marks were simply intended to show the prevalence of the disease over the State.

Dr. McRae: We all agree that there is only one way to stamp out smallpox, and the only thing that we disagree on is the diagnosis. In every community there are some doctors who are influenced too much by the commercial instinct. You will find doctors who are first-class in every respect, but who are brow-beaten by doctors who know less and who disagree with them. I know that in Atlanta certain doctors send out hand-bills that they take is sue with doctors who make a diagnosis. The only thing for us is to get a State law that no child shall enter school who is not vaccinated. This will do more toward stamping out smallpox than anything else.

As to vaccination, I have absolute confidence in it, and I have proven this by taking my boys to the contagious hospital, and I would not hesitate to do it again. It is one disease that we can control, and the only thing to do is to get together and get the authority to control it. Let us get general laws to protect the communities, and let us work together, as Dr. Clark says.

Dr. O. L. Holmes: I wish to endorse what Dr. McRae has said about securing a law in regard to this disease. I had some experience with this last winter. I had a case which I reported to the county authorities, but they did nothing, and I then reported it to the State authorities and they said that they could do nothing until the county authorities requested them to. We need more stringent. laws on the subject.

Dr. Harris (in closing): I have very little to add, but would say that I was very much entertained and enlightened by the remarks, and am glad that they agree with me on the whole as to the existence of smallpox and the fact that something should be done to suppress the disease. I

would particularly thank Dr. McCormack for his lucid and clear remarks on the subject.

In reply to Dr. Williams, I would say that I am quite convinced that the fever of smallpox may be present without the eruption. I have no way of absolutely proving this view, and I can not say positively that it may occur, but I find that a large number of physicians share this view with me.

Of course, gentlemen, it is unnecessary for me to say that I am thoroughly and completely convinced that vaccination is the only way to fight the disease. I have attempted to fight the disease by quarantine regulations, but this is not practicable.

I would like to call your attention to the fact that the State Board of Health has no authority to purchase virus and pay physicians to vaccinate the people. The ordinary of the county usually says "Where are we to get the money?" and I am compelled to say that the board can not furnish it. The State, however, has the power to buy the virus, and it seems to me that if this Association would take up the matter and memorialize the legislature that we will probably get results.

CREOSOTAL IN THE TREATMENT OF PNEU

MONIA, WITH REPORT OF CASES.

BY J. D. HERRMAN, M.D., EASTMAN.

In the Medical Record of February 1, 1902, Dr. W. H. Thompson, physician then to the Roosevelt Hospital, reported eighteen cases of pneumonia treated with creosotal, a combination of beechwood creosote, with carbonic acid, so-called creosote carbonate, with one death, a record which impressed me, and was much more favorable than my usual experience in the treatment of pneumonia. I determined to put every case that came under my care, as far as possible, exclusively upon this drug. So far as medication was concerned, thirty-one cases were so treated from February, 1902, to March, 1904. Of these patients eightteen were males, and thirteen were females, ages from four to forty-five years. Pneumonia is and should be regarded as an infectious disease; there is no longer a doubt that it is produced by a specific organism located in the lungs, and the treatment of pneumonia in adults and children, based upon the theory of attacking this specific germ, appears to be gaining in favor with the medical profession. My experience with creosotal has led me to regard it almost in the light of a specific. We have been taught to believe, and it is pretty thoroughly demonstrated, that pneumonia is a germ disease, and produced by the invasion and action of the "pneumococcus" in the lung tissue. We also know that in pneumonia, as well as all zymotic diseases, the heart depression and variation of temperature are produced and proportioned according to the amount of ptomaines or tox

ines given off through the action of these organisms on the animal tissue. The administration of creosotal is attended by such a prompt reduction of temperature and improvement in the circulation, that it would seem that the drug exerts both an antitoxic and germicidal effect. As a matter of fact, I have no other authority in making the above assertion than the observation of the clinical behavior of the patient under this treatment. I am neither skilled nor equipped well enough to undertake the investigation of proving these claims bacteriologically, but it would be interesting if some one well enough versed in this branch of medicine were to look into the subject from a bacteriological standpoint. It is my intention to give the history and a detailed report of some of the cases treated by creosotal, but before doing so, I wish to add for the benefit of those of you whose experience with creosote and its preparations in the treatment of other maladies has been offset by its caustic properties, digestive and renal disturbance, whicn it sets up, that not in a single instance, even with the most sensitive and delicate stomach, was there any nausea or irritation that could be traced to the use of creosotal. made mention of those drugs because I anticipate that most of the profession present (as well as myself) have been discouraged in the use of creosote and its preparations, because of its irritating and even toxic effect. I have only selected a few cases out of quite a number that I have treated, because the records were more systematically kept by intelligent nurses, to demonstrate its actual value; that the drug exerts a special effect upon the course of pneumonia is shown by the peculiar course of the temperature after its administration. As you will note in some of the cases in my report, in a number of cases a fall in the temperature of from one to two degrees occurred within twenty-four hours after beginning with creosotal. I have never noted any depressing effect by it on the circulation,

I

nor any effect upon the kidneys. Creosotal also seems to affect favorably that very undesirable complication, which we so often see in pneumonia, tympanites. My usual way of giving this drug for an adult is fifteen drops on sugar every three hours, or another convenient formula for administering it is:

The following is a brief synopsis of cases that I desiro to report:

Case 1.-Pearl C. Age nineteen. Past history, always well until present illness; three days prior to my being called had chill and fever, severe pain in right side of chest; cough, with yellow sputum; shortness of breath, headache, and restlessness; chief complaint, pain in right chest. Called March 16, 1902; cheeks flushed, tongue coated and moist, pulse rapid, regular and good force, breathing rapid, grunting somewhat difficult, temperature 104, pulse 120, respiration 48; dullness over right middle and lower lobe, with bronchial voice and breathing; treatment, creosotal; fifteen drops were given every three hours; ice applied to head and chest at intervals until the temperature broke on the eighth day; five days later, resolution complete; discharged thirteen days after first visit.

Cases 2, 3 and 4.-J. R., M. R. and R. R. Ages six, eight and eleven years; brother and two sisters; was called first to the brother, aged eleven years, on the fifth day of his illness, with the history that he was taken four days prior with headache, vomiting, felt feverish, had pain in right side, no appetite, dry cough, pain worse by coughing; -on examination, dullness, with bronchial breathing over up