the test and record the result. If the active practicians of this country were to do this, confirming, rejecting, adding to and particularizing these suggestions, we should soon see that era of accurate, practical therapeusis coming into existence that we all desire."

Eclectics have done just this for the past fifty years. The result is on record and we can gain much valuable information by studying the record. But don't forget to remember that active workers like Dr. Waugh are also adding to our fund of knowledge. What I urge is a study of direct medication and the acquirement of practical knowledge from every source. Ewing, Neb. O. C. MASTIN, M. D.

Pneumonia in Louisiana. Editor MEDICAL WORLD:-Louisiana, I imagine, is with the Northerner a synonym for swamps, bayous, alligators, moccasins and the long moss, superstitiously known as the curtains of death," hanging from the trees. But there are portions of our State which are as high, dry and broken as any part of the Union, and as free from malaria. Such are the northern parishes of Claiborne, Jackson, Bassior, Lincoln and Bienville. While there is a great deal of pneumonia in the alluvial districts, in the hill country there is very little, physicians often passing an entire winter without encountering perhaps a single case. The past season, however, has been an exception to the rule. [This article was written last May, but held over until now, according to our rule.-ED.] Arcadia has only a population of about 1200, with a half-dozen doctors, and, altho I do not do much country practice, I have had as many, perhaps, as a dozen cases of pneu

monia.

I must confess that I am wholly at a loss to account for this deviation from the usual history of our locality, as to the frequency of pneumonia. We had an uncommonly mild winter, as a whole, and some unseasonably cool days in April and May. The other meteorologic phenomena were not unusual. The practical lesson summarized from the season's experience which has specially impressed itself upon me, is that pneumonia is a specific fever with a local expression in the lungs, and running a cyclical course, terminating, if there are no complications, by crisis.

In the treatment we pay no more attention to the lung lesions than we do to the intestinal ulcerations in typhoid fever. An

idea of my management of pneumonia may be embraced in the words tonic, hygienic and supportive. I try, it is true, to fight high temperature, but this is most safely and effectually done, perhaps, by quinin. We have to look out for heart failure, and hence the prophylactic and therapeutic indication for strychnia, digitalis and alcoholics. If you help your patient hold out until he can swim to the shore, he is landed all right.

Arcadia, La. J. ATKINSON, M. D.

Typhoid Fever at the Medico-Chirurgical Hospital.

Editor MEDICAL WORLD:-In the October WORLD appears an article on the treatment of typhoid fever in soldiers at the MedicoChirurgical Hospital. This may not convey in the clearest possible manner the course adopted. Some of the drugs mentioned had not been resorted to in the given conditions among the soldiers, while others, extensively used, have been, as is possible with a verbal report, omitted. The following is a full, yet concise, report of the work as carried on in our wards:

The patients, on admission, represented all the stages of typhoid fever, some, in addition, having complications of hemorrhage, pneumonia, cardiac weakness, etc., so that it was deemed best to not adhere to any special form of treatment, but rather to treat the cases individually and according to the indications presented.

For the temperature the Brand treatment was contraindicated in a number of cases. In many others, on account of the shock as well as the tendency to congestion of the internal organs incident to the use of the bath, we placed our reliance on sponging and the ice-pack. When the temperature reached 102° a tepid alcohol and water bath was given. At 103° or over the ice-pack was used. If in the course of one-half hour no appreciable reduction was obtained, an alcohol rub or bath combined with quinin suppository, grs. v, usually had the desired effect.

The diet was liquid, milk alternating with broth, or, when these were not well borne, clam bouillion, albumen water and meat juices were substituted. Whisky and strychnin were given for the prostration, the quantity depending upon the indications. In cases of severe cardiac weakness, digitalis, strophanthus or rectal injections of warm coffee and ammonium carbonate were used.

Internally, quinin, creasote, salol, tur

pentine, calomel, digitalis, aconite and alcohol (brandy, whisky, champagne) were given for their antipyretic and antiseptic action, according to the indications of the individual patient.

Prof. John V. Shoemaker, who has for many years been teaching materia medica therapeutics and clinical medicine in the Medico-Chirurgical College, has resorted to and tested the value of the Woodbridge treatment of typhoid fever. His conclusions are as follows. When the patient can be seen early (which was not the case in the majority of the patients treated for typhoid fever in the Medico-Chirurgical Hospital) he regards this treatment as being of benefit in some cases while it is not applicable to others. During his experience he has obtained all the beneficial results of this method from the judicious use of calomel for its antiseptic and antipyretic action.

Guaiacol and guaiacol carbonate have been both thoroly tested by Prof. Shoemaker, who has obtained equally as good results, if not better, in the treatment of typhoid fever, with creasote or salol. These latter he finds to be better borne by the mucous membrane of the alimentary tract, and superior in their antiseptic and antipyretic effect to the guaiacol.

Good results were obtained from turpentine and terebene for the hard, dry tongue, in pulmonary complications and intestinal disturbances, and for the delirium and nerve disturbances on account of their action upon the secretory functions, bronchial mucous membrane and nerve centers. They were also effective antiseptics.

For hemorrhage, the ice bag to abdomen was adopted, and packing the rectum with ice. Internally acetate of lead and opium were given. Hypodermic injections of ergotole with elevation of foot of bed were among the means adopted to meet this condition. Where the hemorrhage was profuse an intravenous injection of a salt solution was given at once.

When the nervous symptoms were severe, preference was given to cannabis indica and hyoscyamus by suppository, rather than to the bromids.

The above is a brief outline of the treatment by Professor John V. Shoemaker, the chief visiting physician. The number of soldiers admitted was 435, of whom 248 were suffering from typhoid fever. The number of deaths was 13. Considering

on admission, we feel that our results have been as good or better than had any one method been adopted. Philadelphia. GEORGE W. PFROMM, M.D.

Management of Typhoid Fever.

Editor MEDICAL WORLD:-When typhoid fever has been diagnosed, the patient should be arranged in a large room, between two doors or windows where there can be a draught over the patient, and the stronger the draught the better. This fever is supposed to occur in warm, dry weather, but it matters not. If we are in the Arctic region in December and have a typhoid patient his apartments must be ventilated.

Remove everything from the room except such things as the patient and nurse use constantly. By all means take up the carpet and mop the floor with lime water. Use the mop thus every two or three days.

Next comes the thoro surgical cleansing of the patient, inside and out, with clean warm water. First flush the colon with all the warm water the patient will bear, in which one dram of boracic acid has been dissolved. been dissolved. Repeat this night and morning for the first week, then once a day until convalescence, using one gallon of water at each time. Some noted authorities fear something may be "burst" by introducing so large quantities of water, especially in a typhoid bowel. From personal demonstrations I assure this fear should be forever dismissed, that is, with all patients who have not been neglected.

After the patient has had a warm salt tub bath, the skin rubbed thoroly, place him in bed drest only in a loose gown, and covered with a sheet. He will tell you he feels comfortable.

Dr. Deering J. Roberts, in a lecture February 7, 1882, in the Medical Department, University of Tennessee, said: "The physician who gives the least medicine in typhoid fever is the most successful; don't be too ready to attempt to meet a symptom, be sure it is necessary to have the effect of a remedy before administering it." The above is not only the center guide in the management of the disease in question, but in all practice. I believe this quotation is a signal light over the rock where the profession have wrecked more patients than from all other causes combined. I know it has been the key-note to my success in all branches of practice.

medicine is to secure the full effect of a saline cathartic, epsom salt, if you please. With this you will do no harm but will wash away sufficient typhoid germs to kill an entire family if left alone. Continue with saturated solution of magnesia sulfate in sufficient doses three times a day to keep the bowels open freely, until the patient is discharged, and don't be afraid of the bowels "running off."

By all means never give an opiate. you feel that you must give something to dry the secretions, give only bismuth subnitrate. From this you will get an astringent effect, antiseptic and vulnerary, but be sure you keep the bowels open.

Stimulants are not indicated unless the heart's action is weak. Do not oppress the brain of your patient with alcohol, believing you are giving a stimulant. Nourishment is the only natural stimulant; but if your patient can't take sufficient, give nux vomica or strychnin.

There is no danger in using any febrifuge you may select in this fever, providing the condition of the patient and the strength and therapeutic action of the febrifuge selected are well understood. Not understanding the enemy, or the weapon used, is where the danger comes in.

A safe temperature can generally be maintained by hot water baths during the cool stage and cold water baths during the hot stage.

A hot water bath during the cool stage is comfortable to the patient, and besides, it lessens the animal heat in health or in fevers. Hence, it lessens the heat to come in the next pyrexia.

Judgment in the application of water must be used by the physician in each individual case, as in some cases there is very little variation in temperature during the twenty-four hours. In such cases I use hot water almost continually, with cold water to the head and face, allow ing the patient to drink all the cold. water he will, freed from germs either by boiling or the Pasteur filter. I use the

latter.

Give the best germicide you know of. I generally depend on salol or senin in five grain doses every six hours, diminishing or increasing the dose as the patient tolerates it; the idea being to give antiseptics and germicides as freely as possible so as to do no harm with them.

Never give calomel or any irritating cathartic, in any dose in any stage of this fever. I am a great believer in calomel.

If there is much tenderness over the bowels, use turpentine stupes continuously.

Nourishment is very important in this fever as it is in all fevers. Give all the nourishment the patient will take every four hours, giving no solid food for a week or ten days after the fever has entirely disappeared. Diet should consist of boiled sweet milk, buttermilk, milk and whipped eggs, pressed juice from fresh ripe fruit, pressed juice from broiled beefsteak, chicken and beef teas. Give alternately, so as to change the diet as much as possible. The better nourisht the patient is kept in this fever the less damage will be done by the fever germ.

I follow the above principles strictly in every case, with the result that I have never lost a case of this fever, never had hemorrhage from the bowels, or a bedsore, and have had but few cases to become delirious and none seriously so. Patients never lose flesh or strength to any alarming extent, and are discharged in from fourteen to twenty days, and soon recover their normal weight and strength.

WILLIAM J. EDMUNDSON, M. D. Willits, California.

The Treatment of Enteric Fever. Editor MEDICAL WORLD:-I am delighted with your articles, so fully covering the subject discussed. If it is not presumption on my part, I will offer a treatment I have used very successfully some fifteen years. When I first diagnose enteric fever, calomel is given in 1 grain doses every hour until I change the color and odor of alvine discharges. Sometimes it takes several hours. Then I give potassium chlorate, aromatic sulphuric acid and compound tincture cinchona in combination, using my own judgment as to the size of dose of each and interval between doses, age and strength of patient being taken in consideration, but seldom giving the compound oftener than every six hours. This

I find an excellent antiseptic, tonic and astringent.

When the temperature goes above 101° I use water in my own way, viz: I have the family get two and one-half yards of rubber table cloth; this is amply wide and water-tight. Slip it under the patient on the bed; pack pillows or any bedding along the sides and ends; then sponge the patient well with water of any temperature that feels grateful to him. By the time I have the temperature reduced I have the patient almost floating and in a contented frame of mind. (I have floated patient and pieces of ice at the same time.) Water may be drawn off in a tub by simply removing the packing on one side or at the foot and letting the water run off. Then, if my patient is very weak, I direct him to be rubbed with diluted alcohol and wiped dry with a soft towel. I very seldom have to give more than two baths in the 24 hours.

For tympanites I use enemas of tepid water, slightly carbolized, flushing the colon with a gallon or more, and direct the patient to retain it "as long as you can." This is both antiseptic and cathartic. Besides water having such an affinity for gas, absorbs it and reduces the "bloat," and at the same time, thru the great sympathetic nerves, allays all nervousness. The rectum absorbs sufficient water to allay thirst, and your patient is easy and soon learns to call for his enema.

With these enemas I use opium, oil, etc., as my judgment dictates. I usually have very little complaint of thirst; seldom sordes, or mouth dry, crackt and bleeding; in fact, never have these complications when water is used in abundance as outlined above.

I allow my patients to eat anything they think they want, at any hour, as long as my fever is running. Of course, during the convalescent period, I have them to fight, for at this time they could eat enough to kill. However much they think they desire cabbage, pickles, etc., during their fever, I find if the doctor is very careful to order them to thoroly masticate this food before swallowing, that invariably the food is not swallowed at all, but a mouthful or two of saliva goes down and the hunger is satisfied, also the mind, and this is a great thing in these cases.

With the treatment as given above, I do not have insomnia to amount to anything, as after a bath and alcohol rub a refreshing sleep comes on; then give medicine to the dogs-sleep is good enough. On waking I

order "egg-nogg," or white of egg, beat in a glass of water, with a little lemon juice added to flavor, also for the good effect of the acid. I feed them on milk, cream, eggs, light wines, soups, etc.; order the patient not to drink too much-as water, beer, wine, etc.-but instruct the nurse to slip to them surreptitiously (without telling the doctor), as much as they want, but always the liquid to contain some nourishment of some kind, previously specified. In this manner I manage to get my patients fairly well nourisht. The natural perverseness of mankind delights in going contrary to orders, and, with a good, level-headed nurse, one may feed these patients as much as they should have without trouble.

I do not lay claim to originality in this treatment, neither do I claim it a specific; and yet, I never lose a typhoid patient when my instructions are obeyed. I do not keep a case-book, so cannot tell just how many I have treated in this manner in the past fifteen years, but probably a couple of hundred or more, of all ages, sizes, colors and sex, and yet I cannot now call to mind a death from this disease where I had the patient from start to finish.

Pleasant Hill, Mo. W. H. YOUNG, M.D.

Calomel in Typhoid Fever.

Editor MEDICAL WORLD:-In the October WORLD, page 414, editorial on the Woodbridge treatment of typhoid fever, it is said, "It is possible that the constitutional effect of the mercurial may be produced thro the effects of these prescriptions, and in that event Dr. Woodbridge advocates the discontinuance of the treatment for a day or two."

The National Dispensatory says: "The cholagog action ascribed to mercury, and especially to calomel, was a discovery of the British physicians in India. A careful repetition of their experiments proved that large doses of calomel, as well as small doses, lessen the biliary secretion, and that among purgative medicine, mercury in every form is the very one that tends least to augment the discharge of bile. It has been recommended to administer calomel in small and repeated doses in typhoid fever, and so as slightly to affect the gums about the height of the disease, when the tongue grows dry, the abdomen tympanitic, and the mind dull; but if we know anything about the nature of these symptoms, it is, that they are signs of increased exhaustion of the nervous system, and poisoning of the blood,

and, therefore, the very last to be treated by a medicine which tends directly to aggravate those conditions."

In some formulas leptandrin is combined with podophyllin in double proportion; would it not be better to so substitute it for calomel in Woodbridge's formula? Leptandrin is tonic, cholagog and laxative, and may be safely and efficiently employed in the treatment of typhoid fever, and all diseases connected with biliary derangements; without any danger of producing the objectionable effects of calomel. There would then never be any need of suspending Woodbridge's tablets a day or two on account of the bad effects of calomel. Weakening purgation should be guarded against. Linville, N. C.

C. TEAL, M. D.

Typhoid Fever.

Editor MEDICAL WORLD:-Thirty years ago in Northern New England I discovered that the spirits of niter and Dover's powder every hour alternately were not strictly essential to the life of the typhoid fever patient since he lived quite as long without them. I learned to visit the patient daily and only dose him weekly. Settling in a malarial western town in September, 1878, I practiced six months. for $1.25, the same sum being the fee for tooth extracting and for prescribing an opiate for neuralgia.

"When the winter is over and gone, and the thrush whistles sweet on the spray," chills and fever appeared and by August my practice reached $173.50 per month. By this time the ague was more severe and remissions less perfect. Then the "typhoid" began to rage. I saw the "nigger in the fence" was the same color as the malaria I had been fighting, only grown bigger, and I fired thirty grains of quinin at him, but this only made him mad. Next day I doubled the charge and it made him madder.

Then I asked Dr. M. if he ever heard or read or knew of a case where quinin killed a patient. He said he didn't know. He had known patients to die to whom he had given quinin, but he had also given them other medicines. Then I gave eighty grains in eight hours and the case was cured.

That season I treated 125 cases with the hot pack, doses of calomel or rhubarb and eighty grains of quinin in acid, and all recovered in two or three days. I left there three years later leaving a clientage

embracing more than 400 families, but I never found there a case of typhoid fever that this treatment would not abort.

Observation of forty years in more than half of the States of this Union and several foreign countries convinces me that in any country where ague is possible the fevers can all be stopped with quinin. Yorkville, Ill. M. D.

Antisepsis in Typhoid.

Editor MEDICAL WORLD: - Wonderful luck, is it not, to treat typhoid fever nearly thirty-three years, and with a loss of only two? If the luck will continue I am satisfied to keep on with sulfocarbolate of zinc, turpentine when tongue is dry and cracked, and acetanilid when fever passes 102°, with gentle sponging frequently with cool water. Have five cases now and all are doing well. No loose bowels to contend with. One case started with twenty-seven thin, watery discharges in twenty-four hours, but after a few doses (2 grs.) of the sulfocarbolate, all workt like magic; then moved bowels every other day with injection. W. S. CLINE, M.D.

Woodstock, Va.

Typhoid Fever.

Editor MEDICAL WORLD:-THE WORLD grows better every month. Must have it. Have never added my mite before, altho I have read THE WORLD for seven years.

Having seen a good deal lately written about typhoid fever, I will report results in four or five cases. I may say, in starting, that my experience in eight years' practice is limited to ten cases only, of which three have passed "over the river." My first case, treated, according to Bartholow, with carbolic acid and iodin, with milk diet and astringents, was the first to die. This case, however, had been under treatment for two weeks in a neighboring town, and, when he came home, diarrhea was very bad and the temperature 104°. He took to bed on arrival, which had not been the case before.

Case No. 2. I used the same treatment, but calomel was given with a free hand for the first week-five to eight grains a day followed by seidlitz powder. This moved the bowels well, and diarrhea never was bad. Recovery.

Case 3 was treated by small doses of calomel, given frequently- grain every two hours. Stimulants, milk, white of egg, broths, etc. Severe headache re