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Typhoid Fever.

In view of the interest manifested by your contributors in the subject of typhoid fever I feel called upon to offer a few thoughts in that direction.

The careful record of its symptoms to be found in the text-books are too convenient to the access of physicians to render it needful to encumber the pages of a me 'ical journal with their recapitulation. And it is also apparent to every observing p. 'an that while the treatment of the sy s of this disease is our object there is so little difference in the methods of doing this, that very little is offered in the communications we daily notice in the journals, that is new or adds anything of practical value to the ordinary physician's store of knowledge.

For every twenty years there has been so little change in the manner of treating its urging symptoms that all appear to be satisfied with mild mercurial alteratives in its early development, and subsequently with opium, lead, bismuth, tannin and catechu for the bowels. Turpentine as an alterative to the mucous surface and a like variety of agents as nutritives, febrifuges, stimulants, etc. It is, in fact, probable that we can never improve on the efficiency of the agents now in use for meeting the indications we

No. 2.

have heretofore recognized in the treatment of this disease. Yet with all our resources for controlling its symptoms and guarding against evil results, there is scarcely an ailment for which we can do so little in a curative capacity.

We act as though obeying a treaty to neither retard its development nor shorten its life, and submit to the recognized necessity of permitting it to live out the full period of its natural life, and luxuriate on the corporeal reservations of our patient until, after weeks have passed, the evidence of its existence cease as independent of our influence as when they came, and if vitality still announces its presence in the skin and bones, yet left of our patient, we flatter ourselves with a feeling of success.

With the knowledge we now have of the specific cause of this disease we should be stimulated to a greater effort in throwing this opprobrious yolk from our shoulders and seek a method by which a more specific result can be secured in its treatment. With all that is said concerning it or effected by modern treatment, there is no cause given the bacillic progenitors of the disease to even lift their tails in apprehension of danger, and until we can antidote the existence of this specific cause we can never hope to do more than guard our patient against

its evil results to the best of our ability, as heretofore.

But why not make a more united effort from this stand point, to add to our therapeutic resources; such aid as will enable us to treat typhoid fever with a full confidence in our ability to cut short its existence by the destruction of its exciting and sustaining cause?

The certainty with which we can prescribe for intermittents on this principle, teaches the importance of its recognition and points to the inestimable rewards to be realized when we are enabled to make application to other idiopathic ailments. There can be no extravagance in the belief of an approaching period when this can be done. If we acknowledge the specific action of a remedy over the etiological factor of one disease it is not unreasonable to anticipate the possession of remedies of like power over other diseases, having their origin from similar specific causes.

The search thus far made for a successful germicide in typhoid fever is strongly suggestive that if persevered in, it will be no very distant day until we can successfully prescribe for the destruction of the typhoid bacilli.

The importance of such investigation as will contribute to a knowledge of the best means to secure this result can not well be over-estimated, and every physician should feel himself called upon to extend his field of observation as far as possible and report through current medical literature all evidence at his command of the parasiticide action of any agent in this disease. It is of importance that these reports embrace the enumeration of agents likely to be used that may be known by the reporter to have failed to produce favorable results, as well as those he can report good results from.

Quinine does not impair the health or shorten the life of this germ. Neither does a reduction of temperature, by whatever means secured. A restoration of the secretions does not do it nor stimulation and nutrition, although these may all be required to fill indications.

The iodides, salol, mineral acids and nitrates appear to offer encouragement in the results of their use. Yet this great remedy may be secured from a very unexpected source, and its value discovered

by accident as with cinchona, gelsemium, etc. But, whenever and whatever it may be, the question arises as to whether we exercise that diligence in its search that duty and the welfare of humanity demand of us as a profession, in care of the health and lives of our generation.

These thoughts are submitted to the profession and it is hoped that the devotion to its purpose of saving life and the mitigation of human suffering for which it is so characterized will prompt every one to make known such observations as contribute to the speedy approach of that period when we can confidently cure typhoid fever by the destruction of its specific cause.

We know that such a cause exists; that it is introduced within the system, through the alimentary canal; that it must enter the circulation to reach localities where it has been found; that its faIvorite location for its line of business is among Peyer's glands; that it affects the human system with symptoms 80 uniform as to constitute a special type of disease; that it has a definite period of existence; that its presence is highly productive of an alkaline reaction of the fluids of the system; that it is specially destructive to the blood fibrin.

And the one thing yet we desire to know is, what can we administer that will destroy it?

It should be born in mind that no agent is worthy of being recorded as curative in this disease that does not positively shorten its average duration, and that the value of any remedy should only be estimated by the extent it is capable of doing this.

I am aware that the expression of Dr. Elliot, in your last issue, that "typhoid fever being a self-limited disease there is no agent that will abort it," is commonly endorsed by the profession, but it is an outgrowth of our inability to do what we should do and will continue so, as long as we do nothing more than clear away the debris while the building is burning, and close the scene with the assurance that "the result is satisfactory."

The question may even be appropriately asked, whether in our eagerness to fight the symptoms of this disease, we do not at times contend against the beneficent provisions of nature. Exalted

temperature is fought against as our greatest foe, while it is but an expression of vital force giving us the pleasing assurance that kind nature is yet lending us her aid. Always inspiring us with a hope that we never entertain when nature's powers so far leave us as to permit the temperature to drop below normal.

We like to secure pleasing results from our treatment, and it looks like improving the condition of our patient to cool him down, but statistics fail to encourage the belief that antipyretics either shorten the duration of or add to the list of recoveries from the disease, while their free use is always productive of depression and loss of vital resistance-a result above all others to be guarded against in typhoid fever.

While the mild antipyretic influence of sponging the surface and the use of the mineral acids may be desirable, there is nothing in reason or reported results that justifies the use of the powerful sedatives, the wet sheet, or the extravagant use of quinia for the control of the febrile heat.

Again, when we estimate the character of the alvine dejections in these cases, the evidence of their being heavily charged with the specific cause of the disease the debris of broken down tissues-imperfectly digested aliment, their tendency to eliminate irritating gases, etc., it is easy to concieve of a liability to permit these accumulations to result in the detriment of a patient, through our desire to maintain a control over the bowels.

If these thoughts relating to the want of a more united effort in the behalf of physicians to contribute to a more complete investigation, of the nature of the specific cause of typhoid fever, and the remedies most successful in antidoting its existence, should lend a stimulus in this direction, the motive of this article will be fully realized. Steubenville, O. J. F. PURVIANCE, M. D.

Diphtheria.

I would like to hear from some of the BRIEF family as to the most successful treatment for diphtheria, as there is a very malignant form of it in this parish at present. I would like to hear from them soon. E. F. MCMILLAN, M. D. Prairieville, La.

Malaria and its Complications, or Sequelæ.

BY E. CARMICHAEL ROTHROCK, M. D.

Malaria.-"Bad air." For definition, see Dunglison, or any other dictionary. We know that it is a subtle element producing clearly defined symptoms resulting from introduction of a poison into the system, causing a specific potential train of manifestations that are unmistakable in their primary effects, but when its multitudinous complications (which are legion) are considered, then experience with the hydra-headed monster is necessary to detect the subtle presence of the sneaking foe.

Did you ever practice in a malarial district? If so, then you understand this.

We notice only a few of the multitudinous conditions occurring or caused by malaria, as time and space forbid giving a long list. In malarial cachexia (subacute) the blood contains more water than normal, the red corpuscles are diminished, and there is a large increase not only in water but in cotoyed blood corpuscles from disease of those organs which change colorless corpuscles to red corpuscles. The spleen becomes indurated, and, in some cases, enormously enlarged, extending through the abdominal cavity, obstructing the bowels, pressing on the veins, and occluding the gastrosplenic vessels. There is no suppuration, but by pressure on the abdominal veins, and the blood being in an abnormal condition aids in producing ascites, and sometimes limited peritonitis. In this condition, the spleen is filled with connective tissue, containing black pigment, which is liberated in angular or amorphous masses. These pigment granules, circulating in the blood, may lodge and increase in various parts of the body, as the brain, giving rise to nervous symptoms, apoplexy, vertigo, etc.

In liver affections caused by malaria, we frequently have suppression of bile, congested liver (hyperæmia), enlargement (hypertrophy) of the organ, which is overfilled with blood, fails to secrete or excrete, the blood is surcharged with the entire composition of the bile, or in some cases with the coloring matter (biliverdin), producing jaundice. The bowels are

constipated, and we have stupor, formication, pigmented liver, with accumulation of bile in that organ. The brain is affected, spleen and kidneys, and may cause obstruction of the kidneys, giving rise to albuminuria, or Bright's disease.

Such diseases should be met with remedies having an affinity for those parts involved, and having, at the same time, a tendency to remove the cause—malaria. Quinine with hyposulphites are indicated, rhubarb and podophyllin, ipecac., taraxicum, potassium and sodium. In this condition, or in hepatitis, bryonia and tinct. nux in small doses are excellent. Iodine, bitter vegetable tonics which will restore the normal fluorescence of the blood, and some preparation of iron administered. It is this pigment-granules liberated and circulating in the blood that gives to the complexion a sallow color in chronic malarial diseases-a blood dyscrasia existing. Cinchonidia, two grains every three hours, alternated with ceanothus Americanus, fifteen drops. Tinct. arsenic, two drops three times a day, acts well. Euonymus in hypertrophy of liver or spleen, alternated with chionanthus (gray-beard), thirty to sixty drops, will act like a charm. An ointment of polymnia uvedalia, rubbed over liver and spleen, will have good effect. Oxysulph. iron with tinct. arsenic, two to five drops three times daily, is excellent to restore the blood and produce an anti-zymotic effect, alternated with pyrophosphate iron, and helonias dioica to enrich the blood.

catarrh

Gastro-interitis-intestinal frequently occurs, characterized by watery discharges and often bloody mucus discharges, and is frequently a feature in malarial diseases, and often obtains in children. Quinine and ipecac. and salicylic acid often act well, with other indicated remedies.

Have seen copious hemorrhage from bowels in children, and from bowels and uterus in women; this generally in the pernicious forms of malaria.

Malaria will cause skin diseases. "What!" some will say, "do you really believe skin diseases are caused by malaria?" Yes; most cutaneous diseases can be and are caused by malaria, and it is a great factor in producing such troubles. We do not assert, by a great deal,

that it causes all acute diseases of this kind (excluding specific exanthema), but it is no doubt the source of a good many. And we believe that in sections where malarial influences are rife, such diseases are caused, and the progress and termination of such are influenced, to a great extent, by malaria.

Antiperiodic remedies is the proper treatment. Quinine, internal and external. "What! quinine locally?" Yes, sir; made into an ointment, and used twice or thrice a day, has often cured for me. Arsenic tinct. and other remedies should or could be used as indicated, but antiperiodics will certainly and quickly cure such troubles. We know that cutaneous diseases are frequently caused by struma, etc.

An exciting cause will often develop such troubles, as irritants, filth, injuries, alcohol, dentition, menstruation, improper food, shell-fish, etc. Nevertheless, malaria has, and will, cause skin diseases, and will cause it in all other organs, as the eye in conjunctivitis, iritis, etc.

In the ear, otitis, and in the mucous membranes of the body, as gynecologists know, all of which, if taken in incipiency, can be cured by antiperiodics as promptly as intermittents.

Abortion is sometimes caused by malaria, and has been traced to that factor.

Intermittents frequently attack lyingin women in malarial districts. This is not surprising to those who have had a vast experience in treating malaria. Children are frequently born showing unmistakable symptoms of its mother's disease-malaria. Children, a few days after birth, have chills and disturbance of the cerebro-spinal system-convulsions. Gelsemium and bromides act well in such cases, with minute doses of belladonna, hot water baths, then antiperiodics to strike the cause.

In threatened abortion, we have frequently aborted malaria with quinine, without any unpleasant effects, and then gave aletris, senecio, helonias, viburnum and iron, alternated, for months, the woman going her full time.

In chronic cases, the cerebro-spinal system will frequently become affected, in patients of a neurotic, debilitated, or depraved constitution. We have seen