so markt that they may even mask the main disease. Perhaps the first, as well as the simplest of these, are those sensations which have been called paresthesias, which consist in a disturbance of sensibility causing a feeling of numbness, deadness and coldness in certain spots and localities. These are usually noticed in the extremities and are very annoying at times. Others are due to a condition of nerve-tire or disturbed nervous function, such as occurs in a state of auto-infection and blood impoverishment and consequent malnutrition of the entire system. Peripheral neuritis has also been frequently noticed, either occurring by itself or associated with phlebitis, and a condition causing hemiplegia has also lately been noted and commented on. These states require no different treatment than when occurring under ordinary conditions. The early headache of typhoid does not often require any special treatment, since it subsides spontaneously under ordinary conditions. When it is persistent and distressing, acetanilid in small doses at short intervals seems most effective; but this should be discontinued upon the relief of the symptom. The insomnia so often complained of is best controlled by sodium bromid and chloral, given either separately or combined. Opium should not be used unless these absolutely fail, because of its unfavorable effects upon the digestion and secretions. The opposite condition of stupor is best met by stimulants and external antipyretics. Alcohol in some form is, of course, the most valuable agent, but spirit of chloroform and spirit of camphor are of especial use in emergencies. Delirium can be controlled by hyoscin hydrobromate and codeia, and the oldfashioned remedy of suppositories of asafetida is efficacious in many instances. Cold should be applied to the head by means of an ice-cap, using, at the same time, warm applications to the feet and legs and a mustard plaster over the heart. cating and resulting conditions requiring any special line of treatment, or presenting any especial difficulty in diagnosis. Other conditions may arise, but these require merely the same medical and surgical treatment they would receive when occurring independently in the subject. The Diet in Typhoid Fever. With the tendency of the pendulum to swing backwards, there has, of late, been a revival of the idea that, after all, as much depends upon the nursing as upon the medication in working for the cure of the typhoidal condition. No unimportant part of the nursing is the care of the diet, and this is particularly limited and strict in the condition under consideration. "What shall I eat?" is one of the first questions put to a doctor when he is called in any disease, and this is a most important question in typhoid. In a fever so prolonged, it is of prime importance to carry the patient thru the critical period with the strength so little impaired as possible, and yet to give so little food as possible in order to avoid indigestion and irritation of the intestinal tract. It may be hard to believe, yet it is a fact that the typhoid patient is more apt to be overfed than underfed, despite the apparently small amount of food allowed. It is patent to all that at no stage of the fever, not even in convalescence, until at least ten days after defervescence, should solid food be allowed. To meet the obvious conditions, it is necessary that a food should contain certain constituents needed to maintain the energies, and these in sufficient amount, and that this food should be in such condition as to be assimilable by the system. The typical food in typhoidal states has long been conceded to be milk, and this holds the first place among all foods. No law, however, can be laid down as to how much or in what way to give it. When there occurs the least sign of gastric distress, as shown by belching or the The above comprise the main compli- vomiting of the milk, or by increased di arrhea with milk curds in the stools, the patient has either been given too much or is unable to digest the milk. According to the condition the amount must be lessened, or other food substituted for the milk. Milk is often complained against as too monotonous a diet, but the patient is generally indifferent to his food, owing to the hebetude so natural to the disease. Still a careful nurse may vary even this one article of diet so as to make it acceptable. It may be iced, hot, curded or peptonized, or given as koumyss or wine whey. A good way is to give two parts of rich, fresh milk, diluted with one part of cold vichy water. Where a stimulant is required try six parts of milk, two parts of lime water, one part of whisky, measuring by teaspoonfuls. An excellent way to make koumyss appears in this issue, in another department, but the following is an easy and simple method: Stir together for fifteen minutes a pint of buttermilk and a gallon of fresh milk; repeat the stirring after it has stood twelve hours and bottle immediately, corking tightly and putting it in a cold place for three days, when it may be used. It will not keep very long, how ever. The best way to make wine whey is to heat nearly to the boiling point a pint of milk, add a half-gill of sherry. Stand where it will keep hot for fifteen minutes, and strain. Milk may be curded by the addition of sherry wine, rennet or essence of pepsin, and this is often an agreeable variation. Some patients like milk prepared by boiling a tablespoonful of oatmeal or other cereal in a half-pint of water until it jellies, straining the liquor thru a cheese cloth and adding an equal quantity of milk. The milk can be slightly thickened with arrow root or tapioca, or beaten up with an egg and flavored with either essence of lemon or vanilla, besides being slightly sweetened. Mellin's food, Eskay's, Imperial Granum and some other foods are all of great service, particularly during convalescence. Should the patient develop an idiosyncrasy against milk, or the foods based upon milk, give beef tea (being careful that no bone enters into the making), mutton broth, chicken broth, the expressed juice of a rare-broiled steak, oyster broth; or eggs prepared in various ways, by the addition of lemonade, iced water or a little weakened brandy, will prove acceptable. The use of the fat milk, just as it comes from the separator, is especially recommended in typhoid fever by Dr. Fischer, who claims that it quenches the thirst, is easy to digest, does not produce tympanites, is relisht by the patient, and contains more food value than milk in any other form. It seems strange that ice-cream and eggnogg are not more frequently included in the dietary, since these are frequently used in private practice, and ill effects have never been reported from them. Of course, care must be taken that the icecream is not stale, and that it is not made with the addition of particles of fruit. The kind known as frozen custard would be the best. Unfermented grape juice also is an excellent addition to the dietary. Above all things, no matter what the diet, watch carefully for the least sign of disagreement; and, so soon as this appears, suspend feeding for a short time, beginning carefully with small quantities of predigested foods when feeding is resumed, and gradually venturing to some other article of the above dietary. cannot be gainsaid that the food is a part of the doctor's domain in this disease, if it be in no other. The Atlantic Medical Weekly, of Providence, R. I., the sour, fault-finding old maid of medical journalism, has been discontinued. No tears will be shed for the death of a publication whose chief delight was to make mean, ugly and entirely uncalled for remarks concerning its contemporaries. If it has gone to the medical journal heaven, we hope that it will there learn better manners, and have inculcated into it a better spirit than the one of ill-natured faultfinding which it has always exhibited. Dr. Waugh's book on Treatment and THE WORLD until 1900 for $5. ORIGINAL COMMUNICATIONS Short stories on the treatment of diseases and experience with new remedies are solicited from the profession for this department; also difficult cases for diagnosis and treat ment. Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors. Copy must be received on or before the twelfth of the month for publication in the next month. Unused manuscript cannot be returned. Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else.-RUSKIN. REFLECT. COMPARE. RECORD, READ. Alkaloidal Medication in Pneumonia. Editor MEDICAL WORLD:-Of all the topics that have engaged the attention of the great WORLD family since it first came into being, not one has been discust 80 frequently as pneumonia. No other single affection has called forth so many interesting letters. No section of No section of the country remains unrepresented. There is not a single practicing physician in the United States or Canada-in the North, South, East or West, in lowland or highland, in city or country-but is vitally concerned in the pathology and treatment of pneumonia. We must hold ourselves ever ready to receive new ideas, but not too ready to discard the old. Nor should our acceptance of new teachings outrun their proofs. We accepted the theory ascribing the etiology of pneumonia to the pneumococcus, but the further claim that this was the only cause capable of producing this disease was an unproved assumption. Now, we are told that not one, but any one of several distinct micro-organisms, may set up the pneumonic process. Just so, when Laplace and the rest of Koch's entourage were establishing the tubercle bacillus as the cause of pulmonary consumption, I refused to admit that this micro-organism possessed a monopoly of the production of chronic pulmonary inflammation and destruction; and I thereby earned the name of an old fogy, from the ultra partisans of the new school. Now they admit that the staphylococcus and streptococcus, and perhaps many other forms of microscopic life, are participants in the destructive process; and let me add, parenthetically, that they are a sight worse customers to deal with than the tubercle bacillus. But no bacillary theory as yet promulgated accounts for the oocurrence of pneumonia in isolated localities, hundreds of miles from infected places, without communication therewith. We must either give up the exclusive infection theory, or assume that the causal micro-organisms are universally diffused over the earth. And, in truth, while we admit the agency of these disease-producers, it is not impossible that pneumonia may be caused by exposure to cold and fatigue, without the aid of any of them. The various causes may, however, be disregarded when we come to the treatment. Our cases may be divided into two groups, the sthenic and the asthenic. Either of these may prevail almost exclusively in any locality, and hence we find the physician who meets only sthenic cases loud in the praise of blood-letting, veratrum or antimony; while he who practises among the weakly denizens of septic localities is equally firm in his belief that supporting measures alone are admissible. So we find quinin, digitalis, ammonia, alcohol and strychnin more popular in the cities, while antiphlogistics still rule the country. In this respect the alkaloidal system possesses an elasticity that permits of that accurate fitting of the remedy to the disease which characterizes that method of medication. Beginning with the two primary essentials in the treatment of every febrile affection, emptying the bowels and rendering them aseptic, we follow with digitalin, the chiefest of heart tonics, following Juergensen's dictum, that here is the center of interest, the point upon which all elements of danger converge. The blocking up of pulmonary vessels in the pneumonic area, the increased need of oxygen, the fever, the hyperemia of the unaffected lung, the withdrawal of fibrin from the blood and the interference with nutrition all tend to increase the heart's work or to lessen its nutrition. Hence the need of digitalis, not in the rare and bulky doses of uncertain efficacy used by our ancestors, but the sure, positive, uniform digitalin, given in doses of one to two milligrams, or more if needed, repeated every half-hour. So quickly is this agent absorbed and its effects manifested, that the observant physician can easily see when his patient has had enough, when to lessen or to drop the drug. Next comes our great remedy for congestion, aconitin. Every congestion is accompanied by a compensatory anemia, every relaxation of the capillaries in organ by vaso-motor spasm elsewhere. By relaxing this spasm, especially one in the skin, we allow the blood to flow back, and thus relieve the pulmonary hyperemia by "equalizing the circulation". a phrase correctly employed long before it was comprehended. No safer or more manageable agent exists in medicine than aconitin. Given in the proper dose, repeated at proper intervals, stopt when the object for which it is given has been attained, it is absolutely safe to the smallest infant. Not even idiosyncrasy is to be dreaded. accident with alkaloidal medication is as impossible as with infinitesimals, while the efficacy is something unheard-of under the old systems. Of the crystallized aconitin grain, or of the amorphous grain, may be given every half-hour until the softened pulse, relaxed skin, perspiration and reduced temperature show the danger to be over. But it hardly requires the doctor to watch for these effects. Tell the nurse to lessen or discontinue the medicine "when the fever breaks." Any person of ordinary good sense can be safely trusted to administer aconitin according to the doctor's directions. So far the treatment suits all cases alike, but here we begin to distinguish between the sthenic and the asthenic forms. If the heart is pounding hard, the dyspnea causing much distress, veratrin, gr. 1, is to be added to each dose of digitalin and aconitin. By this the tumultuous action of the heart may be subdued, its rhythm regulated, all the eliminant organs stimulated, and that without the production of diarrhea, nausea or collapse, if the simple rule is followed of giving until you have obtained the effect you want, and then stopping. But if the patient shows evidences of deficient vitality, as is so frequently the case with the denizen of the city slums, the powerful vital excitant, strychnia arseniate should be substituted for the veratrin in similar doses. Frequently the physician finds it expedient to change from one of these to the other, as occasion requires. Strychnia has become very popular of late, and Wood strongly recommends it in pneumonia, giving gr. or more every four hours and alternating with cocain, which he believes to be a synergist. But the true use of strychnia is in these asthenic cases, and in the smaller but very frequent doses-gr. 134 every half-hour till effect. No one who has seen how veratrin steadies the tumultuous heart in asthenic cases can doubt of its applicability. Strychnin is a remedy for the asthenia, not for the pneumonia. I Of local applications, most can be ranged under the heads of heat and cold. prefer the former, using wet heat in poultices or plasters of mustard and molasses; or dry heat in the hot-water bag, or Dr. Britton's flapjacks. The blister has become deservedly obsolete, but counter irritation by iodin is of value in many cases. especially infants; while in the aged, turpentine stupes, with ammonia internally, served a good purpose before the value of strychnin had become known. This treatment is really not new, except that it combines harmoniously two apparently opposing methods. There have been two parties, one claiming that pneumonia must be treated by stimulants, the other contending fiercely for the sedatives. The system here advocated employs certain remedies for conditions common to all cases, and adds the stimulant or the sedative as each may be required. To me it seems the only scientific method extant, as it does not subject every case to the same procrustean treatment, but fits the remedies to the case. Excluding the absolutely incurable cases, when the pneumonia is simply Nature's merciful way of putting an end to a life that has been lived out, and stopping the sufferings of cancer, tuberculosis, diabetes or other such incurable diseases, there should be practically no deaths from pneumonia with this treatment. The forms confessedly dangerous are pneumonia of the aged, of drunkards, and hemorrhagic cases. For old men and alcoholics there is no remedy comparable to strychnin, which can be given with advantage in enormous doses. I should not hesitate to give strychnin arseniate in doses of gr. to such men, provided this was indicated, after the bowels had been emptied and antisepticized thoroly. Hemorrhagic cases are very apt to die, but they have a better chance to live under this treatment than any other; for the equalization of the circulation renders dangerous plethora of any vessels an unlikely occurrence, as the use of veratrum subdues any excess of arterial tension and cardiac action. But if hemorrhage occurs in spite of treatment I would add to it the use of ergotin, in doses of gr. to, or more, every half-hour, dilating the cutaneous vessels with atropin, and thus unloading the congested vessels of the central organs. I will close by remarking that the bacteri I m mal w ли имик im_an always becomes away THE MEDICAL WORLD, the small. the smalle fur for ologists have not contributed a single fact of value upon the treatment of pneumonia. There is no germicide for this coccus, no inhalation has proved more useful than plain, unmedicated steam. WILLIAM F. WAUGH, M.D. Ravenswood, Chicago, Ill. Pneumonia, Direct Medication. Editor MEDICAL WORLD:-In pneumonia the danger is slight if depressant doses of medicine are not given. In March WORLD, page 108, I recommended the use of "small or stimulant doses" of sedatives in every case of sickness where there was present fever with feeble and frequent pulse. Now, I would emphasize what I said before: that my motive was not personal criticism. What I know of specific medication has been valuable to me, and I desire others to enjoy the advantage which a knowledge of it will give. It would not It would not benefit me personally if every reader of this article should profit by my suggestions, as I have nothing to offer for sale. I claim, and have illustrated the truth of the claim by quoting from an authority, that hap-hazard prescribing is prevalent among physicians of our school. Medicine will never become a science when the statement that "the average life of a medical fact is five years," approaches anywhere near the truth. It will not become a science so long as names of disease are considered most important as a guide in treatment. The condition of the circulatory organs, of the nervous system, of the digestive organs, of the blood, etc., should always be recognized, and any departure from the normal standard should if possible, be corrected regardless of the name of the disease. To illustrate: Cardiac debility and capillary obstruction are always accompanied with a small, frequent and feeble pulse. If fever is also present, aconite in small doses is indicated. It is a stimulant to the sympathetic nervous system, strengthens the heart and tones up the capillaries and thus lessens the frequency and increases the strength of the pulse. When the pulse is full and bounding, showing excitation of the sympathetic system, without debility, veratrum viride is indicated. A weak and irregular pulse calls for cactus; a hard, vibratile pulse for bryonia; sharp stroke of pulse, for rhus tox, etc. Active hyperemia of the central nervous system is manifested by flushed face, restlessness, bright eyes, contracted pupils 473 and pain in head. Gelsemium overcomes this condition and hence removes the symptoms. Passive congestion of the brain is manifested by dulness and drowsiness, dilated pupil, etc. When these symptoms are present in febrile disease, bella donna is always indicated, al removes these symptoms, but at the same time favorably influences all vital functions. Such a study of symptoms gives a rational basis for prescribing for pathologic conditions. Causes of disease should be removed when possible. This cannot always be immediately accomplished. In any case the effects-derangement of vital function -should be overcome as promptly as possible. All vital functions can to a large extent be controlled by remedies which act upon the ganglionic nerve centers. These centers can be gently stimulated into activity when their equilibrium has been disturbed, even when it is not possible to at once remove the cause of the disturbance. Acouite not only corrects circulatory disturbances, but at the same time it tends to restore the natural secretions and improve the digestive and excretory functions. with other remedies which act upon the sympathetic nervous system. So I am convinced that thousands of persons are sent to an untimely grave every year because large and depressant doses of drugs have been given them, whose lives could have been saved by small, stimulant doses of proper remedies given for a direct effect. On page 56 of January WORLD is described a method of treating pneumonia in children with ice packs. I should consider myself responsible for the death of every child so treated. The doctor says: "I've lost some cases under this form of treatment, but I've saved some that looked pretty desperate." When we consider the depressing effect of prolonged cold, we are not surprised that some of them looked "pretty desperate." When typhoid fever was treated by blood-letting, etc., some cases that looked pretty desperate managed to pull through in spite of the treatment. In the preface to his book (page vii.), Dr. Waugh says: "Numerous specific indications, especially in the Appendix, are from Scudder and other eclectic writers." In preface to Appendix, page 473, he says: "I desire to urge upon my readers the importance of putting these indications to |