In a case of very deficient urine in catarrhal pneumonia, I made a remarkable change in the general features of it by having the child fed frequently on a cold decoction of sambucus canadensis, which is a pure diuretic. As soon as the urine came in abundance the symptoms subsided and the pneumonia progressed evenly.

It is well to bear in mind that all the the symptoms in pneumonia in children are greatly exaggerated by the state of the nervous system, which the recent pathologists tell us are owing to ptomaines and toxins.

The cough in pneumonia is peculiar in the outset. It is often short and hacking, and painful on account of the involvement of the plura. Every coughing spell is attended with evidences of suffering, as is manifested by contortion of the countenance; the nervous symptoms are often aggravated.

I am inclined to believe that pneumonia in infants is attended with higher temperature than in any other disease, save scarlet fever, and the remissions are more irregular, while the difference between the evening temperature and morning temperature is inclined to be small. Sometimes I have known this to be the danger point in the case, and the nervous symptoms augment greatly in severity. One case of the kind of great severity I believe I saved by liberally administering gelsemium and passiflora to sedate nervous excitement and reduce high temperature. I have always kept these points in view when treating pneumonia in children, especially the catarrhal kind.

Another point worthy of consideration is, that high temperature in pneumonia in children must not be regarded in the same light as it is in typhoid fever, inasmuch as high temperature in pneumonia in children seems to be part of the natural course of the disease and must not be combatted energetically, but rather when the other treatment is wisely adapted to the individual case-high temperature declines and the evening temperature comes to the morning temperature figures; the remissions are longer, and other symptoms give way so that defervescence is soon completed.

I believe, under judicious treatment, that pneumonia in children will run an even course in most cases, which is most true of the lobar or croupous kind. The duration may reach its extreme in four to five days after beginning, after this the acute symptoms slowly fade, the pulse and respiration become more natural. This period may last three, four or six days, then permanent betterment goes on and convalescence is perfected.

In the catarrhal kind the course is more uneven, and I have seen the temperature reach 104 degrees Fahr., stay there while the symptoms pertaining to the nervous system ranged high, varied, put on serious phase and then subside quietly under 24 hours treatment with gelsemium and aconite.

This form of pneumonia in children is generally attended with the most acute and severe symptoms, and is badly treated, especially with coal-tar preparations to lower temperature, and morphine, calomel, large doses of ipecac, blisters, antimony, blood-letting, etc. The treatment of pneumonia in children should be simple, supporting and mildly sedative.

I often use tincture of lobelia in 1-10 drop doses, repeated every 30 minutes, in cases where the nervous element runs high with very gratifying results. Another remedy is tincture of gelemium, which sedates but does not depress, lowers high temperature and quiets overexcitement of the nervous system. Gelsemium and aconite work well together in catarrhal pneumonia: B. Fld. ext. aconite.... Tr. gelsemium.. Aqua....

πν mxx

3 iv

M. Sig. Teaspoonful every 30 minutes, repeated five or six times, then the intervals are extended to an hour.

In 24 hours the hard, quick pulse is reduced in force and frequency without any symptoms of depression. I have never had cause to withhold this form of medication. We know how kindly aconite controls reflex nervous excitements and slows the over-excited heart by sedating the irritated vagus. Gelsemium is a fine antipyretic and sedative to the nerve centers. I have used it 40 years in diseases of children and women in vary

to

ing doses with good results. There are cases of pneumonia, especially of the catarrhal kind, in which dyspnoea is very urgent, heart struggles severely against great obstruction blood passing through the lungs, and at the same time the pulse is feeble. I believe one of our best means of treatment is the warm bath, to dilate the blood-vessels of the skin and draw the blood from the thorax into the cutaneous surfaces; large enemas of warm water, tincture of nux vomica in small and oft-repeated doses, the same of ipecac root. The warm pack, a flannel cloth dipped into water 100 degrees Fahr. and queezed of superfluous water and the child wrapped in this, frequently reduces very high temperature. It was a favorite method of combatting high temperature with the hydropathists. Another way to reduce high temperature is to apply a piece of quilt wide enough to cover the whole thorax and go quite around the body; the child is laid on a folded blanket, to prevent wetting the bed clothes, the strip of quilt, or thick woolen cloth, is squeezed out of water 80 degrees Fahr. and applied to the child's thorax, and is changed often so as to prevent it becoming the same temperature of the body. These frequent changes lowers temperature and does not disturb the child. The results are often excellent. The heat falls, frequency of pulse and breathing are obtained and many of the worst nervous symptoms subside.

This local treatment should be resorted to as often as the high temperature and other symptoms require it. It is wise to remember that children sick with pneumonia need little medicine, certainly none of the coal-tar preparations to lower temperature; few children escape the evil effects of such treatment.

The main point is to fill the skin and deplete the thoracic organs (lungs), stimulate the mechanism that works the heart so as to strengthen and slow the cardiac systoles and lengthen the diastoles. These two points are obtained by nux vomica and ipecac, both of which are safe heart tonics. I know that ipecac in small doses makes the lung tissues anemic by constricting the arterioles and bolstering the capillaries. Nux vomica is a fine nerve

When the skin is caused to be filled and the heart toned, as with nux vomica and ipecac, the evils complained of are removed.

Collinsonia is a heart tonic and a restorative to the pulmonary tissues. I often administer tinctures of collinsonia and ipecac to pneumonic cases of the catarrhal kind when there is great congestion of the lung tissues. Tincture of lobelia, herb and seed mixed together, with tincture myrica cerifera or bayberry, bark of the root (canker root of the noted Thomsonian school of medicine) is a remedy of standard value in low forms of pneumonia.

I have repeatedly administered this remedy in low scarlet fever, typhoid fever, pneumonia and similar asthenic diseases with uniform success, especially in cases deemed unpromising in the extreme. Lobelia, bayberry root and capsicum combined, made into an infusion, constitute a stimulant to the whole organism, which, so far as I know, is unequalled in the materia medica. The compound is a powerful stimulant and restorative, to be used with caution and understanding, which will yield in nearly every case the desired benefit, or, if unwisely used, will do unspeakable harm. In nearly all cases of confluent small-pox that have taken on the typhoid type, as well as the asthenic cases of catarrhal pneumonia that are of low grade and forbidding in nature, we need a stimulant that exalts the sympathetic centers and aids the vital powers to tide the organism through trying ordeals of these destroying diseases to a safe harbor.

Saturated tincture of nux vomica, 1-20 drop, and saturated tincture of belladonna, 1-20 drop, are stimulant to the circulatory and respiratory centers, the intervals of repetition varying from 30 to 60 minutes, according to age of child and deep severity of symptoms. There is need to closely watch the effect of these medicaments. Their operation on the nervous system is stimulant. I have seen the frequency of the pulse fall and the strength of each grow to more normal vigor under the action of these medicaments.

In many cases of the catarrhal kind I administer tincture of ipecac, tincture of nux vomica, each 1-20 drop, every hour with satisfactory results. In small doses ipecac is a good remedy in pneumonia.

Veratrum viride is a standard remedy in croupous pneumonia when the pulse is very quick and hard. The dose must be small, from 1-10 to 1-4 drop of a saturated tincture of the green root, repeated every 20 to 30 minutes until the frequency of pulse is reduced to 100. I never bring the pulse much below 100 in pneumonia, owing to the danger of collapse that may follow. Veratrum viride and ipecac assist each other, the size of doses vary with age. I have maintained the pulse at 100 for 24 hours, with 1-6 drop of veratrum viride, that had been 140; nor was force much diminished, which speaks much in the favor of veratrum viride.

harm, and probably much good, to restudy some of its phases and, by so doing, possibly we may be able to add something by way of treatment.

There are three types of it: Ist, catarrhal; 2d, ulcerative; 3d, phlegmonous. In the first the inflammation is merely superficial and limited to the mucous membrane, and eventuates where the second type begins; that is, in superficial ulceration or ulcerative tonsillitis. Or, the inflammatory action may extend to the submucous tissues and the whole gland, with peritonsular connective tissue, be the subject of infiltration, and then we would have the phlegmonous type.

It it whispered somewhere that there is an intimate sympathetic relation between the testes and ovaries and the tonsilstonsillitis occurring frequently in the newly married. Probably there is not so

much sympathy in the matter, but it might be accounted for upon the theory of the old darkey mother, who exclaimed: "Sarah Jane! Come in yer of' dat ar'

fence. Yo' j'st newly married and yo' pores all open; yo' kitch yo' death ob dampness."

Be this as it may, the main question before us is to find a remedy for our patients who are suffering with this

trouble.

The bowels are usually costive. This must be attended to, of course, and the condition may be met by small and frequently repeated doses of calomel, which, by the way, has a specific influence over the acute grandular affections of the throat and neck.

In some forms of this disease we have much pain to deal with, and we should be able to meet the symptoms in the best manner possible. We are perfectly delighted with a little tablet of—

B. Morphine.. Atropine.. Caffeine cit....

.gr. 1-8

gr. 1-600 .gr. 1-6 One given every four to six hours will relieve pain, check excessive secretion and throttle the inflammatory process.

If the tonsils be bathed in a 10 per cent. solution of carbolic acid and glycerin, it will have a pleasant [anesthetic and antiseptic effect.

The brilliant success of calcium sulphide is especially noteworthy. It will frequently abort the disease when given in 4 grain doses every hour until saturation. Salol will relieve pain. It must be given In 10 to 15 grain doses and repeated four to six times a day.

The following gargle acts gratefully in

Next we took a few of the morphine and atropine tablets, and to-day, the third since the treatment began, we are free from pain and the swelling of the glands has subsided. We are well, and convinced that if our treatment had not been thus active and specific we would have had to have suffered many days of extreme wretchedness with a tonsillar abscess. Mosheim, Tenn.

DOES URIC ACID IN THE BLOOD PRODUCE ECZEMA OR OTHER SKIN DISEASES ?

O

BY W. H. BENTLEY, M. D.

N September 1, 1897, I began to treat a lady 49 years old for a case of eczema that had proved unmanageable to various physicians-six or seven. She said she had first noticed the disease on her feet and ankles soon after passing her climacteric, several years ago. The disease did not annoy her much during the first year after its appearance, but then it spread superiorly to the legs and thighs, and became intensely annoying.

She then consulted a physician. He failed to give her any relief whatever, and she procured the services of another doctor, and soon another, and still another, and so on, still finding but little, if any relief. In fact her last physician, though he made huge pretensions, was the most unsuccessful of them all, for under his treatment the disease rapidly spread to the neck, ears and the scalp. It was worse on the left side; that side of the neck, the left ear and the left side of the scalp, as far as the median line, was covered with a solid crust, which, on being disturbed, gave ready exit to a thick, yellow, offensive pus. The left ear constantly discharged this pus. Patient's suffering was keen and intense.

I do not propose to detail this portion of my treatment. It is sufficient to say that from the first she improved.

By October ist the eruption had almost disappeared, and she suffered little inconvenience from it. On October 8th she got thoroughly wetted in a rain and rode several miles on horseback in her wet garments. That night she had a chill, followed about daybreak by a severe at

was called in and saw her October 9th at 9 o'clock a. m. She had a very high temperature, rapid pulse, ankles, knees, wrists and elbows greatly swollen. She was delirious most of the time, besides she was covered with a fresh eruption that looked quite angry, and which subsequently proved to be a return of the eczema. Urine very acid; bowels constipated.

I took measures to open the bowels, and put her on Alkalithia. This is an effervescing alkaline mixture of potash, soda, lithia and caffeine, prepared by Keasbey & Mattison, Ambler, Pa. She had a dose of this every three hours, and for the relief of pain, to more rapidly subdue fever and to procure sleep, she had ammonol salicylate. I left some litmus paper with instructions.

On October 11th I saw her at noon. Her condition was much improved; no delirium, very little fever, swelling greatly abated, and no pain, except when she moved; eruption much faded, but itching greatly. Continued treatment.

I saw this patient again October 15th. Swelling and pain entirely gone; some eruption, which had become scaly and at night itched terribly. Left a fresh bottle of Alkalithia, and ordered it continued in such manner as to maintain a slight alkalinity of urine. After an interval of 15 days the husband reported the patient to be entirely well, eruption and all. She has so remained ever since.

On January 3, 1898, I was passing the house of a man, 78 years old, who had been the victim of what was called chronic rheumatism for 10 or 11 years. He had been treated by several physicians and had used bushels of nostrums and patent medicines, among them 10 bottles of Hood's (much bragged on) Sarsaparilla. This was the last, and under its use he had grown much worse.

At this time his ankles, knees, wrists and elbows were much swollen, stiff and very painful. His liver appeared to be swollen and was very tender; bowels costive; urine scant, high-colored and very acid; in addition, he was literally covered with eczema. I gave him a quantity of the Waugh-Abbott intestinal antiseptic

tablets and directed him to take one every hour through the remainder of the day. At bedtime he was to take 10 grains of blue pill, followed the next morning with teaspoonful doses of Epsom salts every two hours until his bowels were thoroughly cleaned. Then he was to resume the tablets, taking one just before and one soon after each meal, and five grains of blue pill every alternate night until my return, which was on the fourth day thereafter.

When I returned I ordered the tablets and blue pill continued for a week longer, and in addition he was directed to take a dose of Alkalithia every three hours until my return, which was eight days after. I think my next return to this patient was January 14th, when I found the old man free from pain, with a first rate appetite and in gleeful spirits.

The enlargement and tenderness of his liver had vanished, all swellings had disappeared and all his joints were freely and painlessly movable. His urine was free, normal in color and slightly alkaline. His bowels were regular, and the alvine discharges nearly inodorous. Thanks to the good work of the W.-A. intestinal antiseptic tablets. These tablets are prepared of the sulpho-carbolates of potash, soda and zinc, by the Abbott Alkaloidal Co., of Chicago, and constitue the best internal antiseptic with which I am acquainted; and then they are SO convenient that one is surely to have them along if he is acquainted with their utility.

But to return to my subject. I discontinued the blue pill; the tablets were to be so used as to maintain the present inodorous alvine evacuations; the Alkalithia so as to maintain the present state of the urine, which his intelligent use of the litmus paper I had left on my second visit would determine. His eczema, which had nearly disappeared, was not troubling him. Then, all I had to do, and which I did do, was to leave him a fresh and liberal supply of the tablets and Alkalithia.

I did not see him again until during the ensuing April. He was then entirely well in all respects, and said he had been since about the first of February. In reply to a

question respecting his skin disease, he said it had gradually disappeared and he hardly knew how or when.

I have reported these two cases, not with any desire to exploit my supposed skill in their treatment, but to call attention to the simultaneous cure of the eczema in each patient with that of the rheumatism. I confess that I had not expected such a result, and was greatly surprised when the first case terminated as it did, and I was still more surprised at the favorable termination of the second.

I have often ascribed eczema and other forms of skin diseases to indigestion. I did not think all cases depended on indigestion, however. Now, we find some cases of indigestion, especially those cases called nervous indigestion, ascribed to uricacidæmia. Thinking of all this, and remembering that Dr. Bless, of Chicago, ascribes hay fever to the presence of uric acid in the blood, I was about to adopt the theory that uric acid in the blood had caused the eczema as well as the rheumatism in the above cases. Luckily, about this time I fell in with a pamphlet by Dr. A. B. Conklin, of Philadelphia, entitled "Lithemic Affections of the Skin and Mucous Membranes," which I think sets the matter at rest.

Woodstock, Ky.

[It gives us pleasure to state that the author of the above article, Dr. Bentley, has contributed to the SUMMARY pages, more or less, for the past 20 years. His first article appeared in our second issue, April, 1879,-ED.]

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