water often, as it helps to reduce the temperature and flushes the kidneys. There is no specific treatment for pneumonia as such. Each case is to be treated for the conditions as they arise in the progress of the disease. The ideal method is to prescribe single remedies for the indications met by the different drugs, and as the patient improves change the medicine as conditions change. It is often easier to add another drug to the mixture, when the indication is present for it, and so not disturb the patient with giving so many different preparations separately. The drugs most often indicated in the treatment of pneumonia, according to the Eclectic theory, are: Veratrum is indicated by full, bounding, frequent pulse and flushed face, present only in the early stages, at the time of the initial chill or immediately following it. Veratrum should be given only until the pulse is soft and near the normal rate. The dose is from 4 to 1⁄2 drop of the Eclectic specific medicine veratrum given every hour until the effect of the drug is obtained; then it should be stopped. Aconite is the remedy where the heart's action is rapid, but the pulse is small, hard and wiry. It is generally prescribed for children. The dose of sp. med. aconite is very small, gtts. v. to water ounces four. Sig: teaspoonful every hour. Asclepias is often indicated in the same case and the combination acts nicely, often better than the single remedy. It will be further noted later on. Bryonia has a direct action on serous membranes and, as pleurisy is often a complication, it not only helps the pneumonia but is curative in the pleural complication. It helps to prevent the exudate and favors absorption of the exudate when already formed. Bryonia is indicated by sharp lancinating pains, dry, irritating cough, flushed cheeks. It can be combined with aconite or veratrum, or given separately, alternating with the other remedies. The dose is small, gtts. v to water, oz. 4. Teaspoonful every hour. In the treatment of pneumonia in children, asclepias quiets the nervous system, helps to moisten the hot, dry skin by its action on the sudoriparous glands, eases the pain and relieves the hard, tight cough. The dose is from 5 to 10 drops every one to three hours. It may be combined with bryonia to good advantage when the latter is indicated. Lobelia. We have the sp. med. and the hypodermic lobelia to use. While the specific lobelia will in large doses cause nausea, the hypodermic lobelia will not, as a rule. Lobelia is a vital stimulant and is indicated by a full, oppressed pulse or oppression of the chest with difficult respiration, when the entire lung tissue seems to be filled with a viscid, thick exudate. From 30 to 60 minims of the hypodermic lobelia may be given and repeated in two or three hours. The dose of the sp. med. lobelia is 1⁄2 to 1 drachm to water ounces four. Teaspoonful every hour. The Ipecac selects the small bronchial tubes as its field of action, and is very useful in allaying irritation in them. It is given in pneumonia of children, with bryonia or aconite when those remedies are indicated; in the early stages, before hepatization has taken place; also in the later stages to help clear the lung tissue and restore normal conditions following hepatization. specific indications are irritating cough with deficient secretions. In children this condition keeps the little one from resting, and small doses of ipecac afford great relief. The dose is 5 to 10 gtts. of sp. med. ipecac in water oz. 4. Give teaspoonful doses every hour. I like to combine ipecac and asclepias, when the asclepias indication is present. Kali. Mur. (potassium chloride) is one of the most valuable remedies in pneumonia. It should be given early in the disease and continued until resolution takes place. It does not interfere with the action of other remedies, is tasteless and can be combined with any of the other indicated remedies. It prevents the deposit of plastic lymph in the air cells and assists in the absorption of the deposit if already formed, so there is much less hepatization than would be otherwise. I usually add from 20 to 40 grs. of the third decimal trituration to 4 oz of water and give teaspoonful doses every hour. Sanguinaria may be of use in some cases where there is a tickling sensation in the throat, resulting in an almost constant paroxysm of coughing. The nitrate of sanguinaria is a more pleasant preparation than the tr. Add. gr. 4 of the nitrate of sanguinaria to equal parts of simple syrup and aqua pura, q. s. oz. iv. Give teaspoonful every hour. Gelsemium is indicated in those cases that show irritation of the brain and meninges high temperature, restlessness, flushed face, bright eyes, contracted pupils. It may be added to the sedative. The dose is from 10 to 30 gtts. to oz. 4 of water, and give teaspoonful every hour. Rhus tox. is indicated in sudden starting in the sleep, sharp stroke of the pulse, irritability, irritation of the cerebro-spinal centers. The dose is 5 to 10 gtts. to a 4 oz. mixture. Teaspoonful every hour. Hyoscyamus is indicated in delirium with hallucinations; in sleeplessness from cerebral hyperemia or excitement, in dry, spasmodic cough. It has a soothing influence over the nervous system and does not lock up the secretions. The dose of sp. med. is from 1 to 10 drops, according to severity of the case. Cactus is an important remedy in all cases of pneumonia and, if given early and used throughout the course of the disease, there is less danger of heart lesions following. There will also be fewer cases needing strychnia to bridge over the crisis. The dose of sp. med. cactus is 1⁄2 to 10 gtts., although I do not believe it necessary to use the large dose to get results. Intestinal antiseptics are often needed in pneumonia, as it is very necessary to have the intestinal tract in good condition. Echinacea will be called for in all cases developing a typhoid condition. Baptisia is also indicated in such conditions, as shown by full, dusky tissue and purplish discoloration. Hydrochloric acid dilute. When the tongue is dry and cracked, deep red in color and covered with sordes, add enough of the dilute acid to a tumbler of water to make it pleasantly sour. A little sugar may be added if the patient would prefer it. Give him a sup of this quite often, and the tongue will soon become moist and improvement will be noted. [The Eclectic specific medicines approximate the U. S. P. fluid extracts in drug strength. Dr. Hollingsworth is President of the Ohio State Eclectic Medical Association.-ED.] expectoration is thin and may be streaked with blood. Restlessness, anxiety and fear of death are prominent indications for its use. After hepatization has become fully inaugurated, aconite is of little value. It is commonly used in the lower potencies or the tincture. The indications for the use of veratrum viride are similar to those calling for aconite. The arterial excitement is more pronounced. Great engorgement of the lungs is the keynote for the employment of this remedy. A red streak down the center of the tongue is one of the surest indications for its use. for its use. A hard, rapid and wiry pulse calls for aconite, while a hard, full and bounding pulse points to veratrum. Iodine is useful in both the first and second stages, when there is high fever and restlessness, with difficulty in breathing. It is particularly valuable in delayed resolution when hectic and suppurative symptoms develop. Dr. Kafka, of Germany, prescribes iodine in the first, second or third dilutions every hour, as soon as the physical signs of pneumonia show themselves, and claims to arrest the process in twenty-four hours. He considers it the only treatment necessary if begun early enough. The Bryonia is considered by many Homeopaths the most valuable remedy we have in pneumonia, especially when complicated by involvement of the pleura. Its use follows that of aconite and veratrum viride. The patient may still have a high fever but has lost much of his restlessness. cough is looser and more moist. The bryonia patient wants large quantities of water, has a short and jerky respiration, pains are aggravated by motion of any kind. The more prominent the stitching pains caused by coughing or other motion, the more is bryonia indicated. The tongue is dry and the patient is inclined to be apathetic. The third decimal potency is commonly used. Tartar emetic is of special value in the stage of resolution. Indications for its use are a loose mucus cough, rapid respiration, crepitant râles, great anxiety of countenance, nausea and anorexia. The breathing is oppressed, the patient wanting to sit up. to breathe more easily. It is commonly used in the third trituration. Phosphorous is a remedy considered very valuable by many Homeopaths, especially when there is cerebral involvement accompanied by a sense of pressure across the upper chest and constriction of the larynx with mucus râles. The sputum is a yellowish mucus with streaks of blood or rustcolored. There is severe congestion of the lungs, but the arterial excitement is not marked. Other remedies less commonly used by Homeopaths in the treatment of pneumonia but of value when their special indications are present, are: Belladonna, hyoscyamus, sanguinaria, chelidonium, ipecac and the various forms of mercury. Editorial Note. It must be understood that, in actual practice, both Eclectic and Homeopathic physicians use much the same general management as do the Regulars, giving purgatives, quinine and such drugs in full physiolgic doses. Eclectic "specific medicines" are specifically indicated in certain states or symptoms, not being claimed as "specifics" in the usual acceptation of that term. Relaxing dressings used by Eclectics are pastes or light poultices of such drugs as lobelia, tobacco, ipecac, etc. The Eclectic dosage appears small, but it is frequently repeated, and the most of the gentlemen of that school push dosages up when necessary. Veratrum viride is the only species of veratrum they use. Asclepias is asclepias tuberosa, or pleurisy root. Be careful in handling their preparation of rhus toxicodendron: it may poison your hands if susceptible to the plant. In using phosphorus according to Homeopathic principles, buy the alcoholic mother tincture or dilution wanted and saturate sugar discs or blanks with it, corking well. If added to water in any quantity at all, or exposed directly to the air, the phosphorus is oxidized. This symposium gives Eclectic and Homeopathic treatment fairly. Lack of space will prevent our undertaking to print more elaborate papers. Physicians who wish Eclectic and Homeopathic practice in detail will profit by purchasing the books of these schools. Treatment of Tuberculosis of the Spine. By JAMES K. YOUNG, M.D. Associate Professor of Orthopedic Surgery in the University of Pennsylvania; Professor of Orthopedic Surgery in the Philadelphia Polyclinic Clinical Professor of Orthopedic Surgery in the Woman's Medical College. One of the most frequent forms of tubercular disease of the bones and joints is tuberculosis of the spine or Pott's disease, one in which the greatest advances have been made in recent years, and one which, when not properly treated, results in severe and unsightly deformities. The scientific treatment of this condition requires not only improved hygienic measures and the use of appropriate apparatus but also the intelligent consideration of the proper treatment of the complications prone to occur, including abscesses and paraplegia, as well as the prevention and correction of deformity. indulged in, and the patient may wear an old apparatus in the still surf, or he may simply take the tub bath. Exposure of the body to the sunlight has been found to be of benefit, as well as in high altitudes, where first employed by Rollier and his followers. The apparatus should not be removed and a large part of the body should be exposed to the rays of the sun; in some instances the site of deformity itself is exposed to the sunlight. The general condition is to be further improved by the administration of tonics and alteratives, especially the hypophosphites and the iodine preparations. Apparatus. During the earlier stages of the affection, very great benefit may be derived from the Bradford frame, the frame being so arranged as to make upward pressure on the deformity; and this treatment will be necessary from time to time if paralysis occur or if the patient manifests marked evidences of fatigue. Correction and prevention of deformity is most important and in their application much skill is demanded. This treatment embraces two forms of apparatus. Mechanical treatment by the use of apparatus fulfills three indications: 1. To support the diseased spine; 2. To remove the superincumbent weight; 3. To prevent increase of deformity. The fixed jacket may be made of plasterof-Paris, or of its modifications in poroplastic felt, leather, woven wire, bamboo, paper, or silicate of soda. In certain regions of the spine, and in the treatment of the indigent, the plaster-of-Paris cast has filled a long-felt want. The neatest and most attractive form of fixed apparatus is made of celluloid and stockinet. The spine brace, particularly the antero Fig. 2.-Celluloid Support for Cervical Caries. service; but in the dorsal and cervical regions, braces or celluloid casts are best. In the dorsal region it is best, perhaps, to resort to crutches under the arms attached to the apparatus; in cervical disease the head and neck are extended and fixed by celluloid apparatus made from a plaster form, and including the trunk, neck and head. Of late much has been said against the employment of apparatus and in favor of operation, the desire being to effect cures in these cases more quickly. This object is a most laudable one, but there are only certain cases that are adaptable for operation, and these must be most carefully selected. The governing rule in these cases is this: If an apparatus is used, its use is often better persisted in, until the patient is 21 years of age, or until bodily growth is completed. Deformities will increase rapidly if the apparatus be inefficient or if removed too early. Treatment of Abscesses. Since abscesses occur in different regions of the spine from mixed infection, the question of proper treatment at once becomes important. If the abscess is large or increasing rapidly in size, or exerting pressure on important structures or parts, it should be evacuated and its proper treat ment be decided upon as governed by the results of diagnostic puncture as originated by the author. This consists in removing a small part of the fluid by the hypodermic needle, staining and examining microscopically, and also by the making of a cul ture. Exploratory puncture, to be of diagnostic value, should be made several days before any contemplated operation, in order to take advantage of the laboratory's findings in the proper surgical treatment. If the fluid be found, sterile, the abscess may be incised, thoroughly curetted and closed without drainage. But if the aspirated fluid contains the tubercle bacillus or mixed infection, before instituting drainage the cavity should be thoroughly irrigated with a 5 per cent. formalin solution. It should not be forgotten that the efficient fixation of the spine is frequently followed by the complete absorption of abscesses and their absolute cure, and even after incision its closure may be dependent upon the use of efficient apparatus. There are two forms of abscess, requiring special mention, the psoas and the lumbar. Psoas Abscess. In the earlier stages of psoas abscess, the operation of Treves may be employed, while the abscess is small; but later, when large, through-and-through drainage must be instituted wherever possible. The operation of Treves consists in making an incision in the lumbar region, twoand-a-half (22) inches long, the center of which is midway between the crest of the ilium and the costal margin and about twoand-a-half (2%) inches from the spinous processes of the vertebrae. The transverse process of the third lumbar vertebra is reached by careful dissection and the anterior layer of the lumbar fascia is punctured by a blunt dissector and the psoas muscle is entered, and enlarged by the finger, curetted and drained for a short time only. Lumbar Abscess. In lumbar abscesses, through-and-through drainage is made by a careful dissection half (2) inch internal to the anterior superior spinous process. The external oblique and internal oblique muscles are divided in the direction of their fibers; the sac is carefully opened and a long probe is passed up, above the position of the sacroiliac junction, at which point a longitudinal incision is made upon it. The rubber drainage tube is attached to it Hot or cold applications to the spine are of much value because of their circulatory influence. Towels wrung out of hot water are applied to the spine over the deformity for a period of three minutes, after which the part is rubbed with ice for the same period of time, each application being repeated once. peated once. These applications aid in the absorption of the edema and are frequently followed by marked improvement. Certain medicinal remedies are of special value in this class of cases. Among many that are to be recommended include mercury and its compounds. Special attention is to be invited to the employment of the iodides, preferably sodium iodide, in large doses. Many cases of paralysis yield to the above form of treatment; but, should this not be successful, the method by forcible correction may be employed, or, after a longer interval (as of a year), the operation of laminectomy should be carefully considered. In regard to forcible correction: The modified method of Calot is the one recom |