Stannum is a splendid remedy and has most of the symptoms in question No. 2. except that while there is a good deal of loose rattling cough, there is easy expectoration and for that reason this remedy would not be chosen. Phosphorus has some rattling of mucous and oppression but its symptomology does not come so near as Ipecac or Ant.-tart.

Ipecac has oppressed breathing and the rattling of mucous. "Must sit up in bed," however, does not occur in Ipecac. Ant-tart, also has the oppressed breathing and must sit up in bed. They both have the rattling of mucous in the chest with inability to raise. How then shall we differentiate. Ipecac is indicated in the acute stage, the cough is quite constant, and there is very apt to be a good Ideal of nausea. Where Ant-tart. is indicated, the cough seems to get less frequent all the time with marked increase of the rattling of mucous and then too the Ant-tart. cough is worse at 3 A. M. At this time I have a good opportunity to test the student as to his knowledge of other remedies having a cough at 3 A. M. This is found under Kali Carb. So you see while a student would get down all of these remedies covering some of the symptoms his knowledge of remedies should be such that he would necessarily select Ant.-tart. In making these differentiations he has familiarized himself with a few remedies indicated in a loose, rattling cough which serve him well when he gets out into practice.

Question No. 3. Sour stools, sour vomiting, curds in stools and vomited matter, also undigested stools. There are certain remedies that have symptoms standing out boldly which come to the student's mind at once as he takes these symptoms, for instance: Calcarea Carb., Aethusa and possibly Rheum. I think that in most cases the first two would be selected. As to their differentiation you would proceed about as follows: Both have sour vomiting and sour stools; both have curds in the stools and vomiting matter; both have undigested stools. Rheum has sour smelling stools and perspiration, but does not have the curdled stools, so while this remedy would be thought of, it would be at once eliminated because it would not fit all the phases of the question. As far as the question is concerned Calcarea carb. and Aethusa would be tied for first place, but it is evident that one or the other of them should fit this case so a further differentiation must be made. Aethusa has greater prostration after stool and vomiting. It also has greater acidity so that the curds would be larger. Aethusa is more apt to have convulsions and then it has the peculiar symptoms of the eyes turning down.

Calarea carb. has greater distension of the abdomen and has

the added symptom of being fair, fat and flabby. Calarea carb. has the herring brine odor, also a rotten egg odor. At this point you can challenge your student to name two other remedies having a rotten egg odor to the stool. This should be answered by Arnica and Chamomilla. How are you to differentiate between these two remedies? Arnica has a brown yeast like stool while Chamomilla has a yellow or green stool. You can now go a step further and ask your student to name the remedy that has grass green stool, which should be answered by Ipecac. When that part of the question which referred to the undigested stool is recalled you can again branch out a little and ask what remedy has the prominent symptom of undigested stool and the vomiting of undigested matter.

In this manner the student is kept on the alert to recall the prominent symptoms of the various remedies. This, to me, does away with the dry commitment of innumerable symptoms, and teaches him to apply his remedies in a practical way as he would in a sick room. For I think you will agree that a perfect picture of a remedy containing all the prominent symptoms is never found, but it is oftener true that one prominent symptom will point to you the way for a prescription. Many times questions in the beginning of a recitation will cover a dozen remedies before a student is allowed to be seated. In this way Materia Medica is made very much alive and I feel sure that if you have studied the remedies and questions as you have read this article you will have enjoyed it, as I have in the writing of it.

754 Rose Buldg.

SPECIFIC VAGINITIS OF CHILDREN.

BY J. M. DANFORTH, M. D., CLEVELAND, 0.

That specific or Gonorrhoeal Vaginitis in infants and young girls out-number the simple or catarrhal form ten cases to one, is the startling statement made by Holt.

Raue considers the proposition of specific cases so constant that he says "the subject of gonorrhoea, its control and complications, has become one of the most important topics in Pediatrics in late years."

Dr. L. Langstein, in one of the latest and most complete works on children's diseases, speaks of its terrible frequency.

Statements such as these made by those qualified to speak with

authority are certainly worthy our most careful consideration, not only that we may more readily recognize these cases but that we may by education and warning bring such pressure to bear upon the social life of today that a check may be put upon this most terrible disease.

Miss Helen Keller has sent out a plea for the better care of children's eyes at the time of birth, calling attention to the large percentage of children losing their eyesight through ophthalmia neonatorium. It is urged that incompetent midwives be severely dealt with. To this end a committee has been appointed by the Academy of Medicine of this city to investigate the matter. This is well and will undoubtedly be productive of much good, but when we consider that it is not uncleanliness, nor even neglect alone, that is responsible for these cases as well as cases of vaginitis, but a specific organism, which is fostered and bred in vice, ought we not to sieze every opportunity to go to the root of the matter by enlightening the youth of our land upon the dangers of the social evil, whereby not only beauti. ful and innocent young women become sufferers and invalids, but inIocent children become disfigured and diseased for life. There is nothing more deleterious to the ubiquitous microbe than sunshine and nothing as efficacious in eradicating disease as knowledge.

Specific Vaginitis may be contracted during birth just as ophthalmia is contracted, and one author advocates the use of silver nitrate, 2 per cent solution, for the vagina, in all cases in which we now the mother to be suffering from Gororrhoea. Other methods of contamination are sleeping with an infected person, through wash cloths. bathtubs and bath water. In older children manual and sexual contamination must be considered.

The simple or catarrhal form is due to uncleanliness, worms, scabies, masturbation etc. It is found also in anemic and cachectic children. The symptoms are usually mild without constitutional disturbance, the discharge, upon the child's clothing attracting the rother's attention to the condition. Upon examination some irritation will be found. The discharge is not liable to be purulent. It is not impossible however to have as nearly as mild cases of the specific form, while on the other hand simple vaginitis may be severe enough to simulate the specific. Hence in every case of vulvo-vaginitis it is advisable to have a microscopical examination made of the discharge.

The symptoms of the specific form are the same as for the adult except that in infants the uterus is not attacked. In older children extension to the uterus may lay the foundation for chronic endometritus and sterility. Bladder symptoms and even the enlargement of

the glands have been found in the simple form, but are more constantly a feature of the specific.

So easily does specific vaginitis become epidemic in hospitals and institutions that such cases should be at once isolated, mild as well as severe, and as rigid a regime, with regard to clothing, bedding, dishes, etc., should be carried out as in treating a case of smallpox. Even the nurse should not attend other cases. If a case is treated in a ward with similar cases, just as soon as the discharge is free from the gonococci, it should be removed, as reinfection is so very easy.

To prevent cases in private practice from communicating the disease to other persons it is imperative that the mother or person caring for the child should know the true nature of the disease. Especially should she be warned with regard to the danger of infecting the eyes. Several of these cases have come to my attention. One developed after a Lake trip. In one case the father was known to have it. In several the source of infection could not be determined. That one little girl, a beautiful child of three, contracted it from some infected lad was very probable, because the father was cognizant of the immoral practices of the children in their neighborhood.

The treatment consists principally in douching of the external parts with antiseptic solutions, such as boracic acid in the catarrhal form, and stronger antiseptics in the specific form, Bichloride of Mercury 1-2000, Permanganate of Potash, and in stubborn cases, applications to the vaginal mucous membrane of Argyrol 5-25 per cent, or Protargol 1-10 per cent. One author advocates sitz baths be given once or twice a day of tannic acid 1-1000. Internal remedies are given for the inflammation and discharge, Cantharides, Cannabis Indica, Kali Bichromicum, Pulsatilla, and Sulphur. General and hygienic measures should be used to build up the constitution. Plain hot water is soothing and cleansing and should be used frequently for bathing and douching. All cases should be diapered regardless of age. If the discharge is scant it can be secured for examination by placing a bit of absorbent cotton between the folds of the labia and leaving it there several hours.

Notwithstanding careful and conscientious treatment this disease is one of the most stubborn to treat, the discharge dragging on for weeks and months, stopping, only to reappear. No case should be considered cured as long as the Gonococcus can be demonstrated in the discharge.

The complications and sequences are conjunctivitis, arthritis and endo- or pericarditis. Conjunctivitis is the most common.

The vaccine, or Opsonic treatment of Wright, has been tried in

a considerable number of cases and the results are such as to justify its further use. Frequently profuse discharges which have not been controlled by other means cease in twenty-four hours after the first injection. Negative smears have been found coincident with a rise in the opsonic index. Cures take place in a much shorter time than with the usual methods.

Rose Bldg.

Bleeding after coitus is sometimes the earliest sign of cancer of the cervix.

An obstinate constipation may be due to an extreme retroflexion of the uterus, the organ lying in the hollow of the sacrum.

Hyper nephroma is distinguished from the other malignant tumors of the kidney by the very early appearance of hematuria.

A small, hard, tender nodule situated over the thenar or hypothenar eminences may be a broken-down dermoid cyst

The triad of symptoms-pain, vomiting and distention--without fever, points to intestinal obstruction.

The presence of a tumor of the sigmoid flexure with symptoms of chronic obstruction does not always indicate a cancer. Such a condition may be due to a "diverticulitis.”

When a patient gives all the signs and symptoms of appendicitis. if the stools have been noticeably black, a duodenal ulcer should be kept in mind.

A boggy, tender abdomen is often suggestive of a pneumococcus peritonitis. A careful inquiry as to a previous pneumonia or empyema is most important.

The presence of an indefinite mass in the abdomen of a child running intermittent temperatures may mean a tuberculous peritonitis.

Too frequent enemata before operation may be productive of a great deal of post-operative distention.