these thick and heavy applications applied, you can not make repeated examinations of the chest without disturbing your little patient. Even the bedclothes should be light.

Internal.—As we usually find a torpid liver and furred tongue in these cases, it is well to begin with small doses of calomel followed by oil, or a simple saline mixture. In not a few cases the gastro-intestinal symptoms are a grave complication. Most children swallow the mucus unless vomited up, therefore, keep the tract cleansed. The tympanites is often very troublesome, pushing the heart and lungs out of position, adding greatly to the discomfort of our little patient. The treatment then is the same as for gastro-enteritis.

For the cough, which is usually dry at first, the simplest and most palatable mixture is the best. I might write a number of different prescriptions, yet the one I give will usually answer.

M sig. A teaspoonful every two hours to a child one to two years of age; or this one:

M sig. A teaspoonful every two or three hours. If the cough is quite troublesome add a few drops Tr. opii camph. or deod. tr. opium, according to the age of the child. Never order your anodine in the mixture as you might wish to increase or decrease the dose or leave it out entirely.

Stimulants. In the mild cases very little stimulation will be necessary; if so, whiskey alone will suffice. It is

in the severe cases, where the pulse is so rapid you can scarcely count it, that will tax you to know what to do. Here whiskey, strychnine and my sheet anchor, tr. digitalis, should be used. For a child one year old I order 30 drops best rye whiskey every three hours and strychnine gr. 1-250 to gr. 1-200. Should the child show the effect of too much strychnine decrease the dose or leave it off for a while. Where the pulse is over 130 I use tr. digitalis, and so far have never had any ill effects. Tr. digitalis is a cardiac regulator. By its effect upon the cardiac ganglia and the muscle itself, it induces contraction, and strengthens the systole; by its effect on the vagi it prolongs the diastole. The result of this double action is that the diastole of the heart is lengthened so that more blood is allowed to enter the ventricles, while the systole is made stronger so as to impart more vigor to the flow of blood into the arterial system, and at the same time a rapid and irregular action of the heart is slowed and steadied. As digitoxin is the most active ingredient, and being insoluble in water and, therefore, precipitated by it, never order the tincture in combination, and give in a few drops of syrup so that it will be absorbed at once. No water should be allowed the patient for several minutes after swallowing. The dose is one to two drops every three hours for a child one year old. You must watch carefully the effect on the pulse and know when to leave off the digitalis. I have used adrenalin with good results, especially where there were signs of cerebral trouble.

Fever. An ice cap to the head and sponging with either tepid or cool water is all I use to lower the temperature, and have never had to resort to other methods.

Nourishment.-Happy are the little ones who are breast-fed; they not only have a greater power of resistance, but there is less tendency to abdominal complica

tions. Broth, beef tea, milk and egg albumen will constitute the principal diet list.

Oxygen.-Oxygen should be used at the beginning, if the disease complicates whooping-cough. Here you have the double cough to deal with, and as a rule, get cyanosis from the first. Even where the lung is greatly involved in other cases, it is a good idea to give oxygen early, and not wait for cyanosis.

405-406 Peters Building.

DISCUSSION ON DR. VISANSKA'S PAPER.

Dr. C. L. Williams, of Columbus: I think this subject is one of great importance. There is no disease I have to contend with that I dread more than broncho-pneumonia in children. In fact, I believe it is a rare thing in very young children to find the capillary bronchial tubes stopped up with inflammatory conditions, putting a burden upon the heart, and I have been convinced for a long time that the less remedies we use the better for the children.

As to external applications, I use mustard and counterirritation in mild form; then cover the chest and keep it in that condition. Cough is sometimes so severe that we are compelled to use opium in some form. It has been my practice to use carbonate of ammonia. I make it pleasant for the patient. Then, I have another mixture of carbonate of ammonia, with camphorated opium or codein, and where the cough is severe I usually use carbonate of ammonia, with codein. If the cough is not persistent, I put the child on carbonate of ammonia. For the heart I occasionally use nitroglycerin. I was treating a case before I left home. The patient, a child, was five years of age. I used as much as the one-hundred and twentieth of a grain of strychnia every six hours. Respirations were about 65 to the minute, and the pulse was

160 or more. Respiration under this treatment came down to 40, and the pulse was very materially reduced.

The proper temperature of the room is very important. There ought to be a fire in the room, if necessary, with the windows lowered at the top, so that the temperature of the room should be kept continuously at from 68 to 70. The child I spoke of just now is improving. I went there one morning and found the temperature of the room down to 64. I told the parents they had neglected to notice the thermometer which I put in, and they acknowledged they had. The child's condition was worse. Breathing was worse. The fine subcrepitant rales were more

exaggerated.

I regard the position of the child as very important. It should lie on its back and be kept so.

Dr. W. S. Kendrick, of Atlanta: There is hardly one within the sound of my voice but can testify that I am not a great giver of drugs. I am no authority on materia medica, and I am not a great drug-giver. I may be wrong, while my brethren of the opposite side may be right.

I have listened with some interest to Dr. Visanska's paper. It is a good one. As to the use of digitalis in acute febrile affections, I do not believe that digitalis in any of its forms (I do not condemn its use in toto) has any place in the treatment of any acute febrile affection. The great and brilliant results obtained from digitalis have been in chronic affections, where scarcely any fever existed. In typhoid fever in any of its stages, in acute broncho-pneumonia in children, or in acute lobar pneumonia, or any of the acute febrile affections, it has little place; but where we get the best results from its use is in the organic chronic affections of the heart, whatever that may be, depending upon whether it is secondary to

the kidneys, or to any organic affection of the heart. It energizes the heart. It lessens its number of beats. A heart beating probably one hundred times per minute can be brought down to seventy times per minute by the judicious use of digitalis.

Dr. J. W. Duncan, of Atlanta: I enjoyed the paper very much. It is a good paper. It is timely, and the subject has been well handled. But, as Dr. Kendrick remarked about digitalis, I do not give it where we have a high tension pulse, showing there is a contracted condition of the capillary circulation. Digitalis, if you give it in sufficiently large doses, will increase that trouble. If you want to lessen the arterial tension, give something else. I would rather give small doses of Norwood's tincture of veratrum than to give digitalis in that state. That is my practice in these cases of catarrhal pneumonia, broncho-pneumonia, or lobar pneumonia. When I first began to practice medicine they called it capillary bronchitis. I give a very small amount to a young child, say the sixteenth of a drop of Norwood's tincture. To older children I give more; I give from the eighth to the fourth of a drop of tincture of aconite. Those remedies are better than digitalis in the acute stage. I would rather risk giving them. When you have a case of high arterial tension, indicating that it is difficult for the average heart to force blood through the capillaries, and especially through the lungs, do not give large doses of digitalis. I consider two or three drops too much for a child. You increase the arterial tension; you bring the heart's action down, but at the same time increase the contraction of the capillaries.

As regards local applications to the chest, I generally find mustard, turpentine and lard in nearly all families.