say just as any other traumatic, sporadic or epidemic disease, as met in every day practice. Restraint and rational routine are evidently all that is needful. There are no specifics for disease at all in this day nor have been in any other. Secret medicines are not tolerable surely in this day of medical advancement and achievement. I have no objections to bartering, trading or speculations and the like, but he that hoards money from the misfortunes of his fellow men, barters with human happiness and traffics in human life, as a citizen is, or ought to be graded with the spurious gold brick designer. If a doctor, I could not in all commendable charity for the profession, call him first-rate.

What are the remedies? A little over a decade ago bichloride of gold, a dear name with a refined prefix, caused an unusual flurry in the new, and likewise an interest in the old world. Scores, hundreds, and up to a certain date two hundred thousand, quoting from Johnson's Encyclopedia, flocked to the new, as ancient pilgrims did to the old Mecca, and the new ones were just like the old when they got there. So great was the infatuation of the gold cure, or faith in the gold in the cure, that one of the sons of Abraham in a city who have, it is said, a great liking for the precious metal, on an occasion while importuning and over-importuning an idividual to come into his clothing department, when asked why he insisted so greatly, replied, "Mein Gott, don't you know he's been down to Dwight and got his belly full of gold?”

But let this pass. "Willow Bark" claims its tens of thousands, the "Golden Tonic" likewise, and last, but not least, I know not of the success of the remedies advertised by the president of the W. C. T. U., but trust, as Judge Tuley said of the Dowie corporation, "they will not link God and Mammon, but in purity and in lasting and fond remembrance of the loved and lost Frances Willard, will assail with might and main the potent trusts, who to-day are flooding the land with patent concoctions." A few of them follow:

I quote the above from "American Medicine."

It is worthy of remark that morality attacks the licensure and stock beverages, while these as "medicines " escape.

Apropos, let us say in comparison that beer contains 212 to 6 per cent. alcohol, wine contains 10 to 20 per cent. alcohol, and whisky contains 25 to 40 per cent. alcohol.

And these are condemned as poisons, the vendors thereof maligned, persecuted, sometimes, it is too true, justly, by combined individuals numbering approximately about 1-5 the population of our common country; while corporations, who without taxation, mix this poison crude, neither purified or rectified, with more insiduous and dangerous drug extractions, poisons or toxics, place them in all marts of trade, advertise with shrewd adroitness and cunning, with imaginary indications, fostering desires and unwonted tastes, by the aromatized little Demon getting in his work too well, all under the guise of angelic therapy, to which the whole of professional and lay classes are prostituted, as evidenced in the daily papers; publishing the pretended merits of these concoctions, to which are attached the portraits and statements of politicians, sweet womankind, ministers of the gospel, and others who are either victimized or subsidized.

I confess I have not conception or words to do the subject justice, and therefore submit the subject, crude but pertinent, to the mature reflection of my brethren of the profession.

Pneumogastric Sedatives.

By WILLIAM F. WAUGH, M. D., Atlantic City, N. J.

In cholera infantum and in cholera morbus we have a typical picture of intense irritation of the pneumogastric nerve, or of those filaments that end in the alimentary canal. Since the profession

has passed the point when astringents were thought the one thing needful in this group of maladies, the sedation of this vagus irritation has become the leading indication.

The most direct and powerful pneumogastric sedative is atropin. It is fortunately the most manageable of remedial agents and is exceptionally well tolerated by children. Its effects are also so uniform in their development that it admits of a precision of dosage for effect that none of the old remedies for the choleras enjoyed.

It is quite easy to administer atropin hypodermically, in cases requiring quick relief. For an adult half a milligram (gr. 1-134) is an average dose, for a man weighing 150 lbs. The old rule of dosage by age should be abolished and that by weight substituted, as being much more nearly accurate. Thus a child weighing 15 lbs. should receive 1-10 of the adult dose. This may easily be measured by dissolving a granule containing gr. 1-134 of atropin in 100 drops of water and injecting 10 drops. But as children bear larger doses comparatively than adults, about 15 drops would be advisable.

In any case the dose should be repeated in 15 to 30 minutes, until the physiologic effects are obtained. Among the advantages of the use of naked alkaloids, hypodermically or given by the mouth in solution, are their quick absorption and speedy manifestation of action. Another is the uniformity of effect, which renders explicit directions to the nurse possible.

The first manifestaition of the action of atropin is dryness of the mouth. Then come redness of the face and dilation of the pupils; but it is not necessary to wait for these, as the full therapeutic benefit is obtained from a dose just sufficient to cause some dryness of the mouth. The moment this is felt the remedy is to be stopped. In fact, so potent is it for good, that no more is needed.

Bismuth is a powerful local sedative to inflamed tissues, if it is left in contact with them for at least 12 hours. This is rarely if ever possible in treating an inflamed stomach; yet the persistent instillation of the subnitrate in one to five-grain doses every quarter hour, sometimes has an excellent effect.

Pepsin acts much as bismuth does upon an irritated stomach, when given in small and frequent doses. Possibly pepsin is the better. They go very well together.

Zinc oxide is more useful in chronic gastric irritabilities. The preparations of hydrocyanic acid have long enjoyed repute as gastric sedatives, but the uncertain quality of every one of them has led to their disease. The cyanide of zinc is uniform and stable, but observations on its use are wanting.

The only other gastric sedative worth mention is the application of rubefacients over the pneumogastric in the neck. The nerve lies near the surface, under the anterior edge of the sterno-cleido-mastoid muscle, and a strip of mustard over it will nearly always subdue vomiting, as well as the paroxysms of asthma.

"Laryngeal Complications in Typhoid Fever; Report of Case; Tracheotomy; Recovery."

No subject within the domain of medicine has had more earnest thought and painstaking researches focussed upon it than that of typhoid fever. Yet the laryngeal complications of the disease, which occur more frequently than is generally supposed, and when present diminish the chances of recovery, are wofully ignored by the profession at large.

With one or two exceptions, our text-books bestow on these gravest and least expected complications of typhoid only a passing

notice. Even works devoted to laryngology give the most meagre information on the subject.

The general indifference to the laryngeal affections which sometimes, accompany typhoid may possibly be due to the fact that at the bedside other, apparently, more threatening symptoms overshadow all else. The inability or disinclination of the attending physician to use the laryngoscope, the stuporous and feeble condition of the patient rendering this prodecure impossible, also seem satisfactory explanations.

It is interesting to note that the recognition of laryngeal lesions complicating typhoid is not altogether of recent date. Bouillard, in 1825, and Louis in 1829, refer to cases of this nature. Isolated reports of such cases appeared in the literature from these earlier dates to the year 1876, when William Keen, of Philadelphia, collected 169 cases of typhoid affections of the larynx.

Luning, in 1884, who evidently knew nothing of Keen's collection, published 213 collated cases, presumably identical to Keen's first series, to which he added 14 personal ones. In 1898, Keen published his classic monograph on "The Surgical Complications and Sequels of Typhoid Fever," in which we find 38 cases of laryngeal complications collected since Luning's paper, which, with Luning's 14 original ones added to Keen's 169 cases of his first series, gives a total of 221 cases collated up to the year 1896. This practically included nearly all the cases recorded in the fifty years prior to 1896.

With the valuable assistance of Dr. L. DePoorter and Mr. George Augustin, I have attempted to bridge over the period from 1896 to May, 1903. We have made extensive researches through the literature, using the Index Medicus, Bibliographia Medica and Index Catalogue of the Surgeon General's Office, as references, with the result that I can now add 37 collected cases of laryngeal complications in typhoid to Keen's series, with an additional personal case, which gives a total of 259 cases, the approximate number reported in the last fifty-eight years.

Etiology.-Rokistansky, in 1842, anticipated some of the most recent views as to the causation of these affections, by considering the laryngeal involvement " as a true metastasis of the poison."

Keen, however, in 1898, was not aware of a single observation