exciting literature. Of course, the light and quiet should be maintained as in other sick-rooms.

Under these circumstances sedative cough mixtures should not be employed, unless absolutely required. Here is the time for the use of morphine, or some such excellent drug as heroin in some combination. This latter drug is newer than morphine, and frequently works far better. It also has the advantage of not being "morphine," which has a very bad reputation with the general public.

Despite all this care generally the patient will not get through the night without being disturbed with cough. The secretions collect, the nervous centers become irritable; pyrexia adds to the fuel, with consequent restlessness and cough. It must be remembered that a moderate amount of cough is healthful and necessary; it is only the excessive and exhausting cough that we must check. The use of warm food through the night is most excellent; if he has no nurse, and the majority of consumptives have not, he can use a "night light" feeder containing soups or broths. The prevalence of ready-made soups or some preparation like malted milk is useful. Of course, individual idiosyncrasy should be consulted. Occasionally there are patients who prefer cold liquid foods. Frequently a mild stimulant does better in the milk, such as brandy or port. If these measures are not enough, the use of heroin or similar drug can be repeated once or twice during the night.

It is the morning cough that is naturally the most abundant in secretion, and cough is almost always seen at this time of day. Here it is proper to assist expectoration, to stimulate the system, and to avoid most strictly the use of any narcotic drug. The patient should have retired early, and he should have early breakfast; by early I mean about half-past six or seven o'clock. Cocoa, tea, a nicely cooked egg, or milk punch is indicated, the form depending on the patient's taste. The use of these warm demulcent fluids helps to unlock the secretions and complete the expectoration; as a result the patient frequently feels stronger and more comfortable, and may fall to sleep again for a short time.

The cough of the evening is generally the cough of exhaustion; the patient is apt to be in a close room, filled with the products of respiration and the consumption of gas or oil, trying to brace up for the benefit of relatives, or because he feels depressed himself. As a result he is exhausted; his pulse and face show this fact; all of which is doubly unfortunate. The patient is ready to begin the night, tired, nervous, and exhausted. In fact, the consumptive is apt to turn the night into day, going to bed

late and getting up late. In this way he begins the night with cough, fever, and exhaustion. There should be no evening cough; keep the patient from unhealthful air and surroundings, and put him early to bed.

Probably the severest form of cough in phthisis is that following meals, for it is not only severe in itself, but deprives the patient of much needed nourishment. As a rule these cases are well developed. They are apt to be cases of cavities, surrounded by tense consolidation. The resultant effect upon the stomach and larynx is one of increased irritability. The pharynx, already sensitive from the coughing, is sensitive to the passage of food and starts reflex vomiting as a result. The same is true of the stomach. The use of sedatives to allay the spasm of coughing and vomiting may increase the indigestion, constipate the bowels, and thus decrease an already poor appetite. Absolute rest after eating at times is excellent; if necessary have the meals served to the patient as he reclines on a lounge; or even rest in bed at times is sufficient. This measure should always be tried, while the food should be made as nutritious as possible. Prepare the patient by previous rest and the giving of some stomachic bitter with diluted nitromuriatic acid, or some preparation such as peptenzyme to help digestion. Often it will be found that old-fashioned counter-irritation over the chest wall or over the epigastrium will benefit. Remember the possibility of establishing a vicious circle in these cases where the cough and the sickness in turn increase each other.

There are a variety of expedients which are of service from time to time in selected cases; various applications are useful in certain coughs, such as menthol inhalations consisting of a few drops of a fifteen-per-cent solution of menthol dropped in an ordinary inhaler, or a spray of alum applied with a hand-ball apparatus. Pounded ice is a household remedy; swallowed and not sucked it may be good, but it is apt to produce indigestion. Thymoline is one of the newer drugs that can be used; glycothymoline in a nasal douche may be of service in selected cases. In stubborn cases the inhalation of a little chloroform or menthol may be a relief.

Blistering over the course of the pneumogastric nerve has been recommended by Granville; this is done along the anterior margin of the sternocleidomastoid muscle with glacial acetic acid every two weeks alternately. This has been recommended in any persistent cough, and may be tried. The writer has had no good

results from it.

Remembering that no cough is to be treated in a routine way,

still there are a number of valuable and tried prescriptions which may be worked in as the emergency seems to demand.

The French have a cough mixture which is rather elegant, although containing nothing new:

Dissolve the hypophosphite in the water with the aid of heat, then add the sugar, and when the solution is cold add aromatic water and morphine. Teaspoonful is the dose.

Where the stomach is sensitive and the cough is obstinate, a bad combination, the following is excellent:

Dissolve the chloral in the alcohol and the tar in the water with the aid of the soda solution. Mix the two solutions with the syrup, allow it to stand for five hours, and filter. One or two teaspoonfuls is the dose.

When the cough exhibits a mucopurulent expectoration, and the stomach will stand it, the following can be used:

Sig.: A tablespoonful in water three times a day.

This prescription is a favorite one in the Bellevue Hospital, New York.

Bosworth recommends for constantly irritable cough this mixture:

Sig.: A teaspoonful three or four times daily.

Fothergill recommended another prescription for irritable

cough that has survived many years:

Sig.: One dose to be taken twice or thrice daily.

In closing let me repeat, do not treat a case of phthisical cough in a routine way; approach the case with the deepest anxiety and the utmost resourcefulness, remembering that in our hands lies the power to fight more or less successfully this unpleasant symptom.

FOUR CASES OF TYPHOID FEVER IN WHICH ACETOZONE TREATMENT WAS EMPLOYED WITH SATISFACTORY

RESULTS.

BY CHARLES EMIL BRACK, M.D.,

Associate Professor of Obstetrics, College of Physicians and Surgeons, Baltimore, Md.

Case 1.-Miss J, a trained nurse, had been in charge of typhoid cases in a Pennsylvania hospital during an epidemic, and had come to Baltimore to take up postgraduate work. She had been ailing for three or four days previous to admission, com