theria; Antitoxin is only a "holy hypoth- therefore all our wisdom is only pieceesis" (?) meal; all our knowledge is only a "holy hypothesis," and it can never be an exact science. The virus we use for vaccination is a blood poison-the inoculation of one blood poison to prohibit, forestall or to hinder the ravages of another blood poison or germ of disease, is, to say the least, a "holy hypothesis," a fraud-not sustained by facts-(only a Yankee trick to gull the masses). Is the process of vaccination purifying to the blood or tissues, so that the smallpox germ cannot develop in such soil? Then it would be a benefit to everybody; but the wiseheads of the profession say, do not vaccinate scrofulous children, or those with tainted blood dyscrasia! Dr. Cooper says:-"If one has been living grossly and the blood is in a bad condition, vaccinia will go hard with him; it might furnish a partial excuse for the loss of an arm, or for a result even worse than that. The prudent physician will not vaccinate such a patient till he has cleansed up his system." The more depraved the blood the more susceptible to disease, is it not?-then the worse the arm after vaccination the better the system has been purified and made the least susceptible for the smallpox poison. How is it with such persons where the vaccinia does not take at all? "Holy hypothesis" helps us to find the reason why or if vaccination does prevent smallpox. What is a physiologic effect of a remedy? You would have to experiment upon a standard, normally healthy person, to find out such physiologic effect. Has anyone ever found such a person? Who is authority on such physiologic effects of a remedy-especially on the plant-extracts, which contain from ten to twenty different principles, belonging to organic chemistry? is it not also a "holy hypothesis?" Even Prof. J. U. Lloyd, W. C. Abbott, W. F. Waugh or F. Ellingwood could not vouch for the effect of any remedy. Even strychnin will not kill always! Even the grand theory of dosimetry, an alkaloidal method of administration of remedies is only a "holy hypothesis," for nobody can foretell what chemic combination or decomposition will ensue, while the granule, so given per mouth, will dissolve and encounter the quasi chemic contents esophagus, stomach or intestines ! of All our failures are based upon this unknown change that may ensue-while our remedies are in process of assimilation Why do we rather give morphin by hypodermic injections than by the mouth? It is easier, quicker and more certain in its action. Let us give all our remedies, especially the alkaloids and specific tinctures by electrical transfusion into the system and you will then know their true physiologic effect, unaffected by mouth, gastric or intestinal secretions! Any weak galvanic battery will accomplish this, and the practice of medicine will be a pleasure and the certainty of action of the remedies given will soon forward our hypothesis into an exact science. A. OPPERMANN, M. D. Auburn, Nebraska. Answer to a Criticism. Editor MEDICAL WORLD: From the criticism of my article in the December WORLD entitled "A protest against sweeping classification of diseases-Treatment of pneumonia "-I evidently failed to make myself understood, or was misrepresented in several particulars, thereby creating a false impression of my intention in writing the article. I was not composing an article especially on pneumonia. The remedies I mentioned were only a few suggestions and not intended to cover the whole treatment of the different pathologic conditions on the various forms and stages of that disease. Dr. Waugh asks several questions, and altho somewhat doubtful of the sincerity of his desire for information, I will endeavor to answer as tho he really wished to be enlightened. I have a great regard for his ability as a therapist, and I do not think I can "teach him anything." I can only relate my experience with certain remedies and make an application of the knowledge obtained in that way. He asks "What is an alterative?" It is a term which perhaps is somewhat indefinite, but no more so than many others in our nomenclature. The word has filtered down thru all our medical literature for years, and has become incorporated in all our text-books as signifying special pathologic changes produced in the blood by the administration of certain remedies. Your alkaloidal text-books use the term, then why question its propriety? For fear, however, that any definition I may give will not be acceptable, I will let the eminent Dr. Headly answer the question. He says: "Where shall we place such remedies as mercury, arsenic, iodin? In an arrangement founded on ultimate effect they should be grouped in a class as alteratives, as medicines which result in altering for the better the condition of the system in disease. It cannot be that medicines should be able to affect the nerves and to influence the glands in divers ways, and none should exert any action on the blood. Such remedies would seem to me to be more important than any others." The author does not attempt to explain the exact method of the operation of these remedies in the blood, but says "They seem to counteract certain morbid poisons existing there." We judge of the effect of medicines by their results. It is not really essential in our use of them that we should understand their exact process of attaining those results, however desirable such knowledge might be. Dr. Waugh says "Aconitin relaxes the vasomotor spasm of the skin." He does not tell us how it does this, whether by paralysis of the afferent nerves of the vasomotor system, or simply by its virtue of being sedative to the circulation, thereby lessening the blood-pressure. I believe it is a disputed question. By the administration of the remedy, however, he sees the result and that is enuf for him as it would be for me. In cases of pneumonia coming under our observation I believe fully one-half of those we are called upon to treat have passt the stage where aconitin can be of any value whatever except in controlling the heart action and allaying the fever. In the initiatory stages when the congestion is active and the blood flows freely thru the capillaries I believe that aconitin does tend to relieve the engorgement of the lungs by action on the vasomotor nerves of the cutaneous system. This condition, however, usually lasts only a few hours and if we can see our patient at the very beginning of the attack the remedies suggested by Dr. Waugh are certainly indicated. In the second stage, that of red hepatization, what effect can the administration of aconitin have in drawing the blood from the capillaries, or strychnin in forcing it out? Their effect would only be apparent, I should think, outside of the area of hepatization. I have always thought after tissuechanges have taken place in the lungs and hepatization is fully establisht, aconitin, veratrin, digitalin or strychnin were valueless in relieving the exudation existing in the lungs either immediately or remotely. If this is so, what would naturally suggest itself to our minds? If it cannot be done quickly, would it not be by the administration of such remedies as would gradually act upon these diseased and engorged tissues-remedies which we believe have the power to counteract thru the blood morbid conditions existing in the system, and thus restore them to their normal functions? If by these means we are able to raise the blood to a healthful standard of nutrition, can we not ultimately expect to promote absorption and elimination in the affected lungs when the crisis of the disease comes? Perhaps we all err in considering pneumonia too much as a local disease. The theory has been advanced that the pneumococci in the lungs produce a poisonous material which is immediately absorbed into the circulation and this in turn forms an antitoxin in the blood, and when the process is completed this antidotal substance neutralizes the toxic substances as they are produced by the pneumococci. It is at this period in the process that the crisis comes and resolution takes place. ons. In the admirable article of Dr. Russell he says, "At the present time our treatment is aimed at the effects of these poisHow shall we prevent their formation?" We may not be able to prevent their formation by the administration of remedies acting in the blood where toxin exists, we may be able to assist the blood in hastening the formation of the antitoxin if the theory I have mentioned above is true. Dr. Russell suggests that I call my treatment antiseptic instead of alterative. That would perhaps be carrying out my ideas of the action of the remedies I have mentioned, but the remedies themselves— iodin and bromin-are usually classt under the head of alteratives. Dr. Waugh asks me, "What is the exact pathologic condition at which you aim your singular combination of iodin, bromin, phosphorus and fir balsams?" When I tell him that I expect the iodin and bromin to act as alteratives in the blood, and by such action correct the poisons existing in such a condition as pneumonia, I am stating a process which, from our knowledge of the actions of those remedies, would be likely to occur. If by this means we are able to present to the diseased lungs a condition of the blood as near its normal standard in health as possible, are we not assisting those organs so far on the road to healthful action? Dr. Periera says, "The preparations of iodin exert in the blood some special action of a catalytic nature by virtue of which they are enabled to counteract morbid conditions existing there in disease." By the administration therefor of those remedies, I should expect just that result, and thru this change in the blood I should anticipate a favorable action on the diseased tissues of the lungs by increast absorption and elimination. Why have we not reason to suppose that iodin has a special action also on the mucous membrane? In cases of poisoning, its specific manifestations are always first observed in the mucous membranes of the mouth and nasal passages, acting as an irritant. If it has this effect in large doses, why does it not have an effect in small doses to stimulate excretion and restore the engorged membrane to healthful action in a condition like pneumonia. I do not state this as a fact, but give it as a suggestion-hang it up, as it were, as something to be shot at by my critics. In regard to the phosphorus, I think no one will deny that it is a nerve-stimulant, and that we produce by its administration thru the nerve centers, a decidedly beneficial effect on the peripheral nerves in the capillaries-not by producing contractility in the capillaries, like strychniabut by its furnishing nutrition to the nerve tissues. I would prefer strychnia where there was a tendency to heart-failure or great prostration, but to produce a continued healthful action of the whole nerve-tissue, I prefer phosphorus. The fir balsams I expect (like all the balsamic preparations containing a volatile oil) to be excreted by the glands of the mucous membrane and by their stimulating effect to aid in expectoration. They possess an advantage over other expectorants, such as ipecac, lobelia and equills, because they do not disarrange the stomach. Dr. Waugh entirely ignores the fact that I admitted the value of the medicines he mentioned. I stated they were of use, but added "I would not depend on these alone." The doctor says I must be a pretty good doctor to obtain such good results with the ineffectual remedies I have used," for which all thanks.(?)" The sentence in Dr. Waugh's article to which I particularly objected was this: "There should practically be no deaths from pneumonia with this treatment." Didn't you mean theoretically, doctor, instead of practically? We admit that the theory is all right, but when the results of our best efforts are reviewed, how often do we find our theories fail of achieving all that we had a right to expect. Look at the hundreds of cases of pneumonia which prove fatal every year among the high and the low. Do not those in affluent circumstances employ the best medical talent the country affords to save their lives? Yet, with all the skill of the most eminent physicians, how many succumb to the disease? If your treatment is so far superior to all these, that "you practically lose no patients," I am glad of it. I owe Dr. Waugh an apology, however, for seeming to include him among those who make a wrong diagnosis. I did not mean that for him,--altho he had a right to infer so, but was thinking of many writers for medical journals who claim so often for their methods of treatment that they "had not lost a case in 10 years,' and this too in the treatment of cases, a portion of which must prove fatal, with the best skill attainable. How many of those who write articles for the press, and claim such great results, think you, resort to bacteriologic examination to prove their diagnosis? Probably not five per cent. It is just this negligent habit of calling a disease what it is not and then claiming such remarkable success, at which I aimed my criticism. It is hard for any of us to give up that which we have learned to be valuable thru our own experience, but we are rather inclined to exclaim, in the language of Scripture, "Prove all things, hold fast that which is good." We should not be too ready to accept new doctrines, entirely discarding the old, neither should we be so hedged-about by prejudice as to be unwilling to accept the opinions of those qualified by experience to advance new theories. If we are, we certainly will be left far behind in our professional career. Now, I hope my position is thoroly understood, but for fear it is not, I will recapitulate. 1. In the initiatory or congestive stage of pneumonia, I would begin the administration of remedies to control the fev WITH MEDICAL WORLD Worst support the heart if necessary, and relieve the congested capillaries so far as may be. 2. I would continue their use as long as demanded by this condition. 3. I would use aconite, liquor ammonia acetatis, digitalis, strychnia or similar remedies, to meet these indications as the symptoms might require; but, at the same time, if I was satisfied that I had a case of pneumonia, I would not depend upon those Salone. 4. I would commence the use of some alterative remedies looking to the ultimate results of the disease, so that when the crisis came, the blood, the glandular system and all the emunctories of the body might be in as active a condition as possible to rid the system of the morbific material existing there. 5. To accomplish this last result, I would use the preparation I have mentioned, consisting of iodin, bromin and phosphorus, combined with the fir balsams; or, if I thought preferable in certain conditions, calomel of ammonia muriate or biniodid of mercury. I do not mean that the above treatment should invariably be followed, as there are many conditions in which they might be contraindicated. What I do mean is, that the line indicated would form the basis of my treatment in any ordinary case of pneumonia. I have not mentioned suitable nourish ment, external applications, ventilation, etc., as they would necessarily form part of the treatment in any case. If we would imitate Nature, I should think the administration of nuclein would be indicated. At the seat of the disease in the lungs the leukocytes marshal their hosts as if in defiance of the attack. Why would not the adminstration of remedies, which tend to increase the white corpuscles, aid in warding off the ravages which this disease creates in the system? In Osler's "Practice of Medicine" occurs this remarkable sentence: "Pneumonia is a self-limited disease, which can neither be aborted nor cut short by any known means at our command." Perhaps we are all wrong in this quest for remedies. Shall we say, "Throw physic to the dogs," or "dum vivimus vivamus " by Nature's own remedies, proper nourish ment, pure air and the observation of all known sanitary laws? Perhaps that time will come, and we shall then see the approach of the dawn which shall usher in the "vis medicatrix Naturæ," as applied to the human system in the cure of disease. Who knows? FORDYCE H. BENEDICT, M. D. Weedsport, N. Y. An Outline of Treatment for Pneumonia, Editor MEDICAL WORLD:-When I find I have a case of pneumonia to contend with I generally open the bowels with calomel in four to eight grain-doses every four or six hours from four to six doses, followed with a seidlitz powder (better get Abbott's seidlitz salt) until I get a sure evacuation of the "Primae viae." This treatment is followed up by two-grain doses of quinin and twenty to thirty drops of aconite in three ounces of water, and Norwood's tincture of veratrum viride same amount in three ounces of water, a teaspoonful alternately every half-hour or every hour according to condition of the heart-beat. I have more recently adopted the defervescent granule (Abbott) in place of the aconite and veratrum, and so far they have proved very satisfactory. If the above procedure does not jugu late the attack, and if the fever does not decline after the bowels have moved copiously, say in the next 12 hours, but keeps up and the soreness is not relieved and the cough continues with the characteristic expectoration, red-streaked sputum, you may conclude that your patient will have a run of so-called "lung-fever." Nourish your patient. Liebig's extract of beef is my preference, concentrated or in fluid form. It is easily assimilated and takes up but little space in the stomach. Give little and often and force the feeding if necessary. It should be remembered that concentrated fluid foods are preferable for an undilated stomach, allows the diaphragm to recede deeply into the abdominal region in the respiratory efforts, thereby assisting the intercostal expansion of the chest, so needful in all cases of pneumonia. If your patient is a child from one to ten years, or even older, there will be no expectoration, for the patient will not spit out the mucus. It is raised to the pharynx and is swallowed. This may accumulate in the stomach of the child until vomiting ensues and it is thrown up. It will be seen to have the rusty color and tenacity of the sputum of the adult. Its bulky presence in the stomach obstructs. the abdominal expansion and does not allow the pleural surfaces to rest. When once ejected from the stomach you will see your patient relax into a repose that will be of benefit to the sufferer and satisfaction to the attendant. Double croupous pneumonia " is a holy terror" so far as the sufferings of the patient are concerned. The diffused congestion of the lungs, the patient gasping for breath at every inspiration, the depression resulting from the scant aeration of the blood as it is forced thru the almost hermetically-sealed air-cells, the temperature over 104°, pulse 120, and as hard as a wire under the fingers-such is the clinical picture. Your hair stands on end, but don't lose your head! If the patient is of full habit, strong and muscular, tho an old and unpopular procedure, I bleed. Raise the patient to a sitting posture, cord the arm and draw blood from the vein that shows the best in the fold of the arm. I have taken until the patient showed signs of faintness or complained of being sick. If the patient says he feels easier I check the stream, and if he shows signs of fainting I stop the flow and lay him down. Following this I curtail the drink supply somewhat until I find out the result of my venesection, and if the dyspnea is relieved I allow more fluids and proceed with my aconite and veratrum solutions. Years ago, immediately after the "wah," I used antimonials, but substituted the aconite and veratrum mixture later on in my experiences. Do not think your case has passt the crisis. Don't relax your vigilance, nor don't allow your anxiety to consume your judgment, but watch the case closely and meet the indications as they present themselves. This may sound like symptomatic treatment to some, and I don't care if it does. I am a pretty good homeopathist so far as book-lore is concerned. I have found by experience that gelseminum, specific tincture, is one of the best agents for that peculiar nervousness characteristic of pneumonia, caused by the scant aeration of the blood when the dyspnea seems the worst. Dilute the specific tincture of gelseminum by putting 20 or 30 drops in 3 ounces of water and give a teaspoonful every ten minutes in adult cases for four doses. Lengthen the time as the distress subsides. Give children in proportion to their age. Try this and you will find it all right. It takes the place of the opiates in many cases completely. I have almost discarded opium in its many forms in this disease. As the fever subsides look out for sink The mixture smacks of the shotgun, but it is my favorite formula and one of my "old rut" remedies. I use it for almost everything, even ingrowing toenails. Brace up the flagging energies with tonics, and I especially commend strychnin arseniate or Fellows' syrup hypophosphites. Study your cases, visit them regularly at stated intervals, note temperature and heart-beat. Pneumonia and typhoid fever are two diseases that need close attention and deliberate thought. I haven't used opiates for the last twenty years, except once in a great while. I am afraid of the vitiation that results, obscuring many symptoms that would be noted if not used. I rely on gelseminum to quiet and allay irritation, as before mentioned. In conclusion I wish to say, don't think that I have bled in every case of this malady, but only in a few desperate ones that would not yield to medication; it was the last resort. Some of my cases, 3 that I can recollect, that were bled, died; many lived; some 14 or 15 cases recovered; but whether it was luck or judgment you may form your own opinion. Nor do I recommend that every general practitioner should start out with calomel and the lancet, as in days of yore. These two agents in the hands of a novice would be more deadly than 13-inch shells and |