writings of these scientific medicine men is that no two of them agree, and what is science one day is malpractice the next day, or next year. In the September and October numbers of THE WORLD are a number of articles on typhoid fever. No two agree in treatment, and yet each claims to have the best, and all have advanced. One uses exclusively the Woodbridge treatment, and thinks a man who uses anything else is guilty of malpractice. One uses the sulfocarbolates, and all recover. One uses cold baths; the other fellow objects to cold water. One has had 80 cases, without a death; the other fellow thinks he is romancing. Well, they have all advanced. Any of these methods is better than the treatment of fifty years ago, when they bled, blistered and salivated all kinds of patients for all kinds of diseases. And yet there is a more excellent way. The so-called atypical fever is the typhoid of California. It has the same intestinal lesion, the same range of temperature, and runs the same course. I have treated 38 cases of typhoid fever in the last eight years, and have not lost one. Six of these were typical typhoid, as described in the books; the others were what is described as atypical fever, tho some of these had severe hemorrhages and some of the worst cases had no delirium. baptisia, gelsemium, arsenic and rhus tox, but only one at a time, as they are indicated, according to the homeopathic law of similars. I never give cathartics, but use copious enemas of warm water every day, and when there is diarrhea several times a day. I use tepid baths or sponge baths frequently. W. E. ALUMBAUGH, M. D. Vacaville, Cal. I gave Dosimetric Treatment of Typhoid Fever. Editor MEDICAL WORLD:-It is rather amusing and very instructive to read the many views expressed on the treatment of typhoid fever. I like to read the various modes of treatment, given by the many contributors to THE WORLD, because I think each one contains some valuable truth. My desire is to grasp each truth, so far as I am able, from whatever source. I have thrown prejudice to the dogs, and am now seeking for good practical information, regardless of the "pathies." Dr. J. T. Anderson, page 429 of THE WORLD, condemns purgatives in the treatment of typhoid fever. Dr. H. J. Parker, page 432, says, "Cut off diet absolutely. Milk diet will kill. Purgatives will kill," etc. He also seems to think his mode of treatment is absolute and certain. It seems to me this is putting it rather strongly. Purgatives improperly given may do harm, but purgatives properly given, I believe to be one of the best things in the treatment of typhoid fever. I have never failed to get good results, and relieve some very distressing symptoms in this fever, from small doses of calomel or saline laxative (Abbott's). As to dieting, my observation teaches me that the better a patient is fed thruout the attack, the better he will do, the shorter will be the convalescence. As to any treatment being absolute and certain, I very seriously doubt it. I changed my treatment about three years ago, and I am so well pleased with results, I would not think of returning to the old mode of treatment. My principal febrifuge is the defervescent compound, No. 1 (digitalin, gr. 1-67; veratrin, gr. 1-134; aconitin, gr. 1-134), or in the milder form of the attack, the dosimetric trinity (digitalin, gr. 1-67; strychnin ars., gr. 1-134; aconitin, gr. 1-134). I give one granule every fifteen minutes to one hour, as may be necessary. An occasional dose of antikamnia, or the sponge bath, the wet sheet, or an ice-bag to the abdomen and to the head is occasionally necessary to aid the granules in controlling the temperature, but this is seldom the case, once the patient is thoroly under the influence of the antiseptics. The bowels are kept open by small doses of podophyllin, gr. 1-6 to gr. 1-2, followed by calomel, gr. 1-6, every hour till the bowels move well. This is repeated every two or three days, as indicated, while in the interim, saline laxative is given in sufficient quantity to produce two or three motions in the twenty-four hours. (It does not kill, either, as I have my first case of typhoid fever to lose.) Intestinal antisepsis is produced by the sulfocarbolates of zinc, sodium or calcium, or by the three combined-as contained in the W-A intestinal antiseptic, from gr. xl to gr. lxxx being given in the twenty-four hours. Nuclein (Aulde) is also given in one to two minim doses every three or four hours, to produce leucocytosis. Excessive diarrhea is controlled by zinc and codein compound, one tablet every hour till pain and diarrhea are relieved. Tympanites and soreness, when present, is relieved by turpentine and codein. Hemorrhage is relieved by ergotin, hypodermi cally, atropin, and by ice-bags to the abdomen. I have never had but one case of severe hemorrhage from the bowels. My stimulants consist of strychnin ars., brucin or strychnin, and glonoin. I never give alcoholic stimulants, except in case of habitual drinkers. I never give quinin in I never give quinin in typhoid fever. I feed my patients well thruout the attack, and give them all the pure water they can drink. I regulate the hygiene to the best of my ability, and have the stools all passed into whitewash. By this mode of treatment I have aborted several cases of typhoid fever in ten days, other cases in sixteen days, while I have had but one case which lasted thirty days. In every case the symptoms have been greatly ameliorated, and the convalescence greatly shortened some being able to be up and about the house several days before the fever is entirely gone. G. M. JAMESON, M. D. Buda, Tex. Experience with Typhoid Fever. Editor MEDICAL WORLD:-There is so much that is good in the October WORLD on the treatment of typhoid fever that it seems almost supererogatory for me to add anything to what has been said. At the risk of being called an "old fogy" I will say that I have no treatment for this disease. I treat many cases that I do not see more than one time; others that I cannot see more than two or three times; some that I never see at all. In a widely scattered country practice a doctor cannot see his patients every day. In this, as in all other diseases, I treat the patient. Often the treatment is different among members of the same family. I have never been satisfied that this fever can be aborted; but many cases of fever will get well in a few days under any treatment or no treatment, while other cases will go on for days and weeks. I do not pretend to explain or understand why it is so. Many years ago Dr. Rezin Thompson published a book in which he claimed that he could abort typhoid fever. His treatment was principally oil of sassafras, valerian and rhubarb. Tho few, perhaps, in this age would take his medicine, still as a "cure" for this fever it can scarcely be surpassed. During the war between the States, when medicine could not be had in many localities, pills of oil of turpentine and flour cured many cases and taught the people that the old treatment was wrong. I would rather risk my chances now under this treatment than under that practiced by many physicians. I have not yet learned to like the treatment by purgatives. Nothing but the mildest should be used. Castor oil is better than calomel or podophyllin. Be very careful with coal tar preparations, never use them except when the fever is very high, and then only for a little while. If the tongue is red or dark and dry give mineral acids. I believe I prefer nitric, but often use muriatic. If the tongue is white or brown and not very dry, nothing is better than sodium sulfite. If there is much tympanites give oil of turpentine and apply it locally. If there are any malarial manifestations give quinin in the early stages of the disease, but continue it only a few days. Give the patient the best liquid food. In some cases I reject all solid food, in others they eat what they like. Each case is a study with me. Some require, in the last week of the disease, alcohol, heart tonics and the like, others never need anything of the kind. When the case is going on all right, and no special symptoms require treating I have used zinc sulfocarbolate and nothing else; have "cured" several cases with this alone. Notwithstanding all we read as to the cause of typhoid fever, I am still free to confess that, I do not know what causes it. I have seen it in all its glory" where none of the causes given in our textbooks could be found. C. KENDRICK. Kendrick, Miss. Diarrhea. Editor MEDICAL WORLD:-By diarrhea I mean liquid stools, whether frequent or not. Probably everything written upon the subject of enteric dejecta mentions a liquid stool as pathologic, but this is an error that is readily admitted upon slight deliberation. The only test of what is abnormal and what is not, is the well-being of the patient. There are some in whom a so-called normal stool is always fraught with serious discomfort. Every practitioner of even moderate experience has encountered these cases. It would be much nearer the truth to call the usual so-called normal stool an average healthy stool, thus allowing some latitude for individual idiosyncrasies. This should be one of semi-solid consistence, and of a lightbrown color or yellow. Diarrhea may be frequent or infrequent, very liquid or only partly so. It may be due to ingested drugs, or to special foods, or it may be a sign of inflammatory action, either acute or chronic. Then there are the diarrheas of constitutional disease, as in typhoid fever and phthisis; or those due to nervous strains, as from fright; and also those due to disturbances of circulation, such, for instance, as are caused by chilling of the trunk because of deficient underwear in a sudden drop of temperature. To these may be added those caused by irritation, such as follows the ingestion of indigestible food like corn or green apples. Catarrhal diarrheas are recognized by the presence of mucus in the stools. Ïf of long standing with no unusual disturbance of the system, it is chronic, but if it is of short duration, it is acute, especially if there is markt general disturbance. The latter form may mark a cold, an enteric irritant, or a sympathetic nerve disturbance. Cases of longer standing indicate a cause that is sufficiently powerful to remain active, despite nature's tendency to repair. This should be carefully sought out and removed if possible. Without this, no treatment can be called intelligent, nor can it be expected to yield satisfactory results. The acute variety is more sharply painful than the chronic form, but the mistake must not be made of suppossing that the principal seat of trouble is at the site of greatest pain, for it is well known to experienced clinicians and to abdominal surgeons that the location of a belly pain is no reliable index of the site of the trouble to which it is due. The fact must also not be forgotten that a gut loaded with mucus is in no condition to absorb medicine, nor can we expect much from the practice that would choke it up tight with opiates. The first indication is to clear out the mucus, and at the same time relieve the engorged enteric vessels, by giving a hydragog, such as calomel or one of the salines. These may, with advantage, be combined with an antiseptic, such as zinc sulfocarbolate. Chronic cases require the constant use of a saline in small amounts for several days to keep the vessels unloaded. Ulceration diarrheas should be recognized, both for the sake of the patient and the physician, for they are tedious, as a rule, and it is always advisable to early tell a patient in a lingering case that he will not get well in a short time. These cases are hard to distinguish. They are usually accompanied by persistent localized pain, and the passage of pus, and sometimes blood, with the feces. If the condition is part of dysentery or of typhoid fever, it is readily enough recognized, and its proper treatment becomes merged with that of the disease of which it is a part. But isolated ulcers of the bowel, if in the large intestine, are best treated with antiseptic enemas several times daily. When they are located in the upper bowel, they may be reached, in part, by enemas, while by the mouth, silver, bismuth, catechu, or other astringents, soothers, and antiseptics may be employed. The discharges of typhoid fever have a peculiarly penetrating, offensive odor one that strongly reminds me of the odor from a decaying tooth. The stool is often clay colored, though quite often yellow. But it must not be forgotten that constipation sometimes exists in typhoid fever. Dysenteric discharges are characterized by muco pus with streaks of blood, tho the blood is not always present. In these cases, antiseptic enemas are of special service, and should be combined with a suitable antiseptic by the mouth, together with small doses of a saline frequently repeated. Nervous diarrhea, such as follows fright, has no special characteristics except that it is sometimes serous, the watery constituents of the blood being poured out so fast that the enteric secretions become highly diluted and watery. The previous history and accompanying circumstances aid in the diagnosis. The remedy is, first of all, removal of the cause, and second, a nerve sedative and an enteric astringent. A lead and opium pill makes a good combination for this purpose, tho there are others as good. Diarrheas due to chill are commonly overlookt, despite the fact that they are very prevalent in the fall of the year. They yield with the most gratifying promptness to the right treatment, which consists in the application of warmth to the body, especially to the belly, all of which is amply accomplisht by the donning of heavier underwear. Should, however, such a diarrhea be neglected long enough to set up a habit of excessive secretion in the enteric mucous membrane, a cure becomes a more complicated problem. Then it becomes necessary to treat a chronic catarrhal coated. diarrhea. Irritative diarrheas are also very common, and often overlookt. Those due to improper diet, as green apples, and to what are commonly meant by poisons, are usually recognized with promptness and treated accordingly. But there are others which are not so evident, such, for instance, as those due to the swallowing of expectoration mucus by children. The purulent discharges from a rhinitis or ophthalmia may find their way into the gut by way of the nasal ducts, nares, and pharynx to the esophagus. The presence of these discharges should always be taken into account as a cause of diarrhea, and the treatment be modified accordingly. Irritating substances are readily detected in the stools, which should always be examined, or at least, have their character inquired into. Most irritant poisons leave their mark upon the mouth and lips, or there is usually some knowledge of a poisonous substance having been taken, either by accident or design. A membranous diarrhea is an indication of chronic catarrhal enteritis. The stool contains what appears to be shreds of membrane, or, as one of my patients recently put it, "just like the skin of an egg." It is composed of fibrillated shreds of mucus. It signifies an obstinate state of affairs, and the patient may as well be informed at once that recovery can only be lookt for as the result of the most painstaking attention to diet, medication and hygiene. The condition is said to exist mostly in blonde blue-eyed women at middle life, who have a nervous temperament. The diarrhea of constipation is by no means uncommon, and yet very generally overlookt, not so much because it is not as well understood as are most of the diarrheas, but because it implies an inversion of usual conditions. Diarrhea and constipation being opposite states, it is not readily remembered that one may be the cause of the other at the same time. Besides, it does seem awkward, in fact it may seem entirely wrong, to give a brisk purge in the presence of a diarrhea that is chronic and in no wise seemingly due to the presence of any foreign or irritating substance in the bowel. And yet this is precisely the only way in which many constipations can be cured. In these cases, the belly always feels full and heavy, the stools are never satisfactory, and the tongue is ever coated. The stools are usually a light brown or yellow, being simply liquefied feces, liquefied because it is the only condition in which they can pass through a bowel incrusted with dried fecal matter. The diarrhea of indigestion is common, especially in children, and in them it is readily recognized because diligently lookt for, or at least, not usually overlookt. But in adults, it does not receive the same consideration unless the patient complains of dyspepsia. When due to indigestion, the desire for stool comes on during, or immediately after, a meal, and is accompanied by more or less pain. It is necessarily always associated with more or less malassimilation and consequent loss in weight and spirits. A bilious diarrhea, characterized by claycolored stools, is often met with, associated with hebetude and some hypochondriasis. It is probably due to the absence of bile from the enteric tract, and is readily relieved by either calomel or podophyllin, the former being given when the stools are light, and the latter when they are dark. The diarrhea of malignant disease, say of cancer, is often overlookt until in the late stage. It is well to suspect malignancy in all persistent diarrheas after 40 years of age, in the absence of other clear causes, and it may exist even then, in fact often does. There is, generally, coexisting pain, except very early, in the belly or pelvis. In rectal cases, defecation becomes painful. Much more might be said upon this entire subject, but it is more my object to encourage a symposium upon this subject than it is to treat it exhaustively. If it starts those to thinking who read it, a great deal will have been accomplisht. Constipation. By constipation I mean the passage of hardened feces, or of feces when they are sufficiently dry to require straining to insure their passage, or when the intervals between stools exceed twenty-four hours. That constipation is a very prolific cause of bodily discomfort, is ally admitted than this belief is lived up to in medical practice, thus again showing that fatal tendency to overlook simpler causes in the search of the hidden and abstruse. Truths that are readily discernible when we are brought face to face with them, are not realized when out of reach of the special senses. Thus the disease breeding effect of excrement that is permitted to lie about in the street or in a living room is known to all, but how little do people practically realize that the retention of this same material in the body for one or more days is equally detrimental to health? Even physicians are prone to overlook this very evident fact. Retained feces are continually undergoing changes that liberate poisons harmful to the body. Their effect is various in several ways. The same poisons will not affect all tissues alike, nor will the same poison always have the same effect upon similar tissues. Much depends upon the susceptibility of the patient at the time. Repeated attacks of constipation, and its resultant intoxication, finally produce results not attainable in one attack; while a continuous constipation may gradually so undermine the health as to counterfeit some dyscrasia or simulate some organic disease. I have known a chronic insanity stop with the relief of a constipation, and return so soon as this condition was permitted to reappear. Indigestions, nausea, sick headache, general malaise, hebetude, anorexia, bad breath, hypochondriasis, and a host of other markt symptoms, are quite common effects of constipation. It behooves us, therefor, to study well this condition, and to see that it is not the cause of any ailment with which one is afflicted who comes for relief. Any stool that is dry, particularly if it is hard, is caused by lack of intestinal secretion. There are instances in which the dryness is really caused by neglect to go to stool when the desire exists, atter which some of the moisture is absorbed, thus leading to a subsequent dry stool. These require simple laxatives, such as compound licorice powder or the extract of cascara sagrada. Constipation is often due to atony of the muscle of the bowel, being either a local affection, or else due to a general weakness occasioned by severe or long-continued illness, or by old age. The proper remedy, then, is a stimulant, such as ergot or nux vomica, to the unstriped muscle fibers. If the heart is weak, strophanthus may be used. In some cases of paralysis or paresis, the muscle of the gut is so weakened that a proper stool becomes difficult or impossible. Faradism of the belly and galvanism of the spine are then the best remedies, but should always be associated with some medicinal agents. In tonsillitis, especially of children, con stipation should never be overlookt, for I have known many instances in which the glandular affection rapidly subsided after two or three copious stools had been obtained. I have repeatedly treated one child for typical tonsillitis with high fever and bounding pulse, and always found him to get well so soon as he could be made to have a copious stool. have a copious stool. His mother now recognizes this so well that she begins the use of calomel in 1-10 grain doses every half-hour, so soon as she notices a swelling of his tonsils. It invariably does the work with him. Constipation, associated with diarrhea, is a condition to which I have already adverted under the heading of diarrhea. Still I may add once more, that the gut may be so lined with hardened fecal matter as to form a stiff tube with very limited contractile or vermicular action, so that the only chance for the passage of fresh feces is for them to be sufficiently liquefied to pass thru the thickened tube. In this state, the patient always has a feeling of fullness, even right after stool, unless his sensibilities have been blunted by habit. A brisk cathartic is the proper remedy, and it ought to be repeated three or four times on alternate days. The tendency to recur is considerable, and must be prevented by careful attention to medication and hygiene. Five grains of the extract of cascara sagrada may be given daily at bed-time, and the patient should be enjoined to drink a glass of water on rising, to begin breakfast with fruit, and to go to stool regularly immediately after breakfast, whether there be a desire to do so or not. This should be persisted in till effective, and is often signally successful from the very beginning. Certain foods, like some drugs, constipate, and things that constipate one individual will have no such effect upon another. Quite often, the mere sameness of diet is the cause of constipation, and when it is, a mere change of diet is enough to secure normal stools. A vegetarian diet and abstention from fruit will usually cause constipation, unless large quantities of water are inbibed. A mixt diet is necessary to secure stools of the proper consistency, necessary frequency and ease of ejection. If constipation sets in during a medicinal course, it is always desirable to differentiate between that which is due to the drugs used and what may be a part of the disease, for the correction of the condition in the one instance may necessitate |