that should be better done-and that we need to brace ourselves for the effortresolve anew to make the record of the new year better than the old?

Perhaps we can propose some suggestions that it would be well to follow during 1898. We will venture the following:

Look more carefully after the hygienic conditions and surroundings of your patient; ventilation, cleanliness, water, diet, rest, mental condition, etc.

Rely less on medicines, but when you do medicate, have a definite purpose in view, and don't stop until that is accomplished. Definite effects can best be achieved by single remedies, as a rule. As to self cultivation we will reiterate what we recently said about systematic reading. Avoid Avoid desultory desultory reading. reading. Choose a subject and master it to the extent of your facilities, then take up another, etc.

Train your patients to disturb you at night as little as possible. Systematize your daily work as much as possible, and don't forget that you are a citizen of a great Republic, and the greater the Republic becomes, the greater the duties of

the citizen become.

Winter Suggestions.

DURING this portion of the year your attention is called chiefly to the region above the diaphragm. What is your experience with chest protectors "-a piece of chamois skin lined with flannel worn on the front of the chest, or a piece both front and back, or a jacket of the same material encircling the chest? While such protection may be of value in ce:tain cases during bleak and changeable weather, particularly after an acute illness, the best "protector" is sufficient vitality to resist cold and maintain the equilibrium of health. For "weak chest," the following has been recommended: Wash the chest with cold water every morning, and follow with brisk rubbing. When reaction is prompt and complete, good results may be expected.

Reaction is the test.

TROUBLESOME throats are a bane to the profession as well as to the sufferers. How can they best be kept in a condition of health during the winter season? The above principle may to some extent be

applied here also, with suitable gargles at suitable times added. The care of the feet is also of great importance in this connection. That they should be kept warm and dry "goes without saying." Dressing of the feet will not be discussed here. A good toasting before a hot fire before retiring is recommended. A good rubbing until they are aglow is better; not surface rubbing, but thoro massaging. This persisted in will change habitual cold feet to warm and comfortable feet, with a corresponding improvement in a troublesome throat.

this winter, consider the growing literaIN approaching your pneumonia cases disease. If you begin the application of ture in favor of cold applications in this cold, carry it thru systematically, and with the definite purpose of the effect on the temperature. Don't "blow hot and cold." Do either the one or the other. With the cold treatment there is no place for the poultices, jackets, etc., that have perhaps occupied too large a place in the treatment of pneumonia.

In bronchitis the temperature does not warmth to the chest is important; this go so high as in pneumonia. Here is particularly true in children. An extremely threatening case of capillary bronchitis in a child may be relieved of its threatening features by the timely and skillful application of heat to the thorax. Poultices have been commonly used, but a jacket of cotton batting or carded wool, covered with oiled silk, is much better, as it is not "mussy," and does not need changing. The practitioner that omits this in such cases omits the most important thing.

CONSIDER for a moment the average treatment of an average case, say of pneumonia. A little of this, that and the other is used. Details are important, but let your management and treatment be as simple and direct as possible. Use few drugs, and use these few for definite purposes, and continue them until you get the definite results sought. That is, quit shooting with a shot gun and learn to use a rifle. Medical progress always pursues this path. Our ablest physicians use few remedies, and use them rationally and efficiently. All remedies are not drugs to be taken into the stomach.

Other things frequently have much more to do with the welfare of the patient. Too much dependence upon medicines leads to neglect of other measures. キ

IN less than two weeks after the appearance of the December WORLD, plans were made and a meeting called in a certain part of Texas, to form such an association as is described by Dr. Aspinwall in December WORLD, page 513. This, perhaps, is only one of many, and it shows the practical value of the efforts we are making to serve the real needs of the profession in all parts of the country. Yes, THE WORLD is different from all other medical magazines. It is not content to amuse its readers or to give them long unpractical articles and society reports, but it seeks to serve their actual needs.

on

Please do not send any more notes typhoid fever. We have finished that subject for this year, but still the articles come in. We have just spent a number of hours among our exchanges, trying to find something worth clipping on pneumonia and other winter diseases, but most of them are still discussing summer diseases of children and other subjects without regard to season. True, typhoid exists to some extent during all the year, but it is most prevalent during the autumn, and that is the time to discuss it. If you have any thing to say about pneumonia and other winter diseases, now is the time to say it. Don't wait till February or March in which case your article could not appear till April or May issue, which means that it would not appear at all, for then it will be time for other subjects. Such articles might be carried over till next year, but it would have to be a very valuable article to receive such attention. You see, we are trying to make THE Medical World different from all other medical magazines. One of these differences is that special attention be given to diseases of the season. Just like this: if several of your medical friends were to happen in at your office to spend an evening, what would you talk about? Naturally, about what you were doing. You would all have on hand patients suffering with the

prevailing diseases of the season, and these would be the topics of your conversation. Let it be so in THE WORLD. True, there are many troubles that occur at any and all times; these may be discussed at any time. But what you have to say about diseases of the chest, please say immediately, for our February issue. Not much has been said about pluerisy. Please give your treatment. Also, be preparing what you may have to say about rheumatism and neuralgias.

BY W. C. COOPER, M. D.

It is characteristic of the broad physician to deplore the existence of medical sectarianism. I am convinced that this is because he is more generous than philosophic. A deeper analysis of the question would, I am sure, modify his feeling in the matter. The self-sufficiency and staticism of orthodoxy has passed into proverbialism. But, altho always wrong with reference to progressive possibility, orthodoxy is always right in its relation to necessary institutionalism. But how shall a thing be at once right and wrong? It can be so only in an immediate sense. In the ultimate sense it is wholly right, as constituting a passive factor in the scheme of evolution. In its conservatism of homogenity it furnishes something for heretics to kick away from, and heresy is the active factor in the evolutionary process. The subject is rich in argumentative possibility, but I have not space for its further consideration here.

Dr. Taylor, having with rare philosophy accepted the situation as it is, and having recognized the fact that it takes all the doctors to know all that is medically known, and having made it the policy of his journal to open all the avenues of chirurgic knowledge to his readers, wisely permits, with limitations, the representatives of "irregular" medicine to contribute toward the edification and entertainment of his readers. Responsively to his kind invitation to do so, I shall, in my weak way, attempt to briefly

discuss the important subject of pneumonia.

The subject is such a large one that I cannot more than touch upon its more salient features in one short article. For an excellent reason I shall not tell you whether the proximate is also the ultimate cause of pneumonia. Luckily, such knowledge is far from indispensable, since it would not convey to us the slightest (original) therapeutic hint. Furthermore, aside from its prognostic value, it makes little practical difference which lobe is affected, or whether the case is one of lobar or lobular pneumonia. We know there is inflammation of lung tissue, and I should think that is sufficient. In my opinion, too much time is stolen from the study of drug action, to be bestowed upon diagnostic refinements. For instance, what clinical difference can it make if we mistake an endo- for a pericarditis? Since the best diagnostician is not necessarily the best clinician, and since he necessarily should be so, if diagnostics is as important as therapy, it follows that the ratio of study between them should be modified favorably to the latter.

I am constrained to believe my experience with pneumonia has been unique. I am almost afraid to tell why, unless it be conceded that luck is a reality. A confession of the truth, in this instance, actually makes me feel sheepish, for who will accept the statement doubtlessly when I say that I have my first case of pneumonia to lose, having practiced steadily for thirty-two years? Throw your magazine down in disgust, if you will-I could not blame you-but what is an over-lucky poor devil to do? Whether my success has depended wholly upon an outre expression of fortuity, or partly upon this and partly upon my method of treatment, I cannot say, of course. One thing I am certain of, and that is, that I have never prevented a recovery, whatever the disease, by over-treatment. Early in my medical experience I became convinced that more people have been (not are) killed than cured by doctors. To dissent from this is hardly to be a trilobite, but it implies a preterism that is at least peculiar.

I accept it as an ultimate fact that,

without exception, what will make a well man sick will make a sick man sicker. This results from the fact that, whether one gets sick or sicker depends upon his quantity of vital rebound. Thirty grains of quinine will cinchonize a well man. To that extent he has been made sick. If as completely assimilated it will cinchonize the sick man as much more than it did the well man, as his vital resistance is less than that of the well man. We are justified in giving it to the sick man, because, while it adds an evanescent toxic element, equal to 5, to his system, it subtracts a more permanent toxic element, equal to 50, from his system. Every time we exhibit the wrong drug, therefore, we are committing a degree of murder which may range from the tenth to the first, according as we give it in small or great quantities. Remembering that we have but about a dozen of therapeutic certitudes, is not the over-confident doctor's opportunity of doing mischief tolerably enor mous? From all the foregoing you will rightly infer that I am a cautious medicator..

It

When I am called to a case of sthenic pneumonia I do not think of depletion. He is already depleted. He is already depleted. To the extent that one is below par he is depleted, and this is the consequence of some depleting element at work within his system. makes for total exhaustion and death. Shall I add another such element? No form of disease being consequent upon vital excess, and none but causal treatmen being rational, is general antiphlogistic treatment ever justifiable? YŜince most local manifestations are but effects, is it rational to treat them, except for psychological reasons? Certainly it is not medically wise to do so, aside from moral considerations, unless we have a sane reason to believe that thru an occult somehow it possesses a causal reach. Naturally incident to this train of thought is the consideration of the use of anodynes. Until therapeutics become more definite and reliable, I believe the guarded employment of analgesics to be philosophically legitimate. If we could actually know that, in a given case, the administration of an anodyne would suspend or abolish the action of a drug which was effecting a

cure, then its exhibition would be crim inal. But since, as the medical world goes, it would be a positive benefit to the patient to have the guessed-at drug silenced, I cannot oppose the use of anodynes, provided that, in each instance, the lethal drug is chosen as the lesser of two evils.

From all the foregoing, it will be concluded that my treatment is mainly negative. This is true, unless the avoidance of injurious or doubtful remedies is positive, and not negative. It will have It will have been inferred (and correctly) that I take precious little stock in antipyretics. If there is any disease in which fever is the fundamental expression, it would be philosophic, in such cases, to exhibit antipyretics, provided these did not produce their specific effect thru cardiac depression. This rules out that calamitous gang, the coal tar derivatives. Unless it is within the power of a physician to turn cause and effect end for end, he is wasting the patient's life when he shoves his therapeutic pry under the wrong end of the malady in hand.

If I were limited to the use of one drug in the treatment of sthenic pneumonia, that drug would have to be veratrum viride. I do not give it in doses that would produce a direct antipyretic effect, but for its specific effect upon the primary lesion, whatever and wherever that is. I have not space in which to tell you all about the experimentation which has confirmed my faith in veratrum in active pneumonia. I nearly always combine with it bryonia alba. I fill an ordinary glass two-thirds full of water, and add veratrum (Lloyd's specific veratrum), 5 or 6 drops, bryonia, same make, 2 or 3 drops. Of this, the dose is a teaspoonful every half hour in bad cases; every hour, in milder cases. I name the make, because Lloyd's specific medicines are about four or five times as strong as ordinary tinctures. They are perfectly uniform in quality, which is not at all the case with many makes. Norwood's veratrum is always good, and there are several other reliable makes. The homoeopathic mother tinctures are reliable, but are only one-fourth as strong as Lloyd's. Be sure that your drugs are trustworthy. The veratrum and bryonia constitute the central idea, about

which may play, if needed, several other remedies, according to special indications. Frequent spongings, if the fever runs high, are very grateful and helpful. This bathing is causal treatment, in the (negative) sense that the removal of obstructions is reciprocal to the effort that is hindered. To bathe in fever is not to treat an effect. The temperature of the room should be kept as nearly even as possible-not unusually warm nor unusually cool. That temperature which is most agreeable to the patient is the best. No need of moistening the air unless the room is heated by a closed stove. An open fire is the thing.

Asthenic pneumonia is to be treated the same, except that aconite, in minute doses, is substituted for veratrum. Don't kill your patient off with "tonics." Did you ever reflect real deeply about this "tonic" business? You know, Doctor, there is no tonic under heaven but good air and a good digestion. All the strength we get is from the food ingested and air breathed. Unless medicine is a food (and if it is a food there is no medicine), no medicine can be a tonic. Why, Doctor, if there were such a thing as a true medicinal tonic, what would there be, excepting accidents, to prevent one from obtaining unlimited vitality and living forever? A remedy which will promote digestion, such as nux, etc., may be indicated in the course of a spell of sickness, but iron, quinine, cod-liver oil, etc., never. oil, etc., never. It is hypothetically conceivable that emergencies are possible which call for stimulation. I am sure, however, that stimulants are used too often and too freely.

It did not take long for me to get disgusted with the use of such abominations as mush jackets, flaxseed poultices, etc., in pneumonia. They only render the patient super-susceptible to chill with its consequences. There is some philko-S phy in the ideas of counter-irritation and dermic absorption. I am sure that a greased rag, well sprinkled with the comp. powder of lobelia and capsicum, and applied to the chest does good. It should be renewed every twelve hours. Pleural complications, or the involvement of both lungs, require no special change of treatment. It is all inflammation of lung, or lungs, or their invest

ments. I have not differentiated treatment with reference to catarrhal and croupal types. They are pathologically interchangeable with inflammation, and do not call for a change of medicine, so far as I can see. Of course, threatened Of course, threatened asphyxia from accumulations in the lungs and bronchi may be relieved, if possible. This is, by syncopation, causal treatment.

I can understand that vital exhaustion may develop a new lesion, which will persist coincidently with the original one. The root of sepsis is, therefore, more or less distinct from that of the earlier morbid expressions. It is philosophical to treat this condition. If the breath has a cadaveric odor, chlorate of potash is a good corrective. However, I consider it a superficial remedy, since I have never seen it (undoubtedly) do more than deodorize the breath. In the milder septic conditions, a good tincture of baptisia tinctoria does evident good. But the king of internal antiseptics is echinacea augustifolia. This is a positive remedy. Its certainty eliminates coincident contingencies as evidently as does that of quinine. In blood poisoning, the result of wounds, it is unquestionably the most reliable remedy known. such cases it is to be used both topically and internally. The same is true with reference to its use in snake bites and the stings of venomous insects. Within eclectic ranks this remedy is rapidly building for itself a lofty pedestal. The dose of it is quite large, being from five drops to one dram of Lloyd's specific. For topical use, it may be diluted onehalf. This is a remedy which will not disappoint you, brethren.

In

The supreme element of cure in all diseases is rest. Think of rest, as related to the sick, italically all the time. Allow no unnecessary person in the sick room. Prevent all noise even to the rustling of a newspaper. There must be no avoidable talking. Millions of sick people have been talked to death. Sitting up at night with a patient generally does more harm than good. The practice is to be reprehended, except in rare cases. The nurse may lie down in the same or the adjoining room and go to sleep. Provide the patient with a call bell and he will do the rest. The attendants must

be cheerful and hopeful in all their expressions. The patient must be made to feel that of course he is going to recover. I cannot estimate it to a fraction, but all this is at least five times as important as any known medication.

There will come along cases which must die. must die. I know this, because medical friends of mine, who are far superior to me as physicians, occasionally lose a case. I do not believe, however, that the fatality in pneumonia, including that of epidemics, should exceed 5 per cent. However emphatically our rationalism may contradict it, there does exist a sort of fatalism. A medical friend of mine, who had been in the practice fifty years, and who had always done a large obstetrical practice, never met with but one case of breach presentation, and one shoulder presentation! He had lost a number of cases of pneumonia. Another, who had practiced for forty years, had never seen a case of urethral caruncle. He had lost many cases of pneumonia. I have had everything mean that is known to obstetrics, and have treated at least twenty cases of caruncle, but have never lost a case of pneumonia. I have nearly done it, but not quite. See the fatalism of it? Do not, therefore, bank too highly upon my methods.

But I am making this too long. In closing, I want to ask the reader to forgive the iterant use of the first personal pronoun, and the didactic method employed in this paper. ployed in this paper. Be assured, they are simple concessions to literary directness-nothing more.

Cleves, Ohio.

[The above is from an eclectic point of view, from a high authority in eclecticism. For next month we are promised an article on this subject by an eminent homeopath—Ed.]

Consumptives-Where They Should Go and Where They Should Not Go.

Editor MEDICAL WORLD: -In the December issue of THE WORLD I noticed "Consumption-Its Treatment," by Prof. Waugh of Chicago. This article interested me, particularly that part which directs the afflicted ones to go to Florida.

I wish to say to your readers that that is one of the localities that is a very good place to stay away from. I know that