stood. The broken-down tissues, and effete matter, that should be eliminated through certain channels, are dammed up, hence Nature tries to assist, by throwing off a part through the lungs.

When constipation is associated with this disease, the breath at times is very offensive, because of large quantities of decomposing organic matter. The breath is also offensive in gingivitis, the result of mercurial or arsenical poisoning. The same is true in scurvy and syphilitic ulceration of the mouth and fauces. Ulcers in the larynx and pharynx, especially when syphilitic, contaminate the breath. The same is true of tubercular ulcers.

There is no disease that makes the breath so offensive as ozena. In this disease the breath is exceedingly foul and repulsive.

Patients suffering from uremia have a breath that strongly resembles ammonia, due to a failure on the part of the kidneys to eliminate urea.

Various mineral substances, which are themselves almost, or quite, without odor, when taken into the system, in sufficient quantities, cause a very disagreeable breath, due to irritation of the stomach, or deranged digestion. The odor of the breath may change temporarily under trivial causes. Fits of anger and excitement may, and often do, produce fetid breath.

Some women's breaths are always offensive during their menstrual periods. In feverish conditions in children, the breath has a sweetish odor, reminding one of chloroform. Children suffering from worms, have this peculiar breath, except more fetid, but it can not be relied upon, because many conditions in which there is irritability along the alimentary canal may give rise to similar, if not identically the same bad breath.

In certain forms of bronchitis, and in cancer of stomach and liver, the breath may become very offensive. There are some individuals who suffer more or less from an offensive breath, the cause of which it is impossible to discover. This may be constant, and yet there seems to be no deviation from normal good health.

We believe that the cause of this condition lies in faulty elimination of the skin, because the breath of this class of

persons always partake (smell) of sweat and other secretions.

Treatment.-The treatment of this condition is as varied as the causes themselves. The thing to be remembered above everything else is to find the cause. This found, your success will depend whether the disease is curable or not. Where it is due to caries of the teeth, all cavities should be filled, and teeth that are too far gone extracted. If the gums are spongy, a tooth wash should be used containing thymol and myrrh.

When the cause lies with the stomach, we have found nothing more serviceable than charcoal after meals, in conjunction with the recognized treatment. In catarrhal conditions of stomach and bowels, with fetid breath, we have found the nonalcoholic extract of golden seal to be a most efficient remedy. Constipation should be corrected, if present, in all diseased conditions of the alimentary canal. Begin this with a thorough cleaning out of all retained debris, then follow with your laxative, and add to this the sulpho-carbolates to render the canal aseptic, and maintain it, and the offensive breath will soon disappear.

In all diseases of the mouth and fauces that are ulcerative in nature, a mouth wash or gargle should be used containing carbolic acid (one to two hundred) to which a little thymol has been added.

To sweeten the breath in incurable diseases of mouth, larynx, or throat, use the following:

M. Sig.: Rinse mouth freely or gargle often.

In tubercular conditions, bronchitis, liver, and kidney troubles, everything possible should be done to establish a healthy condition of the skin. There is nothing so essential to purify the breath in these conditions as systematic bathing and friction of the skin with a flesh brush.

For bad breath, where it is impossible to remove the cause, the following can be used, and will be found more or less effectual in disguising it: the oil of cinna mon, cardomum, mint, nutmeg, cloves; cardamon seed, anise, spice, etc. It should

be remembered, also, that in many conditions, the proper restriction of diet will be found exceedingly beneficial.

[Written for the MEDICAL BRIEF.] Is Drug Treatment Useless in Pneu

monia?

BY G. W. N. ELDERS, M. D., Hematite, Mo.

Dr. Arthur D. Bevan, of Chicago, asserts that it is. After an active practice of thirty-eight years, with more of that kind of practice than usually falls to a single physician, and having passed through three severe attacks of the disease myself, I claim to know whereof I speak.

I assert that the proper treatment of pneumonia does do good, and saves many lives that would otherwise be lost. In my own case when remedies were administered and certain local application used, I would at once feel better, and soon begin to mend. The duration of the disease under proper treatment should not run a longer course than from five or seven days, that is when treatment is commenced in the first stage of the disease. Without entering into a description of symptoms or pathology or cause will at once give my treatment of the disease.

First do not treat the name, but the patient and the plain indications of the disease. On being called to case of pneumonia first put the patient in the most favorable condition as to surroundings, room, nurse, etc. The patient should have a comfortable bed, a light room with good ventilation. Temperature should be kept at from 65° F. to 70° F. All company should be excluded save proper nurses; no talking allowed by patient; patient should have plenty of fluid nourishment with plenty of good cold water to drink; lemonade when preferred by patient. Sponging off every six hours with warm soda water, or if extremities are cool, with mustard water (warm), medical or drug treatment. Would first clear out bowels with an active cathartic containing calomel, and at once apply a large fly blister over diseased lung, leaving it on long enough to produce a good blister, opening by pricking with needle, letting water out

frequently, dressing with vaseline and continuing irritation produced by blister until disease subsides by repeating blister as necessary to keep part sore on outside until inside is all right. (This is on homeopathic principles, but is good all the same. Similia similibus curantur.)

Then after bowels are freely moved would continue mercury with Dover's powders, say about one-quarter grain calomel with one or two grains of Dover's powders every three hours. At the same time if fever is high, cheeks red, give three minims of fluid extract of gelsemium every three hours, alternating with calomel, but if cheeks are pale give belladonna or atropine instead of gelsemium. If heart should be weak or should we fear heart failure give digitalis, as indicated after fever has began to subside. Give quinine and iron in small doses every three hours.

In addition to medicine I have chest enveloped in jacket well padded with cotton batting and kept comfortably tight over chest, so as to cause abdominal breathing to rest lung.

This is the way that I have been treating plain, uncomplicated cases of pneumonia. Of course, we often meet complications that require different treatment and a great deal is dependent on our judgment in such cases.

I rarely lose a case when called in time, or not more than ten per cent, and as I said before I have had more than my usual share of such cases from the fact that the people think I am better on pneumonia than my neighboring physicians, and I have practiced in this community for thirty-eight years.

I hope this will give some young physician courage to use drugs in pneumonia.

We have been friends a long time, and I can say for you that you have hated all the foolish fads that have come and gone, and have worked to keep us lesser lights in our senses, and so much depends (to me) on continuing our relations that I enclose one dollar for another year of the MEDICAL BRIEF, to further the good work you are doing.-W. B. TACKETT, M. D., Johnson, I. T.

[Written for the MEDICAL BRIEF.] A Brief History of Modern Surgery.

BY E. J. KEMPF, M. D., Jasper, 1nd.

(Continued from page 168.) Anesthesia.-The National Library of Paris contains a manuscript entitled "A Treatise on Painless Operations." In it the author, Denis Papin, the illustrious philosopher who originally discovered the use which might be made of steam as a motive power, describes the different means which may be used to lull the sensibility of patients and to spare them the pain of operations. It is known that Papin, disgusted at the shackles which were placed on his researches in medicine, gave himself up to philosophical pursuits. The manuscript in question was written in 1681. Papin, when leaving Germany to return to France, gave it to an old friend, Dr. Bremer, who alone had sustained him by his encouragement and appreciation. This manuscript finally fell into the hands of Pador Lahn, a schoolmaster in the environs of Marburg, who died at an old age, when his heirs sold the manuscript to the National Library for a considerable price.

Modern anesthesia, however, was foreshadowed by Sir Humphrey Davy, in 1800, when he wrote: "As nitrous oxide in its extensive operation seems capable of destroying physical pain, it may probably be used with advantage during surgical operations in which no great loss of blood takes place."

This property of nitrous oxide, although a matter of common knowledge, bore no practical fruit until 1844. On December 11th, of that year, Horace Wells, a dentist of Hartford, Conn., being convinced of its anesthetic properties, submitted himself to the influence of this gas and had a tooth extracted without pain. Most truthfully did he claim on awakening, that "a new era in tooth-drawing had been entered upon." For want of apparatus he was unsuccessful in his attempt to extend his discovery to severe surgical operations, and disheartened by failure he put an end to his life. Wells was the Columbus of anesthe

sia; he touched upon the island, but did not recognize the great continent beyond.

By this time the stimulating effects of the vapor of ether had been discovered, and its similarity of action to nitrous oxide recognized. About two years after Wells' discovery, ether was administered by Dr. T. G. Morton, of Boston, on September 30, 1846, and a tooth was removed without pain. On October 17, 1846, ether was administered by Morton for a surgical operation performed by Dr. Warren, and several other successful trials soon followed.

Dr. J. Mason Warren thus relates the circumstances of the introduction of the use of ether into the Massachusetts General Hospital: "In the autumn of 1846, Dr. W. T. G. Morton, a dentist in Boston, a person of great ingenuity, patience and pertinacity of purpose, called on me several times to show some of his inventions. At that time I introduced him to Dr. John C. Warren. Shortly after this, in October, I learned from Dr. Warren that Dr. Morton had visited him, and informed him that he was in possession of, or had discovered, a means of preventing pain, which he had proved in dental operations, and wished Dr. Warren to give him an opportunity of trying it in a surgical operation. After some questions on the subject, in regard to its action and the safety of it, Dr. Warren promised that he would do so. On the Tuesday following, October 13th, after the surgical visit at the hospital, a patient was brought into the amphitheater for operation. This being the first opportunity which had occurred since Dr. Warren's promise to Dr. Morton, Dr. Warren said to us: 'I now remember that I made a promise to Dr. Morton to give him an opportunity to try a new remedy for preventing pain in surgical operations,' and asked the patient if he should like to have the operation done without suffering. He naturally answered in the affirmative. The operation was, therefore, deferred until Friday, October 16th, when ether was administered by Dr. Morton with his apparatus, and the operation performed by Dr. Warren. It consisted in the removal of a vascular tumor of the neck, which occupied five minutes. During a part of

the time the patient showed some marks of sensibility; but subsequently said that he had no pain, although he was aware that the operation was proceeding. On the following day a woman requiring the removal of an adipose tumor from the arm, was rendered insensible by ether, given by Dr. Morton; and Dr. Warren requested Dr. Hayward, who was present, to perform the operation. This was successful, the ether being continued through the whole operation, which was a short one, and the patient being entirely insensible."

"A few days afterward Dr. Warren informed me that he had learned from Dr. Charles T. Jackson that he had suggested the use of ether to Dr. Morton."

The success of this process in the prevention of pain was now quite well established-and anesthesia had been dis

covered.

Though Dr. Charles J. Jackson claimed that he suggested to Dr. Morton the use of ether, and that, therefore, he was entitled to the credit of the discovery, to Dr. Morton rightly belongs the honor of having carried anesthesia for surgical operations into practical operation. Other claimants soon arose to the honor of having made the important discovery.

The discovery of anesthesia conveyed a priceless boon to mankind. Through the use of anesthetics wonders have been wrought. Not only are the pains of the patients minimized and the evil effects of its dread banished, but the operator is no longer obliged to hasten his work unduly. He is enabled, unhindered by the sufferings and struggles of those under the knife, to proceed slowly and cautiously with minute attention to detail. All of which renders possible the performance of operations which could not have been performed in the old days and in the old ways.

In 1839, the surgeon, Velpeau, wrote: "The escape from pain in surgical operations is a chimera which it is idle to follow up to-day. Knife and pain in surgery are two words which are always inseparable in the minds of patients, and this necessary association must be conceded."

Yet, during the next few years, various discoveries revolutionized the practice of

surgery and banished the intense agony caused by the knife. From Boston, where the first experiments with ether were made, the use of the new anesthetic in connection with surgery spread to all parts of the world. Before the close of the year major operations were performed in London, and within a few weeks no serious operations were performed at the hospitals without ether.

Park, in his "Epitome of the History of Medicine," asserts that the name of "Anesthesia" was suggested by Dr. Oliver W. Holmes to Dr. Morton, so that the name as well as the discovery of anesthesia must be credited to the United States.

On November 10, 1846, a new anesthetic was introduced by Dr. (later Sir) James Y. Simpson, who experimenting on himself with various compounds, at the suggestion of Mr. Waldie, a chemist of Liverpool, tried chloroform, and on the 15th of November he published his success with chloroform.

Dr. Guthrie, of Sackett's Harbor, New York, was an original discoverer of chloroform, quite independently of the contemporaneous (1831) researches of Souberran, Liebig and Dumas-made at the same time, but unknown to Guthrie. The credit of the discovery of its virtues as an anesthetic, however, rightly belong to Simpson.

Chloroform rapidly replaced ether and for nearly twenty years it was almost the only anesthetic used in all the countries. The change would have been permanent had not further experiment shown that chloroform sometimes *causes sudden death. The increasing frequency of fatal accidents awakened attention and excited fear. After this many experiments were made by mixing the various anesthetics. Chloroform and ether in various proportions, chloroform, alcohol, and ether, and again ether alone were recommended and used by the leading surgeons of the world. At the present time both chloroform and ether are used as anesthetics. The purity of the chemicals and a better knowledge of giving them have diminished the danger somewhat. The practice of allowing a green student or a bystander to administer the anesthetic was

in the past responsible for the greater number of the fatal accidents attributed to either chloroform or ether. Students should be drilled in the use of anesthetics before they are allowed to administer them to patients about to be operated

upon.

New discoveries in anesthesia have been made during the last few years, but except as to local anesthesia, or, rather, analgesia, no noteworthy improvement can be recorded. Chloroform, ether and nitrous oxide (in dentistry) are the three drugs used as anesthetics at the present time. Each has its advocates, but whilst ether is the safest, chloroform is the most pleasant both for the patient and the operator. The following may be considered good rules:

1. Ether should be administered in acute hemorrhage, in shock, in general pulmonary emphysema, in fatty heart, endocarditis, syncope, and at night, unless an electric light is used.

2. Chloroform should be given in nephritis, in acute pulmonary affections, in the nervous and hysteric, and in obstetrics; also in operations where the cautery is to be used.

3. Nitrous oxide should be used in dentistry.

The discovery of hydrochlorate of cocaine, a salt of the active principle of erythoxylon coca, and its use as a local anesthetic, especially in eye-surgery, was made by some laryngologists of Vienna, and later Dr. Koller, of Vienna, put the remedy into good repute by his experiments and reports. It was soon taken up by the profession, who came to the conclusion that the drug really did fill a longfelt want. The chief use of cocaine is in diseases of the eye, and its great worth in operations on the eye as an anesthetic is universally recognized. Cocaine is also used hypodermically in minor surgery, but has been replaced almost entirely by the so-called Schleich's Infiltration Method, which consists of the hypodermic use of a mixture of cocaine, morphine, and the so-called normal salt solution, and which is injected in sufficient amount to produce the necessary degree of tension and local anemia.

The so-called spinal anesthesia, produced by means of the injection of cocaine

into the spinal canal in the lumbar region, is still in the experimental stage of de velopment, and it is very doubtful whether it is anything more than a chimerical idea.

There are other anesthetics and other modes of applying anesthetics, and there are a great number of apparatuses for the administration of the different anesthetics, but in a work of this kind it is possible only to give the principal facts concerning the history of the subject, which I have endeavored to do in as brief a way as is commensurate with the importance of anesthesia.

Abdominal Surgery.-Ever since the discovery of anesthetics and the establishment of the artiseptic treatment of wounds on a firm basis, surgeons of special repute for skill and learning have made the study of diseases of the abdomen and its contents a special practice or a speciality; and this calling they have been pleased to determine as abdominal surgery. And wonderful, indeed, have been the achievements of these specialists. Special modes of preparing the patient, the field of operation, the assistants, the surroundings, and the after-treatment, and the special skill gained by special study of the anatomy and pathology of the abdomen and its contents, has enabled these surgeons to become especially successful in operating on and curing their patients.

The operations upon the appendix vermiformis and its surroundings, merit special mention, as it is an operation entirely of modern origin. To Dr. T. G. Morton, of Philadelphia, belongs the credit of performing the first operation for the removal of the appendix, after having made the diagnosis of a probably diseased appendix. To McBurney, of New York; Treves, of London, and others, should be awarded the honor of perfecting the most useful operation of appendectomy, bringing it in its various forms to the highest state of perfection.

But this is not all. There is probably no organ within the cavity of the abdomen that is not very carefully and skillfully operated upon to-day by these surgeons. The liver, the gall-bladder, the kidneys, the spleen, the intestines, the