kidneys are not diseased, and says that the same assertion has been made by Robin, Axel, Key, and others. Nearly all authorities, however, consider the presence of tube-casts, of any variety (except, possibly, the mucous), as indicative of morbid change in the kidney. Bartols' declares that true casts are never formed under normal conditions, and that, as a general rule, they are associated with the excretion of albumen. It seems to be pretty certain that hyaline casts of the urinary tubules are the results of irritation of the epithelia of these tubules, in consequence of which a coagulable material is secreted by these cells, which coalesces into cylinders, corresponding to the shape of the tubules.3

To what extent these casts may be evidences of tissue alterations, it is impossible to say. It is certainly reasonable to suppose that at least they may be results of transient irritation, that may subside without leaving its vestiges behind in the tissues of the organ. There can be no doubt that patients suffering from acute febrile disease may, during life, pass urine containing both albumen and tube-casts; and yet, the kidneys of these persons may reveal nothing abnormal after death. This would simply indicate that the irritation that was sufficient to stimulate the glandular epithelium to the formation of casts, was not violent enough, or sufficiently long continued to produce recognizable structural alterations. It must, therefore, be understood that the influences producing these casts may vary from a slight stimulation of the epithelia of the tubules to extensive and irreparable destruction of renal substance; but it must not be forgotten that, while a transient and insignificant irritation may subside without leaving its traces behind it, it is most probable that, if it be continued for an indefinite time, it may finally produce permanent effects. In the cases I have recorded, the results of the irritation by the iodide, were, as observed, at most, slight albuminuria and faintly granular tube-casts. Nor in any of them was noticed systemic evidence of renal disturbance. Certainly, in no case was there the slightest reason to suspect, as produced by the iodide, an extensive parenchymatous inflammation, such as it has been claimed the iodide is capable of exciting.

1 Tyson, Phila. Med. Times, vol. x. p. 293.

2 Ziemmsen's Cyclopædia, vol. xv. p. 87.

3 Aufrecht, Centralbl. f. d. Med. Wissensch., 19, 1878; Langhaus, Virchow's Archiv, lxxvi., s. 85; Edmanson, Rovida, and others.

The effects were such as iodine and the iodides may occasion in mucous membranes generally; a catarrh, in fact. Beyond this it did not proceed; but, on the other hand, there seemed rather to be a tendency towards a subsidence of the irritation, and a toleration of the drug. At least, there seemed to be no increase in the symptoms under its use; and, in one case especially, that of K. G. (Case IV.), the renal affection that had been quite pronounced, gradually and completely disappeared under the full and systematic use of the iodide. (It is not impossible, however, that in this instance, the results were due to the specific action of the drug upon a purely syphilitic renal disorder.)

At the same time, I cannot avoid the conclusion that, while the evil effects of the iodide of potassium upon the kidneys are small, and for the most part transitory, the occurrence of more severe alterations is not impossible, nay, is probable. But upon this point my observations have been too few and imperfect to enable me to speak with confidence. It is perfectly well established that there is no constant tendency on the part of the kidneys to resent the presence of the iodide. My own investigations are confirmatory of this, for they include a number of old syphilitics, to whom the drug had been administered for protracted periods, and in excessive doses, without the smallest sign of urinary disorder. As in other parts of the body, the undesirable effects of the ingestion of iodine and iodides have been attributed to idiosyncrasy, so must idiosyncrasy be invoked to explain any undesirable results of the action of these preparations upon the kidneys.

SOLUBLE COMPRESSED PELLETS.

A NEW FORM OF REMEDIES FOR HYPODERMIC USE, AND APPLICABLE TO OPHTHALMIC AND

GENERAL MEDICATION.

By H. AUGUSTUS WILSON, M. D.,

PENNSYLVANIA.

IN directing the attention of the profession to a new form of medication, it is proper first to establish the fact that the materials or methods ordinarily used are unsatisfactory, and that the proposed innovation has claims to superiority. I shall therefore endeavor to state concisely the disadvantages of solutions, gelatine disks and powders, which are commonly used for hypodermic medication.

That solutions, if kept for a considerable time, are unsatisfactory, is abundantly proven by the large number of communications to the medical journals throughout the world, asking for the best methods of preserving solutions from deterioration by fungous growths, which so soon form in aqueous solutions of morphia, atropia, and strychnia. In the answers to these inquiries, tartaric, hydrochloric, carbolic, and salicylic acids are recommended as the most effectual means for preventing the formation of penicillum, confervæ, and other low forms of vegetable life; but the writers say nothing about the objections to their use, such as the smarting, burning pain at seat of puncture, and the tendency to inflammatory action which is greatly augmented by the hypodermic injection of such irritating sub

stances.

In ophthalmic therapeutics, the addition of the above-mentioned fungicides is contraindicated on account of the liability of setting up serious inflammation of the conjunctiva or other sensitive structures of the eye. Permanent solutions for hypodermic use have therefore been largely abandoned, and will be, I think, in ophthalmic medication, because of the difficulty of

finding a substance which will prevent the growth of the vege table organisms and be at the same time non-irritating to the tissues.

Professor Roberts Bartholow,' a high authority on the hypodermic method, says: "A solution of morphia for hypodermic use should be prepared about the time of the expected administration. Even if free from foreign matter, and carefully filtered, it undergoes a change by keeping, which renders it irritating to the tissues." And again he says: "Since I have adopted the method of extempore preparations of morphia solutions, I have not had occur the hard nodules and points of suppuration which were not infrequent when the regular solutions were used."

Soon after the presentation of my original paper to the Philadelphia County Medical Society2 in October, 1880, my attention was called by Professor J. M. Da Costa to the patented gelatine disks containing substances for hypodermic injection. These disks are very slowly soluble, requiring, in my hands at least, fifteen minutes to make a solution; and when used upon my own person I found that gelatine was quite irritating to the tissues. The fact that these disks are patented will also, I think, effectually prevent their extended use by the profession.

The use of powders for hypodermic medication is also open to some objections. The small quantity of the drugs used renders it extremely difficult to accurately divide them into exact doses. The customary method of weighing out one grain and subdividing it into the requisite number of powders, will perhaps answer sufficiently well for morphia salts, when one-half or one-quarter grain doses are desired; but the impossibility of thus securing accurate doses of less than a quarter of a grain will be apparent. Again, supposing it possible to obtain accuracy with powders, the small quantity required makes it difficult. to remove all of the material from the paper, and the powder being apt to be shaken out, is lost in the hypodermic or pocket case, and thus a diminished dose is given. It was therefore as a substitute for powders that I suggested the use of soluble compressed pellets, because of their convenient size, and certainty of dose and action.

It will not be necessary to consider the various steps taken in obtaining the desired end of accuracy, ready solubility, and

The Treatment of Diseases by the Hypodermic Method, 3d edit., 1879, p. 43. 2 Proc. Phila. County Med. Soc, 1881. Phila. Med. Times, Jan. 1, 1881.

convenient size; suffice it to say that numerous neutral substances were tried, such as potassii bromidum, saccharum album, saccharum lactis, and sodii chloridum. After most careful and exhaustive experiments, the sodic chloride was selected for use, with the muriate of morphia; but as the profession is more familiar with the use of the sulphate salts of morphia, atropia, strychnia, etc., which are more readily soluble, the sodic sulphate was finally adopted as a disintegrator, because of its chemical compatibility.

The use of the sodic sulphate will be apparent, when I say that, if morphia salts are compressed alone, they become extremely hard, and very slowly soluble. Hence, the necessity of mixing thoroughly, before compression, some material, which at the same time, shall give increased bulk, be inert, and have a great affinity for water. The sodic sulphate acts as a disintegrator, for, upon coming in contact with water, it readily dissolves, and leaves the morphia, or other material used, in a fine state of subdivision, ready to be acted upon by water. The sodic sulphate, instead of causing pain or irritation, seems really to assist in promoting absorption, and there can be no objection to its use, when it is considered that it is a neutral salt, does not irritate, and the quantity used is only a quarter of a grain in each pellet.

The pellets may be dispensed in small glass tubes, convenient for carrying in the hypodermic or pocket-case. Dr. Francis H. Brown, of Boston, in a personal communication, has suggested to me the propriety of carrying quite an extended variety of these pellets, thus enabling the physician to be armed and equipped with powerful remedies, in the smallest possible space, ready for use hypodermically, or otherwise.

To accomplish solution for hypodermic use, usually requires not more than thirty seconds, and may be brought about as follows: the syringe is charged with twenty minims of water, which are poured into a teaspoon, or other convenient receptacle; the pellet being dropped in, is crushed, and after all the lumps are broken, the solution is drawn up and forced out three or four times by the syringe, when, usually, the whole mass will be entirely dissolved, and ready for use.

I have thus far spoken of the uses of the pellets in hypodermic medication, and will now briefly allude to their ready adaptability to the requirements of the ophthalmic surgeon.