into purpura variolosa or hemorrhagic small pox, and the patient had become stupid, and later complete coma intervened which was followed by death about midnight of the same day. Thus, in less than forty-eight hours from the time he had appeared at my office a strong, athletic and healthy young man, complaining of feeling slightly unwell, Harry Pitts was a corpse. This hemorrhagic condition is not confined to the skin, but attacks all the internal organs of the body, and patients have been known to die in twelve hours from the time of first complaint. As the disease moved so rapidly in this case the treatment was purely symptomatic.

On April 18, 1894, I was employed by the City of Alton thru Dr. Waldo Fisher who was acting as chairman of the board of health, to treat some small pox cases. At that time there were three cases: Mary Smith age forty-four, Louis Smith age nineteen, Albert Smith age five, all at their home on East Second street. They were at once removed to the pest house, and when they came under my care were all in the second or vesicular stage of the disease except Louis, who was in the suppurativ stage. They were all well developt cases of confluent small pox, and past thru all the stages and symptoms of that type of the disease as described in the first part of this paper. In one of the cases a complete scab cast of the upper surface of the foot was shed in the stage of dessication. They were all well pock markt, and the time from the inception of the stage of invasion to the close of stage of dessication was about four weeks Neither of the three had been vaccinated. fourth case was Joseph Arnold who was living in the Smith family. As soon as he learned of the character of the disease he was vaccinated. It took well, but did not prevent the disease, but modified it so that varioloid was the result, from which he made a complete recovery in about ten days or two weeks, with no pock marks. The fifth case was John Meyers, age fifteen. He had never been vaccinated. He developt a typical case of discrete or distinct small pox and past thru all the four stages of the disease with the symptoms much milder than in the Smith cases. There were pock marks on his face, and he was well in about three weeks.

The

My treatment in these cases was both local and internal; beginning with a calo

mel purge, I followed by quinin and salol to lessen the severity of the febril movement; cold drinks of ice water or lemonade were allowed as the condition of the stomach would permit; the surface of the body was sponged with cold or tepid water. I used creosote as an internal antiseptic, also the sulfid of calcium in the vesicular and suppurativ stages, with, I think, good results; this with supporting remedies such as liquid beef peptonoids, wine of beef and iron, elixir quinin and strychnin as general tonics, was my principal treatment. Locally to soften and assist in the shedding of the scabs, I used carbolized vaseline. As certain chemical rays of the sun are said to benefit small pox, I had red curtains placed over the windows. and doors. I used none of the numerous remedies recommended for the prevention of pock marks as I think them of little if any value.

The prevention of small pox is accomplisht first by vaccination, which is a subject for a paper in itself. I can only say that I believe that if vaccination was inforced on all children at an early age, and revaccination every five or seven years, that in three or four generations small pox would be eradicated. Next to vaccination as a preventativ measure is isolation and strict quarantine of the disease.

In conclusion, I wish to call your attention to the great care I used in order to avoid contracting the disease myself or conveying the contagion to my patients or to other members of the community. On my first visit to the pest house I provided myself with a complete outer covering, consisting of a skull cap, mask for my face and beard, overalls and jacket, also overshoes and a long, linen duster, closely buttoned up, so the only part of my person or clothing exposed was my hands. When I entered the house I toucht nothing, having trained the nurse in the use of the thermometer and taking of the pulse. I only remained long enuf to ascertain, by inquiry and observation, the general condition of my patients, when I returned to the open air, where I heard further reports from the nurse and gave such directions as I thought desirable. About one hundred yards from the house I left, after each visit, my protectiv garments exposed to the sunlight and air, and washt my hands and face in a bichlorid solution, and went on my way rejoicing in the knowledge that I would

not convey that loathsome disease to my patients or other members of the community. During my attendance at the pest house, I was in attendance at several child births and treated a number of children and adults for various complaints, attended to my office and social duties, and that I did not convey the disease to others, I attribute entirely to the extreme precaution taken. W. W. HALLIBURTON, M.D. Alton, Ill.

Treatment of Pneumonia

Editor MEDICAL WORLD:-Pardon me for bringing up this subject after being so well discust in THE WORLD some months ago; but it is an interesting subject to me, and we are now in the midst of a season in which it is so common. Pneumonia is a disease running its course so rapidly and with such fury that it will not bear hesitation or halting on the part of the practitioner. If there is anything he can do in this disease he should do it and do it right off. I firmly believe that a considerable per cent. of cases can be aborted, jugulated, or cut short, as you see fit to call it, but it must be by energetic, persistent treatment. There must be no delay. An activ antiphlogistic plan is the plan in my opinion; aconite, or better, aconitin, pusht carefully but determinedly until its physiological effect is produced, amounts to a whole lot in controlling the fury of this much dreaded disease. Again, mercury, a much abused, tho much used remedy, is valuable beyond description. I often wonder if the authors of text books on practise use calomel as little as their books would lead one to believe. In In pneumonia push the calomel in small but frequently repeated doses. If a tiny, little red line shows itself along the edge of the gums, so much the better. I have never yet seen a case of pneumonia die if the gums were "slightly toucht." Don't be afraid of calomel in pneumonia.

As to counterirritation, it is valuable. Blistering is the best mode. Poultices are valuable, opiates are generally required, and also stimulants; whisky, strychnin, digitalis in rare stages of the disease, but don't use stimulants too soon. Don't mistake oppressions in the patient for a condition of depression or debility. Relieve the patient of the load that is so severely oppressing him, the acute, violent inflammatory action, then if much weakened by

the struggles, use your stimulants and tonics. Of course I do not now go fully into details of treatment; many other important details might be mentioned-as diet, etc.; but only offer in this article the principles of treatment as they seem the rational ones to me.

This treatment will remind many of a by-gone age; but many of the best plans of treatment, the most rational methods, had their origin in the early part of the now past century. The writings of George B. Wood contain matter that would be valuable for many of the M.D.'s of the twentieth century. I hope, tho, that the WORLD readers will not imagin that the greater part of my information has been derived from antiquated volumes, as I possess and read the classical works of Bristowe, Osler, Strumpell, and Tyson, with five or six journals, and try to keep up with the times; but I am not willing to abandon that which I know to be good simply because "it is old."

I forgot to mention in my list of late works on practise Waughs Treatment of the Sick. It is of inestimable value to any practitioner. And I think the advent of alkaloidal medication a decided advance. Surely the alkaloids in the form of granules or tablets, in small safe doses, are an advance in the methods of treating disease. They are disease. They are arms of precision if properly used. They are portable, clean, easily handled and will do the work if we properly inform ourselves in their use. I do not claim to be familiar with all of the alkaloids sufficiently to therapeutically handle them to the best advantage, but with a supply of granules of aconitin, digitalis, atropin, hyoscyamin, codein, morphin, quinin, strychnin, veratrin, apomorphin, cactin, caffein, calcium sulfid, colchicin, gelseminin, pilocarpin, glonoin (two of which are not alkaloids), we can mark the indications in quite a variety of cases, and carry all in a very small vest pocket case. But to do this we need not discard the old remedies that time after time we have found to be indispensable. W. H. THOMAS, M.D. Steele's Tavern, Va.

Editor MEDICAL WORLD:-Accept thanks for January (1901) WORLD, which I was not entitled to until paid for, as my belief and religion is to "pay as we go." Inclosed please find one dollar for subscription to THE WORLD during the ensuing year. I may have told you that I made enuf money out of one article publisht in THE MEDICAL WORLD last year to pay for my subscription to your valuable journal for a much longer time than I shall live, provided the prie remains at $1.00 per annum. Very respectfully yours San Francisco, Cal. H. J. BOUGHTON, M.D.

Treatment of Pneumonia. Editor MEDICAL WORLD:-Permit me to add my mite to the treatment of pneumonia. I am a "regular," have been practising almost twenty-seven years, and until twelve years ago I followed the teachings of the old school closely. Since then

I have been using some of the eclectic and homeopathic treatment in my practise. As soon as the diagnosis of pneumonia is made I have a pad of cotton batting applied to the chest and all around the body, and kept on.

Spec. tr. passiflora incar. Specific tr. pulsatilla . Aquæ ad. q.8.

Zi to 3ij. m.x to 3ss. ziv.

M. Sig. A teaspoonful every 2 to 4 hours can be given at the same time you give the bryonia prescription; and when he gets quiet do not give the passiflora so often, or stop it.

When your patient has a red tongue be very careful how you give opium; or you might cause his death.

I think passiflora incarnata and pulsa

tilla are most excellent remedies.
I use
pulsatilla in nervous troubles in lieu of
bromides, and passiflora in pain in lieu of
bromides, and passiflora in pain in lieu of
opium and its salts. I do not like the old
tinctures as well as I do specific tinctures.
Specific tinctures are uniform in strength.

JOHN E. L. HARBOLD, B.S., M.D.
La Grange, Ky.

Editor MEDICAL WORLD:-Please find inclosed one dollar in payment for THE WORLD for the year 1901. This is my 12th year as a member of THE WORLD family, and my relationship has grown stronger and pleasanter, and the value and benefit that I have received thru its helpful and practical suggestions and counsel has increast and multiplied as the years have gone by. May it live to see the dawn of another century. L. B. YOUNG, M.D.

Rolesville, N. C.

Asepsis and First Aid as "She is Practised" On Some of our Railroads.

Editor MEDICAL WORLD:-Most of the great trunk lines now compel every crew to carry in engine and caboose, or baggage car on passenger trains, what they term an "Emergency Packet." Not long ago I had occasion to inspect one of these boxes. On the lid it bore the information that within were contained pins, bandages, cotton, and a tourniquet. Not a word as to the use of any of them. I questioned a brakeman, and learned that the boxes were placed there to be used by them until the arrival of the company surgeon would permit the injured having proper medical attention. They had no instruction in first aid, and he could not tell me what the tourniquet was for. In the box I found some remnants of bandages, a filthy tourniquet, and a grimy pin paper. This was their equipment for action in injuries which are always mangling and serious.

When

To my certain knowledge this box had been handled repeatedly by those suffering from gonorrhea and syphilis. they needed cotton or pins, they robbed the box. What would be the aseptic(?) results when a mangled leg was wound with these remnants by filthy hands? These are the conditions which confront the railroad surgeon, and yet we seem to get results comparing favorably with more favored circumstances.

It often appears to us that truly the "wind is tempered to the shorn lamb," and the sinful and ignorant have an invisible shield over them.

elm bark (not elm bark); into this infusion is put enuf boracic acid to make a saturated solution. The patient is instructed to avoid the light, keep the eyes closed as much as possible, if necessary using a bandage with cool compresses dipt in the solution, and to bathe the eyes frequently with the solution. The cure is rapid and satisfactory. Tho I admit that I always tell my patients that I am using slippery elm" with my other drugs, I have used enuf of it to know that "suggestion" has no part in the cure.

Those who fall back, fearing that they have not a thoroly aseptic or antiseptic solution, may use boiled or distilled water and saturate it with the horacic acid before making the infusion.

I learned the value of the slippery elm from an old, ignorant midwife, who offered suggestions after had come perilously near failure on a case of non-specific ophthalmia in a week-old infant. I made the slippery elm infusion aseptically, tho she could not appreciate all my "fixings." My case was cured sooner than I could have hoped. The hint was enuf. I use it all the time now, in both young and old. Pittsburg, Pa. "MEDICUS."

Form for Prescription Blank. Editor MEDICAL WORLD:-I notice a

ORIGINAL

PRESCRIPTION FROM

J. S. LEONHARDT, M.D. 1427 0 Street, Lincoln, Neb.

OFFICE HOURS:

9-11 A.M., 2-5 P.M., Daily.

form of prescription blank in your issue for January, page 32, and you ask for criticisms. Here is my idea of a form that will avoid the objectionable features of your form, I think.

The address should be given, to street number, unless the doctor lives in a village. The office hours you give are a bid for night work, and my experience demonstrates that the laity establish these off hours of their own accord if they are permitted to do so. The evils of substitution and refilling are bad, no question, but honest druggists ought not be offended with matter in the hands of customers that are his as much as they are of the physician who wrote the prescription; the rogue will not be affected by it unless it be to make capital out of it. It is necessary to protect patients not only against the base druggist, but also against themselves; but it is not wise to "substitute" in their minds any form of suspicion; I am afraid your prescription would get them on their look out! Of course druggists use only pure drugs (?); of course the prescription is carefully written and for the specific use and cure of the patient paying for it-never let them think in advance that anything else is to be thought of. When they want it refilled, then comes the blocking against themselves if the druggist has any business

PLEASE NOTE!

The medicine obtained on this prescription is to be taken only by

and no longer than is contemplated by the quantity hereby prescribed.

Druggist's Number

usually get at the proper dose in about two days. The mistake, I think, is made in believing that strychnin will create a disgust for liquor, and the inexperienced practitioner is liable to push it to a very large dose if his patient does not give up drinking very soon. I made the same mistake early in my practise. I believe that any case of inebriety can be cured with the proper administration of strychnin. If the patient does not improve while taking strychnin, there is something wrong too much is given, or not enuf. For the past six years I have not had a patient who has not gained from five to twenty pounds in from three to four weeks. I have had nothing but the most flattering results with strychnin, but I consider it a drug which should not be used off hand. Great care should be taken to know the