When giving the drug in this way, and intending to keep up the same dose for a long time, it is the author's preference not to order it in drop doses, but in solution, as follows:

M. Sig. I drachm in half a glass of milk or water t. i. d. after meals.

Again, when giving potassium iodide in this manner for its specific effect, and not to counteract any particular symptom, the writer stops at the first symptom of poisoning, waits a little while, and then changes the dose.

Very different, however, is the method of administering in tertiary syphilis, especially when some vital organ is threatened. Here he does not stop simply because some pustulation or rhinitis occurs, but continues right on in increasing doses till more serious symptoms make it impracticable This is done for two reasons: First, by increasing the dose we may sometimes cause the symptoms of poisoning to disappear, while a larger one may not; and secondly, even if the symptoms do not disappear, or even get worse, it is far more important to saturate the system as rapidly as possible with the drug than to worry over a pustulation or rhinitis. In other words, we must endeavor to put as much iodide of potassium into the system as it can possibly stand, and also do it as rapidly as possible. The method carried out by the author consists in prescribing a 50 per cent. solution (gtt, ij=gr. j), and starting off with gtt. xx increase gtt. ij at each dose as follows: First day 20 drops in the morning, 22 drops at noon, 24 drops at night; second day, 26 drops in the morning, 28 drops at noon, 30 drops at night; third day, 32 drops in the morning, and so on. Given in this way ill effects. rarely occur, and the writer has rarely had cause to stop it on account of unpleasant symptoms. At the same time the increase is rapid enough for ordinary purposes, although under extraordinary circumstances we may increase by four drops instead of two at each dose. The author has two patients at present taking between 500 and 600 grains daily, without any annoying symptoms.-Therapeutic Gazette.

Treatment of Epidemic Cerebrospinal Meningitis:

Osler defines cerebro-spinal fever as "an infectious disease, occurring sporadically and in epidemics, caused by the diplococcus intracellularis, characterized by inflammation of the cerebro-spinal meninges and a clinical course of great irregularity." In discussing the treatment, and in estimating the success of any plan, the great irregularity in the clinical course, the grave character of the anatomical changes and the large proportion of fulminant cases (against which we are absolutely powerless) must not be lost sight of.

In the absence of any specific remedy or antitoxin and our inability to jugulate the affection at the onset, the treatment is necessarily empirical and symptomatic. It is to be sincerely hoped that ere long, when various obscure points are better understood, preventive measures, rather than drugs, will clear the field and counteract the invasion of the germ. While these preventive measures are matters for the sanitarian and the Department of Health the individual should not neglect his efforts. Improved hygienic conditions with plenty of sunlight tend to lessen the danger of contracting the malady. As a prophylactic measure, the intranasal employment of germicides has been suggested in a recent editorial in the New York Medical Journal, March 25th, 1905, page 602. This is nothing new. Jacobi has advocated such procedures for scores of years as a preventive. Caillie's many eloquent appeals have done much to popularize the method of nasal toilet.

Preventive and prophylactic measures thus far have not been crowned with any degree of success. As stated above, the treatment is symptomatic. The mortality in different years varies within wide limits. At present it is about 65 to 70 per cent. In studying the various methods, no great differences in results are noticed.

In the very acute cases of the fulminant type, where upon autopsy little more than intense hyperemia of the meninges and cortex is found, death is the result of a profound toxemia. No remedy thus far emyloyed is of any service in this variety.

The onset of the disease, stormy or otherwise, does not enable the practitioner to forecast the subsequent course. The attack may be ushered in with severe symptoms which, in a few fortunate instances, subside in a few days or a week, and the subsequent convalescence is rapid. Nature, and not our remedies, works the cure in this type. Such cases belong to the aborted or mild type.

In other cases, the irregular and variable course leaves us in doubt as to the value of treatment. Exacerbations and remissions are frequent; unexpectedly a recrudescence or relapse will follow a short period of improvement. Each case must be judged by itself. The strength of the patient must be maintained by proper nourishment and skilled nursing. Nourishment and nursing are of

the utmost importance, particularly in the protracted cases. In other words, the fighting power of the body must be increased to resist the germ.

In private practice the patient should be isolated and placed in charge of a trained nurse, to secure the necessary rest of mind and body. The room should be well-ventilated and dark, or, perhaps, a bandage might be placed over the patient's eyes. The head and neck are to be carefully supported; at times raising the head of the bed six or eight inches seems to add to the comfort of the sufferer. The functions of the body must be regulated, and the bowels kept open. In the beginnining the catheter may be reuired. Plenty of water to drink and fluid diet are advised. The ordinary rules applicable to nursing of serious febrile cases should be carried The nasopharynx, so frequently the seat of trouble, ought not to be neglected, but should be irrigated. Warm salt solution (of I per cent.) slowly poured into the nose with a spoon will improve the breathing and prevent the dry mouth and tongue to a considerable extent. During the early stages, when swallowing is difficult from a paretic condition of the pharynx, and later on in bad cases, forced feeding through nose or mouth may be required.

out.

The usual general recommendations were followed in our cases, both hospital and private. Cold applications to the head, ice-bags, etc., were employed as routine measures. The temperature, when above 103° F. was reduced by means of colon irrigations at 80° F., or mustard packs repeated every three, four or six hours as required.

Local abstraction of blood was not adopted. Many of our patients had been leeched without much apparent benefit before they were sent to the hospital. Ergot has been extensively used and highly vaunted, particularly in the earlier stages. Bromids have been advocated by many authors; they are inferior in their effects to the opium derivatives. Phenacetin, with or without codein, gave relief to the headache and general pains. In others, codein or morphine, by mouth, or hypodermically, was resorted to to relieve the restlessness and suffering. Iodids, so strongly recommended by various authorities, were given as a routine plan.

Various applications have been made to the spine, including Credé or mercurial ointment, without apparent benefit. In order to relieve the intracranial pressure, lumbar puncture was resorted to, with temporary benefit. It may be necessary, particularly in the chronic cases, to repeat the procedure at stated intervals upon the return of symptoms.

In a few cases, lysol injections were made, with but indifferent results. Warm baths at 95° F., given in the later stages, seemed to add to the patient's comfort and quickly relieved the contractures of the extremities and rigid condition generally. Sleep was secured in many instances.

The method of Aufrecht, initiated by him in 1894, has been followed by recoveries in two-thirds of the cases treated by Rogansky. Hot baths at 104° F. are given once or twice daily, an ice-bag being applied to the head. It is claimed that by these means consciousness is restored, the nervous system quieted and sleep is induced. The plan seems to be worthy of further trial.

A few words only regarding antitoxin treatment:-"That branch of bacteriology which deals with the mutual antagonistic relations of pathogenic germs is still in its infancy. The facts already discovered suggest important developments in the future. To what extent clinicians will be able to utilize these antagonisms in the treatment of disease it is difficult to foretell."-(Medical News, March 4th, 1905.)

A further contribution to the subject and one which induced Dr. Waitzfelder and other clinicians to resort to diphtheria antitoxin in treating cerebro-spinal meningitis was made by Dr. A. J. Wolff, of Hartford. He early found that there is a decided antagonism between the Klebs-Löeffler bacillus and the meningococcus, and during the course of study on this portion of the investigation found that pure cultures of the meningococcus were killed by the antidiphtheritic serum, and not only precipitated when mixed with the latter, but active bouillon cultures, when mixed in bulk with the antitoxin, are precipitated in the same manner.

The high expectations founded upon the laboratory experiments were unfortunately not realized, and the procedure after a careful trial was soon abandoned at Roosevelt and Beth Israel Hospitals. Even the intraspinal injections have not yielded better. results

An interesting contribution is the following:-A little girl, three years and nine months old, previously healthy and in good physical condition, was given an immunizing dose (a suspected case of diphtheria having occurred in the same family), of 2,000 units at 2 p.m. The next day at 10 a.m. she was suddenly taken ill, became rigid, lost consciousness and vomited a number of times. When seen in consultation at four o'clock she was in deep coma, pulse imperceptible, numerous petechia over body and face, had vomited large quantity of grumous material. Subsequently "tarry stools." Large tracheal râles and evidences of pulmonary edema made us give a bad prognosis. Death, 8 p.m., due to malignant cerebro-spinal fever.

In conclusion, I would quote from my paper in the Gouverneur Hospital Reports for 1904, as follows:-"A careful consideration of the cause and a study of the pathological lesions, lead to the belief, that in future, preventive measures, rather than remedial agents, will overcome the dangers of the greatly dreaded cerebrospinal meningitis."-FRANCIS HUBER, M.D., N.Y., in Archives of Pediatrics.

Physician's Library.

The Era Key to the U. S. P.-A Complete List of the Drugs and Preparations of the United States Pharmacopoeia. Eighth decennial revision (1905). Vest pocket size; 83 pages; price 25 cents. The Pharmaceutical Era, Publishers, 90 William Street, New York.

The publishers announce a new edition of the well-known "Era Key to the U. S. P.," whose object is to further the introduction and employment of the official drugs and preparations of our National standard, the United States Pharmacopoeia, the eighth revision of which is now in force. The book comes in vest-pocket size and gives in a "nut-shell" all the essential information required by the physician who desires to prescribe pharmacopoeia remedies-their official names, synonyms and constituent parts, with average doses in both metric and English systems. The idea of putting the essential information of the Pharmacopoeia in so small a compass is claimed to be original with the publishers, under whose direction the little work was compiled. The busy physician will find it both helpful and suggestive in his effort to prescribe official pharmaceutical preparations.

A Treatise on Diagnostic Methods of Examination.-By PROF. DR. H. SAHLI, of Bern. Edited, with additions, by FRANCIS P. KINNICUTT, M.D., Professor of Clinical Medicine, Columbia University, N.Y.; and NATHANIEL BOWDITCH POTTER, M.D., Visiting Physician to the City Hospital and to the French Hospital; and Consulting Physician to the Manhattan State Hospital, N.Y. Philadelphia and London: W. B. Saunders & Company. 1905. Canadian Agents: J. A. Carveth & Co., Limited, 434 Yonge Street, Toronto. Octavo of 1008 pages, profusely illustrated. Cloth, $6.50 net; Half Morocco, $7.50

net.

We have been anxiously awaiting the publication of Dr. Sahli's great work in English. Its immediate success in Germany will certainly be repeated in this country, and the English-speaking profession owe to Messrs. W. B. Saunders & Company a debt of gratitude for their enterprise. Not only does the distinguished professor exhaustively consider all methods of examination for the purpose of diagnosis, but the explanations of clinical phenomena are given and discussed from physiologic as well as pathologic points of view, and with a thoroughness never before attempted in any clinical work. The examinations of the stomach, sputum.