less if not harmful in any phase of the disease, if used at all, they should be tonic expectorants, as nauseants tend greatly to increase the depression in protracted cases, where expectoration is profuse with rapid emaciation. Malt extracts, or the Hypophosphites, compound, or both in combination, together with stimulants and a generous diet, should anorexia be a marked feature, as is often the case. The liquid peptonoids, with beef, milk and gluten, with or without creosote, will be found an excellent remedy to sustain the patient, until such times as the appetite returns.

Pneumonia at High Altitudes.

BY H. GRANT SIGMAN, M. D.,

ROCKY FORD, COLORADO.

O much has been said, and so great fear is prevalent of pneumonia at

S the writer ample

tion while practicing at Cripple Creek, during 1895 and 1896, is prompted to give his views on the subjoct, endeavoring to show, briefly, that neither the climate nor the altitude were active factors of the disease.

That there was a great deal of pneumonia, and that the mortality, pro rata, greatly exceeded that of other places will be readily admitted, yet research reveals the fact that those who so dreaded this disease and allowed their fears to keep them away from the Camp, did so, without reason, and that they could have, with safety, dismissed the idea which possessed their minds, that to go to Cripple Creek meant pneumonia certainly.

Observation shows that among the commercial classes pneumonia was scarcely more prevalent than elsewhere, for their occupations and mode of living were not especially conducive to an attack. The question will now be asked, "Why then so much pneumonia?" which is readily answered by saying, "Because the habits and occupation (mining) of many in that district were excellent aetiologic factors." Many people came to Cripple Creek, attracted by the "boom" with scarcely enough money to reach the Camp, and none with which to provide the necessary comforts, so were forced to seek shelter and repose in rude sheds, poorly protected from the weather, in freight cars, or perhaps in the open air, and thus "catching cold" were well prepared for an attack of this disease. Again, the miners, working all day, hundreds of feet underground, at a temperature much warmer than the surface temperature, chilled upon coming to the surface, or while homeward bound, and pneumonia found in them an easy prey. More than that, these men working in deep and poorly ventilated shafts, on account of the impoverished air, often developed a pythogenic pneumonia. Living in rudely constructed cabins, with little protection from the weather, was also an exciting cause in many cases, while another source of the disease was to be found in those, who, leaving the saloons intoxicated, spent the night asleep on the edge of the sidewalk, or in some doorway.

Given a half dozen such factors, any of which would admirably serve as an exciting cause for this malady, is it not reasonable to state that collectively, these agents would account for the extreme prevalence of pneumonia without attributing any direct influence to the climate? Granting that the diplococcus pneumonia is the predisposing factor, in accordance with the germ theory, here we have an abundance of exciting causes to impoverish the system and render it vulnerable to the attacks of the pathogenic micro-organism.

Much was said of the speedy fatality of pneumonic cases, it being generally supposed that the majority of cases succumbed in from one to four days. This idea existed because many when taken sick summoned no medical aid until something especially serious arose in the course of the disease, or perhaps, while sick, lay in the same poorly protected cabins in which the disease first found them.

It is admitted, that even in an ordinary case, without vicious and unhygienic surroundings, at an altitude of 10,000 feet (such is the altitude of Cripple Creek) the liability to cardiac embarassment is increased, showing its effect in some measure upon the mortality.

To briefly summarize, in conclusion, the lack of proper shelter and the principal industry (mining) were the prime causative factors, while the high altitude had a moderate tendency toward increasing the mortality from this disease over other places at a lower altitude, owing to the liability to heart failure as above mentioned; that the morbidity from this affection, among the commercial classes (those who took the same care of themselves that they would in a lower altitude) was not increased over that of places at a lower altitude, and that by early rational treatment, invariably including early support of the heart the mortality of pneumonia in a high altitude compared very favorably with that of any other place.

DR. BRANSFORD LEWIS, editor of our department of Genito-Urinary Surgery, will be at "at home" in Suite 627, Century Building after July Ist. The Century Building is by far the most elegant office building in the city, and the office suites therein are models in every respect. Dr. Lewis has so long been at 1006 Olive street, that it will not be surprising if his friends find it difficult to disassociate him and that number. Dr. Lewis belongs to the progressive element, however, and believes in keeping up with the trend of advancement.

THERE are now in Pennsylvania 25 city boards of health and 532 borough boards. The jurisdiction of these boards covers probably not more than one-twentieth of the area of the State, leaving more than 40,000 square miles of its territory still unprotected by local boards of health. The present population of the State is estimated to be fully 6,000,000. Not more than one-half of this vast population is yet under the sanitary care of local health boards.-Sanitarian.

The Value of Hydrocyanate of Iron (Tilden) in

Epilepsy.

BY C. A. BRYCE, A. M., M. D.,

RICHMOND, VA.

Professor of Surgery in the National College of Electro-Therapuetics, Indianapolis, Ind; Surgeon-in-Charge "The Hickories;" Editor "Southern Clinic:" Author Bryce's Practice of Medicine, etc., etc.

NFORTUNATELY for the epileptic, most physicians treat these cases after a stereotyped method, and feel that they have done all required of them when a patient is placed on a saturated solution of some of the bromides, with directions to use, ad infinitum. It is not to be wondered at that so few cases of epilepsy are cured, for after a temporary amelioration of symptoms most of these cases go from bad to worse.

A careful examination of many cases will reveal the fact that anæmia, nerve exhaustion, and weak heart have much to do with the production and continuance of the trouble. I will cite a case or two bearing upon this point:

Nearly eighteen months ago I was called to see a half-grown boy living near my sanitarium, who had been having epileptic fits for a year or two, and who at the time of the call, had been in convulsions for eight or ten hours. It seems that he had been attacked while up a cherry tree, and had fallen out, without receiving any serious injury, however. I could find no special cause for the attacks, and his father stated that they came on usually after exertion. This time it was evident that they followed the climbing of the tree. He had been subjected to the usual bromidism, and had been rendered anæmic by their over-use. I ordered a more generous diet, the withdrawal of all bromides, and placed the patient on hydrocyanate of iron, prepared by the Tilden Company, of New Lebanon, New York, and St. Louis, Mo. The boy had a few more trifling attacks for a month or so, and now he has improved so much that he is taking nothing, and will not use anything more, unless there should be a recurrence of the convulsions, which seem to be entirely relieved.

Mr. H., about thirty years of age, had been subject to epileptic seizures for ten years, but they were always worse when over-taxed. Of late, his duties as bookkeeper had been very arduous, and he was having convulsions every day or two, when I was called to see him. I corrected his faulty digestion, made him take to his wheel a portion of every day, and put him on Tilden's hydrocyanate of iron. He has continued to improve steadily, and has gone three months (up to the present writing) without an attack.

In all epileptics, hysteroid and other nervous conditions, characterized by impoverished blood, languid circulation, or faulty heart action, hydrocyanate of iron (Tilden) is of inestimable value.

DR. J. D. GRIFFITH, of Kansas City, was elected President of the National Association of Military Surgeons, at its recent meeting in Columbus, O., and Kansas City was selected as the next place of meeting.

Medication in the Gouty and Rheumatic Diathesis.- By Geo. W. Tobias, M. D., New York.-While there can be no doubt of the value of colchicum and the salicylates, the depressant action of colchium preparations and the uncertainty of their action, has caused them to be regarded with suspicion, especially by the younger generation of physicians. Where salicylate of soda produces no beneficial result in the rheumatic diathesis, it may be laid down to the origin of the drug, and in all cases I have found that that derived from carbolic acid and CO2 is vastly inferior to the salicylate existing as salicylate of methyl in the sweet birch. This is the most potent of salicylates (synthetical or organic), and is perfectly safe and free from all objections. An elegant and perfectly safe preparation of the above drugs, and one which in my hands has never yet failed me, is colchi-sal (colchicein methyl salicylate). This drug is dispensed in capsules of 20 centigrammes, and each contains exactly one-fourth milligramme of the active principle of colchicum. The following cases illustrate what results follow its administration: Case 1.-Mr. F. W., aet. 35, came to me with a history of inflammatory rheumatism of several years duration. He had for four weeks previous to my seeing him, been suffering from a very severe attack, which kept him in bed. Salicylate of soda and routine treatment only allowed him to get about on crutches, and no further improvement could be obtained. I found the urine very heavy, acid and full of deposit. The previous treatment was stopped, and I ordered three capsules of colchi-sal every four hours. Within twenty-four hours there was decided improvement, and on the third day he gave up his crutches, and in ten days returned to business. He has since married-and although two years has elapsed, has had no recurrence of the trouble. Case II.-Mr. Č. B., aet. 40, gave a long history of rheumatic arthritis and pain in the lumbar region, with contraction of the muscles around the joints. The patient has no syphilitic taint. The urine was very acid with dense deposit. The pains usually came on after retiring, and appeared to be due to the heat of the bedding. Alkaline and lithia treatment gave little or no result. I ordered hot fomentations to be applied to the limbs and back and three capsules of colchi-sal at bedtime and one every hour during the day. Within 36 hours there was a decided change for the better, and I reduced the dose to two every three hours, and within ten days the patient was almost free from pain at night, and quite so in the day time. While the final recovery was slow, there has been no relapse since. Case III. Mrs. D., aet. 50, widow; has been enjoying fairly good health since the menopause, which occurred six years previously, except during damp weather, when she complains of pains in the joints and great stiffness, which prevents her stooping. On account of some heart trouble, I feared to give the salicylate of soda, and lithia and alkaline waters were of no avail. Colchi-sal, in doses of 20 centigrammes every two hours, gave prompt relief, and in two days she was perfectly well again. She has in rainy weather a tendency to the same trouble, but two or three capsules of colchi-sal suffice to ward off an attack.

Amongst a number of other cases, I recall a gouty patient in which colchi-sal acted wonderfully at a critical stage of the disease, which consulting physician feared might be fatal, and this I take to be due to the elimination of uric acid by the natural methyl salicylate in combination with the active principle of colchicum-which alone has to be used with much caution. In all my cases, no excessive catharsis or untoward effects were noticeable. The value of colchi-sal is not even confined to the human race, for I have tried it on my colley, who had lost complete use of its hind limbs, and which the veterinary thought a hopeless case; a few capsules put him all right in a few days. It is important that the patient gets colchi-sal, and not a mixture of colchicine with a mere synthetic methyl salicylate (the artificial preparation costs less than half the natural product), for disappointment and even dangerous symptoms may result from substitution. The genuine preparation, moreover, can be easily and cheaply dispensed by any pharmacist.

Irritation from the Urine in Diabetes-A Suggestion in its Treatment. The presence of sugar in the urine of diabetic patients was not discovered until 1650, although the disease itself has been recognized before the Christian era. Later researches demonstrated that it was the sugar which really made the disease prominent. The excessive presence of glucose in the urine is the characteristic symptom of diabetes, and with it we note an increased quantity of urine secreted. This leads to frequent micturition, which by reason of the presence of the sugar, soon irritates the labia in women and the meatus in men. This irritation may extend down on the thighs in women, and become very hard to control. Again, in men it may set up urethritis, which is exceedingly painful, and greatly disturbs the sleep and rest of the patient. In five cases of diabetes now under observation, three have had this irritation (two males and one female)-one male and the female have suffered greatly. To meet this symptom, the reduction of the amount of glucose secreted is of the first importance, and this has been done in the general treatment of the disease. The amount of urine passed was also reduced. But to meet the special irritation of the mucous membrane, maizo-lithium has been freely used. In the male it soon overcame the disturbance, as it acts locally upon the membrane, and, besides, renders the urine less irritative. In the female, where constant breaking the rules of diet was a factor, the itching, burning and eczema have been more or less present. But so long as maizo-lithium was used, these symptoms were held in abeyance, but just as soon as it was discontinued, then would follow a night of suffering. For several weeks now, this case has continued to improve by being more careful in eating, but it requires the use of maizo-lithium to permit of relief from the itching and burning. F. P. N.

Bronchitis in Old Age.-

B Ac. benzoic..

Ac. tannic ...

...

. gr. iv .gr. ij

Ft. caps. No. i. Four or five times daily.-Le Prog. Med.