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to the chest is a good thing. It should be made as light as possible and never too hot (the best test is to see if one can bear its heat against the cheek). In the place of a poultice, hot fomentations or spongio-piline may be used with advantage. In children under one year of age the application to the chest of wool, or better a jacket made of "Gamgee tissue" with some camphorated oil or a few drops of turpentine sprinkled on, is preferable, as they are often unable to bear the weight of a poultice, which may increase the difficulty in breathing and even be a direct cause of death. It is as well to sprinkle the camphor only on that part of the jacket which is in contact with the back, for its odor-which to some people, and therefore possibly to children, is very unpleasant and liable to embarrass the respiration is less likely to make itself perceived than it would if the liniment were sprinkled on the part of the wool in apposition to the front of the chest.

In some cases mustard poultices made with one tablespoonful of mustard to four or five of linseed, do a great deal of good. Mixed in this proportion it may be kept on three or four hours without causing more than slight redness of the skin.

In the majority of cases, some stimulant will be needed. If the case be one of catarrhal pneumonia when admitted, and if, as is usually the case, there is great collapse with subnormal temperature, some form of stimulant is imperatively called for, and it is in these conditions that I have found small doses of carbonate of ammonia preferable to brandy. The action is much more speedy and I believe that it lessens, if not entirely removes, the spasms of the tubes which is nearly always present. With regard to the dose of the ammonia, I generally order to of a grain every one or two hours in a teaspoonful of water. If it appears to be causing any irritation of the intestinal tract it should be stopped directly, and it is seldom necessary to give more than three or four doses, when its place may be taken by brandy, which, in infants, can be given in ten-minim doses every one or two hours, and in older children half teaspoonful every hour, or more frequently if necessary. Its effects must be watched, if it is doing good it will slow the pulse, diminish the number of respirations, and probably help to lower the temperature slightly.

The diet must be strictly attended to, and all articles carefully avoided which are likely to cause diarrhoea. To this end milk and barley or lime water to children under one year, and milk, custard and chicken broth in older children may be administered. With regard to medicines, the treatment which has succeeded most in this hospital is that of giving antimonium tartaricum so long as there is no very high temperature. If the

temperature goes above 104° something else will have to be done. Aconite often succeeds now, but even this will sometimes fail, and it is in such cases that we find so much benefit ensue from the external application of cold in one form or another. In infants a bath at 100°, F., gradually reduced until the temperature falls, is the best method. In older children tepid sponging or the application of cold compresses to the chest are the best. The latter is especially useful, the first application causing the patient to take several deep inspirations which in themselves do a great deal of good.

The application of ice to the chest wall, which has been so successful in the treatment of acute lobar pneumonia of children when there is hyperpyrexia, does not seem to be suited to cases of catarrhal pneumonia.

During the sponging or bathing, the general condition must be carefully watched, and if any sign of collapse appears the treatment had best be suspended, and stimulants given if necessary; but I have never seen any trouble follow.

Intestinal catarrh with profuse diarrhoea is another very serious complication, and not an uncommon one. Some explain its occurrence by saying that it is due to the patient having swallowed the expectoration, but in any case, in children, there is generally a good deal of congestion of the intestinal mucous membrane, and any slight irritation will bring on a profuse diarrhoea which is usually sooner or later complicated with hyperpyrexia.

I had occasion, in the earlier part of this paper, to refer to spasm of the bronchial tubes. In not a few cases the spasm affects the glottis and then appears the characteristic breathing. Whilst the child is quiet perhaps there is but little to be noticed, but if it coughs, each inspiration between the expulsive expirations is attended with a crow, not unlike that of whooping cough, only differing from it in the fact that there is no preliminary series of expiratory efforts before the prolonged "whoop comes, and the attack is not usually followed by vomiting.

And in connection with this, I have noticed that an ulcer may appear on the frænum linguæ, showing that it is not in pertussis alone that this complication is liable to occur, but in any case in which the tongue is shot forward during the cough and the frænum rubbed against the projecting lower central incisors.

In treating this spasm, a hot bath will probably set matters to rights. If the case becomes urgent, as it is apt to do when it comes on suddenly in the night, we generally have a certain remedy in the inhalation of a little chloroform or ether. For more chronic cases, in which the spasm is of moderate severity and liable to come on every night, aconite, spongia and causti

cum are three medicines which I believe I have seen do good. I will now devote the last few minutes to the consideration of the chronic form of bronchitis as it occurs in children. The following is a case :

Ada S, aged eight years, had been in the hospital several times before, under Dr. Moir, with attacks of the acute form, and once with pneumonia of the base of the right lung, two years ago. When last seen she had the aspect of a patient suffering from chronic bronchitis, with cyanosed lips and face, and clubbing of the finger ends, with cold moist hands and feet, and dilated external jugular veins. The chest itself was barrelshaped and had a transverse constriction on either side. There was difficient expansion of the right side, and emphysema was indicated at both bases behind, by retraction of the intercostal spaces during respiration and a hyper-resonant percussion note. There was some slight dullness at the left apex. The vesicular murmur was very indistinctly heard on the right side, probably owing to the emphysema, and over the whole chest, but more especially on the left side, coarse bubbling and crepitant râles were to be heard. The apex beat of the heart was displaced downwards and outwards, and there was evident enlargement of the right ventricle with epigastric pulsation.

There was a constant hacking cough with expectoration of muco-pus which occasionally had a fœtid odor.

This was evidently a case of chronic bronchitis and emphysema, with probably some dilated bronchi as evinced by the expectoration.

With regard to the treatment of such cases, the scope here for the use of medicines is enormous, and cannot possibly be discussed now; but I should like to mention one form of treatment which I have seen extremely successful in Dr. Blackley's hands, namely, the daily inhalation, for about an hour, of the vapor of pumiline obtained as follows:

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The first two ingredients should be rubbed well together, and the water added afterwards. If two teaspoonfuls of this be added to four tablespoonfuls of water, and this put into the inhaler containg half a pint of boiling water, the pumiline vapor will come off, and may be inhaled by the patient.

This has succeeded so well in adults that I see no reason why it should not do good in the case of children.

Our attention should be directed to the hygienic treatment of

these cases, which consists in allowing plenty of fresh air, daily tepid sponging whilst standing in warm water, so as to give a general tone to the circulation, and thus possibly ward off chills, and friction to the skin, especially over the thorax. Flannel should be worn next to the skin, both day and night, and great care should be taken to prevent the child from being exposed to chills.

Cod-liver oil, alone or with maltine, after breakfast, in teaspoonful doses, will probably be found of much benefit, or it may be rubbed into the skin, though, from the unpleasant odor hanging about the child, this is generally objected to.

TAIT'S OPERATION; COMPLICATED BY A DISEASED
APPENDIX.

BY W. J. WINN, M.D., CAMBRIDGEPORT, MASS.

[Read before the Massachusetts Homeopathic Medical Society.]

She

Mrs. M; American; thirty-three years of age; three children; oldest twelve years, youngest three. Never has been well since the birth of her second child, eight years ago; a breech presentation that required operative interference. has had trouble in her right side ever since. Says that she was examined at that time and told that there was trouble in the right ovary. Has been very constipated and flowed most of the time since. Severe headache all the time and much trouble with her stomach and eyes. When I first saw the patient, in consultation, over a year ago, I found extensive lacerations of cervix and perineum. These I repaired without any apparent benefit to the general condition.

In February of this year, I was called to attend her in an attack of pelvic inflammation which went on to a severe local peritonitis. Close questioning at this time developed the fact of several similar attacks, one immediately following the severe labor spoken of above. A careful examination showed trouble with the appendages on both sides, and a laparotomy was advised.

May 11, 1891, she entered the Massachusetts Homœopathic Hospital. May 13th, I operated, assisted by Dr. J. E. Briggs and the hospital corps. The great thickness of the abdominal fat made the work more difficult than usual. The uterine appendages were bound down by adhesions in a mass behind the uterus, with quite extensive attachments to the intestines. The breaking up of the adhesions caused a troublesome hemorrhage. The tubes and ovaries of both sides were ligated with catgut and removed. Adherent to the mass was the vermiform

appendix which was also ligated with catgut and removed. A double drainage tube was inserted and the wound closed with catgut and silk-worm-gut. The drainage tube was removed on the eighth day, the patient doing well with no rise in temperature up to this time. Later an abscess formed in the track of the drainage, and a fresh tube was put in. The recovery was uninterrupted from this time. At the present date the patient is perfectly well and free from all pain. On inspection, both ovaries were cystic, and pus was found in both tubes. The perforation in the appendix vermiformis was an old affair, and was protected by the adhesions. It would be interesting to know what was the origin of the trouble. The history seems to point to a septic infection at the time of the birth of the second child. She has told me lately that when eighteen years old she was given up to die with an attack of dysentery.

In my reading I have been unable to find any reference to this complication in connection with Tait's operation. On Oct. 22, 1890, I assisted Dr. Horace Packard in a laparotomy, at the Massachusetts Homoeopathic Hospital, in which he found the vermiform appendix so adherent to the uterine appendages that he was obliged to remove it. This case also made a good recovery. I report these cases as a matter of interest from the unusual complication, and the desire to have them recorded.

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AMERICAN INSTITUTE OF HOMEOPATHY.

The Transactions of the Fourth International Homœopathic Congress and of the Forty-Fourth Session of the American Institute of Homœopathy, will be issued about the first of February, in a single volume of 1150 pages, octavo, and handsomely bound in cloth, similar in style to the recent publications of the Institute. The delay in issuing the work was due to the unusual amount of editorial and mechanical labor involved. Copies will be promptly mailed to all members of the Institute not in arrears, and to all foreign homoeopathic physicians who contributed, in any way, to the success of the Congress; besides which, the usual copies will be sent to homœopathic journals and colleges, and to the public libraries designated by the Institute. It is requested that any homoeopathic journal in the world failing to receive a copy will notify the undersigned.

After retaining copies sufficient to supply the Institute membership, etc., there will be some twenty-five or fifty copies left over. These, the Executive Committee will offer for sale at

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