poisoning, from the toxins of pneumonia, or was it a general exhaustion from over exertion due to these factors combined? The heart fails, of course, in every fatal disease, but the conditions developing with dissolution and attending death should not be confounded. with those producing it.

If the depression from carbon dioxide poisoning is an important factor in producing death, then why not supplement this deficiency by adding more oxygen to the air patients are breathing? This would seem rational, since all authors admit that well-ventilated rooms are better for pneumonia patients than close compart

ments.

In reference to the abortive treatment of this disease, I wish to say that large doses of digitalis, brisk cathartics and vigorous counter-irritations would seem rational, but the good result from such a course could only follow its early use during the stage of engorgement, when the diagnosis is o'ten uncertain. And I would like to ask just here, if any one has ever tried adrenalin in these cases, since its action on the heart and smaller arterioles would seem theoretically correct. But after a consolidation is established, the alveoli filled with corpuscles, pus-cells, epithelium and clotted fibrin, I do not see how we could expect or hope for abortive agents.

I have seen one case where the crisis came within a few hours after the accidental ingestion of a poisonous quantity of carbolic acid. This was an alcoholic subject and not expected to live. In his delirium he drank the water in his spit cup containing 20 per cent. carbolic acid. The next day his urine was almost like ink, the patient had another slight rise of temperature, but finally recovered. If I thought the carbolic acid had anything to do with the crisis in this case, I should be

slow to repeat the experiment until some one tells me how much carbolic acid is necessary to produce death.

In the treatment of pneumonia, the late and much applauded remedy creosote carbonate seems to me to be of less value than was once thought. In some cases it appears to reduce the temperature and exert a favorable influence on the disease. My own experience was observations among patients of the same ward, and on the whole those who took it did not seem to do better than the ones who did not.

This was among alcoholics and old people, and perhaps not a fair test of its efficacy.

Rest. In a typical and well-established case of pneumonia, one of the greatest aids to treatment is-rest. Your patient with a high temperature, pain and restlessness, is also nervous and irritable. The breathing is much interfered with, because of the above conditions as well as the reduced capacity of the lung itself. When the patient is raised in bed to receive water and medication, propped up for nourishment, allowed to sit on a chair while the bed is arranged, and always getting up to defecations and urination, instead of using the bed-pan, you will find, after returning to the recumbent position, that the heart's action has been accelerated ten or twenty additional beats per minute, and from five to twenty minutes (or longer if your patient is very weak) will be required for the heart to calm down and your patient to get back into a state of rest. These little occurrences will amount to at least twenty during the day and night. If the heart has made forty extra pulsations at each exertion, we have eight hundred in twenty-four hours, or 6,400 in eight days, which brings us to the probable turning-point; to this must be added the worry of talking, and we finally have in the neighborhood of 10,000 heart-beats wasted in the course of a

pneumonia: if this unnecessary expenditure be reserved for the critical point it may be the means of carrying many patients over to the safe side. The patient has no breath to spare and never cares to talk while anxious and enquiring friends make their visits even more annoying by relating numerous deaths from this same trouble, and always precede their remarks with "How do you feel this morning?" "Do you feel any better now?" etc. Thus the words produce a disgust and fear to the nervous patient who has been bored already many times with similar enquiries, and now dreads the conversation that is to follow.

Keep your patient quiet; allow no company, and prevent an exertion of the mind and body. He will do better, and while preserving the strength, do not forget that it should be kept up by a systematized course of feeding to be established at the beginning. Allow plenty of fresh milk, meat-juices, milk, eggnog and other forms of liquid food every two hours through the day, and less often through the night. If the temperature is high combine an equal quantity of vichy with the milk to prevent curdling; if the stomach fails, resort to rectal alimentation.

As I bave already alluded to oxygen gas, I will say here that I believe it to be one of the most rational of remedies in certain cases and should be used always when there are marked signs of deaeration; the amount and frequency to be governed by the degree of carbon dioxide poisoning and the effects produced by its administration.

When the crisis is ushered in by cyanosis, beginning delirium and general depression, you always fear the worst, but the judicious administration of this gas will in many instances give most gratifying results and tide the patient over the critical point. I shall not attempt

to discuss the general treatment of this malady, but I would like to emphasize that the three things already mentioned, viz.: rest, diet and oxygen gas are worthy of careful consideration in the treatment of pneumonia; therefore, if you get a good bill of fare, a good nurse, and plenty of good air your patient will generally recover if you have neither the influences of senility nor alcoholism.

CLINIC OF DEAF MUTES WHOSE HEARING AND SPEECH HAVE BEEN ESTABLISHED AND THE INSTRUMENT AND TECHNIC APPLICABLE TO VARIOUS DISEASES AND DEAF CONDITIONS.

BY M. M. STAPLER, M. D., MACON

For the past six years I have devoted much thought to the development of a theory and practice in the treatment of the diseases and deaf condition of the ears which I believed would prove superior and practically supplant the unsatisfactory procedures so long followed with poor results.

In a very brief general way I shall endeavor to compare the advantages and disadvantages of one and the other method.

First, then, I would call attention to the fact that the ears are protected by the rarefier during rarefication and inflation, and such is not the case when using either Politzer's air-bag or the compressed-air tank as is the general method. The most conspicuous objections to their not being protected is that the tension of the delicate tensor tympanic muscle is sometimes overcome or the structure of the membrane itself is stretched, never regains its tone, and the patient is left with a secondary condition worse than the primary.

After having the ears protected from possible bad after-effects, the next thing to consider is the removal of the cause, which the rarefier does, if it be within