauphine, and deviates the polar- 
ized ray to the left by 3°.4; the other is obtained from 
a plant growing in Switzerland, and is also laevogyrus, 
but by 40.8. 
You see how complex is this question of the aco- 
nitias, and how different must be the result according 
to the plant employed. There exist in commerce 
English and German aconitias, an aconitia of Morson, 
another of Duquesnel, etc., and all these aconitias 
have variable therapeutic and physiological actions, 
for the reason that they are derived from plants of 
different origin. It will, then, be absolutely necessary, 
when you wish to prescribe aconite or aconitia, to 
specify the part of the plant and its place of origin, 
if you write for aconite, and the laboratory where it 
was extracted if you order aconitia. 
We actually make use almost exclusively of the 
alcoholic tincture of aconite root, and we add the 
name of the province, whether of Vosges or Dauphine. 
Duquesnal thinks that the tincture is preferable, and 
he proposes the two following preparations: The tinc- 
ture of aconite root, and the extract; the latter being 100 
the most active, three to four centigrammes of the ex- 
tract representing one gramme of the tincture. As 
for aconitia, it is the crystallized nitrate of aconitia 
which you should order, adding the name of Duques- 
nel, and under the form of granules containing a 
quarter of the active principle. (In American phar- 
macy a pill is in use containing grain crystallized 
aconitia.) 
As for the doses, they are exceedingly variable, 
and you should always remember that certain persons 
have a real intolerance of this medicament. I have, 
for my part, seen toxic*phenomena of great gravity 
determined by extremely minute doses of crystallized 
aconitia, scarcely the T| 0 of a grain. 
Therefore you will have care that the doses shall 
be wide apart when you make use of this alkaloid, 
and order, for instance, a granule cf a quarter of a 
milligramme grain) every six hours, giving direc- 
tions not to exceed four granules in the twenty-four 
hours. It will even be necessary to stop the medicine 
when the patient experiences the first toxic symptoms, 
such as tingling of the tip of the tongue, and that 
strange sensation of loss of elasticity of the muscular 
orifices of the mouth, eyes, and nose, when it seems to 
the patient that the skin of the face is shrunken. 
If you make use of the tincture or fluid extract 
of the root, the dangers of poisoning are less, and 
you can give ten or even twenty drops, three or even 
four times in the twenty-four hours. The dose of the 101 
extract is one-sixth of a grain, which you can repeat 
once or twice during the day. 
Aconite and aconitina have a very limited sphere 
of action, which, as far as pain is concerned, is con- 
fined almost exclusively to the trifacial nerve; its 
action on the other sensory nerves is much less 
marked. 
By the side of this analgesic effect, aconite has a 
special action on the circulation; it is an anti-conges- 
tive vascular medicament from which you may obtain 
good results, especially in the pulmonary congestions 
accompanied with cough, of which one of the types 
is influenza. You know that in this affection I have 
been in the habit of ordering the following mixture: 
Into a glass of warm milk put two tablespoonsful 
of syrup of tolu, a dessert-spoonful of distilled cherry- 
laurel water, ten drops of tincture of aconite root, and 
order the whole to be taken in one dose and repeated 
three times a day. 
Aconitia, as I have told you, has a special influ- 
ence on the trigeminus, abolishing conscious and 
painful sensibility, and acting also on the unconscious 
or reflex sensibility; it modifies the blood pressure, 
diminishing arterial tension, and lowering the tem- 
perature. These are especially the physiological 
effects which are utilized in therapeutics. 
Aconitia has besides another effect of which I 
must remind you, for it has given rise to several mis- 
takes. I refer to its action on the pupil. Adminis- 102 
tered internally, aconitia dilates the pupil, and this 
explains why physicians, seeing this mydriasis, have 
sometimes thought that the apothecary had made a 
mistake, and instead of granules of aconitine had given 
granules of atropine; you will not then be led astray 
if you should see pupillary dilatation follow the use of 
this alkaloid. 
It is in facial neuralgia that aconitia produces its 
maximum of therapeutic effects, and for my part, I 
am acquainted with few neuralgias which are not re- 
lieved by this means. When the prosopalgia presents 
itself under intermittent form, you will do well to as- 
sociate quinine with the aconitia. You can unite in 
the same capsule five grains of quinine with one two- 
hundredth of a grain of crystallized aconitia, or hav- 
ing administered a capsule containing the five grains 
of quinine, you can give one of Duquesnel’s granules, 
and repeat the dose every six hours until the pain has 
entirely disappeared. 
Aconitia is not, as I have told you, the only active 
principle obtained from Aconitum Napellus. There 
are also found two amorphous principles, the one sol- 
uble, the other insoluble. It is to the first of these 
principles that Duquesnel has given the name of 
napelline. Thanks to its solubility, napelline may be 
given subcutaneously. Laborde and Daudin have ex- 
perimented with napelline, and have shown that this 
alkaloid is much less active than crystallized aconitia, 
and that, moreover, instead of being purely analgesic, 103 
this napelline possesses quite marked hypnotic pro- 
perties. They have also employed this alkaloid in 
subcutaneous injections in the dose of five-sixths of a 
grain once in the twenty-four hours, and have never 
seen toxic symptoms follow. Hence they think that 
napelline, by its less intense toxic action which ren- 
ders it more manageable, is a medicament which may 
be employed to advantage in the treatment of neu- 
ralgias. 
If you wish to repeat these trials, I advise you to 
adopt the following method: Make subcutaneous 
injections of a solution of one-sixth of a grain of 
napelline in a cubic centimeter of water, repeat these 
injections three or four times in twenty-four hours. 
Grognot, of Milly, has employed napelline in granules 
of two and a half milligrammes (one twenty-fourth of 
a grain), and in the dose of three centigrammes (one- 
half grain), he cured a rebellious facial neuralgia 
which had resisted the action of crystallized nitrate 
of aconitia. But I have no more time to spend on 
aconite and its alkaloids, and pass to the study of 
gelsemium. 
Gelsemium. sempervirens, or Yellow jasmine, has 
been employed largely by the Americans. It is a 
climbing plant, with yellow flowers, which grows in 
the moist soil of Virginia and other of the Southern 
States. The roots and the stem are employed in 
medicine; of these a tincture is made, which is given 
in the dose of ten drops every two hours in facial neu- 104 
ralgias, being especially remedial in dental neuralgia. 
Remarkable results have been claimed, notably in the 
intermittent forms of neuralgia. 
I experimented with gelsemium several years ago 
(in 1877), and my pupil, Dr. Eymeri, has given in his 
thesis the results which we obtained* These results 
were similar to those of previous experimentors who 
had studied the therapeutic, toxic, and physiological 
action of this plant. We found that gelsemium is an 
energetic poison, and that its toxic action is variable, 
according to the preparation employed, so that one 
tincture made with the stem may give small or unap- 
preciable effects, while another made with the root, 
may have a marked toxic action in the same dose. I 
have myself seen a patient who experienced severe 
symptoms of poisoning from thirty drops of the tinc- 
ture; moreover, quite a number of fatal cases have 
been recorded from the use of this drug, so that while 
recognizing the analgesic action of the preparations 
of gelsemium (inferior though this be to that of aconite 
and its alkaloids) it has seemed to me to be wisest, 
owing to the acknowledged uncertainty of the gelse- 
mum preparations, to be very chary in the use of this 
remedy. 
It has been recommended to employ, instead of 
gelsemium, the glucoside Gc/semin, discovered by 
Fredidge, but we know little respecting the action of 
* Eymeri, on Gelsemium sempervirens (These de Paris, 
1877). 105 
this active principle, and we ought to be well estab- 
lished with regard to its physiological and toxic effects 
before giving it a place in therapeutics. Moreover, 
gelsemium, its glucoside and its alkaloid Gelsemine, 
produce not only paralysis of sensibility, but also of 
motility, and, as Rouch has well shown, gelsemium is 
especially a poison of the motor-nervous system. 
Moreover, Rouch has also pointed out in his experi- 
mental researches, as we have also done in our clinical 
observations, that the effects vary according to the 
preparation employed. 
Piscidia erythrina, or Jamaica Dogwood, is of 
quite recent introduction into therapeutics. The first 
experiments made with it, by Ott*, of Philadelphia, 
and Nagle, in 1881, show it to be narcotic to animals: 
it is, however, worthy of note that in 1844, Hamilton 
of Plymouth pointed out the analgesic properties of 
piscidia, and Ford, in 1880, recommended it in neural- 
gias. Since the labors of Ott and of Nagle, there 
have been numerous trials with piscidia, and Firth, 
James Scott, MacGrotz, Seifert of Berlin, and Vanlair 
of Liege, have published observations on the thera- 
peutic effects of this remedy. 
It was Landowski, in 1883, who was the first in 
France to call attention to the narcotic and analgesic 
properties of piscidia. Huchard has utilized it in 
combination with Viburnum prunifolium, and I have 
* On the Physiological Action of the Active Principle of 
Piscidia erythrina (Arch, of Med. 1881). 106 
myself made in this hospital, and in my laboratory, a 
great many therapeutic and experimental researches 
on this subject in connection with my pupil, Dr. 
Legoy of Huilles.* 
Piscidia erythrina is a shrub or tree of the family 
Leguminosae, which grows in South America and the 
West India Islands. Its name comes from the bril- 
liant color of its red flowers, and the stupifying action 
of its bark on fishes, an action which is very similar 
to that of Coceulus Indicus. In America, this plant is 
designated under the name of Jamaica dogwood. It 
is the bark of the root which is used exclusively, and 
according to the researches of my pupil Carette, there 
are found in this bark the following ingredients: A 
resin, a terbenthinate substance, starch, a salt of 
ammonia, and finally an alkaloid which Bruel and 
Tanret have extracted. But here the same difficulties 
have been met with as in the case of gelsemium, the 
alkaloid being found in roots of one source and not 
in those of another, and the therapeutic results being 
variable and uncertain in consequence. 
Besides this different composition resulting from 
the different sources of this dogwood bark, there is 
another fact which obscures its physiological action. 
I refer to its unlike effects on warm-blooded and on 
* Hamilton, Pharmaceutical Journal and Transactions, 
1884; Ford, Therapeutic Gazette; Legoy, Du Piscidia ery- 
thrina (Bull, de ther., 1885, t. cviii, p. 72, et These inaug., 
1884). 107 
cold-blooded animals. While in the case of the former 
the physiological action, even in large doses, is almost 
nil, in the second, on the contrary, it is very marked. 
When piscidia is administered to a frog, there are ob- 
served convulsive movements, an exaggeration of the 
frequency of respiration and of the cardiac pulsations, 
a tetanoid state, and finally death. Piscidia seems to 
act almost exclusively on the gray elements of the 
bulbus aud medulary centre; it acts also on the 
ganglionic nervous system. 
It is under the form of the powder, or fluid ex- 
tract, or tincture, that piscidia is administered; the 
latter seems to us to be preferable. I would recom- 
mend the following formulae: 
5 Fluid extract Jamaica dogwood, 3 ss. 
Syrup aurantii corticis, § viii. 
M. 
Sig. Take a tablespoonful pio re nata. 
The tincture may be given in doses of from 40 to 
50 drops. Huchard associated piscidia with viburnum 
in the following manner: 
Alcoholic tincture of Jamaica dogwood. 
Tinct. (or fluid ext.) viburnii prunifolii, aa gtt 1. 
M. 
To be taken for one dose pro re nata. 
Thus far the majority of physicians who have 
given their attention to piscidia consider it a hypnotic. 
The therapeutic applications which I have made with 108 
this drug do not permit me to share this view, and I 
regard it as an analgesic very similar in its action to 
gelsemium, causing sleep because it relieves pain. 
Moreover, the first trials made by Hamilton with 
piscidia (in 1884) were confirmatory of this view. 
Hamilton was suffering from an intolerable toothache; 
he applied to the gums, in the vicinity of the tooth, a 
pledget of cotton wet in tincture of piscidia; the relief 
was instant and complete. He then bethought him- 
self to apply the same remedy internally for obstinate 
pain; a marked anodyne effect was realized, with pro- 
found sleep. In several cases of rebellious facial and 
brachial neuralgia, we have seen the pain disappear as 
by magic under teaspoonful doses of fluid extract of 
Jamaica dogwood, but like gelsemium it is an untrust- 
worthy analgesic, and this in consequence of reasons 
above given. So when you prescribe piscidia, you 
will do well to specify the Jamaica dogwood, this 
being the only reliable kind. The dose of the 
tincture is from 30 drops to fluid drachm; the Amer- 
ican fluid extracts are much in use and are given in 
the same dose. Syrup is a good vehicle for admin- 
istration. 
I shall finish this lecture by a brief consideration 
of two local means which have of late been used to 
assauge pain: I refer to subcutaneous injections of 
chloroform and to the chloride of methyl spray. 
Subcutaneous injections of chloroform were first 
prescribed by Dr. Roberts Bartholow about ten years 109 
ago,* but their employment in France is of much more 
recent date. It was in 1877 that Ernest Besnier made 
known the good effects which he had derived from 
these analgesic injections, and the following year one 
of my pupils, Dr. Fournier, recorded in his thesis the 
results of the trials which I have made with the same 
remedy in my service at the Hopital St. Antoine. In 
these experimental investigations I found that if in 
man the dose of chloroform injected under the skin 
be raised to about two and a half drachms, sleep is 
produced, but without anaesthesia. 
I have given in elucidation of this fact an explan- 
ation which Claude Bernard had already invoked in 
his studies on anaesthetics. I have shown that in 
introducing chloroform under the skin, this medica- 
ment, before reaching the cerebro-spinal axis, where it 
produces its elective action, traverses the lungs, where 
by reason of its extreme .volatility it escapes with the 
air of expiration, and that the quantity which remains 
in the blood is too insignificant to make a very power- 
ful impression on the nervous elements of the cerebro- 
spinal axis; at each inspiration, however, the patient 
drawing back a certain quantity of air thus charged 
with chloroform, obtains in this way sufficient of the 
anaesthetic to produce sleep and an anodyne action, 
but not profound insensibility.f 
* Roberts Bartholow, On the Deep Injections of Chloro- 
form for the Relief of Pain. Practitioner, July, 1874. 
f Clinical Therapeutics. Published by Geo. S. Davis, 
Detroit. Page 12. 110 
Professor Bouchard has repeated these experi- 
ments from another point of view which had abso- 
lutely escaped me. All the animals, and particularly 
the hares, under whose skin he injected chloroform, 
succumbed with albuminuria;f the explanation of this 
fact has not yet been found. 
Despite their undoubted analgesic action, hypo- 
dermic injections of chloroform have not found favor, 
and I am inclined to attribute the abandonment of 
them by the profession to the local inflammatory 
symptoms which result from these injections when 
carelessly or improperly made. When you desire to 
make use of these injections of chloroform, do not 
forget that it is important to make them penetrate 
deeply. I advise you, then, to plunge the needle of 
your syringe perpendicularly, its whole length, into 
the fleshy parts, and there throw your injection. 
This, moreover, is the way that we generally make 
our hypodermic injections at the present day; for- 
merly it was the custom to pinch up a fold of skin 
and enter the needle obliquely, parallel to the fold, 
and introduce the solution into the cellular tissue. 
The former method is certainly most rapid and advan- 
tageous. 
It is well understood that these subcutaneous in- 
jections of chloroform ought to be made in loco dolenti; 
for this reason their application is rather limited 
t Bouchard, On Albuminuria determined by Subcutane- 
ous Injections of Chloroform. (Acad, de Med., 1784). 111 
through fear of eschars and abscesses. Hence it is 
especially in sciatica and lumbago, or even intercostal 
neuralgia, (in all cases, in short, where the cellular tis- 
sue permits the deep introduction of the medicament), 
that these injections should be practiced. The quan- 
tity ordinarily injected is one cubic centimetre, or 
about twenty drops, but you may go even further, and 
inject at short intervals as much as two or three fluid 
drachms. 
The application of chloride of methyl is of quite 
recent date, and it was in 1884 that Debove made 
known to us the good results which he had obtained 
from external applications of this chemical to the 
treatment of neuralgia. 
Chloride of methyl, which is also called muriated 
methylic ether, is, at the normal temperature, a color- 
less gas, with sweetish odor and taste; it may be 
liquefied by cold or by pressure. It is under pressure 
that it is utilized in the cases of which I am about to 
speak. When liquefied, methyl chloride is a colorless 
liquid which boils at the temperature of about 83° F. 
Hence it is that it evaporates immediately when 
brought into contact with the air, and that by this 
molecular change an intense cold is produced, amount- 
ing to a fall of forty degrees, or even more. 
Formerly these refrigerant properties were only 
employed to freeze histological specimens. This easy 
transformation into gas of liquefied chloride of methyl, 
necessitates keeping this liquid in very strong recipients. 112 
We thought first of all of using the syphon bottles, 
so much employed for dispensing soda water, but had 
to give them up, on account of the bursting under the 
influence of an elevated temperature. To obviate 
dangers of this kind, we have had to resort to flask- 
shaped metallic reservoirs, which are rather complica- 
ted and costly, and this is, it must be confessed, one of 
the circumstances militating against the general use 
of this remedy. Nevertheless, now that you can hire 
these bottles at a reasonable cost, everybody may now 
avail himself of the benefits of this treatment, as the 
most of our instrument makers, and even the pharma- 
cists, have this apparatus to let.* 
The apparatus which I here show you (see Fig.7) 
was made by Galante, and it is one on which you can 
rely. It consists, of a metallic bottle, which at its su- 
perior extremity has two openings closed by screw 
caps. By means of the wrench C you remove the screw 
cap B, and replace it by another screw cap E, to which 
is fixed a metallic tube terminated by a filiform open- 
ing, by which the chloride of methyl escapes. Then, 
still with the same wrench, you remove the screw cap 
A, and place the central part of the wrench upon a 
metallic nut situated at M, which holds the wrench 
horizontally, and it will be sufficient to turn a little, 
by means of this wrench, the screw faucet with which 
* Unfortunately this apparatus, which is expensive, has 
not yet been introduced into this country. See H. B. Millard’s 
article in the Therapeutic Gazette, February, 1885.—Trans. Fig. 7. 114 
it is connected, to cause the chloride of methyl to es- 
cape by the filiform opening which I have pointed out 
to you. The management of the instrument is then 
very easy, and all you will have to do will be to pass 
for a few seconds over the painful points the chloride 
of methyl spray. 
The surface of the skin which is thus touched by 
the methyl chloride spray becomes congealed, pale 
and hard, and the patient experiences a sensation of 
smarting and burning provoked by the intense cold 
which is produced. If the topical effect is too pro- 
longed, a local mortification ensues, which consists in 
simple vesication or in veritable eschars. Ordinarily, 
and when the action of cold has been of short dura- 
tion, the skin turns red, and then it assumes on the 
following days a brownish tint which it may keep for 
some time. Hence I cannot too strongly urge you not 
to prolong the action of the chloride of methyl, and 
never to let the spraying exceed four or five seconds 
on the same part of the skin, for the production of 
vesication and of eschars adds nothing to the thera- 
peutic effect which one desires to attain. When you 
wish to apply the spray over hairy regions, you must 
first shave the skin. 
The therapeutic action of these pulverizations 
of methyl chloride is exceedingly interesting, and 
if we may judge by the facts reported by D6- 
bove, and other of our hospital colleagues, and in 
particular by Dr. Tenneson, brilliant cures in ob- 115 
stinate neuralgias have resulted from this treat- 
ment. You may also have seen in our hospital ser- 
vice the great benefits which we are deriving from 
this method, and when, in rebellious sciaticas, our 
vesicatories and punctiform cauterizations fail to re- 
lieve, we resort to the methyl chloride spray. If it be 
a case of real sciatica, the pain generally ceases after 
one or two applications of chloride of methyl. It is 
not so when we have to do with sciatic pains result- 
ing from affections of the spinal cord, or compression 
of the nerves; here the method generally fails; yet in 
certain cases of sympathetic neuralgia (determined, 
for instance, by cancer of the womb) Desnos has had 
success. 
Clinicians have even gone farther, and have ap- 
plied the methyl chloride to the relief of the phe- 
nomenon pain, from whatever source arising; in this 
way Tenneson has caused to disappear the pains in 
the side attending acute or chronic pulmonary affec- 
tions. I think that this is extending the analgesic 
action of chloride of methyl farther than we are war- 
ranted in doing, and that it will be better to reserve it 
for very rebellious neuralgias. The therapeutic appli- 
cation, then, of chloride of methyl spray is one of the 
really useful discoveries of the day, and you will do 
well always to resort to this treatment (which is in 
itself not at all dangerous) whenever you have to deal 
with stubborn neuralgia. CHAPTER XV. 
ON LOCAL AN/ESTHETICS. 
Gentlemen: In the present lecture I propose 
to consider the new anesthetics, and omitting alto- 
gether surgical anesthesia in its various bearings and 
uses, which would require a whole course of lectures, 
I shall take up only one of the minor aspects of the 
question, and discuss the subject of local anesthesia, 
which presents no little interest at the present day. 
For a long time clinicians have sought to diminish 
or abolish the sensibility of the skin in regions where 
the minor surgical operations, such as simple incisions 
of the skin and cellular tissue, were to be performed. 
This was considered the more desirable, inasmuch as 
grave accidents sometimes attended the first attempts 
at general anaesthesia. One of the means most em- 
ployed was cold. 
It was, in fact, known that when cold strikes the 
exposed parts of the body it produces numbness and 
insensibility, and practitioners had recourse not only 
to local applications of ice, but also to refrigerant 
mixtures. Hence it is that James Arnott, of Brighton, 
many years ago, advised the combination of ice and 
common salt, and Adolph Richard, that of sal-ammo- 
niac, salt and ice. 
One may also obtain this local anaesthesia by the 
rapid evaporation of volatile substances, such as ether, 117 
and Simpson was one of the first to counsel this mode 
of refrigeration. I remember to have seen, thirty years 
ago, at the commencement of my medical studies, a 
very ingenious apparatus made according to the plan 
of Prof. Richet, which consisted of a pair of bellows 
over which was placed a reservoir of ether; as fast as 
the stream of ether was projected on the exposed sur- 
face of the skin, it was volatilized by the blast from 
the bellows. This apparatus which was rather cum- 
bersome, was advantageously replaced by Richardson’s 
spray producer, of which we make use at the present 
day. 
The atomization of ether as a process of local 
anaesthesia possesses great advantages over the local 
application of ice or refrigerant mixtures; neverthe- 
less, these sprays are not free from the other incon- 
veniences of refrigeration. Cold does, in fact, abolish 
sensibility, but during the application the pain is 
quite keen, and when the anaesthesia has disappeared, 
the pain returns more pungent than before, so 
that if one suffers but little during the operation, the 
after effect is quite painful; moreover, the reaction is 
sometimes followed by profuse haemorrhage. These 
are disadvantages which limit the usefulness of local 
anaesthesia by cold. 
Other liquid substances have been substituted for 
ether, such as rhigolen by Bigelow of Boston, and 
Delcomenete of Nancy a few years ago, advised car- 
bon bisulphide as a means of local anaesthesia. I have 118 
myself been much interested in this subject of the 
local uses of bisulphide of carbon. This chemical, by 
reason of its extreme volatility, produces refrigeration 
of the tissues, but this refrigeration is rapidly followed 
by such intense rubefaction that carbon bisulphide 
ought rather to be considered a rubefacient of the 
first order, superior in many respects to mustard 
sinapisms, than as a local anaesthetic. It has also 
been proposed to employ certain gases for the produc- 
tion of local anaesthesia, and it is for this purpose that 
carbonic acid was recommended as early as 1772 by 
Percival. In 1856 Simpson again took up this means 
of local anaesthesia, improving the apparatus for its 
production, and it was then quite a common thing to 
see local douches of carbonic acid used in the hospi- 
tals of Paris, though rather for analgesic than for an- 
aesthetic purposes; they were used chiefly to relieve 
the pains caused by cancer of the uterus. We have 
even seen this gas employed in the treatment of neur- 
algias at the thermal stations, where are found waters 
highly charged with carbonic acid, as at St. Nectaire. 
Finally, in 1883, my friend Dr. Campardon, following 
the ancient practice of Percival and Simpson, applied 
carbonic acid to the treatment of whooping-cough. 
Thanks to the anaesthetic properties of car- 
bonic acid, it abolishes the exaggerated sensibility 
of the glottis, and thereby lessens the fits of cough- 
ing in pertussoid patients. The means employed 
by Campardon is very simple; it consists in utilizing 119 
the well known soda-water syphon bottles—the bottles 
which are in use for this purpose are destitute of tubes 
dipping into the liquid, and only the liberated gas 
issues from the mouth of the bottle. A rubber tube 
adapted to the syphon, and which the patient takes 
between his lips, conveys the gas into his mouth; the 
child makes a few inspirations, and Dr. Campardon 
affirms that by this means he has seen the paroxysms 
rapidly diminished. But I come now to a mode of 
local anaesthesia of much more recent date, and which 
is destined to render us great service; I refer to coca 
and cocaine. 
From time immemorial the Peruvians have made 
use of the leaves of a shrub belonging to a family of 
Erythroxylaceae, the Erythroxylon coca. In their esti- 
mation this leaf has multiple remedial properties, and, 
according to the statement of Dr. Beugnier-Corbeau, 
“ the sacred plant of the Incas was a promise of life to 
the moribund who could drink its sap; an incompara- 
ble viaticum to the traveler whose hunger it appeased; 
a cordial to raise the forces and revive the senses be- 
numbed by the cold of the rugged winter; a source of 
sweet forgetfulness to the man harassed by chagrin; 
and a joy-producer to him who would taste the pleas- 
ures of love.” 
When, twenty years ago or a little more, it was 
proposed to introduce coca into therapeutics, it was 
chiefly its tonic and excitant properties which were 
vaunted; and you will find in the thesis of Damarle, 120 
and in the writings of Reis, indications relative only 
to these tonic properties.* However, in i860, Nie- 
mann had discovered in the leaves of coca a crystal- 
line alkaloid having for its formula Cj,H21N04, to 
which he gave the name of cocaine; and, two years 
afterwards, Wolher and Lossen found another sup- 
posed principle, of syrupy consistence, having a very 
marked ammoniacal odor, to which they gave the 
name Hygrine. 
These chemical discoveries added nothing to our 
knowledge of coca till Roller made known, on the 
16th of October, 1884, to the Medical Society of 
Vienna, the marvellous anaesthetic action of cocaine 
on the mucous membrane of the eye. You remember 
how great was the astonishment, and what incredulity 
was manifested; but soon the facts which Roller had 
announced were confirmed all over Europe. Abadie 
and Darier, Trousseau, Panas, and all the ophthal- 
mologists showed the great advantages which might 
be obtained in ocular therapeutics from the discovery 
of Roller, and the anaesthetic properties of cocaine 
were henceforth everywhere recognized. By what 
train of ideas was Roller led to make this grand dis- 
covery, which constitutes an epoch in the therapeutic 
history of this country? And how is it that coca, from 
being the tonic and waste-restraining medicament 
which it once was, has been transformed into a local 
* Damarie, on Coca, Thfese du ductorat, 1862. Reis, on 
the Use of Coca, Bull, de Ther., 1866. 121 
ansesthetic? The history is so strange that you will 
allow me to briefly to relate the points of interest. 
Moreno y Maiz,* in his thesis of 1868, on cocaine, 
made mention of the following fact: “In large doses, 
cocaine produces in animals diminution, then annihila- 
tion of sensibility, without motility be;ng completely 
abolished; in all cases the pupil remains dilated.” 
In 1870, Gazeaux gave expression to certain 
doubts respecting the tonic and waste-restraining pro- 
perties of coca, and thought that this medicament 
might act by allaying the sense of hunger and thirst 
through its ansesthetic effect on the lingual and gastric 
mucous membranes. 
In fact, physicians who were engaged in treating 
affections of the larynx had noticed this special anaes- 
thetic action of coca; and Fauvel, since 1869, was in 
the habit of using coca in laryngeal diseases. 
In 1877, Saglia insisted anew on the advantages 
to be derived from the sacred plant of Peru in painful 
affections of the pharynx, and this anaesthetic action 
was so well shown that, in 1881, Du Cazal,f at the 
Medical Society of the Hospitals, thus expressed 
himself a propos of a case of tuberculous ulceration of 
the larynx presented by our colleague, Millard: “ The 
tincture of coca is an excellent medicament with which 
* Moreno y Maiz, on Cocaine, Th&se de Paris, 1868. 
f Saglia, on Coca: its Therapeutic Applications, Gaz. des 
H&pitaux, May, 1887. Du Cazal, Compt. Rend, de la Soc., 
1881, p. 283. 122 
to obtain anaesthesia of the pharynx, and to produce 
such anaesthesia it is only necessary to paint the mu- 
cous membrane with the tincture.” Gougenheim,* 
in 1882, when writing of the local treatment of 
laryngitis, said: “ The extract of coca, diluted in 
water so as to form a very concentrated solution, 
produces a veritable sedation; I do not know the 
cause of this therapeutic action.” 
Moreover, the physiologists on their part did 
not remain inactive, and, in 1880, Von Anrep spoke 
of the pupillary dilatation, but had not observed the 
state of the mucous membranes. The following year, 
Coupard and Laborde noticed the anaesthetic action 
of cocaine. Unfortunately their experiments remain 
incomplete, and the results have not yet been pub- 
lished. 
Hence, as you see, what led Koller to his discov- 
ery was the knowledge of the local anaesthetic proper- 
ties of coca on the lingual and pharyngeal mucous 
membrane; he thought, and rightly, that all the mucous 
membranes must respond alike to the action of this 
medicament; and since then we have been able to add 
that even the skin submits in some degree to this 
action. 
When you put in contact with a mucous surface a 
two-per-cent, solution of hydrochlorate of cocaine, 
you obtain, at the end of from five to ten minutes, loss 
*Gougenheim, on Local Treatment of the Laryngites, 
Soc. de Ther.. 1882. 123 
of sensibility of the mucous membrane, and this effect 
lasts an hour or two. The anaesthetic action does not 
seem to exhaust itself by habit—that is to say, a sec- 
ond and third, or any future application is as success- 
ful as the first. The same insensibility is produced 
when the cocaine is introduced under the skin, and in 
the experiments made upon one Christian, by Dr. 
Paul Compain, and which you will find described in 
his inaugural thesis,* I studied thoroughly the anaes- 
thetic action of hypodermic injections of this alkaloid. 
You see before you a patient on whom we are 
about to experiment; we pinch up a fold of the skin 
of the forearm and inject twenty drops of a two per- 
cent. cocaine solution. This injection, as you may 
see, does not cause any painful sensation. If in the 
course of five minutes, we explore the sensibility, of 
the skin over the point of injection, this is what we shall 
oberve: The sense of touch is obtunded, and the pa- 
tient tells us that he feels as if the skin over that place 
were covered with a thick layer of wadding. The 
consciousness of painful impressions is abolished, and 
we may with impunity scrach or prick the part with a 
needle; the patient has over this region only the sen- 
sation of contact of a foreign body. The anaesthetic 
state of the skin is produced in only a very limited 
zone, which exactly corresponds with the portions of 
the derm which have been directly in contact with the 
* Paul Compain, Contribution to the study of hypodermic 
injections of hydrochlorate of cocaine, Thfese de Paris, 1885. 124 
solution of cocaine, and in our patient it represents a 
circular space of abont an inch and a half in diameter. 
This complete anaesthesia of the skin lasts about 
twenty minutes, then disappears little by little, and an 
hour after there remains but a trace of the anaesthetic 
phenomena. 
May these hypodermic injections be accompanied 
by general symptoms? Yes, in certain cases. In the 
first researches which were made in our laboratory by 
Drs. Bardet and Meyer, these experimentors affirmed 
that they had felt such general effects as, first, a 
marked dilatation of the pupil coming on half an 
hour after the injection, then syncopal symptoms, so 
intense that one of them completely lost conscious- 
ness and fell on the door—his face was pale and his 
pulse impreceptible; these symptoms returned when- 
ever he assumed the erect posture. 
Since then we have observed the same symptoms 
in a number of our patients. One of these was a 
woman on whom we wished to practice forcible dilata- 
tion of the anus; we injected around the margin of 
the orifice a syringeful of a two per cent, solution; 
there supervened syncope, nausea, and curious twitch- 
ings of the alae nasi. 
I was recently consultant in a case in which I had 
ordered subcutaneous injections of cocaine to combat 
a vehement intercostal neuralgia. The attending 
physician wished to experiment on himself with the 
same injection, after having administered it to the 125 
patient; in both there were very pronounced symptoms. 
The physician experienced an attack of syncope, while 
the patient had very strange sensations; he felt, he 
said, extraordinarily light, and seemed to himself to be 
lifted up into the air like a balloon. 
In these cases the injections were practiced with 
a two per cent, solution, and the dose did not exceed 
from one to two centimetres; I must add, that in all 
these instances the patients were standing or sitting, 
which postures would be likely to favor syncopal 
attacks; hence it is that, since I have taken the pre- 
caution to make the patient lie down whenever I have 
administered the cocaine injection, these phenomena 
have not occurred. 
To what causes must we ascribe these effects? 
Probably to the cerebral anaemia produced by the 
action of cocaine upon the vaso-motor nerves; in fact, 
besides the considerable part which the dorsal position 
plays in the appearance or non-appearance of the 
general effects of cocaine, it is noteworthy that these 
general symptoms are the more likely to supervene, 
the more anaemic the patient is, and that they are in- 
conspicuous when the patient is strong and vigorous. 
Hence it is that Dr. Compain has never seen such 
accidents produced as the results of numerous injec- 
tions which he has made on himself. Moreover, when 
experiments are performed with cocaine on animals, 
and particularly on the monkey, such as Prof. Grasset 
and Dr. Henri Negre have made, there appear con- 126 
vulsive phenomena characterized by attacks of clonic 
spasm, and this happens when the dose is reached of 
six cubic centimetres of a two per cent, solution. 
Moreover, cocaine has an evident action on the 
temperature, which it raises; it is, therefore, a hyper- 
thermic agent. This action, however, is very variable, 
according to the kind of animal experimented on; 
for, while cocaine raises the temperature in the dog, 
it lowers it in the monkey. In fine, my pupil Dr. 
Rigolet has noted de visu the modifications effected in 
the capillary system by the action of the cocaine. 
Several drops of a one per cent, solution determine 
in the frog, at first a dilatation, then a contraction of 
the capillaries; and Rigolet considers this alkaloid a 
powerful vaso-constrictor. These experiments give us 
a physiological explanation of the general symptoms 
which in man are determined by cocaine. 
However, thus far these accidents of a toxic kind 
have never presented any gravity, and to determine 
such constitutional effects it is necessary to employ 
pretty large doses. Thus, Rigolet has been able to 
inject, without any harm, 40 centigrammes in the 
veins of a dog weighing 18 kilogrammes. Likewise, 
Bignon of Lima, has observed that the Indians can 
absorb as much as 40 centigrammes of cocaine in 
chewing the leaves, without experiencing any toxic 
manifestations. 
Ordinarily, to obtain the anaesthetic effects, we 
make use of a two per cent, solution of chlorhydrate 127 
of cocaine. According to the researches which I have 
made, the increase of the anaesthesia is not propor- 
tioned to the increase of dose, so that we may adhere 
to this two per cent, solution with the certainty of ex- 
periencing the desired results. 
In certain cases we may employ pomades of 
cocaine, and in the preparation of these it is not 
necessary to transform the cocaine into a hydrochlor- 
ate. Bignon of Lima has, in fact, shown us that the 
alkaloids of coca are soluble in unctuous substances 
of mineral origin, such as vaselin; the dose here is 
the same as in the case of the solutions; finally, one 
can have recourse to preparations made from the 
plant itself. Delpech, in particular, has made an ex- 
tract of coca according to the method of the Ameri- 
can Pharmacopoeia—that is, by evaporating the alco- 
hol, and which is said to render good service in 
affections of the pharypx. 
Before undertaking the consideration of the 
action of coca and its therapeutic applications, I de- 
sire to say a few words about its cost. 
When Roller's discovery was first made known, 
cocaine readily brought a very high price, and this 
was the first drawback to its general use. I have, in 
fact, known physicians, ignorant of this high cost, to 
prescribe gargles, lavements, and ointments, the price 
of which exceeded twenty dollars. To-day cocaine is 
sold at a much cheaper rate, and you can find in our 
drug stores cocaine of impure quality, though still 128 
pure enough for all anaesthetic purposes, save in 
ophthalmic surgery, the price of which varies from 
four to six francs a gramme. 
THERAPEUTIC APPLICATIONS OF COCAINE. 
Cocaine is, as we have seen, a local anaesthetic of 
the mucous membrane and the skin. To begin with 
the subject of the production of cutaneous anaes- 
thesia, it is necessary, in order that the cocaine may 
act, that it be applied to an abraded surface, or intro- 
duced under the skin. I have never obtained the 
least effect from the prolonged contact of cocaine with 
the undenuded skin, whether the alkaloid were rubbed 
over the derm in the form of concentrated solutions, 
or in the form of ointment. 
When the skin is deprived of its cuticle, and 
cocaine is applied, the latter has a very marked anaes- 
thetic action, and you can derive advantage from this 
property in the treatment of burns, where solutions or 
pomades of this alkaloid at once dissipate the pain 
which accompanies the first and second degrees. You 
will obtain the same analgesic effects in the case of 
cracked nipples, so common in nursing women, and 
Audhoui has reported interesting instances of this kind. 
In certain pruriginous affections of the skin, moreover, 
cocaine may be used to allay the tormenting itching. 
Administered under the skin, two-per-cent, solu- 
tions of cocaine enable us to perform, without pain 
a great number of minor operations. It is with the 129 
help of this local anaesthetic that I now practice 
pleurotomy, and that I secure for the patient exemp- 
tion from the pain of the first stage of the operation. 
To attain this result, I inject at both extremities of 
the line which my bistoury has to traverse a syringe- 
ful of a two-per-cent, solution of hydrochlorate of 
cocaine. 
You may in this way, without pain, open a super- 
ficial abscess, or extirpate a lupus; the pain of incising 
a felon is much mitigated; by the help of cocaine, 
tracheotomy is robbed of half its terrors; and, in short, 
you will derive advantage from the local use of this 
alkaloid in all instances where the incision of the skin 
is the chief element of pain. In all these cases the 
local anaesthesia by cocaine is far superior to that pro- 
duced by cold. Remember that you should always 
operate with the patient in a recumbent posture, to 
avoid the vertigo which might ensue, and you should 
wait ten minutes, at least, after the subcutaneous in- 
jection, before proceeding to the incision of the skin. 
By the aid of cocaine I have operated for phymo- 
sis, but if you are not very careful you will have diffi- 
culty in approximating the skin and mucous mem- 
brane with your serre-fines, by reason of the artificial 
oedema produced by the injection of the cocaine solu- 
tion in the cellular tissue of the prepuce. 
I come now to the application of cocaine to the 
affections of mucous membranes. I shall omit what 
pertains to the ocular mucosa, this being the special 130 
province of the ophthalmologist, and I shall consider 
rapidly the benefits derivable from cocaine in affec- 
tions of the mucous membranes, commencing with the 
digestive tube. 
The buccal and pharyngeal mucous membranes 
are readily and rapidly anaesthetized by cocaine. In 
operations on the pharynx, epiglottis, and larynx, gen- 
erally so painful, you may make applications of this 
alkaloid, and you have often seen in my service tuber- 
culous patients who could scarcely swallow a mouth- 
ful, enabled henceforth to eat by reason of relief from 
suffering obtained by the repeated use of solutions of 
this charming local analgesic. You all doubtless re- 
member the case of the late General Grant, and the 
comfort he obtained the last few months of his life 
from cocaine. 
In the cases of which I have just spoken, the 
throat is painted with a strong solution of cocaine a 
few minutes before a meal, and the local anaesthesia 
lasts about three-quarters of an hour, giving ample 
time for the repast. 
By means of these local applications of cocaine 
such operations as staphylorraphy are facilitated, and 
laryngoscopic examinations are rendered compara- 
tively easy; it is also a good plan, in order to avoid 
the pain of amygdalotomy, either to inject a little 
cocaine into the tonsil, or, as Lermoyez advises,* to 
* Lermoyez, Anaesthesia by Cocaine in Amygdalotomy, 
Bull, de Ther., t. cviii, p. 108. 131 
paint the tonsils over several times with a two-per- 
cent. solution before resorting to the operation. More- 
over, the painful period in the performance of lavage 
or gavage of the stomach, due to the contractions 
which take place in the isthmus of the fauces, may be 
obviated by painting with cocaine, and I have been 
careful to resort to this method whenever patients have 
experienced difficulty in the introduction of the stom- 
ach tube. 
But the anaesthetic action, so local and superficial, 
of cocaine, can be of no benefit in toothache or in the 
extraction of teeth; on this point all the best dental 
surgeons, such as Galeppe and Magitot, are agreed. 
Certain diseases of the oesophagus, such as spas- 
modic stricture, are tributary to the action of cocaine, 
which may be applied by means of the sound or by 
causing solutions to be swallowed. 
As for the disorders of the stomach, such as spas- 
modic affections of this organ with incoercible vomit- 
ing, cocaine may sometimes render marked service. 
Certain perversions of the stomach, and especially 
bullimia, are also amenable to cocaine, as Beugnier- 
Corbeau has shown. It is even certain than were 
cocaine to be bought at a reasonably low price, so that 
it could be afforded, one might use it to advantage in 
treating the agonizing pains which attend ulcer and 
cancer of the stomach, and this might be done by 
bringing solutions of cocaine directly into contact 
with the lining membrane of that viscus by means of 
the syphon tube. 132 
The great benefit which we have derived from 
the anaesthetizing properties of cocaine in painful 
affections of the upper part of the digestive tube, has 
furnished us with indications for its use in certain 
anal affections. Obissier was one of the first to make 
application of this remedy in cases of anal fissure.* 
Before effecting dilatation of the sphincter, he pro- 
cured complete local anaesthesia by making at two 
opposite points, just at the margin of the orifice, in- 
terstitial injections of two-thirds of a grain of cocaine. 
You have seen me have recourse, and successfully, 
to the same means, aud I have been able in the case 
of one of our patients affected with fissure of the anus, 
to perform forcible dilatation without pain. These in- 
jections must be made around the sphincter, and I 
used in the case at which you were present, four 
injections of a syringeful of a four per cent, solution. 
Lotions do not suffice, as the unsuccessful trials or Dr. 
Clemente Ferreira testify.f 
You can also have recourse to cocaine in cases 
of painful haemorrhoids, and you may here employ 
suppositories containing one-third of a grain. So 
much for the mucous membrane of the digestive 
tube; we will now7 pass on to that of the genito-urin- 
ary organs. 
*Obissier: Note on the employment of Cocaine in Fissnre 
of Anus, Bull, de Ther., t. cviii. p. io. 
f Clemente Ferreria: A case of fissure of the anus treated 
without success by hydrochlorate of cocaine, Bull, de Ther., t. 
cix. p. 216. 133 
It was in this hospital that one of the first ap- 
plications of cocaine to the treatment of vaginismus 
was made. It concerned a patient in the service of 
our colleague Anger, and who had not been benefited 
by forced dilatation under chloroform. A few swab- 
bings with a solution of cocaine, made by my interne 
Lejars, rendered examination easy, and removed all 
pain and spasm, and thereafter made sexual ap- 
proaches possible, as the husband of this woman tes- 
tified some weeks afterward.* 
Almost at the same time Cazin reported to the 
Society of Surgery a similar case, and since then facts 
have so multiplied that we may now say that if coca- 
ine does not cure vaginismus, it at any rate greatly 
alleviates this painful affection in rendering sexual 
relations possible by the help of inunctions or .lotions 
of this alkaloid. 
Gynaecology has even gone further, and by sub- 
cutaneous injections and swabbings of the neck of the 
womb, Doleris has maintained that we may to a cer- 
tain extent mitigate the pains of childbirth. 
The urethral mucous membrane is also advant- 
ageously modified by the salts of cocaine. I have de- 
rived great benefit therefrom in practicing cauteriza- 
tion of those painful vegetations which form around 
the meatus urinarius in females. Guyon has em- 
* Dujardin-Beaumets: A case of vaginismus treated 
with success by hydrochlorate of cocaine, Bull, de Ther., t. 
cvii. p. 489. 134 
ployed cocaine with good effect in the male, to relieve 
the pain and spasm accompanying catheterism. 
Finally, the respiratory and nasal mucous mem- 
branes have also derived advantage from this anaes- 
thetic action, when it has been a case of the extraction 
of polypi from the nose or the application of caustic 
solutions to the larynx, At the same time it is neces- 
sary to bear in mind the paralyzing action of cocaine; 
and in a case described by Ayssaguier, grave asphyxi- 
ating phenomena were seen to follow painting the 
larynx with this alkaloid. In fine, to complete the 
subject, I must tell you that otologists have also 
utilized cocaine in the treatment of affections of 
the ear. 
To sum up, whenever you desire to obtain an 
anaesthesia of the skin and mucous membranes which 
shall be complete, temporary, and of little extent, you 
may utilize cocaine. Are there other substances cap- 
able of producing local anaesthesia of the tissues ? 
This is a question which the future alone can decide. 
For my part I have tried caffeine, and if it diminshes 
the sensibility of the conjunctivia, it does this very 
imperfectly. It has been claimed that menthol has 
the same effect, but the trials which I have made with 
this substance have not given me any satisfactory 
results. Cocaine remains, then, thus far the only local 
anaesthetic of the mucous membranes, and this fact 
renders the introduction of this alkaloid into medicine 
one of the most precious therapeutic acquisitions of 
the age. 135 
Since I have spoken to you of hypnotics, allow 
me finish this lecture by announcing the discovery 
by Dr. Bardet and myself of a powerful hypnotic. 
Among the different products of the great aro- 
matic series which we are studying at the present 
time in their chemical constitution and therapeutic 
action, is found a mixed aceton having for formula 
C6, Hg, CO, CH3; it is phenyl-methyl aceton, or aceto- 
phenon. This body had been already studied by 
Popof and Nencki, who observed that this aceton is 
transformed in the economy into carbonic and 
benzoic acids, and eliminated by the urine in the 
state of hippurates. 
We have found in this aceton remarkable hypnotic 
properties; hence we propose to substitute for its com- 
pound name the shorter appellation of hypnon. 
Administered to the adult in the dose of from two 
to four drops, hypnon causes sleep, and in the in- 
somnia determined by alcoholism its effects seem su- 
perior to those of chloral and paraldehyd. 
When you inject under the skin of Guinea-pigs 
fifty centigrammes to a gramme of hypnon in a state 
of purity, you determine insensibility, then a comatose 
state, in which the animal succumbs in the course of 
five to six hours. Hypnon is, as you see, a body 
which is liquid at the ordinary temperature, having a 
very strong odor which resembles that of cherry- 
laurel and new-mown hay; it is not soluble in water, 
and therefore we have given it dissolved in glycerin 
inclosed in capsules. 136 
Our patients have not experienced any unpleasant 
effects from it, save always the disagreeable odor of 
the breath which results from its elimination by the 
lungs. 
What future is in reserve for this .hypnotic we 
do not fully know, but I thought it worth the while, 
in concluding, to allude to this discovery which re- 
sults from researches in which most of you have par- 
ticipated. 
[To the readers of this work, the Translator would com- 
mend as supplementary to it, the series of articles by the same 
author, entitled “New Therapeutic Agencies,” published in 
the Therapeutic Gazette, 1889-90.] /JUR POLICY in the introduction of new 
drugs is to prepare in convenient form 
for administration such new drugs as we have 
reason to believe possess therapeutic value and 
then submit samples of the drug, with such facts 
as we have been able to collate regarding its 
medicinal application, to the profession them- 
selves for thorough practical trial. 
Tnis method in a short time demonstrates 
the comparative utility or worthlessness of any 
given drug, and while some drugs have thus 
been proven worthless, many have become valu- 
j able additions to the materia medica. We be- 
lieve that therapeutic progress can only be made 
by careful research and thorough trial. 
It is a well known fact that through our 
efforts such important acquisitions to the materia 
medica have been made as Cascara Sagrada, 
Coca Erythroxylon, Grindelia Robusta, Vibur- 
num Prunifolium, Stigmata Maidis, Euphorbia 
Pilulifera, Gelsemium, Manaca, Yerba Santa, 
Eucalyptus Globulus, Boldo, Chekan, Duboisia, 
Hoang-Nan, Coto, Jamaica Dogwood, Conval- 
laria Majalis, Quebracho, Tonga Ustilago 
Maidis, and other valuable drugs and their 
derivatives, many of which have been made 
officinal. 
In response also to a growing demand on 
the part of the medical profession for such pre- 
paration of drugs as are of definite and con- 
stant strength and divested as largely as possible 
of inert mater, we have added to our list many 
alkaloids glucosides and rare chemicals. 
It will at all times give us great 
pleasure to mall to physicians on 
application literature descriptive of 
our products and to afford any In- 
formation In our power regarding 
them. 
New Drugs, Rare Alka- 
loids, Glucosides, 
etc. 
Drugs we have been 
instrumental in 
adding to the Materia 
Medica. 
Send for Descriptive 
Circulars and 
Working Bulletins. 
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Manufacturing Chemists, 
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