Concluding I will say that our thin weak patients are suffering with definite discoverable lesions, that these lesions are amenable to treatment, resulting, in most cases, in a restoration to comparative health and vigor, that they should make a comfortable gain in weight, and that when we do not so restore them, in the majority of cases, we are depriving them of their just rights at our hands; and diminishing our reputation as physicians, and are culpable,. more or less, in both instances.

ANTISEPTIC AND ELIMINATIVE TREATMENT

OF TYPHOID FEVER.

By T. V. HUBBARD, M D., ATLANTA.

There are a few things in connection with this question that I want to speak about. Year before last there was a symposium on this question before this Association and I regret very much that I could not be present at the Savannah meeting, at which time the question of diagnosis and treatment as applied to the antiseptic and eliminative treatment was taken up. What I have to say is purely a matter of personal experience, and I am not here to criticise any methods. What I ask is that you be as fair to me as I shall be to you. No man who has not tried a thing can tell me anything about it. The man who has tried a thing clinically and knows his own results is a man who can stand up and talk to anybody. I have never seen any two men who would agree that typhoid fever was limited to one week or two weeks or three weeks or even six weeks. You can not get any two text-books to say this. They will say that it is a self-limited disease but will not give you the limit. In this treatment which I advocate the temperature usually reached normal by the fourteenth day. I do not say that the fever is stopped and that you will not have any more rise of temperature, but the course of the disease has been mitigated. I do not claim that it is a specific, but you can cure a larger number of cases than the man who depends alone upon the cold-water treatment, or any other method now known.

I have been criticised very severely--and we all make mistakes in diagnosis-but if I have not treated any typhoid in the last five years I would like for some gentleman to say what it is. It may not be, but according to observations of at least ordinary intelligence, it was typhoid fever. It runs fifteen days, it has the characteristic temperature, tympanites, distention, the eruption and typical tongue. If it is not typhoid fever, please tell me what t is. It is such a fever as is not touched by quinine. Dr. Osler says that a fever which resists quinine for three days, in the South, is typhoid. I do not believe this, as we have fevers which resist this but are not typhoid fevers. They say in criticism, that if it was typhoid I would not get the temperature down to normal by the fourteenth day. I do not mean to say by this that the fever is over-the point is that the fever is broken and the patient will get well and you realize that they will get well.

As to the method of treatment it has been criticised as being routine-it is anything but routine. I have not treated any two cases alike. A man has got to make decisions at the bedside as to whether you want to increase a dose of calomel or to leave it off. They say that to give so much calomel is dangerous. I have never seen a man killed with mercury, but you can do it even in syphilis. If you use it unscientifically you can kill a man. The same thing holds good here. You watch the results-and you do this at the bedside, and you prescribe at the bedside. I can only give you the average dosage and you treat your cases accordingly; but the man with typhoid fever can take more mecury than any other fever I have ever seen. There is a tolerance for mercury in typhoid fever that other fevers do not have. This is the point I made in the beginning.

As to the antiseptic part, a great deal has been said about this. I think the eliminative part is the most important.

They have made a great howl that you could not make thealimentary canal aseptic. We are now told that this can be done with acetozone. I have tried acetozone and I do not know that it adds anything to the treatment, for you havegot to use the mercury with it to accomplish the results. Men have jumped on me about trying to render the alimentary canal aseptic. I have never claimed that I attempted to do this. In typhoid fever, we know the germs are not confined to the alimentary canal, and what good would it do to render the canal aseptic if the germs are elsewhere in the system? We have abscesses and infections all over the body caused by the Eberth bacillus; however, if you get the alimentary canal aseptic you have lessened. the autointoxication. In this connection we want to say that it is just as important to remove from the system theproduct of diseased metabolism as it is to remove the toxins of the germs. You can suffer with autointoxication: and can die from this, and you can readily see that the point I make of elimination does apply to this disease. This eliminative part is what I want to impress, and we have no better glandular stimulant than mercury. My experience has been that men are afraid to use mercury as it should be used, as they are afraid of moving the bowels too much. They say there is danger from ulcerations. Let a man have ulcerations and have gases developed in intestines and put the walls on the stretch. Which is more dangerous, to havethe bowels move and prevent this distention, or to allow this distention? At the same time by moving the bowels. you are getting away all the toxins of the germs and also the toxins from the tissue metamorphosis destruction.

I have been very much interested in this subject and have told you what I have seen at the bedside. All the textbooks are opposed to me, and in simple fairness all that I ask is that you try it yourself, and if any man has tried it let him report it and we will see what results he has had..

I have got my first man to say that he has tried it and not obtained the same results that I have. There is a timidity about trying new methods like this-I had the same trouble myself in the beginning. The main point is that you have got to give sufficient mercury. When you first see your patient, you start on small doses of mercury frequently repeated and no matter what the disease is, if it turns out to be typhoid fever you have gained just that much advantage. If you get your case late, probably there is already necrosis of the glands and ulceration established, and you can not cut short this, but you can improve the condition by eliminating the toxins.

As to the mortality, I have not had a death from my treatment. I have seen deaths in consultation, and I had one case which had Bright's disease and got him through the attack, and after he had been up and about, a week later died from uremic toxemia. I have seen some severe hemorrhages, but none have been fatal.

I read a paper in Atlanta a few years ago on this subject and I called attention to the fact that normally there is no leukocytosis in this disease, but that by the use of mercury I believe that leukocytosis was produced and this in a measure accounts for the good results.

I have not made sufficient observation to make this as a positive statement in regard to all cases, but the white cells. were increased in those cases I counted.

As to the treatment, I start with 1-2 gr. of calomel every two hours with 2 1-2 gr. of guiacol carbonate. I have left off everything else. I have also used the acetozone, but did not see any value in this. I keep up the calomel until the bowels move four or five times. Some doctors say they are afraid of diarrhea. I would rather have diarrhea than constipation. When I get the four or five actions, I leave off the calomel. This may be within twelve hours or it may be forty-eight hours, but when this point is reached I then