ani or pruritus vulvæ. When the doctor gets at all the conditions in equation, the value of X is easily found. Nothing perplexes like perplexity, and perplexity spawns and flourishes in wilful confusion of the mind.

There is the hysterical cough, and the hysterical receive valerian, musk and assafetida and have no cough.

Aside from their etiological and prognostical significance, coughs are important.

If the worry of the patient, the worry of friends and the worry of the doctor could be put in the balance, it would outweigh a multitude of some other evils against which it is the custom to inveigh. Cough is very significant by its brassy cavernous intonation; it smites the heart of affection and robs sleep. But all cough is salutary-it punishes, distresses and perplexes, yet conserves, if only its admonitions are heeded.

or

Often it is the first danger signal hung out; often the last sad reproach to failure of our efforts.

Very often it is the first to direct attention to a fact, for the first time known to us, that something is coming somewhere in the economy-the only intimation to date that diseased action exists.

It diagnoses and differentiates bronchitis, laryngitis, phthisis, croup, reflex explosion.

The character of a cough sheds light on the location, stage and nature of lesion. The cough of habit is acquired unconsciously and consciously retained. A real lesion is at the bottom of it which

Polypharmacy has devoted a long career, extending over centuries, to claims of the respiratory tract. And it may be said that the said tract is very little better off on account of what polypharmacy has tried to do.

The polypharmical cough mixture of the past was often an abortion of crude art, alike unsatisfactory to giver and taker. In the modern laboratory polypharmicals have been greatly improved, but of course retain their shot-gun and saccharine features.

The tablet brought a desirable change. Though it contain a multitude of ingredients, these ingredients are more accurately apportioned and the whole is vastly more palatable.

Every doctor has one or many formulas for cough mixtures, one or two which becomes in practice a routine remedy for coughs of all description, and may be given for all diseases, to all classes of people and to all ages. This is certainly wrong.

This is shot-gun prescribing in a manyfold sense. Avoid it.

A safe rule is to treat the patient primarily, cough secondarily. The fountain being impure, cleansing the stream therefrom will not go for much. Begin at the fountain, cleanse that, and the stream below will become pure.

In all cases look to the props, the pillars that support; repair the vital engines, put fuel in furnace, water in boiler and oil wherever needed.

THE "SUMMARY" ENLARGEMENT.

This number of the SUMMARY is enlarged to the extent of four full pages over its

continuance of habit.

Restrictively, cough is a clue to some lesion in the respiratory tract; the great tree of life is injured in some part of the trunk, branches or leaves. To cough of this origin therapeutics are devoted.

provements in other directions was a necessity with us, the growing popularity of the SUMMARY on the one hand and the determination on our own part to make it in every way worthy of the increasing favor and patronage extended to it justifying the step.

Brief and practical articles, SHORT and PITHY reports of interesting cases in practice, new methods and new remedies as applicable in the treatment of diseases, are solicited from the profession for this department.

Articles intended for the SUMMARY must be contributed to it exclusively. The editor is not responsible for the views of contributors.

Write only on ONE SIDE of the paper.

PURPURA A PROBABLE CAUSE OF HEMOPTYSIS.

I

BY J. F. PURVIANCE, M. D.

AM not in the habit of reporting cases for publication, believing that the experience of one physician is largely that of another in his daily observation of disease. Within the last few days, however, I have had charge of a case that I believe to be entitled to notice, as one revealing some facts of importance that are not commonly observed.

The patient, a young lady of 17 years, was seized with hemoptysis, for which I was hastily called to treat her. On my arrival the hemorrhage had ceased, after about a pint of blood had been expectorated. In my investigation I learned that she had been in her usual health up to the moment of the attack. She had never had a trouble of the kind before. She was having no cough, except such as had been produced by the accumulation of the blood during the hemorrhage. I found no febrile action and no evidence of any congestive, inflammatory or tuberculous condition of the lungs. The catamenia had been entirely normal, except a little profuse. A very remote tuberculous history was traced in the family, but no symptoms of it had ever existed with the patient. From these facts I was unable to form any well settled conclusion as to the cause of the trouble. I prescribed: B. Galic acid....

Ergotin.. Hydrastin

.gr. iij

.gr. j .gr. ss

Gave the above every four hours, alternated with morphine sulphate. Ordered the shoulders kept well raised in the bed and the patient to be kept quiet.

In a few hours I was called back on account of the second of two other attacks of hemorrhage that had occurred since

acet., alternated with the previous mix

ture.

On this treatment the hemorrhages were much less in amount, but still occurred once or twice in the 24 hours.

During the third day of this experience she was suddenly attacked with severe pain in the head, followed by delirium and spasmodic action of the extremities. On account of these symptoms I was called in the night and found her semiconscious, hands clinched and very restless, with pain now extending to the back. A liberal use of bromides and morphine relieved her of these symptoms, and by morning we resumed our treatment for the original trouble.

About this time the mother made mention to me of a condition that would develop on the arm of the patient for sometime past after more than ordinary use was made of it. This was described as a few red spots that would first appear and then increase in size until in the course of a day the upper arm would be well covered, when it would become purple and gradually pass off.

This explanation revealed to me the probable existence of purpura simplex that was sustaining a causative relation to the conditions existing with the patient. She was placed immediately on muriated tincture of iron and fluid extract ergot every three hours, with opium when needful to secure quiet.

After this there were two hemorrhages, at periods of two or three days apart consisting of about a pint each. Treatment was continued, with doses two to four hours apart, up to the present. Patient now out of bed, eating well and recovering strength very satisfactory, with no further symptoms of hemorrhage.

The points worthy of note in this arefirst, that we have a severe hemorrhage from this variety of purpura; secondly, that these mucous hemorrhages in cases of purpura hemorrhagica are always to be expected from the nose, bowels or kidneys.

I have never met with a case of hemoptysis before that I recognized as from purpura, and have no knowledge of ever seeing one reported.

With this experience, however, I shall always seek for a history of purpura in cases of pulmonary hemorrhage where a tubercular diathesis is not manifest. It is possible that evidences of tuberculosis may yet arise in this case that would claim our recognition as the cause of this trouble, but the history of the case up to the time of the attack and the results of her treatment both unite in justifying the belief that this hemorrhagic state owes its existence to purpura, which also is responsible for the neurotic symptoms that doubtless existed in connection with a neurasthenia from impoverished fluids. Steubenville, Ohio.

LEONTODIN.

BY W. C. BUCKLEY, M. D.

ARAXACUM, dandelion, from which this active principle is derived, has diaphoretic, aperient, tonic, laxative, nervine, antispasmodic, expectorant and alterative properties. In old times the preparations employed were the expressed juice, the extract, the decoction, the infusion, etc., and were widely used in chronic affections of the abdominal viscera. In hepatic and renal disorders it was highly praised for its effective work, but, like many other good remedies, has passed into a state of neglect.

The fluid extract of taraxacum is officinal and in use to-day, but not very extensively used. An active principle, taraxacine, has been isolated from this plant, but it is not much employed. The concentration, leontodin, the principal subject of this paper, has a considerable number of admirers, and it is probable that others would adopt its use if they were acquainted with its properties and its advantages, which are several. First, it may be given in the trituration form, or in the form of a tablet triturate, or in the form of the dosimetric granule, any one of which may be reduced to a liquid by dissolving or mixing with water or simple elixir. The dose of each of these preparations is small, aud especially for frequent repetition they are quite handy and acceptable as well as efficient.

DIURETIC. Although at the present

day the dandelion and its derivatives have a limited employment, yet it is a remedy of great usefulness when a good preparation is had. Leontodin is serviceable as a diuretic in nephritic complaints when the vis medicatrix naturæ is encroached upon by morbid excitement and is consequently in need of a helper. Especially is this the fact when the disorder is partly the result of obstruction to the function of the liver.

Leontodin is susceptible, therefore, of a much more extensive practicable application than it has met with in later years.

If this article should be of insufficient diuretic power at any particular time, the apocynin or the petroselinum infusion, or any other selected diuretic, may be added to it in the proper dosage; the former when dropsy complicates the condition, and the latter when gravelly conditions are present.

DIAPHORETIC.-Leontodin promotes the secretion of the skin, and through its power over the sympathetic system influences most other organs and tissues of the animal economy, relieving congestion by equalizing circulation; applicable, therefore, to many forms of febrile conditions, rendering unnecessary, in many cases, the use of the doubtful anilids, too much in vogue in mild febrile states.

As an auxillary in febrile irritations the asclepidin or asclepin may be very usefully employed, especially when the serous tissues or the mucous membrane are involved, as in pleurisy, pneumonia, bronchitis, rheumatism, colic, dysentery, etc. As chronic cases of liver and kidney disease are sometimes attacked by the epidemic influenza of the present day, producing severe pains in the back, head and extremities, together with a muscular "soreness," eupatorin (perfo.) may be added to the other articles in doses of one granule every two hours; so also may be added a granule of macrotin to meet the backache and the headache so much complained of in these cases.

APERIENT.-Moderately purgative to the bowels, leontodin is one of the best remedies we can employ with the expectation of removing constipation in cases of liver disease where biliary obstruction exists. To increase its effects on the

liver and bowels, one granule each of sanguinarin and colocynthin may be added to each dose of the leontodin and all repeated once in every three or four hours till effect. This combination of granules is also useful in dysentery of the chronic nature, rheumatism, catarrhal jaundice, and as a purgative in female obstructions.

EXPECTORANT.-Pulmonary diseases of a chronic nature have been treated very successfully with the leontodin. It has been praised even in the treatment of phthisis, partly on account of its beneficial action on the stomach, liver and intestines. The late Prof. Wood employed the preparations of dandelion with confidence; so also did the late Prof. Biddle. In asthma and catarrhal coughs let those judge of its value who persevere in its

use.

TONIC.-Leontodin, having in its composition the bitter principles of the plant, is a very valuable strengthening remedy in all cases of simple debility, especially such as are connected with much nervous irritability, but the dose must be small, say one or two granules three or four times a day, and continued for a long time.

Associated with sherry wine, glycerin and phosphoric acid it is good in the form of an elixir. Gray's tonic is a good one and contains this principle, it is said.

In no one point is leontodin more valuable than in the usual cases of nervous dyspepsia, or in the dyspepsia of the phthisical patient, either singly or combined. I would ask a trial of it. Given combined with cypripedin or with monotropin it is an excellent stimulant tonic to the nervous system; to be used in neurasthenia, hysteria, etc.

ALTERATIVE.-On the biliary organs its effects are slow but sure, therefore a long continuance of the remedy is necessary, and just here, no doubt, has been the stumbling block with some physicians -small doses, continued a long time, should be given. In disorders of the liver and kidneys and their treatment by this method a volume could be written, but I have already exceeded the limits intended in this article. I will add, however, in conclusion, that the leontodin is much

more adapted to the chronic than the acute forms of disease. Generally the remedy should be given at first till a decided effect on some one of the eliminative organs is had. It is good to follow it by daily doses of a good saline laxative and plenty of pure water.

723 Berks St., Philadelphia.

SCLEROSIS OF THE LIVER WITH ACHOLIA.

BY C. H. SCOVILLE, M. D.

HIS is, I believe, my fifth year of fellowship with the SUMMARY, and during this time have gleaned many a good thing. I am a subscriber to more expensive medical journals, but the SUMMARY "takes the cake."

I would like to report the following case with line of treatment, and hope it will call for either criticism or advice, or both. It may be unnecessary to say that the following is my first attempt at reporting:

Mrs. X, 56 years of age; school teacher; married seven years; no children; weight 250 pounds. I saw her perhaps a dozen times in 1896 and 1897, and each time she complained of constipation, frontal headache, distress in stomach after eating and a heavy, uneasy sensation in right side. These symptoms promptly disappeared each time by the use of digestive ferments and laxatives.

I saw her a number of times in January and February, 1898, and she complained of pain in back under left scapula, and much distress in stomach immediately after eating; bowels very constipated, urine scanty and high colored, conjunctiva somewhat yellow, and skin showed a suspicion of cancerous cachexia. She was easily fatigued and had pain in region of spleen, requiring opiates; very tender over the stomach and liver.

Treatment was simple, consisting of Brown's Chlorodyne and gastro-hepatic stimulants, diuretics and digestive ferments, under which she improved greatly. On Oct. 24, she called at my office, a distance of eight miles from her home. She seemed distressingly weak, headache, nausea, skin cold, pulse rapid, small and feeble, and many sores on all parts of body which itched intolerably. They be

gan in small pin-point papules, and rapidly increased in size until they were about the size of a dime, conical in shape, like rupia, surrounding skin for three to five lines of a deep purple hue; no induration; bowels entirely without movement, with slight gaseous distention.

On November 6th I was called to her home. She complained of pain in stomach. Bowels had responded to laxatives given since the office call on October 24th, but the stools were light colored and pasty; urine very scanty and high colored.

I saw her again November 9th. The pain in stomach continued; bowels constipated, skin cold, moist and intensely yellow; pulse small and weak, dull, sickening headache; conjunctiva yellow, spleen large and tender, liver, extending two finger breadths below the ribs, very hard; extreme tenderness over stomach; temperature sub-normal, pain in back, urine loaded with bile.

I saw the patient daily until November 26th, during which time the treatment consisted of strychnine sulphate, 1-60 gr. daily in a glass of water and a teaspoonful given every hour; podophyllin, 1-8 gr. every four hours, alternated with hydrarg., protiodide, 1-50 gr. This

was alternated every second day with phosphate of soda in drachm doses every six hours. The bowels would move occasionally, but no change from the pasty white color.

Diet consisted of grapes, oranges (sweet), beef tea, chicken broth and a little bread. Pulse would vary from 60 to 120, sometimes full and strong, then again almost imperceptable; temperature 97 to 101; spots of ecchymosis appeared on several parts of the body; tongue heavily coated a dirty white.

On Nov. 26th I left her with the strychnine and a small bottle of cascara sagrada, of which she was ordered to take 20 drops in water after meals. The next visit, December 1, 1898, patient had a number of stools which were gradually getting of a darker color; tongue cleaning, no headache, good appetite. Continued the cascara, but in smaller doses.

Saw her on December 4, 7, 13 and 23. Continued improvement; the sores disap

pearing, conjunctiva quite normal, the skin nearly so. I then ordered succus alterans with kali iodid., one grain to one drachm t. i. d.

I saw her again January 23d, 1898. Continued improvement. Where the sores were are the raw ham-colored spots; liver quite large and hard, spleen enlarged, bowels regular, natural color; urine normal, pulse rather weak; patient around the house doing light work, but easily fatigued; good appetite, and very much of a surprise to myself.

My diagnosis on Nov. 9, 1898, was sclerosis of the liver with acholia, which all text-books put down as fatal. Was I right?

You will notice that I gave no morphine except the small amount in the chlorodyne, as somewhere in the SUMMARY I read, "If you want to kill your patients suffering with congested liver give them morphine."

New Canaan, Conn.

PNEUMONIA.-INDICATED REMEDY, ETC.

A

BY C. C. EDSON, M. D.

FEW evenings since, while listening to the words of a profound and well read scholar, I was forcibly struck with this remark, "Diseases are very capricious, they so differ in different individuals that no two cases of the same disease can be treated with the same remedies. What will cure one will kill another."

Returning to my study that evening my thoughts fell into a sort of reverie somewhat as follows: The practice of medicine is not Empiricism; it is a profound, but, nevertheless, rational science, and he who practices it empirically falls far short of his calling, and should return again and again, if need be, to his alma mater and learn the true science of his art.

The science of medicine rests not in the diagnosing of the disease, but in reading the "indications" for the remedies. I care not what you call the disease, give me the indications as pointing to the remedies-symptoms if you please-and I will treat the case far more intelligently