think of such consultations? Better have one or the other, but not both. Better have two of a kind, but not one of each, because if the machine is constructed upon certain principles it will not be made to run upon new ones by a consultation, and if any benefit comes of incongruous consultations it will not accrue to the machine, nor to the principles upon which it develops its power, nor to its owner, but possibly to the consultants.

In the theological profession are consultations ever heard of over the well or the sick or the dying in any such sense as is advocated in this scheme, or is there any interference or any charge of inhumanity in each denomination following its own tenets, yet where is there more general liberality than in intelligent theology?

In the profession of politics, and even in true political economy, such consultations are heard of, and they are generally based upon some variety of the principle of "mixed commissions," with an equal number of both kinds of political doctors on either side. The neat result of all such consultations has always been expressed in two words: "The spoils," and these again are to the consultants-not to the sick body politic. A little reflection can hardly fail to find such illustrations with more or less direct bearing upon the case under consideration, all through the economy of society, and why the absurdity and unwisdom of mixing incompatibles in the medical art is not as clearly seen as in any other art, is a great mystery.

A physician who believes in opposing the tendencies of disease by agencies which counteract such tendencics, can never get any help from consulting with one of directly opposite doctrine,-one who believes that like cures like. Neither can the latter get any help from the former. In any consultation between the two, one or the other, as the first step, must give up the principles upon which his practice is based. The patient cannot have the alleged benefits of both, because they are in antagonism, and therefore he can only have the benefit of one or the other, and these not through consultation, but through the opposite of consultation, namely, through independent action. This line of thought and action are very generally recognized in the treatment of general diseases, and there are few or none who have advocated incongruous consultations in or dinary routine medical practice. Each patient or family decides whom they will call, and they change as often as they please, whether it be to change the individual physician or the so-called system upon which they choose to depend, and it is noteworthy that this desire for inharmonious or antagonistic consultations does not

come from the patient's side of the question at all, if there be intelligence enough to recognize principles in action. But coming as it does almost wholly from the physician's side, and from the comparatively few of those who pursue a consulting practice, it at once opens the question of why this should be. And the answer seems to be that the successful study of the diseases of special organs upon sound principles leading to one, and only one, indisputable and self-evident mode of practice is at the bottom of it all. The specialist is common to all the isms and pathys and quackeries of the day and of all time. His skill is the most cultivated and his successes are so definite and so easily seen that wherever a special organ is diseased it must go to him from whatever source, and he simply wants to receive these special diseases from any source whence they may be brought to him without violating the ethics of his profession, and without having the difficult and troublesome task forced upon him of finding out the ethical standing of those who bring their cases to him, or who call him to their cases. It is not the money he gets by it, for when successful he generally has plenty or does not care for it. His principles being sound, his practice is therefore successful, and his skill makes him an ardent student and almost necessarily an enthusiast. The diseased organs which he so well understands become the single aim of his life, and the anomalies in these diseases, and their difficulties, are his incitements to farther study and better skill. It is hardly wonderful, therefore, that he wants to clear away all obstacles that impede his progress by keeping his cases away from him and thus sacrificing the organs which he knows how to save. He nevertheless may be very wrong if he tries to break down the laws and barriers of the profession to which he belongs, and as an incidental but sure effect of this, the making common cause with error and unscrupulous want of principle. The consultations he gets are really no consultations at all. His patients are brought to him and he takes charge of them, but when brought to him by all sorts of anomalous practitioners, such practitioners must give them up, or he must refuse them. He neither wants to inquire who such practitioners are, nor to ask them to give up their patients, nor himself to refuse to take them when he sees them in need of his services. What is his remedy in this dilemma? Not to repeal the laws and break down the barriers of his already too lawless and over-crowded profession, but simply to treat all such cases freely and fully without pay. He does that already to thousands of cases in the hospitals and dispensaries through

out the land. Why not do it in a few more cases and keep his hands clean from the "mammon of unrighteousness?" Then the codes might stand and be as binding as possible, and his influence would be great to uphold and support them. Laws and restrictions may not be necessary to him, but they are for humanity in general, and he surely makes a great mistake when he sets his high order of intelligence to break them down on any such ground as has yet been taken in this most important discussion.

MEDICATION BY SALICYL COMPOUNDS.

The recent discussion by the Medical Society of London on the use of salicyl compounds in rheumatism, summarized in these pages, brings forward anew two or three important points, which it leaves unfinished. "More than a thousand cases of rheumatic fever " were treated with salicyl compounds, embracing salicin; salicylic acid made by Kolbe's process, from carbolic acid; salicylic acid made from oil of wintergreen, and salicylate of sodium made from Kolbe's salicylic acid. Toxic symptoms occurred in a considerable proportion of the cases treated with the Kolbe acid, and with salicylate of sodium made from that acid; but in the large number of cases reported by Dr. Fowler of Cambridge, where the acid made from oil of wintergreen was used, these toxic symptoms were practically absent. This led to, or strengthened, the inference that there were impurities in the Kolbe acid, which produced these disagreeable symptoms. In The Pharmaceutical Journal and Transactions of April 6th, 1878, p. 785, Mr. John Williams, F. C. S., shows conclusively that there is, or was at that time, another acid occasionally or commonly present in the Kolbe acid to the extent of 15 to 25 per cent., and that this acid formed a contaminating sodium salt. In the subsequent discussion of the subject this acid and its sodium. salt were very generally believed to be the sources of the toxic symptoms.

The experience in this country has, in a desultory inexact way, confirmed this, although within this writer's observation it has been sometimes difficult to decide whether the toxic symptoms were due to over-dosing, or to the contaminating acid. As a rule salicyl com

pounds are rapidly eliminated, and, therefore, the effects are of comparatively short duration. This point has been too much overlooked in the use of these compounds, especially in Great Britain. It leads directly to the necessity for moderate doses frequently repeated. The English practice as deduced from the late discussion seems to have been to give from 60 to 180 grains in the twenty-four hours, divided into three or four doses, occasionally in six doses, and still more rarely in eight doses. In this country the best practice seems to have been in better conformity to the rate of elimination, for it is common to hear of its use every two hours, or every three hours that is, twelve, or eight times in the twenty-four hours. The doses of either the acid or the sodium salt are perhaps usually twenty grains at first. Then fifteen grains until the pain begins to abate, and then ten grains or less, but always with frequent repetition. Such practice would indicate that somewhat less of the medicine is used in a given case, but in larger doses at first, and always more frequently repeated. The acid, however pure, is more apt to disturb the stomach primarily than the sodium salt, but in equivalent doses they seem equally liable to produce perversion of the special senses and delirium. Ringing in the ears seems to be for salicyl compounds, as for quinia, the indication of saturation, or of full physiological effect. Next comes disturbed or perverted vision, and finally delirium. If, as with quinia, the dose be reduced on the first appearance of ringing in the ears the other symptoms will not occur, and the medicine need not be suspended. The parallelism with quinia, strychnia, atropia, etc., is also noticeable in the circumstance that when the full physiological effect is reached, larger or more frequent doses are hurtful or toxic; and of still more importance the circumstance that the full physiological effect is reached in different persons by widely different quantities. This latter consideration is so often neglected in therapeutics that the stated doses of medicines are not regarded simply as quantities to begin with, but are carried from patient to patient, and throughout case after case without regard to differences in individual susceptibility, and individual rates of elimination. If in two persons equally susceptible to a medicine-say salicyl compounds-the rate of elimination be different, either naturally or temporarily, the same full physiological dose will in one case be therapeutic only, while with slower elimination it will be cumulative until a toxic explosion occurs.

Hence in any consideration of the toxic effects of salicyl compounds, it is manifestly unsafe to charge them all to impurities

in the medicine, when idiosyncrasy brings into operation two other important causes of similar effects, namely, different susceptibility and different rate of elimination, under which conditions the moderate or small doses of one case become excessive in another.

While then it may be fairly assumed, that in a proportion of the cases when the medicine had to be suspended on account of toxic effects, these were due to over-dosing, yet still a very large proportion may be as fairly attributed to the contaminating acid.

In some rather roughly made observations on the subject, soon after Mr. Williams' paper was published, the writer came to the conclusion that the contaminating acid was most largely present in the amorphous acid, and that in well crystalized acid it was not present to the extent of more than six to eight per cent., and farther that sublimation freed the salicylic acid from this contaminating acid. Within the last two years, however, the markets have been supplied for those who chose to pay for it, with a well crystalized acid, which does not contain more than three or four per cent. of all impurities. Such an acid is all that can be needed for medical uses, and is quite as pure as any made from oil of wintergreen, and any toxic effects from such an acid, or from the sodium salt made from it, must be due either to idiosyncrasy or mismanagement. A well made sodium salt from such an acid is always white, but after being shut up long in a bottle, is liable to have a faint odor of carbolic acid. This, however, should be so faint as only to be perceptible on close examination, and should not be perceptible after exposure to the air for a time, nor in the solutions.

The salicylate of sodium having now pretty generally, and very properly superseded both salicin and salicylic acid for medicinal uses, it becomes quite important to know when it is of good quality. This is the more difficult because its appearance and sensible properties are no indication, and because any chemical examination or testing in order to be conclusive must be elaborate and troublesome. It is made by the careful saturation of a solution of a pure carbonate of sodium with good salicylic acid, and the evaporation of the solution to dryness by a carefully regulated heat, with constant stirring. The process, though not difficult, is tedious and troublesome, and, therefore, with the proper skill is rather expensive. The salt is never used in substance but always in solution, and, therefore, when redissolved all the trouble and expense of the drying process is lost.

Therefore, as salicylic acid is much more easily judged both by