Typhoid fever being seldom epidemic in our section, therefore we meet only with sporadic and endemic cases, which necessarily limits our experience as to number. In the cases I treated with this. formula, not one of them reached the low stage with its train of depressing symptoms, and though the fever in some few lasted thirty days it seldom reached higher than 103°. Delirium occurred in but two cases and lasted but a short time, and hemorrhage was extremely rare. If my diagnosis was correct, this shows a remarkable result, and very different from my experience prior to the use of the remedy. I know we have to consider the possibility of an error in diagnosis, and that my cases might have been of a mild type, nevertheless I shall continue its use and do most heartily commend it to the profession for a trial. It is to be deplored that so many physicians have such an enthusiastic opinion of their skill, and faith in the power of drugs, that they fail to consider the compatibility of remedies and the ability of the patient to stand his bold and fierce attacks.

There is no pretense of scientific study or display of text-book lore in this little paper, but a simple statement of my experience in the use of a remedy in a disease that often baffles our most skilled physicians. I hope some of the profession will have enough faith to give it a trial and report results. I will say as to the dose, it may run from one drop for children to four for adults, being governed by the violence of the attack and other indications. I have given it regularly for thirty days and have never found any bad effects.

RUSSELLVILLE, KY.

TYPHOID FEVER IN THE COUNTRY.*

BY B. F. FYKE, M. D.

Typhoid fever in the country has lost none of its terrors; it invades the homes of the rich and poor; the strong man goes down by the side of his weak neighbor. No occupation seems to predispose to or exempt us from an attack of typhoid fever. Typhoid fever occurs in nearly every part of the globe; it has a high rate of mortality. The specific cause of typhoid fever is a micro-organism, the bacillus of Eberth, and is found during life in the stools, urine, and sputa, with but little in the blood. After death it is found in all the tissues and in many of the organs of the body.

* Read before the Southern Kentucky Medical Association at Adairville, Ky., April, 1902.

Bacteriologists differ as to how long the bacillus can live out of the body, and how long it can be found in the body; leaving that part of the subject, we find them agreed that the bacillus can live in water several days and in the soil almost indefinitely, that it is rapidly destroyed by heat and protected for a long time by freezing or cold. But in the practice of medicine in the country we must not be too ready to accept everything taught by bacteriology.

At present no greater problem is presented to the medical profession than the prevention of typhoid fever, and its prevention is a subject of much interest, not only to the physician, but to the people also. Ere long I hope to see every physician paying more attention to the prevention of typhoid fever, as I feel well assured that the profession would be amply rewarded for such attention by additional trophies in the healing art.

This is necessary, and is demanded of us as sanitarians and guardians in pointing out the principles of sanitation and hygiene and the means of prophylaxis which are best calculated to secure protection and immunity from typhoid fever. I do not presume to be able to raise the veil and at once make the subject of prevention clear and plain, but for a few minutes will call your attention to the use of well and spring water and pond ice as three of the most common causes of typhoid fever in the country. That other causes may be found I will not dispute, but I think I can trace the cause of every case of typhoid fever in the country to the use of one of the three agents named.

In cities, sewer gas, the inhalation of dust containing dry sputa from a fever patient, doubtless act as the infecting agents, but we can eliminate these in the country. It is hard to convince the people that the clear and sparkling water from a deep well, or the rippling stream that comes from the foot-hills and mountains, is not pure, or that the ice that is stored away in our ice-houses is dangerous and may be infected with the poison of typhoid fever. How, they will ask, can the water in a well or spring or the ice on our ponds be infected?

Looking over our country, we see graveyards on nearly every farm, in which people that died of typhoid fever are buried; oftentimes these graveyards are on the rising ground from a pond from which our icehouses are filled each winter, when the ice is sufficiently thick.

Trace the streams of our wells and springs, and we will not go far until we find an opening in the ground communicating with these springs or wells. Looking further on, we see that these holes are the

receptacles or exits of all washings from barnyards, privy vaults, overflows from foul ponds or cesspools. All our swamps have a stratum or strata that is impervious to water; this stratum frequently extends far out from the swamps and acts as a continuous incline for the water coming down to it. There is no reason why this stratum may not pass under soil that has been previously infected in some of the many ways in which infection may take place, thereby conveying the germs of disease to our wells and springs. Seep wells are really more dangerous than wells with strong streams.

I think we can explain the cause of all obscure cases of typhoid fever by studying the water supply of the neighborhood. Given a case of typhoid fever: The nurses are careless with all dejecta, and it is either thrown out upon the ground or buried in an ash-pile to await a heavy rain to be washed into some sink-hole or basin, thence to be carried into our wells and springs. In a few days there is an endemic of typhoid fever in another neighborhood, that has had no communication. with this neighborhood. The water explains the cause. It is dangerous for those who are not immune to visit these patients and drink the water they are using.

With your indulgence, I will now give a few of many cases illustrative of this means of causing typhoid fever. In antebellum days Mr. H. had frequent outbreaks of typhoid fever among his negroes, with a high rate of mortality; his own family did not escape until all had been made immune by an attack of fever. A spring at the foot of a high hill furnished the supply of water. In 1891 Mr. H. sold this farm to Mr. B. In four years I treated seven cases of typhoid fever on this farm; he continued to use the spring.

One mile southeast of the spring there is another spring at the foot of a hill, on top of which there was a barnyard in which horses, cows, hogs, chickens, and ducks were fed; the privy vault was near this lot, and the washings from the barnyard and privy vault were carried into the stream from this spring about one hundred feet below its source. On this stream there was a sawmill and brandy distillery, with the accumulations of twenty years' filth; about five hundred feet east of this sawmill there is a hole that acted as a receiver of all overflows in rainy season; any pomace or sawdust thrown into this hole comes out at Mr. H.'s spring. In a field close by the spring Mr. H. buried all those that died on his farm. The spring has been abandoned, with a cessation of typhoid fever on the farm.

Mr. B. lived on an adjoining farm, and used a well for a water supply. The well is forty feet deep, and is on a ridge between a pond on the north and a slough draining a swamp on the south. The pond is in a barnyard that is used for all farm purposes. None of Mr. B.'s family escaped an attack of typhoid fever, and as long as he lived there his family suffered from an invasion of some type of fever every summer. He is now living about six hundred yards from this place, and is using cistern water, with exemption from annual visitations of fever.

Mr. J. used a seep well. In June, 1900, he dug a hole six feet deep; his wife used this hole for a milk-house in hot weather. In July this hole was filled by rain to the depth of eight or ten inches with water; it was still used as a milk-house; several buckets of milk were turned over, and the water was never thrown out. Mr. J. had four cases of typhoid fever in his family. Mrs. J. had a sister living two miles away; after the death of Mr. J. she visited there for the first time, stayed one night and half of a day. In ten days she and her baby had typhoid fever. Mrs. J. had other relatives living farther away who came to nurse in Mr. J.'s family; they had typhoid fever.

Mr. P. lives on a farm with a "bored" well eighty-five feet deep. In 1901 he and three boys cultivated a field that had a spring in it; they drank water from this spring while working in this field. On the higher ground from the spring there is a graveyard. Within four days of each other all three of these boys were sick with typhoid fever. Mr. P. had not worked in this field for ten days before the boys were taken sick. Four weeks after the first cases of fever appeared, Mr. P., his wife, and little girl had an attack of fever. Mrs. P. and her little girl had never used water from the spring, and it had been five weeks since Mr. P. had drank water from the spring. At this time I was treating two more cases in different families, one of whom used a spring, the other a well. I did not drink water at either one of these places, believing the water they were using to be the cause of the fever, but I would drink water from the well at Mr. P.'s. I had a mild attack of fever, and believe the water in the well became infected.

With one more illustrative case presenting some obscurities I will close: Mr. R. came to Springfield from Tullahoma, and worked as a barber for several months. He was called home to attend the funeral of a member of his family. When he went home he found a brother sick with typhoid fever. There was an endemic of typhoid fever in Tullahoma. After Mr. R. returned to Springfield he was taken sick,

and the attending physician diagnosed a case of tuberculosis. Six of the physicians in Springfield saw him; two made a diagnosis of typhoid fever; four, tuberculosis. He returned to Tullahoma and went through a typical case of typhoid fever. When I was asked why I made a diagnosis of typhoid fever I said Tullahoma is in an endemic of typhoid fever, and he has been there with it. Had I not had a history of typhoid fever in his home I should have concurred in the diagnosis of tuberculosis.

The means of prevention of typhoid fever in the country is to convince the people that spring and well water and pond ice are the chief sources of typhoid fever, and that promiscuous visiting among neighbors during the presence of typhoid fever should not be indulged in, and to recommend the use of cistern water exclusively for drinking, and boiled water for cooking purposes, and that all dejecta be disinfected either by heat or lime.

SPRINGFIELD, Tenn.

THE TREATMENT OF DIPHTHERIA WITH ANTITOXIN.*

BY W. W. LASLEY, M. D.

In making this report on the treatment of diphtheria with antitoxin, I hope to hear from the doctors of this Association who have had success or failure in its use. I am aware of the fact that the profession is divided on the use of antitoxin for diphtheria. Some of us are too anti to be progressive, and others are too progressive to be safe. The cases that I report to you to-day are not cases of doubt, but cases in which the diagnosis was clear, and of that fearful type that too often leaves the doctor with unpleasant meditations and the home of the patient desolate.

While passing a farm-house November 19, 1900, I was called in to see a little girl three years old, whose mother informed me that the child had been suffering with croup four days, and that the usual domestic. remedies commonly employed in such cases had failed to give any relief. I suspected diphtheria, and examination confirmed my suspicion, revealing a severe case. Believing the case too far advanced to yield to the old methods of treatment, I decided to try the antitoxin. I, however, used an antiseptic wash, mopping the throat every two hours. I began

*Read before the Southern Kentucky Medical Association at Adairville, Ky., April, 1902.