Is There a Complication With La Grippe? A most interesting feature of the inquiry has been the developing of the fact that in a large number of the returned soldiers there have been present notable coryza, bone aching and other symptoms pointing strongly to the existence of la grippe either as a modified form of the disease with typhoid symptoms, or as an infection concurrent with typhoid fever. This is particularly the case with patients at the Presbyterian and at St. Joseph's Hospitals, or perhaps more attention has been. paid to this point at these two institutions. In many of these cases the coryza was exceedingly marked. At St. Joseph's the observation was made that where these concurrent puzzling symptoms existed, the Widal reaction was without exception positive, altho negative returns were had in other cases where it was absent, but the features of typhoid fever were more marked. At the Presbyterian Hospital attention had not been given to this point, as a positive reaction had been obtained in all cases submitted to the test. This seems a most interesting matter, and one with much bearing upon the scientific aspects of the bacteriology of these diseases. Further investigation should be made and in detail, with a view of determining all the elements entering into the agglutination. Future Consideration of Typhoid Treatment. The matter of the hospital treatment of typhoid fever with especial reference to our sick soldiers is far from complete, and will therefore be continued in our next issue. Certain cases showing an interesting concurrent infection of typhoid and malaria-the so-called typho-malaria-deserve more thought, and if possible these will be more fully considered. In addition the returns from some of our institutions are arriving too late for publication in this issue, while those which have already been reported will doubtless desire later returns. Besides this, some facts of general interest concerning the attitude of the hospitals have developed and may be touched upon. Our next issue, therefore, may contain something of especial value to you. ORIGINAL COMMUNICATIONS Short stories on the treatment of diseases and experience with new remedies are solicited from the profession for this department; also difficult cases for diagnosis and treat ment. Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors. Copy must be received on or before the twelfth of the month for publication in the next month. Unused manuscript cannot be returned. Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, G downright fact may be told in a plain way; and we want downright facts at present more than anything else.-RUSKIN. READ. REFLECT. COMPARE. Camp Fevers. RECORD, Editor MEDICAL WORLD:-The appalling mortality from typhoid fever in our armies renders two points clear: First, the laws of hygiene, as relating to the prevention of infectious disease, are not compremost difficult to make the observance of hyhended and obeyed by our troops. It is giene habitual, and unless this is done, it is not comprehended. People agree at once when we tell them they should dispose of the excreta in such a way that it cannot breed disease, should keep the drinking water undefiled, should beware of unripe fruits, impure air, etc., but they do not put these injunctions into practice. They are like children who can recite the catechism perfectly, yet who haven't the slightest idea of the meaning. The first lessons of the soldier should be upon the principles and practice of camp hygiene. We hear excellent accounts of the beneficial effects upon the results of wounds from the application by the soldiers of their lessons on "First Aid to the Injured." The camp of instruction precedes the battle-field. Bring together fifty thousand men, gathered from many cities. towns and farms, and some of these are sure to bring with them the germs of infectious disease. Even without these, the excreta of these men will breed disease if deposited without regard to rule. Young regiments invariably suffer from an epidemic of intestinal affections until they learn the necessity of going to the poles. But so utterly devoid of hygienic instruction are most men, that in laying out camps the latrines have actually been located above the source of the drinking water instead of below it! True, the surgeon may interpose his objections, but here is where the malevolent genius of medioc rity comes in. The mediocrity in command resents the suggestion as an interference with his functions, an encroach ment upon his prerogatives. He doesn't bother to conjure up some suppositious military necessity for adhering to the iniquitous plan, but flatly tells the surgeon to attend to his own business, which is to treat the sick. The surgeon, trained to obedience and accustomed to the restrictions of red tape, lets it go at that, satisfying his conscience with the reflection that the responsibility is off his shoulders. Many years ago, serving upon an unhealthy ship, the surgeon and engineer devised a scheme to remedy the conditions by running ventilators thru the captain's cabin to give the berth deck a free circulation of air. The. young officers were sharply reprimanded and suffered somewhat in standing as being innovators, or "busy bodies." I believe they subsided into routinists, who obeyed the instructions and made no effort beyond them. Here is mediocrity again. The really superior man would consider his duties first, and brave official displeasure to secure what was needed. If personal appeals fail, official protests can be made; if these are pigeon-holed, there are ways of reaching headquarters. Congressmen may be induced to listen; and back of all are the people, and they can be appealed to thru the press. Not that such a final appeal should be made needlessly; for an army must have discipline, and the surgeon is a mediocrity again if he does not consider this need in all he does. But when the conflict is unavoidable, even discipline must yield, for if it be not directed by intelligence, it is fatal to the army even in the military operations. I have felt it wise to write this on account of the terrible mortality in our armies from preventable causes. When the camp at Chickamauga was formed, we heard of the healthfulness of the site and the abundance and purity of the watersupply. Now it is a pest-hole; hundreds of our noble boys have died of typhoid and other fevers, the water is bad and the place infected. It is evident that this has been occasioned by the army itself, and it shows a complete failure of the camp hygiene. My second topic is inspired by a letter from a surgeon in the field. He says: "Modern methods in therapeutics seem to be utterly unknown. I have not found a single army surgeon who has ever heard of the sulfocarbolates as used in typhoid fever, and gastro-intestinal maladies generally. Yet in the treatment of such af fections in the camp I have found nothing to compare with them." Red-tape! Routine! The law of Egypt still holds good; if the doctor uses the regular treatment and the patient dies, well and good. If he tries some other remedy, he is responsible for the result. This sentiment carries far more weight in official practice than in private, for the surgeon's standing and emoluments do not depend upon his success. There is little incentive for him to branch out, apart from his instincts as a physician, if they be not choked by his environment. But it does seem hard that these men should die by hundreds because the surgeons will not read THE MEDICAL WORLD and learn to use the sulfocarbolates. During the year since I last wrote to THE WORLD of typhoid fever, I have been using the sulfocarbolates of lime and soda quite extensively. When the bowels are confined I use the soda, but for typhoid fever in an adult the dose should be two drams every 24 hours. In convalescence, I substitute calcium sulfocarbolate, in daily doses of about 90 grains; but in the beginning, until the bowels are aseptic and the worst of the attack is over, I trust only the zinc sulfocarbolate. The record is the same as last year-not a single death in typhoid fever, cholera infantum, dysentery or any other curable gastro-intestinal affection; or in tubercu losis. Queer, isn't it, that such good luck should, year after year, follow a bad method and inefficient remedies? On page 396, September WORLD, Dr. Wenz recommends burning camphor in a room to drive away mosquitoes. Camphor burns with the thickest, blackest, greasiest of smoke. Mix a dram of potassium nitrate with an ounce of good insect powder and burn it. The insects will get out in a hurry if the screens are left open. Dr. Counts (page 398) should have held an autopsy on his patient. Lacking this, we can but infer the condition. The antisepsis was imperfect, or an obstruction of the bowels occurred, with distention of the abdomen, hiccup from pressure on the diaphragm and fall of temperature from internal hemorrhage. The bowel should have been emptied by enema, the gas drawn off by a colon tube, the urine by catheter, and turpentine added to the antiseptics. Dr. Fields (page 399) has met one of those curious series of cases that make one think of epidemic influences. I have had such series of tonsillites, coryzas, felons, and, on one occasion, of abdominal pulsation. Pleurisy is hardly to be considered epidemic, but many cases may be due to atmospheric changes, possibly to electric conditions. I have just looked over your two pages of patent medicine formulas and five pages of prescriptions in one of my exchanges. How similar they are and what trash! After working with the clean, definite, certain alkaloids, with indications as precise and neatly fitting as the parts of a watch, it makes me tired to see men, who should know better, mix up ipecac, squills, paregoric and muriate of ammonia in one mess and expect benefit from it. A patient was asked wherein lay the special excellence of dosimetric medication. She responded: "The doctor, gives very little medicine, but what he does give goes right to the spot and helps you at once." WILLIAM F. WAUGH, M.D. 103 State Street, Chicago. Auto-Infection of Armies by Masses of Excretions, the Cause of the Great Sickness and Mortality in Our Army. Editor MEDICAL WORLD:-It is the custom to charge the alarming condition of our armies to incompetency of chiefs, from McKinley down through surgeons appointed because related to men in place. Allow the writer to show the real cause, the responsibility of which will rest on many shoulders. The urinary and fecal excretions average about two and one-half pounds per day to the man. The army of Santiago, about 25,000 men, would create 60,000 pounds of excretions per day, and 5,000 horses for cavalry, artillery and transportation will excrete 60,000 pounds more. Here we have sixty tons per day of animal refuse collecting around the camp, creating a thousand hot-beds for the typhoid bacillus, the very best garden for microbes, equalling those of plague-infected India. Thirty days' occupation around Santiago, with the opposing forces, will give vastly more than thirty times the amount allotted to our own army. The regiment on parade is a beautiful vision, the condition of the regiment in the rear of the camp is the acme of horrors, with General Filth as commander in charge with a vast and growing army of bacilli. I was myself astounded when I began to compute the mass of excretions belonging to a camp. The beautiful city of Philadelphia had a centennial in the elegant Fairmount Park. She constructed vast cisterns for drinking purposes, and huge wells for an improvised commode system. The world came and admired. The typhoid bacillus came and tarried with his army of occupation in those ideal bacillus palaces. From the vaults he went to cistern and restaurant, infecting tens of thousands, who went home with bacilli incubating in their systems, and in almost every village and city in the United States the visitor returned to have typhoid fever. It became so common that it was called centennial fever. After the war Memphis became a growing city, without a proper sewerage system. The yellow fever entered her closed vaults, attacked rich and poor, and a terrible epidemic resulted. A lady passing thru about that time, remarked that in a fine hotel every room smelled like a privy. Government had to step in and help the bankrupt city to provide a sewerage system for the removal of the human secretions, and it is now very healthy. The writer was in a prison hospital during the war. It was in the highest point of a stockade of sixteen acres. A bold creek running thru was used by the soldiers as a commode, and there was no fever. But between the hospital buildings shallow ditches were kept as receptacles for excretions, and these were regularly filled and swept over and new ones made. All seemed well, but in two months the typhoid bacillus made his home in these fecal hot-beds. A malignant epidemic appeared. The writer disliked to go out in the stockade and select a good man for a nurse, because he knew it to be so infectious. Seven out of eight medical men in the hospital contracted the disease. Had these excretions been removed some distance from the hospital and deeply buried, we should probably have escaped. Now these things are a part of history. The bacillus has come to stay. If some provisions are not made to deeply bury or disinfect these tons of excreta, the end is not yet. We may run our soldiers from Maine to Texas, but the bacillus will go on free transportation, and so long as these vast hot-beds are allowed to accumulate as culture beds for the cosmopolitan bacillus, General Filth will organize his army of microbes and attack the soldier with weapons more deadly than the Mauser rifle or the rapid-firing cannon. Now, must the general commanding or the medical official apply the remedy? So long as we were ignorant of the cause, we were excusable, but now some remedy must be applied. We take our volunteer from homes of cleanliness and place him where he must succumb to an army of microbes. It is a tradition that the Jew, in his long pilgrimage thru the wilderness, had to take his paddle with him and bury his own excretions without the camp. That paddle was an eminently hygienic weapon. Now, we have whipped the Spanish, and are fleeing from the bacilli which have fattened upon what we pro vided. I have Armies are more compacted than formerly. In the Mexican War, American valor and discipline conquered the Mexicans, but the camp filth killed, perhaps, ten times as many as Mexican bullets. Not only in the army, but in the country, sawdust piles, hot-beds for the bacillus typhoid, are killing thousands upon thousands. thousands. I have been investigating this subject, testing temperatures of fermenting vegetable matter by my thermometer and finding these great accretions of vegetable matter hotter than my garden hot-bed. I am sure that I state facts and that it is auto-infection from camp filth that has been destroying our armies. Laytonsville, Ky. J. D. O'BRIEN, M.D. Typhoid Fever and Malaria. Editor MEDICAL WORLD:-Typhoid fever is a microbic disease, the local manifestation of which is in the glands of the intestine. These glands are first congested or engorged; later we have extravasation and breaking-down of the gland tissue or ulceration. Thus we have symptoms produced by the specific intoxication and also from the absorption and pus as a result of ulceration. All of the sequelæ as bronchitis, myocarditis, parotid abscess, neuritis and the various degenerations that may take place in the nerve centers and vital organs are due to the ptomains and purulent absorption. The point in treatment then is to sterilize the seat of the disease, and to try to obtain revolution in the glands that are already swollen as a result of infection, and also to prevent reinfection. Treatment: Give no purgatives in typhoid fever. They act as an irritant to the already inflamed glands and tend to promote ulceration, the very thing we are Sig. One tablespoonful every three hours. At night, on the same hours as the above solution, I give four capsules of quinin, two grains to the capsule, and one capsule every three hours. For hyperpyrexia use cold water by the sponge and the wet pack. Diet is of prime importance. I make out a bill of fare for my typhoid cases as follows, and see that they adhere to it till ten days after they are free from fever. The bill of fare is this: Sweet milk, butter milk and chicken broth, and nothing else. This course of diet will not hurt them and is nutritious enough. I have seen bad diarrheas produced by beef soup and potato soup, so I have discarded all other food except the three above mentioned. For sleep, if necessary, give Dover's powder. Change bedding often, and see that they have good, pure drinking water. Flush the rectum and colon every other day, if bowels do not move freely of their own accord. Malarial fever: If the temperature is high and the patient is aching and the skin dry, I give a dose of pilocarpin. In fifteen minutes they are in a profuse sweat, which lasts about one hour. During this time they generally vomit two or three times, usually an immense quantity of bile. After this I begin with quinin, in three grain doses, every three hours, until cinchonism is produced. The next day I give fifteen grains of quinin, divided in five doses, and three hours apart; the next, twelve grains, and the next, nine grains, and continue nine grains daily till patient is thoroly convalescent. With the quinin, only continuously during twentyfour hours, I give potassium nitrate, four grains in one-half ounce of water every three hours. J. T. ANDERSON, M. D. Cornelia, Mo. Dr. Waugh's book on Treatment and THE WORLD until 1900 for $5. WORLD for 1899 and balance of 1898 for $1. Can Typhoid Fever be Aborted? The courage that clears away From the diamond cold and grey, About one year ago I wrote an article for THE MEDICAL WORLD in which I endeavored to explain why I could not accept the popular idea regarding the etiology of typhoid fever. My experience with that disease last year seems to confirm the opinions advanced in that article. Typhoid fever is not a germ disease, but originates from poisons generated within the system. It is an auto-infection. In this region, put down in the United States census maps as having a larger death rate from typhoid fever, viz.: 65 per 1,000 of deaths from known causes, than any other region in the United States, the disease does not occur epidemically or endemically, but is invariably sporadic. Last year I treated fifteen cases of typhoid fever, not including a number of .cases that presented well-marked prodromal symptoms, but were never sick enough to remain in bed more than a day or two. Five of the worst cases occurred in one family, two in another and one in each of eight families. All of the families lived on ranches. There were ten persons in the family in which the five cases occurred, these ranging in age from ten to forty-eight years. They received their supply of drinking water thru an iron pipe from a good spring about forty rods from the house. It would be hard to get a better or purer supply of water. The spring was out of reach of any possible contamination from the house or barn. He The first to take the fever, in this family, was a young man 21 years of age. had been in bed four days before I saw him and said he had not felt exactly well for two or three weeks. This proved to be a well-marked case of typhoid fever. During the first seven days of treatment the temperature ranged from 102° to 105.5°. There was right iliac tenderness, gurgling under pressure, stupor, delirium and tympanites. After the first week of treatment the temperature gradually declined to normal; on the sixteenth day of treatment or twenty days after the patient went to bed. While attending this patient my attention was called to a boy 14 years of age. He had not been feeling well for a week Ft. chart, No. xij. Sig. Take one powder every two hours when the temperature is above 103°. Also, cold sponge bath whenever the temperature rises above 103°. Under this treatment the fever gradually declined to the normal on the twelfth day of treatment. In this case as in all the others the fever showed the regular morning remissions and evening exacerbations. It was difficult to persuade this boy to remain in bed during the remissions. The third case in this family was the father, aged 48 years. He had not been feeling very well for six months, but did not know whether he was exactly sick or not. Said every evening for a week or more he had felt weak and chilly, had headache and poor appetite. There was right iliac tenderness, temperature 103.6°. Treatment same as above. Temperature declined to normal on the ninth day of treatment. This patient was about the house every morning and went to bed every afternoon. In about two weeks after I had dismissed these cases two more of this family who had slept in the barn, took their meals in the house and lived in the harvest field while the others were sick presented similar symptoms, but in severity about midway between the first and second cases. Both these, as did the first, developed tympanites during the course of the fever. Both received the treatment above outlined and had normal temperatures on the tenth and twelfth days respectively of |