SUMMARY OF VARIOUS CONTRIBUTIONS ON THE USE OF ACETOZONE IN TYPHOID.

ACETOZONE, the new chemical combination whose wonderful power as a germicide, combined with its remarkable freedom from toxic tendencies, promises to revolutionize the treatment of that annual scourge, typhoid fever.

We append a summary of the investigations and reports of various practitioners in this country, for the benefit of our readers.

Although this dreaded disease has all seasons for its own it prevails chiefly in the fall and winter seasons, and this information is therefore timely.

The recent discovery, by Duval and Bassett, of the presence of the bacillus dysenteriæ (Shiga) in forty cases of infantile. summer diarrhea, awakens renewed interest in the subject of intestinal antisepsis. But a few months have elapsed since Drs. P. C. Freer and F. G. Novy, of the University of Michigan, demonstrated the enormous germicidal power of benzoyl-acetyl-peroxide, more familiarly known as acetozone. Although the preliminary reports of these investigators were of necessity based upon results of laboratory experiments, their expectations are already being realized in clinical work, in the treatment of typhoid fever, particularly.

In the city of Chicago, where a large number of cases of typhoid have been reported acetozone has been used exclusively in the treatment of about 300 of them. The consensus of opinion is that it causes the temperature to decline earlier than usual in the course of the disease, and it ameliorates the mental and physical condition of the patient, in all probability by controlling the toxemia.

Two Chicago practitioners, I. A. Abt, M.D., and E. Lackner, M.D., have thus far reported (Therapeutic Gazette, October, 1902), forty cases of typhoid, in children treated with acetozone, with but two deaths, a mortality of 5 per cent. One of the patients that died suc

cumbed to pneumonia and pulmonary edema, the other to great pyrexia on the fifth day. Stupor and tympanites were almost entirely absent in all the cases; the characteristic typhoid fetor of the stools was markedly diminished, and hemorrhage occurred but twice, and in the same case. The average duration of the febrile period, in 37 cases, after beginning acetozone treatment, was 132 days. The drug did not seem to act upon the heart or respiratory apparatus.

Early this year Eugene Wasdin, M.D., of the U. S. Marine Hospital Service, Buffalo, N. Y., reported 27 cases (American Medicine, Feb. 8, 1902), of typhoid fever, 24 of which were treated with acetozone, ali of the patients recovering. The writer says: "Its application in typhoid fever has been followed by very happy results; its use has been directed to the destruction of the germ in its primary lung colony and also in its secondary intestinal colony, and it has been used by hypodermoclysis to combat terminal expressions, with the result that in 24 cases the disease has been limited almost entirely to the expression of intoxication from the primary focus, the intestinal symptoms remaining entirely in abeyance, and the disease has been shorn of many of its most disagreeable features."

In a second paper, which appeared in the Therapeutic Gazette, for May 15, 1902, the same writer states that his patients were given from 1,500 to 2,000 c.c. of the aqueous solution of acetozone daily. The diet was milk diluted with the same solution. The first influence of the drug is observed in the increased secretion of urine. That this is not due wholly to the ingestion of large quantities of water, necessitated by the use of the saturated solution is evident from the author's assertion that the same result was observed when acetozone was administered in capsules. The second influence to which attention is directed is the very pronounced decrease of the odor of the stools, while plate cultures from the dejecta showed comparatively few germs.

The deodorant and diuretic effects of

acetozone were also observed by G. H. Westinghouse, M.D., of Buffalo (Buffalo Medical Journal, Aug., 1902), who used it in seven cases. This observer remarks that with the increased flow of urine “a corresponding reduction of typhoid symptoms followed, and tympanites and delirium disappeared." It should be remarked that the diagnosis in all these cases, as well as in most of those reported by the Chicago physicians, was confirmed by Widal's reaction and Ehrlich's test, and in some a blood-count was resorted to. Westinghouse concludes his paper by saying that "acetozone, as an intestinal antiseptic, is unequaled by anything I have ever employed. A complete subsidence of all the bowel symptoms followed in every case of typhoid within a few days after beginning its use. The application of the antiseptic consisted, in most cases, in simply allowing the patient to drink the saturated aqueous solution ad libitum; or, in other words, substituting this solution for all other liquids, and urging the patient to partake of it freely when the natural craving was not sufficient to insure the consumption of considerable quantities."

TEA.

THE world's production of tea, based on exports of tea growing countries, in 1900 was 596,420,942 pounds, of which the United Kingdom used 249,792,000 pounds, or nearly 42 per cent. of the total production.

The exports of tea in 1900 were as follows: Indian, 185,641,303 pounds; Ceylon, 148,431,639 pounds; total British grown, 334,072,942 pounds; China, 184,532,000 pounds; Japan, 61,028,000 pounds; Java, 16,788,000 pounds. Grand total, 596,420,942 pounds.

The above figures show an increase in production (exports) in five years of only 53,645,423 pounds. The consumption during the same period increased 71,144,271 pounds.

Gow, Wilson & Stanton, London, to whom we are indebted for the foregoing statistics, say:

"In 1900 production of British grown tea was far in excess of requirements, the result being also a heavy fall in value. The moral to be drawn from the over-production of China may well be used as a lesson by Indian and Ceylon tea growers before disaster overtakes the industry."

DIABETES MELLITUS.

DIABETES is one of those diseases which continues to cast opprobrium upon medical science, for the reason that, like consumption, it must be treated in its incipiency, before the blood is impoverished, and disorganized beyond the power of recuperation, and before structural changes in vital organs become so extensive as to imperil life,

Diabetes, like consumption, again, is a disease of civilization, and is becoming increasingly frequent among men who indulge in high living, and take little exercise, or wholesome recreation. Men who depend upon the activity of the brain and nervous system, both to gain a living and to obtain amusement, sooner or later find that brain and nerves are becoming increasingly weak and sensitive, or developing a paralytic condition.

DIABETES ORIGINATES

in a want of nerve power, affecting principally the pneumogastric nerve, branches of which supply all the vital organs. The first symptoms noticed are usually an unpleasant feeling of distention and fulness after eating, no matter how small the meal, and this is especially true if breadstuffs and such vegetables as peas, beans, and potatoes predominate. There is apt to be increased frequency of urination, abnormal sensitiveness to cold, flabbiness, or wasting of muscular tissue, and often accumulation of fat, both in the organs and muscles of the body, poor circulation, because the blood is full of the fragments of broken-down corpuscles,

which, obstructing the current, and plugging up the superficial capillaries, give rise to boils, abscesses, carbuncles, etc. The mind in this disease is timid and depressed, owing to passive congestion of the brain and impoverished blood.

DIET.

The elimination of starchy and sacharine foods on one hand, and the use of highly specialized products, such as pancreas and thyroid glands, bone marrow, diastase, and malt preparations, and like manufactured foods, on the other, are advocated as the doctor's best reliance in the treatment of diabetes. Giving diseased digestive organs a rest from the rich pastries and sweetmeats with which they have often been gorged to a surfeit, and supplying their place with foods which require little change before they can be assimilated, will often enable these organs to recuperate, if the proper hygienic and drug treatment is employed at the same time.

Constipation is common, and must be relieved, because it increases the congestion of the brain, and favors the production of diabetic coma.

CERTAIN EXPERIMENTS,

however, which have recently been made, tend to rehabilitate "cold" in its position as a cause of disease, for they have shown that exposure to cold lowers the resistance of the body to infection, and, what is more interesting still, they have made it clear that in regard to various diseases which are known to be caused by micro-organisms, and especially in regard to pneumonia, we may carry the organisms about with us and not suffer, and yet that exposure to cold may at once enable the microbes to take root.

Recent demonstrations of the presence of the pneumococcus in the lungs of healthy animals, and the fact that exposing such animals to a thorough chill will bring on pneumonia, is very suggestive, and makes it probable that in many of the ailments which result from "catching cold" a concurrent infection from without is not necessary.

The healthier and cleaner the man, both inside and out, the more, no doubt, will he be able to bear exposure without ill consequences; but for those people whose tissues are already charged with ineffective microorganisms, a "mere chill" may evidently set up disease.

CATCHING COLD.

It is not altogether unsatisfactory to people who think that science and common sense should run together, although no doubt discouraging to those who look upon the germ theory of disease as the opening of a sanitary millennium, to find that after all we can "catch cold."

The great discovery that most of the fibrile diseases from which we suffer are associated with the growth within us of microorganisms, made many people for a time look somewhat sceptically on "catching cold," and we were told that when we felt shivery, and then in a few hours found ourselves sniffling and out of sorts, the chill to which we attributed all the mischief was really the first sign of our being ill.

THIS is the Home-coming time! Have you thought about everything for the health. and comfort of the household through Fall and Winter? How about proper sanitary precautions?

You can protect the entire family by purifying the waste pipes, sinks, closets and cellars with Platt's Chlorides, the odorless disinfectant.

If i had hart disease, & had it bad, i shood laff az meny times a Day az i cood, for i shood Want 2 di with a smile on mi Kountenence.

THE word antiseptic has come to have a much broader meaning than is assigned to it in any of the current lexicons. Gould defines it, 1. "Having power to prevent or destroy putrefaction, or the bacteria on which putrefaction depends. 2. A remedy or agent that prevents a septic process."

The Century, I. "Inimical to the growth and activity of the micro-organisms of disease. 2. Anything which destroys the micro-organisms of disease, putrefaction, or fermentation, or which restricts their growth and multiplication."

Foster, "Preventing or checking putrefaction or septic infection."

Worcester, "A substance which prevents putrefaction."

Standard, "Anything that destroys or restrains the growth of putrefactive micro-organisms."

These definitions are strictly in accordance with the literal meaning of the two Greek words, anti and sepsis, but they are not as comprehensive as the universal adoption of the principle has made appropri

ate.

It means much that the dictionary would not be justified in mentioning. First of all it means cleanliness in the most exact and punctilious sense. It matters not what the dirt may be technically called, or whether it is living dirt, germs, bacteria, bacilli, schizomycetes, micro-organisms or mi

crobes, for their names are legion, or whether mineral and unorganized matter. It now implies measures of prophylaxis as well as antagonism, prevention as well as cure or correction. That is, prevention is made more emphatic than any of the definitions would imply.

Every day adds to the manifold applications of the principle of antisepsis and no lexicographer can hope to keep pace with the extended meaning of the word. Authorities differ in their technic and in minor details of applying the principle, but they are really not much apart in the essential uses of the underlying idea. Even Mr. Lawson Tait insists on the most scruplous cleanliness, and is both punctilious and liberal in the use of hot water in his brilliant operations. Antisepsis is therefore essentially cleanliness, both special and general. Special in its relations to surgery and general in all other applications.

Human beings are susceptible to septic influences to some extent at all times, although it must be assumed that a normal and fully developed organism enjoys a practical immunity from all infective germs, otherwise the extinction of the race would be but a matter of comparatively brief time. The later biological researches have demonstrated that the blood and secretions of the body are at all times in health, fortified, autofortified as it were, from the inroad of septic influences, and it is further found that it is the white corpuscles, leucocytes, or according to some authorities, a basic principle which they have named nuclein, which possesses this power of self-protection. It is only when the organism has been more or less weakened by overstrain, deprivation or injury that it fails to throw out its usual competent guard and keep its picket line intact, that disease germs find a vulnerable point of attack and make their inroads. Even after their successful advent this same power of repulse is constantly endeavoring to reassert itself and to undo the damage already incurred.

Antiseptics are the agents to which modern therapeutists resort to overcome the evil

effects of septic invasion and re-fortify the system against further damage. They are applicable in three particular directions or by three methods. First, they may be used internally by means of the alimentary canal, and may be thus made to act both directly on the contents and secretions of the canal itself, or, second, indirectly on the whole system by absorption or assimilation.

They are indicated in very many conditions of the system. For example, when there is disordered or impeded digestion, fermentation is sooner or later the disturbing factor, and may be so rapid or so longcontinued as to overcome the resistive and reactive powers of the organism and overwhelm them completely.

The use of antiseptics is a marked instance of the clinical corroboration of theoretical deductions. In fact clinical results have fairly exceeded the prognostications of theory.

Practical antiseptics are not exactly a novelty in the therapeutic world. They have been used to some degree and in a blind way for half a century or more. Long before the word was known and long before bacteria had been definitely identified certain practitioners adopted fanciful theories as to the nature and etiology of certain diseases, and urged the use of certain antagonists, or what were assumed to be counter agents, to combat them. The agencies and substances invoked would now be classed as antiseptics. Their employment at that time was wholly empirical, could not be logically explained, and were defended and excused only by the practical results. Even the theory of their use is not so new as is generally supposed. But modern research has assumed the credit of having definitely demonstrated the rationale of the subject and thus made the uncertainty and empiricism of the past both positive and scientific.

The art of medicine has not yet been based on positive science. The demonstration of the laws of antisepsis has, however, supplied the necessary substratum on which to initiate a future science of medicine. It is

chiefly the microscope that has made this advance possible.

As yet, antisepsis has done most for surgery, many physicians hesitating to adopt its plainest deductions in their practice, partly from innate conservatism and partly because they do not fully credit the deductions and do not care to be innovators. With the surgeon it is now the fundamental reliance. Without it the modern surgeon would be practically helpless, and would undertake the simplest operation with the direst misgiving. Whereas the medical practice of the day has only recently begun to inquire how far the principle can be adapted to internal medication. One of the principal reasons for the very slow progress of internal antiseptics has been from the toxic and dangerous nature of the principal substances in use as such. For example, the most popular, at the same time the most dangerous one, is corrosive sublimate. It has even been asserted that to destroy hurtful germs within the system requires the introduction of germicides which are inimical to the organism itself, and that in lesser doses than will endanger the life it is proposed to benefit there will be no efficacy in the matter of destroying germs. In other words, efficient doses are impracticable.

Much blundering has been done since the inculcation of the germ theory of the causation of disease, through the energetic efforts made to destroy the germs in a given disease or attack. It is now well known that the germ itself is often comparatively harmless, the damage being wrought by the secretions or excretions, given off or produced in the system by the microbe. These secretions or excretions, from being found the center of virulence, have been named toxins. They have been found to be analogous to alkaloids in nature, and it is upon these that the mildness or virulence of the disease depends. The destruction of the microbes has therefore failed to interrupt the disease and save the patient. The most successful treatment has been one which did not aim to make sudden and wholesale destruction of the microbes present in a given case, this be