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the houses which publish them. The journals may bear not the name
nor the address of the houses which publish them, but even a ficti-
tious name of some editor, and give as an address some small by-street.
It is the duty of the busy practitioner to cull out and ascertain what is
good when such a condition of affairs prevails. And I would recom-
mend that we put our seal of disapproval upon such journals by return-
ing them, and informing such houses that we can not afford such liter-
ature.

As to opium. It seems that some make bold to sell opium or mor-
phine while they refuse the patient alcohol with which to rub himself
without a prescription. In Louisville it is impossible for a patient to

* Meeting held in Louisville, May 17, 18, and 19, 1S99.



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The American Practitioner and News. 183

get five cents' worth of alcohol, but any child can go into a drug store
and purchase ten cents' worth of morphine tablets, which may be taken
with suicidal intent.

Dr. Early, Paducah : There is one point that I would like to empha-
size. Being the son of a minister, and having been associated with
ministers of the gospel, I feel like saying one thing for them and one
thing about them. They are the most susceptible men on the face of
the earth for imposition.

One reason why the country physician and the general practitioner
do not send for the specialist is because they are afraid the specialist
may be wanting to make a reputation, and will cut when there is no
need of it. If the specialists were always more conscientious than we
think they are, possibly we would send for them more often than we do.

Dr. Doherty, in closing: The paper was not intended to hurt the
feelings of any honest physician, but only to show the great evils that
now exist, and to emphasize the fact that indiscriminate drugging and
treating the disease without treating the patient should be abandoned
as much as it is possible to do so.

"Traumatic Tetanus," by Dr. John A. Lewis, Georgetown.

Discussion. Dr. Lecke: The essayist has given us a splendid paper,
and I agree with him in most of the points he makes, but I am bound to
say that I can not agree with him in the statement that medicinal treat-
ment is of no avail. Without any notes in reference to the cases that I have
had, I call to mind some cases of tetanus that occurred in my practice
years ago. One case occurred in a boy some ten years old, who was
following after a sickle as the grass was being mowed, to pick up sticks
and carry the sickle from the stumps. He caught his toe and fell, and
his forearm and wrist were badly cut. I amputated the arm just below
the elbow as aseptically as I could under the circumstances. About
ten days after the operation was done symptoms of tetanus set in. A
consulting physician advised opening up the wound, but I could not
find any thing in the wound to indicate that there was any trouble
there, although the patient was in a state of contraction of almost all
the muscles of the body, and slight rigors were running over him once
in a while. I could not bring myself to open up the wound, and I put
the patient on heavy doses of bromide of potassium and hydrate of
chloral. These seemed to control the nervous symptoms. I kept him



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184 The American Practitioner and News.

under that treatment about a week, and during that time- the recti
muscles were contracted so that there was considerable opisthotonos.
The masseters were contracted so much that he had to be fed altogether
upon fluid diet. The contractions remained almost constantly for about
a week. They began to subside about that time, but continued to some
extent until the boy was able tQ be out of bed. He could not open his
jaws fully for a good while. But the case went on to recovery, and the
patient is still living. The bromide of potassium and hydrate of chloral
was just about all that I gave him. In another case, a young man cut
his toe slightly with a hoe. He was one of those patients with a hem-
orrhagic diathesis, and he bled very severely from the slight wound, so
much so that I was sent for in the night to stop the hemorrhage. When
I took the bandages oflF and elevated the foot the hemorrhage stopped.

Dr. Early : I have a case I would like to put on record. A little
boy, eight years of age, stuck a splinter into his foot. It was a very
small one, but he showed the symptoms of tetanus in a few days. All
the cases I had seen were fatal, the hydrate of chloral and morphine
having been of no avail. The case getting worse, I sent for the anti-
toxin. Under its use the little fellow recovered. The antitoxic serum
cured him, notwithstanding the splinter did not come out for about a
week.

Dr. T. B. Greenley, Meadow Lawn : I have seen only three cases of
tetanus. One was from a nail in the heel of a young lady, and another
was caused by a piece of lead wire. In a third case I was called in
consultation. This was an incised wound of the foot. The first two
cases I mention got well. The child would have convulsions every
hour or two. I had no hope, but kept him under the influence of mor-
phine, and sometimes under chloroform during the convulsions. He
had locked jaws. He got well. Only one case died, and therefore I
have some faith in the medicinal treatment of tetanus.

Dr. F. J. Yager, Campbellsburg: I did not understand the essayist
to say that he would give no treatment, but I understood the essayist
to say that the main work we have to do is in the prevention of tetanus.
I make no pretension to being a surgeon, but away back there I had a
great many cases of tetanus to treat, and what surgery I did I believe
I did well. I have had some cases of this trouble that come from
wounds, and some seemed to originate in the brain. What caused
those cases I do not know, but the disease killed my patients. The
only ease I could give was with morphine and chloroform, and the



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The American Practitioner and News. 185

patient would die under chloroform. I have had them with wounds
from nails and incisions and contusions and all that, and I have never
lost one of them. If they had gotten a hold such as the doctor describes,
I would have had no hope. If the wound was in the heel, for instance,
I would cut down, let the blood run freely, and then I would apply
warm water freely. If possible, I would put the whole body in warm
water, and then I would rub the part with carbolic acid. I would put
the foot in warm carbolic acid- water and keep it there all the time, and
these cases did not get a firm hold. All the cases I have had I got hold
of suflBciently early, and they all recovered. I would use your new
remedies now, but I did not have them then. You must not think that
because I stick to some of the old remedies that I am going to throw
away any of your new ones

Dr. Dugan, Louisville : My cases of traumatic tetanus do not belong
to me. They are on the other side. I believe the true treatment of
traumatic tetanus is the prevention of it. This is a timely paper, and
I consider it one of the most important that we have had. I arise
more to express myself in hearty sympathy with it than any thing else.
I believe that prevention is the keynote. The old idea that injuries
to the hand and foot were more likely to swell up with tetanus was, in
the first place, because such wounds became impregnated with the dirt
of the barnyard containing the tetanus bacillus ; and the reason we
have better results is because we open up all wounds and cleanse them,
and having gotten rid of the cause of the infection, we do not have
tetanus as we used to have it. When tetanus develops, in my mind all
hope is lost. Notwithstanding I have always had the best physicians
I could get, and they have used the best treatment they knew, the
cases have died. There is only one point I would like to make which
the doctor has omitted, and that is the use of the peroxid of hydrogen
in these cases. He said that the microbe is anaerobic, and does not live
in oxygen. Then in all injuries of the hand and foot that are infected
with the excrement from horses, barnyard dirt, etc., it might be well to
keep them open and pack them with gauze saturated with peroxid of
hydrogen.

Dr. McCormack: It has been my doubtful privilege to see six cases
of traumatic tetanus in Kentucky; four in Louisville. The first five
cases died by the methods of treatment then and still in vogue to a
considerable extent. When I had my last case in Louisville I tried
the antitetanus serum. We left the wound without packing, but



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1 86 The American Pructttzoner and News.

obtained very free drainage. On the fifth day the patient had six con-
vulsions, and I telegraphed for the serum and got it the next night*
The next day he had eighteen convulsions, and that night I gave him
32 c.c. of the serum. I used the French serum to begin with. The
next day he had sixteen convulsions, and the next night I used 32 c.c.
again. The next day he had eight convulsions, and on the fifth day he
had convulsions. After the fourth day I used only 10 c.c. of the serum^
and after the fith day he had only diaphragmatic convulsions. They
were very painful, but that was all. His jaws remained locked until
the eleventh day, and they were so completely locked that I had to
have a tooth cut oflF, and through that space I poured with the funnel
large quantities of fluid. The case was in an ignorant family, and I
gave them a little bicarbonate of soda dissolved in a large quantity of
water, and had them to pour this into the patient's mouth to keep up
the secretion of the kidneys, because in all cases I have seen die there
was suppression of the urine. The case made a splendid recovery.

Dr. E. E. Hume: I have heard a great deal about the curative
influence of medication. We have heard also of cancer being cured,
and we have seen cases where nature has exfoliated the whole cancer
and the patient has gotten well. No doubt these cases have recovered,
but whether or not they were cured by the medicine is a question in
my mind. The value of the bromides was exhausted long ago. I have
failed to see very much benefit from any medication, although I have
seen two cases recover. But I have some doubt as to whether my
treatment had any thing to do with the recovery in those cases. There
is certainly an amount of the bacilli in the body already, as well as in
the soil that is received in these wounds. It is not always the punct-
ured wounds that are followed by the development of the disease. I
have seen one case in an amputation where the patient had been very
badly mangled, and some slight sloughing had begun before amputa-
tion was performed. Five or six days after the amputation the symp-
toms of tetanus developed. The stump was dressed openly with
peroxid of hydrogen, as the doctor suggested, but still we had the
development of tetanus. Sometimes we have the disease, no difference
what is done to prevent it. As far as remedies are concerned, I doubt
very much their value.

Dr. R. O. Pratt, Shelby ville: This question has a somewhat per-
sonal interest to me, and I wish to emphasize Dr. Lewis' position, that
no wound, especially of the foot, can be so trifling but that it should



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The American Practitioner and News. 187

receive prompt and thorough antiseptic surgical treatment. The pre-
vention is every thing in this disease. After a case becomes established
the value of medication is practically nil. It has been my misfortune
to see three cases in the human and one in the lower animals, and all
four died. I have tried the various remedies ; the bromides, as a rule,
eserine and antitoxin, and they are all, in my experience, of no value.
I am not prepared to deny the efficacy of antitoxin. In the case in
which I did use it, it was used early — within five hours after the devel*
opment of symptoms — and yet the patient died within twenty-four
hours. I have known cases where the antitoxin was used in the lower
animals with excellent results. The only point I wish to emphasize
is the point so ably brought out by Dr. Lewis; that is, not to treat any
case of injury of the foot slightingly.

Dr. Lewis, in closing: I know cases of tetanus have occurred as
stated, and have recovered under all sorts of treatment. I only doubt
whether they recovered from the treatment. My own observation is
that treatment is practically worthless. I only wished to bring before
the Society the point I emphasized so strongly. Dr. Dugan brought
out a very good suggestion in the use of peroxid of hydrogen. We
know that the germ can not live in the presence of oxygen. Of course,
I did not mention every thing, and perhaps much I said might have
been left unsaid, but I leave it to you.

** Practical Treatment of Typhoid Fever,*' by Basil M. Taylor, M. D.,
Greensboro.

Discussion, Dr. Hunnicutt: I think the essayist has overlooked
one of the main points; he has overlooked antisepsis in his treatment.
He also states that he would not use heart tonics. He uses as an anti-
pyretic antifebrin, which I think should not be used at all. I do not
think antifebrin, or any coal-tar preparation, has any place in the
treatment of typhoid fever, and when an individual omits heart tonics
in typhoid fever he will sooner or later find out that he is making a
great mistake. In our part of the country we have typhoid fever all
the time, and I have seen it in all forms, from walking typhoid fever to
that severe form which will sweep away the patient, no difference what
you do. I do agree with the gentleman, that we should not overfeed
these patients, but I think we should take a lesson from nature, for we
find nature feeds all her weaker subjects on milk.



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1 88 The American Practitioner and News.

Dr. W. B. Gossett: As to constipation, one point I want to bring
out. When you first get a case of typhoid fever you do not want to
purge, but move the bowels thoroughly with calomel and follow it up
with sulphate of magnesia, and from that day on clear through move
the bowels once or twice a day. Do not go two or three days and say
the patient does not need any thing because there is nothing in the
bowel, but move the bowels once or twice or three times daily. All
you will need will be the calomel and the saline, such as sulphate of
magnesia. As to disinfecting the bowel, we know the bowel is so long
a tract that it is hard to get at the glands that are infected ; but by
keeping the bowels open we find the patient will do a great deal better,
and you will not have as great danger of hemorrhage as you would have
otherwise. Now, as to the fever. If the fever is ioi° to 102 J^^ or 103^,
you need do nothing for it. It is natural to have some fever, but after
it gets over 103° you want to reduce it. For this purpose do not use
any of the coal-tar antipyretics, but use ice, which will lower the tem-
perature and at the same time stimulate the patient. Then as to diet.
You don't want to starve the patient, nor do you want to feed at too
short intervals, but three or four times a day. I think the best heart
stimulant we have is strychnia, one-sixtieth to one-thirtieth grain
every three or four hours, and continue the strychnia throughout the
disease and in convalescence.

Dr. Gaddy : In the first place, the essayist neglected to speak of the
cause of typhoid fever. I believe in order to treat any disease we
should first know the cause, and remove the cause, and then let nature,
the great physician, heal the patient. You know typhoid fever has
long been recognized as a germ disease due to the bacillus typhosus,
the bacillus of Eberth, located in the glands of the bowels, Peyer's
patches. Constipation, I contend, is one of the prime causes of typhoid
fever. Constipation does not necessarily put the germ there, but it
holds it in close contact with the mucuous membrane of the bowel.
My idea of treatment, then, would consist in the very beginning in
giving your patient not necessarily a severe purge, but give him a dose
of calomel and podophyllin, and never neglect the podophyllin, which
we all recognize as an efficient cholagogue to produce a flow of bile,
which is nature's antiseptic. Then I agree with the doctor concerning
the daily moving of the bowels. Feed your patient, and never forget
the liquid diet, especially milk. Then as how to control the fever, I
must disagree with my friend. Dr. Taylor, as to giving any coal-tar



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The American Practitioner and News. 189

preparation when the heart is weak. I would never give them under
any circumstances to a typhoid fever patient, because they depress the
heart and increase the liability to death. On the other hand, I would
reduce the fever by Brandt's system of bathing. Under this system of
bathing Brandt claims to cure 99.5 per cent; that is, there is only one
half of one per cent of mortality under the system of bathing as prac-
ticed by Brandt. Under the system practiced by Osier and other dis-
tinguished American authorities, the mortality is about three fourths
of one per cent. Bathe the patient with warm water or with cold
water. As to which we will use, we must consult the individual
peculiarities of our patient. Some patients want warm water and
find cold water irritating, and others prefer cold water.

Dr. Thornton : Some points in the doctor's paper I want to commend,
and regarding some points I diflfer from him. So far as antifebrin is
concerned, or acetanilid, which is not the patent medicine, I have used
it in typhoid fever considerably. I do not use it after the heart begins
to flag. But I have found that nothing will relieve the headache or
quiet the patient so well as acetanilid. Then, later on, leave the anti-
pyrin or antifebrin or acetanilid oflF. I believe the acetanilid has some
antiseptic effect upon the intestinal canal. I have treated many cases,
and they have not turned out like the cases of cerebro-spinal menin-
gitis that have been reported. Most of my cases got well. In starting
with a case of typhoid fever we can not always see the case early, and
there I believe is where the mortality is increased in typhoid fever.
You will remember that Brandt says that those cases that fail to
recover come under treatment after the fifth day. The patients feel a
•little bad, and think they will feel better the next day, and keep on
working for days and days. Finally they die from perforation or from
hemorrhage. I would say to use calomel in repeated doses, not as a
purgative, but to cleanse the bowel. Then, if you will bear in mind
the etiology and pathology of typhoid fever, and will agree that the
bacillus of Eberth is the cause, located in Peyer's patches, and these
patches are found to be infected, showing first one involved and later
more involved, and showing that not all are involved in the same
manner, you will see the logic of using antiseptics. With the passages
from the bowel the germs are thrown off". If you leave the germs in
the bowel, by force of number they will invade fresh tissue} and this is
the reason why typhoid fever is continued for six weeks, and two
months in some cases. We can not kill the germs in situ, for they are



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190 The American Practitioner and News.

behind the breastworks, but you can make the intestinal tract so
unhealthy for them that no new glands will become involved, and thus
you will cut the disease short. You will not abort the disease, but you
will limit the invasion to the glands already involved, and the patient
will be on the highroad to recovery in from ten days to two weeks.

Dr. Bate : We know in the second week the solitary follicles become
swollen and enlarged. Then at the end of the second week and begin-
ning of the third week we have two possibilities to take place : Either
this enlarged gland becomes soft and we do not have ulceration, or we
have the breaking down of the gland and ulceration. Huchard has
shown that coma and the formation of gas are dependent upon this auto-
infection, and when that is removed we do not have these symptoms.
The infection of many of the glands is absorbed without ulceration
taking place.

Dr. Taylor, in closing: Now, as to the use of a heart tonic. Under
the treatment I have outlined the patient is not poisoned by over-
stimulation or overfeeding and the reabsorption of waste products in
the bowels. I move the bowels twice a day by high enemata, and
thereby prevent any absorption of waste products. The kidneys are
kept flushed, and if the heart is strong, what need have we of
heart-stimulants? Without auto-infection you will not have a
temperature over 101°. It is the absorption of waste matter from the
bowel that gives the extra three or four degrees of fever, and if you get
away from that, what do you need of baths or any thing of that kind ?
I use warm water. Antiseptics are not needed when you practice
asepsis. With care of the stomach and digestion, you have no tympa-
nites. Of course, if you give food every two or three hours, and have
the disease continue several weeks, then it is different. But all you
need is to let the patient get well.



Anti-streptococcic Serum in Smali<pox.— Dr. J.M.Lindsay, health
officer of the Middesboro Isolation Hospital, says that in the management
of a recent epidemic of smallpox he observed that medical treatment had
little or no influence on the diseased It was observed that the date of pus-
tulation marked a period when the patients became much worse. Many
of the patients had abscesses, and this accompanying illness resembled
chronic pyemia in many respects. Anti-streptococcic serum 10 c.c. for
three days, beginning date of pustulation, was administered. The danger
of heart-failure was greatly lessened, and the toxemia was not nearly so
severe. — British Medical JouryiaL



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The American Practitioner and News. 191

.foreign (Eorresponbencc.



LONDON LETTER.

[FROM OUR SPECIAL CORRESPONDENT.]

The Late Sir Edward Frankland: Increase of Lunacy ; Royal Visit to the
London Hospital ; Treatment of Tropical Diseases ; Treatment of Abdom-
ifial Gunshot Wounds ; Pensions for Nurses ; Vaccination in India,
The well-known Government analyst of the London water-supply, Sir
Edward Frankland, has just died in Norway, a country he visited annually
for salmon fishing. His early scientific studies were carried out in this
country, but were completed abroad at the universities of Marburg and
Gies£en. In early life he especially devoted himself to some important
investigations in a new field of organic chemistry, being appointed, in 1851,
to the chair of chemistry in the then recently founded Owen's College,
Manchester, now known as the Victoria University. He subsequently
moved to St. Bartholomew's Hospital. London, which he left in 1863 to
become Professor of Chemistry at the Royal Institution of Great Britain.
Professor Frankland retired from active pursuit of his profession in 1885,
having issued his " Experimental Researches in Pure, Applied, and Phy-
sical Chemistry" in 1878.

The Commissioners in Lunacy have issued their fifty-third annual
report. It appears that on January i, 1899, there were 105,086 lunatics in
England and Wales, an increase of 3,1 14 on the previous year. The report
shows that the increase was the largest annual one on record, and further-
more that the recovery rate was unfavorable, being 36.87 per cent of the
total number of admissions, as compared with 38.81 per cent, which was
the average rate for the ten years 1889-1898. Two new county asylums
had been opened during the past year, making a total of county and
borough asylums for England and Wales seventy-six. The total number
t)f admissions in 1898 was 19,314, of whom 9,382 were males and 9,931 were
females.

The Princess of Wales recently paid a visit to the London Hospital.
Her first visit was to the outpatient receiving-room, where the list of some
three hundred cases which had been treated that day was examined. Her
Royal Highness entered into conversation with several of the patients who
were awaiting treatment. Afterward, while visiting the wards, much
interest was taken in the Hebrew one, where arrangement is made for the
due observance of the religious customs of the Jews, the ward having the
passover cake over the portal, the ten commandments on the door-posts,
and is also provided with a special kitchen. In the three other wards
visited the Princess spent nearly two hours in conversation with the dif-
ferent patients. The visit was quite a private one.



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