Low fevers; chronic wasting diseases; blood dyscrasias; weak heart; long continued recumbent position.

Slight dullness on percussion; subcrepitant raies; feeble bronchial breathing; dyspnea; cough, and slight expectoration.

Prevent development in asthenic cases by cardiac stimulants and frequent change of position. Turpentine and dry cups externally; alcohol, strychnin. digitalis, ammonia, and turpentine internally.

ACUTE CATARRHAL.

Exposure. Excessiv or long continued inhalation of dust or vapors. Great debility. Gouty diathesis. Chronic heart diseases.

Chill, malaise, sense of constriction and soreness in chest. Considerable cough. Slight fever. The cough is "tight" at onset; later becomes free.

Turpentine, mustard or iodin to the chest. In the early stages the sedativ expectorants, such as vegetable salts of potash, antimony, ipecac, with an opiate. Steam inhalations of turpentine or vinegar. When expectoration is establisht, the more stimulating expectorants: squill, senega, terebene, tar, eucalyptus, or chlorid of ammonia.

fever; pneumonitis.)

pneumonia.)

Follows bronchitis, or occurs as a complication of children's diseases, or in diseases of low vitality.

Gradual onset, with cough, irregular fever and prostration. Dyspnea and very rapid pulse. Muco-purulent expectoration, pale anxious face, and bluish lips, sibilant rales and bronchial breathing.

Protect all patients with infectious fevers and bronchitis from drafts or sudden changes of temperature. Keep good ventilation, without draft, and temperature of room at 700. Have the air kept moist by steam. Cotton jacket on the chest. Laxativ on onset; stimulants and stimulating expectorants later. Cyanosis, with mucous bubbling in tubes, calls for an emetic-apomorphin or ipecac. Restlessness and delirium call for cool sponging, hyoscin, bromides, or ehloral. In delayed resolution, use counter-irritants exter-j nally and iodides internally. Protract convalescence, and use tonics.

CAPILLARY.

(Suffocativ Catarrh)

An inflammation of the terminal bronchi, commonly following a severe attack of simple bronchitis. Apt to be a sequel in very old, or very young, or greatly debilitated patients. Often a complication of infectious fevers,diphtheria and influenza.

Cough comes in paroxysms, and in children is frequently without expectoration. Respirations very rapid. High fever. Weak, and rapid pulse. Dyspnea. Blue lips, cold extremities, anxious expression. Sibilant, or fine, moist crackling rales. Death frequently results in a few days from exhaustion and asphyxia. The older the patient, the better the prognosis.

Warm, moist temperature in room. Cotton jacket and turpentine to chest. Liquid, but nutritious diet. Stimulants, quinin, and stimulating expectorants. Absolute rest. Cool sponging or baths if fever be high. Mild emetics, if dyspnea is markt.

CHRONIC INTERSTITIAL. (Cirrhosis of lung; ehronic pneumonia; pulmonary

induration.)

Commonly found in connection with fibroid phthisis, in syphilis, or in those accustomed to the continued inhalation of dust from coal, stone or metal.

Moderate dyspnea, chronic cough, fetid expectoration, either profuse or scanty. No fever. Vocal resonance increast. Breathing may be either bronchial or cavernous.

Always fatal in ten to twenty years. Treatment only palliativ. Fresh, pure air at even temperatures. Hygienic surroundings, and remedies directed toward toning up the system, and relieving the cough.

FIBRINOUS.

(Croupous; pseudo-mem

branous.)

Exact etiology is unknown, but male sex, young adult life, and the existence of chronic pulmonary disease such as pleurisy, asthma, tuberculosis, and emphysema, seem to act as predisposing causes..

Both acute and chronic forms are recognized, but latter is more common. Chronic cough with fibrinous plugs and casts of the bronchioles in sputum. Paroxysmal dyspnea. Physical signs are only those of chronic bronchitis. In acute form, death from suffocation is not rare, and prognosis should be guarded.

Combine for Protection. The Common Council of Ludington, Michigan, offered the health officer of that town the munificent sum of $75.00 per year. The physicians entered into a combination, each of whom bound himself not to accept the position for less than $300.00 a year. The council surrendered, and one physician was appointed at the salary askt. Any other body of physicians can do the same whenever the attempt is made in a proper manner. Almost every influence is combined against the physician, but the physician cannot seemingly grasp the idea that he must enter combinations to meet all such powers and influences. How Shall Tuberculous Cattle be Disposed of? It is quite evident to the most unlearned that tuberculous cattle are not fit animals to furnish milk nor to walk the planks of the abattoir. To those interested in the subject it is a well known fact that there are very few sections of the country where tuberculosis among cattle is not readily found upon investigation. The disease is not confined to one class of cattle, but is fully as common in the beef animal as in the milk cow. It is rarely found as an isolated case; more than one animal in a given herd is generally found to be affected. No class or degree of animals may be declared free or exempt; indeed, it is generally the finest herds which are most deeply saturated. A recent examination of the herd on the Reedhurst farm near Erie, from which milk had been sold at a markt advance in price owing to the exceptional health of the cattle and the care in the handling of the product, demonstrated the fact that 95 per cent. of the animals had tuberculosis. Unquestionably the udder of a tuberculous cow gives forth the most death dealing fluid used by man as food. No thinking man admits the right of the owner of a tuberculous cow to use her products as an article of sale. Were the cases isolated, rare, or easily detected, the problem would be easy. Let the unfortunate owner allow the animal to be killed and burned by the state authorities, accept the small amount allowed him, and pocket his loss as quietly as possible for the good of humanity.

But the case is vastly different. Many men have their entire possessions invested in cattle that they have carefully selected for dairy purposes. The slaughter of these cattle would bankrupt their owners, as the

allowance from the state is but a few cents on the dollar of the value of the animal. Most often the majority of the herd are affected and respond readily to the test; but what about a guaranty of the health of even those who fail to respond? Have they not been in intimate association with the affected animals for a length of time sufficient to permit their becoming infected, or at least to place them under strong suspicion, tho failing to respond to the test? All such animals should be disposed of in such manner as to leave no question as to whether they will again jeopardize life and health. Such disposal is the prerogativ of the state; but it is also the duty of the state to reimburse the owner reasonably for the value of the animals destroyed. How can this expense be met? If all the tuberculous animals in the commonwealth were destroyed and paid for at their actual value, it would almost bankrupt the state. Yet until this is done, all efforts at stamping out the curse are futil. What ought to be done is plain; how to go about doing it is a great problem. Any good citizen might be induced to sacrifice a few animals; yet few men could willingly bring themselves to the level of paupers, for the sake of the state and humanity, by consenting to the destruction of their entire herds. Yet nothing less can be satisfactory if the great white plague be found. Even after the total annihilation of the herd, the stables should be thoroly disinfected under the supervision of a qualified state official. The expense would be far beyond the imagination of the most radical statistician. With no provision for reimbursement; with superficial examination; with every inducement held out for the owner to conceal suspected cases; with thousands of herds unsuspected and uninspected; one must wonder, "what good?"

The scheme proposed by a recent writer: To condemn the herd, isolate it, forbid the sale of any animal, and in time, make a re-examination for the purpose of releasing uninfected animals, is impracticable on its very face. It would take a standing army to enforce it, and in the meantime the infected animals would infect others, and by their very existence imperil and jeopardize the safety of human beings. The plan of isolation is bad enuf in human victims, but vastly worse in the case of the animal. It is only a makeshift. In the animal the action should be emphatic and decisiv in so far as that individual is concerned.

There should be a qualified state inspector, with a numerous staff. Every year he should cause every dairy herd in the limits of the commonwealth to be inspected, and if found suspicious, tested. If any respond to the test, they should be immediately destroyed, and the owner reimbursed; and the balance isolated for a given time and again re-inspected and tested. If the second examination reveal the disease, every animal in the herd should be at once destroyed. Only radical measures can cope with this phase of the great problem.

Other countries have razed towns in the effort to stamp out this greatest of all Scourges, yet we hesitate on the account of the cost of cattle. The only way to dispose of the tuberculous animal is to burn it, and have the state reimburse the owner. Nothing less will do. To do less is to toy with death.

The Latest and Most Accurate Method of

Testing for Albumin in Urin.

Greene, in his book on Examination For Life Insurance, just from Blakiston's press, declares that the older methods of testing for albumin in urin are fallacious and misleading. He gives the following plain and simple rules whereby one may be absolutely certain of the truth of his conclusions after making the test:

"The essentials of a good test for albumin are:-Simplicity, a reasonable degree of delicacy, and decisivness. When a test for albumin is properly made, any haziness or opacity is abnormal. Hold the urin toward the light, with the coat sleeve for a back ground. If held against the source of light, even a well markt albumin ring or haze may be overlookt. The urin must be absolutely clear before any test for albumin is applied. To a portion of the urin add two or three, but not more than five or six drops of acetic acid (50 per cent.). Filter until absolutely clear. If cloudiness persist after filtration, it is probably due to bacteria, which may be removed by shaking with barium carbonate and again filtering. Set aside a portion for comparison. Add to the remainder one-sixth of its volume of a saturated aqueous solution of common table salt. Boil and compare with the unheated specimen, holding both to the light. Any precipitate or cloudiness is due to serum albumin. The amount of time involved

is trifling, and the test is extremely definit and delicate.

"The potassium ferro-cyanid test is beautiful-into a clean test tube pour a dram or two of acetic acid (50 per cent.); to this add twice its volume of an aqueous solution of potassium ferro-cyanid (one to twenty). Shake the mixture and overlay with the suspected urin, as in the contact test with nitric acid. Albumin, if present, appears at once as a band or ring at the junction of the two fluids. It is essential that the full amount of the acetic acid be added, otherwise even a considerable amount of albumin may escape detection."

The following remarks will be new to many of us:-"A curiously persistent idea is entertained by physicians that the early morning urin furnishes the best clinical evidence. This is quite contrary to the truth. The best specimen is that of the mixt urin for twenty-four hours, but that portion most likely to show departures from the normal is excreted about three hours after a meal, and preferably after exercise. The early morning urin is not infrequently quite normal in persons suffering from diabetes or interstitial nephritis, whose urin may always contain sugar or albumin after meals."

Danger from the use of Strychnin in Inebriety.

When strychnin is given in continuous large doses to inebriates, two very markt conditions appear. One is that of general depression, with muscular and mental feebleness and indisposition to all activity; all thought and desire for spirits pass away; and altho the mind is clear, energy and ambition to do more than is absolutely necessary is absent. The conviction that spirits will never be taken again is emphatic and clear, and the certainty of a cure is uppermost in the mind. The appetite is good and sleep is without dreams, and no anxiety or care about any present condition exists. The second general condition is the opposit, and is markt by periods of excitement, both mental and muscular. The same confidence of cure and absence of desire for spirits exists. The mind seems alternately clear and dull. In the dull periods apprehension and a feeling of insecurity and suspicion of disease and trouble exists. In the excited period there is trembling, hypersensitivness and great elation. Dreams occur at night, and

strong disposition to be engaged in something all the time. Emotional states and muscular agitations come and go with the disposition to work it off by incessant activity. When strychnin is withdrawn, both of these conditions pass away, or improve to such an extent that the origin is apparent.

Persons who have taken the "Gold Cures" often display these two conditions, and speak of the profound impression which the medicins make on the mind and body. In some instances the stupid stage never passes away. Such persons exhibit a degree of mental and muscular feebleness the rest of their lives. It is evident that strychnin is a very unsafe remedy given indiscriminately in inebriety. Persons who suffer from the irritable stage following the use of this drug frequently relapse, drinking to greater excess than before, with more prostration and general feebleness. Where strychnin is used to produce a disgust for spirits the result is very unsatisfactory, and it is doubtful if more harm does not follow than good. The impression from the strychnin extends to all the functional and organic activities of the body, and when continued becomes a new source of poisoning, with still further organic derangements. Using strychnin with spirits is still more dangerous, and is often followed by low states of delirium and spasmodic conditions, which disappear when the drugs are withdrawn. In these states the increast heart's action. with muscular trembling, is followed by a markt rigidity and tension of the muscular system which calls for more spirits until states of paralysis follow. Strychnin is, no doubt, a valuable tonic, in very small doses for a few weeks, after the alcohol has been removed, Care should be exercised to discontinue its use on the first appearance of sedation and muscular excitement. It is to be remembered that many cases are very susceptible to the action of strychnin. In all probability the palsy from alcohol increases this susceptibility. These states should be recognized as possible in all cases, even when small doses are given for a long period. It is doubtful if strychnin can be used in all cases with safety, and usually it is inferior to nux vomica and many cinchona preparations.-Editorial from The Quarterly Journal of Inebriety, October, 1900.

WORLD four years for $3.

How to Disinfect Rooms.

Sulfur dioxid is frequently employed for purposes of disinfection on account of the little risk and trouble connected with it. It probably kills germs not containing spores if sufficiently concentrated and in the presence of moisture, and is, therefore useful in the fumigation of rooms and of articles that can not be subjected to steam heat or chemical solutions. But it will bleach and tarnish many articles, and for this reason and the fact that it is much inferior to formaldehyde, it will hereafter probably be almost entirely supplanted by the latter whenever that can be obtained. To secure sufficient concentration at least three pounds of sulfur should be burned for every 1000 feet of air space, care, of course, being taken that there may be no risk of igniting the floor or any articles in the room. Before the fumigation of a room with sulfur dioxid or formaldehyde, all apertures and crevices in the walls, ceiling or floor should be carefully closed from the outside to maintain the gases in as concentrated a state as possible during the process, which should continue for at least twenty-four hours in the case of sulfur

and not less than six hours with formaldehyde. After fumigation, the room is thrown open and well aired, and then thoroly cleansed with a corrosiv sublimate, carbolic acid or hot soda solution, 4 per cent. of the latter being both cleansing and disinfectant.-Hygiene and Sanitation (Egbert) Nov. 1900.

Thermo Therapeutics.

Heat, variously applied, has been, for centuries, the great household remedy for all localized inflammation, as well as a most potent resource to the physician.

Modern scientific handling of this power in nature, as in electricity, is constantly widening its sphere of usefulness to mankind.

I have the names of thirty-three cases treated recently by hot air. I have used during the last year six different kinds of heating apparatus, none of which have been altogether satisfactory. The first two I used nearly set the patient on fire. They were too small. A large limb would come too close to the sides of the cylinder. The next one I tried was an ordinary Betz. In this one the heat came from the end instead of the center. A knee could not be heated without heating the whole leg,

and the greatest heat would come at the wrong place. I had a second burner put in the center of this one which improved it. I next secured a larger apparatus in which both legs could easily be placed. I have never had any unpleasantness with this one except I could not bring the temperature above 300 degrees F. It took me a long time to find out that the kind of gasoline used made a difference.

I have had some very bitter experiences. To begin with the cases I will take first a man forty-five years of age, weighing near 200 pounds. Good family history, but a personal history of occasional attacks of inflammation of the big toe. Patient claimed he was a "plain eater". By this he meant he only took a moderate amount ofwine, champagne and meat. He had, at the time of treatment, an inflamed knee joint slightly reddened and tender, two inches difference in measurement as compared with the other knee. I put his leg in an apparatus where only the knee was exposed to the heat. The temperature reached 350 degrees F. when I discovered the toweling, in which the leg was wrapt, was afire. The apparatus was so small that the toweling around the leg came too near the cylinder. The patient was not burned enuf to prevent putting his leg into a different machine in a few days. This treatment was followed up faithfully in his case, but I cannot state positively how much it modified and cut short this attack. I am skeptical as to its efficacy in this case. To differentiate the doctor's work from nature's work, considering the self-limitation of disease, is, fortunately for the physician, frequently impossible.

The next interesting case was an inflammation of the leg of traumatic origin. I gave the leg a good heating and this was the last I saw of him. The other day I heard he had made violent threats, stating I had roasted his leg in one of those "dofunny" burning machines.

Another markt failure was that of a man in the seventies. It was a typical case for this treatment. A subacute, articular and muscular rheumatism with considerable adhesions. I gave him repeated treatments, after which he had to walk several miles in the country in the cold. He left me worse off than when treatment was begun. Two months later he came in and paid his bill, and very courteously thankt me, stating he grew constantly worse until he stopt all treat

ment and had been gaining rapidly ever since.

The next failure was a barber with a pain in his left iliac and lumbar region. So much for the failures.

To begin with the cases more successfully treated I will take first a man with a bad ankle. Traumatic adhesion caused by an old fracture together with rheumatism, gave him an ankle that had cost him a great deal of suffering as well as money. The hot air treatment made his ankle feel the best it had since his accident. In five days he returned, stating if his ankle was not so much better he would sue me for the beautiful blister he had on his heel. The benefit the intense heat did in this case was positive.

Another more markt case than this was that of a skeptical old fellow that I never knew to consult a doctor. To accommodate his wife, he came in to be experimented upon, as he put it. Rheumatism of the shoulder joint allowed but the slightest movement. After one hour's treatment he raised up his arm quite freely, and said "that beats h." This man had been unable to work for weeks. With three treatments he was so much improved that he has continued work ever since. Another equally successful case was a boy twelve years of age who had been laid up the greater part of the summer with inflammatory rheumatism, leaving one leg flext at an angle of 90 degrees. Medicins, liniments, etc., had no appreciable effect. Hot air treatment was given him for one hour every day combined with massage and passive motion, which was continued for several weeks. There was a constant positive improvement. To-day he uses the leg nearly as well as ever.

A man with a sprained ankle came limping into the office with crutches. After one treatment he walkt off freely on his foot stating that it felt as good as ever. I will not at present go into the rest of the cases. The list includes acute, subacute and chronic muscular and articular rheumatism, gonorrheal rheumatism, traumatic synovitis, arthritis, teno-synovitis, sprains, inflammation from various causes, varicose ulcers, gout, fibrous ankylosis and perichondritis. It also includes a case of rheumatoid arthritis and one of syphilitic nodes. The hot air treatment of the last two cases was a failure. All of these cases, except those