wherever that may be. In most of these In most of these cases belladonna will materially assist in aborting the difficulty or in rendering it of a mild character if given in proper dosage.

In prescribing these remedies certain principles should be obeyed that at once reward the prescriber with successful results. One cardinal principle is that it is essential to keep the circulation and temperature as near as possible to the normal point. The severity of any acute disease is in proportion to the variation of these conditions from a normal standard, and in proportion as we are able to bring back to and keep these to a normal standard, we may correct the processes of disease which influence these conditions. Fever may have a simple cause, which, if removed, and the temperature controlled, will leave no impression upon the system, but if allowed to persist will induce localized inflammation. The severity of acute inflammatory disorder when once induced, depends upon the severity of the fever, and in proportion as the practitioner is able to control the fever is he able to control the inflammatory processes also. These facts are especially true in children and in the aged and should always be observed.

The action of the special sedatives in their influence upon fevers and acute inflammatory conditions is in accord with the following exact indications.

Aconite is demanded when the skin is hot and dry, when the pulse is sharp, hard and quick, when there is chilliness up and down the spinal column with suppressed secretions. Gelsemium is demanded when these conditions are present with great nervous excitability, restlessness, flushed face, bright eyes with contracted pupils. Dilated pupils are usually present when the eye is dull; when there is an inclination to stupor; when the skin is cool. When these conditions are present, belladona in small doses should be given in conjunction with the sedative.

When there is violence of muscular action with sthenic fever, with large full bounding pulse, high temperature

and engorged capillary circulation of the skin, especially of the face and neck, veratrum will be found to be the best of tedatives. We have no remedy so posisively reliable as veratrum when prescribed with a thorough knowledge of its influence. It is a powerful poison, but so regular and uniform in its action and so devoid of erratic and unaccountable or uncontrollable influences that it may be given within the limits of its maximum dosage with perfect safety. It is not rapid and violent in its first effect; it is not accumulative; is quickly eliminated, and the effects of single doses are transient. It is really the safest of our active agents. While aconite is indicated most often in children, this remedy exercises its best influence in adults who have been previously strong and healthy.

When with high temperature there is involvement of the lungs or bronchi with short, sharp, hard, quick cough, inducing general pain or sorenes upon inspiration, or if there are evidences that the pleura is involved with sharp, quick, acute pains, bryonia will exercise a most positive and reliable influence; the same facts are true of peritonitis of childhood where there is pain upon movement, sharp, quick and cutting, with involvement of the serous membranes, also when the same indications are present with other local inflammations. When inflammatory action shows itself with sharp, hard pulse and a circumscribed bright redness of the skin, with burning pain and soreness, rhus toxicodendron is the remedy: Often with these phenomena there is a burning pain in the eyes; sharp supra-orbital pains; the mucous membranes of the mouth are red; the tongue is dry and elongated, narrow, with red tips and edges, and covered with a brown coat. The agent will meet all these indications alone, but if combined with baptisia, we accomplish the result in a shorter time.

It will be seen from these few remarks that this study is necessarily an interesting and valuable one. I could continue these indefinitely, but will reserve for a future paper the consideration of remedies which act upon special organs, such as

the comparative study of heart remedies, or the comparative study of uterine remedies, or the specific influence of acids

Communications.

with the belief that these remarks will be received, not. in every case as new, but as encouraging to a greater study of the minutest detail of the action of single drugs upon the human economy, which is exceedingly important if therapeutics ever becomes an exact science.

The action of compounds, of proprietary mixtures, and incongruous preparations does not conduce to an exact knowledge of therapeutics, but seriously detracts from such a knowledge.

103 State street.

[This paper will be followed by others by Dr. Ellingwood, giving a comprehensive review of direct drug action. -ED.].

covery.

TO THE MEDICAL COUNCIL.

About six years ago I was called to see Mrs. R., aged 43 years, and mother of four or five children. She had been under the care of a Homeopathic physician for several weeks. for several weeks. I found her in an extremely weak condition, vomiting almost constantly. The slightest amount of food, and remedies given to control the vomiting, were immediately thrown off by the stomach.

I found it necessary to nourish and stimulate her by the bowel; also to give all medicine the same way, for four or five days. After this time, I began by

By ABRAHAM GOLTMAN, M. D., C. M., L. R. C. P. and L. R. C. S., Ed. L. F. P., Glasgow. New York City.

I desire to state briefly the measures I have used with marked success in those

cases where there is rapid pulse, high temperature, respirations hurried, and coma; where the child is on the eve of collapse. I refer, as an example, to a little patient of mine, 8 months old:

Ist. Gave drop-doses of spts. ammon. aromaticus hourly, injections of strychnine in very minute doses every 4 hours until slight twitchings of the muscles occurred, and then stopped the drug. I placed the infant in a warm bath, and rubbed it well so as to promote the action of the skin, for about 15 minutes, drying it well, and then applied a cold towel around the whole body. The shock was manifest, but the addition of cold and hot water douches poured from a height, on the chest, stimulates the respiratory center. It is remarkable what an effect it has. If no marked improvement is noticed, continue the same treatment for a longer period.

I have recorded, last year (Pediatrics), a case of pneumonia in an infant 7 weeks old, whose life was despaired of, but who, under the above treatment continued faithfully for 48 hours, recovered.

100 W. 114th St.

she retained, by the stomach, gradually increasing the diet, until she fully recovered at the end of four or five weeks.

Throughout the attack, she suffered great pain throughout the epigastric region, but at no time was it referred directly to the liver. After resuming her usual duties, she suffered frequent attacks of indigestion lasting from three days to a week, each attack growing more severe. After everything given failed to relieve her, I was compelled to give relief by morphia and atropia hypodermatically. This condition lasted four or five years. After two or three years' suffering from these attacks of gastric disturbance, the pain was located more particularly in the region of the liver, resembling biliary calculi. After the acute pain had subsided from hypodermics, there was a soreness over the liver, with shooting pains through the back, under the right scapula. This soreness continued with no relief whatever, rendering life miserable.

Some two years before operation, I diagnosed the case as one of biliary calculi, and recommended operation, which was seriously objected to by the husband, saying that he did not believe that was the trouble. After a long period of suffering, I suggested that we call Dr. John

B. Deaver in consultation, which was agreed to. He confirmed the diagnosis, and recommended operation, saying that she would never be any better until this was done. She was taken to the German Hospital, where Dr. Deaver removed three stones from the gall-bladder as large as as good-sized marbles. The gall-bladder was also removed, and the wound closed. The patient made an uninterrupted recovery, and left the hospital in about four weeks after operation, perfectly well.

The disturbance of the stomach, which lasted over a period of several years, in my opinion, was due to the presence of stones in the gall-bladder. Notwithstanding, during the first few years there was nothing to indicate any disturbance of the liver, the patient never having the least trace of jaundice.

L. S. WALTON, M. D.

Jenkintown, Pa.

Small-Pox in the West.

TO THE MEDICAL COUNCIL.

For almost two years the western portion of the United States, in variously scattered districts, has been undergoing a siege of small-pox during the winter and spring months. Where the disease came from no one seems to know, but there seems to be a widespread belief that it was brought to this country from Cuba, by the United States soldiers, and then transmitted to the West by discharged soldiers in the East.

Last winter and spring but few cases of small-pox were reported here in Missouri, and these variously scattered cases were promptly quarantined and the disease quickly eradicated, but this winter it has come again, and with a vengeance, too. From all sections of the State come reports of the disease, St. Louis alone reporting two thousand cases, and here in the central southwestern part of the State, not only the towns, but the country districts as well, report many cases.

The disease is in a very mild form-so mild, in fact, that many of the doctors, even, are skeptical as to its being smallpox; and this one fact accounts for the widespread contagion. Doctors called to

For

the bedside of a patient, even after the eruption is well out, often make a mistake in diagnosis and, as a result, sympathizing relatives and neighbors become exposed and carry the disease home to their families. In many places, where the disease is raging, the towns and families are not quarantined until forced to do so by the State Board of Health, and it is a common occurence to meet on the streets those who are in a condition to communicate the disease to others. just such negligence as this the doctors are responsible, for they know the disease is contagious, and even if some of them do deny that the disease is smallpox, they should, in the interest of humanity, help to stamp out the pest. Here in this county (Benton) there have been, perhaps, two hundred cases up to the present time, aud had the necessary precautions been taken in time, I am confident the disease could have been confined to one or two families. Doctors, like all other mortals, are fallible; all are liable to mistakes in diagnosis, and at times perfectly excusable therefor; but no doctor is excusable for negligence in allowing small-pox to spread when it is in his power to eradicate it or at least to confine it within bounds

The disease, as I have already said, is mild, but the patients present every symptom of small-pox in a light form. The onset is generally sudden, beginning with a chill, and followed by a rise in temperature, sometimes reaching 104°. More or less aching in all parts of the body, and intense pain in the small of the back, which generally continues until eruption appears. The eruption appears on the third or fourth day, generally, and passes through all the typical stages of the variola eruption. With the appearance of the eruption the temperature declines to normal. and in many cases there is no secondary fever, while in others the temperature rise is considerable. In from two to three weeks the patient has entirely recovered, and in no case have I seen permanent scars remaining.

One peculiarity of the disease is that quite a number of those who are exposed do not contract the disease at all, but in

most of these cases I find persons who have been successfully vaccinated within the last few years. The disease is undoubtedly small-pox, and the sooner we, as physicians, realize this fact and join hands with the Boards of Health to eradicate the disease, the better it will be for the medical profession and for the cause of humanity.

WILL P. BRADLEY, M. D.

Palo Pinto, Mo.

opening which was much hardened-an involucrum. There was very little tenderness and no loss of function.

I decided to open it and remove any dead bone I might find, but the parents would scarcely submit to such a procedure just then. In the meantime, I commenced with syr. feri. iod., and to inject the cavity with a 2 per cent. solution of formalin about twice a week, the little patient experiencing great pain for a few minutes after. Sometimes I would use

Abscess.

TO THE MEDICAL COUNCIL.

I wish to call your attention to the experience I have had with 2 per cent. formalin solution in a case of necrosis of

the humerus.

Case.-A little girl of about nine years old about a year ago caught what we designated as a bad cold, and in course of four or five days settling in the right shoulder, including the whole area of the deltoid and axilla, forming a large abscess. I was called to the case to alleviate the insomnia and pain. My diagnosis and treatment was short and decisive-opening the abscess at once in two places at its lowest extremity. About a quart of lemon-colored pus escaped. I washed it out with a weak carbolic solution and put in drainage of bichloride gauze, giving a tonic of elixir of iron, quinine and strychnine, and in less than ten days the patient seemed almost well, and the parts had receded to their normal size and appearance, excepting a slight serous discharge at one of the openings; but of course we all took it for granted that that would stop running and heal up in a few days. Not having heard anything from the patient or her parents for eight months, they remarked to me one day that Nellie was doing well and going to school, but there was a small running sore still on her arm where I had opened it. I probed the opening, which was close to the insertion of the deltoid muscle, and found a cloaca which ran obliquely up into the bone about two and one-half inches upwards. Upon palpation I found quite an area around the

an aspirating syringe, and in less than five weeks the thing had healed. I was always careful to insert the needle clear down to the dead, rough oavity, and rotate a little in all directions slightly, while pressing on the piston of the syringe. There is no sign of the return of the disease now, going on three weeks, and the patient looks well nourished and healthy.

I had a case of necrosis—or at least I took it to be-of the bones of the middle ear, some time ago, and by two or three applications of cotton moistened in 2 per cent. formalin, after a thorough dry mopping out, the trouble disappeared like magic.

I will say, however, that I depend a good deal on tonics, as syr. fer. iod. and syr. hypophos. comp., alternating, to improve the blood and build up the tissues in such cases, in addition to the local use of formalin.

Elmore, Minn.

DAVID GORDON, M. D.

A Case of Tubal Pregnancy.

TO THE MEDICAL COUNCIL.

In November the writer was consulted by Mrs. L by Mrs. L for pain in left ovarian region, and gave the following history:

Patient 29 years old. In May, 1901, just after what she thought was a regular menstruation, while lifting a heavy weight, felt something give in lower abdomen, had severe pain and collapsed, recovering in three or four days without treatment, except morphine for pain. A week later, had hemorrhages from ulcers, and consulted a physician, who prescribed some

hemostatic without examination. Growing worse, patient was taken to a hospital, in June. The uterus was curetted and finding decidual membrane, the physicians diagnosed pregnancy in left tube, with rupture at second mouth. Advised no operation, but awaited developments. Hemorrhage continued, and in addition, pain, fever, tympanites, constipation, with swelling in wall of abdomen iminediately above pubes. Presented all the appearances of an abscess, but was permitted to develop for two weeks, when the physicians decided to operate, prepared the patient, gave chloroform, and were ready to proceed when they found the abscess had broken into the abdominal cavity. Knowing that most, if not all, cases die after such an accident, the physicians with alacrity left the operating-room, giving orders to carry patient back to her room to die. But the patient, on recovering from the anesthetic, and hearing from her husband of the state of affairs, being self-willed, and obstinate, decided to live, if for nothing else than to fool the doctors. And live she did, although her suffering was horrible. General peritonitis developed, the pus was absorbed, to be eliminated through stomach and bowels by vomiting and purging. The patient progressed very slowly towards recovery, but in July the bowels became constipated, chills, sweat and fever followed, tympanites returned, severe pain and swelling in left ovarian region, and abscess No. 2 broke into the bowels and greatly surprised the attendants, who had not diagnosed it.

The contents of this abscess were foul and very much decomposed, showing what seemed to be placental tissue. The patient left the hospital in August and recovered a fair amount of strength and flesh; the menstrual periods returned, and in November she came to the writer for pain in ovarian region, commencing after a sudden strain, continuing for two weeks before I examined her. On palpating abdomen, the left ovarian region was found tender, percussion gave dullness; vaginal examination showed a tender, doughy swelling in cul-de-sac, extending to left, including ovary and sigmoid flex

ure of colon; uterus immobile. Diagnosis, pelvic cellulitis, with possibility of pus formation; abscess, if present, would probably break into bowel.

Prescribed calc. sulph. to saturation, uterine tonics for pain. Triple arsenates with nuclein as general tonic and a saline laxative. On the third day, abscess broke into rectum, with quick relief of all symptoms. Advised continued use of above drugs; patient progressed rapidly to good recovery.

R. J. S.

White Sulphur Springs, Mont.

Treatment of Rubeola with Belladonna.

TO THE MEDICAL COUNCIL.

This paper shall be limited to an outline treatment for measles, and shall not consider the etiology of the disease further than is necessary to make clear the treatment of certain conditions of the patient.

It is agreed that to bring the eruption out upon the surface, and maintain it there, is the proper thing to do in all cases, but the manner in which it is done determines the efficiency of the treatment. The longer the rubeolous poison. remains in the system before eruption, the greater the amount of poisoning, and the severer the constitution is taxed in relieving itself of this offending matter. Hence the necessity for promptness in assisting nature in this work, and the nearer it coincides with her plans, the more rational the treatment.

In order to bring out the rash promptly, a good capillary circulation is essential. If the patient possesses this, there is but little need of doing anything of consequence, only to hold the high fever in check, which, if not done, evidently favors a quick and heavy production of the measle poison within the system. this instance you need not be afraid to give relaxing and sweating teas, whiskey, asclepias tuberosa, and such other diaphoretics as are indicated. Some might object to whiskey in such cases, but, if it is used at all, here is its forte. Don't

In