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accumulating and decomposing matters in the interior of the respiratory viscus. Expiration into compressed air should be combined with the inspirations of compressed air, when it is desired to relieve congestion, or to stimulate absorption, or when increase of vital capacity is the principal object. Alternation of the combinations may be necessary in some in

stances.

Expiration into compressed air is recommended in cases of deficient normal expiration, as a means of strengthening the respiratory muscles.

Expiration into rarefied air is of signal advantage in emphysema, and in asthma dependent upon emphysema. It is of some advantage in spasmodic asthma, of less advantage in bronchitic asthma, though of value in all, and in the latter variety may be usefully combined with inspiration of compressed air. Inspiration of rarefied air is at times a better combination in emphysema.

Inspiration of rarefied air may also be employed where it is desired to strengthen the muscles of inspiration by increased voluntary exercise, as in cases of contracted thorax in the earlier stages of phthisis, and in convalescence after pleurisy.

That forced voluntary respiration, however useful in suitable cases, cannot replace pneumatic treatment by the differential method in cases where the latter is indicated, is evident from the mere statement that it does not produce differential effects; as well as from the fact that many patients are at first incapable of the necessary muscular exertion. As an adjunct or supplement to the differential treatment, or as a means of keeping up the good effects, it often serves excellently.

Pneumato-therapy, steadily growing in favor as the number of physicians resorting to it increases, bids fair to assume at last its proper position among the resources of med ical art. It can only be damaged, not benefited, by a tendency to indulge in extravagant claims and reckless assertions. There is nothing mysterious about it, -no miracle, no witchcraft. It has its applications and its limitations, and these are exact and capable of determination, almost with mathematical precision. In practice, the benefits to be derived from it will depend upon its artistic employment, as the result upon a canvas depends not on the chemical nature of the pigments, but upon the skill with which they are laid on.

As with all other therapeutic devices, including the administration of drugs, the more

clearly we appreciate the pathological conditions present, and the more comprehensive and accurate our knowledge of the powers and limitations of the agent employed, the more skilfully we can adjust the action of the remedy to the requirements of the disease. The first essential, however, is to get rid of the notion that there is anything mysterious in the process, or that it is not governed by the same unalterable laws that affect all other things under the sun, and from which the sun himself is not exempt, -those laws more inexorable than the laws of the Medes and Persians, in that they were not decreed at the whim of man, and cannot be overturned even by rebels against the Legislator.

A.

A CASE OF BASILAR MENINGITIS.

BY W. G. WINNER, M.D., WILMINGTON, DEL.

W., the child whose illness I am about to describe, a boy about 3 years of age, was born of healthy parents, and no hereditary tendency to any disease existed, unless it might be that in one of its parents, whose father died of a hemorrhage from the lungs. This boy was the third child in the family, the other two being 4 and 5 years of age respectively, and all of them were nursed from the bottle. The oldest child and this one had been very hearty throughout their entire infancy, but the second child was inclined to be a little delicate. Six months prior to the beginning of the child's present illness he had a furuncular eruption on the face and scalp, which yielded to appropriate treatment, lasting only for a period of about three weeks, and was caused, it was thought, by overeating, as he was allowed, in addition to the milk, which he still took from the bottle, to partake of the diet prepared for the family, eating heartily of meats and vegetables.

Recovering from this, he enjoyed good health, appeared to be of a rugged constitution, and, with the exception of being slow in learning to talk, seemed to be a bright child for his age, quick to see and to act.

On January 7, 1886, about ten o'clock in the morning, while sitting in his little expresswagon, he suddenly fell over backwards, and was picked up in an unconscious condition, attended with general convulsive movements of the whole body, remaining in this condition for about twenty minutes. On recovering from the convulsion he seemed to be in a dazed and stupid condition, which gradually

wore off during the day, until towards evening, when he appeared to be almost as lively as usual.

The treatment given him for this convulsion was a hot mustard-bath, the inhalation of ammonia, a mustard draught to the stomach, and when he commenced to revive small doses of bromide of potassium were given.

light broths, and a little arrow-root starch or tapioca, and to place the child upon a combination of bromides, viz., bromide of potassium, grs. x; bromide of lithium and bromide of sodium, āā grs. v, daily, in divided doses. The iodide of potassium, 5 grains daily, was also given.

On January 23 the child's condition seemed to be getting worse. He was irritable, appetite poor, and the light convulsive attacks were numerous. The temperature, which was normal in the morning, showed an elevation in the evening of about one degree and a half, and a correspondingly quickened pulse-rate.

On the 24th a blister was placed on the back of neck, his appetite was a little better, and he rested fairly well at night, the temperature being but slightly elevated. An expression of dulness, which had developed about the 20th, was to-day very marked, and the muscles of neck more rigid.

On January 8, in the afternoon, a few minutes after waking from his afternoon nap, he had another attack, similar in character to the first; also one on the 9th, occurring at the same time of day; likewise one on the 11th, 12th, and 15th. A thorough examination had been made to ascertain the cause of these convulsions. The fall from his little express-wagon at the time he had the first convulsion was thought to be merely a result of the convulsive seizure, as it seemed impossible for him to have received any serious injury from a fall of not more than eight or ten inches, and no mark of any kind could be found. After the second convulsion the child was noticed to pick at his nose and to bore into the ear. These symptoms, together with the suddenness of these convulsive attacks, caused a suspicion of the existence of worms as a probable cause of his trouble. One or two thread-worms were found on pressing apart the nates, but ❘sionally in the afternoon. The child is still

neither the injections used nor the medicine given by the mouth caused the expulsion of any worms, or, if any were expelled, they escaped the notice of those who examined the stools. As the child had been placed upon a liquid diet, and the measures used had failed to throw any light upon the case, the bromide of potassium, which had been discontinued after the second convulsion, was again given.

From January 15 to January 20 no convulsion occurred, but on the afternoon of January 20 one occurred, and was followed by two more on the morning of January 21.

By this time other symptoms were manifested, viz., constipation, which was slight at first, was now becoming more marked; there were also light convulsive movements or jerkings, during which the child would throw the hands up to the head, and give a moan or cry as if in severe pain. A slight stiffness of muscles of neck was observed on the 22d, and slight enlargement of the cervical lymphatic glands. The stiffness of the muscles noticed on the 22d became more marked on the 23d.

As these symptoms indicated a trouble of a very serious nature, and rendered the prognosis very unfavorable, a consultation was held with Dr. H. C. Wood. It was then decided to continue the diet of milk, with

Blistered back of left ear on the 26th, and as symptoms of bromism existed, the amount of bromides taken daily was reduced onehalf. No evening elevation of temperature to-day, but light convulsive movements numerous in the forenoon, and occurring oсса

peevish, but takes food a little better.

January 28.-No severe convulsion has occurred since January 21 until to-day, when two convulsions took place, and the light attacks are numerous.

January 30.-Increased the combination of bromides to full strength, and continued the same until bromism was again developed. A blister was placed back of right ear.

January 31. The appetite not quite so good to-day, probably an effect of the bromides. The bowels have been kept open so far during his sickness by enema mainly, but sometimes by medicine given by the mouth. Gave four 14-gr. doses of calomel to-day, repeating the same on February 1, when the bowels moved three times. The temperature on the evening of February I was 100.8°, late in the evening, this being the first elevation noticed for several days.

On February 2 the bowels moved three times again; no calomel given since the morning before; the light attacks not quite so numerous as on the ist, but glands of neck becoming still more enlarged. Bromide mixture reduced down to one-quarter strength, but continued the iodide as usual.

February 3.-Light attacks not so numerous as yesterday; appetite poor; bowels moved three times again. In the afternoon he awoke from a sleep of about three hours with considerable dulness, and in about twenty minutes had a convulsion, lasting for two or three minutes. As I have not described any of these convulsions, I will do so in regard to this one, as I had an opportunity of witness- | Commenced giving cod-liver oil to-day, and

February 21.-A blister was placed back of left ear.

ing it. It commenced with a twitching of the hands and a falling forward of the head. At the same time the arms were thrown upward towards the head, eyeballs turned upward, and a rapid moving of the jaws occurring, followed by partial opisthotonos, and recovering from the convulsion with a gasping and a yawning, and then a cry as if from fright. At no time in any of his convulsions was any frothing of the mouth observed, nor was the tongue bitten. These severe convulsions generally lasted for several minutes, the first one that he had being about the longest one in duration, viz., about twenty minutes.

February 4.-Ceased giving the bromides to-day, as there did not seem to be any benefit arising from their use. Another convulsion to-day, but not quite so severe as the one yesterday. Gave three 14-gr. doses of calomel to-day.

February 5.-Bowels moved twice to-day. Appetite seems to be improving since sus

pension of bromides.

February 25.- No light attacks have occurred since the 20th. Bowels, although very constipated, have moved naturally for the last three days. Blistered back of right ear.

anointing the enlarged glands with an ointment, viz., ungt. belladonnæ, ungt. hydrarg., equal parts.

February 27.-Light attacks commenced again to-day, and in the evening he had four convulsions.

February 28.-Blistered back of neck.

March 2.-Another convulsion to-day. Bowels still constipated, but moving naturally. A little blood has been noticed on fæces for several days. This appears to be hemorrhoidal in character, and is probably due to the constipation.

March 4.-During the night had three convulsions. Have run the amount of iodide up to 12 grs. per day.

March 8. Three convulsions in the morning. Iodide has been gradually increased until 30 grs. per day are taken, and symptoms of iodism developed.

March 9.-Dropped iodide to 16 grs. per day.

March 13.-A convulsion occurred in the

February 6.-Blistered back of neck. Child morning; light attacks very numerous; he seems a little brighter to-day.

February 8.-No change since the 6th in his condition. Gave four 14-gr. doses of calomel to-day.

February 9.-Another convulsion occurred, but not quite so severe as the last one.

February 11.- Blistered back of right ear. February 14.- Not quite so well to-day as he has been; light attacks (convulsive) more

numerous.

February 17.- Light convulsive attacks not quite so numerous. Bowels moved by giving two 14-gr. doses of calomel. A blister was placed back of right ear.

February 18.-Light attacks not so numerous, but for the last four days he cannot control the passing of water. Appetite during this period seems better. Gave four 14-gr. doses of calomel, but bowels moved only after an injection had been given late at night.

February 19.-Slight symptoms of salivation presented, but otherwise he remains about the same. The light or momentary convulsions, which have been occurring every day for several weeks, ceased to-day about noon, but their cessation was preceded by a convulsion of four or five minutes' duration.

also has the hiccoughs.

March 23.-The hiccoughs, although severe for several days, have ceased; one convulsion to-day.

March 27.-Two convulsions.

April 16. For the last two or three weeks light attacks occur almost constantly during the day. The child cannot walk nor stand alone; cannot feed himself. The dull expression about the eyes is now very marked, and his appearance is one of helplessness. The boy has been losing flesh vety rapidly.

April 19.-Two convulsions to-day. After they had occurred he has better use of his limbs, being able to stand alone.

May 15. A convulsion during sleep, and the first one noticed to occur while sleeping. The light attacks do not now occur. Muscles of neck are not quite so rigid, and the glands are lessening in size.

From May 15 the patient has gradually improved. No convulsions have occurred up to the date of writing this article (November 13, 1886). The stiffness of muscles of back of neck still exists to a slight extent. The lymphatic glands are also a little enlarged, but both the stiffness of muscles and enlarge

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up to the age of thirteen years. Deafness and tinnitus in both ears, -in left ear for a number of years, in right ear progressing for the past six or eight months. She consulted me very irregularly for several months, and was somewhat improved by galvanism applied directly to the ear, one electrode, moistened with a saline solution, being introduced into the external auditory meatus, and various remedies. Upon May 20 I put her upon grain-doses of bromide of quinine t. i. d. In three days she returned, saying she had used the medicine faithfully, but it increased the tinnitus so much she had to abandon it, since which time it has decreased to its usual intensity. She frankly stated she believed I had given her quinine, as she readily detected its usual effects upon her, and as I compounded the recipe in person, I knew she had no opportunity of reading the prescription. I then gave the drug in 4-gr. doses t. i. d., with slight improvement. June 10 I began giving it in To-gr. doses four times a day, still continuing the use of galvanism, when the hearing began gradually to improve, until it reached in right ear nine inches for watch; tinnitus greatly improved. She has now stopped treatment, saying she hears well enough, and the tinnitus is so slight as to cause no annoyance.

I have many times been struck by the similarity of cinchonism and the symptoms of catarrhal deafness, and reasoned that quinine must have some specific action upon the middle ear, for we know where cinchonism has ❘tion. There was found to be a large perfora

been kept up in a patient for a lengthy period a chronic congestion of the middle ear is often produced, leaving impairment of hearing in greater or less degree, and often tinnitus.

The second case. Mrs., æt. 55, came to me for deafness of many years' duration and intolerable tinnitus of over a year's dura

tion in the membrani tympani of each ear, following aural discharges in very early childhood. Watch could not be heard at contact in either ear. Under three months' treatment, by weekly applications of the galvanic current, and quinine bromide To gr., four times a day, there has been a gradual improvement in hearing, first by hearing the watch at contact, and on last consultation she reported having heard the entire sermon at church, sitting in her accustomed pew, the same clergyman as usual occupying the pulpit;

Reasoning from analogy, I determined to try the effect of quinine in small doses in such cases, but in two instances in which I used the sulphate my patients derived no benefit. Now, it is a well-known fact that bromine in its various combinations, as bromide of potassium, sodium, etc., controls and lessens the blood-supply to the cranium, and will often mitigate somewhat the roaring which these ❘ the first sermon she had thus enjoyed for some

patients experience in their diseased ears, so I thought that probably a combination of bromine and quinine would act better. Accordingly I procured some bromide of quinine. The first patient upon whom I tried it was a lady with history as follows :

years. The tinnitus has greatly and decidedly improved, and from being very despondent she is in much more cheerful spirits owing to its decrease. She is now out of town on a prolonged visit, therefore I have for the time lost trace of the case.

Other cases in which I had begun giving this remedy have failed to report themselves, consequently no data can be thus obtained.

Right ear: abscess three weeks ago; drum membrane shows pin-point perforations, opening valve-like upon inflation of the middle ear; watch heard at four inches. Left ear: hearing nil from purulent catarrh, which followed scarlet-fever in childhood, and existed | systemic treatment, will do more for the relief

In conclusion, I would say that systematic, prolonged use of galvanism, combined with December 29.-Been entirely free of tinnitus for two weeks, which is the longest free- | small but well formed; chest and shoulders

and cure of chronic catarrh of the middle ear than any mode of treatment I have yet tried (attention to the health of the nasal and pharyngeal mucous membrane, of course, never to be overlooked or neglected). It is necessary that the physician should know that the results are often slow and gradual, although in some instances very rapid results are obtained, as the following case will show :

A. C. K., æt. 56, consulted me November 17 for tinnitus and deafness in left ear for past ten months, gradually increasing. Politzer's inflation shows Eustachian tubes patulous, although there exists a chronic rhinitis. Membrana tympani intact and of dusky hue. I prescribed an alkaline wash for the nose, and applied galvanism.

November 23. - Since last consultation no tinnitus, and hears better.

December 7.-Hearing improving; momentary returns of the tinnitus noticed; same treatment.

In olden times temperaments were supposed to be due to the relative presence of fire, water, air, and earth, and were divided as follows: "The choleric where the warmth, the phlegmatic where the moisture, the sanguine where the air, and the melancholic where the earth has the upper hand."* But it is now understood that the temperaments are due to the relative development and en❘ergy of the nervous, muscular, lymphatic, or circulatory system.

ment.

The words constitution, diathesis, and cachexia are sometimes misused for temperaConstitution refers to the state of health, or the power to resist disease; diathesis, a tendency to certain diseased conditions; and cachexia, the actual presence of a certain diseased state.

The NERVOUS (Mental) temperament, depending upon the predominance of the nervous system, is characterized by a comparatively large head and small body; a long face, with a high forehead; the bones and muscles

dom he has had for nearly a year. Hearing greatly increased, so as to be now, he thinks, normal. He then discontinued treatment.

I close, hoping to be able to report continued good results from the bromide of quinine treatment.

213 BROADWAY, December, 1886.

THERAPEUTIC INDICATIONS IN DIFFERENT TEMPERAMENTS.

BY W. G. KFMPER, M.D., OMAHA, Mo.

THE recognition of the temperament of a

patient is in many cases nearly as important as the diagnosis of the disease. It would be better understood why maladies in a given family have certain peculiar features and tendencies, and the treatment, as well as the prognosis, would be simplified if the subject was always taken into consideration.

narrow; the complexion is usually light, but may be dark; the skin delicate, generally moist, but rough when dry; the hair fine, soft, dry, and not abundant; the teeth small and separated; nutrition is imperfect; the appetite poor; stomach and viscera small; not much adipose tissue. Urine is abundant, containing alkaline phosphates; the fæcal discharges small. The pulse is small, hard, and quick; the movements quick and active. There is great activity of the mind, a lively imagination, an excellent memory. Great sensitiveness to pain, and but little power to resist disease or starvation. Often displays idiosyncrasies, and is therefore difficult to treat. The diseases are usually due to overwork. In many cases a tendency to insanity, neuralgia, and other nervous affections is present. In low fevers there is apt to be great restlessness, delirium, and much wasting. In the treatment, rest, nourishment, tonics, and sedatives are indicated.

The MOTIVE (Bilious, Choleric, Melancholic) temperament, depending upon the predominance of muscular system and its "supply depot," the liver, is distinguished by a long angular figure, with firm, rather full, muscles ; the face narrow, of dark, sometimes sallow, complexion; hair and eyes dark; the skin

The physician who, by long practice and careful observation, has acquired a knowledge of the peculiarities of his patients, is said to "know their constitution," and is, therefore, trusted to a greater degree, and deservedly so, for his methods are more scientific and successful than the practice of many who apply routine remedies to the same disease ❘ dense; nails hard and of slow growth; the

without taking the temperament into consid eration. Idiosyncrasies and the unusual action of drugs, instead of surprising us, should be expected.

teeth large; stomach and viscera small; pulse hard and slow; disposition harsh and stern,

* Lavater.

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