MEDICINE. PROGNOSIS OF BRIGHT'S DISEASE. (Virginia W. Smiley, M. D., in So. Cal. Pract.)-The prognosis of any extensive organic disease of the kidneys is grave, and especially so if both kidneys are involved. If graver symptoms subside, if there is a steady diminution in albumen and other abnormal ingredients of the urine, and the latter tends to a gradual restoration to its normal composition, the prognosis is more favorable, Even when albumen and casts persist for some time the case may recover; much will depend upon the quantity of albumen and upon the character of the casts. If the urine grows more scanty, if it contains large quantities of albumen, casts and blood, the immediate prognosis is more grave. The chief signs of proximate danger are the supervention of uremic symptoms, edema of the glottis or lungs, abundant pleuritic or pericardial effusion, severe erysipelas afflicting dropsical parts, and the development of acute inflammatory complications. In cases of acute parenchymatous nephritis the prognosis varies. Idiopathic cases in which cerebral symptoms and dropsy are present, or cerebral symptoms alone, usually end fatally. The prognosis of cases characterized by dropsy and anemia is more favorable, although the albumen and casts may persist for a long time. In cases secondary to another disease, severe attacks may aggravate the primary disease or may be prolonged after it. In chronic parenchymatous nephritis the prognosis is not so bad as in chronic diffuse nephritis, as some cases recover without further indications of kidney disease. In the milder cases of acute diffuse nephritis the prognosis in the majority of idiopathic cases is good, recovery taking place in two or three weeks or months. Severer cases terminate fatally at the end of a few days, with cerebral symptoms, or all the symptoms continue, the patient dies at the end of several months, or they pass into the symptoms of chronic diffuse nephritis or some complicating inflammation causes death. In the acute diffuse nephritis following scarlatina, the prognosis in mild cases is good. Severe ones may terminate early, with cerebral symptoms, or at the end of a few weeks. Recovery may take place after cerebral symptoms. In every case of chronic diffuse nephritis the (1) natural course of the morbid changes in the kidney tissues is to become more marked and to involve more and more the kidneys; (2) the effect upon the general health of the patient is not in any exact relation to the extent of the kidney lesion. These two facts render the prognosis of chronic diffuse nephritis very uncertain. The disease is always a serious one and terminates regularly in destroying life, but its duration and the way it will cause death are difficult to foretell. Nephritis, acute and chronic, occurring during pregnancy, gives a serious prognosis. If the albumen is marked and persists, we have threatened abortion, eclampsia, premature labor and post-partum hemorrhage. At the end of pregnancy the renal disorders reach their climax. The prognosis in any form of nephritis is, for the mother, sufficiently grave; for the fetus it is still more so. If it has escaped premature expulsion from the uterus, in a large proportion of cases it succumbs during parturition to the influence of the excrementitious products retained within the maternal blood. DIFFERENTIAL DIAGNOSIS OF TUBERCULAR MENINGITIS.-I. From typhoid fever. This fever may suggest meningitis at the beginning by reason of the cephalalgia, vomiting and constipation which attend it. But meningitis is decidedly distinguished by strabismus, inequality of the pupils, alternate pallor and redness of the head, changes in the respiratory rhythm, and intermittency of the pulse. In typhoid fever, after the eighth day, the abdomen is distended and has lenticular spots upon it. In meningitis the belly is depressed and has no spots on it. 2. From pneumonia. In both diseases there are at the beginning cephalalgia, nocturnal agitation, convulsions, or convulsive movements, prostration and vomiting. But within twenty-four hours, at the most, the respiration in pneumonia has become very rapid, there is a dull percussion-note upon the chest, the diminution of the respiratory murmur. The temperature rises rapidly to 39.2° to 39.4° C., and the pulse to 140 to 160. In meningitis none of these phenomena are observable, the temperature remains under thirty-nine degrees, and there is no fixed relation between the temperature and the pulse. 3. From eruptive fevers. At the begining of these fevers there are phenomena of cerebral congestion which render the diagnosis very difficult. If, however, the case be scarlatina or measles, the angina connected with those diseases will reveal their nature, and enable one to make a diagnosis within twenty-four hours. If there is no eruption or angina the diagnosis will be difficult. An abrupt beginning is not characteristic of meningitis. Within two or three days the peculiarities of pulse and temperature and the respiratory rhythm will show the nature of the disease. In meningitis the pulse is irregular, unequal and intermittent, and bears no fixed relation to the temperature. After eight days the peculiar phenomena of meningitis are usually well developed. 4. From intermittent fevers. Pernicious intermittent fever is rarely seen in children. 5. From cerebral sclerosis. At the beginning of this disease there are cephalalga, insomnia, vomiting and convulsive movement. These phenomena continue one or two days, and then the condition is apparently normal again. Some months later they are repeated with greater persistency. The vomiting increases, being spontaneous, the tongue is saburral, and there is constipation.—Arch. Ped. THE TRUE STATUS OF HOMEOPATHY.-The New York Graphic recently wandered from the easy path of contemporaneous picture-making, and made some remarkable statements regarding the status of homeopathy. Commenting on Professor H. C. Wood's address at the Yale Medical School, it says: "At a time when quite one-half of the medical practice of the world is governed by the philosophic discoveries of Hahnemann, it seems something more than an anachronism to have a member of the Faculty of The Pennsylvania University stigmatize homeopathy as quackery on the plan of faith cure." The Graphic critic adds: "Considering that there are monuments to Hahnemann, the discoverer of homeopathy, in many of the great cities of Germany-that the science he taught is a recognized branch in most of the great medical schools in Europe, Professor Wood's extraordinary doctrine must be regarded as the zeal of ignorance and does no credit to the great university he compromises by such intemperate judgment." Such stupid and blundering criticism as this is of importance and interest only as it shows how prevalent is the ignorance regarding the true status of homeopathy even among men who are well informed as to the world's progress in most directions. The facts are simply these. In the United States there was in 1885 twelve homeopathic and eighty-eight regular medical colleges with one thousand and eighty-eight and nine thousand four hundred and forty-one students, respectively. At the most liberal estimate the homeopathic practitioners of this country form one-eighth of the total number. There is no homeopathic medical college in the country which can be said to be even fairly well equipped and endowed, as compared, for example, with the leading regular colleges of New York, Boston, and Philadelphia. The only school which really flourishes numerically is in Chicago. The statement that "homeopathy is a recognized branch in most of the great medical schools of Europe” is absolutely untrue. Homeopathy has no place whatever in any of the universities of Germany or France, nor has it a school of its own anywhere in Germany. There is a small homeopathic hospital of one hundred beds in London, with a small medical school attached. There are said to be only about two hundred and seventy-five homeopathic physicians in all Great Britain and Ireland. The number on the Continent is proportionably even less.-Med. Record. MORTALITY OF PNEUMONIA.-From a study of pneumonia occurring in the Massachusetts General Hospital, Drs. Townsend and Coolidge thus conclude (Med. News): 1. In the 1000 cases of acute labor pneumonia treated at the Massachusetts General Hospital from 1822 to 1889, there was a mortality of twenty-five per cent. 2. The mortality has gradually increased from ten per cent. in the first decade to twenty-eight per cent. in the present decade. 3. This increase is deceptive for the following reasons, all of which were shown to be a cause of a large mortality. (a) The average age of the patients has been increased from the first to the last decade. (b) The relative number of complicated and delicate cases has increased. (c) The relative number of intemperate cases has increased. 4. These causes are sufficient to explain the entire rise in the mortality. 5. Treatment, which was heroic before 1850, transitional between 1850 and 1860, and expectant and sustaining since 1860, has not, therefore, influenced the mortality rate. 6. Treatment has not influenced the duration of the disease or of its convalescence. THE CREPITANT RALE.-(W. Jackson, M. D., New York.) There is a difference in the definition of this rale by various writers, but all practically follow either Laennec or Walshe. Laennec locates the origin of the sound in the pulmonary cells, believing it due to the breaking of bubbles of air forming in a serous exudation, and describes it as a moist sound. Walshe describes it as a dry crackling, comparable to the breaking of a fine tissue, and probably produced when stiffened air cells are distended. I believe both moist and dry crepitant rales occur, as I have noticed them sometimes in the same patient on different examinations. More recent foreign writers make it due to a variety of possible conditions (thus to the tearing loose of the walls of the vesicles from a fluid, beginning edema of the lung, pleuritic adhesions, collapse of air vesicles, edema of the pleura dependent on old lung diseases, and the first stage of pulmonary apoplexy), as well as to the incipient stage of pneumonia. Dr. Leaming sought to enforce the view that all rales were of pleuritic origin, basing his belief on the finding of fibrine on the pleura, in cases where rales had been heard a few hours before death, and when the lung was completely solidified. He considered it a valuable sign of pneumonia and phthisis, but not as a positive indication of either. Dr. Loomis makes the crepitant rale due to pleuritis; Dr. Delafield made it a friction sound; Dr. Roosevelt, a sound due most commonly, and perhaps always, to pleuritic rubbing, and occurring in pneumonia, phthisis, and dry pleurisy. I have a few observations to offer from a strictly clinical point o view. The crepitant rale is not always persistent. It often disappears and then appears again, from moment to moment. The very fine and dry crackling rales, coming in a gust or shower, were but rarely heard. The crepitant rale was heard in dry pleurisy, in pneumonia, and in phthisis, and in no case could one tell by the rale alone whether the case was one of pneumonia or not. Many patients whose only symptom was pain in the chest, had crepitant rales, which were due to dry pleurisy alone or to pleuritic adhesions. In edema the rale is subcrepitant of a very liquid character. There is a strong probability that crepitant rale common to pneumonia, phthisis and dry pleurisy is due to a pleuritic exudation. The crepitant rale is not pathognomic of pneumonia; but heard also in phthisis, in dry pleurisy, and in broncho-pneumonia. There is a strong probability that it is almost always due to pleuritic inflammation. The question as to whether it is also heard in pulmonary edema and in pulmonary apoplexy is as yet unsettled.—Med. Standard. OIL OF EUCALYPTUS IN HEADACHE.-The Medical News of July aoth has an article on the use of eucalyptus in headaches of various |