treatment. If these cases were not typhoid fever what were they?

I had a case, in another family, that presented very similar symptoms, as in fact all the cases I called typhoid did. I was called at the end of the first week in bed, and prescribed the same remedies. The fever gradually declined, but the patient died from hemorrhage of the bowels on the sixth day of treatment. This is the only case of typhoid fever I have lost in five years. He was allowed to bleed to death before I was called in. I had two cases in another family, a father and a mother, while their four children, from eight to twenty years old, all remained perfectly well, tho living in the same house, drinking of the same water and nursing the sick.

In each of the ten families it was impossible to find that there had ever been a case of typhoid fever on the premises. How then could the water become contaminated with typhoid fever germs, and why did the children, naturally more susceptible to the disease, not have it?

It is but fair, however, to state that the mother had sat up for a few nights with a young lady who had the disease. But that does not account for the father having it at the same time.

In five days after the commencement of treatment, the mother's temperature was normal, and all the other symptoms indicated a speedy convalescence. She had a relapse, however, attributed to injudicious diet, and was sick for two weeks longer, presenting all the symptoms of a case of mild typhoid fever.

The father, who had never been sick in his life, would not consent to take treatment until the temperature reached 104° with a bursting headache. He was convalescent on the twelfth day of treatment.

M. L. had been treated by his father for "biliousness" a week or more before I was called. Diagnosed typhoid fever; temperature 105.6°. On twelfth day of treatment patient was convalescent and rapidly recovered. This patient had worked all summer on a ranch where the well was less than one year old and where there had never been any disease. This man's older brother presented all the prodromal symptoms of "biliousness," took the treatment, laid about the house for a week, and went to work again in the harvest field.

I had, however, a case of typhoid fever that lasted about as long as that fever usually does when treated by physicians

who do not believe that typhoid can be aborted.

Lorna H., aged seven years, a very delicate child, had been sick two weeks, and had, since taken sick, traveled 150 miles in a prairie schooner. Pulse, 135; temperature, 105.5°; other symptoms in proportion.

After the commencement of treatment, the temperature varied from 103° to 104° for several days, and very gradually fell to the normal on the seventeenth day of treatment. Five days afterward a relapse occurred and patient had fever for ten days more. Altho the emaciation was extreme, the prostration was not proportionate. There was scarcely a day that the child did not have her doll and other playthings on the bed to play with.

While treating this girl, her brother, seventeen years old, presented symptoms that I could not differentiate from the prodromal symptoms of typhoid fever. Temperature, 102°; took the treatment; continued work except for two or three days and got well.

It is true I do not know, positively, that these prodromal cases would, if left to themselves, have developed into typhoid fever, but I have this to say: I have never known one of these cases neglected that did not further on present well-marked typhoid symptoms.

Again, at the very time I was treating the five cases in one family, another physician, of large experience, who does not believe that this disease can be aborted, was treating three cases in another family not more than three miles away. He lost one patient after a protracted illness, and the others were sick long after mine were convalescent. There were quite a large number of deaths reported from typhoid fever in this county last year.

The Woodbridge treatment for typhoid fever is the only treatment for which greater success is claimed than I have had with this treatment. But in estimating the value of any treatment in any disease, the virulence and mortality of the disease under the established methods of treatment, in the localities in which the new treatment is tested, must be given due consideration.

While the United States census maps for 1890, showing the number of deaths from various causes, in different localities, for each 1,000 deaths from known causes, is not altogether conclusive, they may, I think, be fairly taken for an average. Ac

cording to this map, page 278, part I, Vital Statistics, there was before the inauguration of the Woodbridge treatment, in the region in which it has been most extensively tried, but thirty deaths from this disease per 1,000 deaths from known causes, while in this State there were sixtyfive or over.

If typhoid fever cannot be aborted, what would you call those cases that were so evidently aborted? J. W. LOCKHART.

St. John, Wash.

Typhoid Fever in Western Pennsylvania. Editor MEDICAL WORLD:-According to the sixth and seventh books of Moses, this year the sun is the governing star. The nature of the sun is hot and temperate. Haussmann says: That typhoid fever will be found when the movement of the ground water is very slow, or there is a dry season. Of course we had plenty of rain here, but it seems it had no beneficial effect, as the rain fell on a very dry ground and did not penetrate the soil.

I use for all kinds of fever my febrifuge, which in the main is composed of aconite, leptandra, cinchona and calcium sulphid. I break any kind of fever in two hours with that remedy.

same treatment and give a pint of whisky in twenty-four hours, at short intervals, half an ounce at a time, well diluted, till the pulse drops below 120 per minute.

If the eyes are injected and delirium appears early, pour sufficient cold water over head. If the head symptoms have been present several days, use the same treatment and apply a blister to the back of the head. Wrap in cold sheet or put patient in tub of cold water, if preferable, occasionally. If the diagnosis is uncertain, use the same treatment.

The foregoing outline is absolute on general principles. No question; no guess work; po doubt. It is absolute and certain.

I applied my cancer cure (mercury and arsenic) a month ago to a cancer of the end of the nose-one of these raw strawberry cancers, the size of the end of the finger. I applied just enough of the powder to cover it. I thought it would leave a disfigured face. In two weeks the diseased parts slufft off and the nose is as natural and sound to-day as anybody's. Clayton, Ill. H. J. PARKER, M.D.

Treatment of Typhoid Fever.

Editor MEDICAL WORLD :-I have treated lately quite a number of typical typhoid fever cases successfully in the following

manner:

As soon as I have seen the patient the first time and had reason to suspect typhoid fever, I prescribed calomel gr. i every hour until the bowels moved two or three times, then discontinued the calomel. I also prescribe:

B Salol

Zinci sulfo carbolatis āā.gr. xxxvj
M. et ft.. capsul. No. xii.

Sig. One every four hours.

At the second visit the patient usually feels much better. I order to continue the salol and sulfocarbolate of zinc and for that day two or three compound cathartic pills to be given at once or one every hour; also 10 drops of diluted muriatic acid. On the succeeding days I follow the same line of treatment, changing only the cathartics, coming back on every third or fourth day to the calomel, which seems to work best. If the temperature is above 103° F., I order cold sponging-not with very cold water, but with water of a medium degree.

Milk, carbonated water and an occasional stimulant were given from the beginning until convalescence was fairly

established. One case I especially want to make note of was that of a girl, 14 years old, whom I found with a very bad brown tongue, a temperature of over 104° F., with a good deal of delirium the night before I was called. With the above outlined treatment the tongue cleared the next day, the temperature during the day never got above 102° F. and delirium and restlessness were hardly noticeable afterwards. I had a good deal of trouble with bronchial complications, which were very severe, but otherwise she got along very well and entered the stage of convalescence on the sixteenth day of her illness, not counting the prodrome.

The best part of the treatment, I think, was the repetition of the cathartics every day; for if for any reason it was omitted, delirium and restlessness followed.

This treatment is simple and effective. The cases in which I found the above treatment work so good were all typical cases of typhoid fever, with all or most of the symptoms present.

I do not claim originality for this mode. of treatment, for the whole profession of late has adopted similar lines, some using salol, some sulfo-carbolate of zinc, others again guaiacol, the favorite intestinal antiseptic. I only write this as a matter of discussion, to show that cathartics in typhoid fever are more important than the intestinal antiseptics as against the old teachings not to give cathartics for fear of perforation of the intestine.

Since I adopted this treatment tympanites was hardly perceptible in any of the cases I treated. Of course, there are very severe cases of typhoid fever which resist every effort on the part of the physician, but we have to remember that there are also very severe cases of malaria which resist every treatment. I cannot boast of limitless experience. I am just giving my limited experience and observation. M. FRIEDLANDER, M. D.

McKeesport, Pa.

hemorrhage from the bowels, in which the fever was 104° the first time I saw the patient, and she had been sick but a few days. In this patient there was distressing nausea and vomiting of biliary matter and constant complaint of uneasiness, burning and anxiety about the stomach. There was extreme restlessness, jactitation, aching of the limbs and pain in the back. There was no diarrhea; rose-colored spots were absent, very little tympanites or other indications of enteric fever. The fatal hemorrhage occurred about the tenth day, when all the symptoms of the aggravated attack had very much improved and temperature was declining.

You say you do not publish communications upon pneumonia in the heat of summer and yet you tell us the old idea of its being due to taking cold is exploded. If it is due to a germ, why is this bacillus more active in winter than in warm weather? I have seen and treated pneumonia in this latitude in July. Success to THE WORLD. Arcadia, La. J. ATKINSON, M. D. [The subject of pneumonia will be taken up later.-ED.]

from

I also give tincture bryonia when indicated. The above prescription has never failed me, tho I have never used it in a malarious district. It is seldom that the prescription has to be renewed, but while the patient remains in the infected district he may have to take several boxes of the remedy in order to eliminate the poison entirely. I have always noticed that

thin

Formaldehyd in Typhoid Fever. Editor MEDICAL WORLD:-I cannot let the opportunity offered pass without calling the attention of the readers of THE WORLD to the efficacy of formaldehyd in the treatment of typhoid fever. It is one of our best intestinal antiseptics and will destroy the typhoid bacillus in every case if properly used. It will cut short the duration of our typhoid fever from three months to a week or ten days and at longest not over three weeks. You can give one drop of a 40 per cent. solution of formaldehyd in a teaspoonful of elixir lactopeptine. If your case is severe you can add to this, the sulfo-carbolates, strychnia elixir and many other drugs that it will be necessary to give in this disease.

If I get a case of typhoid early and the tongue has a white coat on it I alternate with this every two hours a grain of aconitia, continuing this treatment for several days, or as long as the coat on the tongue is white. If the tongue is brown coated or has any other coat than white on it, I give instead of the aconitia grain of calomel in the same way as aconitia. I also give my patients every three or four hours one teaspoonful of an elixir kola composition. This has a quieting effect on nervous system.

While you are giving this medicine by the mouth you should not neglect the large intestines. Empty them with an enema of soap and water or glycerin and water. Then when they have quieted down inject into the bowels a gallon (if possible) of the following solution: Formaldehyd (40 per cent. solution), gtts. x; sodium chlorid, 3 ij; water, the temperature of which is slightly lower than body if fever is high (say 3 or 4 degrees); if fever is not very high, use water about the temperature of the body. Make one gallon of the above, all of which should be forced into the bowels by means of a fountain syringe, hung or held four feet above body. If this gives too great a pressure lower it, or if not enough raise it.

If the treatment I have outlined is followed out intelligently, you will be surprised to note how quickly the fever will drop and stay down. The injections, that is, large ones should be given at least once

a day, and in bad cases oftener. By this means you will have no diarrhea, no constipation, no hemorrhage, but a perfectly clean gut, the small ones being treated from above, the large ones from below.

Don't expect this treatment will bring the dead to life. You may poison yourself and if I can pump the poison out of you before it has been absorbed into the system your life will be saved, but a time comes when your whole system becomes impregnated with the poison and all our efforts to save your life are futile: so with typhoid, you may be poisoned to death even after all bacilli are destroyed. Taking typhoid in its incipiency, with this treatment you will check every case if you use it correctly. Doniphan, Neb. T. H. LINE, M. D.

Duodenal Ulcer.

Editor MEDICAL WORLD:-In recent literature, while many pages are devoted to gastric ulcer, duodenal ulcer is generally dismissed with a few paragraphs. This may be in part be accounted for by the fact that the pathology of the two is identical, and the symptoms and treatment much the same. Yet the difference in prognosis is such that a differential diagnosis is desirable. All authors agree that the risk to life is much greater in duodenal ulcer, since there is less tendency to cicatrization.

The cause commonly assigned for an ulcer in either locality is a loss of vitality of the spot, from the occlusion of a nutrient vessel followed by its destruction by the acid gastric juice. Accepting this theory, one would expect duodenal ulcers to be located between the pylorus and the opening of the bile and pancreatic ducts, and this we find to be almost the universal rule.

DaCosta says: "These ulcers are due to embolic plugging, or to amyloid degeneration of fine vessels, the acid gastric juice acting destructively on the weakened tissue.' ." Wilson says: "They are a manifestation of a neurosis. The digestion of sharply-defined portions of the gastric walls arises from interrupted circulation in the diseased part following vasomotor spasm." Saunders' Year Book for 1896, page 943, quoting from Kelynack, says that since 1867 only ten cases of primary duodenal ulcers are reported, of which six died from perforation and four from hemorrhage. All were males. Same volume, page 944, quoting from Perry and Shaw, reports 70 duodenal ulcers open and

healed in 17,652 autopsies. Of these, 52 were males and 18 females.

Nearly all authors note the fact that duodenal ulcers may occur after extensive burns on any part of the body. Adhesions of the duodenum to the pancreas is a common result of ulceration. A large proportion of gastric ulcers occur in young chlorotic females, while duodenal ulcers are in the proportion of 10 to 1 more numerous in men than women. In view of the fact that the pathology of the two are identical, this ratio is inexplicable.

Anders gives the following comparative symptomatic table:

The fact that gastric and duodenal ulcers may both be present in the same case, renders a differential diagnosis at times impossible. Yet ordinarily, by carefully watching the case, one can, with reasonable certainty, diagnose a duodenal ulcer.

The following case recently came under my care:

G. B. S., male, married, printer, aged 38; height, 5 feet 8 inches; weight, 215 pounds.

For past twenty-five years patient has had once in five or six months attacks of indigestion with vomiting, extreme acidity and severe, often excruciating pain in the epigastric region. These attacks lasted from two to ten days. He sometimes called a physician, but for past few years commonly managed them alone with soda, pepsin and opiates.

Between the attacks any marked indiscretion in diet would produce acidity and perhaps vomiting.

During the past year and a half he had escaped an attack, tho he was more often than usual compelled to resort to pepsin and antacids. His bowels moved habitually two or three times a day.

Aside from digestive trouble his health has always been good, and within the past ten years his weight has increased from 180 to 215 pounds.

April 2, 1898, I found him in bed with what he considered one of his usual attacks, which had already persisted four days with unusual severity. I noted following conditions:

Epigastric pain, constant dull burning, gnawing, with exacerbations that were unbearable. Pain centered beneath ensiform cartilage, extending to back and radiating to the right side. There was extreme tenderness over the right epigastrium. Moderate pressure gave some relief.

The tongue was pale, flabby and slightly coated; the stomach very acid, nausea was constant. Pain was not influenced by food, tho the nausea destroyed appetite, so but little food was taken. Pulse and temperature were slightly raised. The act of urinating was difficult and painful. The large amount of adipose tissue covering the abdomen interfered with a critical examination.

He was put on a liquid diet with remedies to relieve nausea, acidity and pain. During the next two weeks the nausea and vomiting ceased, to return occasionally for a few hours; the acidity was not so troublesome. No remedy but opium would control the pain. The epigastric tenderness would nearly disappear, to return after a severe exacerbation of pain. A slight jaundice occurred and disappeared. All this time he was able to get out of bed and walk around the room.

Diagnosis: Ulceration of duodenum,

That the ulceration was duodenal rather than gastric was rendered probable as the pain was not increased soon after eating, nor was there vomiting of blood. Opiates and liquid foods had caused constipation, which was relieved by effervescing salines.

About April 15 the stools became very dark, evidently from admixture of blood. The location of the ulcer in the duodenum was now, to my mind, rendered certain. During next ten days pulse and temperature became normal, the tongue clean, but very pale. Less opiates were required and the appetite improved, tho food was still restricted to liquids. The stools continue black.

April 24 patient was about the same but the pulse was rapid. April 25 he rose and went to adjoining room to use slop jar. A few moments later was found on the