THE 1900 PHARHACOPCEIA IN ITS RELATIONS TO THE SPECIAL DEPARTMENTS OF MEDICINE. 1 BY C. S. N. HAUJBERG. Ph.G., Fellow of the Chicago Academy of Medicine; Professor of Pharmacy, Chicago College of Pharmacy of University of Illinois. In introducing this subject it may be well to give a comprehen- sive definition of the Pharmacopoeia; what it is, its purpose, and its functions. Medical dictionaries and other standard works give definitions which for practical purposes are wholly unsatisfactory. As a rule these works define a pharmacopoeia as “an authorized work containing a collection of formulae,” etc. While both the Egyptian and the Assyrian monuments and books 2 contain evidences that supervision was exercised over drugs, the earliest work coming under the category of a pharmacopoeia was the ‘ ‘ Prayogamrita ’ ’ of Vardy-achin-tamani, a Sanscrit physician. The Romans attempted 42 a.d. to .establish a standard, as witness the “ Compositionis Medica ’ ’ of Scribonius Longus. The Arabs issued the ‘ ‘ Ibdal ’ ’ in 800 a.d. This gave directions as to the standard of drugs and their preparations. Under the influence of the Arabic and Greek school of medicine, the famous University of Salerno sprang into existence. In the laws regulating medical practise for Naples and Sicily Fred- erick II directed the apothecaries to guide themselves by the “Anti- dotarium” of Nicolaus, the Dean of the Medical Department of the University of Salerno. This contains, about 150 preparations with description of their medicinal properties and directions for adminis- tration. The “Antidotarium” of Myrepsius was the authority in the thirteenth century. The “Antidotarium Magnum seu Dispensa- torium ad Aromatorios ” was published at Florence in 1498. These two Italian works practically long dominated European medicine. In 1543 Eyons, France, adopted legally and published the “Phar- macopoeia Eugdensis. ’ ’ In Southern Germany, early in that century, the necessity for regulation of medical practise and of adulterations in drugs was recognized by the free cities. Nuremberg laid down the following regulations for the preparation of medicine: All the Laxativa, such as Electuaria and Pillulse, must be prepared and dis- pensed by the druggists in accordance with the directions in the book known as the “ Luminare Majus.” To avoid any error or oversight in the preparation of these Laxativa, and to insure even preparations by all druggists, these Laxativa have been carefully copied from the “Luminare Majus,” by the Doctors of medicine. Each druggist will be furnished with a copy, by which he must be guided, to the exclusion of all other formulas. 1 Read before the Chicago Academy of Medicine, February n, 1898. 2 Rice: Reference Handbook of Medical Sciences. 2 THE 1900 PHARMA COPCEIA The “Luminare Majlis” was a collection of formulas by the Alexandrian physician de Bosco, from Greek, Roman and Arabian medical works. De Bosco added to each formula a lengthy explana- tion. Aside from these works, the first work corresponding to a pharmacopoeia, that produced by Valerius Cordus, was published at Nuremberg in 1546. It soon passed through numerous edi- tions and reprints. The author died in Italy before the book was printed, and it was published after his death by the High Senate of Nuremberg. The first known edition other than the Nuremberg was the Parisian in 1548. In Lyons it went through three editions in 1552, 1559, and 1599. Venice issued one edition in 1556 and one in 1563. The Antwerp edition appeared in 1560. The book, like all medical works of the period, was printed in Latin. The names of the compounds were derived in part from the ingredients, in part from their properties, or finally from the name of the author. According to the first mentioned method of nomen- clature, a plaster which contained the juices of fenugreek, linseed and marshmallow was called Emplastrum diachylon ( ‘ ‘ plaster with juice”). A plaster containing vinegar and saffron was called Emplastrum oxycroceum (“sour saffron plaster”). In the course of time these plasters underwent changes and improvement, and the substance to which the remedy owed its name was frequently omit- ted. The modern Emplastr. diachylon contains no juice, and the Emplastr. oxycroceum of to-day never contains vinegar and but rarely saffron. The names of many preparations, by this modifi- cation in their preparation, became problems for the philologist. The etymological obscurity of opodeldoc, which has become pro- verbial, illustrates this. Its origin may be easily traced to the old opodeldoc plaster of the last Nuremberg edition of the ‘ ‘ Dis- pensatorii Valerii Cordi.” This does not contain any ingredients found in modern opodeldoc, but its then chief component parts were opoponax, bdellium, and aristolochus root. The first syllable of the first word (opo), the second syllable of the second word (del), and the last syllable of the third word (loch), gives “opodelloch” as Paracelsus wrote it, which became “opodeltoch” and finally ‘ ‘ opodeldoc. ’ ’ Simples are mentioned by Cordus only when special manipulation is required to render them serviceable as remedies. The most important part of this book is a collection of receipts by Greek, Roman and Arabian physicians, by Dioscorides of Sicily, Galenus of Pergamus, Andromachus (the body physician of Nero), Rhazes of Bagdad (“the Arabian Galen”), Avicenna (Scheich el Reis or prince of physicians), Mesue the younger, and Nicolaus THE 1900 PHARMA COPGEIA 3 Prsepositus of Salerno. The formulary contained chiefly substances derived from the vegetable and animal kingdoms. The compounds were of a class known as galenical preparations, from the Roman physician Claudius Galenus, who greatly believed in complex compounds. As the dispensatory of Cordus was based entirely upon the Galenico- Arabian school, the five essences, tinctures, extracts, and chemicals were wanting. Distillation was only tersely referred to in connection with some ethereal oil. The custom of substitution advocated by Galen became so general during the Middle Ages that substitutes were designated. In the Paris edition the following substitutes were given: For winter cherry take common nightshade, for colocynth take castor bean, for laurel oil take tar, for ginger take pellitory root. As the substitutes did not always possess the same properties, the custom had bad results. The larger German cities introduced pharmacopoeias of their own in the sixteenth century. Augsburg had one in 1564 ; Cologne issued one in 1565; Basel issued one in 1561; Mantua, Italy, issued one in 1559; and Bergamo one in 1580. Salamanca issued one in 1588, which was subsequently reissued in 1601. The first English pharmacopoeia, the Pharmacopoeia Londinen- sis, was published in 1618. This appeared in subsequent editions during the revival of science under the British Commonwealth in 1658, 1677, 1721, and 1746. The early British pharmacopoeias were sensible modifications of the works of Mesue, Nicolaus Cordus, and other authors of that class. The Lyons pharmacopoeia long remained supreme in France. The first Paris pharmacopoeia appeared in 1637. Burdigal published a pharmacopoeia in 1643, Toulon in 1648, and Valenciennes in 1651. In the Netherlands, Amsterdam issued a pharmacopoeia in 1636, Leyden in 1638, Brussels in 1639, Lille in 1640, Gand and The Hague in 1652, Utrecht and Louvaine in 1656, and Antwerp in 1681. The first Danish pharmacopoeia was published in 1658; the first Swedish pharmacopoeia appeared in 1686; the first Swiss was published in 1677. The first Prussian appeared in 1698. The Austrian pharmacopoeia appeared in 1739 and was revised by Storck in 1774. The first Bohemian pharmacopoeia was published at Prague in 1739. Persia issued the “ Makzan el Adwyn,” its first pharmacopoeia, in 1771. The first American pharmacopoeia appeared at Philadelphia in 1778 in consequence of the attempts of Dr. Tilton of Delaware to reform the commissary department of 4 THE 1900 PHARMACOPCEIA Washington’s army. The first Irish pharmacopoeia appeared in 1794. Through the influence of Dr. Josiah Bartlett, one of the medical signers of the Declaration of Independence, the Massachu- setts Medical Society took the initiative in inaugurating a pharma- copoeia for the United States by issuing its own pharmacopoeia in 1808. This Massachusetts pharmacopoeia in its materia medica included a large number of therapeutic agents now used by all schools, but for a long time credited to the homeopathists and eclectics. In 1815 a New York Pharmacopoeia was issued under the editorial supervision of Drs. Samuel L. Mitchill and Valentine Seaman. In consequence of the success of this pharmacopoeia Dr. Tyman Spalding, of New York City, submitted to the Medical Society of the County of New York a project for the formation of a National Pharmacopoeia. This project finally eventuated in the present system of revision of the United States Pharmacopoeia. The first half of the present century saw these local pharmaco- poeias superseded by works of national authority, until now, at the close of the nineteenth century, no country can maintain scientific position as a nation without a pharmacopoeia. The latest, but by no means the least creditable, is that of Japan. The most important republics of Central and South America have their own pharmaco- poeias. In some, foreign pharmacopoeias are employed, chiefly the French Codex and German Pharmacopoeia. The Republic of Costa Rica adopted officially in 1897, through Ea Faculdad de Medicina y Cirugia at San Jose, the United States Pharmacopoeia as the stand- ard authority. In Canada and the British provinces the United States Pharmacopoeia is more used than the British Pharmacopoeia. The project of an Imperial pharmacopoeia for the British Empire meets with but little favor and its realization is doubtful. Attempts have been made toward the formulation of an International Pharma- copoeia and also a Pan-American one. The former question will be considered by the International Pharmaceutic Congress, which is to meet in Paris in 1900. The first United States Pharmacopoeia was issued in 1820, and each subsequent decade has seen a revision. The one now officially designated as the seventh decennial revision was adopted January 1, 1894. The earlier editions and revisions were the work chiefly of such medical scientists as Samuel E. Mitchill of New York, Erastus Torrey of Vermont, William Tully of Connecticut, Nathan Smith of Connecticut, Valentine Mott of New York, Samuel P. Griffith, Joseph Parrish, George B. Wood and Franklin Bache, of Phila- delphia. The committee was increased to twenty-five members in 1880, comprising botanists, chemists, pharmacists and physicians in THE 1900 PHARMA COPCEIA 5 nearly equal numbers. To these were added one representative from each of the medical departments of the Federal Government, the Army, Navy, and Marine Hospitals Service. The national committee on revision is elected by a convention constituted of dele- gates from incorporated medical and pharmaceutic societies and colleges, which meets in the city of Washington, D. C., decennially. This convention adopts rules and principles for the instruction and guidance of the Committee on Revision. The next convention will assemble in Washington in May, 1900. From this brief r£sum£ of the history of pharmacopoeias it will be observed that a pharmacopoeia is essential to every civilized country, and that the work of revision is one of great interest and impor- tance. Although the United States Pharmacopoeia has never been legal- ized through national enactments of the various States pertaining to the practise of pharmacy and the prevention of adulteration in drugs and medicines, it is, however, de facto the legal standard for the entire United States as much as though its authority had been declared by congressional fiat. No especial attempt has so far been made to legalize the Pharmacopoeia through the Congress of the United States, but since the National Government is represented in its creation and accepts its standard quite as readily as do the States and local governments there may be no need for the Federal insignia, at least not until a National Department of Health be created. The United States Pharmacopoeia may be defined as an authori- tative compilation or work ( 1 ) creating standards for the identifica- tion, purity, strength, and quality, and (2) giving directions for the purification, valuation, preparation, compounding and preservation of drugs, chemicals, and medicinal substances. The French Pharmacopoeia is denominated the Codex Medica- mentarius. This last title expresses the scope and functions of a pharmacopoeia better than any other. It should be a pharmacal code for physicians and pharmacists. With thoroughly educated and experienced pharmacists, the physician is assured not only of uniformity in product, strength, purity, and quality, but also that such medicines shall be prepared according to the best and most advanced methods of the pharmacal art. While the United States Pharmacopoeia from a scientific stand- point is undeniably in advance of all other pharmacopoeias, yet it lacks certain features to render it more serviceable and consequently more generally acceptable to the medical practitioner. The first of these deficiencies is in the pharmaceutic preparations, particularly 6 THE 1900 PH A RM A C OPCEIA in such classes as are of solid form and also such as are intended for external use. Another deficiency is that the revised edition does not with sufficient accuracy contain as many new substances as have fairly proved their efficacy, promise and utility as therapeutic agents as it should. Thirdly, it lacks certain general information which should be incorporated as an authoritative guide to the more intelli- gent use and application of various remedies. In this last category should be included the maximum dose of all toxic and potent sub- stances and their preparations. While pharmacology (or the science devoted to the action of drugs) and therapeusis (or the science devoted to the indications for and selection of remedies) are not within the scope or function of a pharmacopoeia, still the certain safe and accurate method of exhibition and administration of remedies cannot be realized unless their respective forms be based upon these fundamental considerations. It is not otherwise possible to realize the motto of Asclepiades, “ cito, tuto , jucundeE Whatever improvement be necessary in the new pharmacopoeia in the direction of its greater therapeutic utility must come from medical men. There may be superfluity of remedial substances in a pharmacopoeia, while no authoritative forms for their administration are given. On the other hand the preparations, though made after elaborate processes, may be so defective as to impair their therapeu- tic usefulness. This is particularly true of solid preparations, espe- cially those intended for external use. While nearly one-half of the 1000 articles of the United States Pharmacopoeia are such prepara- tions, these comprise but thirty - three classes, and of these only eleven are solids, six for internal and five for external use. The French Pharmacopoeia has sixty-four classes, in which there are thirty-four solids, eighteen for internal and sixteen for external use. The British Pharmacopoeia has thirty -five classes, including thirteen solids, four for internal and nine for external use. It is particularly strong in ointments, having forty- four, and is the only pharmacopoeia in which an attempt has been made to discriminate as to the selection of the vehicle employed for ointments of various use. The German Pharmacopoeia has forty-five classes with twenty- two general formulae giving directions for compounding any number of as many different classes of preparations. There are twenty-three classes of solids, about equally divided into preparations for external and internal use. While a compilation of about five hundred formulae for prepara- tions of a polypharmacal or ephemeral character was published by the American Pharmaceutical Association in 1887, and revised in 1895 under the title of The National Formulary, this work does no THE 1900 PHARMA COPCEIA 7 carry authority as a standard like the Pharmacopoeia. The National Formulary has been exceedingly useful in introducing greater uni- formity into such preparations as elixirs, syrups, pills, etc., but its utility is hampered through the difficulty of acquainting physi- cians with a semi-official work. Familiarity with and adherence to accepted standards are more likely to be secured through one comprehensive work of official character than through several. The following tables will illustrate (choosing the ointments for this purpose) the differences between the pharmacopoeias of lead- ing nations other than the United States: OINTMENTS OF THE BRITISH PHARMACOPOEIA . Lard, prepared; Lard, benzoated, 2 per cent, benzoin; Paraffin, hard, melts at 43°-62° C.; Paraffin, soft, melts at 35°-40.5° C. Unguentum. Parts active agent. Vehicle. Percentage of strength. Acid borici Acidi carbolici Acidi salicylici Aconitinse Antimonii tartrati... Atropinse Belladonnse ext. ale. Calaminse Cantharidis Cetacei Chrysarobini Creasoti Elemi Eucalypti oil Gallse Gallae cum opii Glycerini Plb. subacet Hydrargyri, Hg Hydrargyri ammoniatse Hydrargyri compositum, oint- ment mercury Hydrargyri iodidi rubri Hydrargyri nitratis, Hg Hydrargyri nitratis dilutum Hydrargyri oxidi rubri Hydrargyri subchloridi Iodi Potass, iod. Iodoformi Picis liquidse Plumbi acetatis Plumbi carbonatis Plumbi iodidi Potassse sulphuratae Potassii iodidi Resinae Sabin se, herb Simplex Staphisagrise Sulphuris, subl Sulphuris iodidi Terebinthinae oil 1 1 1 1 1 1 1 16 1 6 1 1 1 1 1 2.5 2 1 1 5 16 4 4 1 1 5 8 Veratrinae. 1 Zinci oxidi 2 Zinci oleati 1 Soft paraffin 4, hard paraffin 2... Soft paraffin 12, hard paraffin 6.. Soft paraffin 18, hard paraffin 9.. Alcohol 3.5, benz. lard 55 Simple ointment 4 Alcohol 3.5, benz. lard 55 Benz, lard 9 Benz, lard 5 Yellow wax 1, olive oil 6 Benzoin 1, white wax 4,. oil al- monds 40 Benz, lard 24 Simple ointment 8 Simple ointment 4 Soft paraffin 2, hard paraffin 2... Benz, lard 5 Ointment of galls 13.6 Soft paraffin 4, hard paraffin 1% Suet 1, prepared lard 16 Simple ointment 9 Yellow wax 3, olive oil 3, cam- phor 1 J4 Simple ointment 27.3 HNOs fl. 3, prepared lard 3%, olive oil 8 fl Soft paraffin 2 Soft paraffin 5.3, hard paraffin 1-76 Benz, lard 5.47 Glycerin fl. 12, prepared lard 19. Benz, lard 9 Yellow wax 1 Benz, lard 73 Simple ointment 7 Simple ointment 7 Hard paraffin 18, soft paraffin 55 Potass, carb. 1, water 14 fl., benz. lard no Yellow wax 2, simple ointment 8, oil almonds fl. 1 Yellow wax i l / 2 , benz. lard 8 White wax 1, benz. lard 1%, oil almonds i l / 2 Benz, lard 2, digest and strain... Benz, lard 4 Hard paraffin 18, soft paraffin 55 Resin 1, yellow wax 4, prepared lard 4 Ol. olive 7, hard paraffin 14, soft paraffin 41 Benz, lard n Soft paraffin 1 14 5 3 5 1.6 20 1 .6 10 18 12 5 18 4 11 20 20 18 7 15 45 10 40 3-5 10 3 12 10 65 2.6 12.5 12.5 7 12 25 28 33 20 6 50 i-5 20 50 8 THE 1900 PH A RM A C OPCEIA POMADES OF THE FRENCH CODEX. Pomatum (Pomade). Ammoniacale liquid Antipsoricum sulphur Potass, carb. Nervinum camphor Tolu Belladonna cum extracto ext Camphoratum Carbonate plumbico Chloroformo cum , Citrenum HNO318; Hg. Cucumeris de succo cucumeris- sative Epispasticum cum extracto Gnidii Cantharide luteum de Cantharide viride Pice Iodureto plumbico Iodureto potassico Iodureto potassico iodureto Laurinum leaves berries Hydrargyro Hydrargyro simplex Oxydo and hydrargyrico Populeum poplar buds Regent de mercuric ox Dead acet. Sulfuratum Stibiatum ant. et pot. tart. Quantity of active agent. Vehicle. Percentage of strength. 20 Suet 10, lard 10 50 {'5 Oil almonds 5, lard 35, water 5 16 Ox marrow 350, oil almonds 100, ■1 15 oil nutmeg 450, oil rosemary, t 3 ° Girofle water 2, lard 24 3-3 4 3 ° White wax 10, lard 90 25 10 Benz, lard 50 18 10 White wax 5, laid 85 10 4 Lard 40, olive oil 40 7 120 Tolu 0.2, rose water 1, calf suet 60, lard :oo 4 White wax io 5 alcohol 9, lard 90. 4 6 Curcuma 4, oil citron 4. yellow wax 12, lard 84 6 10 White wax 40, ointment poplar 280 10 Lard 90 10 10 Lard, benz., 90 10 TO Lard, benz., 80, water 10 10 10 Iodin 2, water 10, lard, benz., 80.. 10 (TO l 10 Lard 100 SO Lard 50 50 10 Lard, benz., 30, of Hg 12.5 I Vaselin 15 6 3 f Poppy, belladonna, hyoscya- ou \ mus, dulcamara 50, lard 400.. {; Camphor 0. 1, vaselin 18 10 Oil almond 10, benz. lard 80 10 10 Benz, lard 30 25 OINTMENTS OF THE GERMAN PHARMACOPOEIA. Unguentum. Quantity of active agent. Vehicle. Percentage of strength. Acid borici Basilicum Cantharidum Cantharidum veterinar Euphorbium Cereum wax Cerussse fc . Cerussse camphorata ....’ Diachylon Glycerini starch Hydrargyri album Hydrargyri cinereum, Hg Hydrargyri rubrum Potassii lodidi Leniens (cold cream) Paraffin Plumbi, liq. pb Plumbi tannici ac. tan. Liq. pb. subacet. Rosmarini oil Juniper oil Tartari stibiate Terebinthinse oil Zinci, oxide, imp 1 1 3 3 5 1 10 1 10 1 10 1 10 2 1 I Petrolatum 9 Turpt. 2; wax, resin, suet, each 3; olive oil 9 Oil cantharid 3, wax 2 Turpt. 2, wax 1, olive oil 4 Olive oil 7 Petrolatum 7 Ung. cerussse 95 Olive oil 1 Water 15, trag. 2, alcohol 5, glyc- erin 100 Petrolatum 9 Lard 13, suet 7 Petrolatum 9 Aq. 7.5, sod. thiosulf. 2.12, lard 82. ? White wax 4, spermacet. 5, ( water 16, oil almonds 32 Paraffin oil 4 Evaporate to 50, petrolatum 90 ... Lard 17 Oil nutmeg exp., yellow wax, each 2; suet 8, lard 16 Petrolatum 8 Wax 1, turpentine 1 Lard 9 10 20 30 30 5 50 10 33 10 10 10 10 10 THE 1900 PHARMA COPCEIA OINTMENTS OF THE JAPANESE PHARMACOPOEIA . 9 Unguentum. Glycerini starch Hebrse diachylon Hydrargyri album Hydrargyri cinereum Hydrargyri flavum Hydrargyri rubrum Scopolise ext. Simplex , Stibiatum tart. ant. et pot. Sulfuratum, sublimed Vesicans fort canthar. Vesicans mitius Zinci oxide Quantity of active agent. Vehicle. x Water 1, glycerin 9 I Oil lini 1 I -20 Va selin 9 Eard 18, beef suet 42 I Va selin 9 x Va selin 9 I Eard 9 Yellow wax 1 oil sesami 2 2 Va selin 8 I Eard 0. 10 Olive oil 90, wax 70, terebinth 30.. I Eard 9 Percentage of strength. 90 50 10 33 10 10 10 33 5 2.5 10 From these observations the following suggestions are offered for the work of the revision in these respective special departments of medicine: Diseases of the Eye. — Identification and determination of com- parative value of the mydriatic alkaloids, with special reference to those of the solanaceous plants and their derivatives. Formulas for collyria, especially solvents. Investigation of the employment of the lamellae (gelatin disks), containing alkaloids for solution in the eye, instead of water solutions. Fist of ointments used and char- acter of vehicle employed,^ with reference to the preference of the paraffins to the more absorbable animal and vegetable fats. Diseases of the Ear , Nose y and Throat. — Report on antiseptics, anesthetics, anodynes, absorbents, astringents, demulcents, emolli- ents and protectives used in substance or in the following forms, with special reference to solvent or vehicle used: Gargles, insuffla- tions, injections, lotions, oleates, pastilles, tablets, troches, vapors, cereoli (antrophore), pastes, electuary, confections, sprays, oils, medicated stylus, suppositories, cigarettes, papers (fumigating), inhalants, ointments, cerates, plasters. Skin and Genito- Urinary Diseases . — Report on antiseptics, astrin- gents, absorbents, anesthetics, anodynes, caustics, hemostatics, par- asiticides, protectives, rubefacients, styptics, and vesicants used in substance or in the following forms, with special reference to solvent or vehicle. Comparative study of vehicles as to ratio of absorption and classification of ointments, cerates, suppositories, plasters and unctuous preparations for external use: Baths, cataplasms, caustics, crayons, sponges (prepared), fomentations, oils (medicated), enemas, lotions, powders, soaps, solutions, injections, suppositories, cotton, gauze, pomades, ointments, cereoli (antrophore, stylus), cerates, plasters, plaster mulls. Digitized by the Internet Archive in 2017 with funding from University of Illinois Urbana-Champaign Alternates https://archive.org/details/1900pharmacopoei00hall MEDICINE ¥ ¥ ¥ EDITOR-IN-CHIEF: - HAROLD N. MOYER, M.D., Adjunct Professor of Medicine, Rush Medical College; Neurologist to the Cook County Hospital, Chicago. ¥ ¥ ¥ DEPARTMENT EDITORS: Medicine: Janies B. Her rich, A.B., M.D., Adjunct Professor of Medicine, Rush Medical College; Attending Physician to Cook County Hospital, Chicago; and Bertram TV. Sippy, M.D., Professor of Medicine in the Chicago Post-Graduate School. Surgery: Weller Van Hook, A.B., M.H., Professor of Surgery in the Northwestern University Medical School and in the Chicago Policlinic; Surgeon to the German Hospital. - Pathology and Bacteriology: Arthur B. Edwards, A.M., M.H., Professor of Therapeutics, Northwestern University Medical School; Professor of Practise of Medicine and Clinical Medicine, Northwestern University Woman’s Medical School; Attending Physician to Cook Comity and St. Luke’s Hospitals; Pathologist to Wesley Hospital. Therapeutics: N. S. Davis, Jr., A.M., M.D., Professor of the Principles and Practise of Medicine and of Clinical Medicine, North- western University Medical School, Chicago. Gynecology and Obstetrics: Henry P. Newman, A.M., M.D., Professor of Clinical Gynecology in the College of Physicians and Surgeons, Chicago; Professor of Gynecology in the Post-Graduate Medical School; etc. Pediatrics: Isaac A. Abt, M.D., Professor of Diseases of Children, Northwestern University Woman’s Medical School; Attending Physician Diseases of Children, Michael Reese and Provident Hospitals. Neurology and Psychiatry: Hugh T. Patrick, M.D., Professor of Neurology in the Chicago Policlinic; Consulting Neurologist to the Illinois Eastern Hospital for the Insane. laryngology and Otology: W. E. Casselberry, M.D., Professor of Laryngology and Rhinology in Northwestern University Medical School; Laryngologist and Rhinologist to St. Luke’s Hospital; Laryngologist to Wesley Hospital; etc. Dermatology and Syphilology: TV. L. Baum, M. D., Professor of Dermatology and Syphilology in the Post-Graduate Medical School, Chicago; Fellow of the Chicago Academy of Medicine. Ophthalmology: C. P. Pinckard, A. B., M. D., Professor of Ophthalmology, Chicago Post-Graduate Medical School; Attending Ophthalmologist, Michael Reese Dispensary. Genito- Urinary Diseases: G. Frank Eydston, M.D., Professor of Surgical Diseases of the Genito-Urinary Organs and Syphilology in the Chicago College of Physicians and Surgeons. Climatology and Public Health: Norman Bridge, M.D., Los Angeles, Cal., Professor of Clinical Medicine and Physical Diagnosis, Rush Medical College; and Joseph M. King, M.D., Los Angeles, Cal. Forensic Medicine: Harold N. Moyer, M.D., Professor of Nervous and Mental Diseases, Chicago Clinical School. We ' are endeavoring to place before physicians a journal that shall contain strictly scientific matter, equally interesting to members of the profession in all parts of the country. All matters of a personal or con- troversial kind are excluded; also society news, and items of local impor- tance only. MEDICINE shall be kept abreast of the times, but matters which, as yet, do not admit of an authoritative opinion will not be ex- tensively considered. HAROLD N. MOYER, M.D., Editor MEDICINE A Monthly Journal of Medicine and Surgery. HAROLD N. MOYER, M. D„ EDITOR. ~ FEBRUARY, 1898. ^ GONTENTS. ORIQINAL ARTICLES. A CASE OF EXTIRPATION OF THE SOFT PAlATE AND TONSIL FOR CARCINOMA. Dv Edward H. Lee. M D 80 A CASE OF HYSTERICAL DYSPHAGIA. By Llewellyn Eliot. A.M.. M D <3 THE PATHOLOGIC IMPULSE TO DRINK - ALCOHOL AS A SECONDARY FACTOR IN DIPSO* MANIA. By William Lee Howard. M.D 104 SINUS OR FISTULA FOLLOWING ABDOMINAL OPERATIONS. By J. Garland Sherrill, M.D .. 109 SOME PHYSIOLOGICAL AND ANATOMICAL QUESTIONS REGARDING THE STOMACH. By A. L Benedict A.M.. M D 113 BOOK REVIEWS. Pathological Technique. By Mallory and Wright no ’A System of Medicine by Many Writers. Edited by Thomas Clifford Allbutt 119 Manual of Gynecology By Henry T. Byford. M.D 120 Stirpiculturb. By M. L. Holbrook. M D 121 Essentials of Bacteriology. By M. V. Ball 122 The Bulletin of the Ohio Hospital for Epileptics. Published by the Hospital, Gallipolis, Ohio 12a PROORESS OF MEDICAL SCIENCE. MEDICINE. Lumbar Puncture ] Dextrocardia I Cardiac Failure Acquired 1 A Sign of ( NEUROLOGY AND PSYCHIATRY. Electricity In gout 1 Cerebral Abscess and Visual Aphasia 1 Diagnostic and Therapeutic Vaiue of Lumbar Pune* Triceps Contraction and Radial Paralysis 132 PATHOLOGY AND BACTERIOLOGY . The Microbe ?nd Pathology of Yellow Fever Burns and Visceral Pathologic Alterations Tuberculous Infection through Ingestion of the Bacilli i THERAPEUTICS. Hot and Cold Applications to the Spine in Pulmo- nary Affections : Treatment of Pneumonia LARYNGOLOGY AND OTOLOGY. Diseases of the Mastoid*. Their Course and Treat* ment.. Y Frontal Headache and Sinus Disease DERMATOLOGY AND SYPHILOLOOY. OPHTHALflOLOOY. (Solanum Carolinense) Urotropin as an Antiseptic for the Urinary Channels Treatment of Obesity Physiological Action of Glaucinum OYNECOLOOY AND OBSTETRICS. Mackenrodt’s Operations 148 PEDIATRICS. Congenital Rectal Malformations i$i Present Status of Infant Feeding 102 Congenital Stenosis of the Larynx 153 * ' Fatal Infantile Anemia with Greatly En- t Terrors of Children 154 GENITO-URINARY DISEASES. Treatment of Urinary Fever i CLIMATOLOOY AND PUBLIC HEALTH. Report on Physical Training in the Boston Public Schools. 1 Typhoid from Contaminated Milk 1 Glycerinated Vaccine Lymph 1 Gymnasiums in the Public Parks .: ... 1 Mortality from Typhoid, Scarlet Fever.and Phthisis 1 FORENSIC MEDICINE. The Function of the Expert 1 Post-mortem Findings in Bodies Found Drowned.. 1 Compensation for Expert Testimony 1 Medical Expert Testimony: A Proposed Act in New York H 1 A Legal Alternative .7 1 COPYRIGHT 1898. WILLIAM M. WARREN, Publisher, DETROIT, MICH. Entered at the Post-office at Detroit. Mich., as second-class. matter.