be benefited. In the treatment of delirium tremens I find it a safe, prompt, and reliable remedy. In delirium tremens I give twenty-grain doses of chloral every hour until eighty grains are taken, and the result is a sound and refreshing sleep of eight or ten hours. Many physicians hesitate to administer chloral in many diseases I have mentioned, believing opium and its preparations the Alpha and Omega.

MADISON, IND.

TREATMENT OF CROUPOUS PNEUMONIA.*

BY GEORGE W. WHITE, M. D.

Is the treatment of pneumonia as advised by the text-books entirely satisfactory? I will say, no. With these learned authors as with ourselves, no one line of treatment in any given disease is infallible.

Have we a specific? We have not. But we can benefit our patients by a rational treatment if we are conservative in our ideas. I would advise in the first stages of pneumonia, if our patient is strong and plethoric:

M. Make into four powders. Sig: One every two hours until the four are taken. Follow in three hours after the last dose with a saline sufficient to produce free evacuation of the bowels. The effect of this is to lower the blood pressure in the general system by lessening the quantity of blood circulating in the system at large. It gives the heart less work to do, and reduces the amount of exudate in the air-cells to a minimum. It also has a good effect on the kidneys, stimulating them to better work, and as a general alterative is not surpassed. It should be remembered that in the treatment of croupous pneumonia we have to do with a self-limited acute febrile disease, which usually runs a cyclical course.

The nervous shock which attends the ushering in of severe croupous pneumonia is greater than in any other acute disease, unless it be peritonitis; and the important question presents itself at its very onset, what measures shall be employed to overcome or mitigate the impressions made upon the nerve centers by the morbific agent which is operating to produce the pneumonia? The experience of the last few years leads us to the conclusion that during the developing period of the disease, when the pneumonic blow is first struck, and until the

*Read before the Bowling Green and Warren County Medical Society, March 2, 1895.

pneumonic infiltration is complete, which is usually for the first four days of the disease, if the patient is brought under the full influence of opium and held in a condition of comparative comfort by the hypodermic use of morphia repeated at regular intervals, he is placed in the best condition not only for resisting the shock, but also combating the activity of pneumonia. Opium does not, when thus administered, interfere with a stimulating or antipyretic plan of treatment which may be demanded, but does very greatly diminish the chances of heart failure, cases often recovering under its use, which from age and condition seemed hopeless. Then the great relief and comfort which it gives to the sufferer in the first four days of his struggle are sufficient to commend it, especially in those cases where the pain is severe and the restlessness is exhausting. After the pneumonic infiltration is completed opium should be administered with great caution, for the constriction of the bronchi which it induces, and the consequent accumulation of secretion in the bronchial tubes may greatly increase the already existing difficulty of respiration.

In all severe types of croupous pneumonia there are two prominent sources of danger, heart insufficiency, and high temperature. There are consequently two prominent indications for treatment, that is, to sustain the heart and to reduce temperature. And in doing this I know of nothing better than quinine in five-grain doses every four hours. If we have a full, bounding pulse, I give tr. digitalis in ten-drop doses every six hours. After the fourth day to support the powers of life is the leading general indication. Resolution will be sure to begin and continue if the life of the patient be sufficiently prolonged. The danger is generally not from the amount of persistence of the solidification of lung tissue, but from failure of the vital powers before resolution takes place. The supporting treatment embraces quinine, alcoholic stimulants, and a nutritious diet. It is a serious mistake to defer supporting measures until the symptoms denote imminent danger from the failure of the powers of life. As indicated by the pulse, feebleness, great frequency, and a pulse vibratory or compressible, denoting increased activity but diminished power of the ventricular contractions, are the symptoms that indicate supporting measures, of which alcoholic stimulants are an essential part. Given at first in small or moderate doses, the effect is to be watched and the quantity increased in proportion to the urgency of the indication. Whenever the question arises in the management of pneumonia whether alcoholic stimulants be

advisable or not, it should be borne in mind that to begin earlier than they are required is far preferable to subsequent delay. For with proper care they can be suspended without any injury having been done; whereas, the time lost by beginning too late can not be recalled. Alimentation is an essential part of the treatment. Blisters are not advisable in my opinion on account of the general disturbance which they are apt to produce, and their interference with physical examinations of the chest. A flannel cloth saturated with spirits of turpentine placed over the chest extending from the clavicle to the tenth rib on both sides you will find will be all the counter-irritation necessary in any ordinary case.

POLKVILLE, KY.

Foreign Correspondence.

LONDON LETTER.

[FROM OUR SPECIAL CORRESPONDENT.]

An Aged Medical Man; The Dental Hospital; The New President of the Royal College of Surgeons; Empyema of Antrum; Sir William Savory's Will; Traumatic Neuroses; The Albert Medal; Dr. Thorne on Cholera; A Bequest; Deaths from Starvation.

The oldest medical practitioner in the world, Dr. Salmon, has celebrated his one hundred and fifth birthday at his residence in Glamorganshire. Not only is he the oldest member of his profession, but the oldest Freemason known. He served as surgeon in George the Third's army during the period of Waterloo, although he was not present at the battle. Dr. Salmon is in excellent health.

Of the 40,000 required for the rebuilding of the Dental Hospital about £4,000 has been already collected; £6,000 of the latter sum has been subscribed by the dental profession. Last year's dental operations amounted to 58,499, showing considerable increase when compared with the record of 55,325 for 1893, and this again shows an enormous advance as contrasted with the inclusive 19,255 operations of 1874, when the hospital moved to Leicester Square.

It is estimated by one of our principal oyster merchants that the scare arising from the typhoid letters resulted in one month in a falling off of the oyster trade to the extent of £40,000. During one week the consumption of the better class of bivalves amounted to two hundred thousand as compared with a million and a quarter for the corresponding week of the previous year, and a million and a half for the year before that.

At a special meeting of the Council of the Royal College of Surgeons. of England, held at the college, Mr. Reginald Harrison, the senior vicepresident in the chair, Mr. Christopher Heath was elected president of the college in the room of Mr. John Whitaker Hulk, F.R.S., deceased, for the remainder of the collegiate year. Mr. Heath, as is well known, is the author of a number of treatises on surgical subjects, and is Examiner in Surgery to the Universities of Cambridge, London, and Durham.

St. George's Hospital has made the first provision for special instruction in tropical diseases, having appointed Dr. Patrick Munson lecturer in this special branch of medical knowledge.

Dr. A. Bronner, discussing the diagnosis and treatment of the antrum of Highmore, said it was most important to diagnose between the mild and severe cases. The mild cases he considered were generally caused by nasal disease, and could be cured by treatment through the middle or inferior meatus. If boric-acid lotion syringed into the antrum did not effect a cure, he recommended the insufflation of powder, beginning with boric acid and iodoform, then using aristol in the place of the iodoform, which often caused abnormal growth of granulation tissue. If a diseased tooth existed it could be removed and an opening made through the alveolus, the patient then using a syringe or blowing powder through a small eustachian catheter. Where a polypus existed Dr. Bronner opened the canine fossa, introduced the finger, and if necessary scraped the antrum with a sharp spoon. It was not necessary in every case to introduce through and keep in a tube in the alveolar process when opened. Great stress was laid upon giving minute instructions to the patient, the principal of which were, that after the operation the patient must sit before a mirror and inject a weak astringent solution, so that he could see the fluid come out through the nose. When the fluid became clear he was to stop injecting. At first the injecting was to be done twice daily, then once a day, gradually diminishing until a week's interval was reached. When a fortnight passed without pus appearing the tube might be removed.

The will of Sir William Scovell Savory, Baronet, Surgeon Extraordinary to the Queen, President of the Royal College of Surgeons, who died on March 4th, last, aged sixty-nine years, leaving personalty of the value of £93,190, has been proved.

Mr. Herbert Page, speaking at Liverpool upon the mental aspect of some traumatic neuroses, said railway collisions, accompanied by great terror, provided examples of the neuroses beginning in cerebral disturbance. A great mistake was often made, he continued, in looking on the symptoms in these cases as either feigned or imaginary, and one must not forget the close relationship of mind and body, and due regard to the psychical element in all these nervous disturbances was essential for success in treatment. Mr. Page showed how trifling physical injury to the peripheral nerves might lead in time to considerable mental disturbance, while psychical shock acting on the cerebral cortex might bring about serious impairment of health by causing functional derangement of the organic processes of life.

The Prince of Wales has presented to Sir Joseph Lister the Albert Medal accorded to him by his Royal Highness, the President and the Council of the Society of Arts, for "the discovery and establishment of the antiseptic method of treating wounds and injuries, by which not only has the art of surgery been greatly promoted, thus saving human life in all parts of the world, but extensive industries have also been created for the supply of materials required for carrying the treatment into effect."

Dr. Thorne gives an exhaustive analysis of the epidemic of cholera which threatened England during 1893. The seven cases which were known of in England up to the end of July were all brought from abroad into our ports, and in regard to eleven out of a total of thirteen cases detected in port towns during 1893, no extension of the disease to any person other than those who arrived from abroad took place. The total number of attacks reputed to be of the nature of cholera was 287, and of these 135 terminated fatally. Of the 64 localities, of which 15 were metropolitan sanitary districts, there were no less than 42, including 14 metropolitan districts, in which only single attacks were heard of. In only one metropolitan district did the number of these reputed cholera attacks reach three, and taking England and Wales as a whole there were only five localities in which the attacks exceeded ten in number. Dr. Thorne says that, taking all the attacks together, the death-rate reached 47 per cent, and that in 35 of the 42 single attacks death ensued. With regard to the outbreak at Grimsby, Dr. Thorne says that in a number of cholera attacks the antecedent history of the sick involved either the consumption or the reception at their homes of oysters or other shellfish from beds almost necessarily bathed each tide with the effluent from sewers, and from these circumstances he considers that the state and sources of the waters in which oysters are grown or kept come to acquire importance in so far as the public are concerned.

The Hospital Sunday Fund has received great benefit under the will of Mr. W. Andrew Guesdon. In pursuance to the power given to them the trustees have made a selection of certain charitable institutions to participate in the estate. The Lord Mayor of London has been informed that under this scheme a sum of £45,364 consols is to be at once transferred into the names of the official trustees of charitable funds, who are until further order to remit the dividends on the consols to the Lord Mayor of London for the time being in trust for the Sunday Hospital Fund. The interest on a further sum of £9,000 has been left to the Mansion House Poor Box.

The number of loads of rubbish which passed through the destructor of the London Commissioners of Sewers last year was 23,160, which produced a residuum of 4,879 loads of ashes more or less hard, but valueless, and for the removal of which the authorities had to pay.

Edinburgh Infirmary has benefited to the extent of £50,000 under the will of the Earl of Moray.

In the administrative county of London during 1893, coroner's juries returned a verdict of death from starvation, or death accelerated by starvation, in fifty-one cases, of which sixteen were females.

LONDON, April, 1895.