attack he had severe peritonitis and gastric catarrh, and was only able to resume iodine treatment on June 15. He was, however, too weak to carry it on, and died on August 16.

Whether this patient was reinfected in this picture palace, for he was at work whilst the floors were being swept, and no sunlight enters such places to inhibit the growth of the T. B., or whether after three negative reports the disease still was present, must remain a mystery; but from this and another case at present under observation, where T. B. reappeared in sputum after the patient resumed for the first time unsterilized milk, and after T. B. had been absent for two and a half years, it is apparent that the patient who has once been infected remains very highly susceptible to future invasions, and should be carefully guarded against reinfection.

Case No. 4. A lady, 25 years of age, by occupation a typist. Her illness dates from the middle of August, 1912, when, after an attack of bronchitis, an examination of her sputum revealed the presence of T. B. She entered a public sanatorium and was treated with tuberculin injections, and at first made some progress. After the twenty-fifth injection she became so ill that they had to be discontinued. Later, on the arrival of a new medical officer, she received three other injections, but as she was not improving left after six months' residence. Examined on March 31, 1913, she had bronchial and laryngeal catarrh, and b. report on sputum on April 2 was "T. B. many." Next day she commenced iodine treatment, using 3 ounces chlorine solution, and a week later 4 ounces daily. Under treatment her symptoms rapidly improved, she felt much stronger and was able to spend the most of her time in the open air, but b. examination of sputum on May 6 gave result, "T. B. large number." On June 4 the same report was obtained. On June 6 a skiagram was taken and various parts indicating disease were afterwards treated by ionization after the administration of 100 grains potassium iodide internally. Each ionization was followed on the day of administration by three 2-ounce doses of chlorine solution, and the day following, beginning at 5 A. M., by three other similar doses. When not undergoing ionization she continued the usual treatment. By June 27 she had no night cough and b. examination gave result, "T. B. few." July she spent on the East Coast, continuing daily treatment, but although she had no catarrhal symptoms, on August 7 b. examination gave "T. B. numerous." She then commenced to take 2 ounces chlorine solution after dinner, 2 ounces after tea, and 1 ounce two hours later. By August 15 report was, "T. B. negative." This daily dosage she continues. She now feels quite well, looks well and energetic, and has very little cough. During treatment she has gained 11 pounds in weight, 81⁄2 pounds of which have been made up during the past eleven weeks.

On June 14th it was my privilege to visit, on the invitation of Dr. Edward G. Reeve, the city of Westminster Union Infirmary, Hendon, London, N. W., and see the results of the iodine treatment, on about fifty patients suffering from phthisis, during the past five months. I will let Dr. Reeve tell his own tale by giving extracts from a letter, which is a valuable contribution to our

subject. I will, however, first record three improvements on my own methods with which I was impressed on this visit, and which appear to have contributed to his brilliant results.

First. He discarded the alkali given with As alkali in the the potassium iodide. blood tends to cause the recombination of free iodine into iodide and its elimination in the urine, this is a distinct gain, and Dr. Reeve has had only two cases of iodism in about fifty cases treated.

Second. He administered each dose of chlorine in nine ounces of freshly made still lemonade, instead of the small dose of factory made lemonade used by my patients. As the blood vessels of phthisical patients are in a condition very closely allied to scurvy, I think this is a valuable improve

ment.

Third. At the end of the fourth week of treatment he got his patients to take daily five ounces chlorine solution after thirty grains iodide in the morning. This undoubtedly rendered the blood more bactericidal.

The following extracts from his letter of 3d June record his experiences:

"During the past five months I have treated about fifty patients suffering from phthisis, using the intensive iodine treatment as recommended by you in the Practitioner, with some slight alteration. The results have been extraordinary.

"Patients have put on 1 pound to 2 pounds per patient per week, for weeks. The sputum shows remarkable changes, gradually diminishing almost to nil, and becoming tubercle free. I have constantly watched the sputa for phagocytosis and degeneration of tubercule. They quickly show "spore" formation and become non-acid fast; in fact, I have some slides showing them stained blue. I have had only two failures through iodism; in each there was albuminuria. I find that patients with albuminuria excrete all their potassium iodide before 12 at night, whilst the others still pass it at 6 next morning. This bears out your theory well, as I take it that there is insufficient iodide left in the blood to prevent iodism.

"In the case of a man aged 48 years with winter cough for ten years, his sputum full of T. B. and left lung fibrosed, he put on under treatment 18 pounds in seventeen weeks. He has had no cough for five weeks, no spit, is T. B. free, and he has no moist sounds left. Arneth count 10. 30. 44. 14. 2. He stopped treatment three weeks ago, and has just been discharged as cured.

"A woman, aged 28 years, with both lungs affected, 8 ounces sputum, T. B. many, temperature 102° to 103°, lost 21 pounds in two months, and was dismissed from a well-known hospital as hopeless. Under treatment she has gained 5 pounds, temperature is now 99°, sputum 1 ounce, and T. B. free.

"Amongst the cases I have had one of lupus (erythematosus) cured in five weeks, three of

tertiary syphilis cured, a large number of cases of severe acne, and one bad case of eczema.

"The past five months have given me a lot of splendid work, and results which have not, I feel sure, been anywhere equaled before in the treatment of phthisis. As the patients were mostly over 50 years, and drawn from the poor law districts with past histories of alcoholism and syphilis, the results are all the more astounding." A paper by Dr. Reeve, giving the results. of iodine treatment on seventy-six cases at the Westminster Infirmary, is due to appear in the September issue of the Practitioner. As only three of his patients failed to gain in weight, and one-third of his cases were T. B. free in three months, his results are most encouraging.

For many years iodine has been neglected

in the search for a serum which would do for tuberculosis what antitoxin has done for diphtheria. As the tubercle bacillus, As the tubercle bacillus, soon after it finds a resting place in pulmonary or glandular tissue, becomes stockaded in a mass of inflammatory tissues in which the blood vessels become obliterated, treatment by means of iodine is a suitable preliminary to serum treatment, should serum treatment be necessary. Then also on account of its bactericidal action, iodine is a valuable aid to treatment where phagocytes are outmatched by invading organisms. My first work, with iodine in the treatment of pulmonary tuberculosis, was the use of potassium iodide by ionization, as recommended by Professor Leduc for the treatment of sclerosis of the joints (Ref. 3), with the modification that in addition to using 2 per cent. solution of iodide on the electrodes I previously administered 100 grains internally, so that the iodine ions, in addition to passing through the skin, should also pass from the iodide introduced into the blood, through the walls of the blood vessels, into the diseased pulmonary tissues. By this means alone over three years ago I was enabled to free a patient from T. B. who was considered utterly hopeless, and whose sputum at the beginning of treatment, and after six months' treatment in a sanatorium, contained many bacilli. At the same time, another patient with the same history made a good recovery with ionization, and although a very few T. B. remained in her sputum, was so well and her lungs so dry, that she was informed by the late Prof. Samson Gemmell, who examined her in December, 1911, that no further treatment was necessary. She has remained well and at work with practically no other treatment than the use of an ozone generator in her bedroom. She, however,

has recently taken up the daily use of nascent iodine with the object of getting free from all bacilli, and in the last b. examination very few were discovered. As chlorine was not used after these ionizations, eviction and inhibition of growth, rather than destruction of bacilli, must have produced the results. I now only employ ionization in cases where persistent consolidation remains or pleurisy persists, and follow each ionization with doses of chlo

rine solution to decompose the iodide in

troduced, as in Case No. 4. Where obtainable I use a skiagram to direct operations. The skiagram, however, should not be taken where there is nascent iodine,

which is impervious to X-rays. In each case the patients had 100 milliamperes of current for thirty minutes once or twice weekly.

My past experience leads me to the conclusion that patients who have undergone ionization have stood the test of time better than those who have only had iodine by oral administration.

That much larger doses of iodide and chlorine may, with safety, be administered by the fact I have at present under treatthan are the present ones, I am convinced ment a lad of 14 years who is progressing favorably and suffering no inconvenience on adult doses.

In Dr. Reeve's observations of the effects

of iodine treatment on the blood of patients, as demonstrated by the Arneth's blood count, the percentage of neutrophile corpuscles in classes four and five did not come up to the normal until after bacilli had disappeared from the sputum and the patient was practically well. His conclusions, therefore, are that the place of iodine in treatment is to get rid of the T. bacilli and other organisms present, and that the treatment does not activate the blood, or

increase its resistance against future invasion. This is in keeping with my own observations on the two patients who reHow the lapsed or became reinfected. system of the patient is to be freed from these organisms, and at the same time fortified, is, therefore, one of the great problems before the profession. We have at our command sera, nucleins, hormones, etc., and the use of these in conjunction with hematological observations offers an interesting field of study for the clinical observer. There is also much need for chemical and biological observations on the differences of the blood in phthisical as against healthy

subjects, for it is highly probable that after an attack of phthisis other constituents of the blood as well as neutrophile corpuscles require restitution.

In conclusion, there are numerous fields ripe for observation, in the application of this iodine treatment to other diseases than those touched upon, in particular to those diseases in which micro-organisms spend a part of their existence in the blood of their host, such as in malaria and relasping fever. In the simpler ailments which turn up in the trivial round, the treatment may also be found invaluable. In varicose ulcer of the leg, in chronic catarrh of the throat and middle ear, especially with suspicions of syphilitic taint, and in locomotor ataxia I have recently had splendid results.

Finally, I hope that I have written enough to enlist the co-operation of studious and earnest workers in the States in turning to account their knowledge, their experience and their opportunities in lessening the sum of human suffering by the occasional and proper use of iodine, and in publishing their observations and results. [We will be glad to get reports.-EDITOR.]

Cleanse the bowel tract by means of salt water, followed up in half an hour by a dose of castor oil. Do this on two or three successive days or even shorter periods. Two glasses of salt water, a heaping teaSpoonful to each, should suffice for each dose. As soon as treatment begins flush out the colon by means of very warm water or salt water. Some of this will be absorbed and will increase the salt content of the blood. Salt is germicidal and in the blood, doubtless, reduces the virulence of the typhoid organisms. Several injections should be given each time the colon is flushed out. If the water can be retained for a little while it will accomplish more.

Absolutely no food should be given the patient from the time treatment begins until a day or two after the temperature becomes normal. Water should be taken in abundance. This enters the blood, of course, and

is excreted, for the most part, by the kidneys; it brings away with it large quantities of the toxins which result from the disease. This keeps the fever down and also renders the blood liable to affect the valves of the heart. An abundance of water in all acute fevers preserves the heart and kidneys. If this rule were always followed there would be no heart or kidney troubles follow acute diseases except, possibly, in very rare cases.

Thyroidin should be given to supplement the action of the thyroid gland. It is very likely that the action of the gland is below par in all persons taken with typhoid. This being true or not, it is certainly true that the one taken down with typhoid is full of waste, and the thyroidin aids in ridding the system of it. Otherwise the disease is likely to run its course. Of course, the waste cannot be gotten rid of at once; it takes time. The thyroidin makes it more easy for the patient to fast; he utilizes his own waste as food.

I give the thyroidin in either the second or the third decimal trituration prepared in a homeopathic way. If the patient appears to be full of the grosser kind of waste I give the second. If he seems full of the more delicate poisons such as come from perverted metabolism rather than from excess of food matter, I give the third. In either case two grains are given every two or three hours.

I notice that if the second decimal trituuration is given that, in some cases, it aggravates the tachycardia or palpitation of the heart; then I give the third or a higher trituration. The higher triturations may work well, but having started with the second or third, I leave well enough alone.

As for other remedies, it is possible that the patient might get on well without any. However, I always give the remedy which those educated in my school would think indicated. In nearly all the cases which I have treated gelsemium has been administered in homeopathic doses. Of course, in cases where some other remedy has been indicated the other has been given. The "indicated remedy" has always seemed to be very beneficial.

I have said nothing of cerebro-spinal and nephro-typhoid. nephro-typhoid. It does not seem at all likely that any case would ever manifest these tendencies if the treatment advised in this method were always given in time. None of my cases have ever taken either of these courses. The nervous and nephritic symptoms are due not so much to the pres

ence of organisms in the blood as they are to the presence of the toxins, and a proper elimination of the toxins early in the disease seems to abort all such symptoms. When nephritic symptoms are manifested the patient should be sweated and the bowel injections should be given more often. Apply hot packs over the kidneys and change as often as necessary to keep real hot for an hour or two at a time. This should be done two or three times each day. Sweating can be brought on by use of hot water in Mason jars or hot-water bottles. Sweat as for any other nephritis. But it is in gastro-intestinal typhoid I have had most experience with this treatment.

On August 3 I was called to see a case of typhoid. It was at 7 P. M. and his temperature was 104.5. The aborting treatment was begun at once. The next morning at 9 his temperature was 102-not much gain. In the evening, however, it was 102, which made me rejoice. The next morning it registered only 100, which was still better. The patient was feeling fine and thought himself about well and, although forbidden to eat that day, he ate an orange and a biscuit. This made a change and his afternoon temperature was again 104.5.

This brought the patient to his senses and he was now willing to fast in earnest, but the best we could do was to get his afternoon temperature down to 100 on Friday the 8th. By that time his temperature should have been normal and, doubtless, would have been but for the orange and the biscuit. On Saturday hope of aborting the fever was given up and we decided to let it take its

course.

From that time on for more than three weeks the patient had a salt-water enema each daysometimes two. These were ordered to be retained as long as convenient, so that absorption might take place. The patient never felt weak and exhausted during the whole run of the fever, which lasted five weeks. The temperature in this case seems to me to be very low. During the first week after giving up the notion of aborting it, the fever was rarely above 102. After that time it came down about one degree each week. Only once it mounted to 103 5, which was probably due to too much milk. The patient did not take milk well. His diet was mainly light gruels, albumen water and the juice of oranges.

This is the only case that I have met which I have not been able to abort by means of the above methods. One case which did not take castor oil well used epsom salts with just as good results, although the oil would seem best because it causes a higher degree of peristalsis in the bowel tract. If the salts prove as efficient it would be better to use them because the oil produces much more profound constitutional disturbances.

There are about 500,000 cases of typhoid each year in our country. Of this number 35,000 die. My experience makes me firm

in the belief that almost all of these cases could be saved the ordeal of going through the fever and that there need be very few lose their lives through a run of the fever.

Some Unusual Experiences in Specific
Diagnosis and Therapy.

By B. G. R. WILLIAMS, M.D.,
PARIS, ILLINOIS.

Attempts at specific therapy by vaccines and serums may be counted almost a waste of time unless the diagnosis be accurately made. Strange to say, many men are attempting to use slipshod methods here, as elsewhere. Realizing at length the futility of guessing, they are trying to fall back once more upon the "shotgun mixtures," hoping by some chance to strike upon the proper vaccine or serum for use in the case in mind. Verily the lazy man works hard. Of course such attempts are usually ridiculous, and the results obtained have done much to discredit this form of therapy. It is the man who refuses to diagnosticate carefully who becomes the most dangerous of therapeutic nihilists; this holds especially with regard to the administration of biologicals. (The reader must not infer that I scoff at the use of mixtures, but these mixtures must be based upon the case in mind rather than the opinion of some manufacturer as to what combination is applicable to the majority of cases.)

I can recall cases by the dozen in an extensive diagnostic practice, where mixtures have failed and a single bacteriological examination, perhaps merely the inspection of a smear or a single culture test, gave the clew and the proper vaccine or vaccines did the rest. Verily the lazy man not only works hard, but works in vain. It is especially in the chronic cases, where the patient has been the rounds, that the man who diagnosticates carefully shines.

Mucous colitis has proved an eyesore to therapeutists of centuries past. It is not the purpose of this paper to enter into a discussion of the various suggestions in regard to etiology and rational treatment which have been proposed, but rather to recount some very interesting experiences which I have had with certain of these cases. In one of these the use of typhobacterin was suggested not only by the fact that the man was obviously a typhoid carrier. but that his stools still contained these specific bacteria, although the attack of enteric fever had occurred some dozen years

previously. The diagnosis of mucous colitis. had been made by several prominent physicians; and indeed, so far as symptoms were concerned, there seemed to be no good reason to alter this diagnosis. The results following the treatment were so satisfactory that the question arose in my mind: May not certain of these cases of mucous colitis, after all, be but the sequelæ of typhoid? The experiment was certainly suggestive, though I have never been able to confirm such a deduction. At least it appears to bring out in this case very emphatically the value of correct history taking and the use of the precise aids in diagnosis. In regard to the Widal in the case just recorded, I thought this to be almost positive but not conclusive, but there was no uncertainty as to the presence of the specific bacillus in the stools.

Another case showed neither Widal nor isolation of typhoid bacillus from the stools. However, since her attack of typhoid almost six years previously, two other members of her immediate family had been affected. Relief was prompt after the use of but two injections of the typhobacterin.

A third case, and indeed several other cases of true mucous colitis, showed nothing either in their history or in the examination to warrant expectations in specific therapy. However, the bacterin was routinely administered, though I was not surprised and disappointed that no good results were obtained. A review of these cases convinces me, and may impress the reader, that, the diagnosis completed, the treatment was but a small item.

In other communications I have called

attention to the fact that many of the spring dyspepsias are caused by the bacillus of Pfeiffer (Medical World, July, 1913). Not only may several weeks of sick stomach follow an attack of grip, but may occur when not preceded by a definite sickness of this type. In other words, we are deal

ing with a true chronic infection caused by ing with a true chronic infection caused by

the influenza bacillus. There occurs a loss of appetite and attacks of sick stomach or gastric indisposition immediately after eating, rarely vomiting. Associated may be a headache at certain hours of the day, sweats and possibly some fever, which is erratic to say the least and often absent. At night the patient may cough. But the case is featured by the stomach symptoms. It is surprising how quickly the influenza bacterin will aid in these cases. It seems somewhat far-fetched to administer bac

terins in sick stomach; but, the diagnosis made, the method is not unscientific.

I could detail many other cases where excellent results were obtained, but these only by a careful diagnostic study; however, these few I regard as somewhat unusual, and this may serve as an excuse for their rehearsal.

The possibilities of specific therapy are many and certainly not even estimated by the most enthusiastic worker. But in order that these be realized let us not forget to build solid diagnostic foundations.

Major Points on the Minor Drugs.

By THOMAS S. BLAIR, M.D.,

HARRISBURG, PA.

Second Paper-Stimulants and Excitants. In this high-pressure age stimulants and excitants are used too much, at least the major ones are; but this paper will not consider the major stimulants.

Practically speaking, the minor drugs of this class are really irritants. Water, sunshine and air are irritants; certain foods

are irritants; the forces accountable for modern civilization are irritants; they are natural and physiological. Then why not of ailments not really requiring stimulants? use the drugs which are irritants in the host

The line between stimulation and narcosis is sometimes hard to sharply define, as witness the instances of alcohol, ether and some of the vegetable narcotics. Stimulation plus reaction may not be real stimulation at all. Yet we like to play with fire, and have drugs exhibit spectacular effects; just to our liking. sharply-defined drug reactions seem to be

I have sometimes wondered what would

Su

happen if doctors never ate food themselves but prescribed foods for their patients. What sort of diet would we favor? perior to mundane bread and meat ourselves, yet possessed of elaborate laboratory data regarding the action of foods upon the lower animals-horses, sheep, monkeys, etc. -what would we decide was a proper diet for man?

The first thing we would do would be to announce that tomatoes, cherries, cabbage, and all of the watery foods innocent of calories would have to go. The question would arise, "Why eat starch?" Surely converting it into glucose is in accordance with science; so it would be exit to potatoes, rice, green vegetables and bananas. Probably dates, figs and dead-ripe sweet fruits