The treatment of cases due to the second class of causes must, of course, be extremely varied. I can conceive of no treatment directed to oxaluria per se as being more than temporary avail. Generally it will be necessary to make a careful study not only of the symptoms as they exist, but what, I believe, is of much more importance still, the patient himself, his family both near and remote, his own past history, his habits of work and of play, of diet and of hygiene, a most careful and searching inquiry as to the nature of the excretions, and finally, a careful noting of the symptoms presented before us, both objective and subjective. Then and then only will the physician be prepared to intelligently treat the case. Speaking broadly, the cause being considered, as I have stated, imperfect oxidation either of food or tissue elements, such measures as would increase oxidation would naturally suggest themselves, and this is one of the most important requisites of successful treatment. If the patient's condition will allow of active exercise in the open air it should by all means be advised; if not, then massage should certainly be employed. At any rate, plenty of fresh air should be provided.

The diet of course is of extreme importance, and right here we not only have food for the stomach, but an endless amount of food for discussion.

We are advised that these cases should have no meat because of the excess of uric acid produced by flesh food. But it should be borne in mind that lean meats, which are especially rich in the proteids, are comparatively easy of digestion, while the kinds of vegetable food containing the proteids in any appreciable quantity are, to some organisms, indigestible. Proteids must be had, and as in these cases indigestion is usually present, we then look for the most readily digestible proteid food. On the other hand, it has been shown conclusively by the most able chemists that oxalic acid is a direct product of uric or lithic acid. We are, then, to avoid so far as possible foods that produce uric acid.

Thus we are between Scylla and Charybdis in the selection of food for such cases, and, like most questions in medicine

and surgery, as well as in other mundane matters, reason and judgment must decide for each individual case.

As to medicines, the study of each case will reveal the proper remedy for existing symptoms, backed up, of course, by the particular diathesis or discrasia.

TISSUE REMEDIES IN LUNG TROUBLES.
BY DR. J. M. BARTON.

[Read before the Worcester County Medical Society.]

The indications given in Schussler's tissue remedies — the 1884 edition were few and clearly stated, as for instance for the following four, perhaps most often used in general diseases.

Ferrum phosphate. The cure of all inflammations in the first stages, hyperæmias, the effects of mechanical injuries, hemorrhages.

Kali muriate. The second remedy, following ferrum phosphate for the exudation (thick, white) white-coated tongue. Kali phosphate. Nerve prostrations, putrid discharges, sleeplessness, mental disturbances, cramps with collapse. Magnesium phosphate. Cramps, convulsions, spasmodic cough.

This edition (1884) says ferrum phosphate and kali muriate are sufficient to cover most cases of pneumonia. When a moist rale or wheezing of loose, frothy, or rattling phlegm is heard, and the patient is unable to cough up the great quantity of mucus, kali sulphate or natrium muriate are required. The nature of the expectoration and its color will decide the choice.

In Boericke and Dewey's edition of 1899 the same remedies are given, but with a more extended list of symptoms, with the addition of silicea, for which the indications given are chronic neglected pneumonia, passing over into suppuration, dyspnoea, when lying on the back, deep-seated pain in lying. Sputa profuse, greasy, fetid.

The early edition speaks of calcaria fluorica for whitish expectoration of tenacious mucus if potassium chloride alone is not sufficient.

Ferrum phosphate. The fever indications are not given with much clearness except in the first stage of inflammation without exudation; its nearest analogue is aconite. It stands between aconite and gelsemium. Aconite has more bounding pulse and the characteristic restlessness and anxiety; gelsemium, a more soft, flowing pulse and more drowsiness and dulness.

Ferrum phosphate is indicated when there is flushed face, red, or red and dry mucous membrane of the mouth and throat, dry painful cough, or with bright bloody expectoration, with soreness worse on movement or touch. The sixth potency usually acts nicely, but in some cases the twelfth in water is followed by less aggravation or quicker results. I think at times aconite produces more pronounced heart disturbances and profuse perspiration, especially when given in too low dilutions, than ferrum phosphate.

Kali muriate is useful where the remedies given for the feverish stage do not complete the cure.

After severe attacks of fever or from a continuation of the feverish stage there remain exudations which call for this remedy, especially when there is a white-coated tongue with thick white expectoration.

Catarrhal conditions affecting the nose, ears, throat, and bronchi alone or in complication of catarrhal pneumonia in the second stage with the above characteristics, respond well to kali muriate. Some cases of pneumonia with heart complications and dropsy are cured by kali muriate. The dropsy being generally the first to improve, at the same time the cough becomes looser and the heart symptoms improve, while the cough gradually clears up as the consolidation passes off.

Schussler says that kali muriate assumes a rôle much like sulphur in pure homoeopathy, a deep-acting remedy with eradicating tendencies.

Kali sulphate has the yellowish or greenish shiny expecto

ration, worse in the warm room or in a hot atmosphere, better in cool air. Coarse rales, but cannot cough up much. mucous, watery matter. Mucus slips back and is generally swallowed. Hard, hoarse cough, like croup. A prominent symptom is also "rheumatic pains in the joints or any part of the body, when of a shifting, wandering nature," also face-ache with the other characteristics, especially with the thick yellowish catarrhal secretion. The above pains generally yield to kali sulphate.

The fever indications of kali sulphate are worthy of study. "Temperature rises in the evening until midnight, then falls again. It will assist in promoting perspiration." I have verified that fact in several instances.

Natrium muriate is prominently indicated for pneumonia of alcoholics, especially with the symptoms — clear, watery, frothy phlegm, loose and rattling, sometimes raised with difficulty. The frontal headache, with or without suppressed catarrh, is a prominent symptom.

There is an increase of the flow of saliva and tears, the cavity of the mouth and throat is covered with transparent mucus, and clean tongue. It is also indicated when the pharyngeal mucous membrane looks dry and shiny and pale. Natrium sulphate. Some writers claim this remedy is specific in la grippe.

The tongue has a dirty greenish gray or greenish brown coating at the root. The cough with thick, ropy, greenish, pus-like expectoration; soreness of the chest, which is better by pressure; patients hold on to the chest when coughing. There is aggravation from lying on the left side.

The Bryonia cough corresponds to natrium sulphate in the all-gone sensation in the chest, and soreness and relief in holding the chest; but the latter has much more the muco-purulent, thick, greenish sputa. I use natrium sulphate often where there is irritable liver, soreness of the liver to touch, etc., with sharp sticking pains, with good results. Dewey gives the symptom, "pain in left hypochondriac region, often accompanied by a cough with purulent expectora tion."

Occipital headache with other natrium symptoms suggests this remedy.

Magnesium phosphate. The cough is generally the true spasmodic cough, - dry, tickling, with constriction of chest and throat. Dr. Bennet spoke of a case of pneumonia where he gave ferrum phosphate for the first stage and for the cough magnesium phosphate, using only those two remedies, making a quick cure.

Dry tickling cough with relaxed uvula is cured by calcaria fluorica.

THE KNIFE VERSUS ELECTRICITY IN TUBAL

PREGNANCY.

BY HORACE PACKARD, M.D.

[Read before the American Society of Electro-Therapeutists.]

INTRODUCTION. - The discussion of this subject involves the question of methods. Methods employed vary according to training, practice, and prejudice, and although diverse, may reach the same end, and must be judged according to their results.

Given a known condition, the results of some one particular method employed must accurately be known in order to judge intelligently of the merits of that method.

The primary object of any method of treatment in tubal pregnancy is the preservation of the mother's life. The ovum dies anyway.

Before considering in detail the different methods, it is pertinent to inquire, What are the conditions which seriously menace the mother's life?

1. Rupture of the tube upward accompanied with free hemorrhage into the abdominal cavity—a common occur

rence.

2. Rupture of the tube downward without hemorrhage, and continuation of the life and development of the child