to the aged of three score and ten, and equally all conditions of life. A majority of cases, however, occurred in children under ten years of age. The cases were carefully watched, and their condition noted, from day to day, and this resume is made up from notes and observations made at the time. A large majority were seen by myself, and the rest are taken from notes and observations made by my son, Robert Selden, M. D.

The disease was ushered in by the usual premonitory chill, followed by fever, headache, and general mal aise, pain in one or both sides of the chest, usually in the lower lobes of the lungs, and, in the great majority of cases, attended with a very troublesome hyperemesis. I have never seen gastric disturbance so generally attending this disease. No case was arrested before passing into the second stage, and the mean duration of the disease was about eight days. Delirium was a very common and marked symptom, sometimes violent, but oftener low and muttering. The great majority of these cases were of unusual severity, a much larger proportion than I have ever met with in a like number of cases. The type of the attending fever was essentially typhoid.

The peculiarities of this visitation of pneumonia were the unusually great proportion of grave cases, the urgency of gastric symptoms at the outset of the attack, and the almost universal occurrence of delirium at some period during the progress of the

case.

The treatment pursued was what many would hardly call secundum artem. It was usual to commence by administering a purge, composed of calomel, rhubarb, and bi-carb. sodæ, it having been observed that the vomited matters were strongly acid. After the operation of the cathartic, we gave, during the stage of engorgement, nauseant doses of tart. ant., or ipecac, with anodynes in the form of Dover's powder. As the disease advanced, and the parenchymatous structure of the affected part became solidified by effusion, this was changed for bi-chlor. potass. in free doses, with anodynes as before. The bi-chlor. potass. was given under the theoretical notion that it supplied the system with oxygen, which the diminished capacity of the respiratory apparatus failed to inhale in sufficient quantity to meet the demands of the animal economy. Veratrum, in the form of Norwood's tincture, in suf ficient doses to control the pulse, was given in all cases that seemed to demand it. Blood-letting, either general or local, was not employed in a single instance. When the typhoid stage became well

marked, by frequent and irritable pulse, tendency to diarrhoea, low muttering delirium, and hot and dry skin, stimulants and tonics were employed freely. For stimulants, wine and whisky punch were given, and as a tonic, quinia with anodynes. As good alimentation was given as the patient could be induced to take, preferring, in the early stages, a farinaceous diet, and later, such food as furnished mainly nitrogenous principles. Milk and cream, diluted with water, were freely given to children during the whole course of the attack.

Blisters were applied in only one case. This case presented a singular peculiarity, the disease attacking the upper and lower lobe of the left lung, while the middle portion remained free from disease throughout, giving out good resonance on percussion, and a healthy vesicular murmur on auscultation. The case was one of great gravity, the delirium was constant for many days, and the prostration of strength extreme. The blister was applied, not because of any great faith in its efficacy, but it was one of the means to be used, and the case threatened to terminate fatally. No relief followed the vesication that might be fairly attributed to it, but the patient finally recovered. The topical applications most employed were the cataplasm of mush and mustard. The quantity of mustard used depended on the age and strength of the patient, but always enough to effectually redden the skin. When this was effected, the poultice was removed, and the whole chest thoroughly rubbed with melted lard, and covered with flannel next the skin. If thought necessary the poultice was again applied, when the redness of the skin had subsided, and so on, again and again. Great attention was given to the general condition of the patient. In fact, the treatment was directed toward this rather than the removal of the local trouble by any of the theoretical means laid down by authors on the subject. Many cases required tonics and stimulants from the first, some sooner than others, and none of the graver cases recovered without sustaining treatment in some form. The result of this practice was eighty-five recoveries and three deaths.

Of these three fatal cases, Case I was a case of broncho-pneumonia, complicated with pertussis, in a child ten months old. The treatment was mainly such as I have described, but it grew gradually worse, and on the sixth day the patient perished in an attack of suffocative dyspnoea.

Case II was an old man of sixty-five, who had suffered from

eight attacks of pneumonia previously, this being the ninth. He had bi-lateral broncho-pneumonia, attended with extreme dyspnoea, constant delirium, and great prostration. He came under our care on the fourth day of the attack, and we were obliged to place him on stimulant and tonic treatment at once. Notwithstanding the unfavorable aspect of the case, the amendment was steadily progressive, and on the twelfth day the patient was fairly convalescent. He had no pain or fever, pulse normal, appetite good, expectoration free, some deposit in the base of both lungs, which was rapidly disappearing. He was now warned that great caution must be exercised during convalescence, as his age and enfeebled constitution rendered him peculiarly obnoxious to a relapse. He was very confident of recovery, and remarked that he had always got well when once the fever was broken; that he felt he was now free from fever, and had no fears but he would recover. Eight days afterward I was hastily summoned, and found the patient insensible, with heavy labored respiration. I was informed that since my last visit he had steadily improved until that day, when, after imprudent exposure, he had been seized with a chill, which lasted two hours, and left him in the condition I found him. Physical exploration of the chest revealed no pulmonary trouble, and the immediate cause of death was congestion of the brain.

Case III was a simple bi-lateral pneumonia, in a child one year old. The patient was very intractable, the parents indulgent, and impressed with the belief that the patient could not recover. Finding it was impossible to procure adherence to any plan of treatment that gave a rational hope of success, the case was abandoned, and the child died on the seventh day. Many worse cases recovered, and we can not refrain from the opinion that a correct treatment, thoroughly carried out, would have brought this one safely through.

The results of this practice in pneumonia will, I believe, compare favorably with any yet given to the profession. According to a late writer, Dr. Kocter, of Beme, Switzerland, the lowest rate of mortality yet reported for this disease is 8.3 per cent., while the ordinary percentage is 20.7. It will be seen that a loss of three out of eighty-eight gives a per cent. of a fraction less than 3.5.

I have been accustomed to observe and treat pneumonia every year, more or less, during my whole professional life, now nearly thirty years. During my studentship I was taught to believe in

the essentially sthenic nature of all inflammatory action, and that it could only be controlled by depletion and evacuants, generally and locally. Of course I carried these ideas with me into practice, and acted upon them. In the winter and spring of 1848-9, pneumonia prevailed extensively in my neighborhood, and I treated a large number of cases. The treatment was, bleeding, general and local, tart. ant., calomel, and blisters. I met with average success, but I observed that, after the subsidence of the disease, my patients remained weak, and did not fairly recover, until the warm weather of spring and summer came on. I was often impressed with the thought that I was depleting too freely, but my cases were severe, and I was young, and dared not turn aside from the beaten track of practice. The following year the disease was less prevalent, and less severe, and I ventured, in a few cases, to dispense with general bleeding, and confine myself to the local abstraction of blood. The success I met with, and the perfect recovery of my patients, gave me courage to dispense with both general and local depletion in the majority of cases, but I still adhered to calomel, tart. ant., and blisters. The difficulty of having a blister properly dressed, the pain of its application, the failure to observe its controlling influence over the disease, and its interference with the proper physical exploration of the affected part, led me to employ them less frequently. Then the introduction of the veratrum viridi to the notice of the profession, and having so often noticed its influence in controlling inflammation, by its sedative action on the heart and arteries, has had its influence in changing my practice in inflammation. Also, the more perfect knowledge of the pathology of inflammation, especially of pneumonia, has contributed to lead me to my present course of treatment. I do not consider my plan of treating pneumonia a perfect one, or even that it is the best, and may, and probably shall, change my views in the future, but with my present ideas of the pathology of the disease, developed through many years of large practice, close observation, and rather extensive reading, I can only express my confidence in the treatment herein laid down, by saying that if I were attacked with this disease, I should wish to be treated as I have treated others.

Since writing the above the author has seen a synopsis of a paper read before the London Medical Society, by Dr. Hughes Bennet, in which it is claimed that, under what is in England called the "restorative" plan of treating pneumonia, the mortality is one in twenty-seven or thirty. See Rankin's Abstract, July, 1869.

ART. II.-Monstrosities Again.-A Critic Reviewed.

BY E. MENDENHALL, M. D., Zionsville, Ind.

In the June number of your journal appears an article under the caption, "Congenital Abnormities," from Dr. G. N. Duzan, which is truly amusing, if not very instructive. It is an attempt to criticise our article in the April number of said journal. After quoting liberally and changing somewhat the language used by us, he gratuitously assumes that the animal resemblances spoken of were only "fancied," and then dogmatically asserts, "and hence the announcement of a newly-discovered physiological relation between the material organism and the foetus in utero."

Now, Mr. Editor, I really supposed the readers of the Lancet were gentlemen of intelligence, and would therefore discover nothing new in the questions and suggestions therein made; for ever since the days of Hippocrates to the present time, the idea that mental impressions affected the foetus in utero injuriously or otherwise, has obtained the popular assent and credence among the greater portion of the human family; and within certain limits, has been maintained by men who stood deservedly high in the medical profession. "Such notions upon this subject have existed from the earliest history of the world." Hippocrates, Galen, Quintillian, Denman, Dewees, Hooper, Dunglison, Gross, and many others speak of it as a prevalent opinion; and especially has it been advocated by some within certain specified restrictions. The fact, however, that these writers alluded to it at all is conclusive evidence that if we should apply for a patent for the "newly discovered physiological law," which our critic fancies has just now been announced to this benighted world for the first time, we would utterly fail in our attempts to thus immortalize our name. If it were true that any such announcement or claim had been made, there would have been nothing new in it to the minds of your readers, I presume, except to that of our reviewer, to whom, no doubt, judging from the animus of his language, it was altogether new. The intelligent reader, however, will discover that we made no such announcement at all, nor set up any claim for a "newly discovered physiological law," or any such thing. This existed only in the fanciful brain of our sagacious reviewer. We only asked a few questions in reference to the cause of the abnormal condition of the case then under consideration, and gave a few