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LIBRARY OF CONGRESS, 
 
 Chap.:„:..._ Copyright So 
 Shelf..,\K|l8 
 
 i._ 
 
 UNITED STATES OF AMERICA. 
 
TYPHOID FEVER 
 
 AND ITS 
 
 ABORTIVE TREATMENT 
 
 JOHN ELIOT WOODBRIDGE, Ml D. 
 
 Member and Ex-President Mahoning County, Ohio, Medical Society, 
 Member and Ex-Vice-President Ohio State Medical Society, 
 Member of Mississippi Valley Medical Association, 
 Member of Ninth International Medical Congress, 
 And Member and Trustee American Medical Association, 
 Etc., Etc. 
 
 ALL RIGHTS RESERVED. 
 
 
 
 
 Cleveland : 
 
 L. Leavengood and Company, 
 
 No. 48 The Arcade. 
 
 1896. 
 

 Copyright, 1896, 
 
 By John Eliot Woodbridge, M. D. 
 
 Registered at Stationer's Hall, 
 
 London, England. 
 
"Thus, for me, as in the case of great physicians, the 
 measure of real progress in medicine must not, and should 
 not, be estimated in any other way than the greater or lesser 
 number of patients which the physician can conscientiously 
 say he has seized out of the jaws of death." 
 
 No matter in what position in life a man may be, his 
 greatest object should be to preserve health and life." 
 
 — Semmn'ia. 
 
 CORRIGENDA. 
 
 Page 20. Third line from foot of page— insert or before typho-malanal. 
 
 Page 85. Twelfth line of first paragraph-for respectful read respectable. 
 
 Page 93. Fourth line of fourth paragraph-for but read and. 
 
 Page 102. Eighth line from top-in place of (hey read the symptoms. 
 
 Page 101. Fourth line of second paragraph-for insufficient read inefficient. 
 
 Page 1 14 Fifth line from foot of page— omit which. 
 
PREFACE. 
 
 The objects that are sought to be accomplished by 
 the issuance of this book are : First, 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 — the most destructive to adolescent 
 life of all of the acute specific infections — a disease which 
 is both preventable and curable, but which is not only 
 not excluded from, but has been practically invited to 
 invade every community, and has hitherto been allowed 
 to pursue its course uninterrupted by any scientific or 
 efficacious treatment ; second, to give such explicit direc- 
 tions as will enable all physicians to so intelligently 
 apply the principles of antiseptic medicine to the cure of 
 typhoid fever that they may secure for their patients the 
 least inconvenience and suffering, the shortest duration 
 of illness, and the lowest possible death rate ; third, and 
 finally, to impress upon the minds of the members of this 
 medical profession the enormity of the crime which is 
 committed by all communities that pour their excrement 
 laden sewage into our fresh water lakes and rivers, in 
 violation of all sanitary principles, of genuine humane- 
 ness and even of common decency ; to the subversion 
 of all efforts at the prophylaxis of typhoid fever, cholera, 
 and other diseases. 
 
 The book is written in defiance of the opinions of 
 the bacteriologist, who has demonstrated the impossi- 
 
2 PREFACE. 
 
 bility of destroying- the bacillus typhosis in living man ; 
 of the pathologist, who has shown that the microorgan- 
 ism finds its way deep into all of the organs of the body, 
 and hence cannot be dislodged ; of- the therapeutist, 
 who has asserted that drugs can accomplish no useful 
 purpose in the treatment of typhoid fever ; and of the 
 theorist^ who has exposed the ignorance of those who 
 believe in the curability of the disease. 
 
 The bootless task of endeavoring to demonstrate 
 the manner in which these antiseptic medicines pro- 
 duce their effects, or the settling of other moot ques- 
 tions, has not been essayed ; but these pages will show 
 that for more than fourteen years I have had no death 
 from typhoid fever in a locality in which my death rate 
 had previously been very high — that in no instance in 
 which a case of typhoid fever has come under my care 
 prior to the eighth day of illness have I failed to abort 
 the disease in ten or twelve days or less — that in no in- 
 stance in which I have been called so early that a reason- 
 ably positive diagnosis could not be made on the first 
 or second visit, have I had a well-developed case of ty- 
 phoid fever, although many such cases have presented 
 pathognomonic symptoms of the disease, and they will 
 also show that so large a number other physicians have 
 demonstrated the power of abortifacients over typhoid 
 fever, that, as an ex-President of the Ohio State Medi- 
 cal Society said in a public address (see page 161) "it 
 (the treatment) has stood the crucial test for years in 
 hundreds of cases and the theory is fully sustained by 
 the long list of victories achieved." 
 
 It is to be hoped, therefore, that the importance of the 
 subject to both physicians and their patients, will justify 
 the haste which sent the book from the printer to the 
 
PREFACE. 3 
 
 electrotyper without waiting to have the page proofs 
 returned to me for correction, and that this entrusting of 
 the final proof reading to the printers will serve as an 
 excuse for any consequent grammatical or typographical 
 defects which may mar its pages. 
 
 637 Prospect Street, Cleveland, Ohio. 
 March 10, 1896. 
 
INTRODUCTION 
 
 It has been my intention to publish this book ever since 
 1893, when I first began to keep accurate records of all cases 
 presenting pathognomonic symptoms of typhoid fever, 
 that I might be able to show a few specimens of the 
 evidence of the effectiveness of alexipharmic medicine 
 which had convinced others and satisfied myself that 
 I had made a discovery — that typhoid fever can be 
 aborted and need not necessarily run its usual course — 
 and the treatment capable of accomplishing this result, 
 which if it were promptly accepted by the entire body of 
 the medical profession, and its principles intelligently ap- 
 plied to the cure of microbic diseases would greatly abbre- 
 viate the duration of the illness, signally ameliorate the 
 pathema, and save the life of every victim of typhoid fever, 
 as well as minimize the danger from many other diseases. 
 
 It would have been written long ago had not my 
 announcement that typhoid fever could be aborted been 
 met by such an unanimous expression of disagreement, 
 and such impassioned denunciations, as to admonish me 
 to beware of the storm clouds gathering above the horizon, 
 for every day a new cautionary signal was hoisted, and 
 forewarned and thus forearmed I realized that the 
 medical profession was not yet ready to accept a theory 
 which was not only guilty of the offense of being new 
 and in conflict with the most advanced ideas of pathology, 
 
6 INTRODUCTION. 
 
 but which greatly multiplied the responsibilities of those 
 who treat any of the microbic diseases. 
 
 This reason no longer holds good, because so large 
 a number of the most conservative physicians of so 
 many different localities have succeeded in aborting so 
 great a number of cases of typhoid fever that my theory 
 has become a principle established by the evidence of 
 many observers and that principle at first so universally 
 ridiculed and condemned, now governs the practice of 
 a large and rapidly increasing number of the most 
 intelligent and progressive members of the profession 
 and the results which were formerly with unison and 
 no hesitation pronounced impossible, are now obtained 
 in triumph. 
 
 That which has induced me to take up my pen at the 
 present time is the knowledge that I have hitherto 
 been able only to give directions for the management 
 of the antiseptic treatment of the disease in so brief 
 and abridged a manner in my papers (which were 
 written in as concise a way as possible that they might 
 be finished in the twenty minutes to which each address 
 is limited) that many of those physicians, who honestly 
 and truly desired to adopt this method of antisepsis, 
 were being misled or perverted by my necessarily 
 incomplete and hence imperfect and deficient teaching. 
 I found that others were wisely awaiting more explicit 
 details before attempting to apply so novel a method of 
 controlling a pathological condition which had hereto- 
 fore been regarded as immedicable. Thus many thou- 
 sands of lives were being sacrificed annually to a dis- 
 ease which should never cause a death. 
 
 The incompleteness of my work will, perhaps, be 
 excused when it is remembered that its paragraphs 
 
INTR OD UCTION. 7 
 
 have been written in the leisure time between pro- 
 fessional engagements, that its preparation has been 
 constantly interrupted, and moreover that it has been 
 hurried into press, to meet the urgent demand for 
 copies, a large number of which were ordered before 
 it was even commenced, and that in my haste I may have 
 allowed some grave errors to creep into its lines. 
 
 So many wild and unfounded rumors have been cir- 
 culated concerning my theories on the subject of intes- 
 tinal and general antisepsis, as to require that in justice 
 to myself I ought to define my position in unmistakable 
 language, that may forestall the future tirades and 
 sibilations of those who would castigate and anathema- 
 tize, but more especially that my paraphrasts and com- 
 mentators may not misunderstand or misjudge me, and 
 that my oneirocritics may interpret my dreams of that 
 time to come when each human being shall have be- 
 come the beneficiary of the publishing of this little book, 
 with such acumen and discernment that both physician 
 and invalid will be assured of the truthful maxims 
 it bears on the white pages between its pasteboard 
 covers. 
 
 As I have studied to be brief, no single subject in 
 this book has been discussed in all completeness, only 
 the more important aspects have been touched upon 
 extensively, and I have left much unwritten which 
 should have been presented. 
 
 Since many of these pages have been written for 
 presentation to widely separated audiences some repeti- 
 tion has been necessary and is excusable. 
 
 My statements have been so often misrepresented 
 and my position misconstrued, that I may be excused 
 for defining my position and claims. 
 
8 INTR OD UCTION. 
 
 I believe that in every uncomplicated case of typhoid 
 fever the disease can be aborted, if proper antiseptic 
 treatment be instituted at a sufficiently early stage of the 
 malady. 
 
 I have never taught that the disease can always be 
 aborted when the treatment has been too long deferred, 
 but I have taught that uncomplicated typhoid fever 
 should never cause a death — an obvious deduction from 
 the first declaration. 
 
 I have never, even by implication, given any one the 
 right to assert that I do not recognize the possibility of 
 death from intercurrent disease during an attack of 
 typhoid fever, even though it may have been properly 
 treated from its inception. 
 
 While I have thus far been able to abort the disease 
 in every instance in which treatment was instituted on 
 or before the eighth day, and in a large percentage of 
 those cases in which it was commenced on or before the 
 tenth day of sickness, as well as in a few cases taken at 
 a much later period, I have never taught that the disease 
 can always be aborted when treatment has been so long 
 postponed. 
 
 My first modest announcement of some of the advan- 
 tages of the antiseptic treatment of typhoid fever made 
 in my local society in 1880, was received with such out- 
 spoken skepticism and disapproval as to arouse all or 
 the latent irascibility in my nature, and if I have occa- 
 sionally alluded to the members of the profession, who 
 have been accorded every opportunity to see my work 
 and who for reasons more or less discreditable refused 
 to accept the evidence which they dared not deny, my 
 excuse is that the provocation was prodigious. 
 
 I have condemned in unstinted and unmeasured terms 
 
INTRODUCTION. 9 
 
 those barricades and stumbling- blocks that have cast 
 themselves and all of their impediments in the pathway 
 of progress. I have maintained that willful ignorance is 
 culpable ignorance; that culpable ignorance where human 
 life is at stake is a crime, and that he who has an oppor- 
 tunity of knowing that the life of every victim of typhoid 
 fever can be saved and rejects irrefutable evidence of the 
 fact, is guilty of willful ignorance. 
 
 I have denounced with the utmost frankness the 
 errors of diagnosis and treatment so commonly and 
 habitually made all over the world, wherever this disas- 
 trous malady is prevalent. 
 
 In 1882 I declared that intestinal haemorrhage would 
 never occur in any case of typhoid fever which had been 
 properly treated from the outset of the disease, but I 
 have never claimed any special skill in the treatment of 
 that accident after its supervention as has been unequivo- 
 cally asserted in at least one medical journal by one of 
 its associate editors. I shall not waste time in answering 
 every diatribist or medical editor who sees something to 
 attack or anathematize in everything that does not lie 
 within his intellectual horizon. . 
 
 It has been intimated that I have tacitly consented to 
 the publication in the secular press of some of my arti- 
 cles on typhoid fever. I wish to enter a simple denial to 
 this most annoying slander. I have never in all of my 
 professional career consented to, or connived at the 
 publication in any other than a medical journal of any 
 paper or extract from any paper on this or any other 
 medical subject. 
 
 All other diatribes and scandals may be left to the 
 arbitrament of time. 
 
 The following papers are reproduced here because 
 
1 IN TR OD UCTION. 
 
 after both the reprints and the editions of the Journal of 
 the American Medical Association containing them were 
 exhausted and out of print, many requests for copies 
 which could not be supplied were received and because, 
 having been read before and discussed by various medi- 
 cal societies, it is hoped that they may have some weight 
 in inducing members of the profession to adopt a prin- 
 ciple of treatment in microbic diseases which must con- 
 tribute to the longevity of the human race and the 
 advancement of the dearest interests and the honor of 
 the medical profession. 
 
 My first consideration has been to give such clear 
 and explicit details of treatment as would enable every 
 intelligent physician to so apply the principles. of the 
 abortive treatment of typhoid fever that few lives need 
 be sacrificed to this malady. 
 
TYPHOID FEVER. 
 
 DEFINITIONS. 
 
 The late Dr. Murchison in his classic work, ''Con- 
 tinued Fevers, " under the caption ''Enteric or Pytho- 
 genic Fever," defines "typhoid fever" as, "An en- 
 demic disease, generated and propagated by certain 
 forms of decomposing matter. Its symptoms are: A 
 commencement often insidious or marked by slight 
 rigors, a sensation of chilliness;- a profuse diarrhoea; 
 pulse usually frequent and soft, but pulse and temperature 
 both subject to great variations in the same patient; 
 febril symptoms in mild cases often remittent; tongue 
 red and often fissured, occasionally becoming dry and 
 brownish; in most cases but not invariably increased 
 splenic dullness; tympanitis; abdominal tenderness; 
 gurgling in the iliac fossae and diarrhoea with or without 
 intestinal haemorrhage; skin warm with occasional sweats. 
 An eruption of isolated elevated rose colore spots, 
 vanishing on pressure, first appearing between the 
 seventh and fourteenth days and coming out in succes- 
 sive crops each of which lasts two or three or more days; 
 frequently epistaxis; prostration coming on late, patient 
 rarely taking to bed before the seventh day; headache 
 sometimes followed by stupor and active delirium, but 
 mind often clear throughout the attack even in fatal 
 cases; dilated pupils; the disease protracted to the 
 twentieth or thirtieth day and occasionally though rarely 
 
12 DEFINITIONS. 
 
 followed by a relapse of all the symptoms including the 
 eruption. After death, disease of the solitary and ag- 
 minated glands of the ileum and enlargement of the 
 spleen and mesenteric glands." 
 
 Hutchinson defines typhoid fever as "An endemic, 
 infectious fever, usually lasting between three and four 
 weeks, and associated with constant lesions of the soli- 
 tary and agminated glands of the ileum and with en- 
 largement of the spleen and mesenteric glands. Its 
 invasion is gradual and often insidious. Sometimes the 
 only symptoms present in the beginning are a feeling of 
 lassitude; some gastric derangement and a slight eleva- 
 tion of temperature; at others there are slight rigors or 
 chilly sensations, headache, epistaxis, diarrhoea, and 
 pain in the abdomen. The principal symptoms of the 
 fully formed disease are a febril movement possessing 
 certain characteristics, headache, passing into delirium 
 and stupor, diarrhoea associated with ochre-yellow 
 stools, tympanites, pain and gurgling in the right iliac 
 fossa, a red and furred tongue, which later becomes dry, 
 brown and fissured; a frequent pulse; an eruption of 
 rose colored spots, occurring about the seventh or eighth 
 day, slightly elevated above the surface, disappearing 
 under pressure, and coming out in successive crops, each 
 spot lasting about three days; prostration not marked in 
 the beginning, but rapidly increasing; and occasionally 
 deafness, sweats and intestinal haemorrhages. When re- 
 covery takes place, the convalescence is usually tedious, 
 and may sometimes be protracted by the occurrence of 
 one or more relapses." 
 
 Harley as "A continued febrile condition of uncertain 
 duration, accompanied by marked intestinal derangement, 
 and invariably associated with lesion of the solitary and 
 
DEFINITIONS. 13 
 
 agminated glands of the intestines. It commences in 
 anorexia, with nausea and vomiting; its progress is 
 marked by profuse diarrhoea of light ochre colored 
 watery stools, associated with abdominal pains, tender- 
 ness and tympanitic swelling; and if the issue be un- 
 favorable, it terminates in exhaustion, intestinal haemor- 
 rhage, or perforation of the bowel. Death usually occurs 
 in the fourth week. In the early period the disease is 
 attended by more or less pyrexia; as soon as it is fully 
 developed, there is well-marked hectic fever. 
 
 " During the height of the disease a scattered papular 
 rash appears in successive crops on the abdomen and 
 chest. The rapidity with which the symptoms are mani- 
 fested, the degree to which they are developed, vary 
 greatly in different cases. The intestinal disease is fre- 
 quently obscured by the concurrence of pulmonary or 
 cerebral complications." 
 
 Von Gietl — " As a specific, putrid, intoxication disease 
 (Intoxications-krankheit) which is composed of a chain 
 of diseased processes, which are dependent upon one 
 another, but which do not retain a regularity either in 
 number or in succession. Its local effect is a catarrh of 
 the alimentary canal; the further and peculiar result a 
 swelling of the glandular apparatus as well of the mes- 
 entary as the mucous membrane of the intestines. 
 
 ''Exfoliation and ulceration generally follow, the final 
 effects being mortification in all degrees. The lower 
 grades of typhoid infection agree perfectly in their mani- 
 festations with the simple form of putrid infection." 
 
 These descriptions should be amended, but it would 
 be difficult — perhaps impossible — to give an exact defini- 
 tion of typhoid fever which would not in the near future 
 require emendation; for the signs of the times indicate 
 
14 DEFINITIONS. 
 
 that we are on the eve of wonderful discoveries in bac- 
 teriology which will upset many existing- notions on the 
 nature and cure of disease; but since all of these descrip- 
 tions of the disease are in a greater or lesser degree 
 misleading, some slight improvement on them must be 
 attempted. 
 
 Typhoid fever may be loosely described as an acute, 
 endemic, infectious fever — which consists of a series of 
 pathological changes and anatomical lesions, directly or 
 indirectly due to the presence in the system of a specific 
 microbic poison. 
 
 These lesions and pathological conditions consist of 
 certain changes in the organism, which are dependent on 
 the invasion of the various organs of the body by the 
 bacteria and the absorption into the circulation of its 
 ptomaines. The disease is further characterized by 
 many grave and ofttimes fatal complications and sequelae. 
 Tumefaction, of an inflammatory nature, of the glands of 
 the lower portion of the ileum, the solitary and agmi- 
 nated glands of Peyer, or of the glands of the caecum 
 or of the colon are constant lesions of the disease and 
 unless they regain, as they may, their normal state by 
 resolution, necrosis and ulceration follow and from these 
 ulcerations intestinal haemorrhage or perforation and 
 peritonitis may result. 
 
 The salient pathematic fact around which all minor 
 considerations may be grouped is, that the primary 
 lesions of the disease are always due to one and the 
 same pathogenic influence, probably the bacillus ty- 
 phosis and its toxins, that all of its multifarious compli- 
 cations and sequelae are deuteropathic consequences of 
 the invasion of the system by this poison, that some 
 secondary effects are caused by other noxae which have 
 
NOMENCLA TURE. 1 5 
 
 gained ingress to an organism already weakened by the 
 idiopathic disease, or perhaps it were better to say, 
 caused in some instances, at least, by the virulization of 
 other noxa, already domiciled in the system. Accepting 
 this as a true definition of typhoid fever, the obvious de- 
 ductions are that stowed away somewhere in the recesses 
 of nature is some agent that will neutralize or destroy 
 the noxa of typhoid fever, and the logical conclusion is 
 that if it can be destroyed in one receptacle it can be 
 destroyed in all like receptacles, and as typhoid fever has 
 been aborted it can always be aborted. 
 
 When the medical profession realizes that all this is 
 possible a new impetus will have been given to the study 
 of parasitology and to the relation of this department of 
 science to the cure of disease 
 
 nomenclature. 
 
 1. Synonyms Derived from its Supposed Resem- 
 blance to Typhus. — Typhus Nervosus, Sauvages, 1760; 
 Typhus Mitior and Synochus pro parte, Cullen, 1769; 
 Abdominal Typhus and Darm-Typhus, Autenrieth, 1822, 
 and German writers generally; Synochus and Typhus 
 with Abdominal Affection, Southwood Smith, 1830; 
 Fievre Typhoide, Louis, 1829; Chomel,T834; Typhus 
 gangliaris vel entericus, Ebel, 1836; Schonlein, 1839; 
 Typhoid Fever, Stewart, 1840; Bartlett, 1842; Jenner, 
 1849; Mild Typhoid Fever, Copland, 1844; Ilio-typhus 
 Griesinger, 1857; Typhia, Farr, 1859; Typhus, many 
 writers. 
 
 2. From its Mode of Prevalence. — Febris non- 
 pestilens, Forestus, 1591; Endemic Fever, many writ- 
 ers; Autumnal or Fall Fever, Flint, 1852; and American 
 writers generally. 
 
1 6 NOMENCLA TURE. 
 
 3. From its Remittent Character. — nvperds 
 j)/iirpiiaio$ (?) Hippoc. ; Hemitritseus (?) Tritseophyas 
 
 (?) and Triphodes (?) auctor. antiq. var. ; Febris semi- 
 tertiana seu composita, Galen (?) Forestus, 1591; 
 Spigelius, 1624; Tritaeophya typhodes Mangetus, 1695; 
 Remittent Fever T. Sutton, 1806; Infantile Remittent 
 Fever, Evanson and Maunsell, 1836; and many writers. 
 
 4. From its Lengthened Duration.— Febris lenta 
 Forestus, 1591; Willis, 1659; Linnaeus, 1763; Vogel, 
 1764; Slow or Lent Fever, Strother, 1729; Langrish, 
 1735; Febris chronica, (?) Juncker, 1736; Common 
 Continued Fever, Armstrong, 1816; Fievre continue 
 Lerminier and Andral, 1823. 
 
 5. From its Supposed Nervous or Hysteric Char- 
 acter. — Nervous Fever, Gilchrist, 1734; Slow Nervous 
 Fever, Huxham, 1739; Febricula, or Little Fever, com- 
 monly called the Nervous or Hysteric Fever, Fever on 
 the Spirits, Vapours, etc., Manningham, 1746; Irregu- 
 lar Low Nervous Fever, Fordyce, 1791; Nervenfieber, 
 German writers; Fievre nerveuse, French writers; Low 
 Fever, many writers. 
 
 6. From the Occurrence of Putrid or Septic 
 Symptoms. — Febris Putrida, Riverius, 1623; Febris 
 putrida quae vulgo lenta appellatur, Willis, 1659; Febris 
 putrida nervosa, (?) Wintringham, 1752; Febris putrida aut 
 biliosa, Tissot, 1758 ; Febris a putredine orta, A. Tral- 
 liani, quoted by Burserius as syn. for his Fe. gastric ac, 
 1785 ; Febris atacta, proparte, Selle, 1770; Fievre 
 ataxique, pro parte, F. adena-meningee, Pinel, 1798; 
 Entente septicemique, Piorry, 1841 ; Sepimia, Hare, 
 1853. 
 
 7. From its Resemblance to Hectic Fever. — 
 
NOMENCLA TURE. \ 7 
 
 Febris hectica, Willis, 1667; Infantile hectic fever, 
 various writers. 
 
 8. From the Absence of True Typhus- Eruption. 
 — Febris petechizans vel spuria, Hoffmann, 1699. 
 
 9. From the Common Occurrence of Gastric 
 Derangement, Bilious Vomiting, etc. — Febris gastrica, 
 Ballonius, 1640; Febris acuta stomachica aut intestinalis, 
 Heister, 1736; Febris glutinosa gastrica, Sarcone, 1765; 
 Febris gastrica acuta, Burserius, 1785; Fievre meningo- 
 gastrique, Pinel, 1798; Gastrisches Fieber, Richter, 1813; 
 Fievre gastrique, Diet, des Sc. med., 1816; Epidemic 
 Gastric Fever, Cheyne, 1833; Gastric Fever, Craigie, 
 1837; Febris biliosa, Galen (?) River., 1623; Stahl, 1700; 
 Juncker, 1736; Bilious Fever, Pringle, 1750; Rutty, 1770; 
 Febris biliosa putrida, Selle, 1770; Febbre biliosa, Benelli, 
 1775; Synochus biliosus, Sauvages, 1760; Bilio-gastric 
 Fever, Copland, 1844; Gastro-bilious and Bilious Con- 
 tinued Fever, modern writers. 
 
 10. From the Intestinal Symptoms and Lesions.* 
 — Febris colliquativa, (?) J. R. Fortis, 1368, Feb- 
 ris stercoralis, (?) Quesnay, 1753; Febris mucosa, 
 Selle, 1770; Febris pituitosa, Stoll, 1785; Strack, 1789; 
 Febris colliquativa primaria sue essentialis, Burserius, 
 1785; Morbus biliosis-mucosus, Knaus, 1786; Febris 
 pituitosa nervosa, Jacobi, 1793; Schleimfieber, Kanz, 
 1795; Fievre muqueuse, French writers; Mucous or 
 Pituitous Fever, Copland, 1844; Febris mesenterica 
 maligna, Baglivi, 1696; Hoffmann, 1699; Febris intesti- 
 nalis vel mesenterica, Riedel, 1748; Febris mesenterica 
 acuta, Burchard, quoted by Burserius, 1785; Fievre 
 
 * Many of the cases described by Cullen and his successor, as "Enteritis 
 Erysipelatosa," were probably examples of this fever. (See description of it by 
 Alison, 1844, No. 2, p. 323.) 
 
1 8 NO ME NC LA TURE. 
 
 entero-mesenterique, Petit and Serres, 1813; Enteritic 
 Fever, Mills, 1813; Gastro-enterite, Broussais, 1816; En- 
 tero-mesenteric Fever, Abercrombie, 1820; Febris 
 mesaraica; Wendt, 1822; Dothienenterito, Bretonneau, 
 1826; Leuret, 1828; Christison, 1840; Mucoenteritis, vari- 
 ous writers; Fever, with Affection of the Abdomen, 
 Alison, 1827; Fever with Ulceration of the Intestines, 
 Bright, 1829; Gastro-enteric and Gastro-splenic Fever; 
 Craigie, 1837; Enterite-folliculeuse, Cruveilhier, 1835; 
 Forget, 1841; Enteric Fever, Ritchie, 1846; Wood, 1848; 
 W. T. Gairdner, 1859; Coll. Phys., London, 1869; Febris 
 tympanica, Babbington, 1853; Intestinal Fever, W. 
 Budd, 1856. 
 
 11. From its Supposed Dependence on Worms. — 
 Typhus hysterico-verminosus, Sauvages, 1760; Febris 
 verminosa, Selle, 1770; Worm Fever pro parte, various 
 writers. 
 
 12. From its Mode of Origin. — Night Soil Fever, 
 Brown, 1855; Pythogenic Fever, Murchison, 1858; Cess- 
 pool Fever, various writers. 
 
 13. Other Designation. — Miliary Fever, Pringle 
 and De Haen, 1760.* 
 
 This list of the synonyms of typhoid fever are copied 
 from Murchison's great and classic work, " On the Con- 
 tinued Fevers of Great Britain," from which I shall have 
 occasion to make many extracts, since all authorities 
 agree that the late Charles Murchison, M. D., LL.D., 
 
 * Murchison says, "Some of the descriptions of the Greek writers probably 
 referred to enteric fever. Hippocrates states that in the course of two successive 
 autumns, he met with many cases of fever of the continual type, characterized by 
 diarrhoea, offensive watery stools, bilious vomiting, tympanitis, abdominal 
 pain, 'red rashes,' epistaxis, sleeplessness, or a tendency to coma, delirium, 
 subsultus, irregular remissions, a lengthened duration and great emaciation." 
 (De Epid. lib. i. Syd. Soc. Transl. i. 354-9 and 420). 
 
HISTORY. 19 
 
 F. R. S., should be accredited with having produced the 
 best and most accurate treatise that has ever been 
 written on these subjects. 
 
 The synonyms are given, not because many of them 
 are valuable to-day as designations for this disease, but 
 because, dating as some of them do from a period almost 
 five hundred years before Christ and some of them pos- 
 sibly even antedating that far off time, they in them- 
 selves give a cursory history of the disease. 
 
 That this description written in the years intervening 
 between the eighty-sixth and ninty-sixth Olympiads re- 
 fers to our own typhoid, autumnal fever scarcely admits 
 of doubt, nor is it less certain that the " Hemitritaeus " of 
 Galen which he believed was compounded "of a tertian 
 on a quotidian intermittent and particularly that variety 
 designated bilious fever " refers to the same disease. 
 
 Thus the designation of the great Greek physicians 
 says as plainly as words could tell it that they regarded 
 the disease as of malarial origin. 
 
 Forestus, 1591, in his appellation "febris non peste- 
 lens," clearly separates this fever from "typhus," and in 
 another name, febris lenta, he tells us that it is a "con- 
 tinued fever of long duration." 
 
 In the seventeenth century, Riverius, Willis and 
 others, by the names they gave this illness, referred to 
 its serious characteristics and give us much information 
 of value. 
 
 Again in the eighteenth century, by its many syn- 
 onyms, almost every peculiarity of the disease was de- 
 scribed, but it was not until the early part of the nine- 
 teenth century, 1829, that Louis first gave this pathologic 
 state the title by which we now prefer to distinguish it, 
 viz., "typhoid fever." 
 
20 HISTORY. 
 
 A few years later, 1846 et seq., Ritchie and various 
 other writers styled the disease "enteric fever," a name 
 which has since been adopted by the College of Physi- 
 cians of London in its nomenclature of diseases. This 
 term is largely used both in England and the United 
 States; it is, however, objectionable, since it describes a 
 complex disease by one of its pathologic lesions and one, 
 too, that does not invariably manifest itself during life 
 by any discoverable symptom. 
 
 The most serious misfortune that has occurred to 
 thwart and circumvent the recording of each event in the 
 history of typhoid fever, was the unfortunate but well- 
 meant suggestion of the late Surgeon Woodward, after- 
 ward surgeon-general of the United States army, which 
 he made in 1862, to give to a supposed complex disease — 
 which' cannot exist — the designation of " typho-malarial 
 fever." This proposal not only introduced confusion and 
 ambiguity into the reports of many army surgeons and 
 by so doing greatly impaired the value of the special 
 statistics in regard to the two diseases which our noble 
 and long-suffering soldiers were infected with during the 
 Civil War; but it carried into civilian practice, when 
 the army surgeons returned to their hearths and 
 homes, a precedent that has ever since been a disturb- 
 ing element amongst civil practitioners. It gives 
 ignorant and unscrupulous physicians a pretext for 
 making a vague and undefinable diagnosis of malarial 
 fever, typho-malarial fever, instead of typhoid fever, 
 enabling them to apply all of these names to different 
 stages of the same malady. 
 
GEOGRAPHIC DISTRIBUTION. 21 
 
 GEOGRAPHIC DISTRIBUTION. 
 
 The geographical distribution of typhoid fever is 
 from the nature of the disease necessarily quite or nearly 
 coextensive with the geographical distribution of man. 
 In other words, wherever man goes and carries the 
 virus of typhoid fever, there will the disease find at least 
 a temporary home. It is pre-eminently the serious en- 
 demic fever of North America, most parts of Europe, 
 India and South America. Africa, Asia and Australia 
 have all felt its ravages. Greenland and the frozen 
 north, and tropical Mexico make for it an equally agree- 
 able abode. Thickly- populated New York, London, 
 Paris, Berlin, Vienna, Melbourne, cities of modern times 
 with the sanitary science of the nineteenth century at 
 their disposal, ancient Rome, and the city of the ever 
 changing Nile, Alexandria, that wonderful treasure 
 house of the learning and lore of antiquity, Bagdad, 
 gorgeous city of the plain, Bombay and Calcutta, cities 
 of the Orient, the ice-bound and frigid wayside towns, 
 the temporary resting places of the afflicted and'mourn- 
 ful exiles to Siberia, our own Washington, the city of 
 luxurious private homes and magnificent public institu- 
 tions, the capital cities of the old world containing the 
 enchanting palaces of their kings, shadowy, etherial 
 Venice the bride of the Adriatic, the Phoenix like city of 
 the lake, the tropical sea island cities, Havana, Columbo 
 and Batavia, the tiny St. Helena and gigantic Australia 
 are not exempt from its devastations. The disease 
 spreads rapidly from Cape Town to Archangel, and 
 from Rio de Janeiro to Sitka. Mecca, with its polluted 
 holy wells of the Mohammedan pilgrims, and the 
 assemblages at the shrine of Our Lady of Lourdes are 
 
22 GEOGRAPHIC DISTRIBUTION. 
 
 ready to add their mite to the all destroying virus. The 
 city of the mountain with its pure and rarified air and 
 that of the low and marshy plain alike are the prey of 
 its poison. Patients are found in a Versailles with its 
 bizarre contrivances for the unlimited water supply, that 
 cool pure water so essential to health ; in a gatchina, of 
 an ideal climate, so temperate and regular ; in an Ajuda 
 endowed with the crisp and invigorating air of the 
 mountain, and in the hovels of the very poor beneath 
 their walls, for it recognizes neither poverty nor riches. 
 It has found its victims in the very opposite conditions 
 of life, amongst the uncivilized Indians of our western 
 plains and the rustic natives of Mexico, the pigmy tribes 
 and the wild and untamable races of Upper Egypt and 
 the Congo — this newly discovered country already has 
 it in its midst — and those barbarous savages of Mada- 
 gascar are waiting to receive the care and attention as 
 well as the medication of civilized medicine. Among 
 the hills and rocks of New England, on the adamantine 
 and impregnable rock of Gibraltar, on the Rocky Moun- 
 tains and in the sunny south, at the mouth of the 
 Mississippi and along the mighty Amazon, and the 
 merry brook or rill making its way so hurriedly to the 
 sea, hurrying and skurrying through meadow and wood, 
 past hamlet and village, winding its circuitous course 
 by stately mansion and homely homes, but leaving such 
 dire disaster in its wake. Peopled continents and iso- 
 lated, sparsely populated islands have all alike given it 
 domicile. Indeed, there is no people or country that 
 has been forever free from its unwelcome presence, and 
 no remembrancer would be needed to recall to the mind 
 of the poor wretch who had succumbed to its abhorrent 
 and tormenting scourges the hell on earth through which 
 he has passed. 
 
CA USES. 23 
 
 CAUSES. 
 
 Predisposing. — Wide as is the geographical range 
 of typhoid fever, not less indiscriminate is it in its 
 selection of its victims among the human race. Both 
 sexes of all nationalities are martyrs, the individual in 
 every condition in life, the soldier in bivouac and his 
 royal master in the palace, protected by "divine right" 
 from all else ; the begger in the street and the million- 
 iare in his elysian demesne ; the babe in the cradle and 
 his nonagenarian grandsire; all mankind, who have not 
 been previously immunized, if equally exposed to the 
 poison, are alike susceptible to the disease. All ob- 
 servers agree that age exerts a controlling influence 
 over typhoid fever. This is probably an error arising 
 from several causes. First, very young children are not 
 so freely exposed to the action of such pathogenic 
 germs as could produce the disease, because the diet 
 being principally milk, usually drawn from the mother's 
 breast or sterilized, is not apt to give rise to any ill ef- 
 fects and being liquid takes the place of other drink, so 
 that little water is imbibed. Moreover children residing 
 at home with their parents or even in public institutions 
 are confined largely to the one locality and soon become 
 acclimated to the water they drink and for this reason 
 are not so likely to have the disease. For the slow and 
 gradual exposure of the organism to the noxious influ- 
 ences which cause typhoid fever, does undoubtedly cre- 
 ate in the subject a temporary acquired immunity from 
 the disease. But instances are not wanting in which 
 children have shown their liability to attacks of this dis- 
 ease when exposed to its virus. Murchison quotes a 
 case as reported by Manzini in which a seven months' 
 
24 CA USES. 
 
 foetus, which died within half an hour after birth, pre- 
 sented lesions of Peyer's glands, and infants have been 
 known to die from typhoid fever during the first six 
 weeks of life. 
 
 Ernest Hart, editor of the British Medical Journal, 
 under the caption of " Water borne Typhoid," reports 
 on page 85 of the issue of that journal of the 13th of 
 July, 1895, an instance which proves conclusively that 
 children possess no special immunity from the disease ; 
 it was among the inmates of an institution that the fever 
 spread, the immediate cause of the five hundred attacks 
 being the chance drinking by some of the orphan 
 children of the contents of a stream during one of their 
 walks. The stream received the sewage from houses in 
 some of which typhoid had occurred, and as a result of 
 this consumption, thirty cases cropped up simultaneous- 
 ly in the asylum in children having thus drunk of the 
 specifically contaminated water. The disease once in- 
 troduced, was kept going until five hundred children 
 had caught the infection out of some two thousand in 
 the asylum. 
 
 Osier, analyzing 229 cases of typhoid fever, treated 
 in the medical wards of the Johns Hopkins Hospital, 
 gives the following as the ages of the patients : 5 to 
 15, 23 ; 15 to 20, 51 ; 20 to 30, 109; 30 to 40, 29; 
 40 to 50, 10; 50 to 60, 4 ; 60 to 70, 3. Thus it will 
 be seen that nearly 50 per cent of all the cases oc- 
 cured in the third decade. 
 
 At from fifteen to twenty years of age, the begin- 
 ning of the period of supposed greatest susceptibility, 
 lads leave their homes to enter the universities, the 
 military or naval academies, or the preparatory schools, 
 or to take upon themselves their own support, or it 
 
CAUSES. 25 
 
 may be to seek a life of pleasure, and they are hence- 
 forth exposed to the greatest risk of acquiring- the 
 disease. Young maidens are sent to the cities that 
 they may receive the advantages of metropolitan life 
 or begin their peregrinations about the world in gen- 
 eral in search of amusement or to earn their bread, 
 and the non-immune constitutions yield readily to the 
 strange noxa. 
 
 As one attack gives some immunity against 
 typhoid fever, and as there can be no doubt 
 but a large percentage of all those who are 
 susceptible to the influence or the poison have been 
 exposed and many may have had unrecognized or 
 abortive attacks during the first half century of life, it 
 is hardly necessary to look further for the cause of 
 immunity, which has heretofore been accredited to 
 age. It is probably true, therefore, that age so uni- 
 versally recognized as one of the fruitful predisposing 
 causes of typhoid fever, should have no place in that 
 category. 
 
 While there is no evidence that general weakness or 
 debility or the exhausting effect of other diseases, exerts 
 any predisposing influence toward typhoid fever, there 
 cannot be the slightest doubt but the poisonous ef- 
 fluvia of decaying animal or vegetable matter or of 
 human excrement, or that open sewers may so act. On 
 the other hand none of these influences can act as excit- 
 ing causes of that disease. 
 
 Exciting. — There is but one exciting cause of typhoid 
 fever, viz., the invasion of the organism by the noxa of 
 the disease, presumably a microbic poison, the bacillus 
 typhosis, a water borne virus, the danger from which is 
 rendered insignificant by the boiling of all the water and 
 
26 INCUBATION. 
 
 milk used by the patients for drinking purposes. Oysters 
 if laid down in sewage may and no doubt do sometimes 
 convey the infection; but sea water is fatal to the ba- 
 cillus typhosis, hence the danger from this source must 
 be small indeed; besides it is even then but an indirectly 
 water borne disease. 
 
 The pathological lesions peculiar to typhoid fever 
 are so constant that the conclusion that the disease is of 
 azygous origin is fully justified. 
 
 If no uncooked human excrements were eaten or 
 drank typhoid fever would be a very rare disease. 
 
 INCUBATION. 
 
 The period of incubation of typhoid fever, as esti- 
 mated by different observers, varies between such wide 
 limits, that I cannot do better than quote the conclu- 
 sions of the Clinical Society of Great Britain, from the 
 British Medical Journal of the 20th of July, 1895, em- 
 bodied in Dr. Hart's Report on "Water borne Typhoid.'' 
 
 Period of Incubation of Typhoid Fever. — The deliber- 
 ations of the Clinical Society on this point are of great 
 interest to us in connection with our subject, and it may 
 not be out of place if I reproduce their short and pithy 
 "Conclusions." (1892). 
 
 "1. The general conclusion to be drawn from all of 
 the facts is that the period of incubation of enteric fever 
 varies within rather wide limits. The interval between 
 exposure to infection and the development of distinct 
 symptoms is probably most often twelve to fourteen days. 
 It is not very infrequently nine or ten days, occasionally 
 eight, and possibly even less. According to Dr. Murchi- 
 son, 'it may not exceed one or two days, but no case of 
 the kind has been reported to the committee. In rare 
 
INCUBATION. 27 
 
 cases it has been prolonged to fifteen, eighteen or even 
 twenty-three days.' Dr. Murchison thought 'it very 
 doubtful if the incubation period ever exceeds three 
 weeks.' 
 
 "2. A person suffering from enteric fever is capable 
 of conveying the infection to others throughout the 
 whole course of the disease, from the date of the earliest 
 symptoms of illness until convalescence has been estab- 
 lished at least a fortnight. 
 
 " 3. An epidemic due to milk contamination may be 
 expected to cease at or about the end of the second week 
 after the arrest of the contaminated supply; but an epi- 
 demic due to contamination of public water supply may 
 not come to an end until the fourth week after the source 
 of specific pollution has been removed. Where an epi- 
 demic can be traced to well water its duration may be 
 very much more prolonged, and no general statement as to , 
 the probable date of its spontaneous termination can be 
 made. 
 
 "4. Infection can be conveyed by fomites, and re- 
 tained in them, probably for two months at least." 
 
 As a peculiar instance of the long period of incuba- 
 tion, Dr. Hart mentions as having been put on record by 
 Dr. Blaxal "of the Local Government Board." 
 
 "At Fortune's Well, in the isle of Portland, there 
 arose an outbreak of typhoid fever in 1886, after an ab- 
 sence of fifteen years, the infection being introduced by 
 soldiers from Alexandria, four cases developing en voy- 
 age, and other six after landing, no one outside of the regi- 
 ment being attacked on board. In these latter circum- 
 stances it can only be held that infection was derived in 
 Egypt, and this being so there comes the fact that the 
 period of incubation varied from eighteen to as many as 
 
28 INCUBATION. 
 
 twenty-five days. Of the outbreak as it affected resi- 
 dents near a spring- at Fortune's Well I need not speak; 
 the facts in the appendix are clear to all, showing the 
 source of the subsequent illness, some eighty cases, to 
 have been due to polluted water." 
 
 Dr. Katzenbach, whose opportunity for measuring 
 the period of incubation during the epidemic at Bayhead, 
 New Jersey, was unusual, estimated that the last of the 
 cases (assuming that the milk had been polluted but 
 once) had a period of incubation of twenty-nine days, or 
 that if Fred J., contaminated the milk the last time that 
 he milked the cows then this patient's period of incuba- 
 tion was nineteen days. 
 
CAN TYPHOID FEVER BE ABORTED.* 
 
 The answer echoed and re-echoed from the great 
 thinkers of the profession we all love and practice — 
 from all over the civilized world — is one prolonged and 
 emphatic negative, nowhere more emphatically spoken 
 than in the great representative body of American phy- 
 sicians, the American Medical Association. 
 
 At its last meeting, in the city of Milwaukee, the 
 original papers on typhoid fever, the discussions on 
 them, and the editorial comments in the society's journal 
 clearly indicate this, and also that the medical profes- 
 sion is not at all agreed on its treatment. The most 
 divergent methods were advised, some condemned what 
 others strongly advocated, these again advising different 
 methods, only to be condemned again, and all were 
 finally disposed of by the editor of the association jour- 
 nal, who under the caption, " The Treatment of Typhoid 
 Fever," says, " In the topic which heads this editorial 
 the medical profession is certainly as much interested 
 as it is in the treatment of pulmonary phthisis. The 
 able papers and discussions which we have presented to 
 our readers in the columns of this journal, during the past 
 few weeks, have been of great value as reflecting the 
 
 *Read before the Mississippi Valley Medical Association, October, 1893. 
 Revised 1895. 
 
30 CAN TYPHOID FEVER BE ABORTED. 
 
 opinions of active practitioners whose practical experi- 
 ence is of inestimable service to less favored colleagues; 
 yet the fundamental rules governing the management of 
 enteric fever are not modified by these expressions of 
 opinions. Difference in belief may exist as to whether 
 intestinal antisepsis is desirable or obtainable in typhoid 
 fever, and whether this temperature or that is to be 
 treated as a dangerous symptom, but the important fact, 
 that enteric fever is a disease in which good nursing and 
 watching are the real factors productive in bringing 
 about recovery is universally recognized. In typhoid 
 fever, above all other diseases, the physician must recog- 
 nize that a cure is impossible, that he can guide the pa- 
 tient through the storm but not stop the storm, 
 that the only object he may expect to accomplish 
 is the control of symptoms which directly or in- 
 directly affect the patient unfavorably. While he 
 may not be able to remove the cause of the symp- 
 toms, the very relief may be advantageous; then a 
 delirium indicative of great physical or mental distress, 
 or the presence of some complication inducing pain, may 
 so exhaust the patient's vitality as to seriously impair 
 his chances of recovery; and measures directed to the re- 
 lief of these symptoms may save the particles of strength 
 needed to carry the case over some crisis in his attack. 
 There is, therefore, no specific or routine treatment by 
 internal methods which should be resorted to when the 
 diagnosis of typhoid fever is established, but there are 
 two external methods, aside from feeding, which may be 
 applied to so nearly every case as to be called routine, 
 namely, absolute rest in bed, flat on the back, and the 
 use of the bath in a more or less modified form; a simple 
 mixture, designed to maintain free action of the kidneys 
 
CAN TYPHOID FEVER BE ABORTED. 31 
 
 or stomach may be advised in each case, chiefly to com- 
 fort the patient and his friends, but beyond this nothing 
 is to be used without a distinct indication by some prom- 
 inent symptom. The necessity of absolute rest in early 
 stages of enteric fever is known to every one, yet it 
 often requires the most strenuous efforts on the part of 
 the physician, particularly if he is not aided by a trained 
 nurse, to maintain the degree of rest necessary. If there 
 is one factor potent in rendering a prognosis unfavorable 
 in enteric fever, it is the neglect of this precaution in the 
 smallest detail, and every rising to stool may be re- 
 garded as a most unfortunate cause of future trouble and 
 danger. The use of the bath, or more correctly water 
 in any form, during typhoid fever stands next in impor- 
 tance and next in its approach to routine. 
 
 "It is a mistaken idea with many physicians that 
 ' the water treatment of typhoid fever is solelv indicated 
 by high fever;' nothing can be more erroneous. While 
 high temperature is, without doubt, a most important in- 
 dication for the bath treatment, extreme restlessness is 
 also a positive reason for its employment. 
 
 "Farther than this, there can be no doubt that the 
 use of water not only lowers extreme temperature, but 
 prevents its rapid return, and in some way advantage- 
 ously modifies nutritional changes. 
 
 "Restlessness and insomnia accompanying fever too 
 slight to require the full bath are often entirely relieved 
 by a tepid sponging, which soothes the irritated skin 
 and equalizes the circulation, refreshing and invigorating 
 the patient. Each part sponged should be immediately 
 rubbed dry, so that the patient may not be relaxed by 
 soaking. We presume this does not apply to the cases 
 of high fever, in which friction with the hand must be 
 
32 CAN TYPHOID FEVER BE ABORTED. 
 
 used to bring the blood to the surface where it may be 
 cooled. We have not tried to indicate in this article the 
 medicinal treatment required by various complications, 
 as space forbids, but we are sure that if these views be 
 followed, complications will be less frequent and a firm 
 basis maintained for rational measures sometimes neces- 
 sary for the relief of accidents." 
 
 These are the expressions of the matured thoughts 
 of the members, and of the editor of the journal of that 
 association, of which one of the leading medical period- 
 icals of Great Britain — a not too partial critic — said 
 nearly a quarter of a century ago: "It is probably the 
 most learned medical body in the world." 
 
 I do not believe the great American Medical Associ- 
 tion has taken any retrograde steps, and I do believe 
 that we may accept these opinions emanating from its 
 members and from the trusted editor as coming not only 
 from the most scientific and cultured medical body, but 
 as the expression of the most advanced opinions of the 
 highest medical authority in the world. And yet these 
 are not extreme views. Everywhere one glances in 
 medical literature one sees the same dark and gloomy 
 picture of typhoid fever. 
 
 Now and then a new remedy is proposed, or some 
 one advances slightly more hopeful views, but he and 
 his futile hopes are soon buried in oblivion and his hap- 
 less patient in the ground, and no one dares to say that 
 the physician ought to or can cure the disease. 
 
 I fully realize the responsibility he assumes, who 
 would undertake to criticise adversely the teachings of 
 an hundred generations of thinkers. It is said that "old 
 beliefs die hard," and the one I propose to endeavor to 
 destroy has all the charm of extreme antiquity. Long 
 
CAN TYPHOID FEVER BE ABORTED. 33 
 
 before typhoid fever was isolated from typhus it was 
 taught, as the great scientists of to-day teach, that it can- 
 not be cured, but must run its course. Then a new era 
 dawned — typhoid fever was recognized as a distinct dis- 
 ease, and yet the same theory was promulgated, and in 
 almost the same language as is used in the tautology of 
 the present day. Time passed ; the medical profession 
 made most wonderful strides in the pursuit of knowledge. 
 It was found that many diseases — and amongst them 
 typhoid fever — were due to or at least were accompanied 
 by a germ in some sense peculiar to themselves, and yet 
 the same doctrines were again handed down. Let us 
 take them up with iconoclastic hands, and see if the piti- 
 ful story that typhoid fever cannot be cured may not be 
 retold in a more cheerful and encouraging vein. 
 
 On the 17th of July last I read a paper in my local 
 society in which I said: "Those of you who were present 
 at the meeting of this society held in my office twelve or 
 fifteen years since, when this disease (typhoid fever) was 
 under discussion, will remember that in criticising a 
 paper of one of the members I said: 'While the paper is 
 in strict accordance with the teachings of the best author- 
 ities on the subject, I think it is so radically wrong that 
 if you would leave undone everything that the author has 
 said to do, and do everything he has said not to do, you 
 would come nearer my idea of the correct and scientific 
 treatment of the disease,' which I proceeded to give in 
 every detail. It was not however well received. The 
 author of the aforesaid paper condemned my doctrines 
 most severely and forcibly. To his credit be it said, that 
 he afterward, in an address to the society, remarked 
 that although he had expressed his disapproval of these 
 special therapeutic methods in the very strongest 
 
34 CAN TYPHOID FEVER BE ABORTED. 
 
 language at his command, that these discussions had set 
 him thinking. He told them that he had searched his 
 library over and over to find any authority upon which I 
 could have based my claims — that there was nothing in 
 all of the medical books bearing on my very peculiar 
 theory — but, nevertheless I was right and he would not 
 again dare to treat a case of typhoid fever in any other 
 way than in the manner which I had described and so 
 enthusiastically advocated. 
 
 At this point I must express my regret that of my 
 earlier cases of typhoid fever no bedside histories were 
 recorded. No idea had entered my mind at that time of 
 inflicting upon an already overworked and enduring pro- 
 fession my remarkable theories. The clinical memoranda 
 and charts of many of the later cases are in my posses- 
 sion and are open to the inspection of any scientist of 
 this society. They are well worth studying seriously. 
 
 I wish now to call your attention to a few cases of 
 enteric fever, which illustrate the most marked results of 
 my work during the intervening years while I was still 
 investigating and experimenting with the many different 
 kinds of antiseptics which were brought to my notice. I 
 have selected, as example of the many, only such cases 
 as were diagnosticated by able, clever and expert physi- 
 cians, cases which bore such well-marked symptoms as 
 were quite characteristic of the disease, or were sur- 
 rounded by such circumstances as would indicate beyond 
 the possibility of a doubt that they were really typhoid 
 fever. 
 
 The limits of this paper will however only admit 
 of the presentation of the most salient features of those 
 cases which best illustrate a point, and in estimating 
 their value it should be borne in mind that only a few of 
 
CAN TYPHOID FEVER BE ABORTED. 35 
 
 the teachings of the editorial which I have quoted were 
 followed in these instances. Many of these patients 
 were allowed to get up or move about, or to go out of 
 doors at pleasure. Nurses, trained or untrained, were 
 allowed to sponge or not to sponge them. No other 
 baths were given except to meet the ordinary demands 
 of cleanliness. Very little effort was made to " control 
 the symptoms." No " simple mixtures designed to main- 
 tain free action of the kidneys or stomach, chiefly to 
 comfort the patient and his friends, " were ordered. No 
 medicine was ever exhibited for the purpose of directly 
 reducing the temperature ; and while the patient and his 
 attendants were generally warned against the danger, 
 real or supposed, of eating solid food, the warning was 
 not always heeded. Some of these patients ate solid 
 food on the seventh day of treatment ; others on the 
 twelfth day, and many were not restricted as to the diet 
 any of the time, eating as they pleased. 
 
 The following cases which I treated between the 
 years 1882 and 1892 have been selected as especially in- 
 teresting. Of these I have no clinical charts. 
 
 On the 17th of July, 1882, I was called to see the 
 son of Dr. F., after the attending physician had made 
 a diagnosis of typhoid fever. I immediately put him on 
 antiseptic treatment and he made a complete recovery 
 in twenty days, his temperature having been normal 
 several days when I discharged him. 
 
 A young gentleman died of enteric fever. Clara 
 P. lived in the same house and had assisted in nurs- 
 ing him during his illness. Two or three days later I 
 was called and made a diagnosis of typhoid fever, and 
 in reply to direct questions said that she would probably 
 be well in ten or twelve days. On my second visit I was 
 
36 CAN TYPHOID FEVER BE ABORTED. 
 
 told that another physician had seen her before I had 
 done so, made a diagnosis of typhoid fever, a prognosis 
 that she would be ill four or five weeks at least. Her 
 temperature went up to 104f° F. Tympanitis was well 
 marked and rose spots were abundant. She made a 
 good recovery, and was out to drive on the twelfth 
 day. 
 
 The wife of one of our leading druggists, Mr. W. W. 
 McK., had typoid fever from which she made a good 
 though not a rapid recovery. 
 
 Mrs. Johnson W. and her son both had typhoid 
 fever. Their recovery took place in eleven and fifteen 
 days respectively. In both cases the symptoms were 
 well marked. 
 
 Last winter, when typhoid fever was so fatal at 
 Beaver Falls, Mr. L., Jr., was brought home with the 
 disease, from which he recovered in twelve days. His 
 symptoms were all characteristic of the disease. 
 
 Ulysses S. was brought home from a boarding 
 house in Wampum, where at least one death had re- 
 sulted from typhoid fever. Dr. Wickham, of this city, 
 made a diagnosis of the disease, and treated him for 
 three days, when I was called. I found a well-marked 
 and typical case of typhoid fever, with a history of ten 
 days' sickness. Temperature 105.8°; pulse 124 ; bowels 
 very tympanitic, petechia abundant, tongue brown, hard 
 and dry; stupor so profound that he could with difficulty 
 be sufficiently aroused to show it. My first visit was 
 made on October 25. The last on November 3, when 
 he was sitting up. On November 10 he called at my 
 office and settled his account. 
 
 When typhoid fever was so prevalent and so fatal 
 near the corner of Bryson and Spring Streets, I was 
 
CAN TYPHOID FEVER BE ABORTED. 37 
 
 called to see the two daughters of Joseph D. diag- 
 nosed as typhoid fever, by a nurse of long experience in 
 nursing the disease. Found both cases well-marked. 
 Both recovered in less than ten days. Mr. John H. 
 W., who lived in the same locality and was ill at the 
 same time, made a good recovery from the disease in 
 ten days. His symptoms were all well marked and 
 characteristic of the disease. 
 
 Thomas E., of Girard, came to my office to con- 
 sult me ; after examining him two or three times, I told 
 him he had typhoid fever. He then informed me that 
 his wife was also very sick ; when I gave him medicine 
 for her as well as himself and told him to send her to 
 me as soon as possible. The next day I found her 
 lying on the sofa in my office, having come by train five 
 miles. Her temperature 104.3°; bowels very tym- 
 panitic and tender, all the symptoms pointing to a very 
 severe attack of typhoid fever. She was told to come 
 each alternate day to my office, as was also her hus- 
 band. The latter was permitted to work at his usual 
 occupation, that of a stationary engineer, throughout 
 his illness. After a few days, Mr. E. told me that 
 the doctors in Girard were laughing at him for going 
 
 away from home to a fool of a doctor who would 
 
 tell him he had typhoid fever and could work. I asked 
 him if they doubted his ability to work. He said, " No, 
 they know I can work, but they say I have not typhoid 
 fever." I told him if that were true, when he and his 
 wife had recovered that would be the end, while if they 
 had typhoid fever there would be more cases around 
 them. Within a few weeks thereafter I was called in 
 consultation to nine or ten well-marked cases along the 
 Little Valley in which they lived, and all within a stone's 
 
38 CAN TYPHOID FEVER BE ABORTED. 
 
 throw of their home. After several had had haemorrhage 
 of the bowels, and four or five had died, there was no 
 further question as to the character of the disease. The 
 President of our county medical society, Dr. Gibson, can 
 tell whether some of these cases were typhoid fever or 
 not. So also can the distinguished ex-President of the 
 Ohio State Medical Society, Dr. McCurdy. Mrs. Evans 
 was not able to come regularly to my office, but had to 
 miss occasionally two days at a time. She was refused 
 passage on the train by one of the railroad companies, 
 on the ground that she had a contagious disease, and 
 had to travel by a less convenient route. 
 
 On May 8, 1893, I was called to North Jackson to 
 see Mr. G. W. P., whose son had just died of typhoid 
 fever, after repeated haemorrhages of the bowels, and 
 found Mr. P., who had nursed his son thirty-five days, 
 had himself been ill with typhoid fever seven days. I 
 assured him that he was in no danger of dying, and that 
 he would probably be well in ten or twelve days. He 
 had a normal temperature on the tenth day. 
 
 On the 27th of May, 1893, I was again called to 
 North Jackson to see Wallace E., the son-in-law of Mr, 
 P., whom I saw at once had a severe attack of enteric 
 fever This opinion was not shared by his family phy- 
 sician, who promised should the patient continue to be 
 ill, and if I would leave the case in his hands, to tele- 
 phone me within two days in regard to his condition 
 and the result of treatment. I heard nothing more of 
 him however until I saw the notice of his death some 
 time after in the local paper. Thus in this little outbreak 
 of four cases of typhoid fever I treated the worst of the 
 two cases that I saw and from descriptions given me of 
 the other two cases, probable the severest case at the 
 
CAN TYPHOID FEVER BE ABORTED. . 39 
 
 outset of all of them, with result that my case recovered 
 in ten days and all of the others died. 
 
 Prior to the date at which this particular series of 
 observations begins, I had had large experience in the 
 treatment of typhoid fever both in hospital and private 
 practice with most unsatisfactory results, and when I lis- 
 tened to the various essays read in the section on the 
 practice of medicine at the meeting of the A. M. A. in 
 Washington, so antithetic in their recommendations for 
 the treatment of the disease, I was reminded of these 
 earlier experiences. My imagination pictured them in 
 sharp contrast with the happier outcome of later years; 
 and wishing that others might share with me the pleas- 
 ure and comfort of curing a disease so much dreaded and 
 that humanity might derive some benefit from any 
 knowledge I might possess on the subject, I told the 
 chairman of the section, Dr. Victor C. Vaughan, that if 
 possible I would prepare a paper and read it in the sec- 
 tion before its adjournment, and that in this address I 
 would advise a more hopeful method of treatment for 
 enteric fever. My work with the committee for the re- 
 organization of the sections however took up so much 
 of my time that the preparation of the paper was an 
 impossibility. On the last day of the meeting Dr. 
 Vaughan reminded the members of the section of my 
 promise, and I then said that I hoped to be able to pre- 
 pare and present a short report on the antiseptic treat- 
 ment of enteric fever at the next meeting of the society. 
 
 On my return to my home I availed myself of the 
 opportunity of criticising a paper on the treatment of 
 typhoid fever read by one of the members of my local 
 society, and after condemning some of the remedies ad- 
 vised as worse than useless, since they tended to aid the 
 
40 CAN TYPHOID FEVER BE ABORTED. 
 
 disease to destroy the patient (a criticism justly appli- 
 cable to many methods of treatment which have been 
 advised by some very learned professors) I said, "I have 
 long believed this disease to be due to a germ, whose 
 earliest habitat in man is in the alimentary canal, thus 
 the logical conclusion is, gastro-intestinal asepsis should 
 be the prime object to be attained by the treatment, and 
 when this can be obtained the problem of the abortive 
 treatment of typhoid fever is easily and quickly solved. 
 I believe that I have already acquired the knowledge 
 necessary for its accomplishment. Will any member of 
 the society aid me in making a demonstration of the fact? 
 If my proposition is agreed to, I will not only provide 
 all medicine but will make no extra charge for my own 
 work and will allow all fees to go to the physician in at- 
 tendance originally, making my visits in his company so 
 that he may follow me in all of my course." 
 
 I then consulted the president of the Ohio State 
 Medical Society as to the propriety of publishing a paper 
 on the antiseptic treatment of enteric fever and was ad- 
 vised not to do so until I had sufficient evidence to prove 
 to the medical profession to its entire satisfaction that 
 the methods in vogue could be improved upon. As I 
 was anxious to present a great array of aborted cases of 
 typhoid fever which had been controlled by the antiseptic 
 treatment, and as I had received a letter from the mayor 
 of New York on the subject I went to that city and spent 
 a week seeking an opportunity to demonstrate the cura- 
 bility of the disease, under the observation of some of 
 the famous professors of the metropolis. Failing to ac- 
 complish what I wished I returned home quite discour- 
 aged. I tried Philadelphia next, and for ten days devoted 
 myself to a fruitless effort to have some one give my 
 
CAN TYPHOID FEVER BE ABORTED. 41 
 
 method of antisepsis a trial in one of the great city hos- 
 pitals, without publishing- a treatment that might prove 
 valueless or misleading. Again I returned to my home, 
 this time most truly disheartened. Although I believed 
 myself able to cure one of the most fatal diseases of the 
 Mississippi Valley, I did not dare to give to the world a 
 treatment the action of which I could not explain and 
 which on a more thorough trial might turn out to be a 
 failure in the hands of more able but less enthusiastic 
 practitioners. 
 
 After this I corresponded with the heads of the 
 health departments of all of the principal cities of the 
 United States and Canada; and to the honor of all of the 
 gentlemen who were connected with these departments 
 not one of them hesitated or failed to furnish me with all 
 of the information in their power; often at an outlay of 
 great labor and no doubt great expense. A marked 
 contrast to the treatment I had received elsewhere. I 
 extend to them one and all my most earnest and 
 hearty thanks. 
 
 During the intervening years, I visited most of the 
 large cities of the United States from the Potomac River 
 to the Pacific coast. In Pittsburg, in Saint Louis, in 
 Washington, I gave the resident physicians of the largest 
 hospitals where typhoid fever was treated, the best 
 knowledge on the subject that I possessed at the time. 
 They politely promised to test my method of managing 
 the disease and probably forgot all I had said before 
 dinner. In Chicago, I succeeded in interesting the 
 Commissioner of Health, Dr. John D. Ware, in my work. 
 He asked me to give him a letter which he might show 
 to the superintendents of the hospitals. As this letter 
 and the answer to it, may become in the future, interest- 
 ing reading, I present them here: 
 
42 CAN TYPHOID FEVER BE ABORTED. 
 
 Youngstown, Ohio, May 5, 1892. 
 John D. Ware, Esq., M. D., 
 
 Commissioner of Health, City of Chicago. 
 
 My Dear Doctor: You are aware, that in writing in fulfillment 
 of my promise to you and in giving expression to my peculiar 
 views of typhoid fever, I am winning for myself the uncoveted 
 cognomen of "crank." You will remember I told you that I be- 
 lieved the life of every uncomplicated case of this dread disease 
 could be saved; that I believed the disease could be aborted and 
 that I also believed the excreta, from properly treated cases of 
 typhoid fever would prove to be innocuous. Long before I even 
 hoped for such results, I believed that the disease was due to a 
 germ; that the germ was in the earlier stages of the disease, con- 
 fined to the alimentary tract; and that if the entire tract could be 
 saturated with a germicide at once fatal to the germ, and harmless, 
 or better still, beneficial to the patient, the happiest results would 
 follow. 
 
 That I have been for fifteen years, doing all this, without hav- 
 ing published a word about it, should not be a discredit to me, 
 since it has taken years of testing, to satisfy even myself, and no 
 one likes to have to eat his own words, especially after they have 
 gone into cold type. 
 
 Now, Doctor, if you can, as soon as possible, secure a ward for 
 male, and one for female patients, with a day and a night nurse for 
 each ward, and give me as many cases as possible, none of which 
 have had the disease more than eight days, I will go to Chicago 
 and appear before a Committee of your selection, consisting of 
 members of the regular profession, upon whose judgment, and 
 integrity you could rely; explain to them fully my plan of treat- 
 ment, and if they find any medicine that I wish to administer is, in 
 the proper dose, dangerous, they shall refuse permission to make 
 the test, but for no other reason; you to invite any members of the 
 regular profession, as many as you wish, to watch the patients 
 from day to day, and if my test is entirely satisfactory, I am to 
 have the privilege of giving the treatment to the profession through 
 the American Medical Association. 
 
 Very respectfully, 
 
 John Eliot Woodbridge. 
 
CAN TYPHOID FEVER BE ABORTED. 43 
 
 In reply I received the following letter: 
 
 Chicago, May 27, 1892. 
 John E. Woodbridge, Esq., 
 
 Youngstown, Ohio, No. 29 W. Federal St. 
 
 My Dear Doctor : Your letter of May 5 arrived while I was 
 away from the department, sick. I did not return till the 20th., 
 and have endeavored, from that day till this, to interview the 
 physicians at different hospitals relative to the subject matter of 
 your letter. 
 
 Replying, I will say, I have seen the superintendents with 
 whom I thought possibly I might prevail upon to coincide with 
 our views relative to treatment of typhoid fever. I have also 
 talked with some of the prominent men in the profession, and I be- 
 lieve without a single exception, each and every one of them have 
 said this : " Why does not Dr. Woodbridge read his paper before 
 the National Association next June ? " 
 
 I have said all that I could say relative to the subject which 
 is one that I have become deeply interested in, but being only one 
 man, it has been impossible, apparently, to make any impression 
 upon the members of the profession. 
 
 By reading between the lines you will probably understand 
 more than is written. I do sincerely hope that you will read this 
 paper before the National Association as I believe that it would 
 result in a revolution in the treatment of this disease. 
 
 No one would dare question your paper so far as your results 
 in the past have been concerned, no matter how skeptical they 
 might be in other matters. 
 
 Trusting that you will pardon the delay in replying, 
 I am, sincerely yours, 
 
 John D. Ware, Commissioner of Health. 
 
 Finally, after having spent years of valuable time, 
 much money, and traveled many thousands of miles, I 
 heard of the epidemic of typhoid fever at Ironwood, 
 Michigan, and although I had been too busy to go to 
 the Milwaukee meeting of the American Medical Associ- 
 ation a few days before, I again sacrificed both time and 
 
44 
 
 CAN TYPHOID FEVER BE ABORTED. 
 
 money, and in a day was on'my way to the scene of the 
 worst epidemic of typhoid fever of which I have any 
 knowledge. The disease presented largely the charac- 
 teristics and symptoms, so common in our sporadic 
 cases. In some instances, however, the poison seemed 
 to be so virulent, as to lead one to despair, almost from 
 the very outset. 
 
 A good representative of this class, was Miss T. S. 
 Case, No. 22, whose bedside chart I hand you. When 
 
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 seen on June 25, 1893, her pulse, as you will see, was 
 120; her temperature, 105; her bowels were intensely 
 tympanitic ; marked dullness over the spleen ; tongue 
 dry, hard, and brown ; slight wandering delirium, which 
 soon became so profound that we were unable to take 
 her temperature under the tongue again for several 
 days. Altogether, her condition was so bad that the 
 attending physician, Dr. McLeod, a gentleman of un- 
 
CAN TYPHOID FEVER BE ABORTED. 45 
 
 usual ability, after the examination was completed,* 
 turned to me and said: "You don't want to treat 
 that girl ; she will surely die." I answered : " Not if 
 I treat her." After our second visit, Dr. McLeod said as 
 we went away: " If you can cure that girl, you are a 
 ' dandy.' " 
 
 She began to improve on the night of the third day, 
 at which time Dr. McLeod came to my hotel to tell me 
 that she was exceedingly delirious ; pulse 140 ; tem- 
 perature, as well as could be taken in the axilla, in her 
 extremely restless condition, was 104.8 ; her bowels 
 were exceedingly tympanitic ; and she was bleeding so 
 profusely, that he had to plug both posterior, and ante- 
 rior nares. The amelioriation of all these symptoms was 
 rapid and the temperature touched normal on the tenth 
 day of treatment. 
 
 In the same room with T. S., Case No. 22, lay her 
 sister, P. S., Case No. 28, who had been taken sick at 
 the same time; an equally typical case though somewhat 
 milder; her temperature, as you see, was never high, and 
 was subnormal on July 4, the ninth day of treatment. 
 
 The chart of Mr. F. S., Case No. 24, is very inter- 
 esting, as showing the result of treatment, after continued 
 reinfection. The case bade fair to be a very severe 
 one, but the temperature of 103.2, on June 26, dropped 
 to 99.4 on the 30th. It again rose, on discontinuing 
 treatment to 104.8, on July 2, when investigation 
 showed, that he had been drinking water from a well, 
 from which a dozen very severe cases had originated. 
 
 Case No. 25. Mrs. M. T., whose temperature was 
 in the afternoon of June 25, 103 degrees, and on the fol- 
 
 * This conversation occurred while making a tour of the Typhoid Fever 
 Hospital, and seeing patients in private practice, with the leading physicians of 
 Ironwood, who had very kindly consented to place under such treatment as I 
 should advise, all cases of the disease which I was willing to make an effort to 
 abort 
 
46 CAN TYPHOID FEVER BE ABORTED. 
 
 lowing morning, June 26, 103.8; touched normal on 
 July 9, the fourteenth day of treatment. 
 
 Case No. 26. Charles O., had on June 26 a tem- 
 perature of 101 degrees, on June 28, 101 j^. He was 
 up, and dressed on the following day, when his 
 temperature had dropped to 100.5, and it touched normal 
 on the eighth day of treatment, but went up to 100 de- 
 grees on the eleventh. He was discharged on the 14th 
 day of treatment. 
 
 Case No. 27. Mabel T., was one of five cases in 
 the same house, every member of the family having the 
 disease. Her temperature was on June 25 (the first 
 time I saw her), 103 degrees, pulse 120. The following 
 morning it was 103 y 2 , and soon afterward was 104 de- 
 grees, had been reduced to 98.8 degrees, with a pulse of 
 84 on the 5th of July. 
 
 Case No. 28. Mrs. T., aged 51, had on June 25 
 a temperature of 101.5, pulse 104 which was reduced to 
 98 degrees on July 4, with a pulse of 76. 
 
 Case No. 29. Charles E. E., aged 45; on June 30 
 had a temperature at 10:30 in the morning of 100.4; in 
 the evening was 102.8, and at 8 o'clock was 103.6; was 
 reduced to 98.6, on July 8. 
 
 Case No. 30. John A., aged 33 years, at 7:30 
 P. M. had a temperature of 103, pulse 84. This was re- 
 duced, on July 8, to 98.6 degrees. 
 
 Case No. 31. Mrs. L., aged 31 years; had June 
 25 a pulse of 96, and a temperature of 102. At noon 
 the following day 102^, and was subnormal on July 6. 
 
 Case No 32. Eddie T., aged 12 had a temper 
 ature of 101.6 degrees on June 25, with a pulse of 80, 
 was very hungry on the 27th and 28. His tempera- 
 ture afterward went up to 102^, but was on July 8 
 subnormal. 
 
 Case No. 33. Mr. M., aged 20 years; on June 25 
 had a morning temperature of 102 degrees, which on 
 July 9 was 98^; pulse 63. 
 
 Case No. 34. Albertina O., aged 16 years ; on June 
 
CAN TYPHOID FEVER BE ABORTED. 47 
 
 28, with a pulse of 120, had a temperature of 103.8; 
 which on July 9 was normal. 
 
 Case No. 35. Ed. O., aged 25 years ; came under 
 my care on the afternoon of June 25 ; had been sick 
 eight or nine days, and proved to be a very obstinate 
 case, the temperature being 104 degrees on the third day 
 of treatment, and 103.6 on the sixth day of treatment, 
 from which it dropped to normal on the fourteenth day, 
 with a pulse of 72. 
 
 Case No. 36. G. T. G., aged 28 years. This 
 patient was admitted to the hospital at 3 o'clock P. M. 
 of June 26. Pulse 80 ; temperature 97.4, but with the 
 other symptoms so characteristic of the disease as to 
 leave no doubt in my mind that he was entitled to admis- 
 sion to the Typhoid Fever Hospital. The disease did 
 not yield readily to treatment. On the fifth day his tem- 
 perature was 104. Went below normal on the ninth 
 day, but went up again to 101, whence it gradually 
 dropped to 97 degrees on the fourteenth day of treat- 
 ment. 
 
 Chart No. 37. John A., aged 32 years. He had 
 been sick three days when admitted on June 24. His 
 treatment may be regarded as a failure. His tempera- 
 ture was 100.6 when last seen on July 9. He had prob- 
 ably been ill longer than we had supposed. 
 
 We made two or three such mistakes. One of the 
 cases selected on the supposition that he had been ill 
 less than eight days, was found to be dying of perfora- 
 tion of the bowels when we went to him to administer 
 the first dose of medicine. Another case, after having 
 been put under treatment, showed conclusive evidence 
 of having been well along toward perforation, died a few 
 days later. 
 
 These records were kept by the physicians attending 
 the patients, and by the trained nurses in the Typhoid 
 Fever Hospital. The physicians were all gentlemen of 
 
48 CAN TYPHOID FEVER BE ABORTED. 
 
 unusual talent and capability, and of very large experi- 
 ence in the diagnosis and treatment of typhoid fever. 
 Dr. McLeod, the able Superintendent of the Union 
 Hospital, is a gentleman who would be an ornament to 
 the profession in the world's most enlightened capitals. 
 Dr. Neven, the Health Officer of the city of Ironwood, 
 is a gentleman whose skill and ability were factors of 
 prime importance in fighting this fearful epidemic. 
 Under his magic touch, the conception of to-day became 
 the finished work of to-morrow, and the armory, re- 
 sounding now to officers' commands, became an hos- 
 pital for typhoid fever, perfectly equipped under his able 
 superintendence, and instead of echoing to the soldier's 
 martial tread, the soft footfalls of a corps of trained 
 nurses, scarcely broke the silence. It is enough to say 
 of these nurses, that they were trained, in the city of 
 Chicago. It was the freely expressed opinion of both 
 physicians and nurses, that they had never seen typhoid 
 fever patients do, or feel so well. 
 
 I present here a letter, voluntarily handed me by Dr. 
 Neven : 
 
 Ironwood, Michigan, July 9, 1893. 
 
 This is to certify, that all the patients, whose bedside histories 
 are in the hands of Dr. Woodbridge, were diagnosed as cases of 
 typhoid fever by Drs. McLeod, Holmes, Neven and Woodbridge, 
 in the city of Ironwood, State of Michigan, and that they were all 
 under Dr. Woodbridge's special treatment, no other medicine be- 
 ing exhited during their sickness. 
 
 I also can state, that in no case did any serious condition arise,, 
 as did in other cases, treated side by side, by the same physicians 
 with the older, most approved methods of modern treatment. 
 
 J. K. Neven, M. D., 
 Health Officer of the City. 
 Physician in Charge of Typhoid Fever Hospital. 
 
CAN TYPHOID FEVER BE ABORTED. 49 
 
 The original bedside charts of all the cases treated, 
 either in the Typhoid Fever Hospital, or in private prac- 
 tice, as verified by the physicians in charge, are in my 
 possession and open to the inspection of any one inter- 
 ested in the advancement of science. 
 
 Dr. McLeod, of the Union Hospital, Dr. Neven, of 
 the Typhoid Fever Hospital and their corps of assistants 
 and nurses are entitled to the highest gratitude and 
 thanks of humanity for so ably furthering and assisting 
 me in these important investigations. 
 
 Immediately upon my return from Ironwood, I read 
 a paper in my local society, giving a lengthened account 
 of my investigations and of my work on the subject of 
 typhoid fever up to that date, July 17, 1893, exhibiting 
 the original charts and letters from Ironwood, as evi- 
 dence in part of the truth of my oft reiterated declara- 
 tion that typhoid fever can be aborted, and that death is 
 a wholly unnecessary consequence of the disease. I 
 reminded the society, that thirteen years previously I 
 had outlined before that body, the treatment which had 
 given me such brilliant results. 
 
 I wish now to present the clinical charts and brief 
 reports of a few of the most interesting and character- 
 istic cases which I have treated since my return to my 
 home from my sojourn in the north of Michigan. 
 
 On the day my paper was read in my local society, I 
 was called to see Ed. M., (Case No. 38, the chart of 
 which is now offered for inspection) .* I found him with 
 a temperature of 104^°. The next day it was 104.4° 
 and the day following, 104.8°, from which time it gradu- 
 
 *The cut of this and many other charts which appeared in my earlier papers 
 have been mislaid, but as they had been freely exhibited it was not thought neces- 
 sary to reproduce them. 
 
50 
 
 CAN TYPHOID FEVER BE ABORTED. 
 
 ally declined to normal on the morning of the eighth day 
 of treatment, although he had a rise of temperature for 
 several days thereafter; he walked out on the eighth day; 
 ate a slice of bread on the tenth day for supper. For 
 breakfast on the eleventh day, he ate two slices of bread, 
 two eggs, and two cakes, and continued eating heartily 
 from that time.* 
 
 104^ 
 
 103° 
 
 JiayofDi 
 JPuTs 
 
 Hesp 
 
 On July 24, Leo M., Case No. 39 son of Case No. 38, 
 was taken sick, and on examination, gave the following 
 register: Temperature 102^ in the morning, which 
 rose to 104i on the fourth day, and 105 on the fifth 
 day of treatment; pulse 112 the first day, 160 the fifth 
 day; the bowels became intensely tympanitic, rose spots 
 appeared in profusion, and all the symptoms pointed to 
 
 *The mention of this indiscretion must not be understood to mean that it 
 was sanctioned by me. 
 
CAN TYPHOID FEVER BE ABORTED. 51 
 
 an exceedingly severe attack of typhoid fever. Turning 
 to Mr. M., with the thermometer in my hand, indicating a 
 temperature of 105°, I said, "Fifteen years ago, had you 
 been lying there with typhoid fever, your wife also 
 showing well-marked symptoms of the disease, and these 
 symptoms present in this boy, I should have said sadly: 
 1 He is very ill with typhoid fever; he will probably be 
 sick four or five weeks, or longer;' and if asked for a 
 prognosis, would have said: ' He is in great danger;' 
 now I cheerfully say: * He has typhoid fever; he will 
 probably be sick ten days, or two weeks, or may be 
 mildly sick somewhat longer. There is no danger.' " 
 The temperature touched normal on the sixteenth day of 
 treatment. 
 
 These cases were examined at various times, by Dr. 
 H. H. Hahn, Dr. Thomas, and Dr. Robert Gibson, 
 President of the Mahoning County Medical Society, and 
 all were positively diagnosed as typhoid fever. You will 
 find the statements of these physicians on the original 
 charts. 
 
 Case No. 40. Mrs. M. Her symptoms were decided- 
 ly characteristic, although her temperature was not high at 
 any time nor was she confined to her bed all of any day. 
 The temperature touched normal on the eighth day of 
 treatment. 
 
 On August 11, 1893, I was called to see Lizzie, 
 Case No. 42, who had been sick a few days prior to 
 August 1, when she first consulted a physician, who re 
 ported a temperature of 103° on that day. He treated 
 her four or five days, when another physician was called 
 who did not fully make up his mind whether she had 
 typhoid fever or not. I was then called, and found a 
 temperature of 104^°. I hesitated whether to attempt 
 antiseptic treatment at so late a day ; for six days, the 
 afternoon temperatures were, 104.5, 103.5, 10o^, 102.6, 
 
52 CAN TYPHOID FEVER BE ABORTED. 
 
 101 %°, 101.2°. The pulse ranged from 90 to 96. The 
 improvement in the patient's general condition, however, 
 was greater than the fall in temperature would indicate. 
 She became cheerful, complained of hunger, and wanted 
 to get up ; the bowels, which had been tender, and very 
 tympanitic, lost for a time, all tenderness, and tympan- 
 ites. Both, however, returned in a slight degree, after 
 a few days, and the temperature remained above normal 
 for two or three weeks, all antiseptic treatment having 
 been abandoned after the twelfth day. This case is in- 
 teresting, as showing the effect of what I believe to be 
 germicidal treatment, even when too late to abort the 
 disease. 
 
 While visiting Case No. 42, I was called to the next 
 house to see the daughter of IJx-Marshal Crowley, Case 
 No. 46, whose symptoms of typhoid fever were well- 
 marked. Her temperature was 103°, pulse 112. She re- 
 covered in less than a week. 
 
 On September 17, 1893, I was called to see John H., 
 Case No. 41, positively diagnosed as typhoid fever by 
 four physicians. His symptoms were well marked, and 
 rose spots very abundant. His pulse and temperature ran 
 a very common course ; I give them daily under the 
 dates : 
 
 September 17. Temperature, 103:6°; pulse, 92. 
 
 September 18. Temperature, 104.6°; pulse, 92. 
 
 September 19. Temperature, 104.8°; pulse, 98. 
 
 September 20. Temperature, 103°; pulse, 80. 
 
 September 21. Temperature, 102^°, 
 
 September 22. Temperature, 102.2°; pulse, 78. 
 
 September 23. Temperature, 101^°; pulse, 76. 
 
 September 24. Temperature, 100.6°; pulse, 72. 
 
 September 25. Temperature, 100.6°; pulse, 70. 
 
 September 26. Temperature, 97.6°; pulse, 64. 
 
 September 27. Temperature, 98^°; pulse, 68. 
 
 September 28. Temperature, 98.2°; pulse, 64. 
 
 On September 29, I was called to see Case No. 47, 
 Ralph H., brother of Case No. 41. He was living in 
 
CAN TYPHOID FEVER BE ABORTED. 53 
 
 the same house with his brother when taken ill and is 
 now lying sick with typhoid fever. I will give his chart 
 in a future paper, as well as six or eight other charts of 
 cases now under treatment. 
 
 On the 23d of September, 1893, I was called to 
 Washingtonville, to see William W., Case No. 48, sick 
 with typhoid fever, diagnosed by his attending physi- 
 cian, Dr. Powers, confirmed by Dr. Bertelott in consul- 
 tation. His temperature was normal on September 29, 
 and so continued till he was quite well. 
 
 I have made in this paper a brief summary of some 
 of the worst cases and worst results I have had in my 
 private practice for more than twelve years, during which 
 time I have had no death from typhoid fever. During 
 the same period, I have had a large number of cases, in 
 which a diagnosis of typhoid fever was made, but which 
 recovered in from three to twelve days, without present- 
 ing pathognomonic symptoms of the disease. The re- 
 markable success I have had in these cases leads me to 
 hope and believe that the alimentary canal should be 
 thoroughly asepticized, at the earliest possible moment 
 in all suspicious cases, and that by so doing, only good 
 fortune will ensue. 
 
 Keenly alive to the ignominy and disgrace that 
 await me, should future observations contradict the re- 
 sults and conclusions of the past ; aware, too, of the 
 danger of the too implicit reliance on a limited number 
 of observations, and with all due respect, for the teach- 
 ings of the great thinkers of the profession, whose 
 wisdom has, with strange unanimity, taught the con- 
 trary, I yet wish to answer my question : " Can Typhoid 
 Fever be Aborted ? " in the affirmative. 
 
CAN TYPHOID FEVER BE ABORTED.* 
 
 In my last paper, published in the current issue of the 
 Journal of the American Medical Associatio7i y I concluded 
 the history of my cases with a partial report of Case No. 
 41, John H., who had not at that time recovered from his ill- 
 ness, and with the promise that I would report the case of 
 his brother, Ralph H., Case No. 47, together with six or 
 eiorht other cases which were under treatment at the time 
 
 o 
 
 the article was written. Some of these patients recovered, 
 without having developed pathognomonic symptoms of ty- 
 phoid fever, and consequently cannot be reckoned as such. 
 Case No. 41. J. H. This case is especially interest- 
 ing. I was not aware until several weeks after his recovery, 
 that his attending physician, a personal friend of mine, after 
 having made a diagnosis of typhoid had been discharged, 
 and myself called, although I did think the family unusually 
 inquisitive, when I gave a diagnosis of typhoid fever, and a 
 prognosis of ten or twelve days' sickness, no danger. On 
 the seventh day of treatment, when the rose spots were 
 abundant, and other symptoms well marked, I asked Dr. 
 Thomas, one of the best diagnosticians in our society, to 
 examine. him, and make a diagnosis ; he did so and said at 
 once, ''that is typhoid fever, and I will sustain you in that 
 diagnosis at any and all times," and added, " my experience 
 with cases of this character is, that recovery is slow and 
 tedious." I said, " I shall ask you to come here in two or 
 three days to see a case of aborted typhoid fever." I also 
 inquired. " Doctor, would you dare to give this man solid 
 
 *Read before the Mahoning County, Ohio, Medical Society February 12, 1894. 
 
 54 
 
CAN TYPHOID FEVER BE ABORTED. 55 
 
 food?" "If he were my patient I should certainly not," 
 he said. Turning- to the man, I told him of the opinions 
 held by the best thinkers of the profession, in regard to eat- 
 ing- solid food, warned him of the supposed danger and then 
 asked him if he would be willing to eat a piece of beefsteak. 
 He said yes, if I advised him to do so. However, even 
 after I told him it must be on his own responsibility, he ate 
 the steak without ill effects, and on the ninth day, I asked 
 Dr. Thomas to re-examine him, when his temperature was 
 found to be 97°. He was discharged cured, on Septem- 
 ber 28. 
 
 Case No. 47. Ralph H., brother of Case No. 41, re- 
 siding with him. He was taken sick on September 29 ; pulse, 
 100; temperature, 103°. The appearance of the tongue, the 
 severe headache, and all other symptoms were characteristic ; 
 later rose spots were abundant, and dullness over the spleen 
 was well marked. After treating him five days, I wished 
 to be away at the meeting of the Mississippi Valley Medical 
 Association and the World's Fair, so I asked Dr. McCurdy, 
 a member of our society, to take charge of him, together 
 with Cases Nos. 43 and 44, which he did, continuing my 
 treatment, so that in all of these cases I had the advantage 
 of his valued confirmation of my diagnosis. The tempera- 
 ture of the patient touched normal on the twelfth day of 
 treatment. 
 
 Case No. 45. William W. This patient was seen in 
 consultation with the attending physician, but lived at so 
 great a distance that I was only able to see him twice. On 
 my first visit I found the temperature 104.8° and within 
 the next twenty-four hours it went above 105°, this being 
 the eleventh day of illness. When I saw him again four 
 days later, the temperature had dropped to 103.2° notwith- 
 standing which his friends entertained little hope of his re- 
 covery, so serious seemed his condition. However, he 
 steadily improved, and five days later his temperature was 
 normal and his recovery rapid and complete. 
 
 Case No. 49. William T. On October 31, 1893, 
 Dr. J. J. Thomas, who had seen the result of my treat- 
 
56 
 
 CAN TYPHOID FEVER BE ABORTED. 
 
 ment in two or three cases, telephoned me that he had a 
 typical case of typhoid fever to which he would like to 
 have my treatment applied. After examining- the invalid 
 I expressed the opinion that he had been ill more 
 than ten days ; that there was but a limited area of intes- 
 tine involved, but that it was bordering closely on ulcera- 
 tion. Although the temperature was not high, he did 
 not recover entirely for eighteen days. 
 
 Case No 50. B. C. W. W. This case presented 
 well-marked and characteristic symptoms. Recovery 
 followed by alopecia. 
 
 Case 51. Angus McP., aged 27 years. In the eve- 
 ning of January 22, I was called to see this patient. After 
 examining him, I said: "This man has had typhoid 
 fever more than two weeks." They answered : " Yes, he 
 had a chill two weeks ago last night." The next morning 
 I took Dr. McCurdy with me to see him. We failed to 
 get the morning temperature, which the night before had 
 been 105£°. He was voiding both urine and feces, in- 
 voluntarily ; his teeth, gums, and lips, were covered with 
 sordes, which his faithful nurse, his wife, was unable to 
 keep cleared away. His bowels were intensely tympan- 
 itic ; in short, all his symptoms were characteristic. I 
 hand you his chart, to show the result of treatment dur- 
 ing the first few days, which has since been far from sat- 
 isfactory, and the end is not yet. 
 
CAN TYPHOID FEVER BE ABORTED. 57 
 
 Case 52. Willis H., aged 9 years. On returning 
 from my first visit to Case No. 51, on January 22, I 
 found a gentleman waiting to have me go to see a child, 
 who was supposed to have typhoid fever. He had been 
 with his mother, who was nursing her brother, through a 
 five weeks' attack of the disease. His symptoms were all 
 well marked, the temperature being 104 4°, when I made 
 my third visit on the evening of January 23. Dr. Barnes 
 examined him and confirmed my diagnosis. The tem- 
 perature was below normal on the tenth day. 
 
 Case No. 53. Guy H., aged 6 years, brother of 
 Case No. 52, was taken sick on January 28 with char- 
 acteristic symptoms of the disease ; pulse 112 ; temper- 
 ature 104°. He recovered, however, before a positive 
 diagnosis could be made. 
 
 Case No. 55. Thomas M. On February 6 I was 
 called to see this patient, who lived within a few rods 
 of Case No. 51, his helper in the mill, and his friend and 
 nurse during his present sickness. His symptoms were 
 characteristic and indicated the beginning of a very severe 
 attack of typhoid fever. His chart shows the result of 
 treatment to the present time. After visiting him two or 
 three times I told him he had typhoid fever, but as treat- 
 ment was commenced so early he would be able to sit up 
 and eat solid food in a few days ; and that there was no 
 danger of his being as sick as his friend (whom I did not 
 see until the sixteenth day of illness), or of dying. Dr. 
 Robert D. Gibson, the last President of the Mahoning 
 County Medical Society, visited this case with me and 
 confirmed the diagnosis. 
 
 Case No. 43. Frank V was a rather severe case of 
 typhoid fever. I saw him first on September 27. On 
 September 30, the fourth day of treatment, the temper- 
 ature was 104i°. Three days later, I left him with a 
 temperature of 101.7° in charge of Dr. McCurdy, who 
 confirmed the diagnosis, and continued the treatment, and 
 discharged him cured on the fourteenth clay of treatment. 
 I had attended his brother through an attack of the same 
 
58 CAN TYPHOID FEVER BE ABORTED. 
 
 disease, some time before, from which he made a most 
 satisfactory recovery; however, I did not keep a special 
 record of his case. 
 
 Case No. 44. Mrs. F., was the third case of typhoid 
 fever left in Dr. McCurdy's care at this time. He confirmed 
 the diagnosis, and continued the treatment and discharged 
 the patient on the eighth day. 
 
 Cases Nos. 40, 46 and 53, are excluded from the esti- 
 mates of my cases, because they recovered before a posi- 
 tive diagnosis was possible, as is also Case No. 42, 
 because there was unquestionably ulceration of Peyer's 
 glands, before I was called. 
 
 With the exception of one patient who was dying when 
 I was called, in consultation with the attending physician, 
 and one other case, who had been sick thirty-five days 
 when I saw him, and who afterward recovered, and a few 
 doubtful cases, who were well before a positive diagnosis 
 was possible, these are all the cases of typhoid fever I 
 have seen since my last paper was written. They round 
 out more than twelve years of active work without a death 
 in my private practice from this disease; while my brother 
 practitioners are having no better average results than I 
 had in former years when my death rate was so high. 
 Accept them for what they are worth, as additional evi- 
 dence that my prediction that typhoid fever can be aborted, 
 and that the life of every uncomplicated case of typhoid 
 fever can be saved is a valid one. That this claim will be 
 hotly contested, no one familiar with the most recent 
 literature on the subject can doubt. 
 
 What a contrast when compared with my personal ex- 
 perience during the first sixteen years of my practice, which 
 amply justifies the editorial quoted in my first paper, when 
 my death rate was enormous, and the average duration of 
 illness of those who recovered, as accurately as I can 
 
CAN TYPHOID FEVER BE AB0R1ED. 59 
 
 estimate it was more than thirty-four days. As these esti- 
 mates are made from memory, aided by very insufficient 
 data, the accidental omission of some of the milder cases, 
 may make both death rate and duration of disease too high. 
 But, giving myself the benefit of the doubt, and excluding 
 the large percentage of those who died, the estimates show 
 that those who recovered, did so after more than a month 
 of sickness, that must have left their constitutions fearfully 
 shattered. They recovered, too, probably more in defiance 
 than as a result of treatment — a sad commentary on sixteen 
 years of careful, and conscientious work, according to the 
 best light obtainable from any text-book within my reach at 
 that or at the present time, as far as internal medication is 
 concerned. 
 
 Do not understand me to state that the result of treat- 
 ment during all these sixteen years was equally bad. In 
 1876 a new light began to dawn on me, and during the 
 following seven years, to the beginning of 1882, when I had 
 my last death from typhoid fever, my results were manifest- 
 ly better, not alone in a greatly reduced death rate, but also 
 in a great shortening of the average duration of sickness. 
 In 1880, believing myself to be in possession of valuable 
 knowledge on the treatment of typhoid fever, which ought 
 to be given to my brother practitioners, I took advantage of 
 the chance which was offered when a paper was read on 
 the subject in this society, by one of its ablest members, to 
 advance my own theories and doctrines on this subject of so 
 much magnitude, and was much chagrined to find my 
 critique almost ridiculed, and shall I say, contemptuously 
 listened to by some, and myself standing entirely alone in 
 the advocacy of a method of treatment which, though crude 
 indeed, had yielded to me most excellent results, as com- 
 pared with my early experiences. 
 
60 CAiV TYPHOID FEVER BE ABORTED. 
 
 Years passed, and in 1891 another paper on the same 
 subject was read in the same society, advising a course of 
 treatment, only a little worse than the one I had so merci- 
 lessly criticised eleven years before. In commenting upon 
 this last paper, after showing why its recommendations 
 were not only unwise, but absolutely dangerous, and 
 driving its author to the refuge of the high authorities he 
 'had copied, and to the further statement that he had ad- 
 vised the remedies I had condemned as dangerous, in 
 small doses only, I said that I had long believed typhoid 
 fever to be due to a germ, whose earliest habitat in man 
 was the alimentary canal, and that when a germicide 
 powerful enough to destroy the germ, without detriment 
 to the patient, could be brought in contact with it, that 
 the problem of the abortive treatment of typhoid fever 
 would have been solved, and that I believed the means of 
 doing this were already at our disposal. 
 
 The questions now are, what are these very important 
 ingredients and how are they to be brought in contact 
 with the germs which they are intended to destroy, and 
 what other object, if any, are we to seek to accomplish 
 that we may most speedily restore our patients to their 
 normal condition of health. 
 
 I must confess myself at a loss how to approach this 
 part of my subject. Admitting that the germ enters the sys- 
 tem most frequently with the water and food taken into the 
 stomach, finds lodgment there, and multiplying, finds its 
 way into the small intestines and further. I conceive that 
 he will treat typhoid fever best, who best measures the con- 
 dition of his patient, or rather the extent of territory over 
 which thegerms have spread, and the amount of mischief 
 already done, and having done this, so selects and applies 
 his remedies as to most speedily stop their ravages, and 
 
CAN TYPHOID FEVER BE ABORTED. 61 
 
 most effectually relieve the patient of the ptomaines, tox 
 albumens, injuries to Peyer's glands, or other ill effects of 
 theirtemporary sojourn. This is, I fear, a much too difficult 
 task for me to undertake to-night. Some time in the 
 future I hope to give expression to my views on these 
 points, but at present I think I can do no better than to 
 give the treatment of two or three typical cases of ty- 
 phoid fever in connection with their bedside histories.* 
 
 My cases have been too few to establish the value of 
 my theory of treatment, but they have been too many 
 and the results have been too good to admit of longer 
 silence on my part, hence I deem it my duty to at once 
 present such evidence as I have to the end that humanity 
 may have the earliest possible benefit of my discovery. 
 
 Thus far in my private practice I have had no death 
 from typhoid fever in twelve years. I have been able to 
 abort two or three cases which were first seen on the 
 tenth day, and all of those cases which came under my care 
 on or before the eighth day of sickness. It may not be 
 possible to abort every case when the patient is first seen 
 as late as the eighth day, nor is it necessary, for when the 
 members of the medical profession and the people under- 
 stand that typhoid fever can invariably be cured when the 
 proper treatment is instituted at a sufficiently early stage 
 of the disease, the physician will no longer wait until his 
 patient is covered with rose spots or has one or more 
 haemorrhages of the bowels before making an exact di- 
 agnosis or beginning proper treatment. 
 
 In conclusion, I beg that you will understand, that in 
 criticisingthese papers which were written by physicians of 
 
 *The treatment and prescriptions used in these cases have been omitted in 
 this revised paper to avoid repetition, and because since the paper was first pub- 
 lished they have been somewhat modified. 
 
62 CAN TYPHOID FEVER BE ABORTED. 
 
 Youngstown, I wish to cast no slur on my colleagues in this 
 society. Their work was neither better nor worse than 
 that of the most learned members of the profession. I am 
 sure that my associates of this society are the peers of an 
 equal number of the members of the medical community in 
 any spot on the globe, and when I invite their criticism of 
 my reports of cases, of my unusual and singular ideas, and 
 of my declaration that there are ze^Z/known drugs which do 
 not only shorten the course of this disease, but the action 
 of which in typhoid fever is in the highest degree abortive, 
 I feel that I am standing before a tribunal, which would find 
 errors if there were errors to be found. 
 
CAN TYPHOID FEVER BE ABORTED.* 
 
 As a preface to my paper, I wish to acknowledge my 
 indebtedness to the president of this society, to our last ex- 
 president, to the president of the Ohio State Medical Soci- 
 ety, now present, to Dr. Thomas, Dr. Barnes, Dr. Dickson, 
 and to all other physicians who have confirmed my diago- 
 ses and watched the result of my treatment of typhoid fever, 
 or in any other way have aided me in my efforts to demon- 
 strate the curability and non-fatalness of the disease. I wish 
 also to thank them for their many kind and complimentary re- 
 marks made during the discussion of some of my previous 
 papers. Having my work characterized as the " greatest 
 discovery of the age " by one member; my name associated 
 with that of Jenner, by another ; and to have a third give 
 expression to his pride, that a member of this society has 
 done so great a work for humanity, would be exceedingly 
 gratifying to me at any time, but especially so just now, 
 when I am promulgating ideas, which must arouse the in- 
 dignation of every great professor of the principles and 
 practice of medicine in the world, because they, if true, will 
 convict him of having taught errors, that have not only cost 
 hundreds of lives, but have discouraged all investigation in 
 this most important field. At this time too I must incur the 
 bitter hostility of a large class of physicians, who not daring 
 
 *Read before the Mahoning County, Ohio, Medical Society, March 12, 1894, 
 with the records of the recovery of the cases reported in second paper, also the 
 reports of cases of typhoid fever in the McPhee family, who were attacked by the 
 disease after this paper was read in the society (Revised 1895.) 
 
 63 
 
64 CAN TYPHOID FEVER BE ABORTED. 
 
 to adopt my treatment, will condemn me for awakening 
 hopes which can never be realized by the " expectant 
 method " of treating typhoid fever ; or should they fail to 
 secure with the antiseptic treatment, the results which I 
 maintain are possible, they will forthwith lay all the blame 
 to my method, rather than upon their application of it. 
 
 May I also express my gratitute to the editor of the 
 yoitrnai of the American Medical Association, for so aptly 
 andsopromptly defendingme from the malicious and spite- 
 ful attacks of the editors of two or three medical journals. 
 I also desire to say to the members of this society that I 
 fully appreciate their courtesy, in giving upmost of the time 
 at the last meeting to my second paper on typhoid fever. 
 And when they, by unanimous vote, gave me the floor 
 again. this evening, I could not help wishing that my work 
 were far enough advanced to enable me to make my third 
 paper on typhoid fever somethingmore than a mere effort 
 to inaugurate a new era in the diagnosis, prognosis and 
 treatment of microbic diseases, the subject which for more 
 than twenty years has lain nearest my heart and to which 
 all of the best years of my life have been devoted. 
 
 I do not wish at present to enter into a strictly scientific 
 discussion of typhoid fever. Most of the investigations 
 into the etiology and pathology of the malady, have been 
 done by better observers than I can ever become ; and 
 my own work in that direction is in too chaotic a state 
 to be quoted by scientific men. 
 
 We know too little of the bacteriological world, too lit- 
 tle of the antagonisms existing between the minute deni- 
 zens 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 ad- 
 
CAN TYPHOID FEVER BE ABORTED. 65 
 
 ministered, that we are unable to say whether 'the eucalyp- 
 tol and guaiacol, or the creosote or calomel, or any one 
 agent is essential, or how, or why a cure has constantly 
 followed their exhibition. 
 
 The importance of the subject to you, to all American 
 and Canadian physicians, and indeed to all practitioners of 
 medicine all over the world, wherever typhoid fever pre- 
 vails, cannot be overestimated, because of its terrible mor- 
 tality (the death rate in Pittsburgh in 1892 was 23 per 
 cent) ; because of the broken constitutions of the more 
 than 500,000 who recover from the disease in the United 
 States annually, because the king upon his throne, the 
 statesman wielding the destinies of the greatest nation, the 
 merchant with his princely wealth, and the most brilliant 
 physician, with all their resources, and all their power, can- 
 not escape it, and because, last but not least, aside from the 
 principles of treatment I have given you, there is known to 
 men no means of aborting the disease, or of saving the life 
 of every case. 
 
 That I can do this, the reports of my cases of typhoid 
 fever with the accompanying charts, shown you at the last 
 meeting of this society, a few of which have been published 
 in the Journal of the American Medical Association, should 
 be conclusive evidence. They represent only the cases that 
 I have treated since the 25th day of July, 1893, and of 
 these only such as presented absolutely pathognomonic 
 symptoms of typhoid fever, in nearly every one of which 
 the diagnosis was confirmed by from one to five of the 
 ablest diagnosticians in the country. 
 
 At least, you must accept my declaration that all cases 
 of typhoid fever, uncomplicated by pre-existing or coexist- 
 ing disease, can be so modified as to cause them to run 
 an exceedingly mild course, until you can produce proof 
 
66 CAN TYPHOID FEVER BE ABORTED. 
 
 that I have failed in a single instance, by the application of 
 antiseptic remedies to do it. A bold assertion, after read- 
 ing Osier's statement : " The profession was long in learn- 
 ing, that typhoid fever is not a disease to be treated by 
 medicines," and "We are still without an agent, which can 
 counteract the gradual influence of the poisons which de- 
 velop in the course of acute febrile diseases, such as typhoid 
 fever, pneumonia and diphtheria.' ' 
 
 And yet, in 1880, in an unusually largely attended meet- 
 ing of this society, twelve years before this book was pub- 
 lished, I condemned all of the recognized methods of treat- 
 ment of typhoid fever. I gave in detail my treatment and 
 foreshadowed in some measure the important results 
 which I expected to follow its adoption. I told the essayist 
 of the evening, that if he would abandon his own, and all 
 known beaten tracts of treatment, he would have better re- 
 sults, and he, while expressing his respect for me as a care- 
 ful practitioner, condemned my theories, and the remedies I 
 proposed, as did every other member who joined in the 
 discussion. 
 
 In 1882, the subject of typhoid fever being under dis- 
 cussion in this society, I said that intestinal haemorrhage 
 would be unknown if the disease were properly treated, 
 and that it would be a safe rule to send to State's prison 
 any physician who ever had such an accident, presuppos- 
 ing of course that he had been called to see the patient in 
 due season. I admitted that such a law might occasionally 
 do injustice, but claimed that its general effect would be 
 beneficent. 
 
 Some of you will remember, that on the 13th of No- 
 vember, 1884, in the discussion of the term, "typho-mala- 
 rial fever," I condemned its application to cases of true ty- 
 phoid fever, with no malarial taint, and took occasion to say 
 
CAN TYPHOID FEVER BE ABORTED. 67 
 
 at the same time, that the term, " malarial fever," was mis- 
 applied, when used to designate a fever that runs three or 
 four weeks without intermission, or distinct remissions and 
 ends in death from intestinal haemorrhage, or exhaustion. 
 
 You will remember, too, that again in 1890, I spoke 
 in condemnation of the use of the coal tar derivatives, in 
 the treatment of the disease. I said that doubtless a very 
 large percentage of the deaths from heart failure were 
 due to their exhibition. And again in 1890 I spoke to 
 societies on the same subject, saying that I knew that 
 typhoid fever could be aborted. Thus the fact that I 
 have regarded typhoid fever as a curable disease has been 
 no secret since 1880 ; it has also been well known that if 
 I saw a patient before the sixth or eighth day of sickness 
 I invariably gave the one prognosis, ten or twelve days' 
 sickness, or if sick longer in so mild a way as to cause 
 no uneasiness, no danger, and the medical profession 
 abroad will understand that if I had failed in a single 
 instance to make my prognosis good, both the people and 
 the medical profession here would have held me re- 
 sponsible years ago for every death. 
 
 During all these years I had made every possible effort 
 to prove the accuracy and certainty of my reasoning so 
 that when I appeared before my society, claiming the ability 
 to do what all of our preceptors teach and believe is impos- 
 sible, I might have the means, not alone of proving my as- 
 sertions, but also of defining the principles governing the 
 proper treatment of the disease. But my dialectics were 
 too absurd for belief, even by the most credulous. Although 
 the authorities in some hospitals would permit me to see 
 their patients, or make dissections, it was long an utter im- 
 possibility for me to secure an opportunity to treat even a 
 few patients in a public institution under the observation of 
 
68 CAN TYPHOID FEVER BE ABORTED. 
 
 a skilled diagnostician, notwithstanding the fact that my ap- 
 plications were supported by the highest credentials. 
 
 I have met with so many discouragements, that lack of 
 money alone prevented me from opening a hospital for 
 typhoid fever, in which to demonstrate to the world how to 
 abort the disease. A few thousand dollars, placed at my 
 disposal in 1880, would long ago have resulted in the saving 
 of many thousands of lives, as well as the great ameliora- 
 tion of the condition of those other thousands who languish 
 for weeks in a burning fever, and suffer the horrible pangs 
 of hunger (I have felt them), and finally, as mere shadows 
 of their former selves, emerge from their sick room, and 
 creep about more dead than alive, often for months, when 
 they might just as well have been sitting up and eating 
 beefsteak, or bread and butter, after the sixth or seventh 
 day of treatment. 
 
 A few years since, when Dr. McCurdy was president of 
 the Ohio State Medical Society, and by virtue of his office 
 was the highest representative of the profession of the State, 
 we had several interviews on the subject of publishing in 
 some medical journal my claim that "Typhoid Fever can 
 be aborted," and the method of treatment that seemed best 
 calculated to produce this result ; and we both felt that with- 
 out more conclusive evidence than I could then adduce of 
 my ability to abort the disease, no possible good could be 
 effected by such a publication. 
 
 Although Dr. McCurdy has done me the honor to ac- 
 credit me with having made "a wonderful discovery," yet 
 he expressed the belief that premature public announcement 
 would greatly imperil my professional career, and I under- 
 stand that he still thinks (and I am sure the opinion is 
 correct) that even now it would have been better to have 
 waited a few years longer before giving publicity to and cir- 
 culating abroad my extraordinary and original notions. 
 
CAN TYPHOID FEVER BE ABORTED. 69 
 
 My cases are yet too few to carry conviction to the mind 
 of every member of the profession that it is possible to abort 
 typhoid fever ; and twelve years of active practice, without 
 a death, is not long enough to convince every one of them 
 that death is a wholly unnecessary consequence of the dis- 
 ease. Could I conscientiously have waited until I could 
 have reported the cases of twenty years without a death 
 from typhoid fever, as well as a proportionately increased 
 number of aborted cases ; could I have delayed until I had 
 completed my investigations so far as to enable me to state 
 with exactness, the laws upon which the scientific treatment 
 of the disease depend ; I might then have been able to con- 
 vince a sufficient number of thinking men that my theories 
 are correct, and to have induced them to aid me in con- 
 vincing the unthinking, and the treatment of typhoid fever 
 would have been revolutionized. 
 
 Now what will the result be ? We must wait and see. 
 How long? Who can tell? The lessons of the past must 
 be unlearned before the lessons of the future can be under- 
 stood. All of the great sophists of archaism and the pedants 
 of to-day have so iterated and reiterated the statement that 
 typhoid fever cannot be aborted, that it will take long to 
 efface from the memory that one sententious precept, espe- 
 cially while the very best and latest manuals of medical edu- 
 cation, as well as all of the lecturers in the universities of the 
 world, are teaching quite the contrary ; and until this mis- 
 teaching has been withdrawn from that curriculum, what 
 may we expect ? 
 
 With this bitter and blighting thought on the mind, can 
 a physician hope for triumph ? Can he have a longing to 
 be "master of the situation?" Can he be solicitous and 
 eager to succeed with the abortive treatment of typhoid 
 fever. Does he remember that only to the most careful 
 
70 CAN TYPHOID FEVER BE ABORTED. 
 
 watching- and the most skillful use of the remedies at our 
 command, will this treatment yield its happiest results. 
 How can he gain his end in such a work y when he firmly 
 believes in the impossibility of success, or how can he 
 be expected to give due energy to a task so herculean to 
 accomplish, in which he had no faith ? 
 
 Another bit of instruction which it will be difficult to 
 lose sight of, and which is taught by all our mentors and 
 guides with great unanimity, is, not to treat symptoms. 
 Early in the disease, a patient with a temperature of 105° 
 or 106° should be treated exactly as one with a temperature 
 of 101° or 102°. The physician who says that the impor- 
 tant object to be attained is to bring the temperature down, 
 is like the man who would attempt to resuscitate a drown- 
 ing man without first having taken him out of the water, 
 and the end would probably be the same in either instance. 
 It is not the symptom that kills the patient, and one patient 
 with a temperature of 105° may be on the high road to re- 
 covery, while another with a temperature of 101°, or even 
 lower, may be rapidly approaching the grave. Watch the 
 temperature, the pulse, and all other symptoms as matters 
 of scientific interest, and as showing the result of treatment 
 given hours, or even days before, but not as giving any 
 indication for treatment in the future. This rule applies 
 only in cases which have been properly treated prior to the 
 eighth day of disease. 
 
 In a paper read before this society last month, I gave in 
 detail the treatment of three typical cases of typhoid fever. 
 Two of these were treated regardless of symptoms, and the 
 other (whom I did not see until the sixteenth day of his 
 disease, and for that reason) was treated almost entirely 
 by the symptoms. All of these cases recovered, but while 
 one was not allowed any solid food for ten days after his 
 
CAN TYPHOID FEVER BE ABORTED. 71 
 
 temperature was normal, the others ate solid food all the 
 time. Two were never sponged at all, while the other was 
 sponged thoroughly. The one was not allowed to rise 
 even to stool, the others sat up and walked about, and one 
 of them went out of doors during his illness. The detailed 
 treatment of these individual cases was given, because I ex- 
 hibited nearly every remedy that I regard as essential to the 
 abortive treatment of the disease in all of its various stages, 
 also, because at this time I did not consider myself capable 
 of writing an analytical thesis on the general treatment and 
 consequently I wished to give myself more time for careful 
 observation before doing so. In future, as my investiga- 
 tions result in improved methods, I shall give the profession 
 further details. I hope, also, to be able to go more fully 
 into this part of my subject, in a paper which I propose to 
 read at the San Francisco meeting of the American Medical 
 Association. 
 
 Admitting that typhoid fever can be aborted, it becomes 
 a matter of prime importance to decide how to abort every 
 case and save every life. This will be impossible as long as 
 the people buy and use patent medicines, take domestic 
 remedies, or for any reason neglect to send for a physician 
 in season, and they will never realize the importance of do- 
 ing this, so long as the physician fails to make a diagnosis, 
 and institute proper treatment promptly as soon as he is 
 called. 
 
 Typhoid fever is man's most insidious enemy, having 
 a long period of incubation, its early diagnosis becomes a 
 matter of the greatest importance, and should invariably be 
 made the first time the patient is seen, with sufficient ac- 
 curacy to warrant the institution of proper treatment. I 
 readily concede the impossibility of always making a correct 
 or positive diagnosis at the first visit, but every case in 
 
72 CAN TYPHOID FEVER BE ABORTED. 
 
 which the temperature is ever so slightly elevated, and the 
 pulse ever so little accelerated, in which no contraindications 
 can be discovered, should be prescribed for as a case of 
 typhoid fever, thus giving the patient the benefit of every 
 possible doubt, since I know of no disease or condition 
 which under this rule would be unfavorably influenced; on 
 the contrary,the diseases in which this course would be ideal 
 treatment, are too many to be even mentioned in one short 
 paper. In diphtheria, in measles, in variola, in malarial 
 fever, in pneumonia, in influenza, and all catarrhal troubles, 
 you have given your patient the best possible initial treat- 
 ment. You will remember that I was assigned the duty of 
 presenting a paper on "La Grippe," after its visitation 
 amongst us in 1889, at the annual banquet of the Mahoning 
 County Medical Society, in which I said that I accredited 
 the fact that I had had no deaths from "la grippe," or any 
 of its sequelae, to the treatment I had invariably pursued. 
 I might have added, that although I had made no mistake 
 in diagnosis, I regarded, for purposes of treatment, every 
 case of " la grippe " as a case of typhoid fever except that I 
 usually gave the remedies in larger doses Thus, while 
 " la grippe " and typhoid fever differ so widely that I do 
 not think any careful physician would be likely to make a 
 mistake in diagnosis, these diseases are best treated in 
 almost identically the same way, at least in their earlier 
 stages, and the same is true of all of the malarial fevers, and 
 of the so-called " typho-malarial fever." 
 
 During my long and intimate association with my 
 uncle, Dr. Timothy Dwight Woodbridge, to whom a niche 
 is given in the temple of fame, whose prestige and super- 
 eminence was undoubted, so distingue and dignified, he 
 had dedicated his life to the healing of men, and his 
 posthumous glory will ever shed a luster over the place 
 
CAN TYPHOID FEVER BE ABORTED. 73 
 
 of his nativity. We of Ohio will always remember his in- 
 exhaustable supply of intelligence and his well-stored 
 mind, enriched by the observations and study of eighty 
 years and more of life in this workaday world, and very 
 nearly sixty years of active practice of medicine made him 
 not only a pleasant companion and charming raconteur 
 but always a wise guide and counselor in all matters re- 
 lating to our profession. He has often said to me in his 
 impressive way that there was no malarial fever in the 
 Mahoning Valley which would ever cause a death even if 
 left entirely without medical attendance, and yet the report 
 of the health officer of the City of Youngstown for the past 
 year, 1893, shows twelve deaths from malarial fever and 
 only nine deaths from the more terrible and without ques- 
 tion more fatal, typhoid fever. If Dr. Woodbridge, Sr., 
 were right, and my own experience certainly sustains his 
 boldly expressed opinions, then there are three horns, and 
 three only, to the dilemma of the physicians who made these 
 reports. In every one of these cases either a mistake of 
 diagnosis was made, a false record submitted, or the medi- 
 cine, and not the disease, killed these twelve patients. In 
 this conclusion I am ably sustained by Dr. Eliot, of New 
 Haven, who says : 
 
 "When typhoid fever really exists, but is not correctly 
 diagnosticated, it is in this vicinity most frequently called 
 malarial fever, and at a later stage typho-malarial fever. 
 This mistake generally depends upon a mixture of igno- 
 rance and carelessness. I do not care to maintain, at the 
 present time, that typho-malarial fever never occurs. I 
 presume that every one is aware, however, that this term 
 should be limited to cases of disease which are due to 
 the simultaneous action of the typhoid and of the ma- 
 larial poisons. I am thoroughly convinced that most cases 
 
74 CAN TYPHOID FEVER BE ABORTED. 
 
 of so-called typho- malarial fever are in reality cases of 
 typhoid fever. If a malarial element is present in some 
 of them, it is possible to remove it promptly by appropriate 
 treatment. With regard to cases of so-called malarial 
 fever, it should be remembered, that most fevers which 
 are caused by malarial poison, are of a distinctly inter- 
 mittent or remittent type. If therefore, a case of con- 
 tinuous fever occurs, which is uninfluenced by adequate doses 
 of the ordinarily used anti-periodics, there is good reason 
 for challenging the diagnostic accuracy of any one who 
 pronounces such a case malarial fever. In most cases of 
 this kind the disease is enteric fever. The vital statis- 
 tics of our city and State show a number of deaths as 
 due to malarial and typho-malarial fever, which is almost 
 equal to the mortality reported from typhoid fever. There 
 is little doubt that the majority of these cases reported, 
 represent mistakes in diagnosis, where enteric fever has 
 been overlooked and called by another name." 
 
 The above quotation is perfectly applicable to this lo- 
 cality, except that our statistics are worse than those of 
 New Haven. Many more inaccuracies would have been 
 recorded, had not the mistakes of the attending physician 
 been corrected by the consulting physician, sometimes 
 during the third or fourth week when it had become too 
 late for a change in the medicine to benefit the patient, 
 and there can be no doubt if these reports could be an- 
 alyzed, and autopsies made, there would be found a large 
 number of instances in which the deaths attributed to ma- 
 larial fever should have been reported under another 
 appellation. Osier, than whom there is perhaps no better 
 authority, says in "Principles and Practice," these cases 
 coming on with severe headache, photophobia, delirium, 
 twitching of the muscles, and retraction of the head, are 
 
CAN TYPHOID FEVER BE ABORTED. 75 
 
 almost invariably regarded as cerebro-spinal meningitis ; 
 he says also that he has thrice performed autopsies on 
 cases of this kind in which no suspicious symptom of ty- 
 phoid fever had been present, and adds : " Cerebro- 
 spinal meningitis is however a rare disease, typhoid fever 
 a very common one, and the onset with severe nervous 
 symptoms is by no means infrequent. Fully one-half of 
 the cases of so-called brain fever belong to this category." 
 
 Some of you may object to my method of making a di- 
 agnosis ; may say that I reach conclusions from insufficient 
 data. But you are reminded that this is a diagnosis for 
 treatment only, and to be verified or corrected by future 
 observations, and at the earliest possible moment, and that 
 it can be justified only on the premise that the physician's 
 most important duty is to cure his patient, rather than to 
 strive for the unattainable — an absolute accuracy of diagno- 
 sis. I am aware that an approach to an absolutely exact 
 diagnosis in typhoid fever can be made, if the development 
 of all the characteristic symptoms of the disease are awaited, 
 but in this case the exact diagnosis is purchased at too high 
 a price, and it will come too late to be salutary to the patient. 
 
 It seems strange that so varied a value should be placed 
 by different members of the profession upon the symptoms 
 ordinarily supposed to be pathognomonic of typhoid fever. 
 One will pin his faith to rose spots ; another to tenderness 
 in the right iliac-fossae ; another attaches much importance 
 to tympanitis, and dullness over the spleen ; while one old 
 physician, who actually considers himself to be something of 
 a luminary among the shining lights of the profession, says he 
 never saw a case of typhoid fever in which there was not diar- 
 rhoea, with little black spots through the discharges. He is 
 on a par with those who fail in the discrimination and differ- 
 entiation until their wits are awakened by the appearance 
 
76 CAN TYPHOID FEVER BE ABORTED. 
 
 of rose spots, or the supervention of an intestinal haemor- 
 rhage. Their diagnoses may be exact, indeed, but so far 
 as any benefit to be derived from treatment is concerned, 
 they might almost as well have been made in the dead 
 house. A diagnosis of typhoid fever, based on such slight 
 evidence as two symptoms only, and those common to 
 many other pathologic conditions, might, and probably 
 would, occasionally require future correction, but could 
 never result in harm to the patient, because the remedies 
 administered in the doses advised could by no possible 
 means have any malific influence on any condition which 
 could be mistaken for typhoid fever ; and the treatment par 
 excellence for any stage of this disease would be almost 
 equally beneficial in the early stages of any acute fever. If 
 the appearance of these characteristic symptoms are awaited, 
 typhoid fever will rarely be aborted, and unless made by an 
 exceedingly expert diagnostician a very large percentage 
 of this class of patients will be sacrificed. 
 
 I hand you the chart of Case No. 51, Angus McP., 
 which was shown with the records taken up to date, at the 
 last meeting of this society. It was in this case that a fatal 
 end was so confidently predicted by a physician who had 
 examined him on the day after I first saw him. Pray ob- 
 serve the rapid fall of temperature after each application of 
 large doses of eucalyptol guaiacol mixture to the abdomen.* 
 He had two or three small haemorrhages of the bowels. 
 
 I was called to-day to see Mrs. A. McP., who un- 
 doubtedly has typhoid fever. If so, hers will be an ex- 
 ceedingly interesting case, since it will be complicated from 
 the beginning, she having had extensive pelvic trouble 
 
 *Dr. McCurdy, who saw Mr. McP. with me immediately after I was first 
 called, during the discussion of this paper by the members of the County Society, 
 said: " I consider this the worst case of typhoid fever I have ever seen." 
 
CAN TYPHOID FEVER BE ABORTED. 77 
 
 since the birth of her child. Several nights ago she was 
 called up, and stood on a cold oil-cloth, contracting a severe 
 cold to which she accredited her violent headache and back- 
 ache, cough and the agonizing pains in the region of the 
 right nipple, and for this reason did not send for me un- 
 til to-day. 
 
 I shall report her case in my next paper. 
 
 If in these preliminary papers I have convinced the 
 medical profession that it is possible to cure typhoid fever, 
 that in the future a death from the disease will be prima 
 facie evidence of culpable ignorance, or criminal careless- 
 ness, either on the part of the patient, his friends or his 
 medical attendant; that the long weeks of burning fever, 
 followed by a shattered constitution, and sometimes a 
 clouded intellect, need no longer be feared. If I have im- 
 pressed upon minds the importance of making an early diag- 
 nosis and promptly acting upon it, have shown them the 
 danger of mistaking typhoid fever for malarial fever or any 
 of these milder diseases, and have clearly indicated that 
 the scientific treatment of typhoid fever in its earliest stages 
 is also the best possible treatment for any disease for 
 which it is likely to be mistaken, then their time and mine, 
 and the space these pages will occupy in the yournal of 
 the American Medical Association, could be put to no 
 better use. 
 
 ADDENDA REPORT OF LATER CASES. 
 
 Case No. 60. Mrs. Angus McP., aged twenty -four 
 years. This case was first seen on the 1 2th of March. 
 On the second day of treatment the temperature was 103^° 
 and on the fifth day it was 104^°. The abdominal symptoms 
 yielded promptly to treatment, but the trouble of the lungs 
 grew rapidly worse,and culminated in a profuse haemorrhage 
 of the right lung. The temperature on the 29th of March, 
 
78 CAN TYPHOID FEVER BE ABORTED. 
 
 in the morning, had dropped to 97.8°, and in the evening, 
 99.6°; the cough still very troublesome, but otherwise the pa- 
 tient was quite well; had eaten a little beafsteak on the two 
 preceding days. Thereafter her diet was left unrestricted. 
 
 A brother, sister, and sister-in-law of Angus McP., all 
 three having aided in nursing him, have each had an attack 
 of typhoid fever. 
 
 Case No. 63. Minnie McP. This case was first seen 
 on the 14th of March. Although the symptoms were all 
 characteristic, she was confined to the bed but little of the 
 time. She was fanciful and capricious about her alimenta- 
 tion, and although I warned her of the impropriety of eating 
 solid food, she persuaded a little child to bring her three 
 small cucumber pickles, which she ate, thus causing a severe 
 attack of indigestion, at which time her temperature went 
 up to 104°, after having been 99f ° the day before. How- 
 ever, after the backset caused by this indiscretion, her con- 
 dition improved rapidly and she was soon well. 
 
 Cases Nos. 65 and 66. Frank McP. and Mrs. Hugh 
 McP. Both of these cases presented characteristic symp- 
 toms of typhoid fever, but as I was attending other patients 
 in the house treatment was commenced early, and neither 
 patient was confined to, bed more than a day or two. 
 
 Case No. 59. Thomas M. Was under treatment and 
 the case partially reported in my last paper. (See case No. 
 55.) He continued to improve rapidly. The pulse having 
 been on the second day of treatment 108, and the tempera- 
 ture 1041°. On the tenth day of treatment, the tem- 
 perature and pulse were reduced to normal. He sat up 
 and ate a little beefsteak, and took no medicine after Feb- 
 ruary 19, the thirteenth day. For fifteen days he was ap- 
 parently entirely well, except that he did not regain his 
 strength. I saw him on the eighteenth day, when his tem- 
 perature and pulse were still normal ; he ate such food as 
 he wished; walked out of doors each and every day, al- 
 though he had not yet commenced to attend to his business. 
 On the 3d of March I was recalled, and found the morn- 
 ing temperature was 102.6°; the afternoon temperature 
 
CAN TYPHOID FEVER BE ABORTED. 
 
 79 
 
 104.8°, with a pulse of 112 to 116; although there 
 were no rose spots, not much abdominal tenderness nor tym- 
 panites, it was unquestionably a relapse of true typhoid 
 fever. He recovered more slowly than from the first attack, 
 his temperature first touching normal on the fourteenth day 
 of treatment. Of cases that I have seen early in the dis- 
 ease this is the first relapse I have ever had. 
 
 Case No. 62. Annie M., sister of Case No. 59, resid- 
 ing in the same house, consulted me on the 12th of March. 
 She presented fairly well-marked symptoms of typhoid fever, 
 except that the tenderness and pain in the right iliac fossae 
 seemed to justify a diagnosis of a graver disease. She 
 had been treated during the past summer for a disease 
 which her physician denominated inflammation of the 
 bowels. The development of a well-marked swelling in the 
 painful and tender right iliac fossa, prompted me to call in 
 consultation two eminent abdominal surgeons, Dr. McCurdy 
 and Dr. Dickson, who both expressed the opinion that she 
 had typhoid fever complicated with some grave pelvic 
 trouble. Her temperature touched normal on the fourteenth 
 day, and she made an excellent recovery from the fever. 
 The secondary disorder was also perfectly cured in time. 
 
TYPHOID FEVER.* 
 
 I have recently published in the Journal of the 
 American Medical Association, three papers under the 
 title, "Can Typhoid Fever be Aborted." These essays 
 were accompanied by many clinical charts, containing 
 much important data. They represented only a portion 
 of the cases of typhoid fever which I have treated since 
 the 25th of June, 1893, and of those only such as pre- 
 sented absolutely characteristic and pathognomonic 
 symptoms of the disease. Had I preserved complete 
 memoranda of all of the cases which I have treated since 
 1876, when I first realized that the text-books on the 
 principles and practice of medicine were unsafe guides 
 in the treatment of this most formidable disease; since 
 1880, when I first undertook to introduce to my local 
 society my novel and at that period almost untried treat- 
 ment (for what are four years in the cycles of error dur- 
 ing which typhoid fever has been regarded as an incur- 
 able malady), or even since 1882, the year when I had 
 my last death from typhoid, malarial, or any continued 
 fever, I would now be in a position to present to you 
 such a multiplicity of facts in evidence, such a profusion 
 of records, such an array of incontestable proof as to 
 have rendered all the vicious reasoning and wrangling, 
 all the disputatious debates, all the illogical and flimsy 
 argumentations that have assailed me to be set at 
 
 *Read before the Buffalo Medical Club, 25th of April, 1894. Revised 1895. 
 
 8o 
 
TYPHOID FEVER. 81 
 
 naught. For the cases which I have treated have been 
 so many and the results of the peculiar medication so re- 
 markable that should a man from mere curiosity be 
 tempted to thoroughly examine even these comparatively 
 few records which are placed before the members of this 
 society, should his mind be filled with doubt and in- 
 credulity, should he be influenced by prejudice and mis- 
 judgment, should his opinions be warped and biased by 
 jealousy or enviousness; or should he be a man of such 
 decision of character that this trait amounts to obstinacy, 
 a man with the " idee fixe," or narrow-minded and hyper- 
 critical, ready to fly in the face of facts; should he be 
 careless and superficial, of a hesitating and undemon- 
 strative disposition, lacking in faith and hope; skeptical, 
 suspicious; should his ignorance and illiterateness render 
 him incapable of adjudication, no man in any condition 
 could but be absolutely impressed and imbued with the 
 positively convincing proof which I have to offer that 
 typhoid fever can be aborted. I fully realize the danger 
 of drawing conclusions from insufficient data in such a 
 disease as that under consideration, and for that reason 
 I again express my deep regret that I wasted so much 
 valuable material that would have aided me in convincing 
 you of the truth of my statements. 
 
 I am speaking well within bounds when I say that 
 typhoid fever is far more amenable to treatment than is 
 a large class of the milder diseases, of the curability of 
 which there is no question. If it were in my power to 
 communicate to all of you who sit beneath the sound of 
 my voice to-night, the absolute confidence which I feel 
 on approaching every case of typhoid fever (which I see 
 at a sufficiently early date), it would give the conscien- 
 
82 TYPHOID FEVER. 
 
 tious and ingenuous physician almost as much comfort 
 and peace of mind as it would the patient. 
 
 Some two weeks since I visited two of your great 
 hospitals, where I was received in a most cordial and 
 gracious manner by the physicians in charge. The 
 typhoid fever patients whom I saw had every appearance 
 of doing as well as could be expected under the "expect- 
 ant method," and although records seemed to show an 
 exceptionally low death rate, there was not wanting 
 most positive evidence that the disease is yet the same 
 old enemy, so malevolent and sinister, so virulent and 
 destructive, so lingering and protracted, which in my 
 earlier professional career caused me so many hours of 
 anxious anxiety and disquietude. In one of the hospitals 
 the following remark was made, " We had two deaths 
 last week from consolidation of the lung in the fourth 
 week of the disease." I could with difficulty restrain 
 myself from saying, "There should be no fourth week 
 in typhoid fever," and as I gazed upon the weak and 
 emaciated bodies, which showed so palpably the physical 
 pain and discomfort through which they had passed; on 
 the physiognomy upon which was so visibly and indelibly 
 impressed the mental suffering, which is as excruciating 
 as the other; when I thought of the martyrdom of the 
 thirty-four or thirty-five periods of twenty-four hours 
 each; of the restraint and coercion of this durance vile; 
 when I remembered the long and weary days of watching 
 and surveillance which needed " L' oeil du maitre " each 
 and every instant of time, and of the strain and fatigue 
 which the faithful and untiring nurse and body guard has 
 had to endure, and how easily all of this might have been 
 obviated. And again when told that the nutriment of 
 these patients was to be nothing but milk, until the tern- 
 
TYPHOID FEVER. 83 
 
 perature was normal, and after that only such alimenta- 
 tion would be given as was contained in broths and 
 other liquid foods, until the temperature had continued 
 at the normal point for two weeks, and then a little raw 
 egg was to be administered, I thought of my patients, 
 who after the eighth or tenth day of the treatment 
 (should there be no intestinal lesion) are allowed to eat 
 beefsteak and eggs, and other nutritious and sustaining, 
 and at the same time easily assimilated food, and I pitied 
 these starving ones, so pinched with hunger, so parched 
 with thirst; whose voracious appetites did not need to 
 be titillated; for their mouths were already watering for 
 the delicate and dainty contents of the larder, and my 
 compassion and sympathy were rendered more poignant 
 by the recollection of my own feelings of torment and 
 agony under the same circumstances. 
 
 Would that I could have cast a mystic spell over 
 them or by an "open sesame" caused to appear before 
 their saddened eyes the entrancing luxuries which 
 should have been in store for them. The feast of plenty 
 instead of physic, the bed of roses upon which to bask 
 in the sunshine, instead of the weeks of invalidism spent 
 in a sanitorium; the robust health and strength, the 
 hale and hearty fresh lease of life, all that Hygeia should 
 have bestowed upon them, instead of leaving them 
 tainted and languishing and bedridden, while I was to 
 go forth on life's pathway without the opportunity of 
 rectifying the inconsistencies of a dogmatic age and pro- 
 fession. 
 
 The talisman is in my hand, the magic wand of a 
 Chiron, which has placed before us the life and health 
 giving elixir, the panacea for all the ills of typhoid fever. 
 In 1876, four years before Eberth and Koch discovered 
 
84 TYPHOID FEVER. 
 
 the bacillus typhosus, while attending some cases of the 
 abortive type of typhoid fever, the oft recurring but al- 
 ways new and interesting query presented itself to my 
 mind: Could not such medication be employed in every 
 case of microbic disease, as to cause the course of the 
 malady to be so modified that it would in no sense be 
 dangerous to life, and from that time to the present, 
 these noisome, polluted, infectious diseases have been 
 my life's study. My deliberation and contemplation on 
 the subject has been deep; I pondered long over each in- 
 significent feature; my faculties and senses were strained 
 to the utmost; I took counsel from every source; I cher- 
 ished each idea and thought as it came to me, and my 
 interest and thirst for knowledge on this topic was in- 
 satiable ; I read each and every thesis I could come 
 across with scrupulous care, and as I studied the treat- 
 ment of typhoid fever in the most scientific publications 
 within my reach, I hoped from the sifting and dissecting 
 of a multiplicity of authors to be able to extract the 
 essence of wisdom; I made my examinations with the 
 eye of an Argus; watched each result, neglected no tri- 
 fling occurrence which could in any way cause me to 
 alter my already formed conclusions, and for all these 
 years of solid work I received my recompense, for I 
 was rewarded by obtaining my long sought desideratum. 
 
 If in all of the marvelously great field of medical 
 literature there is one subject that should cause the 
 blush of shame to tinge the cheek of every devotee at 
 the shrine of /Esculapius, it is that veritable witch's 
 caldron of medical writings upon the treatment of 
 typhoid fever. 
 
 Many scores of widely divergent plans of managing 
 the disease have been advised, recommending the use 
 
TYPHOID FEVER. 85 
 
 of so varied an assortment of drugs, that from them a 
 fairly well-equipped apothecary shop might be stocked, 
 and should the student, instead of following his favorite 
 author, attempt to formulate a method of his own, from 
 an indiscriminate course of reading on the subject, he 
 would have a difficult task indeed. I think the gentle 
 men who are present will agree with me when I say 
 that many of the therapeutic agents that have been ad- 
 vised are harmful, and many are also dangerous; while 
 the crowning fact remains that no single method of 
 treating typhoid fever has yet been able to commend 
 itself to even a respectful minority of the profession. 
 On one point, and one only, which bears any relation to 
 the therapy of the disease are the great thinkers and 
 writers of medical literature united, viz. : that no treat- 
 ment whatever has any curative power. Of this fact 
 the editorial on that subject in the Journal of the Ameri- 
 can Medical Association of the 19th of August, 1893, in 
 summing up the papers read at the previous meeting of 
 the Association (quoted in full by me, in my first paper 
 on Typhoid Fever, which was published in the journal 
 of the 10th of February, 1894), is quite conclusive. But 
 the redundancy of the remedies prescribed; the impos- 
 sibility of reconciling the different methods advocated; 
 the glaringly apparent inconsistency of the many theories 
 advanced, and the fact that some of the therapeutic 
 agents most enthusiastically put forward, actually aid 
 the disease in its deadly work; all goes to prove that the 
 great oracles are in this field at least mere novices. 
 If all the theories upon the host of methods of treatment 
 for typhoid fever with the divers claims as to the omnipo- 
 tence of each by their advocates, could be gathered into 
 one volume and published as a whole it would I fear 
 
86 TYPHOID FEVER. 
 
 convict the medical profession of lunacy or worse. 
 Let us abandon then this contradictory mass of in- 
 consistencies. Let us recognize the fact that any treat- 
 ment to be successful must seek to accomplish some- 
 thing- more than merely to combat and overcome symp- 
 toms as they present themselves. All men of master 
 minds have already accepted the germ theory of typhoid 
 fever, and are further agreed that the germs generally 
 enter the system in the water or milk, or perhaps occa- 
 sionally with some articles of food; when a congenial home 
 is found in the stomach and small intestines they form 
 colonies, multiply by myriads, then if not destroyed or 
 dislodged and ejected, find their way into the general 
 circulation, and finally into nearly all of the organs and 
 tissues of the body, producing a series of symptoms and 
 consequences which are so well known that even to 
 mention them would be a waste of your valuable time. 
 It is well recognized that not even a majority of the 
 persons drinking water which has been the cause of an 
 outbreak of typhoid fever are attacked by the disease, 
 and it has been suggested that those who are not ailing 
 do not receive into the system any of the germs. This 
 is scarcely probable. In the imperfect state of our 
 knowledge in this field we can but surmise. It seems 
 to me to be far more likely that the germs enter into the 
 system of a much larger number of individuals than are 
 attacked by the disease; but for some reason (which I 
 shall not attempt to discuss) they have not found an har- 
 monious dwelling place, and hence have entered into a 
 state of "innocuous desuetude," rather than that there 
 were not enough of these same germs to go around. If 
 this be true, then to prevent an attack of the disease en- 
 tirely it would be only necessary to produce a like con- 
 
TYPHOID FEVER. 87 
 
 dition in all stomachs. To cure the malady, however, 
 after the germs have multiplied enough to develop suf- 
 ficient typho-toxins to make their presence felt, more 
 than this must be done. If this or any similar theory be 
 correct, and the germ in any one case can be destroyed 
 and the disease aborted, the logical conclusion must be ac- 
 cepted that at the same stage of the disease in any other 
 case it can also always be aborted. In my boyhood the 
 literature placed within my reach was good indeed, and I 
 early learned to accept with a boy's implicit faith all that 
 I read on theological subjects; and the habit remaining 
 with me after studying medicine I accepted the teach- 
 ings of her text-books with the same unquestioning faith. 
 A morbid condition of mind from which it was exceed- 
 ingly difficult to free myself, and which threw many an 
 impediment in my way, as for instance when hope 
 would tell me that I was aborting typhoid fever, and I 
 would read something that would ring all of the changes 
 of the oft reiterated statement that such a thing was ab- 
 solutely impossible, I would have to whistle very hard to 
 keep my courage up. Then after a period of doubt and 
 uncertainty, hope would again begin to dawn, I would 
 run across some wise author, who would encoffin hope, 
 drive the nail home, and clinch it with a calculation, 
 showing the weight of an average man, and the enor- 
 mous quantity of the antiseptic or germicide (always of 
 course selecting the most poisonous) it would require to 
 thoroughly asepticize this enormous mass; and as such a 
 great amount of so noxious an agent would be incompat- 
 ible with animal life, would imagine that he had settled 
 the question forever, forgetting to realize that the germ 
 finds its earliest habitat in man in the alimentary canal 
 (and perhaps in only a very small part of it ), and that if 
 
88 TYPHOID FEVER. 
 
 one can in the very beginning of the illness thoroughly 
 asepticize this small portion, it is possible at once and 
 most effectually to cure the patient. But even if the 
 germ has spread farther, as would be shown by the en- 
 largement of the spleen, rose spots, or other symptoms, 
 its home and place of multiplication is still in the alimen- 
 tary canal, and if by asepticizing this it is possible to 
 cut off the supply train and reinforcements, the elimin- 
 ants will rid the system of these germs, not so quickly 
 of course as in the former instance, but without much 
 danger to the life or long continued depression of the 
 patient. 
 
 In my previous papers on typhoid fever, I have 
 demonstrated (as far as my limited number of cases of 
 that disease are capable of doing), that it is sometimes 
 possible to abort the disease as late as the eighth or tenth 
 day of sickness. At so late a stage as this, however, no 
 matter how thoroughly the alimentary canal is relieved 
 of the virus producing germ, the course of the malady 
 cannot at once be interrupted, because the system is 
 already so completely saturated with the noxa and time 
 will be required for its elimination. 
 
 If I have not already taxed your patience too much, 
 I should like to add a few words on the treatment of 
 typhoid fever by referring to Case No. 67. George C, 
 aged 10 years. You will see that I began the treatment 
 on the 20th of March, 1894, when the temperature was 
 102i°. His recovery was rapid, and he regained all of 
 his former vigor of constitution.* . 
 
 In addition to the ordinary antiseptic treatment, 
 toward the end of the illness I ordered two or three tonic 
 
 *The treatment of this case is cut out because it has since been much simpli- 
 fied and improved. 
 
TYPHOID FEVER. 89 
 
 doses of quinine, and as he had from the beginning an 
 exceedingly troublesome cough, some ipecac, Wyeth's 
 bronchitis tablets and other expectorants were exhibited. 
 
 I regret that I have had to give the treatment of a 
 single case of typhoid fever as I have done here, or of 
 the three typical cases which were published in a former 
 paper, instead of defining the laws by which I believe 
 the curative treatment of the disease is governed. I 
 concede the right of the medical profession to demand 
 any knowledge that any member may possess, that can 
 directly or indirectly benefit humanity, but I deny its 
 right to insist that any member shall immolate himself on 
 the altar of professional ethics by publishing half formed 
 theories, misshapen thoughts or any ideas that are yet in 
 embryo ; for, let me assure you, I have still much to learn 
 on the abortive treatment of typhoid fever. 
 
 I may be mistaken in my high conception of the duty 
 of each member of the medical profession toward the hu- 
 man race, as well as toward his professional brethren, 
 but I believe that if another operator can perform a 
 laparotomy better than I can, and it is possible to pro- 
 cure his services, I operate and my patient dies, I am a 
 murderer. If he can cure every case of pneumonia, and 
 presents fairly conclusive evidence that he has not him- 
 self been deceived, and I fail to avail myself of his supe- 
 rior skill, and my patient dies, in the High Court, where 
 eternal Justice rules, I will be held responsible for every 
 life. Thus, is it not the duty of every member of the 
 medical profession to secure the services of one who pre- 
 sents the evidence, which I have presented here to-night, 
 of his ability to abort so grave a disease as typhoid fever ? 
 
 Do you ask me how ? There are two ways. Of 
 course I should always be pleased to meet any member 
 
90 TYPHOID FEVER. 
 
 of the Buffalo Medical Club in consultation over typhoid 
 fever, and Youngstown is less than six hours away; but 
 a higher duty devolves upon you, to prevail upon your 
 citizens to expend a little of their wonderful wealth in 
 building for me a hospital in which to treat typhoid fever 
 by the "Woodbridge Method," stipulating that it shall 
 be mine only so long as I can satisfy the members of this 
 club, or some other equally learned and honorable body 
 that I can save the life of every uncomplicated case of 
 typhoid fever ; can reduce the duration of the disease by 
 more than one-half, and can diminish its severity in as 
 great a degree. 
 
 May I picture the marvelous results that such a be- 
 neficent deed would bring. It would ultimately wipe out 
 your death rate from the disease. 
 
 Instead of its victims being confined to the bed from 
 twenty-five to thirty-fi>e days, the average confinement 
 would be less than five days. * 
 
 Instead of being only ready to return to their usual 
 avocations in from sixteen to twenty weeks, they would 
 be already at work in two or three. 
 
 Instead of having to wait until the temperature was 
 normal for a period of two weeks before they were al- 
 lowed a " little raw egg'' they would eat and enjoy beef- 
 steak in an average of less than ten days from the be- 
 ginning of treatment. 
 
 But this would not be all. Chicago, with her terrific 
 death rate would send to you to learn the lesson, and so 
 would Pittsburgh, Washington, St. Louis, and all other 
 cities where the disease prevails ; and Buffalo would 
 teach the best lesson the medical profession of the world 
 has learned for a hundred years. 
 
TYPHOID FEVER.* 
 
 The awful mortality from typhoid fever in Chicago, 
 in Philadelphia, in Pittsburgh, in Washington, and in 
 many other cities, and in many rural districts throughout 
 the United States, and the recent outbreak of the dis- 
 ease in St. Louis, in Buffalo, in Northern Michigan, in 
 North Dakota, coupled with the well-known fact that 
 this malady manifests a marked preference for the 
 young and vigorous of both sexes, fully attest the im- 
 portance of the subject. The interest of the medical 
 profession in it is made clearly apparent by the 
 enormous number of letters that have deluged my mail, 
 since the publication of my first paper under the title 
 " Can Typhoid Fever be Aborted ? " These letters, 
 coming as they do from almost every part of the United 
 States, and some from beyond its boundaries, indicate 
 that this interest is general and widespread, while the 
 misunderstanding of some of the simplest problems in- 
 volved, exhibited by the criticisms of some of those who 
 have essayed the discussion of my papers, together with 
 the contradictory theories and irreconcilable inconsis- 
 tencies of the writings upon the subject, demonstrate 
 the necessity of rewriting the entire literature of typhoid 
 fever. But it is too early to do that — our knowledge of 
 bacteriology is yet too new to justify us in attempting 
 
 *Read before the Ohio State Medical Society. Revised 1895. With clinical 
 
 data. 
 
 91 
 
92 TYPHOID FEVER. 
 
 to write the etiology of this disease, nor are we possessed 
 of such nice comprehension of the action of the alexi- 
 pharmics as would give special value to a thesis on 
 its therapeutics. We know, too, too many lessons which 
 must be unlearned before we can study it properly and 
 well, and the favored few who have abundance of mate- 
 rial and the best opportunity for observation in the great 
 hospitals, seem loath to give up the false doctrines that 
 are now so dear to their hearts. 
 
 Should they not rather keep pace with the workings 
 of the scientists of these "fin de siecle " days — should 
 they not attack many of the ancient legends and tradi- 
 tions of the mediaeval era — give them an entire boule- 
 versement and annihilate the grossest of these dark age 
 errors totally and completely — and leave the minds of 
 the rising generation of medicos free from the bias that 
 has swerved the students of all the past ages from the 
 truth. Because some eminent authority has said that 
 typhoid fever cannot be aborted, it does not necessarily 
 follow that all future ages must accept his "ipse dixit, " 
 and because we have not yet learned why certain reme- 
 dies produce given effects, shall we say that deeds ac- 
 complished are deeds impossible. Until we are pos- 
 sessed of more exact data in regard to bacteria and their 
 ptomaines and the actions of the alexines, abstract 
 reasoning is apt to be misleading. 
 
 Hence I have striven to avoid the discussion of 
 scientific problems and confined myself to the statement 
 of facts which have been proven or are easily susceptible 
 of proof. I believe that I shall accomplish the greatest 
 good in the shortest time and ultimately benefit the 
 greatest number, by first demonstrating that " typhoid 
 
TYPHOID FEVER. 93 
 
 fever can be aborted" and leaving- the speculative dis- 
 cussion of scientific questions to the future. 
 
 I have read three papers in my local society of late, 
 and in each I gave a short narrative of my work in rela- 
 tion to the abortive treatment of typhoid fever up to the 
 date at which it was presented. I also offered for in- 
 spection clinical charts of all of those cases which 
 showed pathognomic symptoms of the disease which 
 were treated by the so-called antiseptic method since 
 June of that year. I exhibited these charts. I made my 
 statement that I had had no death for twelve years from 
 typhoid, malarial, or any continued fever, and I made 
 my claim that typhoid fever can be aborted and that it 
 should never cause a death. My paper was discussed in 
 the society, my charts were verified and my clinical 
 data were endorsed by those physicians who had seen 
 the cases with me. Very soon after the reading of the 
 last of the series I was invited to read a short article on 
 typhoid fever in a society whose individual members 
 were men of high repute and great renown, whose sta- 
 tus in the medical world was unsurpassed, most of 
 whom were personally strangers to me, however. During 
 the discussion of my paper my clinical charts were 
 senselessly and ruthlessly criticised by a gentleman of 
 undoubted ability, a choice master spirit of the world, 
 and he spoke honestly when he said, "I have examined 
 every one of them carefully, and with four or five possi- 
 ble exceptions, there is not a 'typhoid fever curve' 
 among them." 
 
 Gentlemen, you are requested to examine these clin- 
 ical charts, and in the meanwhile I will make this ex- 
 planation, which ought to have been given in the society 
 of which I speak. There are among them three or four 
 
94 TYPHOID FEVER. 
 
 charts which represent cases in which absolutely pathog- 
 nomic symptoms of typhoid fever were not observed. 
 They were placed in the collection because these cases 
 appeared among others of a severe type accompanied 
 by many fatalities. They were diagnosticated as typhoid 
 fever and the presumption is that had they not been 
 seen early, and promptly and properly treated, they 
 would sooner or later have developed characteristic 
 symptoms of the disease. Many of these patients were 
 examined by members of this society who confirmed my 
 diagnosis, watched the treatment, and who are ready to 
 verify its results, every one of whom is the peer of the 
 gentleman who criticised the charts, and quite as compe- 
 tent as he to make an exact diagnosis in typhoid fever, 
 and when he said: "Not all the State of Ohio could 
 convince me that these are the charts of cases of typhoid 
 fever," "or that the temperature of a typhoid fever pa- 
 tient could be brought to normal in so short a time/' he 
 simply exposed his ignorance of the possibilities of anti- 
 septic medicine, and placed himself on record on the 
 wrong side of the question, and his oracular assertions 
 should never have been made in the society. 
 
 You are asked to examine them, and to accept them 
 as typhoid fever charts, upon my diagnosis, with the ver- 
 ification of these gentlemen and to study the " tempera- 
 ture curve" as a "typhoid fever curve" modified by 
 treatment. Had the curves which are drafted on these 
 charts been so traced that they would have pleased my 
 critics, they would lacked much of pleasing me, and had 
 I been unable to modify the curve, and duplicate the 
 modification in almost every instance, no possible reason 
 would have existed for the presentation of these charts, 
 
TYPHOID FEVER. 95 
 
 or indeed for my appearance before this distinguished 
 audience. 
 
 An analysis of these cases of typhoid fever will show- 
 that many of them were put under treatment on the 
 sixth, seventh, or eighth day of sickness, and two or 
 three on the tenth day or later ; but a demonstration of 
 the possibility of aborting typhoid fever as late as the 
 eighth or tenth day of sickness must not be regarded 
 as a claim that this disease can always be aborted at so 
 late a date ; or as a justification of the dense ignorance, 
 or criminal carelessness, or both, which are so often re- 
 sponsible for incorrect or inexact diagnoses. Nothing 
 can justify the correction of a diagnosis of malarial 
 fever, or any other disease, to typhoid fever ; still less 
 the allegation that any disease has "run into typhoid 
 fever." 
 
 In order to make an authentic and precise estimate 
 of the value of my results, you will please bear in mind 
 that nearly everything that the profession has regarded 
 as essential to recovery from typhoid fever has been 
 ignored. Very few of my private patients have had the 
 advantage of the heedful care and watchfulness of 
 trained nurses. No bathing or sponging has been 
 ordered in ordinary cases, except in the case of very 
 young children, when the temperature has remained 
 very high for several days, and in such an instance, as 
 in the case where I first saw the patient on the sixteenth 
 day of sickness. In many cases no restrictions were 
 given as to exercise, my patients were allowed to sit up, 
 walk about, and even go out of doors, if they felt able 
 to do so, and many of them have eaten solid food on the 
 seventh or eighth day after treatment was begun. 
 
 I am fast coming to the conclusion that no restric- 
 
96 
 
 TYPHOID FEVER. 
 
 tions whatever as to diet are necessary, when the pa- 
 tients are properly treated from the beginning- of the 
 malady, for with antiseptic treatment one never finds 
 serious abdominal lesions. 
 
 With my last paper, read on the twenty-fifth of April, 
 1894, I presented charts of cases of typhoid fever 
 
 UQnHnQUlHnQnHElQiUSEHDSnBCDQ 
 
 Nativ&y ..... 
 
 OccupatfJoru^. 
 TtaricLence 
 
 Treatment 
 
 
 JteniH.. 
 
 iQ4? 
 103° 
 102° 
 
 101° 
 100° 
 
 99° 
 ! 98° 
 
 Vtu/tflhs. 
 
 is- 
 
 a 
 
 * 
 
 Tt 
 
 a 
 
 2? 
 
 n 
 
 % 
 
 Jo 
 
 treated by my method up to that date, including that of 
 case No. 71, whom I discharged as convalescent on that 
 day, since which time I have had but two cases which 
 developed absolutely pathognomonic symptoms of ty- 
 phoid fever. These patients were the wife and son of 
 Mr. W. W., residing in the adjoining county of Trum- 
 
TYPHOID FEVER. 
 
 97 
 
 bull, and I consider that they were of singular interest 
 because I had two other patients who presented tolera- 
 bly well-marked symptoms of the disease, in the houses 
 on two sides of his residence, but whose recuperation 
 was so rapid and decidedly satisfactory in all respects and 
 because Mr. W. had previously lost a son and daughter 
 from the disease. 
 
 Case 1ST. 
 
 ' ■ ■ ., 
 
 'ise.. - 
 
 Notes afOhse 
 
 NameJfa— Jtf. MM 
 
 Age. smz?,. 
 
 Natix^itt/ 
 
 Occupation. _ 
 
 Tle*ricLence _ _ 
 
 Date ofadrrussion.. /rte**^ <£71.. 
 
 "'Diet ' 
 
 *ZL<* 
 
 Trealnxenx, 
 
 'iXjC^Cm*- 
 
 
 ^ZT 
 
 Resalt- 
 
 Case No. 72. James W., aged fourteen years. This 
 case presented all of the most characteristic symptoms 
 of typhoid fever. Intense headache, tympanitis, ten- 
 derness and gurgling in right iliac fossa, rose spots, 
 bronchial catarrh, nose bleed and delirium. I saw the 
 boy first on the twenty-fourth of April, when the tern- 
 
98 TYPHOID FEVER. 
 
 perature was 1031°. On the second day of treatment it 
 was reduced to 1011°, but on the fourth day it went up to 
 105°, from which time it rapidly went to normal on the 
 eighth day of treatment. 
 
 Case No. 75. Mrs. William W., mother of Case 
 No. 72, James W. During the last few days of her 
 son's illness this patient complained of fatigue and 
 weariness, but being a remarkably energetic woman and 
 self-sacrificing mother, she nursed her son until he was 
 able to sit up each day and then consulted me about her- 
 self. I found the same characteristic symptoms as were 
 present in the case of her son, except that there was no 
 nose bleed or delirium. To this case I ordered to be 
 given, in addition to the usual antiseptic medicine, a few 
 doses of magnesia, a little ipecac, and as she had not 
 slept for four or five nights her husband gave her a 
 twenty drop dose of tincture of opium. Her temperature 
 after the first four days did not run high, but did not 
 touch normal till the eleventh day. 
 
 Cases Nos. 73 and 77. Pearl H. and Michael M., 
 aged respectively eleven years and seventy years. 
 These patients lived in houses on two sides of Cases 
 Nos. 72 and 75, and presented tolerably well-marked 
 symptoms of the disease, the temperature touching 
 normal on the seventh day in each case.* 
 
 I regret that I am as yet unable to give any rule or 
 regulation by which one may know when the desidera- 
 tum of my treatment has been attained. I am in the 
 habit of watching the symptoms very diligently, but care- 
 fully, and when satisfied that the patient is steadily im- 
 proving, I diminish the size of the doses, or discontinue 
 the medicine. I strive by extreme vigilance to make 
 amends for what I lack in knowledge. 
 
 *The treatment and the directions for the management of the disease in 
 Cases Nos. 72 and 73 which was published with this paper originally, is cut out, 
 because the formulas have been changed, and somewhat simplified, and all these 
 directions are now given under the heading "Treatment" in this book. 
 
TYPHOID FEVER. 99 
 
 There is no language strong enough to condemn the 
 custom of making a composite diagnosis, as is habitually 
 practiced in many localities. It is not at all an uncom- 
 mon occurrence for practitioners to say that a patient has 
 malarial fever, and a few days later, on the change of 
 some symptom, to correct that diagnosis to typho- 
 malarial fever, and at last when the patient has had 
 haemorrhage from the bowels or is dying of exhaustion, to 
 state that the disease has "run into typoid fever." This 
 course is justly condemned by Dr. Gustavus Eliot, of 
 New Haven ; and equally reprehensible is the custom of 
 those physicians who await the development of one or 
 more of the pathognomonic symptoms of the disease, 
 such as enlargement of the spleen, rose spots, etc., 
 before venturing an opinion as to the real disease, or 
 beginning the proper antiseptic medication. Since the 
 method of treatment I have advised in typoid fever is 
 the most desirable and useful course to pursue in any 
 malady for which it could be mistaken, and since the 
 patient who has been put under this treatment early in 
 the course of the disease need not go to bed or in any 
 great degree be restricted or restrained in diet ; de- 
 barred from social enjoyment ; or even be required to 
 neglect or omit his attendance upon his business ; I 
 should recommend that every doubtful illness of this 
 sort be treated as a case of typhoid fever. 
 
 If future developments demand an alteration of this 
 diagnosis and method of treatment the patient will 
 already have been benefited by the medicine given under 
 the mistake, but if the diagnosis should prove to have 
 been correctly made, his life will have been saved. 
 
 I have been very severely criticised by some eminent 
 authorities for having made such "exaggerated (?) as- 
 
100 TYPHOID FEVER. 
 
 severations," considering the comparatively little expe- 
 rience I have had in the treatment of typhoid fever, the 
 one declaring to be premature that which the other con- 
 demned as inexcusable procrastination, and in this con- 
 nection, while one of my papers was under discussion in 
 my local society, several months ago, one member said : 
 " I think Dr. Woodbridge is responsible for a great 
 many deaths, as he did not publish an account of this 
 treatment, which is capable of producing such decidedly 
 remarkable results, twelve years ago." To this I re- 
 joined: "The gentleman should recall to his remem- 
 brance the fact that I gave my ideas of the treatment of 
 typhoid fever to the members of this society more than 
 twelve years ago. The audience of physicians present 
 at the meeing was very large, the gentleman himself 
 being one of the number. Can he have forgotten that 
 every member who took part in the debate most heartily 
 condemned my theories ? No. The responsibility for 
 the many deaths from typhoid fever must not be charged 
 to me. 
 
 All the leaders of thought in the medical profession 
 are an unit in teaching that typhoid fever cannot be 
 aborted. They have a perfect right to their opinion and 
 as far as modern teachings are concerned they are 
 probably correct. 
 
 Mr. President, I speak thus plainly, because of the 
 persistent efforts of two or three "captious critics " to em- 
 barrass my work and because I wish to place the respon- 
 sibility exactly where it belongs. 
 
 I want it to be fully understood that I am ready to 
 go wherever in the whole world typhoid fever claims a 
 victim, take charge of and treat the sick ones and if I 
 have a death from the disease I challenge the publica- 
 
TYPHOID FEVER. 101 
 
 tion of- my failure in a single instance to do with anti- 
 septic medicine, the wonders which I declare are possi- 
 ble. The day of the disease on which I first began to 
 treat the patient should also be noted as a most impor- 
 tant factor in the measurement of the value of my dis- 
 covery of the abortive treatment of typhoid fever. 
 
 The importance of this subject cannot be overesti- 
 mated. Should cholera, or smallpox, cause a few hun- 
 dred deaths, the people would be up in arms against its 
 insufficient health boards, and yet, according to Dr. Victor 
 C. Vaughan, than whom there is no better authority, who 
 says in an article published in the current issue of the 
 Pharmaceutical Era: " About 50,000 people die an- 
 nually in the United States from typhoid fever, and more 
 than ten times that number are sick with this disease." 
 A fearful and unnecessary sacrifice of life, and health, 
 and strength when the disease can invariably be aborted 
 and every patient saved. He says further : " We have 
 no foreign foe who could possibly inflict upon us the in- 
 jury, suffering and death which typhoid fever will cause 
 during the next twelve months." 
 
 Were this country threatened with an invasion of 
 an enemy capable of destroying the lives of 50,000 of 
 her people, and prostrating half a million more, for even 
 the average duration of an attack of typhoid fever, 
 treated by the symptomatic method ; and were a military 
 man to present the evidence of his ability to defeat that 
 foe that I have given you of my ability to save the 
 country the awful suffering and tremendous loss of life 
 and time caused by typhoid fever, the entire resources 
 of the nation would be placed at his disposal, and now 
 I ask you, does not the country owe me one typhoid 
 fever hospital in which I may endeavor to alleviate a 
 
102 TYPHOID FEVER. 
 
 little more suffering", and save a few more lives than it 
 would be possible to do in the private practice of medi- 
 cine. In this hospital I could demonstrate to the pro- 
 fession that typhoid fever is really amenable to curative 
 treatment. If the medical profession and the people 
 can be made to recognize this disease by its earliest 
 symptoms, and will send its victims to me, as soon as 
 they make their appearance, I make you this solemn 
 promise, that 1 will return to them every one of these 
 unfortunates, without a death from typhoid fever, or its 
 ordinary complications, or sequelae, with much less than 
 one-half of the usual loss of time from the sickness, and 
 with little or no impairment of the constitution. 
 
TYPHOID FEVER.* 
 
 It was originally my intention to have made in this 
 paper an effort to discuss, from the scientist's stand- 
 point, the etiology and treatment of typhoid fever, but 
 the positive expressions made, within the past few weeks, 
 of the opinions of many of the greatest thinkers of the 
 age, that typhoid fever cannot be aborted, and in fact 
 that the internal exhibition of drugs can have no cura- 
 tive effect, warns me that I have essayed enough and 
 that this paper had better be devoted to strengthening 
 the evidence that the claims already made are valid, and 
 that I should avoid, as much as possible, the enlarging 
 of the territory which I have to defend, alone and un- 
 aided, by even one of my confreres or collaborators and 
 co-helpers in the work which I have undertaken. 
 
 I feel that I do not owe this section any apology for 
 this change in my plan, because typhoid fever is a dis- 
 ease of supreme importance to the medical profession ; 
 because of its wide distribution, its long duration, its 
 high mortality and because much dreaded as the disease 
 now is, it is rapidly on the increase. 
 
 A disease whose geographical distribution is limited 
 by no boundary lines, whose germs may live indefinitely 
 in the icebergs of the frozen north, and thrive in the 
 
 "^Revised 1895. Read in the Section on Practice of Medicine, at the Forty- 
 fifth Annual Meeting of the American Medical Association, held at San Francisco, 
 
 June 5-8, 1894. 
 
 103 
 
104 TYPHOID FEVER. 
 
 torrid heat of the equator, cannot be accorded too much 
 attention by this association, especially as the medical 
 literature of our day is in such a chaotic state as to be 
 exceedingly confusing to those who place any trust in 
 it. A literature which is not at all creditable to the med- 
 ical profession as long as its recommendations for the 
 treatment of typhoid fever form such a medley of con- 
 tradictions, from "armed expectancy" to the most he- 
 roic exhibition of the most dangerous therapeutic agents ; 
 from corrosive sublimate to the coal tar derivatives, 
 almost every known poison meets with the approbation 
 of some supporter or adherent. These various remedies 
 and methods of treatment have most enthusiastic devo- 
 tees, until finally, the materia medica having been taxed 
 to the limit of endurance, a new class of enthusiasts has 
 arisen, and now the bath tub and sponge, and the cold 
 pack have their advocates who can see nothing but dire 
 disaster in the use of any therapeutic agent except cold 
 water. The most amusing were it not the most tragical 
 publication that has ever issued from any press, is the 
 Johns Hopkins Hospital Report, Vol. IV., No. 1, on 
 " Typhoid Fever," which I have just received, in which 
 the learned " Osier, the clinical oracle of three great 
 cities," Professor of the Principles and Practice of Med- 
 icine of the Johns Hopkins University, asserts, and I 
 quote him literally: "Since typhoid fever like a major- 
 ity of the specific infections runs a course uninfluenced 
 by any known medicines, the duty of the physician is to 
 see that the patient is properly nursed and fed and that 
 dangerous symptoms, should they arise, are combated 
 by appropriate remedies." "In hygienic and dietetic 
 measures his activity is incessant ; so far as drugs are 
 concerned his attitude is best expressed in the term 
 
TYPHOID FEVER. 105 
 
 ' armed expectancy,' giving no medicine simply because 
 the patient has a fever ; nursing and diet are the sup- 
 ports in which we trust, the essentials under all circum- 
 stances, to which is added the cold bath when possible, 
 or cold sponging for the antipyretic action and stimu- 
 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 anti- 
 sepsis of the bowel has yet passed beyond the stage of 
 primary laudation." 
 
 During the past twelve months I have written 
 papers under the title " Can Typhoid Fever be Aborted?" 
 for the Mississippi! Valley Medical Association, the Ma- 
 honing County and the Ohio State Medical Societies, 
 and for the Buffalo Medical Club, in each of which I pre- 
 sented such determinate and categorical evidence that 
 typhoid fever can be aborted, that had it been offered to 
 the men of any other profession save that, which in 
 America's most cultured city, failed to recognize the dis- 
 coverer of ether until he had lain for a generation in an 
 unhonored grave, leaving his widow long in poverty and 
 I fear, even in want ; and which in the most enlightened 
 capitol of the old World, made the life of the discoverer 
 of vaccination immeasurably burdensome, would have 
 been accepted as absolutely conclusive testimony or 
 proof that my narrations of my success are true, and of 
 unerring certitude — nothing dubious or at random about 
 them — all fair, square and above board, and each and 
 every statement "as sure as fate." And any other 
 coterie of men would have accepted my harbinger of the 
 dawn of a happier day with a glad heart and would 
 have heralded joyously the good tidings to the sufferers 
 from typhoid fever, but my " conservative profession,' 
 
106 TYPHOID FEVER. 
 
 with the immutableness of the laws of the Medes and 
 Persians to govern and guide them — the conservative 
 canons and codes which have been the standbys of their 
 forefathers for several generations, must needs tarry 
 awhile before permitting a transformation of their 
 ideas. It has always done so. It has ever ac- 
 cepted newly evolved scientific facts with caution 
 and deliberation. The man of investigative turn 
 of mind must have figures and facts to guide him. The 
 man of his own mind must be approached gently and 
 warily that he may not become precipitately prejudiced 
 and by his hastily formed judgment or his bigotry or il- 
 liberalness estop or dishearten a more progressive man 
 in his philanthropic work. 
 
 Again the credulous man owes to his patients and 
 to himself that he adopts cautiously neoterical ideas. 
 This profession, however, is " slow and sure " and when 
 it is once thoroughly convinced that it has within its 
 grasp the true " Catholicon," it will apply it with no 
 niggard hand. Those who compose it are moderate, 
 and judicious, with gumption and esprit in abundance, 
 their wisdom and good plain common sense indicates an 
 enlightenment of mind and largeness of heart which con- 
 forms admirably with the magnanimousness of the work 
 of human kindness which they have utidertaken. They 
 belong to the profession that the late venerable Dr. 
 Oliver Wendell Holmes alluded to when referring to a 
 charge that in his writings he drew all his villains from 
 the clerical and legal professions, said : " I am afraid I 
 shall have to square accounts by writing one more story, 
 with a physician figuring in it. I have long been look- 
 ing in vain for such a one to serve as a model. I thought 
 I had found a very excellent villain at one time, but it 
 
TYPHOID FEVER. 107 
 
 turned out that he was no physician at all, only a — I mean 
 not what we consider a practitioner of medicine. I will 
 venture to propose a sentiment which, as I am not a work- 
 ing- physician, need not include the proposer in its eulogy. 
 The medical profession, so full of good people that its 
 own story tellers have to go outside of it to find their 
 villains." 
 
 When I read my paper before the Buffalo Medical 
 Club ; I was very careful to say nothing that could give 
 offense ; unless umbrage were taken at the bare 
 announcement that " Typhoid fever can be aborted," 
 and yet my paper was most courteously, and I must say 
 severely criticised, by every member of the club who took 
 the trouble to speak, save the President who said : " The 
 medical profession has always been very conservative, and 
 has sometimes made itself ridiculous by rejecting new 
 ideas that were afterward found to be true." 
 
 The criticism of my paper which was read before the 
 Ohio State Medical Society was highly gratifying to me. 
 The discussion was opened by Dr. Collamore, who spoke 
 in his happiest vein. The general tenor of the remarks 
 were in favor of giving humane and progressive ideas a 
 warm welcome and a fair trial. There was present but 
 one member of the Mahoning County Medical Society 
 from Youngstown, Dr. J. E. Cone, who said: ''Being 
 from Dr. Woodbridge's town and society, I wish to state 
 that we have had several 'fights' on this subject, and we 
 have been watching his cases for several years to see if 
 he could make his pledges good, but so far we have been 
 unable to discover that he has made any failure or has 
 had a death from typhoid fever. And we intend to con- 
 tinue watching his cases in the future, and if he have a 
 death we will report it." A little speech which read be- 
 
108 TYPHOID FEVER. 
 
 tween the lines speaks volumes. Professor Murphy 
 however spoke eloquently in adverse criticism, saying in 
 substance, that there could be no curative treatment for 
 typhoid fever, and that he doubted the correctness of 
 the diagnosis and observation of any physician who as- 
 serted that he was able to abort the disease. He said I 
 shocked him when he heard that I allowed my patients 
 to sit up, walk about, and even eat solid food ; that in 
 his day and generation the pathology of medicine had 
 been upset twice and was now undergoing its third 
 change, and he added: "All that is old is not false, 
 and all that is new is not true. I would beg my friend 
 to be a little guarded in saying that he has cured so 
 many cases of typhoid fever with this treatment." I shall 
 not attempt to quote Dr. Murphy's words any farther, 
 or essay the hopeless task of reproducing in the manner 
 justly its due, or even describing his eloquent speech, 
 but as I sat spellbound listening with admiration to his 
 brilliant oratory, I could not help wishing that he could 
 see the subject as I see it, and that he were speaking 
 for, instead of against the right. At a later period he 
 said: "Our dispute maybe narrowed down to a very 
 small circle. Either your theory that typhoid fever can 
 be aborted is erroneous or all the teachings of pathology 
 are false/' To which I answered : " My theory is cor- 
 rect and the pathology that cannot conform to it must 
 fall." 
 
 If the theory that typhoid fever is caused by a germ, 
 be accepted, its corollary must also be accepted, that is, 
 that the germ can be destroyed, and if in one receptacle 
 or the alimentary canal of one patient, then as a legiti- 
 mate sequence it can be destroyed in every receptacle. If 
 the physician who accepts this theory is enabled to see 
 
TYPHOID FEVER. 109 
 
 his patient sufficiently early in the course of the disease, 
 and treats every suspicious case on the first appearance 
 of suspicious symptoms, he will rarely see a case of 
 typhoid fever and never a death from the disease. It 
 must require the possession of overmuch temerity and 
 audaucity to enable a man, however learned and omnis- 
 cient, in , exalting his individual opinion above the evi- 
 dence of the experience and enlightenment of years of 
 study and investigation of the subject in question. One 
 must be quite au courant in every respect and degree 
 with the whole battle ground before one should impugn 
 the calculations and inductions of the investigator. The 
 sciolist and the tyro should hestitate before placing 
 himself in the pathway of intelligent research and prog- 
 ress. They suggest nothing, offer no new idea, give no 
 word of hope, simply deny that that which has already 
 been accomplished, is possible. Had they anything 
 better to offer, each opinion should be carefully weighed, 
 but when they oracularly assert that a course of treat- 
 ment which they have never tried, or of which they have 
 no knowledge, cannot abort typhoid fever, they are 
 making records of which they may in the near future be 
 ashamed, and when those whose education and achieve- 
 ments in the world of science have raised them to ex- 
 alted positions amongst the members of their profession 
 repeat those oracular assertions they are simply lending 
 their learning and the weight of their famous and illus- 
 trious names to aid in retarding the coming of the day 
 when typhoid fever shall cease to be at once the stigma 
 and the despair of medicine. 
 
 Since the unaided efforts of one man, however faith- 
 fully and indefatigably he may pursue his investigations, 
 must belong indeed in accumulating sufficient data upon 
 
110 TYPHOID FEVER. 
 
 which to base a scientific discussion of a given subject, 
 and longer in giving- such expression to a finished work 
 as to command the attention and confidence of the great 
 body of a profession which is peculiarly prone to look 
 on anything new with much suspicion — in whose ranks 
 are men of every grade and degree of intellect and educa- 
 tion; men of the quickest and of the dullest comprehen- 
 sion ; men whose minds are treasure houses of pantology ; 
 and men who cannot differentiate between the tempera- 
 ture "curves of typhoid and of malarial fever" or realize 
 that there is anything worth knowing that their own 
 feeble faculties have not already mastered. 
 
 I therefore appeal to every member of the American 
 Medical Association, and to every physician who treats 
 a case of typhoid fever to second me in the accumulation 
 of such data as shall lead us to a better knowledge of 
 the etiology and the true pathology of typhoid fever and 
 especially of the action of antiseptics in its treatment. 
 For this purpose, and because I have been unable to 
 find a clinical chart so arranged as to make the collec- 
 tion of the necessary facts practicable and easy, I have 
 devised one that will enable the busy practitioner to 
 make his records valuable, with the least possible loss 
 of time. 
 
 In conclusion, I wish to call the attention of the med- 
 ical profession quite briefly to the antiseptic treatment 
 of typhoid fever according to the method I have advo- 
 cated. This has already been published in the Journal 
 of the American Medical Association and in The Tran- 
 sactions of the Ohio State Medical Society. I hope to 
 be able, when I have had larger experience to secure 
 equally good results with simplified prescriptions, from 
 which I have eliminated some of the ingredients which 
 
TYPHOID FEVER. \\\ 
 
 give the formula such a complex and unscientific ap- 
 pearance. No pretense is made that this is the only 
 preparation which will cure or abort typhoid fever, nor 
 that any or all of its component parts are necessarily es- 
 sential — but thus far it has not failed me, and crude 
 and unfinished as the mixture seems I know of nothing- 
 better. 
 
 No one must say that he has tried my method of 
 treating typhoid fever and failed, who has not exhibited 
 these identical mixtures, alternated as I have directed; 
 nor must he interject any other remedy calculated to 
 interfere with their effect. 
 
 As the mixture is perfectly harmless, it may be ex- 
 hibited in almost unlimited quantities. I always advise 
 beginning the treatment with very minute doses and 
 thus avoid too early catharsis. 
 
 As I have already stated, and with all my heart, in a 
 former paper, I am ready to go wherever in the wide 
 world typhoid fever claims a victim, whether it be across 
 the continent or over the ocean, and I challenge the 
 publication of any failure on my part to do all that I as- 
 sert to be possible in the treatment of typhoid fever. 
 
FURTHER REPORTS ON THE ABORTIVE 
 TREATMENT OF TYPHOID FEVER.* 
 
 When I accepted an invitation to present a paper at 
 the last meeting of the Mississippi Valley Medical Asso- 
 ciation, I selected for the title of my essay the question, 
 ''Can Typhoid Fever Be Aborted?" and answered it 
 in the affirmative, thus antagonizing the teachings of the 
 most learned professors in every medical college in the 
 civilized world ; I knew that I should be severely criti- 
 cised and that all of my friends and enemies would sit 
 in judgment upon me and after much arbitration would 
 bring in a verdict, pro or con, and this verdict would 
 depend upon how conclusive the evidence might be that 
 my views on the subject were correct. I fully realized, 
 to use the words of a distinguished litterateur, that I 
 might expect "to stand and sit and sleep on pin points 
 for years to come. " 
 
 Nothing, save the feeling that it was my bounden 
 duty to prove my allegiance to my ungenerous profes- 
 sion by sharing with it the guerdon I had won as a re- 
 ward for my life's work, and the wish that theey might 
 assist me in removing the moral responsibility it now 
 bears upon its shoulders for every life sacrificed to 
 typhoid fever, could have tempted me to take upon 
 myself so ponderous a burden. 
 
 *Read before the Mississippi Valley Medical Association at Hot Springs, 
 Arkansas. Revised 1895. 
 
ABORTIVE TREATMENT. U3 
 
 I look backward over the twelve years of my experi- 
 ence with antiseptic medicine without a death from ty- 
 phoid, malarial, or any continued fever, to a preceding- 
 series of twelve years during- which time I had a death 
 rate of about 17 per cent from typhoid fever alone; and 
 from the present time, when my confreres are having no 
 better results than I formerly had. 
 
 On the seventeenth of July, 1893, I gave in my local 
 society the names and residences of twenty-one patients 
 (all of whom were familiar to the members) whose 
 symptoms indicated and whom I had treated as cases of 
 typhoid fever, by my antiseptic method, during the pre- 
 ceding years, selecting them from the large number of 
 whom I had seen, as especially interesting because of 
 some peculiar circumstance or characteristic ; and I called 
 the attention of my auditors to them because they were 
 all diagnosticated and the disease verified by well-known 
 and reputable physicians as typical cases of the disease, 
 but of which I had unfortunately kept no particular 
 records and therefore had few items to present of the 
 cases. However, on the twenty-fifth of June, 1893, I in- 
 stituted a series of clinical charts, numbering the first 
 22, and presented at the last meeting of this society the 
 charts of twenty cases of antiseptically treated typhoid 
 fever, to show the modification of the "temperature 
 curve " by treatment. 
 
 I deem it my duty as a conscientious physician, de- 
 siring only the welfare of mankind and the advancement 
 of my profession to continue tabulating the reports of 
 cases of typhoid fever falling under my observation. 
 The many grateful letters and kindly words of encour- 
 agement I have received from my confreres, and in cer- 
 tain instances from the patients themselves, more than 
 
114 ABORTIVE TREATMENT. 
 
 offset the intolerant phrases and unkindly criticisms 
 which I have met with from others, who have not been 
 so choice of their use of language. I have no feeling of 
 unfriendliness for these persons, because I know that 
 " truth being eternal will prevail," and that my critics of 
 to-day will themselves eventually practice the antiseptic 
 abortive treatment of typhoid fever, and in so doing will 
 vindicate me in the position which I have been obliged 
 to assume, as a logical sequence of the facts I have ob- 
 served during the twenty-five or thirty long years of a 
 life devoted to the practice of medicine. I hope, how- 
 ever, by going annually before some great medical body 
 to report the cases in which the fever has been aborted 
 and to exhibit the clinical temperature charts of all cases 
 treated during the intervening periods, premising that 
 when I see the cases at a reasonably early stage of the 
 disease I shall have no death to mar my record, that I 
 may ultimately prove beyond the possibility of a doubt 
 that I am not teaching the world to expect or demand 
 more of my profession than it should do. Few of you 
 realize the anxiety which fills one's mind when one 
 stands before the tribunal of a representative body like 
 this Mississippi Valley Medical Association, nerved and 
 fortified to make one's utmost endeavor to extirpate and 
 annihilate the sophistries that all the great teachers in 
 this most learned of the professions, whose highest aim 
 should be to mitigate human suffering and to save human 
 life, have promulgated. This blind leading of the blind 
 which in the one disease under consideration, costs more 
 than 50,000 lives each year and unnumbered years of 
 miserable physical torment and mental infelicity to hu- 
 manity. 
 
 Since the last meeting of the Mississippi Valley Med- 
 
ABORTIVE TREATMENT. 115 
 
 ical Association in Indianapolis in October, 1893, I have 
 treated alone, or in consultation, fifty-four cases of ty- 
 phoid fever without a death and with an average duration 
 of about twelve days' treatment. 
 
 I had also a case of pneumo-typhus which made a most 
 perfect recovery in the end, but was long in doing so. 
 Three cases of typhoid fever sent by other physicians at late 
 stages of the disease were also treated, one was first seen 
 on the sixteenth day of the disease. I was called in con- 
 sultation to see one case on the thirty-fourth day of sick- 
 ness, when no treatment was needed ; and at another time 
 to see a patient at a somewhat earlier period of the dis- 
 ease, but found him dying of exhaustion, when no treatment 
 was possible. In the Section of General Medicine at the 
 meeting of the American Medical Association in San Fran- 
 cisco, in June last, I reported my cases of typhoid fever up 
 to and including case No. 75. 
 
 Case No. 76. Grace J. W., aged ten years, pneumo- 
 typhus. 
 
 This case was in a desperate condition when I was 
 called. She had been ill for ten days ; was coughing in- 
 cessantly, raving wildly, and having a profuse haemorrhage 
 of the lungs; her pulse was 100 ; her temperature 106.4°. 
 She was treated as a simple case of typhoid fever, with the 
 necessary additions in the later stage of the disease to meet 
 the lung complication. She made a good though not rapid 
 recovery, as you will see. She lost all of her hair. 
 
 Case No. 77. Michael M., aged seventy years. Re- 
 ported in a former paper. 
 
 Case No. 78. John J., aged six years. 
 
 This boy was treated until the tenth day of sickness by 
 the family physician, under a first diagnosis of malarial 
 fever, and when this was changed to typhoid fever, I was 
 
116 
 
 ABORTIVE TREATMENT. 
 
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 CASE 78 —Typhoid fever; name, J. J.; age, 6 years; residence, Darrow street; date of 
 admission, July 26, 1894. Result, temperature normal on the ninth day. • 
 
 sent for. Dr. M. V. Cunningham, who had- seen some 
 practice in Chicago, expressed a desire to see my work, so 
 I invited him to accompany me on my first visit. I asked 
 him to examine the patient and make a diagnosis. He did 
 so, remarking that he considered it atypical case of typhoid 
 fever. Fearing his remark might frighten the boy's mother, 
 who was a stranger to me, I said, "Madame, you need not 
 be alarmed, there is no danger from typhoid fever if it be 
 properly treated." To this she replied, "I have seen 
 several of your cases, and know they all do well. ,, The 
 temperature touched normal on the eighth day of treat- 
 ment, but went up a trifle afterward. 
 
ABORTIVE TREATMENT. 117 
 
 Case No. 79. Mary S., aged twenty years. 
 
 This was the case of an exceedingly delicate anaemic 
 girl. The temperature did not run high, and she was not 
 confined to the bed all of the time. The symptoms were 
 not well marked. 
 
 Case No. 80. Levi B., aged twenty-one. 
 
 This patient was far from well for eight days, and was 
 found on July 31, lying in the straw in the stable, too sick 
 to make his wants known. After four days he used a 
 hammock hung under a tree to lie in during the day. On 
 the ninth day of treatment he left for his home in the west, 
 fully supplied with all the medicine he might need. I heard 
 from him in about a week, and he said he reached his des- 
 tination in safety and with little trouble. He had nose 
 bleed and much tympanitis, and other well-marked symp- 
 toms. 
 
 Case No. 81. Patay H., aged seven years. 
 
 This child was brought to my house each day by his 
 mother (he lived but a short distance away). The symp- 
 toms were all well marked, and rose spots abundant. 
 
 Case No. 82. Ezra M., aged twenty-six years. 
 American farmer. 
 
 This patient was sent to the hospital from the adjoining 
 County of Trumbull, by Dr. T. H. Stewart, of Church Hill. 
 I commenced treatment on the 31st of August, one day 
 before he was removed from his home, nine miles distant, 
 in the ambulance. On this day, the symptoms becoming 
 grave, Dr. Stewart feared to continue the treatment with- 
 out the assistance of a trained nurse, an expense which the 
 family could not afford, hence he was turned over to me on 
 the tenth day of his sickness. 
 
 I found the bowels very tympanitic ; tenderness in the 
 right iliac fossa ; rose spots abundant ; tongue coated, with 
 
118 
 
 ABORTIVE TREATMENT. 
 
 CASE NO. 82. 
 
 margins red. He was in the hospital ten days. I saw 
 him one week later when he drove to my office, and re- 
 turned to his home again on the same day, a distance of 
 eighteen miles, Dr. Stewart having had charge of him in 
 the interval. 
 
 Case No. 83. Walter K., aged twenty years. 
 
 The diagnosis of this case was made by one of the best 
 practitioners in Ohio, who called me in consultation, and 
 together we treated the patient until he made a good re- 
 covery. 
 
 Case No. 84. Mrs. Ett. S. S. 
 
 This patient had been confined just two months before, 
 and had not been in very robust health. The temperature 
 
ABORTIVE TREATMENT. 
 
 119 
 
 on the 12th of September was 105°, from which point it 
 gradually descended to normal on the ninth day of treat- 
 ment. 
 
 Case No. 85. Carl S., aged ten years. (Nephew of 
 Case No. 84.) . 
 
 This boy lived in a neighborhood where there were 
 several cases of typhoid fever. Was not confined to the 
 bed all of any day, and although presenting well-marked 
 
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 CASE NO. 85. 
 
 symptoms of the disease, rode several times on his pony 
 to my office to see me. The temperature on the 13th of 
 September was 104.2°, and touched normal on the tenth 
 day of treatment. The symptoms were all characteristic; 
 headache very severe for several days before 1 saw him, 
 epistaxis, bowels tender and tympanitic. 
 
120 
 
 ABORTIVE TREATMENT. 
 
 Case No. 86. Nellie H., aged seventeen years. 
 
 This patient was taken sick at the home of her parents, 
 but the physician recognizing the gravity of her condition, 
 had her removed to her sister's house, which was in a 
 healthier locality, and had her put to bed down stairs, say- 
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 CASE NO. 86. 
 
 till the twelfth day of sickness, prescribing corrosive sub- 
 blimate and one of the coal tar derivatives ; enjoined perfect 
 rest ; milk diet. 
 
 I was called on the twelfth day, found a typical case of 
 typhoid fever, and being unaware of the doctor's prognosis, 
 I told the family that she would probably be better in four 
 
ABORTIVE TREATMENT. 
 
 121 
 
 or five days, and sitting up in ten days. Rose spots were 
 abundant and* other symptoms were characteristic. The 
 temperature on the fourth day of treatment was 103°, and 
 eight days after it had gone to normal. One week later 
 she developed a phlebitis, which greatly prolonged the 
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 CASE NO. 87. 
 
 The physician who called me in consultation to see 
 Case No. 83 was himself called to see Case No. 87. Olle- 
 son M. 
 
 This patient was the fourth case of typhoid fever in the 
 family, one of whom died after an intestinal haemorrhage. 
 His nervous symptoms being very severe, the attending 
 
122 
 
 ABORTIVE TREATMENT. 
 
 physician asked for counsel, and Dr. Justice, of Poland, was 
 called. After consulting, the two physicians went together 
 to the family, and told them that Mr. M's symptoms were 
 so very bad that they advised them to send for me in con- 
 sultation, expressing the opinion that the patient would die 
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 CASE NO. 89. 
 
 found the patient in an exceedingly precarious condition, 
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 temperature in ten or twelve days;" and added, "there is 
 not only no danger of death in this case, but there never is 
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124 ABORTIVE TREATMENT. 
 
 and his temperature was 105.2°, and his other symptoms 
 were extremely grave, and I was not expected to see him 
 again. My prognosis was verified by the result, for his 
 temperature touched normal on the tenth day of treatment. 
 
 Case No. 88. Cornelia G. Dr. Frazer's case. 
 
 Case No. 89. Paul G., aged four and one-half years. 
 (See chart.) 
 
 This case was first seen on the 16th of October, 1894, 
 when the child had nose bleed, severe headache, bowels 
 very tympanitic, and was slightly delirious. On the twelfth 
 day of treatment rose spots were abundant. On the 
 eighteenth day he was playing out of doors, but was very 
 cross and irritable. 
 
 Case No. 90. Iva M. Dr. Udell's case. (See chart.) 
 
 Case No. 91. Mrs. Alexander G. 
 
 This patient was seen in consultation with her attending 
 physician, Dr. Justice. Her urine showed large quantities 
 of albumen, and had an abundance of both granular and 
 hyaline casts. Her temperature never went above 101°. 
 She had considerable intestinal haemorrhage, but made a 
 good recovery. 
 
 Case No. 93. Mrs. D., aged twenty-four years. 
 
 When called to see this patient I was told that she 
 had been sick about ten days, but later information led 
 me to believe that she had been sick twelve or thirteen 
 days. The sanitary surroundings were terrible ; her con- 
 dition and circumstances horrible ; neither any part of the 
 bedding nor her underwear were changed, nor were her 
 hands or face or any part of her body washed during her 
 sickness. On one of my visits I found the unemptied 
 bedpan on the bed, and on inquiring found her bowels 
 had moved on the morning of the preceding day. In no 
 way were the ordinary demands of cleanliness attended 
 
ABORTIVE TREATMENT. 
 
 125 
 
 to. There was a cooking stove in a back kitchen, which 
 was separated from the house, and no fire elsewhere ; it 
 was cold weather, with snow most of the time. 
 
 The room adjoining hers, separated from it by only a loose 
 board partition, was scrubbed once, and when I went in 
 I found water standing in puddles about the floor. 
 
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 CASE NO. 93. 
 
 Her husband was taken from her bedside to jail. When 
 I first saw this patient she had intense headache ; no 
 sleep for three or four nights ; very nervous ; abdomen 
 tender and very tympanitic. She had three haemorrhages 
 from the bowels on October 15, the fifth clay of treatment. 
 She made as you see, a rapid recovery, her temperature 
 becoming normal on the thirteenth day of treatment. She 
 
126 
 
 ABORTIVE TREATMENT. 
 
 lived so far in the country that I could not visit her every- 
 day. 
 
 Case No. 92. Mrs. J. O. Y., aged twenty-four years. 
 
 This patient was the wife of Dr. J. O. Yost, of 
 Hazelton, Ohio, and had been under the care of Dr. 
 Bennett, a gentleman of unquestioned ability (who about 
 
 CASE NO. 92. 
 
 a year ago passed through a very severe ordeal with 
 typhoid fever, was confined to his bed for six weeks, was 
 unable to attend to business for an additional three months, 
 and even yet has not gotten entirely over the effects of 
 the attack). 
 
 Seeing his patient growing worse, Dr. Bennett called 
 upon me, and asked me to see her, on October 27, the 
 
ABORTIVE TREATMENT. 127 
 
 tenth day of her illness. I found, as he said, a typical 
 case of typhoid fever; the temperature 104^°; the pulse 
 varying between 110 and 134 and which later in the 
 disease became dicrotic. The bowels were very tender 
 and tympanitic ; marked dullness over the spleen ; the 
 margins of the tongue red, the center coated ; much 
 gurgling on pressure ; a few rose spots, which afterward 
 became abundant ; nervous and sleepless ; and very severe 
 headache. The temperature touched normal on the tenth 
 day of treatment. During my first visit, both Dr. Bennett 
 and Dr. Yost asked me if I considered Mrs. Yost in very 
 great danger. I answered giving my usual prognosis 
 " typhoid fever is never dangerous if properly treated at 
 the commencement of the disease." 
 
 Case No. 94. Dr. J. O. Y., (Husband of Case 
 No. 92.) 
 
 October 29th, two days after my first visit to Mrs. 
 Yost, Dr. Bennett called my attention to Dr. Yost, 
 saying that he believed that the Doctor had typhoid 
 fever. 
 
 On examining him, I found his symptoms nearly as 
 well marked as were those of Mrs. Yost, save that his 
 temperature and pulse were not so high nor frequent, and 
 he had no rose spots. He at once said that if he were 
 going to be confined to bed, he should go home. I 
 replied: "Stay at home and attend to your practice. I 
 assure you that you will be able at least to see patients 
 in your office every day of your sickness." And he was. 
 
 Case No. 96. Kittie Y., (Sister of Case No. 94.) 
 
 On November 3, five days after her brother was taken 
 ill, this patient was attacked with typhoid fever. She did 
 not say any thing about being ill until she was no longer 
 able to sit up. Her temperature on the day before 1 saw 
 
128 
 
 ABORTIVE TREATMENT. 
 
 her was 104^° her pulse 100, and all the symptoms 
 characteristic. On November 2 she had severe headache, 
 her cough was incessant, her abdomen tympanitic and 
 tender and pressure produced gurgling. I told the Doctor 
 that she would have to stay in bed three or four days, 
 perhaps, but would be well in ten days and could eat 
 solid food all of the time. 
 
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 CASE NO. 96. 
 
 At the time of the illness from typhoid fever of the 
 family of Dr. Yost, a man who lived in a boarding house 
 near by, died, and the necropsy revealed extensive typhoid 
 lesions, and a perforation of the intestines. 
 
 Case No. 95. Miss K. This case presented char- 
 acteristic symptoms of the disease, severe headache ; 
 
ABORTIVE TREATMENT. 129 
 
 tympanitis, etc. She was not confined to her bed all of 
 the time, and recovered rapidly. 
 
 This closes the record of those cases of typhoid fever 
 which I have treated since the last meeting of this Society. 
 Some of these patients, whose complaint was diagnosticated 
 and treated as typhoid fever, may possibly have been ill 
 with some other fever, but whatever was the infirmity, 
 they all recovered under the abortive treatment of typhoid 
 fever. This manner of managing the disease is the least 
 harmful and most salutary they could have had ; there 
 being nothing in it that could possibly be injurious to the 
 health in any condition, 'in the doses which I have described 
 and it would be invariably beneficial in all disease of a 
 microbic origin. 
 
 No sane man would have the fool-hardiness to dare 
 to enter the abode of his patients, with two or three 
 members of the family ill with typhoid fever (the temper- 
 ature of some of the patients being above 105° F.) 
 and give this one invariable prognosis, unless he were 
 perfectly cognizant with the fact that there was some 
 invincible power in medicine to ward off the threatened 
 danger. No man would be imprudent and incautious 
 enough to dare to make the promises that I have made 
 for so many years, unless he knew whereof he spoke and 
 that he could triumphantly fulfill them. 
 
 Remember, I have invited the most unremitting scrutiny 
 of my cases while under treatment, and should I have 
 a death from typhoid fever or should I fail to abort a 
 case, in which I had commenced the treatment early in 
 the disease, this fact would be emblazoned all over this 
 broad land. Had I twenty years, instead of this fleeting 
 twenty minutes, and could I take you back through the 
 past twelve years of investigation, and present to your 
 
130 ABORTIVE TREATMENT. 
 
 view all of the miscellany of evidence that has proved to 
 me that typhoid fever can be aborted ; could I enumerate 
 for you all the typical cases that have yielded so facilely 
 and submissively to this intestinal antisepsis ; point out 
 the awful complications that have menaced life ; show you 
 the white haired old lady, whose symptoms denoted most 
 positively the proof that she had a pre-existing Bright's 
 disease, and the repeated intestinal haemorrhage that her 
 acute malady was typhoid fever of the most perilous and 
 terrifying type ; show you the venerable old man of 73 
 years of age, whose beloved young son had succumbed 
 to fatal intestinal haemorrhage ; could I let you look upon 
 the young lady, with the year old ovarian trouble, pre- 
 senting a rounded fluctuating mass through the abdominal 
 walls ; could you see the wife of Angus McPhee, with 
 the blood welling up from her lungs and could I show you, 
 as in a kaleidoscope, all of these patients restored to hale 
 and vigorous health in a few days, after having been, during 
 the illness in many instances, surrounded by the most un- 
 sanitary conditions and much of the usual routine of the 
 sick room, which of old, has been invariably insisted upon 
 as essential to recovery from typhoid fever being disregarded 
 and sometimes totally dispensed with. Many of these 
 patients had only such nursing as a young child could give. 
 In some cases, no restrictions in regard to diet were made, 
 and all were allowed to use their own pleasure as to exercise 
 (when there had been no serious intestinal lesion) and 
 bathing and yet I can show you that I have had no death to 
 mar my record. 
 
 You should commend my course in making so great a 
 sacrifice, and even endangering my professional career in the 
 interest of humanity, by placing myself in the unenviable 
 position of one who fixed a higher standard of responsibility 
 for his profession than it was ready to accept. 
 
ABORTIVE TREATMENT. \\\\ 
 
 In the abortive treatment of typhoid fever an early 
 diagnosis is of the first importance. Every case of the dis- 
 ease should be put upon proper treatment the first time it 
 is seen by the physician. There should be absolutely no 
 exception to this rule. If you await the development of 
 pathognomonic symptoms of typhoid fever before beginning 
 treatment you will not always succeed in aborting the dis- 
 ease. Therefore a change of diagnosis from any other dis- 
 ease to typhoid fever is wholly unjustifiable ; but the reverse 
 is always proper, because the best possible treatment for 
 typhoid fever is also a safe initial treatment for any disease 
 for which it could be mistaken. 
 
 If you always begin proper treatment when you first see 
 your patient, he will often be well before a positive diagno- 
 sis is possible, and you will be deprived of what might 
 otherwise have been a valuable record of a case of typhoid 
 fever, but your patient will be the gainer, and after all we are 
 physicians first and investigators afterward. Hence, when 
 consulted by a patient who could possibly become a victim 
 of typhoid fever, diphtheria, influenza, pneumonia or any 
 pathologic condition which would be benefited by an intes- 
 tinal or systemic antiseptic or eliminant, begin at once the 
 treatment for typhoid fever. 
 
 It must not be supposed that because I have been able 
 to begin the treatment at almost every stage of the disease 
 in the large number of cases I have treated and have had 
 no death from typhoid fever or any disease that could be 
 mistaken for it for more than twelve years, that such results 
 are always possible. These cases make the proof positive 
 that typhoid fever can be aborted, but it does not follow 
 that it can always be aborted or even that every life can be 
 saved when the disease has not been properly treated in its 
 earliest stages. Next in importance to an early diagnosis, 
 
132 ABORTIVE TREATMENT. 
 
 if indeed it should not stand first, is that your prescriptions 
 be properly compounded, of pure and active ingredients, 
 for upon the freshness, purity, activity and proper prepara- 
 tion and combination of the drugs, as much as upon their 
 administration, depends the physician's ability to abort 
 typhoid fever. I was, myself, long in learning this import- 
 ant lesson, and longer in learning upon whom to depend for 
 the preparation of remedies that would contain neither inert 
 nor irritant constituents. Messrs. Parke, Davis & Co., of 
 Detroit, Michigan, have for many years supplied most of 
 the materials entering into my prescriptions, and latterly 
 they have put up for me tablets of formulas Nos. 1 and 
 2 ; soft capsules of formula No. 3 ; and for children, tab- 
 lets of Formula No. 4, and soft capsules of formula No. 5. 
 Their work has been done in a most satisfactory manner, 
 and by long experience I have learned to rely upon their 
 preparations so implicitly that I would not feel justified in 
 possibly endangering the lives of my patients by experiment- 
 ing with the products of other manufacturers. 
 
 This antiseptic treatment of typhoid fever, commenced 
 in an early stage of the disease and intelligently carried out, 
 will, if the remedies be pure, active, and properly prepared, 
 abort typhoid fever ; and if used universally by the medical 
 profession a death from the disease will be unknown. 
 
 *The treatment has been cut out of all these papers because it has been 
 modified and simplified. 
 
TYPHOID FEVER IN CHILDREN.* 
 
 Typhoid fever is the same disease, is produced by the 
 same causes and is governed by the same laws, at whatever 
 time of life it may occur, from earliest infancy to the frailest 
 anility; modified as it may be, by age, by organic develop- 
 ment, by concurrent affections, or by extrinsic causes, and 
 probably by the quantity of poison ingested. In the child as 
 in the adult, it is caused by the same morbific influence, 
 which can be neutralized by the same antidotes. In either 
 instance the patient should be regarded and treated simply 
 as the container of the specific poison. 
 
 It follows, that notwithstanding the minor modifications 
 which the character of the disease may undergo, on account 
 of age or other causes, that it is amenable to practically the 
 same curative treatment in infancy as in adult life. 
 
 I must, therefore, make the same declaration here that 
 I have made in every medical society before which I have 
 discussed typhoid fever since 1880, viz., that every case can 
 be aborted and that death is a wholly unnecessary conse- 
 quence of the disease ; and farther, that these results are 
 attainable by a treatment so mild and gentle that, should the 
 newborn babe be given the dose intended for robust man- 
 hood no harm would result ; or should the child, overfond 
 of its medicine, take at once the portion intended for fifty 
 doses, it need cause no anxiety. 
 
 * Read in the Section on Diseases of Children, at the Forty-sixth Annual 
 Meeting of the American Medical Association, at Baltimore, Md., May 7-10, 1895. 
 
 133 
 
134 TYPHOID FEVER IN CHILDREN. 
 
 Yet symptomatically treated, typhoid fever is one of the 
 most serious affections of infancy and early child life ; 
 and in the most alarming- forms of the disease, in which the 
 fever rises rapidly to an excessive height and the nervous 
 symptoms point to some grave cerebral lesion, the true 
 character of the ailment is rarely recognized in time to 
 benefit the patient. Indeed, in a very large majority of these 
 cases a correct diagnosis is never made. Therefore, while 
 treating of typhoid fever in the adult, my pleading has 
 always been for an early diagnosis. In discussing typhoid 
 fever in children, the burden of my plea must be for a correct 
 diagnosis; since the disease in babyhood is so frequently 
 overlooked. 
 
 While Murchison and other eminent authorities have 
 recognized and acknowledged the possibility of the occur- 
 rence of typhoid fever in earliest infancy, and even during 
 utero-gestation, yet neither the best text-books, the teachers 
 in the medical colleges nor the general practitioner have 
 realized how frequently the disease occurs in desperate 
 forms during early childhood. 
 
 Reynold's "System of Medicine" devotes more than 
 seventy-five pages to typhoid fever and does not mention 
 the disease in children in the whole article. Pepper's 
 " System of Medicine," in five large volumes, justly praised 
 wherever the English language is spoken, yields less than 
 two dozen lines out of more than one hundred pages on 
 typhoid fever to the disease in children. Professor Osier, 
 whose "Principles and Practice of Medicine" is perhaps 
 more largely quoted than any other work on the subject, 
 disposes of typhoid fever in children in less than one dozen 
 lines, and this is the author who says: " Cases (of typhoid 
 fever) coming on with severe headache, photophobia, de- 
 lirium, twitching of the muscles and retraction of the head 
 
TYPHOID FEVER IN CHILDREN. 135 
 
 are almost invariably regarded as cerebro-spinal meningi- 
 tis." And again, " I have thrice performed autopsies on 
 cases of this kind, in which no suspicion of typhoid fever 
 had been present ; the intense cerebro-spinal manifestations 
 having dominated the scene. * * * Cerebro-spinal 
 meningitis is, however, a rare disease ; typhoid fever a very 
 common one, and the onset with severe nervous symptoms 
 is by no means infrequent. Fully one-half of the cases of 
 the so-called brain fever belong to this category." 
 
 But while medical literature has recognized the possible 
 predominance of the nervous symptoms of typhoid fever in 
 the adult, it has failed to give due warning of the frequency 
 with which these symptoms occur as the most prominent 
 manifestations of the disease in early childhood, an omission 
 which has been responsible for many errors in diagnosis 
 and treatment. 
 
 In the first number of the Journal of the American 
 Medical Association for this year, 1895, a distinguished pro- 
 fessor of the diseases of children says that : "It has been my 
 good or ill fortune to see during the past ten years, a num- 
 ber of cases in children under the age of two years which 
 presented mild intestinal disturbance, no marked tenderness 
 over the bowels, a very high temperature, and where the 
 apparent cerebral complications, delirium and stupor being 
 prominent symptoms, were the apparent cause of death 
 In these cases, in the death certificate, the cause of death 
 was usually given as congestive fever or meningitis. Two 
 of these cases occurring within the past year, in both ol 
 which the post-mortem examinations revealed a pronounced 
 error of diagnosis, has emphasized in my mind the thought 
 that typhoid fever exists more frequently in early child life 
 and in a serious form than is generally suspected 1 present 
 the folio win or case: 
 
 «3 
 
136 TYPHOID FEVER IN CHILDREN, 
 
 "A little girl of eighteen months, the child of a very 
 prominent physician, was taken sick early in May, with 
 marked intestinal disturbances ; the evacuations from the 
 bowels were frequent and copious, accompanied by mucus 
 and blood. The temperature ranged from 102° to 104°, 
 and on one occasion reached 105°. There seemed to be a 
 history of acute indigestion. The usual treatment was 
 applied in this direction, and the temperature was controlled 
 by cooling baths. Flushing of the colon with medicated 
 warm water was applied, followed by starch water injections 
 containing a few drops of laudanum, for the purpose of 
 calming and reducing the frequency of the operations, which 
 interfered with sleep. During the early part of the attack, 
 the child, though having frequent operations, was noticed 
 to be calm and gave no evidence of pain. Not until the 
 fourth day, however, was marked obtundity observed, and 
 the staring appearance of the eyes, together with the in- 
 difference to surroundings, impressed me with the fact that 
 there was a cerebral complication. The course of the 
 treatment was continued and the supposed cerebral com- 
 plication became more pronounced. Inability to distinguish 
 light or sound, and a crossing of the eyes, apparently 
 justifying a diagnosis of meningitis. The child died about 
 the tenth day. Post-mortem examination developed the 
 absence of meningeal inflammation and the presence of 
 ulcerations of the glands of Peyer, showing us, the physi- 
 cians in attendance, how little we knew of the cause of 
 death." 
 
 The author adds : " The indications for treatment were 
 the same. A recognition of the disease in advance would 
 probably have made no difference." 
 
 I have quoted thus largely from this paper because it is 
 really a valuable contribution to medical literature, and I 
 honor the learned author for giving less enlightened mem- 
 bers of the profession the benefit of the many sad experi- 
 ences which have finally opened his eyes to the fact that he 
 has been stupidly floundering in his differentiation of dis- 
 
TYPHOID FEVER IN CHILDREN. \\\- 
 
 eases, albeit he has yet to learn of his greater deficiency 
 in knowledge of the treatment of typhoid fever. I fore- 
 go all criticism on the long years and the number of 
 pronounced errors of diagnosis which were required to im- 
 plant in his mind a just conception of the vast number of 
 children who must die annually of typhoid fever, after 
 having been treated by the average practitioner for acute 
 indigestion, and later for meningitis, and finally are buried 
 under a false death certificate. If this article, by one of the 
 world's most distinguished professors and medical editors, 
 truly represents the practice of tr^e class to which he be- 
 longs, it paints a sad picture of the little victims of typhoid 
 fever who were so unfortunate as to have come under 
 their skillful care. It presents to our view what costly mis- 
 takes these illustrious gentlemen make, and yet the author 
 eliminates but one or two of the diseases with which, in 
 infancy and early childhood, typhoid fever is so often con- 
 founded. 
 
 With our present knowledge of the causes which pro- 
 duce typhoid fever and the susceptibility of young children 
 to their influence, taken in connection with the exceedingly 
 limited number of cases of the disease which are reported 
 to the various health departments in our cities where the 
 disease prevails, it must be evident that the eminent writer 
 of the paper quoted is not the only physician who should 
 have had the fact emphasized in his mind "that typhoid 
 fever exists more frequently in early child life and in a more 
 serious form than is generally suspected." 
 
 I have in consultation seen typhoid \v\c\- in young 
 children mistaken for malarial fever, pneumonia, cholera in- 
 fantum, teething, and even for worms, in addition to menin- 
 gitis and acute indigestion. 
 
 The diagnosis of typhoid fever in children as in adults 
 
138 TYPHOID FEVER IN CHILDREN. 
 
 should be made by reasoning by exclusion, and if thus the 
 disease cannot be eliminated from the patient's possible 
 ailments, the case should be treated as typhoid fever, be- 
 cause no other disease is so insidious in its character ; be- 
 cause no other disease is so amenable to treatment in its 
 earlier stages and so intractable after its anatomic lesions 
 have reached a certain stage ; because it is so often impos- 
 sible to make a positive diagnosis in time to save the 
 patient's life ; and finally because the best treatment we yet 
 know for typhoid fever not only fulfills both of the require- 
 ments of Hippocrates ; it is curative, it is harmless in health 
 or in any pathologic condition at all resembling the disease 
 for which it is instituted. 
 
 I learned the importance of making a correct diagnosis 
 in typhoid fever many years ago, and in 1881 I was taught 
 a lesson on the management of the disease in children 
 which I shall never forget. 
 
 Little Gracie Wick, aged three years and ten months, 
 was taken sick on December 14. Her temperature on my 
 first visit was 105°. In fourteen days she died of typhoid 
 fever. A few weeks later her younger sister Emily, aged 
 two years and ten months, was attacked by the disease, 
 which ran a parallel course and ended in death, again on 
 the fourteenth day. Both children presented abdominal 
 symptoms. In both the nervous symptoms predominated. 
 Both had opisthotonos, and both died the victims of almost 
 criminal stupidity on my part. They were my last two 
 fatal cases of typhoid fever, and to-day should I be called 
 as promptly as I was then, they would have been in no 
 danger of dying. 
 
 Looking back to those gloomy days, I cannot realize 
 why I let those children die, for I knew well enough how to 
 treat typhoid fever in adults even then. I made a very in- 
 adequate effort to assuage the pangs of conscience by call- 
 ing two of the oldest and ablest physicians of the city in 
 
TYPHOID FEVER IN CHIIDREN. 
 
 139 
 
 consultation after the time had passed when counsel could 
 have been of any avail. 
 
 As a marked contrast to the sad picture portrayed by 
 the death of these little ones, my last two fatal cases, I wish 
 to present the clinical charts of a few of the cases of 
 typhoid fever I have treated during the intervening years 
 
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 CASE NO. 105. 
 
 and relate the annals that have been kept of them, and as 
 an addendum give the records of a few cases treated by 
 other physicians, by that which for want of a better name I 
 have designated antiseptic medicine, for it is antiseptic 
 medicine, and it is also something more. 
 
 Case No. 105. Annie W., aged three years. (Cousin 
 of Case 78, John J.) I was called to see this patient on 
 
140 TYPHOID FEVER IN CHILDREN. 
 
 February 7, and given the following- history : She had 
 been sick eight days, had been treated by an irregular phy- 
 sician, under a diagnosis of malarial fever until the parents, 
 alarmed by the severe symptoms, continued high fever and 
 the enormous tympanitic distention, questioned him closely 
 as to the nature of the disease, finally eliciting from him 
 an admission that it might be typhoid fever, when he was 
 promptly discharged. I found the temperature 105.5°, 
 pulse 140, on the evening of my first visit, and the same 
 the next morning; the parents having about given up 
 hope, as the child was thought to be dying twice during 
 the night preceding my first visit, There was marked im- 
 pairment of vision, deafness, and well-marked retraction of 
 the head. When asked if I entertained any hope for the 
 life of the child I gave my usual favorable prognosis, say- 
 ing: " I think the child will recover, and she certainly will 
 if she survive the next forty-eight hours." She had intes- 
 tinal haemorrhage, which in my experience is rare in young 
 children. She also lost all power of speech, her lower 
 limbs were paralyzed, she had just recovered from whoop- 
 ing cough, which returned to plague us during this attack 
 of typhoid fever, in spite of which she made a good re- 
 covery. Her temperature, as you will see, touched normal 
 on the tenth day of treatment, but went up slightly again 
 on the eleventh day. On the thirteenth day the tempera- 
 ture and pulse were normal and the patient was discharged, 
 and ten days later was in more robust health than before 
 her illness. 
 
 Case No. 111. Sarah J., aged thirteen years. (Cousin 
 of Case 105, Annie W.) When I first saw this case her 
 temperature was 103°, pulse 130. The next evening it was 
 103.8°, with a pulse of 136. I gave my usual prognosis, 
 ten or twelve days of illness, no danger. Her temperature 
 touched normal on the tenth day of treatment. This case 
 was an exception to the almost invariable rule commented 
 on by so many observers, that after this so-called antiseptic 
 treatment of typhoid fever, almost as soon as the tempera- 
 ture touches normal the patient is in better health than 
 
TYPHOID FEVER IN CHILDREN. 
 
 141 
 
 before the illness. This patient had had some stomach 
 trouble before her illness, and although she recovered 
 quickly from the fever and her appetite was better than 
 usual for a week or two, she has since been to my office 
 several times for treatment of her old trouble. 
 
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 CASE NO. 111. 
 
 Case No. 112. Florence J., aged eleven years. (Sisterof 
 Case 111.) On February 27, the temperature of this patient 
 was 102. 5 C , pulse 130. Three days later it was 103°, 
 from which time it declined to normal on the thirteenth day 
 of treatment, the patient being in good condition and 
 having an excellent appetite. 
 
 Case No. 113. Blanche J., aged five years. (Sister of 
 Case 112.) This patient had a temperature of L01.5 oil 
 March 2, with a pulse of 128. On the third day of treat- 
 ment it was 104° from which point it declined to normal 
 on the eleventh day. 
 
142 
 
 TYPHOID FEVER IN CHILDREN. 
 
 I am not infrequently called to see young children, 
 especially in consultation, in the late stages of typhoid fever, 
 when no suspicion of the character of the disease had been 
 aroused, but in which the symptoms are so distinctive that 
 no trouble should have been experienced in making an 
 accurate diagnosis. One case of this sort which had been, 
 however, under the care of an irregular practitioner, was 
 
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 CASE NO. 112. 
 
 Case No. 98. Margaret O., aged two years. I found the 
 child lying in a cradle, in the corner of the kitchen, between 
 the wall and the cooking range. She was moaning pitifully 
 and sometimes screaming violently; her head was retracted 
 and turning rapidly from side to side. A diagnosis of brain 
 fever had been made. The temperature was 106° ; 
 the bowels very tympanitic and the stools very frequent. 
 Taking the necessary steps in the order of their importance, 
 I first dropped a little powder (to be described hereafter) on 
 the child's tongue ; I then ordered the cradle to be moved 
 
TYPHOID FEVER IN CHILDREN. 
 
 U3 
 
 as far as possible from the fire, and had the child sponged 
 and ordered that the powder be given every fifteen minutes. 
 Later in the night I visited the child but found little change 
 in its condition. The next day I visited her three times and 
 that evening the temperature fell to 105°. The following 
 day the symptoms began to improve rapidly, and she made 
 a quick recovery, being well in ten days. 
 
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 CASE NO. 113. 
 
 While visiting this child on the second day, I saw a 
 younger child sitting in a suspicious position and when it 
 moved a bloody stool remained. Glancingaround the lloor I 
 saw two or three others, which though small were quite appar- 
 ent I asked the mother to explain and her answer was brief 
 andtothepoint : " I declare to goodness he's been doing 
 that all day ! " Upon examination I found the child with a 
 very rapid pulse and high temperature. The recovery of this 
 child was somewhat tedious, owing to the advanced stage 
 of the disease when I was able to begin treatment. 
 
144 
 
 TYPHOID FEVER IN CHILDREN. 
 
 One of the most prominent physicians in Chicago, (a 
 gentleman who was long at the head of Cook County 
 Hospital, and was for many years one of the most highly 
 esteemed professors in the foremost medical college in that 
 
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 mm 21 23 Z+ZfiUeZj IS 2?3o 3/7^ 
 
 CASE HELEN McC. 
 
 city so noted for its clever and accomplished preceptors, and 
 whose name is cut in the corner stone of the college, as one 
 of its founders) has done me the honor to write me several 
 
TYPHOID FEVER IN CHILDREN. U5 
 
 letters of inquiry (he is altogether the best questioner with 
 whom I have ever corresponded) in regard to my method 
 of treating typhoid fever. He has favored me with the 
 reports of several cases treated since our correspondence 
 began. 
 
 Case marked— "Dr. Mc Williams No— Helen McC, 
 aged six years and three months. She was taken sick, as 
 you will observe, while away from home at a summer resort. 
 A diagnosis of typhoid fever was made by a local physician, 
 and on the tenth day she was sent home to be under the care of 
 the family physician, Dr. McWilliams. Her temperature was 
 106° the first day that the Doctor saw her and on 
 the tenth day she was sitting up, dressed, enjoying 'Judge,' 
 'Puck/ etc." 
 
 Dr. Cunningham, of Youngstown, reports the following : 
 
 Case marked " Dr. Cunningham No. — Ella G., aged 
 seven months. She was under the care of three different 
 physicians, before I saw her in consultation. 
 
 The first physician (according to the statements of the fam- 
 ily) made a diagnosis of whooping cough; the second physician 
 said it was meningitis." The child growing worse, Dr. 
 Cunningham was called and made a diagnosis of typhoid 
 fever. When the temperature went to 105° he called 
 me in consultation. The chart indicates the rapidity 
 with which the child recovered. The correctness of the 
 diagnosis was corroborated a few weeks later, when the 
 mother of the child (see chart marked Dr. Cunningham 
 No. — Mrs. G.) had an attack of typhoid fever, from which 
 she recovered; and the uncle (see chart marked Dr. 
 Cunningham No. — James K.) died of shock, resulting from 
 an intussusception, occurring after he was almost well from 
 an attack of typhoid fever. 
 
 Dr. C. N. Udell, of Iowa, kindly sent me a report of 
 
H6 
 
 TYPHOID FEVER IN CHILDREN. 
 
 twelve cases of typhoid fever, and one of cholera infantum 
 treated by my method, with excellent results from which I 
 extract the following record of cases of typhoid fever in 
 children : 
 
 105° 
 104^ 
 103° 
 102° 
 101° 
 100° 
 99° 
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 IX 
 
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 ty 
 
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 w>m 
 
 W 
 
 t& 
 
 $?' 
 
 tr. 
 
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 «f-4 «?•£ ^ 
 
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 t3_H * 
 
 r/f n 
 
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 £ 
 
 u 
 
 XI 
 
 CASE ELLA G. 
 
 ^ Case 8. S. B., male, aged nine years. Was taken with 
 chills, fever, headache, vomiting and some abdominal pains. 
 Treated by the family for ague. I was called after the boy 
 
TYPHOID FEVER IJV CHILDREN. \\~ 
 
 had been sick eight days. Found the temperature 104.6° 
 skin dry, tongue very dry and red, dirty gray fur 
 in center ; very nervous ; hyperesthesia, delirium, a papular 
 rash; secretions locked. Gave to this boy Nos. 1 and 2 for 
 two days ; repeated it at short intervals. Then No. 1 for 
 three days ; No. 3 for four days. Discharged patient on 
 ninth day. In this case, as in all others, I insisted on 
 frequent sponging of the body, frequent change of linen, 
 good ventilation of the sick room, same food given at regular 
 intervals, etc. 
 
 "Case No. 10. N. S., male, aged eight years. Had an 
 intermittent fever. Prescribed c. cath. pills and quinine without 
 seeing patient. Continued sick and weak ; no improvement. 
 Visited the boy and found temperature 104°, skin dry, 
 suppression of urine ; very weak, headache, and general 
 aching, some delirium, very foul breath, heavy gray fur on 
 tongue with edges red, sondes on teeth, a good deal of tym- 
 panitis, some eruption, and sudamina. Diagnosis: septic 
 fever, or paludal typhoid." 
 
 " Gave R. No. 1 and No. 2. After three days gave R. 
 No. 3. On the seventh day gave Nos. 1 and 2 again. 
 Then No. 3 for about one week at longer intervals. Patient 
 discharged well." 
 
 "Case No. 11. D. H., male, aged two years. Was sick 
 with diarrhoea, high fever, very restless, abdomen puffed, 
 vomiting, and furred tongue with foul breath. Gave baptisia 
 tinct. R. No. 3 in minute doses. Recovered in five days." 
 
 Case No. 12. E. P., aged eighteen months. Hygienic 
 surroundings very bad. Child had cholera infantum with 
 very offensive stools. Gave R. No. 1 in very minute doses 
 every half hour. Had the child kept as clean as possible, 
 and that was not very clean. The child recovered speedily 
 in spite of bad nursing. 
 
 These cases illustrate the admirable results which may 
 be invariably obtained and even confidently predicted, when 
 proper treatment has been instituted at a sufficiently early 
 stage of the disease and intelligently and energetically pros- 
 
148 TYPHOID FEVER IN CHILDREN. 
 
 ecuted ; and they, by contrast, serve as a warning against 
 the danger of mistaking the nature of the most common, the 
 most dangerous and by far the most frequently overlooked 
 cases of typhoid fever in children, viz., those cases in which 
 the nervous manifestations are in the ascendant ; those cases 
 which are diagnosticated as brain fever, meningitis, or cerebro- 
 spinal meningitis. These are the cases in which an inac- 
 curate diagnosis is most liable to occur and which is so often 
 followed by such disastrous results. 
 
 As long as the best treatment for typhoid fever, known 
 to the medical profession, aimed only to ameliorate the most 
 perilous symptoms as they presented themselves, it did not, 
 perhaps, greatly signify when an exact diagnosis was made, 
 or indeed, whether or not it was ever correctly made 
 but we are approaching a more enlightened era. In reality, 
 the day has even now dawned upon us in which the treat- 
 ment to a fatal end, of a case of typhoid fever with a tem- 
 perature of 105°, as a case of indigestion, with inefficient 
 antiseptic medicine, starch and laudanum injections, and 
 cooling baths, is no longer admissible. 
 
 The physician who respects the Hippocratic oath and 
 does the utmost in his power for his patient, must acquire 
 skill in differentiating betwixt those diseases which can and 
 which cannot be benefited by the abortive treatment of 
 typhoid fever. 
 
 Without entering into the field of speculative controversy, 
 it may be generally stated, that any of the so-called microbic 
 diseases, such, for instance, as diphtheria, malarial fever, 
 measles, scarlatina, cholera infantum, etc., would lose much 
 of their fatality if treated on the same general principles 
 which I have so often advanced for the treatment of typhoid 
 fever.* 
 
 *The treatment of typhoid fever in children is transferred to its proper place 
 after treatment. 
 
REPORTS ON TYPHOID FEVER (Continued). 
 
 EIGHTH PAPER. 
 
 Mr. President, and Gentlemen of the Society : 
 
 A few days since, I over heard a physician say : "there 
 is no physician in the world so learned, and possessed of 
 such perfect integrity, as to have been able to convince me, 
 by any statement, that the uniform results I have seen Dr. 
 Woodbridge secure in the treatment of typhoid fever were 
 possible." When asked by his interlocutor what he 
 regarded as the strongest evidence of the truth of the dec- 
 laration that "typhoid fever can be aborted," he answered; 
 "seeing it done." "After that, the charts and reports of 
 cases of other physicians who have treated typhoid fever by 
 Dr. Woodbridge's method, and have thus succeeded in 
 saving the life of every patient and greatly shortening the 
 duration of the disease." His remarks prompted me to amend 
 the report which I had prepared, of cases of typhoid fever 
 which I had treated during the past year, by embodying in 
 it some accounts of the failures and successes of other 
 physicians, who have essayed the abortive treatment of the 
 disease, relying on the directions which I had given in 
 papers (written only to prove that the disease could be 
 aborted), on hastily written letters, on instructions given 
 orally, or on bedside consultations. Many of them have 
 shown their enthusiasm over the results of their trials and 
 
 *Read before the Ohio State Medical Society, Columbus, Ohio, Seventeenth 
 of May, 1895. 
 
 149 
 
150 TYPHOID FEVER. 
 
 tests of this method of treatment, by sending me clinical 
 charts of the cases ; and gratefully acknowledging their 
 indebtedness to me for their marvelous success. 
 
 A most laudable example of true courage and heroism 
 to thus report results (the very possibility of which had 
 been so strenuously denied), which precedent it is devoutly 
 to be hoped may be largely followed. 
 
 As the object of this paper is to place the Ohio State 
 Medical Society in a position to reach a just conclusion of 
 the veracity of the affirmation, "that typhoid fever can be 
 aborted," I shall draw from all these sources. Many of the 
 original clinical charts (copies of which I hand you) and the 
 letters from which excerpta are made, are here for your 
 inspection. 
 
 Those of you who were present at the last meeting of 
 this Society, when I read my paper on "typhoid fever," 
 will remember that a member arose in his place, and said : 
 "being from Dr. Woodbridge's town and Society, I wish to 
 say that we have had several "fights" on this subject and 
 we have been watching his cases for several years, to see if 
 he could make his pledges good, but so far we have been 
 unable to discover that he has made any failures, or had a 
 death from typhoid fever. And we intend to continue to 
 watch him in the future, and if he have a death we will 
 report it." The fact that no such publication has been made, 
 may be accepted as conclusive testimony that for thirteen 
 years I have had no death from the disease and have aborted 
 every case of typhoid fever which has come under my care 
 at a reasonably early stage of the disease. 
 
 During the past year I have treated alone or in con- 
 sultation fifty-eight cases of typhoid fever. During the same 
 period, there have been treated by 117 other physicians, 
 acting under my advice ; by consultation at the bedside ; in 
 
TYPHOID FEVER. 151 
 
 conversations in which I have given very complete and 
 precise counsels in regard to the guidance of the patient 
 throughout the illness, more than eight hundred cases. 
 
 I have seen in consultation, during the past twelve 
 months, two fatal cases.* 
 
 Case No. 1. Mr. H. C. O., of Sewickly, Penn. 
 
 This patient had been sick and feeling miserably, and 
 under the supposition that he had la grippe, had been 
 taking quinine for several days. Yielding to the inevitable, 
 he finally went to bed and sent for a physician, who found 
 that he had pneumonia. Later he had an alarming haemor- 
 rhage of the lungs. No pathognomonic symptoms of 
 typhoid fever were observed until the night of the 1st of 
 December, during which he had numerous profuse intes- 
 tinal haemorrhages. I was called the next day and found 
 him in a condition bordering on collapse, bleeding from 
 both the lungs and bowels, and he died before the haemor- 
 rhages could be arrested, 
 
 The only other fatal case which I have seen in con- 
 sultation occurred in the practice of Dr. M. V. Cunning- 
 ham, whose experience in the Cook County, 111., Hospital 
 and at the Emergency Hospital, during the World's Colum- 
 bian Exposition, had served to render him an unusually 
 accurate diagnostician and taught him to appreciate the 
 value of antiseptic medication. Conservative to a degree, 
 educated to believe that there was no power in medicine to 
 abort typhoid fever, he had watched my cases with the eye 
 of an unfriendly critic, until forced by the logic of my re- 
 peated successes, he called me in consultation several times. 
 and consequently was able to produce such brilliant results 
 in a number of instances that I had the most implicit con- 
 
 * Since this paper was written a third case, which I saw only once on the 
 twenty-ninth day of the disease, died. 
 
152 
 
 TYPHOID FEVER. 
 
 fidence in his ability to treat typhoid fever in a perfectly 
 scientific manner. 
 
 ^105° 
 lOF 
 103° 
 102° 
 101° 
 100° 
 99° 
 
 4 98° 
 
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 ? 97° 
 
 Dayoflhs. 
 Pulse. 
 
 s 
 
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 m 
 
 CASE JAMES K. No. 3. 
 
 Case No. 3. James K., aged twenty-four years. (See 
 chart marked Dr. Cunningham No. 3.) 
 
 This patient was very sick on the 30th of March. On 
 the 1st of April he sent for a physician, who (according to 
 the statements of the family) made a diagnosis of la grippe, 
 
Plate 1. 
 
 One section of ileum from near the lleo-caecal valve and ' from 
 
 about three feet nearer the stomach of Dr. Cunningham's 1 :; Jamei 
 
 K.— of aborted typhoid fever, showing healthy granulating nlcers of Payer's 
 
 glands. 
 
 See chart of this case on opposite page. 
 
TYPHOID FEVER. 153 
 
 and called again the next day. The patient grow inn- 
 worse, Dr. Cunningham, who a few weeks earlier had 
 treated a niece of the patient through a very severe attack 
 of typhoid fever by the method I had advised with unusual 
 success (see chart marked Dr. Cunningham No. 4, Ella 
 G.), was called on April 6, and on April 7, he called me in 
 consultation. I found the patient had been so sick nine 
 days before I saw him as to lead to the obvious conclusion 
 that he had been sick even longer ; a conclusion fully 
 justified by his condition, his temperature having been the 
 previous day 105°, his bowels excessively tender and tym- 
 panitic, nervous symptoms exceedingly bad, his tongue 
 tremulous, very dry and brown. He had persistent hic- 
 cough, and was delirious. 
 
 The next morning Dr. Cunningham came to my office 
 to say that his patient was so wildly delirious that his father, 
 who was taking care of him, was unable to give him medi- 
 cine and could with difficulty keep him in bed, and conse- 
 quently wished to send him to the hospital, a desire which 
 met my heartiest concurrence. This unfortunately 'was 
 abandoned on account of expense. 
 
 I did not hear from the patient again until April 1". 
 when Dr. Cunningham invited me to see him, remarking 
 in a pleased way, "I would like you to visit him once more 
 before he is well, and you must hurry or you will be too 
 late, for his temperature was 101° this morning, and at the 
 rate it is dropping it will be normal in a day or two.' 
 Visiting him about 10 A. M., we found his temperature 
 100.6°, his tongue moist and less coated, his head dear, his 
 abdomen quite flat and entirely free; from tenderness ; tym 
 panitis very slight; nervous symptoms greatly improved, 
 and sleeping naturally. He had taken no antipyretics or 
 stimulants. His condition having improved so rapidly 
 
154 TYPHOID FEVER. 
 
 since my last visit, I told the doctor that I believed his 
 patient would be well in less than ten days, and according 
 to the reports he continued to improve until the following 
 evening, when his symptoms were all better and his tem- 
 perature was 99.6°. Up to this time the disease had run 
 the usual course expected under antiseptic treatment, and 
 save that it had been instituted too late to prevent necrosis 
 and ulceration of Peyer's glands, which must needs have 
 time to heal by granulation, the patient was nearly well. 
 
 Consequently I was greatly surprised when Dr. Cun- 
 ningham telephoned me the next day, that the patient had 
 had two convulsions during the early morning, and was very 
 restless, delirious, and seemed to be suffering great pain, 
 apparently abdominal, as indicated by the manner in which 
 he rubbed and tugged at this region. 
 
 Examination revealed a doughy mass, filling up the 
 abdominal cavity, most solid on the right side. He continued 
 to have convulsions; his mouth and tongue became dry and 
 parched ; his temperature became subnormal ; he grew more 
 restless ; his delirium became more profound ; and he died 
 of shock two days after the accident. The autopsy revealed 
 an intussusception, the obvious cause of death by shock to the 
 nervous system, already exhausted by the long and ex- 
 ceedingly severe delirium, and under great strain on account 
 of the septic condition, due to the enormous pyogenic surface ; 
 the whole of the small intestines being inflamed, and all of 
 the agminated glands of Peyer, in the more than six feet of 
 intestine examined, ulcerated. The stomach and intestine 
 above the intussusception were full and distended, almost 
 beyond endurance ; below it, empty and collapsed. 
 
 This case presents the strongest possible confirmation of 
 the correctness of my diagnosis, because there is not, amongst 
 all of these cases that I have reported as typhoid fever, a 
 
Plate 2. 
 
 Section of ileum from fatal case of typhoid fever (not treated by the Wood- 
 bridge method), showing unhealthy ulcers of Peyer's glands 
 
TYPHOID FEVER. 155 
 
 single case which offers fewer pathognomonic symptoms of 
 the disease, than this one. It positively confirms my dec- 
 laration that "typhoid fever can be aborted," for severe as 
 it was, and despite the fact that treatment was so long- 
 deferred that necrosis of Peyer's glands was unavoidable I 
 it yet pursued the ordinary course toward recovery, and 
 before the unfortunate accident which caused his death, 
 occurred, he was practically cured. 
 
 It presents the most convincing and irrefutable evidence 
 of the validity of my assumptions as a whole, and it seems 
 to me, that it should overwhelm with shame and confusion, 
 the arrogant, and impudent critics, who forgetful of my 
 nineteen years of clinical experience, with a method of treat- 
 ment to which they have not given the slightest attention ; 
 presume to say that because the thermic line on the clinical 
 chart does not present the so-called typical typhoid fever 
 curve, ipso facto, it ceases to be a typhoid fever chart. 
 
 If any one of the gentlemen are present, who in former 
 years have criticised my charts (and in doing so have 
 positively asserted that a chart showing a step-like decline 
 in the temperature, which touches normal in eight or ten 
 days, could not be one of a case of typhoid fever), will 
 scrutinize well the chart marked Dr. Cunningham's Case 
 No. 3, James K., and examine also that book of charts, in 
 it he will find that there are not three charts which depart 
 further from the so-called typical "typhoid fever curve," than 
 the delineation of the thermal line on the chart of this man. 
 whose small intestine presented the most extensive series ot 
 ulcerated Peyer's glands that I have ever seen. 
 
 Had the physician, who was called to attend this man on 
 the first of April, made a correct diagnosis, or failing to do 
 so had he called in consultation a physician who, if unable 
 to make a positive diagnosis, would at least have given the 
 
156 TYPHOID FEVER. 
 
 patient the benefit of the doubt, and immediately instituted 
 proper antiseptic treatment, the misfortune of an intussus- 
 ception may still have befallen the patient, and he may have 
 died ; but he would have been spared those days of burning 
 and torturing fever ; those sleepless turbulent nights of wild 
 delirium; the necrosis of Peyer's glands and their conse- 
 quent dangers. 
 
 I have known all these years, that these were the 
 clinical charts of cases of true typhoid fever; known that 
 in some of the patients the disease had progressed so far 
 that necrosis and even ulceration of Peyer's glands, had 
 already supervened ; and I have also been well aware that 
 there were amongst them the records of the illness of 
 patients, who, but for the treatment I had advised would 
 have been sleeping beneath the sod. 
 
 In nearly every medical society before which I have 
 presented dissertations on typhoid fever, certain members 
 have wisely delivered themselves of one or more of the 
 following sage citations, either literally or with a very slight 
 rearrangement of words ; as for instance. "We all know 
 that typhoid fever is a specific infection that must run its 
 course of four, five, six, or ten weeks or longer." Or it 
 may be that one will sapiently remark; "if there is one 
 fact in medicine that is well established, it is that the course 
 of the disease in typhoid fever cannot be shortened by a 
 single day." And these erudite persons seem to deem these 
 parrot-like assertions as incontrovertible testimony, amply 
 sufficient to confute totally and instantaneously, the whole 
 of the accumulated evidence of my clinical experience ; and 
 indeed even quite sufficient to disprove the statements of 
 all the proficient physicians who have corroborated my 
 diagnoses and results. But it should be remembered, that 
 unwarrantable assumption is not valid reasoning and the 
 
TYPHOID FE VER. \ 5 7 
 
 plausible arguments that have been adduced in confutation 
 of my claims are not more convincing than have been 
 opposed to every step in the progress of medicine. 
 
 In the Cleveland Medical Society, where without 
 malice toward any member of the medical profession of that 
 city or locality ; but for the two-fold purpose of emphasiz- 
 ing my confidence in the potency of antiseptic medicine ; 
 and also of letting the profession abroad comprehend 
 and realize that I had attained the unattainable, that I 
 had in defiance of all known laws of pathology, 
 " achieved a victory " over diseases of a microbic origin, 
 which, when accepted by the medical profession, would 
 add perceptibly to the average duration of human life! 
 by greatly reducing the mortality from this class of 
 diseases. I told what I had accomplished, described my 
 method of procedure, and stated in strong language the 
 responsibility which I believed devolved upon those 
 members of the profession, who knowing or having the 
 means of learning how to save the lives of all cases ot 
 typhoid fever, and who failed to give their patients the 
 benefit of the knowledge ; thus nettling the members of 
 this, as well as of my own local society, to such an ex- 
 tent that had my house been made of glass it would 
 soon have been about my ears, for my expressions were 
 harshly criticised, and in the heat of debate main broad 
 and preposterous arguments were advanced. 
 
 The ubiquitous professor, already in possession of 
 all of this world's knowledge that is worthy of Ins atten- 
 tion, was ridiculously conspicuous, in a way that would 
 have been laughable, had not the subject been so seri- 
 ous, and exposed his ignorance not only of antiseptic 
 medicine, but of the true character and pathology oi 
 typhoid fever. Thus one savant added superciliously 
 
158 TYPHOID FEVER. 
 
 and blusteringly to his previous remarks : " He claims 
 that the temperature has gone to normal in four or five 
 days after intestinal haemorrhage. Absurd; what could 
 he do for the ulceration of the bowels?" As if the 
 ulceration of Peyer's glands were the cause of the ele- 
 vation of temperature. Absurd; and as a climax and 
 final adjustment of the subject said, sententiously: "Talk 
 of aborting typhoid fever; impossible." To me and to 
 those who have with ease, confidence and tranquility 
 aborted the disease, these infelicitous comments are 
 "absurd" indeed. 
 
 A latter day Sydenham, gifted with peculiar perspicu- 
 city, selected three charts as looking to him very much 
 like the records of the temperature in cases of malarial 
 fever. The fact of the matter is, that his extraordinary 
 clear sightedness availed him nothing, for he had, un- 
 luckily for himself, chosen the charts of three cases of 
 typhoid fever, which occurred during two epidemics. 
 
 The patients had been examined and the diagnoses 
 verified, by no less than six different physicians, at the 
 bedside; and no doubt was expressed at the time as to the 
 character of the disease. It is hardly conceivable how so 
 grievous a mishap could have befallen the critic, for the 
 thermic lines on the charts did not delineate the rise and fall 
 of the temperature of malarial fever, a blunder inexcusable 
 even in the most inexperienced medical man. The argu- 
 ments thus adduced by notable professors, whose repu- 
 tation for scholarship has heretofore been undisputed, 
 have been puerile indeed, unworthy alike of the speak- 
 er, his auditors, and the topic under discussion. It 
 is hard to understand how a philosopher, so penetrating, 
 so profound, could be so willfully blind, as not to have 
 observed that at least fifty of these were the clinical charts 
 
^i* 
 
 Plate 3, 
 Showing intussusception which caused the death of Dr. Cunningham's ca 
 3— James K. 
 
TYPHOID FEVER. 159 
 
 of typhoid fever patients^ach one of whom had been ex- 
 amined by from two to six different physicians, the diag- 
 noses and results of treatment attested to, and all of these 
 facts written on the face of the original charts which were 
 signed by physicians whose integrity and expertness in 
 diagnosis cannot be questioned. 
 
 But when these charts were criticised and when the 
 fact that the temperature touched normal in seven or 
 eight days, was said to be proof that these patients did 
 not have typhoid fever, I knew that, if the opportunity 
 should ever present itself I would be able to demonstrate 
 on the cadaver the truth of my statements. I little ex- 
 pected, however, that I would live to see a case of 
 aborted typhoid fever in the dead house. 
 
 But here I present to you a temperature chart, kept 
 at the bedside of the patient by the attending physician, 
 Dr. M. V. Cunningham (Case, No. 3 — see page 152), in 
 which the temperature touched normal on the seventh 
 day of treatment — the thirteenth day of the disease. 
 And here I present to you both dried and moist speci- 
 mens of the intestine of the same patient, showing the 
 characteristic and extensive ulceration of Peyer's glands. 
 Here is the intussusception which caused the death. 
 Please open the bottles and investigate to your entire 
 satisfaction. The bedside history and the pathological 
 specimens prove conclusively that one case of typhoid 
 fever was aborted. " Ab uno disce omnes." Thus 
 this obscure colored man, dying, has rendered a greater 
 service to the world than can her most distinguished 
 citizen, living. 
 
 It is interesting to note that every adverse criticism 
 of my theories, my management of disease or my con- 
 clusions, have come from those having no practical and 
 
160 TYPHOID FEVER. 
 
 I fancy, very little theoretical knowledge of the subject ; 
 while those who have tested my methods have favored 
 me with more valuable reports and kindly expressions 
 of approval of the same than I have been able to tran- 
 scribe or properly answer. 
 
 I append a few of them here; I presented others in 
 my papers read before the Sections on Pediatrics and 
 Practice, A. M. A., last week. 
 
 Dr. John McCurdy, one of the most distinguished 
 physicians in the State of Ohio, many times President of 
 his County Medical Society, ex-President of the Ohio 
 State Medical Society, during the war was Regimental, 
 Brigade and Division Surgeon, Assistant Medical Direc- 
 tor and Acting Medical Inspector of the 14th Army 
 Corps, has had 320 cases of typhoid fever under his care 
 at one time ; a firm believer in the idea that any limita- 
 tion of the course of the disease in typhoid fever was 
 impossible. In the County Medical Society, in 1880, he 
 spoke eloquently against the acceptance of my theories, 
 and in 1893, in the same society in which he had spoken 
 thirteen years before, said : " Dr. Woodbridge has made 
 the greatest discovery that has been made in medicine 
 for a hundred years. I have treated typhoid fever by 
 his method for several years and have aborted a large 
 number of the sixty-five or seventy cases treated since 
 1890, although I have not been able to abort every case, 
 and have had two or three deaths, these occurred, how- 
 ever, in cases that came under my care at the end of the 
 second week of the disease or later. I know that this 
 treatment has power to destroy the specific poison of 
 typhoid fever, and if begun early will abort the disease. 
 It is the best treatment I have ever seen advised. " At a 
 public banquet given to the Chamber of Commerce, at 
 
TYPHOID FE VER. \k\\ 
 
 which there were probably 300 guests present, Dr. Mc- 
 Curdy, responding to the toast, " The Medical Profes- 
 sion," said: " We claim that one of our number here is 
 the discoverer of a treatment for that universal and 
 justly dreaded disease, typhoid fever, which, as a rational 
 and scientific plan of waging battle with that life de- 
 stroyer, is far in advance of any treatment yet practiced. 
 This treatment has stood the crucial test for years in 
 hundreds of cases, and the theory is fully sustained by 
 the long list of victories achieved." 
 
 Dr. C. R. Justice, the very able Health Officer ot 
 Poland, Ohio, and ex-member of the Pension Board, 
 with whom I have had seventeen bedside consultations 
 over cases of typhoid fever during the past year, had 
 for years condemned my theories and denounced im- 
 position as "absolutely untenable," until 1 had learned 
 to regard him as a devotee at the shrine of the "ex- 
 pectant method; "who would go onto the end of his pro- 
 fessional career, treating the disease symptomatic rally ; 
 accepting the long weeks of sickness of his patients as 
 something entirely beyond his control, and the deaths as 
 visitations of Providence, for which he was in no way 
 responsible. I was greatly surprised, therefore, to learn 
 that he had been investigating the subject for month-. 
 
 That he has continued his investigations to good 
 purpose, is proven by the success he has secured in 
 treating some very severe cases of typhoid fever I a few 
 of the charts of which are submitted for your inspection . 
 and by the fact that I was able to write to one of his 
 brother practitioners, advising him to call Dr. Justice in 
 consultation, as he had treated so many eases by my 
 method that I felt perfectly safe in saying to the friends 
 of his patients, that if they called him early enough tl 
 
162 
 
 TYPHOID FEVER. 
 
 need never fear that he would have a death from typhoid 
 
 fever, or that any of his patients would be severely sick. 
 
 Your attention is especially invited to the clinical 
 
 chart of case No. — , Lorenzo C, who had been under 
 the care of two other physicians at a neighboring town. 
 He had been sent home with the statement that he had a 
 terribly severe attack of typhoid fever, and would neces- 
 sarily be sick along time. He arrived wildly delirious, 
 with a temperature of 106°, and all other symptoms of 
 the disease characteristic. His temperature touched 
 normal on the eleventh day, and in a few days he was 
 out driving, feeling perfectly well. 
 
 Dr. Justice has treated during the year, by my 
 method, twenty-three cases, without a death ; although 
 
TYPHOID FEVER. 163 
 
 some of them have been complicated by grave pre-exist- 
 ing or concurrent affections, and some of them came 
 under his care at late stages of the disease. In speaking 
 of the treatment Dr. Justice said : " Looking back over 
 the past I can see where I could have saved many lives, 
 had I understood thi c method of managing typhoid fever 
 as I do now ; and I think I would be committing a crime, 
 were I to treat a case of the disease in any other way 
 than that advised by Dr. Woodbridge." 
 
 Dr. J. A. Dickson, of Youngstown, O., a gentleman 
 of the highest integrity, a physician whose reputation 
 as a general practitioner, is happily not marred by his 
 success as a laparotomist, sends me the following report: 
 
 "Youngstown, O., April 29, 1895. 
 
 " I have treated several cases of typhoid fever with Dr. 
 Woodbridge's treatment, and find that it will invariably cut the 
 fever short, if commenced early enough in the disease, the illness 
 lasting often but a few days, the temperature soon dropping to 
 normal and remaining there. I have also tried the mixed treat- 
 ment, that is, using the tablets as directed, and also perhaps, some 
 turpentine emulsion, quinine, etc., but find that it pays much 
 better to « hew to the line.' I have been recently treating a case" 
 of typhoid fever, which came to me from another physician, who 
 was ill. It had not been treated by Dr. Woodbridge's method, 
 and when I first saw the case I found the temperature 104°, the 
 pulse 100. I immediately commenced witli the tablets, giving 
 one every fifteen minutes for the first day, one every hall hour 
 during the second day, and one every hour during the third day, 
 etc. Upon the second day the temperature came down to 101.8°. 
 Upon the third day it was 101.4°. Fourth day, 101.4°. Fifth 
 day, 101.2°. Sixth day, 98. G°. After this the temperature re- 
 mained normal for four days, when the patient came down with 
 pneumonia, with the characteristic rales, egopheny hepatization 
 and expectoration ; from which he is now recovering. The tem- 
 perature upon the onset of the pneumonic trouble went up from 
 normal to 101.8° the first day, and gradually to 108°, but the 
 
164 
 
 TYPHOID FEVER. 
 
 tongue was moist and there were no symptoms of typhoid fever. 
 "If I were stricken with typhoid fever, or one of my family 
 were taken down with the dread disease, I think that I would feel 
 like sending for Dr. Woodbridge from the Atlantic Coast to the 
 Golden Gate. J. A. Dickson." 
 
 There must be royal blood coursing through the 
 veins of Dr. Reed, of Massillon, Ohio, for of such mate- 
 rial as he is made, made they the kings and rulers of the 
 earth in olden times. In one of the darkest hours in my 
 existence he wrote me as follows : 
 
 1040 
 103° 
 102° 
 
 KH° 
 100° 
 
 99° 
 
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 "Massillon, Ohio, Nov. 14, 1894. 
 J. E. Woodbridge, M. D. 
 
 Dear Doctor : — I wish to add a word of encouragement to 
 you against the many denunciations of your treatment of typhoid 
 fever. I wrote for your formula some time ago, and you referred 
 me to the American Medical Journal, from which was obtained the 
 required knowledge. My father, Dr. T. J. Reed, has also used it, 
 and we have met with very good success, and can only offer words 
 of praise in its favor. 
 
 We have been giving about 30 grains of quinine per day, 
 
TYPHOID FEVER. 
 
 165 
 
 (this being a great malarial district) for four days, and if at the 
 end of that time we found the temperature high, and the symptoms 
 the same or aggravated, we put them on the treatment prepared 
 under your formula, and although we have not aborted the disease 
 in every case inside of ten days, we have, with the exception of 
 two cases, inside of fourteen days, and seldom see them after the 
 sixteenth day. I have kept diligently the charts of the cases I 
 have had, and have taken pleasure in showing them to the other 
 physicians, who laughed at my daring to use the treatment. They 
 take a different view of it now though. Had I but known a few 
 hours earlier of your intention to speak in Cleveland, I should 
 have gone up, and let my voice help to defend you, or if not allowed 
 that, at least it may have been some satisfaction to you to have 
 seen the few charts (ten in all) we have been able to prepare. 
 
 Hoping that you may meet with greater encouragement at 
 the hands of the profession, and that 1 may be able to meet yon 
 personally at some future time, I remain 
 
 Yours truly, T. F. Reed." 
 
166 
 
 TYPHOID FEVER. 
 
 A few days later Dr. Reed* kindly sent the charts to 
 which his letter refers, to me with the accompanying 
 letter : 
 
 " I send you by this mail, a few of my charts that were unmis- 
 takably typhoid fever cases, and some of them were the last cases 
 of from two to four in the family, who had similar attacks, but of 
 which I regret to say no records were kept. We have had, in all, 
 about twenty-five cases, and these charts are examples of them 
 all. We are well pleased with the results we have had, and can 
 positively say that it is due to the form of treatment. I hope the 
 charts will be of some use to you, and anything that I have is at 
 your disposal. I should like to have the charts returned, as I 
 have no duplicates of them, and want to keep them for future use. 
 The temperatures marked were taken at the height of the disease." 
 
 Dr. E. J. March, of Canton, Ohio, sends me the fol- 
 lowing letter with the charts, which are marked" Dr. 
 Marsh, Harry W. and Sadie J." : 
 
 *The denunciations to which Dr. Reed refers are those of physicians who de- 
 nounce the abortive treatment of tvphoid fever, without trial or investigation as 
 they would disparage anything, which did not chance to fall within their intel- 
 lectual horizon. 
 
TYPHOID FEVER. 167 
 
 "Canton, Ohio, April 26, 1895. 
 
 DR. J. E. WOODBRIDGE, YOUNGSTOWN, OHIO. 
 
 Dear Doctor: — An apology is due you for my long delay in giving 
 the reports of some of the cases of typhoid fever which I have 
 treated with the medicine you furnished so kindly. I have 
 simply postponed it from time to time till this P. M. I saw a 
 report of some of your cases in P. D. & Co.'s therapeutic notes. 
 
 Enclosed find the detailed treatment and temperature charts 
 of two cases. The first of Mr. W. was to my mind a typical 
 case. The second, Miss J., a trained nurse came from a family, 
 all of whom had typical and severe attacks, at which place she 
 contracted the disease. She came back to Canton and asked 
 me to give her ' Woodbridge treatment', as she had nursed my 
 first case, and was much taken with the results obtained in it. 
 By the way, she had had large experience in New York hos- 
 pitals in nursing typhoid. You will see the result as per charts 
 enclosed, I had two other cases as well marked and typical 
 as these two, but being in nonprofessional nurses' hands, no 
 notes or charts were kept. But they were both convalescent in 
 ten days' time. The one, a woman about thirty years old, had 
 come from the bedside of her brother, who died from the disease, 
 and she started in with a severe attack. I am sorry I did not keep 
 such a record as I could, myself, so as to add water to your wheel. 
 I have a friend here who has tried the plan of treatment, some- 
 what modified, and says that the objection he has to it is that, 
 whereas he formerly made from $20 to #40 out of each case of 
 typhoid, this cuts his bills down to less than $10 in each case. 
 
 Doctor, I feel sure that you are on the right track, and if we 
 should have a run of fever in our hospital wards this fall, I will fur- 
 nish you with some more charts and results. Thanking yon again 
 for your courtesy, Yours very truly E. J. MARCH." 
 
 I will now present from my own practice a few cases 
 which ran a course similar to that of Dr. Cunningham's 
 Case No. 3, with the exception of the unfortunate acci- 
 dent of the intussusception. The cases represent not 
 only most careful and positive diagnoses from the clin- 
 ician's standpoint, as they were generally verified by one 
 
168 
 
 TYPHOID FEVER. 
 
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TYPHOID FEVER. 
 
 169 
 
 or more physicians ; but every precaution has been taken 
 to reduce errors of diagnosis to a minimum, by calling to 
 my aid every known means of excluding mistakes. The 
 diazo-reaction described by Ehrlich, and the microscope 
 were appealed to, and in a large number of cases where- 
 malarial fever was suspected, or had been diagnosticated, 
 careful search was made for Laveran's hematozoon. 
 
 Case No. 106. Mrs. McC, aged seventy years. Was 
 a feeble woman, and one of five typical cases in one house. 
 When I first saw her, on February 7, 18 ( J5, her temper- 
 
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 CASE LEN0RE S. No. 101. 
 
 ature was 105°, pulse 140. Although she was reported 
 to have been sick only frve days, she was delirious ; her 
 bowels were very tender; there was considerable tym- 
 panitic distention ; rose spots were abundant : her tongue 
 was thickly coated, dry and brown. Her temperature, 
 as you will see, had dropped to 99 , her pulse 96, on the 
 13th of February, after which her temperature was not 
 taken ; and in a few days she was able, to be about, and 
 at the end of a week was out of doors. 
 
 Case Xo. 101. Lenore S., aged twenty-seven y< 
 
170 TYPHOID FEVER. 
 
 (daughter of Case No. 106, residing in same house). 
 When I first saw her, on Jannary 14, 1895, she had a 
 temperature of 103°, pulse 120, and all other symptoms 
 of typhoid fever as characteristic as were those of her 
 mother. A few days later, January 17, her temperature 
 was 100°, her pulse 100, and the general condition so 
 much improved that I have no record until the 21st, when 
 the temperature had been reduced to 99.8° and the pulse 
 96. I saw her the last time on the 26th, and she was out 
 in one week. 
 
 Case No. 108. Carolyn S., aged two years (daughter 
 of Case No. 101). She was far from well on February 
 7, when I was called to see her grandmother, and on 
 February 9 had a temperature of 105.2°. She was dis- 
 charged, cured on February 16, after nine days of treat- 
 ment. 
 
 Cases Nos. 107 and 109. Katie McC. and Jerry 
 McC, aged respectively five years and twenty-three 
 years (granddaughter and son of Case No. 106). These 
 cases both showed decidedly characteristic symptoms of 
 the disease, but recovered so rapidly that no records were 
 kept. 
 
 Case No. 115. John O'L., aged twenty-eight years. 
 This young man was taken sick on the 1st of March 
 and was treated by an irregular practitioner who called 
 two other physicians in consultation after twenty-two 
 days of illness, during which time (according to the 
 statement of the family) a diagnosis was made of la 
 grippe, malaria, pneumonia, and finally of pneumonia 
 with "typhoid malaria." On the 22d of March an un- 
 favorable prognosis was given and I was sent for. I 
 found a typical case of typhoid fever, complicated with 
 pneumonia. His temperature was 103°; pulse 118, and 
 dicrotic ; condition of nervous system very bad ; he was 
 sleepless and delirious; his abdomen was covered with 
 rose spots ; typanitic distention enormous ; bowels very 
 tender ; tongue very dry, brown and cracked ; he was 
 
TYPHOID FEVER. 
 
 171 
 
 spitting blood and had three intestinal haemorrhages. On 
 the 25th of March his temperature was 104.7°. However, 
 his condition improved rapidly indeed ; he was sleeping 
 naturally, without hypnotics, on the second night, when 
 he was no longer delirious. Within three days, his ab- 
 domen flattened out ; the tympanitis disappeared ; his 
 appetite returned, and he declared that he was gaining 
 strength on milk diet. On the 1st of April and the fol- 
 lowing day, the temperature being normal, he was dis- 
 
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 CASE MARY O'L. No. 120. 
 
 charged cured. Dr. M. V. Cunningham, who is much 
 interested in the abortive treatment of typhoid fever, saw 
 the case with me, for the purpose of watching the (Meet 
 of treatment. He pronounced it wonderful. 
 
 Case No. 120. Mary O'L. (sister of Case No. 116, 
 John O'L.) I was called to see this case on the 2 
 April, and was given the following history 
 
 She had 
 
172 TYPHOID FEVER. 
 
 nursed her brother through a very severe attack of the 
 fever a month before. During- the latter part of his 
 illness she had severe headache and general malaise. 
 About two weeks before I saw her, her headache in- 
 creased, her back and limbs ached, she became dull and 
 apathetic, and as her mother expressed it, "could hardly 
 drag one foot after the other, she, who was the most 
 active and energetic of all the kith and kin." At this 
 time she took the residue of the medicine I had left for 
 another sister, whom I supposed was taking typhoid 
 fever (from which illness she recovered at once) after 
 which she felt quite well for several days. Six days be- 
 fore my first visit the headache returned, the back and 
 limbs began to ache, and all the characteristic symptoms 
 of typhoid fever presented themselves ; her pulse was 
 120, her temperature 104.9°; her tongue heavily 
 coated ; spleen enlarged ; her bowels very tender and 
 tympanitic. I left her in the care of Dr. M. V. Cun- 
 ningham, on the ninth day of treatment, when I started 
 to attend the meeting of the A. M. A. at Baltimore. 
 During my absence she had a very severe intestinal 
 haemorrhage, but made a good recovery. While Dr. 
 Cunningham was making his daily visits, a married 
 sister was taken sick with the fever and proper treat- 
 ment was instituted early, so that the temperature never 
 rose above 103.5°, and on the seventh day, when she was 
 doing very well, her husband came home drunk and 
 brought with him an irregular practitioner, who very 
 promptly decided that she had no fever. It was very 
 fortunate for his reputation that he was called in after 
 Dr. Cunningham had aborted the disease. 
 
 Case No. 116. E. S., aged forty years (husband of 
 Case No. 84.) This patient resides about four miles 
 from my office and he drove that distance to see me 
 about one o'clock each day. He consulted me first on 
 the 1st of April, when I found his temperature was 100° 
 and pulse 112. Although feeling at times miserable he 
 was able to be out each day, as I had advised him, and 
 
TYPHOID FEVER. 
 
 173 
 
 on the loth his temperature was 99.4° and pulse 80, 
 and his recovery was excellent. 
 
 Case No. 114. Mrs. Michael J., aged thirty-two years. 
 This was the fourth case of typhoid fever in the same house 
 at once (the three other cases were reported in the paper 
 which I read in the Section on Pediatrics, A. M. A., in 
 Baltimore). A small son, Case No. 78, John J., and a 
 little niece, Case No. 105. Annie W. having also had 
 the disease some time before. The symptoms were not 
 well defined and an absolutely positive diagnosis was 
 not possible, but as the family used water* from a well 
 which was supposed to be the source from which several 
 other cases had originated, she was treated as a case of 
 typhoid fever and assured that if the diagnosis were 
 correct she would not be confined to her bed or be long 
 sick or too sick to nurse her three children, who had the 
 disease, as I had been able to treat her from the be- 
 ginning of her indisposition. 
 
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 CASE FRANK S. No 110. 
 
 Case No. 110. Frank S. This was an ambulatory 
 case, and although the symptoms seemed to indicate 
 that the patient was growing worse, his temperature 
 being 103° on the sixth day of treatment, he felt fairly 
 well after the first two or three days. 
 
174 TYPHOID FEVER. 
 
 Case No. 118. John S. This case showed premon- 
 itory symptoms of typhoid fever for more than a week 
 before the patient consulted me. He drove to my office 
 for a few days, with all of the marked characteristics of 
 the disease plainly to be seen, but finally had to go to 
 bed for a week or more. The temperature ranged from 
 100° to 102.8° for eight days, and he was discharged 
 cured on the twelfth day. 
 
 Case No. 117. George J., aged fourteen years. Hecame 
 to my office on the 14th day of April, and called daily for 
 four or five days, when his afternoon temperature was 
 only 101°, but his other symptoms were sufficiently char- 
 acteristic to justify a diagnosis of typhoid fever. I soon 
 discovered that he was not doing well, and warned him 
 of the danger of neglecting, to follow implicitly my in- 
 structions. After which he improved fora few days, but 
 again grew worse. Sending for his father, I learned 
 that he had been left to take his medicine or not, as he 
 chose ; and choosing the latter, he had been casting the 
 expensive medicine which I gave him into the cuspidor. 
 I refused to have anything more to do with him, unless he 
 was properly nursed, when his mother gave up her situa- 
 tion and gave him her care; but more than two weeks had 
 now passed, and instead of being well, as he should have 
 been, his symptoms were all aggravated ; his pulse 136 ; 
 temperature, 103 2-5° ; the tympanitic distention of the 
 abdomen was enormous, and his bowels were very ten- 
 der and painful. 
 
 Leaving him under the care of Dr. Cunningham I went 
 to Baltimore, and returning on the 13th of May, the Doctor- 
 requested me to see him, saying that he was unable to con- 
 trol him. On several occasions he had stolen out of bed and 
 secured bread and other articles of solid food and once he 
 was said to have eaten a pound of candy. I ordered him to 
 be handcuffed to the bed, where he still remains, but is 
 nearly well. 
 
TYPHOID FEVER. 
 
 175 
 
 CASE ELLEN H. No. 104. 
 
176 TYPHOID FEVER. 
 
 Case N o. 1 04, Miss Ellen H. , aged twenty years, residing 
 in a neighboring town; she had been sick ten days, under the 
 care of the family physician, who, being one of those gentle- 
 men who do not believe in the possibility of aborting typhoid 
 fever, very naturally blundered in his diagnosis, and treated 
 her for la grippe, until about four days before I was 
 called. At this time he corrected his diagnosis to typhoid 
 fever, which caused no little excitement, as the other most 
 prominent physician in the town was, and is, an enthusiastic 
 advocate of the " Woodbridge method," (he says publicly 
 that no patient should die of typhoid fever. ) Thus the 
 friends of scientific medicine and the friends of "old fogyism," 
 became partisans ; and for days that young lady's mother, in 
 her anxiety to save her daughter from death or needless 
 suffering, was swayed from side to side. It would be hard 
 to tell which party would have won, had not the condition of 
 the patient become alarming ; for, although the Doctor was 
 keeping the temperature down nicely with acetanilid and 
 sponge baths, and was sustaining the heart with strychnine 
 and digitalis, her mother could see that all was not right, 
 and she, at last, telephoned to me to come down and meet 
 the attending physician in consultation. I found both physi- 
 cian and friends exceedingly anxious about a "failing heart," 
 a threatening danger which I assured them would disappear 
 as soon as a little of the poison of the disease was neutralized. 
 I discontinued all heart tonics and stimulants, and all medicine 
 in fact, except the three prescriptions which I have advised 
 in former papers ; and before I made my next visit, the fol- 
 lowing afternoon, all the ill-omened heart symptoms had 
 vanished and the pulse had resumed a healthy tone. In two 
 or three days, all of the nervous symptoms, all of the tym- 
 panitis, all of the abdominal tenderness were gone, never to 
 return, and she was very comfortably sick, although, as you 
 will see by the chart, the temperature did not touch normal 
 until the eleventh day. 
 
 In conclusion, I wish to say, that an apology is due the 
 large number of physicians who have reported cases of 
 typhoid fever treated and aborted by the " Woodbridge 
 
TYPHOID FE VER. \ 7 7 
 
 method," which I have been unable to reproduce here or in 
 my previous papers, for want of time, an unintentional 
 discourtesy, since the twenty minutes which are allowed me 
 in the medical societies, or the space in the "journal " 
 would have been wholly inadequate to admit of even the 
 briefest possible mention of all the valuable and valued 
 reports in my possession. But every case reported is an 
 object lesson to those who doubt the possibility of aborting 
 typhoid fever, and each individual account will aid in hasten- 
 ing the day when death or long or severe illness will be 
 unknown. Hence the medical profession is to be con- 
 gratulated that it has in its ranks, proficient and practiced 
 men, whose finesse and savoir-faire enables them to learn 
 the truth, and whose manliness endows them with the cour- 
 age and valor to teach it. 
 
REPORTS ON TYPHOID FEVER.* 
 
 (continued.) 
 
 When I first publicly declared that " death is a wholly- 
 unnecessary consequence of typhoid fever, and that 
 every case in which proper treatment is instituted suf- 
 ficiently early in the course of the disease can be 
 aborted," I stated also that " I fully appreciated the dis- 
 grace and ignominy which would await me" should I be 
 found guilty of promulgating a false doctrine. 
 
 I knew that I was speaking a language which would 
 be utterly unintelligible to the greatest thinkers in the 
 profession ; and also that it would have been so to me, 
 but for the eclaircissement of many years' experience. As 
 it took so much evidence to convince me — first, that any 
 case of typhoid fever could be aborted ; then, that any 
 severe case could be aborted ; and finally, that every case 
 could be aborted, and death from the disease could be 
 always averted, I cannot understand how, without the 
 most indisputable and undeniable proof, these claims can 
 be admitted by any physician, who had been taught as I 
 was in my youth, to regard typhoid fever as a " specific 
 infection," possessed of some occult power of resistance 
 to all curative treatment, which it was hopeless, if not 
 flagitious, to attempt to counteract, and a completion of 
 the title of " quack" to make any pretension to having 
 succeeded in so doing. 
 
 *Read before the Section on Practice, A. M. A., Baltimore, Md. 
 
 178 
 
REPORTS ON TYPHOID FEVER. L79 
 
 I shall, therefore, endeavor in this report to present 
 the strongest available evidence, not only that the 
 declaration is true, but that which for want of a better 
 name I have designated "Antiseptic Medicine," has a 
 reserve power for good that I have not even mentioned. 
 For this purpose I wish to reproduce the verdict of a few 
 of the many physicians who have treated by my method 
 a large number of cases of typhoid fever, and also to 
 note some of the most characteristic or otherwise inter- 
 esting cases which I have treated since our last meeting. 
 
 Desiring to give every facility for the formation of a 
 just estimate of the value of my statistics, I have invited 
 the closest scrutiny of my cases of typhoid fever ; have 
 ever held myself in readiness to demonstrate the correct- 
 ness of my theories, in hospital or in private practice, at 
 home or abroad ; and I have requested the publication of 
 any failure on my part to do all that I have been teach- 
 ing the medical profession that it ought to do. I have- 
 also promised to present a report of cases before some 
 great medical society each year, until a general assent 
 has been given to the accuracy and truth of my theories, 
 and death from typhoid fever is unkown, and long con- 
 tinued, constitution destroying sickness from the disci .<• 
 shall be regarded as a disgrace to the individual practi- 
 tioner, and not as at present a reproach to the great 
 body of the medical profession. 
 
 During the past year, as during the preceding thirto en 
 years, I have had no death from typhoid, malarial, or an\ 
 continued fever, or following any pathological "condi- 
 tion, which could by any possibility be mistaken for 
 either of them, and I have failed in no instance, in which 
 the patient has come under my care before the eighth 
 day of sickness, to abort the disease. 
 
180 REPORTS ON TYPHOID FEVER. 
 
 Since my return from San Francisco, last July, 1 have 
 treated, alone or in consultation, fifty-eight well-marked 
 cases of typhoid fever. Of these cases some occurred 
 in Youngstown, or the surrounding country or towns ; 
 some in Pennsylvania ; some in Northern Ohio, and 
 some in other States ; and no doubt existed in any in- 
 stance, in the minds of the attending or consulting physi- 
 cians, as to the correctness of the diagnosis. I have, 
 during the same time, aborted the disease in a large 
 number of cases, of which no charts were preserved. 
 
 During this period there have been reported to me 
 as treated by other physicians, acting under my advice 
 given orally, in consultation at the bedside, by letter or 
 otherwise, about 800 cases of typhoid fever, with nine 
 deaths from the disease. A marvelously good result 
 when it is remembered that they were sailing on an un- 
 known sea, with no pilot to steer the course ; that they 
 had unshipped the rudders, thrown overboard the com- 
 passes and were endeavoring to weather, unaided, the 
 fiercest storm that could ever strike the ship — having 
 learned that all recognized methods of treating typhoid 
 fever are so valueless that the cleverest men deny the 
 possibility of doing what 117 physicians have done, viz. : 
 curing the disease. They abandoned all the procedures 
 with which they were familiar and with only a brief out- 
 line of my modus operandi, which must necessarily have 
 proven a quite insufficient guide ; yet there were enough 
 earnest and conscientious physicians, whose keen insight 
 and mother wit enabled them to follow these rather in- 
 complete directions to a successful issue, in so many 
 typical cases of typhoid fever, as to afford me conclusive 
 evidence that the disease can invariably be aborted and 
 every life saved ; and which should also carry conviction 
 
REPORTS ON TYPHOID FEVER. 181 
 
 to the mind of any intelligent physician who will care- 
 fully and impartially weigh these reports and also my 
 fuller treatises on the subject. 
 
 While neither these accounts nor my own observa- 
 tions have added anything to my knowledge of the power 
 of this so-called "antiseptic medicine" to abort typhoid 
 fever, when the treatment is commenced early in the 
 course of the disease, they have served to convince me 
 that in my original declaration I did not place too high 
 an estimate on its value. They have done more — they 
 have strengthened in my mind the belief that even in 
 late stages of uncomplicated typhoid fever it has power 
 to eliminate all ordinary causes of death, save the acci- 
 dents of haemorrhage and perforation, and to minimize 
 the danger of their occurrence. 
 
 An analysis of the failures in a test of any given 
 method is sometimes more instructive than an equal 
 number of successes would be; and as that happens to 
 be quite true in this instance, the following abstract of 
 cases of typhoid fever, coming, as they do, from disinter- 
 ested observers, may possess for this reason a higher im- 
 port than would the report of a much larger number oi 
 universally successful cases from my own practice. 
 
 In one large hospital, in which the observer held an 
 honorable position under the Government of the United 
 States, several exceedingly serious cases of typhoid 
 fever were aborted by the " Woodbridge method ; " but 
 finally a death occurred, for which catastrophe I could 
 find no excuse, until I discovered that the patient had 
 taken at three-hour intervals the extremely minute d 
 which I had advised to be given every fifteen minute 
 
 An instance of the lack of that discernment so req- 
 uisite in securing success in so difficult and delicate an 
 
182 REPORTS ON TYPHOID FEVER. 
 
 undertaking is well pictured in the following quotation 
 taken from the epistle of an apparently conscientious, 
 just and high-minded gentleman : 
 
 The patient had been sick several days; had a morbid 
 appetite ; complained of being " so tired," chilly, headache, 
 etc. . . . before consulting a physician. I gave 
 him a simple laxative pill, containing colocynth, podoph- 
 yllin, aloes, etc., which had a tremendous effect, so 
 much so that I had to interfere with remedies. His 
 temperature rose to 104i°. I pushed large doses of 
 quinine upon him, and for two days the fever stayed 
 away, and he got up and walked about the place. This 
 was against my orders and he was soon compelled to go 
 to bed. . . . Real typhoid tongue, some tympanitis, 
 high temperature. I commenced giving him guaiacol and 
 eucalyptol, as recommended by you, but mixed with bis- 
 muth. . . . He was sponged freely; . . . given 
 four ounces Walker's best whiskey. . . . He died 
 that night at 11 o'clock. 
 
 The writer closes this eight page account of his ex- 
 periences with the " Woodbridge method " of treating 
 typhoid fever with : " Now in this case your powder 
 was not used — all your other suggestions were fol- 
 lowed." Were they? The patient did not consult the 
 doctor until he had been sick " several days," he was 
 then given a "simple laxative pill, which produced a 
 tremendous effect ;" then "large doses of quinine were 
 ' pushed' for two days," and finally he was given two of 
 the ingredients of my formulas, but not those, which to 
 his patient were a veritable "sine qua non," i. £.,"the 
 play of Hamlet with Hamlet omitted." 
 
 Thus, in these illustrations, one can easily see that 
 not only were the minutiae of my instructions unmistaka- 
 
REPORTS ON TYPHOID FEVER. [83 
 
 bly disregarded and neglected ; but the chief essentials 
 were likewise overlooked to such an extent that neither 
 these deaths, nor others occurring under like circum- 
 stances, should be charged to the " Woodbridge treat- 
 ment." 
 
 Dr. Dodge, of Michigan, has written me several 
 letters, which I consider most valuable contributions to 
 current medical literature, and which I am unfortunately 
 prevented from giving in full for want of space in the 
 Journal. 
 
 He says : "I have seen three fatal cases this year, 
 but none of them were uncomplicated cases, though I 
 presume none of them would have died, had it not been 
 for the typhoid element. One case was admitted to the 
 hospital in the second week, as near as we could ascer- 
 tain. He said he had been sick two weeks ; and he had 
 a temperature of 104J° when admitted. We gave him 
 your formula No. 1, until free catharsis was produced ; 
 then the guaiacol and eucalyptol combination in grad- 
 ually increasing dosage, until he took 5 m. of g., and LO 
 m. of e. every two hours. His temperature came down 
 to nearly normal in a few days ; he had severe diarrhoea, 
 and pain in the abdomen ; became wildly delirious ; then 
 comotose, and died about ten days after admission. An 
 autopsy revealed a great many ulcerated Peyer's patches 
 and a general enteritis as well. The next fatal ca 
 also admitted in the second or third week. It was im- 
 possible to learn just how long he had been sick. He 
 also had pneumonia when admitted, and in the course «>f 
 a week succumbed to the two diseases. Autopsy showed 
 ulcerated Peyer's patches in abundance. He was given 
 the same treatment as the other case, in the same man- 
 ner, with the addition of appropriate medication for 
 pneumonic complication. The third case I saw in con 
 sultation, and was in the private practice of Dr. B. The 
 young man had been sick two weeks when Dr. B. was 
 
184 REPORTS ON TYPHOID FEVER. 
 
 called, and had been starved by a quack who l starves 
 fever/ He was reduced, and had a haemorrhage the day 
 Dr. B. was called. I have had five other cases that 
 have recovered. Two of them were aborted in the 
 proper sense of the term, and in three, where the treat- 
 ment was commenced about the tenth day, I am satisfied 
 that the course of the disease was modified for the bet- 
 ter. I have never before attended cases of equal 
 severity that passed through the disease, and made so 
 nice a convalescence as did these three cases. 
 
 "Two cases (and they were the only two in which I 
 was able to commence the treatment during the first 
 week of illness) were certainly aborted. 
 
 "One of them lived in a neighboring town. I visited 
 him first one evening, and found that he had been sick 
 four days and had a temperature of 103°. I gave him 40 
 grains of quinine to be taken during twelve hours. The 
 next night he had a temperature 103^°. I placed him on 
 the powder in half hour doses for 24 hours, then 3 m. 
 doses of guaiacol and 6 m. doses of eucalyptol every three 
 hours. I did not see him for 48 hours, when he had a 
 temperature of 100°. I did not see him at all after that, 
 but he continued the g. and e. mixture steadily, and a 
 week later came to my office when he had a temperature 
 of 100° or a little less, and had an abundant rose eruption 
 over the abdomen. I ordered him to continue the mix- 
 ture as long as he had any fever, and I have not seen 
 him since. 
 
 " The other case simply had fever that did not yield 
 to quinine, but was aborted speedily by your treatment. 
 Some might deny this case being one of typhoid fever as 
 there were no pathognomonic symptoms, but, at any 
 rate, she had some kind of fever attended with diarrhoea 
 and epistaxis. Quinine had no effect on the temperature, 
 even in large doses, and the fever disappeared two days 
 after the guaiacol mixture was commenced. ... I 
 think the system may be so impoverished by the toxins 
 absorbed in the blood that no treatment will avail to 
 
REPORTS ON TYPHOID FEVER. 185 
 
 save the life of the patient, and the three fatal cases I 
 have described may be considered as evidence support- 
 ing this position. I have, however, great faith in the 
 treatment when it can be commenced early, even in the 
 second week I think -it will generally very favorably 
 modify the course of the disease." 
 
 An extract from another letter from Dr. Dodee, 
 dated the 2d of April, 1895, is as follows : 
 
 " All of the cases of uncomplicated typhoid fever that 
 I treated in this manner recovered in a much shorter 
 time than such cases have ever done with me before. 
 The two hospital cases that died were complicated, the 
 one with pneumonia and the other with severe enteritis, 
 as the autopsy disclosed. The fatal case that I saw in 
 consultation with Dr. B , should not properly be in- 
 cluded in your list as he had been ' starved' by a homoeo- 
 path for two weeks and had a profuse hemorrhage from 
 
 the bowels before Dr. B was called. He died within 
 
 forty-eight hours of the time I saw him, and, of course, 
 there was no time to get him under the influence of your 
 medicine. Our efforts were principally directed to 
 stimulation, and to try to get him out of the state of 
 collapse. Incidentally your formulas were administered, 
 but without any idea that it was a fair case to try them 
 in. I merely reported it to you as an instance of the 
 terrible condition in which we sometimes receive these 
 cases. 
 
 " I also rather wished to warn you to dwell upon the 
 necessity of giving your treatment early in the course of 
 the disease, which you have done in later papers. I found 
 some who thought from reading your papers that von 
 claimed any case might be cured, no matter in what 
 stage the treatment was commenced. I was well aware 
 that you had not claimed any such thing, but I desired 
 to call your attention to the fact that some persons had 
 drawn that inference." 
 
 Dr. C. N. Udell, of Iowa, wrote me on the 19th of 
 
186 REPORTS ON TYPHOID FEVER. 
 
 April, 1894, seeking an outline of my treatment for 
 typhoid fever. This letter was answered in its turn on 
 the 3d of July. On the 25th of August I received a 
 letter, from which I quote the following : 
 
 "The first trial was with Case No. 1, Iva M., aged 
 fourteen years. The enclosed chart will show you the 
 range of the temperature. This was rather a grave 
 case, with bad hygienic surroundings and poor nursing. 
 I did not begin the antiseptic treatment until she had 
 been sick nine days. She made a good recovery, but 
 the case ran for some weeks and could not be called 
 aborted. 
 
 "Case No. 2. Frank B., was sick a week when I 
 was called, and I diagnosed typhoid fever. He had the 
 usual prodromic symptoms, with all the phenomena of 
 true typhoid following. I put him on your formula No. 1 
 and continued that most of the time. In' one week he 
 was about well. 
 
 "Case No. 3. Mrs. C, was employed as nurse for 
 Case No. 1 in the latter part of her illness. She is now 
 sick with typhoid, in rather a mild form, yet unmistak- 
 ably typhoid fever. I think from the present indications 
 she will run the course in about fourteen days. Treat- 
 ment — Formula 1 is given most of the time; No. 3 when 
 the bowels are too loose. I have been using the same 
 treatment in cholera infantum with good results. I have 
 procured what I supposed to be pure guaiacol and 
 eucalyptol, but find it difficult to give this to children, 
 the taste is so horribly bad. Some children strangle 
 badly on it even in small doses. I begin to fear impurity. 
 I believe your theory is correct." 
 
 Dr. Udell sent me on the 22d of March another 
 report of cases. He says : " I will give a brief report of 
 cases, selected from amongst those treated with your abor- 
 tive treatment for typhoid fever. In the management of 
 
REPORTS ON TYPHOID FEVER. 187 
 
 these, as well as other cases, I relied almost wholly upon 
 your prescriptions Nos. 1 and 3, giving- a diuretic occa- 
 sionally when required ; also an occasional dose of bro- 
 midia, when the patient was too restless to sleep at night. 
 
 " Case No. 4. A. D., male, aged forty-two years. 
 Suffered with all the prodromata of typhoid fever for six 
 days, without treatment, with the exception of some 
 domestic remedy. I prescribed R. No. 1 for three days ; 
 No. 3 for four days ; and No. 2 on fourth day. Patient 
 was discharged on the seventh day, with No. 3 to be 
 continued at intervals of four or five hours for a few 
 days. No relapse. Highest temperature in either of 
 the above cases was 103.4°. No delirium or eruption. 
 
 "Case No. 5. J. C, aged eighteen years. Taken 
 just as Case No. 4 was, with feelings of weariness, lassi- 
 tude, constant headache, fever, rigors, foul furred tongue, 
 anorexia, slight nausea, nosebleed ; some diarrhoea and 
 tympanitis and tenderness over the abdomen. I was 
 called after the patient had been sick one week and found 
 that he had taken some cathartic pills. Prescribed R. 
 No. 1 for three days, No. 2 on the third day. No. 3 for 
 one week, when the young man began to do light work. 
 No relapse. 
 
 Case No. 6. W. C, aged twenty years, (brother of Case 
 No. 5). Symptoms much the same, so he was treated the 
 
 same way as was his brother. No further treatment needed 
 after six days. 
 
 Case No. 8. D. B., male, aged twenty-one years, (brother 
 of Case No. 7) taken with the usual premonitory symptoms of 
 typhoid fever. Had taken some cathartic pills on his own 
 notion. I gave him Nos. 1 and 2 and then No. 3 for five days 
 and he was well and able to do light work on the farm. I 
 let him eat anything and all he wanted. 
 
 Case No. 12. Ellen P., female, aged forty-four years. 
 Had been sick for three weeks with typhoid lever, under the 
 
188 REPORTS ON TYPHOID FEVER. 
 
 care of another physician. The family and doctor were 
 alarmed and were looking for perforation, or fatal haemor- 
 rhage. I advised R. No. 1 every half hour for one day, then 
 No. 3 every hour unless the patient was resting well. Gave 
 bromidia at night if patient did not sleep. Improvement from 
 the first dose of medicine. Patient sat up in bed on fourth day 
 of my treatment and was doing some of her own house- 
 work in two weeks. I insisted upon this patient eating 
 proper food regularly after the first week. Recovery com- 
 plete. 
 
 Case No. 13. Ef. R., female, aged twenty-three years. 
 Was taken with chills, fever ; had headache; backache; dysp- 
 noea ; nosebleed ; anorexia ; very dark, strong urine ; a little 
 blood passed from th e bowel. Temperature soon ran to 104.4° 
 F. I prescribed R. No. 1 with frequent alkaline sponge baths 
 and flushing of the colon every day with an alkaline wash. 
 After two days, I left R. No. 3, but the patient would not 
 take it to do much good. Gave very small doses with sugar 
 of milk, and was compelled to continue very small doses of 
 No. 3. Patient was up and walked to the dining-room on 
 the fourteenth day. Took a relapse, and was confined to 
 her room for ten days longer. Continued R. No. 3 in 
 small doses. Patient made a good recovery, but was some- 
 what fastidious about taking medicine, and of course I 
 could not call this an aborted case. 
 
 " Thus I have given a brief sketch of such cases as 
 would be a fair sample of those treated with the ' Wood- 
 bridge prescriptions.' The cases I failed to render 
 abortive, were those who had endeavored to treat them- 
 selves for one or more weeks, or those in which my 
 directions were not carried out according to orders. The 
 one fatal case was doubtless beyond all earthly help 
 when I was called." 
 
 On the 13th of August, 1894, I replied to a letter of 
 Dr. H. G. Chritzman, of Pennsylvania, giving a detailed 
 account of my method of treating typhoid fever. 
 
REPORTS ON TYPHOID FEVER. 189 
 
 He wrote me on the 20th of December, 1894, a letter, 
 from which I make the following excerpta : 
 
 "I have had eighteen cases of typhoid fever this 
 summer and fall. My last case was discharged well last 
 week. In none of these cases was there intestinal 
 haemorrhage, except the first, which I reported to you, 
 and none have died. 
 
 " The most of these cases were not wanting in 
 virulency. I have charts of most of them, and the num- 
 ber of days under treatment was from fifteen to twenty- 
 four. 
 
 " I find also that many of my patients had the dis- 
 ease a week or more before coming under my care. I 
 cannot agree with you in reference to the question of 
 giving patients solid food.* Temperature under your 
 method of treatment often becomes normal before the 
 ulcers are healed. Care, therefore, should be used in 
 the administration of solid food. I believe a perfectly 
 clean and normal tongue is the indication for solid food. 
 I found guaiacol exerts no disturbing influence on any 
 organ, except in a few cases. An irritable stomach re- 
 jected it, and those cases gave a little trouble for a 
 while. I believe your antiseptic treatment is the rational 
 treatment for typhoid fever. Under its influence the 
 course of the disease is greatly modified; tympanitis is 
 prevented, the tongue remains moist throughout the ill- 
 ness ; delirium is rare and the intestinal tract is placed 
 in the best possible condition for the healing of the 
 wounds. I am certainly thankful that I discovered your 
 articles in the 'Journal' 
 
 *The doctor has misunderstood me. I have never advised physicians to 
 allow typhoid fever patients " solid food." 
 
190 REPORTS ON TYPHOID PEVER. 
 
 I quote the following letter from Dr. Balmer, also of 
 Pennsylvania : 
 
 " I have treated a number of cases of typhoid fever 
 this summer by your method with remarkable success, 
 and will endeavor to copy the temperature charts and 
 send them to you soon. I presented these cases and the 
 method of treatment before The Jefferson County 
 Pennsylvania Medical Society at the last meeting, and 
 I had introduced it previously orally in the society, and 
 to individual members. Dr. S. M. Free, of Du Bois, Pa., 
 one of our members, is very enthusiastic; also Dr. J. J. 
 Brewer, of Clarington, Pa., who treated a number of pa- 
 tients by the method at my suggestion." 
 
 I very soon received a letter from Dr. S. M. Free, 
 dated the 26th of December, 1894 : " I have used your 
 plan of treatment in a few cases of typhoid fever. It is 
 the best I have ever employed. I have tracings and 
 fairly complete notes of my cases, and I am having my 
 assistant make copies, which I shall take pleasure in 
 sending to you as soon as completed. I trust that they 
 may be of some service to you, for I am under great 
 obligations to you for your great kindness to me. I 
 am thinking of preparing a paper for presentation to our 
 West Branch Medical Society on your plan of treat- 
 ment, and will exhibit my charts and notes. Do you 
 object to such a procedure ? I feel sure that the more 
 we can induce to use the treatment, the less will be the 
 mortality in typhoid fever." 
 
 A quotation from a letter from Dr. H. K. Meyers, of 
 Indiana, dated the 6th of January, 1895, is as follows : " I 
 carefully tried your mode of treatment in three well- 
 marked cases of typhoid fever, in the past few months, 
 and was well pleased with it. Case No. 1. Girl, aged 
 
REPORTS ON TYPHOID FEVER. 191 
 
 fourteen years. Very poor ; surroundings bad ; parents 
 as ignorant as they were poor, yet willing to do as I 
 directed. Temperature was from 104° to 105.2° F. ; 
 bowels tympanitic, and very tender ; rose spots ; tongue 
 literally dried up, and with red edges. During the first 
 three days the nose bled almost constantly. I tried to 
 carry out your treatment to the letter, and I think I suc- 
 ceeded, as near as any one can carry out another's 
 ideas. The temperature was normal on the eleventh 
 day ; she made an excellent recovery. I should have 
 stated that she had been sick a week before I was called 
 in. The other two cases were treated in the same man- 
 ner, and made good recoveries. While my success in 
 treating typhoid fever has been fair in the past, the fever 
 was always protracted and tedious. I think your treat- 
 ment is correct in principle, and is bound to succeed." 
 
 Dr. W. N. Sherman, of Merced, California, wrote me 
 August, 1894, asking for more definite rules for the manage- 
 ment of typhoid fever than I had given in my papers. These 
 directions were sent on the 13th of September and on the 
 29th he wrote me a letter from which I extract the fol- 
 lowing : "I have given your remedies in a modified form, 
 in two cases, resulting in a normal temperature in both cases 
 on the eighth day. I am highly pleased thus far." Other 
 letters followed reporting cases successfully treated, the last 
 on the 6th of February, 1895, in which he says : 
 
 "I am greatly pleased to inform you that I succeeded in 
 inducing my patient to take your remedy, and this third re- 
 lapse is yielding to the treatment promptly. As the bowels 
 were somewhat constipated, I first gave 5 grains of calomel, 
 followed by mineral water and sul. magnesia. These failed 
 to establish catharsis, and I gave 1 oz. of castor oil with tur- 
 pentine. I started with your combination No. 1 and kept it 
 
192 REPORTS ON TYPHOID FEVER. 
 
 up all the time, and this morning (the sixth day) the tem- 
 perature touched 98-8°, F. The patient has been able to sit 
 up all the time and is cheerful and comfortable, a very marked 
 contrast to the other attacks/' In another letter he kindly 
 says : 
 
 "You are at liberty at any time to use my name as 
 one who has proved and practiced your treatment and 
 believes it to be superior to all others." 
 
 Dr. G. Law, of Colorado, published a paper in the 
 Denver Medical Times of December, 1894, from which I 
 take the following extracts : 
 
 "Dr. John Eliot Woodbridge, of Youngstown, Ohio, 
 read a paper on typhoid fever in the Section on Practice 
 at the forty-fifth annual meeting of the American Medi- 
 cal Association, San Francisco, June 5-8, 1894. I was 
 present and heard the paper. . . . On looking over 
 the action of the drugs named by Dr. W., I came to the 
 conclusion that the carb. of guaiacol was the central and 
 efficient agent, if there were any efficiency in the pre- 
 scription. . . . Hence I framed a formula for my- 
 self. . . . From the 25th day of July up to to-day, 
 Nov. 23, I have treated thirty-five cases of typhoid fever 
 without losing a single patient. I have not had a case 
 in which the fever lasted beyond twenty days. I have 
 had a number of cases where complete subsidence of 
 fever had ensued at the end of fifteen days. 
 
 " Cases that started with a temperature of 104° F. in 
 the afternoon, after about four days of this treatment 
 showed usually an afternoon temperature of 102° F. and 
 a morning temperature of 100° to 101° F., with some 
 sweating, which usually occurred about midnight. Not 
 one of the thirty-five cases ever had a dry tongue at any 
 time ; not one of my cases manifested the slightest 
 delirium. It was not necessary to give any of these 
 patients anything for the purpose of securing sleep or 
 rest. Not a single relapse occurred in the entire num- 
 ber treated. 
 
REPORTS ON TYPHOID FEVER. \\v.\ 
 
 " The guaiacol compound was continued for one 
 week after the total subsidence of the fever, but given 
 every three, then four and, finally, every six hours. 
 
 " In none of the thirty-five cases was there noticeable 
 meteorism, or the slightest haemorrhage from the bowels. 
 During the last twenty-four years I have seen and treated 
 from twenty to fifty cases of typhoid fever each year. I 
 never before treated thirty-five consecutive cases without 
 losing a patient. I never before treated that number of 
 consecutive cases without a relapse. 
 
 u Typhoid fever during the present year (1894) in 
 our town has manifested about the usual characteristics, 
 with about the usual mortality, in the hands of practi- 
 tioners other than myself. I saw several fatal cases in 
 consultation with other doctors, but I did not regard 
 them as being suitable cases for the " Woodbridge 
 method of treatment," as they were almost, if not quite 
 in articulo mortis. 
 
 " I am not sanguine of the value of this treatment if 
 instituted late in the course of the disease, after the nerve 
 centers have become profoundly poisoned by the fever 
 toxin. I have made no secret of what I was doing with 
 reference to my work to my colleagues in our city. 
 However, only Dr. R. F. Graham seemed to attach any 
 importance to it. He has been giving the matter some 
 attention, and I thank him for his courtesy and will leave 
 him free to speak for himself at his own elected time. 
 I am aware that the bright and brilliant lights in the 
 profession have scouted the idea of there being any 
 efficiency in the plan of intestinal antisepsis, and I will 
 admit that it has not hitherto happened to be markedly 
 successful. But let me ask, is it not in line with the 
 present trend of so-called rational, not to say scientific 
 medicine. In conclusion, I am inclined to infer that 
 either I have had a remarkable and continuous sua 
 sion of mild cases, or the treatment on the lines of intes- 
 tinal antisepsis that I have steadily pursued during the 
 time indicated have been remarkably efficacious." 
 
194 
 
 REPORTS ON TYPHOID FEVER. 
 
 During the recent epidemic of typhoid fever at Lorain, 
 Ohio. I was called there in consultation with Dr. J. F. 
 McGarvey whom I found was treating the disease by my 
 method so scientifically, and so successfully, that I knew that 
 time would give the "Woodbridge method" at least one 
 more warm advocate on the shores of Lake Erie. The evi- 
 dence convinced him more promptly than I expected, and 
 now every few days he sends me the clinical chart of a pa- 
 tient in whose case he has aborted the disease. 
 
 io4p zn 1 n_j — ! — i 
 
 - '±\ -t +EET :: t 
 
 ' ,„. =E •■■£ 5- f "^Et^ :: E 
 
 103° — »==«^-y— 1 4 = ^i 1 -| — 
 
 =E= Efc \d=- a ^ ' :: 
 
 , n „„ -\ — *-. > ■* ■ c -- t 
 
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 DR. McGARVEY'S CASE ARCHIE K. 
 
 Your attention is invited to his chart marked, " Dr. 
 McGarvey's Case." 
 
 Dr. J. O. Yost, of Hazleton, Ohio, in whose family Dr. 
 Bennett treated with me three cases of typhoid fever last 
 autumn (see charts of Cases Nos. 92 and 96 — of the third 
 case no chart was kept) has contributed a chart of a re- 
 
REPORTS ON TYPHOID FEVER. 
 
 195 
 
 markable case, in which he reduced a temperature of 106° 
 to normal in ten days, when he reports the patient around 
 the house, covered with rose spots. 
 
 See Dr. Yost's case, marked Wm. McC. 
 
 1 — _ ._. = ._- 
 
 1106° --T 
 
 llllllHI+tt^PI 
 
 |l03° 
 
 — i— _4— 
 
 1040 tx h 
 
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 102° -H 1 «- 1 
 
 ttH PI 
 
 101 o q^ 
 
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 1 
 
 99° 1 
 
 f 98° 
 
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 Pttm 
 
 a 970 . 1 1 
 
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 ^IMS-T^-— ^ ■ - 
 
 
 ■'■ » \" 1 \ J, 
 
 $£/ T7> F7f ~x *i '> 
 
 ii ^'d^iJS ^2a.7 y h. 
 
 Dr. Yost's Case. — William McC: residence, Hazleton. Date of admission, 
 March 16, 1895. Commenced "Dr. Woodbridge's abortive treatment" Sunday 
 evening— the first day the patient thought the services of a physician necessary- 
 he had been complaining for five days before. Omthe tenth day he was covered 
 with rose spots, and about the house. 
 
 Dr. W. B. Shields, of Arkansas, under date of the 2d 
 of October, 1894, says : 
 
 "I have for some time past been keenly interested in 
 articles from your pen which have appeared in the Journal 
 
196 REPORTS ON TYPHOID FEVER. 
 
 of the A. M. A. in regard to treatment of typhoid fever. That 
 you have struck the correct treatment, I am further convinced, 
 not only by your own brilliant success, but by a very re- 
 markable run on four cases which I treated in September, 
 following your directions as nearly as possible. No one, it 
 would seem to me, with intelligence would question the treat- 
 ment after having tried it, especially with such testimonials 
 as you have presented from those who cannot possibly be 
 interested in your success. ... I think as you say, that 
 possibly your treatment could and may be improved upon in 
 the future, but not materially changed, and it will have to be 
 carried out on the same lines. ... I was an Interne in the 
 Memphis City Hospital nearly two years, and had a large 
 opportunity of treating typhoid fever with ammonia salycil, 
 but although it seemingly modified the disease, I have no 
 recollection of one case being cut short. I have been in 
 private practice for five years, and can't say that I have seen 
 any better results than in hospital practice, my cases all run- 
 ning from three to five weeks. These four cases I am just 
 through with, in two of them with morning temperature 102° 
 evening temperature 104° and 105° several times in the first 
 week, were free from fever at the end of the thirteenth day of 
 treatment and fifteenth day of disease. 
 
 "One other case with evening temperature 103.5° and 
 104°, several times was free from fever on the fifteenth day 
 of treatment and seventeenth day of disease. 
 
 "The last case had evening temperature of 104° and 
 105° several times, was free from fever on the seventeenth 
 day of treatment and twentieth day of disease. This 
 last case had such a bad attack, as to suffer with incon- 
 tinence of feces for several days. 
 
 "All of these cases felt strong at the end of the 
 fever, could walk around the house. 
 
REPORTS ON TYPHOID FEVER. 197 
 
 11 With my limited experience in this treatment, I have 
 to allow patients no solid food. I have used no coal 
 tar derivatives whatever, but had my patients sponged 
 off once or twice in the evening, on days when the 
 fever was high. As you said, after two or three days 
 of treatment their fever could be and was controlled by 
 the antiseptics administered. I feel that with further ex- 
 perience in this line I can have as good results as you 
 have. These few cases which I present, few in number 
 but brilliant in results, convince me that you have struck 
 the keynote and whilst begging your pardon for mono- 
 polizing your valuable time, I must return thanks for the 
 great benefit I have seen result from your teachings." 
 
 Dr. C. I. Burt, of Iowa, wrote me on the 10th of 
 December, saying: 
 
 " We are having an unusual epidemic of typhoid 
 fever in our locality. I have at present some thirty- 
 eight cases. Your antiseptic treatment was called 
 favorably to my attention to-day by Dr. Wright, of Car- 
 roll, Iowa, and he suggested that I write you for reprints 
 of your late articles on typhoid fever. Our source of 
 contagion is such that the physicians of this town will 
 yet have to contend with some hundred more cases." 
 
 Very soon after I received another letter (unfortu- 
 nately mislaid) in which the doctor complained of his 
 inability to secure the results I had promised, not- 
 withstanding the fact that I had written him a long 
 letter, giving him the fullest possible details of my 
 method of procedure, but on the. 22d of January, 1895, 
 I received another letter from which I make the follow- 
 ing extracts : 
 
 " I do not seem to get quite the promised result 
 from the tablets, in the nature of producing effect, as 
 
198 REPORTS ON TYPHOID FEVER. 
 
 stated in a previous letter, but am now having better 
 success, and I now push them to their limit. However, 
 I have at all times followed very closely your directions, 
 and must state that the effects have been wonderful. In 
 no instance have I failed in relieving my patients 
 within three weeks, and often in two. In that time, 
 understand, some of them were sitting up, others mov- 
 ing about, and in a manner attending to their usual busi- 
 ness. Many cases I commenced upon when the fever 
 reached the 103° and 104° point. Of course, they had no 
 serious intestinal lesion. However, when I discover the 
 matter has passed to an intestinal infection I yet obtain 
 splendid results. 
 
 " Now, this point is one to which I wish to call your 
 attention. Leaving out the abortive fact of your treat- 
 ment, what are your results after the case has pro- 
 gressed, even to haemorrhage ? I find, by pushing the 
 treatment then as persistently as at any other time, that 
 I obtain pleasant results, at least, a thorough intestinal 
 disinfection, and in fact, a general better tone. Without 
 doubt, Doctor, any one who uses your treatment, and as 
 effectually as described by your directions, nothing but 
 the most happy results will be the outcome. I have had 
 several nurses from Omaha, and one recently from the 
 Royal Infirmary from Dundee, Scotland, who is in this 
 country for her health (they are all noted typhoid fever 
 nurses), and let me tell you, they were absolutely para- 
 lyzed that a country doctor could produce such effects as 
 they had never seen in Omaha, or any city. They think 
 they will go home now, and treat typhoid fever on their 
 own account. They say the only objection they have to 
 this treatment is, that it cuts off their time in nursing. 
 In every instance I prescribe the full bottle, without eras- 
 
REPORTS ON TYPHOID FEVER. 199 
 
 ing formula or attached notices. My nurses fully under- 
 stand where the credit belongs." 
 
 Another letter from Dr. Burt, written on the 21st of 
 March, 1895, says : 
 
 " I am still using your treatment and novv obtain all 
 the results that you claim. I have a patient — one case 
 reinfected four times within 18 weeks — under my care 
 the last five weeks and strictly under your treatment. I 
 have avoided any high jumps of fever from 104° to 106°, 
 as had previously been the case. 
 
 " My patient is now convalescent, but if I stop the 
 treatment two days I note a rise of temperature, often 
 from 103° to 104°. I am not experimenting further on 
 this case, but rigidly keeping to the ' Woodbridge treat- 
 ment/ and the happiest results follow. I note that you are 
 to defend yourself. . . . It does not seem to me that 
 one ought to produce a defense in the line of argument; 
 if any of the gentlemen will permit themselves to follow 
 out your instructions and use your treatment there 
 would be no need of argument; they would all coincide 
 with your views. It is just as positive that typhoid 
 fever can be aborted by your method as it is that it can- 
 not be by any other treatment to my knowledge. 
 
 " I have had some sixty cases this winter, and there 
 has been no mistake in the diagnosis, as our eminent 
 local authorities have assisted me from time to time in 
 the diagnosis. I note that some physicians criticise the 
 fact that they can in no instance find the 'typhoid fever 
 curve ' in your records ; were they to do this, after using 
 the treatment a few days, the treatment then would be 
 useless ; the treatment is to prevent this curve. It docs 
 so, most satisfactorily. 
 
 " Most of my cases have been among the poorer 
 
200 REPORTS ON TYPHOID FEVER. 
 
 classes, and scarcely any attention was given other than 
 the medicine. I have lost one case, but that was not 
 under 'the Woodbridge treatment.' 
 
 " It may no doubt seem an exaggeration as to the 
 number of cases I have had and the happy results, but 
 every fact can be verified. I have not kept a presenta- 
 ble account of cases in children." 
 
 At the last 1894 meeting of the Mississippi Valley Medical 
 Association, I had read my paper on " typhoid fever," and 
 during its discussion, which occupied three hours, my theories 
 had been assailed in a most vindictive manner. Learned 
 professors and editors of medical journals had vied with each 
 other in making ungentle speeches. He who declared most 
 positively in his harangue the time-honored aphorism 
 "Typhoid fever must run its course of four, five, six, or ten 
 weeks or longer," was most loudly and emphatically cheered. 
 Of all the more than three hundred members in attendance, 
 not one voice was raised in behalf of the principle I have so 
 earnestly promulgated, or to give the slighest countenance 
 to the treatment which will ultimately save an hundred thous- 
 and lives annually in the United States alone. No man in 
 all that assemblage dared or cared to say that "typhoid fever 
 can be aborted" and to the end of the discussion I remained 
 the single and lone defender of this great and fundamental 
 truth that means so much to the human race. After the 
 session adjourned, I was introduced to Dr. Dalton, of St. 
 Louis, with whom I had had already some correspondence 
 and who had written me (after having tested my method of 
 applying antiseptic medicine to the treatment of typhoid 
 fever) that he had been six years at the head of the great 
 St. Louis City Hospital, through which 10,000 patients pass 
 annually and he regretted that he had not then known of the 
 "Woodbridge method." And Dr. Henry Clay Dalton 
 
REPORTS ON TYPHOID FEVER. 201 
 
 healed all the wounds which that three hours' debate had 
 given me, when he said; "lam very sorry that I was not 
 at hand when your paper was under discussion ; I would 
 have waited until those disputants had finished and then 
 would have said ; ' Gentlemen I would like to inquire how 
 many of you have used Dr. Woodbridge's treatment of 
 typhoid fever ? ' and when they admitted that not one of them 
 had (as they would have to do), I would have said : 'That 
 is about as I expected; you have been endeavoring to dis- 
 cuss a paper that you do not understand and a treatment 
 you have never tried.' I have investigated this matter and 
 know that the treatment will abort typhoid fever." Dr. 
 Dalton has in various letters to me indicated his entire 
 satisfaction with my therapeutic procedures, and has reported 
 so many instances in which he has applied them, as to give 
 assurance that the "abortive treatment of typhoid fever" in 
 St. Louis is in a master's hands. Quotations from his last 
 letter, written on the 25th of April, are as follows : " When 
 I first tried your treatment for typhoid fever, I was a 
 "doubting Thomas," but luckily the excellent result in the 
 first case caused me to try it in a number of other cases, and 
 I have not the slightest hesitation in saying that the treat- 
 ment undoubtedly aborts the disease. Two months since I 
 purposely allowed a typical case to run its course for eight 
 days, using the old treatment. The temperature followed 
 the general course, being a degree higher each evening. 
 On the eighth day, I put the young man (eighteen years of 
 age) on prescription No. 1, giving the powders every fifteen 
 minutes for the first twenty-four hours, and every half hour 
 for the next twenty-four hours. On the third day they were 
 administered every hour and on the fourth clay, every two 
 hours ; after that every four or five hours for a week. 
 
 When I commenced the medicine, the temperature was 
 
202 REPORTS ON TYPHOID FEVER. 
 
 103.5°. On the evening of the second day, it fell to 101°, 
 and in two days more it was entirely gone, never to reappear. 
 The bowels moved freely, six or eight times daily for several 
 days. Ptyalism did not appear. I used no other treatment 
 after commencing the powders. (Tablets.) Put me down 
 as a firm believer in the treatment, an enthusiast in fact. 
 Let the doubters try the treatment and be convinced. ,, 
 
 The original letters and reports from which these ex- 
 tracts are taken, and more than a thousand others on the 
 same subject, as well as the original charts (of which you 
 have been inspecting copies, many of them containing the 
 verification and signature of the physician who attended 
 the patient or who watched the results of treatment), are 
 over at my hotel, all of which I shall be pleased to have 
 you inspect. They contain much valuable information and 
 would well repay a careful examination. 
 
 I should like to have presented more of this unim- 
 peachable testimony, but the line has to be drawn some- 
 where, and these documents, with those I have already 
 transcribed for presentation before the Ohio State Med- 
 ical Society, should be amply sufficient to accomplish 
 their purpose, especially since through the courtesy of 
 Dr. Cunningham I have been able to exhibit the ana- 
 tomic specimens, showing the ulcerated Peyer's glands, 
 the tumefied mesenteric gland, and the intussusception 
 which caused the death of the patient; and with them 
 the clinical chart, kept at the bedside, in which the 
 thermic line as it approached normal, indicates that the 
 disease was aborted and the patient practically cured of 
 his typhoid fever on the seventh day of treatment. (See 
 chart marked Dr. Cunningham, Case No. 3.)* And 
 
 *The report of Dr. Cunningham's case No. 3 (James K.) was taken from this 
 paper to be reported to the Ohio Medical Society. 
 
 The report of this case after having been read in connection with this paper, 
 
REPORTS ON TYPHOID FEVER. OQH 
 
 if it be admitted that even one case of typhoid fever has 
 been aborted, the total fabric of those who dissent from 
 my views, reared as it is upon the antiquated and illogi- 
 cal hypothesis that this specific infectious, this " self- 
 limited, disease " cannot be aborted, is demolished. 
 
 The reports heretofore made by me should have left 
 no doubt as to the power of antiseptic medicine, nor do 
 I believe they would have done so, could all or even 
 two or three of the dozen papers I have written on this 
 all important subject during the last few years, have 
 been listened to and deliberated upon by one body of 
 scientific men. They have, however, been so much 
 diluted by their great distribution (having been read 
 before so many widely separated societies, from the At- 
 lantic to the Pacific) that very few physicians have heard 
 more than one discussion of the subject, but when all 
 these papers are gathered together and published under 
 one cover, what Virchow calls " the brutal force of fig- 
 ures" cannot but convince any thinking and unpreju- 
 diced physician " That typhoid fever can be aborted." 
 " Bis ac ter, quod pulcrum." 
 
 Summarizing, you have my nineteen years of fairly 
 satisfactory clinical experience with the method I have 
 advised ; the last thirteen years without a death in my 
 own practice from typhoid, malarial, or any continued 
 fever, and as long practice added to my proficiency, a 
 gradual reduction of the duration of the disease, as well 
 as a lessening of the intensity and violence of the symp- 
 toms. 
 
 was presented and the anatomical specimens exhibited before the Ohio State 
 Medical Society, in the transactions of which it will be published. This double 
 report is fully justified by the rarity of the case, no other instance having ever 
 come to my knowledge in which death has ensued after typhoid fever had been 
 aborted, and because of its great value since it establishes the truth of my 
 theories beyond question or cavil, in the court of final resort. 
 
204 REPORTS ON TYPHOID FEVER. 
 
 You have the 800 cases, with nine deaths, reported by 
 117 other physicians, some of whom have treated large 
 numbers — as many as sixty cases through severe epi- 
 demics, without a death — approximating my best results, 
 and showing a grand total of 1,200 cases, taken at all 
 stages of the disease, with only nine deaths, seven or 
 eight of which were clearly due to grave complications, 
 to the late stage of the disease at which treatment was 
 commenced, or to faults of preparation or administra- 
 tion of the remedies. 
 
 The foregoing is a brief summary of the (at present) 
 voluminous and cumulative evidence ; absolutely apo- 
 deictic as to the possibility of aborting typhoid fever ; 
 strongly presumptive as to the truth of the declaration 
 that every case of the disease " can be aborted, and that 
 death is a wholly unnecessary consequence," and more 
 than competent to convict me of grave dereliction of 
 duty, did I not impart my theories to the medical pro- 
 fession in unmistakable language. 
 
TYPHOID FEVER.* 
 
 Gentlemen of the Mitchell District Medical Society : 
 
 I thank you for your invitation to come so far to ad- 
 dress you. I fully appreciate the honor you have thus 
 conferred upon me, and I accept it as an earnest of your 
 interest in and anxiety to learn more of the strange the- 
 ories which I have promulgated. I presume that you 
 wish to know wherein my practice differs from that to 
 which you are accustomed, as having been taught in the 
 best medical colleges, and what it will accomplish, what 
 caused me to discard the long cherished dogmas of my 
 profession ; upon what substratum of fact my theories 
 stand, and by what evidence they are supported. 
 
 Since the year 1880, and especially during the past 
 two or three years, I have presented such a redundancy 
 of absolutely apodeictic evidence that "typhoid fever 
 can be aborted," that any allusion here to that part of 
 my subject may appear supererogatory ; but the medical 
 profession, and through it the world at large, has become 
 so thoroughly imbued with the reverse opinion and the 
 sentiment expressed in the phrase, " Typhoid fever must 
 run its course," forms so conspicuous a part of the medical 
 literature of thisage — extending its baleful influence every- 
 where— that it teaches the physician to regard the Ion- 
 weeks of a living death, through which the victims of this 
 disease must, under the "old regime," pass on a journey 
 
 "Written for the Mitchell District Medical Society, West Baden Mineral 
 
 Springs, Ind., July, 1895 (not read). 
 
 205 
 
206 TYPHOID FEVER. 
 
 which he can neither arrest nor guide nor select the final 
 halt ; as a period in which his own uselessness is so ap- 
 parent that not only he exalts the nurses' and degrades his 
 own sphere ; but the patient, if he have sufficient conscious- 
 ness, and the friends, also, learn to place a higher es- 
 timate on the services of the nurse than upon the skill of 
 the physician. 
 
 Indeed, the denunciation of Mephistopheles in Faust, 
 
 " Of medicine the spirits caught with ease 
 The great and little world you study through, 
 That things may then their course pursue 
 As Heaven may please," 
 
 is but slightly, if at all, at variance with the teachings 
 and practice of the mass of the medical profession, and 
 it can scarcely be condemned for its severity when ap- 
 plied to the "symptomatic treatment of typhoid fever.' 1 ' 
 This may seem an unjust arraignment of the medical 
 profession, but I know of no professor of the "Principles 
 and Practice of Medicine " in any medical college in the 
 whole civilized world, who teaches that it is possible to 
 "abort typhoid fever." Nor do I know of any medical 
 text -book which directly or by implication admits that such 
 a result is obtainable, or does not educate its pupils to 
 put their faith in the apochryphal dogmatisms of an age 
 entirely ignorant of the pathogenesis of the disease. I was 
 told that the distinguished French Professor, Bouchard, 
 taught that " typhoid fever could be aborted," but in his 
 latest work I find that he denies the possibility of at 
 once destroying the pathogenic agent. He says that 
 " we must reckon with the fever," and adds : " We are 
 here in the presence of a continued fever, which is with- 
 out intermission destroying the patient for weeks." 
 Moreover, the recent appearance in his own country 
 
TYPHOID FEVER. 207 
 
 of an exhaustive work on typhoid fever (La Fievre 
 Typhoide) in which rational (antiseptic) treatment is 
 most unintelligently discussed, and the Brandt method 
 lauded, would seem to indicate that even the very con- 
 servative teaching- of this distinguished professor has 
 not met with the welcome to which it is entitled among 
 his own people. 
 
 Notwithstanding all of this positive testimony to the 
 contrary, the fact that I have been " aborting typhoid 
 fever " can be questioned only upon the hypothesis that 
 all of the patients whom I have treated for " typhoid 
 fever" since 1882 (and nearly all since 1876) were the 
 subjects of mistaken diagnoses ; that during all the in- 
 tervening years I have happened to have only " mild or 
 abortive cases of typhoid fever ; " that I have had no 
 typhoid fever at all to treat ; that all of the physicians 
 who have confirmed my diagnoses were mistaken ; that 
 all of the physicians who have called me in consultation 
 to see cases of typhoid fever were incompetent ; that all 
 of the 123 physicians who have reported about 900 cases 
 have been in error when they supposed that they were 
 " aborting typhoid fever ; " that virtually all of the (partly 
 estimated) 1300 cases of typical typhoid fever treated 
 antiseptically happened to have been some other disease, 
 because they recovered in a few days ; that in the worst 
 epidemic of typhoid fever of which I have any knowl- 
 edge, all of the cases taken sick within eight days before 
 my arrival, happened to be exceedingly mild, while those 
 who were ill earlier or later were exceedingly severe, 
 and, finally, that this antiseptic treatment for typhoid 
 fever is practically applicable to the cure of some occult 
 disease so like typhoid fever, that not myself only but a 
 large number of physicians supposed to be competent 
 
208 TYPHOID FEVER. 
 
 diagnosticians, have been unable to make a differential 
 diagnosis between them. The hypothesis is absolutely- 
 untenable and its indefensibility will be rendered more 
 apparent by a brief history of my work. 
 
 On the 29th day of August, 1876, I was called to at- 
 tend the young daughter of the President of the First 
 National Bank of Youngstown, Ohio. She presented 
 well-marked symptoms of typhoid fever, and on my 
 second or third visit I made a diagnosis in accordance 
 with the indications. In a very few days the patient 
 was well. In the meanwhile, a young son had also been 
 attacked and presented exactly the same symptoms. I 
 have no complete record of this case, but it is indelibly 
 impressed upon my memory as the severest, long-con- 
 tinued case of typhoid fever I have ever treated. His 
 temperature reached 107° F. It was 106° several times 
 and it rose above 105° every day for weeks. His wild 
 delirium and incoherent ravings were piteous, indeed ; 
 his extreme exhaustion, extending over a long period of 
 time awakened the keenest anxiety. The long weeks 
 during which he lay on the very verge of the grave was 
 a time of weary watching for his parents and friends and 
 especially for his physician. In compliance with • the 
 earnest solicitation of his parents I slept in the house 
 for weeks, to be near at hand in case of emergency. 
 During his early convalescence his craving and begging 
 for food were sorrowful to hear, and when he finally 
 crawled out of bed he was so emaciated that his lips 
 would cover neither his teeth nor gums, and his old 
 vigorous boyhood seemed a long way off when, on the 
 27th day of December, after 120 days of sickness, and 
 then scarcely able to walk, I discharged him cured (if 
 that may be called a cure in which the constitution has 
 
TYPHOID FEVER. 201) 
 
 been destroyed, stalwart youth converted into almost 
 helpless debility, and the functions of some of the or- 
 gans, perhaps, permanently deteriorated). I felt more 
 pride (so strangely is the human mind formed) in look- 
 ing on that almost total wreck of a young life than I 
 would to-day on a dozen severe cases which were re- 
 stored to perfect health in ten or twelve days. 
 
 During the illness of this young man, another son 
 and two servants of the house had very severe attacks 
 of the disease. The father and still another son pre- 
 sented the same characteristic symptoms of typhoid 
 fever, but they recovered in longer or shorter periods, 
 and these were undoubtedly "abortive" or "aborted" 
 cases of typhoid fever, such as present themselves to 
 every practitioner who treats many cases of the disease. 
 
 These cases, all occurring in one house, exhibiting all 
 grades of violence, from the most pernicious type con- 
 sistent with ultimate recovery, down through all of the 
 gradations, to the "abortive type" in so mild a form as 
 to render a precise diagnosis impracticable, awakened a 
 deep interest in my mind and led me to wonder why, if 
 nature could give complete immunity from all evil and 
 deleterious effects of the poison of typhoid fever to 95 
 per cent of those exposed to its malign influence, 
 why should not the science of medicine aid her by curing 
 the insignificant few which she fails to relieve. 
 
 It seems to me a ridiculous and presumptuous as well 
 as an illogical position which the medical profession as- 
 sumes in recognizing the power of nature unassisted, to 
 abort typhoid fever by giving this name, "abortive type, ' 
 a place in the nomenclature of diseases, and then to delic- 
 to all medicine the potentiality to assist her a little in her 
 endeavor. Nature's work is thereby accepted, given an 
 
210 TYPHOID FEVER. 
 
 appellation and an honorable place in the list, while man, 
 going a step farther and doing for all cases that which 
 nature does for a few, and regardless of the erroneous 
 teachings and moss covered prejudices, applying the right 
 name to his work at the expense of the destruction of 
 what has always been considered awell-established axiom, 
 is looked upon as an iconoclast. 
 
 Ten years before the occurrence of the above men- 
 tioned incidents, I had given much thought to the appli- 
 cation of antiseptic medicine to the cure of microbic dis- 
 eases, and had in 1866-7, treated a few cases of cerebro- 
 spinal meningitis and erysipelas with the sulphites, with 
 no very wonderful results, truly ; but since, theoretically, 
 antiseptic medicine offered the only hope for the misera- 
 ble beings who are the prey of typhoid fever, I turned 
 all of my attention to this field of investigation, and very 
 soon had abundant opportunity to study the disease 
 clinically and to test my theories. The narrative of my 
 failures or partial successes with all of the various agents, 
 from turpentine and the sulphites to iodine, which were 
 one after another used and abandoned, would be a 
 waste of time and space, and would I fear exhaust the 
 reader's and hearer's patience, although it might save 
 future explorers the trouble of testing unreliable anti- 
 septics. The only one of these earlier remedies which I 
 still occasionally use is turpentine. Creosote has been 
 displaced by its active principle, guaiacol, and that by 
 the more potent and nontoxic guaiacol carbonate. It 
 was long before I dared to use the saline or vegetable 
 cathartics, on account of the strong condemnation of them 
 by some of the best authorities, notably Harley in " Rey- 
 nold's System of Medicine," who says " the vegetable 
 and saline cathartics must never be employed in the 
 
TYPHOID FE VER. o \ \ 
 
 treatment of the disease at any period ; . . . calomel 
 should be avoided ; its action is too irritant." I consider 
 this the worst advice that could possibly have been 
 given. Were I limited to two remedies in the treatment 
 of typhoid fever, I should select one of these despised 
 drugs for one of them. Yet the article was written by 
 a most eminent and trustworthy writer; by one who had 
 had large experience in the London fever hospitals, and 
 I had not at first the courage and fortitude to ignore his 
 advice, but in the end I became thoroughly dissatisfied 
 with all of these other medicaments ; so I began using 
 exceedingly minute portions of the mildest of the salines 
 and mercurials, and as continued observations added to 
 my perception of the great importance and assistance they 
 would eventually be to me, I began to use all of them 
 more heroically. 
 
 While learning my lesson in the dear school of ex- 
 perience, I saw many melancholy and calamitous scenes, 
 one of which is ineffaceably engraved upon memory's 
 tablet. A brilliant and beautiful young school girl had 
 an exceedingly distressing and unique attack of typhoid 
 fever. I was first called to see her at 10 o'clock A. M., 
 and was told that she had felt as well as usual in the early 
 part of the morning, and had attended to some light 
 household duties. Her temperature was 106° F., her 
 pulse bounding and 160, her face flushed. She com- 
 plained of an intense headache. I attempted no 
 diagnosis at that time, but prescribed the medicine to be 
 given, and left the house to find my uncle, Dr. Timothy 
 Dwight Woodbridge, a gentleman of unusual ability and 
 more than half a century of experience in the practice of 
 medicine. He has since deceased. On returning to 
 the house we found her temperature 107°, pulse uncount 
 
212 TYPHOID FEVER. 
 
 able, and she had become absolutely unconscious. Dur- 
 ing her illness she had repeated haemorrhages ; was ill 
 nine weeks ; asthenia so pronounced that on returning 
 one evening I found the nurses (two nuns) and all of the 
 relatives and friends sitting around the large room, 
 waiting for her to breathe her last breath. My ques- 
 tions were answered with the statement that she had been 
 lying as I now saw her, apparently lifeless, for several 
 hours. Nictation had become so infrequent that the con- 
 junctivae were dry and glazed. No respirations were per- 
 ceptible ; the heart beats were inaudible, and she was to 
 all appearance dead. The nurses did not think that she 
 ought to be tortured any longer to prolong a life which 
 could not possibly be extended many hours. I immediately 
 resorted to every known means of stimulation, and had the 
 satisfaction after several hours to see her breathe deeply 
 once more, and half an hour later swallow a few drops of a 
 mixture of brandy, ammonia and water. She finally re- 
 covered, but was unable to continue her studies. She felt 
 that her mind was gone and she wished she was dead. 
 
 I did not feel so proud and so much elated over my 
 work after hearing her sad remark as I had a few months 
 before, when I had discharged her, cured (?). During her 
 illness, her mother and sister both had mild attacks of 
 typhoid fever, which I think were greatly modified, if not 
 actually aborted by antiseptic treatment. 
 
 A succeeding six years passed. My patients continued 
 to have intestinal haemorrhage, and three died after that 
 accident; but I was groping blindly through the black 
 night of ignorance to the dawn of a brighter day. 
 
 I learned to exhibit my antiseptics more intelligently, 
 and to add one ingredient after another to my prescriptions, 
 eliminating such as seemed to accomplish no useful pur- 
 
TYPHOID FEVER. 213 
 
 pose. I could see that although I was not cutting the dis- 
 ease off entirely, I was having better results, both in a 
 lower death rate and a shorter duration of illness. Even 
 in those cases that ran a tedious course, my patients 
 showed the effect of the better treatment in that they had 
 less delirium ; a generally lower temperature ; less tym- 
 panitis ; very little troublesome diarrhoea ; a good condi- 
 tion of the nervous system, evidenced both by the lack of 
 severe symptoms and also by the fact that they slept well ; 
 by a good pulse ; a moist tongue ; by a general feeling of 
 comfort; and above all, by rallying rapidly. Health was 
 quickly regained, with strength and hearty appetite. All 
 of these things had been seen over and over again for 
 more than twelve years before I dared to announce to my 
 profession that "typhoid fever could be aborted," and then 
 not till I had satisfied myself that every typical case which 
 came under my care as soon as a diagnosis was practicable 
 could be aborted in ten or twelve days or less, and that in 
 cases in which treatment was begun too late to abort the 
 disease, it could be so modified in its course as to leave no 
 doubt on the mind of any unprejudiced man capable of 
 drawing correct conclusions from given facts, that I could 
 do all that I promised, that I was satisfying every ex- 
 pectation awakened by my most favorable prognoses. 
 
 With the white light of professional jealousy turned on 
 my work and every penny-a-liner and psilologist writing in 
 defense of the well-nursed dogmas of the days of yore, 
 with the medical profession and the people watching me, 
 with the knowledge that I have always courted the fullest 
 investigation of my work and that I have always held my- 
 self in readiness to have the experimentum cruris applied 
 to my theories in hospital or in private practice, at home or 
 abroad, these facts should be regarded as final and decisive 
 
214 TYPHOID FEVER. 
 
 proof that " typhoid fever can be aborted ; " leaving out of 
 consideration the extreme folly of which one would be 
 guilty, who would, without the most indisputable ground of 
 belief, or indeed of positive knowledge of the invulnerable- 
 ness of his role, take issue with those who from time imme- 
 morial have maintained utterly antagonistic ideas. It must 
 be quite clear to the most casual observer of the trend of 
 medical thought that if all this could not have been done, I 
 would have been driven from my place in the medical pro- 
 fession as an impostor long ago. 
 
 It was fortunate for me however, that a little army of 
 brave men, a forlorn hope, in defiance of the ridicule they 
 must face, if in the end it should appear, that all the great 
 master minds of the medical profession are right, and I am 
 wrong, and that typhoid fever cannot be aborted; have 
 written me, declaring their perfect conviction of the correct- 
 ness of my teaching. Some of them in giving in their ad- 
 hesion to the treatment, have deliberately used language as 
 strong as that which I have been so severely criticised for 
 uttering in the heat of debate. In extenuation of their faults, 
 and of mine, this plea should be allowed, that when a phy- 
 sician has for years treated typhoid fever symptomatically 
 with the usual results ; has seen his patient pass from a 
 bad state to a worse one ; has exhausted his resources in 
 futile attempts to mitigate the horrors of his condition, sees 
 him drifting to the great "beyond," and himself and all other 
 agencies, powerless to impede his passage, and has then 
 learned to so utilize antiseptic medicine, as to be able to meet 
 the fell destroyer with such power to cope with the enemy 
 as to assure always an easy victory ; it arouses in the most 
 sluggish intellect, some enthusiasm. But when he sees that 
 he may take charge of a patient, with a temperature of 
 105°, or 106°, with all the other symptoms correspondingly 
 
TYPHOID FEVER. 
 
 215 
 
 bad ; and with perfect confidence that he is awakening no 
 false hopes, by assuring the patient and his friends, that 
 there is no danger of death, but that after a brief illness, at- 
 tended by little discomfort, he will be able to resume his 
 ordinary occupation, with all his faculties normal, and his 
 
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 Taken from Murchison.] 
 
 strength little if at all impaired ; he ma)', I think, be excu >ed 
 for discussing the subject without much regard to eu- 
 phemism, especially when he has been pestered by the criti- 
 cisms of those who seem to know little of the pathology ol 
 the disease, and less of its antiseptic treatment. 
 
216 
 
 TYPHOID FEVER. 
 
 I have exhibited all of the clinical charts that have been 
 sent me by these physicians, and related the bedside his- 
 tories of my own typical cases so frequently in the various 
 societies in which I have read papers on typhoid fever, that 
 their appearance must be familiar to every one who has 
 been in the habit of attending- these meetings, and so I have 
 
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 The above chart shows the average highest daily register of the temperature of cases of 
 typhoid fever which were treated by the abortive method. The number of cases incduded in the 
 daily averages is shown at the bottom of the chart. It should be noted that after the fifth day of 
 treatment a certain number of patients were discharged each day with a normal temperature 
 and the average is always of cases which are left uncured, hence the thermic line does not 
 delineate the effect of treatment as favorably as it would were the record of the entire number 
 carried to the end. 
 
 decided to give a synopsis of the well-thumbed charts in one 
 which will give the thermic line of the daily average of all 
 the patients which I have treated by my method, so far as 
 I have complete records, 122 in all, . . . and I present 
 with it a chart of a severe case of typhoid fever, giving the 
 thermic line after Wunderlich, copied from Murchison. 
 
TYPHOID FEVER. 217 
 
 I regret that I have such incomplete memoranda, which 
 is due to the fact that a great many of the physicians who 
 have reported their general results with the abortive treat- 
 ment in 900 cases, sent no charts, and of my own cases, I 
 kept few complete records prior to 1893. 
 
 A comparison of these charts will show you at a glance 
 the effect of antiseptic medicine, and yet, not all of its effect. 
 
 The tracing of Wunderlich conveys no idea of that which 
 is known as the typhoid state. It does not show the patient 
 in his rambling delirium, with a burning fever and a parched 
 tongue ; with the necrosed and ulcerated Peyer's glands, 
 with the enlarged spleen and the tumefied mesenteric glands, 
 with the enormous tympanitic distention ; with the not in- 
 frequent accidents of intestinal haemorrhage and perforation 
 or the grave complications and the fatal termination. Nor 
 does the thermic line in my chart show as I wish it might 
 do the absence of all of these hideous symptoms and com- 
 plications. 
 
 If it could present the picture in its true coloring the 
 patient would be found three or four days after the institu- 
 tion of efficacious antiseptic treatment, with all of these 
 graver symptoms in abeyance, free from ache or pain ; sleep- 
 ing the sleep of health ; hungry for food which the system 
 is quite capable of assimilating ; anxious to take outdoor 
 exercise which is always allowed as soon as it is certain 
 that there will be no necrosis of Peyer's glands. In fact, in 
 all respects a perfectly comfortable invalid who will be; ready 
 to resume the active duties of life, with the strength and all 
 of the mental faculties unimpaired, as soon as the tempera- 
 ture has touched normal and remains there. 
 
 Assuming that the medical profession has recovered 
 from the shock occasioned by my first modest announce- 
 ment " that typhoid fever can be aborted" and "that (hath 
 
218 TYPHOID FEVER. 
 
 is a wholly unnecessary consequence of the disease ; " I 
 wish to open up to-day a new field of discussion, a fruitful 
 field, which I have cultivated and gleaned as carefully as the 
 limited means at my disposal would permit, and to which all 
 of my papers on "typhoid fever" have been but a prelude. 
 
 I allude to the application of the same general principles 
 which govern the antiseptic treatment of typhoid fever, to 
 the cure of a large class of the so-called "microbic diseases " 
 such for instance, as diphtheria, scarlatina, pneumonia, chol- 
 era infantum, la grippe, smallpox and probably many dis- 
 eases of which I have no practical knowledge. 
 
 As far as my experience can be relied upon as a criterion, 
 it seems to indicate that a very considerable number of the 
 diseases which are supposed to be of microbic origin yield 
 far more readily, cause much less anxiety and suffering, and 
 no impairment of the constitution, are accompanied by fewer 
 and much less grave complications, and are followed by a 
 much lower death rate under a judicious antiseptic treat- 
 ment than by any other known method. 
 
 For these reasons alone, antiseptic medicine should com- 
 mend itself most highly to the medical profession. It has 
 however other charms which endear it to my heart, promi- 
 nent among which is its benignity, it being so harmless that 
 I know of no pathological state at all resembling any of 
 these conditions in which any one or more of the, ingredients 
 that constitute my armamentarium, would do the slightest 
 injury to the most feeble patient, were a dozen doses admin- 
 istered at once. 
 
 This statement must sound strangely paradoxical to the 
 gentlemen who have been seeking for antiseptic remedies 
 among the most virulent and dangerous poisons known 
 to toxicologists. It is difficult to understand just why this 
 rash and pernicious practice should have become so com- 
 
TYPHOID FEVER. 219 
 
 mon among a certain class of physicians whose remedies 
 unquestionably often placed the lives of their patients in 
 greater jeopardy than did the disease; and I have no 
 doubt you all know of cases of typhoid fever, diphtheria and 
 other maladies which owed their fatal ending, not to the ail- 
 ment, but to the corrosive sublimate or other poisons ad- 
 ministered. Those who pursue this senseless course, do so 
 under a mistaken idea that human life and germ life are 
 governed by the same laws. It is well known that many 
 bacteria are destroyed by substances which are entirely in- 
 nocuous to man, and that others are unable to live in the air 
 we breathe. A notable instance of the former class is the 
 "hematozoa malariae," which although found circulating in 
 the blood and permeating the spleen and other organs, are 
 quickly eliminated by doses of quinine so small as to pro- 
 duce no other appreciable effect. 
 
 In. the treatment of zymotic affections, it may be and 
 probably is not necessary to kill all, or possibly any of the 
 germs which cause the disease ; some respect should be 
 paid to the "vis medicatrix naturae" and in arranging our 
 line of battle, we should give due consideration to the fact 
 that in man the protective alexins need little aid to guard 
 him from all ill effects from germic attacks, and if we but re- 
 inforce them by weakening the enemy, we will have done all 
 that is requisite. 
 
 But little as seems to be demanded of us, it must be 
 remembered that typhoid fever has through all time resisted 
 successfully, not antiseptic treatment alone, not the feeble 
 efforts of the weaklings only, but all of the resources of the 
 giants of the profession ; and no one must imagine that he 
 who would abort this masterful disease will have an easy task, 
 or without especial training will be invariably successful. 
 
 Notwithstanding my nineteen years of careful study and 
 
220 TYPHOID FEVER. 
 
 experience, despite my unremitting vigilance; my care that 
 every remedial agent exhibited was pure, active and prop- 
 erly prepared, I have made so many mistakes, that in look- 
 ing back only a very few years, I can see that "vigilance" 
 stands not least among the causes that have saved me 
 from having a death from typhoid fever for more than thir- 
 teen years. 
 
 I therefore insist that it is but just that in any future 
 measurement of the value of the treatment I advise ; that 
 these facts should be given due weight, and that one suc- 
 cessful abortion of the disease should counterbalance an 
 hundred failures ; for example, the twenty-five cases of 
 typhoid fever aborted by Dr. Reed are of more worth as 
 evidence that the disease can be aborted, than would be 
 2,500 failures as evidence that his results were impossible. 
 Although up to the present time, there have been very few 
 failures reported to me, and but two condemnations of the 
 " Woodbridge treatment " from that cause, it must not be 
 expected that the reports will always be so one sided. 
 
 It is greatly to their credit that so many physicians have 
 succeeded so well, under the brief outline of treatment that 
 I have been able to give ; and although I shall in a few 
 weeks publish a treatise on" Typhoid Fever and its Abortive 
 Treatment" in which I shall give the management of the dis- 
 ease in detail, and shall make an effort to tell all I know on 
 the subject, I shall be greatly surprised if, after the medical 
 profession in general attempt to follow my directions, there 
 are not reported many failures to secure satisfactory results. 
 
 I believe there are two ways in which the " Woodbridge 
 treatment" of typhoid fever and allied diseases, in all of its 
 minute details can be fully imparted, and that is by clinical 
 teaching in consultation or by clinical lectures. By the 
 former method I have already made a few physicians abso- 
 
TYPHOID FEVER. 221 
 
 lute masters of the disease, and as soon as I can encompass 
 it I shall, either at home or abroad, open a hospital in which 
 I will teach those who honor me with their attention, 
 not the " abortive treatment of typhoid fever" only, but the 
 application of antiseptic medicine to the cure of some of the 
 most dreaded of the zymotic diseases. 
 
TYPHOID FEVER AND ITS ABORTIVE 
 TREATMENT.* 
 
 Gentlemen of the Society: 
 
 You who were present at the last meeting of this Asso- 
 ciation at Hot Springs a year ago ; heard your most dis- 
 tinguished members flood that great hall with their elo- 
 quent speeches in denunciation of my declaration that 
 typhoid fever could be aborted; heard my silver-tongued 
 friend on the right declare that typhoid fever " must run its 
 course of four, five or six weeks or longer, uninfluenced by 
 any known drug;" heard the peroration of that other gen- 
 tleman when he argued that because my cases were aborted 
 they were mistakes in diagnosis, heard all of these im- 
 passioned harrangues, which were received with ovations 
 of applause, and despite the fact that there were more than 
 300 members in attendance, so many of whom were 
 anxious to join in the discussion that your President was 
 at last forced to peremptorily close the debate, when not 
 one voice was raised in behalf of my theory, you may 
 imagine that I met with, in your society, an unique recep- 
 tion. This is not so. I have presented reports of aborted 
 cases of typhoid fever before a large number of medical 
 societies, and my experience justifies the conclusion that 
 the same declaration would be met with a like greeting if 
 read before any gathering of well-informed medical men, 
 anywhere in the world, and that your orators simply 
 showed themselves well versed in the literature of the sub- 
 
 *Read before the Mississippi Valley Medical Association, Detroit, Michigan, 
 September 4, 1895. 
 
ABORTIVE TREATMENT. 223 
 
 ject, a blind guide which they may be excused for follow- 
 ing until it has been rewritten. 
 
 With this object in view, the first query would be : Is 
 the ancient assumption of the medical profession that 
 "typhoid fever cannot be aborted," in defense of which so 
 much eloquence has been expended; is this belief really 
 sustained by our present knowledge of bacteriology? More 
 than two centuries have elapsed since, in 1673, the 
 microscope was, by Leeuwenhoeck made to show living 
 germs in the alvine dejections, and therapeutists have had 
 ample time to profit by the discovery ; but is any one 
 ready to say that the accepted treatment of typhoid fever 
 in this year, 1895, is more scientific than it was when in 
 1864 I sat so long, so many weary hours, over the micro- 
 scope, studying cell development and cell metamorphosis, 
 of which we then knew so little. Giant strides have been 
 made in the science of bacteriology since a dignified pro- 
 fessor and your humble servant on one bright Sunday morn- 
 ing in the latter year, trundled heavy scales through the 
 streets of Cleveland, down into the basement of the court 
 house, to weigh the body, the liver, the spleen and other 
 organs of a man (who had been shot down in the vigor 
 of manhood and health) and carried away other portions 
 of them for microscopical examination. We realized then 
 that the microscope would reveal to us new worlds of 
 which we had not even dreamed. 
 
 We sought then in the sputa and the lung for the cause 
 of tuberculosis; in the urine and kidneys for nephritic 
 derangement; in the buccal cavity, the blood, the feces 
 and the intestines for the pathogeny of typhoid lever; and 
 in the blood, perspiration, etc., for what Laveran has since 
 found, the hematozoa malariae. (A year or more later tin- 
 above mentioned professor published a treatise on his 
 
224 TYPHOID FEVER AND ITS 
 
 microscopical studies of typhoid and malarial fevers, tuber- 
 culosis, etc., so that our investigations did not quite go for 
 naught.) 
 
 Bacteriologists have delved for the origin of typhoid 
 fever in microbic fields more industriously and successfully 
 than the general practitioner could possibly have done, and 
 they are undoubtedly entitled to the most honorable men- 
 tion for the noble, far-reaching and promising issue of their 
 bewildering and arduous task. 
 
 Escherich, who first described the bacillus coli communis; 
 Eberth and Koch, who each independently of the other, 
 discovered the mobile rods, with their thin, viscoid coating, 
 since known as the bacillus typhosis or the bacillus of 
 Eberth ; Gaffky, Klebs, Friedlander, Meyer, Fischl, 
 Browitz, Sokolof, Klien, Recklinhauser, Brieger, who iso- 
 lated and described typho-toxin ; Pfieffer, who has proba- 
 bly come nearer than any one else to an actual demonstra- 
 tion of the pathogenic nature of the bacillus typhosis ; and 
 a host of others, including our own Sternberg, form a 
 galaxy of stars whose names and deeds will live forever. 
 
 The revelations of their microscopes followed each other 
 in quick succession. Sometimes it seemed as if the patho- 
 genesis of typhoid fever were truly written ; but the appar- 
 ently fixed fact of to-day became the moot question of to- 
 morrow. 
 
 The germ, to whose presence in man is accredited, by 
 one observer, the most dread disease, is by another taken 
 with impunity. That which was supposed to cause a path- 
 ological state, is found to be the prime factor in its cure. 
 What was supposed to be harmful is found to be beneficent. 
 The bacillus typhosis — the bacillus of Eberth — has been so 
 long and so generally accepted as the cause of the disease, that 
 the wisdom of questioning the proof may be well impugned, 
 
ABORTIVE TREATMENT. 225 
 
 but the characteristics of this microbe and those of the 
 bacillus coli communis are so interwoven with each other; and 
 the signs that have been supposed to be pathognomonic of 
 one or the other, have been found in so many instances to 
 be common to both, that it is impossible to ascertain any 
 unequivocal evidence that the bacillus typhosis may not be 
 the bacillus coli communis virulized by some occult poison. 
 
 If then, in this year 1895, after all of the deep researches 
 of these studious painstaking and expert scientists and 
 scholars, we are still without such exact data as would war- 
 rant us in giving a name to the pathogenic agent of typhoid 
 fever — what title best befits him who first announced the in- 
 curability of the disease? — and what say you of a learned pro- 
 fession, which without inquiring upon what special knowledge 
 it was made, accepted such a damnable prediction and al- 
 lowed it to stupify the brain and paralyze the hand of every 
 investigator ; allowed itself to become particcps criminis — 
 thus assuming the responsibility of every death from typhoid 
 fever since the day on which the discovery of a curative 
 treatment would have been made, had the hateful and blight- 
 ing vaticination never been issued. 
 
 While we cheerfully and gladly acknowledge our in- 
 debtedness to the bacteriologists for their tireless and by no 
 means fruitless investigations, it must be confessed that their 
 wonderful discoveries have not been productive of such 
 marked advancement in practical medicine as we had a right 
 to anticipate, especially when encouraged and stimulated by 
 Flint, who in his " treatise on the principles and practice oi 
 medicine" said "it is not an unreasonable expectation that 
 an antidote or a parasiticide as effective in typhus and ty- 
 phoid fever as quinine in malarial fever, may hereafter be 
 discovered, and such a discovery is a proper aim lor con- 
 tinued experimental observations." 
 
226 TYPHOID FEVER AND ITS 
 
 The patient, sinking lower and lower from typhoid fever 
 would not be greatly edified with a dissertation on the find- 
 ing of the bacillus typhosis and its toxins, only to be told 
 that the "disease must run its course" that as Wilson in 
 1881 said: "No medicine or method of treatment by which 
 enteric fever can be arrested is at present known " that from 
 10 to 20 percent of those attacked by typhoid fever die, that 
 if he fall within that category he too must die, because "the 
 known resources of therapeutics do not afford means for the 
 arrest of these fevers (typhus and typhoid) , nor even for 
 shortening the duration of the febril career." (Flint). 
 
 [The remainder of this paper is inserted in this book under its appropriate 
 head of "Treatment."] 
 
DIAGNOSIS. 
 
 Symptomatology. — In making an analysis of the more 
 important symptoms of typhoid fever, I have arranged them 
 in the order in which they occurred to my mind, endeav- 
 oring to think of and describe the more important ones 
 first; but it is not claimed that they are all arranged in 
 that order. 
 
 The rose spots — the "taches roses, lenticulaires " of 
 Louis — constitute the most truly pathognomonic symptom of 
 typhoid fever to be found during life; they are rounded, 
 slightly elevated, convex, not acuminous, not indurated, pur- 
 plish or rose colored spots. They vary from one-half to two 
 lines in diameter. They have well-defined regular margins ; 
 they disappear on pressure and reappear quickly when the 
 pressure is removed ; it is rare tnat a minute vesical forms 
 at the apex. They have been known to appear as early as 
 the second day of the disease (see report for 1888 and 1889 
 of Dr. John B. Hamilton, Supervising Surgeon-General of 
 the United States Marine Hospital Service), and in other in- 
 stances they make their appearance for the first time late in 
 the course of the disease. They generally appear about 
 the eighth or tenth day, fade away in three, four or five days 
 and are replaced by a fresh crop, and so they continue, 
 fresh ones coming out and old ones fading away. It is rare 
 to see many of these spots at one time. I have seen a very 
 large number of cases in which not more than a dozen spots 
 would appear from the beginning to the end of the illness, 
 while on the other hand I have seen the entire abdomen, 
 chest and arms covered by crop after crop, and Murchison 
 
 227 
 
228 DIAGNOSIS. 
 
 says that he has counted repeatedly more than one thousand 
 on one patient at one time and adds that several other cases 
 in which they were equally numerous had come under his 
 notice. These rose spots are found most frequently on the 
 chest, the abdomen and the back ; they may sometimes be 
 seen on the under side of the arms and on the back, when 
 they cannot be found on any other part of the body. Various 
 writers have called attention to the fact that they sometimes 
 appear after a warm bath. The average duration of the 
 eruption is about fifteen days, the spots generally disappear- 
 ing when convalescence is fairly established. Under the 
 abortive treatment of typhoid fever, it is not at all unusual to 
 see patients walking about the house, or even on the street, 
 an examination of whom would reveal an abundance of char- 
 acteristic rose spots. This symptom being absolutely pa- 
 thognomonic of the disease, it is to be regretted that it is not 
 always in evidence. 
 
 Murchison says : " Of 5,988 cases (of enteric fever), ad- 
 mitted into the London Fever Hospital during a period of 
 twenty-three years, they (rose spots) were noted in 4,606, 
 or 76.92 per cent. In some of the other 1,382 cases, the 
 fact of the spots not being observed, was probably because 
 they were not looked for with sufficient care. 
 
 " Louis observed them in 150 out of 177 cases, and in 
 the remaining seventeen cases, he was unable to say that 
 they were wholly absent, except in five of the cases." 
 
 Surgeon General Hamilton's investigations show that 
 the eruption was absent in 64 of 241 cases. "The earliest 
 date (of their appearance) was the second day ; it (the erup- 
 tion) appeared on the 3d day in 2 cases ; on the 4th day 
 in 3 cases ; on the 5th day in 5 cases ; on the 6th day in 
 8 cases ; on the 7th day in 21 cases ; on the 8th day in 17 
 cases ; on the 9th day in 8 cases ; on the 10th day 18 cases ; 
 
DIAGNOSIS. 229 
 
 on the 11th day in 11 cases; on the 12th day in 10 cases ; 
 on the 13th day in 2 cases ; on the 14th day in 10 cases ; 
 on the 15th day in 1 case ; on the 16th day in 3 cases ; on 
 the 17th day in 4 cases; on the 18th day in 4 cases; on 
 the 19th day in 1 case ; on the 20th day in 1 case ; on the 
 21st day in 2 cases ; the date was not given in 45 cases." 
 
 Dr. Osier says: "Rose spots were noted in 199 of 229 
 cases, 86.9 per cent. In nine cases they were very abun- 
 dant, occurring not only on the trunk, but on the arms and 
 thighs. In one instance, a lad of fourteen, they were present 
 on the face. In two instances there were small petechial 
 spots." 
 
 My experience corresponds with the oft expressed opin- 
 ions of various writers, that the amount of eruption is no 
 measure of the danger of the disease — if it have any sig- 
 nificance at all, it is a favorable rather than an unfavorable 
 sign. 
 
 Temperature. — The one constant symptom which in my 
 experience has been present in some degree in every case 
 of typhoid fever, is a greater or lesser elevation of the tem- 
 perature. An exact counterpart of the thermic line of a 
 typical case of the disease, after Wunderlich (to whom we 
 are so deeply indebted for having educated the profession in 
 the use of the clinical thermometer), would perhaps present 
 itself very rarely, even to a close observer of a very large 
 number of patients. Nevertheless a steplike rise of the tem- 
 perature with a morning, or — very rarely' an evening- re- 
 mission of one or two degrees, during the first three or four 
 days of the disease, is the most constant, and shares with 
 headache alone, the honor of being the most characteristic 
 symptom of this early stage of typhoid fever. The absence <>l 
 the typical typhoid fever curve (so-called), is however, not 
 negatively pathognomonic of the disease. I cannot agree 
 
230 DIAGNOSIS. 
 
 with the author of " Typhoid Fever" in Pepper s system of 
 medicine, who says; that a temperature of 104:°, F. (40 C.) 
 at any time during- the first or second day, should exclude 
 typhoid fever from the diagnosis. Greater variations from 
 the typical typhoid fever curve, than would be a temperature 
 of 104° (40 C), on the second day have been observed many 
 times. Osier reports "two instances in which contrary to 
 the general rule, the temperature reached the fastigium on 
 the second day. One is the interesting case ... in 
 which within twenty-four hours . . . the temperature 
 rose eight degrees and then remained high. The other 
 after seven days apyrexia rose more than seven degrees in 
 thirty-six hours and did not reach normal for fifteen days/' 
 I have seen one instance in which the temperature at 
 nine o'clock in the morning- of the first day of the malady 
 was 106° F. (41.1 C), and the pulse 160. 
 
 An hour later my uncle, Dr. Timothy Dwight Wood- 
 bridge, examined with me this patient and we found the ther- 
 mometer registered 107°, F. (41.6 C), and the pulse was 
 absolutely uncountable (see report of the case of Orrie W). 
 If the abortive treatment really aborts the disease, we should 
 expect the period of fastigium to move backward in propor- 
 tion to the rapidity with which the malady is cured. And 
 this we find to have been accomplished in my cases, for 
 whereas, Dr. Osier reports as something- very unusual the 
 fact that two cases out of 229 reached the fastigium on the 
 second day of the disease, 82 of 151 aborted cases had 
 reached the fastigium on the second day, and 53 of these 
 were at the acme of the temperature on the first day of ob- 
 servation. That my cases were not unusually mild, is 
 evidenced by the fact that 68 of 151 cases had a tem- 
 perature of 104° F. or over, during- the first three days of 
 observation; that 54 had a temperature of 104°by the second 
 
DIAGNOSIS. 231 
 
 day ; that 34 had a temperature of 104° F. or over on the 
 day on which they came under observation, 13 of these cases 
 had a temperature of 105° F. or over, and five had a tem- 
 perature of 106° F. when first seen. Of this 151 cases, 
 44 were at the fastigium when they came under observation, 
 and the temperature rarely went so high again during the 
 disease; 29 other cases registered highest on the second day 
 of treatment ; 18 on the third day ; 16 on the fourth day; 1 1 
 on the fifth day; 13 on the sixth day; 6 on the seventh 
 day; 2 on the eighth day, and 1 on the ninth day of treat- 
 ment. 
 
 The temperature in these cases reached normal in the 
 following order; 4 on the fifth day; 9 on the sixth day ; 10 
 on the seventh day; 9 on the eighth day; 21 on the ninth 
 day; 19 on the tenth day; 16 on the eleventh day; 9 on 
 the twelfth day; 15 on the thirteenth day; 9 on the four- 
 teenth day; 4 on the fifteenth day; 3 on the sixteenth day; 
 7 on the seventeenth day; 1 on the eighteenth day; 3 on the 
 nineteenth day; 2 on the twentieth, and one each on the 
 twenty-first, twenty-second, twenty-third, twenty-fifth, thirty- 
 first, and thirty-second days. 
 
 Of the 229 cases reported by Dr. Osier, "there were 
 152 cases, 66.3 per cent in which at some time during the 
 disease the thermometer registered 104° and over. Eight 
 cases only had a temperature above 106° F., in one the reg- 
 ister was 107°. Fifty-nine cases had a temperature between 
 105° and 106°; and eighty-five cases had a temperature be- 
 tween 104° and 105°. Of the 85 cases with a temperature 
 between 104° and 105° there were 7 deaths, 8.2 per cent. In 
 the 59 cases with a temperature between 105° and 106° there 
 were 10 deaths, 16.9 per cent and of the 8 cases with a tem- 
 perature above 106° there were 4 deaths, 50 percent. There 
 was only one fatal case with a temperature below 104°, a man 
 
232 DIAGNOSIS. 
 
 aged seventy, who was admitted in a state of extreme 
 debility, with consolidation of the lower left lobe, and 
 the case was regarded as one of pneumonia. " 
 
 While as we have seen a rapid and early elevation 
 of temperature is not inconsistent with a diagnosis of 
 typhoid fever, neither is a lower temperature than Wun- 
 derlich claims essential to such a diagnosis, negatively 
 pathognomonic of that disease. 
 
 It is possible for a patient to have typhoid fever 
 with a temperature registering at all times below 101°, 
 indeed a patient may, with such a temperature have ex- 
 tensive ulceration of Peyer's glands, accompanied by co- 
 pious intestinal haemorrhage. Enormous rises in tem- 
 perature sometimes occur in late stages of typhoid fever 
 apparently from the most trivial causes. I have known 
 an elevation of four or five degrees which was occasioned 
 by some slight indiscretion in diet, when the intestinal 
 lesions were severe, and of three or four degrees when I 
 was quite satisfied that there were no severe intestinal 
 lesions, the disease having been so effectually aborted as 
 to prevent necrosis of the glands. One patient, a giddy 
 girl, who persistently gratified a morbid appetite, had a 
 rise of temperature of five degrees from eating two or 
 three pickled cucumbers, and on a later occasion it was 
 elevated two degrees from a supper of pickled pigs feet. 
 
 It is often impossible to take the temperature accu- 
 rately in the mouth, and the failure to do so, has been 
 the source of grave errors in diagnosis, and might lead 
 to an erroneous prognosis or evun injudicious advice as 
 to diet and treatment. I therefore advise when no in- 
 surmountable obstacles exist, that the temperature be 
 taken in the rectum, where 99° F. will represent a normal 
 temperature. 
 
DIAGNOSIS. 033 
 
 It must be understood, that the exceptional tempera- 
 tures noted are exceedingly rare, and that they do not 
 greatly impair the value of this symptom as a diagnostic 
 sign. 
 
 We may still regard an elevation of temperature with 
 some of the characteristics of the Wunderlich curve, as 
 the most constant and one of the most characteristic of 
 all of the symptoms of the disease. I have never seen 
 a case of typhoid fever, in which there was not a well- 
 marked elevation of temperature with decided remissions. 
 
 Meteorism. — Tympanitis is a symptom of much diag- 
 nostic value. It was present in some degree in 463 out 
 of 654 cases reported by various observers. These re- 
 ports do not include my own recorded test cases, in 93 
 per cent of which it was present. By the extent of the 
 tympanitic distention is given some indication of the 
 gravity of the patient's condition. 
 
 Abdominal Tenderness and Pain. — These are 
 amongst the most characteristic symptoms of typhoid 
 fever. My experience is that by the eighth day, and 
 usually much earlier, pressure deep into the right iliac 
 fossa will rarely fail to elicit some expression of pain. 
 Sometimes patients will shrink from the lightest touch, 
 while others will complain of but a slight soreness under 
 firm pressure. When pain is complained of, it is some 
 times referred to this region, sometimes to the neighbor- 
 hood of the umbilicus, and sometimes it is general over 
 the abdomen. 
 
 Gurgling. — Under palpation in the right iliac 
 region is present in a large majority of cases, but is com- 
 mon to too many other diseases to be regarded as of 
 great diagnostic value. 
 
234 DIAGNOSIS. 
 
 Enlargemement of the Spleen. — : This symptom 
 is generally, if not always present. It is greatest toward 
 the end of the second week of the disease, and has almost 
 if not entirely disappeared by the end of the fourth week. 
 The enlargement is also greatest in young subjects. 
 
 Diarrhcea. — Usually of ochre colored stools, some- 
 times containing sloughs of Peyer's glands, shreds of 
 membrane, particles of undigested food, and blood, is 
 present at some stage of the disease in a large majority 
 of cases ; it was present to some extent in 347 of 442 
 cases examined for this symptom by several observers. 
 The stools are alkaline instead of acid as in health. Triple 
 phosphates frequently found and formerly supposed to be 
 peculiar to typhoid fever, are common to other diseases 
 in which the stools decompose rapidly. A careful micro- 
 scopical study of the dejecta might verify the diagnosis 
 in doubtful cases. 
 
 Urine. — The discovery by Ehrlich of the Diazo 
 test, has added greatly to the importance of the urine 
 as an aid to the diagnosis of typhoid fever. The ex- 
 cretion of the kidney is. especially in the earlier stages 
 of the disease, scanty, dark colored, of high specific 
 gravity, of offensive odor, and of excessive acidity (on 
 account of diminution in quantity). It is hypertoxic, 
 maintaining the latter quality sometimes for weeks after 
 convalescence is well established. Although the Diazo 
 reaction is not pathognomonic of typhoid fever, nor its 
 absence conclusive negative evidence, it undoubtedly 
 possesses some diagnostic value. It has been largely 
 used and much discussion has taken place as to its im- 
 portance, but its exact import must be determined by 
 future investigations. It merits a place here. 
 
DIAGNOSIS. 035 
 
 Ehrlich's Diazo Test. — Made by adding to 1 
 volume of urine, 1 volume of the test solution which is 
 composed of - 1. c. c. of b. (b = sodium nitrite 0.5 dis- 
 tilled water 100) added to 40 c. c. of a (a = sulphanilic 
 acid 5.0, hydrochloric acid 50 c. c, distilled water 
 1000.0). Add sufficient ammonia to render the solution 
 alkaline, allowing" the latter to flow down the side of the 
 tube. Shake to produce a foam, which should be rose- 
 red overlying a ring of orange red. 
 
 The microscope may prove a valuable aid to diag- 
 nosis, since the Koch-Eberth bacillus can be found in 
 the urine in a very large percentage of cases of typhoid 
 fever, and when found are, when supported by other 
 symptoms, pathognomonic of that disease. 
 
 Large numbers of foreign and a few American ob- 
 servers (notably at the Johns Hopkins Hospital) have 
 devoted much time and study to the urine and to renal 
 complications and the literature on the subject is exten- 
 sive indeed, but I have not referred to it regarding 
 any such reference as a waste of time, since the fact 
 that all of these studies have been made under mis 
 taken notions as to treatment and in ignorance of tin- 
 fact that the disease can be aborted, and that under 
 abortive treatment the renal complication so carefull) 
 studied and so verbosely described, will rarely or 
 never occur and hence this literature will all have to 
 be rewritten. When the malady is properly treated, 
 the urine rapidly loses its disagreeable odor, its high 
 specific gravity and becomes clear and normal in quan 
 tity and quality. 
 
 Intestinal Hemorrhage.— With the exercise oi 
 ordinary care to exclude haemorrhage from di 
 able extraneous causes, this symptom is practically 
 
236 DIAGNOSIS. 
 
 pathognomonic of typhoid fever. Although it may oc- 
 casionally be due to the congestion of the capillaries, 
 when it occurs before the twelfth day, and in insig- 
 nificant amounts ; and in this instance it may be con- 
 sidered beneficial. It is generally caused by the ul- 
 ceration of Peyer's glands, and is directly due to the 
 extension of an ulcer through the walls of an artery. 
 When it occurs after the twelfth day, it is alv/ays an 
 alarming symptom and ominous in proportion to the 
 quantity of blood which is lost — not the quantity es- 
 caping from the bowel — for fatal haemorrhage may 
 supervene and yet no blood be passed. Too much 
 confidence must not be placed upon the time in the 
 course of the disease, at which the haemorrhage occurs, 
 because, no matter how early it happens, it may always 
 be due to ulceration, and though small in quantity, it 
 may be but the earnest of that which will come later, and 
 close the scene. It cannot be doubted but in exceptional 
 instances ulcerations of Peyer's glands have been ob- 
 served in cases which have ended fatally during the 
 first week of the disease. 
 
 Murchison says: ''There are several cases on 
 record where ulceration has been found as early as the 
 ninth or tenth day, but it may commence on the sev- 
 enth day." Cases have already been referred to in which 
 the ulceration has advanced to perforation on the eighth 
 or ninth day. " Stoll relates a case where extensive 
 sloughs were found in the ileum as early as the seventh 
 day," and Boudet has published minute particulars of 
 a case, fatal at the end of five and one-half days, in 
 which deep ulcers, with partially detached sloughs, 
 were found in the bowel. There is reason to believe 
 that in rare cases ulceration may commence on the 
 
DIAGNOSIS. 0-7 
 
 first or second day. The intensity of the morbid pro- 
 cesses may, and no doubt does, in some degree at least 
 determine the date as well as the extensiveness of the ul- 
 ceration. The following rough outlines will give an 
 illustration of the course usually pursued by a typical 
 case of ordinary severity. During the first eight days of 
 the disease, Peyer's glands, solitary or agminated or 
 both, become infiltrated with the poison of the fever, 
 enlarged by the proliferation of the cellular tissues and 
 highly inflamed (the bacillus typhosis has been found 
 deeply imbedded in its structure, as well as in that of the 
 mesenteric glands, the spleen, the liver, kidneys and 
 other organs). On the eighth or ninth day these glands 
 present smooth, soft, elevated, noneroded excrescences, 
 extending two or three lines above the mucous surface 
 of the intestine. They are pink or rose colored, but 
 there is no evidence that the enlargement is preceded 
 by a stage of congestion. Hence a mere congestion 
 of the bowel after death, without tumefaction of IV \ 
 glands, is not evidence of typhoid fever. Moreover, the 
 glands may regain their normal state by resolution at 
 any stage prior to necrosis. This is effected, as in Other 
 inflammations, by diminution of the vascularity. About 
 the tenth or eleventh day the tumefied glands become a 
 little more indurated. On the eleventh or twelfth day 
 the mucous membrane covering the gland is softened 
 and eroded. From the thirteenth to the fifteenth day tin- 
 gland itself becomes necrosed. From the fifteenth to 
 the seventeenth day the sloughs separate, leaving ul 
 of varying depth, surrounded by swollen and inflamed 
 margins G f mucous membrane. Cicatrization may be 
 long delayed, but should commence by tin- twentieth or 
 
238 DIAGNOSIS. 
 
 the twenty-first, and be completed by the fortieth day or 
 a little earlier. 
 
 Headache — Is one of the most valuable diagnostic 
 signs of typhoid fever, being one of the earliest as well 
 as one of the most constant symptoms of the disease. 
 Murchison says that it was present in 77 out of 82 of 
 his cases. Louis noted its presence in all but 7 cases 
 of 133 cases. Of 126 cases in which Louis noted 
 its date of commencement, it existed from the first in 
 112, and in all of the remaining 14 it began on or before 
 the sixth day. It was present in 97 out of 101 of my 
 cases and was the first symptom complained of in a large 
 majority of them. It may be frontal, occipital or a 
 general cephalalgia. 
 
 Murchison says: "It is usually confined to the 
 front of the head. It is almost always a dull, heavy, 
 persistent headache, which ends toward the close of the 
 second week." 
 
 Closely allied to the foregoing symptom, is the pain 
 of the back and limbs, which is usually described by the 
 patients themselves as " aching of the bones." Like the 
 headache it is often present from the very onset of the 
 disease. 
 
 Vertigo is also an early and tolerably constant 
 symptom, and is sometimes the one of which patients 
 make the most bitter complaints. One patient told me 
 on my first visit, that she was so dizzy that she could not 
 sleep; that she was afraid of falling out of bed, and re- 
 peated this at every opportunity, until her temperature 
 was nearly normal. 
 
 Epistaxis is in my experience a very common symp- 
 tom, and a valuable aid to diagnosis. I inquire about it 
 in all doubtful cases, and its absence would lead me to 
 
DIAGNOSIS. 39 
 
 scrutinize other symptoms more closely before accepting 
 a diagnosis of typhoid fever. 
 
 The general consensus of opinion of most of the 
 modern writers on the subject, however, is that the symp- 
 tom is far less frequent and consequently of less value as 
 a diagnostic sign, than it appears to me to be. It usually 
 occurs early, but is found at all stages of the disease ; it 
 may amount to but a few drops of blood, or the flow may- 
 be so copious as to prove fatal. Haemorrhage sufficient 
 in quantity to cause alarm, or even to require the plug- 
 ging of the posterior and anterior nares is not very un- 
 common. 
 
 Pulse. — The condition of the pulse is of value, as an 
 aid to early diagnosis, or rather as a warning to the phy- 
 sician to look for other symptoms which may be suspicious. 
 It is as a rule accelerated, but its increase in rapidity, 
 although accompanying the elevation of the temperature, 
 is not always in due proportion to the pyrexia. It is 
 possible for a case of typhoid fever, with a temperature of 
 106° F., accompanied with delirium, to have a pulse rate 
 always below 90. One such instance has come within 
 my knowledge during the past few weeks. A patient may 
 have a pulse rate throughout the entire course of the dis- 
 ease but little above normal, and it may also be so rapid 
 as to be out of all proportion to the temperature, even 
 when that is extraordinarily high. It varies greatly in dif- 
 ferent patients and also in the same patient at (lit 
 ferent times of the day or stages of the disease. It is 
 usually strong and beats with considerable force in the 
 earlier stages, but as the disease progresses, it grows 
 weaker and more compressible ; beats more rapidly and 
 often increases in frequency as the temperature drops. 
 An irregular intermittent or imperceptible pulse, Of a 
 
240 DIAGNOSIS. 
 
 pulse rate continuously above 120, is always an indica- 
 tion of danger, and a low pulse rate is sometimes fol- 
 lowed by immediate death. Murchison says he has 
 known cases to prove fatal, in which the pulse never 
 reached 100 ; and in eight of Louis' fatal cases the pulse 
 never exceeded 90. 
 
 Tongue. — The appearance of the tongue is usually 
 characteristic in typhoid fever. When the patient re- 
 alizes that he is ill enough to consult a doctor, the tongue 
 will give assistance in making a diagnosis, if this disease 
 be present. A moist tongue, covered with thin white fur, 
 the margins and tip usually red, the latter often present- 
 ing, especially in infants, a triangular red space at the 
 tip, is as characteristic of the early stages of typhoid 
 fever as is the dry, brown and often cracked and fissured 
 or the red glazed tongue of the second or the third week 
 of the disease. 
 
 The Respirations in the early stages of typhoid fever 
 are not usually accelerated, when no lung complications 
 are present ; in later stages, however, they become more 
 frequent. Sometimes this frequency is out of all propor- 
 tion to either the pulse or the temperature. 
 
 Sordes. — In the typhoid stage, sordes accumulate 
 on the teeth, and haemorrhage from the gum sometimes 
 occurs. 
 
 Heart. — In severe cases of typhoid fever the heart's 
 action may become alarmingly weak, and since the intro- 
 duction of the coal tar derivatives a few years ago, a 
 large number of deaths from heart failure in typhoid 
 fever have been reported. 
 
 Vomiting — Nausea — Retching — are sometimes the 
 earliest symptoms of typhoid fever, but being neither con- 
 stant nor characteristic of this disease, they are more apt 
 
DIAGNOSIS. 241 
 
 to lead to an erroneous diagnosis of a "bilious attack," 
 or some minor ailment, than to direct the physician's 
 attention to the real disease. 
 
 Hebetude. — Is a symptom of considerable signifi- 
 cance, and is present in some degree in a very large ma- 
 jority of cases. 
 
 Delirium. — The delirium of typhoid fever is not 
 usually present until the end of the second or the beginning 
 of the third week, but sometimes it is very profound on the 
 second or third, or even from the first day of the disease. 
 It begins in almost every instance with a slight aberration 
 of mind on first awakening; it sometimes increases to the 
 wildest raving, and often is a prominent symptom until the 
 temperature is normal; or it may merge into a deep stupor, 
 coma and death. I have known of an instance in which a 
 patient who escaped from the hospital while delirious, wan - 
 dered miles away, without clothing, on rather a cold night, 
 was arrested by the police, lodged in the station, returned 
 to the hospital, and after all this exposure made a good and 
 rapid recovery. 
 
 Diagnosis.— While the series of pathologic changes 
 which we designate typhoid fever, are primarily all due to 
 the presence in the system of a single noxa, described by 
 bacteriologists under the appellation of bacillus typhosis, 
 there is no other acute disease so insidious in its attacks, 
 so deceptive in its course, so varied in the forms in which it 
 presents itself — which is accompanied by so many grave 
 complications — is followed by so many dangerous sequelae 
 — or is so often mistaken for other diseases, and in which 
 these errors of diagnosis are followed by such direful mis- 
 fortunes. 
 
 The great variety of forms assumed by typhoid fe 
 together with the fact that all of the prodromic symptoms, 
 
242 DIAGNOSIS. 
 
 and indeed many of those of the fully developed attack, are 
 common to many other pathological conditions, make this 
 disease one of the most difficult, and again one of the most 
 easily diagnosticated diseases. 
 
 When all of its manifestations are typical and regular, 
 the tyro may recognize it with perfect ease, while in some 
 of its atypical forms, a diagnosis by the direct method pre- 
 sents insurmountable obstacles even to the nicest diagnos- 
 tician. A diagnosis is possible then only by reasoning by 
 exclusion. It is, therefore, a differential diagnosis between 
 typhoid fever and every other disease for which it (typhoid 
 fever) could be mistaken. The other disease presenting 
 usually more positive symptoms, can almost always be 
 recognized much sooner than can typhoid fever. This of 
 course requires an intimate knowledge of the symp- 
 tomatology of a large number of maladies, a few of the 
 most important of which are given here. When typhoid 
 fever is present and not recognized, it is far more frequently 
 mistaken for malarial fever than for any other ailment. A 
 most fatal blunder — which the discovery of immortal 
 Laveran, verified and supplemented by Golgi, Marchi fava, 
 Celli, Bignami, Mannaberg, and many others, has rendered 
 wholly inexcusable. Familiarity with all of the varied 
 forms and stages of development of the parasites of malaria 
 and a sufficiently accurate knowledge of the technique of 
 the subject, to enable one to distinguish all phases of ma- 
 larial disease by a microscopic examination of the blood is 
 of course too much to expect of the busy general practi- 
 tioner, but the recognition of the presence of the parasite is 
 so easy that any physician ought to be able to at once 
 exclude malarial fever from the patient's possible ailments 
 when that disease is not present. The hematazoa in the 
 red blood disk, or even the pigment globules in the leu- 
 
DIAGNOSIS. 243 
 
 oocytes, in any of the varied forms are pathognomonic of 
 malarial disease, and although not negatively pathogno- 
 monic of typhoid fever, are strongly presumptive evidence 
 that the latter malady is not present, since it is rare that 
 the two diseases coexist in the same patient at the same 
 time. 
 
 . The importance of differentiating between typhoid and 
 malarial fevers in the early stages, and the elimination 
 from future discussion of the "vexed question" of 
 " typho-malarial fever " is so great that too much space in 
 this book cannot be accorded to the subject. I therefore 
 quote from " Paludism" by Laveran — ■" the Parasites of 
 Malarial Fevers " by Marchiafava and Bignami, and " The 
 Malarial Parasites " by Mannaberg, which have been 
 republished in English by the New Sydenham Society, 
 as well as from the valuable article from the London 
 Lancet of the sixth of July, 1895, by Dr. George Thin. 
 
 Laveran says: "The parasite of palustral blood 
 is seen under rather varied forms, which may be classed 
 under the four following types : 
 
 1st. Spherical bodies. 
 
 2d. Flagella. 
 
 3d. Crescent shaped bodies. 
 
 4th. Segmented bodies and rose shaped bodi< 
 
 The bodies which most interest the diagnostician 
 whose object it is to differentiate between typhoid fever 
 and malarial diseases are the spherical bodies, since he 
 sees them far more frequently than all others combined. 
 Laveran saw them in 389 of 432 cases. 
 
 While observers generally agree thatthe amoeba in 
 the stages of sporulation may not in all mild ca s< i be 
 found in the blood from the finger tip, and that in mild 
 cases they may not always be found in blood from the 
 
244 DIAGNOSIS. 
 
 spleen at the outset of the disease or during the rise of 
 temperature — this does not greatly diminish their value 
 for differentiating between typhoid and malarial fevers, 
 because although the means of making an exact diag- 
 nosis of any one particular form of malarial disease may 
 be wanting, there will almost invariably be present some 
 form of the parasite of malaria, quite sufficient to indicate 
 the nature of the disease, if not its class or stage, and it 
 may be stated that the finding in the blood of a single 
 malarial parasite is absolutely apodeictic evidence of 
 malarial infection. These parasites of paludism are so 
 easily recognized that any one having seen them once 
 would be able to make a diagnosis of malaria, without 
 any reference whatsoever to the text. Added to this the 
 knowledge that many varieties in fresh blood declare 
 their nature by their movements, amoebic, of the flagella, 
 or of the pigment, and that they fasten themselves to the 
 red blood disk and grow and increase in size, at the ex- 
 pense of the haemoglobin and an error of diagnosis 
 would be very unlikely to occur. 
 
 These facts seem to be well established — that the 
 paroxysms of malarial fever are coincident with the ar- 
 riving at maturity of a generation of parasites — that cer- 
 tain forms of the disease are caused by special parasites 
 and that the periods of time intervening between the 
 paroxysms of a given attack of malaria, correspond ex- 
 actly with the life cycle of its parasite. Thus a quotid- 
 ian ague is dependent on an amoeba whose cycle of 
 evolution is completed in one day — the tertian in two and 
 the quartan in three days. Irregular forms of malarial 
 disease may be variously accounted for, as for instance 
 by the presence in the organism of two generations of 
 one parasite or the presence of different varieties of the 
 
DIAGNOSIS. 245 
 
 parasites, but I believe that all malarial infections are 
 dependent on some form of Laveran's parasite or on the 
 retrograde metamorphosis of their noxious products. 
 
 The technique of the microscopical examination of blood 
 presents some difficulties, but the great and rapidly increas- 
 ing importance of the subject demands that every physician 
 should surmount them. The appliances for the purpose are 
 not numerous or very expensive. An apochromatic oil im- 
 mersion objective capable of magnifying 1,000 diameters, a 
 series of good eyepieces, a good steady stand, and an 
 apochromatic condenser, constitute the only costly essentials 
 necessary for making a microscopical diagnosis of malarial 
 disease. The lobe of the ear or bulb of the finger should be 
 thoroughly cleansed before being pricked with a narrow lan- 
 cet, to secure the small drop of blood for examination. This 
 should be compressed between thin cover glasses and be ex- 
 amined fresh or stained and allowed to dry. 
 
 Dr. George Thin suggests the use of a mixture of two 
 dyes and recommends Chezynsky's formulae as the best for 
 general purposes, " which is made by mixing }4 percent 
 solution of eosin in 70 per cent alcohol, 20 parts; concen- 
 trated solution of methylene blue in distilled water, 40 parts; 
 water 40 parts." In preparing this mixture I think the pre- 
 cise strength of the alcohol is of importance.* 
 
 For "concentrated" solution of methylene blue it would 
 be more precise to write " saturated" solution. I have found 
 the results more satisfactory by taking care that the solution 
 of blue was really saturated. Some of this solution is filtered 
 into a watch glass, and the cover glass with the blood sur- 
 face downward is floated on the fluid. The length of time 
 
 *Seventy per cent alcohol is made from methylated alcohol, which 
 free from naphtha, by diluting 100 measures to 121 ; from I 
 (0.793) by adding 31 ^ volumes of water to 10(1 volumes of the ftl< ohol In work- 
 ing in analine dyes it is best tQ avoid the use of methylated alcohol. 
 
246 DIAGNOSIS. 
 
 which should be allowed for the staining is, I think, generally 
 understated, and depends on the temperature. I generally 
 use an incubator with a temperature of about 98° F., and at 
 this heat a quarter of an hour to about twenty minutes amply 
 suffices ; at room temperature half an hour to two hours may 
 be found necessary, according to the time of the year. If 
 the preparation is an important one, it is advisable to watch 
 the staining process by washing off the dye occasionally with 
 distilled water and looking at it unmounted with a low 
 power, putting it back in the dye if necessary, until the req- 
 uisite degree of staining is obtained. When this has been 
 found the cover glass is washed in distilled water and al- 
 lowed to thoroughly dry, and is then mounted as a dry prep- 
 ration, being kept in position on the slide by a margin of 
 melted paraffin, brushed around it. It may be examined 
 at once or after a period of weeks. After a little practice, 
 the parasites can be easily picked out in such preparations 
 with a very low power. For this purpose I use successfully 
 a low power objective with Powell and Lealand's No. 10 
 compensating eyepiece. This gives me a very large, clear 
 field, the magnifying power being 210 diameters, and the 
 blue stained parasite stands out distinctly and boldly 
 (although a very minute object) in the red corpuscle. 
 When a parasite has been found it may be examined by a 
 high power objective, an j4 or higher, when the pigment, 
 if present, should be seen more or less distinctly according 
 to its fineness and distribution; but for the satisfactory ex- 
 amination, particularly as regards the stage of development 
 of the parasite and the distribution of the pigment granules, 
 an oil immersion objective should be used. 
 
 " For the size and form of the parasite and its relation to 
 the red corpuscle, and for the presence and condition of the 
 pigment, the use of methylene blue and eosin is sufficient. 
 
DIAGNOSIS. 047 
 
 Eosin is particularly useful in showing the poverty in 
 haemoglobin of the large, swollen, red corpuscle which 
 harbors the tertian parasite. In order to render the 
 detection of the parasite by this method easier to those 
 who are beginning the work, I have thought it useful to 
 show by definite outlines, drawn to scale, the size of the 
 objects which have to be looked for, according to the 
 magnifying power which is used. 
 
 Although I recommend every observer to provide 
 himself with apparatus which will give him a magnifica- 
 tion of 1,000 diameters, it must happen to many to be 
 obliged to use a lower power, at all events for a time. I 
 have therefore made the drawings which are printed in 
 the accompanying plate chiefly to two scales, one of 500 
 and one of 1,000 diameters ; 500 diameters being with- 
 in the reach of most, even of the commoner microscopes, 
 if the highest system with which they are provided is of 
 sufficient quality to bear a fairly high eyepiece. For 
 the finer details of the structure of the parasite, more 
 particularly of the spores, haematoxylin should be em- 
 ployed. It is by the use of this dye that Mannaberg has 
 made a distinct advance in our knowledge of this diffi- 
 cult subject. The process which he recommends, al- 
 though apparently somewhat complicated, is not difficult 
 to carry out. "The dried preparation is floated for five 
 minutes in distilled water, and after being dried with 
 blotting paper is passed several times through a weak 
 solution of acetic acid (a drop of acetic acid in 20 centi- 
 meters of distilled water) until the haemoglobin dis- 
 appears. The colorless preparation is then laid for two 
 hours in the following fixing fluid: concentrated aque- 
 ous solution of picric acid 30, distilled water 30, glacial 
 acetic acid 1. From this mixture it is placed for .-mother 
 
248 DIAGNOSIS. 
 
 two hours in absolute alcohol, and then placed from 
 twelve to twenty-four hours in an alum haematoxylin 
 solution. Differentiation of the stain is effected by 
 using a % per cent hydrochloric acid alcohol (alcohol of 
 75 per cent) and then ammoniated alcohol (3 drops of 
 ammonia in 10 cubic centimeters of 75 per cent alcohol), 
 which is washed in 80 per cent alcohol. The prepara- 
 tion is mounted in Canada balsam dissolved in xylol. 
 The process is a tedious one, and care must be taken 
 regarding the strength of the hydrochloric acid alcohol. 
 If the ammonia is used too strong, or for too long a 
 period, it acts very destructively. Unless the prepara- 
 tion is allowed to dry thoroughly before mounting in 
 balsam, I recommend a stronger, say absolute, alcohol. 
 Some of the most interesting appearances shown in 
 Mannaberg's book, such as those in the plates 3 and 4, 
 were obtained by this process, and these drawings can- 
 not be neglected by any one who studies the structure 
 and development of the parasite. Dr. Thin also says : 
 
 " The utility of examining blood for the malaria par- 
 asite in cases of fever is too evident to be enlarged 
 upon, but its utility is much greater in some classes 
 of cases than in others. It does not require a microscope 
 to diagnose or treat successfully a case of classical ague, 
 or even many of the cases of irregular and remittent 
 fevers which are due to malaria, although microscopical 
 observation is much more important in them than in 
 tertian and quartan fevers. It is certain, however, that 
 even in malarial countries many cases of fever are diag- 
 nosed and treated by skilled and experienced observers 
 as of a malarial nature, which are really due to other 
 causes. There are cases in which a considerable time 
 must elapse before the diagnosis can be made from the 
 
Fig.l 
 a 
 
 ^-. 
 
 • 
 
 [ 
 
 "ig.2 
 
 
 a 
 
 
 
 1 
 
 1 
 
 • 
 
 • 
 
 Q 
 
 
 • 
 
 Fig.+ 
 
 a 
 
 Fig.5 
 
 b id 
 
 * e c 
 
 * 
 
 Fig-6 
 
 Fi^7 
 
 Fig.8 Fig.9 
 
 
 r ■■ 
 
 • 
 
 F'g- 1 2 
 
 ^ 
 
 Fic.13 
 
 • .* M 
 
 > 
 
 a 
 
 
 • 
 
 Copied by permission of Dr. Geo. Thin from the London i I July 8 
 
 Plate 4 
 
EXPLANATION OF PLATE IV. 
 
 Fig. 1. A red blood corpuscle from fresh normal blood, drawn to scale by camera lucida, to form a standard 
 for comparison with the figures of dried and stained blood which follow. (The color of the fresh blood is not 
 reproduced), a, x 500 diameters ; b, X 1.000 diameters ; and c. x 2.000 diameters. (In this and the subsequent 
 figures the objectives employed were, for the 500 diameters, a dry objective by Powell and Lealand ; for the 1,000 
 diameters Powell and Lealand's apochromatic Jjth oil immersion with the No. 10 eyepiece, or the „y,h apochro- 
 matic oil immersion of the same makers with a low eyepiece; for the 2,000 diameters the r J a th with No. 10 eye- 
 piece). 
 
 Fig. 2. Blood from a dried preparation stained in haematoxylin and mounted in glycerin ; chronic irregular 
 fever ; sporulation in internal organs. The blood, which is from the finger, shows the red corpuscles being 
 attacked by the parasite in its earliest stage. In one corpuscle two parasites are observed. The part chosen for 
 drawing contained an unusual number of affected corpuscles, a, x 500 diameters ; and b, X 1,000 diameters. 
 
 Fig. 3. A blood vessel from a section of a portion of brain given to me by Dr. Bignami from Prof. Marchia- 
 fava's laboratory in Koine. The section which was cut in paraffin, was stained in haemalum and cochineal, a. 
 A red corpuscle containing no parasite, b. A red corpuscle containing an eccentrically situated parasite ; c. A 
 red corpuscle containing two parasites. The protoplasm of the parasite is stained a deep pink, the nuclear 
 elements a very dark purple. (In this and similar preparations the resolution of the stained nuclear elements 
 into separate minute spheres depends to a considerable extent on the excellence of the objective used. The 
 darkly stained nuclear elements of the parasite as shown in this figure must not be confounded wilh pigment. 
 No pigment was observed in the section, and the case was therefore probably one of quotidiana perniciosa 
 caused by the pigmentless quotidian parasite described by Marchiafava and Bignami. 
 
 Fig. 4. The crescent shaped form of the parasite found in the blood in irregular chronic fever. The dried 
 blood from the finger was stained by haemalum in excess, and subsequently partially decolorized by weak hydro- 
 chloric acid, a. The parasite with arc shaped line indicating the contour of the red corpuscle in which it had 
 developed, b. Free parasite x 500 diameters, c and d, the same x 1,000 diameters, e. Red corpuscles in tlve 
 same preparation x 1,000 diameters. 
 
 Fig. 5. Crescent shaped parasites in the blood, sealed in solution of methyl green in 1 per cent acetic acid. 
 The color of the methyl green is not shown in the plate, a. A crescent sealed in the solution, to which a little 
 glycerin has bren added, b. A crescent in the solution without glycerin, drawn shortly after being sealed. 
 Many crescents seen in this staining solution have the shortened, mutilated appearance shown by this one. The 
 red corpuscles, which are much shrunk in size, are quite colorless, and are indicated only by very fine lines, 
 much fainter than is shown in the drawing. The magnification in this figure was not accurately estimated, but 
 that of a is about 700 to 800 diameters, and that of b nearly 1,000. The red corpuscles in b had shrunk more than 
 those in a. c. A red corpuscle containing a round parasite with peripheral pigment from a case of irregular 
 fever with the formation of crescent bodies, Sporulating forms were not found in blood from the finger. This 
 drawing is shown under this figure because it is typical of forms that are found (in my experience, sparingly) in 
 cases with crescent formation. The drawing was not to scale by camera lucida, but the magnification is slightly 
 over 1,000 diameters ; eosin and methylene blue. 
 
 Fig. 6. A red corpuscle containing the tertian parasite before the formation of pigment ; eosin and methy- 
 lene blue ; the parasite is stained blue, x 1,000 diameters. 
 
 Fig. 7. A red corpuscle containing the tertian parasite with the beginning of pigment formation and two 
 normal red corpuscles beside it ; eosin and methylene blue. The larger size of the corpuscle which contains the 
 parasite is to be noted, x 1,000 diameters. 
 
 Fig. 8. A red corpuscle containing the parasite in a more advanced stage of pigment formation. Note the 
 serrated appearance at one part of what remains of the red corpuscle, caused by the destructive action of the 
 parasite, x 1.000 diameters ; eosin and methylene blue. 
 
 Fig. 9. The tertian parasite with spore formation and central pigment. The number of spores is unusually 
 small for the lertian parasite. Note the disappearance of the haemoglobin from the red corpuscle and its com- 
 paratively large size as compared with the normal corpuscles around it. which appear to have been considerably 
 shrunk by the drying process, X 1.000 diameters ; eosin and methylene blue. 
 
 Fig. 10. a. A red corpuscle containing the tertian parasite with spore formation complete; haemalum and 
 eosin. The nuclear element of each spore is stained by the haemalurn. x 1,000 diameters, b. The same x 
 2,000 diameters. Note the contour of the perfectly colorless red corpuscle, and that in the parasite between 
 the spore zone and the mass of central pigment there is a structureless substance less deeply stained than the 
 spores. 
 
 Fig. 11. The tertian parasite. A group of spores just separated from the corpuscle ; haemalum and eosin. 
 The position of the central mass of pigment shows that the relative position of the spores has been comparatively 
 little changed by drawing the one cover glass over the other in making the preparation. Each spore contains a 
 distinct haemalum stained nuclear element, a. x 1,000 diameters, b. x 2,000 diameters. 
 
 Fig. 12. Sporulating form of the quartan parasite stained by alkaline (Loefiier's) methylene blue. Sporu- 
 lation is complete, with central pigment, a. x 500 diameters ; b. X 1,000 diameters ; c. x 2.000 diameters. 
 Note in b and c that there is still a narrow rim of corpuscular substance preserved, that the spores are the usual 
 number in this parasite (8), that the corpuscle which contains the parasite is hardly larger than the unaffected 
 red corpuscles which surround it, and there is an absence of the zone between the spores and the pigment which 
 is seen in the tertian parasite. 
 
 Fig 13. a. Phagocyte white corpuscle containing small pigment spheres. The patient was suffering from 
 chronic malaria acquired in Bombay. He was weak and anaemic, his spleen was slightly enlarged, and at con- 
 siderable intervals he had slight fever lasting for a day at a time. I found no parasite in the blood from the 
 finger, but several pigment bearing white corpuscles. The figure was drawn by camera lucida from a sealed 
 preparation of fresh blood the day after it was prepared ; x 1.000 diameters, b. White corpuscle containing rod 
 shaped blocks of pigment from blood preserved in Pacini's fluid, kindly sent me by Surgeon-Major Sharp from 
 Sierra Leone. The patient was said to be suffering from ague, and when the blood was taken his temperature 
 was 105° F. No parasites were found in the red corpuscles, but there was an unusual number of white corpus- 
 cles heavily laden with pigment. (Not a camera lucida drawing, but magnifying power probably about 1,000 di- 
 ameters.) c. Phagocyte white corpuscle from dried preparation of blood from a case of chronic irregular fever. 
 There were crescents in the fresh blood. The dark outline on the left, which did not take on the eosin color so 
 deeply as the rest of the corpuscle, contained minute spheres of pigment, and seemed to be formed by extremely 
 minute powdery pigment; the particles of which were too small to draw, and is suggestive of a parasite, prob- 
 ably a crescent, enclosed in the corpuscle ; eosin and methylene blue ; x 1.000 diameters, cl. A white corpuscle 
 containing pigment spheres in a blood vessel in a material spleen. For the section from which it is taken I am 
 indebted to Surgeon-Captain Duggan. who prepared it in the British Institute of Preventive Medicine ; x 1-000 
 diameters. 
 
DIAGNOSIS. 249 
 
 clinical symptoms alone. I conceive that it is very im- 
 portant to use the microscope in cases of so-called ' fever 
 from exposure to the sun,' and I am afraid that occa- 
 sionally cases diagnosed and treated as sunstroke are 
 examples of pernicious malaria with coma. In all doubt- 
 ful cases' of fever, therefore, occurring in countries where, 
 for example, the diagnosis may lie between typhoid 
 fever and malaria, and ' sun fever,' the microscope should 
 be used and it should also be employed for diagnostic 
 purposes in many cases of coma with acute febrile symp- 
 toms which might perhaps more naturally suggest sun- 
 stroke." 
 
 This short outline of the diagnosis of malarial dis- 
 eases by the microscope will enable any intelligent phy- 
 sician, possessed of a microscope, with a compensating 
 eyepiece and an apochromatic immersion objective, 
 magnifying about 1,000 diameters, and the essential 
 accessories, and who has acquired the necessary tech- 
 nique of their use, to differentiate at once between these 
 diseases as a class and typhoid fever. This will effec- 
 tually eliminate the commonest of all errors in diagnos- 
 ticating typhoid fever, if the observations of the future 
 sustain the hopes and predictions of the present ; for 
 there are those who, unable to find the parasite or even 
 the pigmented leucocytes, insist that they arc not 
 always present even in fatal attacks of malarial fever, 
 and they would bury Laveran, Golgi," Mannaberg and 
 Thin, the discoverers and investigators in unhonored 
 graves along with the plasmodire malarise. 
 
 Typhus Fever. — Notwithstanding the fact that t\ 
 phoid and typhus fevers have so often been confound 
 the features which distinguish them are usually better 
 defined than were those which distinguished the former 
 
250 DIAGNOSIS. 
 
 disease from the continued forms of malarial diseases 
 prior to Laveran's discovery. For while the bowels may 
 be constipated in typhoid, and diarrhoea may be present 
 in typhus fever, these occurrences are comparatively 
 rare and in such instances some of the symptoms of the 
 latter disease are apt to be prominent enough to guard 
 the careful physician against the danger of making an 
 erroneous diagnosis. If there be marked tenderness in 
 the right iliac fossa, epistaxis, headache, etc., typhoid 
 fever should be suspected even though the bowels were 
 constipated. 
 
 The slow insidious attack contrasted with the char- 
 acteristically sudden onset of typhus fever; the remit- 
 tent type of the fever ; the absence of early eruption ; 
 the presence of meteorism — of intestinal haemorrhage — 
 of the circumscribed pink flush seen in one or both 
 cheeks in typhoid fever ; contrasted with the absence of 
 these symptoms and with the general dusky hue of the 
 skin and the congested conjunctivae of the victim of 
 typhus fever; all make up a series of symptoms which 
 should make it an easy matter to differentiate between 
 the two diseases. The history of the source of the at- 
 tack if known will aid the investigator in reaching a cor- 
 rect conclusion. 
 
 Further assistance will be obtained by noting " the 
 principle points of distinction between the spots of en- 
 teric fever and those of typhus " as given by Murchison. 
 
 Enteric Fever. Typhus. 
 
 1. Pink or rose colored 1. May be dirty pink or 
 throughout. red at first but soon be- 
 
 come reddish brown. 
 2. Undergo no change 2. Become gradually 
 
DIAGNOSIS. 
 
 251 
 
 Enteric Fever. 
 
 until they fade or disap- 
 pear. Never converted 
 into petechias. 
 
 3. Circular. 
 
 4. Isolated and few in 
 number. 
 
 5. No subcutaneous mot- 
 tling. 
 
 6. Elevated above the 
 skin. 
 
 7. Disappear on pressure, 
 as long- as they last. 
 
 8. Rarely appear before 
 the seventh day. 
 
 9. Appear in successive 
 crops. 
 
 10. Each spot lasts only 
 three or four days. 
 
 11. Never present on a 
 dead body. 
 
 12. A large number does 
 not indicate danger. 
 
 Typhus. 
 
 darker, and are often con- 
 verted into petechias. 
 
 3. Of irregular form. 
 
 4. Numerous and adhere 
 in patches. 
 
 5. Mottling common, in 
 addition to spots. 
 
 6. Not elevated, except 
 at first appearance. 
 
 7. Do not disappear on 
 pressure, except at first. 
 
 8. Appear on the fourth 
 or fifth day. 
 
 9. Never in successive 
 crops. 
 
 10. Many of the spots may 
 last to the end of the 
 fever. 
 
 11. Often persist after 
 death. 
 
 12. Direct ratio between 
 the number and dark 
 ness of the spots and tin- 
 severity of the disease. 
 
 "It is important to determine whether the lenticular 
 spots above described be ever present in other diseases 
 than enteric fever. ... At the London Fever Hospital 
 I have had occasion to examine many thousand cases ot 
 acute disease of every form, and my opinion is that an 
 eruption which presents all the characteristics above men- 
 tioned is peculiar to enteric fever." 
 
252 DIAGNOSIS. 
 
 Scarlatina. — Although a scarlet rash sometimes ac- 
 companies early stages of typhoid fever, the two diseases 
 should never be confounded. The sudden rise of tempera- 
 ture in scarlet fever forms a marked contrast to the Gradual 
 step like rise of typhoid fever. Moreover, there is rarely 
 any sore throat in the latter disease, and its dryness should 
 never be mistaken for the characteristic sore throat of 
 scarlet fever. 
 
 Puerperal Fever— Pyaemia. — When typhoid fever oc- 
 curs in the puerperal state it is often mistaken for puerperal 
 fever, and sometimes simulates that disease so closely that 
 an exact diagnosis is exceedingly difficult. The presence 
 of rose spots, epistaxis, step like rise of temperature, indi- 
 cate the one, and the profuse sweating, the rigor and the 
 absence of the foregoing symptoms, together with the cir- 
 cumstances under which the attack comes on, may indicate 
 the other. 
 
 Tuberculosis. — The most perplexing diseases to differ- 
 entiate from typhoid fever are the several forms of tuber- 
 cular disease. 
 
 Acute Phthisis Pulmonalis. — Since the fever in this 
 disease is sometimes remittent — the cheeks present the same 
 circumscribed flushes — and other symptoms of typhoid fever, 
 they may very easily be mistaken for each other. The 
 clinical and family history, the tympanitis, the enlargement 
 of the spleen, the rose spots or epistaxis — when these are 
 present, will usually enable the careful diagnostician to 
 avoid error. If these symptoms are not found, the particu- 
 lar observance of the thermic line, an ophthalmoscopic 
 examination of the eye for the evidence of tubercle in the 
 choroid, or a microscopical examination of the sputa for 
 the bacillus tuberculosis will give pathognomonic evidence 
 if the disease be the latter malady; though this would not 
 
DIAGNOSIS. o*q 
 
 be negatively pathognomonic of typhoid fever, as the tuber- 
 cular affection might possibly be a sequel to it. 
 
 The same remarks apply to miliary tuberculosis, to 
 tubercular meningitis, etc. 
 
 "La Grippe."— Since the invasion of this country by 
 epidemic influenza, a few years ago, a very large number 
 of cases of typhoid fever have been erroneously designated 
 "la grippe;" not a very unnatural mistake — as typhoid fever 
 when the onset is sudden and the nervous symptoms pre- 
 dominate very closely simulates influenza. 
 
 A correct differential diagnosis may generally be made 
 by a careful observance of the thermic line, as well as by a 
 careful examination of the abdomen, which although fre- 
 quently distended, never presents the tenderness in the 
 right iliac fossa, which according to my observation is one 
 of the most constant symptoms of typhoid fever. If these 
 symptoms fail to appear the distinction can invariably be 
 made in a very few days, as the two diseases after the first 
 onset usually run quite dissimilar courses. 
 
 Variola and Varioloid. — Although typhoid fever is 
 sometimes mistaken for either of these diseases, there is 
 little excuse for such an error. The cause of the mistake 
 being usually a profuse crop of rose spots. The difference, 
 however, between the characteristic eruption of typhoid 
 fever and the acuminated eruption of variola is so marked 
 that the two should never be confounded. The latter is 
 hard, elevated, and presents to the touch the sensation oi 
 split peas underlying the skin, while the former, although 
 slightly elevated, yields readily to and disappears under 
 slight pressure. 
 
 Pneumonia. — I know of no certain means of distinguish- 
 ing clinically between a true pneumonia and pneumo- 
 typhus. I have been called too often at the closing scene, 
 
254 DIAGNOSIS. 
 
 after the supervention of a fatal intestinal haemorrhage — 
 after a few days of illness from pneumonia — to attempt to 
 describe symptoms which might be misleading, and would 
 at best give no information which could benefit the patient. 
 I can therefore advise but one course \— treat pneumonia 
 as typhoid fever as long as any doubt exists as to the char- 
 acter of the disease. 
 
 "A Bilious Attack." — Typhoid fever is very frequently 
 mistaken for an ordinary bilious attack — an error which 
 may be easily avoided by careful observation of the thermic 
 line, but like pneumonia, the initial treatment of the former 
 should be the same as that for typhoid fever. 
 
 Acute Mania. — When typhoid fever comes on sud- 
 denly and nervous symptoms and delirium predominate, it 
 is frequently mistaken for mania, insanity, meningitis and 
 cerebro-spinal meningitis. In all of these instances the 
 thermometer alone will give sufficient information upon 
 which to base a correct diagnosis. 
 
 While it is true that obscure and atypical attacks of 
 typhoid fever are sometimes exceedingly difficult to di- 
 agnosticate, it is also true that in its regular and typical 
 forms, where several of its characteristic symptoms are 
 present, it is one of the most easily recognized diseases. 
 The careful diagnostician who has seen the patient from 
 the outset of the disease will make his diagnosis and 
 have his patient well on the road toward recovery, while 
 he who strives for scientific accuracy rather than for the 
 patient's good will be awaiting the development of pa- 
 thognomic symptoms, which may come too late to avail 
 any useful purpose, or may never come at all. 
 
 Sometimes the earliest symptom which is presented 
 is a slight but persistent headache — a scarcely noticea- 
 ble mental hebetude — a loss or even an unnatural increase 
 
DIAGNOSIS. 055 
 
 of appetite — a little diarrhoea — a little dizziness — ring- 
 ing in the ears — epistaxis — weakness — chills or chilly 
 sensations — the diluted chills of Alonzo Clark — pain in the 
 back and limbs — the bowels may be constipated or there 
 may be mild or copious diarrhoea. The temperature 
 maybe little above normal, the pulse sluggish or slightly 
 accelerated. 
 
 The presence of one or more of these symptoms 
 should put the physician on the qui vive, for at this time, 
 if never after, the patient may be cured — the disease 
 aborted. The symptoms may now become more pro- 
 nounced, insomnia supervenes, the temperature rises, 
 usually by step like gradations and a degree or two each 
 day, being from one-half to two or more degrees higher 
 in the evening than in the morning. 
 
 The period of highest elevation of temperature as 
 also of greatest frequency of the pulse is about 8 
 o'clock in the evening and both are nearest normal from 
 7 to 9 o'clock in the morning. 
 
 The symptoms generally increase in severity so very 
 slowly that neither patient nor family realize the magni- 
 tude of the mischief that is being done during the first 
 week or two of the disease. It is unusual for the pa- 
 tient to be confined to the bed and he may be able to 
 attend to ordinary business or even perform hard man 
 ual labor for six or eight days after he realizes that he is 
 ill. Moreover it occasionally happens that the disease 
 makes such slow and insidious inroads on the general 
 health that before the patient feels sufficiently indispi 1 
 to seek medical advice he has passed beyond the reach of 
 medical aid. (See letters of Dr. Dodge for the repeat 
 of a case in which the patient worked at hard manual 
 labor, not knowing that he was sick until within a lew 
 
256 DIAGNOSIS. 
 
 hours of his death as the result of perforation.) This 
 case is one of great interest because he walked into the 
 hospital one day, having- chopped wood in a lumber 
 camp the previous day, and died on the following day, 
 and the autopsy furnished the first positive proof of the 
 character of the disease, several ulcerated Peyer's glands 
 and a perforation in the center of one of them. A case of 
 typhoid fever of moderate severity, running a typical 
 course and coming under observation on the eighth day 
 should present about the following conditions: range of 
 pulse from 100 to 120, almost invariably accelerated toward 
 evening, when the temperature should be 103.5° to 104.5° 
 Fahrenheit, and a degree or two lower in the morn- 
 ing, but both temperature and pulse vary greatly in 
 the same patient; but while the latter is generally weak 
 and compressible it is sometimes quite the reverse. 
 
 The skin is hot and dry, especially in the afternoon 
 and early part of the night. Although the bowels at the 
 outset of the disease may have been, and more rarely 
 may still remain constipated; there will usually be a 
 more or less copious diarrhoea of ochre colored watery 
 stools. This may however have been a precedent con- 
 dition and there may be left only its history. There is 
 complete anorexia and vomiting of a bilious character. 
 The tongue presents a furred center and red margins and 
 tip. The urine is scanty, high colored and strong; the 
 abdomen is slightly distended and tympanitic ; palpation 
 produces gurgling in the right iliac fossa; there should 
 be slight tenderness also. Rose spots appear, fade away 
 and reappear in successive generations. The headache, 
 pain in the back and limbs give place about the middle of 
 the second week to delirium, generally mild and at first 
 appearing only at night, but gradually becoming wilder 
 
DIAGNOSIS. 237 
 
 and lasting throughout the day. The splenic dullness, if 
 previously observed, becomes more apparent ; sordes ac- 
 cumulate on the teeth, and the tongue becomes dry and 
 brown, and sometimes deeply fissured; the diarrhoea be- 
 comes more profuse ; bed sores form over the bony prom- 
 inences ; the pulse grows weaker and sometimes becomes 
 dicrotic. Emaciation goes on to an alarming extent; 
 low muttering delirium supervenes and intestinal haemor- 
 rhage, perforation, peritonitis or coma and death may 
 follow. 
 
 Another equally typical case may present all, or a 
 majority of these symptoms in a milder and modified form, 
 may run its course to the middle or end of the second 
 week, the patient being so little sick that no alarm what- 
 ever is felt, but while lacking some of the elements of the 
 danger of the preceding case, it is quite as liable to in- 
 testinal haemorrhage or perforation and death, as is the 
 sicker prototype. How frequently the daily bulletin has 
 announced the patient " doing well" " progressing 
 nicely" "temperature and pulse good" "feeling better 
 to-day," until the friends are beguiled into false security 
 from which they are rudely awakened "because! the 
 symptoms have taken an unfavorable turn." 
 
 Therefore every physician should remember that 
 while cases, which at the outset present exceedingly 
 severe symptoms sometimes recover, those which offer 
 the mildest symptoms, not infrequently develop grave 
 lesions when everything seems to be going smoothly and 
 the patient seems to be reaching safe ground. It is safe 
 to say that no matter how mild the symptoms, the 
 typhoid fever patient is in serious danger from the time 
 Peyer's glands have become inflamed until the la it ulcera 
 tion is healed. If but one ulceration exists, and that 
 
258 DIAGNOSIS. 
 
 ends in perforation — without surgical aid — death is practi- 
 cally as certain as if all of the glands of the ileum were 
 necrosed. 
 
 A very large number of cases of typhoid fever never 
 develop these fatal lesions or the " typhoid state" but 
 it is far the most treacherous and fatal of all of those 
 which we now recognize as preventable diseases. 
 
 The results of the antiseptic treatment of typhoid 
 fever when instituted at the outset of the disease have 
 emphasized the importance of an early and exact diag- 
 nosis, and ought to revolutionize the teachings of the 
 medical colleges and text-books on this point. As long 
 as the " expectant method" of treating the disease 
 could be justified on the assumption that there was no 
 better way — at least none that was feasible in private 
 practice — it did not much matter when the diagnosis was 
 made, so that it was gotten ready for the death certifi- 
 cate—which is unfortunately not always done. 
 
 Dr. James H. Hutchinson says : " In the doubt 
 and obscurity which generally envelopes the diagnosis 
 of the disease when the physician is first called upon to 
 treat it, it is impossible to lay down any positive rules 
 for the treatment of typhoid fever at its commence- 
 ment." 
 
 The author of the article on " Typhoid Fever in 
 Pepper's System of Medicine " is not the only instructor 
 or practitioner who has found it necessary to await the 
 development of pathognomonic symptoms before for- 
 mulating a course of treatment. This has long been, and 
 is yet the usual custom. It would be impossible to con- 
 ceive of a more pernicious and reprehensible practice, 
 and yet it is exactly the course pursued by the dis- 
 tinguished physicians who attended H. R. H. the Prince 
 Consort of England so long ago. 
 
DIAGNOSIS. 259 
 
 Typhoid fever has blighted many homes — has broken 
 many hearts — and many sad chapters could be written 
 on its history. What could be more heart rending and 
 dolorous than the story of the far reaching misery and 
 desolation resulting from the last illness and death of 
 Queen Victoria's Royal Consort. 
 
 I have dug up the history that I may most emphat- 
 ically emphasize the importance of making an early 
 diagnosis, and because the failure of those learned men — 
 the flower of English Medicine — to make an exact diag- 
 nosis until within eight or nine days of the death of their 
 royal patient, was fraught with such direful results, and 
 because this practice of yesterday conforms precisely 
 with the course pursued by so many physicians of note 
 to-day, in this land of progression, in these days of de- 
 votion to bacteriology and sero-therapy ; indeed, it is 
 the exception rather than the rule that a positive and 
 exact diagnosis in typhoid fever is made early in the 
 course of the disease or that any effective treatment is 
 instituted in time to benefit the patient. 
 
 The rational supposition would be that the cause 
 of the illness of Prince Albert, this man so great and 
 good, most dearly loved during life, most deeply mourned 
 after death, practically the greatest ruler on earth ; 
 with all the resources of the greatest and most enlight- 
 ened nation at his disposal ; with all of the talent of the 
 medical profession of the whole civilized world at his 
 command, would be correctly diagnosticated at the 
 earliest moment possible. "But he was so sick on the 12th 
 of November, that the queen noticed it." Eleven days 
 passed and on the 23d and again on the 2 Ith " his mind 
 wandered strangely." " He was sleepless and his appe- 
 tite was lost." On the 27th he went to see his son, the 
 
260 DIAGNOSIS. 
 
 Prince of Wales, at Sandhurst, " who found him greatly 
 out of sorts." '" On the 28th he was still worse." 
 
 On the 1st of December Sir James Clark and Dr. 
 Jenner " were disappointed at finding him so very mis- 
 erable." On the second of December after a night of 
 " shivering and sleeplessness" he sent for Dr. Jenner, 
 who " found him suffering great discomfort and much 
 depressed." " The symptoms of what might prove to 
 be 'low fever' were beginning to be more marked," 
 when the Prince heard of the death of his royal cousin, 
 the King of Portugal and his brother, both of whom had 
 died of typhoid fever at this time, he said he was 
 glad that his disease " was not typhoid fever," because 
 he knew he could not survive an attack. The Queen 
 could not bring herself to believe that her husband was 
 seriously ill, and on the 3d her opinion was confirmed 
 by that of Sir James Clark, and on the fourth he still 
 "consoled the Queen with smooth prognostications," 
 and Dr. Jenner told her "the Prince must eat for he was 
 simply starving to death/' On the 5th Sir James Clark 
 " reported him somewhat better." Up to this time the 
 prognosis given, and the fact that Dr. Jenner insisted 
 that he must eat, very clearly indicates that the true 
 character of his disease had not even been suspected. 
 On the 6th of December the Queen's diary contains the 
 following entry: "The doctors declared that they had 
 all along been watching the patient's state suspecting 
 fever, but unable to judge what it might be or how to 
 treat him until that morning . . . that the fever 
 must have its course, viz., a month . . . that he 
 was not alarmed — that there were no bad symptoms, 
 but he could not be better till the fever left him." . . . 
 "They thought him less well and feverish," " the char- 
 
DIAGNOSIS, 261 
 
 acter of the disease was now clear beyond a doubt, and 
 the examination revealed physical signs that it was gas- 
 tric or ' low fever.' " 
 
 Martin says : ''Above all things the Prince seems 
 to have had no doctor attending him who was capable of 
 recognizing the gravity of the disease in time." Sir 
 James Clark, Dr. Jenner, Dr. (later Sir Thomas) Wat- 
 son, Sir Henry Holland and Dr. Brown, of Windsor — 
 these learned and distinguished gentlemen were not 
 more likely to blunder than the best of their confreres 
 of that day (or for that matter of the present) and 
 this narrative of the last illness of this royal Prince, 
 "who, in the prime of manhood and full career of his 
 usefulness, was removed by death," sounds much like 
 the accounts of many cases treated very recently. In- 
 deed the mode of procedure can hardly be said to 
 have done injustice to the teaching or the practice 
 of the present day. 
 
 For a failure to make a diagnosis of typhoid fever in 
 time to be of the slightest benefit to the patient is far more 
 common than one who had not made a study of the subject 
 would believe. This same course was pursued and with 
 like results so frequently about this time as to throw nearly 
 every Court in Europe into mourning deep and doleful. It 
 was repeated ten years later in the case of the Prince of 
 Wales, who however happily did not die. 
 
 A repetition was seen last year in our own capital, when 
 the Chairman of the Ways and Means Committee! at the 
 time the most prominent political figure in the United 
 States, stood up in the halls of Congress, speaking day 
 after day, when he was really on the brink of the gra 
 which he barely escaped. About the same time the wife 
 of the President of the French Republic, the head of a 
 
262 DIAGNOSIS. 
 
 noble English house, and many others whose rank and 
 condition were evidence of their ability to command the 
 best professional advice, were dying-, or lying very low, the 
 prey to errors of diagnosis or treatment. 
 
 Dr. Eliot, of New Haven, says: " Let me remind you 
 that a little less than nine years ago, Frederic Mahomed, 
 one of the assistants of Guy's Hospital, London, died at 
 the age of thirty-five years, of enteric fever, and that a few 
 days before his death, while his temperature was 104°, he 
 left his residence and went to the hospital to see a student 
 ill with rheumatic fever." His death " may serve to em- 
 phasize a point of the very greatest importance in this con- 
 nection ; it is the necessity of making a very early diagno- 
 sis if one wishes to treat enteric fever with the best results. 
 If the brilliant young assistant physician of Guy's Hospital 
 had realized that he had this disease he would probably 
 have remained in bed, and very likely would have recov- 
 ered, to continue his investigations in cardiac and renal 
 pathology." 
 
 In alluding to one of the fatal cases, Osier, the oracle, 
 says : " We did not really appreciate that he had typhoid 
 fever during the first week in hospital. The temperature 
 chart was very deceptive, and we thought it might be an 
 anomalous form of malaria ; but repeated examinations of 
 the blood were negative. After the enlargement of the 
 spleen and the appearance of a few rose spots rendered 
 certain the diagnosis of typhoid fever, the temperature did 
 not rise above 102° until the thirteenth day in hospital. 
 . . . . He took in all 114 baths. Death occurred from 
 perforation on the fifty-first day. " 
 
 While I am writing, hundreds are lying in the " valley 
 of the shadow ofdeath," because, as the diary from which 
 I have quoted says; "they seem to have no doctor 
 
DIAGNOSIS. 
 
 263 
 
 around them capable of recognizing in time the gravity" 
 of the most fatal of all of the curable and preventable dis- 
 eases. 
 
 The reasons given in the extract from Pepper's 
 "System of Medicine," for not specifying explicit rules for 
 the treatment of the earliest stages of enteric fever, viz., 
 the doubt and obscurity which generally envelopes the 
 diagnosis of each case, when the physician is first called 
 to treat the patient, are the very reasons why the diag- 
 nosis should be made at once, and every doubtful case 
 be regarded and treated as typhoid fever. 
 
 Many if not quite all of the pathognomonic symptoms 
 of typhoid fever are evidence of already existing anatom- 
 ical lesions; they are consequently valueless as a guide 
 to the physician, whose aim it is to abort the disease. 
 Although he may be able to succeed occasionally after 
 their supervention, in a malady of so insidious a char- 
 acter as typhoid fever, it would always be unwise and it 
 would sometimes be a fatal error to await their develop- 
 ment. Therefore the physician who would avoid having 
 a death from typhoid fever, must ever be on the alert 
 lest the disease pass beyond his control. 
 
 He should waste no time treating a case of this dis- 
 ease for any of the milder ailments, and since the loss of 
 hours in applying proper treatment for typhoid fever 
 would sacrifice more human lives than would the loss 
 of days in malarial fever, no physician should ever be 
 guilty of the stupid and criminal blunder of treatin 
 case of typhoid fever as malarial fever, a practice which 
 cannot be justified by any course of reasoning. It de- 
 prives the physician of the golden opportunity to abort the 
 disease. It condemns the patient to a longer duration of 
 illness. It places his life in jeopardy, and for what? The 
 
264 PROGNOSIS. 
 
 credit to the physician of having made an absolutely cor- 
 rect diagnosis. What does the patient care for the phy- 
 sician's reputation, or what the disease is called, so long 
 as he is cured of it in the shortest possible time and with 
 the least discomfort and danger ? I am aware that the 
 difficulty of making a correct positive diagnosis in atypi- 
 cal forms of typhoid fever are sometimes insurmountable. 
 In such cases as in all others the diagnosis for the pur- 
 pose of treatment should be by the process known as 
 ''reasoning by exclusion " and when by this method all 
 of the diseases from which the patient could not be suffer- 
 ing have been eliminated, if typhoid fever be not among 
 the excluded, the patient should be treated for that dis- 
 ease. 
 
 Prognosis. — In a very large majority of persons at- 
 tacked by typhoid fever, the disease comes on so insid- 
 iously, the patient during the first week perhaps scarce- 
 ly realizing that he is sick, and during the second week 
 growing worse so gradually that he, without awak- 
 ing to the gravity of his condition, passes into a realm 
 where he is incapable of caring or acting for himself, 
 and as the friends notice only a slight change for the 
 worse each day, they become accustomed to his state 
 and usually fail to recognize the danger until aroused 
 from their lethargy by the supervention of some grave 
 condition which is intelligible to them. Under such 
 circumstances the physician, because of the trust con- 
 fided in him, is under a high moral obligation to warn 
 the friends of the danger as soon as he recognizes the 
 character of the disease, without awaiting the superven- 
 tion of these alarming symptoms. 
 
 The prognosis in typhoid fever should always be 
 guardedly given. We have no certain means of finding 
 
PROGNOSIS. 265 
 
 out how long" the patient has been indisposed or how ex- 
 tensive or severe are the anatomical lesions ; death has 
 occurred at all stages of the sickness and from perfora- 
 tion and peritonitis within forty-eight hours of the time 
 at which the patient first realized that he was ill, — from 
 toxaemia at a period but a few hours later, from haemor- 
 rhage on the eighth day, and extensive ulceration of 
 Peyer's glands have been found in a patient who died 
 on the seventh day. 
 
 The usual course of the disease under abortive 
 treatment has been clearly stated elsewhere, but if the 
 physician gives a rose colored prognosis he should also 
 explain the possibility of the occurrence of all of the 
 numerous accidents which might befall the patient. 
 He should keep 'his promises well within his power 
 of performance, and to do so, he should know the history 
 of the condition of the patient from the hour in which he 
 felt the least invalidism. He should cross-examine the 
 historian with the shrewdness and cunning of the pro- 
 verbial lawyer, measure his intelligence and weigh his 
 words, make his decision, and render his verdict, with 
 the nicety of a supreme judge, to the end that he be not 
 himself deceived as to the duration of the patient's ill- 
 ness. He should examine the patient with great care, 
 allowing no symptom to escape his observation and 
 even then promise too little rather than too much. If the 
 patient has been ill but a day or two, the disease will be 
 easily and should be quickly aborted. If he has been 
 ill four, five, six or seven days and the disease; is running 
 an ordinary course, it can usually be aborted in from five 
 to ten days, and the physician who has had large experi- 
 ence with the abortive treatment will feel that he i i 
 speaking within due bounds when he gives a progn 
 in accordance with these facts. 
 
266 PROPHYLAXIS. 
 
 Should the patient have been indisposed longer than 
 the seventh day when first seen, no promise of speedy 
 convalescence should be made. Hence it will be appar- 
 ent that it will be from the general practitioner in private 
 practice that must come the evidence that typhoid fever 
 can be aborted, because the patients are usually beyond 
 the reach of abortive medication when they are obliged 
 to enter a hospital. 
 
 Prophylaxis. — The conservation of the health of the 
 people from the dangers of typhoid fever, as well as from 
 those of many other diseases, is best secured by giving 
 them an uncontaminated water supply. The fact that 
 polluted water and typhoid fever occasionally holds the 
 relationship of cause and effect has long been known, but 
 the intimacy of their connection is not to this day fully 
 recognized. While I am writing, there is appearing in 
 successive issues of The Journal of the British Medical 
 Association, a series of articles under the caption, 
 " Water-borne Typhoid " from the pen of its distinguished 
 editor, Mr. Ernest Hart, which are destined to do much 
 good, by emphasizing the importance of pure water in the 
 prevention of this disease. The author has collected and 
 tabulated the principal facts of the occurrence of 206 out- 
 breaks of this malady, in Great Britain and Ireland, which 
 were disseminated directly or indirectly by water. All, 
 with one exception, of the instances in which the water 
 was the indirect cause of typhoid fever, were cases in 
 which polluted water had been used to adulterate milk, 
 or to rinse the cans. The one exception being that of a 
 family, ten in number, all of whom had more .or less pro- 
 longed attacks of enteric fever, which were the result of 
 using the milk of a cow that had nothing to drink save 
 "mere sewage." "The cases lingering on for months, 
 
PROPHYLAXIS. 2G7 
 
 while the cow was herself getting thinner and thinner, at 
 last refusing to graze. After she was got rid of the dis- 
 ease disappeared from the house, but convalesence was 
 tardy, though ultimately complete." "But during the 
 tedious stages of the illness, one prominent feature was 
 that of partial convalescence ' by fits and starts,' one day 
 cheerfulness, another day lassitude, first playfulness, then 
 a desire for rest." 
 
 To strengthen my comments on this terrible con- 
 dition of things I will quote Mr. Hart, who says: 
 
 "My study of the subject dealt with in this report has 
 led me very strongly to support the theory that sees in 
 the soil the natural habitat and breeding ground of the 
 bacillus of typhoid fever outside of the human body. This 
 belief in nowise lessens my regard of the disease as being 
 largely caused by water, rather the reverse." He further 
 says: " Certain it is to my way of thinking that the es- 
 sential element in the prevention of water-borne typhoid 
 fever is cleanliness. All that go'es to cause pollution of 
 the soil tends to foster the disease. No point is so 
 strongly or so persistently brought in the history oi 
 typhoid fever occurrences in our country as that dirt and 
 disease go hand in hand. Only in the case of rivers, 
 does man seem to place his excrement directly into his 
 own or his neighbors drinking water, but he does not 
 scruple in too many instances to so dispose of his filth 
 that it must in the natural order of things find its way to 
 that drinking water. It is not alone in our rural and 
 sparsely populated districts that such disposal takes 
 place ; it is just as common to see people harboring then- 
 filth in proximity to dwellings and local water supplies in 
 our towns. These abominations which to-day persist in 
 so many of our towns — leaky and huge midden privies, 
 
268 PROPHYLAXIS. 
 
 uncovered and ill constructed ash pits, cesspools per- 
 mitting soakage of their contents, no one knows where — ■ 
 all these and more are the accompaniments of daily life 
 in scores of towns. And where town populations have 
 the good sense to so dispose of their filth, as not poison 
 the air they breathe or their local wells, too often we find 
 them in their selfishness and negligence, endangering the 
 water service of a vast aggregation of people in some ad- 
 jacent city, or borough by so ridding themselves of their 
 excrement as to pollute a gathering ground or stream, or 
 river used for purposes of domestic water supply." 
 
 One of the greatest dangers is the pollution of the 
 wells in the suburbs of cities in our smaller towns and 
 in the country, by outside privies or other like abomina- 
 tions. In this connection I again quote the words of 
 Dr. Hart, which are quite as applicable to these United 
 States of America as to England. 
 
 "Wells from a subsoil liable to pollution should in 
 nowise be made use of as sources of water supply. 
 The soil on which many of our towns are built has been 
 subjected to gross contamination for many years, and it 
 is not to be thought of as likely that the mere abolition 
 of cesspools, and so forth, will at once render safe the 
 abstraction of water from wells sunk in their proximity. 
 . . . It is obvious, however, that many wells to-day in 
 our country are not only so circumstanced as to seriously 
 threaten the health of the consumers of their contents, 
 but also that the wells are constructed in such a manner as 
 to permit of soakage from surrounding soil into them, both 
 surface and subsoil drainage. It should, therefore, be the 
 aim of all sanitary bodies to secure the internal lining of 
 wells being so finished as to prevent the ingress of water 
 from any questionable source. . . The further danger 
 
PROPHYLAXIS. 
 
 269 
 
 of contamination of well water by reason of rain storms 
 and resulting- floods is one to be thought of, and calls for 
 the proper construction of well mouths, lest they be sub- 
 jected to periodical overflow by surface water of polluted 
 character." 
 
 In regard to the use of the water from wells I shall 
 quote a few remarks from "The Report on Typhoid 
 Fever in the District of Columbia, submitted by the 
 Medical Society of the District of Columbia to the Com- 
 mittee of the United States House of Representatives." 
 
 "The drinking of the infected water of wells has long- 
 been known to be a mode of propagating typhoid fever. 
 If the soil of the city is receiving a considerable amount 
 of the excreta of typhoid cases — if much of that soil is 
 badly drained and wet with returned sewage — is it possi- 
 ble to avoid the danger of fouling the well water? It 
 may be assumed that where there are the largest number 
 of pumps there is the largest consumption of well w ater ; 
 that well water is used most largely by the poor, and in 
 those quarters of the city where the water and sewage 
 connections are fewest ; the soil underlying the city is 
 being constantly impregnated with human excrementi- 
 tious matter, and with all micro-organisms therein con- 
 tained, and that the water of wells liable to be contain 
 inated with such material is being constantly and 
 generally used as drinking water by the people. It is 
 not a violent assumption that the well water thus con 
 sumed is infected and dangerous to health. It is a mat 
 ter of chemical and bacteriological demonstration. As 
 sanitarians we must condemn the whole system and ad- 
 vise an early abandonment of all wells as the only solu- 
 tion of the question." 
 
 The lesson of the experiences of Vienna should be 
 
970 PROPHYLAXIS. 
 
 accorded some attention. " From 1851 to 1874 well 
 water of an impure character was used to a large ex- 
 tent. During this time the deaths from typhoid fever 
 ranged from 10 to 34 annually in every 10,000 of the 
 population. In 1874 spring water of great purity was in- 
 troduced and the well water of impure wells given up. 
 The annual mortality rate immediately fell to 5, and in 
 three subsequent years to 1.1 per 10,000 of population. 
 A good sewerage system was in existence long before 
 this, but it had no effect in reducing the mortality, as 
 sewerage without the abandonment of the drinking of 
 infected well water is without effect." 
 
 Mr. Hart in his superlatively excellent and inimitable 
 report says : " What have the pages of my report 
 shown ? They have shown typhoid fever caused and 
 spread in a variety of ways by the agency of water ; 
 they have testified to the fact that water can become 
 polluted at its source, on its way to the consumer (alike 
 before and after entry to the distributing mains), and 
 within the precincts of the domestic dwelling. We have 
 seen outbreaks caused by polluted wells, by sewage 
 contaminated rivers and streams, by water services 
 which have received the drainage of manured fields, the 
 sewage of whole villages, and innumerable excremental 
 pollutions over the areas of the gathering grounds ; by 
 careless laying, in close proximity and in badly jointed 
 fashion of water mains and sewers (the former even 
 passing through the latter) ; by washing of milk cans 
 with polluted water, by the mixing of milk with equally 
 polluted water, and by numerous other ways." 
 
 The time-honored practice of polluting our rivulets, 
 creeks, rivers and lakes by pouring into them all excre- 
 menta for equally civilized and refined human beings re- 
 
PROPHYLAXIS. 271 
 
 siding further down their courses to drink will be re- 
 garded by future generations with amazement and dis- 
 gust, and fortunate indeed will it be for us, if in their 
 charity they see any excuse or palliation for so criminal 
 and barbarous a procedure. 
 
 This great basin of the Mississippi Valley (bounded 
 on the north by great inland seas ofpurest water, dotted 
 all over with springs, veined everywhere by the ramifica- 
 tions of streams, forming great rivers of water, every 
 drop of which would be as pure and palatable as the 
 "Fountain of the Virgin," were it not for man's filth 
 which we have poured and still continue to pour into 
 them) should and would be as free from typhoid fever as 
 it is to-day from cholera. But this foul contamination 
 has made the disease man's most dreaded enemy all over 
 this princely realm. 
 
 Typhoid fever prevails in the town in which I am now- 
 writing, because the defilement and defcedation, the offal 
 and carrion and fecula from the dunghills and quagmires 
 and various other putrefying and festering sinks of cor- 
 ruption in the two miles of the shore of the meandering 
 little shallow river, whose waters creep sluggishly down 
 to the intake at the water works, collecting on its way 
 all that is reeking and stinking and vile along its banks, 
 (above which are the homes of a dense population, with- 
 out sewer connections), from the sewers and washings 
 from the numerous towns in the valley above, and is 
 then pumped into the water mains for 40,000 people to 
 
 drink. 
 
 Because of similar circumstances the city of Pitts- 
 burg has at present many hundreds of cases of typhoid 
 fever, with new cases reported at the rate oi t< n per 
 diem. 
 
272 PROPHYLAXIS. 
 
 These object lessons should teach the sanitary 
 authorities the importance of so disposing of human ex- 
 crementa that the inhabitants of the cities need not im- 
 bibe in the water the noxa from the sewage from the 
 cities, towns and the extensive country drained by the 
 water courses in their vicinity. 
 
 At this point I will quote what Mr. Hart says as to 
 the remedy of the spread of typhoid fever. " I would 
 suggest ridding the country of cesspools in the midst of 
 towns, and would also see cesspit middens removed from 
 off the face of the earth." 
 
 And again he says "all midden privies and cesspools 
 in towns should be abolished by law, feeling that these 
 disease disseminating abominations, as we permit them 
 to-day are annually costing the country enormous sums 
 by these very qualities of disease provocation. To this 
 end I would see that the statutory duty of sanitary 
 authortiesto make provision for proper sewers* for their 
 districts, enforced in all cases where sewage is practi- 
 cable. . . . It will be necessary also, that the old disused 
 forms of excrement disposal be done away with so as not 
 to prove dangerous by reason of their condition at the. 
 time of abolition. So I would see the application of 
 some powerful disinfectant to the receptacles, when 
 emptied finally, as well as of the complete filling, in of 
 the space occupied by them, in such manner that no 
 danger shall accrue to the water supplies by reason of 
 future soakage of filth left in the middens, etc. ,, 
 
 We should do all that our author suggests, but we 
 should go much farther. No city, town or village should 
 be allowed to pour her excrementa laden, poison bearing 
 
 * Instead of sewers Mr. Hart should have written proper and efficient garbage 
 crematories and sewers for drainage. 
 
PROPHYLAXIS. •);•: 
 
 into any lake, river or stream. Pittsburg 
 should not be required to drink the sewage of cities situ- 
 ate above her in the valley, nor should she be allowed to 
 thrust her corruption on the people of Cincinnati, and the 
 hundreds of other cities and villages along the banks of 
 the beautiful rivers. At the present time we may well 
 say "distance lends enchantment to the view." Our 
 water ways should not be converted into sewers convey- 
 ing disease and death to the people. Each brooklet, and 
 rill, and mountain torrent should gush, each lake, lagoon 
 and estuary contain, and each aqueduct, conduit and 
 canal overflow with pure and innoxious and potable water 
 with which to supply man with a wholesome drink to 
 quench his thirst, and in which to obtain wholesome fish 
 for food, which we cannot take from impure water. The 
 air wafted over their surfaces should be cool and sweet 
 and salubrious, instead of the veritable tornadoes, reek- 
 ing with the stench that now makes the vicinity of so 
 many of them only places to be avoided. 
 
 For all of the various ways in which water is polluted, 
 some remedy must be found. Think of the conditions oi 
 the cities, whose populations are now thoughtlessly 
 drinkingwater polluted with human excreta, should chol 
 era invade our shores, and yet typhoid fever is a little 
 more slowly but just as surely destroying our people, 
 and in the most disgusting way — for the presence of this 
 disease is evidence that the patient has taken into his 
 system a product of human excrement. Typhoid fever is 
 a preventable malady. Is it not the plain duty of the 
 Congress of the United States to adopt some measui 
 arrest the wholesale pollution of the drinking water ol 
 the country? 
 
 The administration which rises above the petty affairs 
 
274 PROPHYLAXIS. 
 
 which so often engage the attention of our Statesmen, 
 — grasps the full import of this very important matter, and 
 creates a new department of the Government of the 
 United States — the Department of Public Health — will 
 merit and receive the blessings of the people. 
 
 It should be the first great duty of this " department " 
 to prevent the occurrence of a disease which is known to 
 be preventable, which has been practically abolished in 
 some of the capitals of Europe, and when water and soil 
 pollution have been arrested will be abolished every- 
 where. If the causes of its persistence is known, if, 
 above all, these causes can be removed — and they can — it 
 is our part and duty to make the facts public and to arouse 
 public attention to the necessity and urgency of the de- 
 mand for action. 
 
 A Secretary of Public Health on his induction into 
 office, would find abundant occupation worthy of the most 
 brilliant intellect, and demanding the highest executive 
 ability, and not the least of his duties would be the pre- 
 vention of water and soil pollution. Give all of the peo- 
 ple of all of the land potable water, untainted with human 
 excrement, and typhoid fever and cholera would be un- 
 known. And only the strong arm of the general gov- 
 ernment through a Secretary of Public Health can do 
 this. But propose to the Congress of the United States 
 the creation of such an office, and some cold, calculating 
 member — some guardian of the treasury — forgetting all 
 the grief and sorrow and suffering that these diseases 
 cause, would ask if this secretary, which in the name of 
 humanity we demand, could earn his salary. 
 
 It is impossible to answer the question with all of its 
 true force because we have no available statistics, as to 
 the prevalence or mortality from typhoid fever outside 
 
PROPHYLAXIS. 075 
 
 the larger cities, and the editor of the Journal of the 
 American Medical Association, Dr. John B. Hamilton, 
 whose knowledge of the distribution of diseases and of 
 sanitary science is probably unexcelled says that typhoid 
 fever is the bane of the rural districts, therefore the 
 statistics of cities do not do full justice to the subject. 
 In measuring the cost of an epidemic of typhoid fever, Dr. 
 Osier says : " Cold lifeless things, figures make no more 
 impression on the ordinary mind than would the enu- 
 meration of the days of the year; not more also does the 
 statement that at an estimate of an average of six weeks 
 illness to each case, there have been from 1888 to 1892 
 (inclusive) 82,512 weeks of lingering illness, about 1,600 
 years. 
 
 "When beneath untouched lintels the destroyer, <equo 
 poede, enters our own door, in weeks of suspense, if 
 not in the anguish of loss — needless loss — such as has 
 been felt in 1,146 families of this city within five years- 
 then only can be realized to the full the bitter penalties 
 attached to the transgression of all well-known sanitary 
 laws. 
 
 "The direct money loss in the community from 
 typhoid fever alone during the past five years may be 
 readily estimated. The loss in wages, the expenditure 
 on the attendance upon the sick, and the cost of the feed- 
 ing may be placed at the very low average of $10 a 
 week, which would make a total loss of $825,120 for the 
 five years, above $165,000 a year, to say nothing of the 
 yearly loss of 229 lives— lives too at the period oi 
 est value to the State." 
 
 Dr. Munro, medical officer of health for the county 
 of Renfrew, England, gives an approximate cost of an 
 epidemic, which occurred some years since in Mid-Ren 
 
276 PROPHYLAXIS. 
 
 frewshire. " There were 859 cases, out of which seventy- 
 four were fatal. The average cost of hospital treatment 
 was about £8 15s., ($41.22) on which figure Dr. Munro 
 puts the average cost of treatment all round at £^ 
 ($24. 20) per head, a figure which seems certainly well with- 
 in the mark. From data to which he has had access, he 
 puts the average wages lost to the patients at £3,291 
 ($15,928,44). The cost of funerals is taken at £5, ($.24.20) 
 and the capital value of a human life at Farr's low figure of 
 ,£159, ($769.) The total pecuniary cost of the epidemic 
 to the community of Mid-Renfrewshire was accordingly 
 ,£21,496, ($104,040.64), or just over £25, ($121.00) for 
 each case. These figures are all calculated on the very low- 
 est scale, and no doubt were in fact exceeded. If local 
 authorities could realize such figures they would see that, 
 quite apart from questions of sentiment or moral duty, 
 no expenditure could yield a better interest on the in- 
 vestment than that which is bestowed on the provision 
 of pure water supplies and the establishment of isolation 
 hospitals and adequate means of disinfection." 
 
 During the last five years, 1889-94, there have oc- 
 curred in Chicago from typhoid fever about 5,655 deaths, 
 allowing ten cases of the disease for each death and ap- 
 plying Osier's estimate of six weeks' illness, that city 
 had 56,550 persons suffering an aggregate of 339,300 
 weeks or 6,525 years of sickness ; if the loss in wages, 
 the feeding, care and medical attendance of each one 
 was worth ten dollars per week, there was expended on 
 these items $3,393,000 ; if the funeral expenses of those 
 who died averaged $25, and the life of each decedent 
 from the disease — usually the young and vigorous — may 
 be estimated at $1,000, it brings the cost of typhoid 
 fever in this one city during the period mentioned to 
 
PROPHYLAXIS. 
 
 •277 
 
 the grand and enormous total of $9,189,375 and more 
 than sixty-five centuries of " miserable " sickness. 
 
 Mr. Sutherland has calculated that the loss to 
 Great Britain by typhoid fever for the twenty years 
 1861-1880 = ^23,300,000 ($112,772,000). " The deaths 
 from typhoid fever in Scotland during the ten years 
 1880-1889 show a gradual and tolerably regular diminu- 
 tion from 1,335 deaths in the former year to 795 
 deaths in the latter year ; but this is due to bettered 
 sanitary conditions, and not to treatment. 
 
 " Of 6,960 cases of typhoid fever in hospitals, 1,332, 
 or 17.7 per cent, died." This is about the average 
 death rate of Philadelphia at the present time. 
 
 I quote the following statistics from Dr. J. YV. 
 Moore's comprehensive work, "Eruptive and Continued 
 Fevers" (1892). 
 
 Year. 
 
 No. of Cases of 
 Typhoid Fever 
 admitted to the 
 Dublin Hospi- 
 tals. 
 
 No. of Deaths from 
 Typhoid Fever in 
 Hospitals. 
 
 No. of Deaths from 
 Typhoid Fever 
 in Dublin Regis- 
 tration District. 
 
 1879 
 
 367 
 377 
 169 
 202 
 182 
 218 
 265 
 263 
 276 
 365 
 783 
 636 
 
 36 
 25 
 22 
 9 
 18 
 29 
 22 
 35 
 28 
 4 4 
 79 
 66 
 
 205 
 
 18S0 
 
 188 
 
 1881 
 
 123 
 
 1882. 
 
 135 
 
 1883 
 
 132 
 
 1884 
 
 134 
 
 1885 
 
 144 
 
 1886 
 
 129 
 
 1867 
 
 
 1888 
 
 168 
 
 1889 
 
 
 1890 
 
 185 
 
 
 
 The Cincinnati Lancet-Clinic on pa 
 gives the following death rates for 1894 for the cities 
 
 named : 
 
278 
 
 PROPHYLAXIS. 
 
 DEATHS FROM TYPHOID FEVER PER 100,000 OF POPULATION (1894). 
 
 London 16 
 
 Glasgow 20 
 
 Rotterdam . . .- 5 
 Stockholm ... 8 
 Hamburg. ... 18 
 
 Munich 15 
 
 Buda-Pest ... 15 
 
 Rome 34 
 
 Dublin 87 | 
 
 Prague 36 | 
 
 Manchester 25 j Edinburgh. . . 14 
 
 Paris 25 
 
 The Hague 2 
 
 Christiana. 6 i 
 
 Dresden 4^ 
 
 Trieste/ 17 
 
 Brussels 27 
 
 Turin 29 
 
 St. Petersburg . . 51 
 
 Milan 62 
 
 Amsterdam. . 16 
 Copenhagen . 9 
 
 Berlin 9 
 
 Breslau. . .... 10 
 
 Vienna 7 
 
 Venice 26 
 
 Liverpool. . ..53 
 Moscow 40 
 
 There were returned to the State Board of Health 
 for Michigan during the sixteen years 1867-1882, 7,957 
 cases of typhoid fever, and 2,890 deaths from the dis- 
 ease. In 1891 (the latest report at hand) there were 
 returned 4,670 cases and 697 deaths. 
 
 Dr. Guy McCandless, Registrar of Pittsburg, gives 
 the number of typhoid fever cases reported in that city 
 in July, August and September, 1894, at 407, and in the 
 same months of 1895, at 526, an increase of 119. The 
 number of deaths in 1894 was 46, and in 1895 was 49. 
 
 Dr. McCandless says : " You will observe that 
 there are more cases reported in 1895 than in 1894, with 
 only three more deaths. I believe there are cases 
 reported as typhoid fever in which the diagnosis was 
 mistaken, for to my knowledge some of the cases re- 
 ported were well and out in less than two weeks."* Dr. 
 McCandless seems not to have known that some of the 
 physicians of Pittsburg and Alleghany were during that 
 period treating their cases of typhoid fever by the abor- 
 tive method, several of them having written to me per- 
 sonally for directions for the treatment. If all had used 
 
 *Pittsburg Despatch of November 15, 1895. 
 
PROPHYLAXIS. 279 
 
 this method scientifically instead of "some of the cases 
 being well and out in two weeks," the average duration 
 of illness of all cases would have been even shorter. 
 
 There were reported in the District of Columbia in 
 the decade ending June 30, 1894, 1,611 deaths from 
 typhoid fever. In Cincinnati, from 1868 to 1894, there 
 were 3,935 deaths, and in Boston from 1871 to 1894 — 
 twenty-four years — there were 4,165 deaths from the 
 disease. During the thirty-three years, 1862 to 1894, 
 Philadelphia had 17,457 deaths from typhoid fever and 
 applying the same low estimate already made for Chi- 
 cago, it shows that from this one malady there was 
 enough sickness in Philadelphia to cost that city $185,- 
 480,625. There were 1,047,420 weeks, or 20,142 years 
 of sickness, or enough to keep ten persons sick from 
 the beginning of the Christian era to the present time, 
 with more than twelve hundred years to spare. 
 
 These statistics, incomplete as they are, are sufficient 
 to give the reader some idea of the awful ravages oi 
 typhoid fever in the near past, and I believe when the 
 records of 1895 are compiled they will show the latter 
 to have been the most fatal year in the history of this 
 disease, the preventability of which calls for the institu- 
 tion of some measures to arrest its devastating progress 
 by providing for every member of the commonwealth 
 unpolluted water to drink— but by whom ? 
 
 That it is possible for the municipal authorities of the 
 present day to do this is proven by the work ol the 
 scientific engineers of long ago— and we surely have 
 men of genius who can do all that they have den- 
 successfully. The Greeks of Homer's time taught oi 
 hygiene as well as of medicine. We read of Eupalinus, 
 an engineer celebrated for the skill with which he con- 
 
280 PROPHYLAXIS. 
 
 structed the works for the water supply of the city of 
 Magara, during the reign of the tyrant Theagenes. 
 (Circa 625 B. C.) One of the earliest forms of the 
 aqueduct in which to convey pure water to the abodes 
 of the people — that water which went so far toward 
 making the Greeks the proverbially vigorous and 
 athletic race they were — was the one on the Island of 
 Cos, a part of which consisted of a bell-shaped chamber, 
 built under ground in a hillside, in which to receive the 
 water from a spring where it might be kept fresh by the 
 air which was supplied through the airshaft. 
 
 In Athens, 560 years before Christ, cold, pure and 
 wholesome water was brought from the hills Hymet- 
 tus, Pentelicus and Parnes — the ruins of which can still 
 be traced in the village of Chalandri, by the airshafts 
 which were from five to six feet in diameter. 
 
 Tradition tells of the works of Empedocles, who 
 brought water to the city of Selinus in Sicily, and there 
 lived in Syracuse a man whose work was done for the 
 ages — for his tunnels and pipes are still used for sup- 
 plying the city with an abundance of drinking water. 
 
 No obstacle seems to have been too great for the 
 men of this ancient day to surmount, for they tell us of 
 the tunnel for fresh water which passed under the sea 
 to the Island of Ortygia — and all this was accomplished' 
 successfully to conserve the health and comfort of the 
 people. When one remembers the great achievements 
 of the men of antiquity — looks upon the undertaking of 
 Appius Claudius in constructing the Via Appia in the 
 year of Rome 442, when the first attempt was made to 
 supply from a distance the water to the City of the 
 Seven Hills. When they .built the many series of 
 arches and pillars in order to bridge the valleys and 
 
PYOPHYLAXIS. 281 
 
 bring across the Campagna the water from the springs 
 in the lofty Sabine Hills, making the aqueduct almost 
 three hundred miles in length, erected the Porta 
 Maggiore, through which the water was conducted in 
 two separate channels, one above the other, and under 
 which the traffic of the city might pass ; the remains of 
 which make some of the most striking monuments of 
 modern Rome. 
 
 They were not niggards in those days, when the Cura- 
 tores Aquarum had the oversight of the aqueducts and 
 public waterways of the Republic or Empire, and their 
 expenditures were most lavishly made but unfortunately 
 their efforts did not seem to be appreciated, for during 
 the middle ages these wonderful artificial provisions for 
 the water supply were neglected to such an extent that 
 many of the colossal creations — these triumphs in archi- 
 tecture — are now in ruins. 
 
 These aqueducts of solid masonry were a necessity 
 to this people, for although they were not ignorant of 
 the hydrostatic principle that water would rise to its 
 own level they lacked the ability of making suitable 
 pipes of the proper material to conduct these enormous 
 quantities of water, for the use of cast iron was quite 
 unknown. 
 
 We do not labor under this difficulty for we have at 
 our command the means of manufacturing so admirably 
 this much needed article, and we are in general spared 
 the vast expense of the stone aqueduct, and can bring 
 our water from where we will at our pleasure But the 
 rarity of these desirable conduits in modern time 
 proportion to the number of cities which so greatly need 
 them is marvelous. But neither are we niggards in this 
 age of progress and prosperity. We hear of the great 
 
282 PROPHYLAXIS. 
 
 system of waterworks which supplies Marseilles with the 
 water of the Durance, by a canal sixty miles long, com- 
 prised of many tunnels through mountains and aque- 
 ducts across valleys, which is considered an extraor- 
 dinary engineering feat of to-day. Most grand in design, 
 solid in structure and of most extensive utility are the 
 Ganges fresh water canal in Bengal, India ; the Croton 
 aqueduct with its magnificent bridge across the Harlem 
 River ; the famous and stupendous Manchester water- 
 works system, with a conduit ninety-six miles long; the 
 Loch Katrine aqueduct, which brings to Glasgow the 
 pure and potable waters of this beautiful and noted lake; 
 and the well-known conduit by which the waters of the 
 Vyrnwy are conveyed to Liverpool. On the Continent, 
 we find that the City of Vienna obtains her water from 
 the Styrian Alps, a distance of almost sixty miles ; the 
 water for Paris is brought about 110 miles to the 
 reservoirs at Belleville when the waters of the Seine 
 became too much polluted for domestic use. 
 
 Thus in ancient and in modern times vast sums of 
 money have been expended and herculean tasks under- 
 taken to give pure and wholesome water for domestic 
 use. In our day a few large cities have done much for 
 the sake of sanitation, but the tendency in this age of 
 the aggregation of large bodies of people in cities, and 
 the short-sighted and selfish policy of each community 
 to pour its sewage into the most convenient stream or 
 lake, regardless of the injury it may do others if only it 
 flows away from its own door, calls urgently for the 
 inauguration of some means to prevent the wholesale 
 pollution of fresh waters, whether of springs, rivulets, 
 lakes or rivers. 
 
 The authority of the City Health Board is practically 
 
PROPHYLAXIS, 288 
 
 confined to the city's corporate limits ; that of the town- 
 ship officers ends at the township line ; that of the 
 county officials at the county line ; and the State Boards 
 of Health can go no further than the State line ; while 
 the causes which produce the disease may come from 
 without their jurisdiction. But the authority of a Secre- 
 tary of Public Health of the United States would not 
 only be coextensive with its boundaries, but wherever 
 the American flag waves he could make his influence 
 felt for the good of mankind. Therefore I repeat that 
 a Department of Public Health is a public necessity, 
 and the appointment of a Secretary of Public Health is 
 demanded alike by the highest and by sordid motives. 
 
 That this official, if competent and clothed with 
 adequate power, could save the country many millions 
 of dollars annually is easily demonstrable. That he 
 could prevent a vast amount of sickness and suffering 
 and the unnecessary sacrifice of many thousands of 
 lives during the first year — and in an increasing ratio 
 during each succeeding year — of his incumbency is 
 equally certain; and the government of the United 
 States will not have attained its full stature— the cul 
 minating point of its influence for the highest benefit of 
 all of its citizens, the zenith of its greatness until a 
 Bureau of Public Health is one of its integral and co- 
 equal departments. 
 
 Sanitary science should find a place in the man- 
 agement of every individual case of contagious or 
 infectious diseases; therefore, the duty of a medical 
 attendant on cases of typhoid U:\<-v is to see thai 
 all of the evacuations of every emunctory of the 
 patient— the sputa, the urine, the vomit, as well 
 all the alvine dejections are disinfected as soon as 
 
284 PROPHYLAXIS. 
 
 voided, nor should he await the development of pa- 
 thognomonic symptoms of typhoid fever before attend- 
 ing to this important matter any more than before 
 commencing the abortive treatment. The body and bed 
 linen, especially if soiled by excrement, should receive 
 scrupulous attention and should be put into some disin- 
 fecting solution,* or better in boiling water. These 
 precautions are especially important in the country 
 where there is the greatest danger of contaminating the 
 water supply. Every practitioner, however, who does 
 private practice will realize how easy it is to have 
 these directions followed for two or three days, while 
 the patient is not very ill, but how difficult — how impos- 
 sible it is to have these sanitary precautions attended to 
 for weeks, when those whose duty it is to care for the 
 sick, as well as guard the health of the uninfected, are 
 (as is too often the case) the immediate relations of the 
 patient, who is perhaps passing dangerously near the 
 brink of the grave, and all around are overwhelmed with 
 anxiety ; or perhaps one or two members of the family 
 have passed to the great beyond, and in addition to the 
 anxiety for the living is added grief for the dead. How 
 much this labor of disinfection will be lightened, and 
 rendered more efficient by the abortive treatment, only 
 he who has passed through both experiences can tell. 
 Antiseptic treatment in typhoid fever will prove to be of 
 greater value to humanity, if possible, as a prophylactic 
 than as a curative measure. It is much more than four 
 
 *There are on the market many manufactured or proprietory disinfect- 
 ants, but there is nothing better than a simple solution of hydrargyrum chloridum 
 corrosivum or ferrum sulphatum (corrisive sublimate or copperas), and these 
 possess the advantages of being both convenient and inexpensive. Other good 
 and efficacious disinfectants are zincum chloridum, acidum sulphurosum, and 
 chlorinum. 
 
PROPHYLAXIS. 
 
 285 
 
 times as difficult to have thorough sanitation for four 
 weeks, than for one week. It is very much more difficult 
 to have sanitary matters attended to when the patient is 
 very sick, and every one anxious and perhaps over- 
 worked, than when the patient is but mildly ill, requiring 
 no special care and causing no anxiety. No language 
 can picture the difference between the results of the 
 antiseptic and the " expectant method " of treating 
 typhoid fever as shown in the condition of the patients. 
 Still less can any pen indicate the advantage to human- 
 ity of the abortive treatment of the disease, arising from 
 the shortened period of time during which the patient is 
 a menace to the community, even though the hope should 
 prove to be groundless, that by asepticizing the ali- 
 mentary canal the alvine dejections are rendered innoc- 
 uous. This point assumes higher importance from the 
 conclusion of the Clinical Society of Great Britain, 
 that "a person suffering from enteric fever is capable of 
 conveying the infection to others throughout the whole 
 course of the disease, from the date of the earliest symp- 
 toms of illness until convalescence has been established 
 for at least a fortnight." 
 
 As typhoid fever is essentially a water borne disease 
 it seems to follow that it is almost as frequently dissemi- 
 nated by the use of contaminated milk. Mr. I [art, writing 
 in 1881, said : " The influence of milk in spreading 
 motic diseases was then almost a new danger revealed by 
 hygienic science. Ordinary measures oi sanitary (don 
 tic) precaution do not seem to avail to secure immunity 
 against the incidence of dis< i spread, although the 
 
 boiling of milk was seen to be a method of rendering 
 that article innocuous." 
 
 The well-known property of milk of absorbing odors — 
 
286 PROPHYLAXIS. 
 
 the fact that it is an excellent culture medium for disease 
 germs, and that it has been known to be the prime factor in 
 the spread of many epidemics of disease should, without 
 farther teaching lead to its universal sterilization by heat. 
 Milk has been responsible for so many outbreaks of 
 typhoid fever in this country, that we instinctively in- 
 quire about the source from which the supply of that 
 fluid is obtained as soon as we see a case of the disease. 
 These outbreaks have all resulted from using polluted 
 water with which to rinse the milk cans or adulterate the 
 milk, with few exceptions — one heretofore mentioned 
 as having occurred in a village near Leeds, England, 
 during the summer of 1876 and reported by Dr. R. P. 
 Oglesby ; and another occurring in Bayhead, New Jer- 
 sey, during July 1894, reported by Dr. W. H. Katzen- 
 bach to the New York Clinical Society, October 1894, 
 which included fifteen cases of the disease. 
 
 In this instance the first patient came from Whites- 
 ville, fifteen miles distant, to take charge of a herd of eight 
 or ten cows, " which he stalled and pastured on a small 
 farm, . . . and milked daily until July 11th, when, un- 
 able to be about any longer, he took to bed." From the 
 facts offered it is fairly conclusive that the milk was not 
 contaminated by the " water used in the cans for cleans- 
 ing or dilution. The only way, consequently, in which 
 
 the milk could have been infected was by Fred J 's 
 
 hands. How this could occur can be left to the imagina- 
 tion of those who are familiar with the personal habits of 
 some who work on dairy farms." 
 
 Dr. Welphy, of Belfast, Ireland, has noted in his 
 article, " Creameries and Infectious Diseases," an in- 
 fected dairy was the cause of the certain outbreak of 
 typhoid fever, and shows how minute a quantity ofmor- 
 
PROPHYLAXIS. 
 
 287 
 
 bific matter is capable of "well nigh indefinite multipli- 
 cation in such an ideal culture medium as milk." He 
 found in his examination that the cows in this dairy 
 were milked by a person whose hands had been soiled 
 by typhoid dejecta, and that some of the dairy maids 
 acted also as nurses to the sick." 
 
 The bright, spicy and independent Sanitary Era, 
 June, 1895, gives the following: 
 
 " In Stamford, Conn., the local health officer reports 
 337 cases (in a population of 16,000), of which 307 have 
 been traced positively to the milk supplied by one dairy- 
 man, and thence to shallow wells near his barns, which 
 furnished the water in which he rinsed his milk cans, 
 and which water was foully contaminated from a little 
 settlement of Italians close by. . . . The typhoid 
 bacilli were found abundant both in the water and the 
 milk of this dairy. 
 
 "In New Milford, Conn., twenty-three cases of 
 typhoid fever have been traced to the milk from a herd 
 of cows that were milked by a laborer suffering from the 
 disease. 
 
 "The above epidemics are a continuation of the reg- 
 ular line, running back through those of Montclair, New- 
 Jersey, Springfield and Somerville, Mass., Waterbury, 
 Conn., etc." 
 
 The -knowledge that could be gained from an inti- 
 mate association with some of those who milk and care 
 for cows, might have a salutary effect upon some munic- 
 ipal lawgivers, though it might also destroy their ap- 
 petite for this almost universal article of diet 
 
 I fancy some members of the Roman syndic have 
 visited some of Rome's out lying modern dairies, since- 
 
 " For some time past excellent regulations have I 
 
288 PROPHYLAXIS. 
 
 in force in Rome proper, in relation to the health of 
 milch cows and other animals which supply milk to the 
 residents. By order of the syndic just issued similar reg- 
 ulations are put in force for the whole of the commune, 
 which includes a considerable extent of the surrounding 
 Campagna. They are to the following effect : All milch 
 cows and other animals which supply milk in the sub- 
 urbs and Agro Romano will be subject to a rigorous ex- 
 amination by the municipal veterinary surgeons. To 
 this purpose, notice of every animal introduced into the 
 commune must be given to the health authorities before 
 the milk can be sold, and it is then placed under the in- 
 spection of the veterinary surgeon. When the animal 
 is healthy and capable of furnishing good milk it will be 
 marked in the horn, and a special license will be given 
 to the owner." 
 
 Until some laws similar to the above are made and 
 enforced in this country, and until we know who does 
 the milking, it would be the part of wisdom to sterilize 
 all milk used for domestic purposes, and especially for 
 the sick room, and while treating typhoid fever it 
 should not be used until perfectly sterilized by heat 
 The unpleasant flavor of boiled milk can be avoided if it 
 is prepared in a closed vessel and immediately put into 
 the refrigerator to be cooled. The addition of benzoic 
 acid to milk cannot be too strongly condemned. It is 
 fortunate for man that the earliest fermentative changes 
 render milk acid before becoming putrescent, but the 
 most of the chemical preservatives retard the acid fer- 
 mentation without arresting putrefactive changes. 
 
 Every outbreak of typhoid fever which cannot 
 be traced to the use of infected milk, may be assumed 
 to depend upon water pollution — notwithstanding the 
 
PROPHYLAXIS. 
 
 very able arguments of Dr. Priestly at the last meet- 
 ing of the British Medical Association. Long before 
 the true pathogeny of typhoid fever was even sus- 
 pected careful observers had connected outbreaks of 
 the disease with the water supply, and even as late as 
 1854, that great scientist, Pettenkofer, regarded the 
 oscillations of the water in wells as in some mysterious 
 way giving origin to the disease without realizing that 
 its pathogenic influence is due to the pollution of the 
 water with human excrement, and that variations in the 
 level of the ground water merely gives opportunity for 
 its contamination, which sometimes produces effects 
 apparently out of all proportion to the cause ; as at 
 Winnefrede, West Virginia, where a single case of ty- 
 phoid fever caused an outbreak of 154 cases in a com- 
 munity of 1,600 souls, by the pollution of a single spring 
 and the stream flowing from it ; or at Plymouth, Penn., 
 where 1,200 cases were the result of the contamination 
 of the water by the excrement of a single patient. 
 
 The drainage from cemeteries where victims of ty- 
 phoid fever have been buried, have also been the proba- 
 ble cause of many outbreaks of the disease, as at 
 Watertown, New York, where a large number of < 
 occurred during the summer of L895. Professor Prest- 
 wick has pointed out that the growth of London 
 restricted till the establishment of a system supplying 
 the inhabitants with an abundance of other than the 
 sparkling water of old shallow wells which had 1 
 contaminated by infiltration of water from graveyards 
 and elsewhere. 
 
 In my own practice, some of the most seven 
 have ever treated seemed to be the direct result of the 
 pollution of well water by drainage from cm A 
 
290 PROPHYLAXIS. 
 
 powerful argument in favor of cremation of bodies dead 
 from contagious diseases, as well of sewage ; therefore, 
 no water from any suspected source should be admitted 
 into the sick room to be used as drink until it has been 
 sterilized. 
 
 These simple precautions are all that are necessary 
 to protect the community, the family and the nurses 
 from the infection of typhoid fever, as well as to guard 
 the patient from the danger of reinfection. There is no 
 real danger of communication of typhoid fever from the 
 patient directly to the nurse or to any one else. 
 
 The science of bacteriology has refuted the con- 
 tagion theory of Bretonneau, Leuret, Gendron, and the 
 host of observers who believed that the disease could 
 be transmitted through the air and has confirmed the 
 teachings of Budd that every case of typhoid fever is 
 the child of some previous case — that the pathogenic 
 principle is voided with the excrement of the patient, 
 and that it is capable of such wide diffusion that all of 
 the inhabitants of a populous city might be infected by 
 the discharges from a single case of typhoid fever. 
 
 Murchison, in summing up the evidence of the conta- 
 giousness or noncontagiousness of typhoid fever, says : 
 " But the most remarkable fact is what follows. Since 
 1861 it has been the practice to classify the patients in 
 the fever hospital in this way. The typhus, relapsing, 
 and scarlatina patients have been kept in distinct wards, 
 whereas the patients suffering from enteric fever have 
 been treated in the same wards with the many patients 
 sent to the hospital, who have not been the subjects of 
 any form of contagious fever. The two classes of pa- 
 tients have remained together, both during the acute 
 stage of their maladies and in convalescence, in most in- 
 stances for several weeks. 
 
PROPHYLAXIS. oi)] 
 
 "The same night chairs have been used by both 
 classes, and the employment of disinfectants has been 
 exceptional. The result has been this : During the 
 nine years 3,555 cases of enteric fever have been treated 
 along with 5,144 patients not suffering from any spe- 
 cific fever ; not one of the latter has contracted enteric 
 fever. My experience, in fact, has led me to the con- 
 clusion that when enteric fever originates in the hospital 
 as a rule there is something radically defective in the 
 sanitary arrangements, and that either the air or drink- 
 ing water is polluted with decomposing excrement." 
 
TREATMENT. 
 
 The abortive treatment of typhoid fever is hedged 
 around with many barriers and obstacles, which are 
 all the more difficult to surmount because of the existing 
 uncertainty as to its true pathogeny, but whether we as- 
 sume that it is due to the presence in the system of the 
 Eberth bacillus and its toxins, to a virulized bacillus 
 coli cummunis or to some other noxious influence, 
 the indications for treatment, though numerous, and in 
 some respects obscure, are in others clear and well de- 
 fined. To reinforce the natural power of the body to re- 
 sist the encroachment of disease, to destroy and neutral- 
 ize and eliminate as much as possible of the poison before 
 it or its toxins have passed beyond their earliest usual 
 habitat in man — the alimentary canal — and to reach into 
 the general circulation and render innocuous the 
 ptomaines, toxins, typho-toxin, tox-albumens or what- 
 ever interferes with the patient's health or comfort. 
 
 In early stages of uncomplicated typhoid fever in the 
 adult, the patient should be regarded and treated simply 
 as the container of the poisons, and when they are de- 
 stroyed or neutralized and the container cleansed, nature 
 will restore to each organ its normal function and all 
 symptoms of the disease will disappear. 
 
 The treatment, to meet all of the indications, must be 
 antiseptic, laxative, diuretic, and diaphoretic ; it must be 
 more even than all this — it must have power to devitalize 
 or render nontoxic all of the lethal or deleterious ele- 
 ments that have entered the system, whether circulating 
 
 292 
 
TEE A TMENT. 093 
 
 in the blood or migrating through the various tissues 
 and organs of the body. It must also be harmless to 
 the healthy organism, and since a positive diagnosis of 
 typhoid fever at a sufficiently early stage to abort the 
 disease is sometimes impossible, it should be incapable 
 of injuring the patient in any pathological condition that 
 could be mistaken for that disease. 
 
 From the little we now know — and the much we imagine 
 — of the cause and origin of typhoid fever, we may sur- 
 mise that upon the invasion of the human system by the 
 materies morbi of the disease, war is immediately in- 
 augurated by the protective alexins, which is sometimes, 
 no doubt, waged for days or even weeks with uncertain 
 results, ending frequently in all probability in such easy 
 and complete victory for the alexifers, that the patient in 
 whom this internecine battle is fought is and remains 
 totally oblivious of the great problems which are being 
 solved within him — ending sometimes in a closer contest, 
 but in ultimate victory — in this we recognize the " abort- 
 ive attack, " — and again in a rout for the health restoring 
 friend of man — this is the prolonged and often life destroy- 
 ing attack — and now while this conflict with one specific 
 poison is in progress, the enemy may be reinforced by- 
 other kindred noxas or morbific influences from without, 
 or even developed within the organism, for we have to do 
 with a pathological as well as with a physiological 
 and chemical laboratory— with a creator as well as a 
 receiver of poisons — and here we have those dangerous 
 complications and sequela? so common in typhoid fever. 
 To guard the patient against the dangers of these most 
 frequent causes of a fatal termination of typhoid fever, 
 constitute one of the most imperious demands for the 
 early abortion of the disease. 
 
094 TREATMENT. 
 
 It not infrequently occurs that an attack of typhoid 
 fever which has run a mild course, suddenly assumes 
 a malignant type, and may we not see here the defeat of 
 the friendly alexins, the abuse of the victory of the 
 pathogenic influences and an imperious call for the ad- 
 ministration of alexipharmacons. 
 
 Since the principles that govern the abortive treatment 
 of typhoid fever govern also the treatment of a large num- 
 ber of other microbic diseases, and if the exact formulas 
 which have thus far proven most puissant for this purpose will 
 not also cure all of the diseases that could be mistaken for it, 
 they will at least put the patient in the best possible condi- 
 tion to recover from any pathological state at all resembling 
 this disease. Hence it is not necessary to await in worse 
 than idleness the development of such symptoms as would 
 make an exact diagnosis possible. 
 
 As the so-called pathognomonic symptoms of this dis- 
 ease, with one doubtful exception, are evidence of already 
 existent anatomical lesions, it becomes apparent that to 
 await their supervention would be unwise. Thus the 
 earlier the alexipharmics are exhibited the easier it will be 
 to abort the disease, and the less will be the danger of 
 relapses or grave complications. 
 
 This treatment to be invariably successful must be com- 
 menced 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 head- 
 ache, a slight acceleration of the pulse and a scarcely per- 
 ceptible elevation of the temperature. Upon such data one 
 could not base a diagnosis of typhoid fever, but it would be 
 
TREATMENT. 095 
 
 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 
 be put to no inconvenience or discommoded in any way — 
 may in fact be allowed every liberty and latitude to the 
 extent of following any ordinary avocation. 
 
 If convalescence follows the exhibition of a few doses of 
 medicine no harm has been done, and the patient will be 
 the better for having taken the antiseptic — but if charac- 
 teristic symptoms of typhoid fever declare themselves, the 
 physician will have conferred an inestimable blessing upon 
 the patient by having begun the treatment early, and thus 
 warded off all the danger of death and delivered him from 
 the hazardous and disastrous ravages of the malady and the 
 perils of its many complications and sequelae. 
 
 But as it is not always possible to know just how severe 
 the intestinal lesions may have become, every possible pre- 
 caution and forethought must now be taken to guard 
 against accident or injury to the inflamed abdominal visa ra. 
 
 The nurse must be directed to exercise all devotion to 
 her patient, and be vigilant and prudent and alert in the 
 performance of every duty, and exact and attentive in the 
 management of every detail, and withal cheerful and agree- 
 able. 
 
 The sick room should be sunny and bright, well ven- 
 tilated, clean in every sense of the word, and as free from 
 draperies and superfluous furniture as possible. No rem- 
 nants of food or drink or the dishes upon which cither has 
 been served should be left within it, and all soiled garments 
 transferred to be disinfected and all excrementitious mai 
 
296 ' TREATMENT. 
 
 removed as soon as voided, and subjected to the action of 
 proper disinfectants. 
 
 The bed and bed linen should be perfectly clean and 
 spotless, and changed as frequently as is consistent with the 
 patient's rest and comfort. Care should be taken to replace 
 immediately all articles that may become stained with ex- 
 crementitious matters. The covering- of the bed should be 
 light, but (especially in late stages of the disease) suffi- 
 ciently warm to meet every demand of comfort and protec- 
 tion to the invalid. 
 
 When put to bed the patient should be sponged and 
 well rubbed with a course towel, and this should be re- 
 peated as often as necessary to keep the skin active and 
 free from morbific materials. The body linen should be 
 clean and stainless, and should be changed frequently. 
 The nurse should endeavor to beguile away the time and 
 soothe and reconcile her charge to his invalidism, humoring 
 his fads and fancies when they do not interfere with his 
 welfare, that his peace of mind and his serenity may aid in 
 his rapid recovery, for by repining and bewailing, his ner- 
 vous symptoms are aggravated and their alleviation delayed. 
 She should guard the sick man from all unnecessary dis- 
 turbances, the turmoil and agitation of the world should be 
 kept from his ears, especially if nervous symptoms pre- 
 dominate, and except in case of emergency no other person 
 should be allowed to remain for any length of time in the 
 sick room, and low talking and whispering in his presence 
 should be absolutely forbidden. It should be her duty to 
 administer every portion of medicine, every particle of food 
 and even every drop of water, only as and exactly as pre- 
 scribed by the medical attendant. All medication and all 
 nutriment should be given promptly and at proper intervals. 
 No routinism should be permitted in regard to the bath. If 
 
TREATMENT. 297 
 
 the patient is bathed at all it should be done in accordance 
 with and at the time specified in the orders of physician. 
 
 A clinical record should be kept at the bedside of each 
 patient which should show at a glance the following data : 
 The name, age, sex and occupation of the patient, the day 
 of the disease when first seen by the physician, the morning 
 and evening temperature, the frequency and character of 
 the pulse beats, the number and character of respirations 
 per minute, the date of the institution of the treatment, the 
 number and exact character of stools, the quantity and 
 quality of urine voided, condition of the tongue, and any 
 other important clinical features under the head of " re- 
 marks." The record should also show the kind, size and 
 number of doses of medicine taken and the time at which 
 they were administered, the quantity and sort of food and 
 the intervals at which it was given, and even the quantity 
 of water drank. For thus only can the physician see that 
 all of his orders have been obeyed in the most minute 
 detail. For the collection of scientific data the record- 
 should be more complete ; z. e. y the date of the appearance 
 and the character of all symptoms, as well as the date of 
 their partial and total disappearance. 
 
 Unless the physician is ably and efficiently seconded by 
 a thoroughly competent, thoroughly careful and intelligent 
 nurse, his talents will be of minor importance, his efforts 
 hampered and his success in aborting this hitherto refi 
 tory disease seriously imperiled. His records, too, (upon 
 which the final adjudication of the question as to the power 
 of antiseptic medicine over microbic di must r 
 
 will be valueless for all scientific purpose 
 
 As the curative treatment of typhoid fever depends 
 quite as much upon the withholding of dangerous i 
 terious medicines or such as interfere with either the admin- 
 
298 TREATMENT. 
 
 istration or effect of the antiseptics or on the proper admin- 
 istration of the latter, it is fully as important a matter to 
 point out and correct the errors of the "old method" of 
 treatment as to promulgate the intrinsic merits of the new. 
 Much has been said and written by earlier authors 
 about "treating dangerous symptoms " and especially about 
 keeping the temperature down within " safe limits.' ' Phy- 
 sicians of the present day are so prone to follow this unwise 
 and irrational advice — a most reprehensible practice, at least 
 in the first week or so of the disease in the adult — and the 
 opinion that a high temperature is the chief source of peril 
 is so general in the medical profession that it is necessary 
 to warn its members against medicinal antipyretics. No 
 doubt some of the advocates of the Brandt method of treat- 
 ing typhoid fever are responsible for this erroneous idea, 
 since they, in accrediting the benefits resulting or supposed 
 to result from the cold bath, place a reduction of the tem- 
 perature first in importance, and make this symptom the 
 indication for its repeated use. 
 
 The greatest therapeutic advantage to be derived from 
 the bath is due to the increased elimination of the toxins 
 and perhaps in a lesser degree to its stimulating effect and 
 not to a lowering of the temperature — which may not be an 
 unmixed blessing. A temperature of 105° or 106° F. prior 
 to the softening or sloughing of any of the intestinal glands, 
 in the adult, is not of itself fraught with extreme danger and 
 is a danger signal only so far as it is indicative of the pres- 
 ence in the system of a conquering pathogenic influence. 
 The truth of this proposition would seem to be established 
 by the fact that a much higher temperature than is usually 
 seen even in fatal cases of typhoid fever is not very uncom- 
 mon in other ailments from which the patients recover with 
 little exhaustion of the vital forces. 
 
TREA TMENT. 099 
 
 But three cases of typhoid fever with a temperature of 
 107° F. have ever come under my observation, while I have 
 seen a patient recover from rheumatism without material 
 loss of flesh or strength, whose temperature taken in the 
 axilla registered 110° F. 
 
 Hence whatever we may think of the cooling effect of 
 water — applied externally — there can be no question but 
 the use of the cold bath and its apparently beneficial 
 effects has (by inducing physicians to resort to ail sorts of 
 medicinal antipyretics) been the cause of much pernicious 
 practice, through which many valuable lives have been 
 sacrificed. Their use is not more defensible than is that of 
 the corrosive poisons as microbecides and the physicians 
 who will employ energetically the coal tar derivatives as 
 antipyretics and corrosive sublimate as a germicide may kill 
 more patients than could the most malignant epidemic of 
 typhoid fever. Therefore give no corrosive or irritant poi- 
 sons as a means of destroying the germ, and none of the 
 coal tar products as antipyretics — they are never beneficial 
 — they are always harmful — they are often perilous and 
 sometimes will cause a fatal termination; when nature, un- 
 aided, might have exterminated the disease and not killed 
 the patient. 
 
 Quinine should be administered in the treatment of 
 typhoid fever only as a tonic and in very small doses late in 
 the disease. The large doses sometimes administered to 
 control the temperature are valueless for the purpose for 
 which they are prescribed and are decidedly detrimental to 
 
 the patient. 
 
 Alcohol, so largely used by many practitioners should 
 have no place amongst the therapeutic agents applied to 
 the curative treatment of this disease. Its use. il usi d at 
 all, should be limited to such cases as have pa ond 
 
300 TREATMENT. 
 
 the power of abortive treatment, when toxaemia threatens 
 the life of the patient — when the nervous symptoms become 
 alarming or exhaustion is extreme, then it may possibly 
 prove to be beneficial and should be poured with a lavish 
 hand at least when used as a nervous sedative. 
 
 Diarrhcea. — -This is another "symptom" which those 
 who treat typhoid fever " symptomatically " usually make 
 most heroic and unwise efforts to arrest. This is wrong — 
 the diarrhcea is an expression of nature's objection to the 
 presence in the system of obnoxious matter, and it is her 
 method of getting rid of it; and to check it, would be to 
 defeat one of her most laudable efforts. It would be wiser 
 to encourage her by giving a simple laxative or cathartic — 
 at least, give no opium or astringents. When the alimen- 
 tary canal has been thoroughly asepticized the diarrhcea will 
 cease. 
 
 Dr. Woodbridge, of Williams College, Massachusetts, 
 a fi rm believer in the possibility of aborting typhoid 
 fever, and an early advocate of the antiseptic treatment of 
 the disease, says: "The advantage of an active laxative in 
 the initial stage of the disease is too generally conceded to 
 admit of doubt — an advantage shown on reduction of the 
 number of the micro-organisms and in the reduction of tem- 
 perature/' 
 
 In every pathological condition from which diphtheria, 
 pneumonia, meningitis, cholera-infantum, scarlatina, rubeola 
 and typhoid fever cannot.be excluded, antiseptics should be 
 exhibited. 
 
 Every hour from the moment in which the poison is in- 
 gested until the patient is under the mystic spell of anti- 
 septics is precious, therefore, every resource at the physi- 
 cian's command should be utilized for the purpose of asepti- 
 cizing not only the alimentary canal, but also the whole 
 
TREATMENT. ;> )01 
 
 organism as thoroughly and as rapidly as possible, and as 
 soon as the presence of the virus has become manifest. 
 The graver the symptoms, the more heroic should be the 
 treatment. 
 
 Assuming that an adult, not suffering from any concur- 
 rent affection is found on the ninth to the eleventh day of an 
 attack of typhoid fever in the following condition : Tem- 
 perature 105° F.; pulse 120; headache severe, insom- 
 nious ; profuse bronchial catarrh ; palpation reveals tender- 
 ness and gurgling in the right iliac fossa or possibly in the 
 left, or even generally over the abdomen some tympanitic 
 distention; no enlargement of the spleen; margins of the 
 tongue red; the center coated, brown and dry; the mind 
 wanders in delirium but the patient can be aroused ; the 
 characteristic rose spots are present ; there is a history of 
 epistaxis, as well as of chills or chilly sensations earlier in 
 the disease. The bowels may be constipated or the patient 
 may have an alarming diarrhoea, but there has as yet been no 
 intestinal haemorrhage. This patient is rapidly passing, if 
 he has not already passed, beyond the reach of abortive 
 treatment. Therefore let no time be lost. Be sun.' that 
 every dose of medieine exhibited is properly prepared of 
 pure and active drugs, properly administered at the proper 
 time, and that every day of treatment has accomplished its 
 just proportion of the cure. This patient should h;i\ e I 
 for some days confined to bed; he should be required to 
 maintain at all times a recumbent position, and on no ac 
 count allowed to rise even to evacuate the bladder, or to 
 assist in raising his hips to permit the placingofthe bedpan 
 or draw-sheet He should be sponged etc., and the instruc- 
 tions given to the nurse on a previous page should be 
 rigidly enforced. The diet should consist exclusivel] 
 liquids of the most assimilable sort and such as l< 
 
302 TREATMENT. 
 
 the least detritus, of which milk, peptonized, or not, should 
 have the first place. Should tough curds be formed, it 
 should be peptonized or mixed with a modicum of lime- 
 water. If necessary the milk may be replaced in whole or 
 in part by Fairchild Brothers & Fosters Panopeptin. 
 Meat juices or broths, or egg albumen may be allowed. 
 These foods should be continued to the exclusion of all solid 
 or less digestible liquid articles of diet for at least ten days 
 after the rectal or sublingual evening temperature has been 
 normal, or in very severe cases for five or six days longer. 
 Food should be given at regular intervals of not less than 
 three hours, with a longer interval in the night, and as lib- 
 erally as is consistent with complete digestion and assimila- 
 tion. 
 
 Treatment. — Begin the medicinal treatment of this pa- 
 tient with formula No. 1. 
 
 #. No. 1. Podophyllin resin -§\§ gr. 
 
 Mercuous chloride, mild ... j\ gr. 
 
 Guaiacol carbonate „ T ^ gr. 
 
 Menthol , . , , T V gr. 
 
 Eucalyptol q. s. 
 
 Make one tablet. 
 
 Give one of these tablets every fifteen minutes during 
 all of the wakeful portion of the first forty-eight hours. 
 There will usually be little inclination to sleep during the 
 first and second nights of treatment, so that from 80 to 100 
 or more tablets may be given. As it is essential to the 
 success of the treatment that the medicine be distributed in 
 minute portions over a considerable period of time, with no 
 long breaks, the patient should be aroused if necessary 
 often enough to take the required number of doses. Equal- 
 ly 'important is it that each and every dose of medicine ad- 
 ministered should be washed down with large quantities 
 
TEE A TMENT. 
 
 of distilled, sterilized, or if not contraindicated, some eood 
 laxative or diuretic mineral water. 
 
 The most useful potation for general purposes, be- 
 cause it is the most highly solvent, is distilled water, 
 lightly charged with carbonic acid gas, preserved in 
 tightly stoppered bottles. As it is slightly sparkling, if 
 kept moderately cool, it proves to be a most agreeable 
 beverage. 
 
 If vomiting be troublesome, a little menthol may 
 be exhibited, or a sinapism may be placed over the epi- 
 gastrium, but the tablets should be continued uninter- 
 ruptedly, and will themselves usually arrest the emesis, 
 and relieve the nausea. 
 
 At the end of twenty-four hours begin with formula 
 No. 2, each tablet of which contains : 
 
 #. No. 2. Podophyllum resin ^-J T gr. 
 
 Mercurous chloride, mild. x \ gr. 
 
 Guaiacol carbonate } gr. 
 
 Menthol ,V & r - 
 
 Thymol V 6 gr. 
 
 Eucalyptol q. s. 
 
 It will be noted that formulas Nos. 1 and 2 differ only 
 in the addition of guaiacol carbonate 3-16 gr. and thy- 
 mol 1-16 gr. to each tablet. So slight adifference might 
 seem unnecessary, but experience has shown that some 
 patients require so many tablets to produce the desired 
 effect, that by taking £. No. 2 from the beginning of 
 the treatment an unnecessary quantity of guaiacol I 
 bonate and too much thymol would be administered, 
 thus impairing the normal function of the Stomach and 
 possibly the integrity of the kidneys. 
 
 Give one tablet of this formula every fifteen mini 
 together with the one or more tablets of formula No. I, 
 
304 TREATMENT. 
 
 until five or six free evacuations of the bowels have been 
 procured during- this and the following- day. It some- 
 times happens that the tablets of formula No. 1 produce 
 sufficient relaxation of the bowels during the first twenty- 
 four hours, in which case they should be promptly dis- 
 continued and No. 2 administered with just the requisite 
 frequency to secure the desired effect. Those who have 
 had no experience with this treatment are shocked when 
 advised to give medicine every fifteen minutes, both 
 night and day, and seem to think it would be a fearful 
 hardship to the patient to take it in this manner. The 
 fact is, the patient with typhoid fever rarely sleeps dur- 
 ing the first two nights of treatment, and if they do, they 
 can easily be sufficiently aroused to swallow the tablet 
 and a draught of water, without being fully awakened 
 and will drop off to sleep again immediately. It is sel- 
 dom that this frequent administration of medicine has to 
 be continued longer than the second night. 
 
 If diarrhoea be a prominent symptom when the treat- 
 ment is begun, and if it be not arrested by the antisep- 
 tic action of the tablets, the stools should be carefully 
 watched for this effect, which will be manifested by the 
 change in character and loss of offensive odor. Some- 
 times the cathartic effect of the medicine follows so closely 
 upon its antiseptic action, that the diarrhoea of the disease 
 runs imperceptibly into the purgative effect of the medicine, 
 in which case the tablets must be continued but at longer 
 intervals. 
 
 Not less than six free evacuations of the bowels hav- 
 ing been secured during each of two successive periods 
 of twenty-four hours, the dosage of formula No. 2 may 
 be lightened, by giving the medicine less and less frequently 
 each day, and thus allowing the alvine dejections to grad- 
 
TREATMENT. 3Q5 
 
 uaiiy diminish to two or three evacuations at the end of 
 the first week. 
 
 About the third or fourth day, or as soon as the medi- 
 cine has produced sufficient elimination and all danger of 
 emesis interfering with the treatment has passed, formula 
 No. 3 should be administered, each capsule of which con- 
 tains : 
 
 #. No. 3. Thymol 1 gr . 
 
 Guaiacol carbonate 3 grs. 
 
 Menthol y 2 gr. 
 
 Eucalyptol 5 m. 
 
 Give one of these capsules every three hours until the 
 temperature has been normal at least three days. 
 
 About the fourth or fifth day, or as soon as the evac- 
 uations of the bowels have become sufficiently active and 
 before any ill effects of the mercurial manifest themselves, 
 discontinue the tablets and give of a saturated solution of 
 chlorate of potash one teaspoonful every two or three 
 hours until diminished activity of the bowels indicates the 
 necessity of returning to the tablets No. 2, or if the stomach 
 is irritable to No. 1. 
 
 The administration of formula No. 3 should not be 
 allowed to interfere with the exhibition of formula No. 
 2, but if the bowels become too active the tablets should 
 be discontinued for a day or two at a time, and No. 
 3 exhibited, returning to them as soon as possible. Ii, h(W 
 ever, in cases of extreme costiveness, a very large quan- 
 tity of the medicine has been necessary to secure the de- 
 sired laxative condition, vigilance should be maintained for 
 the slightest symptoms of ptyalism, and should they 
 supervene, formula No. 3 and teaspoonful d of a 
 
 saturated solution of chlorate of potash should be given 
 at three hours intervals, for two or three days if n< 
 
306 TREATMENT. 
 
 It is sometimes advisable too to replace formula No. 
 2 with some mild saline cathartic, and in very consti- 
 pated cases to substitute for the distilled water some 
 gentle laxative mineral water. 
 
 The tendency to grave renal complications in typhoid 
 fever is an attestation of the importance of using every 
 possible precaution to protect the kidneys from all morbi- 
 genous influences, a purpose best conserved by diluting 
 the urine and removing its irritating qualities. This is gen- 
 erally satisfactorily accomplished by the medicines already 
 advised, but a mildly diuretic mineral water, in a certain 
 class of cases, may be highly advantageous. 
 
 If the excretion of these organs is of very high specific 
 gravity, a diuretic mixture such as the following should 
 be given for a day or two, but it should be discontinued 
 as soon as the urine is clear and bland. 
 
 R. Potass acet ounces 2. 
 
 Spir. nitri. dale ounces }£. 
 
 Aquae dest q. s. ad. ounces 6. 
 
 S. Dose, ateaspoonful in a large draught of distilled water 
 pro re nata. 
 
 After such management chemical analysis or the micro- 
 scope, will rarely show albumen, or casts, or other evi- 
 dences of any pathological condition of the kidneys. 
 
 The severity of the symptoms given in the hypothet- 
 ical case of typhoid fever, emphasize the importance of 
 guarding against these ordinary complications, indicate 
 that the mesenteric glands were tumefied, that the spleen 
 and liver were involved, and that necrosis and ulceration 
 of Peyer's glands was imminent, if indeed, these conditions 
 were not already present, and notwithstanding the rapid 
 amelioration of all the symptoms, we have no means of 
 knowing the exact state of the intestinal glands. Some of 
 
TREATMENT. 307 
 
 these may be deeply ulcerated, and although we at once 
 put them in the most perfect consonescent condition, we 
 have yet to avoid the danger of intestinal haemorrhage 
 and perforation. The patient must therefore be confined 
 to a state of complete rest and a liquid food, until all 
 danger of these accidents — his only peril — has passed. 
 
 During this, the second week of the treatment, the tem- 
 perature should be carefully watched and on the slightest 
 elevation tablets of #. No. 2 should be administered as fre- 
 quently and as boldly as at the beginning of the treatment, 
 and under all circumstances the bowels should be kept free 
 and active, moving once or twice each and every day, and 
 the capsules should be continued until the patient is re- 
 stored to perfect health. 
 
 This type of the disease was purposely chosen as it was 
 on the very border line dividing the curable from the in- 
 curable stage of typhoid fever. It would be by far the 
 most difficult variety to abort, and would be liable to all of 
 the complications so general in this disease under sympto- 
 matic treatment. But for these reasons much of the cau- 
 tion as to diet and rest, and much of the advice as to the 
 administration of medicine would be entirely superfluous. 
 Had the same patient been put under efficacious treatment 
 a few days or it may be a few hours earlier, there would 
 have been no chance for any of the peculiar and annoying 
 complications of this dire disease. 
 
 Complications involving the lungs are various in kind 
 and degree, from the mild bronchial catarrh of the period ol 
 invasion, to the hypostatic congestion which is apt to In- 
 caused by the patient lying too long in one position, or by 
 an enfeebled heart during the final stages of the disc 
 and to those cases beginning with a pneumonia wind 
 completely dominates the scene at the outset of the atta. k. 
 
308 TREATMENT. 
 
 that it not infrequently happens that no suspicion of the 
 true character of the malady is awakened until the patient 
 has passed beyond all human aid. There is no way to 
 positively differentiate between true pneumonia and that 
 pseudo-pneumonia resulting- from an invasion of the air 
 passages by the bacillus typhosis in the absence of charac- 
 teristic symptoms of typhoid fever. 
 
 Therefore, there is but one safe therapeutic procedure 
 in the incipient stage of pneumonia, viz., it should be treated 
 as a case of typhoid fever. It will rarely be needful to 
 resort to any other than these antiseptic medicaments, and 
 then only such remedies should be given as are necessary 
 to temporarily allay the cough, to make the patient more 
 comfortable by relieving him of this irritating feature of the 
 disease. Should it be proved that the Eberth bacillus is 
 causing the mischief, and that the malady is only a variety 
 of typhoid fever, the attack will be shortened, but the pros- 
 pect of a rapid recovery would not be lessened by this 
 treatment, even if true pneumonia be present. 
 
 In addition to the various stimulating or anodyne expec- 
 torants so valuable in certain pathological conditions of the 
 air passages, one remedy, benzoyl-guaiacol, stands out as 
 prominently useful in those cases in which the inflammation 
 embraces the smaller ramifications of the bronchial tubes. 
 
 The frequently occurring catarrhal bronchitis, the cere- 
 bral symptoms, the paralysis, the chorea, the jaundice, and 
 the muscular degeneration of the heart as shown by the en- 
 feebled action of that organ, all being due to the presence 
 in the system of the toxins of the disease, are most sci- 
 entifically and satisfactorily treated by the antiseptic 
 method already described for the original illness, and with 
 the exception of minute doses of strychnia to strengthen 
 the weakened heart, none of them need any other special 
 medication. 
 
TREATMENT. ;iQ9 
 
 One of the most troublesome symptoms — one too not 
 wholly devoid of danger — is the venous thrombosis, usually 
 affecting the veins of the lower extremities, and sometimes 
 causing enormous swelling, generally of one, but sometimes 
 of both legs, and extending from the toes to the hips, and 
 even the body. This condition requires no special thera- 
 peutic management, it being safer to leave the swelling un- 
 disturbed for a time, rather than run the risk of detaching 
 a portion of the thrombus and causing embolism of the 
 pulmonary artery. Later this complication may be treated 
 by hot fomentations, massage, and elevation of the member. 
 
 A physician engaged in a large consultation practice, 
 especially if called long distances, will not infrequently see 
 for the first time patients ill with typhoid fever, with all of 
 the characteristic symptoms shown in the previous case, but 
 in an aggravated form. 
 
 The patient has been ill fourteen to sixteen days or 
 longer, his morning temperature is 104°, his evening tem- 
 perature 105° or even higher. His pulse beats 130 times 
 to the minute, is soft and sometimes dicrotic. He is de- 
 lirious, picks at the bedclothes and at his own fingers. I [e 
 evacuates his bowels and bladder involuntarily. His ab- 
 domen is covered with rose spots and is very tender, and 
 there is also much tympanitic distention. He has for sev- 
 eral days had slight hemoptysis, and has had one or per- 
 haps more intestinal haemorrhages. He has been treat* d 
 "symptomatically" and "secundum artem." but unless the 
 art be newly interpreted and a radical change in tin- 
 treatment be inaugurated, the closing scene is not difficult 
 to foresee, nor must we look far into the future to find it. 
 What then is the consultant's first duty? To discontinue 
 and abandon forever and at once the course of treatment 
 which has brought the patient to his present precarious 
 
310 TREATMENT. 
 
 state. To institute immediately efficacious antiseptic thera- 
 peutics. The treatment must be varied somewhat from 
 that advised on a preceding page. 
 
 Begin with tablets of formula Nos. 1 and 2, giving a 
 tablet of each every fifteen minutes until twelve tablets of 
 each have been taken, then discontinue No. 1 and give 
 No. 2 alone until the freer evacuations or the change in 
 character of the stools and the loss of offensive odor show 
 that some antiseptic effect has been obtained. They should 
 now be continued at longer intervals and in varied periods 
 according to the strength of the patient, who is already ex- 
 hausted by the distressing and violent strain of the disease. 
 Every precaution should be exerted to prevent farther low- 
 ering of the vital forces by excessive and debilitating diar- 
 rhoea, but the eliminative effect of the medicines should be 
 obtained, and under no circumstances should any day be 
 allowed to pass with less than two free evacuations of the 
 bowels. A perfectly aseptic condition of the alimentary 
 canal must be procured and maintained, but if very many 
 tablets are administered, they should be discontinued for a 
 day or two at a time, and a teaspoonful dose of a saturated 
 solution of chlorate of potash exhibited at three hour inter- 
 vals. Time is very precious just now, and as there is less 
 fear of the interruption of the treatment by emesis, the 
 capsules containing formula No. 3 should be commenced 
 early in the treatment. 
 
 They should be given every three hours until im- 
 provement in the condition of the patient is manifested 
 by a considerable amelioration in all symptoms, when the 
 interval between the doses should be lengthened gradu- 
 ally, but they should be continued three times a day until 
 the temperature remains normal. 
 
 The temperature, which prior to the eighth day of 
 
TREATMENT. ;U1 
 
 the disease, was a symptom which gave little alarm, is 
 now of the gravest consequence, and should be con- 
 trolled by every legitimate means at the disposal of the 
 physician in charge of the patient. 
 
 The nurse should be directed to sponge the patient 
 two or three times each day, or oftener if necessary. In 
 extreme pyrexia, from five to twenty-five, or in an emer- 
 gency, thirty minims of guaiacol absolute should be ap- 
 plied to the abdomen, the entire surface of which should 
 first be cleansed by using an alkaline wash (bicarbonate 
 of soda). This remedy should be used with discretion, 
 since its application has sometimes been followed b\ a 
 sudden and alarming decline in temperature, and threat 
 ened collapse. An embrocation of spiritus terebinthinae, 
 aqua ammoniae, oleum eucalyptus and guaiacol should be 
 rubbed gently upon the abdomen, and over the most 
 seriously involved thoracic region. The nurse should 
 be instructed to watch carefully for the slightest symptom 
 of threatening bed sores, and on the first appearance oi 
 redness of the skin over any prominent part of the body 
 — especially of the hips — a piece of ordinary adhesive 
 plaster, large enough to cover not only the reddened por- 
 tion, but several inches around it should be applied at 
 once. If this does not suffice, a ring cushion or a water 
 bed may be called into requisition. 
 
 The flagging heart should be sustained with strych- 
 nine and possibly digitalis, though the Litter is oi 
 doubtful utility and its use is not always devoid <>i 
 danger. The cough and dyspnoea may sometimes b< 
 relieved with Dover's powder and the excessive diarrhoea 
 controlled with opium and camphor. Quinine as a toni< 
 may now prove to be useful, and here if ever, am- 
 monia and alcoholic stimulants find their appropr 
 field. 
 
312 ' TREATMENT. 
 
 The food should be made as nutritious and assimila- 
 ble as possible ; milk should be peptonized ; meat juice, 
 egg-nog, and other easily digested foods may be added 
 to the milk diet, and in failing digestion or in ano- 
 rexia stimulating or nutritious enemata should be given. 
 
 Hopeless as seemed the condition of this patient 
 when the antiseptic treatment was begun, he has sur- 
 vived without material retrogression the first forty- 
 eight hours after the consultant was called, and has 
 apparently made some progress toward recovery, but 
 there are still the accidents of haemorrhage and perfo- 
 ration to be dreaded. Every other cause of death has 
 been done away with, and the danger to the patient 
 from these calamities has been reduced to the minimum 
 by emptying and cleansing the alimentary canal, thus 
 rendering the intestinal wounds sanable and reducing 
 the tympanitic distention. 
 
 From this point the treatment has been indicated, 
 and all of the instructions previously given as to rest, 
 etc., must be observed. It may be generally stated that 
 every resource of nature, art and science that can di- 
 rectly or indirectly minister to the patient's comfort, 
 arrest waste, add to the strength, or in any way aid in 
 the conservation of the vital forces, should be mustered 
 into active service. Had this patient been left under the 
 inexcusable "symptomatic treatment " a few days or pos- 
 sibly but a few hours longer, the indications for treat- 
 ment would have been the same, but the result would 
 have been very different. Toxaemia and coma or pro- 
 fuse haemorrhage or perforation and peritonitis would 
 soon have closed the scene, or later exhaustion would 
 have carried the patient beyond all human aid. 
 
 From this careful administration of every kind of medicine 
 that can aid in the abortion of typhoid fever — in slowly re- 
 
TREATMENT. 313 
 
 storing the patient to health or even alleviating his condition 
 —in which is given every dose required even to the limit of 
 his utmost necessity, taking the most painstaking precautions 
 to avoid even the improbable accidents — from all this the 
 scientific treatment of the disease varies through every gra- 
 dation down to the administration of a few tablets of formula 
 No. 1, in cases that present symptoms so unpronouncedthat 
 no diagnosis whatever could be predicated upon them. 
 
 Had the treatment of the hypothetical case been com- 
 menced two or three days earlier the same medicine would 
 have been administered, and in exactly the same manner, 
 but a very much less quantity of it would have been given 
 and it would have been discontinued very much sooner.. 
 The patient would not have been confined to bed so long 
 and perhaps not at all. He would have been allowed to 
 take such exercise as he desired, and if he felt well enough 
 it would have been possible after the first week, and in many 
 instances even during this period, for him to follow his usual 
 avocation. He would have been permitted to eat solid food 
 at all times, as soon as danger of necrosis of Peyer's glands 
 could be excluded as a possible lesion. When his tempera- 
 ture had become normal, he would have been well in all that 
 the term implies. His mind would have been clear and vig- 
 orous, his strength unimpaired. His appetite and digestion 
 would have been in as good condition as before the attack. 
 Every organ of the body would have been performing its 
 proper functions in a normal manner and this too, with the 
 loss of but a few days from his business or pleasure 
 
 The warm advocacy of the "Brand method oftreatment 
 by cold bathing" in this country by Wilson. Osier and other 
 professors of note, have raised the bath from its legitimate 
 place which it held at the close of the last century, as an ad- 
 junct to the treatment— to a routine method of managing the 
 disease. This method has become quite popular with some 
 
314 
 
 TREA TMENT. 
 
 physicians, and for it the most extravagant claims have been 
 advanced by Brandt and others of his school. It is not be- 
 lieved that it shortens the duration of the disease, and the 
 last report of the German Hospital of Philadelphia, for the 
 year 1894, giving a death rate of 16^ per cent (78 cases, 
 with 13 deaths) is hardly calculated to encourage physicians 
 to adopt a treatment which has been designated ■ ' brutal " 
 by one of its most enthusiastic advocates. The Medical 
 News of the 27th of July, 1895, page 109, says : "The 
 German Hospital has been the home of the so-called 
 cold water treatment in this country, and the beneficial 
 results of the treatment in this institution in previous 
 years have been largely quoted. The following table 
 shows the number of cases of typhoid fever treated and 
 the mortality from the year 1890, when the Brandt 
 method was introduced: 
 
 YEAR. 
 
 NO. OF CASES 
 TREATED. 
 
 DEATHS. 
 
 PER CENT. 
 
 1890 
 
 106 
 
 116 
 
 1\ 
 
 n 
 
 18 
 
 5 
 
 8 
 
 3 
 
 11 
 
 13 
 
 4.1 
 
 1891 
 
 6.9 
 
 1892 
 
 4.2 
 
 1893 
 
 14.8 
 
 1894 , 
 
 16.6 
 
 
 
 In the Medical News of November 26, 1892, Dr. 
 J. C. Wilson reported one series of 160 cases treated 
 according to the method of Brand with eight deaths, or 
 5 per cent ; and another series of sixty-six cases with 
 four deaths, or 6 per cent. (These cases are included 
 in the figures already given, though differently ar- 
 ranged.) It would be interesting to determine what has 
 caused this unfavorable increase in the mortality rate 
 under the cold water treatment. As far as we can learn 
 the methods have not been changed, and the disease in 
 
TREA TMENT. 
 
 315 
 
 The 
 
 Philadelphia has not been especially virulent, 
 death rate varies in different years. In the same hos- 
 pital previous to 1890 the mortality varied from 11 to 
 20 per cent. 
 
 The Pennsylvania Hospital typhoid fever statistics 
 are as follows : 
 
 YEAR. 
 
 NO. OF CASES 
 TREATED. 
 
 DEATHS. 
 
 PER CENT. 
 
 1890 
 
 126 
 144 
 104 
 94 
 105 
 
 22 
 23 
 
 10 
 
 4 
 
 14 
 
 17.4 
 
 1891 
 
 16.0 
 
 1892 
 
 9.6 
 
 1893 
 
 4.2 
 
 1894 
 
 13.3 
 
 
 
 The Presbyterian Hospital reports show the following 
 
 YEAR. 
 
 NO. OF CASES 
 TREATED. 
 
 DEATHS. 
 
 PER CENT. 
 
 1890 
 
 17 
 
 39 
 83 
 69 
 80 
 
 5 
 
 5 
 
 6 
 
 12 
 
 3 
 
 
 1891 
 
 12.8 
 
 1892 
 
 7.0 
 
 1893 
 
 17." 
 
 1894 
 
 3.7 
 
 
 _ 
 
 In the Pennsylvania and the Presbyterian Hospitals 
 the Brandt method has been used in the majority of the 
 cases during the last two years. There is some danger 
 of such a method of treatment becoming routine, to the 
 exclusion of all other treatment, and this is always to be 
 guarded against. 
 
 A death rate of 14.8 per cent in 1893 and L6# per 
 cent in 1894, so much higher than during the previous 
 years, may not fairly represent the treatment but it 
 certainly fails to fulfill the promises so lavishly made for 
 this method." 
 
TYPHOID FEVER IN CHILDREN. 
 
 The impressionable, partially developed nervous or- 
 ganism of the child — the great variety of diseases to 
 which the nonimmune babe is susceptible* — the rapid 
 metabolism of infantile life — all serve to render an exact 
 diagnosis of typhoid fever in early stages of the malady 
 in young children more difficult than in the adult. 
 
 The onset of the disease is usually more sudden and 
 the nervous symptoms are far more prominent ; vice 
 versa, the intestinal lesions are milder, the inflammation 
 of Peyer's glands takes place earlier, but more frequent- 
 ly ends in resolution. On the other hand, the inflamma- 
 tion invades a larger area, not being so well confined to 
 Peyer's glands ; but these glands increase in size in the 
 same manner by hyperplasia, through proliferation of 
 the lymphoid cells. 
 
 The tumefaction of the spleen is as constant and pro- 
 portionally as great, and the symptom consequently 
 possesses the same diagnostic value in the child as in 
 the adult. 
 
 Tympanitis and tenderness in the right iliac region 
 are symptoms of great importance, and have been 
 present in a very large majority of my cases. 
 
 The gastrointestinal symptoms are sometimes lack- 
 ing ; the bowels, especially in early stages of the dis- 
 
 *Murchison reports eight cases in which the eruption of typhoid fever and 
 that of scarlatina coexisted. Numerous observers have noted the coexistence of 
 the former disease with rubeola and various other diseases of infantile as well as 
 
 of adult life. 
 
 316 
 
TYPHOID FEVER IN CHILDREN. 317 
 
 ease, being- normal in condition or even constipated, 
 while in other instances these symptoms are so pro- 
 nounced that men of large experience have not infre- 
 quently diagnosticated typhoid fever as gastroenteritis 
 and even as "acute indigestion." 
 
 Bronchial catarrh is almost as constant and as 
 prominent as in rubeola, and often leads to fatal errors 
 of diagnosis. So commonly is the cough connected 
 with typhoid fever in children that its presence should 
 always excite a suspicion as to the nature of the indis- 
 position. Some observers have even proposed to in- 
 clude the symptom in the nomenclature of the disease. 
 Professor Woodbridge, of Williams College, says : "A 
 more or less severe bronchitis with not infrequent en- 
 largement of the bronchial glands, is fast gaining de- 
 served recognition as one of the most frequent lesions.' 
 Wilson says : " Slight bronchial catarrh can hardly be 
 regarded as a complication, it is so much a part of the 
 clinical history of the disease." Flint says : "A slight 
 or moderate cough is almost invariably present." From 
 Niemeyer I quote the following: "We find changes in 
 the respiratory organs in all cases. The typhoid laryn- 
 geal ulcer is not infrequently found. There arc alwaj 
 signs of an extensive catarrh, even in the smallest bron- 
 chi, marked by dark redness of the mucous membrane 
 and scanty, tough secretions. The bronchial glands are 
 swollen, vascular, and occasionally have a medullary ap- 
 pearance such as we shall describe for the mesenteric 
 glands." 
 
 The foul odor of the breath and sordes often found 
 on the lips and gums of the babe, with rhagades al a 
 later period, are often the accompaniments oi 
 nervous symptoms. 
 
318 TYPHOID FEVER IN CHILDREN. 
 
 The appearance of the tongue is one of the most 
 characteristic symptoms of typhoid fever in infants, and 
 although the coating may vary much in thickness and 
 even in color, and may be moist, or dry and fissured, 
 the clean red margin, and especially the red triangle at 
 its tip are so typical of this malady as to amount to a 
 practically pathognomonic symptom. 
 
 The babe and young child will plainly show by the 
 movements of the head and hands that headache is 
 present, and this symptom, usually prominent at the 
 onset, is apt to increase as the malady progresses, and 
 the babe will rotate its head from side to side and bur- 
 row it into the pillow, and finally well-marked opisthot- 
 onos may present itself. The eyes may become 
 crossed or sightless, and deafness, total or partial, is 
 not an uncommon occurrence ; and the delirium and 
 insomnia may be extreme. But grave as these symp- 
 toms are, it must be remembered that they result from 
 no organic cerebral lesion, save in rare instances. 
 
 The pulse is always more frequent, and often found 
 very much accelerated even when the other symptoms 
 do not appear to be especially grave. Dicrotism is 
 very rare. 
 
 Epistaxis is less constant in the child than in the 
 adult. 
 
 Vomiting is frequently a troublesome symptom, and 
 may be controlled by a sinapism placed over the epi- 
 gastrium. 
 
 The chill at the onset of the disease is rare or 
 rarely observed in children, but if accompanied by a 
 rapid rise in temperature may be regarded as a serious 
 symptom. 
 
 Haemorrhage from the bowels during typhoid fever 
 is rare in childhood. 
 
TYPHOID FEVER IN CHILDREN. 319 
 
 Rose spots are usually an early but not a constant 
 symptom in children. 
 
 A child will as a rule lose appetite from the very 
 onset of the disease, and this is one of the earliest 
 conditions which may indicate ill health. 
 
 The designation of "mild" or "severe" or "abor- 
 tive " or " prolonged "or " malignant " attacks of typhoid 
 fever in the adult or in the infant as "varieties of the 
 disease" is certainly a misapplication of terms, due to a 
 misapprehension of the etiology of the infection. There 
 is and can be but one "variety " of typhoid fever (un- 
 less the invasion of the lung by the bacillus typhosis 
 may come under this head) although a partial immunity 
 on the part of the patient or the quantity of poison in- 
 gested, or perhaps other causes may influence the char- 
 acter of the attack. 
 
 As typhoid fever in children is produced by the 
 same causes and is governed by the same laws, the 
 general management of the disease should be the same 
 as has been indicated already, modified, of course, by 
 the age of the patient. 
 
 Should the child be so ill that it is necessary to con 
 fine it to one room, a selection should be made of one 
 which is large, light and well ventilated, and all unnec- 
 sary articles of furniture removed ; and the temperature 
 of which should be kept at from 65° to 68°. It should 
 be immaculately clean in all respects. Two beds an 
 importance, one for the child and one for tin- nui 
 The bed covering should be soft and warm, the linen 
 frequentlv changed, as well as the wearing apparel ol 
 the child,' if in the slightest degree soiled, and properly 
 disinfected in a solution of the chlorides or subjected to 
 a high degree of heat. (Above 248' I 
 
320 TYPHOID FEVER IN CHILDREN. 
 
 The nurse should be intelligent, and competent to 
 take charge of the patient under all circumstances. 
 Her personal habits should be unexceptionable, and her 
 clothing- of such material as can be consigned to the tub 
 as occasions indicate. 
 
 The child should be given a sponge bath when re- 
 quired for cleanliness or for its soothing and refreshing 
 influence. The bath should always be hot, indeed cold 
 water (except as a drink) should have no place in the 
 treatment of typhoid fever in children. 
 
 We were taught of old to guard against intestinal 
 peristalsis, fearing that it would increase the danger of 
 haemorrhage and perforation, but now the more rational 
 idea that all of the noxas and microbes and (if the dis- 
 ease have progressed so far) the bloodclots and pus and 
 foul gases and all excrementitious matter should be elim- 
 inated, and that the first and most important step is to 
 thoroughly asepticize the alimentary canal as one would 
 an abscess, and by so doing rid it of the specific poison 
 of the disease and all of the other morbid material and 
 debris which may have been accumulated, and to do this 
 by free catharsis and diuresis, thereby stimulating the 
 circulation in the peripheral vessels of the intestines and 
 overcoming the tendency to blood stasis. 
 
 All this can be effectually done in older children with 
 the tablets and soft capsules which I have advised in 
 another portion of this book, administered a little less 
 frequently in proportion to the age of the child, but in 
 such doses and at such intervals as to secure the results 
 sought to be obtained in the treatment of adults. 
 
 In younger children my method of procedure is to 
 begin the treatment with the following tablets, which are 
 made soft and friable so that they may be easily crushed 
 
TYPHOID FEVER IN CHILDREN. 321 
 
 or dissolved in a little milk, sweetened water or any 
 agreeable vehicle or dropped into the mouth as a powder. 
 
 Formula No. 4. 
 Each tablet contains 
 Podophyllum resin, fine pwd. . .-g^ gr. 
 
 Murcurous chloride, mild ^ gr. 
 
 Guaiacol carbonate ^ gr. 
 
 Menthol ^ gr. 
 
 Eucalyptol q. s. 
 
 Formula No. 5. 
 Each capsule contains 
 
 Guaiacol carbonate y z gr . 
 
 Thymol 3 s gr. 
 
 Menthol tV gr. 
 
 Eucalyptol 1 minim 
 
 Olive oil a. s. 
 
 I give to a child one year old, one, two, or three 
 tablets, every hour or oftener. If the case present very 
 severe symptoms the child will require larger doses. 
 
 Ordinarily it is not necessary to push the remedies 
 as heroically as in adults nor is it advisable to produce 
 such free catharsis. Four or five free evacuations of the 
 bowels daily is the utmost limit to which the laxative 
 effect should be carried in very young children and even 
 this number should be procured for two or three days 
 only. Capsules of formula No. 5 should always be 
 given every three hours for a day or two after having 
 given No. 4 for three or four days and every dose of 
 every sort of medicine should be washed down with as 
 liberal draughts of distilled water as the child can be in- 
 duced to drink. These directions apply, whether the 
 condition of the bowels be normal, constipated or alarm- 
 ingly diarrhceic. If the latter condition prevails and 
 the temperature is still high, the indications for the ,u\ 
 ministration of antiseptics are all the more urgent and 
 they should be exhibited promptly and nothing should 
 be given that could in any way interfere with tin ir action. 
 As soon as sufficient laxative effect of the medication 
 been produced, or if the bowels were already diarrh 
 when the change in color or the absence of di ible 
 
322 TYPHOID FEVER IN CHILDREN. 
 
 odor indicates that the antiseptic effect of the medicine 
 has been obtained, smaller doses should be given at 
 longer intervals until the condition has become normal. 
 
 Sometimes it is necessary to give carbonate of gua- 
 iacol more freely than could be done with Formula No. 
 4. In such instances this remedy may be given alone 
 or combined with eucalyptol and menthol, or guaiacol 
 absolute may replace the guaiacol carbonate. 
 
 If the temperature remain alarmingly high, despite 
 the antiseptic treatment, the child may be sponged with 
 hot or warm water and if necessary a few drops of 
 guaiacol absolute and eucalyptol may be rubbed over 
 the abdomen, carefully graduating the dose to such an 
 amount as will reduce the temperature to from 101° to 
 102° F., but never lower than the former register. The 
 effect of the application is apparent for several hours, 
 the patient being more easily affected by the second 
 embrocation which should be less in quantity than the 
 first, but this repetition is rarely necessary. 
 
 I have never exceeded thirty drops of guaiacol and 
 sixty drops of the eucalyptol as an external application 
 on the adult and the dose for children should be rather 
 smaller in proportion to age, although I have never seen 
 any bad results following its use in either instance. The 
 irritation of the skin is nil and the patient is not discom- 
 moded by its use. When the continued high tempera- 
 ture indicates the necessity for this application it should 
 be used under the supervision of the medical attendant, 
 a*s alarming depression is said to have been observed. 
 
 The object sought to be accomplished by the various 
 steps in treatment are first to asepticize the alimentary canal 
 and dislodge and eliminate the germs that are found within 
 its walls to reduce to a minimum the quantity of poison in 
 
DIET. 3,3 
 
 the system by thoroughly flushing out the prima viae ; to de- 
 stroy or neutralize the toxins of the disease ; to sustain the 
 vital and resisting powers of the patient; to excite the liver, 
 kidneys and stomach to healthy action. These results will 
 manifest themselves by the arrest of the diarrhoea, the relief 
 of the delirium and the insomnia ; and the abatement of the 
 other nervous symptoms ; the mind will become clear and 
 remain so throughout the illness ; all the abdominal 
 tenderness and tympanites will disappear, the urine will 
 become clear and lose all disagreeable odor ; the 
 tongue will become moist, and its coating begin to clear away; 
 the appetite will return ; the temperature will decline rapidly 
 to nearly, if not quite normal ; the pulse will increase in 
 strength and diminish in frequency ; the skin which may have 
 had that typically, earthy pallor will take on a healthy color 
 and tone ; the respirations will become of normal frequency, 
 and the bronchial catarrh will end in early resolution, and by 
 the end of the first week or ten days of the treatment the 
 patient will have lost all appearance of the typhoid state, ami 
 should begin to be quite cheerful and happy, having none 
 of the fretfulness incident to the illness, and will be henceforth 
 a very manageable invalid. 
 
 Diet. — As typhoid fever patients have a peculiar and dis- 
 tinctive patholysis, i. e. the inflammation and threatened 
 ulceration of Peyer's glands and the small intestines - the 
 toxic centers — a most important factor in the success <>! the 
 treatment is the proper and scientific management oi the 
 dietetics. 
 
 Milk is the ideal food — mother's milk for the babi 
 or cow's milk for the older child and adult ; it is easy <>f di- 
 gestion, assimilable and the fat and sugar which it contains 
 are well adapted to keep up the failing strength and supply 
 the " waste of combustion " caused by the high fever. The 
 
324 DIET. 
 
 feeding of typhoid fever patients, if treated intelligently from 
 the onset of the disease by the method I have advised is not 
 of so much importance or consequence as if the pathological 
 process be allowed to go on to necrosis and ulceration of 
 the intestines. The proper feeding of infants in health or in 
 disease is always a problem of much scientific interest. How 
 often we find that children or adults, who seem to possess 
 an antimilk idiosyncracy, can take it without discomfort and 
 with benefit if rendered faintly alkaline by the addition of a 
 little limewater or soda-bicarbonate or peptonized. It has 
 been found too that milk of cows fed on beets and certain 
 kinds of grass (notably the blue-grass of Kentucky) is 
 slightly alkaline. It would be well therefore for the phy- 
 sician to ascertain that the milk that his patient is using is 
 alkaline, and this is especially important in typhoid fever, in 
 which the diet should always be liquids of the most assimi- 
 lable sort and such as leave the least debris behind. The 
 food in this malady should always be selected with a view of 
 adding as much as possible to the total liquids taken into the 
 system. In addition to milk, the diet may consist of toast 
 water, an infusion of barley, or of rice, which is rich in starch 
 of a very, digestible form, and oatmeal, which contains a 
 large proportion of fats. Meat juice and jellies, jelly made 
 of iceland moss or of apple are sometimes very valuable and 
 grateful additions to the dietary. 
 
 Egg albumen or the white of egg beaten with lemon 
 juice and sugar, blancmange followed a little later by 
 fish or shellfish and finally by roast beef and beefsteak, 
 but these articles of diet must not be given indiscrimi- 
 nately. If the medical attendant could always be cer- 
 tain that he is aborting the disease without any serious 
 intestinal lesion, the selection of the different kinds of 
 food would indeed be a simple matter. 
 
RELAPSES. 
 
 i 
 
 The relapse is as a rule much more abrupt than the 
 first attack, that is, the temperature rises quickly and the 
 pulse is sooner accelerated, the rose spots come early 
 and after aborted attacks of the disease the relapse is 
 more obstinate and generally of longer duration than 
 the primary attack. 
 
 Relapses of typhoid fever should be treated as new 
 attacks of the disease, and a little more energetically. 
 As a relapse is a reinfection from within, it follows that 
 its occurrence should be rare, because if the virus which 
 caused the disease originally, has been destroyed there 
 can be no resuscitation of it. However if the noxa has 
 not been entirely neutralized and the patient remains 
 under .the observation of his medical attendant, any 
 slight elevation of the temperature, the return of the rash 
 or gastrointestinal, or other symptoms which signify the 
 reawakening of the malady, can be seen at once, and 
 should be regarded as an indication for a return to the 
 antiseptic medication. 
 
 Of 110 cases of well-marked typhoid (ever I have 
 had three relapses which were severe and resisted 
 abortive treatment more obstinately than the original 
 attack of the disease. All of them might have been | 
 vented by sufficient caution, but each of the patients had 
 been walking about or driving long distances and two "1 
 them had passed from observation for several days.* 
 
 *Since the above was written two of my cases have relapsed. 
 
 325 
 
326 RELAPSES. 
 
 Case No. 128. Alonzo O., residing in the adjoin- 
 ing county (Trumbull) whose brother had died a few days 
 before from typhoid fever under the "expectant plan of 
 treatment." 
 
 After making a diagnosis of typhoid fever, I told 
 him to come to my office every day, which with two or 
 three exceptions he did throughout both his primary at- 
 tack and relapse. 
 
 The former was severe and ended in a subnormal 
 temperature about the tenth day, which remained at or 
 below normal for ten days when a relapse occurred with 
 a longer high temperature (but in other respects not so 
 severe) but rather more obstinate than the original ill- 
 ness. In this attack the temperature was below normal 
 on the ninth day, went up to 100° on the thirteenth day 
 and did not again touch normal till the sixteenth day. 
 This rise in temperature took place during my absence 
 in Detroit when the patient considered himself so far 
 convalescent as not to require any more attention. 
 
 Case No. 129. Austie O. (wife of Case 128. J 
 
 This patient had been feeling miserably ill for ten 
 days, but as her husband had not recovered from his ill- 
 ness she did not pay proper attention to herself, imagining 
 that she had taken a very severe cold and the aches and 
 pains were "just rheumatism." I saw her first in the 
 early morning of the 30th of August, after a drive 
 of three miles to my house (it was not yet eight o'clock) 
 I found her temperature 104 °. I told her to go home 
 and to bed and that I would come out and see her that 
 evening. She went home and washed all of the accumu- 
 lated household and wearing apparel of the period of 
 her husband's illness, which was not taken from the line 
 till after dark of a cool late summer evening when the 
 
RELAPSES. 327 
 
 dew and fog was so very disagreeable as to require a 
 greatcoat for my drive to her home. I found her tem- 
 perature 104.8° and pulse 140, and the attack promised 
 to be very severe. From this it dropped to 100.4° on 
 the morning of the 2d of September, at which time 
 I gave her explicit directions in regard to the manage- 
 ment of the medicines, directing her to call a physician 
 if necessary and left to attend the meeting of the Missis- 
 sippi Valley Medical Association at Detroit. 
 
 Returning on the 6th of the month, I found that she 
 had neglected to take the medicine as directed ; for she 
 thought herself in no more need of especial attention 
 than had been her husband, whom I had seen on the 
 second or third day of his indisposition. Hence, ins; 
 of finding her on the fair road toward perfect health, I 
 found that the temperature had gone up to 104.8°, and 
 on the evening of the 9th of September (eleventh day 
 of treatment, eighteenth day of disease) to 105.8 , pulse 
 112. I ordered a recumbent position to be maintained 
 at ail times, forbidding her to rise at stool. This order 
 was not obeyed, for each time she insisted on rising ; 
 in fact, was very troublesome in this respect, which in- 
 discretion resulted in a slight haemorrhage on the even- 
 ing of the 14th. 
 
 From this time she improved rapidly, the tempera- 
 ture being normal two days later, and remaining tl 
 (with the exception of one insignificant rise of less than 
 a degree) till the 19th, when I saw her for the last time. 
 She was directed to remain in bed for ten days, and tin- 
 physician who was called during my absence in Chi< 
 reported a normal temperature still on the !0th, 
 which time she felt well and hungry, and i ould not un- 
 derstand why she could not sit up and eat solid 
 
328 > RELAPSES. 
 
 her husband had done. She continued to improve until 
 the 22d, when her temperature had gone up to 100° F., 
 pulse, 100 ; which was the beginning of the relapse 
 which terminated fatally under the care of another phy- 
 sician during my absence in Chicago, which I shall 
 allow the doctor to describe in his own words. 
 
 During the latter part of the primary attack of ty- 
 phoid fever of Case No. 129, Austie O., her sixteen 
 months' old babe, Case No. 130, Roy O., had a very 
 severe attack of the disease. The morning temperature 
 the first time I saw him (the 14th of September) was 
 104.6° F., eveningtemperature 105° F. ; and it wentabove 
 this point sometime each day for the five following days, 
 the highest temperature being 106° F. on the fifth day 
 of the disease, after which time the patient rapidly re- 
 covered, being left in the care of another physician on 
 the ninth day of the illness. Temperature 100° F., pulse 
 100, which went to normal on the seventeenth day of 
 treatment. 
 
 The percentage of my cases of relapses (2.7 per cent) 
 is lower than the lowest recorded per cent of the London 
 Fever Hospital (3 per cent), and a very considerable 
 improvement on that of the 229 cases treated by Osier 
 in the Johns Hopkins Hospital (7.3 per cent), by the 
 German observers, Leibermeister, in Basle, 8.6 per 
 cent; Gerhardt, 6.3 per cent; Baumler, 11 per cent; 
 Biermer, 3.3 per cent, and Hutchingson, 6.25 per cent. 
 
 A relapse in the child is rarely seen. 
 
 The rational inference would be that an aborted 
 attack of typhoid fever would be more likely to be fol- 
 lowed by relapses than one that had been allowed to 
 run its ordinary course ; but this is not so, if the small 
 number of my cases which I have quoted constitute a 
 reliable criterion. 
 
 
COMPLICATIONS AND SEQUELS. 339 
 
 Complications and Sequels — When typhoid fever is 
 allowed to run an uninterrupted course for several weeks, 
 its complications and sequelae are so serious, so grave and 
 so numerous, and withal are responsible for so large a per- 
 centage of deaths that physicians who have not had an un- 
 usually low death rate, sometimes say that they never lost an 
 "uncomplicated case of typhoid fever" — and to outline the 
 exact treatment of each, would require a much larger volume 
 than the one I am writing. Such a dissertation would more- 
 over be out of place in this work, since the whole burden of 
 my argument is — that the patient is but the container of a 
 specific poison which destroyed and eliminated leaves every 
 organ free to resume its normal functions — hence dangerous 
 complications and sequelae should be rare indeed in properly 
 managed cases of typhoid fever. 
 
 One Complication — perforation, demands especial at- 
 tention ; should this take place the object to be attained is to 
 preclude the extravasation of the contents of the intestine in- 
 to the peritoneal cavity. The indications are for the admin- 
 istration of morphine hypodermatically and perfect and 
 absolute rest secured at once. In case of severe inflammation 
 a poultice or ice should be applied over the abdomen. It 
 will sometimes happen thata physician, quite capable of pre- 
 venting necrosis and ulceration of Peyer's glands, had In- 
 treated his patient from the onset of the disease, will be 
 called upon to assume the management of a case oi t\ phoid 
 fever at too late a stage to prevent the intestinal lesions; 
 but in ample time to place the alimentary canal in a perfectly 
 aseptic and as far as possible in a healthy condition before 
 perforation occurs. Under these circumstances the aid ol 
 the surgeon should invariably be invoked, without 
 time, since without operative interference death is practically 
 inevitable, and especially since the aseptic condition of the 
 
330 COMPLICATIONS AND SEQUELS. 
 
 bowel renders possible much better results from a surgical 
 operation than have heretofore been obtained. 
 
 Dr. B. Merrill Ricketts, in the Cincinnati Lancet Clinic of 
 April 6, 1895, in his paper on "Typhoid Ulcer ; Perforation, 
 operation, death," says: 
 
 "The enfeebled condition at the time when the operation 
 is most likely to occur, is no doubt one of the greatest factors 
 in allowing these cases to die without surgical relief. But 
 now that drainage of the peritoneal cavity has been established 
 in so many conditions we are led to believe that it may be suc- 
 cessfully done, even when indicated in typhoid fever of any 
 degree, for surely recovery cannot be expected without it in 
 cases of perforation, or where the peritonitis is the result of 
 the extension of typhoid inflammation. Now that we have 
 the report of nineteen cases operated upon, with four recov- 
 eries, it seems that the operation is proven to be a rational 
 one, and that the greatest step in advancing the treatment of 
 this condition has been made. There does not seem to be 
 any question as to the time to operate, so far,as has yet been 
 determined. The abdomen should be opened as soon after 
 the perforation as possible, or as soon as peritonitis, with or 
 without pus is discovered, whether or not the patient has 
 rallied from the shock, for no time should be lost in washing 
 out the abdominal cavity, and closing the perforation in any 
 case that may be necessary. Attention should at once be 
 given to the collapsed condition of the patient, the injection 
 of warm salt water into the rectum, the irrigation of the abdo- 
 men with warm salt water or peroxide of hydrogen, the use 
 of nitrate of strychnia, digitalis, nitro-glycerine, and, as Abbe 
 suggests, "very warm saline infusion into the vein, of at 
 least one pint." 
 
 "The reports of Van Hook and Abbe are as follows 
 (Medical Record, page 2, January 5, 1895.) 
 
CO MP LIC A TIONS AND SE Q UELjE. 331 
 
 1884. Mikulicz, four cases, one recovery, though un- 
 fortunately the diagnosis is doubtful. 
 
 1885. Lucke, one case, resection, death. 
 
 1886. Escher, one case, recovery, but the case is re- 
 garded by Louis as one of appendicitis. 
 
 1886. Greig Smith, one case, doubtful diagnosis, death. 
 
 1886. Bartlett, one case, death. 
 
 1887. - Bonticue, one case, death. 
 1887. Morton, one case, death. 
 1889. Bonticue, one case, death. 
 
 1889. Senn, volvulus and perforation, one case, death. 
 - 18S9. Hahn, two cases, death. 
 
 1890. Kimura, one case, death. 
 
 1890. Taylor, one case recovered. 
 
 1891. Van Hook, three cases, two dead, one recovered. 
 1894. Caley and Bland Sutton, one case, fatal. 
 
 1894. H. Allington, one case, fatal. 
 
 1894. Netschagaw, Medical News, December 1, 1894, 
 
 page 609, one case, recovery. 
 
 1894. Abbe, one case recovery. 
 
 1894. Alezandroff, one case, death. 
 
 1894. Dandridge, one case, recovery. 
 
 1895. Ricketts, one case, death. 
 
 " It is not necessary that a perforation should be found 
 to verify the diagnosis of typhoid fever, especially when tin- 
 appendix is found intact, and all the symptoms have verified 
 the diagnosis. I fully agree with Van 1 look and Abbe that 
 the diagnosis maybe doubtful where the appendix is involved 
 or cannot be found, but where the patient 1 in 
 
 competent hands and has had the usual symptom 
 typhoid, and a sudden collapse occurs from the fifteenl 
 the thirtieth day, I see no reason why doubt should - 
 to the propriety of operative interference." 
 
332 COMPLICA TIONS AND SEQ UEL^.. 
 
 This report does not offer much hope to the victims of 
 perforation of the intestine and peritonitis. Fifteen deaths 
 after nineteen operations (or, as is stated in a late issue of 
 the British Medical Journal, twenty operations with one 
 recovery) is a fearful percentage to face but the awful alter- 
 native makes the procedure a legitimate one and in view of 
 the consanescent condition in which the ulcers are placed 
 by antiseptic treatment, future reports may be expected to 
 present much more favorable statistics ; albeit the occasion 
 for the operation will become more and more rare, as 
 physicians learn to secure adequate results from general 
 and intestinal antiseptics. 
 
 Abdominal section and ligation of the bleeding artery 
 has been advised in alarming intestinal haemorrhage, but 
 this is an operation which, (when the haemorrhage has be- 
 come copious enough to justify the procedure), must be 
 performed under most inauspicious conditions, therefore 
 cautious and wise physicians will prefer to treat the patient 
 through this accident by the application of ice to the ab- 
 domen and the administration of ergot to arrest the haem- 
 orrhage, and strychnia and stimulants to sustain the heart's 
 action and the strength of the patient during the period of 
 depression, to the hazard of such desperate surgery. 
 
 Another complication has recently come under my ob- 
 servation, in which a celiotomy might have saved the life 
 of the patient had it been possible to make an exact diag- 
 nosis in time to operate successfully. This allusion is to the 
 case of James K, (reported on page 152) in whom all ordi- 
 nary dangers of long continued illness or a fatal termina- 
 tion from typhoid fever had been averted, as was evidenced 
 by the disappearance of all of the unpropitious symptoms — 
 the tympanites, the pain and tenderness of the abdomen, 
 the delirium ; by the tongue becoming moist and clean ; by 
 
COMPLICATIONS AND SEQUEL.-E. 333 
 
 the rapidity of the decline of temperature; by the return of 
 the appetite ; by the cheerful and happy state of the mind ; 
 and anatomically and most conclusively, by the healthy 
 granulating- condition of the ulcers of the ileum. (See 
 colored plate No. 1, page 152). There is a marked contrast 
 to be seen in the appearance of these lesions as compared 
 with those which are represented on the colored plate No. 
 2, (page 154). This illustration shows a section of the 
 lower portion of the ileum of a patient in whom a post-mor- 
 tem had been made at the Cook County Hospital, Chicago. 
 The patient died very soon after having been admitted to 
 the ward of the Hospital and nothing was known as to the 
 previous treatment of the case, but such information as I 
 have at my disposal was courteously furnished me by Dr. 
 Oliver N. Huff, of Chicago, who also very kindly arranged 
 to have the specimens photographed, that they might be 
 placed here to show the phcegedenic and gangrenous ulcers 
 in contrast to the beautifully healing ulcers exhibited in 
 plate No 1. Had a celiotomy been performed and the in- 
 vagination (shown on colored plate No. 3, page 159 ) been 
 unsheathed, it might have saved the life of the patient. 
 
 Pregnancy. — Complicating typhoid fever, should be 
 referred to, not as indicating or demanding any special 
 treatment, but as requiring an early and careful application 
 of antiseptic medicine, the beneficial effects oi which are 
 made manifest by the reports of all of the physicians who 
 mention the subject. These gentlemen report more than 
 50 per cent of their patients as having recovered and 
 eventually giving birth to health)- children at full term, 
 whereas a very general summing up of the data <>i th 
 cases which have been treated by other methods, indii 
 that an average of not less than seventy out of every hun 
 dred women have miscarriages, and an abnormally 1 
 
334 COMPLICATIONS AND SEQUELS. 
 
 per cent die. It should be observed therefore, that neither 
 the coexistence of pregnancy nor Bright's disease with 
 typhoid fever, contraindicates the use of antiseptic medicine ; 
 nor do I know of any other complication or pathological 
 condition which does so. 
 
 Pregnant women should receive the most scrupulous 
 care and attention from both physician and nurse ; the 
 medicine should be given at regular intervals and care 
 should be taken to confine its laxative effect within due 
 bounds. These patients should be kept as nearly as 
 possible in a state of absolute rest and their diet should 
 be restricted to the most easily assimilated articles of 
 liquid food, preferably milk which should be taken in 
 sips and, if necessary, peptonized. 
 
 Pneumo-Typhus. — One of the most perilous compli- 
 cations of typhoid fever — it probably very rarely con- 
 tinues more than a day or so as a true pneumo-typhus, 
 dependent upon the invasion of the lung by the bacillus 
 typhosis only. The pathogenic microbe of typhoid fever 
 is early reinforced by other microorganisms, most 
 frequently, perhaps, by the microccoccus pneumoniae 
 crouposae. The imminence of the invasion of the lung 
 by these marplots emphasizes the importance of treating 
 this complication antiseptically, early and heroically. 
 
 The nervous complications of typhoid fever are sup- 
 posed to be caused by the absorption of the toxins of 
 the disease into the system — toxaemia — but the well- 
 known fact that the microorganisms have been found in 
 all parts of the body, coupled with the suspicion that 
 they may excite inflammations and abscesses, would ap- 
 parently justify the conclusion that the so-called neu- 
 roses of typhoid fever are sometimes due to the migra- 
 tion of bacteria to the brain, sometimes to meningitis 
 
CO MP LIC A TIONS AND SE Q UELJ5. 3 3 5 
 
 caused by their presence and sometimes to hemostasis, 
 or blood clot, and pressure. Sometimes the onset of 
 illness is so sudden as to make the symptoms closely 
 simulate those of cerebro-spinal meningitis, and instances 
 are known in which patients have been stricken down 
 and have died within forty-eight hours of the inception of 
 the disease, without having regained consciousness ; 
 hence in those attacks of typhoid fever in which the ner- 
 vous element predominates, as well as in those involving 
 the lung, the patient should be more energetically treated 
 than I have recommended in typical attacks of the disease. 
 Instead of giving one tablet of Formula No. 1, it is advis- 
 able that two or three tablets of No. 1 and one or two 
 of No. 2 should be administered every fifteen min- 
 utes until their effects are perceptible, and instead 
 of waiting until the third or fourth day to begin 
 capsules of Formula No. 3, they should be given at once 
 (or as soon as the danger of causing nausea or vomiting 
 is averted) and continued at two or three hour intervals, 
 until some abatement of the alarming symptoms has been 
 observed, after which the patient should be treated 
 cording to the directions which have been given on a 
 previous page for an uncomplicated case o\ typhoid 
 fever. 
 
 Closely allied to the complications of the nervous 
 system and which are due, no doubt, in some measure, at 
 least, to the same cause, are those which involve the eye 
 and ear. Choroiditis, irido-cyclitis, congestion and 
 inflammation of the conjunctiva-, opacity ol the cornea, 
 the not infrequent supervention of cataract and Other 
 anomalies of vision, should constitute a sufficient warn- 
 ing to the physician to take especial care of the 
 his patients during attacks of typhoid fever. 
 
336 CONCLUSION. 
 
 Abscesses occasionally make their appearance dur- 
 ing an attack of typhoid fever and they should always be 
 freely opened. Tumefied and inflamed parotid glands 
 especially, should be deeply incised, even though no fluc- 
 tuation can be detected and though no pus be escaping 
 by Steno's duct. The operation is almost invariably fol- 
 lowed by diminished tumefaction and a lowered temper- 
 ature, as well as by a general improvement in the condi- 
 tion of the patient. 
 
 CONCLUSION. 
 
 To the medical profession is committed the Abor- 
 tive Treatment of Typhoid Fever and with it Antiseptic 
 Medicine — the most important subjects which this, the 
 most learned of the professions, will ever be called upon 
 to investigate and adjudicate. 
 
 Prof. Da Costa said in one of his lectures "typhoid 
 fever is the fever of this country ; yes, it is the fever of 
 the whole world." 
 
 " Of this life destroyer," Sir William Jenner said "I 
 have never known a case of typhoid fever to be cut 
 short by any remedial agent — that is, cured. The poison 
 which causes any of the acute specific diseases (to 
 which typhoid fever, as much as smallpox, belongs) hav- 
 ing entered the system, all of the stages of the disease 
 must, so far as we know, be passed through, before the 
 patient can be well. The ordinary duration of a fully 
 developed attack of typhoid fever is from twenty-eight 
 to thirty days." 
 
 These expressions of opinion were written in 1893, 
 after more than half a century of special investigation 
 of the subject in the best school for its practical study in 
 
CONCLUSION. 337 
 
 the world — the Fever Hospitals of London — and his 
 words are entitled to every possible consideration, espe- 
 cially as he voices the sentiment of his coadjutors on 
 this side of the ocean, and they might well cause the 
 boldest observer to hesitate on the eve of sending out 
 to his profession, a book which promulgates theories 
 which are in such direct conflict with those that are uni- 
 versally taught, that its teachings must subvert those in 
 conflict with it or consign its author to dishonor or 
 oblivion, but I am writing from knowledge which is 
 grounded on twenty years of personal experience sup- 
 plemented by the reports of a large number of cases of 
 typhoid fever, which have been aborted by this special 
 method of treatment, and which were kindly sent me by 
 an enormous number of physicians to support my as- 
 sumptions, and the analysis and synthesis of these con- 
 stitute irrefragable proof that my postulate is an estab- 
 lished fact and they should remove the whole subject 
 from the sea of speculation and theory, to the solid foun- 
 dation of applied science. 
 
 For this disease, at least, antiseptic medicine has 
 passed out of the field of experimental study and it will, 
 in the hands of those who understand its use and value, 
 and who wisely select and dexterously exhibit the rem 
 edies which are to be applied, be found to be as potent 
 for the cure of typhoid fever as are the antiperiodics for 
 
 malaria. 
 
 The full import of this statement will become appar- 
 ent as soon as the symptomology of the prodromi 
 of the disease has been amplified, and its apodeixis will 
 come quickly if the promise of the possibility 
 early bacteriological diagnosis made by the re 
 Eisner's experiments, should be sustained by the touch 
 
338 CONCLUSION. 
 
 stone of practical experience, or if some other pathog- 
 nomonic symptom of the incubating disease should be 
 discovered, by means of which a direct diagnosis in its 
 inchoative period could be established, then the world 
 will recognize the truth of my oft repeated declaration 
 that typhoid fever can be aborted and death from the 
 diseases always averted. 
 
INDEX. 
 
 331 
 256 
 311 
 330 
 330 
 
 15 
 
 Abbe, Report on Perforation. . 
 
 Abdomen, Condition of 
 
 Guaiacol applied to 
 
 Irrigation of the 
 
 Condition in Perforation 
 
 Abdominal Affection, Southwood 
 
 Smith (1830) 
 
 Abdominal Fever, Flint (18 52) 
 
 American Writers 15 
 
 Abdominal Pain, (Hutchinson on 
 
 12) 233 
 
 Abdomimal Tenderness, Murchi- 
 
 son on. 11 
 
 Abdominal Section 332 
 
 Abdominal Typhus Autenreith, 
 
 (1822) 15 
 
 Abdominal Viscera. 295 
 
 Abercrombie (1820) Entero-mesen- 
 
 teric Fever 18 
 
 Aborted Typhoid Fever 
 
 207, 209, 213, 214 
 
 Abortive Attack 293 
 
 Abortive Treatment 114, 129 
 
 Remedies for 132 
 
 Harmlessness of 133 
 
 Should be instituted early 70 
 
 Averted all deaths for fourteen 
 
 years 179, 203 
 
 Advantages of, to humanity. . . 285 
 Importance of early diagnosis 
 
 in *• 
 
 Endorsements of 48, 122, 127, 
 144, 145, 146, 147, 161, 162, 
 163, 164, 165, 166, 167, 168, 
 184, 185, 186, 187, 188, 139, 
 190, 191, 192, 193, 194, 195, 
 196, 197, 198, 199, 200, 201, 202 
 
 Abortive Type of Typhoid 209 
 
 Acetic Acid ~* 7 
 
 Acid, Carbonic : ^ ):> ' 
 
 Picric 217 
 
 131 
 
 Acid, Sulphanilic 235 
 
 Acidum, Sulphurosum 284 
 
 Acid, Hydrochloric . 235 
 
 Acute Indigestion, differential di- 
 agnosis of 317 
 
 Acute Mania, differential diagno- 
 sis of 254 
 
 Acute Phthisis pulmonalis, differ- 
 ential diagnosis of 252 
 
 Adhesive Plaster 311 
 
 Age, influence of 23, 24 
 
 Osier on , '2-i 
 
 Agminated glands, Harley on. ..13, 14 
 
 Ague, Quotidian, Amoeba of 844 
 
 Tertian, Amoeba of 844 
 
 Quartan, Amoeba of *. . '-' \4 
 
 Air Passages, Bacillus Typhosis in. 806 
 Albert, Prince, Report on Death of 259 
 
 Albumen in Urine 
 
 Alcohol in Abortive Treatment. . . . 890 
 
 in Late Stages 811 
 
 in Chezynsky's Formula for 
 
 Dye 
 
 Ammoniated 
 
 Absolute 845 
 
 Hydrochloric Acid 
 
 Methylated 
 
 as a Nervous Sedative 
 
 Alexandroff, On Operation in I 
 
 foration 
 
 Alexifers 
 
 Alexins, Protective 
 
 Alexipharmacons 
 
 Alison, (1844), Kntrr.tr. I 
 
 latosa, Fever with Afiectiofl 
 of Abdomen ; ■ 
 
 Alkaline Milk 
 
 Alkaline Stools 
 
 Alkaline Wash 
 
 Alkaline Solution 
 
340 
 
 INDEX. 
 
 Alleghany, Reports of Typhoid 
 
 Fever in 278 
 
 Allington, H. f On Operation in 
 
 Perforation 331 
 
 Alimentary Canal, Habitat of 
 
 Bacillus Typhosis 40, 42 
 
 Alvine Dejections, Microscopical 
 
 Study of 223, 234 
 
 Leeuwenhoeck on 223 
 
 Disinfection of 283, 285 
 
 Alum Hematoxylin 248 
 
 American Medical Association, 
 
 Journal of, Editorial in ... . 29 
 Quotation from Article on ' 'Ty- 
 phoid Fever in Children." 135 
 
 Meeting in Milwaukee. . 29, 43 
 
 Meeting in Washington 39 
 
 Meeting in San Francisco. .71, 103 
 
 Meeting in Baltimore 133, 178 
 
 America, Importance of Antisep- 
 tic Medicine to 65 
 
 Amoeba of Malaria 243 
 
 Ammonia 235, 311 
 
 Salycil 19G 
 
 Amsterdam, • Death Rate in 278 
 
 Analine Dyes 245 
 
 Anatomical Lesions 14 
 
 Plate of 152, 154, 333 
 
 Date of Appearance of 237 
 
 Andral, (1823), Fievre Continue. . . 16 
 
 Anodyne Expectorants 308 
 
 Anorexia, (Harley on, 13) 256, 312 
 
 Anti-milk Idiosyncrasy 324 
 
 Antiperiodics in Malaria 337 
 
 Antipyretics, Medicinal, Condemna- 
 tion of 299 
 
 Antiseptic Medicine 53, 60 
 
 No Death During Antiseptic 
 
 Treatment 113 
 
 All Physicians will Use 114 
 
 Many Types Yield to 130 
 
 Has a Reserve Power for Good 179 
 
 Value in Early Stages 181 
 
 Application of, to the Cure of 
 
 Microbic Diseases 210,218 
 
 Usefulness of 214 
 
 Antiseptic Medicine, Condition of 
 
 patient after 217 
 
 Lower Death Rate After 218 
 
 Resistance of Typhoid to 219 
 
 As a Prophylactic 284 
 
 As a Neutralizer and Elimi- 
 
 native 292 
 
 Professor L. D. Woodbridge, 
 
 an Early Advocate of 300 
 
 Directions for the Administra- 
 
 iton of 302 
 
 Cathartic and Antiseptic Ac- 
 tion of 304 
 
 Usefulness in Renal Complica- 
 tions 306 
 
 Treatment of Pneumonia with 308 
 Various Complications Treated 
 
 with 308 
 
 Administration in Late Stages. 310 
 
 Administration to the Child. . . 320 
 
 Relapses Treated Energetically 325 
 
 Apparatus for Microscopical Work 245 
 
 Appetite in Children 319 
 
 Appius Claudius 280 
 
 Apyrexia 230 
 
 Aqua Ammonia 31 1 
 
 Aqueducts 281 
 
 Croton 282 
 
 Armstrong (1816), Common Con- 
 tinued Fever 16 
 
 Artery, Pulmonary 309 
 
 Bleeding, Ligation of... 332 
 
 Ashpits •. . 268 
 
 Athens, Water Supply of 280 
 
 Atypical Typhoid, Differential 
 
 Diagnosis of 254 
 
 Autenreith (1822), Abdominal Ty- 
 phus 15 
 
 Autopsy, After Error in Diagnosis. 136 
 in Dr. Cunningham's Case. . . . 154 
 
 in Dr. Dodge's Case 183 
 
 Osier on , 75 
 
 Babbington (1853), Febris Tym- 
 
 panica 18 
 
 Bacillus Coli Communis, first de- 
 scribed by Escherish 224 
 
INDEX. 
 
 341 
 
 Bacillus Coli Communis, Pathogno- 
 monic Signs of 225 
 
 Virulized, as a cause of Ty- 
 phoid 292 
 
 Bacillus Tuberculosis, Microscopi- 
 cal examination of the sputa 
 
 for 252 
 
 Bacillus Typhosis, Typhoid Fever 
 
 due to 14 
 
 Discovery of the, by Eberth 
 
 and Koch 84, 224 
 
 1 As a Cause of Typhoid Fever 224 
 Same as the Bacillus Coli 
 
 Communis, virulized 225 
 
 in the Urine 235 
 
 Pathological changes called 
 Typhoid Fever, primarily 
 
 due to 241 
 
 Presence in the System of . . . . 292 
 Invasion of the Air Passages 
 
 by the 308 
 
 Invasion of the Lung by the. . 319 
 
 Bacteria 92 
 
 Destruction of 219 
 
 Ptomaines of ". 92 
 
 Bacteriology, Wonderful Discover- 
 ies in 14, 64 
 
 Knowledge of, too new 91 
 
 Giant Strides in the Science of 223 
 
 in Microbic fields 224 
 
 Indebtedness to 225 
 
 in Diagnosis 241 
 
 Bacteriological Demonstration 2G9 
 
 Baglivi (1696), Febris Mesenter- 
 
 ica Maligna 1? 
 
 Ballonius (1680), Febris Gas- 
 
 trica *« 
 
 Balmer, Dr. Report of cases, from 
 
 letter 100 
 
 Balsam, Canada 248 
 
 Baltimore, Meeting of American 
 
 Medical Association at . . 13:5, 178 
 
 Health Reports of 275 
 
 Death Reports of 275 
 
 Papers Read at, in the Section 
 
 on Diseases of Children, 
 
 May, 1S95 133 
 
 Baltimore, in The Section on Prac- 
 tice, May, 1895 178 
 
 Barley, Infusion of 324 
 
 Barnes, Dr., Verification of Diag- 
 nosis 63 
 
 Bartlett, (1842), Typhoid Fever.. . 15 
 on Operation in Perforation 331 
 Bath, American Medical Journal 
 
 on 30, 35 
 
 in Children, when Tempera- 
 ture remains high 95 
 
 Advocates of 104 
 
 No Routinism in 296 
 
 in Children 320 
 
 Brand Method of 298 
 
 Advocacy of Wilson, Osier, 
 
 etc., of 313 
 
 Baumler, On Percentage of Re- 
 lapses 328 
 
 Bay Head, New Jersey, Epidemic 
 
 of Typhoid Fever at 2^ 
 
 Bed Sores 
 
 Treatment of 311 
 
 Beefsteak 
 
 Beets, Cows Fed on 
 
 Belfast, Ireland, Epidemic of Ty- 
 phoid Fever at. ... 
 
 Benelli (1775), Febbre Biliosa. . . . 17 
 Bengal, India, Water Supply of... 
 Bennett, Dr., Report of Cases. l'Jl>. 194 
 
 Benzoic Acid 
 
 Benzoyl Guaiacol 
 
 Berlin, Death Rate in 
 
 Bertlotte, Dr 
 
 Bicarbonate of Soda 
 
 in Milk 
 
 Biermeron Percentages I 
 
 Bignami, Laveran's I I Ver- 
 ified by 
 
 ••The Parasites ol Malarial 
 Fevers," by. . . 
 Bilio-Gastric 1 
 
 Bilious Attack 
 
 Differential DiaglK 
 
342 
 
 INDEX 
 
 Bilious Continued Fever, Modern 
 
 Writers 17 
 
 Bilious Fever, Pringle (1750), Rutty 
 
 (1770) 17 
 
 Bladder, Recumbent Position to 
 
 Evacuate the 301 
 
 Blanc Mange 324 
 
 Blaxal, Dr., Report of Case 27 
 
 Bleeding Artery, Ligation of 332 
 
 Blood, Microscopical Examination 
 
 of 223 
 
 Blue Grass, Cows Fed on 324 
 
 Body and Bed Linen, Disinfection 
 
 of 284 
 
 Clean and Spotless 296 
 
 Warm and Light 296, 319 
 
 Bonticue, On Operation in Perfo- 
 ration 331 
 
 Boston, Death Rate in 279 
 
 Bouchard, Professor, On Abortion 
 
 of Typhoid Fever 206 
 
 Boudet, On Haemorrhage 236 
 
 Bowels, Condition of, by Boudet. . 236 
 In Early Stages 316 
 
 Brain Fever, Osier on 75 
 
 Differential Diagnosis of. . 142, 148 
 
 Brand Method 298 
 
 Of Reducing the Temperature 298 
 Advocated by Osier, Wilson, 
 
 etc 313 
 
 Cases Reported Treated by, in 
 German Hospital, Philadel- 
 phia, Penn 314 
 
 Breslau, Death Rate in 278 
 
 Bretonneau (1826) Dothien Enter- 
 
 ite 18 
 
 Brewer, Dr. J. J . , Cases of Ty- 
 phoid Fever Treated by 190 
 
 Brieger, On Isolation of Typho- 
 
 toxin 224 
 
 Bright's Disease 130 
 
 Complicated with Typhoid 
 Fever 334 
 
 Bright, (1829) Fever with Ulcera- 
 tion of the Intestines 18 
 
 British Medical Association 289 
 
 British Medical Journal, "Water- 
 Borne Typhoid," Reports on 
 
 24, 25 
 
 On Importance of Pure Water 266 
 
 Bromidia 187 
 
 Bronchial Catarrh, and Hypostatic 
 
 Congestion 307 
 
 Professor Woodbridge on 317 
 
 Bronchial Tubes, Affection of ... . 308 
 
 Bronchitis, Catarrhal 308 
 
 Wyeth's, Tablets 89 
 
 Wilson on 317 
 
 Flint on 317 
 
 Niemeyer on 317 
 
 Broussais (1816), Gastro-enterite. . 18 
 Brown, (1853), Night Soil Fever. . . 18 
 Brown, Dr., Illness of the Prince 
 
 Consort 268 
 
 Brussels, Death Rate in 278 
 
 Browitz, Microscopical Work of.. 224 
 Burchard, Febris, Mesenterica 
 
 Acuta 17 
 
 Buccal Cavity, Microscopical Study 
 
 of 223 
 
 Buda-Pesth, Death Rate in 278 
 
 Budd, W. (1856), Intestinal Fever, 
 
 Theory of 18 
 
 Buffalo Medical Club, Paper Read 
 
 at 80 
 
 Reference to Discussion in . . . 107 
 Burt, Dr. C. I., Report of Cases. . . 197 
 
 Caley, on Operation in Perforation 331 
 
 Calomel 65, 191 
 
 Condemnation of, by Harley.. 211 
 Camphor and Opium, Diarrhoea 
 
 Controlled by 311 
 
 "Can Typhoid Fever be Aborted ?" 
 Paper read, M. V. M. A., 
 
 Oct. 1893 29 
 
 Paper read, Mahoning Co., 
 
 Jan. 1894 54 
 
 Paper read, Mahoning County 
 
 Medical Society, Feb'y, 1894 63 
 Paper read, Ohio State Medi- 
 cal Society, May, 1895 ...*.. 149 
 
INDEX. 
 
 343 
 
 Canada, Health Department of 41 
 
 Canada Balsam 248 
 
 Canadians, Importance of Abortive 
 
 Treatment to 65 
 
 Canton, Ohio, Letter from 166 
 
 Capsules, Formula No. 3 305 
 
 Formula No. 5 321 
 
 Carbonic Acid Gas 303 
 
 Cardiac Pathology 262 
 
 Casts, in Urine 306 
 
 Castor Oil 191 
 
 Catarrh, Bronchial, Antiseptic 
 Medicine, Best Initial Treat- 
 ment for 307 
 
 VonGeitl on ; ... 13 
 
 Catharsis, Free, Dr. Dodge on. . . . 183 
 
 Cathartics, in Diarrhoea. . . 300 
 
 Mild Saline 306 
 
 Condemnation of 210 
 
 Causes of Typhoid Fever, Predis- 
 posing 23 
 
 Age 23 
 
 Poisonous Effluvia 25 
 
 Human Excrement 25 
 
 Open Sewers 25 
 
 Exciting, Bacillus Typhosis. . . 25 
 Previous Attacks, Causing Im- 
 munity 25 
 
 Caecum, Glands of 14 
 
 Cell Development 223 
 
 Metamorphosis 223 
 
 Celli, on Malaria 242 
 
 Celiotomy 332 
 
 Cemeteries, Drainage from, Prof. 
 
 Prestwick on 289 
 
 Cerebro Spinal Meningitis, Osier 
 
 on r >° 
 
 Differential Diagnosis of . .137, 254 
 
 Inaccurate Diagnosis of 148 
 
 Treated with the Sulphites 210 
 
 Antiseptic Treatment of. 300, 308 
 Cesspool Fever, Various Writers. . 18 
 
 Cesspools, Illconstructed '- ),;x 
 
 Chairman of the Ways and Means 
 
 Committee, Illness of 261 
 
 Chalandri, Ancient Airshafts to 
 
 Aqueducts, at 280 
 
 Chamber of Commerce 100 
 
 Chemical Analysis 306 
 
 Cheyne (1833), Epidemic Gastric 
 
 Fever 17 
 
 Chezynsky, Formula for Dyes. .. . 245 
 
 Children, Typhoid Fever in 23 
 
 "Children, Typhoid Fever in," 
 Paper on, read before A. M. 
 A., at Baltimore, May, 1895. 133 
 
 Murchison on 134 
 
 No Mention of, in Reynolds' 
 " System of Medicine"... 134 
 
 Pepper on 134 
 
 Osier on 134 
 
 Predominance of Nervous 
 
 Symptoms in 135 
 
 Quotation from A. M. A. Jour- 
 nal on 135 
 
 Post-mortems in 185 
 
 Reports of Cases. ...186, 138, 
 Differential Diagnosis in 
 
 136,137, 148 
 
 Limited Number of Cases Re- 
 ported as 187 
 
 Last Two Fatal Cases in I N 
 
 Dr. McWilliams' Case 146 
 
 Dr. Cunningham's Case 146 
 
 Dr. Udell's Cases 146 
 
 Results Predicted for Antisep- 
 tic Treatment in 117 
 
 Treatment in* 316, 8» 
 
 Symptoms in 
 
 Cough Connected with 
 
 Dicrotism of Pulse Rare in . 
 Chill Rarely Observed in. 
 
 Hemorrhage Rare in 
 
 Management of 
 
 Tablets of Formu! 
 Capsules of Formal 
 Carbonate of Gnaitcol I 
 Cainiacol and I 
 
 plied to .' 
 Milk, Cow's nr r.... 
 
 Chilliness, Mur< 1 .11 
 
 Hutchinson on 
 
344 
 
 INDEX. 
 
 Chlorate of Potash, Saturated So- 
 lution of 305, 310 
 
 Chlorinum 284 
 
 Cholera, Differential Diagnosis of. 101 
 Cholera Infantum, Mistaken Diag- 
 nosis of . 137 
 
 Treated as Typhoid Fever. . . . 148 
 Chomel (1834), Fievre Typhoide. . . 15 
 
 Chorea 308 
 
 Choroid, Tubercle of 252 
 
 Christiana, Death Rate in 278 
 
 Christison (1840), Dothienenterite 16 
 Chritzman, Dr. H. G., Report of 
 
 Cases from Letter 188 
 
 Cincinnati Lancet Clinic, Report 
 of Death Rate in Foreign 
 
 Cities, from 277 
 
 Report of Ricketts on Typhoid 
 
 Ulcer, from 330 
 
 Cincinnati, Death Rate of 279 
 
 Clark, Alonzo 255 
 
 Clark, Sir James, on Illness of the 
 
 Prince Consort 260, 261 
 
 Cleanliness 267, 269 
 
 Cleveland, Microscopical Work in . 223 
 
 Cleveland Medical Society 157 
 
 Clinical Record, Importance of . . . 297 
 Clinical Society of Great Britain, 
 
 Conclusions of 26 
 
 Report on Infectiousness of 
 
 Typhoid Fever 285 
 
 Lectures * 220 
 
 Coal Tar Derivatives 104, 120 
 
 Condemnation of 67 
 
 Dr. Shields on 197 
 
 Heart Failure From 240 
 
 As Antipyretics 299 
 
 Collamore, Dr. Remarks at Colum- 
 bus 107 
 
 Collapse 319 
 
 College of Physicians of London, 
 England, (1869) Enteric 
 
 Fever 15 
 
 Colon, Glands of the 14 
 
 Coma, Malaria with 249 
 
 In Hypothetical Case 257 
 
 Coma, During Symptomatic Treat- 
 ment , 312 
 
 Common Continued Fever, Arm- 
 strong (1816) 16 
 
 Complications of Typhoid Fever. . 14 
 
 Air Passages 308 
 
 Bedsores 257, 311 
 
 Brain Fever 75, 142, 148 
 
 Catarrh 92, 307 
 
 Bowel 256 
 
 Bronchial Catarrh... 307, 308, 317 
 
 Cerebral 38 
 
 Chorea 308 
 
 Cough 89, 308, 317 
 
 Delirium. . .213, 217, 241, 254, 257 
 Diarrhoea 
 
 ....213,254, 256, 257, 300, 304 
 Diphtheria, 72, 131, 148, 218, 300 
 
 Dyspnoea 311 
 
 Embolism of the Pulmonary 
 
 Artery 309 
 
 Enfeebled Heart 307 
 
 Headache 238, 256 
 
 Heart, Enfeebled 307 
 
 Flagging 311 
 
 " Muscular Degeneration of 308 
 
 Hebetude 241 
 
 Hemorrhage 76 
 
 130, 140, 181, 198, 217, 235, 307 
 Hypostatic Congestion of the 
 
 Lungs 307 
 
 Influenza, 72, 130, 151, 152, 210, 253 
 
 Insanity 254 
 
 Intussusception 154 
 
 Jaundice 308 
 
 Kidney 234, 306 
 
 La Grippe 
 
 72, 130, 151, 152, 218, 253 
 
 Lung 307 
 
 Mania, Acute 254 
 
 Meningitis 
 
 Meteorism 213, 217, 233, 256 
 
 Opisthotonos 138, 317 
 
 Paralysis 33, 68 
 
 Pelvic 130 
 
INDEX. 
 
 345 
 
 Complications of Perforation 
 
 47,131, 217, 256, 257, 
 
 Peritonitis 
 
 Phthisis Pulminaris, Acute.. . . 
 
 Pneumonia 72, 
 
 88, 131, 137, 151, 218, 307, 
 
 Pneumo Typhus 253, 
 
 Pregnancy 
 
 Ptyalism 
 
 Pyaemia 
 
 Pyrexia 
 
 Renal 235, 
 
 Retching 
 
 Spleen, 75. 88, 99,(217, 219, 234, 
 Swelling of the Legs, Toes and 
 
 Body 
 
 Rubiola 300, 
 
 Thrombosis, Detaching of . . . . 
 
 Tympanitis 233, 213, 217, 
 
 Urine '.234, 
 
 Venous Thrombosis 
 
 " by Harley. . 
 
 " " by von Geitl 
 
 " Cause of. ... 
 
 AGravel30, 
 
 Concentrated, Solution of Methy 
 
 lene Blue, 
 
 Conclusions of the Clinical Society 
 
 of Great Britain, (1892) 
 
 Condition of Patient at Onset of 
 Disease, by Murchison.. . . 
 
 Cone, Dr. J. E 107, 
 
 Congestive Fever Certified as 
 
 Cause of Death 
 
 Congestion of the Capillaries 
 
 Congress, the Duty of 
 
 Consultant's Duty 
 
 Contagious Diseases 
 
 Contagiousness of Typhoid Fever 
 
 by Bretanneau 
 
 by Budd 
 
 by Leuret 
 
 by Gendron 
 
 Control of Symptoms, A. M. A. 
 
 Journal on 
 
 Convalescence 
 
 307 
 257 
 252 
 
 308 
 335 
 334 
 305 
 252 
 311 
 306 
 240 
 257 
 
 309 
 
 317 
 
 309 
 
 236 
 
 256 
 
 309 
 
 13 
 
 13 
 
 14 
 
 241 
 
 245 
 
 26 
 
 11 
 150 
 
 135 
 
 236 
 273 
 309 
 283 
 
 290 
 290 
 290 
 290 
 
 30 
 12 
 
 Conveying Typhoid to Others. .2 
 Cook County Hospital, Death and 
 
 Post-Mortem at 144, 151 
 
 Copenhagen, Death Rate in 278 
 
 Copland (1844), Bilio-gastric Fev- 
 er, Mild Typhoid Fever, 
 Mucus Fever, Pituitous 
 
 Fever 17 
 
 Coperas 284 
 
 Corrosive Poisons, as Microbicides 299 
 
 Corrosive Sublimate 120 
 
 as Cause of Death 
 
 as a Disinfectant 
 
 as a Microbicide 
 
 Cos, Island of, Water Supply of. . 280 
 Cost of Typhoid Fever, Dr. Osier's 
 
 Estimate, 275 
 
 Dr. Moore's Estimate 275 
 
 in Chicago 
 
 in Great Britain 'JT7 
 
 in Scotland 27*3 
 
 of Treating 187 
 
 Costiveness 805 
 
 Cough, Treatment of 89, » 
 
 A Usual Complication 
 
 Cow's Milk, the Ideal Food 
 
 Laws of the Roman Syndic in 
 
 Regard to 
 
 Cows, Feeding of, on Beets 
 
 on Blue Grass 
 
 Craigie (1S37), Gastric Fever. Gas- 
 tro-enteric Fi tro- 
 
 Splenic Fever 9 
 
 "Creameries and Infectious 1 
 
 eases" 
 
 Crematories, Garbage 
 
 for the Dead from C 
 
 Diseases 
 
 Creosote 
 
 Displacement 
 Crescent Shaped Boi" us- 
 
 tr.il Blood.. . 
 Crnveilbier (l v 
 
 culeuse 
 
 Culh-n (1769), Entei 
 
346 
 
 INDEX. 
 
 tosa, Typhus Mitior, Syno- 
 
 chus pro parte 15 
 
 Cunningham, Dr. M. V., Diagnosis 
 
 of 116 
 
 Report of Case 14G 
 
 Report of Fatal Case 151, 202 
 
 Curability of Typhoid Fever, Evi- 
 dence of the 33, 65, 101 
 
 Cases Illustrating the 
 
 35, 53, 59, 63, 77 
 
 Declaration of 67 
 
 Questioned, 30 30 
 
 Curative Treatment of Typhoid 
 
 Fever advantages of 39 
 
 Curatoret Aquarum 281 
 
 Dalton, Dr. H. C, Report of Cases. 200 
 Dandridge, on Operation in Perfo- 
 ration 331 
 
 Dangerous Medicines, Withhold- 
 ing of. 297 
 
 Dangerous symptoms, Treating. . . . 298 
 Darm Typhus, Autenreith (1822), . 15 
 
 Deafness, Hutchinson on 12 
 
 in Children 318 
 
 Death, from Typhoid Fever Can 
 
 Always be Averted 133 
 
 Due to Corrosive Sublimate.. 219 
 No Death in Thirteen Years. . 203 
 
 Harley on 13 
 
 Death Rate, from Typhoid Fever, 
 Former, Under Symptomatic 
 
 Treatment 113 
 
 in Foreign Cities 278 
 
 in Boston 279 
 
 in Buffalo 90 
 
 in Chicago 276 
 
 Cincinnati 278, 279 
 
 District of Columbia 279 
 
 in German Hospital, Philadel- 
 phia 314 
 
 in London 278 
 
 in Philadelphia 279 
 
 in Pittsburg 65, 278 
 
 in New Haven 74 
 
 in Michigan 278 
 
 Death in Scotland 277 
 
 in St. Louis 90 
 
 in United States 65, 114 
 
 in Vienna 270 
 
 in Youngstown 73 
 
 Debility, Influence of 25 
 
 Definitions of Typhoid Fever, by 
 
 Murchison 11 
 
 Hutchinson 12 
 
 by Harley 12 
 
 by von Geitl.... 13 
 
 Hippocrates 18 
 
 De Haen (1760), Miliary Fever. . . . 18 
 
 Delirium, Murchison on 11 
 
 Hutchinson on . , 12 
 
 Journal of the A. M. A. on 30 
 
 Minified by Abortive treatment 213 
 Rambling, After symptomatic 
 
 treatment 217 
 
 as a Symptom 241 
 
 in Hypothetical Cases 256, 257 
 
 in Children 318 
 
 Denver Medical Times, Quotation 
 
 from Dr. Law's Paper. .... 192 
 Department of Public Health of the 
 
 United States 274 
 
 Detroit, Mich., Paper Read, at, 222 
 
 September, 1895 
 
 Diagnosis, of Typhoid Fever, 227, 241 
 
 Harley on Difficulty of. 13 
 
 Confusion in, Caused by False 
 
 Nomenclature 20 
 
 For Treatment 73, 155 
 
 Mistakes in 
 
 74, 136, 137, 148, 241, 317 
 
 Value of Symptoms in 75 
 
 Tardy, Condemned 76 
 
 Danger of Mistaken, of Ma- 
 larial Fever. 77 
 
 Condemnation of Composite. . 99 
 
 Possible Error in 129 
 
 Early, of First Importance . . . 131 
 Early and Correct, in Chil- 
 dren 134 
 
 Report of Error of in, Journal 
 of A. M. A 136 
 
INDEX. 
 
 :;47 
 
 Diagnosis, Made by Exclusion, 138, 
 
 Correct 
 
 Criticism of, by Members of M. 
 
 V. M. A 
 
 By Aid of the Microscope 
 
 Exact, in Children, Difficult. . 
 
 Dr. Gustavus Eliot on 
 
 Difficulty of Taking Tempera- 
 ture, Cause of Error 
 
 Confirmed by Several Physi- 
 cians 
 
 Diazo Reaction as an Aid to. . 
 
 Diaphoretic, Treatment 
 
 Diarrhoea, Harley on 
 
 Hutchinson on 
 
 Murchison on 
 
 in Diagnosis 
 
 Ochre-Colored Stools 
 
 Copious, as a Symptom 
 
 An Indication for the Exhibi- 
 tion of Laxatives 
 
 Change in Character of. . .304, 
 
 in Children 
 
 Diazo Reaction, an Aid to Diag 
 
 nosis 
 
 Test 
 
 Dickson, Dr. J. A. , Report of Cases. 
 
 63, 
 
 Dilated pupils, Murchison on 
 
 Dicrotism, of the Pulse 
 
 in Children 
 
 Diet 
 
 of Patients in the Buffalo Hos- 
 pitals 
 
 of Patients after Abortive 
 
 Treatment 
 
 No Restriction necessary in 
 Aborted Cases of Typhoid, 
 
 Fever 96, 99, 
 
 Given at Proper Intervals. . . . 
 
 Proper 
 
 Directions for 
 
 Journal of A. M. A. on 
 
 Differential Diagnosis 1 ; 57, 
 
 of Acute Mania 
 
 242 
 154 
 
 222 
 
 249 
 
 316 
 
 99 
 
 232 
 
 167 
 
 234 
 
 292 
 
 13 
 
 12 
 
 11 
 
 234 
 
 256 
 
 257 
 
 300 
 310 
 321 
 
 234 
 
 235 
 
 163 
 
 11 
 
 309 
 
 318 
 
 50 
 
 82 
 
 83 
 
 130 
 296 
 
 312 
 
 323 
 
 80 
 
 Differential Diagnosis of Atypical 
 
 Typhoid 
 
 Bilious Attack 
 
 Cerebro-spinal Meningitis. . . . 
 
 Epidemic Influenza 
 
 Gastroenteritis 
 
 Insanity 
 
 La Grippe 
 
 Malarial Fever 
 
 Meningitis 
 
 Pneumonia 
 
 Pneumo-typhus 
 
 Puerperal Fever 
 
 Pyaemia 
 
 Scarlatina 
 
 Tuberculosis, Acute Phthisis 
 Pulmonaris 
 
 Tuberculosis, Miliary 
 
 Tubercular Meningitis 
 
 Typhus Fever 
 
 by Murchison 
 
 Digestion 
 
 Digitalis 
 
 in Perforation 
 
 Diphtheria, Proper Treatment for 
 
 73, 148 
 
 Diuretic Mixture Given in Dr. 
 Udell's Case 
 
 Formula for 
 
 Treatment 
 
 Disinfectants, Proprietary 
 
 Disinfecting Solution 
 
 Disinfection, of Every Emunr: 
 
 Not N fter Abor- 
 tive ;it 
 
 all Soiled Garment 
 
 District of Colombia, I 
 Typhoid Fever in . 
 
 Death Rate in 
 
 Distilled Water, witl >e of 
 
 Medicine. . . 
 Displaced by 1 
 
 Dodg 
 
 264 
 254 
 
 '.2.-> 4 
 
 316 
 
 •212 
 253 
 
 258 
 248 
 
 Bll 
 
348 
 
 INDEX. 
 
 Doses, Minute, of Antiseptic Medi- 
 cine. . .111, 302, 303,305, 306, 302 
 Dothienenterite, Bretenneau, 
 (1826), Christison (1840), Leu- 
 ret (1823) 17,18 
 
 Dover's Powder 311 
 
 Dresden, Death Rate in 278 
 
 Dublin, Typhoid Fever in 277 
 
 Death Rate in 278 
 
 Durance River, Water Supply.... 282 
 
 Duration of Typhoid Fever 103 
 
 Murchison on 11 
 
 Hutchinson on 12 
 
 Harley on 12 
 
 Sir William Jenner on 336 
 
 Dyes, Dr. George Thin on 245 
 
 Chezynsky's 245 
 
 Mannaberg's 247 
 
 Dyspnoea, Treatment of —311 
 
 Ebel (1836), Typhus Gangliaris vel 
 
 Entericus 15 
 
 Eberth, Discovery of Bacillus Ty- 
 
 phosis 83, 224 
 
 Bacillus, Found in the Urine. . 235 
 Bacillus Present in the System 292 
 
 Edinburg, Death Rate in 278 
 
 Editor of the Journal of the A. M. 
 A., "On Treatment of Ty- 
 phoid Fever" 64 
 
 Editorial in Journal of A. M. A. . . 29 
 
 Egg Albumen 324 
 
 Eggnog 312 
 
 White of 324 
 
 Egopheny 163 
 
 Ehrlich's, Diazo Reaction, in Diag- 
 nosis ..169, 234 
 
 Test 235 
 
 Eliot Gustavus, Dr., on Incorrect 
 
 Diagnosis of Typhoid Fever 73 
 
 on Composite Diagnosis 99 
 
 on Correct Diagnosis, Case of 
 
 Dr. F Mahommed 262 
 
 Emaciation 257 
 
 Embolism of the Pulmonary 
 
 Artery 309 
 
 Embrocation of Guaiacol and Eu- 
 
 calyptol 322 
 
 of Spiritus Terebinthinae 311 
 
 Emesis, Arrest of 280 
 
 Empedocles 280 
 
 Emulsion, Turpentine 163 
 
 Endemic Disease, of Murchison. . . 11 
 
 of Hutchinson 12 
 
 Endemic Fever, Many Writers 15 
 
 Enemata 312 
 
 Enlargement of the Spleen, Dr. 
 
 Eliot on 99 
 
 Under Symptomatic Treat- 
 ment 217 
 
 A Symptom of Typhoid Fever 234 
 
 Eosin, Solution of 245 
 
 Enteric Fever. Ritchie (1846), 
 Wood (1848), W. F. Gairdner 
 (1859), Coll. Phys., London, 
 
 (1869) 15 
 
 Enterite-folliculeuse. Cruveilheir 
 
 (1835), Forget (1841) 18 
 
 Enterite Septicemique. Piory 
 
 (1841) 16 
 
 Enteritic Fever. (Mills 1813) 18 
 
 Enteritis Erysipelatosa. Cull en 
 
 (1769) 17 
 
 Entero-Mesenteric Fever, Aber- 
 
 crombie, (1820) 18 
 
 Epidemic Gastric Fever, Cheyne • 
 
 (1833) 17 
 
 Epidemic Influenza, Differential 
 
 Diagnosis of 253 
 
 Epidemics of Typhoid Fever 24 
 
 Bay Head, New Jersey 28 
 
 Belfast, Ireland 286 
 
 Buffalo 91 
 
 Fortune's Well, England 27 
 
 Ironwood, Michigan . 43 
 
 Lake City, Iowa 197 
 
 Leeds, England 286 
 
 Lorain, Ohio 194 
 
 Montclair, New Jersey 287 
 
 New Melford, Connecticut 287 
 
 North Dakota 91 
 
 North Jackson, Ohio 38 
 
INDEX. 
 
 349 
 
 Epidemics of Typhoid Fever, 
 
 Northern Michigan 91 
 
 Orphan Asylum, England 25 
 
 Plymouth, Connecticut 289 
 
 Renfrew, England 275 
 
 St. Louis 91 
 
 Somerville, Massachusetts. . . 287 
 Springfield, Massachusetts. . . . 287 
 
 Stamford, Connecticut 287 
 
 Wampum, Pennsylvania 36 
 
 Waterbury, Connecticut 287 
 
 Watertown, New York 289 
 
 Winnifrede, West Virginia ... 289 
 
 Epigastrium 318 
 
 Sinapism Over 303 
 
 Epistaxis 238, 252 
 
 in Children 318 
 
 Murchison on 11 
 
 Hutchinson on 12 
 
 Ergot in Haemorrhage 332 
 
 Erysipelas 210 
 
 Eruption of Variola 253 
 
 "Eruptive and Continued Fevers," 
 Death Rate in Dublin Hospi- 
 tals 277 
 
 Escher on Operation in Perforation 331 
 Escherich First Described Bacil- 
 lus Coli Communis 224 
 
 Eucalyptol 65 
 
 and Guaiacol Applied to the 
 
 Abdomen 76, 322 
 
 as Used by Dr. Dodge 183 
 
 in Formula No. 1 302 
 
 in Formula No. 2 303 
 
 in Formula No. 3 805 
 
 in Formula No. 4 321 
 
 in Formula No. 5. . . . 321 
 
 Eucalyptus. Oleum 311 
 
 and Guaiacol, Applied to Ab- 
 domen 311 
 
 Eupalinus 279 
 
 Evacuations, Disinfection of 
 
 Number of 804 
 
 in Children 321 
 
 Evanson (1836), Infantile Remit- 
 tent Fever 16 
 
 Exciting Cause of Typhoid Fever. 
 
 Invasion of the Noxa 25 
 
 Excrementa, Rendered Innocuous 
 
 by Abortive Treatment 42 
 
 Disinfection of 284 
 
 Exercise not Restricted in Abor- 
 tive Treatment of Typhoid 
 
 Fever 35, 95, 813, 217 
 
 Exhaustion, Harley on 13 
 
 Expectant Method of Treatment. . 258 
 
 Expectorants, Anodyne 308 
 
 Stimulating '. . 309 
 
 Expectoration 163 
 
 Eyes, in Brain Lesions of Children 318 
 Ophthalmoscopical Examina- 
 tion of 252 
 
 Fasces, Microscopical Examination 
 
 of 
 
 Fairchild Brother and Foster's 
 
 Panopeptin 
 
 Fall Fever, Flint (1852) 
 
 Farr (1859), Typhia 
 
 Fatal Cases 183, 188, 185, 
 
 in Consultation 
 
 Last, from Typhoid Fever. . . . 
 
 of Dr. Cunningham 
 
 of Dr. Dodge 
 
 of Boudet 
 
 Faust, Denunciation of 
 
 Febbre Biliosa, Bonelli (1775) ... 
 
 Febricula, Manningham (1746) 
 
 Febril Condition of Harley 
 
 Febril Symptoms, Murchison on. , 
 
 Hutchinson on 
 
 G. Thin on 
 
 Febris Acuta Stomachica, I 
 
 Intestinalis, I 
 Febris a Putredim rral- 
 
 liani (1 : 
 Febris Atacta, Pi 
 
 (1770)... 
 Febn 
 
 (1638), Stahl 
 
 (1786) 
 
 Febi Putrid*, G 
 
 888 
 
 B09 
 
 16 
 18 
 
 151 
 189 
 164 
 
 17 
 16 
 
 12 
 11 
 
 i.; 
 16 
 
350 
 
 INDEX. 
 
 Febris Chronica (?), Juncker (1736) 17 
 
 Febris Colliquativa (?), Forestus 
 
 (1668) 17 
 
 Febris Colliquativa Primaria Sue 
 Essentialis; Burserius, 
 (1785) 17 
 
 Febris Gastrica Ballonius, (1640) . . 17 
 
 Febris Gastrica Acuta Burserius, 
 
 (1785) 17 
 
 Febris Glutinosa Gastrica, Sar- 
 
 cone(1765) 17 
 
 Febris Hectica, Willis (1667) 17 
 
 Febris intestinalis Vel Mesenterica, 
 
 Riedal, (1748) 17 
 
 Febris Lenta, Forestus (1591), 
 Willis (1659). Linnaeus 
 (1763), Vogel (1765) 16 
 
 Febris Mesaraica, Wendt (1822). . . 18 
 
 Febris Mesenterica Acuta, Burch- 
 ard, (1785), Burserius, 
 (1785) 18 
 
 Febris Mesenterica Maligna. 
 Baglivi (1696), Hoffman 
 (1699) 17 
 
 Febris Mucosa. Selle (1770) 17 
 
 Febris non Pestilens, Forestus 
 
 (1591) 15 
 
 Febris Petechizans vel spuria. Hoff- 
 mann (1699) 17 
 
 Febris Pituitosa. Stoll (1785). 
 Strack(1789) 
 
 Febris Pituitosa Mucosa, Jacobi, 
 
 (1795) 17 
 
 Febris Putrida. Riverius (1623). . 16 
 
 Febris Putrida aut Nervosa. Wint- 
 
 ringham (1732) 16 
 
 Febris Putrida aut Biliosa. Tissot 
 
 (1788) 16 
 
 Febris Putrida quae vulgo lenta 
 
 appellatur. Willis (1659) 16 
 
 Febris Semitertiana seu compos- 
 ita. Galen (?), Forestus 
 (1591), Spigelius (1624) 16 
 
 Febris Stercoralis (?). Quesnay 
 
 (1753) 17 
 
 Febris Tympanica. Babbington 
 
 (1853) 18 
 
 Febris Verminosa. Selle (1770). . 18 
 
 Ferrum Sulphatum 284 
 
 Fever on the Spirits. Manningham 
 
 (1740) 16 
 
 Fever, with Affection of the Abdo- 
 men. Alison (1827) 18 
 
 Fever, with Ulcerations of the In- 
 testines. Bright (1829) 18 
 
 Fievre Adena-Meningee. P i n e 1 
 
 (1798) 16 
 
 Fievre Continue. Lerminier (1823) 
 
 Andral(1823) 16 
 
 Fievre Ataxique, proparte. Pinel 
 
 (1789) 16 
 
 Fievre Entero-Mesenterique. Petit 
 
 (1813). Serres (1813) 18 
 
 Fievre Gastrique, Diet, des Sc. 
 
 Med. (1816) *17 
 
 Fievre Meningo-gastrique, Pinel 
 
 (1798) 17 
 
 Fievre Muqueuse, French Writers. 17 
 Fievre Nerveuse, French Writers. 16 
 Fievre Typhoide, Louis (1829), 
 Chomel (1829), Bouchard 
 
 (1895) 15 
 
 Fischl 224 
 
 Fish, as an Article of Diet 324 
 
 Flagella in Palustral Blood 293 
 
 Flagging Heart, Treatment of 311 
 
 Flint (1852), Autumnal Fever, Fall 
 
 Fever 15 
 
 on Antidote to Typhoid Poison. 225 
 
 on Arrest of Typhoid 226 
 
 on Bronchial Catarrh 317 
 
 Fomentations, hot 309 
 
 Food 217 
 
 Administration of. 296, 300 
 
 Solid 313 
 
 Liquid 307, 312 
 
 Fordice (1791), Irregular Low Ner- 
 vous Fever 16 
 
 Forestus (1591), Febris Colliqua- 
 tiva, Febris Lenta, Febris 
 Non Pestilens, Febris Semi- 
 tertiana seu Composita. .15, 19 
 
INDEX. 
 
 351 
 
 Forget (1841 ), Enterite-f olliculeuse. 18 
 
 Formula, No. 1 302 
 
 No. 2 303 
 
 No. 3 305 
 
 Diuretic Mixture 306 
 
 No. 4 321 
 
 Chezynsky's for Dyes 245 
 
 Thin's 247, 248 
 
 No. 5 321 
 
 Diazo Reaction 235 
 
 Fortune's Well, Epidemic at 27 
 
 Fraser, Dr., Report of Case 124 
 
 Free, Dr. S. M., Letter and Re- 
 ports of Cases 190 
 
 Friedlander 224 
 
 Frontal Headache, in Diagnosis, . . 238 
 
 Gaffky 22 
 
 Gairdner, W. T., (1829) Enteric 
 
 Fever 18 
 
 Galen (?) Febris Biliosa 17 
 
 Febris Semi Tertiana Seu 
 
 Composita 16 
 
 Ganges, Fresh Water Canal 282 
 
 Gastric Derangement, Hutchinson. 12 
 Gastric Fever, Craigie (1837). . .17, 261 
 Gastrisches Fieber, Richter (1818). 17 
 Gastro-bilious Fever, Modern Writ- 
 ers , 17 
 
 Gastro-enteric Fever, Craigie(1837) 18 
 Gastro-enterite, Broussais (1816).. . 18 
 Gastro-enteritis, Differential Diag- 
 nosis of 317 
 
 Gastro-intestinal Antisepsis 40 
 
 Gastro-intestinal Symptoms 316 
 
 in Relapse 325 
 
 Gastro-splenic Fever, Craigie 
 
 (1837) 18 
 
 Gendron, Contagion Theory of... 290 
 Geographical Distribution of Ty- 
 phoid Fever 21, 10:5 
 
 Gerhart, Percentage of Relapses.. 32S 
 German Hospital, of Philadelphia, 
 
 Brand Method in 814 
 
 German Observers on Relapses. . . 328 
 
 Germicides, Nontoxic 219 
 
 Gibson, Dr. R. D 
 
 Gilchrist, (1734), Nervous Fever. ... 16 
 
 Glasgow, Death Rate in 278 
 
 Goat's Milk 323 
 
 Golgi 242, 249 
 
 Grass, Blue for Cows 324 
 
 Great Britain, Typhoid Fever in. . 277 
 
 Greeks, Health etc 279 
 
 Griesinger (1857) Ilio-Typhus, . . . 15 
 
 Guaiacol 65 
 
 Applied to Abdomen 7''' 
 
 and Eucalyptol Mixture 183 
 
 Replaced by Carbonate of . . . . 210 
 Absolute, External Applica- 
 tion of 311, 322 
 
 Benzoyl, in Lung Complica- 
 tions 308 
 
 Embrocation of 822 
 
 Carbonate of, Report of Dr. 
 
 Law 1M 
 
 in Formula No. 1 302 
 
 in Formula No. 2 3^3 
 
 in Formula No. 3 805 
 
 in Formulae Nos., 4 and 5. . . . 821 
 
 Gurgling, Murchison on 11 
 
 as a Symptom of Typhoid 
 
 Fever 266 
 
 in Diagnosis 
 
 Guy's Hospital 862 
 
 Hematoxylin for Staining Spon 
 
 Hahn, Dr. H. H 
 
 Verification of Diagnosis . r >l 
 
 Hahn on Operation in l'crforati 
 
 Hamburg, Death Rate in 
 
 Hamilton, John B , A M . M 
 
 Report of Marine Hospital 
 
 Service 
 
 on Rose Spots 
 
 on Typi) in Rural 
 
 District 
 
 Hare (1858), Sepimia ..16 
 
 Harlem Viaduct 
 
 Harley, Definition 
 
 Fever 
 
 Condemnation oi 
 Catbarf 
 
352 
 
 INDEX, 
 
 Hart, Ernest, Mr., "Reports on 
 
 Waterborne Typhoid " 24 
 
 on Period of Incubation of Ty- 
 phoid Fever , . . 26 
 
 Duration of Power of Convey- 
 ing Infection 27 
 
 Modes of Convection 27 
 
 on Prophylaxis 2G6 
 
 on Polluted Wells and Streams 270 
 
 on Contaminated Milk 285 
 
 Headache 256 
 
 Murchison on 11 
 
 Hutchinson 12 
 
 Louis on 238 
 
 in Diagnosis, Occipital 238 
 
 Frontal 238 
 
 Health Boards of Canada 41 
 
 of the United States 
 
 Duty of 268, 272 
 
 Limited Jurisdiction of. . .282, 283 
 Health Reports as Evidence of Er- 
 rors in Diagnosis 137 
 
 Health Report of Typhoid Fever 
 
 in Chicago 276 
 
 in Dublin 8 
 
 in the German Hospital, Phil- 
 adelphia 314 
 
 in Michigan 278 
 
 in Mid-Renfrewshire 276 
 
 in New Haven 74 
 
 in Pennsylvania Hospital, 
 
 Philadelphia 315 
 
 in Philadelphia 275 
 
 in Pittsburg 65, 278 
 
 in the Presbyterian Hospital, 
 
 Philadelphia . . . . 315 
 
 in Scotland 277 
 
 in Great Britain 277 
 
 in Stamford, Connecticut 278 
 
 in the United States 65 
 
 in Youngstown, Ohio 73 
 
 Heart, in Diagnosis 240 
 
 Enfeebled. 307 
 
 Flagging 311 
 
 Muscular Degeneration of. . . 308 
 
 Failure. Due to Coal Tar De- 
 
 rivitives 240 
 
 Hebetude, in Diagnosis 241, 954 
 
 Hectic Fever, Harley on 13 
 
 Heister (1736) Febris Acuta Stom- 
 
 achica aut Intestinalis 17 
 
 Hematozoa, Malariae, Action of 
 
 Quinine on 219 
 
 Laveran's Discovery of 223 
 
 Valuable in Differential Diag- 
 nosis 242 
 
 Hemitritaeus 15 
 
 Auctor. antiq. Var Galen (?).. 19 
 
 Haemoptysis 309 
 
 Haemorrhage 14 
 
 Harley on 13 
 
 Hutchinson on 12 
 
 Murchison on 11 
 
 Should be Unknown 66 
 
 in Case No. 51 151 
 
 From the Lungs 130 
 
 Common in Cases Not Scien- 
 tifically treated 211 
 
 in Diagnosis 235 
 
 and Perforation 307 
 
 Accident to be Dreaded 312 
 
 in Case No. 105. 140 
 
 Rare in Children 318 
 
 Danger of, Minimized 181 
 
 Does Not Contra-indicate 
 
 Abortive Treatment 198 
 
 Danger of, Not Increased by 
 
 Peristalsis 320 
 
 Ergot in 332 
 
 Ice in 332 
 
 Hepatization 163 
 
 History of Typhoid Fever . . 19 
 
 Hoffman (1699) Febris Petechizans 
 vel Spuria, Febris Mesenter- 
 
 ica Maligna. 17 
 
 Holland, Sir Henry, on the Illness 
 of the Prince Consort, of 
 
 England 261 
 
 Holmes, Dr. O. W., on the Med- 
 ical Profession 106 
 
INDEX. 
 
 353 
 
 Hospitals, for Clinical Teaching. . . 221 
 Condition of Patients in Buf- 
 falo 82 
 
 Cook County ]44, 151 
 
 German, Philadelphia . . 314 
 
 Guy's, London 262 
 
 Death Rate in 314 
 
 Ironwood 45 
 
 Memphis 196 
 
 Pennsylvania, Philadelphia. . . 315 
 Presbyterian, Philadelphia. ... 3io 
 Saint Louis, Superintendent of 200 
 
 Scotland 277 
 
 Hot Springs, Paper, "Can Typhoid 
 Fever be Aborted ?" Read 
 November. 1894, Denuncia- 
 tion at 222 
 
 Huff, Dr. Oliver N., Photograph 
 
 Supplied by 334 
 
 Human Excrement 26, 269 
 
 Poisonous Effluvia from, Pre- 
 disposing Cause of Typhoid 
 
 Fever 25 
 
 in Drinking Water 267 
 
 Hutchinson, Dr. James H., Defini- 
 tion of Typhoid Fever 12 
 
 on Diagnosis and Treatment. . 250 
 on Percentage of Relapses. . . . 328 
 Huxham, (1739) Slow Nervous 
 
 Fever 16 
 
 Hydrargyrum Chloridum Corrosi- 
 
 vum 284 
 
 Hydrochloric Acid 236 
 
 Hydrogen, Peroxide of 330 
 
 Hydrostatic Principle, Known to 
 
 the Ancients 281 
 
 Hygiene 
 
 Hygienic Surroundings, Bad . .147, 18G 
 Hyperesthesia in Reported Case. . 147 
 
 Hyperplasia 316 
 
 Hypostatic Congestion 307 
 
 Hypothetical Case, Nursing and 
 
 Treatment of. .301, 306, 309, 313 
 
 in Children 828 
 
 Murchison's 
 
 Hysteric Fever, Manningham, 
 
 (1746) .' 
 
 Ice, in Perforation 
 
 in Bleeding Artery 
 
 Ileum, Necrosis of the glands of. 
 
 Tumefaction of the glands of. 
 
 Murchison on 
 
 Hutchinson on 
 
 Iliac fosae, Tenderness in 
 
 in Diagnosis 
 
 in Hypothetical Case 
 
 Murchison on 
 
 Hutchinson on , 
 
 in Children 
 
 Ilio-typhus, Griesinger (1857) 
 
 Immunity from typhoid fever ac- 
 quired 
 
 children posess no special .... 
 
 Incubator 
 
 Incubation period of typhoid, 26, 27 
 Incurability of typhoid fever, Jour- 
 nal of the A. M. A., on. . . . 
 Indigestion, differential diagnosis 
 
 of 
 
 Infantile Hectic Fever, Various 
 
 writers 
 
 Infantile Remittent Fever, Evan- 
 son (1836), Maunsell (lfi 
 
 many writers 
 
 Infectious Diseases, Prophylaxis 
 
 
 
 Infectious Fever, Hutchinson 
 
 Influenza, treatment of 
 
 Differential Diagnosis of 
 
 Insanity, Differential Diagnosis of 
 
 Insomnia 
 
 Intestinal Derangement 
 Intestinal Fever, W. Budd 
 Intestinal Haemorrhage 
 
 Harley on 
 
 Hutchinson on 
 
 Murchison on . 
 Intestinal Pel 
 
 Lesions, Date of h 
 of 
 
 16 
 .329 
 
 «aa 
 
 14 
 
 12 
 
 12 
 
 7.", 
 
 233 
 
 256 
 
 11 
 
 12 
 
 316 
 
 15 
 
 23 
 
 24 
 2 46 
 . 71 
 
 17 
 
 16 
 
 19 
 L8 
 
 1 1 
 18 
 
 1 1 
 n 
 
354 
 
 INDEX. 
 
 Intestines, Microscopical Examin- 
 ation of 223 
 
 Intoxications krankheit, von Geitl. 13 
 
 Introduction 5 
 
 Intussusception, Case of 159 
 
 Anatomical Specimen 202 
 
 Colored Plate of 159 
 
 Iodine 210 
 
 Ipecac 98 
 
 Ironwood, Mich., Epidemic of 
 
 Typhoid Fever at 43 
 
 Irregular Low Nervous Fever, For- 
 
 dice (1791) 16 
 
 Island of Cos, Water Supply of. .. 280 
 Island of Ortygia. Water Supply of 280 
 Jacobi (1743) Febris Pituitosa Ner- 
 vosa 17 
 
 Jaundice 308 
 
 Jellies, of Meat, Iceland Moss and 
 
 Apples 2.34 
 
 Jenner Sir William (1849) Typhoid 
 
 Fever 15 
 
 on the Incurability of Typhoid 
 
 Fever 236 
 
 on the Illness of the Prince 
 
 Consort 260, 261 
 
 Johns Hopkins' Hospital Reports, 
 
 24, 104 
 
 Relapses 328 
 
 Juices, Lemon, Fruit, Meat 324 
 
 Juncker (1736), Febris Chronica, 
 
 Febris Biliosa 16 
 
 Justice, Dr. R. C, Consultations 
 
 with 122, 124 
 
 Report of Case 162 
 
 Endorsement of Abortive 
 Treatment 163 
 
 Kanz, Schieinfeiber (1795) 17 
 
 Katzenback, Dr 28 
 
 Report of Epidemic at Bay 
 
 Head, New Jersey 286 
 
 Kentucky Blue Grass, for Cows' 
 
 Food 324 
 
 Kidneys, Journal of the A. M. A. 
 
 on Treatment of the 30 
 
 Kidneys, Excretion of the 234 
 
 Protection of 206 
 
 Free Action of 35 
 
 Microscopical Examination of. 323 
 Kimura, on Operation in Perfora- 
 tion 331 
 
 Klebs 224 
 
 Klein 224 
 
 Koch, Discovered the Bacillus Ty- 
 
 phosis 83, 224 
 
 Koch— Eberth Bacillus 235 
 
 Knaus, (1786) Morbis Biliosis Mu- 
 
 cosus 17 
 
 La grippe, Abortive Treatment for 
 
 Typhoid Fever in 72 
 
 Typhoid Fever Mistaken for 
 
 151, 152 
 
 Antiseptic Treatment for 218 
 
 Differential Diagnosis of 253 
 
 Lake City, Iowa, Epidemic at.... 197 
 Lancet Clinic of Cincinnati, Re- 
 port on Death Rates. 277 
 
 Report of Ricketts on Typhoid 
 
 Ulcer, etc 
 
 Langrish (1735) Lent Fever 16 
 
 Laryngeal Ulcer, Niemeyer on 317 
 
 Lassitude, Hutchinson on 12 
 
 Laveran, Exclusion of, hsematozoa, 
 
 of 169 
 
 Hasmatozoa, Sought for 223 
 
 Discovery of 242 
 
 Types of 243 
 
 " Diagnostic Value of 249 
 
 Law, Dr. G., Paper on Abortive 
 
 Treatment of Typhoid 192 
 
 Laxative Effect Important in Abor- 
 tive Treatment 292, 300 
 
 Professor L. D. Woodbridge 
 
 on 300 
 
 Leeds, England, Epidemic at 286 
 
 Liebermeister, Percentage of Re- 
 lapses. 328 
 
 Lemon Juice 324 
 
 Lent Fever, Strother (1729) 16 
 
 Lerminier (1823), FieVre Continue. 16 
 Lesions, of Typhoid Fever. ... 12 
 
INDEX. 
 
 
 Lesions, Hutchinson on 12 
 
 Harley on 12 
 
 Anatomical 14 
 
 Date of Appearance of 237 
 
 Leucocytes, Pigmented 249 
 
 Globules in 243 
 
 Leuret (1823), Dothienenterito, of. 18 
 
 Contagion Theory, of 290 
 
 Leeuwenhoeck on Living Germs in 
 
 Alvine Dejections 223 
 
 " Life of the Prince Consort," 
 
 Quotations from 261 
 
 Ligation in Intestinal haemorrhage 324 
 
 Linen, Disinfection of 284, 296 
 
 Linnseus, (1763) Febris Lenta 16 
 
 Little Fever, Manningham, (1746). 16 
 
 Liverpool, Death Rate in 278 
 
 Loch Katrine, Water Supply from. 282 
 
 London, Death Rate in 278 
 
 London Fever Hospital 251 
 
 Relapses in 328 
 
 Lorain, Ohio, Epidemic in 194 
 
 Long Continued Case of Typhoid 
 
 Fever, Report on 208 
 
 Louis (1829), Fievre Typhoide 15 
 
 on Rose Spots "....'...19, 228 
 
 on Headache 238 
 
 on Pulse 240 
 
 on Operation in Perforation.. 331 
 
 Low Fever, Many Writers 16, 260 
 
 Lucke, Report on Operation in Per- 
 foration 331 
 
 Lung, Microscopical Examination 
 
 of 22:? 
 
 Complications 
 
 Invasion of. ... :; 1 9 
 
 Lymphoid Cells 816 
 
 Magnesia 98 
 
 Liquid Citrite of 
 
 Sulphate 19 
 
 Mahomed, Death of Dr. Frederick 
 
 Mahoning County Medical Society, 
 
 Taught Abortive Treatment 
 
 in, in 1880 
 
 Paper on Typhoid Fever 106 
 
 Mahoning County Medical Soc: 
 Members of, Endorsed Report 
 
 inState Society 1*17 
 
 Malarial Fever, Diagnosis of . . . . 
 Confusion of, with Typhoid 
 
 Fever, Deprecated 
 
 Deaths from Typhoid Fever, 
 
 Reported as 
 
 Typhoid Fever, Mistaken foi . 
 Danger of Mistaking Typhoid 
 
 Fever for 
 
 Typhoid Fever Charts 
 
 taken for Charts of 
 
 Dissimilarity of Thermic Lines 
 of Typhoid Fever and Case^ 
 
 No Death from 
 
 Early Studies of 
 
 Microscopic Diagnosis of . . . . 
 Differential Diagnosis 01 
 
 Dr. G. Thin 
 
 Malarial Parasites, Laveran and 
 
 Other Discoverers on 
 
 Manchester, Water Supply of. . 
 
 Death Rate in 
 
 Mangetus, (1G9.'>) Tritaeophya 
 
 phodes 16 
 
 Mania.Differenti.il Di 
 Mannaberg, Verification 
 eran's Discovery I 
 Method of Staining Malarial 
 
 Parasites 
 
 Manningham (174 
 
 tie Fever, Nerv >a 1 1 ■■■ 
 
 1 on 
 the Spirits, V 16 
 
 Manzini. 1 
 
 March. Dr E, J 
 
 an'i 
 
 Mart:- '•• of 
 
 the Prli 
 Marseilles, V 
 
 ■' 
 Massillon.O • 1*1 
 
356 
 
 INDEX, 
 
 Maunsell (1836), Infantile Remit- 
 tent Fever 16 
 
 McCandless, Dr. Guy, Health Re- 
 ports of Pittsburg 278 
 
 on Deaths from Typhoid Fever 278 
 
 McCurdy, Dr. John 38, 55 
 
 Endorsement of Abortive 
 
 Treatment 160 
 
 Cases Seen by 38 
 
 McGarvey, Dr. J. F., Report of 
 
 Cases 191 
 
 McLeod, Dr 44 
 
 Remarks of 45 
 
 McWilliams, Dr., Report of Cases. 145 
 
 Meat Juice 324 
 
 Medical News, on the Brand 
 
 Method 314 
 
 Netschagaw on Operation and 
 
 Perforation 331 
 
 Medical Record, Report on Opera- 
 tion in Perforation 330 
 
 Medicaments, Great Variety of . . . . 85 
 
 Mild and Gentle 133 
 
 Medicinal and Antipyretics, Con- 
 demnation of 299 
 
 Megara, Water Supply in 280 
 
 Memphis City Hospital 196 
 
 Menthol, in Formula No. 1 302 
 
 in Formula No 2 303 
 
 in Formula No. 3 305 
 
 in Formula No. 4 321 
 
 in Formula No. 5 321 
 
 Mercurous Chloride, Mild, in 
 
 Formula No. 1 302 
 
 in Formula No. 2 303 
 
 in Formula No. 4 321 
 
 Mesenteric Glands, Hutchinson on 12 
 
 von Geitl 13 
 
 Tumefied, Specimen of 202 
 
 Mercurials, 111 Effects of 305 
 
 Metabolism in Children 316 
 
 Methylene Blue, Solution of, in 
 Chezynsky's Formula for 
 
 Dyes.. ., 245 
 
 Meteorism 233 
 
 Meyer, B 224 
 
 Meyers, Dr. H K., Report of 
 
 Cases 190 
 
 Microbic Diseases 148 
 
 Power of Antiseptic Medicine 
 
 Over 157 
 
 Application of Antiseptic Medi- 
 cine to, Case of 210, 218 
 
 Microbicide, Corrosive Sublimate 
 
 as a 299 
 
 Microorganisms 269 
 
 Micrococcus Pneumoniae Crou- 
 
 posae 335 
 
 Microscope 306 
 
 in Alvine Dejections, (1673), . . 223 
 
 Examinations of Stools 234 
 
 Valuable Aid in Diagnosis. . . . 235 
 Examination of Blood for ma- 
 larial Parasites 242 
 
 in Diagnosis of Malaria 245 
 
 in Diagnosis, by Dr. Thin. . . . 249 
 Examination of Sputa, of 
 Urine, of Buccal Cavity, of 
 
 Fasces 223 
 
 Necessary Outfit 244 
 
 Mikulicz, Operation on Perforation 331 
 Mild Typhoid Fever, Copland, 
 
 (1844) 15 
 
 Miliary Fever, Pringle, (1760), De 
 
 Haen, (1760) 18 
 
 Milan, Death Rate in 278 
 
 Miliary Tuberculosis, Differential 
 
 Diagnosis of 253 
 
 Milk 26 
 
 Contaminated 27, 86 
 
 Katzenbach's Report on 28 
 
 as a Nutriment 82 
 
 from Unhealthy Cows 266 
 
 Influence in Spreading Zymo- 
 tic Diseases 285 
 
 Boiling of 285, 286, 288 
 
 Peptonized 312 
 
 for the Babe 323 
 
 Alkaline , 324 
 
 Mills, (1813), Enteritic Fever... . 18 
 
 Mind 313 
 
 Mineral Water 191, 306 
 
INDEX. 
 
 > I 
 
 Mississippi Valley Medical Society 
 
 Paper Read at, 1893 29, 55 
 
 Discussion of Paper in 105, 200 
 
 Paper Read at, (1894), Hot 
 
 Springs, Arkansas 112 
 
 Paper Read at, (1895), Detroit, 
 
 Michigan 222 
 
 Mississippi Valley 41 
 
 Mitchell District Medical Society, 
 
 Paper Written for, (1895), 
 
 West Baden Mineral Springs 205 
 
 Moore, Dr. J. W., Quotation from 
 
 " Eruptive and Continued 
 
 Fevers" 277 
 
 Montclair, New Jersey, Epidemic 
 
 at 287 
 
 Morbus Biliosis-Mucosus, Knaus, 
 
 (1786) 17 
 
 Morphine. . m 329 
 
 Morton on Operation in Perforation 331 
 
 Moscow, Death Rate in 278 
 
 Muco Enteritis, Various Writers. . 18 
 Mucous Fever, Copland, (1844)... 17 
 
 Munich, Death Rate in 278 
 
 Munro, Dr., on Cost of Typhoid 
 
 Fever 275 
 
 Murchison, Definition of Typhoid 
 
 Fever 11 
 
 Nomenclature of Typhoid 
 
 Fever 15 
 
 Pythogenic Fever 18 
 
 Report of Lesions in Seven 
 
 Months' Foetus 23 
 
 on Incubation of Typhoid 
 
 Fever 26 
 
 on Typhoid Fever in Children 
 
 134, 310 
 
 Chart of Wunderlich 210 
 
 on Rose Spots 227, 228 
 
 on Haemorrhage 236 
 
 on Headache 238 
 
 on Pulse 210 
 
 on Contagion of Typhoid Fever 2!)0 
 Murphy, Professor, Denies the Pos- 
 sibility of Aborting Typhoid 
 Fever 108 
 
 Muscular Degeneration of the Heart 308 
 
 Naphtha 245 
 
 Nausea .21 
 
 Harley on 18 
 
 Necrosis 217 
 
 Nephritic Derangement 228 
 
 Nervenfieber, German Writers. ... ]>'•. 
 
 Nervous Complications 335 
 
 Nervous Fever, Gilchrist (1734). 
 
 Manningham (1740) 16 
 
 Nervous Sedative, Alcohol as a. . . . 300 
 Netschagaw, Report of Case of Op- 
 eration in Perforation I 
 
 Neven, Dr. J. K., Health Officer of 
 Ironwood, Endorsement of 
 
 Treatment 4 s 
 
 NewMilford, Connecticut, Epidem- 
 ic of Typhoid Fever at 
 
 New York Clinical Society, Katzen- 
 back's Report of Epidemic at 
 
 Bay Head to 
 
 New Theory 4* 
 
 New Sydenham Society 249 
 
 Niemeyer on Bronchial Catarrh. 
 Night Soil Fever, Brown (1856) . 18 
 
 Nitrate of Sodium 888 
 
 of Strychnia 
 
 Nitro-Glycerin 
 
 Nomenclature, from Murchison... 18 
 
 Nontoxic Germicides 
 
 Normal Temperaturr in RectDDO 
 
 Noxa? 
 
 North Dakota, Epidemic in. 
 North Jackson, Ohio, Epidemic h 
 Northern Michigan, 1 
 
 Nurses 
 
 from Royal Inf: 
 
 Scotland 
 
 Directions to 
 
 Importance of. 
 Sep 
 Nursing, Journal 
 
 Ochre Yrllow S *>on 
 
 on 
 
358 
 
 INDEX. 
 
 Ochre Yellow Stools, Harley on. . . 13 
 
 Occipital Headache . . 235 
 
 Oglesby, Dr. R. P., Report of 
 
 Epidemic at Leeds, England 286 
 Ohio State Medical Society . . .63, 105 
 
 Papers read at, 1894 91 
 
 Paper read at, Columbus, 1895. 149 
 
 Discussion in 107 
 
 Exhibition of Specimens in . . . 202 
 
 Oleum Eucalyptus. 311 
 
 Olive Oil 321 
 
 "On the Continued Fevers of Great 
 
 Britain, " Quotation froml2. . 15 
 Onset of Fever, Condition of Pa- 
 tient at, by Murchison 11 
 
 by Hutchinson 12 
 
 by Harley 13 
 
 Operation in Perforation 330 
 
 Ophthalmoscopic Examination of 
 
 the Eye 252 
 
 Opisthotonos in Children 318 
 
 Opium 98, 300, 311 
 
 Ortygia, Island of, Ancient Water 
 
 Supply in 280 
 
 Orphan Asylum, England, Epi- 
 demic in 25 
 
 Osier, Reports on Age in Typhoid . 24 
 on Incurability of Typhoid 
 
 Fever , 66, 104 
 
 on Mistakes in Diagnosis 74 
 
 on Rose Spots 229 
 
 on Typhoid Fever in Children. 134 
 
 on Temperature 230, 231 
 
 on Differential Diagnosis 262 
 
 on Cost of Typhoid Fever 275 
 
 on the Brand Method 313 
 
 on Relapses 328 
 
 Oysters as an Exciting Cause of 
 
 Typhoid Fever 26 
 
 Outbreaks of Typhoid Fever, Re- 
 ports of Mr. Ernest Hart. . . 266 
 Caused by Polluted Wells .... 268 
 *' Sewage Contamin- 
 ated Rivers 267 
 
 Caused by Water Services 
 from Manured Fields 270 
 
 Outbreaks of Typhoid Fever, 
 
 Caused by Sewage of Villages. 270 
 Pollution of Water- 
 gathering Grounds 270 
 
 Caused by Careless Laying of 
 
 Watermains 270 
 
 Caused by Contaminated Milk. 86 
 
 ". Paludism, " by Laveran , 243 
 
 Palustral Blood 243 
 
 Papular Rash 147 
 
 Paraffin 246 
 
 Paralysis 308 
 
 " Parasites of Malaria," by Mar- 
 
 chiafava and Bignmi 243 
 
 in Palustral Blood 243 
 
 Paris, Water supply of 282 
 
 Death Rate, in 278 
 
 Parke Davis and Company 132 
 
 Paroxysms of Malaria 244 
 
 Pathological Changes in Typhoid 
 
 Fever 14 
 
 Patient, Care of 296 
 
 Pennsylvania Hospital, Reports of 
 
 Health 315 
 
 Pepper's " System of Medicine". . . 134 
 
 on Temperature. 230 
 
 on Diagnosis 258, 263 
 
 Peptonized Milk, 312 
 
 Pfieffer, on Pathogenesis of the 
 Pettenkofer, on Oscillations in 
 
 Water in Wells 289 
 
 Bacillus Typhosis 
 
 Perforation 14, 217 
 
 Report of Death from 256 
 
 Cause of Death. 257 
 
 Danger to be Avoided 307 
 
 Danger of 312 
 
 to Minimize the Danger of . . . . 181 
 
 Danger from Peristalsis 320 
 
 Treatment of 329 
 
 Ricketts on 320 
 
 Operations in 331 
 
 Period of Incubation '. 26 
 
 Peristalsis Intestinal 320 
 
 Peritonitis 14, 257 
 
INDEX. 
 
 
 Pernicious Malarial Fever, with 
 
 Coma 
 
 Peroxide of hydrogen 
 
 Perspiration, Microsc o p i c a 1 Ex- 
 amination of 
 
 Petit (1813), Fievre entero-mesen- 
 
 terique 
 
 Peyer's Glands.. 14, 217, 306, 313 
 Date of appearance of lesions 
 
 Lesions in infants 
 
 Cicatrizing Ulcers of, Evidence 
 of Effect of Abortive Treat- 
 ment 152, 153, 154, 155 
 
 Colored Plate of Cicatrizing 
 Ulcers of, No.l, facing page 
 
 Lesions of 
 
 Condition of, in Hypothetical 
 
 cases 300, 
 
 Ulceration and Perforation of 
 Elevation of Temperature Ac- 
 credited to Ulceration of . . , 
 
 Sloughs of, in Stools 
 
 Early Ulceration of 236, 
 
 Reported Death from Perfo- 
 ration 
 
 Danger of Perforation of, in 
 
 Mild Cases 
 
 Grave Lesions of, infrequent 
 
 in Children 
 
 Cicatrizing Ulcers Exhibited 
 
 Diet in, Ulceration of 
 
 Case of Perforation of Ulcer 
 
 of, Reported 
 
 Pharmaceutical Era, Dr. V. C. 
 Vaughn, on Typhoid Fever 
 
 in the United States 
 
 Philadelphia, Death Rate in. .277, 
 
 German Hospital Reports 
 
 Phosphates, Triple in Stools 
 
 Phthisis Pulmonaris, Acute, Dif- 
 ferential Diagnosis of 
 
 Picric Acid 
 
 Pigment Globules in Leucocytes. . 
 
 Pinel (1798), Fievre ataxique pro 
 
 parte, Fievre adena menin- 
 
 gee 
 
 249 
 330 
 
 223 
 
 18 
 329 
 237 
 
 61 
 
 5, 159 
 
 152 
 14 
 
 313 
 
 329 
 
 158 
 234 
 205 
 
 25G 
 
 257 
 
 316 
 202 
 323 
 
 183 
 
 101 
 
 27!) 
 311 
 234 
 
 217 
 
 16 
 
 Piorry(1841) Entente Septicemique 
 
 Pittsburg, Death Rate in 
 
 Cases of Typhoid Fever in. . . 
 Pittsburg Dispatch, Report of 
 
 Health Returns 
 
 Pituitous Fever, Copland (1814).. 
 
 Plasmodia Malariae, stain for 
 
 Plaster, Adhesive 
 
 Plymouth, Penn., Epidemic of Ty- 
 phoid at 
 
 Pneumonia, Initial Treatment, 
 
 Abortive 
 
 Differential Diagnosis of. . 137, 
 
 Reported Death from 
 
 Antiseptic Treatment of 
 
 Complicating Typhoid 
 
 Treated as Typhoid 
 
 Treatment of 
 
 Dr. Dickson's Case of 
 
 Pneumo-typhus, Case of 
 
 Dr. Dodge's Case 
 
 Differential Diagnosis of 
 
 Treatment of 
 
 Podophyllum Resin, in Formula 
 
 No. 1 
 
 in Formula No. 2 
 
 in Formula No. 4 
 
 Poisonous Effluvia, as a IV 
 posing Cause of Ty; 
 
 Fever 
 
 Portugal, Death of King of . . 
 
 Post-Mortems 
 
 by Osier 
 
 by Dr. Dodge 
 
 Revealing Cicatri/i: 
 Aborted 
 Potash, Chlor it< 
 
 l'otass acetate 
 
 Poultice, in Peri 
 Powell and 1- 
 
 for M 
 Pragu<\ I 
 
 I 
 
 ■nancy, Compli- 
 
 t 
 
 16 
 278 
 271 
 
 878 
 
 17 
 845 
 
 311 
 
 889 
 131 
 
 151 
 
 218 
 307 
 300 
 308 
 
 115 
 
 BOfl 
 
 
3G0 
 
 INDEX. 
 
 Presbyterian Hospital, Health Re- 
 ports of 315 
 
 Prescriptions, Formula No. 1 302 
 
 Formula No. 2 303 
 
 Formula No. 3 305 
 
 Formula No. 4 321 
 
 Formula No. 5 321 
 
 Diuretic 300 
 
 Prestwich, Professor, on Drainage 
 
 from Graveyards. ... 289 
 
 Previous attacks of Typhoid, Im- 
 munity given by 25 
 
 Priestly, Dr 289 
 
 Prince Consort, Report of Illness 
 
 and Death of the 258 
 
 "Principles and Practice," Osier's 
 
 Quotation from 234 
 
 Pringle (1750), Bilious Fever, Mili- 
 ary Fever 17 
 
 Privies, Outside, Condemnation of 268 
 Prodromata of Typhoid Fever. . . . 187 
 
 Prognosis 264 
 
 Prophylaxis 266 
 
 Prostration of Patient During Ty- 
 phoid, Murchison on 11 
 
 Hutchinson on 12 
 
 Pseudo-pneumonia, Differential Di- 
 agnosis of 308 
 
 Ptomaines 14 
 
 of Bacteria , 292 
 
 Public Health, Department of 274, 283 
 
 Secretary of 274, 283 
 
 Puerperal Fever, Differential Diag- 
 nosis of 252 
 
 Pulmonary Complications, Harley 
 
 on 13 
 
 Pulmonary Artery 309 
 
 Pulmonary Phthisis, Journal of the 
 American Medical Associa- 
 tion on 29 
 
 Pulse, in Murchison's Definition of 
 
 Typhoid Fever 11, 240 
 
 in Hutchinson's 12 
 
 Louis on 240 
 
 Good During Antiseptic Treat- 
 ment 213 
 
 Pulse, as an Aid to Early Diagnosis, 239 
 Period of Greatest Accelera- 
 tion 255 
 
 Range in Hypothetical Case. . 256 
 
 Period of Greatest Weakness. 257 
 
 Dicrotic 309 
 
 Frequency in Children , 313 
 
 in Relapse 325 
 
 Pupils, Dilated, Murchison on. . . . 11 
 
 Pus, in Perforation 330 
 
 Pyaemia, Differential Diagnosis of . 252 
 
 Pyogenic Surface 15 
 
 Condition of 154 
 
 Pyrexia 311 
 
 Harley on 13 
 
 Pythogenic Fever, Murchison 
 
 (1858) 18 
 
 Quartan Ague 244, 248 
 
 Quesnay (1753), Febris Stercoralis 17 
 
 Quinine 89, 151, 164, 184 
 
 as Destructive of Haematozoa 
 
 Malarise 219 
 
 in Malarial Fever 225 
 
 as a Tonic .299, 311 
 
 Quotidian Ague 244 
 
 Rales in Reported Case of Pneu- 
 monia 163 
 
 Recklinhauser 224 
 
 Record, Clinical 297 
 
 Rectum, Normal Temperature in. . 232 
 Reed, Dr. T. F., Report of Cases. 164 
 
 Cases Aborted 220 
 
 Registrar of Pittsburg, Reports of. 278 
 
 Relapses 325 
 
 Hutchinson on 12 
 
 Report of Cases of 59, 78, 326 
 
 Murchison on 12 
 
 Percentage of, in the Child. . . 328 
 in the London fever Hospital. 328 
 
 in Johns Hopkins 328 
 
 of Hutchinson 328 
 
 of the German Observers, Lei- 
 bermiester in Basle, Ger- 
 hart, Baumler and Biermer. 328 
 
INDEX. 
 
 361 
 
 Relapses, Dr. Udell's relapse 188 
 
 Dr. Sherman on , . 191 
 
 Dr. Burt on 199 
 
 Remedies, antiseptic, condemnation 
 
 of , 39 
 
 in modified form 191 
 
 Remittent fever 248 
 
 T. Sutton (1806) 16 
 
 Renal Complications 235, 306 
 
 Pathology of 262 
 
 Renfrew, England, epidemic in... 275 
 
 Reports of Cases of Typhoid Fever 
 treated by Woodbridge Meth- 
 od in Youngstown .... 35, 49, 
 54, 76, 77, 88, 113, 138, 196, 208 
 
 in Ironwood, Michigan 44 
 
 in Trumbull County. 96 
 
 in Sewickley, Penn 151 
 
 by Dr. Cunningham 151 
 
 by Dr. Reed.. 164 
 
 by Dr. Justice 162 
 
 by Dr. Dickson 164 
 
 by Dr. March 166 
 
 by Dr. Dodge 183 
 
 by Dr. Udell 185 
 
 by Dr. Chritzman 188 
 
 by Dr. Balmer 190 
 
 by Dr. Sherman 191 
 
 by Dr. Law... 192 
 
 by Dr. McGarvey 194 
 
 by Dr. Yost 195 
 
 by Dr. Shields 195 
 
 by Dr. Burt 197 
 
 Report of deaths 182 
 
 by Murchison, Stoll and Bou- 
 
 det 286 
 
 my last 138 
 
 Report of Long Continued Case 208 
 
 unusually High Temperature. . 230 
 
 Respirations 240 
 
 Respiratory organs, Niemeyeron.. 317 
 
 Rest in typhoid, Journal of the A. 
 
 M. A. on 30, 31 
 
 Essential and when 307, 312 
 
 in Inflammation 
 
 in Pregnancy 334 
 
 Retching ?1 
 
 Reynolds' "System of Medicine," 
 Quotation on Typhoid in 
 
 Children 130 
 
 Rhagades 317 
 
 Rheumatism, High Temperature 
 
 in 
 
 Rice, Infusion of 
 
 Richie (1846), Enteric Fever . . .18 
 Ricketts, Dr. Merrill, on Typhoid 
 
 Ulcer and Perforation 330 
 
 Richter (1813), Gastrisches Fie- 
 
 ber 17 
 
 Riedel (1748) Febris Intestinalis 
 
 vel Mesenterica 17 
 
 Rigors, Murchison on 11 
 
 Hutchinson on 12 
 
 Ring Cushion 311 
 
 Riverius (1623), Febris Putrida, 
 
 Febris Biliosa 16 
 
 Rivers, Pollution of '-• 
 
 Contaminated 
 
 Pure Water in. B71 
 
 Roast Beef 
 
 Roman Syndic, Laws of 
 
 Rome, Ancient Water Supply ci 
 
 Protection of Milk in 
 
 Death Rate in 
 
 Rose Shaped Bodies in Palustral 
 
 Blood 
 
 Rose Spots 
 
 Co-existence ol 
 
 Scarlatina with. . . . 
 Pathognomonic 
 
 Osier on 
 
 Murchison on Lfl 
 
 Surgeon General u.iur.'- 
 Huti binaoo on .... 
 
 Louis on 
 
 Harley i 
 in Childi 
 in I. 
 
 Cot 
 
362 
 
 INDEX, 
 
 Rose Spots, Diagnostic Value of. . 251 
 
 Rotterdam, Death Rate in 278 
 
 Routine Treatment of Typhoid, 
 
 Journal of A. M. A. on 30 
 
 Rubeola 300, 316 
 
 Rural Districts, Disposal of filth in 267 
 
 Typhoid the Bane of 275 
 
 Danger of Polluting Water of 284 
 Rutty, (1790) Bilious Fever 17 
 
 Saint Louis Hospital 200 
 
 Saint Petersburg, Death Rate in. . 278 
 Saline Cathartics, Condemnation of 210 
 
 Advised 306 
 
 Saline Infusion, in Vein in Perfo- 
 ration 330 
 
 Sandhurst .... 260 
 
 Sanitary Authorities 272 
 
 Sanitary Era, on Epidemics of Ty- 
 phoid Fever 287 
 
 Sanitary Science, Importance of. . 283 
 Sarcone (1765) Febris Glutinosa 
 
 Gastrica 17 
 
 Sauvages (1760) Typhus Nervosa, 
 Typhus Hysterica Vermino- 
 
 sus 15, 18 
 
 Scarlatina 148, 218, 290, 300 
 
 Differential Diagnosis of 250 
 
 Complicating Typhoid 316 
 
 Schleimfieber, Kanz (1795) 17 
 
 Schonlein (1839) Typhus Gangliar- 
 
 is vel Entericus 15 
 
 Scotland, Typhoid Fever in 277 
 
 Secretary of Public Health; 274 
 
 Sedative, Nervous, Alcohol as a. . . 300 
 Segmented Bodies in Palustral 
 
 Blood 243 
 
 Seine, River 282 
 
 Selle (1770), Febris Atacta Pro 
 
 Parte 16 
 
 Febris Biliosa Putrida 17 
 
 Febris Nervosa Febris Ver- 
 
 minosa 18 
 
 Selinus, Water Supply of 280 
 
 Semmola, Quotation from 3 
 
 Senn, on Operation in Perforation 331 
 
 Sepimia, Hare (1853) 16 
 
 Sequelae, of Typhoid Fever 14, 329 
 
 Dangerous 241 
 
 Serres (1813), Fievre Entero-mes- 
 
 enterique 
 
 Sero-therapy 259 
 
 Sewage as Cow's Food 266 
 
 Sewers 25, 272 
 
 in Washington 269 
 
 in Vienna 272 
 
 Sherman, Dr. W. N., Report of 
 
 cases : 191 
 
 Shields, Dr. W. B., Report of 
 
 Cases 195 
 
 Sick Room, Proper Condition of. . 295 
 
 Sinapism 303, 318 
 
 Skin, Murchison on Condition of. . 11 
 
 Condition 256 
 
 Care of 296 
 
 Application of Guaiacol to 322 
 
 Sleep, Natural During Abortive 
 
 Treatment 213 
 
 of Health 217 
 
 Frequent Dosage not Destruc- 
 tive of 302, 304 
 
 Slow Fever, Strother (1729), Lang- 
 
 rish (1735) 16 
 
 Slow Nervous Fever, Huxham 
 
 (1739) 16 
 
 Smallpox, Less to be Dreaded than 
 
 Typhoid Fever 101 
 
 Amenable to Antiseptic Treat- 
 ment 218 
 
 Smith, Greig, on Operation in Per- 
 foration 331 
 
 Smith. Southwood (1830), Syno- 
 chus and Typhus with Ab- 
 dominal Affection. 15 
 
 Sodium Nitrate 235 
 
 Soil, Natural Habitat of Typhoid 
 
 Bacillus 267 
 
 Sokolof 224 
 
 Solid Food.35, 70, 95, 174, 189, 197, 313 
 Solitary Glands of Peyer, Harley 
 
 on 12 
 
 Tumefaction of 14 
 
INDEX. 
 
 363 
 
 Solutions, Disinfectant, 
 
 of Eosin 
 
 of Methylene Blue 
 
 Chlorate of Potash, Saturated. 
 Somerville, Mass., Epidemic of 
 
 Typhoid in 
 
 Sordes, a Symptom of Typhoid. . . 
 240, 
 
 in Children 
 
 Specific Infection 
 
 Spherical Bodies in Palustral 
 
 Blood 
 
 Spigelius, (1624) Febris Semi-terti- 
 
 ana Seu Composita 
 
 Spleen, Dullness Over 75, 
 
 Murchison on 
 
 Hutchinson on 
 
 Enlargement of 
 
 Enlarged 
 
 Invasion of the, by Haematozoa 
 Malarias 
 
 Enlargement of, a Diagnostic 
 Sign.. 
 
 Dullness in Typical Case 
 
 Tumefaction of 
 
 Spiritus Nitri Dulcis 
 
 SpiritusTerebinthinae 
 
 Sponging 71, 104, 
 
 Journal of the A. M. A. on. . . 
 
 in ordinary Cases 
 
 Directions to Nurses, in Re- 
 gard to 
 
 in Children 
 
 Springfield, Mass., Epidemic of 
 
 Typhoid at 
 
 Sputa, Microscopical Examination 
 
 of 
 
 Stahl (1700) Febris Biliosa 
 
 Stamford, Conn., Epidemic at 
 
 Sternberg 
 
 Stewart (1840) Typhoid Fever.... 
 
 Stewart, Dr. H. T 
 
 Stimulants 
 
 Stockholm, Death Rate in 
 
 Stoll (1785) Febris Pituitosa 
 
 284 
 245 
 245 
 308 
 
 287 
 
 257 
 317 
 178 
 
 243 
 
 16 
 88 
 11 
 12 
 99 
 217 
 
 219 
 
 234 
 257 
 316 
 306 
 311 
 296 
 31 
 95 
 
 311 
 322 
 
 287 
 
 223 
 
 17 
 278 
 2 'J I 
 
 15 
 
 117 
 B08 
 
 17 
 
 Stoll, on Haemorrhage and Ulcera- 
 tion 
 
 Stomach, Journal of the A. M. A. 
 on Treatment of, during Ty- 
 phoid Fever 31 
 
 Free Action of 
 
 Stools, Alkaline 884 
 
 Condition of, Value as a Symp- 
 tom 234 
 
 Microscopical Examination i : 
 
 Disinfection of 
 
 Loss of Offensive Odor 
 
 Ochre Yellow, of Hutchin- 
 son 13, 834 
 
 Strack (1789) Febris Pituitosa ... . 17 
 Strength Impaired by Typhoid 
 
 Fever 
 
 Journal of the A. M. A. on . . . 80 
 
 Strother (1729) Slow Fever lfl 
 
 Strychnine, in Flagging Heart. 
 
 in Perforation 
 
 in Haemorrhage 
 
 Stupor, Murchison on, 11 
 
 Hutchinson on 12 
 
 Styrian Alps, water of 
 
 Sudamina 1 W 
 
 Sulphanilic Acid 
 
 Sulphate of Magnesia 191 
 
 Sulphites 210 
 
 Sunstroke, Differential : 
 Surgery, in Perforation. ... 
 Sutherland, Mr., on Cosl ol 
 
 phoid Fiver in Great Brit- 
 ain 
 
 on Cost of Typhoid 
 
 Scotland 
 
 on Death Rate In E 
 ;:. Bland, 
 
 ■ 
 Sutton T ' : W 
 
 lfl 
 
 Fevc; 
 Symptomatology 7() . *** 
 
364 
 
 INDEX. 
 
 Symptomatology, Rose spots, 61, 
 75, 88, 99, 227, 228, 229, 250, 
 
 251, 256, 276, 319 325 
 
 Temperature, 12, 30, 35, 70, 
 
 129, 148, 158, 198, 201, 211, 
 
 213, 214, 217, 229, 230, 231, 
 
 232, 246, 255, 256, 298, 299, 
 
 310, 319, 320, 322, 325. 
 
 Meteorism 233 
 
 Tympanites 
 
 11, 13, 65, 213, 217, 233, 256, 316 
 Abnormal Tenderness or Pain 
 
 11, 12, 232, 233, 256 
 
 Gurgling 11, 233, 256 
 
 Enlargement of Spleen 
 
 99, 217, 234 
 
 Diarrhoea 213, 
 
 234, 256, 257, 300, 304, 311, 321 
 
 Urine 234, 256, 283, 306 
 
 Renal Complications 235, 306 
 
 Intestinal Haemorrhage 
 
 ...66, 76, 130, 140, 181, 198, 
 
 217, 235, 307, 312, 318, 320, 332 
 
 Headache 238, 256, 318 
 
 Vertigo 238 
 
 Chilliness 11, 12 
 
 Epistaxis 238, 318 
 
 Pulse 213, 
 
 239, 255, 256, 257, 309, 318, 325 
 
 Respirations 240 
 
 Heart 240, 307, 308, 311 
 
 Vomiting... 240, 256, 303, 318, 335 
 
 Nausea 235, 240 
 
 Retching 240 
 
 Hebetude 241 
 
 Delirium 
 
 213, 217, 241, 256, 257, 318 
 
 Peyer's Glands, Lesions of. . . 
 14, 154. 155, 
 
 156, 158, 202, 217, 236, 237, 
 
 256, 257, 265. 306, 313, 323, 329 
 
 Sloughs from 234 
 
 Opisthotonos 318 
 
 Symptoms of Typhoid Fever, by 
 
 Murchison ... 11 
 
 by Hutchinson 12 
 
 Symptoms of Typhoid Fever, 
 
 by Harley 13 
 
 Control of 35 
 
 Synochus, Southwood Smith (1830) 15 
 
 Biliosus. Sauvages (1760) 17 
 
 Pro parte, Cullen (1796) 15 
 
 Synonyms of Typhoid Fever, by 
 
 Murchison 15 
 
 Synopsis, of Cases. . .204, 207, 230, 325 
 
 "System of Medicine," by Rey- 
 nolds 134 
 
 by Pepper 134 
 
 Tablets Formula No. 1 302 
 
 Formula No. 2 303 
 
 Formula No. 4, (for Children). 321 
 Directions for Administration 
 
 of 302, 303, 
 
 304, 305, 307, 310, 313, 320, 321 
 
 Wyeth's Bronchitis 89 
 
 Taches, Roses Lenticulaires of 
 
 Louis 227 
 
 Taylor on Operation in Perforation 331 
 Teething, Differential Diagnosis of 137 
 
 Temperature 35, 129, 210, 298, 299 
 
 Typical, Chart of Wunderlich 217 
 
 of Sick Room 319 
 
 not a Measure of Danger 70 
 
 Case with High, Treated as a 
 
 Case of Indigestion 148 
 
 Ulceration of Peyer's Glands 
 
 not a Cause of Elevation of. 158 
 High, in Cases Reported by 
 
 Dr. Burt ~ 198 
 
 Typical, in Cases Reported by 
 
 Dr. Dalton... 201 
 
 Report of Case of Unusually 
 
 High 211 
 
 Lower During Abortive Treat- 
 ment 213 
 
 in Diagnosis 229 
 
 in Rectum 232 
 
 Slight Elevation, a Symptom 
 
 of Typhoid 255 
 
 Exacerbation of 256 
 
 in Children 322 
 
INDEX. 
 
 365 
 
 Temperature, Journal of the A. M. 
 
 A., on 30 
 
 Osier on 230, 231 
 
 Hutchinson on 12 
 
 in Relapse 325 
 
 of Bath 320 
 
 of Disinfecting Solution 319 
 
 of Incubator 246 
 
 After Application of Guaiacol. . 322 
 
 in Children 133 
 
 Terebinthinae Spiritus 311 
 
 Tertian Ague 244, 248 
 
 Test, Diazo, of Ehrlich 235 
 
 Therapeutic Agents 299 
 
 The Hague, Death Rate in 278 
 
 Theory of Typhoid Fever 188 
 
 Thermometer, Clinical 229 
 
 Thin, Dr. George, Quotations from 
 
 Article in London Lancet. . . 249 
 on Dye for Staining Parasites 
 
 of Malaria 245 
 
 on Microscopical Examination 
 
 of Palustral Blood 247 
 
 on the Microscope in Diagnosis 249 
 
 Thomas, Dr. J. J 51 
 
 Thoracic Region 311 
 
 Thrombosis, Venous, Treatment of 309 
 
 Thymol, in Formula No. 2 303 
 
 in Formula No. 3 305 
 
 in Formula No. 5 321 
 
 Tissot, (1758), Febris Putrida aut 
 
 biliosa 16 
 
 Toast Water 324 
 
 Tongue, Parched 217 
 
 Murchison on 1 1 
 
 in Diagnosis 240 
 
 Condition of, as a Symptom. . . 256 
 
 Condition of 257 
 
 in Infants 318 
 
 Towns, Sanitation in 268, 272 
 
 Toxaemia in Hypothetical Case 312 
 
 Tox-albumen 292 
 
 Toxicologists 218 
 
 Toxins 14, 292 
 
 Tralliani, A. (1785), Febris a Putri- 
 
 dine Orta. Typhus Hyster- 
 
 ico Verminosus 
 
 Treatment of Typhoid Fever, Mod- 
 ifying Effect of . . . . 
 
 Typhoid Amenable to 
 
 Unscientific 
 
 Action of Antiseptics in 
 
 Abortive 114, 12fl 
 
 in all Stages of Typhoid 
 
 Antiseptic 
 
 Under Mistaken Diagnosis. . . . 
 
 Abortive, Endorsement of, 
 vidi Abortive 
 
 Salines in 
 
 in Hospital Wards with Other 
 Diseases 
 
 Efficacious 
 
 of Typhoid in Children. . .810, 
 
 in Relapses 
 
 Complicated with Pregnancy. . 
 
 Trieste, Death Rate in 
 
 Tritaeophyas, Auctor Antiq. Y.tr. . 
 Tritaeophya Typhodes, Mangetus 
 
 (1695) 
 
 Tubercle of the Choroid 
 
 Tubercular Meningitis, Dii! 
 
 tial Diagnosis of 
 
 Tubercular, Differential Diag- 
 nosis of 
 
 Miliary 
 
 Microscopical Examination in 
 Tumefaction of the Glands 
 
 of the Spleen 
 
 Tumefied Mesenteric 
 
 Turin, Death Kate in 
 
 Turpentine 191 
 
 Emulsion of 
 
 Tympanites, M 
 
 Harley on 
 
 A Diagnostic Sign . 
 
 Minified bj PtU 
 
 Treatment 
 
 in Hypothetic el Case ■ . 
 in Cnildi 
 Typhi:., Parr, (U 
 
 16 
 
 184 
 
 81 
 
 104 
 
 110 
 
 131 
 1 82 
 
 136 
 
 211 
 298 
 Blfl 
 
 16 
 
 IN 
 
 1 1 
 
 11 
 
366 
 
 INDEX. 
 
 Typhoid Fever 11 
 
 Stewart, (1840), Bartlett, 
 
 (1842), Jenner (1849) 15 
 
 Typhoid Fever, Insidiousness of 
 
 Attack 241 
 
 Typhoid State 250 
 
 Typhoid Ulcer 330 
 
 Typho Toxin 292 
 
 Isolated by Brieger 324 
 
 Typho-malarial Fever 72, 99 
 
 Woodward (1863) 20 
 
 Condemnation of Application 
 of Designation to Typhoid. . 66 
 
 Dr. Eliot, on 73 
 
 Typhus 15 
 
 Differential Diagnosis 249 
 
 Isolated 290 
 
 Spots of, contrasted with Rose 
 
 Spots 250 
 
 Typhus Gangliaris, vel Entericus 
 
 Ebel (1836), Schonlein (1839) 15 
 Typhus Mitior, Cullen (1769) 15 
 
 Udell Dr., Reports of Cases. . .124, 145 
 
 Communication from 185 
 
 Ulcer „ 236 
 
 Typhoid, Rickets on 330 
 
 Murchison on 226 
 
 United States, Health Departments 
 
 of Cities in 41 
 
 Death Rate in 101, 114 
 
 Benefit of Abortive Treatment 
 
 to 200 
 
 Report to House of Representa- 
 tives of 269 
 
 Need of Bureau of Public 
 
 Health in 274 
 
 Demand for Secretary of Public 
 
 Health in 274 
 
 Urine, Microscopical Examination 
 
 of 223 
 
 in Diagnosis 234 
 
 Scanty 256 
 
 Disinfection of 283 
 
 Dilution of 306 
 
 Hy pertoxic 234 
 
 Van Hook, on Operation in Per- 
 foration 330 
 
 Report of Case 331 
 
 Vapours, Manningham (1746) 16 
 
 Varieties of Typhoid Fever 319 
 
 Variola 72 
 
 Differential Diagnosis of 253 
 
 Vaughn, Dr. Victor C, Estimate of 
 Loss to the United States, from 
 
 Typhoid Fever 201 
 
 Vegetable Cathartics, use of, Con- 
 demned by Harley 210 
 
 Venice, Death Rate in 278 
 
 Venous Thrombosis, Treatment of, 309 
 
 Vertigo, in Diagnosis 238 
 
 Via Appia 280 
 
 Victoria, Queen, Diary of 259, 260 
 
 Vienna, Death Rate in 278 
 
 Water Supply of 269 
 
 Virchow 203 
 
 Virus, Waterborne 25 
 
 Viscera, Abdominal 295 
 
 Vogel, (1764) Febris Lenta 16 
 
 Vomit, Disinfection of 283 
 
 Vomiting, in Diagnosis 240 
 
 in Hypothetical Case 256 
 
 Treatmeut of 303 
 
 in Children 318 
 
 Harley on 13 
 
 Von Gietl, Definition of Typhoid. . 13 
 Vyrnwy River, Water Supply 
 
 from 282 
 
 Wales, Prince of, Illness of 261 
 
 Wampum, Penn., Epidemic of Ty- 
 phoid at 36 
 
 Ware, Dr. John D 41, 42, 43 
 
 Washington, Infected Wells of 269 
 
 Water, Impure, Tolerance of . ... 23 
 
 Contaminated 24 
 
 Boiling of '. . . . 25 
 
 Journal of A. M. A. on 31 
 
 Nonpotable, Effect of 86 
 
 as a Therapeutic Agent 104 
 
 as a Cause of Outbreaks of Ty- 
 phoid Fever 266 
 
INDEX. 
 
 
 Water as a Disinfectant 
 
 Pollution of 288, 
 
 Warm Salt 
 
 Administration of 
 
 Large Draughts of 
 
 Cooling Effect of 
 
 Distilled 235, 245,247, 
 
 Mineral 191, 303, 
 
 Charged With Carbonic Acid 
 Gas..... 
 
 for Children 
 
 Sterilized 
 
 Lime 
 
 Toast 
 
 Diuretic Mineral 
 
 Bed , 
 
 "Water Borne Typhoid," by Mr. 
 Ernest Hart, Report on. . . . 
 
 24, 26,266, 
 
 Water Borne Virus 
 
 Waterbury, Conn., Epidemic of 
 
 Typhoid at 
 
 Watertown, New York, Epidemic 
 
 of Typhoid at 
 
 Water Supply 
 
 In the District of Columbia, 
 
 in Vienna 269, 
 
 in Magara 
 
 in the Island of Cos 
 
 in Athens 
 
 in Selinus, Sicily 
 
 in Syracuse, Sicily 
 
 on the Island of Ortygia 
 
 in Rome 
 
 in Marseilles 
 
 in Bengal, India 
 
 in Manchester 
 
 in Glasgow 
 
 in Liverpool. 
 
 in Paris 
 
 Watson, Sir Thomas, Report of 
 
 Case 
 
 Well Water 
 
 Pollution of 
 
 Mr. Ernest Hart on 
 
 2S4 
 291 
 330 
 296 
 302 
 299 
 303 
 306 
 
 303 
 321 
 303 
 328 
 324 
 303 
 311 
 
 270 
 25 
 
 289 
 
 289 
 
 27 
 269 
 282 
 280 
 280 
 280 
 280 
 280 
 280 
 280 
 2S2 
 282 
 
 382 
 
 2G1 
 
 268 
 
 270 
 
 Well Water, Infected, Typhoid 
 
 Propagated by 
 
 Pollution of Milk by 387 
 
 Oscillation of 
 
 Welphy, Dr., "Creameries and In- 
 fectious Diseases, " Quotation 
 from 286 
 
 Wendt (1812), Febris Mesaraica.. . 18 
 
 West Baden Mineral Springs, Meet- 
 ing of Mitchell District Med- 
 ical Society at 
 
 West Branch Medical Society, 
 
 Cases Reported at 190 
 
 Whiskey 183 
 
 Whitesfield, Epidemic of Typhoid 
 at 
 
 Whooping Cough Complicating Ty- 
 phoid Fever 14o 
 
 Wickham, Dr., Diagnosis made by 36 
 
 Willis, (1659) Febris Lenta, Febris 
 Putrida Quae Vulgo Lenta 
 Appellatur, Febris Hectica 
 16, IS 
 
 Wilson, on Treatment of Typhoid 
 
 Fever 
 
 on Brand Method 81! 
 
 Report of Cases 
 
 on Bronchial Catarrh -17 
 
 Winnifrede, West Virginia, B 
 
 demic of Typhoid at 
 
 Wintringham, | [1 1 I 'utri- 
 
 da Nervosa 16 
 
 Wood (1848), Enteric Fever 18 
 
 Woodbridge, Profess r, L D 
 
 La 
 
 on Bronchial Catarrh 'Ml 
 
 Woodbridge, Dr. Til 
 
 
 
 on M.ili: 
 Iward, Snt 
 
 20 
 Worms, Typhoi 
 
 ly I 
 Won:: "M* 
 
 Writeri 
 
368 
 
 INDEX. 
 
 Wunderlich 232 
 
 Chart of 216 
 
 Reference to Chart 229, 284 
 
 Wyeth's Bronchitis Tablets 89 
 
 Xylol 248 
 
 Youngstown 107 
 
 Health Reports of 73 
 
 Youngstown, Cases of Typhoid Fev- 
 er Treated in, vide reports 
 
 Yost, Dr. J. O., Report of Cases. . 
 
 126, 294 
 
 Zincum Chloridum 284 
 
 Zymotic Affections, Treatment of . 219 
 Zymotic Diseases, Antiseptic Treat- 
 ment of 221 
 
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