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esophagus being quite flat from pressure.

The innominate and left carotid and subclavian arteries were greatly disturbed in their relation, the innominate being found at the left upper extremity of the sack and the left carotid and subclavian being found at the left side well below the top of the sack.

The interior of the sack was filled with many laminated clots of varying ages. The wall of the descending aorta was found to be the seat of sclerotic changes of such a high grade that they actually cracked when bent. Other viscera were found to be practically normal except for the chronic congestion.

A very perfect specimen of fused or horseshoe shaped kidney was discovered on examining the abdomen.

Special interest attaches to the mode of death in this case, as by far the larger percentage of fatalities result from rupture of the sack and not from cerebral embolism, as in this case. Attention might also be called to the extensive and firm pericardial adhesions as an indication of the extent to which the heart may be crippled and still do fairly good work.

POEMS THE DOCTOR SHOULD KNOW.

THE COMING OF LOVE.

He came in the sea-drift and rain,

His eyes held a passionate pain,

The night-dew lay damp on his hair;

I knew not the face nor the form,

The voice of undying despair

That craved for a rest from the storm.

I opened my door straight and wide,
And beckoned him safe to my side.

He lingered anear me: each day

Brought a gladder, new sense of dismay
As closer he crept to my heart,

This outcast who came with the wind:

I never dared bid him depart

For I knew there would nestle behind

Grave sorrow, unending regret,
For something too fond to forget.

One morning I arose unaware,

And stole up my heart's secret stair,

And gazed through the half open door:

My guest sat awake on a throne,

His dread quiver lay on the floor,

And I knew it was Love, who alone
Had braved all the tempest's mad strife
To teach me the glory of Life.

-Ethna Carbery, in November Lippincott's

Clinical Therapeutics

TREATMENT OF COUGH, BRONCHITIS AND TUBERCULOSIS, ACCOMPANIED BY CLINICAL REPORTS.

L. H. Warner, A.M., Ph. G., M.D., New York.

"Is life worth living ?"-W. H. MALLOCK.

"It depends upon the liver."-ANON.

SIMPLE question for timely thought with a plain answer, whether you consider the Anon from the physical or anatomical standpoint. Excesses and privations of all kinds reduce vitalism, interfere with perfect metabolism and disease results. In disease we find morbid conditions which have been brought about by causes both proximate and remote. These causes have generally done their work when the cases come under the observation of the physician. Again the disease may be in the incipient stage with no information whatsoever to indicate what the morbid action may prove to be, unless we employ and enlist the services and aid of the three important departments of medicine, microscopy, chemistry and pathology. If we fail to do so we may find, and alas too late, that the force of incipient causes has been expended, and the morbid action, the natural outcome of their action, has been established. The time of the year is on hand when a large percentage of our cases represent cough, laryngitis, bronchitis and phthisis. The scientific treatment of cough is of as much, in fact of greater importance, than the majority of diseases. Cough is primarily a physiological act, protective in character. Under pathological circumstances it occurs as a symptom of local and general morbid conditions, and may be of mechanical or reflex origin. It is essentially a quick and forcible expiratory effort performed with complete or partial closure of the glottis, and is preceded by one or more deep inspirations. It has for its object the removal from the air passages of obstructive and irritating material, or it may be a neurosis. If the latter it can be easily established by the finding of an eosinophilia in the blood, excessive phosphatic elimination in the urine and a possible finding of eosinophilic cells in the expectoration. These neuroses can only be positively recognized and correctly diagnosed with the aid of microscopic examinations, as above cited. The most important point to determine in relation to cough is its cause, the diagnostic possibilities should, therefore, be carefully considered. Coughing may be reflex in origin, or it may be due to foreign bodies in the ear, to the existence of a tumor, inflammation or other irritative substance, a relaxed palate, elongated uvula, etc., etc. It may also arise reflexly from irritation in any part of the digestive tract, including the liver, or may be due to congestion or edema, secondary to disease of the liver, kidney or heart. The distressing symptoms of cough indeed give rise to W. H. Mallock's query, "Is life worth living" "It depends upon the liver" (Anon). Cough most frequently occurs as a symptoms of inflammation of the upper or lower respiratory tract, as in laryngitis, bronchitis, pleurisy, pneumonia, and it is a marked feature in advanced cases of phthisis pulmonalis. Of great significance becomes the character of the cough. A metallic cough is associated with pressure upon the pneumogastric nerve or its branches, it is hoarse and stridulous with little or no expectoration. Muffled cough suggests the presence of

membrane in the larynx, croupy cough suggests catarrhal and spasmodic laryngitis, and hysterical cough of the paretic. Cough accompanying acute faucial and pharyngeal inflammation is relieved by the treatment of the causative condition, if due to catarrhal laryngitis symptomatic treatment is indicated. The cough in acute bronchitis, pleurisy, pneumonia and phthisis needs especial attention. When the cough is hard and expectoration difficult, a stimulating, tonic and expectorant treatment is indicated. Do not resort to depressants which only suppress the symptoms and are likely to extend the area of inflammation. The administration of any alkaloids of opium should never be resorted to excepting in extreme cases, as for instance in cases where excessive coughing becomes so painful as to interfere with the sleep of the patient, thus adding to his physical and mental distress. Cough should never be suppressed, our aim should be to aid the expectoration of any and all morbid substances and accumulations in the air passages. Much could be written on this subject on theoretical, suggestive and practical lines. In late years the research work on physiological and biological lines has been carried on to such an extent that modern methods of diagnosis and treatment become a necessity to the successful practitioner of medicine. In all diseases a tonic treatment becomes imperative, and in many instances adjunct treatment is necessary. Thus in the treatment of cough and its sequelae tonic treatment is imperative. The physiological action of tonic treatment exhibits itself primarily in the reconstruction of the blood, increasing its oxygen carrying and supplying capacity, and also in its nutritive distributing power to all tissues, thus re-establishing perfect metabolisın. The therapeutic agent furthering elimination and reconstruction and permitting to incorporate with same if necessary any and all antipyretics, diuretics, antispasmodics, narcotics, etc., thus becomes a factor of prime importance in the treatment of cough, bronchitis and phthisis. To such a product my attention was called some months ago. Fitchmul, a tonic eliminative, combining the active principles and properties of balsam canadensis, Venice turpentine, chloric ether, with minute quantities of dilute hydrocyanic acid, tartar emetic and aromatics. I cite herewith a series of cases giving complete history and treatment of same accompanied by complete records of blood examinations, sphygmographic charts, urinalyses and records of microscopical examination of sputum and urine. These cases were selected from the clinics at St. Catherine's Hospital.

BRONCHITIS.

CASE 2036.-T. D., age 32, bookkeeper. Has been troubled with cough more or less for a year past, when he had an attack of influenza. Complains of cough both day and night; has no appetite, is constipated, pains all over chest, troubled with insomnia, and has lost seventeen pounds in weight. Expectoration thick, purulent and offensive.

Microscopically. --Eosinophiles, fat cells and crystals, Charcot-Leyden crystals, alveolar epithelium, leucocytes, pus cells, streptococcus aureus and diplococcus.

Urine Examination. --Color: amber. Reaction: acid.

Specific gravity, 1028. No albumen, no sugar but 0, 5 per cent nucleo albumen, 2, 25 per cent excess of phosphates. Microscopically.

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Uric acid, triple phosphates, squamous epithelium, hyaline granular casts, pus cells. Micrococcus and smegma bacillus.

Blood Examination.-Hemoglobin 59 per cent; red cells 3,700,000; white cells 14, 200, a marked eosinophilia is noted accompanied by digestive leucocytosis.

Patient is ordered two teaspoonful doses of fitchmul every three hours. Daily observations are made of sphygmogram blood, urine and sputum examination. From the very outset the expectoration is easily effected, becoming lighter in color and substance, patient is afforded great relief, and after forty-eight hours treatment enjoys a comfortable night's rest. With this returns new vigor and appetite. The dose of fitchmul is now increased to tablespoonful every four hours, and is continued till the fourteenth day when patient is discharged ready to resume his vocation. On the day of discharge the urine appears normal excepting the presence of some triple phosphates. Expectoration, what little there is, shows no pathological factors and blood examination reveals: Hemoglobin, 71 per cent red cells; 4,210,000, white cells, 9,300. The weight has increased twelve pounds.

Patient is advised to continue fitchmul medication in teaspoonful doses three to four times daily. The reconstructive tonic properties of fitchmul are thoroughly demonstrated in this case by: First. Increase in quality and quantity of blood. Second. Causing the cessation of cell destruction, as demonstrated by the cessation of phosphatic elimination. Third. Its bactericidal effect upon micro-organisms, as exhibited in the different microscopic and bacteriological examinations of the sputum. (P. S.-The bactericide properties of fitchmul I attribute to the cinnamic acid of balsam canadensis.)

The treatment in cases 2051, bronchitis, case 2049, phthisis pulmonalis (incipient), case 2048, phthisis pulmonalis (incipient) and case 2039, bronchitis, was exactly the same as in case 2036, heretofore cited. I will only record the microscopical, chemical and bacteriological findings in one of these cases.

CASE 2051.-J. H., age 29, mason. Bronchitis. Sputum Examination. Eosinophiles, fat cells and crystals. Soot cells, Charcot-Leyden crystals, Cushman spirals, alveolar epithelium, pus cells, streptococcus aureus, staphylococcus. (P. S.-Soot cells noted in this case are generally found in the expectoration of people employed in quarries, mines and mills.) Urine Examination.-Color, straw; reaction, acid. Specific gravity 1028, no albumen, no sugar except traces in form of inosite, 2 per cent excess of phosphates

Microscopically.-Triple phosphates, indican, squamous and caudate epithelium, epithelial cast, pus cells. Streptococcus and smegma bacillus. Blood Examination. First day.-Hemoglobin, 64 per cent, red cells 3,820,000; white cells 10,600. Fourteenth day, hemoglobin 73 per cent red cells 4,310,000, white cells 7,600.

Aside of the reconstructive effect upon the blood, as shown by this table, the medicinal value of fitchmul is demonstrated in this case by the increase of weight of patient of nine pounds.

The study of the remaining cases, is reproduced by the microscopical plates accompanying this paper are of instructive and remunerative nature.

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