far overbalance the slight advantages, and the mouth is now becom ing very generally accepted as far the best place. The axilla has one or two disadvantages that are perhaps rarely thought of. In dry and harsh conditions of the cuticle, not rare in cases requiring frequent observations by thermometer, the cuticle becomes so bad a conductor that even by waiting a very long time the thermometer gives an indication much below that of the mouth at the same time. This can be measurably corrected by sponging the axilla out with tepid water, and leaving it moist when the thermometer is placed in it. The other difficulty is that when a thermometer is placed in the axilla, some pressure of the arm is needed to keep it in place, and this pressure diminishes the cutaneous circulation in the parts in contact with the instrument, and this in time lessens the temperature so that the thermometer indication is liable to be too low. In the conditions of enfeebled circulation of low fevers, the errors of observation from this cause are often important. If any one will take the bulb of a sensitive good thermometer between the moistened surfaces of his finger and thumb and compress it pretty firmly for the time needed to attain its highest indication, and notice carefully what this indication is, he will find it very low, because the pressure has impeded the circulation and kept the blood out of the parts. Let him now slack up the pressure gradually and he will soon see the temperature begin to rise as more blood begins to cir culate in the parts, bringing with it the internal temperature.

Hence, when all circumstances are fairly considered, the rapidly increasing custom of using the mouth for temperature observations is the best, and whenever it is adopted, then cleanliness, even to great nicety, should be used, and the success which attends the cleanly eye-surgeon or dentist will be sure to follow. This plea for cleanliness, which comes so near to Godliness, may be impressed by a little story which, if not true, is well found ("è ben trovato ") for the illustration it affords. The scene presents a philanthropic visiting committee at the second bed from the door of a hospital ward. "Well, my man, how are you getting on? Is there anything we can do to make you more comfortable ?"

The patient, after a little modest circumlocution, admits that there is one thing he would very much like, and that is, to ex change beds with the man next to the entrance door of the ward. "Well, but why do you wish to make that change particularly?' The patient thought it would be more airy and cheerful ther

with a better light, and these did not matter to the patient there now, for he was either unconscious or slept all the time.

When pressed for a better reason, however, he gave it.

"The doctors always come in at that door, and they put the same thermometer in my mouth that has just been in that man's stern."

"THE ELIXIR NUISANCE"

AND THE NEW PHARMACOPOEIA.

Some years ago, at one of the meetings of the American Pharmaceutical Association, a speaker alluded to the then growing popular delusion as "the elixir nuisance." This significant expression came from the pharmaceutical side of the question entirely, and it meant that each agent or travelling salesman of each manufacturing establishment would capture a certain number of physicians by his sam ples and his smart therapeutic logic, and thus "create a demand” which the pharmacist was called on to supply. And in order to supply this demand the pharmacist must keep on hand an assortment of the elixirs of every manufacturer who saw fit to send a drummer through the country, and thus his shelves became loaded: with elixirs, many of which were duplicates, excepting only in the names of the makers. To mitigate this evil, created rather by the cupidity of trade than by the necessity of any true or legitimate therapeutics, the National Association appointed a committee to prepare a set of formulas for elixirs, which, for all legitimate uses, would enable pharmacists to offer to physicians preparations of their own make from good formulas published by the authority of the Association. Such preparations, however, never gained a general popularity against the trade preparations of the manufacturers, because, from having a more useful proportion of the medicaments and a smaller proportion of alcohol and sugar, they were much less agreeable to the taste, and these often served the drummer in his missionary work for the conversion of physicians and their patients, as samples, which, by contrast with those from his manufactory, showed how much more agreeable his elixirs were. These waves of fashion in medicines must, however, have their ebb as their flow, and even the most enterprising manufacturers, with the ablest of drummers, cannot command a continuous high tide for any one article of popu

lar fallacy, and new fields must be sought for the old articles, and new articles for the older fields of mercantile labor.

When "the elixir nuisance" had probably passed its height, but was still a popular source of revenue and harm, it naturally and necessarily came before the Committee of Revision of the U. S. Pharmacopoeia, and is before that committee still, upon the question whether or not to admit this class of preparations to the national standard; and it is the object of this note earnestly to offer some objections to their admission as a basis of protest against such admission.

First, the polypharmacy of all such preparations is generally acknowledged to be hurtful to all the true interests of therapeutics. All the true progress in modern rational therapeutics is based upon a very simple, uncomplicated medication which commonly applies one well-studied medicament at a time to obtain a well-defined effect. The old scattering shot-gun principle, which, if not used at too close quarters, is sure to hit more things than one, is rapidly giving way to the single missile well aimed at a definite object which is clearly in view. And the physicians who know how to use their uncomplicated agents, but do not know how to administer,—and when necessary, how to combine them without being taught by the manufacturers or their drummers,-must necessarily diminish in number, if not through the better teaching of the schools, then through the surer operation of the law of survival of the fittest.

Secondly, these elixirs are but inferior triplicates of agents already duplicated in the older and better tinctures and fluid extracts, the main difference beside novelty and fashion being a more attractive form for administration. This alleged advantage of elixirs, however great or small it may be, does not bring them within the proper or legitimate scope of a pharmacopoeia, because pharmacopoeias do not aim to be standards for methods of administration of medicines. The choice of vehicles, as of combinations, is wisely left to the physician and pharmacist to be varied by the skill and judgment necessary to each individual case. And the physician and pharmacist who together cannot apply alcohol, sugar and flavoring and coloring material as well as they are applied in the class of elixirs, are hardly worthy of their important callings. Again, the combinations of active medicines met with in the most popular elixirs can no more fit any large class of cases, consistently with the progressive knowledge in accurate medication, than the same size coat can fit a regiment of men. Every man could put the coat on, as every pa

tient could take a compound elixir, but only in accidental instances would there be a proper or accurate fit. No two cases of disease can, except by accident, require the same proportions of iron, quinia and strychnia at the same time, and it would be a grave mistake for a pharmacopoeia to recognize such erroneous principles of medication as are here involved, especially at the present time, when all pharmacopoeias are so actively engaged in eliminating those heterogeneous mixtures, many of which are supported by long expe rience in use.

It does not need a very profound analysis of the past success of "the elixir nuisance" to show that it consisted mainly of two elements; first, extensive advertising and drumming, and next, a certain convenience or so-called saving of time and labor to the physician in having his prescriptions written and put up for him in an agreeable form by the large manufacturer, who thus supplies him not only with his materia medica but also with the therapeutics upon which it is to be applied. Neither he nor the pharmacist have to think or act for themselves, but have simply to hand out parcels of compound elixirs and pills. And this is called saving of time, labor and expense!

A third and most grave objection to elixirs and to their recognition in any form or any degree by the Pharmacopoeia is that from the very first they have stimulated the growing evil of popular or self medication, and it is highly probable that the great mass of all that have been sold have gone into this abuse. Popular, as contradistinguished from professional pharmacists, and popular dry goods stores have sold dozens into popular use where physicians have prescribed single bottles; and "Beef, Wine and Iron" is still an occasional addition to the stock of the enterprising dry goods merchant. To realize the great danger inseparable from this large popular use of elixirs it is only necessary to remember that they are highly flavored, and to most palates agreeable mixtures of alcohol and sugar, or in other words are alcoholic stimulants under a disguise in both name and character, which especially adapts them to the tastes of the women and children of this candy-loving age. Indeed, they are often little else than fluid candies with the most dangerous addition of alcohol hidden away in them. Hence it is that physicians and laymen so often hear that elixirs agree so well with women and children, and that if physicians don't give them such things they will either take nothing or send for a homeopath, whose medicines are always pleasant. If the alcohol habit has not been largely extend

ed by the introduction of elixirs, then means specially adapted to a specific end have for once failed. But there is good reason to believe there has been no failure here. Should the Pharmacopoeia then lend its sanction and weight of authority to such a class of preparations when already its Tinctures have occasionally been recognized as the source and origin of the alcohol habit, and when one of the best arguments for its Fluid Extracts has been their minus proportion of alcohol?

A fourth objection to the introduction of elixirs into the Pharmacopoeia is that as a class of preparations for professional use, at least, they have passed their flood-tide and are now naturally on the wane. If they had done all the harm they could do, and were now going out of fashion beyond redemption, like hoop skirts, then it would not matter so much that the Pharmacopoeia should introduce them behind their day. But they have not ceased to do popular harm, and probably now never will until some more ingenious and insidious form of tippling supersedes them with those who cannot go to the "saloon" or the "sample room." Hence, should the Pharmacopoeia now, at this late day, use its high authority to re-establish in the medical and pharmaceutical professions an abuse which seems to be rather rapidly dying out there, it will simply strengthen and extend the abuse while weakening and belittling its own character as a standard.

It is not probable that one in ten of the better educated physicians upon whom the better educated classes of the community depend in their hour of need ever use these popular elixirs. Then for all other classes of physicians and patients, the large variety of elixir formulas carefully prepared and authoritatively published by The American Pharmaceutical Association at the high tide of the fashion in 1875, volume 23, will surely be sufficient for all legitimate or semilegitimate demands.

Moreover, all the principles involved in the construction of such a class as the elixirs belong specially to the domain of what is now called "elegant pharmacy," and are as appropriate to The American Pharmaceutical Association as they are inappropriate to the United States Pharmacopoeia.

If the Committee of Revision will make an intelligent forecast of the future of this class of preparations, it seems not at all probable that they will introduce them, even if they have of late thought of doing so.