VACCINATION.*

BY A. D. PRICE, M. D.

As the years come and go, as the peoples of the earth multiply and intercommunication increases by means of rapid transit, the importance. of vaccination grows apace.

There is nothing new to offer you on this important subject. The object of this brief paper is to elicit discussion on the most perfect and certain preventive measure known to the medical world, to urge upon the profession the importance of teaching the public, at all times and under all circumstances, the necessity of being rendered immune to smallpox, the most dreadful of all diseases, and to learn from the individual member his experience relating to the complications that have occasionally followed vaccination.

It is surprising to know how quickly a community becomes unprotected against smallpox. Children are born and grow to be men and women without the protection of vaccination; many even go through life without giving it a thought till confronted with the contagion. The medical profession only can remedy this sad condition by teaching the public its importance, and by urging upon the lawmakers the necessity of enacting laws to secure its adoption.

The prevalence of smallpox in various sections of the country, and its liability to develop in any locality, render this subject of special interest at this time. Were every person properly vaccinated and revaccinated at stated intervals, smallpox would become an unknown. disease. This is proven to be true by the results in communities where these regulations are enforced by law. The necessity, then, of urging and securing the universal adoption of this life-preserving measure is imperative.

Only the healthy should be vaccinated. Those in ill-health, those exposed to acute infectious diseases, and the subjects of chronic dermatoses should not be subjected to this procedure unless there has been an exposure to the contagion. Every child should be vaccinated when two years old, revaccinated in five years, and thereafter every ten years. It may be done, however, at any age if necessity requires.

The virus should be pure; the glycerinated calf-lymph only should be used. "The lymph properly prepared with chemically pure glycerin

* Abstract of paper read before the Kentucky State Medical Society, May, 1901.

and sterilized water, and sealed in sterilized glass tubes, is found free of the various streptococci and staphylococci, of the streptococcus of erysipelas, and of the bacillus of tuberculosis," and is, therefore, devoid of danger.

Vaccinal immunity, it is claimed, is less than 1 per cent, and smallpox immunity has been demonstrated to be acquired in ten days after vaccination. "Vaccinia is an acute infectious disorder which ordinarily runs a mild and uneventful course," but grave accidents, often due to other causes, sometimes arise.

Unfavorable conditions may develop in cases of diabetes mellitus and hemophilia. Pustules may become hemorrhagic; adenitis, ulceration, abscess, septicemia may at times be serious complications; erysipelas and tetanus may be the result of inoculation. Gangrene, otitis media, nephritis, convulsions in children, neuritis, keloid and various dermatoses have been laid to its charge.

General vaccinia is the result of the virus being transported by scratching or by the blood-current. Tuberculosis, according to some observers, is possible, not probable. The occurrence of syphilis is impossible where the bovine virus is used, and consequently does not demand any consideration. "The more complete the vaccination the greater the protection." The virus should, therefore, be thoroughly inserted in three or more places. The physician, in doing vaccination, should be as careful as in the performance of a capital operation. Clean hands, clean arms, clean instruments, aseptic dressings are imperatively demanded. The old haphazard and unscientific method is responsible for many of the unfortunate complications.

To teach people how to live, how to avoid disease, how to grow old gracefully, peacefully, and happily is a matter of continual and persistent education. To the medical profession belongs this duty, and it would not shrink from it if it could. The general practitioner and the obstetrician should, therefore, see that the families under their charge are properly vaccinated and revaccinated.

HARRODSBURG, KY.

TREATMENT OF TYPHOID FEVER.*

BY BASIL M. TAYLOR, M. D.

The domain of medicine, though infinitely beyond the grasp of man's mind, is divided into two great subjects, physiology and pathology. When nature puts into existence a being she attains to but one end, and that is to maintain physiology.

Every organ in the body suffers from the effects of toxines from typhoid fever. The mind and the muscles can rest, but the stomach and heart must work or the struggle soon ceases. These are the two sentinels upon

They must be congratulated

which depends the safety of the patient. if they have a physician who walks hand in hand with them through the struggle, but they are to be pitied if he tramples them under his efforts to cure typhoid fever.

There is one rule to guide us in the treatment of disease—“treat the patient and not the disease." Keep in touch with nature, and have a scientific reason for every thing you do and say; treat the case as nature treats it, and you will be nature's assistant.

The constant irritation of the delicate mucous membrane of the stomach by medicine for two or three weeks may change a once healthy stomach into a diseased one that may end the patient's life. Injudicious feeding may cause intestinal catarrh, from which the patient may never recover. The responsibility of the physician in prolonged diseases is far greater than he realizes; it is no honor to make a "catch-all" out of a healthy stomach and bowels during typhoid fever, and make a physical wreck out of what was once a perfect type of physical manhood. This has been done in many cases. It is lucky for the doctors that the laws of God and man apply only to willful murder and maiming.

When we look over our record and see the number of lingering cases of typhoid fever, we may safely say that 90 per cent of these cases could have been different if we had treated the cases skillfully. We may nurse and feed the patient faultlessly, loving hands may smooth the pillow and make the bed easier, anxious friends may kindly remember, but one irritating and useless drug may defeat our plans and wreck the progress of the case. Then whose is the fault? It is not the drug, for pills and bullets are blind, and wound friend and foe alike. You can claim the fault as your own. We must reason from cause to effect, and from effect Abstract of paper read before the Kentucky State Medical Society, May, 1901.

to cause.

Meet every indication with its corresponding remedy, and give medicine for its effect. Routine feeding and prescribing is vicious practice; a drug that is indicated in the father may kill the son, though they lie side by side with the same disease. The sum total, then, is know your patient, or he will be unrecognized by his friends if you do not give up the case.

As typhoid fever is a septic disease, we must favor elimination and assimilation. No army can win a battle without ammunition. Toxines must pass out as rapidly as they are absorbed; the system has enough to do to eliminate the toxines from the fever alone, without the extra labor of eliminating undigested food and useless drugs. The functions of the stomach are threefold-digesting, absorbing, and germicidal. The three work in harmony, and to impair one impairs the other two; keep in perfect harmony with the trinity. To interfere, then, for a day with the functions of the stomach places your patient in an extra hazardous position.

The bacilli of Eberth are selfish enough to claim all the praise, and they do not mention it that the doctor was responsible for the extra sickness after they finished their contract with the patient. When called to see a patient with typhoid fever, open the journal and examine his liabilities and assets. Is the patient older than his age? If so, why? Is his pulse excited, weak, or strong? If so, why? Is he nauseated, full of aches and pains? If so, why? Is there gurgling in the right iliac fossa, and is his tongue foul? If so, why?

If there are these symptoms, be sure that you can wash your hands clean of their cause. There is no necessity for foul tongues, delirium, sick stomach, pains, headache, insomnia, high temperature, weak pulse in typhoid fever. If we will practice physiology instead of medicine, we will avoid these.

When you get a fever patient in bed, give him a rest; I mean a rest from the crown of his head to the soles of his feet. There will be a drain on the system-a disturbance of the equilibrium between assimilation and waste. The patient lives on himself to a certain degree; then he must minimize waste in every organ. The patient's mind must not be upon his business; if he has been irregular in his habits, we must at once establish a regularity; in fact, we must, as nearly as possible, reorganize his organic harmony and let each organ do its work.

Let us divide our cases into two classes: First, those who are healthy prior to the acute disease; second, those who have had some chronic

disease for years. In the first cases we have an opportunity to show our skill or to put the patient into the second class for the next case of fever. Case "A" is in the first class; he is a perfect type of physical manhood; he has been complaining for a few days, and has called at the doctor's office several times for medicine. He was given calomel for biliousness and quinine for malaria. His already inflamed bowel is irritated by the calomel, and his liver wonders why it is dosed and stirred up for a trouble that is ten or fifteen feet down the alimentary canal, and over which it has no control. He grows worse, and, after a chill, a restless night with aches and pains, he sends for the doctor. His liver, irritated by the calomel, has poured out a lot of bile, and the patient has been vomiting it into the slop-jar for several hours. The sight of so much “bile on the stomach" proves to the doctor that he is very bilious and must have more calomel. (He fails to realize that the slop-jar is more bilious than his patient.) The calomel is repeated, and so are the deleterious effects of the drug.

Now, keep in harmony with the trinity. The patient has been taking medicine irritating to his stomach, and has been eating indiscriminately since the first symptoms of his trouble, and the chill, high fever, and headache tell us of the fact. If the physician recognizes typhoid fever at once, he informs the nurse that he must begin to nourish and stimulate the patient to tide him over a long and dangerous illness. He directs the patient to take a glass of milk or bowl of soup every three hours, and if his pulse is a little accelerated from the toxemia, he mistakes this for an indication for stimulants, and directs him to take a tablespoonful of whisky every three hours until his return. How many of us have been guilty of this mistake? A link in the trinity has already been broken, and we make the separation greater and perhaps permanent by overfeeding and stimulants.

A healthy stomach has enough to do to digest three meals a day, but when the stomach of Case "A" takes typhoid fever, it needs a rest for the tong task it has before it. You cause it to work constantly by giving food every three hours. This is kept up for a week, until he begins to vomit ; you have been pouring antiseptics and septics down him day and night, disturbing his sleep to give him food, so that if he dies the family and you can say that every thing was done for him that could be done. This is true in one sense of the word. No wonder it takes him weeks and months to recover; the doctor and disease make a combination disastrous to any patient.

His temperature is running to a hundred and four