Correspondence. SCIENTIFIC EDITORIALS. EDITORS OF THE PACIFIC MEDICAL JOURNAL The last issue of the California State Journal of Medicine has an article upon the above subject, in which some criticism is made against a committee which reported dur ing the meeting of the State Society, and advised that the editorial pages of the State Society Journal be devoted only to scientific matter. Following this editorial there appears another one, under the heading "The Board of Examiners." This we give in full: "The State Society, by a vote of twenty-six to four, has recorded its approval of the present medical licensing law, and its disapproval of any attempt to modify it by placing the control of the Board of Examiners in any hands other than those of the medical profession. The attack upon the law was but poorly masked under the guise of an attack upon an individual member of the Board, and its failure is not regarded as the failure to defeat an objectional individual, but as the last move of a most carefully laid plan to tear down somewhat from the protective wall placed about the public by the passage of the last medical practice act. Very few people were at any time deceived." The committee which advised that the editorials be confined to scientific subjects meant to exclude just such an editorial as has been quoted above. The sense of the committee was that the State Journal should be impartial so far as the interests and opinions of members of the State Society were concerned. This editorial is a reflection upon somebody, and shows an unfair method of discussing this important question. I am probably the one who has been most active in opposition to the present medical law. I did make an attack upon the law, but I did it unmasked. What I have had to say I have said openly. I am not ashamed of the course I have pursued. I believe my position is right. I opposed the passage of the law, because I believed that the State Society was not the proper power to appoint this Board. I felt sure that strife would be engendered by the attempt to exercise such power, and I felt that someone's rights would be trampled upon. I even predicted as much, and my predictions have come true. The Board of Examiners has not been fair. It has discriminated; it has trampled upon the rights of individuals and corporations; it has used its powers to injure some and to help others. It has not been neutral, but partisan. I made my attack upon the Board at Santa Barbara because I knew these things were true, and I care not whether my position failed of endorsement by 26 to 4 or 1,000 to 1. It makes no difference. Numbers can not make wrong right. Such editorials as the one above-quoted ought to be beneath the dignity of a State Journal of Medicine. The Society and its editor should be courageous enough to speak their convictions without clothing them in cowardly insinuations and accusing someone, whom it seems afraid to mention, of fighting under cover, and attempting to deceive the public. The fault lies with the other fellow. Any criticism that I have made I am ready to stand by. I believe in a medical law, but I believe in one that is just, and that may be justly administered. Of the members of the Board elected at Santa Barbara four were named by the University of California, and one by the University of Southern California. I would like to ask if these schools require a packed Board in order that their graduates may secure a license. Would it not look better for the University of California to keep its hands off of the Board of Medical Examiners? Does the President of the University know the kind of medical politics his Medical Faculty is doing? D. A. HODGHEAD. AT THE last session of the Medical Society of the State of California, the following committee was appointed to investigate the prevalence of tuberculosis in this State, and to make such recommendations to the Society at its next meeting as they may deem appropriate: Dr. F. M. Pottenger, Los Angeles, Chairman; Drs. Geo. L. Cole, Los Angeles, Jno. C. King, Banning, Geo. H. Evans, San Francisco, and Edward von Adelung, Oakland. DR. M. C. FAAS FAIRCLOTH has established a sanatorium at Fruitvale for the treatment of nervous and mental diseases. Alcoholism and drug habits are also taken. Terms moderate. M. C. FAAS FAIRCLOTH, M. D., Superintendent, Peralta Avenue, near Belmont. Proceedings of Societies. SAN FRANCISCO SOCIETY OF EYE, EAR, NOSE AND THROAT SURGEONS. The monthly meeting of the San Francisco Society of Eye, Ear, Nose and Throat Surgeons was held on January 15, 1903. The President, Dr. Louis C. Deane, was in the chair. DR. ROBERT COHN, on a case of cocaine poisoning: I wish to report briefly a case of acute cocaine poisoning. It was that of a young man about twenty years of age. Other than having just recovered from an attack of bronchitis, he was in very good health. Upon examination, I found a spur of bone of the septum. Removed it with regular nasal saw. I used a 12 per cent solution, and applied the cocaine on cotton to the nose, frequently, for some time. I warned the patient to be very careful and not swallow any. Just as the operation was finished he turned very pale and said he felt dizzy. Immediately put him into bed, and, almost quicker than I can tell it, he was in a state of collapse. In the next few minutes the pulse ran up to 150 and 160, respiration as high as 50, 55 and 60, showing signs of extreme collapse. Almost died. Gave him 1/20 grain of strychnine; respiration more regular and slower. He complained of pain in breathing and feeling suffocated. For three hours he was between life and death. We thought every minute we would lose him. Repeated 1/20 grain of strychnine and strong coffee enemata keeping him awake. It was between three and three and a half hours before we could leave him with safety. DR. EATON: I happen to be old enough to have worked before cocaine had been discovered. Can remember when the first of it came to this country. The first patient I used it on, after giving her, perhaps, a 4 per cent solution, collapsed, and I thought she was going to die. Now I frequently use a 20 per cent solution, and have not had an accident. One early case was an old man to whom I gave a 15 per cent solution and whisky. Met a dentist about that time who said I would probably kill some one. Have not yet, and now I use 20 per cent. I believe two things in regard to this. First, the psychical condition. Personally, I am extremely susceptible to cocaine. Am intoxicated by it after just a few moments. Second, would not use strychnine, but some stimulant. This case of Dr. Cohn's seems to me to be psychical. DR. DEANE: To state whether collapse is due to the local anesthetic or not is sometimes puzzling. There is no question that collapse can occur from psychic influence whether of fear or a reflex from the local irritation of a nerve. It would seem from Dr. Cohn's description that his case was clearly the result of the toxic influence of the drug, as the symptoms were marked and profound; yet there are few of us who can not state similar cases of a much milder character, the result of mere aural or nasal application where no anesthetic was used. DR. POWERS: Dr. Cohn's patient probably collaped from swallowing the solution, but, as a rule, I think the collapse is more from the idea of an operation than from the cocaine. A patient seldom faints from a moderate solution. I begin with a 10 per cent solution, and keep increasing the strength until the patient is entirely under its influence. DR. BURNETT: I think the best method is by electrolysis and then give a 5 per cent solution of cocaine up to 5mm. This will render the operation absolutely painless. Remember the case of a man who was to have a nasal operation. The cocaine was given, and quite an operation was performed with no pain. But after the operation was all over there was extreme collapse. This doubtless was due to a psychical condition. In regard to the strength of the solution, 10 and 20 per cent solutions are seldom found necessary. I prefer an 8 per cent solution. DR. REDMOND PAYNE: The use of dionin in diseases of the eye, I believe, was first reported by Darier, of Paris, at any rate, it was upon the suggestions made by him that I began its use. So far as I can learn, neither he nor any one else has made anything like an extended report upon its therapeutic value, and what I have to say to-night is not in the nature of complete conclusions, but simply a few clinical hints as to the effects I have found in its use. I hope as time goes on to make a more methodical and complete test of its therapeutic value in diseases of the eye. Dionin is a derivative of morphine, and has been used successfully as a substitute for both it and codeine as a general analgesic, the claim being made that it has narcotic VOL. XLVI-24 and sedative effects without their disadvantages. My experience with it has been in diseases of the cornea and conjunctiva only. I use it in 4 and 7 per cent solutions, placing two or three drops above the cornea, which then run down over it. I used it primarily for its local analgesic effect, but found later that it produced more than the analgesia. The only remedy we have had to relieve the pain caused by corneal diseases has been cocaine, which, if used continuously, produces a bad effect on the epithelium, thereby affecting the nutritive process and repair. Further, the anesthetic effect of cocaine is only temporary and must be repeated. For all the painful conditions of the cornea, where an analgesic is indicated, two or three drops of dionin used in one of the above strengths, depending on the severity of the pain, will produce analgesia, and complete relief from pain for from 24 to 72 hours. Further, if the condition is an erosion, an ulceration or a laceration of the corneal tissue, its repair is aided. If it is an infiltration, or serous exudation, it will hasten its resorption, and have the same effect upon all inflammatory products within the cornea or around it. In several cases where the cornea was lacerated, both superficially and deeply, the pain from which was very severe, causing a great amount of local and super-orbital pain, two or three drops of a 4 or 7 per cent solution, after the eye had been properly cleansed, gave splendid and prolonged analgesia and complete relief from all severe pain. In ulcerations of the cornea, both superficial and deep, a 4 per cent solution has accomplished the same result in addition to hastening its repair. In a serpiginous ulcer the pain and progress were immediately arrested by two or three drops of a 4 per cent solution used once daily. In a case of abscess of the cornea, involving two-thirds of its extent, with great pain and continued advance of the disease, two or three drops of a 4 per cent solution daily, had the same effect of changing the progress to that of repair. The phlyctenula and their ulcers, are favorably influenced and pain relieved, in children, by a 4 per cent solution, a drop once or twice a day. In a case of trachoma with dense pannus, two or three drops of a 4 per cent solution, used daily, together with |