the infant be allowed to cough every five or ten minutes, and the cough be rendered as loose as possible by appropriate remedies, it will do better, according to my observations, than when the cough occurs at longer intervals. If it requires sleep, give medicine separately once or twice daily, as in the following formula for a child of one year.

R Liq. opii compositi (Squibbs) gr. xij.

I have seen much harm done by employing stupefying agents which, while they produce sleep, also cause suspension of the cough, upon the strength and frequency of which the safety of the infant depends. The very prevalent opinion among the laity that the cough does no good to the infant unless mucus is ejected from the mouth, needs to be corrected. In order to obtain their full co-operation, I often find it beneficial to explain to the mother or nurse the process of expectoration in the infant, so that they understand that the tubes are freed from mucus as effectually when it is swaliowed, after the cough, as when it is received upon the handkerchief.

Among the agents to fulfil the first indication mentioned above-that of promoting expectoration with the least possible loss of strength-the first place must be given to the ammonium salts, of which the two in com mon use are the carbonate and the muriate. The carbonate is both a stimulant and expectorant, but its irritating property is such that it should not be prescribed in a larger dose than one grain to the drachm; a larger dose frequently repeated may produce gastritis, especially if there be little food in the stomach. It has been known to produce gastritis in animals when administered in considerable quantity, and its irritating action on the fauces can be noticed by anyone who swallows a solution of two or three grains to the drachm. The Curator of the Foundling Asylum has noticed in the cadaver the ill effects of the more irritating ammonium preparations. In one instance in which the aromatic spirits of ammonia had been employed, it was supposed with sufficient dilution, the extent and severity of the gastritis were such that it seemed as if this agent might have hastened the fatal result. The preferable way of employing this valuable agent, to prevent its irritating action upon the stomach, is to prescribe it dissolved in water, and order each dose administered in a tablespoonful of milk. The muriate does not possess the irritating prop

erty of the carbonate, and it can be safely administered in double or treble the dose of the latter, and at short intervals. It is therefore, I think, to be preferred to the carbonate in most cases of severe bronchitis, except at an advanced stage, when an active stimulant of the heart is required.

In this connection, I will state my conviction that the ammonium salts, whether the carbonate or muriate, are not given in sufficiently frequent doses in the practice of most physicians, in severe forms of the disease which we are now considering. If there be marked dyspnea, and urgent need that the mucus be expectorated from the tubes which it is obstructing, I think that the effect is better if the dose be administered every half hour instead of every second or third hour. Half-hourly doses are not inconveniently given if the vehicle be milk.

The muriate of ammonium may, like the carbonate, be administered in milk, but the following is with me a favorite formula:

Fifteen drops, which contain one grain of the muriate, should be given to an infant of three months, and thirty drops, or two grains, to an infant of six months. Physicians, in my opinion, often defer too long the use of the ammonium salts, using for the first days depressing remedies instead. The infant suffering from dyspnea, and requiring a strong and frequent cough to expel the mucus, may, according to my observations, take the muriate from the first day of the sickness with benefit; and every half hour or hour when it is awake. No harm can result from this agent in frequent doses, and for several days, such as might result from the carbonate.

The ammonium salts tend to increase the frequency of the cough, perhaps by the slight irritation which they produce upon the fauces in the swallowing. The muriate may be employed so long as an expectorant is required, and usually with as much benefit as can be derived from any drug.

As regards those other common expectorants which have long been employed, particularly senega and squills, those have been better observers than myself, who have witnessed any marked benefit from them.

It is so necessary, as a means of relieving the dyspnea, to assist the infant to expel the mucus with which the tubes are clogged, when the respiration is much embarrassed, that an emetic is sometimes proper. One should be selected which causes little exhaustion. The syrup of

ipecacuanha may be employed, given with an alcoholic stimulant, as brandy or whiskey. Infants a few months old I have sometimes temporarily relieved by removing with the finger or a swab the mucus that collected upon the fauces. This simple operation produces a forcible cough, and sometimes vomiting, by which a large amount of mucus is expelled. The necessity of sustaining the strength of the patient, and, at the same time, of reducing the fever, has led to the employment of quinine by many, perhaps most, physicians in the treatment of severe infantile bronchitis. I cannot say that I have noticed any marked reduction of temperature from its use in bronchitis or broncho-pneumonia, but it has seemed to me that it has been useful as a heart tonic. Much harm may, however, be done by employing quinine in the treatment of infants, by the use of doses too large. In the adult, according to the sphygmographic observations of Dr. M. Putnam Jacobi, while quinia in a dose of five grains increases the strength of the heart's contraction, a dose of twenty grains enfeebles the contractile power of the heart in a marked degree. According to Stille and Maisch, "Poisonous doses occasion dyspnea and noisy respiration, which is also jerking, interrupted, retarded, and finally arrested." (National Dispensatory.) A dose too large, therefore, would be likely to produce just such symptoms as occur in severe bronchopneumonia. To an infant aged one year, with this disease, I do not give a larger dose than one-half grain to one grain of the sulphate of quinia, every fourth hour, as in the following formula:

R. Quiniæ sulphat.,

Ext. glycyrrhiz.,

Syr. pruni Virginianæ,

gr. xij.
3ss.

- 3ij.-Misce.

Quinine, however, administered to an infant is very likely to cause vomiting from its bitterness, a result which I do not regret in the treatment of capillary bronchitis, because it causes the expectoration of considerable mucus. The second or repeated dose is usually not vomited. It is difficult to appreciate the beneficial effects of quinine in this disease, but that it does increase the contractile power of the heart seems probable.

If the temperature rise above 103°, if the infant have a full and strong pulse and flushed face, and if the lungs are not involved, or but slightly inflamed, antipyrine may, according to my experience, be safely administered, in proper dose, and with beneficial effect as regards the febrile movement. It should not be administered at stated intervals, but according to the temperature, so that, perhaps, only one or two doses daily may be sufficient. When the lungs are implicated, and the patient

has severe broncho-pneumonia, I have seen such pallor from a single dose of antipyrine, in one instance, that I did not dare to repeat it. It seems to me, therefore, that there should be a careful discrimination in regard to the cases in which it should be employed, so that, while vigorous infants, with severe bronchitis, without pneumonia, or with but slight pneumonia, are benefitted by its use, feeble infants, with weak pulse or with extensive pneumonia, and young infants, incur too great risk to justify the employment of this agent, until its exact therapeutic effects are more clearly ascertained.

When the pulse is becoming more rapid and feeble from the extent and severity of the inflammation, the use of the digitalis is indicated as a heart tonic. Not infrequently in severe bronchitis, with the minute tubes clogged with muco-pus, the heart is taxed to the utmost to carry on the circulation. Digitalis may furnish the needed assistance by increasing the contractile power of the ventricles. It is, therefore, an important remedy in a large proportion of cases of this form of bronchitis. Two drops of the tincture of digitalis may be given every second hour to an infant of eighteen months, during three or four days, or longer, if the action of the heart be oppressed so as to require it. But no one of the medicines which I have mentioned is more urgently needed in severe infantile bronchitis than alcoholic stimulation. It may be employed at an early stage when the heart begins to fail, without fear of increasing the inflammation. A rule with me is to give two or three drops of brandy or whiskey for each month in the age of the infant after the third month. It should be given hourly, or each second hour, by day aud by night, when the infant is awake.-Weekly Medical Review.

NEW INSTRUMENTS.

RECTAL SPECULUM FOR HEMORRHOIDS.-The treatment of internal hemorrhoids by injection has become an established operation, almost to the exclusion of the knife, ligature and cautery: the latter operations being not only not devoid of danger, but also so painful as to require an anesthetic. The treatment by injection is essentially painless; there is no loss of blood; it is almost absolutely safe, and the result is as sure and as permanent as by any other method.

Heretofore, however, there has been no speculum well adapted to the operation. But this want is now supplied by one devised by Aloe

The

As seen in the cut, the speculum is about the same as the Ashton, with the point a trifle more conical, to allow of an easy introduction. The slide B is shown partly withdrawn. The mirror A, placed at an angle of 45°, besides acting as a reflecting surface, prevents the mucous membrane from becoming caught as the instrument is withdrawn. point of the speculum is made of hard rubber, so as not to make the instrument too heavy. The speculums are made in three sizes, the smallest being 3/4 of an inch in diameter, by 4 inches long; the medium, % of an inch by 5 inches; the large, inch by 51⁄2 inches. The advantage claimed for this speculum is, that the smallest part of the mucous membrane can be exposed to the exclusion of all other parts. Price, for a single speculum, $5; for a set of three $13.50.

As a companion to the above speculum, the same firm has devised a syringe, the cut of which is given below.

The instrument consists of a silver syringe made to hold 30 minims, one sharp injecting needle A, which has an outer canula, or guage, B, by which the sharp injecting point can be made longer or shorter, at the option of the surgeon. The point C is made of pure silver, with a probe end, and can be used to advantage in the exploration of sinuses, etc. The injecting needle is of gold, making it non-corrosive to the action of any fluid that may be used. The rest of the instrument is made of silver. Price, in morocco case, $6.00.