TREATMENT OF PERTUSSIS.

By T. L. HAZARD, M.D., Iowa City, Iowa.

In order that we may get a broad view of the treatment of whooping-cough I purpose briefly to bring together the ancient and modern methods of both the alloeopathic and homoeopathic schools.

First I will quote from Cullen's "First Lines on the Practice of Physic" published 130 years ago. You will recall that it was while translating Cullen's Materia Medica a hint regarding the action of cinchona gave Hahnemann inspiration to found the new school of medicine. Probably quinin in this instance had more far reaching and beneficent effect than all the quinin prescribed since that time.

Cullen says: "The cure of this disease has been always considered as difficult, whether the purpose be to obviate its fatal tendency when it is violent, or merely to shorten the course of it when it is mild. When the contagion is recent, and continues to act, we neither know how to correct, nor how to expel it; and therefore, the disease necessarily continues for some time: but it is probable, that the contagion in this as in other instances ceases at length to act; and that then the disease continues, as in other convulsive affections, by the power of habit alone.

"From this view of the matter I maintain that the practice must be different and adapted to two different indications, according to the period of the disease. At the beginning of the disease, and for some time after, the remedies to be employed must be such as may obviate the violent effects of the disease, and the fatal tendency of it; but, after the disease has continued for some time. and is without any violent symptoms, the only remedies which can be required are those which may interrupt its course and put an entire stop to it sooner than it would have spontaneously ceased.

"For answering the first indication: In plethoric subjects, or in others, when from the circumstances of the cough and fits it appears that the blood is with difficulty transmitted through the lungs, blood-letting is a necessary remedy; and it may be even necessary to repeat it, especially in the beginning of the disease; but, as spasmodic affections do not commonly admit of much bleeding, so it is seldom proper in the chin-cough to repeat this remedy often.

"As costiveness frequently attends this disease, so it is necessary to obviate or remove it by laxatives; and keeping the bowels open is generally useful; but large evacuations in this way are commonly hurtful,

To obviate or remove the inflammatory determinations to the lungs that sometimes occur in this disease, blistering is often useful, and even repeated blistering has been of service; but issues have not so much effect and should by no means supersede the repeated blistering that may be indicated. When blisters are proper, they are more effectual when applied to the thorax than when applied to any distant parts.

"Of all other remedies, emetics are the most useful in this disease; full vomiting is frequently to be employed; and in the intervals necessary to be left between the times of full vomiting, nauseating doses of the antimonial emetics may be useful.

"Fright may possibly be a powerful remedy, but it is difficult to measure the degree of it that shall be produced; and, as a slight degree of it may be ineffectual, and a high degree of it dangerous, I cannot propose to employ it.

"The other remedies which we suppose suited to our second indication, and which indeed have been frequently employed in this disease, are anti-spasmodics or tonics. Of anti-spasmodics, the most certainly powerful is opium: and when there is no considerable fever or difficulty of breathing present, opium has often proved useful in moderating the violence of the chin-cough; but I have not known it employed so as entirely to cure the disease. I consider the use of Peruvian bark as the most certain means of curing the disease in its second stage; and when there has been little fever present, and a sufficient quantity of the bark has been given, it has seldom failed of soon putting an end to the disease." Such was the accepted treatment in the year 1784. One hundred years later Loomis, another member of the dominant school, said, "All of the internal and external specifics for the prevention. of the paroxysms of whooping-cough, which have been proposed, and in some instances strongly advocated, are of very doubtful benefit."

In the year 1910 Jacobi published a treatise on diseases of children. He stands among the highest of the present day authors of the allœopathic school. Let us learn of him:

"As a matter of fact the prevention of contact and holding at a distance is the only prophylaxis in whooping-cough; there is no other protection of which I am aware. Even more than the prophylaxis is the therapy of the disease limited, and, as we may frankly admit, helpless.

"Up till now there is no active therapy of whooping-cough, although every day, air-bubbles of therapeutic successes are exploded. Unfortunately now, more than ever, pharmaceutical industry is busy in forcing remedies upon us; up till now, all without effect. Whether we prescribe reputed specific measures, which are

none, like pertussin-a sweetened thymus extract or extract of chestnuts, antibacterial remedies of a general nature such as carbolic acid, thymol, resorcin and many others, whether these remedies are administered internally or externally, no matter, they are and remain without effect. The attempt has been made a hundred times to hang clothes dipped in carbolic acid over the beds of children; occasionally amelioration is said to have occurred; according to my experience it is entirely without result; the same is true of inhalations of oil of turpentine, naphthalin, petroleum, nitrite of potassium, tincture of eucalyptus, gazeol steam, sulphurous acid, etc. This only tortures children; we accomplish nothing with these remedies, for the disease progresses uninfluenced if it does not even show a deleterious effect, as occasionally after the use of naphthalin, in that the respiratory organs show an inflammatory reaction and bronchitis develops."

Let us now see what homœopathy offers for the treatment of whooping cough. We find materia medica is rich in drugs for this disease but this richness may be a source of embarrassment to the prescriber. How fortunate it would be if we had a specific for whooping-cough! Under such circumstances all we would need do would be to diagnose the disease and, presto! it would be cured. But giving specifics has been not only a way of ease for the alloeopaths but also a way of pitfalls. To their sorrow they have found that what is most successful at a certain time is an utter failure at other times. This will explain why the profession raves over a drug as the ne plus ultra at one time and entirely repudiates it a few years later.

On the other hand, the usual way of differentiating the homœopathic remedy in each individual case is a weariness to the flesh and often entirely unnecessary.

I contend that there is a middle ground especially in the treatment of contagious diseases between alloeopathic specifics and homœopathic individualization. In almost every epidemic a certain remedy may be found which will cure a large majority of cases of that epidemic.

Instead of treating each case without reference to any other we should study as much as possible the epidemic as a whole, especially as to the drug best indicated and most successful in the non-strumous cases. Soon as we find a medicine which cures two or three cases of the disease occuring in children otherwise healthy we can be quite certain we have the epidemic remedy.

I do not mean when we find a remedy under which cases recover but one which undoubtedly has an actively curative effect.

Such a remedy did Hahnemann find for an epidemic of whooping-cough appearing in his time. "No known medicine,”

said he, "is so capable of producing a state similar to that of the epidemic whooping-cough as the sundew; and this disease, which, notwithstanding all the exertions of allœopathic physicians, either becomes chronic or terminates fatally, is cured in a few days in a certain and safe manner, as I first showed, by the smallest portion of a drop of the decillionth dilution of the juice of drosera rotundifolia." The decillionth dilution is the same as the twelfth decimal attenuation. [We figure it to be the thirtieth decimal. Ed.]

In a recent extensive epidemic of whooping-cough I found mephitis to be such a remedy. After obtaining this information I prescribed it in nearly all cases with the most happy results. "It worked like a charm," "It helped me immediately," "It is great stuff," etc., were among the many commendations for it.

I should consider my paper a failure if any one should go home with the thought that mephitis is the remedy par excellence for pertussis. Though it has been for one epidemic some other remedy may be needed in the next. Castanea is an excellent remedy for this disease, as are drosera and several others.

Cases not benefited by the epidemic remedy call loudly for antipsoric treatment.

No less than ninety different drugs are useful in whoopingcough under differing conditions. Should I mention all of them or go into detail regarding a few, the length of my paper would be tedious; so I will give a few leading indications for a few of the most frequently called for remedies and will leave more extended information to be found in our text-books, my chief reliance being Lilienthal's "Homoeopathic Therapeutics."

Before mentioning the internal remedies let me emphasize the fact that hygienic conditions should be made the best. Especially is this true as to fresh air.

Belladonna.-Useful early in the disease where with dry and violent cough we find cerebral congestion, with headache, red tace, congested eyes, dilated pupils, throbbing carotids and dry, inflamed throat.

Castanea vesca.-Early stage, dry, ringing, violent, spasmodic cough. Desire for warm drinks. Cough worse during the day. Coccus cacti.-Difficult expectoration of tenacious white mucus, with or following whooping-cough.

Cuprum met.-The keynote for this remedy is cramps or spasms. Generally the extremities and muscles of respiration are affected. Spasm of the latter accompanies the paroxysm of cough, arrests the respiration and causes the face to become blue or purple. A cold drink at the beginning of the paroxysm stops or greatly reduces it.

Drosera. Paroxysmal stage.-Constriction of the chest, with violent cough, worse at night.

Hyoscyamus.-Cough worse on lying down, constriction of throat causing difficulty in swallowing, especially liquids.

Ipecacuanha. Excess of mucus. nausea and vomiting, cyanosis or pale face with tendency to spasm. Epistaxis of bright red blood.

Mephitis. Spasmodic, hollow or deep cough, with hoarseness and pain in chest. Vomiting of food hours after eating. Inhalation difficult, exhalation still more so with sensation of smothering; worse on lying down at night.

The two thoughts I desire to emphasize are,-whoopingcough is amenable to medicines, and, finding the epidemic remedy is practical and decidedly advantageous.

THE RATIONAL TREATMENT OF FRACTURES.

By HUGH M. BEEBE, M.D., Prof. of Surgery, University of Michigan, Ann Arbor, Michigan.

In taking up the discussion of a subject so timeworn and at the same time so vital to us as surgeons or general practitioners, it is necessary only to call attention to the percentage of poor results in the practice of any surgeon, however skilled he may be. This percentage is not high but presents possibly the most serious difficulty to those whose practice brings them in more or less constant contact with emergency surgery.

The first thought in the treatment of any fracture is functional result, and there is no question in my mind but that the most certain way to obtain good function is by obtaining the best anatomic result possible. However, it is the very common experience of all of us that good function commonly exists at the site of marked deformity; but this is to be considered as a good result rather in spite of the malposition than because of it. To accept a method of treatment for fractures in general, one must find that method which promises definitely the best anatomic result.

The broader classification of the existing methods might be mentioned: (1) non-operative and (2) operative. Each of these may be subdivided into (1) early, (2) delayed, (3) late, according to the time of application.

The non-operative method up to a few years ago was the sole treatment for simple closed fracture; and there is no question in my mind that that same treatment should still be the method of choice in the very large proportion of these cases. It is inter