The prognosis of this fever, in my opinion, depends entirely upon the tempera ture. A fever gradually rising a degree or so until the morning temperature is over 10210, and the evening 104°, or more, on the fifth day, will almost invariably end fatally on the eighteenth or twentieth day, unless means are devised by which the temperature shall be reduced and maintained below 102°, ❘ without disturbing in any great degree the normal functions of the body. The question therefore arises, how can this be done? The answer that has proven very satisfactory to me is, by the continuous application of cold

water.

The indications to be fulfilled in the treatment of typhoid fever are "to reduce the temperature, soothe the inflamed glands of the bowels, prevent or counteract septic absorption and support the patient."

Any treatment devised that will fulfill these indications, without disturbing any of the normal functions of the different organs of the body, will prove eminently successful in the treatment of this treacherous disease. Fatal cases of this disease die because of a continuous high temperature, the presence of which aids and assists in causing extensive ulceration in the patches of Peyer, which ultimately ends in hemorrhages or perforation. Believing this to be true, our efforts then should be first directed towards reducing the temperature and keeping it down. The method which I have used has been to strip my patients, place them upon an oil cloth so folded that when water is placed thereon it will not soil everything, and any excess may be directed into buckets placed at the side of the bed. I then take a large sheet and fold it four or five thickness, so that it will completely envelop the patient from the arm pits to the hips; wet this in cold well water, and wrap it around him. The temperature of the water should be at 80° F. Then cover the patient with any comfortable covering; renew this wrap every ten or fifteen minutes till the temperature in the bowels shall not be over 101° F. It may not and usually is not necessary to renew this pack in the morning hours oftener than once an hour, but in the afternoon from the fifth to

twelfth day, and in severe cases from the fifteenth to nineteenth also, it will keep an attendent busy renewing this pack, and this must be done to prove successful. This treatment is not pleasant at first to the patient, but after it has been continued for a day or so, the feeling of relief it gives the patient is so great that in a number of instances they will ask for the renewal. In the case of young ladies it will require a great deal of persuasion before they will consent. But my experience has been such that should I find a young lady patient suffering with this disease whose temperature was on the afternoon of the fifth day 105° F., I would insist that she undergo this treatment, and if she persistently refused as one of my patients did, I should retire from the case. The next indication to be met is to soothe the inflamed bowel and counteract septic absorption. This is done by administering the following remedies, and they are remedies in fact. Pepsin, bi carbonate of soda and subnitrate of bismuth, ten grains of each every four hours.

(The question arose on discussing this paper, how did pepsin act as a digestive in an alka line solution? It is the excess of acid that the soda is given to neutralize, and that it does well is proven by the cases presented.)

The stomach and bowels are always highly irritated, and a more sensible combination of drugs to relieve this condition it seems to me, will be hard to find. To counteract the absorption that necessarily takes place from the ulcerated glands in the bowels, a solution of hyposulphite of soda to which is added a little carbolic acid is given every four hours. This constitutes the medicinal treatment of typhoid fever, and in its earlier stages, before extensive lesions and hemorrhages have occurred, fulfils every indication. It now becomes necessary, as we have to deal with a fever of three or four weeks' duration, to support the patient so that when the fever leaves him he will have strength enough to sustain him. With every dose of medicine there is given four to six ounces of fresh unskimmed milk, and as much spoon victuals of a non irritating character as the patient will partake of. The administration of the milk, however, is imperative. Persons treated in this manner from the start or from the third or fourth day where one is satisfied that one has a case of typhoid fever, will very seldom become delirious. There will not be any extensive distension of the abdomen, no tympany. Their tongues will not become dry, brown and fissured, sordes will not collect on the teeth, there will not be any alarming looseness of

dients. She was immediately put upon the cold water treatment with all the other sensible good things before enumerated. There was considerable opposition manifested when applying the pack, but upon positively assuring her and her husband that it afforded, in my opinion, the only hope of a perfect recovery, it was reluctantly assented to. As she resided some distance from me I told them that I would not return for two days, but endeavored to impress upon them the absolute necessity for often repeated renewals of the pack. Bright and early on the following morning I was summoned in haste as my patient was supposed to be dying, would probably be dead before my arrival. I immediately responded to the call, and found upon my arrival one of the most uncontrollable delirious women it has ever been fortune to meet. Upon examination I found the temperature 105 °. The wrap had not been renewed often because it would not keep down the fever, so they said, and they never heard of such treatment, had seen lots of sick people and had known some mighty smart doctors. Gentlemen, things looked squally; something had to be done, or my patient would certainly die. It would not do to abandon the packs. I was determined that cold water should win, and set to work to cool that fever with as determined a will and as anxiously beating heart as ever possessed me in my life. There is no telling how many renewals were made of that pack, nor how much cold water was required, but at the expiration of the next four hours I had the supreme satisfaction of being able to record a rectal temperature of 10040, a quiet patient, and smiling faces all around me. I left my thermometer with the husband, taught him how it should be used, and told him never to let the temperature be more than 100°. On my return the next day he informed me that between 5 p. m. and midnight he had used twenty-seven buckets of cold water on her. The temperature never being more than 101. Her fever left her on the twentieth day, and on the twenty-eighth she was up doing all the the housework, apparently not having lost a pound of flesh nor a hair from her head. I do not think it is possible to make this kind of a record with medicinal agents alone.

was

CASE IV. H. Suhre, 9 years of age, taken sick in October, 1882. I saw him for the first time on the seventh day of his sickness, had been taking domestic medicine and some quinine; pulse 140°, temperature 105°, bowels loose, with thin, greenish yellow offensive stools, abdomen enormously disten led; completely delirious. Upon inquiry,ascertained that fever was very high in the afternoon and

only moderately so during the forenoon. Supposing it to be so-called typho-malarial fever, gave some soothing remedies for bowels. and ordered thirty grains of quinine to be given before 10 a. m. next day. The next afternoon the condition of the boy was evidently worse. The pulse, temperature, delium, frequency of stools and general appearance of the boy indicated the early approach of dissolution. A cloth five or six folds extending from chin to pubes, and from side to side, was wet in cold water and placed upon the boy, (a partial pack.) The quinine was repeated.

The next day, the temperature was 104,0 bowels worse than ever,delirium complete,very nervous, subsultus tendinum excessive. He was placed upon the complete cold water treatment, pepsin, bismuth and soda.. Carbolized soda, broths, and all the good things were added. The next day he was improved in every condition. The same treatment was continued until convalescence was fully established on the twenty-first day. There occurred, however, in this case, an episode in the treatment which completely won me over to this method, and proved to me almost conclusively, that there was but little danger to be apprehended in the application of cold water for the purpose of reducing a fever. You will observe that the case occurred in October, 1882. That year I commenced the cold water treatment, and you will also observe that I endeavored to control the fever with quinine but failed. On one of my visits I remarked to the father that in hospitals where the appliances were convenient, that the patient was put in a cold bath and allowed to remain till the fever was reduced, when he was removed and again a bath given, when the height of the fever demanded it. This par ticular case was one in which the morning and afternoon temperatures were decidedly different. In the morning the temperature would be from 101° to 10210, and the afternoon from 1044° to 105° and over. The most distinctly remitting type that I ever saw. When the fever increased in the afternoon, the boy would become wildly delirious, and, to an observer, intensely hot. On the 16th day of his fever, in the afternoon, the father informed me that he thought his boy would actually burn up. He poured bucketful after bucketful of water upon him, and still the fever to him appeared to be past control. night previous had been a very cold October night, water being frozen in exposed vessels

The

of an inch thick; on the north side of the house there were standing several barrels of rain water. The father picked his little

naked boy up and carried him to one of these barrels, and, after breaking the ice, stored him up in it, and then with a dipper poured this cold water upon his head and kept him there till he was cold. I arrived shortly afterwards and found the little fellow blue, his hands and feet as cold as ice, and shivering from head to foot. I took his temperature in the rectum, it recorded 101° scant. The barrel was used as a bath tub when the fever demanded it for the next four days, since which time I have no hesitancy in applying cold water in any case of high temperature. I have used it on infants two and three months old in these cases of occasional high temperature in acute intestinal catarrh and entero colitis, and in cholera infantum it seems to me to be the sine qua non; have used in the colliquative diarrhea of measles with the most satisfactory results. Have thrown it in the faces and poured it down the backs of children when suffering from atelectatic conditions in catarrhal pneumonia, and I have no regrets for its past use, and naught but bright visions appear to be arising over the therapeutical horizon for me in its use in the future. But to be effective it must be continuous.

The question was sprung, would there not be found cases of collapse from the use of cold water? In answer, would state that I have never seen any but could easily imagine that such accidents might occur if the patient was allowed to remain out of the pack until the temperature rose to 105° F., then apply it, and to allow this performance to take place every four to six hours, but if the pack is constantly applied as advised, there never will be a dangerous elevation of temperature and no shock will occur in the efforts at reduction, and a temperature of water at 80° F. will never produce shock.

VOMITING IN PREGNANCY.

ex

all of which failed to effect any amelioration of her symptoms. At the end of the third month there was coated tongue; general feverishnes, pytalism, almost complete rejection of nourishment, with painful and continuous retching; her countenance was tremely haggard; she was becoming greatly emaciated and exhausted. I could encircle the lower third of the thigh with my thumb and finger. Believing that, unless the uterus was relieved of its contents, she would soon succumb to inanition, I advised the induction of abortion, which I induced by partial separation of membranes, and the introduction of sponge tent.

Three days later the fetus was expelled.

The effect was really wonderful. Her stomach began to accept light nourishment before the abortion was completed, and she proceeded to regain her health. The weight of professional opinion is, I think, opposed to this procedure. I recall the statement of a famous French accoucheur, who asserts that, during a life-long experience, he had never found it necessary to produce an abortion to save life from vomiting in pregnancy. Carl Braun gives expression to the same convic tion. There are, however, equally as prominent obstetricians who recommend it. I sincerely believe that had I persevered in the expectant method with the case reported, the woman would have soon died. Medical men entertain a repugnance towards this plan, but I believe that when it fails to save life it is on account of delay. During During a practice of thirteen years I have observed two cases, including the one above, that I considered as imperatively demanding the production of abortion

I have recently had two young married women under my care for this distressing condition. One of them, after trying all the vaunted specifics and old-time remedies, and deriving no benefit, became very comfortable after the application of nitrate of silver to the os and cervix, the other one was relieved by

Surgeon, Tracy, Minnesota.

The article in the REVIEW, of July 17, under the above caption, by Dr. Marshall, leads me to report a case which recently occurred in my practice.

The woman was Scandinavian, æt. 30; has had four children. She commenced vomiting during the first week of her conception, which continued unabated. At the end of the second month she consulted me. I administered the usual measures, including cerium, ingluvin, chloral and ipecac. Dilated the cervix

PRESIDENT'S ADDRESS.

Published at Request by Resolution of the Society. Address delivered before the Rolla District Medical Society, Rolla, Mo., May 27, 1886, by Dr. S. B. Rowe, President of said society.

Gentlemen: I congratulate you on account of the large attendance on this occasion of meeting in council, as the twenty-fifth semiannual session of the society. Those of you who have come from other towns and from the surrounding country, in many cases having traveled long distances on horseback, I feel like thanking for your zeal. Medical societies have done more during the last twentyfive years to diffuse medical knowledge, than had been accomplished before for centuries. In all parts of our country where there are wide awake, progressive physicians, they are organized into societies for the purpose of advancing their art by narrating their individual experiences, often wonderfully modified by surroundings peculiar to their locality alone. Where the country is sparsely settled as is ours, they come from greater distances and their bounds embrace more territory. In addition to the advantages derived from listening to the experience of our professional brethren, these meetings accomplish much in cultivating the sociable qualities among us, increasing our respect for each other and showing us how we compare in medical information and success in practice with those more highly favored with hospital advantages, and with patrons who can afford the more elaborate methods of treatment. Country physicians are particularly to be envied their versatility of experience, with the limited means at their command. While the ablest minds of the profession are grappling with such important questions as,for instance, in laparotomy, whether bichloride of mercury solution or the carbolized spray is the best antiseptic, or whether for sutures it is best to use catgut or the tail of a kangaroo, two or three country doctors, one of them probably fresh from a case of diphtheria and another from a case of erysipelas, will meet by appointment at a log cabin in the head of a hollow, operate for an ovarian tumor without regard to those details except the condition of cleanliness that may be required by the use of soap and water, sever the pedicle with a red hot poker, ligate the stump with a piece of pack thread, sew up the abdominal wound with an ordinary surgeon's needle and silk, or if not so fortunate as to have those things, with an ordinary needle and thread obtained

at the place, and the woman will recover without having missed a meal or have an elevation of temperature of more than one or two degrees.

While we ascribe all honor to our brethren who are specialists, to whose deep research and untiring devotion in a single direction we owe so much for the minutia in their several lines, we can truthfully say that were the collective experience of the country physicians in such a society even as this, spread before the profession, it would prove intensely interesting reading.

While we are proud of our society and its record, and proud to see so many present on this occasion, we feel that we should have the hearty co-operation of every practitioner of rational medicine in our bounds. It is a principle in which we take pride that we have no therapeutic secrets, and yet the physician who stands aloof and wraps himself in the solitude of his own originality when there is a society to which he can attach himself and enlighten his brethren from his every day experience, gives color to the idea that he has some secret discovery that he is unwilling to communicate to his less fortunate fellows, or else, that he feels that he is too ignorant to mingle with progressive and enlightened men. The Good Book enjoins upon us to "let our light so shine that others may see our good works." Life in the present age consists in something more than shutting ourselves up as within a Chinese wall. While the lives of our fellow men hang trembling in the balance, we should all, as admonished by our several almæ matres, publish to our brethern, by the best means at our command every original suggestion that is likely to prolong their lives.

In regard to the proceedings of these meetings, I would suggest that each member, in addition to any special case he may desire to report in extenso, or essay that he may wish to read, make a list of say a half dozen of the most important cases he may have encountered since last meeting, and have them read by their titles, with result of treatment. Then any member who desires information on any one of the sbjects mentioned, may call for details of the case by the member reporting it. Cases need not necessarily be very important so far as rarity or danger to life is concerned, as for instance, your humble servant would be particularly grateful for information as to a successful remedy in controlling the spasmodic stage of whooping cough in very young children.

I would also suggest that this society by resolution to be made a part of our proceedings