panopepton of the Fairchild's, given at intervals of three or four hours.

Once more: "Although typhoid fever is essentially a system disease, its characteristic lesion is the intestinal ulcer, which should, as far as possible, be kept at rest. Milk, which has heretofore been regarded as the only proper exclusiv food, is, as a recent writer, Dr. Inglis, says, 'not a liquid, but a deceptiv solid,' capable of filling the small intestins with dense indigestible curds, which irritate the ulcerated bowel, and, in addition, ferment and cause gaseous distension.”

Now, typhoid fever is a conservativ process; it naturally tends to recovery. I believe that Professor Osler is on record that, in typhoid left entirely without medical treatment, 75 percent of them would recover, and 85 percent would get well with very little medical attention. My experience and observation, after mature reflection, teach me that this estimate is even too low; that under intelligent nursing, without medical aid, 90 percent of them would convalesce favorably. That the results do not vary under the many different forms of treatment attests the truth of this statement, the only advantage being, under the strict Brand method, where the intensity of the fever is always greatly modified, and the mortality very close to zero. I have seen cases of typhoid fever protracted three and four months by the use of milk, while others have finally succumbed under its continued administration. The idea that typhoid patients would starve, or that they would lose strength to the danger point without food, is contrary to experience and common sense. The absence of the high temperature, the dry tongue, and other distressing concomitants of the milk-fed patient, the decided shortening of the period of fever, enable the patient to convalesce with comparativly little loss of strength or weight, and with no troublesome sequelae.

But leaving aside all appeals to common sense, how dare our hospitals, and prominent practicians, many of whom guide the opinions of the majority of physicians, continue to feed milk to typhoid patients, and render a mortality record of 15 percent, when Dr. Brand has shown that under the no feeding practise the legitimate mortality is 1 percent?

Before going further, let me say that there may be cases in which, owing to the prejudices of the family, it is impossible to carry out the above advice. In this case you have the liquid

Now, let us consider the case of Senator Hanna. I have taken this case under consideration from no wish to accuse anyone of neglect or wrong-doing, but simply because, by the daily bulletins of the Associated Press, the entire nation was made acquainted with the progress of the case, the daily variations in the condition of the patient, and some glimpses at the treatment. But I have especially chosen this because it illustrates, as I look at it, the disastrous results of feeding milk to a typhoid patient.

The majority of practicians is guided by authority and precedent, and follow the dictum of men like Professor Osler, who advises the use of milk in these cases.

It seems to me, however, not difficult, in following the record in this case, to see how, step by step, day by day, taking a case of mild fever by the acknowledgment of the attending physicians, the administration of milk played havoc with the vitality of the sufferer, culminating in the chill, which banisht all hope.

We get the first intelligible report on February 5, which, it seems, was the fifteenth day of the fever, the first symptoms having shown themselves on January 22. We find a morning temperature of 100°, and an evening temperature of 102.2°. The pulse was regular at 80. The doctors report no complications, and this seems to be the case thruout the course of the fever. Surely this record justified the physicians in claiming that it was a mild case. A man in the fifteenth day of typhoid fever who has a regular pulse counting 80 to the minute is certainly in very good condition. But there is one ominous remark in this report, to which the attention should be called.. "He has been having milk for several days."

The reports for the two following days are not important, except that we begin to get some intimation of the irritability of the stomach which naturally follows the ingestion of milk. On the eighth we find the fever accelerated, being 103° in the forenoon, but dropping a degree in the latter part of the day. The pulse has increast, being 92 in the afternoon, and we still find that the irritability of the stomach continues. How much mischief has been done to the gastric and intestinal tract we do not learn; but, as later we are told that the patient is now retaining his nourishment better, we may form some idea. tenth the fever is decidedly less, being 100 8° at noon, and a little lower later in the day; but the pulse has increast and the stomach still rebels, tho Professor Osler reports that "all

On the

MAY, 1904]

tar preparations. In substantiation of this, I will call your attention to the evenness of his temperature at 102°, and of the weakness of his heart, and tendency to such a high range at the last. You may not want to publish this last part; in case you do not I will ask, why?

I would like to know a sure remedy, outside the use of a shot-gun, for the alcohol habit. Pittsburg, Pa. E. H. MOORE, M.D.

[We think you are wrong in your guess that coal tar antipyretics were given to Senator Hanna. Remember that his age, corpulency and a suspicious condition of the kidneys, were all against him.

As to the reason "why" an editor does or does not publish a communication, or certain parts of a communication, is entirely a matter of judgment as to whether or not it will be of interest and value to his readers. This is my standard, and I suppose it is the standard of every other editor. According to that standard, I decided to publish the above as written; however, leaving it to every reader to decide for himself as to its value. In deciding on the admission of communications, perhaps all my errors, if any, are on the side of generosity. I much prefer to err on that side, if at all, for I want these pages to faithfully reflect the rank and file of the profession as it is, its mental grasp, state of progress, etc., and its opinions, resulting from its vast experience and observation.-ED.]

Smallpox or Chickenpox?

Editor MEDICAL WORLD: -I note in the April WORLD, pages 158 and 159, an article by Dr. J. D. Groom, on supposed smallpox of a mild type which offers difficulties in points of diagnosis. There have been a number of similar cases in this neighborhood, diagnosed smallpox and rigidly quarantined. I think five families in all. I was called to one of these families some three weeks ago and pronounced the disease chickenpox; and to confirm my opinion I vaccinated four of the children. The vaccination was successful in all four of the cases. This I regard as a confirmation of my diagnosis. What have the WORLD readers to say? Will vaccination settle the question? Can anyone who has had smallpox be successfully vaccinated? Let us hear from you. Mr. Editor what have you to say ?

Lexington, Ohio. H. H. SMITH, M.D. [We suppose that you vaccinated after recovery from the suspected disease in those four cases, tho you do no say so. Vaccination after an attack of smallpox would not be successful. -ED.]

Terebene in five-drop doses dropt on a lump of sugar makes a cheap and efficient expectorant, especially valuable in bronchitis of the aged.

197

Pemphigus Acutus Contagiosa. DEAR DOCTOR TAYLOR:-I am greatly interested in a communication from J. D. Groom, M.D., of Maxton, N. C., appearing in April WORLD, pages 158 and 159, entitled "Diagnosis Wanted for Epidemic Eruptiv Disease." During the past winter the village of Medina, in the western part of this state, has been passing thru an epidemic which has been called "mild smallpox" by some, including, I believe, the health authorities. This diagnosis has been disputed by several competent men ; however, quarantine was maintained, and properly so, if there was any doubt as to the identity of the disease. One of my clients was employed in Medina until December, 1903, when he returned (whether he evaded quarantine or not, I do not know), and within two weeks he presented all the symptoms of a mild “ grip," which he did not think needed any treatment. He noticed three or four red spots on his neck. His wife was confined late in December, and ten days later was taken with high fever, headache, pain in back, and complete anorexia. In my absence she was attended by another physician, therefore, this one week's history is second-hand. The doctor diagnosed the condition as "grip"; but on the fourth day, on account of an eruption, he changed it to chickenpox; and later said he did not know what "it" was. A week after the onset I returned and saw the case. Mrs. F. was then covered with a vesicular eruption, discrete in character, and scattered all over the entire integument. The vesicles were situated on a hard, reddened base; they were about marrow fat pea sized and showed no umbilication. There was little itching, but much burning pain.

Urin

General condition was unsatisfactory; tongue heavily coated (yellowish-white); bowels constipated; partial anuria. dark, with specific gravity of 1,034; no sugar, but a trace of albumin; acidity high. Temperature 103°; pulse 105; was able to take only a little liquid food; lactation absolutely nil; baby artificially fed. Within the next twenty-four hours the vesicles became distended with serum, tending to turbidity, and the temperature fell to almost normal; pulse came down to 80, bowels moved copiously, urin became profuse and, of course, lighter in color and gravity, and there was a desire for food. Next day contents of vesicles increast in turbidity and rapidly became pustules, dried down, and crusting took place. At no time was there any umbilication or reticulation. The woman convalesced without other notable symptom. The skin cleared up gradually, leaving smooth red spots where the pustule and its areola had been, but in no instance was there any pitting.

The two weeks' old infant presented, in due time, all the mother's symptoms, but in a milder form. In the child only three papules appeared, and they did not pass beyond the papular stage. By January 20 the mother's milk reappeared, and the baby accepted it with joy, and both rapidly regained health.

These cases were the starting point for a small spread of the disease to, perhaps, twelve other persons, male and female, ranging in age from this infant to eighty years, in my practise, while there were three cases from the same source attended by other physicians. Last week three new cases were referred to me, but they are only the shadow of the earlier ones, symptoms and all the phenomena being in every way extremely mild. I believe they are the final struggle of the morbific agent, whatever it is.

The winter here promist, in December last, to be exceptionally hard financially and meteorologically (and it was); therefore, I felt it my duty to make absolutely sure whether or not this was variola. If it were, quarantine would be essential, and that would kill what little business there was in this section, and many individuals would suffer hardship, possibly hunger and starvation. If it were not variola, a little precaution would prevent its spreading much, and every industry need not be paralyzed by the stigma of quarantine for smallpox. After most painstaking study of Mrs. F.'s case in every bearing, and observation of the happy effect of appropriate remedies in her treatment at the end of the first week, I became thoroly convinced that I had neither variola nor varicella to deal with. My final diagnosis was pemphigus acutus contagiosa, based upon my observation of that eruption on sailors from the tropics coming under my care years ago. I have as yet seen no reason to alter my opinion on that point. In this disease, while there are small, hard bodies to be felt under the skin, we do not get that "buried bird-shot" feel so characteristic in variola. The individual lesions are not so small as those of variola, nor do we meet with a secondary fever, as in the latter disease. Smallpox and chickenpox are self-limited pathological entities, not to be aborted by any line of treatment, while this affection seems to be favorably influenced by early and vigorous measures. This eruption, in my experience, is never confluent, and there is no umbilication nor reticulation, nor is there any distinctiv odor connected therewith. Some of these distinctions apply as well to varicella and vaccinia. Furthermore, vaccination has no influence on the disease under discussion. Some of my cases had been vaccinated and some had not. I vaccinated two after the onset, to ascertain whether it would

In conclusion, I believe that this disease was brought to us by our soldiers and sailors from the tropics-from our insular possessions; and that much of the socalled smallpox and severe epidemic chickenpox is nothing more nor less than acute pemphigus, contagious in character; therefore, much of the fear, expense, and trouble caused by this supposed variola has been needless; but great care must be exercised not to err on the wrong side, and every precaution should be observed until the diagnosis is certain. T. HAVEN Ross, M.D.

Cato, N. Y.

P. S.-I learned today that the physician who saw Mrs. F. said "it" was smallpox, after my diagnosis was announced.-R.

Proposed Cure for the Secret Nostrum
Vendors.

DR. C. F. TAYLOR.-Dear Doctor: I have been reading your journal for sixteen years, and I don't hesitate to say that I believe you to be one of the ablest champions of the rights of the people that we have in our country today. Therefore, I come to you for aid in a cause that should interest every leading man of our profession. To come at once to the subject of this letter, I have succeeded in interesting our congressman, Hon. E. Y. Webb, in a bill to lessen the secret nostrum evil. My idea is to pass a bill requiring the manufacturers of all proprietary medicins to print in plain language the formula of the contents of every package put on the market. Congressman Webb askt me to draft a bill embodying my ideas. I don't feel capable of doing this, as I am not a lawyer. As a representativ of this county in the last Legislature of North Carolina, Í drafted several bills of a local character, but in a matter of so much importance as this I want the aid of wiser and better informed men. Therefore, I come to you and appeal to you to interest yourself in this matter. I want you to get up a bill that you think will best suit the case and send it to me; or send it direct to Mr. Webb. I also want you, if you can endorse this move, to present the case to readers of THE WORLD, and urge each one to write his representativ in Congress in behalf of the measure. Now, Dr. Taylor, if you will aid in this matter I will greatly appreciate the

[The above letter is an able presentation of the matter. I have taken the liberty of changing in the above the expression "patent medicin evil" to secret nostrum evil; for patent medicins are not secret; anything that is patented cannot be secret, for the process of obtaining a patent involves revealing the secret. Any one can go or send to the Patent Office at Washington, and for five cents get a copy of any patent, and he can then publish it if he wishes to do so. Peruna, for example, is not patented. The name is trade markt, or copyrighted, and the composition and process are kept secret. So with antikamnia and many other proprietaries, but in the case of antikamnia and other analgesics with fanciful (copyrighted) names, we know that the chief ingredient is acetanilid. Also, in the following clause: "A bill requiring the manufacturers of all secret nostrums to print in plain language the formula," etc., I changed "secret nostrums" to proprietary medicins, for if such a law were in operation there would be no secret

nostrums.

I wrote the Doctor to get a copy of the Hepburn Pure Food Bill, now before Congress, and consider adding his suggestion as an amendment to said bill; or if not, to study said bill as a model, as much thought and talent have been spent upon it. I understand that Germany has a law embodying Dr. Alexander's proposition, and that it works very satisfactorily, but is a thorn in the side of the wouldbe secret nostrum vendors.-ED.]

Later:

Editor MEDICAL WORLD:-I desire sufficient space in your most excellent journal to call the attention of the WORLD readers to the fact that Hon. E. Y. Webb, Congressman from North Carolina, has in preparation a Bill to regulate the manufacture of proprietary medicins, or any other secret medicinal compound. This Bill will require all such manufacturers to label every package with the formula or ingredients of the same, and if such package contains opium, chloral, cocain or alcohol, then such label shall state the quantity of each of these drugs contained in a given quantity.

Now every man who has practised medicin for any length of time knows full well that secret medicins are one of the the greatest curses inflicted on the American people today. Hundreds of lives are sacrificed by their use, millions of dollars are annually mulcted from the people, and thousands of drunkards and opium habitues are made every year.

Their obscene and disgusting advertisements fill the columns of every paper that comes into our families. By ingenious and persistent advertising they excite the passions, stimulate the prejudice, arouse the hopes and expectations of a too confiding public, and thus defraud the people in more ways than by taking their money without giving value received.

Now I ask every reader of these lines to write at once to his Representativ in Congress and urge him to co-operate with Mr. Webb in putting thru this much needed legislation. The Bill has not yet been introduced, but is under. preparation. If you would like to make any suggestions about the matter of this Bill, don't hesitate to write to Mr. Webb at once and give him your ideas. Of course a bill of this kind will meet with tremendous opposition, but let the medical fraternity and all the friends of humanity rally to the support of the measure, and it will eventually prevail. Thanking the Editor for his kindness, I am,

Yours for better conditions,

Matthews, N. C.

H. Q. ALEXANDER.

Tetanus from Flea Bites.

On

Editor MEDICAL WORLD:-Thru your valuable journal, I wish to call the attention of those concerned to a rather mysterious case which I was recently called to treat. Man, married, age 30, strong and robust. arriving I soon saw that he had tetanus. Of course I began to make inquiries to ascertain some etiological factor of the disease, thinking surely I would get a detailed account of a previous injury; but to my ultimate astonishment, I could get no trace of a traumatic injury. But the man had tetanus—no mistake. I could have treated him probably as well then as to have studied the etiology for hours; but I was "bent" on ascertaining how he got that germ. So I proceeded to remove his gown. I found that the skin had been feasted upon by many insects, and I inquired about it. His wife remarkt: "Doctor, that is where fleas bit him. He was hauling manure from the gin house (old house gin) for several days, and was always complaining about the fleas biting. him, and they nearly kill him (would most of us brethren); so a few days later he began to complain of soreness in his neck, could hardly swallow, and this morning his jaws were lockt." Now doctors, that's the way she told me about it.

Evidently there was no puncture in the skin more than those put there by the bills of those fleas. Gentlemen, could it be possible that the tetanus germ could have gotten there thru those flea bites? And if that be true, Louisiana would as well exhibit at the 1904 Fair some of her varieties of dangerous germ carry