I had a case say one word in regard to bleeding in these cases. very similar to the one suggested by Dr. Clark, in which the face was blue and the finger-nails were purple. The patient insisted upon being bled. I went away and came back and then bled her until she fainted. I was a little frightened I confess, but somehow felt that she would come out all right. She recovered, and still believes I saved her life by the lancet. There are very few of the physicians in my region who resort to venesection. Parties come to me to be bled every spring-I accommodate them every time and am glad to do it. There is an allusion to the custom, in one of the papers I have heard read upon the therapy of pneumonia, in which it is styled a ceremony of purification. Well, perhaps it is. DR. ROBERT SELDEN, of Greene County.-I have heard, or seen it stated, that pneumonia was more fatal in the city of New York than anywhere else; if so be that this is a fact, can any one now present tell. DR. FERGUSON.-The only statistics I have heard and remember about, are the two hundred and fifty cases of Dr. Loomis, in which the mortality was, I believe, thirty per cent. DR. W. H. THAYER, of Kings County.-If permitted to revert to the matter of treatment, I may say a few words with reference to a valuable agent. Carbonate of ammonia is a very efficient remedy in all stages of pneumonia. It is the more desirable to bring it to the notice of the Association, since an examination of all the latest treatises on practical medicine fails to discover any allusion to its use. Dr. Napheys, in his work on therapeutics, a collation of American and English authorities, quotes Dr. A. T. H. Waters, of Liverpool, as treating pneumonia with carbonate of ammonia from the outset. This constitutes the only exception to my general statement. The agent spoken of has long been used as a stimulant in the purulent stage of pneumonia, and in other low conditions; but its advantage is not alone that of a general stimulant; and its good effect on the lungs-through which it is eliminated-is not limited to the time when the lung is in the stage of gray hepatization. For the last fifteen years, at least, it has been my practice to put the patient at once on the carbonate of ammonia, an adult taking from five to ten grains every two hours-which, as Dr. Rochester has stated, can be easily taken in milk. When I first resorted to this treatment, it was limited to patients seen in the first stage, before hepatization; with the result that hepatization never took place, and the fine crepitus was gone within sixty hours. Do not think this an extravagant claim. From using this remedy in the first stage of the malady, I soon discovered that it was a safe and very useful remedy in any stage. It furnishes a needed cardiac stimulant, and begins at once to act on the pulmonary cells, arresting further exudation, if the exudate is not yet solidified, and liquefying it and promoting absorption if hepatization has taken place. Used in the first stage of uncomplicated pneumonia, the lungs give evidence of complete restoration within sixty hours; and, begun when hepatization is already established, we find an evident impression made on the disease on the second or third day, and convalescence following rapidly. It is always desirable to begin the treatment with a cathartic, preferably mercurial; and to follow with all the well-established hygienic measures, which need not be further specified here. The use of carbonate of ammonia does not exclude the employment of any form of antipyretic treatment, whether by quinine or by tepid or cold baths, when required. Although the opinion is gaining ground that pneumonia is a specific fever, of which hepatization of the lung is a characteristic lesion, yet there is some testimony that it can be aborted: Dr. Austin Flint, in his "Clinical Medicine," published in 1879, says he has indubitable evidence that the disease can be aborted, and has been aborted by quinine in large doses; and Dr. A. B. Palmer claims as much for opium. of DR. County. As much of late has been spoken and written upon a somewhat new remedy, antipyrin, and as I have understood that Dr. Stockton has given much attention to it, will he kindly give the Association his views upon the subject? DR. CHARLES G. STOCKTON, of Erie County.-I have given the subject a little attention during the past year, and I am convinced that the drug is being much abused; that it is in proper cases a good drug. There seems to be a tendency among some in the use of new drugs-certainly in the use of this one-to use it in a most dangerous manner. They seem to think that the temperature can be brought down summarily to 96° or 95°. I believe that antipyrin should be given in not larger doses than twenty grains, and that it should be given at long intervals, say of from eight to twelve hours, and then if you have no reduction of the temperature abandon the agent. DR. FERGUSON.-I listened, last summer, to Dr. Stockton, in his remarks on antipyrin, at Rochester, with a great deal of pleasure and profit. His mastery of therapeutic subjects is such that I know we can place a great deal of confidence in his statements. Let me ask Dr. Stockton whether, so far, in a careful and judicious use of the drug, he has seen such notable effect upon the circulation as to give him any anxiety in the ordinary dose of twenty grains. I ask more particularly regarding any fears of disaster to the heart. DR. STOCKTON.-In reply, I would answer decidedly, No. I believe that the effect of antipyrin is no more serious than that of quinine. You do get some heart sedation, but not enough to give any anxiety. In doses of fifteen to twenty grains, repeated in eight to twelve hours, there is no danger whatever. DR. FERGUSON.-I have used antipyrin very freely since its introduction. I believe it is the one agent we have which can be put in the stomach which is reliable for reducing temperature. My experience is that of Dr. Stockton: that a single dose of twenty grains is often enough for twenty-four hours, but it may be repeated once or twice. In urgent cases I have repeated it every one or two hours, for several times, and so far I have had no unpleasant cardiac symptoms. I can readily see that if the drug were pushed too far it might have a toxic effect; but in doses of twenty grains, repeated at intervals of one or two hours, provided the evidences of reduction of temperature do not begin; its use has been, in my experience, successful, and justified by the results. Forty grains do not always succeed in hyperpyrexia, say where the temperature is as high as 106°. ADDRESS ON SOME OF THE RELATIONS OF By AUSTIN FLINT, JR., M. D., of New York County. PHYSIOLOGY is the only natural basis of scientific medicine; even if we use the term medicine in its widest signification, and include in it the practice of surgery, obstetrics, and gynæcology. While therapeutics has always been more or less empirical, the results obtained by the purely experimental exhibition of drugs, when the value of such agents has been established by clinical observation, have nearly always been explained by researches conducted in accordance with the methods most successfully employed in physiological investigations. Illustrations of the principles of harmony years ago, in the musical compositions of Bach and Beethoven, were as purely the results of empirical methods as the treatment of miasmatic fevers with quinine or of syphilis with mercury. As the comparatively recent mathematical investigations of Helmholtz have established a physical basis for the laws of harmony and modulation, so strictly followed by the early classical composers, so the rationale of what was formerly empirical therapeutics becomes positive and definite, as our actual knowledge advances in the direction of the modus operandi of medicinal agents and the exact morbid modifications of physiological processes which constitute disease. Although anatomy and, to a certain extent, animal chemistry have an existence separate and distinct from physiology, physiology itself can not be divorced from a knowledge of the structure, relations, and composition of parts of the body; al though it may be empirically or even accidentally ascertained that a certain drug will cure a certain disease, the rational treatment of diseases, in their various phases and modifications, can not be employed without a knowledge of pathology based upon facts drawn from physiology; and, while a practitioner of medicine may meet with some success in using prescriptions which are said to be "good" for certain maladies, he rises but little above the avowed "empiric" when he fails to make use of "the aids actually furnished by anatomy, physiology, pathology, and organic chemistry." The relations of physiology to the practice of medicine, surgery, and obstetrics constitute a subject much too large for discussion within the time to which this address is necessarily limited; and I shall be forced to content myself with a brief review of a few, only, of the most striking applications of anatomy and physiology to the every-day practice of the physician, leaving out of consideration surgery and obstetrics—a great part of the latter being in itself pure physiology. It may be stated, however, as a general proposition, that the more familiar and trite the examples of the dependence of the pathology and treatment of diseases upon physiological knowledge, the more complete and perfect are they as illustrations of the practical applications of the study of normal functions. It is difficult to imagine the existence of a rational pathology anterior to the discovery of the circulation of the blood. The method of study illustrated in the classical work of Harvey did not immediately influence physiological research in other directions; but a review of the important physiological discoveries made since 1628 shows that the experimental method, which led to such brilliant results in the hands of Harvey and which was formulated in the Baconian system of philosophy, has been the only one which has stood the inexorable test of time. The indirect applications of this method to practical medicine are too many to be even enumerated here. They are to be found in both ancient and modern medicine. The physiological facts handed down from Aristotle were ascertained by the experimental method. It was direct observation and experimentation |