ease does resemble small pox in the first stages (I have treated both). Has all the ear marks" of the genuin, up to the eruption and pustulation stage varying in intensity as the difference in the temperament of the patient might happen to control. In probably two hundred cases I had no secondary fever, no pitting, no death. Mostly, the odor (as a sheep pen) was confined to those who really stink under the most favorable conditions. I treated them, male and female, ranging in age from an infant of sixteen months to a gentleman of ninety-two summers. Had alcoholics, syphilitics, tuberculous and almost every other kind, including the lying-in state, and "nary a death." I do not attribute this good record to any superior smartness on my part. I used symptomatic treatment on all, kept them warm, and gave as much whiskey as they cared to use. Diet "anything you want, or can get." Many of them were on the street or in their places of business daily. I have lookt up the history of this disease and find that in the sixteenth century the doctors had much the same kind of a time with it as we are now having, only in those days, in Germany they would kill a doctor who called it small pox, and across the line in France they killed him if he said it was not. One may take his choice at this late day, and be sure of meeting some other equally bright M.D. who will be obstinate and not agree with him. In Pleasant Hill, Missouri, where I then lived, you will find fully ninety per cent. of the population who do not believe it was small pox, as they can point out several people, yet living, who have had the "Simon pure" and this other small pox too. I really believe that if there were no state boards of health to draw their sustenance from the people, this disease would have come and gone without exciting a ripple upon the average medical mind or leaving a pit to mar the beauty of the girls.

Quincy, Ill.

W. H. YOUNG.

Editor MEDICAL WORLD:-We are having the so called small pox. It is every where. Affects the vaccinated and often affects those who have had variola. Leaves no scars. Repeats in ten days from first attack. No cases bad unless whiskey users have it. No cases die with it. Becomes chronic.

Oswego, Kan. W. S. NEWLON, M.D.

So-Called Cuban Itch. Editor MEDICAL WORLD:-Having just become a member of the WORLD family, I want to say a few words on the above subject, as we have had quite a lot of it in this country. I was called to see a man, on the 11th day of October, 1898, whom I found to my satisfaction with every symptom of small pox. Feeling very certain that there was no small pox in this section, I began to doubt my diagnosis, so took up clinical investigation to ascertain if possibly it had been imported into our country, but failed to find anything that would enable even a suspicion. I therefore proposed to keep quiet and watch the case. Temperature remained at about 102° for four days, then there appeared small blebs, which grew thicker and a little larger, with a radical decline in temperature, which even went below normal, and patient seemed to almost collapse; but under heroic administration of stimulants, rallied and took nourishment. In six hours he wanted to get up and go about, claiming that he felt all right. The blebs, sixteen hours after their appearance, became pustules. In about seven days they began to dry and formed scabs and peeled off with no trouble other than some itching when in the air. No secondary fever, no stage of lassitude after appearance of blebs. Now in the name of common reason can we call this small pox in any form? I have treated about forty patients, and if I had no complications it has been in nearly every case a reproduction of the first.

Now about it being contagious: I have seen families of six or seven and only one member in the family have it. Yet I will admit that I cannot account for it staying in a community so long, cropping out here and there; but I can't recall a single instance where it caught every member of a family, and I do know that it cannot be carried in ones clothing by simply going in and out, for 1 certainly would have carried it to my own family were that the case, for I have visited as many as eleven cases in one day and went to my home and sat among my family without changing my clothing. As to vaccination being a preventive, I cannot accept that theory, as I have seen patients have it that were vaccinated, in which it took well. Yet I have heard men of good repute pronounce it small pox, and advise vaccination as a preventive. I utterly fail to find any

La Grange, Ark.

NAT. A. EVANS, M.D.

Editor MEDICAL WORLD: To begin with, I belong to the "pill rolling family"; been at it for seventeen years, out in the piney woods, among the hills and hollows, red mud, sand, creeks and branches, chicken hawks, jay birds, woodpeckers, big eyed cottontail rabbits, brush, briars, broom sage, etc., etc. While I have had my share of the ups and downs (mostly downs), the good, bad and indifferent, the joys and sorrows, the serious and the ludicrous, I have never before appeared in print. When I read the scholarly and scientific articles from those who are so much my superiors, I have an inward hesitancy (as the duck said to the bold hornet) that I may get stung. But when so many people begin to talk so much on a subject, I can't refrain from putting in my "bill."

There has been, for two years or more, in and adjacent to my practise, an eruptiv, infectious and contagious disease among white, black, "yaller," coppercolored, brown and brindle, young and old, for it is indeed no respecter of persons. I have not kept a record of the number of cases seen and treated, but there have been many. I have seen it in all of its forms from the lightest, when the patient had very light fever for from eighteen to twenty-four hours (never going to bed for it), with a few "bumps," a vesicle or two, and all was over. Again I have observed very high fever, temperasure 102° a. m. to 104° to 105° p. m. for three to four days and nights, with headache, backache, thirst, restlessness, etc., with but few "bumps," fewer vesicles and no pustules at all. The following case will suffice to show the nature and character of the majority of cases seen and treated, tho a few cases were more violent, two cases having had secondary fever:

Man, white, aged 30 years, farmer, got up the morning of the 8th, feeling "sore. all over, tired and aching; at 4 p. m. felt much worse, symptoms aggravated, head and backache, legs hurting, temperature 1021°. The 9th, 8 a. m., no better; "eyes hurt; " temperature 103°; 3 p. m., pains in back, head, legs and arms, very severe; eyes red, face flusht, thirst,

hacking; general restlessness; temperature 105; 10th, 8 a. m., symptoms the same, but feeling a little better; temperature 103°; 4 p. m., symptoms the same as previous evening, eyes watery, sore throat, complained of some difficulty of deglutition; temperature 105°; 11th, 8 a. m., about the same; temperature 1033°; 4 p. m., the same as previous evening, tho more quiet; not so thirsty; temperature 1043°; 12th, 8. a. m., patient "feeling fine; no soreness, no aches nor pains; perfectly quiet, wanted a little breakfast; temperature 9810. Eight or ten little, red, hard bumps were around edge of hair on forehead and upon the face, three on one arm, two on the other, and one on the hand. These bumps were from the size of a No. 6 squirrel shot to a buckshot; 13th, 4 p. m., face almost covered with bumps, also more on arms and hands, several on neck and chest. Those that first appeared now began to vesiculate. This "breaking out" and vesiculation continued its course on down the body, legs and feet until the 19th, requiring seven days to complete the eruption. Vesiculation following in its due course of time, tho not all of these pimples formed vesicles, yet a large majority of them did. On the third and fourth days these first vesicles became flattened on top and deprest in the center (umbilicated), when pus would form, and about the sixth or seventh day scabs would form, tho the scabs formed much earlier in some of the pustules. Scabs would form in twentyfour hours on some few of the vesicles, when they would dry up, never forming pus at all. pus at all. He had pimples, vesicles and pustules on him at the same time.

When the smaller pustules dried up and scaled off, there was left a white spot on the skin, but the larger ones left a pit or regular pock mark, which required from ten to eighteen months to become obliterated, and some of them remained after thirty months, and are there yet. The white spots are all gone in from thirty to ninety days. It required fourteen to fifteen days from first eruption to complete desquamation. Those who had been successfully vaccinated, and those who have previously had small pox, go among it with impunity, and so far as my knowledge extends, have never contracted the disease.

Patients are very sick for the first three

or four days, yet there have been no deaths from it in this vicinity, notwithstanding one old "nigger," on being askt how he felt, answered: "Boss, I feels des like I'se gwine right on to my Jesus." But the last account I had of him he had not met that divine character, nor do I think he will soon, if he ever does, for he has never paid my fee yet.

What was my treatment?

Oh, nothing but salts and in some cases sweet spirits of nitre; gave calomel in a few instances. Diagnosis, modified small J. P. PHILLIPS, M.D.

pox.

Yantley, Ala.

To Prevent Pitting in Small Pox. Editor MEDICAL WORLD:-I notice a number of articles on small pox in February WORLD. I will here add my mite. To avoid pitting in small pox, the vesicles on the face should be opened, and the liquid contents evacuated before the vesicle becomes a pustule. The pus destroys the epidermis, causing scars. If the vesicle is emptied of its contents, no scar or pit will result. Mr. Henry L., living near here, had genuin small pox; the vesicles were opened and evacuated, and there is not a scar on his face. Other members of the family who had it at the same time, in which this was not done, are badly scarred.

WESLEY VAN NETTE, M.D.

Poplar, Ohio.

Early Diagnosis of Small Pox. Editor MEDICAL WORLD:-Please tell us what is the earliest time that one may give small pox some claim before the eruption shows? What, at the present day, is the best method of disinfecting the house? How shall we disinfect clothing? The text books are silent on the first query, and somewhat behind the times on the last. "X. Y. Z.," M.D., University Place, Nebraska. [The books are silent for want of knowledge; one must make a provisional diagnosis from the following symptoms, signs

and history:

(1) If patient has been vaccinated, how long since, and what is the condition of the scar?

(2) The pain in lumbar region is generally complained of more bitterly than in any other disease.

(3) Has the patient been exposed to infection? Question rigidly and persis

tently on this; he may have traveled, and been exposed on street and railway cars, without his knowledge.

(4) Is there small pox in the vicinity? Doctors, you must bunch guesses and ideas; there is no absolute method of diagnosing small pox before eruption, and even then doctors differ.

The house is best disinfected by formaldehyde. What will disinfect bedding and carpets will prove good in clothing. Every article in each room should be shaken loose or opened so that it may be fully exposed to the fumes of the gas. It is better to burn mattresses, books, and such other articles as might leave doubt as to whether every germ nest had been reacht. Hang clothing loosely on racks, chairs, or beds. Pack all windows with paper or rags. When every room has been thus prepared, set your formaldehyde lamp going. Allow the fumes to remain in every room for six to twelve hours; then air the room; it will then be safe. Whitewashing the walls, repapering, soaking floors with bichlorid or carbolic acid solutions are all good in the homes of the poor. See that the county or boro pays the bill for disinfectants, which they can well afford to do if the doctor must lose his fees.-ED.]

66

After the above was in type, articles on 'the strange disease" continued to come in so steadily that we allowed them to accumulate until nearly time to go to press, and then determin what to do with them. We concluded to put them in a slightly smaller type, and run them all in this issue, thus allowing a full and free expression, hoping that this will close the discussion. Heading for each separate article is not needed, yet a few original ones have been allowed to stand. We have now heard from nearly every nook and corner in the country. It is evident that small pox is, and has been, prevalent in a great many parts of the country, in most instances in an unusually mild form-so mild as to make the diagnosis perplexing. At the same time other exanthemata, of a more or less indefinit character in many instances, have also been widely prevalent. Our soldier boys returning from Cuba scattered to their

Editor MEDICAL WORLD:-We had small pox here in November and December, 1899. We had chicken pox here in November and December, 1900. We have small pox here now, it having been brought here from the Delta about the middle of January of the present year. The disease was called "Cuban itch " in 1899, because no one died of it. It is called small por now, because fifteen of the thirty-five who had it died. It is but justice to our county health officer and myself, however, to add that I pronounced the disease small pox in 1899, and he visited the cases and sustained my diagnosis. As the cases of 1899 were confined to the Boys' Home at the Bennett Academy, the outside world, the laity, knew very little of the sufferings of the unfortunate students, and, I blush to say, the physicians knew less. Two-thirds of the cases, perhaps, were very mild; but the other third took the regular "book-route." One young man and an old lady lost each an eye, and many toe and finger nails parted company with their erstwhile hale possessors. If I mistake not, Welch tells us (American System of Practical Medicin, Vol. 7,) that "it is only in extraordinarily severe cases that the nails sluf off." Altho these unfortunate people "rotted " in that "Home" for weeks, glued to their beds, suffering all the tortures of a "bookcase" of small pox, the laity, and those physicians who could not be induced to see them, were crying-"Cuban itch!”

I know, Mr. Editor, that those people had small pox! I know that one year later we had chicken pox. I had it myself, as did two other adults in this section, and I don't know of a white child in this section that did not have it. This was chicken pox.

I want to be understood as talking about small pox, and not chicken pox, or "Cuban itch." We have small pox here now. My reason for thinking so is this: I understand, from either Bartholow or Welch, "that small pox is an acute infectious disease, characterized by an initial fever of about three days' duration, succeeded by an eruption, passing thru the stages of papule, vesicle and pustule, ending in incrustation, and leaving pits, or scars; the fever either intermitting or remitting in the papular, and increasing in the pustular stage." Now, Mr. Editor, if this definition of small pox has "past both Houses," this discussion is

entirely uncalled for. We find every symptom in this disease that is mentioned in the above definition. While a vast majority of the cases do not pit, a considerable number do pit. While a great many cases, especially discrete cases, do not have the secondary fever, a great many do have it. The mildness of the disease is what has caused all this confusion and discussion. As the "Cuban itch" advocates seem to rest their cause on this fact, let us see if the disease has ever prevailed, or does ever prevail, in a System of Practical Medicin, Vol. 1, pp. 5195"mild" form. I will quote Welch (American 20): "Conditions seem to exist at times more favorable to the spread of small pox than at others. For instance, at one time the disease is met with in isolated cases, and shows little disposition to spread; or if it spreads and assumes the proportion of an epidemic, the epidemic is small and markt by unusual mildness. At another time the disease rapidly spreads from a single case, and speedily assumes the dimensions and fatality of an extensiv and malignant epidemic. This variation in the behavior of the disease at different times has never been satisfactorily explained" (Italics ours). Now, while I am no young bird, and do not always throw open my mouth and swallow everything that is brought to the nest, I am willing, however reluctantly, to concede that "predecessors" could be right about this thing. there might be a possibility that Welch and his

I have already remarkt that some of the cases do pit. Now, as to vaccination. Eli J-contracted the disease about four weeks ago and has remained in the house with his family all the while. His entire family were vaccinated as soon as it was suspected that he was taking the disease. Not one of his family has taken it. He has a large family. I could cite numerous other instances in which vaccination has served its "legitimate" purpose. Indeed, I am far from being certain that it has failed in a single instance. Another thing I will mention. A young man returned from the Delta and developt small pox. The whole family, except the mother, had the disease. family thru the disease. She had small pox during the Civil War, when a child.

She nurst the

W. J. Willingham has charge of the Boys' Home, at the Bennett Academy. Some thirtyfive or forty of the inmates had the disease, and while the atmosphere in the vicinity of that Home was mellow with the stench of the disease, and while Mr. W. remained in the "thickest of the fight" as nurse, he stubbornly refused to have it. He had been successfully vaccinated. The P. M. at that place went thru with a like experience, he also having been vaccinated. They have also a Girls' Home at that place. The disease "struck "that Home. Not one who had been vaccinated took it. matron of that Home nursed the cases thru, but could not be persuaded to have the disease. She had been vaccinated. Indeed, they "vaccinated" the disease out of that Home.

The

I have spoken "as unto wise men. Judge ye what" I have said. Until I shall have mastered the diseases which we have already,

I do not want the "boys" to introduce any new ones. I therefore protest against the introduction of this "Cuban itch." Until medical books become cheaper, I cannot afford to pay for a "distinction without a difference." The disease described by Dr. McCampbell, of Mt. Pleasant, Miss., is not the disease which we have here at present. That disease visited us in December and January last. While a few adults had it, the children all had it. There is little similarity between the diseases. That disease came and went; then came small pox, and about 45 per cent. of the cases have died. Where there was fever at all, in the former disease, it appeared simultaneously with the eruption. In the latter disease there is a chill, or repeated rigors, followed by a fever, of variable intensity, and a violent head and backache, which is followed on (generally) the third day by an eruption, which passes thru the stages of papule, vesicle and pustule, and ends in incrustation and desiccation. Now, if the truth can be put in "cold type," the above is the course taken by the disease which I am trying to describe. We have had two distinct eruptiv diseases in this section during this winter. As this is, or may prove to be a worse disease than some seem willing to admit, let no one attempt to "write it up" who cannot say: "I, John, saw these things!" If THE WORLD survives this article, certainly it (THE WORLD) will never "end." A. C. GORE, M.D.

Hohenlinden, Miss.

Editor MEDICAL WORLD:-Will you let one from the wilderness go on record in this much discust question? In this land where the noble red man is standing naked on the brink of civilization, hesitating whether to don the breech clout or the boiled shirt, while the Goddess of Liberty is blushing at the performance; in this land of the outlaw, the Crazy-Snake Indian, the screw-worm and the Dawes Commission, the conditions are favorable for small pox to do business. Here we have the white, the red, the black and all intermediate shades of color and previous conditions of servitude, mixt up together. And like the poor, this prevailing disease has been with us a long time. It may all be well enuf for boards of health to diagnose, resolute, proclamate and ultimate at a distance, but it goes on just the same. Seeing is believing; but feeling is the naked truth. I have seen more than 200 cases, under all conditions of sanitation, from the new born to the old and decrepit; from the unsoapt, unwasht negro in his hut, to the charming school "marm" in her cosy room, whose cleanliness touches the borders of godliness. I have seen it in the construction camp of our new railroad, where 150 negroes are employed. I now have twenty Indian children broken out with it in the mission school, where near 100 Indian children are kept day and night. Yet in all this we have had no deaths nor dangerous symptoms. Does this look like small pox? We have made no effort to restrict, confine or quarantine the thing. It has been as free to spread as the winds of

heaven. Surely we would reap the whirlwind in funereal processions if this be small pox. I once had charge of a small pox hospital, and of a truth the performance was entirely different then from this. There they were sick from start to finish. In the unvaccinated the fever was sometimes terrific; the face swollen beyond recognition; the itching almost unbearable; delirium in many cases, with death in about one-third of the unvaccinated.

The initial symptoms of this prevailing disease look much like a mild case of varioloid. Some fever, head and back ache for three or four days. Then the rash appears, and that is about the end of it, as far as the doctor is concerned. Not sick enuf to make a bill. It leaves no pits or scars. Vaccination does not modify it. It does not look much like, it does not act much like, it does not smell any like small pox, and the ending is a long, long ways off from small pox. Sapulpa, I. T. J. H. HOUSER, M.D.

Editor MEDICAL WORLD:-Having read the articles upon small pox and "Cuban itch" in your valued journal, I desire to add my testimony to that of other physicians as to the identity of the eruptiv disease prevailing so extensively over the United States. Beyond any question, except that raised by the laity, it is small pox. No physician who has observed the disease in as many as ten cases can doubt that it is small pox, whatever doubts he might have had as to the first case. No medical writer since Hippocrates has described under another name any eruptiv disease for which this could be mistaken in ten consecutiv cases.

It is a contagious eruptiv disease, with an incubativ period approximating twelve days; a chill or chilly sensation followed by fever, more or less intense, with headache, backache, and vomiting occur in almost every case; the eruption occurs almost invariably on the third day, first upon the head and face, gradually developing over the body; the fever subsides as soon as the eruption appears, at which period the sick person expresses himself almost invariably as feeling perfectly well. The eruption is first papular, then vesicular, then pustular. The vesicles are umbilicated in many instances. There is a black speck in the top of the vesicle as it begins to assume the pustular character. The eruption occurs invariably in the palms and upon the soles as well as upon other parts of the body. In a vast majority of the cases the eruption is discrete, tho three cases of the confluent variety have come under my observation. Did some one say it did not leave scars? If so, just agree to pay the photographer, and I will convince you to the contrary by sending photographs of some cases who will carry the marks for life. True it is that many cases, equally as characteristic in other respects, are not markt. Vaccination is a positiv preventiv. In four families consisting of from five to eleven persons, all exposed, I have limited the disease to the primary case in each instance by prompt and successful vaccination. No freshly vaccinated person has had the disease in even the mild or varioloid form in this community, where, per