monthly meeting. The Scientific meeting shall occupy the remainder of the meeting. Regular meetings shall be held at 8 p.m. on the second Tuesday of each month.

Sec. 3. Special meetings shall be called by the President whenever requested in writing by two or more members.

ARTICLE X.

Amendments.

All articles or amendments to this Constitution shall be in writing and signed by three members of the Society and be read at a regular meeting, the same to go over for one month before action can be taken, and shall require a two-thirds affirmativ vote of the members present to assure their adoption.

BY LAWS.

ARTICLE I.

Order of Business.

Reading the minutes of last meeting.

Introduction of new members.

Unfinished business.

Reports of officers and committees.

Report of Censors on application for membership. Election of members.

Correspondence.

New business.

Proposals for membership. Receiving dues.

Presentation of cases.

Reading and discussing of papers announced at the meeting.

Reports of cases and exhibition of specimens.
Miscellaneous scientific business.

ARTICLE II. Elections.

Section 1. Election of officers shall be held at the April meeting of each year.

Sec. 2. A member who is under suspension shall not be allowed to vote at any election, nor shall he be eligible to any office.

ARTICLE III.

Standing Committees.

Section 1. All committees shall be appointed by the President, subject to the approval of the Society.

Sec. 2. At the meeting in April, the President shall appoint a committee of three, to be known as the Committee of Scientific Progress, whose duty it shall be to arrange the program of the Scientific meetings of the Society. This committee may, when it deems advisable, invite any regular physician residing outside of Duquesne to read papers and take part in the discussions of papers read before the Society, providing that such invitations shall be extended only upon the approval of the President, and further provided that no expense be incurred by the Society on account of such invitations unless by direct action of the Society. This committee may, with the approval of the President, call a special Scientific meeting of the Society when it deems such advisable.

Sec. 3. The President shall also appoint an Editorial

By-Laws may be amended any time by two-thirds vote of the members present.

ARTICLES OF AGREEMENT. Agreement made between the Duquesne Medical Society and the members thereof, as follows:

We, the undersigned members of the Duquesne Medical Society, of Duquesne, State of Pennsylvania, hereby agree and bind ourselves, subject to the penalties named herein :

First: Each member shall submit to the Secretary of this Society the names of persons who have persistently refused or neglected to settle their accounts for medical services rendered within a reasonable period, and such other names from time to time as each member may think to their interest.

Second: The names submitted as per section first, shall be arranged alphabetically, to be known as the "Information List," and each member of this Society shall be assigned a number by which he shall be known in this List.

Third: Every member of this Society shall be furnisht a copy of the "Information List." All names reported by the Secretary shall be added or removed as reported.

Fourth It shall be the duty of each member of this Society to inform any person whose name appears in the "Information List" applying to them for medical services, that they owe an account to the physician or physicians reporting their names. Exceptions to this rule may be made as follows: In case of emergency the physician applied to may render immediate medical aid to the extent of one visit to such person, providing the physician rendering the service demands and receives cash payment for the services, pending the applicant's satisfactory arrangement with the physician having reported his name to the Society.

Fifth The person so reported shall make application to the physician or physicians reporting his name, pay the amount due, or make satisfactory arrangements for the payment thereof. Then it shall be the duty of the physician reporting said person to issue a certificate on the form prescribed by this Society, certifying that he had paid the account or made other satisfactory arrangement for payment of the same. In this event, it shall be the privilege of any physician to whom said person shall apply and present said certificate, to render medical services.

Sixth In the event of the person receiving a certificate of satisfactory arrangement for settlement of his account failing to comply with his agreement made in order to receive said certificate, the name shall again be placed on the "Information List," and each and

Eighth It shall be the duty of each and every member of this Society to render statements to his patrons quarterly on the first day of January, April, July, and October of each year. Privilege is hereby granted to render monthly statements.

Ninth It shall be compulsory upon each and every member of this society to comply with the conditions of this agreement, also to abide by the minimum fees as set forth in the fee bill adopted, also the code of ethics; and upon trial and conviction before the Censors of the Duquesne Medical Society pay a fine of fifty dollars; or expulsion from the Society shall be imposed upon any member who willfully or negligently refuses to comply with the conditions herein set forth. Signed:

Members

Poultice for Inflamed Ear. An exchange says that nothing will check beginning inflammation and relieve pain in threatened suppuration of the ear so quickly as a poultice properly applied. The following directions are given: Lay the patient down with the affected ear uppermost; fill the canal with water as warm as can be comfortably borne ; have already prepared a hot poultice; quickly invert the poultice over the ear, and allow patient to assume any desired posture. The heat is transmitted to the column of water in the canal, and thus is transmitted into the canal and to the membrane tympani, or to the site of inflammation. This is a venient method of applying warm and moist applications directly to the site of trouble.

con

Our plan has always been to apply a warm and moist compress over the ear, and to cover it with a bag of hot table salt. This keeps the heat a long time, but the above plan would seem to be preferable, providing, as we presume is the case, that the water in the canal prevents any particles from the poultice entering the canal. But a facing of cheese cloth upon the poultice would prevent that.

ORIGINAL COMMUNICATIONS

Short articles of practical help to the profession are solicited for this department.

Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors. Copy must be received on or before the twelfth of the month, for publication in the issue for the next month. We decline responsibility for the safety of unused manuscript. It can usually be returned if request and postage for return are received with manuscript; but we cannot agree to always do so. Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else.-RUSKIN.

Stimulates the Heart in Pneumonia. Editor MEDICAL WORLD:-Your leading editorial in Jan. WORLD on the "Treatment of Croupous or Lobar Pneumonia" is excellent. I have read it with interest and profit. I want to say, that I fully agree with you in all but one point; and that is, my experience has taught me not to wait till the heart begins to lag before prescribing a heart stimulant. Now, I agree with you that the indiscriminate use of such drugs as strychnin may produce physical exhaustion-the very thing we aim to combat by the use of stimulants; but in thirty years of continuous practise the only fatal cases of pneumonia that I have met with were those in which I used no heart stimulants until the heart showed signs of weakening; then the most heroic measures to support the heart proved futil. It was this experience that led me to adopt the plan of moderate but not excessiv heart stimulation from the earliest period of treatment of every case of suspected pneumonia, and in over twenty years I have not had a single fatal case except those of which I shall speak in this article.

Case 1: The patient had a son practising medicin; but the son being sick and unable to visit his father, sent a brother physician to see him. The third day of his sickness I left the patient doing well; but after I had left, the other doctor came and arranged for me to meet him there the next day, which I did; and after deciding on the course of treatment we agreed that I should see the case one day and Dr. the next day, as I was employed by the father and he by the son. On one of my visits later I found the pulse quite weak and ordered the strychnin increast from to gr., when to my surprise the nurse informed me that there had not been any strychnin given since she had taken charge of the case as nurse, which was when Dr. - made his first visit. I immediately had them summon the doctor, who upon learning the critical condition of the patient, brought an old and experienced practician with him and we instituted the

most heroic measures to keep up the heart action, but we failed.

66

Case 2: A typical case of lobar pneumonia; it was so critical that the friends desired counsel. Counsel agreed with me that it was a well markt case of pneumonia ; but, said he: Doctor, why are you giving strychnin in this case? you have a remarkably good heart, considering the condition of your patient otherwise. The good heart action is the only hopeful symptom in the case."

I told him that it had been my custom for years to begin the treatment of such cases with a moderate heart stimulant. The case made a speedy and uneventful recovery.

I believe in supporting the patient in every possible way, and especially the heart. The first case mentioned and several others which were treated by other physicians at the beginning of the attack are the only fatal cases that I have treated since I began the heart stimulation from the beginning of the attack. I do not claim to have treated a great number of cases of pneumonia, but it is fair to say that I have had some extremely critical cases that made a good recovery. I have not kept a complete record of all my cases and cannot say just how many I have treated; but cases which seemed to have every symptom of pneumonia at the beginning, but which promptly yielded to the so-called abortiv measures, have been quite numerous in my hands. I do not know, of course, that any of these cases would have developed a case of pneumonia if I had not seen them early and began the abortiv treatment.

I have no routine course of treatment either as abortiv or treatment of a well developed case of pneumonia. I usually give veratrum or aconite at the beginning of an attack. Have never used quinin except in small doses, but I have not treated a case in twenty years without giving syrup of hypophosphite of soda from the beginning of treatment until the patient was convalescent. I prepare my own syrup of the hypophosphites, and make the syrup of hypophosphite of soda only 2 grs. per f. dr., and of this give to teaspoonful every 2 or 3 hours till convalescent, then the full dose of 1 teaspoonful to adults, children proportion to age, four times a day, the last dose at bedtime, the others before meals.

I have had great difficulty in persuading the patients' friends who nurse the case to allow sufficient ventilation of the room. They are generally too much afraid of a little fresh air. I prefer keeping the room at 60 to 65° and protecting the patient from direct drafts by means of screens. I have devoted some study to a plan of giving the patient the benefit of an open window while the patient's body and the attendant can be in a comfortably warm room. A wool jacket

will protect the throat, shoulders, and chest of the patient, and a heavy woolen cap may be necessary to protect the head and ears and parts of the face, while the cold air will be entirely excluded from the room. There will be some difficulty in administering to the patient without admitting a draft of air to the room, but this can be partly remedied by means of rubber tires on wheels attacht to the legs of the cot, so that it can be rolled clear inside when necessary to give the patient such attention as will require much time. With this arrangement a sanitarium could be made of an upper-story bedroom at small cost, which would give tuberculous patients all the benefit of outdoor treatment with a comfortable room for dressing and for the attendant. E. K. SUTTON, M.D.

Independence, W. Va.

[By placing the head of the cot in front of a window, raising the window, and placing a curtain so as to form a sort of tent over the head of the cot and fitting tightly up to the sides of the open window, the patient will be enabled to breathe the air from the open window, while his body lies in a warm room. These window tents have been arranged in various ways, and some apparatus of this kind has been advertised for sale. An improvement sometimes adopted is to insert an isinglass window into one side of the tent, thru which the attendant may observe the patient without disturbing the tent. See an illustrated article showing and explaining devices of this kind in the Jour. A. M. A. for Jan. 19, '07, by Dr. S. A. Knopf, of 16 W. 95th st., New York City. Doctors specially interested can doubtless get further information by addressing Dr. Knopf, with stamps for reply, or the sending of any illustrated reprints that the doctor may have, as he has frequently written on this subject and is deeply interested in spreading the best ideas.-ED.]

Applications of Ice in Pneumonia.

Editor MEDICAL WORLD:-I want to say Amen to all that Dr. J. E. Taylor (Feb. WORLD, page 53) says about ice in the treatment of pneumonia. I have had many similar experiences, with nothing to discourage me in the use of ice in pneumonia. The chilliness of which the doctor speaks can be overcome by occasionally removing the ice bags and applying hot fomentations for 15 minutes, and then replace the ice bags. Also by placing hot-water bottles to the lower extremities, hips, etc.

The hot fomentations consist of a half wool blanket cut in two in the middle. Fold onehalf in such a shape that the attendant can wring it out of a dish-pan two-thirds full of boiling water. Do not wet the hands, but quickly twist the ends of the folded blanket. Keep twisting till the folded blanket is knotted. Then pull hard on both ends. The

water is expelled. Then very quickly fold it in the dry half and apply over lungs. Change every five minutes. In fifteen minutes replace ice. If our Editor will try this method, his courage will be increased. Greeley, Col. D. W. REED.

Prompt and Heroic Treatment of Pneumonia. Editor MEDICAL WORLD:-In reporting these cases it is hoped that they may, at least, more firmly convince the users of the treatment outlined that pneumonia can be controlled, and that the terribly dreaded "crisis "" may lose its terrors by being abolisht from existence. Since Dr. Galbraith's report of cases treated with massiv doses of quinin and tinct. iron in the Journal A. M. A., I have used no other treatment in all cases in which it could be conveniently administered. In small children where capsules or pills cannot be given, the soluble tablets of aconitin, veratrin, etc., are easily administered, and if given in small, frequently repeated doses, will produce equally favorable results tho they do not act so much like specifics as the quinin. No doubt some of these cases will be questioned by some readers as to diagnosis, and to make the argument stronger I may say that I spent one year in special nose, throat, and lung work and feel competent to judge correctly on a large majority of cases I meet, yet I realize the fact that no one man nor even hundreds of men know it all. I have tried to give all the essential features of these cases as they have covered the field from the first day up to the fifth or sixth day of the disease, when with any other treatment I have ever heretofore used there was sure to be a crisis. Let me add here that since I began using this treatment I have entirely discarded the use of poultices or any plastic substances to the chest. It is extremely hard to get any one of the family, busy with other cares of the household, to attend to this matter properly, and even if so attended I doubt very much the efficacy of such treatment.

I give directions to have patient put in a room away from the fire, have it properly ventilated and quiet whenever possible, and a light diet, and do not attempt to force the feeding. I allow very frequent drinks of cold water, which are limited to a teaspoonful if given oftener than every five minutes. That one must wait for the complete consolidation of the lung in order to be sure that the case is pneumonia seems to me unwise; and it is advanced only by those who retard advancement in the application of medicins to cure diseases simply from the fact that they are "big guns" and often what they say goes without giving the little fellow's ideas a fair trial.

I most emphatically disagree with the Editor (begging his pardon) when he says in the wind-up of his editorial on "Treatment

of Croupous or Lobar Pneumonia": "But, to our mind, the profession has erred in instituting heroic treatment too early." I never get a case so early but that I go after it like a man-hunting shark. I believe that the use of aconitin and veratrin in oft repeated doses is heroic treatment. It is, at least, heroic enuf to conquer the disease without allowing it to come to a crisis of its own accord. Surely the administration of 30, 40, and even 75 grains of quinin at one dose is heroic treatment. From my own experience in the following cases, who can blame me for believing in heroic treatment for this disease? I believe the quinin treatment to be as sure of squeezing the terror of this disease from the minds of the physician and family and the terrible suffering and consequent death of the patient from him as one squeezes the water from a sponge held in the hand. In many cases I now assure my patient of his recovery because I feel so confident that the result will surely follow. In my journals I notice that there are some members of the profession who claim that in different parts of these United States this disease assumes a different form with different accompanying symptoms and different etiological factors. Well, I will not contradict, but will add that North Dakota pneumonia and that in Dr. Galbraith's country (Mexico) yield alike favorably to this treatment. You who are reading this article, why are you losing your cases of pneumonia? Do you not think it time to use something that in a number of physicians' hands has produced undeniable recoveries with perfect health remaining? It is to interest you and to support the doctor who gave us this treatment that I report these cases. I, too, once felt blue when I met these cases, but not so any more. I have not lost a case in the last two years; those reported being a partial list of those I have treated. I have withheld those in which there might be some doubt in your minds, tho I am firmly convinced of their character.

Case 1: A. G., male, age 4 years. Had lung fever two years before, which I attended and which ran the usual course and patient recovered. Saw case 12-13-'06 at 9 p.m. Had cold for two or three days previous, now chill, headache, pain in right lung, cough with very little expectoration, bowels constipated, vomited several times, anorexia, tongue coated, skin dry and hot, urin dark colored and scanty; temp. 1033, pulse 150, resp. 34. Crepitant rales over lower part of right lung, dullness over same area. Ordered 5 doses of calomel, gr., each half hour, aconitin gr., veratrin gr., alternated each hour. 12-14'06. 9 a.m: condition about same, but bowels had moved. Ordered above dosage alternated each half hour until effect, and fever abated in about 3 hours with sweating. 12-15-'06: Temp. 98, pulse 90, pain gone, and patient resting easy and no further symptoms.

Case 2: J. M., male, age 3 yrs. Father died of pulmonary tuberculosis. Patient very susceptible to taking colds. First saw patient 1-5-'07, at 9 p.m. Had had cold several days; this morning had a chill, pain in the right lung, headache, vomited twice, tongue coated, dry cough, no expectoration, urin scanty and dark colored, very restless and nervous, skin dry and hot, cheeks flusht. Bowels had been moved with Epsom salts. Temp. 104, pulse 160, resp. 38. Crepitation over lower third of right lung; also dullness. Ordered aconitin gr., veratrin gr. 132 alternated each half hour. Was informed next day that two doses of each had reduced the fever, that the patient sweat, and there was no return of further symptoms.

Case 3: R. G. Mc., male, age 30, married. No previous history of illness since childhood. Had taken care of a horse that a competent V. S. said had lung fever, but I do not venture any opinion as to whether or not this had any connection with this case other than the exposure that it caused. Saw patient 6-18-'06 at 10 a.m. Had felt chilly for several days; pain over both lungs, headache, vomited once, tongue coated, bowels constipated, hacking cough, slight bloody expectoration, skin dry and hot, temp. 103, pulse 136, resp. 28, crepitation over lower part of both lungs, percussion flat. Gave one dose quinin sulfate gr. 40, and left tinct. iron gtts. 15 each three hours, and acetanilid, caffein, and sodium bromid compound tablets one each three hours. Patient telefoned next day that his temperature had fallen in about three hours, and he had perspired quite freely, that he felt quite well, but was somewhat weak. There were no further symptoms.

Case 4: L. S., male, age 4 yrs. Previously healthy. First saw patient 1-30-'05 at 9 a. m. Complained of chilliness, pain over right lung, headache, vomited several times, bowels constipated, dry cough with little or no expectoration, skin dry, face flusht, especially right cheek, temp. 105, pulse 160, resp. 40, crepitation and dullness over lower half of right lung. Ordered calomel in broken doses gr. 2, aconitin gr. each 15 minutes for 4 doses then each half hour until fever left. Temperature went to normal but rose next day to 103, and a repetition of dosage of aconitin brought it to normal in two hours, where it remained.

Case 5: Miss C. B., age 35. Previous health good. Had had cold several days. Saw patient 2-7-'06 at 10 a. m. Complained of pain over both lungs, dry hacking cough, a little very sticky expectoration, headache, skin dry, tongue coated, urin scanty and high colored, bowels constipated, temp. 103, pulse 120, resp. 26, bronchial rales over both lungs, no perceptible dullness on percussion. Gave calomel gr. 1 each hour for 5 doses, tinct. aconite gtts. 5 each two hours, and acetanilid

co. tablets each three hours. 2-8-'06: Bowels moved, otherwise patient was about same. Now gave quinin gr. 20 and tr. iron in 15 gtt. doses. Third day patient felt much better; temperature and pulse normal; pain gone and no further symptoms.

Case 6: H. E. M., female, age 1 yr. Previous health good. Saw patient 12-19-'05 at 10 a. m. Cheeks flusht, dry cough, vomited several times, bowels constipated, child nervous and cried a great deal; tongue coated, skin dry, temp. 104, pulse 150, resp. 37, crepitation over lower part left lung, also dullness. Ordered broken doses gr. calomel, aconitin gr. each half hour until fever came down. 12-20 a. m., temp. 103, pulse 140, resp. 30; bowels had moved, vomiting stopt, dullness over area more markt. Explained further about giving medicin and now had it given as directed. Next day child was much better and from the following day made an uneventful recovery.

m.

268

Case 7: E. R. D., male, age 27, married, always healthy. Saw patient 2-13-'05 at 7 p. Face flusht, dry cough, headache, pain over center of right lung, temp. 104, pulse 138, resp. 27; percussion dull over circle of 3 inches over center of right lung, with crepitant rales. Gave calomel gr. 5 in divided doses, aconitin gr. each half hour, tr. iron gtts. 10 each 3 hours. Temperature came down in 3 hours; pain, cough, and headache left, and patient felt fair next day and made an uneventful recovery.

Case 8: C. H. C., male, age 8 months, always healthy. Saw patient 2-16-'05 at 11 a.m. Symptoms were vomiting, dry cough, face flusht, restlessness, anorexia, tongue coated, skin dry and hot, temp. 103, pulse 144, resp. 32; crepitation over lower part both lungs; slight dullness. Gave colomel gr. 24 in divided doses, aconitin gr. half hour. 2-17-'05: Temp. 102, pulse 120, resp. 30. Repeated frequent doses of aconitin and in few hours temperature fell to normal. 2-18-'05 Temp. 99, pulse 104. Patient seemingly well able to take nurse and had no further symptoms.

each

Case 9: J. W. M., male, age 60. Had obstinate case of sciatica for 3 weeks, which was only partially relieved by the usual course of treatment when he had a chill and sinking spell. There had been a slight cough for two days. Complained of severe pain in the left lung, headache, vomited, coughed up a little bloody mucous, temp. 102, pulse 90 very weak, resp. 22. Patient at times semiconscious; crepitation and dullness over lower part of left lung. Gave quinin gr. 20 and ordered tr. iron gtts. 15 each three hours and gave a hypodermic of gr. strychnin. Patient rallied from collapst condition in an hour; temp. came down same day, and from that time there was very little pain over sciatic nerve, and in 4 or 5 days patient felt well but weak. His lung symptoms left the

Ο