five drops of a one to one thousand solution. It is especially useful in emergencies during the low stages of typhoid fever, acting as a powerful adjuvant to strychnine. Also in collapse following injury or operation. In diseases of the kidneys characterized by scanty secretion, it is reported to act very promptly as a diuretic. A few instances have occurred of idiosyncrasy causing most unpleasant effects. Urticaria, loss of consciousness, and mania are recorded among its untoward results. The concensus of opinion is against its use hypodermically, as the intense ischemia produced by contracting the capillaries sometimes causes local sloughs of a serious character, but the character of the emergency sometimes warrants its injection, well diluted. Thyroid extract has been exploited in the reduction of obesity, but the verdict is against its usefulness. It still remains our most reliable agent for the control of myxedema. Caution should be exercised in its administration, as it is liable to derange the action of the heart in a very disagreeable manner.

The use of imponderables in medicine is increasing, though it is difficult to decide in which class some of them belong. Such an agent is colored light. It is definitely demonstrated that obstinate cases of lupus are cured by the use of an intense ray of light, colored blue by passing through a blue medium. Expensive apparatus is provided for the purpose, comprising the electric arc, a jar of concentrated solution of cupric sulphate in water, and a condensing lens. The same principle can be applied much more economically by passing the rays of the midday sun through a conical reflector, then through a jar of the blue solution, and finally condensing them upon the diseased spot with an ordinary reading glass. Of course the complete apparatus is better, but, such as it is, the light of the sun is always at our disposal.

Centuries ago it was customary to confine unfortunate people smitten with small-pox in a room in which all the hangings, window curtains, floor coverings, and bed clothing were of a bright red color. Modern therapeutists have long laughed at the idle superstition, as they supposed it; but the very latest fad in the treatment of small-pox is to keep the patient in a room saturated with red light. It is claimed that under its influence the disease runs a more favorable course, terminates more quickly, and leaves hardly any scars. Before accepting these claims as demonstrated, it may be well for us to wait for observations upon epidemics of a more virulent character than that whose mildness has led so many diagnosticians astray.

In the treatment of cerebro-spinal meningitis there is a revival of the old Russian plan of using potassium iodid in the very beginning of the disease, in full doses, not neglecting, however, morphine for pain, bromides and chloral for convulsions, ergot to contract the cerebral capillaries, and the derivative action of blisters. In certain well authenticated instances this treatment has proved more successful than any other, both in epidemics and in sporadic cases. More radical procedures, such as trephining the skull, or withdrawing the cerebro-spinal fluid, have been repeatedly tried, but their recorded results are inferior to those of the plan just described.

The production of anesthesia by the injection of cocaine into the spinal cavity is again coming into favor. Its advocates claim that by using great care to avoid sepsis, and by withdrawing a quantity of the spinal fluid equal to that of the solution injected, the evil effects of the procedure are avoided. In operations in the region of the bladder, especially for the enucleation of the prostate, its results have proved most happy.

The introduction of drugs into the system by way of the skin is becoming more common than has hitherto been the case. It is found that when an affection is local it can, in many instances, be attacked directly, instead of indirectly, by sending the required medication into the diseased tissue through the overlying skin, instead of administering it by the mouth and trusting that a minute fraction of the whole amount may be carried to the desired spot by its blood supply. Two ways are open for the accomplishment of this object. One is by combining an oily solution of the drug with lanolin, and using it as an ointment kept in constant contact with the part; or with some other oil applied as a liniment. The use of ichthyol and lanolin in the treatment of erysipelas is an example of the first; and of oil of gaultheria, which is ninety per cent. pure salicylic acid, with tincture of soap as an application for a rheumatic joint, of the other.

The second way of introducing drugs through the skin is more useful in the case of salts or alkaloids insoluble in oils but soluble in water. It is called electro-cataphoresis. A concentrated aqueous solution of the desired salt, whether morphine, cocaine, or potassium iodid, is poured upon a disc of blotting paper, the disc laid upon the part to be treated, and the positive pole of a galvanic battery held upon it. The negative pole is held in the hand of the patient. The current need not be very strong, that secured by four or five cells such as are

used for ringing door bells being sufficient. The relief of pain when morphine or cocaine is thus infused over a painful nerve appears magical, while the persistent use of potassium iodid in this manner over a scrofulous gland, will, if it has not reached the stage of suppuration, abolish the pain and diminish the swelling, and in many cases secure its disappearance. In the line of antipyretics and analgesics, it is doubtful whether there is anything really new. There is a swarm of compounds masquerading under all sorts of pseudo-scientific names. Acetanilid is the base, the active agent, in nearly all of them. To this may be added a little citrated caffeine, or some carbonate of ammonia, and almost always a liberal amount of bicarbonate of soda. The writer has known instances of prescriptions being written by reputable physicians, containing three drugs of different names, each of which had acetanilid as its active agent. It is hoped that the new Pharmacopoeia may so deal with acetanilid compounds as to protect the ordinary physician from being duped by conscienceless, so-called manufacturing chemists. It is doubtful if there be a single one among the swarm of widely advertised antipyretics that possesses any more virtue than acetanilid, phenacetin, or antipyrine. When caffeine or carbonate of ammonia or bicarbonate of soda are desired in a prescription the physician himself should designate them. Then he would know what he was giving. In the class of derivatives there is a real advance. An old domestic remedy for chronically inflamed joint or a painful swelling was a clay poultice. Some enterprising druggists in Denver conceived the idea of combining the clay with glycerine and adding thereto a few germicidal agents, such as boric acid, sulphate of zinc, etc. A fine white kaolin suitable for the purpose was available in inexhaustible quantities. After some experiment they produced a substance which, under a catchy title, has achieved an immense popularity in every civilized country. A great many physicians use it as a poultice over the affected lung in cases of pneumonia, and if their observations be reliable, the application affords comfort to the patient and tends to facilitate recovery. The hydroscopic properties of the glycerine undoubtedly exert a powerful influence over the tissues with which it is in contact, and that influence must be, through the agency of the spinal nerve roots, transmitted directly to the internal tissues beneath the poultice. Almost any locally painful affection may yield to its soothing, derivative influence.

A very great number of new drugs, or old drugs with new applications, could be enumerated under the title of Modern Therapeutics. It is the opinion of the writer, however, that enough has been said to illustrate the tendency of that department of medicine. It leans more and more toward a rational basis. It depends more and more upon pathology and physiology as guides to the selection of means and materials for the treatment of disease. The constant additions to our knowledge concerning toxins and their effects, is a continual stimulant to the search for antitoxins. We can hardly hope that that search will ever result in an antidote for every poison, a specific for every disease; but as our knowledge of causes increases, the importance of Preventive Medicine becomes more. appreciated. The final goal of Medicine seems to be the destruction of all pathological entities, and the abolition of disease. If that day ever comes there will be no further use for Therapeutics, for there will be no diseases to heal. However, there is no immediate need for the present generation of doctors to be alarmed.

RECENT DEVELOPMENTS IN THE STUDY OF DIAR-
RHOEAL DISEASES OF INFANCY
AND CHILDHOOD.

BY SAMUEL WALLACE WELCH, M. D., OF Talladega.

Senior Counsellor of The Medical Association of the State of

The unsatisfactory state of our knowledge of the intestinal inflammation of children is probably felt more keenly by the general practitioner than any other ailment considered in his busy life. When we realize that during at least six months of the year, one-half of his work may be thus classified, the importance of any discoveries made by investigators may be estimated.

The Bacillus Dysenteriae was first demonstrated by Shiga to be the cause of epidemic dysentery in Japan in 1898. It has since been proven by Flexner, Kruse and others to be the etiological factor in the dysenteries, epidemic, endemic and spo

radic, in all latitudes, the world over, not otherwise classified as amoebic.

With these data in hand, the Rockefeller Institute for medical research, in the summer of 1903, under the direction of Dr. Flexner, undertook an investigation into the causes of the diarrhoeal troubles of children. During the previous summer, Messrs. Duval and Bassett, pupils of Dr. Flexner, made a study of the so-called summer diarrhoea of children in the Wilson Sanatorium of Baltimore. They found in the dejecta and intestines of a large percentage of these children, an organism agreeing in all essential points with the Shiga bacillus dysenteriæ. These discoveries served as a basis for the next summer's work.

The plan followed in the investigation during the summer of 1903, consisted in the study of sick children in Boston, New York, Philadelphia and Baltimore. It was expected by this means to prove the etiological relationship of the bacillus dysenteria to the diarrheal diseases of children, and ascertain whether or not its occurrence was local or general. The harmony of the findings of these different workers is a tribute, not only to the accuracy and efficiency of the work done, but also to the master mind that formulated the plans for the investigations. About six hundred sick children in the above named cities were examined by about a dozen expert bacteriologists. The bacillus dysenteria was found in the dejecta ani mucus membranes of the bowels of about four hundred and twenty-five of the six hundred. The harmony of the finding in the four cities, justify the conclusion that the bacillus dysenteriæ is distributed all over the country, and that the dysen tery of childhood is a distinct disease agreeing essentially in pathological finding and etiological factors with the dysentery of adult life. It is also demonstrated that fully one-half of all the intestinal disturbances formerly variously called chronic indigestion, entero-colitis, etc., are due to the infection of the bacillus dysenteria.

VARIETIES.

There were several varieties of the bacillus dysenteria isolated, all agreeing morphologically, but possessing essential differences.

In the present state of our knowledge, these differences are only interesting to the pathologist. The true "Shiga," "Flex