a resolution of this condition and cause the parts to become normal. In order to reach such an end we must have a breaking down of abnormal structures. We must have a change in the hepatization until the normal condition is again reached. Now there is no remedy known that can do this. Our duty is to support and nourish our patient until nature can take care of this condition by restoring it to the influences of the circulatory system. That is my idea in regard to specifics. In the early stages of the disease, that is in the period of engorgement, an immense dose of digitalis might do good by preventing the pathological changes that we know will probably occur, but when we have a properly developed case of pneumonia, and when the changes described have taken place, I can see no reason to expect any specific to be of service in the way of bringing about a change to a normal condition.

DR. F. B. SHIELDS, Victoria: Dr. Crouse and I have been using a remedy which we do not claim to be specific, but which in certain conditions of the disease has had the effect of lessening the severity of the attack and in all probability has reduced the number of days the patient was sick. In addition to carbonate of ammonia we give vitalized eucalyptol, two drachms every twenty minutes. In eighteen cases we found that this treatment shortened the duration of the disease and decreased the cyanosis, cough, fever and expectoration.

DR. RED, in replying on the discussion, said: I do not want to interfere with any man's hobby, but opinions expressed here are apt to be regarded out of doors, not as the individual views of particular individuals, but as the views of the Medical Association of the State of Texas. Therefore I feel bound to protest against its being supposed that the views we have heard advanced as to the merits of the creosote treatment of pneumonia are in any way endorsed by this body. For one thing, before putting much faith in these reports that have been made to Dr. Van Zandt, I would like to know something more about the gentlemen who made them. I would like, also, to point out that the doctor has proceeded in the wrong way in the conduct of his investigations. There are, as we all know, many varieties of pneumonia. They are not all due to the same cause, though, as I said in my paper, they are ordinarily caused by the pneumococcus. In order to demonstrate that he has a specific, Dr. Van Zandt must show that he can give his remedy by the mouth in sufficient strength to kill the pneumococcus or destroy its effect. That he has not done. It is necessary

that he should do this, and also that he should do the same in regard to other kinds of bacteria. This I repeat he has not done. He has simply got a number of reports from men scattered all over the country. I do not question the honesty of these men. I simply say that their reports do not give us sufficient data on which to base scientific conclusions. A friend of mine in Fort Worth used to say he could cure pneumonia with

a teaspoonful of digitalis, but he did not say what kind of pneumonia or at what stage. As has been brought out in this discussion, there is a period when no specific treatment can be expected to be of avail in the treatment of this disease. Similarly in regard to the specific about which we have been hearing so much for the cure of typhoid fever. It all depends on the stage of the disease, for after typhoid has advanced a certain extent the only antiseptic that could be expected to cope with it would be one that would reach every part of the body. All we can do in the treatment of pneumonia is to follow the common sense method indicated by Dr. Morris in his excellent paper. That is the only specific we have at present. I hope some day we will find one that will be still better.

DR. MORRIS, in closing, said: I have investigated this subject very carefully, and after the discussion that has taken place I may say that I have read all about creosote, but could not find sufficient data on which to found any conclusions. The gentlemen reporting the cases do not show that creosote aborted the disease or mitigated its severity. At the same time I believe creosote deserves to have a fair trial. Accurate and complete histories should be kept of each case, and laid before the profession, so that it should have an opportunity of forming its own opinion on the matter. Dr. Van Zandt speaks as if he would be much disappointed if he did not get rid of a case of pneumonia in the third or fourth day. With all respect to the doctor, I feel inclined to take with a large dose of salt any paper that comes to us with statements of that kind.

14-Trans.

RHEUMATISM.

J. H. MCCRACKEN, M. D.,

MINERAL WELLS, TEXAS.

I have selected this subject, "Rheumatism," which is old and, to many of you, may not seem interesting, but when we take into conideration the great number of cases that occur annually, the untold suffering these unfortunates endure, and irreparable damages that may follow, it behooves us to investigate the cause and, if possible, select a treatment which will relieve these patients.

The predisposing causes are wet, cold, exposure, fatigue and a depression of the vital forces, and, perhaps to a certain extent, heredity. The exciting cause is still unknown; however, the latest researches point to a definite micro-organism as the cause, which perhaps exists in the blood. As to the mode of entrance, it is not definitely known. Some have claimed it enters through the tonsils, and that there is a close analogy between tonsilitis and rheumatism. With the advantage of modern methods for investigating causes, I hope ere long the question will be solved. We believe there is a kindred relation between rheumatism, rheumatoid arthritis, gout and sciatica, and that the difference in the types is due to the virulence of the micro-organism, or to the resisting powers of the tissues. In acute rheumatism, the micro-organisms are most virulent. The toxins generated by this micro-organism being responsible for the initial chill and fever. It selects for its focus of infection serous and synovial membranes, fibrous structures about the joints, sheaths of nerves, and muscles, giving rise to acute arthritis, sciatica, muscular type of rheumatism, and endo and pericarditis. On account of the effect of this micro-organism causing a low state of the vitality, we get imperfect oxidization of the nitrogenous products with an excessive formation of uric and lactic acid, which, if not neutralized and eliminated, aids in producing chronic rheumatism, rheumatoid arthritis and gout. The acute attack sometimes

emerges into the chronic type, which is due to a partial success in treatment, or to a lessened power of the reactive forces of nature. In other cases of rheumatism it may be chronic from the start, which may be explained on the hypothesis, that the system is so strongly fortified that the micro-organism is held in check to the extent that we do not get the acute type, but the chronic form from the start; or it may be due to the attenuated form of the bacteria. Rheumatism in its course is very similar to malaria, if we give just sufficient quinine to check the acute process, and stop, we are almost certain to get a reinfection, and a return of the acute symptoms. This process, repeated a few times, and the acute type assumes the chronic form, or, as in rheumatism, it may develop as a primary condition from the start by slow infection. This condition existing in rheumatism, the bacteria with its toxins are not sufficiently active to give ferver, etc., but has just force enough to produce pain, soreness, and a low grade inflammation about the focus of infection, resulting in a thickening of the fibrous structures, with a deposit in and around the joints. This, in older persons and those of lessened vitality, may go on until we get destruction of the articular cartilages, ossification, and finally complete ankylosis, giving rise to a condition known as rheumatoid arthritis. The reason why the heart is so often involved in the acute type is due to the toxins being turned loose in the blood, and increasing the heart's action, causing a forcible closure of the valves, which injure each other in closing, giving rise to a favorite site for infection.

There have been divers and sundry remedies employed in the treatment of rheumatism, both acute and chronic, but there is no remedy that compares favorably with the salicylates. This, in my judgment, is almost a specific, and the reason why so many fail to get good results is due to the fact that they give too small a dose, do not repeat often enough, and discontinue too soon. Salicylate of soda, to be effective, must be given in twenty-grain doses, and repeated from two to four hours, as necessary to relieve pain and fever. This perhaps acts directly on the micro-organisms, destroying them. As proof of this theory, an anerobic bacillus was found, in 1892, by Sucotello and confirmed later, in 1897, by Thiroloix,

which is probably the same as Achalme's bacillus and is perhaps the true bacillus of rheumatism. The growth of this micro-organism was markedly retarded by the addition to the culture medium. of salicylate of soda in quantities smaller than those necessary to check the growth of other bacteria. As further evidence, if we leave off the treatment before the patient has fully recovered, which requires from four to six weeks treatment, after acute symptoms have subsided, we may get a return of the acute condition, which we attribute to reinfection, just as we have return of malaria, when quinine is left off too soon. As a result of this infection, we have a defective metabolism, giving rise to excessive amount of uric and lactic acid, which are poisons, keeping up an irritation and aids in lessening the vital forces; hence it is necessary to neutralize and eliminate these from the system. This is best accomplished by alkaline diuretics, plenty of water and saline purges. Any good alkaline saline mineral water is beneficial. During the active stage of inflammation, to assist in preventing cardiac complications, I give aconite for the purpose of lowering arterial tension, and slowing the heart's action, which I believe to be of great advantage. In connection with this treatment, we enjoin absolute rest. If this treatment is properly carried out, I believe most of the cases will recover without complications, at least this has been my experience. In the chronic type, the salicylates have their place, so long as there is any evidence of infection, such as soreness, fever, etc., but after all the infection is destroyed, and there remains an exudate in and around the joints, with thickening of the fibrous structures, nerve sheaths, etc., then the iodides have their place in connection with the alkaline eliminative treatment, hot baths, massage and electricity.

DISCUSSION.

DR. W. H. MOORE, Runge: I agree with Dr. McCracken in most, indeed in all, he has said. I think the subject is a very important one for us to discuss at this meeting, and it has been brought before us in a well written paper and one that is well worthy of consideration. Salicylate of soda is certainly one of the greatest remedies we have for rheumatism. Given in large doses it will at all events relieve the pain, and in some cases will