roused into violent delirium, in which it took several people to hold him. With great difficulty (and to the horror of the neighbor who assisted us) we got him into a sitzbath of 70°, poured cold water over his head almost continuously, and rubbed his body vigorously all over. In ten minutes he was conscious, but complained of the most agonizing pain in head and neck. He was kept in the bath for half an hour or more, and the pain was much relieved. The physician who came later, an experienced, well educated man, pronounce it cerebro-spinal meningitis-not infrequent in that locality, and all cases there, so far as I know, excepting my brother, ended in death or permanent maiming or crippling of its victims. The doctor gave quinine and salicylate of soda, and we used, with his consent, wet packs and sitzbaths, as we deemed necessary. Double vision, strabismus, "risus sardonicus," all appeared, and confirmed the diagnosis, if that had been necessary, but in ten days or two weeks he was convalescing. In the early part of his convalescence, and co incident with marked improvement, an eruption of small furnucles appeared upon his back. There were, perhaps, ten or a dozen, all coming about the same time, and reaching about the same size, on both sides of the spinal column and within two inches of it, reaching from two that were within the border of the hair, down to the lumbar region - not below This is an unusual part in the history of this disease. There can be no reasonable doubt, however, I think, that the vigorous stimulation which the patient's skin received, both by the application of cold and by friction, was the direct cause of the elimination of poisonous matter by this unusual route, and that, had the pus from the boils been examined, it would have been found to consist mostly of cultures of the microorganism of the disease. Pomona, Cal. T. WILKINS, M.D., Acetanilid in Practice. Editor MEDICAL WORLD:-Much mention has lately been made of acetanilid, and in connection there with I should like to mention a circumstance that occurred in the practice of my preceptor. He had been called to a case in which the fever had run very high, and had prescribed acetanilid, without, however, informing the nurse (inexperienced) as to what the effect on the heart might be. Symptoms of cyanosis appearing early next morning, the other physician of the little burgh was called, who pronounced it a "most beautiful expression of erysipelas-very grave prognosis; but I think Acetanilid in Typhoid Fever. Editor MEDICAL WORLD:-During 1893 and 1894 I have treated twenty-three cases of typhoid fever, all resulting in recovery. All of these cases were seen within one week after they were confined to their beds. No reasonable doubt as to diagnosis in any case. average duration, from date of taking the bed to the day on which temperature remained normal for twenty-four hours, was 21.7 days. The Treatment. -Nurse was carefully instructed in the use of fever thermometer, and impressed with the necessity of absolute cleanliness of clothing and bed of patient, the great importance of thorough ventilation, and, finally, the instructions for giving a hot sponge bath to the patient as needed. A good, easily read thermometer was left with every case, and patient charged up with same, to be credited when returned. I usually began treatment with calomel and bicarb. soda, tablet trituate, gr. calomel and gr. soda bicarb. in each tablet, and one given every hour until ten are given. 1 Temperature taken every hour or two, and record of same kept for my inspection at future visits. If temperature is above 102 sponge bath ordered at once, and repeated every hour until temperature is not more than 102. If this fails, acetanilid, in from 3 to 8-grain doses, is given every two hours, until temperature is down. I have always used care, but never have hesitated to bring the temperature to 102, or lower, and keep it there. Nurse always instructed what to do in case there should be cold feet and other evidences of too much acetanilid being given, but I have never had any trouble in this regard. I have proceeded on the theory that fever kills, and have kept the temperature down at all hazards. During the first few days I have ordered quinine sulph., grains iij, every two or three hours. Acetanilid has always been given at first in small doses-three to five grains-and increased if needed until desired result was obtained. have not hesitated to use it during the entire course of the fever. Its antiseptic powers are wonderful, and in no case have I had hemorrhage; neither has there been delirium nor disturbances of nervous system, sub sultus tendi Editor MEDICAL WORLD:-The remarks of the editor, in the December number of THE WORLD, on fevers, have been fruitful, in my case at least, in that they have induced me to write this paper. Daring the fall just passed I have seen several cases of fevers, which have given rise in my mind to doubts as to their character. That they were such as my neighbors call typhoid I know; but that they were of that type I had and have very grave doubts. They were continued fevers, running from fourteen days to twenty-one; the pulse ranging from 105 to 125 er 130; the bowels either natural or slightly constipated; urine, as in any case of febrile disturbance; the mind unaffected; no rose spots, no gurgling in the hypochondriac region; the tongue in every case covered with a white fur; the temperature 102 to 105; such, in each case, was the outline of their symptoms, roughly sketched. One of my brother physicians has told me that he had several such cases, which he could not call typhoid fever. Most of the cases were widely separated in location and seemed to have no demonstrable cause. The houses were all supplied by water from the town reservoir, and not objectionable on account of drainage, or other sanitary conditions. That there were a number of other such cases in the vicinity, I had reason to know; and that they were regarded by their attending physicians as cases of typhoid fever I know also, but it has seemed to me that they were lacking in the most important symptoms. But if not typhoid what were they? I certainly cannot believe that cases of typhoid fever as severe as some of these were-though none that I saw were regarded by me as dangerously sick-could have gone through their history without developing some symptoms of the typhoid state. The question which has been in my mind is this: Do we have an autumnal fever, which is different from the usual typhoid? Indeed, it has not happened to me to see many cases of clear typhoid type. In one of the cases there had been exposure to the emanations of a foul privy, and there had been a history of malaise for some days before calling on the doctor; but this case, lasting nearly the three weeks, had no symptom that could properly be called typhoid. Do we have a simple, continued fever, as distinguished from typhus, or typhoid? I mean a fever which runs a period of two weeks or even three weeks? I feel very sure that, in a practice extending over more than forty years, I have seen many cases of fever that could not be classed under either of those diseases; not merely cases of febricula, lasting only a few days, but such instances as those already spoken of; and I must think that such has been the experience of others. Does not the influence of the prevailing type of medical thought have something to do with the number of cases of "typhoid which are so common in the talk of physicians? And, is not a revision of our notions on that subject in order? Some of us are old enough to remember the struggle which was had in order to secure a correct diagnosis of typhoid fever as distingu shed from typhus; is it not just possible that we have been trying to compel all febrile diseases of a continued character to wear the livery of typhoid, without discriminating between them? Or do we have typhoid fevers without the speci ic symptoms? It is true that in some other diseases, such as scarlatina, we do see cases in which the specific symptoms do not appear, or else they are so evanescent as not to attract notice, but certainly not Now in frequently, nor in cases of any severity. the cases to which I have referred, the attacks of disease have been of quite as much severity as the ordinary cases of typhoid fever. So I have been accustomed to think that we in New England, at least, have a continued fever which cannot be classed as typhoid; which is not often characterized by any distinct period of invasion; which does have very distinct morning or evening exacerbations; which, so far as I have noticed, is rarely fatal, has an indefinite course of two or three weeks, is not usually attended by any marked remissions, and ends by a gradual defervescence. Before I close I want to make my, perhaps unnecessary, protest against the habit of using the modern antipyretics on all possible occassions, because, in the first place, they are gener. ally unnecessary, and secondly, because they are, as I believe, often injurious, and that not only in the sense that anything unnecessary is injurious, but because they add a dangerous element to the blood, while the system already has all that it can contend with, or at least all that it ought to be asked to undertake. Cold water is the only true antipyretic, and this applied either as baths or by sponging and repeated as often as the thermometer indicates its necessity, will do all that can be desired in the way of refrigerating. It may be difficult in many cases to secure the necessary conveniences for bathing or, indeed, to overcome the prejudices against it; but sponging is always possible, and its successful application may lead the way to the more effi cient bath. The sense of comfort obtained from the use of water is such that it will be its own most successful advocate. Besides reducing the Besides reducing the temperature, it does what the chemical antipyret. ics do not-it cleanses the skin, and while it pro motes perspiration, at the same time it removes the debris from the skin, and promotes cleanliness at the same time that it relieves the discomfort of the patient. Bristol, Conn. H. A. CARRINGTON, M.D., Sulpho-Carbolate of Zinc vs. Salol as an Intestinal flammation of Parotid Gland Cured Editor MEDICAL WORLD:-In looking over the December number of The World I see that Dr. J. Hunton Peak, of Louisville, Ky., says that he has used sulpho-carbolate of zinc in two cases of enteric fever, and in both cases had severe gastric symptoms. Both had persistent vomiting, and one of them had increased diarrhea with intestinal hemorrhage. He says the vomiting would disappear when he discontinued the sulpho-carbolate of zinc and would return again on its readministration. In both cases he substituted salol and had no further gastric irritation; and consequently he concludes that salol is preeminently the drug to be used as an intestinal antiseptic in enteric fever. I think the question as to the cause of the vomiting in the above cases is easily answered, viz.: The presence of the sulphate of zinc existing as an impurity in the sulpho-carbolate. The sulphate is certainly a prompt emetic, whether given by itself or when present in the sulpho The carbolate. None other than the chemically pure sulpho-carbolate should be used. From its use I have never once had vomiting to occur, but have almost invariably seen its rapid disappearance, frequently after taking the first dose. I will mention one case of enteric fever I am treating now, in connection with Dr. R. L. Hardwick, in which, on my first visit as consultant, I noticed considerable nausea and there was a history of occasional vomiting, which disappeared after the first day's treatment with the sulpho-carbolate of zinc, and was present no more during the course of the disease. I prefer the sulpho-carbolate of zinc to salol in the treatment of enteric fever for the following reasons: 1st. Sulpho-carbolate of zinc is soluble in water, and when taken in solution incidentally acts as an antiseptic and astringent for the mouth and pharynx-a very important point in the treatment of enteric fever, thus diminishing the liability of the passage of septic material to the parotid gland and its subsequent inflammation. Salol, being insoluble in water, and generally given in capsule or tablet form, does not have any effect upon the mouth or pharynx. 2d. When taken into the stomach the chemically pure sulpho-carbolate of zinc relieves nausea, pyrosis and all fermentative disorders which are frequently present in enteric fever. If salol passes unchanged through the stomach into the bowels and is there resolved into its component parts (salicylic acid, by weight 60 parts and carbolic acid 40 parts) it certainly cannot have as much local sedative and antiseptic effect upon the congested gastric mucous membrane and its contents as the sulpho-carbolate of zinc. 3d. By virtue of its astringent property it is of more value in restraining the diarrhea and hemorrhage than salol. 4th. It will deodorize the stools and disinfect the alimentary canal with as much certainty and celerity as salol or any other drug I have ever used. 5th. It does not seem to affect the kidneys. Salol, being eliminated by the kidneys, is dangerous if there be a chronic nephritis, which may be made acute by its administration. 6th. Sulpho-carbolate of zinc is not an antipyretic, per se, consequently we do not fear its antipyretic effect when given for the bowels in low temperature cases. Dr. Robert L. Goodbred, of Mayo, Fla., asks treatment for an ulcer on the leg of a young man aged 21. The treatment, of course, would vary somewhat according to the nature of the ulcer, whether irritable, phlegmonous, edematous, sloughing or callous. As the callous ulcer is the one most commonly met with in practice I cium sulphide every hour while awake. Two C. M. SMITH, M.D., The Typhoid State or Typhoid Fever.-Hot Editor MEDICAL WORLD:-The typhoid state is one of depression, and one in which we most frequently have a strong grade of feverin some cases a very high grade, in others a very low grade, and I have seen four cases of well pronounced typhoid fever (or, I should have said, the typhoid state, as there was no fever), in which, in fact, the temperature was below normal, running from 96 to 98, all the other conditions of typhoid fever being present. These cases continued the usual three to five weeks, and made good recoveries. I think the will tell how I cured one recently. I at first had the ulcer washed twice daily with carbolic acid and water; then dusted the surface over with iodoform and laid over the ulcer a small cloth saturated with iodo form and glycerine, and over that some absorbent cotton and a bandage. It healed nicely until it was about even with the surrounding healthy skin, when it stopped and refused to heal any further. The surface of the ulcer became very dry and fissured and remained so for several days. Antiseptic dressings, counter irritants and poultices all alike failed to produce any change in it. As it had been on her foot for eight months, and one physician had treated it and failed and then pronounced it a cancer, and as I had told her that I would certainly cure it, I was in a dilemma as to what course to pursue next. So I sat down and wrote her a perscription for the following: Esmarch's caustic, composed of arsenious acid one part, morphine sulph. one part, calomel eight parts, pulv. acacia forty-eight parts. This I ordered sprinkled on twice daily, followed by majority of the profession lay too much stress poultices, until I thought it had cauterized the ulcer to about its original depth. It was then cleansed by poultices and kept moist with glycerine and carbolic acid, being washed twice daily. The caustic had also blistered the hard, callous ring around the ulcer and it gradually softened and was absorbed. The granulations were again nearly even with the surface. So now, to be more sure of cicatrization, I concluded to try the transplantation of the inner membrane of the hen's egg in small bits over the surface of the ulcer. This I did, but they did not produce any centres from which the healing process extended; but the operation appeared to stimulate the whole sore to take on a more healthy action. The cuticle gradually extended from the edges toward the center, commencing first on the sides where the callous ring showed least. It is now sound and well. I think if I had applied a blister at first over the whole ulcer and a little adjacent sound tissue it would have healed much quicker by producing softening and absorption of the callous ring, without which they will never heal. Two weeks ago I saw a little girl ten years old who had just recovered from an attack of scarlet fever, and had as a sequel an inflammation of the right parotid gland. The inflamed area covered a space of three inches in diameter, was somewhat reddened but not very painful to touch. I ordered her to take two granules of calcium sulphide every two hours and did not see her again for three days, when, to my surprise, there was not only no improvement, but a steady, gradual enlargement with some fever. I then ordered her to take three granules of cal on the fever, and not enough on other points of this much dreaded disease, for there is no disease of which the laity are as much afraid as typhoid fever, the mere mention of it causing alarm to both patient and friends. I do not look upon the fever as the prime cause of that low condition we find in our patients. On the contrary, I deem the absorption of the poisons generated in the bowels from the discharge of the many ulcers as the cause of the low, muttering delirium, black-coated tongue, dry lips, weak pulse, and extreme nervous condition so frequently found, and the muscular twitching and trembling. The poison is re absorbed from the ulcers, and is responsible for all of the above serious conditions. Assuming this to be true, as I believe it is, the next thing is, how are we to prevent this condition? What means will we employ to destroy the ptomains existing in the bowels? We will presume that we are called to see a case which, in our opinion, is of the typhoid type. The bowels are constipated, or have only moved slightly. The first thing in order will be a dose of calomel, grs. v, sodii bicarb., grs. x, given at night, and a dose of Rochelle salts in the morning, to thoroughly wash out the bowels. Then commence with an antiseptic line of treatment, something as follows, using powders, or I use tablets of P. D. & Co. : R. No. 1.-Acetanilid.. Citrated caffeine........ Tr. gelseminum... ..ers. 21⁄2 .grs 22 .....gr. 1 ..m. 3 Sig.-One tablet or powder three or four hours apart, a5 the fever indicates. And with this I give R No. 2-Sulpho-carbolate zinc....grs iii to grs iV. R. Strychnine sulph... Acid nitric...... ..ounces iv M. Sig. One teaspoonful in some water three or four hours apart. If the bowels move too freely, which they seldom do if sulpho-carbolate of zinc be used, I give a small amount of opium or morphine, and the same to procure sleep, if it be necessary, as I consider opium a much better drug in this fever than chloral.. Give the patient plenty of water, or, if desired, lemonade; also plenty of good liquid food-malted milk, cow's milk, soup, and soft-boiled eggs; no hard or solid food of any kind. Keep mouth and teeth clean by washing several times a day with listerine or sodii bicarb. in water. If bowels do not move at least once a day, give an injection of water, or give a dose of castor oil or Rochelle salts. I know this is not what we were taught some years ago, but I know a purge is good, and I give it, and have not had any bad results from so doing. My plan is the antiseptic treatment, and if any brother M.D. wants more knowledge about it, address me, and I will give a complete out. line on many cases I have treated as above, and never have a dry tongue nor any delirium, and a very slight bowel trouble. For hemorrhage I use ergot and turpentine, and for tympanites I prescribe an emulsion of turpentine, but with the antiseptic treatment tympanites will be very rare. For hot flashes at the menopause, give pɔtas R. Burdock seed, ground...... ounces ii .ounces iii ......ounces xvi M. Sig-One teaspoonful one hour before meals and at bedtime. Always shake the bottle. If his patient spits up her food in a sour condition, give R. Acid. mur C. P. m 5 to 10, well diluted in cold water, just before meals, and tablets of charcoal, pepsin and ginger, after meals; also, tablet triturate of aloin, belladonna, strych. and cascara sagrada, P. D. & Co., night and morning, to keep the bowels free. In Dr. Forman's case of straining at stool, use injections of water once a day, and R. Fluid cascara arom... P. D. & Co.........ounces li and his case will soon improve. For Dr. Bismarck's case of intestinal catarrh, I would advise B. Sodii phosphate, dr. i, in water, three times a day, and the following three times a week for a few weeks: R. Calomel Bismuth sub-nit... ...grs i .....grs x And a tablet of sulpho-carbolate of zinc. grs v, on alternate nignts with the calomel and bismuth. I see in the medical press some very severe condemnations of the hypodermic syringesuch expressions as "It is a good instrument to leave at home." Now, I don't see how I could succes: fully practice without a good hypodermic. I deem it one of the best productions of the instrument maker. I have used it more than one thousand times, and have never yet had a bad result from its use. It is the most prompt method of relieving pain and getting the best and quickest action from medicine. M. MCMAHON, M.D., [May not the sub normal temperature cases have been cases of appendicitis, very easily and frequently mistaken for typhoid fever? A certain class of cases of this disease have sub-normal temperature.—ED.] |