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 ресиliar 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. 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, indi-、 rectly, 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. IT 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 more tympanitis, the severer the case, and vice versa. Meteorism arises from two principal causes: 1. Increased fermentation which takes place in the intestinal contents, and 2, paralysis of the muscular coat resulting from toxemia. If the gases in the tympanitis are not themselves toxic, they, at least, increase the tension in the bowel and increase the absorption of the toxins and the germs that do exist in the canal. It is a firm conviction with me, that the serious nervous and muscular symptoms are, to a very great extent, if not altogether, due to the absorption from the intestinal canal of toxins. The results of the castor oil treatment prove this clearly enough and, it seems to me, does it conclusively. Take any case of uncomplicated typhoid fever where the temperature ranges above 103 deg. F., and give a dose of castor oil every twelve hours, giving no other medicine at all, and the temperature will invariably be reduce in three days, and will generally be below 102 deg. F., and always below 103. Any case with wild delirium will subside in the same length of time. The effect of the oil is confined to the bowel. It accomplishes what it does effect by eliminating from the bowel germs and toxins which would otherwise be absorbed. If sweeping the germs and toxins out of the bowel, thereby preventing their absorption, diminishes these symptoms then, surely, the absorption of these poisons must be the thing that causes them or agravates them. The administration of antiseptics, such as have no effect on the nervous system, will generally accomplish the same thing. This is again evidence that the cause of the severe symptoms, or the cause of their severity, is the taking up of something from the alimentary canal Therefore the theory is deduced, that, the more of these gases, toxins and germs are eliminated from the bowel, the milder will be the case. The thing then, if this much of the theory is correct is a drug which will eliminate these poisons from the bowel and, at the same time, has no effect upon the general system and will not spend the patient's strength. Castor oil is the medicine wanted. It goes through the bowel practically as a bolus, or en masse, and cleanses them more thoroughly than any other purgative, and it does not draw upon the system or any organ for its purgative property, but acts of itself, and is not absorbed to overload the already overburdened blood with abnormal substances. I feel myself justified amply in saying, after repeated and careful tests, that castor oil does not weaken or injure the patient, and that no other purgative known to me or used by me acts in the same way. In typhoid fever, digestion is very imperfect, and fermentation is excessive. We have in the alimentary canal, therefore, at all times, more or less fermenting and undigested food, which, of course makes a bad application to the inflamed, necrosed, or ulcerated mucous. membrane. Move this off often enough to prevent any accumulation of it, and protect the membrane with oil, and the inflamed spots will not be so likely to pass to necrosis and ulcers will heal more rapidly. The quantity of this fermenting and undigested food will be kept less by moving it off often, and the amount absorbed will thereby be lessened, and the case thus held to as mild a course as possible. If the ulcers are slow to heal, and the case runs a long course, the patient is not overburdened with toxins to exhaust him before they do heal and the fever subsides. Abortive cases will be kept abortive, mild cases made milder, and severe cases will be converted into mild ones. 2. The Method-Taking tympanitis as my guide, my object was to keep the bowels as free as may be of germs, toxins and fermentation. When I first began the use of the treatment, I gave one dose of castor oil every twenty-four hours. I found that, after giving a dose, tympanitis was partially or wholly relieved, but that it usually began to return before time for the next dose. I also found that the typical typhoid odor of the stool, while perhaps it was partially relieved, was never altogether. I then began to give a dose every twelve hours, and found that, in from one to three days these conditions were entirely removed, the stool was rid of the typhoid odor, and was as odorless as that of the healthy man. The presence or absence of the typical odor of the stool became at once another valuable guide in the treatment. These two results: 1, the bowels free from tympanitis, and 2, a stool free from the odor, indicating a satisfactory condition of the canal, can be had by administering a dose of castor oil every twelve hours, but it cannot always be had by less than that. A dose of castor oil is an indefinite quantity in the treatment of typhoid fever. It varies in different cases, and in different stages and conditions in the same case. It may vary from one to eight drams. Enough to act in three to five hours should be given, but not so much as to act more than twice. If the patient is seen in the first week, when constipation usually exists, the dose will be from two to four drams, but if in the second or third week, when diarrhea is the rule, one to two drams will be the proper dose. After one or two doses have been given, it can be easily regulated. During the second and into the third week, the dose is about the same, but increases considerably during the last week in bed. In abortive cases the dose is usually larger all through the course of the disease. The taste is very well disguised by giving it in a warm cup with a little boiled sweet milk. 3. Results-The result of the treatment is about as follows: The temperature ranges lower; the tympanitis and delirium do not occur, and if they are present, they soon subside; diarrhea and dysentery are prevented, or checked if they already exist; the disease runs a milder course, and the patient does not lose flesh and strength so fast as they generally do under any other treatment. The last named result is its greatest advantage over any antiseptic treatment. The explanation is, that any antiseptic that is effective enough to prevent, or materially retard fermentation and germ life, will also prevent or greatly retard digestion. Castor oil does not do this. Up to the present time, I have treated thirty-two cases of typhoid fever with castor oil, and, except in a very few of these cases, in which I gave some other medicine to meet some special symptom, I gave nothing else. In order to be brief, I will report them collectively. Thirteen cases were treated with one dose every twenty-four hours, and nineteen cases with one dose every twelve hours. Three of the thirteen cases which were treated with a dose every twenty-four hours, had a temperature above 103 F., delirium and tympan |