shoulder was very severe, and I had lost all mental fear of what the result might be. The doctor gave me something which relieved all pain and I went to sleep. When I awakened he was examining my shoulder and arm. About where vaccine is generally placed on the arm was another place similar to the one around the bite, and still another on the shoulder blade. They were all about the same size and color, slightly raised and hard. I was in bed two days. About the fifth day a sharp line had separated the healthy flesh from the diseased flesh at the three swollen places, and the dead flesh fell out in a lump, leaving a clean healthy hole that would hide about two half dollars. I lost flesh and it was about a month before I regained my usual health. I do not know what remedies Dr. Troup used. Please excuse pencil, as we have neither pen nor ink in camp. Very truly, your friend,

Dr. Crouse.

J. D. MITCHELL.

BURNET, TEXAS, April 17, 1902.

DEAR DOCTOR: In reply to yours of the 11th, I report the following case: Calvin H., male, age 12. Bitten by a Rattlesnake on left leg a little below the knee on the 28th of September, 1900. I arrived an hour after he was bitten; gave whisky freely, bandaged the limb above the bite, cupped the bitten area and injected pot. permanganate in several places around the wound, gradually loosened the bandage and left him on whisky and strych., applying ammonia to the wound. September 29th: Leg badly swollen and turning dark, high fever, pushed stimulants, wrapped entire limb in bandages and kept it constantly wet with the following: В Aq. ammo., aq. camph., sodii chloridi, aquæ pura, Q. S. Cold sponging for fever. September 30th: Limb very black and badly swollen, left side of body dark. Fever very high, pulse very weak. Cold sponging continued, pushed stimulants freely. Put hot poultices around limb and left side, and kept the bandage constantly wet with the above solution. October 1st: Some improvement, treatment kept up. From now on he continued to improve and made an uneventful recovery. Of course, his bowels and kidneys were looked after through his entire sickness. The above is the treatment usually followed by me. Of course, modified as circumstances require. Have had no recurrent symptoms. Hoping the above may be of some use to you, I remain yours,

Dr. H. W. Crouse, Victoria, Texas.

A. HOWELL.

EDNA, TEXAS, April 8, 1902.

DEAR DOCTOR: On the 17th of June, 1899, I attended a negro boy, age five years, who was bitten on dorsum of right hand, about three-fourths of an inch from outer border, by a Diamondbacked Rattler. The snake

was very large, measuring five and one-half feet long. Constriction was not applied above the wound until about twenty minutes had elapsed, as the boy's story about the snake was not credited until the snake was found. I saw the little patient at 3:40 p. m., two hours and forty minutes after he had received the wound, and found the following: Just below the elbow the parents had tied a piece of a suspender, and the arm was plastered with mud. Patient very much prostrated, extremities cold, pulse 162 and scarcely perceptible at the wrist, respiration forty-eight and very shallow, moist bubbling in abundance over both lungs. Temperature 97° F. Pupils contracted and conjunctiva intensely hyperæmic. Stomach irritable, vomiting a frothy mucous about every two minutes. Patient unable to retain anything. No marked swelling of hand, though parents stated that swelling was great shortly after he was bitten. Cutaneous anesthesia, which was general. Up to this time the child had received nothing to counteract the effect of the venom. As quickly as possible I injected hypodermically nitrate strychnia 1-20 in whisky. The whisky was repeated every few minutes. The wound was incised and injected thoroughly with a solution of potasii permanganate. 3:52 p. m. Pulse 132 and of good volume. I eased up on the constriction, but unfortunately allowed the system to take up too much of the venom, which caused the child to become more prostrated, pulse rapidly disappeared at wrist and elbow, respiration more hurried, comatose, but was easily aroused and mind perfectly clear when awake. I should have stated that the mind was clear all the way through when the child was aroused. He tried to urinate once, but could not. Not having a small catheter with me, and him telling me that his bladder did not distress him much, I made no attempt to empty the bladder, as I could see that he would live but a little while. He rapidly became weaker, and just before he died (7:30 p. m.) had a slight general convulsion.

E. A. MALSCH.

SNAKE BITES.

CASE I. Child, age 4 years. Two distinct wounds on left foot. Limb badly swollen, pupils contracted, pulse and respiration much accelerated. Nervous twitching of muscles. Injected a two per cent. sol. potass. permanganate in each wound and also in calf of leg. Gave strychnia every three hours, first dose (hypod.) till pulse was nearly normal. Six hours after injections of permanganate swelling was almost entirely gone, respiration and pulse very good. Had no further trouble and child was playing as usual next day. When child was playing, its father found two snakes together under a box and killed them. They were of the Copperhead variety and classed as very poisonous. Did one of the snakes do all of the biting, or did both indulge in taking a bite apiece?

CASE II. Negro boy, age 10. Bitten on left calf by Moccasin. Injected

a one per cent. sol. P. P. in wound, also in left thigh. Next day was out at work. Did not give anything else but the two injections.

CASE III. Boy, age 5 (German). Bitten on leg by Copperhead; injected a one per cent. sol. in wound and also on leg above knee. No other treat

ment.

CASE IV. Negro woman. Bitten on big toe of right foot by Moccasin. Did not see her for two or three hours after bite. Leg swollen up to thigh. Injected a one per cent. sol. P. P. in wound, one in calf and also another in thigh. Gave strychnia as needed. Next day swelling subsided and patient thought she was well and went to work. Three days later leg commenced swelling, with severe pain in joints. Put her on the salicylates and in a few days she was well. This same woman ten days from time of first bite was picking berries and was bitten on left foot by Copperhead. There was no swelling and very little pain. I used the P. P. as before and she never stopped work. In all of these cases I applied absorbent cotton dipped in a saturated sol. P. P. to wound and kept it continually soaked with same. Am sorry in above case that I used any treatment, as I believe the treatment for first bite would have in so short a time been sufficient for the last. I have treated quite a number of patients for snake bites, and three years ago had twenty cases in less than four months, but the above cases outlined were I consider the most serious, and I did not see any of them within two hours after being bitten. Some had the limb corded tightly above bite, but I could not see any difference in results.

I

I also treat spider bites the same way, with equally good success. have never had any abscess to follow a single injection of the P. P., as many writers complain of. I use a clean syringe and inject deep in the tissues. I consider permanganate of Potassa, when injected correctly, to be a remedy one can fully rely upon, and I have no fear as to prognosis of any of my cases when so treated.

I have not had time to more than briefly outline these cases, but hope it will impress the value I hold P. P. in poisonous bites of insects and reptiles.

A. S. CROCKER, M. D.

My personal experience from the venomous accidents of serpents has been confined, with the exception of one case, to the bite of the Ground Rattler. The four cases that I have met had nothing distinctly peculiar about them. The limbs had been constricted, the cases were seen soon after the injury, and were treated by permang. pot. locally injected, two grains by mouth every couple of hours, strychnia, small doses of alcohol, and quiet. All recovered. April

25th, a small Mexican boy, aged 11 years, was brought to the hospital at 1 p. m., in the last stages preceding death, as a result of a moccasin bite, received at the outer portion of the right calf. The child was pulseless, pupils widely dilated, respiration stertorous, skin cyanosed, extremities cold, limb not swollen. The distance between fang punctures was one and one-half inches. Treatment: strychnia, according to Mueller; recognizing the desperate nature of the case 3/8 of a grain was given hypodermically, followed by nitroglycerine, pilocarpine, 1/40 of a grain; artificial respiration, heat to the body, and attempts to rouse. The strychnia, nitroglycerine were repeated in fifteen minutes. The site of the wound was injected with one per cent. sol. pot. permang. by nurse, area scarified and massaged. The child died twenty-five minutes after being in the hospital. The history given by the Mexican with him when bitten was that he had been struck at 9 o'clock in the morning; that the child became stupid in twenty minutes; that the snake was seen, and was the Water Moccasin species. Nothing had been done, the limb not even constricted, until 11 a. m.; nothing further until brought to the hospital at 1 p. m. On account of the condition of the child, stomach lavage could not be used. In fact, the child was practically dead on entering the hospital.

My experience in spider bites has been confined to two cases. Cases seen late, second or third day; treatment antiseptic application to sloughing areas. Location of bites, the privates. Result, recovery. I am convinced, after studying carefully the effects of spider bite, that the symptoms of pain are due to the influence of the poison upon the nerve end; that we have in consequence a condition analagous to, or rather an acute peripheral neuritis, furious in its nature.

SYMPOSIUM ON PNEUMONIA.

PATHOLOGY OF LOBAR PNEUMONIA.

R. W. KNOX, M. D.,

HOUSTON, TEXAS.

In taking a retrospective glance at the history of pneumonia and the various theories that have been advanced regarding every phase of the disease, we are forcibly reminded of the adage that "Times change and we change with them."

It is not necessary to search the archives of the renowned Watson, or the gifted Meigs and Pepper to get ancient history regarding pneumonia. We have only to look up our modern text-books dating back not more than half a score of years, and to contrast the ideas therein advanced with the more recent literature to appreciate the iconoclastic hand of modern research.

How little did we imagine a few years ago that pneumonia was an infectious disease, and that care should be exercised to prevent its spread as in other epidemic diseases. Nor is this our only surprise a recent writer in the "Twentieth Century Practice of Medicine" proves at least to his own satisfaction that an uncomplicated case of lobar pneumonia is not an inflammatory process.

These revolutionary theories regarding the pathological processes involved in this disease began with the discovery by Fraenkel in 1884 of the diplococcus pneumonia. This micro-organism was isolated by Sternberg a few years before this date, and was obtained from his own saliva, but no causative relation was supposed to exist between this germ and a disease of the lungs.

While it is true that the pneumococcus does not answer all of Koch's celebrated laws as a causative agent, its invariable presence in pneumonia, together with its behavior in other respects, lead us to believe that it takes a high rank as an etiological factor.