organs, especially heart and kidney, the prognosis is usually a grave one.

Before taking up the treatment it will be well to consider the sick-room. As most of our cases occur during the cold months, we usually find the doors and windows of the sick-room tightly shut, the room overheated and the patient covered with an excess of bed-clothing. Owing to the prejudices of the people and the fear that, if the window be opened, the patient will catch cold, there is difficulty in getting sufficient ventilation. Such fear and danger are readily overcome by raising the lower window and placing between it and the sill a board in length the width of the window and in width three to four inches. This permits of fresh air entering the room from between the upper and lower windows without creating a draft. With a little persuasion, lighter bed covering can be substituted. A temperature of between 65 and 70 degrees should be maintained in the sick-room.

Another difficulty I have encountered has been in the application of water to the body of the patient. Several times the information has been vouchsafed that I might as well sign the death certificate as make such application. Not long ago, when called to see a patient with a temperature of 105.5 F. and I requested the nurse to give him a bath, the entire family protested, as they had never heard of such a thing, but it was done and the patient made a nice recovery.

Diet: The patient should be restricted to an exclusive fluid diet. I find that milk, buttermilk, the various broths, fruit juices, egg albumen and the peptonized fiuid foods on the market will usually satisfy the wants of the patients. An abundance of pure water is also beneficial, as it aids in eliminating the toxic poisons and assists in flushing the kidneys.

Specific Treatment: As in the study of other infectious diseases, much time and thought has been given to finding a specific for this disease and an antipneumococcus serum has been used by some authorities and encouraging reports have been made, but up to the present time its action has not been as decided as is antitoxin in diphtheria. Let us hope that the time is not far distant when a serum which is a specific for this disease will have been found.

Recently Galbraith has published a paper in which he reports having treated fifty cases of pneumonia without a death or complication. The method of treatment is as follows: When the patient is first seen an initial dose of 50 grains of quinine is given, followed in an hour by 30 grains. This second dose is repeated in two or three hours. At the same time tr. chloride of iron is given in 15-20 drop doses every three hours. In none of the cases was cinchonism observed. Within a few hours improvement could be noticed, and gradually the temperature fell. so that in five to seven days the patients were practically well. In no case did the temperature fall by crisis. He states that malaria is not found in the mountainous district in which he practices, and that no bad effects were observed from the use of large doses of quinine. During the stage of resolution, however, small doses of quinine will produce cinchonism.

S. Solis Cohen, in commenting on this paper, states that a patient of his who had all the physical and other signs of pneumonia was given a 10-grain dose of quinine, and this to be repeated in six hours. By mistake 10 grains were given every hour for six or eight hours. At the next visit on the following day he found that the physical signs had disappeared and that the patient was practically well. He had been afraid to try such large doses of quinine in subsequent cases, but after reading Galbraith's

paper he suggests that tests in the pathological laboratory be made regarding the antitoxic powers of quinine.

At the onset of the disease a thorough evacuation of the bowels is beneficial, and for this purpose I give calomel the preference. The intense pain in the side and the hacking cough will frequently require the use of morphine; in the milder cases heroin will suffice. In children, the application of the poultice (the preparation on the market which only requires one or two changes in twentyfour hours) will usually make the patient comfortable. After a few hours use I have frequently seen a tired, restless child fall into a perfectly peaceful slumber. In adults, usually the same results can be accomplished by means of cold compresses or of ice-bags applied to the chest. Expectorants are rarely indicated. Hyperpyrexia can usually be gotten under control by means of the ice cap to the head and sponging or bathing of the body. Occasionally an antipyretic is needed. For this purpose lactophenin gives good results. Blisters are applied by some in the early stages of the disease, but personally I make no use of the same. Veratrum viride is also used, being regarded as a specific, but also this I have never made use of.

Delirium and insomnia are frequently encountered, and the cause of same must be discovered. We will often find the habitual user of alcohol a sufferer from delirium and sleeplessness. The hyperpyrexia will account for it in others. The bromides act very nicely, and under their use the delirium subsides considerably. For sleep, the newer hypnotics have done me good service; 10 to 15 grains of trional, or veronal, given per rectum in suppositories act promptly.

To sustain the strength of the patient during the attack is our main object, and close attention must be given

to the heart. For habitual users of alcohol I prescribe it from the beginning, either as a toddy or in milk punches, though wine is preferred by some patients. With others I do not begin with its use at once, but note the symptoms and with the first sign of exhaustion prescribe it. Strychnine is one of our best heart stimulants, and I frequently begin its use early to sustain and aid the heart.

Digitalis and digitalin, combined with strychnine, is often of great service. Of late I have been making use of the adrenalin and suprarenalin preparations, and they usually stimulate and act promptly.

In conclusion, let me say that I have used the inhalation of oxygen in cases where cyanosis was marked with good results.

LOBAR PNEUMONIA IN CHILDREN.

BY MARION MCH. HULL, M.D., ATLANTA.

The fact that pneumonia is the most common disease of childhood, according to an eminent authority, is sufficient excuse for our consideration of it, and if we needed other, the well-known fact, appalling as it is, that the disease is more prevalent to-day, if not more fatal, than a generation ago, would fully justify us in turning our thoughts to it again. We have chosen to deal especially with the fibrinous form in childhood, (a) because of the frequency with which it occurs, and (b) because of the peculiarities it presents.

When we think of pneumonia in a child we are apt to think of the catarrhal form, but while broncho-pneumonia is more prevalent under eighteen months of age, lobar pneumonia is far more so after that age, and is by no means unknown in the first few months of life. In a recent article in a foreign journal, one writer records sixteen cases following measles, of which thirteen were of the lobar variety, and of the thirteen ten were under three years of age. He cites it as his experience that this proportion holds good in cases with causes other than measles. While this is undoubtedly too high for the relative proportion between the two varieties mentioned, it at least serves to impress us with the greater frequency of the lobar variety in childhood than is ordinarily supposed. Jacobi probably has the proportion nearer right when he says that of all pneumonias in childhood about two-thirds