comes a real blessing to many parturient women. During the first stage it exerts a soothing effect, relieving nervousness and restlessness when given in doses of one dessertspoonful, followed every half hour by a teaspoonful. In the second stage its action is that of a uterine tonic, increasing the efficiency of the pains, and here it may be given in teaspoonful doses whenever required for that purpose. In the third stage it satisfactorily replaces ergot, being equally as efficient and devoid of its unpleasant sequelæ. One of the striking differences in the effects of ergot and Hayden's Viburnum Compound, during the period of parturition, is that while the former produces a continuous contraction of the uterus with scarcely any intervals between the pains, Hayden's Viburnum Compound simply reinforces the strength of the uterine contractions without otherwise changing their character. This enables it to be employed when ergot would be dangerous both to the mother and the child.

Gude's Pepto-Mangan.

The Dietetic and Hygienic Gazette, commenting upon the dietetic value of iron, says:

"Pathologists have given pointers as to the special condition of the iron in the system and in the circulating medium, and the newer preparations aim to imitate that condition. Most of them have a brief day of fame and then drop out of sight, for the reason that they lack some element of eligibility. Few are standing the test of time, and the critical ordeal of the clinicians. Foremost among

these, it is safe to name Gude's Pepto Mangan. It is probably the nearest approach to a physiologic reproduction yet devised. It deserves its universal popularity, and its manufacturers do well to restrict its sale to strictly ethical channels."

Dust, Dirt and Germs.

Your sick-rooms are best freed from dust, dirt and germs, if the sweeping is first done with a cloth-covered broom moistened with water containing just a little Platt's Chlorides. The furniture should be dusted with a cloth similarly moistened.

(Read before the San Francisco County Medical Society, April 14, 1903.) From what we know of the digestive and antiseptic properties of hydrochloric acid, when a deficiency of it had been discovered in the stomach by analysis of contents, great expectations were raised as to the benefits from its medical use; these have not been realized in practice by the medium or even the largest doses used, up to five minims of the strong acid, and it has, therefore, become to a certain degree discredited. This disrepute of HCl is probably from insufficient doses; and there has, hitherto, been no practical way to give larger doses. The amount of HCl formed in the body daily, calculated on two parts per 1,000 of 6,000 cc. gastric juice (Michael Foster), would be 12 grammes absolute HC1-36 grammes strong liquid HCl. Calculated on the amount required to combine with 226 grammes cooked beef (the daily proteid requirement), it would be (Vanvalzah1) 15 grammes of liquid HCl. Whatever is required to make up the deficiency in the amount that is secreted is the daily physiological dose. The strong liquid HCl in a less quantity of water than 100 to 150 times its bulk burns the mouth and throat; injures the teeth when still weaker; 100 times diluted we would have to give 1,500 cubic centimeters of water (50 ozs.), this would burden too much the stomach, which in most dyspeptics contains too much liquid.

When muscular tissue is digested with strong or weak hydrochloric acid an organic hydrochloric acid combination is formed, which in contact with pepsin is transformed into

VOL. IL VI-17

peptone. The acid unites with the proteid to form an acid and a basic combination. The acid combination requires for 100 grammes boiled beef 3.10 grammes of HCl, or 10 grammes of liquid HCl, this in such a state of combination that it reacts acid with litmus and neutral with dimethylamidoazobenzol, and some other indicators of free hydrochloric acid. I find that this combination, although containing so much active acid, does not have the slightest action on a piece of marble or shell kept in it, and therefore will not have any on the teeth. It is able, on the addition of pepsin, to dissolve 65 per cent of the beef with which it is combined, and an additional 40 per cent of beef with which it is mixed, still retaining an acid reaction to litmus; this kind of acidity is found in health to exist in the small intestine by Cash, Victor Harley,' Moore' and Rockwood, and does not interfere with the further action of the pancreatic juice. I find with the presence of-pepsin

.068 gr'm. HCl. with 2 gr'm. boiled meat dissolves 0.650 gr'm. 66 2 66 2

.034 .102 "

66

66

0.410 0.850"

Reduced to constant amounts of HCl., the results are:

1 part HCl to 29 parts meat dissolves 12 parts meat.

The acid was used in a dilution of 1.2 per 1,000.

It offers a method of giving very large doses up to 2 grammes or 3ss. of the strong hydrochloric acid, without burning the throat, injuring the teeth, or burdening the stomach with a large quantity of water of dilution. It has no bitter or unpleasant taste, and may be given in soup or beef tea; one heaped up tablespoonful carrying about (15 m.) 1 gramme of the strong acid in the proper condition for the digestion of the meat with which it may be combined, and 40 per cent additional. Besides what is dissolved, a part of the residue is converted into anti-albumose which is readily dissolved by the pancreatic juice.

This organic combination of HCl is formed by 1 part of strong liquid HCl, 50 parts of water, 16 parts of boiled beef ground to a coarse, moist powder, heating a few hours until a paste is formed; prepared in this way it contains about 7 per cent strong liquid HCl. I have also been able to make a dry white powder containing 14 per cent of

strong liquid HCl, and a clear white liquid containing 2 per cent liquid HCl, all having similar properties-samples of which I show you-in place of boiled ground beef, commercial meat powders may be used, or tropon, somatose, etc., using double the amount of HCl.

It may be urged that giving large doses of HCl would withdraw too much alkali from the blood, and too much reduce its alkalinity. Every 36.5 parts of absolute HCl or 111.5 parts of liquid HCl would require for its neutralization, when absorbed into the blood in combination with proteid, 53 parts of sodium carbonate. There being in the blood of an average man only 20 grammes sodium carbonate, the giving of 6 grammes liquid HCl daily would take nearly 3 grammes daily. In case continued large doses of HCI are given, it would be advisable to give one hour before meals one-half as much bicarbonate soda as liquid HCl given.

Hydrochloric acid has been used in meat preparations as follows: J. K. Chambers" advises acidulating a raw beef tea with a few drops of HCl. Liebig recommends a few drops in soup. Lepp used 50 grammes pepsin, 50 grammes HCl, 1,000 grammes water, 500 grammes beef, heated several hours and neutralized with a 10 per cent solution carbonate soda. Leube's beef extract is made by heating the beef with dilute HCl and afterwards neutralizing the acid by carbonate soda; it contains principally albumose, with a little peptones. I believe I am the first to use meats and other proteids as carriers for large (physiological) doses of HCl, although incidentally these cominations are valuable nutritives.

Hydrochloric acid, and pepsin, with other acids, are employed rather vaguely in most cases of disordered digestion. Although the exact indication for the use of HCI can only be obtained by the use of the stomach tube, good hints may be had from the history: 1. An acid treatment is not suited to most children and young adults or any cases of short duration. 2. It is unsuited to persons who dislike acid foods generally, also to cases of apparent nervous dyspepsia. 3. Acid treatment will probably suit dyspepsia in persons above 30, or in young persons where it has lasted many years.

The diseases which lessen the HCl in the gastric juice

do not act equally on the pepsin. We often find enough pepsin present when there is no free or organic HCl. The determination of the amount of pepsin present is by comparing the digestive power of the acidified liquid with a normal gastric juice, and is not suited for clinical purposes; inasmuch as pepsin can do no harm, it is advisable to use it when the HCl is deficient.

13

Riegel, in his hand-book, Der Erkrankungen des Magens, shows that the pepsin-forming function of the stomach is far more resisting to disease than the acid-secretion function; and that therefore the pepsin is seldom entirely absent. Dr. Jul. Toller,12 in new researches, confirms this: two patients who had a total deficiency of HCl for years were found to have a considerable pepsin secretion. Dr. Arthur Schiff, in an examination of 23 cases of benign gastric disease with low or absent HCl, found in the majority of cases a sufficient amount of pepsin. An efficient bacteriacide has been vainly sought hitherto as a prophylactic in cholera, typhoid fever, and intestinal tuberculosis, and as a curative in typhoid fever, and certain forms of nervous disease, dependent on intestinal putrefaction. The large amount of hydrochloric acid secreted in the gastric juice in health has been shown to have this desired action, but the medical doses (being physiologically minute) have not had such an effect.

The antiseptic effect of the natural hydrochloric acid is shown by Dr. Bruno Mester, Dissert, Breslau, 1891; E. Ziemke, Dissert, Halle, 1893; J. Hoppe Seyler, Einwirkung der Magens aftes auf einige Gährungen, 2 Heft, 1867; E. Cohn, Zeitschrift für Physical Chemie, Bd. xvi. The bacteriacidal effects have been shown by R. Koch on the splenic fever bacillus and the cholera bacillus. Mittheil der Kaiserlich Gesundheits Amt, Bd. I; Kitasato on the Typhus Bacillus, Zeitschrift für Hygeine, Bd. III; Wagner on the Tetanus Bacillus, Central Blatt für Bacter, 1890, Bd. VIII; Kabrhel on the Diphtheria Bacillus, Archiv für Hygeine, Bd. x.

All acids act in a similar manner to hydrochloric acid, but not to the same degree in peptonizing food. Under the theory of chemical affinity which had been accepted up to 1886, when a mixture of various acids, in equivalent quantities, mineral as well as vegetable, are put in contact