DR. J. B. WHITE-I did not hear the early part of the paper, but there was one point which I would like to emphasize in regard to the etiology of pericarditis, and that is the frequency of tuberculosis in cases of pericarditis, the acute onset and the acute course. I have seen two cases within the last year that began with an acute onset, and ran a well-defined course, that were found at the autopsy to be tuberculous in nature. We failed to recognize the nature of one of those cases, even at the post-mortem, we failed to recognize the nature of the lesion until the microscope showed extensive infiltration of the pericardium. There was an effusion of fluid that looked like spider webs, a characteristic appearance of the surface of the heart underneath the pericardium.

DR. R. O. BEARD-I think we are becoming more and more impressed with the necessity of basing our therapeutics on the physiologic action of the drugs, and if we use drugs, and we all do, we must use them with reference to what the physiologic action might be. Empiric remedies used to be administered without any clear idea or understanding of what they would effect. We are all very much interested in the new treatment suggested, but we would be more interested if he would suggest why he administered the bromides and the salicylic acid.

DR. WALTER R. RAMSEY (essayist)—I did not mention the special treatment of these cases, but I might say they all left the hospital and were partially recovered, and they have not come under my observation since, but the conditions at the time were entirely normal. We must look into the remote results, for the formation of adhesions, and if I should see those children later I might be better able to tell the outcome. The treatment was by counter-irritation, and I think it is logical to treat by counter-irritation. None of them had large serous effusions, and it was not necessary to operate on any of them.

OF WHAT VALUE ARE DRUGS IN THE TREATMENT OF CHILDREN?

DR. FREDERICK LEAVITT, ST. PAUL.

I take it that at the meeting of a scientific body like this we may, upon occasion, safely spend a little time in reflection; and, instead of always marching forward, as I know it is our aim to do, act wisely and call a halt that we may see where we are at. So, for a few moments, let us stop and reconnoiter. Since it is so much easier to ask questions than it is to answer them, and more natural-for some people-to condemn than to commend, I propose in this instance to do that which is both easy and natural.

The question is asked: Of what value are drugs in the treatment of children? This is putting the subject in rather a negative light, perhaps, and might suggest to your minds that all drugs are, viewing them from such a standpoint, somewhat under a cloud. I am not prepared to take such a stand, however, though I have sometimes felt with Dr. Oliver Wendell Holmes, who said many years ago that, excepting opium, a few specifics, chloroform and ether, he believed that if the whole materia medica were sunk to the bottom of the sea, it would be better for mankind—and all the worse for the fishes.

Of concocting many drugs there is no end. If we add to this the great number of medical journals which must, in order to fill their columns, publish every new plan of treatment and exploit every new drug, is it much wonder that our heads become filled with a host of remedies and we grow skeptical and unwilling even to give them a trial?

Let me ask another question: Are there not those among us who have had patients, perhaps in our earlier practice, that were made worse by medication? And, going a step farther, can we remember many instances of sick children

who were benefited by drugs alone? And, finally, is not the drug we administer oftentimes some senseless makeshift given to pacify our subject's mind-generally the father or mother of the child being treated-looking all the while for nature, the best physician of all, to come with her timely aid? With due respect to the members of this society, I venture to assert that we are all guilty of sometimes giving a dose of calomel on the same principle upon which we order a steak and coffee at the restaurant-because we can not think of anything else quite so handy.

The practice of medicine, though making progress as the years go by, is still an art and not a science. Indeed, there is little exactness and few absolutely settled facts upon which to build a science; therefore, we shall have to be content to try and keep on trying for a long time to come. We prescribe empirically a drug because some one else has employed it under certain conditions and claims for it satisfactory results. Some years ago while serving in the capacity of city and county physician under Dr. Ancker, a pharmaceutic agent called my attention to a physician in one of the eastern states, to whom he sold many thousand tablets and pills, but the interesting part of it was that these tablets and pills contained no medicine whatever, and yet this physician is said to have a large and lucrative clientele. Forthwith I purchased a variety of placebos and dispensed them promiscuously as specifics for all manner of ailments. I am forced to acknowledge that seemingly as many cures were wrought and as many patients returned for more of the wonder-working but drugless blanks as came for calomel, acetanilid, quinine and ipecac. And I can not help believing that their effect was less harmful.

The recollection of a few carefully observed sick children whom I treated after the orthodox fashion stands out prominently in my memory, and, I regret to say, some of these were made worse dangerously worse-from taking the medicine I prescribed. This was particularly true in cases of summer complaint and of capillary bronchitis. Opium in

some form was commonly given in both ailments, and nearly every text-book on pediatrics indorsed it. Then it was that I resolved never again to prescribe dangerous or even questionable remedies; that while a less potent drug or inert substance might not help the child get well, I could rest assured that no harm would come from its administration. Very rarely since then have I been persuaded to break this resolution that I did not have occasion to regret it. Looking at the matter from this standpoint, I am a believer in homeopathy, for this school of medicine has unquestionably helped to teach wise people that nine times out of ten nature heals disease without the aid of pharmaceutic art. In truth, I honestly believe, taking the world over, greater harm has been done children from the giving rather than the withholding of drugs. I would not be understood as advocating nihilism in medicine, though I do not hesitate to express the opinion that after all which has been said, the community is still overdosed. It is certainly a source of encouragement to note that the general trend of thought and work in the art of medicine these days is to ascertain the causes and quarrel less with the effects, and it would seem a still greater good to be able to ward off the former than to remedy the latter. In other words, "An ounce of prevention is as good as a pound of cure."

For such constitutional diseases as anemia, rickets, scrofula, goiter, cretinism, acromegaly, Addison's disease and diabetes, can we rely on drugs alone as exerting much influence in their cure? And for infectious diseases such as tuberculosis, typhoid, scarlatina, measles, mumps, variola, whooping-cough, how much real benefit is derived from the thousand-and-one indicated remedies. We can not change their course one whit. Is there any specific for meningitis? What drugs have we that avail us in pneumonia or even a common cold? If the alimentary canal was ever benefited by the exhibition of poisons (and is not poison the chief principle of most remedies), then why can we not cure the gastric fever of childhood?

There is another way of looking at the matter, and a very natural one, too. Many of the diseases we strive to cure are undoubtedly of benefit to the human race by their fatal consequences; such, for example, are hydrocephalus, tuberculous peritonitis and similar maladies. These seem to be natural agencies which weed out, as it were, the weaklings of the race before they reach the age of reproduction, and are really not so much diseases as manifestations of congenital incapacity for life. It may be conscientiously asked, Would the race not be ruined if our art could always preserve the individual subject of such maladies? All about us are seen individuals utterly unfitted for the struggle of life who would have benefited humanity more had they ceased to live and reproduce their kind. We bless the Creator when He takes them away, and yet our art demands that we strive to save and prolong their life. The time may come again as in the days of ancient Greece when weaklings will be allowed to perish. Until then we must do all we can for them, but we ought also to know what these diseases mean. If I strain the truth or offend your sense of humanitarianism, I can not but believe that many of you in your practice have considered the advisability-in select cases-in aiding nature snuff out the candle of life rather than prolong its flickering and hopeless misery. To be sure, there is a joy in living that even an imbecile may delight in. But a light that shineth only unto itself would not be missed, and its going out would not be regretted.

In reviewing the whole category of children's ailments, I am at a loss to discover any recent and decided advances made in their treatment as regards drugs save in the one disease of diphtheria. Within the last four years we have had thousands upon thousands of cases of smallpox in our midst and yet the treatment recommended by Sydenham in the seventeenth century is practically the same as that in vogue today (Osler). The mortality from whooping-cough in New York City is as great as that from typhoid fever. Twenty-five per cent. of all cases under a year terminate fatally