have been noted. They are oval and lance-shaped, becoming slightly narrower at the ends, which are turned in opposite directions. It can scarcely be doubted that these are an exciting cause of pneumonia, both of the croupous and some of the secondary forms. Yet the coccus has also been found in pleuritis, metastatic meningitis, otitis, arthritis, peritonitis with perforation, etc., and therefore seems to be a general and very malign exciting cause of inflammations. It is also sometimes found in the saliva of about one-fifth of the healthy people, and therefore is not a pathognomonic sign of the condition

under consideration.

Friedlander's coccus is very similar to Fraenkel's, like it staining readily by all anilin dyes, but, contrary to the former being readily decolorized by Gram's method. It is, however, not exclusively found in the sputum of pneumonic patients, but also under other conditions.

Pio Foa's coccus is a diplococcus enclosed in a capsule, only found, however, in the tissue juice of the pneumonic lung, not thus far demonstrable in the sputum. It also closely resembles Fraenkel's coccus, both in form and manner of staining. None of these can be considered as the sole cause of the condition known as pneumonia, since both croupous pneumonia and forms similar to it may be produced by not only the pneumococci, but also by the streptococci and pyogenous staphylococci. Still, the pneumococcus of Fraenkel is the most generally present in pneumonia, and has been demonstrated in all possible organs during the progress of the disease, some of which showed no signs of inflammation at all. It may be, therefore, a general infection, with the localized lesion in the lung.

Still, to sum up, the absence of a pneumococcus in the sputum argues against a diagnosis of pneumonia. Its presence does not make the diagnosis absolutely certain, since it is also found in the sputum of healthy individuals. If the pneumococcus is found in the pus of empy

ema, for instance, it makes the etiology of the attack depend upon a former pneumonia. The pneumococcus may be responsible for purulent processes in other parts of the body.

The Staining of Specimens.

Fraenkel's coccus is stained after Gram's method, in dry cover-glass preparations, and best with anilin gentianviolet solution. From this it is immediately transferred to the decolorizing fluid for two or three minutes, then to absolute alcohol. This will leave the Fraenkel cocci intensely stained, but will decolorize the Friedlander coccus.

To stain the Friedlander coccus: Dry cover glass preparations are put for a couple of minutes in a 1 per cent. solution of acetic acid. of acetic acid. This is then blown away by a pipette. The specimen is then dried in the air, placed in the anilin gentianviolet solution for a few seconds, and then rinsed in pure water.

The same method is recommended for the Pio Foa coccus as for the Fraenkel.

The decolorizing fluid used is: Iodin, 1 part; potassium iodid, 2 parts; distilled water, 300 parts.

In any form of pneumonia there may also exist abnormal conditions in the urine, to be revealed by examination. Albuminuria may be present and peptonuria has frequently been noted. Glycosuria has been found to exist in a number

of cases of the sthenic type.

The treatment of pneumonia will be considered in our next issue.

Foreign and Domestic Prices on Foreign Drug Products.

The discussion as to the unjust discrimination of American patent laws against the American manufacturer and consumer, which took its rise from the recent patenting of antitoxin, is still in progress and is leading to the widest investigation as to further applications of the law. THE WORLD presents the following facts, collated as a contribution to general knowledge upon the subject. The figures will

It will be noted that, in a few instances, the figures in the second column are somewhat smaller than the prices quoted as Canadian; but the fact must not be lost sight of that the American price is that to the trade, while the Canadian is that to the consumer. In other words, the retailer's percentage of profit, which, of course, will vary with the locality and also with each dealer, must be taken into account.

In certain instances, figures could not be obtained either in Canada or here. This is indicated by use of the words “ no data "

in the column where information is lacking. The fact that there is an import duty required by this country of 25 per cent must also be taken into account; and here the comparison is somewhat faulty, as the basis for such duty should be the foreign wholesale valuation, which is here lacking. Yet, even with these obviously imperfect data, the fact of unjust discrimination is most patent.

There is a ready remedy to this evilthe amending of the patent laws so that. in no instance, can any product which is denied a patent abroad obtain that protection here. The mere fact of patent being refused in the country in which it is manufactured should be sufficient to exclude any product from the benefit of our laws. In every instance we can call to mind this would strike at the root of the matter. without giving rise to any justifiable complaint of discrimination either for or against.

The American doctor is entitled to pay only the same prices that are paid by the German, English, or French physician. Independent of price, the inhabitants of this country are notoriously larger consumers of drugs than those of any other nation, and for this reason alone should receive consideration at the hands of those who desire their trade. There is no intention to prejudice any product by this presentation of fact. The sole objects are to demand equal justice for the American physician, to call attention to existing anomalous conditions and to suggest a possible remedy. A fair profit will never be protested against. Unfair discrimination is another story and should never be submitted to.

The Spitting of Blood in Tuberculous Subjects.

Few symptoms are so alarming, either to the laity or the profession, as that of hemoptysis or the spitting of blood. This is particularly the case when the loss of blood is considerable. It must be understood that this is some form of hemorrhage of the larynx, trachea, bronchi or the lungs,

and is apt to occur in the more advanced stages of tuberculosis. It frequently, however, may occur in children at puberty who previous to that time have been habitually subject to bleeding from the nose, and in such cases it is the starting point of pulmonary tuberculosis, instead of a symptom of its approaching unfavorable termination. This fact has not been generally recognized, the opinion being prevalent that where there is spitting of blood some form of tuberculosis must already exist, even if there are no discoverable signs of the disease.

Here is a point in diagnosis that is of serious import to the treatment. If the hemorrhage is due especially to some form. of tuberculosis, latent or developed, the treatment must of a necessity be directed toward the specific germ producing the condition. But there exists in other states than that of the typical hemophiliac a condition of fragility of the vessel walls disproportioned to the degree of blood pressure, and this may result in hemorrhages, slight or great, according to the immediate cause of the symptom. In such cases

other constitutional measures are indicated and indeed sometimes other immediate remedies will produce better results.

In tuberculous patients, hemorrhage of this nature, unless excessive, does not affect the prognosis to any markt degree, the length of life being about the same. The chief danger is that the patient may become exsanguinated thru excessive loss of blood and hence may die of immediate exhaustion, or that he may be actually suffocated by the onrush of the vital fluid. Sometimes the resultant anemia may be the ultimate cause of death. This is more apt to be the case when the patient is subject to frequently recurring light hemorrhages, to which he becomes so accustomed that he does not pay the proper attention to his condition.

One of the most important requisites in meeting the condition, no matter what the cause, is the possession of a "level head" by the medical attendant. When the hem

orrhage is severe there is every appearance of immediately approaching death, and there is often extreme excitement both on the part of the sufferer and of his attendants, each acting and reacting upon the other until the worst possible conditions are produced, two hemorrhages often following in quick succession. Anything that tends to increase the excitement and alarm of the patient will necessarily increase arterial pressure and predispose to a recurrence, and the excitement may thus prove immediately disastrous.

In such a scene a cool and clear-headed physician who will act with calm deliberation is invaluable. A hasty, nervous man has no business in a sick room of this kind. The first measure is to calm the patient and restore to him some degree of confidence. When such a state of mind is induced it is ample time for more energetic measures. Sometimes this condition may be produced by the mere personal magnetism of the attendant; sometimes some therapeutic measure is necessary to give the idea that all possible is being done immediately; but whatever means may be used it is necessary that the mental equilibrium of the patient be restored. He will then be in a condition to be benefited by whatever may be done.

First of all, clear the room of all save the necessary attendants. Be rigorous on this point, and choose as your assistant an optimist if at all possible. Put your patient to bed, and keep him quiet. Tell him to cough as little as possible, holding the blood when it begins to collect, long enough to form a clot. Tell him he is not going to bleed to death and that you are not at all frightened. It is well to begin at first with some familiar practical remedy like common table salt. Call for this and give your patient a full tablespoonful, telling him to swallow it at once with as little water as is absolutely necessary to wash it down. Keep him quiet a few moments and then place an ice-bag on his chest, and let him swallow small pieces of ice. Tell him there will probably be another hemor

rhage in a few hours. This will steady him and probably prevent harmful excitement and loss of confidence in you and your treatment should hemorrhage occur. Make a solution of one grain of atropin in an ounce of pure water, and give of this five to eight drops every three hours until the hemorrhage has absolutely ceased. If there is cough, give minute doses of some form of opium, preferably Dover's powder, every two or three hours. A single grain of the powder will generally be sufficient for a dose.

If the pulse is excited and strong, veratrin is indicated, digitalis being the indication for the opposite condition. If there is great dyspnea with danger of suffocation, withdraw the clotted blood from the throat and larynx, and give champagne in small quantities. Fever is often best met by five-grain doses of quinin every three or four hours, but this must be used with caution. Fluid extract of ergot in doses of one dram every hour is claimed to be of excellent avail in cases where there is not great vascular tension, but this drug has its chief effect upon the uterus and atropin will meet the condition under consideraation far better in hemorrhage from the lungs.

Make no examination of your patient by percussion or in any other way that will require movement or be likely to break down clots and bring on a renewal of the hemorrhage. It is nearly always almost impossible to find the source of a hemorrhage, and after all the source is not a matter of crucial importance.

The patient should remain in bed at least a week after all indication of hemorrhage has ceased, and so soon as he can leave his bed, the question of change of climate should be considered. This because, altho the occurrence of hemorrhage does not necessarily denote the existence of lung lesion, it may show the predisposition to phthisis. The climate of Arizona has been considered the best for this class of invalids, and the patient should be advised to go first to an elevation of about

2,000 feet, and then gradually work northward and to higher elevations as the succeeding summer comes on, until at last a residence in Denver may be had. The climate of the latter place is apt to be too stimulating for the first trial.

Particular attention to the dietary is necessary. Food should be taken of the most nutritious character in concentrated forms and at frequent intervals. All bulky foods of no matter what kind, are to be strictly forbidden.

Yet, to return to the keynote of the treatment, this is after all the inspiring of confidence in yourself and in the patient. All therapeutic measures are of an "assisting" nature, and largely depend for their effects upon the mental attitude of the patient. Therefore-keep cool and be cheerful, but above all, keep cool.

Bronchitis.

The usual "bad cold" is what is medically known as bronchitis under one or the other of its varieties of acute catarrhal, chronic capillary or fibrinous forms. It is an inflammation of the bronchial tubes and is usually the result of exposure to cold and wet, particularly when the system is overheated, but may be an associated condition in certain infectious diseases, especially typhoid fever, influenza, measles, etc. It is more apt to occur in persons whose occupations necessitate rather close confinement or the inhalation of irritating substances, or in those whose system is at a low ebb, or who are suffering from the uric acid diathesis or chronic heart disease.

In most cases only the wind-pipe and the larger bronchial tubes are affected, the mucous membranes appearing red, injected and swollen, altho inspection, palpitation and percussion give negative results. Ausculation will reveal sibilant and sonorous râles in the first stage, these becoming moist as secretion is establisht.

The patient will complain of feeling chilly and of having a sense of soreness and tightness behind the breastbone, this becoming worse on coughing. There will

usually be some degree of fever, with the associated symptoms, altho the temperature will seldom be greater than 102°. The cough in the initial stages will be dry and painful, but later a muco-purulent expectoration will be establisht, and this will become quite free as the inflammatory symptoms subside. There will not be the prostration which is so characteristic of influenza, nor the physical signs of consolidation one would look for in catarrhal pneumonia. There is little to affect a most favorable prognosis, altho in the aged, the extremely young, or in the feeble there is some danger of bronchitis leading to capillary bronchitis with a serious prognosis or to catarrhal pneumonia which might prove still more grave, hence care in attendance upon the trouble will not be out of place. In the treatment of colds of this type, it is well to insist primarily upon the patient keeping the house and preferably his room for at least 48 hours. Inaugurate the treatment with a full clearing of the bowels, using preferably a saline. If you see the patient in the initial stages order a hot foot-bath, and direct a large linseed poultice in which there has been mixt about a teaspoonful of mustard, to be placed on the chest. This poultice should be mixt rather dry, should be large enough to cover the chest, and should be applied hot. It should be applied as closely as possible, and closely covered with a piece of mackintosh, the whole left on three hours or longer. If the poulticing is not done thoroly and skilfully it would better be left alone altogether as otherwise it may only increase the tendency to cold. It is not necessary to change the poultices too frequently. If the poultice is not practicable, it may be well to paint the chest with iodin, keeping the affected area closely

covered.

With the beginning of the treatment, after the hot foot-bath and the cathartic, give hot drinks plentifully, hot ginger tea and hot lemonade being probably the best. Then give at once a full dose, about ten grains, of Dover's powder, and follow this

with quinin. Only give this treatment, however, when the patient will consent to remain in-doors. It will otherwise quite probably result in an aggravation of the symptoms.

Before the stage of expectoration is inaugurated, expectorants are in order, and among these may be mentioned apomorphia in doses of 1-30 of a grain, or even less, ipecac, the vegetable salts of potasIf there is difficulty sium, antimony, etc.

in breathing it will be well to let the patient inhale steam, this often producing immediate relief.

Codeia is excellent to relieve the pain and soreness and antikamnia will generally control all the nervous symptoms. When expectoration has been establisht, ammonium chlorid combined with digitalis will be useful, and tar, turpentine or terbene, squills, and eucalyptus, have all excellent effect.

tained rather by the systematic and perThe best results are generally to be obsistent use of some one mixture than by a too frequent change of medicinal agents, no matter how efficient they may be.

Sometimes, when the patient is very plethoric and there is venous stagnation, should there be dyspnea, it is well to bleed about ten or twenty ounces from the arm, altho before such measure is taken, the condition of the heart should be carefully investigated.

Our Policy of Discussion.

Subscribers of THE WORLD have long been familiar with the the special feature made of discussing, as each season appears, the diseases most apt to prevail at that time, the idea being workt out by an editorial presentation of the latest estabtaught in the colleges and publisht in textlisht facts in diagnosis and treatment as books, dissertations and current periodicals, this reinforced by personal experiences, theories and questionings of members of the WORLD family. In this manner we have treated heat diseases, malaria,

typhoid fever, and are now taking up cold

weather diseases, such as the various affections of the throat and lungs, rheumatism, grip, etc.

Yet there are a large number of diseases ing to any one time of the year, since they that cannot be rightly classified as belongare liable to be met with at any time. In this category we must include venereal and