Jacob Bell
New Member
ON TRAUMATIC TETANUS AND ITS TREAT¬MENT, WITH SOME REMARKS ON THE EXTRACT OF. CANNABIS INDICA OF COM-MERCE.
By JAMES INGLIS, M.D., Halifax.
(Concluded from page 147.)
In . the Journal of March 5th, my remarks bore especially upon, traumatic tetanus, but they egdally apply to the idiopathic form of the disease. In the one case, the immediate exciting cause is apparent ; in the other, it is more obscure. The proximate cause, however, in both is similar, and any plan of treatment whichmaybe found to be successful in traumatic tetanga, will, doubtless, .be no, less efficacious in idio-pathic, inasmuch as the latter is the less fatal form of the disease.
In traumatic'tetanus, the first care of every medical man is evidently, at the invasion of the disease, to cut off from the membranes of the brain and spine the exciting or primary irritation, by isolating or removing immediately the injured member. His next care, if he see the case early enough, is to attempt to reduce the secondary, but more serious irritation in the spinal theca, by the.; usual remedies for the reduction of local inflammatory action, by the application of cold (ice-if it can be obtained) to the spine, as Professor
Miller recommends; or, by cupping or leeching, imme-diately succeeded by counter-irritation of an active character. A more soothing treatment has been recommended in the application of direct sedatives to the-spine, as of morphia, belladonna, hyoscyamus, and the like, but any ultimate benefit arising therefrom, seems questionable. The warm bath, the cold bath, and cold effusion, have all in succession had their supporters, and have as often again fallen into disuse.
The internal remedies which have been exhibited in this disease, are, from the very intractability of tetanus, exceedingly numerous; and, in proof of the uncer¬tainty of their action, I may quote, as Dr. Symonds has done, the language of Sir James MEGregor,'who has thus written-" The remedies which have been chiefly trusted to for the cure of this formidable disease, are opium, mercury, wine, warm and cold paths, venesection, ipecacuanha, and digitalis, in large doses, enlargement of the original wound, and amputa¬tion of the limb. These have been.tried alone,and in various combinations, and Iam obliged to confess that the whole failed in almost every acute case of tetanus which occurred. The three first have been admi¬nistered in unlimited doses without effect; the ,cold bath is worse than useless."
There are, however, other internal remedies, not enumerated in the above list, which appear to be entitled to our more favourable consideration; of such are, the sulphate of quinine,. carbonate of iron, tartrate of antimony, turpentine, assafmtida, and, perhaps, the tyabis indica.
+:J.am induced to place the sulphate of quinine at the head of these remedies, from the decided, sedative effects which I have found to arise from its exhibition in large does, in aclass of disease, less intense, it is true, but nearly allied to the one under consideration
I mean epilepsy and hysteria. I have 'seen epilepsy simulate tetanus so closely, that foratime the one was not to be distinguished from the other, except by the temporary nature of the spasmodic contraction of the muscles in the former. But to return to 'what is 'of greater import than a mere general statement, as to the sedative effect of large doses of sulphate of quinine, in cases which are not now before us, we have direct'tes¬gmony as to its decided utility in traumatic tetanus itself. In the Provincial Medical Journal for Decem¬ber 30, 1843, we find a very interesting case given, ,fmm the practice of Dr. Malone, of Florida, in which blood-letting, purgatives, turpentine, and opium, bad been had recourse to, but with so little effect, that upon the third day of the disease we find the report to run as follows :-" The case appears' to be hopeless; the pulse ranges from 130 to 140 ; * * * epigas trium firm and unyielding; * * * frequent spasms extend from the foot to the stomach, and from thence to the throat; pain in the region of the epigas¬trtuin upon pressure, and frequent hiccups." It was at this extreme, this "hopeless " period of the disease, that the quinine treatment was commenced ; it was administered at first in five-grain doses every two hours, combined with a quarter of a grain of morphia. Symptoms of amendment soon after appeared,; the treatment was persevered in, and: the
j
patient.was dismissed convalescent on the fourteenth day. of. the disease. . ~,, ,lit would extend these remarks to too great a length
were I to notice the various successful cases, in which one or other of the remedies named have been exhi-bited. Our own Journal contains ninny of them, and the pages of contemporary periodicals sufficiently bear me outin thieobeervation, that there are other remedies besides those enumerated by. Sir James M'Goegar which appear entitled to opr more favourable eonsi¬demtion.
Of the ease, which forms the subject matter of these remarks, a very unfavourable opinion was from the first famed. The disease, ere we saw our patient, had made considerable progress; the pule was ranging from 120 to 130, (a fatal progsostic, according to Dr. Parry,) and the , primary irritation had been allowed, unmolested, to exert its influence for full twe}ve days. Under these circumstances it was considered to be a fair case for the trial of the cannabis indica; relieving at the same time the intestinal canal, by turpentine enemata, in combination with the tincture of assafmtida.
The treatment commenced with one grain of the extract of gunjah, repeating it at short intervals, and gradually increasing the strength until four grains were .given at a dose. Deglutition at length becoming so difficult, recourse was had to gunjah enemata. Thus, . in fifty-eight hours, the total amount of the extract exhibited was fifty.four grains ; besides the exterpal application of a scruple of the gunjah, to a denuded surface along the spine. The general effects were soothing to the patient, subduing sensibility, whereby suffering was diminished; whilst the cerebral functions were left unimpaiSed. But the disease, robbed doubtless of some of its Wrors, had taken lob strong a hold of its victim, and nature at length gage way.
A question may now naturally arise respecting the purity, and strength of the.extract of gunjah adminis tered to this patient. , Of its purity I shall speak here-after; and, in proof of its activity, I shall merely have to adduce, two short cases. The first is that of a lady, aged 32, married,; she had been subject for several years to chronic rheumatism; had taken the general list of remedies, without mt;;h relief.; the pain was most seven during the night. She was ordered a pill, con¬sisting of the fourth of a grain of the extract of gunjah, three grains of extract of colocynth, and a little essential oil, to be taken at bed-time. At three o'clock on the following morning I was rung out' 6f' bed by this. lady's husband, who, in 'much alarm, told me that he thought his wife was dying. Uport+ entering her room, I found her complaining of cold and general numbness ; , there was an inability, a' rather a disinclination to move; and, on raising the head, she became giddy and nauseated ; pulse, 138; tongue, moist, clean ; there was slight thirst. I imme¬diately allayed their fears; told them that after a sleep, accompanied by perspiration, she would awake refreshed and better. Stimulants internally and hot external applications soon rendered her feelings more comfortable, and she fell into a deep calm sleep, during which she perspired profusely, and on awaking, aftersome hours, all those symptoms, for the time so alarming, had passed off, and with them, I am glad to say, also her pains.
The second case which I shall briefly notice, is that of a young woman, aged 27, unmarried, Who had, for' a long time, been subject to sudden gastric pain, or, as she said, cramp of the stomach, after eating. I ordered her pills somewhat similar to the former. containing a fourth of a grain of the extract of gunjah, and to be taken about half an hour before dinner. In the afternoon of the same day, I was suddenly -sent for by the lady at whose house this woman was . servant; and, on arriving, was informed that the patient had taken the pill as directed; had expressed herself as more comfortable and freer from pain than she had been for years; but, that an hour had scarcely elapsed ere she complained of giddiness, numbness, and a feeling of cold. She then fell from her chair in , a fit, and was thence taken to bed, where I found her perfectly conscious, but listless, and di$nclined to move; she had all the other symptoms of. wdalt might be called, specifically, cannabirm; for the appearance of a person under the influence of thegunjab, when once seen, cannot ' be forgotten. The bowejs had been inactive, and I ordered immediately an enema, whilst a little castor oil and brandy were given by the mouth. The girl soon fell asleep, perspired freely, and awoke with slight vertigo, of which, however, she was quite relieved by a second sleep. She did not repeat 'the gunjah, and I need not say, she had no more " fits."
In other cases, as I mentioned, about two years since, in a former communication, where opium bed been exhibited for any length of time, and where, from its use, its powers had become deadened, I have found the gunjah in quarter-grain doses., combined with the opium or morphia, to be of essensid benefit.
But this remedy, like every other of scarcity, and consequent high price, is subject to abominable adulte-ration, and it is accordingly most shamefully adaite-rated. Since I first obtained, through the kindnessof Mr. Squire, a portion of the original specimen of the extract, which had been given to him by Dr. O'Shaughneiey, ' I had entirely given up the use of the gunjah, solely from the uncertain effects resulting from the administration of a spurious drug, manufactured and vended as the genuine extract. It is only within these few months that I have recommenced the' use of this medicine, from having found a very pun specimen of the extract in the shop of Mr. Suter, of Halifax, and it has been of this extract that I have hitherto spoken in this paper. I am led, however, from circumstances connected with this particular case of tetanus, to notice another extract, which, from having been sent to Mr. Swallow, from York, as the genuine drug, we had very nearly, in the case mentioned, exhibited.
It is not my intention to enter into a minute chemical analysis of either of these extracts, but I shall state sufficient to show that they differ from each other in many essential properties; and perhaps the observations made may tend to guide others, either in the choice of the pure, or in the rejection of the adulterated drug.
ESSENTIAL PROPERTIES.
In Spring Water.
Pure Extract. Spurious Extract.
Wholly Insoluble Partially Soluble
Immiscible. Miscible.
A dirty green sediment separates on standing; supernatant fluid, amber-' coloured.
Pure Extract. Spurious Extract.
In Wood Nitphtla.
Entirely Soluble. (Almost) wholly Soluble'. Soiation : fresh, bright, Solution : olive brown; emerald green. Very little throwing down, on stand-deposition of green colour¬ log, a mixture of brown
ing matter. and green precipitates.
Other extracts I have examined, and have found them to vary much in their constitution, but none of their to approach to anything like purity. A very small pion of the genuine extract is sufficient to give to agglomerated masses of extract of hyosyamus, hop, the, opium, &c., a slight green tinge, and also the peculiar, flavour of the gunjah ; but a very slight examination may readily detect the fraud ; indeed, so easily may this be 'done, that should there not be opportunity for testing it as above, it is only necessary to place a piece of common glass upon a sheet of white writing paper, drop a minute portion of essential oil upon it; add a grain or two of the suspected extract, and rub together with a clean knife or spatula. With the genuine extract, a smooth, clear, bright green stain is made upon the glass; whereas, with the impure extract, the stain is of a- dirty green, or brown colour, generally rough, and interspersed with black or brown specks, accgrding to the extent of adulteration.
M the pure extract is abundantly soluble in the essential oils, these may be made to form elegant' vehiAles for the exhibition of the gunjah. Solutions are;produced of a bright green emerald colour, which, partaking of the soothing sedative properties of the gunjah, do not posses so powerfully its death-like depressing effects, which for the time are so alarming to the patient. These solutions may be made of such strength, that a quarter of a grain of the extract may be exhibited in two drops of oil, which may then be rubbed up with a little sugar, and made into-a draught .by the addition of hot water. I have frequently, in a similar manner, given internally the gunjah, in com¬bination with cajeput oil, in which it is particularly soluble; and I have found, that with it may be formed a valuable embrocation, in chronic rheumatic affections of the joints.
in now drawing to a close a paper which has, I feel, already too far exceeded the ordinary bounds, I dare scarcely further trespass; yet I cannot refrain from adding a very few remarks, which appear necessarily to arise out of the foregoing observations. Thus, when we find such differences to exist in the chemical pro-pertiea of medicines which are vended as genuine, we surely cannot be surprised at the discrepancies which are to be found in the statement's of Medical men, with respect to the action of the same, or rather, of what ought to be the same, remedies.
Is it not, then, high time that the cupidity of the medicine-vender should be made to give way to the well-being of the community at large? If the already large profits of the druggist are not a sufficient guarantee for the genuineness of the drugs he vends, it is necessary, for the good of our patients, for the character of the profession, and for the furtherance of medical science, that some plan be adopted, whereby, with confidence, the physician may. prescribe, knowing, well that the prescription ordered, shaU be faithfully prepared. For this purpose, might it not be advisable to suggest to Sir James Graham, the propriety of urging upon the Council of Health the necessity of instituting, or of himself causing to be instituted, certain government district chemical inspectors, who should he entrusted with full power, in their districts, to enter at all times, and to examine in any moaner, all drugs and pharmaceutical preparations kept and sold by druggists; and to seize and destroy every spurious drug, or every genuine.drug rendered inert by age, or otherwise deteriorated, and every pharma¬ceutical compound not prepared according to, the received and acknowledged formulae of the recognized Colleges.
A thorough conviction of the importance of some such plan must be my apology for obtruding these observations, and should they be the means of drawing forth, from some one else, a more explicit and better digested scheme whereby these objects may be obtained, my aim in writing will have been fully gained.
Source: ON TRAUMATIC TETANUS AND ITS TREAT¬MENT, WITH SOME REMARKS ON THE EXTRACT OF. CANNABIS INDICA OF COM-MERCE.
By JAMES INGLIS, M.D., Halifax.
(Concluded from page 147.)
In . the Journal of March 5th, my remarks bore especially upon, traumatic tetanus, but they egdally apply to the idiopathic form of the disease. In the one case, the immediate exciting cause is apparent ; in the other, it is more obscure. The proximate cause, however, in both is similar, and any plan of treatment whichmaybe found to be successful in traumatic tetanga, will, doubtless, .be no, less efficacious in idio-pathic, inasmuch as the latter is the less fatal form of the disease.
In traumatic'tetanus, the first care of every medical man is evidently, at the invasion of the disease, to cut off from the membranes of the brain and spine the exciting or primary irritation, by isolating or removing immediately the injured member. His next care, if he see the case early enough, is to attempt to reduce the secondary, but more serious irritation in the spinal theca, by the.; usual remedies for the reduction of local inflammatory action, by the application of cold (ice-if it can be obtained) to the spine, as Professor
Miller recommends; or, by cupping or leeching, imme-diately succeeded by counter-irritation of an active character. A more soothing treatment has been recommended in the application of direct sedatives to the-spine, as of morphia, belladonna, hyoscyamus, and the like, but any ultimate benefit arising therefrom, seems questionable. The warm bath, the cold bath, and cold effusion, have all in succession had their supporters, and have as often again fallen into disuse.
The internal remedies which have been exhibited in this disease, are, from the very intractability of tetanus, exceedingly numerous; and, in proof of the uncer¬tainty of their action, I may quote, as Dr. Symonds has done, the language of Sir James MEGregor,'who has thus written-" The remedies which have been chiefly trusted to for the cure of this formidable disease, are opium, mercury, wine, warm and cold paths, venesection, ipecacuanha, and digitalis, in large doses, enlargement of the original wound, and amputa¬tion of the limb. These have been.tried alone,and in various combinations, and Iam obliged to confess that the whole failed in almost every acute case of tetanus which occurred. The three first have been admi¬nistered in unlimited doses without effect; the ,cold bath is worse than useless."
There are, however, other internal remedies, not enumerated in the above list, which appear to be entitled to our more favourable consideration; of such are, the sulphate of quinine,. carbonate of iron, tartrate of antimony, turpentine, assafmtida, and, perhaps, the tyabis indica.
+:J.am induced to place the sulphate of quinine at the head of these remedies, from the decided, sedative effects which I have found to arise from its exhibition in large does, in aclass of disease, less intense, it is true, but nearly allied to the one under consideration
I mean epilepsy and hysteria. I have 'seen epilepsy simulate tetanus so closely, that foratime the one was not to be distinguished from the other, except by the temporary nature of the spasmodic contraction of the muscles in the former. But to return to 'what is 'of greater import than a mere general statement, as to the sedative effect of large doses of sulphate of quinine, in cases which are not now before us, we have direct'tes¬gmony as to its decided utility in traumatic tetanus itself. In the Provincial Medical Journal for Decem¬ber 30, 1843, we find a very interesting case given, ,fmm the practice of Dr. Malone, of Florida, in which blood-letting, purgatives, turpentine, and opium, bad been had recourse to, but with so little effect, that upon the third day of the disease we find the report to run as follows :-" The case appears' to be hopeless; the pulse ranges from 130 to 140 ; * * * epigas trium firm and unyielding; * * * frequent spasms extend from the foot to the stomach, and from thence to the throat; pain in the region of the epigas¬trtuin upon pressure, and frequent hiccups." It was at this extreme, this "hopeless " period of the disease, that the quinine treatment was commenced ; it was administered at first in five-grain doses every two hours, combined with a quarter of a grain of morphia. Symptoms of amendment soon after appeared,; the treatment was persevered in, and: the
j
patient.was dismissed convalescent on the fourteenth day. of. the disease. . ~,, ,lit would extend these remarks to too great a length
were I to notice the various successful cases, in which one or other of the remedies named have been exhi-bited. Our own Journal contains ninny of them, and the pages of contemporary periodicals sufficiently bear me outin thieobeervation, that there are other remedies besides those enumerated by. Sir James M'Goegar which appear entitled to opr more favourable eonsi¬demtion.
Of the ease, which forms the subject matter of these remarks, a very unfavourable opinion was from the first famed. The disease, ere we saw our patient, had made considerable progress; the pule was ranging from 120 to 130, (a fatal progsostic, according to Dr. Parry,) and the , primary irritation had been allowed, unmolested, to exert its influence for full twe}ve days. Under these circumstances it was considered to be a fair case for the trial of the cannabis indica; relieving at the same time the intestinal canal, by turpentine enemata, in combination with the tincture of assafmtida.
The treatment commenced with one grain of the extract of gunjah, repeating it at short intervals, and gradually increasing the strength until four grains were .given at a dose. Deglutition at length becoming so difficult, recourse was had to gunjah enemata. Thus, . in fifty-eight hours, the total amount of the extract exhibited was fifty.four grains ; besides the exterpal application of a scruple of the gunjah, to a denuded surface along the spine. The general effects were soothing to the patient, subduing sensibility, whereby suffering was diminished; whilst the cerebral functions were left unimpaiSed. But the disease, robbed doubtless of some of its Wrors, had taken lob strong a hold of its victim, and nature at length gage way.
A question may now naturally arise respecting the purity, and strength of the.extract of gunjah adminis tered to this patient. , Of its purity I shall speak here-after; and, in proof of its activity, I shall merely have to adduce, two short cases. The first is that of a lady, aged 32, married,; she had been subject for several years to chronic rheumatism; had taken the general list of remedies, without mt;;h relief.; the pain was most seven during the night. She was ordered a pill, con¬sisting of the fourth of a grain of the extract of gunjah, three grains of extract of colocynth, and a little essential oil, to be taken at bed-time. At three o'clock on the following morning I was rung out' 6f' bed by this. lady's husband, who, in 'much alarm, told me that he thought his wife was dying. Uport+ entering her room, I found her complaining of cold and general numbness ; , there was an inability, a' rather a disinclination to move; and, on raising the head, she became giddy and nauseated ; pulse, 138; tongue, moist, clean ; there was slight thirst. I imme¬diately allayed their fears; told them that after a sleep, accompanied by perspiration, she would awake refreshed and better. Stimulants internally and hot external applications soon rendered her feelings more comfortable, and she fell into a deep calm sleep, during which she perspired profusely, and on awaking, aftersome hours, all those symptoms, for the time so alarming, had passed off, and with them, I am glad to say, also her pains.
The second case which I shall briefly notice, is that of a young woman, aged 27, unmarried, Who had, for' a long time, been subject to sudden gastric pain, or, as she said, cramp of the stomach, after eating. I ordered her pills somewhat similar to the former. containing a fourth of a grain of the extract of gunjah, and to be taken about half an hour before dinner. In the afternoon of the same day, I was suddenly -sent for by the lady at whose house this woman was . servant; and, on arriving, was informed that the patient had taken the pill as directed; had expressed herself as more comfortable and freer from pain than she had been for years; but, that an hour had scarcely elapsed ere she complained of giddiness, numbness, and a feeling of cold. She then fell from her chair in , a fit, and was thence taken to bed, where I found her perfectly conscious, but listless, and di$nclined to move; she had all the other symptoms of. wdalt might be called, specifically, cannabirm; for the appearance of a person under the influence of thegunjab, when once seen, cannot ' be forgotten. The bowejs had been inactive, and I ordered immediately an enema, whilst a little castor oil and brandy were given by the mouth. The girl soon fell asleep, perspired freely, and awoke with slight vertigo, of which, however, she was quite relieved by a second sleep. She did not repeat 'the gunjah, and I need not say, she had no more " fits."
In other cases, as I mentioned, about two years since, in a former communication, where opium bed been exhibited for any length of time, and where, from its use, its powers had become deadened, I have found the gunjah in quarter-grain doses., combined with the opium or morphia, to be of essensid benefit.
But this remedy, like every other of scarcity, and consequent high price, is subject to abominable adulte-ration, and it is accordingly most shamefully adaite-rated. Since I first obtained, through the kindnessof Mr. Squire, a portion of the original specimen of the extract, which had been given to him by Dr. O'Shaughneiey, ' I had entirely given up the use of the gunjah, solely from the uncertain effects resulting from the administration of a spurious drug, manufactured and vended as the genuine extract. It is only within these few months that I have recommenced the' use of this medicine, from having found a very pun specimen of the extract in the shop of Mr. Suter, of Halifax, and it has been of this extract that I have hitherto spoken in this paper. I am led, however, from circumstances connected with this particular case of tetanus, to notice another extract, which, from having been sent to Mr. Swallow, from York, as the genuine drug, we had very nearly, in the case mentioned, exhibited.
It is not my intention to enter into a minute chemical analysis of either of these extracts, but I shall state sufficient to show that they differ from each other in many essential properties; and perhaps the observations made may tend to guide others, either in the choice of the pure, or in the rejection of the adulterated drug.
ESSENTIAL PROPERTIES.
In Spring Water.
Pure Extract. Spurious Extract.
Wholly Insoluble Partially Soluble
Immiscible. Miscible.
A dirty green sediment separates on standing; supernatant fluid, amber-' coloured.
Pure Extract. Spurious Extract.
In Wood Nitphtla.
Entirely Soluble. (Almost) wholly Soluble'. Soiation : fresh, bright, Solution : olive brown; emerald green. Very little throwing down, on stand-deposition of green colour¬ log, a mixture of brown
ing matter. and green precipitates.
Other extracts I have examined, and have found them to vary much in their constitution, but none of their to approach to anything like purity. A very small pion of the genuine extract is sufficient to give to agglomerated masses of extract of hyosyamus, hop, the, opium, &c., a slight green tinge, and also the peculiar, flavour of the gunjah ; but a very slight examination may readily detect the fraud ; indeed, so easily may this be 'done, that should there not be opportunity for testing it as above, it is only necessary to place a piece of common glass upon a sheet of white writing paper, drop a minute portion of essential oil upon it; add a grain or two of the suspected extract, and rub together with a clean knife or spatula. With the genuine extract, a smooth, clear, bright green stain is made upon the glass; whereas, with the impure extract, the stain is of a- dirty green, or brown colour, generally rough, and interspersed with black or brown specks, accgrding to the extent of adulteration.
M the pure extract is abundantly soluble in the essential oils, these may be made to form elegant' vehiAles for the exhibition of the gunjah. Solutions are;produced of a bright green emerald colour, which, partaking of the soothing sedative properties of the gunjah, do not posses so powerfully its death-like depressing effects, which for the time are so alarming to the patient. These solutions may be made of such strength, that a quarter of a grain of the extract may be exhibited in two drops of oil, which may then be rubbed up with a little sugar, and made into-a draught .by the addition of hot water. I have frequently, in a similar manner, given internally the gunjah, in com¬bination with cajeput oil, in which it is particularly soluble; and I have found, that with it may be formed a valuable embrocation, in chronic rheumatic affections of the joints.
in now drawing to a close a paper which has, I feel, already too far exceeded the ordinary bounds, I dare scarcely further trespass; yet I cannot refrain from adding a very few remarks, which appear necessarily to arise out of the foregoing observations. Thus, when we find such differences to exist in the chemical pro-pertiea of medicines which are vended as genuine, we surely cannot be surprised at the discrepancies which are to be found in the statement's of Medical men, with respect to the action of the same, or rather, of what ought to be the same, remedies.
Is it not, then, high time that the cupidity of the medicine-vender should be made to give way to the well-being of the community at large? If the already large profits of the druggist are not a sufficient guarantee for the genuineness of the drugs he vends, it is necessary, for the good of our patients, for the character of the profession, and for the furtherance of medical science, that some plan be adopted, whereby, with confidence, the physician may. prescribe, knowing, well that the prescription ordered, shaU be faithfully prepared. For this purpose, might it not be advisable to suggest to Sir James Graham, the propriety of urging upon the Council of Health the necessity of instituting, or of himself causing to be instituted, certain government district chemical inspectors, who should he entrusted with full power, in their districts, to enter at all times, and to examine in any moaner, all drugs and pharmaceutical preparations kept and sold by druggists; and to seize and destroy every spurious drug, or every genuine.drug rendered inert by age, or otherwise deteriorated, and every pharma¬ceutical compound not prepared according to, the received and acknowledged formulae of the recognized Colleges.
A thorough conviction of the importance of some such plan must be my apology for obtruding these observations, and should they be the means of drawing forth, from some one else, a more explicit and better digested scheme whereby these objects may be obtained, my aim in writing will have been fully gained.
Source: ON TRAUMATIC TETANUS AND ITS TREAT¬MENT, WITH SOME REMARKS ON THE EXTRACT OF. CANNABIS INDICA OF COM-MERCE.
