Auscultation is said to be the keynote to the proper physical examination of children. The man who can successfully auscultate an infant's chest is truly a diagnostician. We should always use a stethoscope in examining children, as most doctor's ears are entirely too large for this procedure when lain flat against the chest of the child.

Much valuable information may be gained by percussion. For this purpose some physicians prefer the fingers, while others use the percussion hammer. I am of the former class. Young children's chests should be percussed while the child is standing or sitting. Each lung should be percussed from apex to base, both anteriorly and posteriorly; also in the axillary line. It is well to percuss first one lung and then the other, beginning at the apex and dropping down about one-eighth

each time.

The liver and the heart must be thoroughly gone over while examining the chest. Some physicians claim to be able to map out by percussion the existence of enlarged thymus glands or the presence of enlarged bronchial glands; this I have never learned to do. Percussion of the abdomen is less used in the examination of children than in examination of adults, for there is little in a child's belly that you cannot feel by palpation.

The knee-jerk should always be taken in cerebral and spinal cases.

The examination of the throat is very important and should be done thoroughly. Many a case of diphtheria has been overlooked from lack of observing this part of the anatomy, during a routine examination. The nose should always receive attention, as should the ears and eyes.

A few pertinent points and then I am done: "The man is father of the child." When peculiar conditions exist, which cannot be readily explained, examine the man.

Always have a child undressed before fully deciding what his trouble is.

Nine-tenths of children's disorders are due to infection, external or intestinal.

Fever almost always means infection; locate the seat of the trouble.

Never forget to examine the ear and throat carefully when fever of an obscure origin exists.

Do not let old women lead you to believe that fever is caused by teething alone.

Extremely high temperatures are noted early in malaria, influenza and the acute infections; late in trismus and meningitis.

Don't forget to inquire as to where the child with a high fever has been and with whom he has been playing.

In the summer months we may first give our attention to the gastro-intestinal tract; in the fall and winter, attend to the respiratory organs.

It is well to remember that tubercular children present temperature at intervals. The same thing is true in chronic endocarditis.

Notched, deciduous teeth do not mean lues. Hutchinson's teeth are not notched until the permanent teeth appear.

Do not forget that the pulse rate means little in infancy; it is the quality of the pulse that counts.

It should be remembered that in childhood,

functional murmurs are common. Bear in mind, too, that in infants the apex is outside the nipple line.

It seems to me that this important field is being shamefully neglected by the general practitioner, and that we need a general awakening along this line, that we may, at least, become sufficiently proficient in the diagnosis of diseases of children to know when to take our serious patient to the specialist, if nothing

COMMENT WANTED, ALSO CRITICISM, IF NECESSARY

By C. W. CANAN, M.D., B.S., Ph.D.

We report this case hoping that its study may benefit the readers of The Summary as well as the writer. Clinical History: Miss Annie L......Age 19 years, farmer's daughter, brunette, weight 124 lbs., full of life and fun. Was called to see her on Jan. 7, 2 A. M., secured the following history; had been in splendid health; ate a hearty supper on the evening of the 6th, also an apple or two an hour before retiring; went to bed at 10 P.M. Her sister heard her moaning at 12 M., and found her suffering with a bad headache. While she was trying to give her relief she began vomiting; before she had recovered from this attack of vomiting her bowels began, and moved several times within a half-hour. About this time she began to suffer with pain in the stomach and abdomen.

When I first saw her at 2 o'clock, she was vomiting occasionally, bowels moving every 20 to 30 minutes, stools watery and of a greenish-yellow color; circulation and nervous system much depressed, pulse 120, temp., 101% F.; pain growing more severe, tender on pressure over the whole abdomen. Thirst very great; begging for water every few minutes, but would vomit it promptly after taking. The outlay, as it looked to me was a case of poisoning, I questioned her closely and she said she had taken nothing and her sister said she could not have gotten anything accidently. I asked about her menses, she said they had been regular and that they started about an hour ago. Also said that it was the right time.

I ordered a napkin put in place by her sister. I then proceeded to try to give her some relief. The whites of three eggs were given every 2 hours alternated with 20 grains of bismuth subnitrate, also a tablet containing codeine and acetate lead.

After a period of 30 or 40 minutes I ordered the napkin removed and it was saturated with blood. On examination I found her gown and the sheet saturated. It began to dawn upon me what we had to contend with; I again questioned her closely and asked her how she accounted for so much hemorrhage. She declared it to be her regular period and said she was always terribly bad

the first day or two. On examination her vagina revealed a slightly dilated os through which the blood flowed freely, Pains were very severe, lulling a little now and then. Under antiseptic precaution we decided to tampon.

Leaving some strychnine to sustain the heart, we returned to the office at 8 A. M. Four hours later we were again with our patient. Pains were not severe except just before bowels moved, and these had checked considerable. She still vomited occasionally, and now was complaining of a dry sore throat, so much so, she only swallowed with difficulty. Pulse 120, temperature 104° F. So sore all over abdomen that she could scarcely bear the weight of the bedding, still begging for water; said the albumen and milk did not quench her thirst.

On removing the tampon I found a six or eight weeks fetus intact in the sack lying in the vagina. There had been but little hemorrhage after the tampon had been placed. No amount of questioning could elicit any knowledge on her part that she had been pregnant or that she had attempted to produce abortion. After ordering my former treatment continued, and the application of hot water and spirits of turpentine, stupes over abdomen, I left for home at 10 P. M., leaving my patient in a critical condition.

Saw her early on the morning of Jan 8th; pulse 130, temperature 102° F.; bowels worse, moving unconsciously, eyes congested; whole face cyanosed; finger nails blue; every danger signal out. Gave whiskey and strychnine hypodermically and asked for consultation. Consultant came in afternoon. Under the powerful stimulation the circulation had rallied slightly, but patient said her throat was nearly swollen shut, and could only swallow under great difficulty.

Stimulation was increased by adding digitalis and the doses of bismuth were increased to 30 grs. nuclein in 5 minim doses, was placed on back of tongue every 3 hours. The difficulty in swallowing robbed us from getting much benefit out of medicines that went by the gastric route.

Patient continued to grow worse, and died on the evening of Jan. 9th; sick 64 or 65 hours. Died without admitting any knowledge of her condition or the cause of her terrible suffering. There was no evidence in her mouth of a caustic being swallowed, except

that part of the pharynx to be seen was a darkred color.

The abdomen was slightly tympanitic on the second morning, but soon became normal and was very flat, and even depressed when she died. The tenderness was universal in the beginning, but on second day was most pronounced in lower segment. The lochia The lochia was normal and a vaginal douche brought away very little débris.

The complexion of this patient was the most striking the writer has ever seen. It was not so noticeable by lamp-light, but when daylight came, at my first visit, it was striking, and increased until the end came. It was one of those things that words will not describe, but to attempt it: A yellowish-dusky hue, or a yellow-greenish muddy cast. The conjunctiva had the same color.

There seemed to be no chance for the girl to get a poison, excepting her sweetheart might have given it to her. If so, to what drug do the symptoms point? Do those who die from poison remain conscious up to the last, as this one did? Is there any known plan of treatment that would have saved this patient's life?

Orkney Springs, Va.

BIER'S HYPEREMIC TREATMENT

By J. A. BURNETT M.D.

It is an established fact that the circulation of the blood is one of the most powerful factors in the human and animal system in bringing about the so-called "spontaneous cures." The blood must continue to circulate; there must never be a stasis of the blood. Bier's hyperemic treatment especially the non-surgical use of cupping is to cause free circulation of the blood. There are three methods by which hypermia may be produced: 1st. By means of an elastic bandage or band. 2nd. By means of cupping glasses. 3rd. By means of hot air. The first and second named methods produce a passive or venous hyperemia, while the third produces an active or arterial hyperemia. Obstructive hyperemia when produced by means of the elastic bandage, can be employed only in diseases of the head, scrotum and testicles, and the extremities. Cupping can be applied to any part of the body. Hot air apparatuses are made by which hot air can be applied

locally to any part of the body or extremities. Also a body hot-air apparatus can be obtained by which the entire patient can (except the head) be subjected to the application of hot air. In discussing hyperemia of the head produced by elastic bandage, Meyer says: "Special care must be exercised in the case of patients suffering from arteriosclerosis." There is quite a lot of literature on all forms of hyperemic treatment except the nonsurgical use of cupping.

In discussing obstructive hyperemia by means of suction apparatuses, Meyer says: "Hyperemia produced in this way is similar to that resulting from the application of the elastic bandage." Again he says "In making use of these vacuum apparatuses we not only rely on the artificial hyperemia they produce, but also, and by no means least, on their mechanical effect." As there are but little literature on cupping (Vacuum Treatment) in non-surgical cases I undertook to manufacture some literature on this subject.

In order to explain I will state that I recently purchased several books on vibration as a therapeutic agent. I have found that "Vibratory Technique" by N. M. Eberhart, was the best book. Eberhart explains vibration so one can understand it and apply it intelligently. The chapter in his book on Stimulation and Inhibition is worth the price of the book and is a subject almost entirely overlooked by other writers on this subject. It is absolutely necessary to understand stimulation and inhibition when using a vibrator as well as to understand it in using many other forms of treatment. As Eberhart's book gives the technique of vibration so plain it occurred to me that one could use cupping in place of vibration in the same conditions using the came technique as given for vibration. I wrote Dr. Eberhart and asked him what he thought of my idea and received the following: "In reply to yours would say that you may make use of Bier's Hyperemic Treatment in the form of spinal cupping to the points mentioned in my 'Vibratory Technique.' I have tested out the results you use moderate cupping for stimulation and prolonged or heavy cupping for sedation or inhibition".

Now if anyone is interested in the nonsurgical use of cupping they should get Eberhart's book and a pump with different size cups and follow the directions in the book

substituting cupping for vibration. I do not wish to be understood that I advocate cupping as a subtitute for vibration, I am only in a round about way, manufacturing some literature on the non-surgical use of cupping. I consider cupping as a valuable physical method of treatment.

Hartshorne, Okla.

STUDIES IN THERAPEUTICS, PROFESSIONAL INTERESTS AND ETHICS

BY JAMES S. SPRAGUE, M.D., C.M.

Recently, an agent of a proprietary antiseptic compound visited me and left a sample, of whose ingredients or composition, I know nothing excepting that he told me it had three or four preparations of Sodium, and the conclusion I reached (and such conclusions I have reached very often and nearly fifty years ago and often foolishly not exercised) is that said agent must regard me as a very easy mark or totally ignorant of my Materia Medica and a willing advertiser of his goods not only, but as an unpaid vendor and prescriber thereof. I, too, thought then, now think and have often thought that we as M.D.'s must be considered by proprietary Compounds' Companies as very susceptible to the blandishments of their agents, to whom we give reception very humbly, yet royally and often give praise, encouragement and endorsement of their patented goods. What reception would a Clergyman or Barrister at Law, respectively, give the vendor of cut and dried sermons?-How to Succeed as a Preacher, or how Pastor Russell Conducts Sunday-schools, or How to be Your Own Lawyer; How to Do Cheap Conveyancing; How to Buy Cheap Editions of Law Books of No Standard Authors, etc?

Brother, do you think the preacher or the lawyer, when thus assailed or interrupted in his work, would give the vendor or sampler the best chair, entertain and be entertained(?) by the said clergyman or lawyer-for even ten minutes?-if so, I do not. If either of them did, you and I, brother, would consider he had much valuable time to abandon, and really would be an easy catch. But you, Doctor, whose profession costs double that required by the Church or Law, can give the reception and swap yarns.

Brother in arms, medical, allow me to state I am a poacher, and for nearly fifty years have been a poacher in obscure, literary, especially the Greek and Latin volumes; really a "plunderer of literature" for copy to several medical journals, however, careful I have been in the analecta to preserve the hall mark or stamp. As regards our capabilities as M. D.'s, to think, I may present Ruskin's views to which you will, if not too egotistic, fully agree as applicable to yourself, as I do to myself-and I make this assertion when in my 72nd year.

"There are hundreds of people who can talk for one who can think, and thousands can think for one who can see," and although man a thinking being was designed, few use the great prerogative of Mind, and how few think justly of the thinking few, and how many never think, who think they do!"

"The part you talk with is all out of proportion, too often, to the part you think with" is a selection of mine from an unknown author. Anyway, study thyself and know thyself, yes, "be noble, and the nobleness that lies in other men, sleeping, but never dead, will rise in majesty to meet thine own." Yes, too, "be honest enough to be bold, and bold enough to be honest." I may add that Herod said that in his days there were three kinds of men— those who understand things of themselves, those who understand things when they are explained to them, and those who neither understand things of themselves, nor when they are explained to them. Such was the classification in Greece more than two thousand years ago, and that it applies to men of our day to you and to me--is without doubt, and you can easily arrange your own and your brother's classification in leisure moments, yet his classification of you as yours of him, may differ.

To learn, to teach and to live is our duty to our country and to ourselves, and someone said it is "not my right and your duty, but your right and my duty," and in Senate and in individual discourse, said Marcus Aurelius "let your language be dignified, but not elaborate."

He also said: "Look beneath the surface; let not the several qualities of a thing nor its worth escape thee," especially so when proprietary marks its literature.

"Oh, the years we waste and the tears we waste, and the work of our head and hand,"

said Kipling, whose words, evidently, we can use to illustrate years and tears wasted, work of head and hand wasted, for "sure cures" from nostrums: "The world is a comedy to those that think, and a tragedy to those who feel," or think they think. It is essential that we learn that "the boneless tongue, so small and weak, can crush and kill," declared the Greek. "The tongue destroys a greater horde," the Turk asserts, "than does the sword." The Persian proverb wisely saith, "A lengthy tongue, an early death." Not this only, but the following few nursery lines I recall quite frequently when instead of being a commendable and wise listener I am notor was not, as wise as the owl: "There was an owl that lived in an oak, the more he heard the less he spoke; the less he spoke the more he heard-O, if men were all like this wise bird."

I think it was Epectetus, who flourished during the first half century, A. D., who told us in good Latin this fact: "That appearances to the mind are of four kinds. Things either are what they appear to be; or, they neither are, nor appear to be; or, they are, and do not appear to be; or, they are not, and yet appear to be. Rightly to aim in all these cases is the wise man's task." Dear brother, write in large letters and not to be effaced these lines on the tablets of memory, for not only will they be monitors, but will remind you of perilous and unworthy motives which, if carried to the full fruition, grief and disappointment would have marked the issue. In no other learned profession do things appear in so manifold colorings, not that we are especially susceptible to well unfounded impressions and deductions, for we have been termed, and very wisely so, easy marks in business relations, and if applicable, certainly thus in other and many considerations that are not necessary to name, and are the doctor's obligations to their patients, to their profession and to themselves, and it is requested that you recall these words after your druggist has compounded the following antiseptic solution from the Druggist's Circular in 1907. (Medical World, Dec. 1907.) I have used this internally and externally and consider it without superiors, for when I employ any similar compound and whose components are unknown to me, I am encouraging quackery and thus legally I may justly be named a quack.

And for the "sure cure" reader I may state that the old Black Wash (Calomel gr. xxx, Liquor Calcis, 3x) will do more to assuage eczema than many other preparations whose titles appear more scientific, and when making this assertion I may state that not unless one is acquainted and thoroughly, with old and reliable medicines, should he forget them in search of modern cures, whose day is very transcient and disappointing. In brief, it is always advisable to be off with the oldthe first love-before you are on with the new, and well it is to know that he who does not know his Materia Medica or Pharmacy Studies is a believer in Nihilism Medical or a quack compound vendor, endorser or prescriber and you can make out to what "class" you belong. One fact is this: there are greater professional interests than sure cures, for they are few, and every patient is a special study.

Without pronounced methods and ready references, too many there are in medicine who may read this paper, and but very few will carefully read it, and procure from their druggists the two preparations named. How many, too, will carelessly read it, yet expect more fully to read it, yet never will, for this journal is lost or forgotten, and now and then a vain