since. Many of the laity assert that they have had an attack of grip whenever they get a severe cold; and too many doctors encourage such assertions. Grip is an actual epidemic disease, with plain, tho diversified, symptoms. When it appears When it appears in any community few escape. It is not a "bad cold," it is grip. The records up to 1870 show 90 pandemics in three centuries.

It is time or the competent physician to meet any emergency which may confront him. Reports of widespread infection come to us. We are thus inclined to the belief that another epidemic is covering the universe. If so, let us meet it manfully; but if it is all "a scare," let us try to quiet the people. All reports we have had seem to point to a mild form of the epidemic disease; but we will trust our readers to inform us of any outbreak in a malignant form.

The bacteriology has been lookt up by Pfeiffer (in 1892), and he has run the bacillus thru the postulates of Koch, producing the disease in apes by inoculation. The etiology proves that adults are more susceptible than children, but that no age is exempt; and we have found that when children are attackt, their cases are apt to prove severe.

The infection seems to be carried thru the air more than by actual or intermediate contact; yet it is indisputable that it is contagious and directly infectious.

It is generally classed as a catarrhal disease, tho some writers attempt other classifications modeled after the prominent symptoms. It certainly does appear as "nervous," "gastro-intestinal" and "catarrhal." It is enuf for us to be on the alert, and to meet the symptoms as they arise. We know of no method of prophylaxis, nor have we any specific. Incubation may be only a few hours, but is commonly several days. The onset is always acute, generally accompanied by chilliness and moderate fever. Muscles are sore and the whole body aches; the

legs and lumbar region generally being the worst. Soreness of the eyeballs, increast on pressure, and earache are common phenomena. There may be nosebleed, injected conjunctiva, lachrymation, herpes labialis, loss of sense of smell and taste, anorexia, constipation, vertigo, insomnia, restlessness, hoarseness and tickling sensation in throat, dry and obstinate cough, hot and dry skin, high colored and irritating urin, or even the graver symptoms of delirium and extremely high fever with pulmonary involvement. The fever lasts two to six days, and subsides by lysis. Recovery is markt by weakness, anemia, cough or tendency to heart fail

ure.

One attack does not confer immunity, but predisposes to others.

We know of nothing else which produces such protean classes of symptoms. The diagnosis is easy after an epidemic is well started, but is difficult or impossible in its inception.

The treatment is the most interesting phase of the subject; and the suggestions have been legion. It is an old rule that the more drugs one finds commended for a disease, the less the profession knows of the disease. Truly a sad commentary. It is fact, and not theory nor sentiment, which confronts us, however; and until bacteriology or serum therapy point out a better way, we can only meet the indications.

The victim should be compelled to stay in bed; not only for his own sake in warding off possible sequelæ, but to prevent him acting as a pernamulating focus of dissemination. If the attack is mild, he will persist in roaming, much as a canine with hydrophobia; for if there is anything the average man loves to do, it is to go about and tell how bad he is with the grip, but is "fighting it out." This "fighting it out" is the worst of foolishness and is responsible for most of the complications which worry the doctors and fill the graveyards. It always results in defeat and disaster, and is especially calamitous

in the aged. Purge well in the inception.

Use

Keep the patient warm and quiet. Use alcohol in some form, freely. Insist upon easily assimilable food being taken. nerve sedatives which will not irritate the sensitiv gastric mucosa. Beware of antipyretics, especially in the aged. Quinin is one of the safest and best antipyretics for use in grip, but really does little good. All the coal-tar derivations are dangerous; it is stimulation and not depression which you need. Quiet nausea, restlessness, cough, and insomnia, by morphin, bromides, lupulin, or codein. Support the heart by strychnin, digitalis, caffein, or aromatic ammonia. The vaporization in the room of turpentine, menthol, eucalyp tol, or compound tincture of benzoin is useful. The latter may aggravate nausea, and may have to be discontinued on this account. Have all food administered in liquid form milk, broths, egg-water, koumyss, true meat extracts, milk punch, egg-nogg, and oyster broth make a dietary

from which to select.

In convalescence, it is often necessary to use strychnin, quinin, iron, or cod-liver oil. Watch the heart closely, and guard the lungs carefully.

Timidity has no place when dealing with grip. Dosage must be heroic, and sleepless caution is necessary. The onset is sudden; the symptoms alarming; the sequelæ and complications serious; the mortality frightful. Much of this might be changed by prompt action, adequate dosage, reasonable hygienic adaptation, and attempts at isolation.

The laity know less about actual grip than about any other known malady; and they not only pretend to know more about it, but actually do treat more of it than they ever get opportunity to treat any other disease. So long as present conditions continue, the history of grip need not be rewritten; when the profession wake up to a realization of their duty, a new historian must arise. Hygiene, isolation, therapeusis, instruction, and energetic common

1. Have the patient chew a large wad of paper or rag vigorously.

2. Cut a cylinder from a sponge; moisten well, press out all the water, tie a string to the end, and pack firmly as far back in the nostril as possible.

3. If tannic acid is at hand, it may be blown into the nostril from any tube; a pipe stem, a quill, a catheter, or even a roll of paper.

4. Ice to the back of the neck and to the forehead.

5. Inject very warm water, if syringe be available.

For internal use, the best drugs are gallic acid, iron, hydrastis, ergot and cal

cium chlorid.

Vomiting.

Vomiting is a symptom of many diseases, and rational therapeutics would teach that one should search out the cause of the reflex act and treat it; yet the symptom is often so distressing and urgent that we are impelled to seek relief for our patient thru empiric procedure while we search out material for a diagnosis. It is also true that in many cases of vomiting our careful investigation leads us to nothing more exact than the conclusion that the patient has ingested some indigestible article of food; a conclusion which does the patient little credit, and in many

cases reflects no more brilliantly upon ourselves.

Tho many causes of vomiting are well known, doubtless fully as many are entirely unknown. It is relief in pressing emergencies, of which we would speak.

1. Insist upon the recumbent position; turn the head so the vomited material may be projected easily from the lips.

2. Stimulate circulation in hands and feet by mustard baths or poultices, hot water bags, or brisk rubbing.

3. Apply a mustard plaster over the epigastrium and over the seventh cervical vertebra.

4. Forbid water, but permit the swallowing of small pieces of ice, without allowing them to melt in the mouth.

5. Secure quick bowel action by the injection of emulsion of castor oil, one ounce of the oil to half pint of warm water, or one ounce of glycerine to two ounces of water, or one dram of turpentine to half a pint of water, or plain, soapy water with a liberal allowance of molasses added, or even plain, tepid water, if no other agent be available.

Keep thinking hard all the time, and ask questions as you get the chance. The most certain relief is obtained by the internal administration of tablets of cocain (gr. 1-12), bismuth subnitrate (gr. ij), and cerium oxalate (grij) combined. Give in rapidly repeated doses every fifteen minutes till two grains of cocain are taken. This is occasionally rejected before it has had time to act, in which event, only the hypodermic injection of morphin will bring relief to the patient, and gain time for the doctor. If the doctor injects morphin, he has some more thinking and some more work ahead of him when the effect of morphin wears off; better try everything else first. The latest suggestion, backed by experience, is to apply a poultice of ice over the spine opposit the stomach. Never get perturbed; allow attendants to "hold the patient's head"; keep doing something and thinking all the

time; and time will be gained, and also the patient's confidence will be gained. Send every unnecessary person from the room; get everything quiet, and keep cool yourself. Apply these suggestions, and most cases will subside permanently, or at least offer you enuf respit to permit time for diagnosis.

The Mystery of Immunity.

It has been known for centuries that a condition of immunity against certain diseases may and does exist under certain circumstances and in certain people. Yet our knowledge along this line does not advance. We still may wonder, in our ignorant silence, what immunity may be. Is it a condition of the tissues or fluids of the body? Is it in the "condition of the system," so volubly explained (?) by the old time doctor? Is it a toxin or antitoxin retained in the body after one attack? May it be a transmitted peculiarity from paternal or maternal influence?,

In some cases this immunity, so called, seem absolute; in others but relativ. Some families never have known a loss from consumption, but many of them pass away at a uniform age from cancer; and this cancer is generally of the same form and type, and in about the same location. Some have no history of tuberculosis or cancer, yet are marktly prone to nervous troubles, such as neurasthenia, epilepsy and insanity. The continued freedom of many branches of the same family from diseases which are common in the community in which they live, when traced back thru generations, points strongly to what some authors have termed “natural”’ immunity. Natural immunity can be nothing else than hereditary immunity.

Napoleon boasted that he was immune to bullets. Certain races fall an easy prey to certain diseases contracted in their nativ or foreign lands, and are marvelously resistant to even more insistent maladies common in their homes or in the land of their adoption. The Creole does

not possess absolute immunity from yellow fever, but he is much less susceptible than the white man. The negro resists malaria and yellow fever, but falls quick prey to tuberculosis and small pox. Thus races as well as families offer instances not rare of the existence of natural immunity.

In addition to the natural relativ immunity, so commonly observed, we have the artificial and temporary immunity observed as the result of the use of serums and antitoxins. We know no more of this immunity than of the other kind. But little has been added to the sum of our knowledge since Jenner tried his experiments with vaccination. There is a world beyond the reach of our finest mechanical instruments for diagnosis. "The microscope is a coarse, blundering tool," which lights the way but a few steps towards the deep mysteries of infinity. The mystery of immunity is attractiv, and may yet enlist the efforts of some one abler than those gone before. We can only We can only yearn and await the light. When immunity is better understood, the incurable diseases must rapidly yield to scientific therapeutics. As pathology leads therapeutics to victory, so will a knowledge of the unknown laws of immunity broaden the field and increase the number of the hard-earned victories.

How to Get the Most Out of Us. The knowledge of the manner in which most physicians read and use their favorit medical journal has been a "thorn" with us for many years. It is incomprehensible to us how any man can read a medical magizine for diversion, yet we sorrowfully record the fact that this is just what the average practitioner commonly does. After the painfully conscious effort of the work required to get out a single issue, this treatment appears to us a real abuse. To be sure, it is not our loss so much as it is the loss of the wasteful doctor; yet we would like to see every one of our readers get more out of THE WORLD, and we are

sure the medical world would be better off if more of our readers would speak their experience.

It is so easy to pick out your favorit medical journal from the pile of mail; to light the pipe; to forget the day full of misery and pain and horror; to even forget one's own weariness; to skim the editorials; to glance at the headlines of the book-reviews; to read the title of the various original articles; to run thru the "Monthly Talk"; and-go to bed. The doctor who does this has never realized what is in his favorit medical journal, for he has never read it. We work hard to get out every one of our issues in such a manner that those physicians who do not read it will suffer loss. None but the Editor realizes the Herculean effort required to engineer one issue thru to the subscriber. None but the Editor so keenly feels how much of his labor is wasted.

It is "not all of life to live, nor all of death to die." You are not practising for fun, nor likely for your health. We have never felt funny" "while we did our work; our ideal is too high. When you use any medical journal as a mere source of recreation you are doing yourself and the Editor an injury. We can see a future for medicin which is pregnant with possibilities, and is nearing full term. There is abundant expulsiv power if it can be brought into action. We are doing all we can to dilate and deliver the goods. It is your loss, our loss, and a loss to the profession if you continue in lethargy. Wake up! Write up! Speak of your cherisht victories, and tell of your bitter disappointments. The profession will be the gainer, and your "bread" will surely come back to you before many days.

We have thousands of subscribers who have absorbed more or less of what THE WORLD has put out during many years. They have paid their subscriptions regularly; they have occasionally tendered us words of praise; they have read their favorit journal so carelessly that they have

askt us questions upon points fully covered in issues not three months old; they never file their WORLDS; they lose much. We want them to get more for their money than they have gotten in the past.

The way to derive greater benefit from your medical journal is to read it thru from cover to cover, advertisements and all, every month; to file every copy, so you can refer to it when you want it in emergencies; to think over what it offers, and if your experience is at variance, write and say so. Most of our subscribers have come into the WORLD family and smuggled themselves into a corner to watch proceedings. It is very liable to get cool in such corners. Come out before the fireplace, and get warmed; you may be thoroly warmed before you get thru, but you will be the better doctor for the "roasting." At least, you may count on a thickened cuticle. Get the most out of us by getting the most for yourself. Read

more! Think more! Write more!

The Pendulum Begins to Swing Backward on Calcium Sulfid.

It has always been the reproach of medicin that any new remedy which might gain credence among the the profession, whether possessing potency or being inert, was certain of being "overworkt" and misapplied. We have had calcium sulfid highly lauded by journalists and practitioners, and we have often used it ourselves with what we supposed to be rather remarkable results; but as we used it more frequently, the failures and disappointments became more frequent, and now the drug has been declared of no value by those who have had full opportunity to test it in numerous and pronounced cases. Among others, Munson (Tropical Diseases, 1900, page 610) declares it valueless in boils. It is in this complaint that it won its first and perhaps greatest laurels, and this unequivocal declaration is stunning. If valueless, we cannot drop it too soon. If it has merit, even in slight degree, it is best to retain it. What has been the experience of WORLD readers?

Suffocativ Catarrh of Children.

It was Laennec who first made use of this term to describe a rather peculiar disease often found in young children. The term is not found in the ordinary textbooks on Pediatrics and Children's Diseases; few dictionaries give it space; most writers confuse it with bronchitis or pneumonia; yet it exists as a separate and distinct disease.

We have seen cases where it seemed to have been brought on by exposure, and have also seen cases where the possibility of exposure could not be considered. While some writers use the term capillary bronchitis as a synonym for suffocativ catarrh, the majority ignore it altogether, or hopelessly confuse it with bronchitis or pneumonia. The symptoms, clinical history, and mortality, are all at wide variance with these diseases.

It usually follows an ordinary severe cold; and commonly after an apparent brief progress toward convalescence. It frequently complicates the infectious exanthemata, whooping cough, grip, and diphtheria. It is ushered in by dyspnea, with paroxysms of coughing without expectoration (or without the sound of the mucus being expelled from the bronchi and again swallowed), moderately high fever, feeble, rapid pulse, and markt prostration; severe cases present in addition, play of the nostrils, an anxious expression of the countenance, retraction of the base of the chest, and cyanotic lips and finger tips. The resonance is commonly normal, and auscultation reveals fine, moist, or sibilant rales. The cyanosis increases, the mind is dull, the feet and hands become clammy or cold, and death quickly follows from heart failure or respiratory collapse.

The prognosis is generally very unfavorable; we have never seen a well developt case recover. Respiratory and cardiac stimulants are indicated, but never seem to act potently in any safe dosage. We have had temporary effect from amyl nitrite, but cannot say as much of any other drug. One must follow the indications, and meet the symptoms as they arise, but always impress upon the family the grave prognosis. One may order "absolute rest," but it is never attained. The struggling child is constantly tossing and turning; getting up and sinking from exhaustion. We order the air in the room kept at a temperature of 70° F, and have it moistened with vapor of tur