disease and urge its use for this purpose, yet I cannot recommend it so strongly and with as much confidence, as a diuretic, as I can a perfect anti-emetic. I recall the fact that cocaine did act as a "heart-tonic and stimulant" in my cases of yellow fever, but failed to note it at the time, being more occupied with its action in quieting the stomach and keeping up the action of the kidneys. In summing up the value of cocaine in the treatment of yellow fever, it may be stated to be almost a specific, in my experience doing more to cure this disease than any other drug I have ever tried, taking away or removing all nausea and vomiting, acting as a diuretic and as an excellent and sure"heart-tonic and stimulant." Chloralamid as a Hypnotic. W. Hale White, M.D., F.R.C.P., Senior Assistant-Physician to, and Lecturer on Materia Medica and Therapeutics at, Guy's Hospital: In his exhaustive account* of many of the new hypnotics, Professor Leech says of chloralamid that the observations upon it are so far few in number. I have recently given it to twenty patients suffering from various illnesses, in all of whom insomnia was a troublesome symptom. Brief notes are appended. It will be seen that the drug produced comfortable sleep in all the patients except two; one of these was suffering from delirium connected with cerebral hemorrhage, and the other was admitted with rheumatic fever complicated by delirium tremens and salicylic poisoning. Both these patients died shortly after admission. It is noteworthy that some of the other patients were suffering from extremely painful diseases, and yet chloralamid produced sleep; thus a woman who had a thoracic aneurism preferred it to morphine, and another patient who had carcinoma of the stomach also slept better with chloralamid than with morphine. The patient with carcinoma of the liver suffered intense pain, yet she dozed comfortably after chloralamid. The man suffering from cerebral softening who was quieted by the drug is also a striking case. Probably the house physicians, sisters, and nurses are the best judges of hypnotics, as they see the patients frequently during the night. They all tell me that those who take chloralamid sleep well and comfortably after it, and the sisters of the three wards in which I have used it tell me that the patients sleep better after chloralamid than after any of the hypnotics which have been introduced during the last few years. My own experience, and what the patients themselves tell me, certainly agree with this. In none of the twenty patients to whom I have given it-and many of them have taken several doses-have any effects followed that can be looked upon as contra-indications to its use. Never have I observed any depressing results, nor has headache followed its use. The time which elapses between its administration and the commencement of sleep varies between a quarter of an hour and two or three hours. If it is given in the evening, when once asleep the patient usually sleeps quietly till morning. Some writers have stated that occasionally after a dose in the evening the patient does not go to sleep till the next morning, and that he remains asleep all the day. This was so with one of my patients; but it must be remembered that, as the drug is feebly soluble in water-20 grains take five hours to dissolve in 2 ounces of water-it is often given as a powder with some milk. It was administered in this way to my patient who slept the next day, and I should think that some of these cases of delayed action were due to delayed absorption. Now I always prescribe it with spirit; 20 grains will dissolve in 1 drachm of rectified spirit in fifteen minutes, and water may be added to this solution without reprecipitating the drug. A good way of giving it is to tell the patient to dissolve it in a little brandy, add water to his liking, and drink it shortly before going to bed. If given in milk, not only is it insoluble, but it is difficult to swallow, for it sticks to the sides and bottom of the glass. The taste is slightly bitter, but by no means disagreeable. It should never be prescribed with alkalies, for they decompose it, nor should hot water be mixed with it, for it decomposes at 148° F. For an adult, 20 to 60 grains—the exact amount depending upon the cause of the insomnia-is the dose; usually 30 grains will suffice. It has the advantage over sulphonal that it is only half the price, and it has the great advantage over paraldehyde that it has no nasty smell or taste, nor is it difficult to dissolve. The few cases which have been published quite bear out the cases recorded here. It would seem that in chloralamid we have a safe hypnotic, which hardly ever has any depressing effects, which does not produce indigestion, and very rarely gives rise to any unpleasant results. We do not of course yet know what harm may result from its prolonged References to those authors who have studied the chemistry and physiological action of the drug will be found recorded by Leech, Patterson,* and in a leading article in the Therapeutic Gazette for September, 1889. Rabowt considers 45 grains of chloralamid to be equivalent to 30 grains of chloral. Chloralamid has been used successfully as an enema by Peiper.‡ use. Case 1. Typhoid. A girl aged 4. Very irritable and fretful, often keeps the other patients awake by her crying; 5 or 10 gr. of chloralamid always sent her to sleep a quarter of an hour after taking it. She slept quietly for many hours. She took it frequently for a fortnight. Case 2. Sarcoma of last rib, growing extensively into the tissues and organs around. A middle-aged man. He suffered intense pain, but 30 or 40 gr. of chloralamid always gave him sleep, often for the whole night. It relieved him as much as, or even more than, morphine. Case 3. Cerebral hemorrhage with noisy delirium. An adult man. 30 gr. of chloralamid did not relieve the delirium. Case 4. Thoracic aneurism; a woman. She suffered great pain. Before the introduction of chloralamid she was treated with injections of morphine. For the last month of her life she had many doses of 30 gr. or 40 gr. of chloralamid. She always slept well after it, and she said she preferred it to morphine. Case 5. Subacute nephritis. A woman aged 27. Slept well and comfortably after a dose of 30 gr. Lancet, October 26, 1889. † Centralblatt fur Nervenheilkunde, August 1, 1889. Case 6. Mitral regurgitation, pericarditis. A boy aged 12. Slept all night after a dose of 5 gr. A man Case 7. Mitral regurgitation and albuminuria. aged 40. 30 gr. made him sleep well and comfortably. Case 8. Extreme ascites, probably due to cirrhosis. elderly man much troubled with insomnia. 50 gr. made him sleep well and comfortably. Case 9. Carcinoma of the liver. A woman aged 38. She suffered extreme pain, but 30 gr. of chloralamid caused her to sleep well and doze in comfort. Case 10. Erysipelas. A middle-aged woman. 30 gr. always made her sleep comfortably. Case 11. Rheumatic fever. A boy aged 10. 15 gr. every four hours gave him quiet sleep, although he suffered much. Case 12. Rheumatic fever, delirium tremens, salicylate poisoning. A man aged 40; died a few hours after admission. 3i of chloralamid had no effect upon him. Case 13. Brachial monoplegia, probably due to embolism and cerebral softening. An old man, who was very noisy and delirious. 30 gr. always quieted him and produced sleep lasting some hours. Case 14. Mitral disease. A middle-aged woman. always produced sleep. 30 gr. Case 15. Carcinoma of the pylorus. A woman aged 56. 30 gr. always produced sleep better than morphine. Case 16. Chronic eczema. A man aged 40. 30 gr. caused comfortable sleep. Case 17. Mitral regurgitation and floating kidney. A woman aged 50. 30 gr. produced sleep, although the floating kidney caused much pain. Case 18. Spastic paraplegia. A woman aged 56. 20 gr. caused comfortable sleep. A Case 19. Phthisis, aortic disease, saturnine paralysis. man aged 65. 20 gr. always produced sleep, but it took twelve hours to act, so that if the medicine were given in the evening the patient did not sleep during the night, but he slept all the next day. Case 20. Mitral regurgitation. An adult man. 30 gr. produced comfortable sleep. case. A severe Clinical Notes on the Use of Campho-Phenique in the Treatment of Burns and Lacerated and Contused Wounds. It is now some five or six years since my attention was first called, by a brother practitioner, to the remarkable preparation which has since become so widely and favorably known to surgeons as Campho-phenique. It was then in an experimental state and was undergoing a series of practical and scientific tests with the view of the determination of its properties-physical, physiological and therapeutic. Being in daily contact with those who were conducting the experiments, I soon acquired an appreciation of the value of the substance as a vulnerary, local anesthetic and antiseptic, which the experience of subsequent years, and its use in many hundreds of cases, has served only to exalt and intensify. The result achieved with its aid in many classes of surgical lesions have been uniformly satisfactory, and, in some instances, so remarkably excellent as to justify an endorsement of the remedy, which, to those who are unacquainted with it, would seem like the grossest exaggeration. The rapidity and the freedom from inflammation and suppuration with which ordinary incised wounds unite under its use are remarkable; but it is in badly lacerated and contused wounds and burns of all descriptions that its greatest virtues are exhibited, and it is to the results achieved in this latter class that my foregoing remarks concerning exaggeration especially apply. As a proof of the truth of the statement, I present herewith a brief clinical report of a typical case in each description treated with Campho-phenique alone. Case I. Amy B., white, aged 4 years. In reaching for a plaything on a lamp stand, the cover of the latter was pulled off, and a lighted night-lamp standing thereon was overturned, a portion of its contents (coal oil) being thrown over the hands and arms of the child. The latter fell to the floor amid the debris, and in a moment, or before the parents, both of whom were in the room, could smother the flame, was superficially, but badly burned from the finger tips to above the elbow of the left hand and arm, and over a space of three inches in diameter on the right shoulder. There were also a few blisters made on the feet. I was called; saw the little |