THE American Practitioner and News. "NEC TENUI PENNÂ.” "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 downwright facts at present more than anything else." -RUSKIN. STATISTICS of all acute diseases of the present day show that pneumonia is one among, if not the most, fatal of them all. I do not mean by this that a fatal termination is more certain in pneumonia than in some of the more fulminant diseases, but that the disease is more prevalent and that more people die with it than from any of the acute diseases. Tuberculosis is considered our greatest scourge, yet recent reports show that more people die with pneumonia than from pulmonary tuberculosis. It would be a very difficult task to arrive at a satisfactory explanation of the death rate from pneumonia. It may be due to an increase in the severity of the type of the affection, the local conditions favoring its development may have grown worse, or it may be due to defective methods of treatment. Wherever the fault may be, this is an important question and one which merits careful thought and investigation. The present treatment of this affection is not satisfactory and it is not my purpose to offer anything new, but to insist on the use of more of those remedies which from experience have proved to be effective, and to use less of those which on the other hand do no good and are often times productive of harm. The promiscuous drugging of a patient simply because he has pneumonia is unjust, and the indiscriminate use of a remedy is worse than not to use it at all. The proper treatment of pneumonia does not consist in giving a large number of medicines, but in properly giving a very few. The patient should be treated with pneumonia, not the pneumonia with the patient. I mean by this that we should take into consideration the patient's idiosyncrasies and note the fact that certain remedies affect him more favorably or unfavorably as the case may be than some other person under like circumstances. Patients suffering with pneumonia are usually nervous and very susceptible to noise and confusion. It is therefore important in the management of such cases to remove the patient to a quiet room, and in the absence of a trained nurse to select some member of the family who has had some experience in the care of the sick who can count the pulse and take the temperature. He should be provided with a clinical thermometer and a history chart. He should be instructed as to his duties and no other person should be allowed in the room unless absolutely necessary. Experience teaches us that there is what might be called a routine treatment for most of the common diseases. This may differ slightly from the treatment we each carry out, but it will certainly represent the prescribed treatment of the majority. It is surprising after reading up this sub; ject, as given by the various authors, what a uniformity of opinion they have in the treatment of pneumonia. We do not notice this uniformity so much in the treatment of other diseases, with the possible exception of acute rheumatism. About the first thing to be done in the way of medical treatment is to give the patient several small doses of calomel at short intervals, and follow this the next morning with a saline carthartic; generally epsom salts. This should be repeated during the course of the disease if indications demand. For the relief of pain hot local appli cations or a sinipism should be applied to the affected lung only. It is surprising what a soothing effect these applications have upon the patient if they are persistently used and kept hot. Soft flannel sprinkled with a few drops of spirits of turpentine over which is applied a hot water bottle makes an excellent local application. With children it is best to put on a flannel jacket open in front so that applications can be placed beneath and pinned snugly to the affected side. In addition to the relief of pain these measures equalize the temperature of the lung, act as a counter-irritant and relieve congestion. The use of ice and the cold packs do not relieve the pain, are uncomfortable and the reaction caused by them is usually too great. That period of the disease known as the invasion, which is so often attended with agonizing pain and nervous shock, due to the flooding of the system with the toxines of the disease, can easily be relieved by giving, hypodermically, a full dose of morphine sulphate. This drug does not only relieve the pain and shock, but it stimulates the heart by quieting the nervous system, and the patient is thereby in better physical condition to enter upon the course of the disease. After these effects are attained, of course, the further use of morphine is contraindicated. The temperature can usually be controlled by giving the patient large quantities of cold water and cracked ice. Unless a high temperature is attended with restlessness, delirium or other nervous symptoms there is no need of giving a febrifuge, but the patient can be sponged with tepid water which should be allowed to evaporate from the surface of the body. Alcohol can be used in the same way and it is not only effective but very pleasant. If these measures fail then the cold tar preparations can be given in doses sufficiently large to reduce the temperature, but their effects should be closely watched. The diet should be light and highly nutritious, consisting of milk, eggs, crackers, gruel and broths. The patient should be encouraged to take these in liberal quantities whether he has an appetite for them or not. The evidences of cardiac failure is an indication of one of the most critical periods of the disease. A systolic weakness and a failure of arterial tonicity should be promptly combated with cardiac stimulants. The best of these are alcohol, strychnine and digitalis. Alcohol in some form is the remedy above all others as a stimulant in pneumonia. Perhaps this can only be said of alcohol in so far as it stimulates the cardiac muscles directly. Three or four ounces of good whisky should be given to an adult in twenty-four hours, and in some instances two or three times this amount may be given with advantage. The old and debilitated and alcoholics require the greatest amount of stimulants. Strychnine stimulate by its peculiar action upon the vaso-motor centers, and for this reason is a valuable remedy in some cases where alcohol would fail. Strychnine is not followed by secondary depression such as we sometimes see after the use of alcohol. Strychnine should be given hypodermically in ascending doses from 1-60 to 1-20 grain careful watch being kept for untoward symptoms. Digitalis may be given where there is evidence of weakness of the right ventricle or compensatory hypertrophy of the heart muscles. The tincture is the best preparation and should be given in from 10 to 15 minims according to indications. The cough is a very distressing symptom, and for its relief there is nothing better than the adminstration of from 1-4 to 1-2 grain of codeine every four hours, or 1-4. grain morphine given hypodermically at same intervals. The last few years the writer has been using heroin and turpen hydrate prescribed in the form of an elixir with a great deal of satisfaction. The carbonate and muriate of ammonia are time honord cough remedies, but they are usually prescribed in syrups which derange digestion, and for this reason they should not be given, except to patients whose digestive organs will tolerate them. A very good remedy to give throughout a typical case of pneumonia where a mild stimulant is needed is liquor ammonia acetatis. It not only serves the purpose of a stimulant, but it is a good refrigerant, flushes the kidneys, and is not attend ed by unpleasant gastric symptoms. After the crisis has passed and convalesence is tardy iodide of potassium should be given in increasing doses to promote absorbtion of the inflammatory products of the lung. If there is evidence of a tubercular or rheumatic element creosote, cod liver oil and the salicylates can be given. Patients whose nutrition is bad should be given an enema of about eight ounces of normal salt solution every four hours. The danger signals are those which indicate severe toxemia and heart failure. If these do not appear, symptomatic treatment, proper care in regard to diet and good nursing constitute the principal treatment. Many specific remedies have, from time to time, been recommended for pneumonia, but each after having been given a fair test were discarded as failures. It is to be hoped that the serum treatment will be more successful, but it is yet in its infancy and sufficient time has not elapsed to warrant a final opinion upon its efficacy. THE THE LIFE INSURANCE EXAMINER. BY O. P. NUCKOLS, M. D., PH. G., 'HE old prejudices against Life Insurance have long since passed away, and to-day the business of Life Insurance affects the interests of a larger number of people, and involves a greater monetary interest than probably any single enterprise in our country. The fundamental principles upon which all Life Insurance is calculated, is that of mortuary statistics, as regards healthy or insurable lives at the various ages. It is patent to every one that a single life is very uncertain, but an agregated number, of say, one thousand healthy or insurable lives, resolves itself into, practically, a mathematical certainty. While this statement is true of healthy or insurable lives, it would not be true of unhealthy or noninsurable lives. From these premises it can readily be seen that there |