of threatened attacks of fever. With the explanation of what I believe to be the character of these fevers, I will explain the details of treatment as carried out by me. I may say that I have not lost a patient of which I have had the care from the start in five years. Being engaged in a speciality, I may not have had as many cases as some others, but I have had a considerable number, and enough to give me confidence in my methods. There is one remedy that I esteem of more value than all others-and that is water. Fifty years ago my parents lived near a water-cure establishment in central New York, and from them I heard accounts of water treatment of typhoid fever long before I even thought of being a doctor. I have never used the shower-nor the bath-tub immersion, as has lately become popular under the Brand system, for two reasons: 1st, because in most private houses there is either no bath-tub, or it is remote and inconveniently located for such use. 2nd, because I object to the physicial and mental shock necessarily attendant upon the mode of precedure: My favorite plan is to put the patient on a cloth-covered cot, wrapped in a wet sheet only. Where the patient is nervous or inclined to spasms, instead of having the sheet wet beforehand, I have it put on dry and then slowly wet by pouring on warm water from a pitcher or squeezing it from a sponge. Colder water is gradually used and I do not calculate to wait for more than an hour before I have the temperature down to 102 degrees, however high it may have been at the start, and I never allow it to stay above that point. When it approaches 101 degress, a flannel blanket is put round the sheet, and when 100 degrees is reached, patient is removed to dry clothing and bed. By taking advantage of evaporation and radiation in the manner described, it is just as easy to control high temperature as it is to keep up a fire in a stove in the winter time. The feet and legs below the kness are generally not subjected to refrigeration, hot bottles and dry flannel often being applied. Sometimes the hands and arms have to be treated the same way to keep them warm. The prolonged packing I believe to be beneficial beyond the reduction of temperature. It softens and clears a dry torpid skin and tones up a flabby perspiring one, and I am sure that a restored functional activity of the skin helps materially in elimination of poison from the system. I carry the water a step further and wash out the colon every two or three days. In my whole experience so far, I have found but two patients in whom the water treatment was not well borne, and in one of those I think it would have been beneficial but for the father who thought he knew more than I did. The case in which it was undoubtedly harmful was that of a person of delicate constitution, and weak reactive power, have adynamic fever with not very high temperature. A single pack of two hours duration sometimes suffices to dissipate a fever at its commencement. In my extreme case the patient was in pack fully two-thirds of the time for three weeks. About midway of her attack, her left leg became considerably swollen, red and painful from her foot to her body. She and some of her friends thought it came from being wet so much. If such was the case, I applied the homœopathic remedy, for nothing dismayed, I wrapped it up in a wet cloth and surrounded it with oilcloth for twentyfour hours, and had no further trouble with it. While I look upon water as the main remedy in these cases, I do not disregard anything else that may promise benefit. Maintaining quiet in a recumbent position and a fluid diet, I give gelsemium and eupatorium as the regular remedies in most cases, with bryonia, arsenic, mercurius and lachesis as I think they are called for. At any stage when an intermission with perspiration has occurred I have given quinine, with the effect of sometimes stopping the fever, sometimes mitigating it, sometimes not modifying it, and sometimes making it worse. My conviction is that convalescence has been delayed and attended by more complications in those cases in which I had used quinine. To allay nervousness, belladonna, stramonium and acetanilid have been used. Neither acetanilid nor phenacetine have been used to reduce temperature. I know a safer and better way. DISCUSSIONS. Dr. Kershaw:-I believe in the use of water in the treatment of typhoid fever, hot or cold, according to the indications in individual cases. Some patients are violently shocked by cold water; it should not be used in such cases, but rather hot, or warm, which soothes and quiets the nervous system, and is grateful to the fever stricken sufferer. I believe with Dr. Morgan, that the water can be best applied while the patient is in bed. The Brand treatment cannot be carried out in all bad cases of typhoid fever. Νο typical case should be allowed to raise his head from the pillow until convalescence is well established. I do not believe rectal injections should be given in all cases, as I have known three people to die while taking such treatment. I believe with Dr. Richardson that the glycerine suppository is a simple and harmless means of relieving the bowel of gas and faecal matter. I believe in the Brand treatment; but when the heads of large hospitals report that it is well-nigh infallible as a treatment for typhoid fever, and yet the mortality reports show that patients die in those institutions, just exactly as they do outside of them, it is apt to make one a little sceptical as to all he hears about this treatment. It is such an easy thing to tell a newspaper reporter about one's success in the treatment of disease; such an easy thing to write a learned article about our successful cases, and tell and write too, when we have just had a good dinner and feel comfortable and at peace with all the world; but when, in the dead hours of night, we stand at the bed-side of one who has placed his life in our keeping, and watch the dreadful battle with disease, the terrible struggle for that which is so dear to all of us, then, I say, the careful, thoughtful, conscientious physician realizes his great responsibility, feels how little he knows, and how useless too, and utterly impracticable are many of the well-known means of treatment when he comes to apply them to individual cases that differ from other cases in their course, com plications, and in the constitutional peculiarities of the subject. Every disease is an individual difficulty, and differs from other diseases of the same name, just as the individual subjects differ from each other. I believe in the homœopathic treatment of typhoid fever. I believe in the single indicated drug remedy as far as possible. I believe in absolute quiet, in the recumbent posture; the feeding with fluid food only; the free use of water as a drink and as an external application, and the treatment of every case as an individual disease, differing from all other diseases of the same name. Dr. Richardson:-The fevers change their character from time to time. Those we now meet are in no way similar to those we had five or even three years ago. Water is at present the fashionable treatment of fever among physicians who depend for their therapeutics upon magazines. I think the method of Brand is bad if not carried out properly. It is hard and impracticable, and consists in the immersion of the patient in water till his temperature falls to 100 degrees. The mortality of typhoid has been reduced by the Brand and its modified methods to six or eight per cent. It is used regardless of complications, let them be bronchitis, pneumonia or even the menstrual state with, it is claimed, only good results. Thinks the germs of typhoid and malarial fever may coexist, or that the latter may change or develop into the former. It don't really matter what the condition is that is presented, it is more a question of making a cure. That is what our patients want, and what we want, and certainly I have seen a case of simple malarial fever develop into a genuine typhoid, with genuine enteric symptoms from mismanagement or neglect. ment or neglect. The speaker was of the opinion that we must feed a fever liquid foods-milk when it can be borne, beef tea, broths, bovinine are all good. It is comparatively easy now to choose a good fluid diet. I think that when milk is constipating and impactions result, they must be washed away by copious enemata. When from any cause, it is impossible to use the enema, such as excessive tenesmus or tormina, or ulcerations of the rectum or colon, then a Wampole's 98 per cent. glycerine supposatory will give best satisfaction. I think solid food bad from its tendency to constipate. So. Dr. McElwee:-Fever is a disease of many varieties and there must necessarily be many remedies. In asthenic cases, low vitality, temperature of 97 to 99 degrees, pulse 65 to 68, thinks the cold pack directly contra-indicated, but in the converse of these it does great good. Thinks we are afraid of the term 'typhoid" and that we do not report many cases as being such, when they really are Thinks any fever that has present enteric symptoms, together with hebetude may be correctly reported as "typhoid". Thinks that this is the reason why the allopaths make such a favorable showing of cures in their reports. He would use a reasonable discretion of course, but is confident that we do not report all our cases as typhoid when we might, no matter how mild the symptoms. For irrigating the rectum, he uses Cole's irrigator and crystal water to which he adds 33 per cent. glycerine to soften the scybala and has most gratifying results, when this latter result is desirable by this means. Has tried pure glycerine, but it does not flow through the syringe. Also has used suppositories of glycerine and likes them equally well or better, especially if the scybala be in rectum, or if ulceration or the general conditions prohibit the intestinal irrigation. In cases of subnormal temperature and low vitality he supports the system by mild alcoholics, artificial heat, stimulating and bland foods. Where acid diarrhoia is present, as indicated by the litmus paper, he uses salol grains V. twice a day. Has not frequently had tenderness in cœcal region, but has met it in the opposite side of abdomen occasionally. Dr. Schott: The old school of medicine use refrigeration and intestinal irrigation, antiseptics, both internally and externally, and if we do not use the homoeopathic remedy, why do we call ourselves homœopaths. In listening to this evening's debate, was obliged to recall to his mind that it was a homœopathic society he was attending. He greatly decried the fact that so little attention was seemingly paid to the selection of the homoeopathic remedy, and that any means should be adopted to artificially raise our percentage of cures by misrepresentation or falsely reporting cases as typhoid when they were but malarial or simple continued. If we cannot find the homœopathic remedy and cease seeking it, let us go bodily over to the enemy and cease to cast a slur upon our escutcheon. He thinks it is the manufacturing pharmacist who is now our master of therapeutics. It is he who does the prescribing. He leaves us a barn full of bottles, pills, draughts and all abominations with minute details, as to how and when to use them, the exact cases they will belp, and those they will not, and we are too prone to take his word for it, and do as he directs, often making a cure, more often failing and always to the detriment of homœopathy, and why we should call ourselves homœopaths, while we follow this course, he failed to see. The homœopathic law is difficult to apply and we can absolutely never do so, if we treat the name of the disease only. As a curative agent cold is absolutely of no avail. It may prove a means of promoting the comfort of the patient for a time by reducing the amount of absolute heat in his body by abstracting it more quickly than it is formed, but it does not for a moment prevent its formation. The indicated remedy may be obscure, may be difficult to find, but we may be assured that it exists and that it is our own lack of knowledge and that only, that prevents our finding and applying it. Recited a case where low temperature, constipation, dark almost black urine was found indicating as he supposed terebinthina which was administered without avail followed by lacheses and oxalic acid with negative results, till an obscure symptom, and one remotely related suggested helleborus, which was then given with the happiest results. If we hunt for the remedy hard enough and long enough we will find it, and it will never fail us. He has found no one remedy to cure many cases and never expects to. Thinks the iliac tenderness in fever may appear over rectum and signoid flexure instead of over the ileo-cœcal region. Dr. Canfield:-Spoke of the difficulty of choosing the homœopathic rem |