favorably with, and I dare say with the exception of Mr. Tait, are more successful than, those abroad. It is true that Mr. Tait's success has been marvelous, indeed phenomenal, for he exceeds the world in number of cases, and his per cent. of mortality is the lowest yet attained.

Dr. John Homans, of Boston, lost thirteen out of a hundred cases, taking them as they come; his last thirty-eight cases were all saved. Drs. Drysdale and Goodall, of New York, are operating with excellent results, their mortality being exceptionally small. Numerous eastern, western, as well as Southern, operators are now making a wonderful showing. In comparing the work and results of American operators with those of Great Britain, we must take into consideration the number of operators in the respective countries. In Great Britain they may be classed as experts, and their number can be counted on your fingers. Among those whose names are prominent and proficient in abdominal surgery we may mention the name of Dr. Bantock, who estimates the relative advantages of Listerism as 2 to 25. In Mr. Thornton's 423 cases of ovariotomies, he lost a little over 10 per cent. Our Dr. Battey, of Rome, Georgia, has reported over seventy operations and only two deaths. The wonderful success now being had doubtless is owing perhaps as much to strict cleanliness as to Listerism; both combined, together with operative skill, has resulted in the marked change of mortality. It would afford me much pleasure to furnish statistics of the cases and percentage of success for a given period, but that work I understand is now in the hands of Dr. Joseph Price, of Philadelphia, who, I trust, will soon have it printed.

COLD IN THE TREATMENT OF PNEUMONIA.

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

The therapeutics of pneumonia are still in what may be called an unsatisfactory condition. This is all the more surprising, when we reflect that it is one of the oldest diseases in the history of medicine, and yet in which no difference of opinion prevails in regard to its pathology.

We are all familiar with the old treatment of pneumonia, when venesection was practiced to the point of syncope, while calomel and tartar emetic were administered internally and blisters were applied externally. Then this treatment was displaced by hot poultices, aconite, veratrum, belladonna, and other agents, which, like their predecessors, have been cast aside by clinical experience.

I believe it can be safely said that no real advance has been made in the treatment of pneumonia, only until up to a recent date. It is my opinion that this step of progress in the treatment of pneumonia is chiefly if not entirely due to the application of cold, and while this is by no means a new procedure, still it has not yet received the use in private practice that it deserves.

Cold has been applied in the treatment of this disease, by the Germans for a long time, and chiefly in the hospitals of this country.

The fever is largely due to the inflammatory disturbances in the lung, and it is evident that any measure that abates the pulmonary disorder also strikes at the very root of the difficulty, and brings about an amelioration of the whole

condition of the patient. This is the way it accomplishes its good results, not through its general but local influences, and hence the cold must be applied continuously and persistently. It is just here where the strength of the remedy lies. How is it applied?

The ice must be broken in pieces small enough to be put into a small mouthed rubber bag. The ice-bag is wrapped in a towel and is placed against the affected area and is changed if the disease extends. The length of time that ice should remain is governed entirely by the wave of the temperature; if this falls to or near the normal point, the ice should be removed, and again be applied should there be a tendency to a rise.

The ice not only reduces the temperature, but I am quite convinced when properly applied checks the further spread of pulmonary congestion, and I have reason to believe that it produces resolution in areas which are in the stage of exudation.

The temperature begins to fall in a very short time, and in some cases makes a very rapid descent. I have seen it fall two or three degrees in the course of six to ten hours, and what is more interesting than all, is that a decline of this kind is very rarely followed by a rise, if the ice is assiduously kept in place.

The pains in the chest, the laborious breathing and the cough are alleviated, and often to such a degree that the patient, who rebelled against its use at first, calls for its continued application.

The question of age also comes up in relation to the use of ice in this disease. Can it be used at all ages? or is its use limited in this respect?

I consider no age a bar to its use if the temperature warrants it.

It must not be inferred from what has been said that other treatment is not necessary in this disease.

Next to ice strychnia and digitalis are probably of the greatest importance.

It has been my practice to give digitalis (infusion) in the first and second stage, as I regard the use of this drug as of undoubted efficacy in pneumonia, and when the temperature has been reduced I apply the oil-silk jacket, which I regard of great value. It keeps the skin at a uniform temperature, maintains a moderate amount of counter-irritation, and gives the patient a great deal of comfort. Has the ice any injurious effect? So far as my experience goes, I can say I have never found any detriment from

its use whatever.

From the practical result of this mode of treatment for the past two years I have had good results.

DISCUSSION ON DR. HERRMAN'S PAPER.

5 Dr. J. D. Chason of Iron City: In reference to the use of ice in the treatment of pneumonia, I would like to say that in the continued fevers, where the temperature has a tendency to run high, and where cold has been kept up for a number of days, most cases have involvement of the lungs. Again, in those cases where hemorrhage takes place in typhoid fever, heat, when applied to the external surface, dilates superficial vessels, brings the blood to the surface, and stops the hemorrhage in many instances. For instance, the hypodermic use of atropine will do it in many cases, the surface having been kept warm. I should think that the use of ice locally would stop pain in some instances, but I never could conceive of the idea recommended by Sturges and Copeland that it would relieve inflammation. It certainly does cause dilatation locally of the blood-vessels, but only to part applied; it does not give a

uniform dilatation of the blood-vessels that heat applied around the entire chest and flannel cloths with oil-silk will do, and I much prefer from my own experience the use of heat instead of cold.

As to the use of digitalis and strychnia, they are beneficial in certain stages of the disease. I would withhold the administration of digitalis in the primary stage by all means and use veratrum, because it bleeds a patient into his own vessels, it dilates the superficial vessels and brings the blood to the surface. It equalizes the circulation, while the physiological action of digitalis is to contract the small vessels and raise the tension in the large ones. I think it would be necessary to use it when the circulation begins to fail later; I do not see where the use of digitalis should come in with an asthenic patient in acute primary pneu monia.

Dr. Mark H. O'Daniel of Bullards: I was much pleased with Dr. Hermann's paper, and also with the remarks of Dr. Chason. So far as my experience goes in the treatment of pneumonia, I prefer veratrum to any one remedy, that is, in the full habit, plethoric subjects.

As a college student, I was taught with its use. You could say to the pulse beat thus, and no more, but I never relied on it until recent years, during which time I have given it a great deal.

I have at this time a patient, a stout, robust fellow, who has a very violent attack of pneumonia, whom I am giving veratrum with nice effect. Of course, I always leave it in the hands of a careful and intelligent nurse, and with whiskey and opium at hand, in event the effect should be too great. I usually commence with two-drop doses, and increase until I get the desired effect. Of course I give other remedies to meet complications and other issues.

In children and delicate subjects, I would prefer the ap