throat was regarded as diphtheritic, and even a case of indigestion was magnified by anxious parents into a genuine case of diphtheria.

The Sunday-school was given up, and a children's concert which had been long in preparation was postponed. Just here comes in the part played by the health authorities of the city, and which shows the efficiency of an active, wide-awake health department. The funerals of the The funerals of the dead victims were held at midnight, attended only by the parents and undertaker. The stores and dwellings were closed and placarded, and no one permitted to either enter or leave the infected premises. That is to say, the surviving victims were quarantined-isolated. No means were used, so far as we are aware, either to disinfect the premises or to amend the unsanitary condition of the alley. The result of the quarantine measures was, however, eminently satisfactory. No other case of diphtheria developed, either in the infected block or in the town; and as a full month has gone by, it may safely be inferred that no new cases will occur.

There are several points of interest in this brief epidemic to which we desire to call attention. There were five cases of undoubted diphtheria, two of them fatal. We personally inspected the throats of the three survivors, and there were unmistakable evidences of the specific nature of the disease. In all of them there were remnants of exudation, foulness of breath, prostration, and in one-the last of the series-the disease was in full bloom and unmistakable when we saw it. The odor was pathognomonic as we entered the sick room, the nose was exuding the characteristic foul and acrid discharge of nasal diphtheria, and the pharynx was covered with grey, leathery patches, with curled up edges, ready to slough off, as they did, after a time. The first case of the series was as nearly and completely a sporadic one as can be found anywhere.

Only one previous case is known within a radius of six miles, and that occurred four

months before, with no history of any possible infection, either direct or indirect, from it.

The first case was, according to the best information we could obtain, a case of simple sore throat; the boy was taken sick, but a doctor was not called for several days. He had a sore throat, some fever, and his cervical glands were swollen, but no anxiety was felt for him, and his disease was not recognized as diphtheria until his little nephew was taken suddenly ill and died. This second case was so pronounced as to be unmistakable. Two deaths out of five cases is a mortality of forty per cent., a mortality nearly as great as that of cholera when at its worst.

Another point to which we wish to call attention is that with five cases developing in close proximity inside of ten days, with a mortality of forty per cent., it cannot be denied that there was a virulent nest of infection which might have given birth to an epidemic of much larger proportions.

This epidemic illustrates another point, we think, quite forcibly-that in order for a healthy person to take diphtheria the contact must be very close, and a healthy adult is almost exempt. All of the five cases were under fifteen years of age. The two fatal cases were under seven.

Only one other fact in this connection is perhaps worth dwelling on, and that is the cessation of the epidemic as soon as the disease was recognized and the cases isolated. Had public funerals been held and free intercourse with the sick been permitted, Fort Atkinson might easily have had an epidemic that would have put scores of families in mourning and affected the good reputation of the city for years to come.

The uncovering of "London's infamy " by the heroic Pall Mall Gazette commission, reveals a disheartening state of affairs to the enthusiastic humanitarian who had all along cherished grand and bright beliefs in the moral ascension of the world towards those upper levels where the sunshine of purity shines clearly through human lives,

and where our beautiful ideals of the complete man, almost entirely eliminated from the animal, await us. To have such a Vesuvius of Vice suddenly erupt, as it were, beneath our very feet, where the verdure smiled greenly and the flowers of society bloomed serenely only a little while before, is confusing to one's previously-formulated ideas of what should be and what had been argued must be, along the grand line of progressive ideas, evoluting into moral, spiritual and physical betterment of classes. The phrase "modern civilization" embraced our cousins of the British island in all the nearness of consangunity and contained a shadow of compassion for that barbaric past where women were trafficked in as slaves and variously and numerously suppressed as to individuality, to suit the requirements of whatever man or men might be master of the situation.

Alas, that Past'! our thought whispered to us; but now, oh now-how rejoiced should the upgrowing generation be to live in the glad present, with its safety, and sweetness, and light! And then, having grown up with this wraith of self-gratulation beside us, to have such a boiling lava of the lower passions disclosed with only a single note of warning, burning and scorching its way among the defenseless, leaving a blackened track of desolation in its wake-what an extinguisher of any undue efflorescence of belief in the continuous progression of the human species at large!

But then,

Secondly,

We need not become pessimistic and exchange our belief in the supremacy of Good to that of the reign of malignant forces towards malignant ends, simply because we have seen a bad case of its outbreak. Comparison is the safe rule by which we may measure our rate of speed towards the "perfeet man" which society must surely illustrate in some future day, and if we compare the standards of to-day in this country with those prevalent in early Colonial days, we shall be able at once to place our grade

of refinement at its proper niche, and be encouraged thereby.

Edward Eggleston's series of articles in the Century on that topic shows up the question in a wonderfully clear light. The long and dark shadow of the times when woman was captured by force has diminished within the last two centuries so rapidly that it is now nearly at its vanishing point. The American girl treads on no such danger as underlies the thoroughfares of London. She is safe if she so wills; and with that safety she commands an unquestioned liberty of action not dreamed of by the English maid or

matron.

This people is the last outcome of the Oldand as the latest progeny of the higher Aryan race, is its best. A woman born in any of the large cities of the United Statesespecially Chicago-may feel more truly than any previous type that she is the arbiter of her own destiny, and that if she holds her own purity sacred, that standard will be respected by all classes of American gentlemen under any circumstances in which such a woman might be placed. Honor to whom honor is due. As Galileo said, "The world does move!"?

There is blood in the moon. The times seem ripe for war. A veritable cyclone, which was faintly foreshadowed in our last issue, has struck the projected International Medical Congress which was to assemble in this country in the year of our Lord eighteen hundred and eighty-seven. An invitation was extended to the members of the World's Regulars, by the American Medical Association, to come over here and hold a convention, and the invitation was duly and formally accepted.

Committees were appointed, officers were elected, honorary positions were distributed, when it suddenly dawned on the benighted vision of one of the Irreconcilables that there were too many New-Coders on important committees.

War was at once declared, and, as one of the Old-Code men expressed it, these

"offensive partisans" "must be lifted by the hair and their heads cut off." Accordingly a special meeting of the committee of arrangements was convened and the afore-. said heads were severed.

It so happened that these heads contained brains and belonged to some of the most distinguished members of the medical profession, albeit they could not see and appreciate the vaunted worth and virtue by many believed to be inherent in the Old Quode. The result is that all of the principal members of the proposed Congress in Philadelphia --some of them occupying high official positions in the quasi organization-have resigned.

The Secretary-General; the Presidents of sections on Therapeutics, Medicine and Anatomy; the Vice-Presidents of sections on Pathology, Medicine, Surgery, Obstetrics, Ophthalmology, Dermatology and one VicePresident of the Congress, have resigned. Several secretaries of sections and three members of the committee of arrangements have withdrawn. Four of the most important sections are left vacant. Following the lead of Philadelphia all of the Boston officers of the Congress have resigned, as also have those of Washington and others of Baltimore and St. Louis.

Altogether it looks very much as if the new outbreak of Anglo-Russian complications, even should it embroil all Europe, would be but as a tempest in a teapot when compared with the trouble which is brewing in the ranks of our Old School medical brethren. It is not our fight and we do not propose to offer any suggestions to the contending parties. Revolutions never yet have retarded progress. We rest serenely in the belief that dogmatism, sectarianism and Old Fogyism will get badly beaten in the struggle, and Liberalism, Freedom of Opinion, and Justice will ultimately triumph.

The Medical Record of July 11th contains the following editorial paragraph, which, all things considered, as Artemus Ward would have said, is "trooly amusin:"

"CONSULTATIONS WITH HOMEOPATHS IN CANADA. The Canadian Practitioner complains that several prominent physicians in the Province consult habitually with homœopaths. It very correctly deplores this practice, but incorrectly urges the Dominion Association to take action in the matter. Any attempt on the part of a body of physicians to combine and try to take away the right of the individual to consult with whom he pleases will fail in the future, ast it has done in the past. The best way to get rid of homoeopaths is to show the people that rational medicine is the best, and includes all the good in homœopathy or any other 'pathy.""

Why, our dear old fogy across the border will wake up some day and learn that nearly all of our large American cities are illuminated by electricity and even in the country towns of the United States doctors prescribe for their patients over a large territory by means of an electrical instrument called a Telephone. Why, bless the dear old shadow of a reminiscence, there hasn't been a slave in this country for over twenty years, and the only human beings ever held in bondage in the United States and never freed were the chattels who ran away before the proclamation of emancipation and settled in Canada.

If the medical Rip Van Winkle who edits the Canadian Practitioner will rouse up, brush the dust off his brow, get squarely on his feet and look around he will find that he is just about a score of years behind the times; and in the twenty years he has been dozing the world around him has been making full twenty years of progress, not only in thought and achievement but in charity, liberality and unfettered manhood.

Dr. John M. Keating has used Listerine extensively with good results in the treatment of whooping-cough. He employs it. in the strength of one drachm to two ounces directs the nurse to apply it twelve or more of water, with an ordinary hand-atomizer, times a day, and finds that little children, even babies, do not object to it.

A SCHEMA

FOR A TEXT-BOOK OF PRACTICE.

BY CHAS. GATCHELL, M.D.

PNEUMONIA.

SYNONYM: Pneumonitis.

"Lung fever." Inflammation of the lungs. A common and wide-spread affection; comprises three per cent. of all diseases. Mortality rate: homeopathic treatment, 5 to 7 per cent.; other methods, about 12 per

cent.

VARIETIES.

I. Croupous Pneumonia; II. Catarrhal Pneumonia; III. Interstitial Pneumonia.

ARBITRARY SUBVARIETIES. Typhoid pneumonia-attended by a marked degree of prostration and low delirium; bilious pneumonia -accompanied by congestion of the liver and jaundice; pneumonia notha-"a febrile bronchial catarrh in a marasmic subject" (NIEMEYER); pleuro pneumonia-secondary to pleurisy.

1. CROUPOUS PNEUMONIA. SYNONYM: Lobar Pneumonia.

Always acute; generally right-sidedthree to one; rarely double-one case in eight; generally lower lobe.

ETIOLOGY.

Climate and Season. In equable climates less prevalent than where there are extremes. Two-thirds of cases occur in winter and spring.

Men are more subject than women; all ages liable (most common, 20 to 40); delicate and cachectic more than robust; one attack predisposes to subsequent; open-air life exempts to some degree.

As exciting causes-inhalation of cold air, of dust, getting chilled, and "catching cold" have unquestionable influence.

Pneumonia is apt to complicate Bright's disease, pyæmia, septicemia, uræmia, diabetes, various paralyses, and other diseases, in many of which it is the immediate cause of death; it terminates many chronic dis

eases.

PATHOLOGY AND MORBID ANATOMY

The process consists in the throwing out of a fibrinous exudation, which rapidly coagulates upon the surface of the pulmonary mucous membrane.

There are three principal stages to the pathological process:

I. Engorgement (congestion); II. Red hepatization (solidification); III. Gray hepatization and resolution. I.-Engorgement, or congestion. Bloodvessels of the affected part become distended; the mucous membrane congested; the lung tissue infiltrated; alveoli and alveolar passages contain a reddish-brown, adhesive, viscid fluid.

Post-mortem. On section, the lung involved does not collapse; it is dark-red, heavy, firm, retains indentations; tissue moist and easily torn; crepitation lessened, or wanting; floats or sinks, according to the degree of engorgement; cut surface exudes reddish, viscid fluid, sometimes frothy. The nature of the contents of the alveoli (dark-red, viscid fluid) will distinguish it from simple congestion and edema.

II. Red hepatization. Pulmonary capillaries now distended with closely-packed corpuscles; alveoli filled with fibrillated fibrin, inclosing red and white blood corpuscles (exudation corpuscles, pus corpuscles, lymphoid cells) and large, nucleated Fibrinous cells (changed epithelium). plugs are also found in adjacent small bronchi (up to one-fifth inch).

Post-mortem. On section, the lung is solid, firm, heavy (sinks in water); it is easily torn or broken down; the cut surface is dark-red, or slightly mottled; granular; on pressure it exudes an opaque, bloody fluid, mixed with flakes.

III.-Gray hepatization. The color has changed from red to gray (or yellow), beginning in spots; the change in color is due to disintegration of the hæmatin of red blood-corpuscles. At the same time there is active formation of new cells (probably from epithelium of vesicular walls-NIEMEYER; migrated white blood corpuscles-COнNHEIM); with the cell production the exudation softens and becomes fluid. The cut surface still shows granular appearance (except in the aged and in the pneumonia of typhus); a dirty-gray fluid may be expressed. Lung tissue soft and friable, though still intact; still sinks in water.

MODES OF TERMINATION.

Resolution. The contents of the vesicles (fibrin and cells) undergo fatty metamorphosis, become emulsified by an albuminous fluid, and this is removed, partly by expectoration, chiefly by absorption; the blood again circulates freely in the vessels, and after some time the lung-tissue regains its

integrity, the epithelium being restored to the surface of the mucous membrane of the part involved.

Abscess. If the pulmonary parenchyma becomes cedematous and purulently infiltrated, it breaks down and forms abscesses, single or multiple.

The abscess, if superficial, may burst into the pleural sac and give rise to pneumothorax. If it breaks into a bronchus the contents are discharged, and the pyogenic walls continue the formation of pus until the patient becomes hectic. If it has no outward escape, the contents may become encapsulated, re-absorbed, and a cicatrix mark the spot; or, the contents may undergo caseous, and subsequently calcareous degeneration. When abscess occurs, it is usually in those who were previously cachectic, or in victims of alcoholismus.

Gangrene. If the nutrition of a part of the affected lung is interfered with by complete stoppage of blood-supply, due to embolism or thrombosis of pulmonary or bronchial arteries, gangrene becomes a sequel.

Bronchiectasis is a rare sequel. The unaffected part of the lung may become hyperæmic or oedematous. If the pneumonitis is peripheral, the pleura inflames. The blood contains an excess of fibrin.

POST-MORTEM APPEARANCES.

Rigor mortis, marked; skin cyanotic; brain congested; large veins filled with firm clots; the heart contains coagulated fibrin, and long clots, attached by one end to the chordæ tendineæ, extend into the arteries; spleen generally enlarged; lungs in condition described under the different stages; they do not collapse-retain imprints of the ribs.

SYMPTOMS AND COURSE.

Invasion. Sudden; distinct and violent chill; aching pains in back and limbs; in the aged, chill sometimes absent; in children, convulsions may replace the chill; anorexia; coated tongue; sometimes vomiting; invasion also marked by prostration and debility.

Fever.-Temperature rapidly rises, reaching 103° or 104° F. even on the first day. Type, continued-morning remissions and evening exacerbations of about one degree; at its height, temperature reaches about 104°F.; it is high in children-low in the aged and cachectic; extremes of 107° have been known to be followed by recovery, though it is generally fatal. An un

usually high temperature attends inflammation of the apex. With defervescence the temperature rapidly falls to near normal, usually occurring on the fifth day; a high range persisting after the tenth day denotes extension of inflammation to new areas of lung, previously unaffected.

Pain. Seldom absent; character-stabbing, piercing, cutting; usually appears early-delayed if the inflammation begins centrally; greatly aggravated by contact or motion; singularly it is sometimes on the side opposite to that of the inflamed lung(!); involvement of pleura will not altogether account for this peculiar symptom-may be due to myostitis. Pain may sometimes be absent in pneumonia of the aged.

Cough.-Appears early; character-short and harsh; repressed on account of the pain; sometimes absent in the aged.

Expectoration.-Sputum-color, brick-red or "rusty;" due to intimate mingling of blood; consistency, thick and viscid-must be wiped from the mouth; clings to inverted dish; consists of the exudation which characterizes the disease, containing blood-corpuscles and young cells; in second stage, branched fibrinous casts of the bronchioles, may be found in the sputum; expectoration in quantity usually slight; persists throughout the attack; prune-juice expectoration position; with resolution sputum more proof grave importance-denotes blood decomfuse and creamy. Expectoration loses saltish taste simultaneously with appearance of chlorides in urine. "Brick-dust" sputum not pathognomonic of pneumonia unless fibrinous casts also exist.

Respiration.-Rapid and superficial; increased to 40 or 50 per minute; in children even more-as high as 80; alæ nasi "work" (does not demand lycopodium); the rapid respiration due to (1) diminished lung surface, (2) pain, and (3) fever.

Pulse. In ordinary cases about 100; with high fever 130 to 140; quality-outset, large and full; later, small and soft, due to lack of filling of left ventricle; ratio between pulse and respirations altered-normally, this is as 2 to 9; in pneumonia, owing to great increase in respirations, it may become as 2 to 5.

Countenance.-Anxious expression, lips blue; cheek of side affected, mahogany red; herpes labialis second or third day in twofifths to one-half the cases.

Gastric.-Coated tongue; anorexia; thirst;