diarrhea and a typhoid-like range of temperature, running for from four to seven days at 104° to 105° F. In some of these, there was hemorrhage from the bowel, with tympany and prostration.

I institute quarantine of all persons in the household and strict fumigation after the disease had subsided, and isolate the patients for ten days thereafter. It is my belief that these patients are carriers and the use of chlorazene and dichloramine-T, in the form of sprays, will tend to limit the spread of the disease, while in strict quarantine we have one of the most useful of the methods advocated for the control of this infectious disease. In this, I am aware, I am going far beyond the stand taken by other health-officers in this state and the state of Utah and perhaps in most localities; yet, I am certain that I am right, At any rate, on instituting quarantine of the household, the sick and the well, the number of new cases diminished rapidly, and one new case a day was the rate for two weeks.

In the beginning of the epidemic, I made the cases reportable in this city, and the state followed suit. I advocated closing of the schools at once, and think it the proper thing to do. The state followed suit in ten days. We stayed closed here until the deaths were about 2 a week, and then we opened the schools, so far without any increase in new cases. If we are again invaded, the infection will come from the outside.

The treatment has been symptomatic. Fresh air (not cold), nursing, isolation, frequent feedings of small amounts of liquid food meet the indications in the early stages. The salicylates or acetylsalicylic acid, without Dover's powder or acetanilid or quinine, and hot drinks, so as to produce sweating, will relieve the aching and headache and reduce the temperature. Keeping the patient covered and protected from exposure or drafts will prevent lung complications.

Influenza-vaccine seems to have given results in the early cases. "Clean up" and "keep clean" still holds good in this as in all other diseases. Free evacuation of the bowels, free action of the skin and kidneys early in the disease lessens the toxemia and hastens recovery. A preliminary course of calomel followed by castor-oil and then by daily soapsuds enemas seem to act better than magnesium sulphate.

Citrate of magnesia, also, is well tolerated by the patient.

For the burning in the larynx and bronchi, the cold-pack or the icebag will invariably relieve. In patients that do not stand the application of cold (and, in influenza, cold applications are not well born, as a rule), calx iodata, one to three tablets (gr. 1-3) every hour until relief, and then every three hours, will do the work promptly. It has done exceptionally well in the complications especially in children with laryngitis and bronchitis. In the hoarse, croupy cough of laryngitis, it is best given in hot solution, with emetine. The dose may, with benefit, be increased, for adults, to 1 or 2 grains every two hours.

Geseminine hydrobromide is indicated in high fever, flushed face, full bounding pulse, together with veratrine hydrobromide to effect. In children, gelseminine is a certain remedy for the above indications. It relieves the backache and restlessness and is given in the early stages of the attack in association with aconitine hydrobromide, and with calx iodata, if there is respiratory irritation.

In sleeplessness, I have found somnos of benefit, without any resulting depression. All narcotics are to be condemned in this disease. They are unnecessary and, in the respiratory complications, are deadly. Pain can be relieved in other ways-by external applications, such as hot camphorated oil and oil of turpentine, libradol, (very efficient), hot-water-bag, and the pneumoniajacket.

Cough is relieved by inhalations of steam and eucalyptol. Plenty of fresh air, without chilling the patient, is one of the greatest aid to control the cough. Expectorants are of little benefit. Sweating relieves in the early stages.

There takes place a great loss of chlorides, and these may be supplied by means of enteroclysis and by drinking the alkaline saline waters. Sodium bicarbonate and sodium chloride may be injected intravenously, glucose to be added in the proportion of 2 to 5 percent.

In the pneumonic cases, nuclein, 1 mil (Cc.) subcutaneously, should be given twice or three times each twenty-four hours, in order to increase leukocytosis. In this disease, there is leukopenia, and nuclein is the logical remedy.

Antipneumococcic serum has been employed in many cases, with good results in some and without seeming results in others. The good results were shown in an immediate drop of temperature. A patient with bronchopneumonia of seven days' standing, with a temperature of 104 to 5° F., and increasing consolidation in the right lung, and slight invasion in the left, was given 120 mils of the serum beneath the breasts, and a subnormal temperature followed in twenty-four hours, with no further rise, and with immediate resolution. Three others in a serious condition were given 500 mils intravenously, without much effect on the condition. A number were given 50 mils subcutaneously, with decided benefit. The doses were repeated at 12to 24-hour intervals. Nuclein was given with benefit in reducing the temperature and increasing the resistance of the patient. In one case 50 mils of the CarrelDakin solution was given intravenously, with a decided lessening of the toxemia, as shown in the mental condition and a decrease in the number of respirations. This patient died of double bronchopneumonia. The cyanosis was very marked, the temperature high and respirations over 60. The prognosis was bad from the beginning. The solution named was given as a last resort and might have been of greater benefit earlier in the attack. The bacterins and vaccines have been used frequently, but, not with any great benefit in the pneumonic stage of the disease.

As a prophylactic, vaccine seems to be the only remedy we have to control the disease and, in conjunction with strict quarantine, will do more to limit the number of attacks than will any regulation toward closing the places of business and limiting crowds. Isolation of the patient in central isolation-hospitals is an excellent means of control, especially where nursingaid is deficient and physicians are overworked, as is the case in every community at the present time.

The army supplies, cots, and blankets, doubtless will be stored for future demand and become moth-eaten and worthless in the waiting. There is an immediate need for all such material in hundreds of communities all over this land, and the logical solution of what to do with these supplies is, to place them at the disposal of the state authorities for use wherever needed. That they will be needed soon, when the recurrenc now anticipated is a thing present, goes without question. Then the ques

I have thus far treated about 400 cases of this disease. About 35 had pneumonia as a complication. One patient, about 10 years of age, developed colitis as a sequel but is convalescing. One had suppression of urine, and pneumonia. Another developed, in addition to pneumonia, enteritis, cervical adenitis, otitis and meningitis. A few had otitis media.

I wish to state, parenthetically, that the socalled pneumonia is generally a sort of edema of the lungs due to failure of the lesser circulation and is not inflammatory as is pneumonitis.

Early in my treatment I lost 5 cases altogether. In the last 100 cases, however, 1 had no deaths whatsoever. My treatment is symtomatic avoiding all depressing remedies especially coaltar derivatives. My lack of fatalities with the last 100 cases, I attribute mainly to my use of a serobacterin of a very heavy suspension containing in each cubic centimeter 1,000 million influenza bacilli, as well as 1,000 million of each of pneumococcus and streptococ

cus.

The average beginning dose for an adult is 3-10 mils of the above suspension. For infants or children 1-10 mil. I have given this last dose to several infants and generally one or two doses is all they require even with a severe complicating pneumonia, so called. If improvement is not manifest in 24 hours and no symptoms of a reaction supervene, I increase the dose by 1-10 mil. The increase is kept up till improvement is manifest after which the interval between doses is lengthened--oftentimes no more doses being required. I have seen 4-10 mils produce focal and constitutional reaction in a patient within in 24 hours, which subsided in 72 hours, leaving the patient convalescing.

I am confident that, if this heavy suspension is used on well individuals, it will produce symptoms similar to those of Spanish influenza. I urge the cautious use of this serobacterin. It will do the work as nothing will. It is as nearly a specific as is quinine in malaria. As stated above, if a reaction follows the vaccination, a Carter, Okla.

M. SHADID.

HYOSCINE AND MORPHINE IN INFLUENZA

Mrs. C. S. B., my youngest daughter, aged 23, in the seventh month of gestation, had a very mild attack of influenza, accompanied by the usual symptoms of a mild attack of the catarrhal form of this widespread disease. I first saw her on October 22, and, by the 25th, her temperature was normal and she was "feeling fine", το use her own expression. On the 27th, she was allowed to spend the day with her sister, residing in this village. On Sunday, I brought her to our home, she ate a good meal at noon, and still was feeling good.

By the middle of the afternoon, however, she had grown restless and nervous. An examination showed a temperature of 101° F. She was put to bed and remedies were administered for fever and nervousness. Next day, October 29, not much change was apparent. On Tuesday morning, cough made its appearance, and every attempt to cough provoked vomiting. Her temperature now was 102 degrees. The remedies administered to allay the cough and vomiting did very little good. Examination of the chest at 6 a. m. was negative. She still vomited at every attempt to cough. I examined her at 10:30 a. m. The temperature stood at 102.3° F. An area of about 2 inches in diameter, about 3 inches from the median line toward right, just above the free border of the costal cartilages, emitted crepitant rales (percussion negative, on account of the liver). There was rapid superficial breathing, face was flushed, she complained of a feeling of extreme illness and increased nervousness, vomiting continued whenever coughing was attempted, her pulse was 88, and respirations were 40. Diagnosis: lobar pneumonia in the stage of engorgement. Treatment: aconitine hydrobromide, gr. 1-800; digitalin, gr. 1-64; codeine, gr. 1-12; two granules of each as the initial dose, thereafter one granule of each every fifteen minutes until the patient slept. Four hours of this treatment did not allay the nervousness. She coughed several times, vomiting whenever coughing was at

pectorated.

At this point, because I wished to control the cough, vomiting, and the extreme nervousness, a hypodermic of the halfstrength granules of hyoscine and morphine was administered, using half of the standard dose. The patient slept within thirty minutes, resting for two and one-half hours. Upon awakening, the coughing and vomiting returned. A little more rusty sputum now was expectorated-tough, glairy, tenacious. Another half-dose of the hyoscine and morphine combination now was given. She again slept for two and one-half hours more, except when awakened, every fifteen minutes, in order to administer some aconitine and digitalin.

At this point, I retired and instructed the nurse to continue the aconitine and digitalin every fifteen minutes, unless sweating occurred, and to call me at midnight. The temperature now stood at 103° F. I was awakened by the patient coughing and vomiting. This was at 1:30 a. m. Another hypodermic of the hyoscine and morphine was given. I wanted her to sleep. Her temperature still stood at 103 degrees. The nurse was relieved, I taking charge. The treatment was continued. At 2:30 a. m., the temperature was 101.3° F. The intervals were lengthened to thirty minutes. At 3:30 a. m., the temperature was down to 100.2 degrees, and she was perspiring. The intervals were lengthened to one hour. At 4:30 o'clock, the temperature was 99.3° F.; she was perspiring. At 5:30 o'clock, the temperature was 99 degrees which held throughout the day. At 6:30 a. m., the patient awoke and said that she felt fine. She again went to sleep promptly and slept during most of the day. By evening, her temperature was normal and never again went higher during the rest of her illness. Her recovery was uneventful, and her convalescence prompt and uncomplicated in any way.

The only excuse for this report is, that I wish to call the attention of the readers of this journal to the part that the hyoscine-morphine combination played in this instance. I am convinced that it constituted a large factor in aborting this attack of pneumonia, and I firmly believe that this treatment saved my daughter from a prolonged and serious illness, the results of which under any other form of treatment known to me would, in all probability,

have resulted in an abortion and subsequent death.

The salient points are these three; early diagnosis; prompt administration of remedies of proved efficacy; and keeping my patient asleep and unconscious of the seriousness of her condition until the disease was subjugated.

Pain, restlessness, worry, fear, and nervousness only aggravate and increase any illness. Sleep annuls them all.

I sincerely trust that the medical profession may ultimatey be brought to realize that there is a more excellent way of practicing medicine than by simply following blind leaders of the blind. For, "there are those who know, and they know that they know; and there are those that know that they know not." But worst of all, "there are those that know not that they know not." And, hence, they will not even try the better way.

That alkaloidal therapeutics may grow strong, live long, and spread fast, is the sincere wish of one who, though doubting. tried it out and made good many times.

Yours for more knowledge and better treatment of the sick.

P. S.-On Saturday, December 14, 1918, this patient gave birth to a girl baby weighing 8 pounds. At this date of writing, December 16, mother and babe are both doing splendidly.

Canal Winchester, Ohio.

J. W. SHOOK.

[The favorable course of the disease in this instance, after the patient had been brought fully under the influence of narcotics, naturally is of great interest. Yet, we are not ready to admit that it was this factor in the treatment that determined the happy outcome; the other measures adopted by Doctor Shook undoubtedly having been contributory. Nevertheless, the absolute quieting of the nervous system probably enabled nature to mobilize its resisting forces against the microorganisms responsible for the pulmonary congestion. As to this, though, the point may be raised that the administration of morphine has been demonstrated to diminish leukocytosis, and, so, a contradictory factor enters into the argument.

The problem evidently is not as simple as appears upon the surface, and we should like others to air their views upon it.

[The hyposulphites, as well as the sulphites, act mainly through the sulphur of their composition. Unfortunately, they are quite irritating as well as depressing. Personally, this present writer can not see any advantage in using either the hyposulphites or the sulphites in preference to calcium sulphide, since, according to Sollman, virtually, they act in the same manner. Calcium sulphide, of reliable quality, has "made good" in wide clinical use its claim to recognition, and, besides, is harmless, while the other preparations referred to easily may give rise to troublesome and even alarming symptoms. For himself, therefore, the present writer prefers the calcium sulphide.

Another point is, the employment of an alkali. Sodium bicarbonate, or, better, calcium carbonate is of unquestioned value as all these patients without exception present a very high urinary acidity.

Has anybody else, besides Doctor Beynor, employed sodium hyposulphite? If so, with what results? Let us hear about it, please.-ED.]

TARTAR EMETIC IN INFLUENZA

In response to your appeal to members of the profession for "suggestions, admonition or advice" as to the treatment of patients suffering from the socalled influenza, I will point out the fact that virtually death from this disease, in every instance, immediately results from capillary

bronchitis or bronchopneumonia or pneumonia or pneumonitis. For at least thirty years, I have regarded antimony and potassium tartrate, given in minute doses, as a specific and have used it as such in the conditions so often present in grip this fall, and also frequently in children when the disease is not prevalent. I firmly believe that its universal use would practically prevent deaths from grip.

During the recent epidemic, I gave personal attention to 124 cases of influenza. Early in the epidemic, I lost 3 patients from bronchopneumonia, largely owing to the entire absence of any care of these patients. I had under care many other cases of socalled pneumonia, all of which yielded promptly to the tartar emetic in minute doses. Later, I gave to every patient 1-8 to 1 drop of wine of antimony every three hours. After adopting this course, there was an entire absence of pneumonic complications, except when these already were present when the patient was first seen. When so present, though, the condition was promptly removed by the aforementioned course.

Should you decide to publish this, I sincerely hope that, in the absence of definite information from the laboratories, this statement may reach a few members of the profession who, in view of the fresh invasion, are willing to try the suggestion, based upon clinical observation, of an obscure practicer like myself.

GEORGE M. AYLSWORTH.

Collingwood, Canada.

THE PROPHYLAXIS OF INFLUENZA

In answer to your request, in CLINICAL MEDCINE, for the best prophylactic for the "flu," permit me to say that my experience has proven that most satisfactory results may be obtained from 5 grains of quinine dissolved in 1-2 ounce of whisky, this dose to be taken, by those exposed, at 8 o'clock in the morning and at 4 in the afternoon. If the patient feels chilly, double the dose.

In addition, I usually give the advice to "keep away from people and out of crowds."

I hope that your readers will try this.
Dubuque, Ia.
J. J. BROWNSON.

[A number of our good friends, some of the oldest, brightest, and best of them

all-such men, for instance, as Dr. W. S. Cline, of Woodstock, Virginia-insist that good spiritus frumenti is, after all, the best or one of the best remedies we have for influenza. With this, we can not agree, and we must continue in our protest, even in the face of such strong support as that here given by Doctor Brownson.

Whisky is not a stimulant; on the contrary, it is a depressant. This is the testimony of every advanced pharmacologist. Instead of increasing resistance of the body, it markedly reduces its resistance; and in such a disease as the influenzawhere the individual has need for every atom of defensive force for repelling the attack of this terrible infection to administer depressants, can only be folly.

At any rate, that's the way we look at it. What say our readers? We have epitomized our suggestions for the prevention of influenza on page 805 of the November number of CLINICAL MEDICINF. Put in the fewest possible words, they are as follows:

1. Segregation or, as Doctor Brownson says, "keep out of crowds," and especially avoid contact with the sick.

2. Sterilization of the nasopharyngeal tract, for which chlorazene and dichloramine-T are the best antiseptics.

3. Protective vaccination, using a mixed bacterin of the type recommended by Rosenow, containing the organisms most prevalent in this disease.

4. Avoiding all fatigue, enjoying plenty of sleep, maintaining a cheerful frame of mind, and saturating the system with calx iodata and calcium sulphide.

Has anyone anything better to offer?

ED.]

A PROPHYLACTIC MEASURE AGAINST THE INFLUENZA EPIDEMIC

Below is the bulletin I posted in this company-town, where we employ 500 men in the lumber-industry. We also quarantined against outside places, and in this way kept the plant running at full cараcity. Fright had as much to do with this epidemic as anything, and continually preaching to the people, that there was nothing to be frightened about, helped a great deal to keep them in good physical