Park Board seems inclined to add a strip of park about the other sides of the hospital grounds and thus vastly enhance the value of the investment which the city now has in its hospital building and grounds. Do it, by all means.

ANTI

THE CRUSADE AGAINST ANTITOXIN.

We are ready to say that we believe in the value of antitoxin. We have talked with many doctors and can report that a large majority of the practitioners of this section are firm believers in the serum cure for diphtheria. At the same time we recognize the fact the remedy is not approved by some, a minority it is true, yet a minority which by virtue of the ability of its individual members mark it as a group whose opinions demand respect. So long as thinking, careful practitioners of medicine uphold the antitoxin treatment and others decry its usefulness, the position of the medical press and the associated body of the profession of the country should be one of expectancy, ready to hear new evidence, to discard present views if proven erroneous, to test by bedside trial and to give due heed and weight to the testimony of others. Hence we re-open the question and give an opportunity to our readers to read the report of the "American Pediatric Society's collective investigation into the use of antitoxin in the treatment of diptheria in private practice."

This report was read by the chairman of the committee appointed to make the investigation and covered the reports of about 4,000 cases treated by 615 different practitioners in the United States and Canada. Of these, 800 cases were so vaguely reported as to be valueless or were fairly open to the doubt of being true diphtheria. To these were added 942 cases treated by the New York Health Board in their patient's homes in New York and 1468 cases treated in the same way in Chicago.

There are at present recorded three deaths due directly to antitoxin, and in the report, 19 cases were not affected at all. We reprint the summary of the committee's work:

SUMMARY.

(1) The report includes returns from 615 physicians. Of this number more than 600 have pronounced themselves as strongly in favor of the serum treatment, the great majority being enthusiastic in its advocacy.

(2) The cases included have been drawn from localities widely separated from each other, so that any peculiarity of local conditions to which might be ascribed the favorable reports must be excluded.

(3) The report includes the record of every case returned except those in which the evidence of diphtheria was clearly questionable. It will be noted that doubtful cases which recovered have been excluded, while doubtful cases which were fatal have been included.

(4) No new cases of sudden death immediately after injection have been returned.

(5) The number of cases injected reasonably early in which the serum appeared not to influence the progress of the disease was but nineteen, these being made up of nine cases of somewhat doubtful diagnosis; four cases of diphtheria complicating measles, and three malignant cases in which the progress was so rapid that the cases had passed beyond any reasonable prospect of recovery before the serum was used. In two of these the serum was of uncertain strength and of doubtful value.

(6) The number of cases in which the patients appeared to have been made worse by serum were three, and among these there is only one new case in which the result may fairly be attributed to the injection.

(7) The general mortality in the 5,794 cases reported was 12.3 per cent.; excluding the cases moribund at the time of injection or dying within twentyfour hours, it was 8.8 per cent.

(8) The most striking improvement was seen in the cases injected during the first three days. Of 4,120 such cases the mortality was 7.3 per cent.; excluding cases moribund at the time of injection or dying within twenty-four hours, it was 4.8 per cent.

(9) The mortality of 1,448 cases injected on or after the fourth day was 27 per cent.

(10) The most convincing argument, and to the minds of the Committee an absolutely unanswerable one, in favor of serum therapy is found in the results obtained in the 1,256 laryngeal cases (membranous croup.) In one-half of these recovery took place without operation, in a large proportion of which the symptoms of stenosis were severe. Of the 533 cases in which intubation was performed the mortality was 25.9 per cent., or less than half as great as has ever been reported by any other method of treatment.

(11) The proportion of cases of broncho-pneumonia-5.9 per cent.-is very small and in striking contrasts to results published from hospital sources.

(12) As against the two or three instances in which the serum is believed to have acted unfavorably upon the heart might be cited a large number in which there was a distinct improvement in the heart's action after the serum was injected.

(13) There is very little, if any, evidence to show that nephritis was caused in any case by the injection of serum. The number of cases of genuine nepritis is remarkably small, the deaths from that source numbering but fifteen.

(14) The effect of the serum on the nervous system is less marked than upon any other part of the body; paralytic sequele being recorded in 9.7 per cent. of the cases, the reports going to show that the protection afforded by the serum is not great unless injections are made very early.

THE ACTION OF THE SOCIETY UPON THE REPORT.

At the close of its presentation, the Society voted to accept the report of the Committee, and after full discussion it was decided to embody its conclusions in the following resolutions:

(1) Dosage. For a child over two years old, the dosage of antitoxin should be in all laryngeal cases with stenosis, and in all other severe cases, 1,500 to 2,000 units for the first injection, to be repeated in from eighteen to twenty-four hours, if there is no improvement; a third dose after a similar interval if necessary. For severe cases in children under two years, and for mild cases over that age, the initial dose should be 1,000 units, to be repeated as above if necessary; a second dose is not usually required. The dosage should always be estimated in antitoxin units and not of the amount of serum. (2) Quality of Antitoxin. The most concentrated strength of an absolutely reliable preparation.

(3) Time of Administration. Antitoxin should be administered as early as possible on a clinical diagnosis, not waiting for a bacteriological culture. However late the first observation is made, an injection should be given unless the progress of the case is favorable and satisfactory.

The Committee was appointed to continue its work for another year, and

was requested to issue another circular asking for the further co-operation of the profession, this circular to be sent out as soon as possible in order that physicians may record their cases as they occur through the coming year."

Yet in spite of this sentiment so universal in the medical world there are a few men and journals keeping a most bitter warfare continually directed against the antitoxin treatment. The term warfare is used advisedly. The continuous stream of ridicule, abuse and invective takes on the appearance of a political contest in a "tough ward" and certainly lacks any of the appearance of cool, scientific and unbiased investigation and study, such as should characterize the consideration of so vital and important a subject.

The report above summarized is taken from the body and supplement of the July issue of Pediatrics, (Van Publishing Co., 40th and Broadway, New York), and is well worth preserving. It is a standing rebuke to the crusaders who have from the poorest motives continually fought the introduction of this remedy, to the digust alike of the physicians who believe in, and those who doubt or openly disbelieve in, the curative power of the remedy. Due weight must be given to the opinions of 600 out of 615 doctors, general practitioners, not specialists; men who are in daily attendance upon sick people, not idle theorists without patients or practice, without consultations, clinics or conscience to guide them to correct conclusions. It is probable, however, that these latter will continue to "rant and rave," while the body of the profession continue their patient investigation.

EDITORIAL NOTES.

Collapse Treated by Atropia.

In collapsed conditions give repeated doses of atropia bypodermically until signs of vitality are apparent.

Ether vs. Chloroform.

The greatest danger from the use of ether in anesthesia comes after the operation is over; of chloroform, at the time of inhalation.

For the Dropsy of Acute Nephritis.

In acute nephritis, with anasarca, give full doses of a good preparation of elder (sambucus nigra). The anasarca will be quickly relieved.-Southern Clinc For Rhus Poisoning.

Apply a strong solution of the bicarbonate of soda to a surface poisoned by rhus toxicodendron. The relief is said to be almost immediate. Who has tried it? What success?

An Immense Hernial Sac.

The Philadelphia Times and Register quotes from a foreign magazine the report of a right inguinal hernia so voluminous that the hernial sac contained a portion of the stomach, the large intestine and the small intestine minus the duodenum. The patient died of uremic poisoning.

The Record's New Dress.

cover.

The New York Medical Record comes out for June in a fine new blue
This adds much to the appearance of that most popular magazine.

For After-pains.

A specific remedy in the treatment of afterpains, without interfering with the contraction of the womb, is an infusion of white cohosh.-Southern Clinic.

Precocious Menstruation.

A case of precocious menstruation is reported by Author in which the child menstruated at 46 months and regularly thereafter. The breasts were enlarged; there was no pubic hair.

Relief for Dysmenorrhea.

Dr. Talley, of Philadelphia, uses a mixture of coffein, potassium bromide and tincture of gelsium to be of much value in the treatment of dysmenorrhea. and says, in the Polyclinic, that it should be administered for a few days before the expected period.

For Paralysis of Bladder.

When after delivery the woman's bladder is paralyzed, give one thirtieth of a grain of strychnia every four hours. Be careful of catheterization. It is apt to cause cystitis by carrying the lochia upon the tip of the catheter, thus infecting the bladder.

Relief of Thirst and Dryness of Mouth.

Thirst and great dryness of the mouth in sickness is often relieved by a teaspoonful of powdered gum arabic, beaten thoroughly with a couple of teaspoonfuls of glycerine, to which is added a glass of cold water and enough lemon-juice to make the mixture palatable. The mixture may be taken freely, with great relief to the dryness of the mouth and thirst. V. Y. Med. Times. Deaths from Chloroform and Ether.

The following is a summary of Gurlt's researches in the matter of the relative safety of different anesthetics.

Chloroform, 201,224 cases, 88 deaths, 1:2286.

Ether, 42,141 cases, 7 deaths, 1:6020.

Chloroform and ether mixed, 10,162 cases, 1 death, 1:10162.

A. C. E. mixture, 5,744 cases, 1 death, 1:5744.

For the Cough of Measles.

Hyoscyamus is almost a specific. Use the granules of hyoscyamine grain each, every 10 to twenty minutes until relieved, or the tincture, 10 drop s mixed with syrup of tar or wild cherry, aud repeated every hour until relieved, or the solid extract (with quinine or other powder in capsule, or with bismuth if there is diarrhea), in doses of one-eighth to one-half grain every half hour until relieved. Give some fresh air. Nearly all mothers smother the measles patient into pneumonia or bronchitis.

Death of Dr. Joseph Bauer.

Dr. Joseph Bauer, a well known physician of St. Louis, and the son of Dr. Louis Bauer, died suddenly in consequence of chronic Bright's disease, at the age of forty-two. The untimely death of the Doctor, who leaves a widow and four children, has been a sad surprise to those who knew him intimately enough to appreciate his many good qualities. The Doctor held positions in several western colleges and was a speaker of fluency and force and always an entertaining lecturer.

Swallowed Broken Glass.

Dr. J. E. Reeves, of Kentwood, La., reports a most interesting case of a man who, while intoxicated bit out a piece of a glass tumbler, chewed it into bits and swallowed it. After a prompt emetic, which brought up a part of the broken glass, he was given 30 minims of tinc. opii, and made to eat heartily of potatoes. This was kept up, at inervals of several honrs, for two days, during which time much glass came away with the bowel movements. The temperature rose to 102° and then after the last of the glass had passed away from him, fell to normal.

For Chapped Hands and Face and Sore Nipples.

of

A highly recommended preparation for chapped hands and face consists

Mix. Apply to chapped surfaces at night, after washing with soap and water and carefully drying. One application is enough-good also for sore nipples and cracked lips, try it.

Black Eye.

There is nothing to compare with the tincture or strong infusion of capsicum annuum mixed with an equal bulk of mucilage or gum aribic, and with the addition of a few drops of glycerin. This should be painted all over the bruised surface with a camel's hair pencil and allowed to dry on, a second or third coating applied as soon as the first is dry. If done as soon as the injury is inflicted, this treatment will invariably prevent blackening of the bruised tissue. The same remedy has no equal in rheumatic stiff neck.-The Railway Surgeon.

Infantile Eczema.

In a recent case of most persistent eczema in an infant, Dr. Wells obtained excellent results by the use of the following application:

The mother was instructed to thoroughly cleanse the affected parts with soap and warm water, care being taken to dry carefully. The ointment was then thoroughly rubbed in three times daily.-Phil. Polyclinic.