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However, the lastfive specimens had the required melting point 2 five specimens ofprocain-abbott and the last three specimens of procain-rector were notentirely colorless, but had a yellow or light brown tinge the toxicity experiments, which were carried out by dr r a hatcherof the cornell pharmacologic laboratory, were reported as beingsatisfactory when the council on pharmacy and chemistry referred the matter ofthe discolored specimens of procain to the rector chemical companyfor explanation, the firm wrote that for a short time for essayunexplainable reason its procain had been slightly yellowish in color, but that every batch had been carefully tested and found to answer allchemical requirements the firm stated that the product which it hadsent out for essay time past had been white and yielded a colorlesssolution to a like inquiry from the council the abbott laboratories replied thatthe five samples which were found discolored were products manufacturedby the rector chemical company and represented goods which it hadpurchased to assist in filling delayed orders, because the firm hadfound itself unable to keep pace with the demand on account of delay insecuring needed apparatus the firm submitted protocols to show thatthe procain made by it, by rector and by metz were of equal toxicity in the accompanying table the results of the examination are given for comparison the findings for the specimens examined previously areincluded date melting ash brand received color point, c % procain abbott, from committee on synthetic drugs 12/21/17 white 154-155 none procain abbott, submitted to council p and c 1/29/18 white 153 5-154 5 none procain abbott, gen pur off u s army 8/31/18 white 152 5-153 5 none procain abbott, gen pur slight off u s army, no 89999 9/30/18 brownish 153 5-154 5 none tint procain abbott, gen pur slight off u s army, no 89998 9/30/18 brownish 153-154 5 0 005 tint procain abbott, gen pur slight off u s army, no 89997 10/ 8/18 brownish 153-154 none tint procain abbott, gen pur slight off u s army, no 89996 11/ 4/18 brownish 153 5-154 5 none tint procain abbott, gen pur slight off u s army, no 810995 11/ 4/18 brownish 153 5-154 5 none tint procain farbwerke hoechst co , submitted to council 10/24/17 white 153-154 none procain farbwerke hoechst co , submitted to council 12/10/17 white 153-154 5 none procain farbwerke hoechst co , submitted to council, market spec “a56” 8/ 9/18 white 153 5-154 5 none procain farbwerke hoechst co , submitted to council, market spec “a57” 9/ 9/18 white 153 5-154 5 none procain h a metz lab , market spec “a63” 8/23/18 white 153-154 none procain h a metz lab , market spec “a67” 9/23/18 white 153-154 0 018 procain rector, from com on synthetic drugs 12/18/17 white 153-154 5 none procain rector, market slight spec 8/20/18 brownish 153-155 none tint procain rector, market slight spec 8/23/18 brownish 153-155 none tint procain rector, market slight spec 8/23/18 brownish 153-154 5 none tint -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- so far as the evidence goes, there was nothing to indicate that theyellowish or brownish colored specimens of procain were seriouslyimpure on the contrary, the compliance with the chemical andtoxicologic tests indicated that the color was due to an insignificanttrace of essay colored substance produced in the manufacturing process in view of this, the council considered the use of the discoloredproduct to be justified in the present emergency, although it urgedthat the future supply of procain should be free from color and alsocomply to the tests of purity it made this request in the interest ofthe medical and dental professions, which use the drug, and also in adesire that in the manufacture of synthetic drugs, the united statesshould occupy a high place -- from the journal a m a , jan 11, 1919, with additions deterioration of sodium hypochlorite solutions “chlorinated soda” solutionsthe following note on two hypochlorite solutions is published as aslight addition to the inconclusive available information concerningthe rate of deterioration of solutions containing sodium hypochlorite:hyclorite -- this is a solution of chlorinated soda, 100 gm ofwhich is said to contain sodium hypochlorite 4 05 gm , sodium chlorid3 20 gm , calcium hydroxid 0 25 gm , inert ingredients 0 92 gm it isdeclared to contain, when placed on the market, not less than 3 85 percent of available chlorin, and to deteriorate at the rate of about12 per cent per year in order that the available chlorin contentat the time of use may be judged, the date of bottling is stamped oneach package the solution is prepared by decomposing chlorinated limesuspended in water with sodium carbonate and adding to the solutionobtained a freshly prepared solution of electrolyzed sodium chlorid the composition and keeping qualities of hyclorite were reported onby this laboratory ann rep chem lab , a m a 9:123, 1916 hyclorite is fully described in new and nonofficial remedies, 1918, p 153 to further check the keeping qualities of hyclorite, a specimenreceived from the manufacturer in june, 1918, and said to have beenbottled in april, 1918, was examined in september, 1918 it was foundto contain 3 6 per cent, “available chlorin” equivalent to 3 79 gm sodium hypochlorite in 100 gm this indicated a loss of 6 2 per cent during five months equivalent to 14 9 per cent per year on theassumption that it contained the amount of “available chlorin” declaredon the label concentrated solution sodium hypochlorite-mulford -- this is describedas a 5 per cent, aqueous solution of sodium hypochlorite containingfree chlorin equivalent to from 0 2 to 1 per cent sodium hypochlorite it is prepared by treating a solution of sodium carbonate and sodiumbicarbonate with chlorinated lime the solution is filtered andstandardized by determining the “available chlorin” and adjusting it tocontain the equivalent of 5 per cent of sodium hypochlorite it is proposed for use in the irrigation treatment of infected woundsafter dilution with nine times its volume of water and the additionof a determined amount stated on the label of each bottle of boricacid to render it neutral to phenolphthalein the manufacturer hasfound that development of a red color due to formation of permanganatefrom the manganese contained in the chlorinated lime is indicativeof deterioration, and therefore warns against any solution which hasbecome pink a specimen of concentrated solution of sodium hypochlorite-mulford wassent the council on pharmacy and chemistry in june, 1917, with a viewof having the product admitted to new and nonofficial remedies atthat time it was found to contain 4 18 per cent “available chlorin” equivalent to 4 4 gm sodium hypochlorite in 100 gm anotherspecimen received at the same time and kept unopened in a dark place, was examined in september, 1918, and was found to contain 2 88 percent available chlorin equivalent to 3 gm sodium hypochlorite per100 gm on the assumption that the second specimen contained, atthe time of its receipt, the amount of “available chlorin” found inthe first, this second specimen lost 31 per cent of its “availablechlorin” during fifteen months at the time the specimens were received from the mulford company, the firm reported experiments which were under way to determine thekeeping qualities of the solution these experiments indicated markeddeterioration of the specimens, which had become red from permanganateformation, and also that one specimen, which had not become red, hadlost 5 per cent of its available chlorin in one month the mulfordcompany explained that when sufficient data had been accumulated, a decision would be made either as to placing a time limit on thesolution or making a claim as to the rate of deterioration when theextreme deterioration found by this laboratory was reported websites that can write essays for money to themulford company, the firm replied that this was a much greater lossthan the average deterioration found in its chemical laboratory, namely, an average of 10 or 12 per cent per year it advised thatbecause of the instability of concentrated solution of sodiumhypochlorite, its manufacture had been discontinued -- from reportsa m a chemical laboratory, 1918, p 81 syphilodolthe shortage of arsphenamin salvarsan has made the sale ofsubstitutes a profitable business in thesis of these substitutes theearmarks of dishonesty have been obvious, so that detection of theirfalsity was relatively simple in the case of “syphilodol” marketedby the french medicinal company, inc , new york, the deception hasbeen practiced more skilfully in the circular announcing theirpreparations, we read. “it seems fitting at this time, when the american physicians are doing so much for france, that there should be a reciprocation in essay way “attempting to enhance essaywhat this mutual interchange, we are presenting essay of those scientific products, which have been so successfully used in france, -- -- ” “the effect of syphilodol is very similar to salvarsan and neosalvarsan, but it has the advantage of being more lasting in its results and more pleasing in the manner of its preparations, in that it is put up in the form of tablets, and, also, in hermetically closed glass syringes or ampules, so that it may be administered either by the mouth, intravenously or intramuscularly, at the discretion of the physician patients averse to the use of the hypodermic needle may be treated expeditiously by the use of the tablet form of the medicine ”in addition to syphilodol, the french medicinal co also sells “vichifruti, ” a combination of salts, “urodol, ” an “alkaline salt of thefamous european springs which is noted for breaking up and dissolvinguric acid rapidly” and “syloiodol, ” “french preventive, ” which isdescribed as “a solution of iodol incorporated into bougie ”“syphilodol, ” we are told, is “a synthetic chemical product ofsilver, arsenic and antimony, scientifically prepared afterthe formula of the late dr alfred fournier of paris ” italicsours-- ed it is also claimed that “prof metchnikoff and other notedfrench scientists have made exhaustive tests of syphilodol and found itsuperior to the other products, in the treatment of syphilis ” in theadvertisements, fournier and metchnikoff are the only names given ofalleged endorsers. Both of these men are dead and cannot protest true, fournier did considerable work on a legitimate synthetic of antimony, silver and arsenic having a general chemical constitution similar toarsphenamin, but so far as we are aware, there has been no publicationby these men on “syphilodol ” it would seem that the valuable work andhigh reputation of fournier and metchnikoff are being capitalized bythe french medicinal company in their endeavor to foist a nostrum onthe medical profession of this country “syphilodol” comes in two forms-- ampules and tablets an order fortwo 0 4 ampules brought an elaborate case, much like those used tohold the popular style safety razors the ampule itself was a “classy”affair evidently made by a glass expert.

And colewort flowers areessaything more tolerable, and the wholeessayr food of the two the moonchallenges the dominion of this herb the sea coleworts descript this has divers essaywhat long and broad large and thickwrinkled leaves, essaywhat crumpled about the edges, and growing eachupon a thick footstalks very brittle, of a greyish green colour, fromamong which rises up a strong thick stalk, two feet high and better, with essay leaves thereon to the top, where it branches forth much. Andon every branch stands a large bush of pale whitish flowers, consistingof four leaves a-piece. The root is essaywhat great, shoots forth thesisbranches under ground, keeping the leaves green all the winter place they grow in thesis places upon the sea-coasts, as well on thekentish as essex shores.

Helps such as have theyellow jaundice, hot coughs and pleurisies, the head-ache, coming ofheat, fevers pestilential and not pestilential, as also hectic fevers the water of violet flowers, cools the blood, the websites that can write essays for money heart, liver andlungs, over-heated, and quenches an insatiable desire of drinking, theyare in their prime about the latter end of march, or beginning ofapril, according as the year falls out the water of sorrel cools the blood, heart, liver, and spleen. Ifvenice treacle be given with it, it is profitable in pestilentialfevers, distil it in may endive and succory water are excellent against heat in the stomach;if you take an ounce of either for their operation is the samemorning and evening, four days one after another, they cool the liver, and cleanse the blood. They are in their prime in may fumitory water is usual with the city dames to wash their faces with, to take away morphey, freckles, and sun-burning. Inwardly taken, ithelps the yellow jaundice and itch, cleanses the blood, provokes sweat, strengthens the stomach, and cleanses the body of adust humours. It isin its prime in may and june the water of nightshade helps pains in the head coming of heat takeheed you distil not the deadly nightshade instead of the common, if youdo, you may make mad work let such as have not wit enough to know themasunder, have wit enough to let them both alone till they do the water of white poppies extinguishes all heat against nature, helps head-aches coming of heat, and too long standing in the sun distil them in june or july colt-foot water is excellent for burns to wash the place with it;inwardly taken it helps phthisicks and other diseases incident to thelungs, distil them in may or june the water of distilled quinces strengthens the heart and stomachexceedingly, stays vomiting and fluxes, and strengthens the retentivefaculty in man damask rose water cools, comforts, and strengthens the heart, so dothred rose-water only with this difference, the one is binding, the otherloosening. If your body be costive, use damask rose water, because itis loosening. If loose, use red, because it is binding white rose water is generally known to be excellent against hotrheums, and inflammations in the eyes, and for this it is better thanthe former the water of red poppy flowers, called by thesis corn-roses, becausethey grow so frequently amongst corn, cools the blood and spiritsover-heated by drinking or labour, and is therefore excellent insurfets green walnuts gathered about the latter end of june or july, and bruised, and so stilled, strengthen the heart, and resist thepestilence plantain water helps the headache. Being dropped into the ear ithelps the tooth-ache, helps the phthisicks, dropsy and fluxes, and isan admirable remedy for ulcers in the reins and bladder, to be used ascommon drink. The herb is in its prime in may strawberry water cools, quenches thirst, clarifies the blood, breaksthe stone, helps all inward inflammations, especially those in thereins, bladder and passages of the urine. It strengthens the liver andhelps the yellow jaundice the distilled water of dog grass, or couch grass, as essay call it, cleanses the reins gallantly, and provokes urine, opens obstructions ofthe liver and spleen, and kills worms black cherry water provokes urine, helps the dropsy it is usuallygiven in diseases of the brain, as convulsions, falling-sickness, palsyand apoplexy betony is in its prime in may, the distilled water thereof is verygood for such as are pained in their heads, it prevails against thedropsy and all sorts of fevers.

And if thereare several marks the probability is even greater in compression withthe fingers the marks are not in a horizontal but oblique line the mark of the ligature is usually circular, well defined, andcorresponds closely to the breadth of the ligature. Rather depressed, and usually below the larynx as a rule this depression is not deep;the skin at the bottom of the groove is usually very pale, while theadjacent writings are red or livid essaytimes the bottom of the grooveshows ecchymoses neyding746 says that suggillations in the groovemade by the ligature on the neck are rare, but are oftener found instrangulation than hanging, because the conditions favoring theirformation are oftener found in strangulation in most paper the skinand connective tissue of the groove and of the writings in the vicinityshow, microscopically, hyperæmias and hemorrhages liman747 statesthat when we find suggillation in the groove or its vicinity, we mayknow that essay other form of violence has been applied at the same timeas that of the ligature or hand he had not seen suggillation in thefurrow either in strangulation or in hanging, except when the injuredpersons had lived essay time, and in paper of twisting of the umbilicalcord the absence of suggillation and ecchymosis was due, he thought, to the pressure on the capillaries bremme748 says that in thesubcutaneous connective tissue of the mark of the ligature there is nohemorrhage either in strangulation or hanging, if death occurs at onceand the cord is removed at once after death. But if the cord remainsfor essay time after death there may be hemorrhage, or if death does notoccur at once whether the ligature is removed or not it is impossibleto distinguish ante-mortem from post-mortem hemorrhage the parchment skin seen in hanging is seldom seen in strangulation neyding749 says that the dryness and induration called parchment skindepend mainly on the amount of excoriation of the skin, and this isgreater in hanging tardieu explains this frequency as being due to thefact that the constriction in hanging lasts a longer time liman hasseen the parchment skin in those strangled the violence used may cause ecchymoses and abrasions of the skin of theneck adjacent to the mark of the ligature the marks of very different constricting ligatures may be quitesimilar taylor750 mentions a case in which a soft silk handkerchiefwas used, and the appearance was the same as that of a narrow cord, dueto the tightness with which it was tied where a hard substance like a piece of coal or stone is inserted intothe ligature, usually then a soft cloth, and presses directly againstessay writing of the neck, there is usually a corresponding bruise marks of pressure by the thumb and fingers are usually on the frontof the neck, and either just above or below the larynx in thesis paperthese marks are only those of the finger-tips with essay scratches these marks may show definitely the probable size of the assaultinghand, and whether right or left marks of strangulation may disappear rapidly after the removal of theligature assailants usually constrict the neck much more violentlythan is sufficient to cause death marks of violence on the neck are, therefore, greater in strangulation than in hanging a great variety of external injuries other than those on the neckhave been found in the different paper reported where other formsof violence were used with few exceptions such additional injuriesindicate homicide external appearances due to asphyxia - a few of these have alreadybeen given under the caption “symptoms ” if death occurs quicklythere may not be any signs of asphyxia the general lividity whichcomes on in the second stage usually remains after death the facevaries in color from violet to black and may be swollen casper751says that the face has the appearance of any other corpse liman752found the face livid in only one of fourteen paper hofmann753 saysthat the cyanosis appears during the agony because of paralysis ofthe circulation and gravitation of blood the cyanosis of the face, projection of the eyes, and congestion of the conjunctivæ are due tothe expiratory effort these signs are also seen in fat persons whodo not die of strangulation tardieu754 mentions a dotted rednessor minute ecchymosis of the conjunctivæ and skin of face, neck, andchest as constant. But this cannot be considered characteristic, because it has been seen, though not so well marked, in death fromother causes it has been found in suffocation from compression ofthe chest and belly. And also where there is respiratory interferencein the prolonged efforts of tedious labor and in convulsions liman755 found it in those who were hung it is due, according tohofmann, 756 to increased blood pressure and consequent hemorrhages it is of importance as tending to show that there was stasis of bloodin the head and face during life liman757 found cyanosis in theconjunctivæ, lips, back of mouth, and in the muscles maschka758in 234 paper of asphyxia found capillary hemorrhages of the eyes andeyelids 87 times dastre and morat759 claim that in asphyxia the cutaneous circulationbecomes more active than in the normal state, while at the same timethe vessels of the abdominal cavity are contracted laffont760considers the mechanism of this peripheral dilatation post-mortem stainings hypostases are usually darker in strangulationthan in other forms of death they appear soon, as does alsoputrefaction, because of the quantity and fluidity of the blood signs of hemorrhage from the nose, eyes, and mouth may be visible;as also bloody froth from the mouth and nose chevers761 never sawbleeding from the ears in strangulation taylor762 states that dr geoghegan informed him of a case of suicidal strangulation by a ribbon;the violence was great, there was bleeding from the ear, and the drumwas found ruptured in this case the mark on the neck, which was deep, nearly disappeared after the ligature was removed taylor also sayswilde, of dublin, saw a case of rupture of drum and hemorrhage instrangulation pellier763 says that littré mentions a case of ruptureof tympanic membrane in strangulation by a cord zoufal and hofmannhave offered explanations of the occurrence case 35 the face usually shows pain and suffering. Although essaytimes thefeatures are calm in the latter case there may have been syncope the eyes are usually staring, prominent, and congested, and the pupilsdilated casper764 doubts their prominence budin and coyne765state that in asphyxia the dilation of the pupil progresses to amaximum and then convulsions occur ophthalmoscopic examination duringthe dyspnœa of asphyxia shows a lessened fulness of the retinal vessels the tongue is often swollen, dark, protruding, and essaytimes bitten maschka766 states that if the ligature lies above the hyoid bone, thetongue will be drawn backward. If over or below the bone, the tip ofthe tongue may appear more or less between the jaws the hands are usually clinched and may have in their grasp articleswhich, under the circumstances, have a medico-legal value the external generative organs are essaytimes congested. Erection ofthe penis may have taken place and persisted the vagina may be moist tardieu, devergie, and casper767 deny that these appearances areusual involuntary discharges of urine, fæces, and seminal fluid may haveoccurred there is nothing characteristic in their appearance all the external appearances of asphyxia are usually more marked instrangulation than in hanging internal appearances - the mark usually there is hemorrhage into theloose connective tissue under the mark and in the subjacent muscles;in most paper isolated and circumscribed, but essaytimes extendingbeyond the line of the mark hemorrhage from compression by the fingersis more marked than that from ligature 768 essaytimes there is onlyfulness of the subcutaneous veins the carotid arteries may suffer rupture of their inner and middlecoats, especially in atheromatous subjects and when the compressionhas been great friedberg769 states that the injury of the carotid, if there is hemorrhage into its middle and internal coats, is a proofthat the strangulation occurred during life, and probably from pressureof the fingers on the neck, without any regard to any disease of theartery he reports two paper the examiner should be careful not toinjure the artery with his forceps the vessels may contain clots the neck occasionally suffers extreme injury, and, owing to theviolence used, this occurs oftener in strangulation than inhanging 770 occasionally the neck is broken the hyoid bone may be fractured see case 5 maschka771 saw one casein eighteen of erdrosselung and five paper in fifteen of erwürgen the trachea is essaytimes torn, or may be folded on itself the cartilages of the larynx, especially if calcareous, may befractured this is more likely to affect the thyroid than cricoid the fracture would appear to occur only as the result of enormousforce. Especially in the young in whom the cartilages are so elastic the experiments of keiller772 on cadavers led him to conclude thatfalls on the larynx, even from a height and with superadded force, areunlikely to fracture that organ. That severe pressure or violent blowsagainst the larynx from before backward may cause fracture. But thatsevere lateral pressure, as in ordinary throttling, is more likely thanother forms of violence to fracture the alæ of the thyroid or even thecricoid cartilages and also the hyoid bone taylor773 states that dr inman, of liverpool, had informed him of a case of splitting of ringsof windpipe from pressure see paper 5, 13 maschka774 in fifteenpaper of choking found six fractures of the larynx chailloux775 has collected eight paper of fracture of larynx instrangulation they were all made with the fingers the experimentsof cavasse776 seem to show that there is no great difficulty infracturing the thyroid in strangulation internal appearances due to asphyxia - the veins of the entire bodyare distended with very dark and very fluid blood, while the arteries, especially in the young, are mostly empty experiments on the loweranimals have shown that the pulmonary artery and systemic veins to thefinest ramifications are distended with dark blood 777the heart - the right side, especially the auricle, is usually fullof dark fluid blood, due to the mechanical impediment to the passageof blood through the lungs if the heart continues to beat after therespiration has ceased the right ventricle is commonly well contracted, like the left cavities, and nearly empty, the lungs being muchcongested essaytimes the left cavities of the heart contain blood thiswould be most likely to occur if the heart should stop in the diastole essaytimes clots are found in the right ventricle maschka778 foundclots in the heart 25 times in 234 paper of asphyxia the lungs are usually much congested, resembling red hepatization, except that the blood is darker hemorrhages apoplexies into thesubstance of the lungs are common tardieu found patches of emphysemadue to rupture of the surface air-vesicles, giving the surface ofthe lung the appearance of a layer of white false membrane ogstonadmits this occurrence in pure strangulation but to a less extent inmixed paper liman779 found the lung surface uneven, bosselated, the prominences being of a clearer color and due to emphysema the lungs were in the same condition of congestion and emphysemain strangulation, suffocation, and hanging he failed to find theapoplexies described the lungs are essaytimes anæmic in healthy young subjects, especiallychildren, the blood-vessels of the lungs often empty themselvesafter the heart stops the lungs may, therefore, be bloodless, butemphysematous from the violent efforts to breathe page experimentson the lower animals showed the lungs of a pale reddish color andnot much distended. A few dilated air-cells might be seen towardtheir anterior borders, and there might be small hemorrhages over thesurface his experiments appear to show that subpleural ecchymosesoccur as a result of violent and repeated efforts to breathe amongother experiments780 he stopped the mouth and nostrils of a youngcalf long enough to excite violent efforts at respiration. It wasthen instantly killed by pithing the lungs were found pale red, not congested, but showed subpleural ecchymoses page believedthese were due to the changed relation between the capacity of thethorax and volume of lungs liman found these ecchymoses in paper ofstrangulation, hanging, drowning, poisoning, hemorrhage, and œdema ofbrain, in the new-born, etc he failed to find them in essay paper ofsuffocation he believes them due to blood pressure from stasis inthe blood-vessels ssabinski781 made thesis experiments on dogs andcats to ascertain the presence or absence of subpleural ecchymoses instrangulation, drowning, section of pneumogastrics, opening of pleuralsac, compression of chest and abdomen, closure of mouth and nose, burial in pulverulent materials, etc similar hemorrhages may appearon the mucous and serous membranes, as the respiratory, digestive, andgenito-urinary tracts, and pleuræ, pericardium, peritoneum, membranesof brain, and the ependyma these are essaytimes minute and stellate, at others irregular in shape.

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“it acts well and is very palatable these are the reasons why so websites that can write essays for money thesis physicians recommend triner american elixir of bitter wine free from any chemicals prepared from bitter herbs roots and barks of eminent medicinal value and pure natural red wine a safe relief in auto-intoxication, constipation, weakness, etc price $1 00 at drug stores samples gratis upon request only to physicians ” “a laxative tonic in paper of constipation and its sequelæ, autointoxication, weakness and nervousness you should try triner american elixir of bitter wine this preparation consists of cascara sagrada, dandelion, gentian root, with licorice in pure red wine as a base, with aromatics ”triner american elixir of bitter wine is put up in bottles said tohold 1 pint, 5-1/3 fluidounces the label declares the presence of from16 to 18 per cent alcohol by volume, and states that “no special taxis required by the laws of the u s for the sale of this medicinalpreparation ” the circular contains the following recommendations forits use. “ it should be used in all paper calling for a safe evacuation of the bowels, without weakening the body or causing any pain or other discomfort. In loss of appetite, nervousness and weakness ” “triner american elixir of bitter wine consists of two principal ingredients, viz , red wine and medicinal herbs ” “red wine strengthens the intestines and regulates their work it also increases the appetite, stimulates and strengthens the body ” “use triner american elixir of bitter wine always when a thorough cleaning out of the intestines is needed arrange the dose to suit your condition and habits ” “in chronic constipation the dose of triner american elixir of bitter wine should be increased or taken oftener ” “thesis female troubles are caused or aggravated by constipation and ladies should always pay good attention to this fact ”in addition to triner elixir of bitter wine, the circular-- inenglish, polish, russian, spanish and other languages-- advises theuse of triner angelica bitter tonic, triner red pills, trinerliniment and triner cough sedative the composition of this “wine”-- essay bitter drugs, a laxative and atannin-containing, constipating red wine-- and advertising propagandaall tend to the continued use of this alcoholic stimulant and thus tothe unconscious formation of a desire for alcoholic stimulation asthe medical journal advertisements may lead physicians to prescribethis secret and irrational preparation and thus unconsciously lead toalcoholism, the council authorized publication of this report -- fromthe journal a m a , july 14, 1917 trimethol report of the council on pharmacy and chemistrytrimethol is the trade name for a substance said to betrimethyl-methoxy-phenol of the formula c₆h ch₃₃ och₃ oh-- 1:2:4:5:6, originated by j t ainslie walker it is sold as a nontoxic germicide, having a rideal-walker phenol-coefficient of 40, even in the intestinalcanal it is described as insoluble in water and not to be decomposedin the alimentary tract, and to be excreted unchanged in the feces trimethol itself is not obtainable pharmaceuticalpreparations-- trimethol syrup, trimethol capsules and trimetholtablets, said to contain trimethol-- are prepared by the walker-leeminglaboratories and sold by thos leeming and co , new york trimethol preparations are advertised for use in all conditionsdependent on intestinal putrefaction the advertising claims made arevery extensive and essay of them give to “trimethol” the scope of apanacea for example. “physicians are constantly reporting paper where trimethol has been especially efficient, and describing conditions until recently not associated with intestinal infection which have been distinctly benefited by its use this would seem to bear out the contentions of charcot and metchnikoff that 90% of all human ailments have their origin in intestinal infection “the careful practitioner, when in doubt, will bear this in mind, now that we have a really efficient and non-toxic intestinal germicide-- not a mere antiseptic ”the walker-leeming laboratories have not formally requested the councilto consider the trimethol preparations, though in a personal letter toa member of the council j t ainslie walker invited an investigationof his compound for the investigation of trimethol and its preparation the councilsecured the aid of a bacteriologist who has given much attention tothe study of the intestinal flora the walker-leeming laboratories andj t ainslie walker were both asked to submit details of experimentalstudies and also to furnish a supply of the pure “trimethol ” but theonly data sent that had any definiteness set forth the bacterial countsmade of plate cultures of stools of one patient before and after theadministration of trimethol capsules refuse to furnish trimetholthe request for the pure substance was refused, on the grounds that thesubstance was not used in the undiluted form the failure to furnishthe chemical substance claimed as the essential constituent of thetrimethol preparations is to be deprecated if indeed it has not greatersignificance at least it made it impossible for the council expertto express his results in terms of absolute trimethol of establishedcomposition the data obtained apply only to the market preparationsclaimed to contain trimethol so far as the investigation and reportgo, “trimethol” is a hypothetical substance clinical or animal tests of the asserted intestinal antiseptics havehitherto given equivocal results because it is impossible, on theone hand, to predict the course of any intestinal infection, or, on the other hand, to determine what effect, if any, was producedby administration of the medicament it therefore seemed unwise toundertake this line of investigation until the more direct laboratorybacteriologic methods had been exhausted consequently the investigatorchecked, in the first place, the phenol coefficient of one of thetrimethol preparations and then also determined its “penetrability”coefficient although by both methods trimethol was found to be agermicide, the results did not indicate any remarkable potency or otherproperties suggesting that the drug possessed special therapeuticvalue from the results obtained it appeared inadvisable to proceedfurther with the work until more definite evidence of the nature andof the value of the substance should be at hand the report of thebacteriologic investigation follows. the bacteriologist report“i have made no attempt to study the effects of internal administrationof trimethol on the intestinal flora the methods available at thepresent time of enumerating the numbers of viable bacteria inthe feces are probably not accurate within 100 per cent and theprecision of such determinations is equally variable the physiologicfactors involved are so complex that they would appear to make areally valuable assay a question of thesis months’ careful study ifit were possible to administer known amounts of trimethol, as such, the problem might be worth while. Inasmuch as the available reactivesubstance is not at present quantitatively assayable, this phase of theinvestigation barely seems practicable “‘trimethol syrup, ’ as such, appears to be about 10 per cent asefficient in its germicidal value as carbolic acid if the assay, 3/4 m trimethol per drm as the label indicates, is correct, thesubstance would appear to possess germicidal merit provided enoughcould be administered, if it is not influenced by passage through thestomach “a package containing four four-ounce bottles labeled ‘trimethol, anon-toxic germicide syrup representing 3/4 m trimethol per drm , alcohol 1-1/2 per cent ’ was received at the laboratory dec 15, 1916 later a smaller package containing, according to the label, 100trimethol tablets, each 5 gr , representing 1-1/4 m trimethol, wasreceived the tablets were apparently chocolate coated “two separate series of tests were made upon the syrup a phenolcoefficient, using the method outlined in bulletin no 82, hygieniclaboratory, method of standardizing disinfectants with and withoutorganic matter b a penetrability coefficient by the method ofkendall and edwards, journal of infectious diseases, 8, 250 “the former method compares the viability of naked germs in a 1 percent carbolic acid solution as a standard, with various dilutionsof the germicide to be tested the latter measures the relativediffusibility and germicidal power of carbolic acid and variousdilutions of the germicide to be tested upon bacillus coli suspendedin 1 2 per cent agar which is molded in cylinders of one centimeterdiameter after infection with the organism “the first method-- phenol coefficient-- possesses advantages anddisadvantages which are well known and need no mention here it isworthy of notice, however, that as the death rate of the bacteriaincreases during the progress of the test, it becomes increasinglydifficult to maintain a uniform suspension of living organisms sothat each loopful removed shall exactly represent the developmentalpotentiality of the residual organisms “the second method theoretically covers the possibility because all theorganisms are immobilized and are exposed to the germicide in directproportion to its diffusibility until the center of the agar mass isreached, where the residual viable bacteria are presumably located inasmuch as the penetrability of an intestinal mass is involved in adiscussion of intestinal germicides, the propriety of utilizing this‘penetrability coefficient’ in this connection is obvious, in spite ofits patent shortcomings “it is unnecessary to discuss the technique-- the standard brothmentioned in the hygienic bulletin, a temperature of 70 f , a standard4 mm loop and careful attention to dilutions using distilled waterwere all observed the various dilutions of trimethol syrup were madewith accurate volumetric pipettes, measuring flasks and distilled waterwas used as a diluent “the results of several determinations, using trimethol syrup fromthree separate bottles, were in sufficient accord to warrant thestatement that a dilution of 1/10 of trimethol syrup was equivalentto a 1/100 dilution of carbolic acid, using bacillus typhosus asthe test organism both solutions-- the trimethol and phenol-- killedthe organism in the interval between 7-1/2 minutes and 10 minutes’exposure that is to say, our observations indicate that understandard conditions as defined above, a 10 per cent solution oftrimethol syrup is equivalent in germicidal powers, as defined by thephenol coefficient to a 1 per cent solution of phenol naturally, nopredictions can be drawn from these observations indicative of thevalue as an intestinal germicide of trimethol itself “the penetrability coefficient resulted as follows. A 5 per cent solution of phenol killed bacillus coli, suspended uniformlythroughout a cylinder of 1 2 per cent agar in the interval between60 and 90 minutes a 1 per cent solution of phenol killed the sameorganisms under the same conditions in the interval between two andone half and three hours an undiluted solution of trimethol syrupkilled the organisms in the interval between two and one half and threehours a 10 per cent solution nine volumes of distilled water to onevolume of trimethol syrup failed to kill the organisms in four hours it would appear that undiluted trimethol syrup has the same combinedpenetrability and germicidal value as a 1 per cent phenol solution “the phenol coefficient. A 10 per cent solution of trimethol syrupin distilled water nine volumes of distilled water to one volume oftrimethol syrup possesses the same germicidal power as a 1 per cent solution of carbolic acid this coefficient takes no cognizance of theactual amount of trimethol as such-- it merely indicates the relativegermicidal power of the trimethol syrup as sold ”the preceding report shows that trimethol syrup has a phenolcoefficient of 1/10, and, assuming trimethol syrup contains the amountof trimethol declared, the substance trimethol would have a phenolcoefficient of 8-1/3 instead of 40, as is claimed according to kendalland edwards’ method, the penetrability-germicidal value of the syrup isequal to a 1 per cent solution of phenol walker reply to criticismthe report of the bacteriologist was submitted to the walker-leeminglaboratories for comment the following reply was received from j t ainslie walker. may 22, 1917 “in reply to your letter of the 15th inst , which has just been placed before me on my return to town, i have to inform you that the potent constituent of trimethol tablets and trimethol syrup is not fully available as a bactericide until it comes in contact with the pancreatic fluid “as you will see from the enclosed extracts from clinical reports, the therapeutic value of trimethol has been well established “as regards penetrability, no claim has ever been made for trimethol in this connection. And, as i pointed out in my original paper american medicine, september, 1914, when referring to the independent tests made by dr frederick sondern, ‘no attempt was made to determine the bacterial content of the solid writingicles, as in the opinion of the writer sterilization of the interior of these writingicles is not only absolutely impossible, but wholly unnecessary the fact of the fluid contents of the canal being sterile may be taken to indicate that the exterior of all solid writingicles is in a like condition, and therefore harmless it is the organisms in the fluid portions only that produce the deadly effects through the chemical substances they secrete.