2. The greater number of cases are curable.

3. Many apparently hopeless cases are

curable.

4. The length of time a case has persisted is no bar to treatment-providing organic change has not obtained that precludes possibility of cure.

5. Treatment used must always depend upon the case in hand.

No. 3416 Vermont Avenue.

Obstruction of Gall Ducts.

By I. B. WASHBURN, M. D. Rensselaer, Ind.

The patient, a veteran of the Civil War, aged 64; occupation, physician and surgeon.

He contracted a chronic diarrhea in 1862, that was worse in hot than in cold weather until six years ago, when it continued bad all the year.

He obtained most relief from intestinal antiseptics, subgallate of bismuth serving a better purpose than the sulpho-carbolates, salol, etc.

About three years ago he consulted an intestinal expert because of the intestinal disease accompanied by jaundice of the sclera and skin, pruritus from crown to sole, so bad that it prevented sleep or rest unless under the influence of a hypnotic. His urine was as dark as port wine, and his stools were a light gray color. There were no pain, fever, or other symptoms of serious import. The diagnosis was "catarrhal jaundice causing obstruction of the bile ducts." He suggested that the patient consult a surgeon, but this was not done until several months later, when one of the most noted in the city of Chicago was called upon, who, after a careful examination, said "the obstruction is most probably caused by gall stones," and proposed an operation for relief.

After due preparation, the operation was performed, but no gall stones were found. The bile cyst was atrophied to half its normal size, and there were peritoneal adhesions between the liver, stomach, and pancreas, which were broken up.

No other pathologic condition was found, notwithstanding that the existence of carcinoma and hypertrophy of the liver had been suggested by some of his medical friends.

The first day after the operation the patient suffered very much from pain in the region of the wound. This was controlled so well by hypodermics of morphine that the patient declared himself much better the next day. The icterus began to disappear at once, the pruritus was lessened, the wound healed very kindly, and in three weeks the patient returned to his home in good condition. The surgeon was the most surprised of anyone at this, as his prognosis had been unfavorable, his supposition having been that during his manipulations he had dislodged the obstruction, whether a small stone or a plug of mucus in the common duct is not known.

After two months, the patient had recovered so that he resumed practice, taking long rides to patients in the country. This he continued to do for about five months, until one day, after a ride of seven or eight miles in a sleigh, he was seized with a chill (the first he had ever experienced), followed by fever (104.4°), and severe pain in the region of the gall bladder, radiating over the abdominal region.

He contended that the chill, fever and pain were caused by infection, but his friends thought it due to malaria, and prevailed upon him to take an antiperiodic, which he did, his fever and general discomfort increasing nevertheless.

After this attack his urine showed the presence of bile pigment, stools were light-colored, the pruritus and jaundice. returned. The attacks came upon him quite frequently, even daily.

A medical friend suggested that he take sodium succinate. Tyson mentions it in his practice, and quite a number of writers had commended it in the journals. It was lauded by one or two writers in the COUNCIL. He took it (5 grains ter die) for five months without noticing the slightest effect.

Following this, he consulted a professor of "internal medicine," who suggested

that he take salicylate of sodium (10 grs. ter die), which he did for two months without other effect than to disturb his stomach.

Later another Chicago friend tried to relieve him by a meat diet, excluding fats, sugar, and starches. This was likewise a failure, as the attacks of pain, chills, and fever, were as frequent as before. He had slight fever all the time, ranging from 99° to 102°. By this time (October, 1901) his case was becoming desperate, when his son, who is a physician, consulted the surgeon who had operated the year before. He prescribed large linseed-meal poultices to be applied hot every 15 or 20 minutes for three hours each forenoon and afternoon, and that he take a quart of Carlsbad water (imported) in divided doses, as hot as he could drink it, every day. He followed this treatment for over three weeks, which lessened the frequency and severity of the attacks of pain, but the fever continued.

He then went back to the hospital. His physician having taken a vacation, he was referred to his colleague, who is equally eminent, and who examined him most thoroughly and ordered the following treatment. Carlsbad salts to free catharsis, with benzosol as an intestinal antiseptic, and a liquid diet.

He said that the object was to clean the intestinal canal of infection and to keep it so. The effect was all that could be asked, as it seemed not only to be immediate, but also complete, for the pain, chills, high fever, and pruritus disappeared and remained away until the salt was given less frequently and in smaller doses, when his bowels again became constipated, not moving for nearly three days,

and another attack followed.

His physician, having returned and examined him, proposed another operation, which was done, but no gall stones were found. About the same pathologic condition was noted as before: complete atrophy of the bile cyst, and a partial atrophy of the duct, with some peritoneal adhesions.

The wound was closed, and healed very nicely in three weeks. The patient then The patient then

returned home very weak, weighing probably less than 115 pounds.

He was thoroughly tired of "hospital diet," having had six weeks of liquid food, and he naturally craved something more substantial.

Since his return, he has taken from 1 to 2 drachms of Carlsbad salts in half-apint of water as hot as he could drink, before breakfast; also benzosol, 5 grains in capsule, every 4 hours, and, if required, one or two laxative tablets evenings to insure free catharsis the next day.

He has now been at home seven weeks, has gained over 30 pounds, has had but one attack of pain in eight weeks, which was light and of short duration. He now hopes that if he continues this treatment long enough, Nature will thin the thickened walls of the duct, the lumen will be enlarged, and that permanent relief may

follow.

A Bureau of Public Health.

By WILL P. BRADLEY, M. D. Pale Pinto, Mo.

From time immemorial, man has been

negligent of his physical well-being, and has ignored the very patent fact that he is, physically, a very delicate machine that needs the utmost care and attention. Men of all ages and climes have devised ways and means by which their incomes might be increased; have toiled and labored that their children and children's children might be educated, cultured and refined; have worked incessantly on their farms or in their counting-rooms to improve agriculture and commerce; but scarcely a moment's time has been given to the physical well-being of their families, save when some malady forced them to call in the family physician. Sanitation, hygiene, and proper ventilation were things unthought of save when attention was called to them by the doctor.

This

As the family, so is the nation. great country of ours pays far less attention to the health and physical welfare of its inhabitants than to its commerce, growing crops, or the improvement of hogs, sheep, and cattle. The finances of the country are looked after by a great

department; our foreign relations are cared for by a cabinet officer; the Secretary of Agriculture has the care of the farming and stock-raising of the country; and a measure is now pending in Congress for the establishment of a Bureau of Commerce and Labor, with a Cabinet officer at its head.

All these are of much importance to the country, but none, it seems to me, are more so than would be a Bureau of Public Health presided over by a Cabinet officer. The good that might be done by the establishment and proper maintenance of such a Bureau can hardly be overestimated, and none save members of the medical profession, or those who have made a proper study of sanitary conditions, are competent to judge of the farreaching results that would accrue from the proper working of such an organiza

tion.

Year after year contagious and epidemic diseases are brought to our shores, and are allowed to be scattered broadcast throughout the land, counting their victims by the thousands. It is true the Government makes an attempt to prevent the bringing of these diseases ashore, but there is no organized effort, and when the diseases are once started, the care at once falls on the boards of health of the different States, most of them poorly organized and none of which work in concert.

As a result of negligence somewhere, presumably with the National Government, small-pox was brought to this country by the soldiers from Cuba, and, through a lack of organization, the disease has been allowed to spread until this dreaded malady now has hundreds of victims in almost every State and Territory in the Union, with the boards of health of the various States unable to promptly stamp it out.

Any thinking person can understand how, with a National Bureau of Public Health, this pest could have been throttled in its incipiency, and the country at large been saved from its most dreadful effects. Of course the blame for all this is shifted to the shoulders of the poor Army Surgeons-the men who were not allowed, in our Cuban campaigns, to even

raise their voices in protest against the unsanitary conditions that were killing a hundred times more soldiers than the Spanish shot and shell. But the American people will not believe that the selfsacrificing Surgeons were to blame, and the medical profession know that hundreds of lives need not have been sacrificed if the Army Surgeons had had a Cabinet member at Washington to back them in their insistence for better food and more suitable clothing, together with better sanitary conditions in camp.

We all know how the medical profession has been degraded by the army and navy until the self respecting men have almost ceased to apply for positions in either department. And who can blame them for this, when it is known by all that the humblest line lieutenants treat the surgeons with a patronizing air that plainly tells that they only endure them because their services may be needed? These young army and navy officers should be taught that a course at West Point or Annapolis is no more arduous or elevating than a medical course, and the United States Government should teach them this important lesson.

Let Congress establish a Bureau of Public Health, make the head of this department a cabinet officer, and let the President fill the place with a member of the medical profession. Then will our army surgeons not only be respected, but also obeyed in all matters pertaining to their department. The good that would result to the army, alike in war and in peace, is readily imagined; but all this is but a single pebble on the seashore compared with the vast amount of good that would ensue to suffering humanity. the country over with such a Bureau working in good order.

Sub-bureaus or stations could be established in every State and Territory, a scientific study made of all diseases common to each locality, the cause and prevention, so far as possible, of these diseases made known to the people, and a

uniformity of action secured throughout the country. Should yellow fever, smallpox, or any other of the contagious diseases break out, the entire machinery

218

could be set in working order in an incredibly short time, and the malady confined to its place of origin. There would be no wrangling of State Boards, but Uncle Sam would have the matter well in hand, with the afflicted community under the surveillance of a corps of competent physicians.

Since the days of Esculapius, honest, conscientious, and self-sacrificing physicians have, at a great financial loss to themselves, been trying to eradicate disease, and teach the people the use of hygienic measures and sanitary precautions, but at every turn they have been hampered in their work by the very ones they were seeking to benefit-the people themselves. Much has been done tor the cause of humanity, but it has all been accomplished either by individual selfsacrificing effort, or by medical societies working without the sympathy of those they wished to benefit, and without any aid whatever from the Government.

With a Bureau of Public Health, and a scientific and conscientious medical man to preside over it, with a seat in the President's Cabinet, the United States would soon outrank Germany in the application of scientific medicine, with resulting good to humanity that could. hardly be overestimated.

Results Following the Use of Bichloride of Mercury Baths in Small-Pox.

By G. W. BOLKCOM, M. D.
Tower, Minn.

After reading Dr. Osborn's specific treatment of small-pox, in February COUNCIL, I determined to try it.

Shortly afterwards a man of about 45 years, strong and vigorous, his business being that of a lumberman (as we call them here, "lumberjack "), was removed to the pest-house with a well-developed case of small-pox.

I commenced using a 10-per-cent. solution of bichloride of mercury twice daily, pulling the clothes on without drying the skin, and using a spray of peroxide

[THE MEDICAL COUNCIL.

of hydrogen in the throat, mouth, nose and eyes.

Second day, first mishap. The patient thought, as his scrotum and penis were more generously supplied or covered with papules than other parts, that they ought to receive an extra bath. Accordingly, after the nurse had finished his bath, he gave these parts an extra dose by dipping the cloth in the solution and squeezing it so that the fluid ran down over the penis and scrotum. He did not continue long before the parts thus deluged turned white, and he complained of excruciating pain.

They tried everything that they knew to allay pain, but without avail. I was hastily summoned. hastily summoned. I found him nearly crazy with pain. We happened to have some wood alcohol, and with this I saturated a cloth and applied it with almost immediate cessation of pain. Anyone can readily imagine the condition of the penis and scrotum from that tiine on.

Not discouraged, I kept up the baths for a week, when he commenced to complain of his gums and teeth being sore. I stopped the baths immediately, and

commenced the treatment for mercurial

ptyalism, but he developed a severe case of old-time salivation, with loose teeth, etc.

Dr. Osborn says: "But the danger is minimized when we are assured that the aqueous solution does nothing more than produce a mercurial ptyalism, and that only in cases of hereditary idiosyncrasy, or about one instance in ten thousand cases."

Was this case one of hereditary idiosyncrasy, or one in ten thousand? Perhaps it was, but I am going to let some one else try it on the nine thousand and ninety-nine, and in future use a solution. of from 1 in 1,000 to 1 in 500, which will be found equally as efficacious, without the danger of complications arising from the use of a stronger solution.

Correction.

In the article by Dr. Carl Gissler, page 113 of the March (1902) number of THE COUNCIL, the statement that the doctor blamed Mrs. Butz for sending a certain postal card was a typographical error. The doctor wishes it stated that he does not consider that Mrs. Butz sent the postal card.

A Clinical Report of the Osborn Treatment of Small-pox-Uniformly Successful.

By S. S. BOGLE, M. D. Santa Rosa, Cal.

Case No. 1-J. W. C., age 32; male, brunette. Saw patient for first time January 24th; found him well broken out all over the body with small-pox; took the following history: On January 15th took sick with chills, headache, backache, and high fever; on the 19th a rash appeared on face and hands; on 20th rash covered the whole body; there was also a slight sore throat; on 22d vesicles were well formed; on 24th I was telephoned for, and found the characteristic odor of small-pox along with the history and rash; there was also orchitis of the right testicle. I immediately telephoned Dr. J. W. Jesse, county health officer, who confirmed my diagnosis. We prickel several of the vesicles, none of which collapsed. Patient's temperature was 102 2-10°. I ordered Osborn treatment of bichloride baths to be given twice a day. Those having been exposed were also to use the bath, as directed by Dr. T. C. Osborn, of Cleburn, Texas. January 25th, temperature, 101 3-10°; no odor; had slept well for first time in four days. January 26th, temperature normal, and remained so throughout remaining period of the disease. Patient was discharged from quarantine on February 10th. spoke of immediate relief from odor, burning, and itching after using the first bath. He has no pock-marks or pitting. Diagnosis, discrete variola.

He

Case No. 2-Mrs. T. A., age 21; female, blonde. Had headache, backache, chills, and high fever for four days prior to rash. Had well-defined small-pox rash of discrete form, also had vesicles in throat and on tongue. Put her on Osborn treatment, January 25th, with immediate relief. Uninterrupted recovery, with no pitting.

Case No. 3-L. A. P., age 30; male, brunette. Had the usual symptoms preceding the eruption, and on fourth day rash appeared. Had a well-defined case

of confluent small pox. Face was swollen until eyes were closed, and there was no place unoccupied by vesicles; the arms, back, and lower limbs being also covered with coalesced vesicles. Vesicles on chest and abdomen were discrete; also had right orchitis. The eruption appeared on 17th. Saw patient on 25th for first time, and put him on Osborn treatment. In two days, the edema of face had almost disappeared, and the odor, burning, and itching had entirely gone. Made an uninterrupted recovery without pitting (only four or five marks). I fully expected this case to pit when I wrote you on February 3d. The patient was discharged from quarantine on February 18th.

Case No. 4-R. C. C., age 50; male, brunette. On January 25th, saw patient first time; found a well-developed case of confluent small-pox with full premonitory history. Put him on Osborn treatment, with immediate relief from itching and odor. He developed several boils, also specific iritis, which delayed his recovery somewhat. Fully recovered from smallpox, and has no pitting.

I have had, altogether, eight cases of small-pox and ten cases of varioloid during this present epidemic, all of which were treated by the Osborn method, and all with the same pleasing results, every one being relieved of offensive odor and annoying itching. Have had no deaths, nor any pitting in any of my cases. was there a single case of small-pox or varioloid developed among those who were exposed before quarantine (about forty-five in number). All those exposed used the bichloride bath twice a day as a preventive.

Nor

None of those who developed smallpox had ever been successfully vaccinated. Two had had varicella. All those who Two had had varicella. developed varioloid had been successfully vaccinated. I am fully satisfied with the remedy, and believe that I would have lost two of my cases (the two with confluent form) if it had not been for the Osborn treatment.

I must have The Council, for it is a great help to me in my practice. Faithfully yours, Burt R. Miller, M. D.

New Washington, O.