still, occasionally, nature and diet need help, and the remedies will then come into service. Chlorine* gas, "which has been absorbed by ice cold water, has a special affinity for mucous membranes, and is useful in all forms of low-grade inflammations;" consequently, when a scorbutic patient's breath is foetid and the mouth is filled with small, putrid-smelling, yellowish-white ulcers, aphthous in character, with spongy, ulcerated gums, chlorine will be of marked value.

Natrum muriaticum is particularly indicated in all types of anamia, especially in cases where it is dependent upon the loss of fluids. Its similarity to the hæmorrhagic type of scorbutus is vivid and characteristic. The bloody stools, the hæmaturia, the nose bleed, the blood blisters on the inner surface of the lips and the putrid bleeding gums are excellent indications. Carbo veg. with its swollen, receding, bleeding, ulcerated gums, the frequent epistaxis, the hæmoptysis, the hæmatemesis with its dark bilious bloody masses, the striking pallor of the face, the coldness of the breath, of the nose, the ears, the extremities, the attacks of sudden weakness simulating the faintness and prostration of cardiac syncope, stamps the remedy as one of value, and Arsenicum alb. with its debility, the stiffness and immobility of the knees and ankles, with the violent pains and exquisite sensitiveness of the limbs, the restlessness of despair, added to the bleeding, spongy, fœtid gums, and offensive diarrhoea, present a strong curative remedy. To these remedies must be added Cal. phos., China, Cistus, Kreosote, Mercurius, Phosphorus, Phosphoric and Sulphuric acids, Silicea, etc.

When great physical weakness is present and the respirations are hurried and shallow with cold extremities and other symptoms indicating the probability of fatal cardiac syncope, rest in bed is called for, with active stimulation and sustaining measures.

of

CASE I.-Herbert C., six years of age, the only child of a second marriage, his father being fifty and his mother twenty-four years age at the time of his birth; his father died four years later, the autopsy revealing a red granular horseshoe kidney and valvular heart disease, mitral and aortic. His mother's supply of milk failing at the end of the third month he was raised on condensed milk and a brand of well advertised and much lauded artificial food. As

* Farrington.

he grew older he evinced a dislike for vegetables and his parents for some unknown reason discouraged his use of fruits, especially oranges and apples, but permitted him to partake of bananas. Otherwise he was an indulged and spoiled child, and having a fondness for his proprietary food he had continued to use it extensively up to the end of his fourth year, and, occasionally, to the time of his attack. He was fairly developed, being flat and flabby, with a tendency to bowleg. His striking individuality was a dislike or distaste for things and conditions most craved by children of his years. He had no aptitude for learning and was backward, but not dull; other than this nothing unusual presented.

He commenced to complain of nausea and what was supposed to be rheumatism of his left leg, always being pale. No attention was paid to his condition until his eyelids commenced to swell, and widely separated purplish-red spots appeared all over his bodypurpura hæmorrhagica—and an offensive bloody saliva began to drool from his mouth, which he complained was sore. On examination the left thigh was flexed and held immovable, the lower part swollen and very sensitive. He had been crying and fretting from this cause most of the time day and night. His eyelids were swollen, nearly closed, having the appearance of "black eyes." On the anterior surface of each tibia about the centre was a large blood bulla, which subsequently discharged and ulcerated. During the following two weeks his conjunctiva were infiltrated with blood, he had frequent attacks of nose bleed, occasionally vomited blood and passed it with his bowel movements, which were frequent, diarrhoeic and offensive, and blood frequently appeared in his urine. He emaciated rapidly and suffered greatly from his swollen and sensitive lower limb. His appetite remained fair, and his temperature was never higher than 100° F., being much more frequently at 97° F. On and off for nearly ten days there were occasional alarming attacks of faintness and syncope.

He was fed on milk, broths, and fruits, with plenty of orange and grape juice. During the ten days when his respiration and circulation seemed at times to almost fail he was stimulated and sustained with old cognac. His remedies were Rhus. tox, Lachesis and Arsenicum in order named, and an antiseptic astringent mouth-wash for his gingival symptoms.

While the progress of the case, considering its severity, was satis

factory, the recovery was prolonged and tedious, although eventu ally perfect.

CASE II.-Clifford F., 10 years old, of poor parentage and poorly fed, was admitted to the children's ward of the Hahnemann Hospital, Philadelphia, May 24, 1893, with exceedingly offensive, bleeding, spongy, ulcerated gums and a small blood-blister on the inner surface of the right cheek. The lower limbs were painful and sufficiently sensitive to touch and motion to cause him to remain quietly in bed. He was given a mouth-wash of diluted Peroxide of hydrogen, a generous diet with fruit, and Merc. viv. internally. His recovery was rapid and uneventful.

CASE III.-Mary W., 11 months. Healthy at birth. No breast milk after the fourth week. Emaciated; tenderness of the lower limbs; ulcerated gums around the upper and lower incisors; few petechia, three or four on eyelids and cheeks, balance scattered over the chest and abdomen. Been using artificial food; occasional vomiting; diarrhoea, six or seven yellowish, offensive, watery stools daily; fretful, sleepless and restless, this latter condition causing increased fretting and screaming; limbs sensitive and painful to pressure and movement, ends of long bones at the knee-joints swollen, simulating knock-knee; chest formation good; temperature 100° F. The child was given fresh milk, strained vegetable broth, grape and orange juice, and Cal. phos. 6x, with marked and rapid improvement.

How little, comparatively speaking, have the schools of medicine availed themselves of the dictum, "An ounce of prevention is worth a pound of cure." Strange that medical men should for thousands of years have devoted all their talents and energies to the cure rather than to the prevention of disease. Until the last score of years there was scarcely a school of medicine that placed sanitary science in the curriculum of studies, and even to-day many colleges pass it unobserved while many others touch it so superficially as to be of no benefit whatever in practice. Yet it is a science requiring

the most profound knowledge of chemistry, biology, climatology, ethnology, besides the knowledge of usages, manners and morality. As an art it involves architecture and engineering for the construction and application of mechanism to secure ventilation and drainage. In economics the disposal of the offal and débris may be of importance to a community to make it a revenue instead of an ex

pense.

To be a physician one should know all these things. What avails his knowledge of therapeutics if within the range of his vision diseases multiply and the thousands are taken to the grave while he is trying to save one? Yet we meet with such physicians every day where scarlet fever, diphtheria, yellow fever or cholera prevail, helpless to stay the scourge as a child to silence the thunder of heaven. We see them in the sick-room looking for key-note symptoms mindless of the drain-pipes that so often generate and diffuse the bacteria that swarm within those chambers. Such a physician is a cheat and

a snare.

There is no excuse for ignorance of sanitary science; it is open to all and is surely not the privilege of the few.

Sanitary science should rank first in the curriculum of medical education. Know the arts and methods of preserving health, of preventing contagion and infection, then, when disease comes in spite of all, apply drugs for the cure.

There are physicians also who labor under the delusion that sanitary practice is the concern of the plumber, of the architect or of the builder. While these have their part to play in the work of sanitation, it is eminently the duty of the physician to be thoroughly versed in every branch of sanitary science. Professor Lister has made himself immortal by introducing sanitary science into surgery. What means all these precautions that the surgeon of to-day observes while performing an operation? It means that after a thousand years sanitary science has at last entered into the conscience of the surgeon. The monuments that are now raised to Listerism indicate the universal gratitude the people feel for the boon of sanitary practice.

Medicine has fought many a memorable battle on behalf of therapeutics; Allopathy, Homœopathy, Electropathy, Hydropathy, Eclecticism and many others, have, each in its turn, demanded recognition and fought to the very death for the right of existence, yet