pulse. Ver. vir. in many cases is far superior to Acon,, and its value is inestimable in the first stage of pneumonia.

In regard to cold- and hot-water applications in pneumonia, I make a distinction. In robust, strong patients, cold-water compresses are best; but in weak and debilitated persons, hot-water compresses are better. I am in favor of external applications, and use them in most cases. Generally, they give immediate relief, and if judiciously applied never do any harm. They serve, also, to keep the attendants busy. Pneumonia never is cured in a day or two, and if the attendants have nothing to do but to administer a few teaspoonfuls of medicated water once in a while, they are apt to become restless and fidgety, wishing that something could be done, and many times induce the patient to change doctors.

As to fatal cases, I am not so fortunate as my friend, Dr. T. C. Duncan, who said that he never lost a case. I do not know how it is possible to cure all cases, especially in inebriates, infants, old, or debilitated persons. Although I believe Homoeopathic treatment is the best, yet I think Homœopathy cannot cure all cases of pneu

monia.

DR. RAND: It seems to me, that Dr. Duncan's success is very extraordinary. I am surprised that any man of his years and experience can say that he has never lost a case of pneumonia; and I would like to ask him if he refers to simple pneumonia only, or includes cases that were complicated with something else.

G. W. LAWRENCE, M.D.: I had one case six months old. It was a case of double pneumonia. I put the child in a hot compress, just as hot as I thought it could stand, and then gave the indicated remedies. It was a bad case, but the child recovered; and I think the hot water and Veratum and Ferrum phos. did it. Veratrum and Ferrum phos. in pneumonia give better results than any remedies I have ever used. At least in the early stages.

I have never lost but one case of pneumonia, and that was a man who had travelled three days on the railroad and one day by stage, and was nearly dead when I took charge of him. That is the only case in twenty-one years that I have lost, and I have always stuck to

hot water.

A MEMBER: I do not recall that I have ever lost any uncomplicated cases of pneumonia. In the use of Veratrum, I use about 10 drops of the tincture in a half-glass of water. I have never used a local application, either for an adult or for a child. It seems to me, that the value of the application is the added moisture to the circulation, and that we can get in a better way by giving them plenty of water to drink.

I have never used a plaster on the chest; if I was going to put one on, I would put it on all the way around; but my experience has been that there is danger of the patient getting chilled.

L. C. GROSVENOR, M.D.: There are quite a number of doctors in favor of these compresses, and I know they are very good, as I have cured many cases with them in connection with other remedies that undoubtedly would not have recovered without the use of the compress. I always have the compress renewed about every hour. In preparing the compress, take a newspaper and put the cloth on that, and you will find that you can handle it much better that way. I get good results from Bryonia, Phos., and Ipecac.

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C. C. BRACE, M.D.: I have had about nineteen years' experience in the practice of medicine, and about all of it in Colorado. I have practiced at an elevation of 8500 feet. The only difference in cases of pneumonia in high altitudes and those in low altitudes, is in the first stage. The congestion is apt to be more rapid. I have had men walk into my office, whom at first glance I thought were intoxicated, with red face, a temperature of 105° and with one lung filled nearly to the apex. The lung often fills so rapidly, that upon forcing them to take a deep inspiration, the cough that follows frequently causes the blood to flow from the mouth, amounting to a slight hæmorrhage of fresh blood, the characteristic rusty and prune-juice expectoration appearing in the later stages of the disease. In the early days of Leadville, when almost every man was full of whiskey, pneumonia would develop very rapidly, and under the old treatment of quinine and opium the mortality was large. These same cases under Homœopathic treatment and a good hot poultice would have gotten well. I am a thorough believer in the hot poultice in pneumonia. I generally use flax-seed meal and ground slippery elm about half and half, and in severe cases put it clear around the chest and change it about every three-quarters of an hour. In some cases after the fever abates somewhat and the patient becomes more comfortable, I find it advantageous to substitute absorbent cotton at night, and renew the use of the poultice during the day, until the lung is entirely clear. But it takes a skilled person to run a poultice, for it is a two-edged sword, and unless used right, had better never be used. The remedies in pneumonia to stay by, are few, Aconite, Verat. viride, Bry., Phos., Ars. and Tartar emetic. I believe in the very incipiency of the disease, during the chill, and immediately after, that many cases have been aborted by the use of Verat. viride tincture; say ten drops of Norwood's tincture in a half glass of water, and give teaspoonful doses every half hour. Every uncomplicated case of pneumonia occurring in the young and middle aged adult life ought to recover, but in the cases of the very young, and the very aged, the reaper is frequently there. And it is more especially true of old people, while we frequently have marvellous recoveries from pneumonia in aged people, yet more often the vital spark seems sapped of its vitality from the commencement, out of all proportion to the severity of the case and they sink and die as

if paralyzed. I am not so fortunate as to be able to say that I have never lost a case of pneumonia, and when I hear men make the claim that they never lost a case, though their hairs are whitened by the frosts of many winters, I know their experience has been limited in this disease.

WM. W. VAN BAUN, M.D.: I regret I did not hear the paper which has called out this discussion. That one should go through a long lifetime practicing medicine in the city of Chicago without the loss of a single case of pneumonia seems marvellous.

A great deal has been said about the use of local applications in the treatment of pneumonia; their value is really an uncertain quantity. I suppose we will all admit that our Old-School friends use them to a far greater extent than we do. Yet to-day, under the best Allopathic treatment, their loss is fully 20 per cent., while the Homoeopathic loss is not over 7 per cent. I have had the same kind of cases at the sea's level as the gentleman from Colorado finds in his high altitudes.

I. T. TALBOT, M.D.: My experience with pneumonia has been of a peculiar character. I was associated in the earlier part of my professional life with Dr. Samuel Gregg, one of the founders of this Institute. His success in the treatment of pneumonia I have never seen equalled elsewhere. I have seen him treat successfully the most severe and violent cases. Naturally, I studied to find the secret of his success. In most cases he applied the cold wet bandage. Forty years ago I was in Vienna, and followed Fleischman through the treatment of the great number of cases of pneumonia he had. He did not use local applications. His success, compared with those cases in the Allopathic hospitals, was remarkable; the fatality was about 7 per cent.

With regard to the application of cold water: From my early experience, I have used it as an outside application, and when the question is asked for what reason it ought to be applied, I may say, because it relieves and benefits the patient, and that is the great object of all treatment. As regards the method of applying it I have in mind one case where a cold application was to be made, and I supposed they knew how to apply it properly, but I found afterwards that it had done no good. A wet cloth simply had been laid on the chest, and was displaced on slight motion; the sheets had been wet, the bed wet, and the child was lying in wet surroundings. Now, that would absolutely do harm; it could not be otherwise. But, if you take a piece of flannel, long enough to go around the chest, and fold it to three thicknesses, of width proportionate to the size of the patient, and then lay on this the wet towel, and wrap the whole together carefully around the patient and secure it; this always gives relief. I state that as a fact, sustained by an extended experience. I have put it on babies seven weeks old, with double

pneumonia, and on men over eighty years old, and both of them were relieved in their breathing in a short time. As it is not an application to be kept on forever, the question is, how long should it remain? At first touch, the cold gives a shock to the patient, but in a little while reaction takes place; it becomes very warm; and then another bandage should be prepared in the same way. Take the pins out of the bandage, raise the patient, and with one person to take the old bandage away and another to put the fresh one on immediately, there is scarcely three seconds altogether of exposure, and I never have seen any injury from it. These changes are to be continued as long as they give relief to the patient.

I was once called to see a patient who had been attacked with a sudden chill about 2 o'clock at night. I gave her medi ine, and expected to find her better in the morning. Much to my surprise, in the morning the woman was almost unconscious; her temperature was 10610, she was just gasping, with pulse uncountable, and I felt that the woman would live but a very few minutes. I filled a bath-tub with water at about 90°, and she was put into it at once; cold water was added to reduce the temperature to 80°; she remained in the tub about 10 minutes, and her temperature came down to 103°; her breathing became better; her circulation was improved. She was taken out and wrapped in a wet sheet, and although she had a very severe case of pneumonia the recovery was complete.

As to the question of diet, it has always been my belief and experience that when there is a high temperature, and a very rapid pulse, a simple and light diet at frequent intervals is much better than more substantial food; and while I do not think that a patient should be allowed to go without anything in the stomach, I think it should not be highly nutritious diet.

DIAPHRAGMATIC PLEURISY.

BY J. MONTFORT SCHLEY, M.D., NEW YORK, N. Y.

AT our last meeting, held in Chicago, I presented a paper titled "A Plea for Early Operation in Pleurisy with Effusion;" to-day, I will trespass upon your time-to a less degree, however-with a subject very closely allied to it; in fact, it may, at times, progress by extension into a condition requiring operative interference.

The opinions presented in my first paper have become more deeply and firmly rooted in my mind, as to their correctness, from further experience during the past year. Some strictures put upon my article then by one of the speakers, and which time did not allow me to refute in detail, should receive some notice here.

In all my own cases, submitted in the paper, Homœopathic treatment had been received from the very start-in some cases the Hahnemannian had prescribed, in others, more potent doses of medicines, homoeopathically administered, had been swallowed. Here the disease had run along unmindful that a something was being done to check its course, or perchance stop it forcibly. The discusser, in touching upon this point, stated, with apparent authority, that Bryonia and other well-known drugs employed in this disease, would prevent pleurisy from becoming such an alarming disease, and that they hindered effusions. To this no good diagnos

tician would ever consent.

Pleurisy frequently goes by another name until an autopsy occurs. Weber and others have shown by the microscope and pathological specimens and abundant post-mortems that the fluid organizes in the pleural cavity, i.e., it becomes less easily absorbed, becomes more fibrinous, more dense, if the surfaces are forcibly kept apart. When the fluid is evacuated the pleure approach each other, rub against each other, and may or may not become adhered.

This the discusser objected to upon a baseless argument. Many of us have seen slight spinal curvatures; some of us have seen hide