night bottle of Ecthol was received; visited patient next day, and put her on Ecthol, teaspoonful six times a day and injected medicine in the wound and applied cloth saturated with same. In four days pain, swelling and inflammation gone, wound healing and patient able to do her work.-A. L. Stiers, M.D., Dawson, Neb., November 25th, 1898. The Rational Treatment of Grippe. -While antipyretics and antiperiodics may somewhat stimulate the excretions and relieve congestion, thereby controlling certain features of the disease, a complete cure cannot be expected until the grippe poison is thoroughly eliminated and the diseased organs enabled to resume normal functions. The successful treatment of grippe depends upon the thoroughness of the remedy employed, hence we ask why temporize with antipyretics and antiperiodics when Tongaline always secures prompt and efficient as well as permanent results. The internal use of Tongaline Liquid, taken at short intervals in hot water, washed down with copious draughts of hot water, may be supplemented by its local application to the inner parts of the thighs and to the abdominal surfaces. Or, as grippe invariably renders the stomach irritable and the nerves sensitive, the disturbing effects of internal medication can be entirely avoided by the external use of Tongaline Liquid alone. The Treatment of Cough in the Phthisical.-Among the most prominent symptoms in phthisical cases is the harassing cough, which is not only extremely annoying, but, if unrelieved, contributes greatly to the loss of flesh and strength by robbing the patient of his night's rest. While the remedies that have been recommended are almost innumerable, the physician has usually been compelled to fall back upon opium in some form. Most of these drugs, however, have the injurious property of giving rise to disagreeable after-effects. These features are absent in Heroin, a new remedy which combines the sedative action of morphine and codeine with perfect freedom from injurious after-effects. Heroin exerts a specific influence upon the respiratory tract, increasing the volume of inspiration as well as the force of expiration, and reducing the frequency of respirations. It acts as a respiratory sedative and relieves cough without risk or checking of the bronchial secretions. In tuberculous patients it reduces the temperature and relieves night sweats. By CHARLES PINCKNEY HOUGH, M.D., President of the Rocky Mountain Inter-State Medical Association, Member American Salt Lake City, Utah. Mr. President and Gentlemen-I will not trespass upon your valuable time with tedious and laborious references to pathological anatomy, physical signs and symptomatology in this most serious and frequent disease, it being a fair presumption that all are informed on those essential points upon which our text-books are quite agreed. Broncho-pneumonia, usually designated catarrhal pneumonia, is essentially the pneumonia of infancy. It is a bilateral disease, and when fully developed gives scattered areas of dullness on percussion. In this disease we should bear in mind the double circulation of the lungs, that is, the functional and the nutritive, and also remember the pulse-respiration ratio common to infants in health, and as found in pneumonia; this is often the principal diagnostic feature early in the attack that attracts the attention of the observing and wide-awake physician, which, with a high temperature always expected, and circumscribed rales, is good grounds for apprehending this often insidious dis ease. Nearly all cases of primary pneumonia in children under two years of age are of this kind, as are nearly all secondary pneumonias during childhood. In the primary affection the mortality is high on account of the age, and in the secondary form on account of the complications to which it is sequela. It is very infrequent after four years of age as a primary disease. Male children seem to be more subject to it, and about 70 per * Presented to the Wyoming State Medical Society, Rock Springs, Nov. 1, 1898. cent. of the cases occur in the winter and spring, children with poor hygenic surroundings being most frequently attacked. Exposure to cold and sudden atmospheric changes are still recognized as potent factors in its causation. To this fact I would especially ask your attention; you may protect some precious little ones if you still believe that people catch cold or catch hot, as you may choose to term it. Broncho-pneumonia as a sequela to diphtheria is usually due to the streptococcus infection. In twenty-five cases reported by Netter, in which only one form of bacteria was present, in ten only the pneumococcus was found, in eight only the streptococcus, in five only the staphylococcus, and in two only the Friedlander bacillus. This observation of the different kinds of cocci by the microscope would suggest some factor of irritation preceding their activity. In primary cases the pneumococcus is nearly always present and in a large per cent. of such cases it occurs alone. The mixed infection is common in secondary cases, while those that show the stpertococcus infection are usually the most severe. The cases resembling lobar pneumonia are usually due to the pneumococcus infection. I think it would be wise if authors and teachers would discard all synonyms in writing and lecturing upon this disease. It would do away with much confusion in the minds of medical men. The more clear our understanding in pathology, the wiser and safer our therapeutics. The rule is for the catarrhal inflammation to extend from the bronchial tubes to the bronchioles and air vesicles, yet in some cases the disease would appear to begin in the bronchioles and air vesicles at the same time. A very large per cent. of autopsies show very general disease in both lungs; while the pathological process may be arrested at any stage, death may also occur at any stage. Resolution sometimes takes place quickly, but when it is very slow, or only partial, there is likely to be recurring attacks, after which you may have chronic interstitial pneumonia. Pleurisy is almost invariably found over every large area of dullness after the fourth day, while autopsy in cases fatal on or before the third day show that up to that time the pleura is normal or only congested. Large serous effusions are rare in the pleural cavity, the disease is without typical course, while prostration is extreme from the beginning, cyanosis is usually present in some degree and is rarely absent before the fatal issue. Cough may be slight or absent, cerebral symptoms are often quite prominent. Physical signs are often few and slightly marked. Death has been reported within twelve hours after the attack, diagnosis being verified by autopsy. This type of the disease passes for malignant scarlet fever or measles, with sup pressed eruption, or possibly as cerebro-spinal meningitis. We should not overlook this serious feature and should always examine the lungs in infants who are taken suddenly ill with embarrassed respiration, cyanosis or cerebral symptoms. The severity of the symptoms in these cases is explained by compression of the air vesicles from the intense engorgement of the tissues almost as much as from the exudates. The treatment is largely a matter of individual personal experience, influenced for or against the patient in accordance with the good judgment and attention of the mother or nurse, as well as the therapeutic ability of the physician. A close clinical observer once said that in broncho-pneumonia we can do but little for the disease, but much for the patient. This being recognized to be most frequently a secondary pneumonia, we should not overlook the prophylactic measures in those diseases that are chiefly productive of broncho-pneumonia. The nose, mouth and pharynx should command our attention and be kept as clean as possible. The position of the patient should often be changed, and expectoration should be aided and encouraged. Tepid bathing and cold douching is recommended as an efficient agent in preventing broncho-pneumonia, or if it be in the incipient stage, checking its further development. By some the cold pack is preferred. The child should have a large airy room, with an even temperature of not less than seventy. The atmosphere should be kept somewhat moist with vapor. The diet should be nutritious and easily assimilable; the bowels should be freely moved, by preference with calomel. Alcohol or a combination of alcohol and strychnia should be given in sufficient amount to maintain a good heart action. The preparations of ammonia with expectorants, while condemned by some, are generally accepted as being beneficial. It is my custom to irritate the chest with mustard, afterwards freely apply camphorated oil, or simply use camphorated oil and turpentine, covering the chest with flannel or cotton adding, not changing it until it becomes soiled from the excretions. I never use the oiled silk jacket, as I wish the full benefit of evaporation. I have much faith in diaphoresis in bronchopneumonia. The kidneys receive my especial care. Since this is not a self-limited disease, and we cannot calculate as to its duration, I would urge especial attention to the diet and drink. A new fad in the diseases of infancy is to rely largely on the latter, to which I give my partial endorsement, believing it to act as an eliminant. As a rule children get too little water, especially when indisposed. I have confidence in quinia as a tonic in combination with ammonia and digitalis. Aconite is an efficient remedy in the acute stage. I am wholly without experience with the cold bath and pack, but frequently resort to the hot mustard bath in threatened collapse or sinking, and have had from it prompt and happy effect. In reducing the temperature, cold to the head and sponging the face and upper extremities give good results. I have found it quite impossible to adopt in my family practice many highly praised hospital methods, and have believed it good judgment not to try to force methods of external treatment wherein I could not have the full co-operation of the family and the nurse. It is possibly mortifying to confess unfamiliarity with the highly commended antipyretics, the cold bath and the cold pack, but a due regard for truthfulness justifies the statement. When mucus accumulates and the patient cannot expectorate, an emetic of ipecac or alum is beneficial. Strychnia through central stimulation is said to aid expectoration. The alternating of the hot and cold douche is said to be efficient. Frequent cough frees the bronchial tubes, but if it be very annoying, I use small doses of antipyrin or tinct. opii camph. Oxygen gas is by some used with satisfaction, and the inhalation of creosote is said to be good. For extreme nervousness the bromides, antipyrin and phenacetin, are used, while for failing circulation I would commend the hot mustard bath. strychnia, nitro-glycerine, nitrite of amyl, or perhaps atropia of caffeine hypodermically. Good and intelligent nursing and feeding is in my opinion the great essential, and in this particular trouble I place as much confidence in wise and tender motherly care as I do in medication. THE RADICAL TREATMENT OF DISEASE By CHARLES G. PLUMMER, B.S., M.D., During the past two or three decades we have learned much in the treatment of disease of the hip-joint. Some of our knowledge is the direct result of years of research-yet more has the freshness and newness of the teachings of men of our own age. The equipment of recent graduates in the theoretical treatment of this class of ailments is immense, but what they lack is the illustrated application. This we call experience. It is that something which we do not attain didactically-it only comes by personal contact. *Presented at the Second Regular Meeting of the Wyoming State Medical Society, Rock Springs, Wyo., Nov. 2, 1898. |