culation or directly stimulate the glands of the skin, we will have attained powerful auxiliaries in the battle against disease. DISCUSSION Dr. Thomas J. Carlton, Savannah: I have enjoyed the paper just read very much because it emphasized the improtance of elimination, a subject which is worthy of all that can be said of it. We recognize today that faulty metabolism, defective elimination, occurs in a great group of cases, and especially in the group which is labelled "Bright's Disease," and particularly in those people who have passed the age of forty (40) years. This also occurs in the glycosurias. Dr. Oliveros also referred to the eclampsias; I think that today we can safely say that eclampsia is a preventable disease, preventable through careful regulation of the diet, thorough elimination through the kidneys and skin. Our trouble is that we are apt to build too little upon this, elimination. I believe that the number of salts and diuretics that are now upon the market shows that our friends are sharper along this line of work than we are. In many of the cases of so-called chronic rhemutism, iodide of potash and other things are given; but we should come down to a careful diet and careful elimination, we should keep the bowels open and the kidneys well flushed and the skin active. By so doing, without the action of any specfic drugs, the patient should make a rapid and continuous progress. Again in cases of toxemic arthritis, for instance, a condition which causes so much worry, give a good dose of calomel and a diuretic, and the patient will begin to improve, as a rule, at once. I am very glad that the doctor brought out so many good points in his paper. For years I have been impressed with the influence and the great importance of elimination, and the part it plays, especially in those over forty years of age. REPORT ON AN UNUSUAL CASE OF PNEUMONIA J. E. Summerfield, M.D., Atlanta, Ga. patient hav Those of us who are called upon to treat ing Broncho-Pneumonia, realize how seriously ill such a patient is and how dubious is the prognosis, when we find the patient with an anxious expression of the countenance, high fever, cough, dyspnoea, pulse 100-120, respirations 40-50 per minute and the patient struggling for life. Fortunately for us, in the majority of such cases, resolution soon sets in, the pulse and respirations return to the normal and our patient is on the high road to recovery. If a patient with a history as given above is a cause of anxiety, how much more worried must we be when we find a patient with all these symptoms greatly exaggerated and this grave condition continuing for some time. As the case to be reported ended in recovery we felt well rewarded for the worry and time spent. I trust that the report will interest the members of this Association. Sarah B., age 31⁄2 years, with a negative family history, had never been sick until the early spring of 1909, when she and all her brothers and sisters had whooping-cough. The attack was comparatively mild and lasted about five weeks, leaving her with a hacking cough which persisted about three months. On October 6th, the mother noticed that the child coughed but as it seemed to be slight and did not inconvenience the child nor keep her from her play, no attention was given to same. bed at her usual hour, apparently well. the parents were awakened by her cough and her rapid and difficult breathing. They attempted to arouse her but met with poor success. I saw her shortly afterward and found her in the following condition: She was put to During the night She was in a stupor from which she could only be aroused with difficulty, cyanotic, dyspnoea quite marked -pulse 160, respirations 100 per minute-temperature (rectal) 103°. Examination showed throat normal. Chest on percussion, small areas of dulness both anteriorly and posteriorly on ausculation medium and fine moist rales over entire chest. Abdomen highly tympanitic. Diagnosis: Broncho-Pneumonia. A hypodermic injection of 1-100 grain of nitrate of strychnine was given at once. This relieved the cyanosis somewhat but had little or no effect upon pulse and respirations. The con Consultation was asked for and granted. sultant suggested the possibility of membranous croup, so a culture test was made from the throat but with a negative result. At my suggestion, the child was removed to a private hospital as the mother was unable to give her the proper attention and besides, three other children slept in the same room. For nearly two weeks the exhausting rapid pulse and respirations continued, the respirations rarely going below 90 per minute. The tympanitic condition was also the cause of much worry and frequent turpentine and asafoetida enemas gave some relief. After two weeks the chest began to clear up-the respirations and pulse became less frequent and at the end of four weeks the patient was discharged with a pulse of 90 and 22 respirations per minute. The treatment was as follows: 1-100 grain of strychnine nitrate and 1-500 grain of Atropine were given every four hours-inhalations of oxygen given at frequent intervals. A cough mixture containing Terpin hydrate, Heroin and Cascara was taken for some time. About six weeks after her discharge I was called one midnight to see her as she had fever, cough, complained of pain in her chest and her respirations were 60 per minute. An expectorant quickly relieved her and in the course of four or five days she was discharged. I saw her several days ago and her mother stated that she had remained entirely well since her last illness. DISCUSSION Dr. John Edge, Toccoa: I recall a case in which I employed treatment similar to Dr. Summerfield's. This child was nine months of age. There was quite an epidemic of broncho-pneumonia in my section of the country at this time. The baby had been sick about three days before I was called. He had a temperature of 103, a pulse of 180 and respirations about 90. I ordered strychnine and atropine and, in addition digitalis. In nine days the condition subsided and the child made a complete recovery. I do not know just what effect the administration of digitalis had upon this patient. This child had no careful nursing and no hospital care. ACUTE CATARRHAL BRONCHITIS. A. A. Barge, M.D., Newnan, Ga. It is a recognized fact by many of the highest authorities that a large per cent. of the cases of Acute Catarrhal Bronchitis is due to what is commonly called taking cold, and is manifest primarily in the upper air passage which subsequently involves the large and smaller bronchi by entension from above. It is stated by good authority that few cases are recorded where the bronchi were the seat of the primary attack. This being true, it is reasonable to assume that the cause is the same regardless of the location of the affected area. Copland says that the investigations of Ritchie clearly established that there is no specific organism for bronchitis, but it may be the result of infection by pneumococci, streptococci and occasionally staphylococci, while there are cases due to a mixed infection and in cases of grip it is due to the Bacillus Influenza. I admit the possibility of a primary Acute Catarrhal Bronchitis being caused by the action of the different bacteria, and yet I can scarcely understand how the bacteria can develop except the vitality of the mucous surfaces is lowered and the secretions changed in character by a blood dyscrasia. The reaction of normal blood is alkaline and alkalies dissolve mucin, leaving no suitable media for the development of bacteria. But with reduced alkalinity of the blood and the consequent lowered vitality of the entire system due to the acid products floating in the blood it is not difficult to understand how bacteria develops in the tough mucus with a nuetral or slightly acid reaction. A. Habel reports a case that from my view-point, sup |