much satisfaction to know that their thorough application has so often been the balm that has abated the paroxysms of the sufferer and hastened recovery. But here, as with the well, there must be thoroughness, and an unyielding enforcement of the measures, which, owing to environment, quite often find unconquerable obstacles and frequent defeat. Nevertheless, pertussis being generally considered a germ disease, and as disease germs thrive best in filth and darkness, the conditions opposing their energy and prosperity should be rigidly applied, so that, as far as possible, the cause of the disease may be destroyed or rendered inert. This disease being of microbic origin, highly contagious, and destructive far beyond the knowledge of all except the profession, puts us under bonds to the public to do all in our power for its prevention. and amelioration, and makes it incumbent upon us to bestir ourselves to greater activity for the establishment of the methods we unanimously approve, and by our better information know to be needful.

As to those who nurse the sick, it seems decidedly legitimate that they should make use of extraordinary means of sanitation, avail themselves of all the helps cited, avoiding as far as possible contact with the diseased, and the inhalation of their breath, and be diligent in the purification of their surroundings in every particular-whether sleeping or waking in their person, their sleeping apartment and in their food, and thus secure the very highest promise of safety. It being a conceded fact that the germs of this disease are carried in clothing and other articles which have been exposed, it seems legitimate to conclude that, for the safety of the public at large, exposure to such articles should be rigidly avoided, and that those who have been exposed should not mingle with other people until after complete purification, and a sufficient lapse of time to prove themselves not a vehicle of communication; carelessness in this regard being no doubt

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the frequent cause of the wide-spreading of the disease, which by proper precautions might have been confined within much narrower limits.

With an eye single to the belief which I entertain, that by the proper use of the prophylactics already in use, rather than by the search for others, will the speedy reaching of the desired abatement of this disease be accomplished, I have thus hurriedly glanced at them, with the view of discussing briefly the seat of responsibility as I see it, for the establishing of the methods necessary for the accomplishment of the work we see to be necessary for the relief of the suffering, the saving of life, and the abridgment of this disease which stands second. only to diphtheria in its ravages among the little ones, and in its unheralded war upon the lives of the innocents.

In all departments of education the unlearned must depend for their enlightenment on the superior information of others. The blind make poor leaders of the blind, and the badly learned are but poor helpers for their peers.

Those who have reached the highest point of education in any department are best calculated to impart useful information in that department, and unless they do, the ignorant must remain in helplessness, and in the darkness that environs them.

The medical profession is the best informed of any class as far as diseases, remedies and preventives are concerned; hence they are the legitimate instructors of those who through want of information are unable to help themselves, and must look to the physician in time of trouble. If, with regard to the disease now under consideration, the official authorities are lax or lack information, and the laity are ignorant, it reveals more fully the duty of the medical fraternity without whose aid there can be no comprehensive or successful guardianship of the public health, and their want of knowledge but binds more tightly upon us the chains of duty, to shirk which in the face of contagion would savor too much of cowardice or

selfishness to protect our professional honor, and keep unsullied the good name of our high and chosen calling. Conservators of the health of others by the force of our self-adopted profession, we have a right to the exercise of aggressiveness far beyond the privileges of others, and our duty seems but half done when we furnish, as best we can, relief for those who are sick; if we rest here and make no outcry against the neglect and ignorance of those who might, with our instruction, become the most powerful auxiliaries the profession could have in heading off this unmerciful slaughter of infants. If the lawmakers, executives and laity are lacking in information on this intricate subject it is not a thing to be wondered at, they having had no proper instruction nor time for the reading of text books in the midst of life's cares and hurry. To awaken them from their slumbers is the high duty of our profession, by our unceasing diligence, a constant outcry, and warnings repeated to the seventieth times seven, until the constant din shall rouse them to a sense of their duty and push them forward to the execution of the long neglected work which would long since have robbed old death of thousands of his tender victims had our profession been less modest in its efforts to scourge them on to the performances of public duty.

The enlightenment of those whose aid we most need depends on ourselves. Our only hope is in throwing aside what remains of our own indifference, boldly and untiringly demanding help in the shape of proper refuge and sanitary enforcement, claiming for ourselves the right of dictation and adjustment of methods, and the instruction of those whose ignorance has been the greatest obstacle to our efforts of relief.

To have a large and lucrative practice is, beyond doubt, very desirable to us all, but the higher and nobler desire to relieve suffering should inspire our movements, and no higher honor can befall us as physicians than a well-earned reputation for

earnestness, diligence, sagacity and success in relieving our fellow men of the pains and dangers of disease. In the disease under discussion, seeing as we so clearly do the greatest obstacles to our success, it should give us an intensity of desire and determination to hasten the removal of all hindrances as speedily as possible, by letting our light shine upon others, and by united, harmonious effort to bring into activity the sleeping elements which, though obstructions now, may, by our efforts, become fellow workers with us in this long neglected labor of love in the field of public and professional duty.

THE PROPHYLACTIC TREATMENT OF COUGH IN INFANTS AND YOUNG CHILDREN.

BY T. H. HAY, M. D., OF MILWAUKEE.

The symptomatic value of cough is, I believe, fully realized by the profession, and a knowledge of its production is of great clinical value, without which proper and successful treatment can not be carried out.

Cough may be the result of a great variety of morbid conditions of the respiratory apparatus, but it is of cough as we most frequently meet it in children, the result of primary conditions in the nasal cavities, and its treatment, that I especially desire to speak. Careful observation, I am convinced, will demonstrate that at least ninety per cent. (90%) of the coughs of children are primarily due to acute nasal catarrh, or secondarily to extension to surrounding tissues. Pharyngitis, enlarged tonsils, bronchitis of the larger bronchi, and laryngismus stridulus may all be direct producers of cough in children, but it is my observation and belief that the vast majority of these conditions are due to extension by infection from a primary catarrh of the nasal cavities. This statement does not apply to constitutional or specific conditions.

There may be no discharge from the anterior nares at the time we see the case, but inquiry will develop the fact that, perhaps two or three weeks before, the child had a "cold in the head" with discharge which ceased, soon after being followed by the cough. A few months ago I saw a case, the report of which may illustrate: Child three and one-half years old; asleep at time of visit, restless, respiration hurried; temperature 101.50; cough occasionally disturbing sleep; on auscultation coarse mucous rales were to be heard. The trouble was evidently in the large bronchi. On questioning the