physical condition of his patient at the time the medication produced results, a reader attempting to follow him and who has a patient in the stage of red hepatization, must of necessity be disappointed in obtaining results. No report of favorable results can be considered of practical value unless accompanied by an accurate clinical picture of the disease at the time of exhibition of the medicament.

The generally accepted pathological beginning of a pneumonia is considered to be a hyperemia of the lung tissue. From this hyperemia develops a stage of inflammation, and the inflammation progresses, if the course continues, thru engorgement, red hepatization, and gray hepatization. Now, if this process can be stopt at any stage, or if any phase of the disease or its preliminary conditions can be modified by medication, it is not the part of wise therapeutics to quibble over hair-splitting arguments as to the exact time at which one is justified in asserting that premonitory conditions have given way to the actual condition classically known as pneumonia; except, of course, in so far as the exactness in reporting the case as above referred to is concerned.

However much we may differ in our opinion as to whether or not the pneumococcus of Fraenkel is responsible for all cases of pneumonia, all will agree that the symptoms of a pneumonia are generally typical, however much they may vary in individual cases. A distinct chill, followed by a rapidly rising temperature reaching its maximum within the first twenty-four hours and falling by crisis within nine days; supprest secretions; flusht face; quickened pulse and respiration; restlessness or delirium; pain in the affected area; cough, becoming more aggravated as the temperature rises; rusty-colored sputum ; together with the signs elicited by methods of physical diagnosis which denote consolidation, go to make up a complete clinical picture. The mortality of such a group of symptoms is high.

These symptoms are familiar enuf to us all. We have met them by antiphlogistic, heroic, expectant, stimulant, and a variety of other tactics. There is little doubt but that therapeutic errors have been made. Certain practicians claim to be "able to abort pneumonia with ease"; "to have run a series of dozens of severe cases without a death," etc. To deny such claims without having observed a case so conducted, or to ignore them as the vaporings of incompetent enthusiasts, cannot be lookt upon as rational, in the face of the ever present and increasing mortality under old forms of treatment. Less rabid assaults upon the methods of those who are practising at variance with our own customs, and a judicious study and trial of their methods, might result in much good being accomplisht.

In our opinion, the practise of the dominant school is, in many instances, too drastic.

We are convinced that, under pretense of "sustaining the heart," many a heart has been driven to physical exhaustion by illyadvised doses of such drugs as strychnin. The disease in itself is rapidly devitalizing in nature, and demands a high degree of skill in nourishing and sustaining the patient, but it is not proven by results so far in evidence that routine stimulation to the limit of the potency of drugs has been of benefit. Nor has the custom of giving a severe cathartic at the outset of the disease any rational ground for its continuance. If the patient is constipated, a gentle laxativ is indicated, but "sweeping out the bowels" is unnecessarily weakening to the patient and is not indicated. To begin "prodding" the heart with stimulants at the outset of the disease "to guard against weakness later on" not be defended. It is quite soon enuf to employ heart stimulants when the heart gives evidence of weakening under its load.

can

We have never had the courage to apply cold to the chest of the pneumonic patient. While the local application of cold primarily induces contraction of the capillaries, its later effect is to slow the blood stream and induce congestion. The final effect is identical with that of acute inflammation. Heat, locally applied, on the contrary, is continuously stimulating to the capillaries, and induces the arterial capillaries to hurry the blood along to the veins. It should be persisted in so long as it is evidently aiding in abatement of the symptoms.

Every precaution should be taken to conserve the vitality and strength of the patient. He should not be allowed to converse with his attendants more than is absolutely necessary. The use of the bed pan should be insisted upon as rigidly as in typhoid fever. Nothing should be done which can in any manner aggravate nervous irritation, decrease vital force, cause pain, or induce weakness. The temperature of the room should be maintained at 70°F. Thoro ventilation is imperativ, but direct draughts are to be avoided. All "fussiness" about the patient should be avoided, and one attendant is ample. We like to keep the air in the room moist, and the vapor may be medicated with carbolic acid, turpentine, or eucalyptus. An improvised vaporizer may be made by placing a couple of nails across the top of a lamp chimney in such manner as to give steady foundation for an ordinary pint tin cup; the lamp is lighted, the cup half filled with water, and the medication added; this should be kept simmering, and the contents be thrown out and renewed every third hour.

If seen early, within a few hours of the initial chill, it is our custom to give a hot sitz bath of twenty minutes duration; or, if this be inconvenient, a hot mustard impregnated foot bath, in a deep vessel. A flannel

cloth is then well greased with lard, upon which is sprinkled eclectic emetic powder,* and this is applied to the chest. This dressing may be supplemented by a hot-water bottle so placed that its weight will not fall directly upon the patient's chest. Such treatment does not prove weakening to the patient; on the contrary, patients express themselves as refresht and relieved. If twenty-four hours have elapst since the initial chill, however, such a bath does not induce the beneficial effects which it does when given earlier, and some patients seem exhausted by it; we do not order it when so much time has passed after the chill.

With a full, strong, bounding pulse, small doses of veratrum every one, two, or three hours is of pronounced benefit. The eclectics use 30 minims of the specific veratrum to four ounces of water, and give a teaspoonful dose at above intervals.

If the pulse is rapid, but hard and wiry, aconite is the drug of choice; but this drug is strongly contraindicated if there is the slightest evidence of weakness in the pulse.

Jaborandi acts happily on the hot skin, nervous excitement, and high temperature of the earlier stages.

A fractional dose of morphin will assist in combating the nausea sometimes noted in those taking repeated doses of veratrum. If the eclectic plan of adding the 30 drops to the 4 ounces of water be followed, a grain or half grain of morphin may be included in the prescription.

If the cough be excessiv, fractional doses of ipecac may be employed. Divided doses of Dover's powders act well. Codein, in doses of to grain, is also efficient. If the catarrhal condition in the bronchial tubes causes distress outside of the coughing, ammonium carbonate or lobelia may be given to facilitate expectoration.

If the pain be severe, wet or dry cups may be tried, but in many instances only the use of morphin will gain rest for the patient.

In severe dyspnea, the use of oxygen lessens cyanosis, makes the breathing easier, and is conduciv to sleep. Dyspnea is not always a call for cardiac stimulation.

If there is evidence of heart weakness, alcohol in judiciously divided doses and strychnin in grain doses are the agents of choice. Digitalis is often disappointing here, and should not be used where a certain effect is so essential. Do not give heart stimulants till convinced that they are actually de*The eclectic emetic powder referred to in the above article is composed of: .6 drams .3 drams

Powdered lobelia. Powdered blood root

Powdered skunk cabbage root ......................................... 3 drams
Powdered ipecac.......
Powdered capsicum

.4 drams ..........I dram

They are now using extensivly a mixture similar to the above compounded with glycerin and clay, much as many of the regulars employ kaolin poultices. See, by aid of the Yearly Index in December issue of each year, references to eclectic emetic powder, and eclectic treatment of pneumonia.

manded; but when deciding on their use, give them so that the effect will not be in question.

The secret of successful treatment of pneumonia lies in gentleness. Many cases will not demand more. If alarming symptoms develop, stronger methods must be employed; but, to our mind, the profession has erred in instituting heroic treatment too early.

Opsonic Therapy.

While it has been the policy of THE WORLD to omit mention of "new things in medicin" until after they had been proven of practical clinical worth, the general and widespread interest in the theories which Wright has built up around the opsonins impels us to give at this time an outline of the theory and the work.

An opsonin, as defined by Dorland, is: "That constituent of the blood serum of a normal animal which renders bacilli prone to be absorbed by phagocytes."

Sir A. E. Wright, assisted by Doctors Stewart R. Douglas and J. Freeman, have been for some time past experimenting and working along the line of developing a serum therapy in accordance with the facts regarding opsonin that are now known. They do not perform their experiments upon the lower animals, but work with men and women; their "laboratory" is not an isolated back room, but is the pathological laboratory of St. Mary's Hospital. They have been averaging about 30 patients, each reporting three

times a week.

According to Wright's theory, this normal constituent of the blood, opsonin, acts upon such germs as gain entrance to the blood in such manner that they more readily succumb to the phagocytes. In the blood of man a variety of opsonins circulate, each of which is capable of acting against a certain pathological organism, should such organism reach the blood stream. In health, this amount of opsonin remains at a certain quantity, known as "the opsonic index." Wright has devised a method by which the "opsonic index" for any given pathological germ may be ascertained. Fresh leucocytes from human blood, the serum to be tested, and the bacteria in question, are blended; after allowing time for incubation, this mixture is stained and examined under the microscope. The germs are found within the phagocytic leucocytes, and by counting the number of germs in a number of leucocytes, making an average, and comparing it with serum which has not been so blended, the "opsonic index" for that germ is establisht. If infection with a germ occur, the opsonic index for this germ is lowered; or, as stated by Wright,

then the serum is in a negativ phase of opsonic power." Hence, in tuberculosis infection, the tuberculosis index is lowered. In

cases where an individual recovers from an infection, it is held that he has elaborated enuf opsonin to overwhelm the invading germs and admit of the phagocytes absorbing them. Therapeutic measures, when successful, act by increasing opsonic power. Therefore, Wright treats disease by vaccines which augment the indicated opsonic power to be desired.

To prepare his vaccines, he grows pure cultures of the germ on an agar-agar surface, and then kills them by raising the temperature to a height of 140° F. for thirty to sixty minutes. This culture is then suspended in normal salt solution, and lysol is added as an antiseptic. By experiment, he has learned the dosage, in numbers, of bacteria. In handling tuberculosis, instead of preparing the vaccine by his own method, he prefers to use the new tuberculin of Koch.

After an injection of the vaccine, observations show that the opsonic index has fallen even below the level to which it had been deprest by the infection; i. e., to a "negativ phase." Then, generally within three days, the opsonic index rises, reaches normal, and even exceeds it; this is the "positiv phase.' The dose of vaccine is not repeated till the index falls, thus indicating that the effect of the vaccine is passing away. Sometimes a cure is effected by one injection of the vaccine; at other times, in more obstinate diseases, the inoculation is repeated at intervals.

At this time, the use of the opsonic method must be restricted to those who are adept in bacteriology and in the use of the microscope, and who have unlimited clinical and laboratory facilities. The method is not at all applicable in the hands of the general practician. It is entirely within the range of possibility that as the method is further elaborated and perfected, that it may in time become available for use among general practicians, in some such manner as inoculation with the virus against small-pox is now employed.

Wright is not a cheap notoriety seeker. His colleagues on the other side of the water hold him in high esteem. Even the surgeons are glad to refer their unsuccessful and inoperable cases to him. He is fearless of any disease, and will cheerfully prepare his culture (which he prefers to make from germs taken direct from the body of his patient) and make a trial of any case. His greatest successes, so far, appear to be in tuberculosis of the skin, phlegmons, inveterate acne, furunculosis of long standing, lupus, various streptococcic infections, and in malignant tumors. uses a vaccine prepared from the micrococcus neoformans in the latter cases. It is too early yet to forecast the ultimate results in sarcoma and carcinoma, but undoubtedly the patients become more comfortable under the treatment, the tumors decrease in size, and their general condition improves.

He

THE WORLD has never been a "rainbow chaser"; our files will prove that we have not taken spasms over every new fad in medicin, and in consequence we have had little to retract with the ebb of the tide; we have not been to Europe to learn at the feet of Wright, and the information here given is gleaned second hand from those who have seen his work. But, the reputation of the man; the simplicity of the theory upon which he works; the undoubted successes which have so far attended him; and above all, his courage in his convictions, appeal strongly to us. If his theories and practise will stand the test of time, he has made the greatest advance stride practical medicin has ever known, and he has solved the vext problem of immunity forever. No glory is too great for him, if his claims are establisht.

We cannot do better than to close this sketch with a quotation from his own words, taken from an article by Dr. Chas. D. Aaron, in The New York Medical Journal, Dec. 1, 1906, as follows:

"In view of the very favorable, and what is more important, uniformly successful results which can, as will have appeared, be obtained by the therapeutic inoculation of tuberculin carried out under the safeguards explained, and in view of the fact that not less favorable results can be obtained by the aid of the corresponding bacterial vaccines in the treatment of localized infections by other microorganisms, I do not hesitate to contend that we have in the power of raising the anti-bactericidal power of the blood with respect to any invading microbe, out of all comparison the most valuable asset in medicin. I would, in view of this new asset in medicin, fain induce the surgeon to abate somewhat from his conviction that extirpation and the application of antiseptics offer in connection with bacterial infection the only possible means of cure; I would have the surgeon resort to extirpation only when the physician tells him that all other means have been employed; and I would have the physician assume everywhere the role of an immunisator; and I would have him defer handing over his patients to the surgeon before he has tried in every case of localized bacterial infection, which is unassociated with immediate risk to life, the therapeutic inoculation of the appropriate bacterial vaccine."

A Thought in Connection with Cancer and Pneumonia.

The battle against many diseases has been valiant and highly successful. For example, the tuberculosis mortality has been markedly decreased, and also the mortality of children under five years of age. Better control of epidemics, and better public and private hygiene, have greatly reduced the death rate. But at the same time we have an increase of deaths from pneumonia and cancer. Now let us think for a moment. People have to die from some cause. If they escape one danger, they are threatened with another, and another, and so on, until finally they must succumb to something. Cancer is a disease of senility; pneumonia is particularly dangerous to the aged. As the percentage of people who reach an advanced age increases, it is but natural that the mortality from the diseases which specially affect, or

threaten the lives of, the aged, should increase. Let us think of this in connection with cancer and pneumonia, which are frequently held up to us as threatening specters. And let us also realize that the average human life is growing longer as the sciences of medicin, hygiene, and sanitation advance.

Medical Clubs.

Doctor, before you put the 1906 volume upon your shelf for future reference (we presume that it is bound in a WORLD binder), please read again the article beginning on page 256, July issue; also the article on page 387, October number, entitled, "It Pays to 'Quit Your Meanness.'" You should belong to your county medical society if you have one; but whether you have or not, it would be well for you to help form in your community, along the lines suggested in the above articles, an organization consisting of all legal practicians, regardless of school, for business and social purposes, rather than scientific purposes. Few doctors realize the possibilities for pleasure and profit in this direction. It would wonderfully raise and broaden the professional and personal standard of the medical guild in most communities. Call it the Smithville Medical Club; or the Brown County Medical Club; or THE MEDICAL WORLD Club, if you choose. If sufficient interest is manifested, we will get up the framework of an organization that may be used in any community. We trust that this suggestion will be the germ that will grow into a powerful movement for the good of the medical profession all over this great country.

The Sturdy Rank and File.

The ethics of some of the leaders of the profession may be summed up this way: "Do as I say, and not as I do." An editorial in the December Medical Era shows up the advertising propensities of three prominent medical men in St. Louis; prominent in the local societies and the medical colleges there, and "in good standing" in the local, state, and National societies. They are Drs. William G. Moore, Clarence M. Nicholson, and Bransford Lewis. Some of the "leaders" think they can do anything they please, or whatever may be to their interest financially, while "the common herd" must "be good." We congratulate the editor of the Era upon his courage. Let us demand the same observance of ethics on the part of the "shining lights" in the profession, as of those in the humbler walks. The traditions of the profession, and its real ethical spirit, are better preserved by the sturdy character of the rank and file than by those who are avaricious for fame, leadership-and money.

"I get more actual working knowledge from THE MEDICAL WORLD than from any other journal that comes to my desk."Dr. J. J. Rose, Marshall, Ill.

Hard Times Among Doctors in England. It is said that the doctors of England are in a distrest condition financially, owing to unusual good health. There has been no serious epidemic of disease for several years. Thus the greatest blessing to the peoplegood health-carries with it distress to the doctors. The reduction of disease is doubtless due largely to the efforts of the medical profession to promote the public health. Thus the medical profession unselfishly strives to cut off its own income.

But in connection with the above facts, here is a thought: Even when the general health is good, Christian science, magnetic healing, osteopathy, etc., thrive, just the same. This shows that there is always plenty for us to do, if we will only do it. Not that we should join the ranks of mystery or go into quackery of any kind. There are always chronics and hypochondriacs who are searching for something to help them. The doctor turns them off, perhaps sometimes with remarks akin to ridicule. Naturally they then seek more sympathetic quarters, and pay well for benefit, which is either fancied or real. Attention to psychic and mechanical therapy during dull times would pay, both by direct returns and by increasing the confidence of your clientele in your abilities. The practise of medicin should not consist solely of pills and powders. A place should be given to baths, massage, dietetics, exercise, etc.

Keep Your Share of Our Prosperity. Perhaps some of the steady, non-speculating doctors are getting tired of our editorials on this subject, but they make a mistake when they conclude that other doctors keep their equilibrium in the midst of the many grandiloquently presented propositions which assail them. No one would be happier than I to see this matter dwindle down to the little end of nothing; but in spite of my assaults, my "investment" mail, and that of other medical men all over the country, as judged by the quantity of it that they send to me (thanks for this enlightenment), is steadily increasing. Maybe the schemers want some of the money that usually comes to doctors in pretty good "chunks" about the close of the year (I am writing this Dec. 15). Be that as it may, many of them are after doctors specially. A certain marble company is particularly persistent (do they think doctors can increase the demand for marble for tombstones ?). have had a doctor or two at the quarry to "investigate," and they are using these doctor reports as a means to get other doctors in. Sometimes the expression "decoy duck" is used in connection with this method of promotion. What do doctors know about the quarrying and marketing of marble, and the various competing sources of supply? Last

They