results. With our Homoeopathic remedies and proper hygienic surroundings, every effort should be made to protect children from tuberculous parents or near relatives, who are puny and delicate or who show any constitutional or so-called scrofulous tendencies, from tubercular meningitis, by placing them in the best possible hygienic conditions. They should have pure, dry air, wholesome, nourishing food, outdoor exercise; prohibit all mental development; if in school, order them out; avoid all fatigue of mind or excitement; sleeping-room well ventilated, and regular tepid baths should be given, followed by friction with towel wrung out of strong salt water. Change of climate is of the greatest importance.

Remedies: Calcarea carb., Calcarea phos., Calcarea sulph. and Kali carb. are the principal remedies for constitutional treatment. Calcarea phos. is one of the best and should be followed for weeks. Calc. carb. for characteristic Calcarea patient, fat and slow.

If glandular enlargement, Calc. iod, should be substituted with an occasional dose of sulphur.

Bell. for the fever and headache will be beneficial. If symptoms of effusion, bryonia should be given, followed by Apis. After effusion, Helleborus niger will do efficient work, and do much to relieve the suffering.

Dr. J. Compton Burnett, in his work on tuberculosis, reports many cases of genuine tubercular meningitis cured with his tuberculinum in the 30th and 200th potency. I have used it myself with apparent wonderful success; still, I am not yet prepared to indorse all that is claimed for it. I am sure it has a place, and is entitled to honest and faithful consideration in treating tuberculosis.

Dr. T. F. Allen emphasizes the power of Kali carb. in tuberculosis. Kali carb. patient, like Calc. carb., may be fat, flabby and exhausted, but is always anæmic. Chilly, never has fever, and worse from exposure, especially damp air. This is a powerful constitutional remedy in the early stage of tubercular meningitis, and should not be forgotten.

DISCUSSION.

WILLIAM BOERICKE, M.D.: The reading of the splendid paper by Dr. Gale brings to my mind a feeling of humility, and I am sorry to say that I have not cured a case of the kind indicated. There are two symptoms that I have learned to fear in the very be

ginning weeks before the child is actually taken down, and I have learned to depend upon them very much and to fear them. It is the combination of the drowsiness and the peculiar vacant, far off look.

GENEVIEVE TUCKER, M.D.: This paper is of peculiar interest to me, because of the disease. As you may know the death-rate among children in the high altitudes of our Rocky Mountains is very great. A large per cent. of this mortality is due to some form of meningitis, basilar meningitis taking the lead. How many of these cases are of a tuberculous type it is hard to say. I wish to emphasize one point in the paper and that is the one relative to the training of precocious children. A precocious child is a deformed child. Over development is just as much of a deformity as arrested development. Such a deformity is more pleasing and gratifying and not as repulsive as one of arrested development, nevertheless we must regard the precocious child as a deformed one. There is another point in the paper I would take with a question mark after it, and that is whether this form of tuberculosis, viz., tubercular meningitis is ever developed from infection? I am of the opinion a case caused by infection would attack the lungs rather than the meninges of the brain.

BENJAMIN F. BAILEY, M.D.: There are certain symptoms in tubercular meningitis that are unmistakable, particularly the far away look. I have had parents speak of their children as seeming to be thinking. In the East I have learned to fear that look, and Ĩ found it in all of those cases that developed tubercular meningitis. As to the curing of tubercular meningitis, I fear that we have some reason to doubt the correctness of the diagnosis in cases reported cured. I have in mind a case of a child, a patient of my own, that was attacked with whooping cough, and it went from that to tubercular meningitis. After using Zine the child made a perfect recovery. I do not believe it was tubercular meningitis, although we all diagnosed it as such. Another case which I have in mind was a case I had this last winter, and I presume in all my lifetime I will never see such a case again. I was called to see a child. As I got into the buggy I asked about the case. The child was the daughter of Dr. Hackett. He had three children, a single child and twins. The wife and three children had been to New York City visiting. They returned and shortly after one of the twins began to show symptoms of tubercular meningitis, and it went on until the child died. I was called in to see the second of the twins. It became ill a little while before the first died, showing all the signs of tubercular meningitis. Both the father and another doctor diagnosed the case as tubercular meningitis and when I saw the child it took me but a short time to diagnose it the same way. It was then in the last stage and the child died. That was in December. In February, Dr. Hackett wanted me to come over and see his wife. I found her with marked tubercular affections. It was a sad case. I do not believe a man

lives who can go into such a family as that without feeling that it is very hard to come away without tears. I said to him: "Doctor, for years I have been giving Phos., Kali carb., Sulphur, Arsen. and other remedies that are indicated, but the patients all die, and if it was my wife I would feel that it was time to use something that had never been tried. Suppose we try Bacillinum?" He did so and since that time she has been on one dose a week, and I think she will recover.

DR. GALE: I consider that the only time that doctors or treatment or anything else will do these cases any good is in the very first. stages. I regard this peevishness as one of the most indisputable symptoms. I tell you, ladies and gentlemen, that au early start means a good deal if you have got a patient that has any inherited tendencies, and that is the time to do the work, and I think I can say, with good reason, that these cases, a good many of them, if they are not attended to, will go on to tubercular meningitis. That may not be curing tubercular meningitis, but it is preventing it; that is, taking notice of it in the very early stages.

I find in looking up this disease that we have very little to aid us in prescribing for it. You cannot find more than half a dozen remedies mentioned; there are some indications given, of coursebut the clinical results have all been so unsatisfactory that there is very little that we can tie to in treating the disease. The information about the treatment that Dr. Allen gave us yesterday morning is of the greatest importance. I believe the disease to be infectious.

BARLOW'S DISEASE.

BY MARTIN DESCHERE, M.D., NEW YORK, N. Y.

FROM time to time the attention of pædologists has been drawn to a peculiar condition in children which it seemed difficult to classify under the head of any positive pathological state. Some describe it as an acute rachitis, others as scurvy, and, again, it has been thought to be a combination of purpura with rachitis.

Dr. Thomas Barlow, of London, England, gave the first positive anatomical description of this affection. This can be found in the London Medico-Chirurgical Transactions, 1883, Second Series, vol. xvi. Barlow considers it a combination of scurvy and rachitis modified by infantile peculiarities. German authorities proposed the name of Barlow's Disease for this reason, until a larger number of observations will have determined the actual condition. They thus add another complication to medical nomenclature by a forced method of differentiation. Under Barlow's Disease, according to Prof. Heubner, and lately Prof. F. A. Hoffman, we understand an affection during the first two years of life, characterized by exceedingly painful swelling in various bony regions, with symptoms of rachitis. Anatomically, the swellings are caused by hæmorrhages underneath the periosteum.

Post-mortem finds hæmorrhages under the periosteum of various bones, also between the muscular and serous sacs; besides this, evidence of partly active, partly repaired rachitis can be seen in the cartilages and bones. Hypostatic foci are frequently found in the lungs.

This form of disease occurs, as a rule, under two years of agemost frequently between the sixth and eighteenth months of life, and is found rather frequently among the wealthier classes. The cases vary from subacute to chronic ones. Light cases have recovered after a week's duration, others have lasted for months. Some children have succumbed after a gradual and steady decline. The

symptomatology runs about as follows: You are called to a child between ten and twenty months of age who had been apparently well for some time, but who had lately developed great peevishness, caused by a most extreme sensitiveness to touch, especially of the extremities. The mother will state that she hardly dares to change the child's diapers, much less to bathe it, as the poor sufferer gets into a most pitiful crying spell as soon as the limbs are taken hold of, and it cannot be pacified for some time after. The sensitive parts appear somewhat swollen, the child shuns motion, and while it used to move its arms and legs most briskly-even making attempts at walking-it now remains very quiet in one position, and the lower limbs appear as if paralyzed. There is evidently spontaneous pain; for during the night the child will often cry for hours, and thus gradually become entirely sleepless. Fever of a fluctuating character has always been present in the cases which I have treated, and a profuse perspiration appears, mostly on the head. Appetite is lost, and the food most favored formerly will now be refused. On inquiry, you will learn that farinaceous or malted milk preparations have been the sole nourishment since birth, or that mother's milk has been supplied but for a short time. Attacks of indigestion have not been rare, still the child seemed to thrive. On examination, we find the above-mentioned extreme tenderness on the slightest touch, as well as on any attempt to move the patient. When lifting him ever so carefully, he will cry in a most deplorable manner, and will not pacify himself until quietly resting again. The child may even appear well nourished and plump, but the skin is very pale, rather waxy. The cranium, as well as the thorax, show more or less signs of well-advanced rachitis.

On closer examination, it will be observed that the knee- and ankle-joints are not so very tender; but palpating the shafts of the femur or the tibia, the tenderness becomes marked. These parts also appear swollen. The subcutaneous connective-tissue may participate in the swelling, and the skin covering these parts looks shiny. In cases where the infiltration of the cellular tissue is not very prominent a cylindrical swelling of the femur, as well as a diffuse swelling of the tibia, can be felt through the soft parts. Palpation must be gone through with with the utmost care and gentleness, as pressure is a torture to the child. The bones of the arms and those of the cranium may also show swellings, but the sensitiveness in these parts is less intense than in the lower extremities.