Vol. 60, 1909 - University of North Carolina at Chapel Hill

ORIGINAL COMMUNICATIONS.
to administer morphia hypodermically; if it
is only slight, it may be relieved with chloroform
water and bismuth or some of the
milder anodynes.
Where perforation has occurred, a surgical
operation is the only hope of saving the
patient's life. Where there is a slight but
constant bleeding which does not respond
readily to rest and treatment, surgical intervention
is indicated.
Typhoid Fever. Importance ol Early
Diagnosis —Fasting — Special Diet —
Surgical Rest of Bowel ~ and
Simplicity of Treatment.
By Dr. A. J. Burkholder, Mt. Sydney, Va.
This disease has a very interesting history,
and was for several centuries confused
with typhus fever. Ancient writers describe
in part what we recognize as typhoid; but
to a physician of this country justly belongs
the distinction of first differentiating, and
setting forth clinically and pathologically
this fever as a separate and distinct d.sease.
F.om American sources even today we are
able to study this disease with greater satisfaction
than from foreign observers.
The time allotted will not permit of a discussion
of the complex manifestations and
types of infection, modes of entrance, systemic
effect, and complications. Therefore
we will confine this brief to the consideration
of a few points found in the sick room
—leaving those winged questions until our
aeroi^lane is sufficient thereof.
With the advancement of medical science
we are able to delve into the depths of mystery,
defy disease by immunization and antitoxin.
Vet we must not forget that njany
of these valuable agents are only in their
infancy of development, and many of the
valuable tests employed in diagnosis are
not infallible, are confirmatory if positive,
and if negative in no wise proves that disease
does not exist. The time has not yet
arrived, and never will, when we can in
our laboratory diagnose the patient. That
is what we propose to treat, therefore let's
come down. With the adv'ancement of our
profession, there is a growing tendencx- to
wander away from convictions of bedside
study. Yet what evidence has been produced
to show that the clinical conclusions
of eighty-five years ago should be displaced
by the observations of today? The longtail
coat, the solemn face, the silent tread,
the modulated tone, the lancet and depleting
measures have gone, and with them the
impression plate, bedside diagnosis. The
clinical picture of typhoid fever as drawn
by Chapman, by Wood, and by Thompson
eighty-odd years ago stands as a living
monument today to those profound students;
and when compared with our most recent
writings, those not yet dry from the printer's
ink, they define clearly in every line those
diagnostic symptoms observed at the bedside,
upon which alone they depended.
We would here enter a plea for a closer
clinical study of disease, especially typhoid
fever; for upon an early diagnosis, immediate
in many cases, depends the life of the
patient. Even where the least suspicion
exists it should be regarded typhoid and
treated as such until you go and develop
your cultures, search through available
literature, and make several mathematical
calculations as to possibilities. These means
of diagnosis are to our credit. Yet let us
not forget that too often valuable time is
lost. The life of the patient and our success
demands that we act then and there
no future time offered. To do this requires
a higher degree of trained powers of observation;
and such should be our aim, our
first and main dependence.
—
Years ago—and so it is today universally
admitted that the food factor is one of the
most important questions to be solved,
livery writer and every practitioner holds
to his own belief, however, all with varying
degree of success. Many claiming that
in the event such diet produces disorder it
should be withdrawn. The most natural
question suggested by that direction is this:
l)y withdrawing the offending agent, can
you also always withdraw tht evil effect
l)roduced? If such diet is competent of
producing disorders, is it rational to employ
it in a single case? Withdrawn, after the
stomach rebels, after the cripjiled bowel
has been unduly excited, after mixed infection
has been favored, after the toxic system
has been borne down to the very brink
of the grave by increased sepsis, after the
\ital forces have lost all power of resistance,
after cell activity ceases from profound
toxemia? And, we might add, after distention
favors a long list of dangers.
That life-giving fluid that stands par excellence
hermetically sealed, transposed by
transfusion, possessing all the nutritive elements,
the proximate principals, kind for
kind, gives abundant evidence of its utility
in its natural sphere. This connecting link
that spans the chasm from darkness to light
ceases to be food at a certain period. Nature
so says. We will jjatiently await evidence
to the contrary.
Let's leave off the milk and give beef
bullion, possibly we will grow a better
culture.
In the administration of drugs we consider
the physiological action, the therapeutical
action, and the toxic action; and
we are very careful to carefully guard the