ing the spinous processes and laminae only. The procedure in such cases is just as warrantable as operation for depressed fracture of the skull. Injuries due to direct trauma are apt to be of this character. Sudden forced flexion of the spine is usually the cause of dislocation and fracture of the bodies of the vertebrae.

Laminectomy for fractures or dislocation should be made early. The earlier the better. The longer pressure has existed the more extensive the degeneration of the cord. Still hope need not be entirely abandoned in old cases, for laminectomy has relieved many such even after months had elapsed since the injury was received.

Laminectomy is per se not dangerous. It represents the surest method of diagnosis of fracture and dislocation, and the most raional and efficient means of relief.

Hot Baths in the Treatment of Fevers, More Particularly in the Case of the Aged, Debilitated Persons and Children.

H

BY GEORGE I. BLUHM, M. D.

SAN FRANCISCO.

YDROTHERAPY in the form of baths in the treatment of fever has been employed since the dawn of history. As to the method of their application, whether hot, cool cr cold, the medical profession since the earliest times has been divided into different schools. Hippocrates advised tepid baths in the treatment of fevers and pneumonia. In the time of Galen among the medical profession at Rome were the thermophiles who preferred hot, the psychrophiles who preferred cool, and the psychrolites who preferred cold water in the treatment of fevers (Westbrook and Brickner). In our own time, however, the hot bath in the treatment of fevers has been relegated to the background, giving way to the cold bath. In the administration of the latter there are the adherents of the Brand method, that is to immerse the fever patient at once in a bath of 65 deg. to 70 deg. F., and the followers of the Von Zieinssen's method, namely, to start with a temperature of 90 deg. F., and, by the addition of water at 40 deg. F. or of ice, gradually lower its heat to the desired temperature, while the patient is in the bath. Both Brand and Von Ziemssen insist that friction must be continued as long as the patient is in the bath. If this be omitted the patient is only chilled by the long and thorough contact with the cold water, and the subsequent dilatation of the superficial blood-vessels is delayed, or lost altogether, defeating the object of the procedure. Westbrook and Brickner (Foster's Therapeutics) also point out the fact that the immediate result of the cold bath on human temperature is a slight rise, due to the large amount of heated blood driven from the periphery into the internal organs. The temperature of the body in the course of an hour slowly falls. In part this is effected by the active dila

tation of the blood-vessels of the skin following their early contraction, thereby carrying cooled blood to the internal part of the body, and in part to the opportunities of heat dissipation offered by the dilated vessels. We can readily see then that the beneficial results of the cold bath depend not upon the primary action-the mere reduction of temperature by the rapid abstraction of heat due to surface radiation-but upon the reaction, the dilatation of the superficial blood vessels and the heat diffusion. Therefore, a patient who does not react from the first shock must and will be greatly harmed by the cold bath. I have observed that debilitated persons, the old, and especially children, do not react very well to the cold bath. They seem to lack the natural rebound which is necessary to prevent congestion of a permanent nature, after being subjected to a cold plunge. Furthermore, in a majority of instances in private practice the cold bathing cannot be carried out, due to prejudices on the part of the parents or relatives.

Again, if we are to be guided by the sensations of the patients the cold bath is certainly cruel in the above-named instance. Every one of us knows how bitterly those patients complain while in the bath or cold pack. Some beg to be killed outright rather than inch by inch. The shivering and the cyanosis of the little ones appeals to us for sympathy. Last, but not least, the services of the attending physician are often abruptly discontinued if he insists on the cold bath, thereby doing an injustice to himself without benefiting the patient. Considering all these disadvantages and unpleasant features connected with the cold bath, more particularly in the class of patients mentioned I will venture to lay before the medical profession my method of hot baths in the treatment of fevers for their critical consideration and trial.

The procedure is very plain. (1) The bath having been prepared at 90 deg. F. the patient is immersed in it. The water should cover all of the body to the head, which should rest on a pillow. (2) By the addition of hot water the temperature is gradually increased to about 103 deg. F. This temperature is kept up for about ten minutes: then (3) by the addition of cold water the temperature is gradually lowered to 90 deg. F., or even to 85 deg. F., being guided by the sensation of the patient. Then he is removed to bed, wrapped in a dry sheet and covered with a light blanket. Food and some stimulant is given after the bath. A handful of mustard put into the bath helps to produce cutaneous hyperemia. A slight rubbing of the limbs and trunk is kept up during the first and third stages of the bath. A drink of cold water should be offered to the patient during the second stage. It will help to bring on perspiration by causing contraction of the blood vessels in the center of the body, and the blood rushing to the surface stimulates the sweat glands to activity. The perspiration is very essential, as it will, among other things, abstract heat and prevent overheating. Currents of air should be carefully guarded against. The air of the room, if possible, should be at about 70 deg. F. The bathing can be repeated two or three times a day. Reviewing the immediate effects of this bath it will be seen that the first two stages are devoted to opening and stimulation of the pores of the skin. A physiological dilata

tion of the cutaneous blood vessels is brought about. The skin becomes somewhat hyperemic, congested and soft, it contains more fluids, and it becomes a good medium of exchange of heat. Through the sweating heat is abstracted and the moistened epithelium favors an increased heat excretion and dissipation. The last stage of the bath is devoted to the contraction of the opened pores and their supplying blood vessels, thereby preventing the gradual chilling of limited areas which might result in internal congestion. The latter is still further guarded against by the alcoholic stimulant after the bath, and by the blanket. If properly carried out the action is certain and the effect durable. In this manner everything which is claimed for the cold bath seems to me is obtained. There are some advantages which I will endeavor to point out.

1. Elimination.-Simultaneously with the perspiration the volatile acids, albumen and urea are removed (Armstrong). The toxins, our greatest enemies, are to a great extent eliminated. That the skin is endeavoring to free the system from the toxic products is well proven by the peculiar odors associated with many diseases. The odor of typhoids and carcinoma patients f. i. It is the best assistant to the temporary crippled emunctories, kidneys, intestines and lungs, to free the body from effete matter.

2. Counterirritants.-In fevers with some local congestion the blood is drawn off from the congested organs through the dilatation of the cutaneous blood vessels, thereby lessening the congestion, tension and, indirectly, pain.

3. Produces Cerebral Anemia.-Armstrong cites Musso and Bergesio who found in a person who had lost a portion of the scalp and skull that in a bath of from 100.4 deg. to 102.2 deg. three or four minutes sufficed to produce venous congestion and slowing of the pulsation of the cerebral blood vessels, followed by cerebral anemia and slight acceleration of the pulse, these latter conditions persisting for some hours after the bath. It has also been experimentally observed that a warm bath causes a diminution in the caliber of the vessels of the pia mater, on which ground may be explained its hypnotic action. It occurred to me then that the hot bath should be a great therapeutic agent in the treatment of all forms of cerebral and cerebro-spinal meningitis. I applied it in practice with much gratifying results. I applied it extensively during the epidemic of cerebro-spinal meninigtis in the summer of 1898 in Chicago with marvelous results. I want to emphasize that in the cerebral and cerebrospinal fevers I remove the patient at the end of the second stage of the bath, in order to give him the benefit of a full hot bath on the above explained ground. To guard against gradual chilling with its possible bad results, as explained before, the little ones are dried and wrapped in a light blanket, also a dilute alcoholic is administered per os.

4. Analgesic and Anesthetic.-By the calming effect upon the central nervous system it acts as a decided sedative. Moderate degree of heat diminishes the irritability of the nervous system, thereby the hot bath exercises a general sedative effect, and acts as an analgesic.

5. Antispasmodic.-Every practitioner knows that when called to a case of convulsions in a child he finds the patient in a hot mustard bath, as the laity has already been taught of the great antispasmodic effect of the hot bath, and they know that the first thing the doctor will do is to order it. From its direct antispasmodic effect upon the nervous system it is particularly advantageous in fevers accompanied with excessive excitability and insomnia.

6. Cardiac Stimulant and Tonic.-The hot bath produces a general diminution of blood pressure due to the cutaneous vascular dilatation, thereby relieving the heart's action. The tonic effect of the cold bath on which so much stress is laid is, therefore also produced by the method in question.

7. It Avoids Shock.-It is agreeable. There is no cyanosis. Therefore the hot bath in the treatment of fevers, especially in the case of the aged, debilitated persons and mainly in children, accomplishes just as much as the cold bath without subjecting the patient to torture, combining the useful with the agreeable, which should be our watchword in treating the sick and the suffering.

1012 Mission St.

MENTHOL has reached a higher price than demanded at any time during the past ten years. The advance seems to be due to a short crop of peppermint in Japan. It is interesting in this connection to recall the fact that it is now only twenty years since menthol became an important article of commerce in this country. In the early eighties the menthol pencil became popular and was expected to cure all forms of neuralgic troubles. At that time menthol sold as high as $18 per pound.-Meyer Bros. Druggist.

MISTLETOE AS AN ANTISPASMODIC.-Dr. C. P. Mills, of Addison, Mont. (Chicago Medical Times, February, 1902), who has, found viscum album or mistletoe, a specific for chorea, reports a case treated with the fluid extract of phoradendron flavescens (American mistletoe). Five-drop doses were given every two hours all day, and until the child went to sleep in the evening. He slept soundly until nine o'clock the next morning, and awakened improved. In a case of infantile convulsions relief was obtained from the use of one-tenth minim fluid extract mistletoe (P., D. & Co.) every thirty minutes, at first, then every hour until the spasms ceased. Acute Laryngitis.-Progres medical recommends the following:

gr. 30

.aa m 45

aa m 30

The patient should breathe twice or thrice daily the vapor of a few drops of this mixture.

Evaporate in an iron spoon over a lamp.

Treatment of Typhoid Fever with Castor Oil.

BY C. C. BASS, M. D.

COLUMBIA, MISS.

Read before the Mississippi Valley Medical Association, Kansas City, October 15, 1902.

T is proposed in this paper to call the attention of the association to a treatment for typhoid fever which is at once old and new. The treatment is old in that castor oil has been administered for many years to relieve certain conditions as they arise in the course of the disease, it being often used to relieve tympanitis, constipation and accumulation of undigested and hurtful food. Perhaps there are few physicians present who have not used castor oil at some time in the treatment of typhoid fever. It is the equivalent of the established eliminative treatment, but it is a better choice of drugs. It is new in that castor oil has never been administered as an exclusive, or nearly exclusive treatment. The quite considerable inquiry which I have made has failed to find the treatment suggested in this light, except in an article of my own published in the Mississippi Medical Record, April, 1902.

ere forms.

This paper will present briefly: (1) the theory; (2) the method, and (3) the result of the treatment.

I. The Theory.-Typhoid fever is an acute, contagious, self-limited disease characterized by inflammation, necrosis and ulceration of Peyer's patches and the solitary glands of the small and large intestines. The cases are generally divided into three varieties; the abortive, the mild, and the seIn the abortive form there is no necrosis and no uleration of Peyer's patches. In this form the temperature reaches normal in the second week. This form seldom occurs in the section of the country where I practice. In the mild type, the temperature reaches normal in the third week, with slight elevations generally extending into the fourth week. The bowel lesions may be extensive, but healing is prompt. In the severe form the temperature ranges high. It may reach normal in the fourth week, but may not do so for a number of weeks longer. In the second or third week, the patient passes into a low adynamic condition characterized by dry tongue, sordes, delirium and muscular disturbance. It is also claimed that severe cases are those in which the absorption of toxins from the alimentary canal is excessive, and elimination therefrom defective. In the abortive cases there is seldom tympanitis, in the mild ones very little, in the severe ones this is a prominent symptom. The