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food thru the intestins at a rate which allows Senator Hanna's Case, and the Dietetic of free absorption. They are taught to avoid

Treatment of Typhoid fever. over-clothing themselves day or night, to keep Editor MEDICAL WORLD:—The following the extremities dry and warm, to sleep nine extract from an editorial in the World's hours out of twenty-four, and to avoid heated Work is of interest to the entire medical assembly rooms. They visit the dispensary at profession : “Every man in middle life, who 7 a.m. and 7 p.m. for advice, and to report has had the usual experiences and the usual obtheir condition, and are weighed twice a week, servation of an American, knows how murgreat importance being attacht to gain or loss derously incompetent a very large number of of flesh. The entire method is that of increas- practicians are—it is a public scandal in almost ing the patient's resistance by food, air, sun- every part of the country.” light, and a minimum of drugs, quite after the We must confess that this charge is too well manner so successful carried out by Trudeau founded ; but, that this incompetence is not at Saranac Lake.

confined to the humbler members of the proThe plan at Vanderbilt clinic is really the fession, to the “rank and file,” we need no same, with about the same relativ results. So plainer demonstration than the publisht records far, in a period of three years, nearly 50 per of the case of the late Senator Hanna. cent of all cases treated—incipient, advanced, The percentage of mortality in typhoid, and far advanced—have had the disease under the treatment approved by the profesarrested; and 25 percent have been “appar- sion, following the advice of the leading ently” cured. The experimenters are very authorities, ranges from 15 to 20 in the careful not to be over sanguin, and are rather various epidemics. I am aware that many inclined to minimize the results in order not physicians in various parts of the country reto give a false impression of the efficacy of this port much more favorable results. There are treatment.

hundreds of physicians who “never lose a case Professor Walter B. James has said that he of typhoid fever" ; none, however, have, in a has been surprised to see how very bad cases large number of cases, approacht the results ateven will improve under strict surveillance of tained by the strict Brand method, socalled, this sort; for the rules laid down are most viz., 12 deaths in 1,200 cases. rigid, and any departure from them is likely to Now, if you were to ask your subscribers cause the patient to be “ dropt”-a proceed- what is the Brand method in the treatment of ing he very much fears. But the whole matter typhoid fever, I will venture the assertion that is one of absolute obedience to the laws of 75 percent of them would answer, the cold health enforced by intelligent and competent bath; whereas that is only one item, and the supervision. If a patient has a temperature, least important of Dr. Brand's recommendaspits blood, and refuses to eat, he is put to bed tions. The withholding of food is Dr. Brand's with all the fresh air it is possible to get in a main point, the cold bath being incidental, crowded city, and is thus prevented from exer- and rarely required if the former is rigidly encising while under the care of a district nurse, forced. who can see many such patients daily.

In the March number of the Journal of AdThe method is not an ideal one, and no vanced Therapeutics there is the second part special claim is made for it, but it seems to be of a very able article on “Lobar Pneumonia as doing exceedingly well in New York, and a Secondary Disease,” in which occur the ought at least to prove worthy of a trial else- following remarks on diet, which I cordially where.

J. W. VOORHEES. endorse: “Especially to be avoided are all 355 W. 56th St., New York City.

nitrogenized foods—meat, eggs, fish, cheese, [What do our rural friends do for their tuber- milk; and broths containing them. The culous patients ? Are they neglected and products of these bodies, when undergoing allowed to die? Here is a voice from the city; putrefactiv decomposition, are of a highly now let us hear a voice from the country. -Ed.] poisonous character. Milk especially must be

avoided. It is swallowed as a fluid, becomes We have received quite a number of Pneu- precipitated as casein, leaving the whey free for monia articles that we are carrying over till absorption. My experience is, that this casein next fall. Perhaps now, just after the close of traverses the bowel almost unchanged during the season, is the best time to write up your impaired digestion ; if any change does occur, experience, while it is fresh in your mind. it is in the direction of putrefaction." We will keep the articles over and publish Now, if this be true in pneumonia, it is most them early next season. Don't forget bron- emphatically true in typhoid fever, when dichitis, too. And also, don't forget the cur- gestion and assimilation are virtually susrent diseases now and in the near future. pended; where the digestiv secretions, from Write of them for immediate publication. the salivary glands thruout the entire digestiv

a

tract, are nearly absent. It would seem that, peptonoids of the Arlington Company, or the under these circumstances, common sense panopepton of the Fairchild's, given at interwould teach the avoidance of food during the vals of three or four hours. continuance of the fever, unless it had been Now, let us consider the case of Senator predigested. But, of all foods that the prac- Hanna. I have taken this case under considtician should hesitate to force into the disabled eration from no wish to accuse anyone of digestiv tract of the typhoid patient, milk un- neglect or wrong.doing, but simply because, by digested is the worst.

the daily bulletins of the Associated Press, the Once more: “Although typhoid fever is entire nation was made acquainted with the essentially a system disease, its characteristic progress of the case, the daily variations in the lesion is the intestinal ulcer, which should, as condition of the patient, and some glimpses at far as possible, be kept at rest. Milk, which the treatment. But I have especially chosen has heretofore been regarded as the only proper this because it illustrates, as I look at it, the exclusiv food, is, as a recent writer, Dr. Inglis, disastrous results of feeding milk to a typhoid says, 'not a liquid, but a deceptiv solid,' patient. capable of filling the small intestins with dense The majority of practicians is guided by indigestible curds, which irritate the ulcerated authority and precedent, and follow the dictum bowel, and, in addition, ferment and cause of men like Professor Osler, who advises the gaseous distension."

use of milk in these cases. Now, typhoid fever is a conservativ process; It seems to me, however, not difficult, in it naturally tends to recovery. I believe that following the record in this case, to see how, Professor Osler is on record that, in typhoid left step by step, day by day, taking a case of entirely without medical treatment, 75 percent mild fever by the acknowledgment of the at. of them would recover, and 85 percent would tending physicians, the administration of milk get well with very little medical attention. My played havoc with the vitality of the sufferer, experience and observation, after mature re- culminating in the chill, which banisht alí flection, teach me that this estimate is even too hope. low; that under intelligent nursing, without We get the first intelligible report on Feb. medical aid, go percent of them would con- ruary 5, which, it seems, was the fifteenth day valesce favorably. That the results do not of the fever, the first symptoms having shown vary under the many different forms of treat- themselves on January 22.

We find a mornment attests the truth of this statement, the ing temperature of 100°, and an evening temonly advantage being, under the strict Brand perature of 102.2°. The pulse was regular at method, where the intensity of the fever is 8o. The doctors report no complications, and always greatly modified, and the mortality this seems to be the case thruout the course of very close to zero. I have seen cases of the fever. Surely this record justified the typhoid fever protracted three and four months physicians in claiming that it was a mild case. by the use of milk, while others have finally A man in the fifteenth day of typhoid fever succumbed under its continued administration. who has a regular pulse counting 80 to the The idea that typhoid patients would starve, or minute is certainly in very good condition. that they would lose strength to the danger But there is one ominous remark in this report, point without food, is contrary to experience to which the attention should be called. “He and common sense. The absence of the high has been having milk for several days." temperature, the dry tongue, and other dis- The reports for the two following days are tressing concomitants of the milk-fed patient, not important, except that we begin to get the decided shortening of the period of fever, some intimation of the irritability of the enable the patient to convalesce with com- stomach which naturally follows the ingestion parativly little loss of strength or weight, and of milk. On the eighth we find the fever with no troublesome sequelae.

accelerated, being 103° in the forenoon, but But leaving aside all appeals to common dropping a degree in the latter part of the day. sense, how dare our hospitals, and prominent The pulse has increast, being 92 in the afterpracticians, many of whom guide the opinions noon, and we still find that the irritability of of the majority of physicians, continue to feed the stomach continues. How much mischief milk to typhoid patients, and render a mor- has been done to the gastric and intestinal tality record of 15 percent, when Dr. Brand tract we do not learn ; but, as later we are told has shown that under the no feeding practise that the patient is now retaining his nourishthe legitimate mortality is 1 percent?

ment better, we may form some idea. On the Before going further, let me say that there tenth the fever is decidedly less, being 100 8° may be cases in which, owing to the prejudices at noon, and a little lower later in the day; of the family, it is impossible to carry out the but the pulse has increast and the stomach still above advice. In this case you have the liquid rebels, tho Professor Osler reports that “all

of very

the vital organs are working well except the Dysmenorrhea.-Coal Tar Remedies. stomach.” On the eleventh the temperature Editor MEDICAL WORLD :-In reply to M.D., remains uniform at 102.2° during the greater regarding dysmenorrhea, page 167, April issue, part of the day, but the pulse has reacht 100 will say that he will have trouble in such cases. at noon, the temperature running up later to The ordinary remedies and analgesics will 104', the pulse following it to 112. While

most likely be useless. The Editor has recomagain affirming that there are no complications, mended gelsemium, which is good if used in the attendants are alarmed at this sudden very large doses, but he has suggested the comchange, tho attributing it to an imaginary bination of belladonna with it, which is its crisis. Here I think that they are mistaken; physiological antidote, and would neutralize, that the sudden increase of fever, reaching if not otherwise more seriously interfere with 105° that night, was due to septic infection its action. from the undigested and putrid casein in the Now Doctor, give the lady three 5 gr. capcolon. The attendants seem to have thought sules of quinin ; tell her to take one at 4 a.m., so, for we now find them giving saline trans- 6 a.m. and 8 a.m., accompanying each with a fusions to “neutralize the poison in the blood.” half

cup

hot water, ihe morning that Still there are no complications, and the vital she expects the trouble. Tell her that the pain organs are all right. But the milk diet still

will not come ; and I miss my guess if it does. continues. The temperature drops to 101.9°, Now I don't want you or anyone else that may but the pulse climbs up a little to 108. Whether succeed under such circumstances to laud this the chill, which occurred at 2 p. m. on the as a cure for dysmenorrhea, for it is not. It is twelfth, was the second I cannot gather from a cure for anything that is periodical, from a the report, but on the thirteenth at 9 a. m. we toothache to a pain in the big toe. 1 straightfind the temperature 104.9°, and the pulse 120, ened up the worst case of gastralgia I ever saw the same continuing with but small variation with these capsules as here recommended, as till the last.

soon as I had discovered that the exacerbation When we consider the sudden rise of fever

came at 2 p.m. every day-i. e., as soon as I after a severe chill occurring on the twenty- recognized its periodicity, when all pain relievesecond day of a mild case of typhoid fever-a ing remedies had failed, as well as any other man who cannot read septic infection in that, treatment I had used. A month is a long time is blind.

(28 days) to consider as periodical, but the 9 The following remarks of Dr. McLane Ham

o'clock business gives me confidence.

I conilton may serve to elucidate this point :

trol a great many cases of ordinary dysmenor“ That the lower bowel is the seat of infec- rhea with stramonium. I see gelsemium tion appears to be very well establisht by the recommended in the Eclectic Med. Jour., Janexperiments of Baumann, who found that when uary, 1904, in doses starting at 4 teaspoonful a fistula was made in the portion which included every hour and increasing to a teaspoonful, in the lower portion of the small intestin, there tetanus. was disappearance of the ethereal sulfates of

The Doctor says it is not a poison, and that the urin; but that, when the intestinal con- no bad signs are ever manifest until spasm has tents were allowed to pass thru the lower been subdued. natural outlet, the putrefactiv products were There is one good reason for keeping up the largely increast, and their presence was again price of all coal tar preparations which should detected in this fuid. . . . When we con- not be over-lookt, and that is that the doctor sider that the proteids have passed undigested who buys acetanilid by the pound is a dangerthru the small intestins and have accumulated ous man in a community. He may not know below, where they lie infolded in a congested it, but let him look over the list of his deaths and feeble gut, it is not difficult to appreciate in the last year or two. I don't mean immedthe fact that they form a rich field for bacterial iately after its use, but will say that terminated attack, with the resultant introduction into the fatally, or died a few months later from heart system of an amount of toxic material sufficient trouble. The fatality of wars is not in it with to produce a most serious change.. this remedy. It suppresses pain and fever by The alcoholic extracts of fecal matter, ac- force, the same as you would subdue an antagcording to Bouchard, are more toxic than or- onist by choking him with your hand. It is dinary putrid matter; so it will be appreciated quick and seemingly efficient, but beware. how readily the various alkaloids of the feces Nature asks for the removal of the cause, and may be introduced in such quantities as to do aid to strengthen the heart; then the heart can much mischief."

do its work easily and will work slower and with The application of these observations to the

ease, and the temperature will be reduced. I case under consideration is obvious.

don't know it to be a fact, but I venture to say Meriden, Conn.

N. NICKERSON. that the late Senator Hanna had plenty of coal

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May, 1904]

Smallpox or Chickenpox-Pemphigus Acutus Contagiosa

197

tar preparations. In substantiation of this, I Pemphigus Acutus Contagiosa. will call your attention to the evenness of his DEAR DOCTOR TAYLOR :-I am greatly intemperature at 102°, and of the weakness of his terested in a communication from J. D. Groom, heart, and tendency to such a high range at the M.D., of Maxton, N. C., appearing in April last. You may not want to publish this last WORLD, pages 158 and 159, entitled “ Diagpart; in case you do not I will ask, why? nosis Wanted for Epidemic Eruptiv Disease.”

I would like to know a sure remedy, outside During the past winter the village of Medina, the use of a shot-gun, for the alcohol habit. in the western part of this state, has been pass

Pittsburg, Pa. · E. H. MOORE, M.D. ing thru an epidemic which has been called

[We think you are wrong in your guess that “mild smallpox" by some, including, I becoal tar antipyretics were given to Senator lieve, the health authorities. This diagnosis Hanna. Remember that his age, corpulency has been disputed by several competent men ; and a suspicious condition of the kidneys, were however, quarantine was maintained, and propall against him.

erly so, if there was any doubt as to the identity As to the reason why" an editor does or of the disease. One of my clients was emdoes not publish a communication, or certain ployed in Medina until December, 1903, when parts of a communication, is entirely a matter he returned (whether he evaded quarantine or of judgment as to whether or not it will be of not, I do not know), and within two weeks he interest and value to his readers. This is my presented all the symptoms of a mild “grip,” standard, and I suppose it is the standard of which he did not think needed any treatment. every other editor. According to that standard, He noticed three or four red spots on his neck. I decided to publish the above as written ; how- His wife was confined late in December, and ever, leaving it to every reader to decide for ten days later was taken with high fever, headhimself as to its value. In deciding on the ache, pain in back, and complete anorexia. In admission of communications, perhaps all my my absence she was attended by another physierrors, if any, are on the side of generosity: 1 cian, therefore, this one week's history is much prefer to err on that side, if at all, for I second-hand. The doctor diagnosed the conwant these pages to faithfully reflect the rank dition as grip"; but on the fourth day, on and file of the profession as it is, its mental account of an eruption, he changed it to grasp, state of progress, etc., and its opinions, chickenpox; and later said he did not know resulting from its vast experience and observa- what "it" was. A week after the onset I retion.—ED.]

turned and saw the case. Mrs. F. was then

covered with a vesicular eruption, discrete in Smallpox or Chickenpox?

character, and scattered all over the entire inEditor MEDICAL WORLD:- - I note in the tegument. The vesicles were situated on a April WORLD, pages 158 and 159, an article by hard, reddened base ; they were about marDr. J. D. Groom, on supposed smallpox of a row fat pea sized and showed no umbilication. mild type which offers difficulties in points of There was little itching, but much burning diagnosis. There have been a number of sim- pain. General condition was unsatisfactory; ilar cases in this neighborhood, diagnosed tongue heavily coated (yellowish white); smallpox and rigidly quarantined. I think bowels constipated; partial anuria. Urin five families in all. I was called to one of these dark, with specific gravity of 1,034; no sugar, families some three weeks ago and pronounced but a trace of albumin ; acidity high. Temthe disease chickenpox; and to confirm my perature 103° ; pulse 105; was able to take opinion I vaccinated four of the children. The only a little liquid food; lactation absolutely vaccination was successful in all four of the nil; baby artificially fed. Within the next cases. This I regard as a confirmation of my twenty-four hours the vesicles became disdiagnosis. What have the WORLD readers to tended with serum, tending to turbidity, and say? Will vaccination settle the question ? the temperature fell to almost normal ; pulse Can anyone who has had smallpox be success- came down to 80, bowels moved copiously, fully vaccinated ? Let us hear from you. Mr. urin became profuse and, of course, lighter in Editor what have you to say ?

color and gravity, and there was a desire for Lexington, Ohio. H. H. SMITH, M.D. food. Next day contents of vesicles increast

[We suppose that you vaccinated after re- in turbidity and rapidly became pustules, dried covery from the suspected disease in those four down, and crusting took place. At no time cases, tho you do no say so. Vaccination after was there any umbilication or reticulation. an attack of smallpox would not be successful. The woman convalesced without other notable -ED.]

symptom. The skin cleared up gradually,

leaving smooth red spots where the pustule and Terebene in five-drop doses dropt on a lump of sugar makes a cheap and efficient expectorant, espe

its areola had been, but in no instance was cially valuable in bronchitis of the aged.

there any pitting.

The two weeks' old infant presented, in due exert any influence for good. It did not. The time, all the mother's symptoms, but in a eruption and accompanying phenomena were milder form. In the child only three papules milder the younger the victim; in the elderly appeared, and they did not pass beyond the they were the most serious, but in no case was papular stage. By January 20 the mother's there a fatal issue nor any extreme prostration, milk reappeared, and the baby accepted it with and convalescence was always rapid. An interjoy, and both rapidly regained health.

esting point, it seems to me, is the apparently These cases were the starting point for a progressiv attenuation of the poison in each small spread of the disease to, perhaps, twelve succeeding case, evidenced by the mildness of other persons, male and female, ranging in age the later invasions. from this infant to eighty years, in my In conclusion, I believe that this disease was practise, while there were three cases from the brought to us by our soldiers and sailors from same source attended by other physicians. the tropics—from our insular possessions; and Last week three new cases were referred to me, that much of the socalled smallpox and severe but they are only the shadow of the earlier epidemic chickenpox is nothing more nor less ones, symptoms and all the phenomena being than acute pemphigus, contagious in character ; in every way extremely mild. I believe they therefore, much of the fear, expense, and are the final struggle of the morbific agent, trouble caused by this supposed variola has whatever it is.

been needless; but great care must be exerThe winter here promist, in December last, cised not to err on the wrong side, and every to be exceptionally hard financially and meteor- precaution should be observed until the diagologically (and it was); therefore, I felt it my nosis is certain. T. HAVEN Ross, M.D. duty to make absolutely sure whether or not Cato, N. Y. this was variola. If it were, quarantine would P. S.—I learned today that the physician be essential, and that would kill what little who saw Mrs. F. said "it" was smallpox, after business there was in this section, and many my diagnosis was announced.-R. individuals would suffer hardship, possibly hunger and starvation. If it were not variola, Proposed Cure for the Secret Nostrum a little precaution would prevent its spreading

Vendors. much, and every industry need not be paralyzed Dr. C. F. TAYLOR.- Dear Doctor: I have by the stigma of quarantine for smallpox. been reading your journal for sixteen years, After most painstaking study of Mrs. F.'s case and I don't hesitate to say that I believe you in every bearing, and observation of the happy to be one of the ablest champions of the rights effect of appropriate remedies in her treatment of the people that we have in our country toat the end of the first week, I became thoroly day. Therefore, I come to you for aid in a convinced that I had neither variola nor vari- cause that should interest every leading man cella to deal with. My final diagnosis was of our profession. To come at once to the pemphigus acutus contagiosa, based upon my subject of this letter, I have succeeded in interobservation of that eruption on sailors from esting our congressman, Hon. E. Y. Webb, in the tropics coming under my care years ago. a bill to lessen the secret nostrum evil. My I have as yet seen no reason to alter my opinion idea is to pass a bill requiring the manufacturers on that point. In this disease, while there are of all proprietary medicins to print in plain small, hard bodies to be felt under the skin, language the formula of the contents of every we do not get that “ buried bird-shot” feel package put on the market. Congressman so characteristic in variola. The individual Webb askt me to draft a bill embodying my lesions are not so small as those of variola, nor ideas. I don't feel capable of doing this, as I do we meet with a secondary fever, as in the am not a lawyer. As a representativ of this latter disease. Smallpox and chickenpox are county in the last Legislature of North Caro. self-limited pathological entities, not to be lina, I drafted several bills of a local character, aborted by any line of treatment, while this but in a matter of so much importance as this affection seems to be favorably influenced by I want the aid of wiser and better informed early and vigorous measures. This eruption, Therefore, I come to you and appeal to in my experience, is never confluent, and there you to interest yourself in this matter. I want is nó umbilication nor reticulation, nor is you to get up a bill that you think will best there any distinctiv odor connected therewith. suit the case and send it to me; or send it diSome of these distinctions apply as well to rect to Mr. Webb. I also want you, if you varicella and vaccinia. Furthermore, vaccina- can endorse this move, to present the case to tion has no influence on the disease under dis- readers of The WORLD, and urge each one to cussion. Some of my cases had been vac- write his representativ in Congress in behalf cinated and some had not. I vaccinated two of the measure. Now, Dr. Taylor, if you will after the onset, to ascertain whether it would aid in this matter I will greatly appreciate the

men.

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