-ST -SP) years. He has never obtained more | be obtained down to just below the umthan temporary relief. During the past bilicus. After the ingestion of 150 c.c. few years he has been troubled a great of water the area of succussion descended half-way to the symphysis. (See diagram.) Chemically the gastric contents showed no abnormality after a testbreakfast except excess of mucus. Here was a group of symptoms dependent on muscular insufficiency of the stomach. The patient was ordered to take a full albuminous diet. (In ordering diets it is well to give directions in black and white; for this purpose I use printed diet-lists, which I vary according to individual needs.) His exact condition was explained to him, and he was advised to exercise out of doors as much as possible. Fortunately, he was able to ride horseback, and every evening he rode up and down the country from one to several hours. He was given syr. hypophosph. comp. as a tonic, and asafetida pills to control the intestinal flatulence. After one week of horseback riding he began to improve, he avoided excess of starchy foods, rode horseback in good and bad weather, and in one month had gained five or six pounds. All winter he has kept up his horseback riding, and two weeks ago was in fine health, weighed twelve pounds heavier, and had no symptoms of ill-health of any kind. FIG. 4. Mr. B. 18, ix, '96. I P.M. Area of succussion. Nothing to drink or eat since breakfast. Case of neurasthenia with motor insufficiency of the stomach. deal by bloating after food-taking, burning in the abdomen, belching of gas, regurgitation of sour material, constipation, loss of weight, insomnia, and a ST -SP FIG. 5.-Mr. B. Area of succussion after the ingestion of 150 c.c. water immediately after the examination as shown in Fig. 4. whole train of nervous symptoms, completing the picture of neurasthenia. His chest organs were normal. Five hours after breakfast a succussion splash could Similar cases are not infrequent, and treatment of any kind without appropriate out-of-door exercise (horseback riding especially, and bicycle riding to a less degree) is unavailing. We send our pulmonary patients far from home, and they go willingly, seeking relief. Many an otherwise incurable dyspeptic could be cured by a few months or years spent in camp, "roughing it." I (c). Cases associated with, and in a measure dependent upon, disease of the gastric mucosa.-This class of cases falls naturally into two groups, the hypacid and the hyperacid forms. The weak stomachs with hypacidity or anacidity form a large proportion of the cases of chronic gastritis, are exceedingly difficult to cure permanently, and require care throughout life. It is not the purpose of this paper to discuss their treatment. They tax the patience of the physician, improve for a time, It is and have a tendency to relapse if vigilance be suspended. The weak stomachs with hyperacidity form a fair percentage of all atonic stomachs. assumed by most writers that hyperacidity leads to muscular weakness by over-exciting muscular contraction, and at the same time stimulating the pyloric muscle to contract. My own experience leads me to doubt this generally accepted view. In my experience primary hyperacidity occurs in well-nourished, well-fed individuals of the socalled higher classes, and remains for years without inducing muscular weakness or dilatation. Where dilatation or motor insufficiency coëxists with hyperacidity the excessive secretion is secondary, being due to the constant irritation of the stagnating food particles. The treatment in these cases (aside from the measures directed to restoring the muscular tone of the stomach and system) is directed to controlling the excess of acid, and this is accomplished best by a diet excluding acid foods, starchy foods and irritating foods. Alkaline powders are exceedingly useful under these circumstances. This concludes our discussion of those forms of motor insufficiency of the stomach which are unassociated with dilatation or gastroptosis. Dilatation of the stomach is a chapter in itself, and will not be further touched upon here. Regarding gastroptosis very much could be written. It is a condition too seldom recognized by the general practitioner. In the young it occurs as an independent condition, and gives rise to considerable annoyance, mainly a dragging sensation in the abdomen, a sense of fullness after the ingestion of even small quantities of food and drink, constipation and neurasthenia. In those more advanced in years it is a part of the general condition known as enteroptosis, and is associated with ptosis of the intestines, the kidneys, and sometimes the liver. The disease is incurable, and all that the patient can expect is relief from the more annoying symptoms. The consideration of this latter condition is reserved for another paper. 426 W. Eighth Street. [FOR DISCUSSION SEE P. 525.] WOODBRIDGE TREATMENT OF SE, A DELUSION.' BY HUGH F. LORIMER, M.D, Much might be said on the Woodbridge treatment of typhoid fever pro and con, but to prove that the treatment of itself is a delusion is a big contract. The attempt to do so will test my ability to stick to the text. For a cross-roads doctor to assail one whose presence is familiar in State and National medical circles seems presumptious, but the country physician, whose privilege is not often to meet such distinguished bodies, must depend upon some textbook for authority or select from his reading some defined course in handling his cases. After having treated a few wellselected cases of typhoid fever in 1889 by J. C. Wilson's antipyretic doses of quinine, also in the fall of 1890 treating a number of cases by Bartholow's iodine and carbolic acid prescription, depending, too, upon sponging as an accompaniment in both of these methods; and since 1890 having had no routine medication, and often relying upon placebos as far as drugs are concerned — in fact, adopting the expectant method, together with faith pinned to absolute rest, sponging and liquid diet—I am now willing to accept the teaching of Osler, found in Johns Hopkins Hospital Reports, Vol. 4, No. 1. Osler says" That at least 75 per cent. of enteric fever patients recover under any and all forms of treatment, and even without the good nursing and regulated diet upon which we lay so much stress. By judicious care, by careful feeding, and by the withholding of drugs of uncertain value, fifteen additional patients are saved, and, if any reliance can be placed upon figures, 3 or 4 per cent. are saved by hydrotherapy. Nursing and diet are the essentials, to which may be added the cold bath when possible, or cold sponging for the antipyretic and stimu I Read before the Union District Medical Association, at Connersville, Ind., April 22, 1897. lating effect. Medicines are not, as a rule, indicated; no known drug shortens by a day the course of the fever. No method of specific treatment or of antisepsis of the bowels has yet passed beyond the stage of primary laudation." In 1883, the first year of my waiting for practice, I had much-very much -time for reading. There appeared in the Medical News a series of articles by Dujardin-Beaumetz on typhoid fever and its treatment. All the then known methods of antipyresis were fully discussed. Digitalin, quinine and other agents were discussed and awarded merit. Each complication was dealt with and prescribed for, so that about the conclusion of the concluding article I had made up my mind that, theoretically, I was loaded for typhoid fever; but my ardor was the subject of antipyresis when told, finally, that all of these failed at times, and the best thing for typhoid fever was a good doctor. With the emphatic and pronounced declaration of Woodbridge we certainly have reason to think that in him has been reached that climax of being not only a good doctor, as the late Parisian | suggests, but the only doctor. In the early part of last winter I met Dr. Pigman in his home city one day, and he, in the way of conversation, told me that he had several cases of typhoid fever, and that they were all convalescing. I asked him what he was doing for them. He said not much of anything. "Why, Doctor, the efficacy of Woodbridge treatment consists in not giving the patient much," said Dr. Pigman. I told him then if I ever got typhoid fever I wanted him to treat me. the abortive and antiseptic treatment for the fever. In the preface of the work, "Typhoid Fever and Its Abortive Treatment," "the first object sought to be accomplished by the issuance of the book is to present to the members of the medical profession so much evidence of the truth of the startling declaration that typhoid fever can be aborted as will induce a large number of physicians to give antiseptic medicine a fair and faithful trial in this disease." This statement is misleading. Others have used intestinal antiseptics as potent as those found in Woodbridge's formula, yet no one has claimed to be able to abort typhoid fever. Further, the book is written in defiance of the opinions of the bacteriologist, who has demonstrated the impossibility of destroying the bacillus typhosus in living man; of the pathologist, who has shown that the micro-organism finds its way deep into all of the organs of the body, and hence cannot be dislodged. As I understand it, the reasons governing the administration of antiseptics result from pathological and bacteriological findings, hence there can be no conflict, and if intestinal antisepsis is a scientific course, then there can be no variance with our present teachings in pathology and bacteriology. On page 64 in his work we find the following: "We know too little of the bacteriological world, too little of the antagonisms existing between the minute denizens, and as a consequence know so little of the etiology of typhoid fever, that we cannot affirm positively that any one germ invariably produces it; and so little of the real action of the remedies which have been advised to be administered that we are unable to say whether the eucalyptol and guaiacol, or the creosote or calomel, or any one agent is essential, or how or why a cure has constantly followed their exhibition." Does this not look like he stumbled upon his formula? No scientific principle was ever worked out in I am not convinced that I ever cured possibly but one case of typhoid fever with medicine, and that was one by the use of guaiacol, and administered as Dr. Sexton recommended in our meeting eighteen months ago. Some may claim this a scintilla of evidence in support of the Woodbridge treatment. Not at all, for his is the treatment. Com-that way. ponent parts of his prescription in the hands of others are not recognized as antiseptics, but the exact, peculiar administrative way of his that makes it The undertaker's hopes are not all blasted by this man Woodbridge, for we find in his introduction these remarks: “I believe that in every uncom plicated case of typhoid fever the disease | doses of calomel or some other antiseptic can be aborted if proper antiseptic treat- and substitute rest and liquid diet for ment be instituted at a sufficiently early liberty and latitude, would stage of the malady." Again: "I have accomplish as much in this case and never even by implication given any possibly run less risk? "If convalesone the right to assert that I do not cence follows the exhibition of a few recognize the possibility of death from doses of medicine no harm has been intercurrent disease during an attack of done, and the patient will be the better typhoid fever, even though it may have for having taken the antiseptic." Need been properly treated from its incep- this intestinal antiseptic be the formula tion." Again: "While I have thus far of Woodbridge? "But if characteristic been able to abort the disease in every symptoms of typhoid fever declare instance in which treatment was insti- themselves the physician will have contuted on or before the eighth day, and ferred an inestimable blessing upon the in a large percentage of those cases in patient by having begun the treatment which it was commenced on or before early, and thus warded off all the danger the tenth day of sickness, as well as in of death and delivered him from the a few cases taken at a much later period, hazardous and disastrous ravages of the I have never taught that the disease can malady and the perils of its many comalways be aborted when treatment has plications and sequelæ." In answer to been so long postponed." With these this, a case taken so early as this deadmissions, and barring the cases of picted one none of the characteristic abortive forum, is it not possible that symptoms of typhoid fever should there are a few deaths occurring under declare themselves, if this vaunted Woodbridge's treatment? treatment is a specific. On page 294 we find the following: "This treatment, to be invariably successful, must be commenced in time to admit of resolution before necrosis of Peyer's glands takes place; therefore, the first time a patient who is or who could become a victim of typhoid fever is seen the antiseptic treatment should be instituted. The indisposition may be ever so insignificant, the symptoms far from characteristic; there may be but a trifling headache, a slight acceleration of the pulse, and a scarcely perceptible elevation of the temperature. Upon such data one could not base a diagnosis of typhoid fever, but it would be equally impossible to exclude it from the list of the maladies from which the patient may be suffering; consequently, it is the physician's plain and imperative duty to give the patient the benefit of every doubt in a question of such vital importance to him; the more so because this antiseptic treatment is innocuous and uninjurious, and the patient need not be put to inconvenience or discommoded in any way-may, in fact, be allowed every liberty and latitude to the extent of following any ordinary avocation." Dissolve the cupric sulphate in glycerine and heat. When cold add the liquor potassa. Pour a drachm of the solution in a test tube with two or three drops of a saturated solution of pure tartaric acid and boil. Now add, drop by drop, eight drops of urine. If there is no reaction there is no sugar. Sugar is present if the reaction yields a yellowish, reddish or greenish-gray deposit.If we should administer a few minute Scientific American. The proper treatment is to remove any distressing symptoms. Not all these cases are benign, but often there is great distress, especially in those with spasmodic vomiting. In some of these cases the attacks come on after eating, when a coughing paroxysm will cause the diaphragm to contract, to be followed by emesis. This cycle may occur several In some times daily, after each meal. of the cases, on account of the obstinacy of the gastric trouble, we later find anatomical changes. Then there are other cases in which the vagus is incorporated in a cicatrix, and from this there is such irritation as to cause reflex vomiting. In others there is an amyloid degeneration of the mucous membrane of the stomach, which is applicable to those cases of cavity formation. At first all may be but functional disturbance, to be later followed by atony of the stomach-wall from motor insufficiency. The larger number have deficient motor work of the stomach, and interference with the chemical process of that organ, with a decrease from the normal amount of HCl, while others, again, may have an excess. In cases where there is anemia, by removing this condition you often do away with the dyspepsia. Again, we may have general debility, with nervous symptoms; the fundamental evidences generally are lassitude and torpor. DR. G. A. FACKLER: I shall confine my remarks to gastric disturbances as the initial condition of incipient phthisis. If a patient consults you with chronic dyspepsia your attention should be directed to eliminating the possibility of primary phthisis, in which stage the objective symptoms at best are quite meagre. Often such cases are put upon local treatment, which is continued until a cough or hemorrhage calls the attention of the physician to the fact The best therapeutic remedies are that there is something more than the first to remove the cause and then direct local condition to deal with. Even attention to hygienic measures. The when a physical examination does not subject at first is not pathological, but give enough evidence to warrant a diag-functional. Do not limit the food; nosis of tuberculosis, yet if there is a because of the indisposition for food it history of loss of appetite and rise of is often reduced, which has often done temperature it should put you on guard, harm. Instead of reducing there should for probably you may have to deal with be paid attention to the appetite. incipient phthisis. This form often form adopted by the French is forced hides itself, and we are not aware of alimentation. You will find that they its presence until emaciation, loss of will digest their food if some attention appetite and fever inform us of the is paid to their tastes. The best charcondition. Later we may have symp- acter of foods should be fluids and easily toms manifesting structural changes of digested solids, and given at short inthe gastric mucous membrane. At first tervals. After the disappearance of the there is a chronic inflammation, with atony they can return to their former hypertrophy of the glands, and later diet. The reason of the success of saniatrophy of these cells, while in the tariums with these cases is on account early part we do not find these anatomi- of their excellent sanitation. Their cal changes. dining-room is made attractive, and A |