the pregnant period, as it has no oxytocic effect and will cause a freer action of the kidneys, which is also beneficial.

The Elimination of Methylene Blue.

At a recent meeting of the Société Médicale des Hopitaux, ACHARD and CLERC recorded their views in regard to the duration or rate of elimination of methylene blue,

It will be remembered that Castaigne has pointed out that its elimination is prolonged if there is any condition which impairs the permeability of the kidneys, as, for example, in the case of parenchymatous nephritis. As a rule the material is eliminated in the urine in a very short time after the drug is swallowed, and continues in a more or less marked degree for a period of twenty-four or forty-eight hours.

They also found that in chronic contracted kidney there is a very great decrease in the permeability of the kidney and the rapidity with which the blue escapes, and they believe the severity of the lesion is in direct proportion to the slowness of the elimination.-La Presse Medicale, Feb. 16, 1900.

Thiosinamine.

Dr. C. B. A. Pennoyer, in the "Minneapolis Homeopathic Magazine," reports favorable results from the use of Thiosinamine in a case of stricture of the rectum, given in two grain doses twice daily.

"The praise bestowed of late years by some homeopathists on the larger doses is owing to this, either that they choose low dynaminazations of the medicine to be administered, as I myself used to do twenty years ago, from not knowing any better, or that the medicine selected were not perfectly homeopathic."Hahnemann.

EYE, EAR, NOSE AND THROAT.

Conducted by David A. Strickler, M. D.

Local Anaesthetics in the Eye, Ear, Nose and Throat.*

Of the drugs used for local anaesthesia in the eye, ear, nose and throat, hydrochlorate of cocaine undoubtedly heads the list both as regards priority and frequency of employment.

In the eye it is used generally in from 2 to 4 per cent. solution, though may be as high as 10 per cent. by distillation to produce anaesthesia of the conjunctiva, sub-conjuctiva and the cornea for operation. Its primary action is on the conjunctiva and cornea, lasting about ten minutes. If repeated, and sufficient time be given for absorption through the cornea, it likewise produces anaesthesia of the iris, permitting an iridectomy without pain. Under its use the conjunctiva becomes pale; the palpebral fissure is more widely open, the act of winking is less frequent, so that the cornea may readily become dry on its surface.

The effects of cocaine are best explained by assuming that it acts as a stimulant to the fibres of the sympathetic, causing contraction of the vessels with pallor of the conjunctiva; contraction of the superior and inferior palpebral muscles, which are supplied by the sympathetic, thus giving a wider palpebral fissure; contraction of the vessels of the iris together with contraction of the dilator fibres of the iris, producing mydriasis. This latter action makes it a valuable agent in producing mydriasis for opthalmoscopic examination.

In the ear it is used for operations upon the drum and drum head. Its action applied to the external surface of the drum head is slight because the outer layer is cutaneous, but when an incision is first made in the drum head, the cocaine in solution applied with absorbent cotton on carrier to cut edges, producing sufficient anaesthesia for extensive operations on the drum head and tympanum. If used in conjunction with a solution of supra

*Read before Denver Homeopathic Club, July, 1900.

renal capsule, the operation can be made both bloodless and painless.

In the nose and throat the cocaine is applied by cotton pledgets saturated, the excess pressed out, applied to the part to be operated upon. Here, as elsewhere, it contracts the vessels giving pale membranes and comparatively bloodless operations. Its action, both anaesthetic and contractile, are greatly enhanced by using in conjunction fresh solution of suprarenal capsule.

In addition to cocaine there may be mentioned

HYDROCHLORATE OF EUCAINE "A." which in the eye is used in a 2 per cent. solution. Its application is followed by some smarting and conjunctival injection. It has no effect on the pupil and does not dry the corneal epithelium. Its anaesthetic effect begins in a few minutes and lasts from ten to fifteen minutes.

HYDROCHLORATE OF EUCAINE "B." is related to eucaine "A." as well as to cocaine and tropococain. It is not decomposed by boiling and is less irritating than eucaine "A." A 2 per cent. solution causes local anaesthesia in from one to three minutes and lasts about fifteen minutes. It does not dilate the pupil, does not decrease the tension, nor cause clouding of the corneal epithelium. It does not contract the vessels, as does cocaine, and is therefore not suitable for operations on the conjunctiva or muscles of the eye-ball where absence of hemorrhage is a consideration.

In nose and throat work it has the advantage of being less poisonous, can be used more freely with greater safety. On account of its comparative safety it is substituted mostly for cocaine for infiltration-anaesthesia either in the nose and throat or about

the eye.

Schleich has called the attention of the profession to a plan whereby the deeper tissues may be rendered anaesthetic. The method is known as the infiltration method, and consists in the injection into the area of operation of a sterilized fluid. The solution used is

This solution is injected into the eye-lids, or submucously

in the nose for extended operations, and subcutaneously for tracheotomy.

HOLOCAIN is an active local anaesthetic closely allied in its general properties to phenacetin. A 1 per cent. solution causes anaesthesia in from fifteen seconds to one minute. It does not affect the pupil, the intraocular tension, the accommodation, nor the vascularity of the eye; nor the desiccation of the cornea.

It has decided germicidal action, rendering it the anaesthetic par excellence for operations on the cornea and iris, and for the treatment of painful corneal ulcers with or without septic infection, and for removing foreign bodies from the cornea.

It has been used with decided advantage in the treatment of corneal ulcers, relapsing in type, and Dr. Schereinitz reports with decided advantage in hypopyon keratitis.

It is about as poisonous as cocain, is not suitable for infiltration-anaesthesia, nor for operation on the conjunctiva and ocular muscles. I have seen no reports of its use in the ear, nose or throat, but my personal experience in its use in the eye, as above indicated, has been most satisfactory.

ORTHOFORM is extensively used as a substitute for cocain in relieving the pains of ulcers, wounds, excoriations, burns, etc. It is not suitable for hypodermic use, as the orthoform itself is insoluble and the hydrochoric acid irritating.

In the eye it is useful in painful relapsing ulcers, used in the proportion of

Orthoform 4
Petrolatam 30 parts.

One grain placed in conjunctival sac and bandage applied. It has the advantage of maintaining long-continued anaesthesia.

It is applicable in throat troubles as in cancer or tuberculosis of the throat.

MENTHOL, CARBOLIC ACID AND COCAIN. This solution was introduced by Bonain (Revue hebdomadaire de Laryngologie, Bordeaux, June 17, 1899) who recommends two preparations as follows:

I.

Pure carbolic acid.

Menthol.

Hydrochlorate of cocain, aa 1 gramme.

Hydroch, of cocain, aa 50 centigrammes.

The first for simply anaesthetic, the second for anaesthetic and caustic purposes.

He has used the mixture as a local anaesthetic upon the drum head. In the nasal fossæ for exploratory punctures of the antrum through the inferior meatus and for galvano-cautery in inflamed tissue when the ordinary solutions of cocain are not efficacious. In the larynx, especially in the dysphagia of tuberculosis and in ulceration of the pharynx. In some of these cases the relief is marked for as much as four days from our application. In using the caustic solution for tubercular ulceration the surface should be first brushed over with cocain solution to prevent the burning sensation. "Bonain, in summing up his experience, comes to the conclusion that the three qualities—the anaesthetic, slightly caustic and strongly antiseptic-made this application one of great usefulness."

EXTRACT OF SUPRA-RENAL CAPSULE. This is not an anaesthetic, but is mentioned now because when used in connection with cocain it greatly increases its efficiency, causing it to penetrate more deeply and to maintain its action for a longer period of time. As a vasoconstrictor and a contractor of erectile tissue it blanches the mucous membrane of the nose and shrivels up the turgescent tissue rendering operations bloodless, and the space large for examinations and manipulations.

As a therapeutic agent it has gained some credit in relieving the distressing symptoms of hay fever.

There are other remedies that have more or less local anaesthetic effect, but these are the only ones that have gained for themselves any definite position thus far.

Chloretom is being pushed by Park, Davis & Co., but I have had no experience with it, nor do I know of any literature bearing on it save that circulated by that firm.

D. A. S.