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selves of change of climate as a means of relief, yet the house should be kept dry and warm, and wool should be worn next the skin. Still these measures are of more preventive than curative value. In addition, tone up the system with codliver oil, iron, arsenic, etc., which increase the resisting power of the tissues and lessen the tendency of the structures around the joints to involvement.

There are varied opinions as to diet, many recommending an almost strictly vegetarian diet, while others think it best to maintain constitutional vigor by a liberal meat diet. This probably depends upon the individual patient. There is a consensus of of opinion that all stimulants are contra-indicated.

Among local measures the use of the Paquelin cautery has many adherents, and excellent results are quoted from its use. Blisters over the seat of pain are also well 1 spoken of. Among liniments are recom-mended the simple iodin liniment, soap liniment with potassium iodid applied with gentle friction, equal parts of chloroform and extract of aconite root or belladonna, or veratrin, or ichthyol.

Myalgia.

Under this general term may be classt all manifestations of muscular rheuma

tism, such as torticollis, lumbago, pleurotism, such as torticollis, lumbago, pleurodynia, and cephalodynia. In all of these pain is the chief symptom, resulting from irritation of sensory nerve fibres terminating between the proper muscular elements of a voluntary muscle. In all of these gentle kneading and rubbing of the affected part with a liniment such as that composed of chloroform, extract of aconite root and soap liniment, and a general course of hot baths followed by application of dry heat will usually yield relief. When it is at all possible, much relief is often to be had by putting the muscles to absolute rest, best obtained by strapping the affected parts. Acupuncture has given brilliant results. Often the internal use of gelsemium, pusht to the physiologic

limit, will prove successful when all other measures fail.

Sciatica.

The claim is made that sciatica is purely a neuritis, but it is nevertheless more often occurrent as a manifestation of the rheumatic tendency, and hence the present seems an excellent connection in which to consider it. It occurs more frequently in males of middle life and of the uric acid diathesis than in any one else, and usually follows exposure to cold and wet or an attack of inflammatory rheumatism.

It is chiefly characterized by a sharp shooting pain running down the back of the thigh, intensified by movement, and becoming worse at night and on approach of stormy weather. Recovery may follow persistent treatment, but relapses often occur, and sometimes the pain becomes continuous and chronic.

Enjoin rest upon your patient and apply either hot fomentations or blisters along the line of the nevre. Give deep injections of some analgesic such as cocain or morphin, and give full doses of sodium salicylate and potassium iodid. your patient understand that patience and perseverance are essential, and that the chief good to be obtained from a change of physicians (where there seems to be

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danger of this) is that the other fellow will probably reap the delayed results of

your attentions.

Gout.

Gout is of somewhat rare occurrence in this country. It is a disease of the general system, characterized by constitutional disturbances and local manifestations, particularly affecting the smaller joints. It occurs most frequently in middle or advanced life among men who have inherited the tendency, or who are accustomed to rich food and the use of stimulants, especially malt liquors and strong wines.

An attack of the disorder is usually ushered by restlessness, insomnia, irritability, etc., and the arthritic complication. usually appears in the early morning,

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generally as pain and swelling in the ball of the great toe. The joint becomes a reddish purple and is exquisitely painful and tender. There is a moderate general perspiration, constipation and scanty, high colored urine, showing a deficiency of urates during the continuance of the paroxysm. The prognosis is good in the acute form, but is rather unfavorable in the chronic form.

Colchicum is first, last and always the remedy par excellence in this trouble, and should be given every two hours in doses of about fifteen drops of the wine, well diluted. Alkalies are valuable adjuncts, the salts of potassium and lithium being generally given in conjunction with the colchicum. Constipation should be relieved, and the free drinking of water, particularly those containing lithia, should be encouraged. Opium constitutes the best local application, and the affected part should be wrapt in cotton wool and elevated. A light and non-stimulating diet should be enjoined.

Pneumonia, Its Management and Treatment. Too often the patient with pneumonia fails to recognize the gravity of his condition, and in an effort to "fight it off" keeps up and about until his vitality is so sapt that a fatal termination is inevitable. The first step of all is to send the patient at once to bed and in a room that is thoroly warmed, altho the air should be kept fresh, and for the best results, also moist. Yet the heat is above all else the indispensable requisite, if choice must be made among these, tho it is a hard matter to discriminate and say which is the most important of the three, heat, moisture or ventilation.

The treatment will depend in some degree upon the type of the disease to be dealt with, for instance whether it is of the hypostatic variety, a splenization of the lung dependent upon the prolonged recumbent position occurring in sthenic diseases; the acute specific disease known as croupous pneumonia or lung fever; or the

catarrhal variety, broncho-pneumonia. The course of the disease is different in all of these, and necessarily, different measures must be adopted to meet the different indications. Hence it will be well to consider the treatment for each variety separately, paying no attention to points of similarity where they occur.

Croupous Pneumonia, Medical Treatment. The first indication in a case of croupous pneumonia is that of absolute rest. A jacket should be made of oiled silk lined with a thick layer of cotton batting, and this should be fitted closely to the thorax and lightly sewed together in a way to prevent its slipping from place. A strictly liquid diet, or at least a semi-liquid one, milk, broths, eggs, koumyss, beef juice, etc., will produce the best results.

The immediate danger is frequently from obstruction to the pulmonary circulation. If the patient is in the stage of congestion, with a full and strong pulse, three or five minims of the fluid extract of veratrum viride, or 1-134 grain of veratrin every hour until the pulse softens is a valuable remedy. This acts by slowing the heart action and dilating the systemic vessels, thus determining the blood from the engorged lung. If the patient is very robust, venesection may often be employed to advantage. If the head is flusht and delirium present give 1-200 grain of aconitin, or 1-250 grain of gelsemin every hour. It is far better in drug medication to employ small doses frequently given than to attempt to "shock the system" by giving large doses, since the effect of treatment can be watcht and regulated to a closer degree.

It is important that the temperature be kept down, since the work of the weakened and overburdened heart is increased in an arithmetic ratio with every degree of fever. Experience seems to have shown that if the temperature is kept down the heart will be equal to the demands made upon it unless it is too much interfered with. A first step in the process of regulating the

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THE MEDICAL WORLD.

system is the placing of the bowels in a soluble and aseptic condition. To do this administer a fairly large dose of calomel, say three or four grains, followed by an ounce of epsom salts in as small a quantity of water as possible. This will produce a

free evacuation with the removal of as much of the blood serum as possible, performing in some degree the same office that bleeding would. Then inaugurate antisepsis, using those well-tried and reliable agents, the sulfocarbolates.

When consolidation or hepatization appears there is danger of heart failure from the strain put upon the right ventricle, and therefore when this stage begins there is indication for the employment of some form of cardiac stimulant. Perhaps digitalis and strychnin meet this indication best, being administered in accordance with the character of the pulse. If digitalis be preferred, about ten drops of the fresh tincture may be given every two or three hours, unless the stomach be too irritable to retain it, in which case the alkaloid administered hypodermically will give better results. If the respiratory function is deeply involved at the same time the heart weakness is noticed, strychnin in 1-30 grain doses would better be employed, since this drug is of great value as a cardiac and respiratory stimulant.

Certain cases seem to require ammonia, particularly those where the symptoms of failure seem very rapidly advancing, and here either the aromatic spirits or the carbonate may be employed. The inhalation of oxygen often gives quick relief.

If the face assumes a bluish or purplish hue, and there is markt engorgement of the right ventricle, venesection should be resorted to at once.

If pain is complained of, place an icebag over the location, or use the cups. The hot fomentations may also be used, and have long proved efficacious to a certain degree, but the treatment by cold applications shows a larger percentage of recoveries, and produces more rapid effects. Opium may also be given.

For delirium, potassium bromid, hyoscin, musk or camphor all act satisfactorily without interfering with the action of the other remedies used for conditions enumerated. Where there is high fever also, the cold pack will serve the double purpose of diminishing the delirium and affecting a rapid reduction of the temperature.

Care must be observed in employing the various antipyretics, since they lower the cardiac power too effectually, often preventing the proper reaction to meet the emergencies of later stages, and produce depressing and hurtful results. Venesection and cold sponging should meet with due consideration for the production of any desired effect.

Wherever possible, excessive drug medication should be discountenanced. Any prescription made should only be given until the immediate effect desired is produced, and not continued, as is so often done, until the contents of a three- or fourounce bottle is used, irrespective of overshooting the mark aimed at.

It is an excellent measure to keep a teakettle boiling in the room in order to retain the proper moisture in the atmosphere, and a room heated by an open fire is always better for the sick-room of a pneumonia patient, if the proper degree of heat, about 70°, can be maintained.

Sometimes cough will prove troublesome, and in such case codeia, in doses of onequarter grain, in combination with ammonia, will have excellent effect, not only relieving the symptom immediately under consideration, but also stimulating the function of the skin.

If there is circulatory failure with pallor, irregular respirations and intermittent pulse, the call for alcoholic stimulant is urgent. It should be met by giving brandy or whisky, in from two to four drams every hour, according to the urgency of the symptoms, bearing in mind, however, that every dram over and above what is strictly necessary is productive of great harm, and should be withheld.

It is imperative that the eliminating

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channels of the system should be kept open, and that the kidneys especially be kept up to the mark. If there is any sign of renal hyperemia, it must be promptly met or a fatal result will be imminent. In the same line, the bowels must be kept open and the liver active, and particular attention must be paid to the action of the skin. Upon all these points much depends. The friends of the patient will always fight for medication in the form of mixtures, and are not apt to be satisfied unless something of this nature is done. To meet this demand, it may be well to give some harmless expectorant which will lessen the tendency to cough and allay irritation, thus contributing to the comfort of the patient. A combination of ammonium carbonate and Dover's powder in syrup of wild cherry, with the addition of a small amount of codeia, is often wellliked. If there are pleuritic stitches, a fly-blister or a mustard plaster over the seat of pain will give the promptest re

lief.

Thruout the course of the disease, the patient should be encouraged to drink freely of water, lemonade, or any cooling drink.

During the crisis, unless absolutely necessary to check a diarrhea which becomes too exhausting, opium should be avoided, as it will add to the depression of the already enfeebled vital forces and diminish the ability to rally.

During the convalescing period care must be taken to guard against relapse, and every effort should be directed to sustaining the patient. This does not necessarly mean the use of alcoholic stimulants, since at this point of the disease the necessity for stimulation will often be better met by the use of a small cup of black coffee than by giving whisky or brandy.

How to Treat Catarrhal Pneumonia.

The prognosis of catarrhal pneumonia should always be guarded, since the disease is commonly fatal in the old, the very young or the debilitated. The death-rate

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is estimated so high as 45 per cent. generally consequent upon an attack of capillary bronchitis and lasts about three weeks or less. A longer duration would suggest tuberculosis.

The moist, fresh atmosphere at a uniform temperature of 70 degrees is imperative here. tive here. The chest should be painted with iodin and then enveloped in a pneumonia jacket made of oiled silk and cotton batting.

The disease generally takes the sthenic form, and hence supportive measures are indicated thruout. The diet should be liquid, or nearly so, and food should be given in very small quantities, not over an ounce and a half at a time. The prostration is usually extreme, and brandy or whisky should be given at once.

The indications for keeping the bowels open are urgent, and the kidneys should be carefully watcht, as a fatal result often is caused by an interference with the emunctories. Y

Strychnin is invaluable in this form of trouble; and the cold bath or pack is invaluable where there are any nervous symptoms. It must be used with caution, however, and the patient carefully watcht. There should be care to prevent any harmful degree of shock.

Ammonia, senega and squills are all valuable agents here, but care should be taken to guard against excessive medication.

Often death seems imminent from the accumulation of mucus in the bronchial tubes, a condition indicated by extreme cyanosis, a weak pulse and bubbling rales. Here there should be the prompt administration of an emetic, wine of ipecac being perhaps the best agent, altho the hypodermic administration of 1-12 grain of apomorphin will produce prompter results where its weakening effect upon the heart is not to be too much to be feared. Still

the condition is one requiring great promptitude in action, and all effort should be directed to relieving the complication.

Tonics, such as cod-liver oil, arsenic and

the hypophosphites, should be used in the period of convalescence, and a change of climate should be enjoined,

Pneumonia Following Prolonged Illness. The pneumonia which follows upon any prolonged illness is in the nature of a hypostatic congestion of the lungs dependent upon a weak heart and a recumbent posi

tion.

There should be a frequent change of position in order to prevent the statis of the blood, and such cardiac stimulants as digitalis, alcohol, ammonia, strychnin and turpentine should be used. Turpentine stupes applied externally are excellent to set up the necessary counter-action. Sa. line laxative may prove useful and the application of dry cups often gives temporary relief. Convalescence should be watcht, since the attack may predispose to the occurrence of the more serious form of catarrhal pneumonia.

A Notable Meeting.

SUBJECT FOR DISCUSSION:-"SEXUAL HY

GIENE."

Chairman: Dr. John Milton Dodson,

1. "The Awakening of the Sexual Instinct ;" Dr. Emil Riess.

2.The Effects of Genital Derangements and Malformations on Sexual Appetite;" Dr. C. S. Bacon.

3. "The Psychical Correlation of Sexual Desire, Love and Religious Emotion;" Dr. George F. Butler.

4. "The Sexual Act. Frauds in the Conjugal Embrace;" Dr. Zeisler.

5. "The Results of Sexual Excess or Continence." "Sexual Misinformation and Quack Literature;" Dr. W. T. Belfield.

6. "The Effect of Coitus during Pregnancy and Lactation ;" Dr. A. C. Cotton.

7. "Sex Problem in Education;" Rev. Pau) Carus, Editor of "The Open Court."

8. "Legal Aspects;" A. S. Trude (lawyer). The above was the program of the regular meeting of the Physicians' Club of Chicago, held on the evening of November 28. A good dinner was enjoyed before the literary program was begun. When When the above program was completed, a teacher who had been specially invited, was askt to speak, and then the general subject of the evening was thrown open to

general discussion, the speeches being limited to five minutes. The writer of these lines was present, and he wishes to say that this was the most noted medical meeting that he ever attended, and one which he will never forget. About seventy persons were present, and the above program consumed about three hours, during which there was not a single effort to be funny and not a single vulgar allusion; not a single joke nor humorous story. These matters were considered in an earnest, serious, scientific vein, just as they should always be treated. They are a legitimate part of science, and should be handled just like any other scientific subject.

The patent formerly held on antipyrin, which enabled the manufacturer to sell this preparation for $1.50 per oz., has expired; the price now at which this preparation is bought in New York from the same manufacturers, same style package, is 27 cents an ounce. There is no way, under the present laws, by which these synthetic products can be prevented from securing a copyright or patent, and the only hope is to prevail on the commissioners as well as Congress, to make a change in our patent laws.

At this time in the year we always have this problem before us: Thousands of subscriptionexpired with our December issue, and the renews als are rapidly coming in, but there are thousands still to hear from. Shall we reserve a sufficient number of January WORLDS to meet this demand as it comes? or shall we send January WORLD to all December expirations? trusting that the renewal will be received soon thereafter. We have tried both plans, and as for ourselves, we prefer the plan which is the most considerate to our readers-that is, the latter. This we will do. So this issue will go to all those whose subscriptions expired with our December issue, with the earnest request that those who have not yet sent their renewal kindly do so, if it is their wish and intention to do so, at their earliest convenience. If it is your intention to leave us, would you mind sending us a postal card to that effect? This will save us the trouble of sending you reminders from time to time, thinking that it is only neglect or rush of business that keeps you from us. Also, we always desire the most frank expressions from the members of the profession -we want to keep in the closest touch with their wishes, views and desires. We here wish to again express our thanks to the many faithful adherents whose renewals we have received in great numbers, and which are still coming in every day. We appreciate promptness, for you know that uncertainty is not a comfortable state of mind. You like patrons that you can "count on;" so do we.

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