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Pharmacology and Therapeutics.PHARMACOLOGY AND THERAPEUTICS AT CAMBRIDGE.

DR. BRADBURY, Downing Professor of Medicine in the

University of Cambridge, selected the subject of Pharma-cology and Therapeutics for his inaugural lecture. After

stating that, with the help of an assistant, it was hoped thatan active school of pharmacology would soon grow up inCambridge similar to the Schools of Physiology and Patho-logy, he gave a very clear definition of the objects in view-viz., "to investigate the physiological action of drugs, withthe hope of turning them to account in the treatment ofdisease, as it is only by such investigations that we canexpect to establish a basis for rational therapeutics." He

justified his position by an interesting account of the growthof therapeutics, starting with the empiricism of herdsmenand proceeding, step by step, from Egyptian medicine, thehealing art of the East, of the Greeks and Romans, to the timeof Harvey, and then by more rapid stages to the present day.He showed that medicine, like other arts and sciences,travelled pari pcssu with civilisation. His chief contentionwas that mere experience can never satisfy the requirementsof science or supply an ideal system of treatment. Turningfrom history to deal with pharmacology in greater detail, hegave a very clear summary of what is known of the relation-

ship between chemical structure and physiological action,and, after numerous interesting examples of what had alreadybeen done, he once more endeavoured to elucidate the trueposition of pharmacology. ’’ Although some would advocatethe study of pharmacology as a purely physiological science,I prefer to regard it in its application to therapeutics. The

province of the pharmacologist is to be a forerunner of thephysician, to point out the therapeutic indications of newremedies, and an extended or more rational use of old ones. "These views, coming from a physician of Dr. Bradbury’sposition and experience, should have especial value at thepresent time.SCOPOLAMINE HYDROBROMATE IN OPHTHALMIC PRACTICE.

Scopolamine is an alkaloid which was discovered byA. Schmidt of Marburg in the root of scopolia atropoides,and has been employed by Dr. Raehlmann1 of Dorpat for ’Imore than two years in his ophthalmic clinic, with excellent Iresults. At first he used the hydrochlorate, but subsequently found that the hydrobromate was more easy to obtain in ’,a pure state, and so recently he has exclusively employed thelatter salt. It is a much stronger mydriatic than atropine,acting more rapidly on the pupil and on the accommodation,but not affecting the intra-ocular tension. In iritis it acts veryenergetically, often removing synechiæ which atropine had ’’,failed to influence. It exerts, too, a very beneficial effecton the course of the inflammatory processes, which itshortens considerably. Consequently it quickly and tffec- ’,tively relieves the pain of iritis and other inflammations of the Ianterior portion of the eyeball. Unlike atropine and hyoscine- ,to which, by the way, it seems to be the more closely allied-it produces scarcely any unpleasant by-effects, and those ’,which it does occasionally cause, such as dryness of the ’’,throat, are not of serious consequence. As it is five times as ’,active as atropine, a solution of from 1 to 2 per 1000 is quite ’’,strong enough for ordinary purposes. When used to dilatethe pupil for ophthalmoscopic purposes it has the advantageof not paralysing the accommodation for long. As the Ieffects are transient, it is desirable when using the drug for ’,its antiphlogistic properties to repeat the instillations three orfour times a day. Dr. Raehlmann considers scopolamireto be the most valuable and the most active of all ophthalmicremedies.

IRON HYPODERMICALLY ADMINISTERED IN ECZEMA.

In eczema due to an anaemic condition, where iron admi-nistered in the usual way presents the disadvantage of pro-ducing or increasing constipation, the plan of giving it inhypodermic injections is recommended by Professor Pellizzari

1 Wiener Medicinische Wochenschrift, No. 20, 1894.

and Dr. Venturini of Florence, who have found it most suc-cessful in acute as well as in subacute and chronic forms ofeczema. The preparation they use is the ammonio-citrate,and of this they inject into the gluteal muscles the thirdof a grain dissolved in fifteen minims of sterilised water.When the injections are carried out with antiseptic precau-tions no local irritation is produced. As a result of this.treatment the appetite improves, the body weight increases,also the dynamometric power, and a larger amount of urea is.excreted. Then the eczema begins to show signs of improve-ment and generally entirely disappears after from twenty tothirty injections. The results appear to have been especiallyfavourable in the case of female patients.

THE INDIAN MEDICAL CONGRESS.

ALL preparations for the Indian Medical Congress, to beheld from Dec. 24th to 29th, 1894, at Calcutta, are in a for-ward state. The Congress will be opened by his Excellencythe Viceroy, Lord Elgin.The General Purposes Committee, with Surgeon-Captain

H. W. Pilgrim, M.B., and Dr. Prandhan Bose as secretaries,have undertaken to arrange for the accommodation of visitorsm

Owing to Calcutta being always full to overflowing duringthe Christmas week, this will prove no easy task. The

Hon. Surendra Nath Banerjee has placed the Ripon Collegeat the disposal of the Congress for the accommodation ofnative medical men. Babu Behari Lall Seal has also giventhe use of Seal’s College for the same purpose, as well as a.portion of a house in Vansittart-row for the accommodationof European members. The military authorities have givensome ’accommodation in Fort William, and special arrange-ments have been made with the Great Eastern Hotel andsome of the boarding-houses. Private hospitality will alsoprovide accommodation for many of the visitors. The

Reverend Fathers of St. Xavier’s College have generously puttheir buildings at the disposal of the Indian Medical Congress,and the meetings will be held in this place. The college isa magnificent building, capable of providing accommodationfor a score of sectional meetings simultaneously. Its situa-tion is very accessible, being centrally placed in Park-street-one of the best-known streets in the European quarterof the city.The Government of India have graciously granted the fol-

lowing concessions to members of the Indian Medical Con-gress : (a) twelve days’ special leave to such medical officers,in civil or military employment as can be spared from theirduties, preference being given to those intending to readpapers ; (b) the loan of one section of a field hospital as anexhibit; and (c) return tickets at single fares on all State rail-ways to medical men and their wives attending the IndianMedical Congress.A similar concession has been made by twelve private rail-

way companies (Assam Railway and Trading Company,Bengal-Nagpur Railway, Bhavnagar-GondaJ. Railway, Bom-bay, Baroda, and Central Indian Railway, Darjeeling-Hima-layan Railway, East Indian Railway, Jodhpur-Bikanir Rail-way, Madras Railway, Nizam’s Guaranteed Railway, Rohilk-hand and Kumaon Railway, South Alahratta Railway, Bengaland North-Western including Tirhoot Railway) and by two=steamer companies (British India Steam Navigation Com-pany and Rivers Steam Navigation Company.

OFFICE-BEARERS OF THE CONGRESS.Patron : H.E. the Earl of Elgin, G.C.S.I., G.C.I.E., Viceroy

and Governor-General of India.Vice-Patron : Sir Charles A. Elliott, K.C.S.I., Lieutenant-

Governor of Bengal.Honorary Presidents : Surgeon-Major General W. R

Rice, M.D., C.S.I., I.M.S.; Surgeon-Major-General A. F.Bradshaw, C.B., V.H.S., A.M.S.

President: Surgeon-Colonel R. Harvey, M.D., F.R.C.P.,D.S.O., V.H.S., I.M.S.

Vice-Presidents : Joggobundhu Bose, M.D. ; Surjee CoomarSarbadhicari, G.C.M.B.

Presidents of Sections-Medicine and Pathology : Surgeon-Lieutenant-Colonel A. Crombie, M.D. Surgery, including

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’Ophthalmology : Surgeon - Lientenant - Colonel E. Lawrie,M.B., M.R.C.S. Militarv Medicine and Surgery : Surgeon-Colonel Gore, A.M.S. Obstetrics and Diseases of Womenand Children: SurgEon-Major H. P. Dimmock, L.R. C.P.,M.R.C.S. Public Health : Surgeon.Major W. G. King, M.B.,C.M., D.P.H. Medico-Legal MEdicine und Insanity : Hon.W. R. Kynsey, C M.G.. F.R.C.P.I. Pharmacology andIndigenous Drugs : G. Watt, M.D.. F.L.S., C.I.E. ; KanaiLal Dey ; Rai Bahadur, G.C.M.D , C.I.E.

Presidents have been chosen to represent Bengal, Bombay,Madras, Hyderabad, and Ceylon, and for each Section four"Vice-presidents have been elected.

The committees are as follows : (1) Transactions Com-mittee, 17 members ; (2) General Central Committee,- 40 members ; (3) Central Executive Committee, 14 members ;(4) General Purposes Committee, 20 members ; (5) ReceptionCommittee,, 32 members. Local spei etaries have been chosenfor Assam, Northern Bengal, Bombay. Burmah, Central,India, Central Provinces, Ceylon, Eastern Bengal, Hyderabad,Deccan, Kashmir, Madras, North-Western Provinces, Oudh,Punjab, and Rajputana.

The local secretary for London ig Brigade - Surgeon-Lieutenant-Colonel K. McLeod, M.A., M.D., F.R.C.S. Edin.,,LL. D., and his address is 39, Clanricarde-gardens, Bayswater-road, W.

SERUM THERAPEUTICS AND DIPHTHERIA.

The Debate at the Berlin Medical Society.No detailed reports have as yet been published of the

"discussion upon the serum treatment of diphtheria raised by- Dr. Hansemann ;1but a brief outline of the course of the,discussion has been given in the Berliner Ktizzische Wochen-schrift. From this we learn that on the 5’ih inst. the subjectwas resumed by Professor von Bergmann, who maintained the.13pecificity of the Löffler bacillus and the duty of practitioners to undertake the trial of Behring’s discovery on the theo-retical grounds which had been advanced ; but he as yet’withheld the results of his own experience. Professor Virchow,’who followed, reported the favourable results so far obtainedat the Emperor and Empress Frederick Children’s Hospital,,and admitted that facts must outweigh the theoretical con-ceptions which he held with regard to the baci’lus and itsrelation to diphtheria.. On the l2ch Drs. M. Wolff, Benda,Korte, Gottstein, and Baginsky spoke. Dr. Wolff referred,to the facts in favour of regarding LoSlgr’s bacillus as the- cause of human diphtheria. Dr. Benda contrasted the re-.-corded accounts of Bretonneau’s diphtheria with modern views,.and averred that from his experience in the post-mortemroom of the Urban Hospital no direct action of the diphtheriaserum upon the organs of the body was to be detected.’Dr. Korte dwelt particulaily on statistics which he had pre-’viou&ly adduced, increased by the addition of thirty-six re-cently completed cases, to meet the objection that the cases.now admitted into hospital were milder thaa formerly.Dr. Gottstein also referred to statistics, ard averred that acomparison of the mortality from diphtheria in Berlin andin its hospitals since 1891, and especially the morta’ity of’two months, September and November, did not show that.-serum therapeutics had idillenced the diphtheria death-rate. But the small figures and the special grouping of-them laid his conclusions open to fallacies. Dr. Biginskyreviewed the experience of diphtheria in the Emperor andEmpress Frederick Children’s Hospital from the beginningof January to the end of November, 1894, and showed theinfluence exercised by the serum treatment Not merely the’statistics but the course of iodividual cases compared withthose of former days tell undoubtedly in favour of the newremedy, and, moreover, only cases that are certainly diph-theria are being treated by it He protested against thestatement that the cases were of a milder type than formerly.

Dr. Kossel on the Antitoxin Treatment.A useful and instructive broe7cure upon the rationale and

Bmethod of the antitoxin treatment has just appeared from/the pen of Dr. Kosel, who is assistant in Professor Koch’sInstitute for Tnfectious Disease. 2 It opens with a briefaccount of Loiiler’s discovery of the bacillus, and the sub-

1 THE LANCET, Dec. 15th, 1894.2 Die Behandlung der Diphtherie mit Behring’s Heilserum. Berlin :

S. Krager. London : Williams and Norgate.

sequent researches of Brieger, Fiaezbel, Proskauer, andWassermann on the nature of the toxine. The basis ofBehring’s serum tuatmpnt corsisti in the fact that the serumof animals rendered immune against a certain kind of patho-genic organism is capable of transmitting that immunity toother animals inoculated with the seium. Its first appli-cation was in regard to tetanus, and the discoveryis declared by Kossel to mark the opening of a new

era in the decline of immunity. For it is a distinctadvance upon the Pdsteurian method of conferring immunityby means of attenuated virus. Ehrlich terms the serum

immunity "passive," as distinguished from the "active"immunity by attenuated virus. For this passive immunityis far more transient, the serum not inducing any change inthe tissues of the body analogous to that excited by thevirus itself. P dssive immunity lasts only so long as theserum circulates. It was, further, found by Behring andKitasato that the tetanus antitoxin, besides conferring im-munity, had the power of curing an animal already under theinfluence of the poison. The extension of this to diphtheriawas made by Behring and Wernicke, who found that the "cura-tive" dose was much larger than that required to produceimmunity, and hence the attempts to produce concentratedantitoxin. The method of the preparation of the serum is thendescribed, and the principle upon which the strength of agiven preparation is determined is explained on the plan intro-duced by Ehrlich. This consists in first obtaining a "normalserum "-that is, a serum which can neutralise a tenfold fataldose of the virus, this being expressed in the formula thatone c.c. of the "normal serum " contains one "immunisingunit." Ehrlich and Kossel found that to cure diphtheria inchildren at least 600 "immunising units" were requisite-that is, either ten c.c. of a serum sixty-fold the "normal,"or five c.c. of a serum 120 fold the "normal." There aretwo explanations of the action of the remedy. Behring holdsthat the toxine is destroyed by a suitable quantity of theantitoxin, and Buchner and Roux that antitoxin renders thetissue cells insusceptible to the toxine. In their experimentsRoux and Martin found that if diphtheria bacilli were

iaoculated on the tracheal mucosa of the rabbitthe animal died within three days after symptoms compar-able to those of laryngeal croup in a diphtherial child. Butif such an animal was injected with antitoxin within twenty-four hours of its inoculation it was saved ; and that propor-tionately the course of the infection was modified the nearerthe antitoxin was injected to the period of primary infection.By inoculating streptococci together with the bacilli thereensued rapid formation of false membrane and broncho-pneumonia with fatal result unless antitoxin was injectedimmediately after the inoculation. It was found, too, that alarger dose of the antitoxin was required to cure the diph-theria in these cases of "mixed infection " than in purediphtheria.

In applying these results to the treatment of human diph-theria it is essential to determine what ii diphtheria, andnaturally that is limited to the disease caused by the bacillus.There are throat affections which macroscopically andanatomically are similar to those caused by the bacillaryinfection. But there must be a reversion to the etiological,rather than the anatomical, distinction of diphtheria. It isa disease excited by a specific organism, and the effects it

produces may be simulated by those due to other agents.Again, there is much variation in the degree and amount ofthe anatomical changes induced by the diphtheritic bacillusitself, as every infected family shows ; but the mild cases maysuccumb to cardiac p3,ral.N sis or to diphtherial paralysis equallywith the severe ones. Dr. Kossel then dwells on the micro-

scopical examination for the bacillus and on the dangers due tothis infection and to the combined effects of it and other infec-tions. He is particularly emphatic upon the need for commenc-ing the treatment early in the case. Speaking of the specialeffects of the injected serum itself, he says that it producesno fever, but is rather antipyretic, and that practically theocly effect is the production of an urticarial-like eruption,which may appear on various parts. He distinctly avers thatit has no action en the heart or kidney, and he has never seenalbuminuria produced by it. Its local effects are striking.It often happens that the day after injection fresh membrane

, becomes visible, which only proves that the infection hadspread there when the treatment was commenced, for it doesnot continue to spread and rapidly becomes detached.The readiness with which the membrane is detached is seenin laryngeal cases after tracheotomy ; whilst the sub-sidence of submaxillary swelling is also marked. There