suit individual cases come in to the druggist.

I

I also wish to congratulate him on taking the position he does on carbonate of ammonium. We have heard a great deal lately as to whether this drug is of value as a stimulating expectorant or not. think clinical experience teaches us that this is one of our sheet-anchors in bronchitis, particularly in those cases where we have a tough, tenacious mucus present.

So far as apomorphia is concerned, I fully agree with Dr. Bailey and the essayist in regard to the sedative effect of this drug. The cases in which I have found it to be useful are those in which we have a good deal of bronchial disturbance with asthma. In such cases it not only relieves the bronchial irritation, but the spasmodic element which is present in asthma. I have given it to young children who were subject to asthma, children seven or eight years old, asthmatic cases with summer colds or rose fever, and it has usually acted quite well. If the dose is too large its action on the stomach is made manifest, but this passes off more quickly than that experienced in the use of any of the other expectorants.

I wish to congratulate the essayist again on his giving us a plain, practical, oldfashioned paper.

DR. JOHN A. THOMPSON: Experiment ally we have very little knowledge as to how the various expectorants act, and we must rely for our knowledge of their uses upon clinical evidence, and it is to this court in the practice of medicine that we must make our final appeal. We have all read about the results of laboratory investigations, but when we come to apply this knowledge in actual practice we find that their teachings are not carried out.

I wish to commend what has been said in regard to the use of apomorphia early in acute bronchitis. This has been mentioned by Dr. Gillespie. If given early in the attack there is nothing which will give as much relief as apomorphia. I would like to know the experience of others in combining opiates with it. I have given it in connection with codeine, where the effect of an opiate was needed, and the patients have vomited it every time.

The creosote preparations are especially valuable in the catarrhal inflammation of the upper portion of the lungs, the ca

tarrhal inflammation of long standing. Dr. Howard S. Straight, of Cleveland, called attention to this in an excellent article written by him on apical catarrh. In persistent cough with tough expectoration, where the only evidence of disease that you find on auscultation is a roughened respiration in the upper portion of the lungs, creosote will cure.

While I am on my feet I will take occasion to say that the use of expectorants in the treatment of the ordinary cough is a very awkward way to get at a plain pathological condition. If we had an inflammation on the surface of the body we would apply medicaments directly to the inflamed surface, and this would, of course, be the rational method of treatment. Now it is possible by tracheal injections to apply medicines to the inflamed mucous membrane and thereby get a much more certain action than by any medicine introduced through the stomach. By the time medicine is dissolved in the stomach.passed into the intestines and carried through the blood current to the lungs, we know nothing of its composition. I believe there is only one drug of the expectorant class which we know reaches the lungs in its original shape, and that is chloride of ammonia. In the use of tracheal injections we know that there is no danger of the drug combining and recombining with other elements before reaching the lungs. With a little training on the part of the patient and a little patience on the part of the doctor it will be a very easy matter to give them. I can say as the result of ten years' experience with this method of administering medicine that you can cure an ordinary acute bronchitis in about onehalf the time that is necessary with the ordinary expectorants. Take a chronic or fetid bronchitis, the result of treatment by giving drugs by the stomach cannot be compared in the least with those obtained by tracheal injections. The treatment is neither painful nor dangerous, and I want to impress the fact upon you that the technique is not difficult. This method of treatment is not appreciated by the profession as it should be, and not used once in a hundred times when it should be.

DR. INGRAM: In reference to pilocarpine, I would say I did not mention anything about it, as I was compelled to stop somewhere. I simply considered the common, every day drugs which are in general.

use. Pilocarpine is a very valuable expectorant, and its action is very much like apomorphine.

I am very glad to know Dr. Gillespie thinks so much of our old friend, carbonate of ammonium.

In reference to the experimental action of drugs, experiments do not coincide with clinical facts. Rossbach's experiments of opening the trachea of cats and dogs after the administration of various expectorants show that these drugs act exactly opposite from what we observe at the bedside, except, possibly, apomorphine.

One speaker has mentioned the value of heroin to control cough in children, which is quite true. Heroin is also valuable in any patient to allay cough, especially when there exists an idiosyncrasy to other forms of opium.

I certainly thank Dr. Bailey for his pertinent remarks on creosote.

In reply to Dr. Thompson, I would say too much cannot be said in favor of intratracheal injections in inflammations of the pulmonary mucosa, but in acute affections I would rather think the treatment an adjunct. Dover's powder, aconite, veratrum, active purgation or Turkish baths would be more efficient. Time and again I have seen Dr. Thompson demonstrate in his clinic the value of tracheal injections in chronic pulmonary inflammations, especially tuberculous affections. After tuberculous patients would exhaust the resources of the medical department in hope of relief, I have seen these patients referred to the throat department and thereby receive great comfort, oftentimes improve in general health, but the treatment always smoothed the way of these sufferers to the inevitable termination.

I wish to thank the gentlemen for their spirit of indulgence in discussing the paper. I presented a plain, old-fashioned subject in a simple way, thinking it might be of interest, especially at this time of year.

WHAT SUBstitution MEANS.-Outside of the

serious consequences often resulting from using a substitute, it also means that the original article was of established merit or it could not pay commercially to try and imitate it. Bear this fact in mind when prescribing a uterine wafer, that the great service rendered by Micajah's Medicated Uterine Wafers in the treatment of diseases of women have popularized them with the physician. Consequently they are largely substituted. Be sure it is a Micajah.

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ATTITUDE OF MICROBES ON THE SILVER QUESTION.

That microbes, according to medical scientists, have peculiar tastes as regards all the senses is not to be gainsaid by those who keep up with modern microbology. Thus we have learned that some microbes are intolerant of light, seeking the darkest and most hidden spots, like veritable criminals, from justice, and dying when under the glare of X-rays. Others cultivate peculiar appetites, being so dainty in all that regards their food that they resemble bloated aristocrats in New York and Baltimore, persons who can only exist on pate de foie gras and diamond-back turtle stew, their soul's yearning evidently emanating from their stomachs entirely; there, for instance, is the aspergillus niger, that needs a specially prepared broth, the ingredients of which are unnecessary to enumerate, and the aristocratic aspergillus niger will turn up his belly and die if his food is even in the least modified by some cruel bacteriologist. It is the celebrated Raulin who has made a specialty of the fine bred aspergillus, the palate of this aristocratic microbe, too, growing disgusted if the composition of its favorite

broth is changed even a millionth of a milligramme; its delight at its favorite diet, its animal exuberance, causes it to be imbued with the deepest shades of melancholia, and it calmly expires with a perfect contempt for the bacteriological chef who attempts to impose a badly made culture medium. There are other, very many other, gentlemen and lady microbes that resemble the aspergillus niger in their regard for their little belly provender. There are microbes also that hate oxygen. There are millions of these little fellows, the gutter snipes of our bodies, the dwellers in sewers, that, when once emptied out into some river of pure water have as much horror as the floating vote population that gathers in the Rat Rows and Bucktowns of all great cities. The pure water kills them off, for after floating down stream for two or three miles they are destroyed by oxidation, and all traces of them are lost to even the most powerful microscopes. Perhaps if the readers of the LANCETCLINIC were microbes, and had the same span of life, the distance of two miles and a half by our human measurement would mean an incalculable stretch of time and space. There are microbes, too, that cannot stand the least current of air; they are like hypochondriacal old bachelors and maids that are never able to be in a draught without sneezing or having rheumatic twinges. There are microbes, again, we are told by Ardetti, of Genoa, that are ever anxious to hear music, so that they can dance in bladder mucus to the dulcet sounds of the piccolo; perhaps, if they are discovered anew by some Edinburgh bacteriologist, they will only give a Terpsichorean response when enchanted by the sound of Scotch bagpipes.

That the human body is an immensely populated world no one doubts, if he ever looks through a microscope. They have colonies, obey laws, eat, drink, sleep and fight just like poor humanity does on the globe we inhabit. The vastness of this

subject is too large to even contemplate closely in the limited space of an editorial; in fact, we would not have touched on it were it not that two European microbian assistants, Raulin and Vincent, have discovered that microbes, as a large majority, are not bi-metalists, but single-standard animalcules. When it comes to the consideration of gold and silver, we call the attention of our friend William Bryan, of Nebraska, to this curious point. We were led to vote for Bryan on at least two occasions, and he must have misled us scientifically on this question. Yes! microbes are in the vast majority for the gold standard in preference to silver. It was Raulin who first discovered this-Raulin, who has studied the aspergillus niger, too, so closely, and it seems that the aspergillus, this very prince of plutocrats and species of dainty appetite, requiring a special broth, was the first microbes to evidence its antipathy to silver; aspergilli were probably the Pierpont Morgans and Wall Street brokers of the human body originally. Raulin says that they fainted with affright if they were placed on a hundred sous silver piece, so much desired by many of our own humanity.

Dr. Vincent, according to a reliable Paris journal, has also furnished a positive proof of this aversion of most microbes for silver money. He states: "While a piece of ten centimes (which is copper) gives 11,000 microbes, and a gold piece 3,000, a silver piece will never be found to have more than 500 to 1,000, according to its dimensions." It is curious that microbes have such an overweening love for copper, preferring it to gold even, but alas! brazenness and gold are generally found together. It may, perhaps, be objected that this is a simple question of manipulation, and that if a piece of ten centimes is richer in microbes than a piece of silver, it is because copper money passes through more dirty hands and pockets. not contaminated by soap than silver, but

if such an argument is to hold good twentyfranc gold pieces are usually found only in the pockets of the wealthy, and the harvest of microbes should be less than on pieces of silver money. But it is quite the contrary, according to bacteriological analysis, for Vincent has positively shown that microbes are ever quite rare on silver pieces and cannot abide the metal. Besides, Vincent took a number of pieces of silver and gold money and sterilized them perfectly; then he placed some drops of culture on the surface of each coin with a round assortment of microbes. The money thus seeded was left to a temperature of 36° Centigrade, and Vincent tells us (noble Vincent! you, we know, are no Ananias) that the bacillus of typhoid fever only lived five days; the microbe, so-called, of diphtheria only six days; the microbe of pus only nine days, while all other microbes using the silver standard were dead in eighteen hours. At the ordinary temperature of 98°, which is about the temperature of an American pocketbook, by Fahrenheit measurement, put in your guzzle, these microbes were all killed in less than six hours.

Here we pause to ask this gullable French bacteriologist whether the copper money, that seemed best liked by the microbes, did not kill them too, inasmuch as most of the alleged germicides sold by commercial germ houses have a copper salt basis, a diet which, it appears, the average microbe dotes on. But this is digression. But even in the case of metals this lust of gold among microbes results all too often in their deaths, even as with silver. Like the human microbes on our own globe, too much gold is a bane and a sorrow for many of these d-d diseased fellows, who grab all with avidity, whether in a steak trust or an overcrowded traction line company.

Raulin has discovered that the seventh of a milligramme of silver (think of that, William Bryan, and reflect before running

again) is sufficient to arrest the life of the aspergillus niger (perhaps this should be spelled "nigger"), for this aristocratic and powerful microbe absolutely dies when placed in a silver vase. Even the celebrated bacteriologist, Strauss, long ago proved that the so-called bacillus of tuberculosis never developed if the broth culture was placed in a silver dish. It must be then that microbes, born with the proverbial silver spoon in their mouth, must he unhappy, for all die young.

Another bacteriologist, Follet. has shown that a silver wire used in place of platinum to mix the cultures leaves such cultures always sterile. What could better mark the antipathy of the majority of microbes to a double standard? We pause again and await an echo from Nebraska. "The simple contact," says Follet, “no matter how transitory it may be, of these with silver suffices to destroy the viability of the germs and prevent their reproduction."

This antipathy of microbes for silver, of course, has not failed to tempt the therapeutist, so it has come to pass that tuberculosis has been doctored with injections of solutions of silver, but up to the present time the patients have died. Thanks to a new preparation of silver invented by Germany, and which has been used in France by Netter, this metal, it is claimed, will be the panacea for all microbian diseases. It is known as colloidal silver, warranted to cure meningitis, typhoid fever, pericarditis, erysipelas, diphtheria, etc., without counting scarlatina, purulent infections and consumption.

This is a great deal for a single remedy to cure, so, after all, the silver idea remains triumphant, viewed from a germ, or rather Germ-man, standpoint. It is to be the universal remedy. Great is the science of the germ theory! With a scientist at one end or a microscope and microbes at the other, the Lord only

The highways as well as by-paths in the practice of medicine are constantly interrupted and intercepted by obstacles which are to be overcome, either by surmounting the ridges, cliffs and chasms, or by an erection and construction of bridges which have for their purpose extensions of leases on life. Some such bridges are of great and valuable carrying capacity, while others are filmy and correspondingly weak. Bridges are to tide over streams which are narrow or shallow, turbulent or destructive. At any rate, the purposes of the bridge are the same. It is to tide over and carry beyond the lives of the people for whom it was originally constructed. Some remedies are found to be as invaluable as bridges, as carrying over one and another individual from time to time. Occasionally a bridge goes down and the traveller over its planks becomes submerged, and must either struggle for life in the deepest of waters or go down in the chasm. When a remedy constitutes sure enough planks, with their necessary hand-rails, for bridging purposes has been pronounced a success, it becomes one of the valuable adjuncts in the science and art of medicine. Environment and climatic conditions have much to do in the construction of available bridges, and are the means very frequently of lengthening the span of human life. It is the most natural thing in the world to praise the bridge that carries one safely over and beyond and into the fair fields of healthful verdure.

As a progressive science, medicine is thronged to a greater or less extent continuously with those who are delving and hewing out under the planks for a new bridge-work. There have always been

those who have imbued in them skeptical minds-disbelievers in everything-but, fortunately, such individuals are few and far between; but it is necessary to recognize their existence and activity by saying their intellects are more or less cut bias and are not of the straightforward and reliable variety. The dictates of reason as exemplified by common sense manifested in results from cause to effect, fortunately, govern the great mass of mankind. A blow penetrating the skull and entering the brain substance will prostrate and kill an ox or a man. A blow similarly wielded upon a padded surface covering the skull of man or ox will constitute a bridge which will be protective of life by reason of the padding which intervenes. Many a man and woman have had apparently fatal blows averted by reason of the padding formed by a change of climatic environment. Others have averted the blows which were seemingly fatal by use of medicinal and dietetic remedial agencies. All of which are acting in the capacity of bridges reaching from one peak to another in the span of a human life. Sometimes it is one thing and sometimes another. The skeptic says material strength and vitality of the individual constitute the bridges, but these bridges so constituted are in need of braces, girders and stringers in order to encompass the purpose for which they are constructed. However, the rational thing to do always is to praise the bridge that carries us over.

EDITORIAL NOTES.

GROWTH.-Expansion is a manifestation of health, while contraction is equally indicative of senility and decay. The writer wishes to express his most appreciative thanks for the good will shown by so many of the readers of the LANCETCLINIC, as indicated by their filling out of blanks sent them for the purpose of commending non-subscribers, who, it is