than I can from its particular name. The nomenclature of disease is not a safe guide to their treatment, but something to satisfy the inquisitiveness of the patient or his anxious friends. Amongst the hardest things in life for me is ofttimes the naming of the particular disease from which my patient is suffering, although I may, with ease, meet the indications and promptly cure the case.

We believe the practice of medicine to be a positive science; we believe the actions of medicines to be always similar if similar conditions prevail, but, to name a specified abnormal condition a certain disease, and then fire in our remedies regardless of special indications, is but abject folly.

Take for instance the very common, and ofttimes fatal, disease designated pneumonia. One eminent author says: "Pneumonia in its early stages can be arrested, cut short, and all danger to the structure of the lungs thus avoided. *** For this purpose aconite, gelsemium, veratrum and asclepias combined answer well." Another equally prominent author says that he administered digitalis in 43 cases and only 19 died; in 52 cases he administered quinine as the principal

dency to inflammation of the brain, then gelsemium is the remedy. Ten to 20 drops in four ounces of water; teaspoonful every half to one hour.

With the pulse of medium size, blood flowing steadily, wave not well marked, but with the special indication of pleuritic inflammation, which is a cause of cough and unrest; increased determination of blood to the lungs, then bryonia is the remedy; with the hard, dry cough and the scanty, tenacious, bloody or rustcolored expectoration. It may be alternated or added to the sedative mixtures. Ten to 20 drops in four ounces of water and given the same.

Just why the above-mentioned author should bunch the whole lot and then fire the shot-gun into the poor victim I am unable to discover, unless it be on the principle that if one remedy fails to hit the case the other may. Certainly, no one case of this or any other disease could possibly indicate them all at one and the same time. These remedies, to get their best results, should be given in the small, but frequent doses, as indicated above. In fact, I make that the rule in about all acute cases as well as in some of the chronic ones. I believe that if this rule

Now let us see how we would treat the case as per indications. A general rule may be laid down, as is the fever so is the pulse. If we have a frequent and small pulse, aconite is the remedy; if we find that peculiar characteristic of constriction and dryness of the fauces, no other single remedy will so quickly influence it for good. Prepare, tincture aconite, 5 to 10 drops; aqua, 4 ounces; a teaspoonful every half to one hour.

Given a full, either hard or bounding pulse, veratrum is the remedy, especially where the case is marked with great irritation of the lungs with active circulation none other is its equal. Fluid extract veratrum, 10 to 20 drops in four ounces of water; teaspoonful every half to two hours.

Given a fairly full virbratile, but rapid, pulse with bright eyes, contracted pupils restlessness, vascular excitement or ten

would be more prompt and satisfactory. Other remedies frequently indicated in pneumonia are:

Macrotys; where there is an unusual amount of muscular pain and soreness of the respiratory organs, as if bruised or suggestive of rheumatism. Add to the sedative mixture 20 to 30 drops of the tincture.

Asclepias; with pleuritic pains, pulse not hard, but sometimes bounding; with a tendency to moisture of the skin. Add one drachm of the tincture to the sedative mixture.

Rhus; small pulse, sharp stroke, bright flushed left cheek, pain in forehead and orbits, the peculiar appearance of the papillæ of the tongue indicating the remedy. In children, the sharp cry during sleep, and, in advanced stages, the pinched features and contraction of tissues about the eyes, this is an excellent remedy. Add to the sedative mixture 5 to 10 drops of the tincture.

Lobelia; with the sense of oppression in the chest, impaired respiration from atony, parecardial oppression, increased secretion of mucus, the pulse may be full and oppressed, small, or soft and feeble; symptoms which may come up suddenly, and may be met frequently with a single dose of from 10 to 20 drops of the tincture of the seed; or it may be added to the sedative mixture in less than nauseating doses. When the bronchial tubes are filled with mucus or muco-pus, the following is an excellent preparation: B. Tr. lobelia sem..... Tr. lavender comp..

Syrup..

3 j

3 iij

.q. s. Zij

M. Sig. Teaspoonful every hour or two; children smaller and more frequent doses, but always keep it below the nauseating point.

Ipecacuanha; with a diarrhea of irritation, or colitis, if intercellular passages and minute bronchial tubes are involved. Add to the sedative mixture from 10 to 20 drops of the tincture.

Phosphorus; if the sputa becomes markedly rusty, alternate it with aconite, 20 drops in four ounces of water; teaspoonful every hour or two.

Sanguinaria; with irritative cough, sense of rawness and constriction in the throat, secretion of frothy muco-pus. Sanguinaria nitrate, 1 to 2 grains in four ounces of water; give a teaspoonful every hour or two.

Sticta; with pain in or between the shoulders, neck or occiput, cough harassing; when the secretion is established it is very abundant. Add to the sedative mixture 10 to 30 drops of the tincture.

Ferrum; with flushing of both cheeks, surface glistening, tongue deep red, papillæ very prominent, or coating raised in spots showing red beneath; sputa grumous or like prune juice, sometimes red blotches appearing on extremities. Add four drachms of the tincture to 11⁄2 ounces of syrup; teaspoonful every four hours.

Arsenicum; with soft and feeble pulse, inelastic skin, skin, small pallid pallid tongue. Fowler's solution, a drop every four hours. Carbo-veg.; with a soft and feeble pulse, extremities cool, atonic and pallid tongue, hemorrhage of the nose, throat,

lungs or bowels. Carbo veg., one grain, sac-lac., nine grains; mix. triturate and divide into 10 powders; one every hour or two.

Quinine; I seldom find any indications for this much abused drug, except for its tonic or stimulating effects in the later or convalescent stages, or where there is a lack of innervation, and then to be given in one or two grain doses every hour or two, and never more than eight grains in the 24 hours. Yet, in malarial districts, or where the patient has heretofore been afflicted with malarial troubles, during the treatment of the case a distinct periodicity may show itself accompanied by soft pulse, soft skin and moist tongue, with irritation of the nervous system, a 10 to 15 grain dose will mitigate, if not arrest the disease.

As for digitalis, I should not think of using it in a case of pneumonia, except, possibly as a renal stimulant with a tendency to dropsy, a condition rarely met with in this disease, and even then I would use it only in the form of an infusion.

I have tried to point out a few of the indications for the principal remedies I find called for in pneumonia, although probably not all. These indications will be as promptly met by the indicated remedies in any other disease as well, be it small-pox, measles or what not. The indications of disease often vary; the indications for remedies never.

But in the case of pneumonia, if called before the destruction of tissue has set in, why not give your patient a 20-minute inhalation from your bottle of ether, and, if necessary, repeat at intervals of two to four hours, and thus do away with the whole category of remedies as well as the annoyance and, possibly, the fatal termination of the disease. Ogden, Ill.

was he had thus exposed to the public gaze he wrote underneath, "This is a horse."

In my recent articles on my special method of cure for fistula in ano, I do not seem to have been sufficiently clear as to the modus operandi, for I have received a number of letters asking for "more light." I shall, therefore, try to give it.

In the August number of the SUMMARY I was made to say "finding the causes of the sinus of each fistula." It should have read "course of"-(a typographical error, due to my penmanship, of course). Then I said, "begin at the opening fartherest from the anus," and, having it very clear in my own mind where this was, I did not think any one would stumble, but here comes a letter asking, "Did the Doctor mean the opening in the bowel or the skin opening?"

Well, really now, I should have said the external opening, but, honestly, who would think of going inside of the rectum to commence treatment? and, sure enough, what kind of a pair of backaction, double-jointed scissors could a man use to cut downwards and outwards from within? You could not crawl into the rectum yourself and thus get back of the internal opening, and what would be the use if there was an external opening to commence on. Then, I very clearly say, in my second article, that "after cutting as far as the sphincter muscle, or into the mucous membrane of the rectum or anus, thereby giving an outlet for drainage, the upper portion will be very likely to consolidate."

Then, in another typographical error (my poor penmanship again) I was made to say, in the December number, "propepointed scissors" for "probe-pointed scissors." I presume here, however, the printer's devil, in his hurry, got the "b" upside down, or picked out a "p" instead. I will forgive him this time.

Now as to anesthetics, local or otherwise. Do I use them? No! That was emphasized in my statement of there being no pain, except the slight half-inch cut at the time, and also that there was scarcely any discomfort during the entire treatment.

The history of the case I mentioned is

as follows: It began with a marginal abscess which, from future development, proved to be the external evidence of trouble deeper in, as I shall demonstrate farther on in the history of the case. This manifested itself in the usual way, with heat and enlargement close to the border of the anus, externally, and finally resulted in the formation of pus-acute, primary abscess; pain intense, excruciating. A physician was called, who found patient in bed, of course, and that he had been under the influence of morphine to quiet the pain. A slight opening was made to allow pus to discharge, and of course relief was obtained temporarily. Now here begins the error in treatment. I am describing a case which ran the gauntlet of a long series of treatments and methods before a final cure. The open

ing of an abscess here should be free-a long cut-and should radiate from the anus. I am satisfied, from what I know of this case, that the opening was not free enough, and then it was left to heal itself without any after treatment. What was the result? A cold or chronic abscess, ' tissues surrounding same became indurated, and there was a constantly repeated filling up of the pus pocket, closing of the pinhole opening and a reopening and discharging. This was about the stage of affairs some months thereafter, when another method was tried. The patient lay on his back and allowed himself to be cut open in that that region thoroughly and the diseased tissue scraped out with the sharp spoonhospital method. Case was not properly watched for existing sinuses in the bottom of the wounds, which were made on both sides of the anus, for there was a double abscess. What was the result in this case? Patient was left, as wounds healed, with a triple fistula, or at least that was what resulted afterward. Had been two weeks in bed and six weeks confinemet to the house, and the outcome as above.

Years passed and still these three fistulæ existed. Then injections of astringents and other like remedies were tried with some benefit, but the fistulæ still existed and were exceedingly annoying. One of these was about six inches

in length, running deeply into the tissues, and no doubt was the outlet for drainage of an abscess situated in the superior pelvi-rectal space above the levator ani muscle. These abscesses discharge their contents sometimes by the pus working its way toward the rectum and then downward until it points externally near the verge of the anus. Possibly it was from this region the sinus ran. If not one of those rare abscesses, it at least must have been from one originating in the loose tissue around the rectum in the cavity known as the ischio-rectal fossa.

Well, the next procedure was to try the ligature on one of these fistulæ, and after a season (being laid up) of suffering and the experience of the filthy nature of this disgusting method, the case went to a physician who tried my slow cutting method, one-quarter of an inch at a time, until two of the tracts were cut through to the mucous membrane of the anus. These cuttings were done every second or third day, and each one was separately and gradually cut in this way until the sinus had been followed up to just within the anus and to the border of the sphincter muscle, and then left for a week or two. What was the result? Consolidation above, without a doubt, as the patient has no more trouble from those fistulæ, which had been bothering him for 12 years. The long one, however, of which I spoke, did not need any treatment at all. It consolidated itself. Why? or how? Well, to God be the praise, for this was one, if there ever was any, that could not be operated on by this method, on account of the extent of triangular solid tissue between its external opening and the margin of the anus. did not run under the integument simply as fistulæ usually do, but directly down, or up, deep into the muscular tissue.

It

I want to say, that almost all of the tissue surrounding the anus in this case was of that unhealthy honey-comb nature, which you will find in long-standing cases of this kind.

I know something about this case I have just described, for it happened to be myself.

1011 Park Ave., New York.

One dollar for the SUMMARY one year.

อ

MATERNAL STOMATITIS.

BY CHAS. E. TUCKER, M. D.

EAR Doctor, you so earnestly solicit the profession to report cases that I venture to send you the following, which I hope will be adding something practical to the columns of one of the most practical medical journals I have ever read.

Mrs. S. B family history good, personal history fair, had good health, although rather of a neurotic temperament, until about one year ago, when she became a victim of malaria, which terminated in a few months in the malarial cachexia. On November 8, 1898, she gave birth to twins, a boy and a girl, both well developed and healthy. The puerperium was complicated by acute cystitis and excessive uterine discharge, the former being very difficult to control. During this period there also developed an ulcerative stomatitis accompanied by excessive salivation.

white, 26 years old,

After commencing lactation all her symptoms were augmented and she became very anemic. Both the general condition and the stomatitis refused to yield to any method of treatment that I could institute, and there was abundant evidence that she was rapidly sinking from the combined effects of the malarial cachexia, excessive lactation and salivation. At this period she was so very weak that walking across the 100m completely exhausted her. She was greatly emaciated, skin and mucous membranes pale and shining, eyes jaundiced, heart action weak and rapid, daily rise of temperature, poor digestion, constipation, hypertrophy of spleen. Her urine contained sugar, and the saliva and milk just absolutely poured from her.

Just here I decided to wean the babies (to decide is to act with me), so I put them on artificial food at once, and gave the mother the following treatment: rest in bed, a morning bath followed by a brisk rub down, a liberal, plain, nutritious diet, and five grains of quinine sulphate every four hours, followed, in 30 minutes, by 10 drops of tincture ferri chlor.; also,

five drops of tincture belladonna every four hours, and an aloes and iron pill (U. S. P.), one or two, at bedtime, provided bowels did not move freely.

Now here are the symptoms and the treatment, and I leave you to draw your own deductions, but will add that I found it very difficult to learn anything from the text-books concerning maternal stomatitis. Sure enough, I came near forgetting to tell you that my patient is slowly, but surely, recovering.

Joppa, Ill.

R

PNEUMONIA OF CHILDREN.

BY JOSEPH ADOLPHUS, M. D.

ECENT years of pathological research, as well as clinical experience, have led medical men to conclude that pneumonia is a bacteriological disease. All the forms and conditions that signify the disease are the products of toxins. However, I think we cannot go beyond the fact that the bacteria that cause the disease are numerous and complex.

There are two varieties of pneumonia that attack children, viz: (a) lobar, (b) broncho-pneumonia. The latter is of the catarrhal kind; the air cells and small bronchi are filled with peculiar mucus and many forms of cells, these latter are nearly related to the cells found in inflamed mucous membranes-some are leucocytes, others of the white cells found in highly congested cellular tissue.

The disease is essentially of a catarrhal nature, plus the depressing influence of toxins. Possibly three fourths, if not four-fifths, of all the cases of pneumonia in children are of the catarrhal type; a few only are croupous, and these latter are found mostly in older children. It is seldom seen in children under three years old.

The catarrhal type of pneumonia often attacks both lungs. The symptoms are intense, but they begin mostly as a bronchitis; many cases of the capillary bronchitis kind end in catarrhal pneumonia.

The onset of the symptoms of this disease are not sudden; the symptoms develop slowly. In the croupous kind the onset is often so sudden as to produce

the whole train of pneumonic symptoms in 24 hours. I have seen the pulse reach 140 beats and the respirations 60 to 70 in 24 hours. In the catarrhal kind the same frequency of pulse and respiration occur, but a longer time is consumed in developing the train of symptoms. In the croupous kind the pulse is hard and strong in the onset, and continues so from two to four days if the treatment is adapted to sustain the powers of life and not depressing in nature. In the catarrhal kind the pulse is very quick, often reaching 165, but quite compressible, seldom strong or hard, and the respirations may reach 70 when the small bronchi are involved. In the catarrhal kind the powers of life are at a low ebb from the onset, and all kinds of medication that tend to lower the resisting and defensive powers of the organism are surely to be avoided.

The general symptoms are too frequently misleading in their nature, and the local symptoms are in nowise in proportion to the general symptoms. So true is this that often the nervous system is so greatly disturbed by the toxins as to cause excessive reflex activities. We often witness great dyspnoea, excessive restlessness, very high temperature, often amounting to 104.5 degrees Fahr.; very quick, shallow breathing; cyanosis, and indications of great pulmonary congestion, which, in itself, is a cause of extreme nervous disturbance, owing to imperfect oxygenation of the blood and large quantity of CO2 circulating in the nerve cen

ters.

In catarrhal pheumonia symptoms resembling cerebro-spinal meningitis may prevail during the opening period of the lung disease, which may mislead the medical attendant as well as others. Some cases may be ushered in by convulsions, others, and these most frequently, are attended with great irritability of temper, vicious illnaturedness, distressful impatience; some have extreme rise of temperature at nightfall; delirium, when the child is old enough. Complete loss of appetite and great thirst are noted; the urine, in some cases, is very deficient, in other cases the quantity voided is in proportion to the fluids taken in.