called at an earlier stage, thereby giving them active treatment earlier.

I do not discover any marked change in the disease in Wolcottville during the past six years.

To question 3d, Drs. Beach and Bidwell answer, "About the same." Drs. Deming, Lyman, Knight, Thompson, and Minor, think it is slightly so.

This

Dr. Goodwin writes, "This depends entirely upon its type. Severe cases are not so amenable to treatment as mild ones. fact is the same now as formerly. Dr. Derrickson, "More amenable to treatment than in 1859."

I do not observe any great difference.

Question 4. Dr. Stevens of Norfolk cannot give the numerical ratio. Dr. Derrickson, one in ten, although from 1862 to 1868 it was not over one in fifty. Dr. Brown, one in twenty-five to one in thirty. Dr. Goodwin has not lost over one in twenty. Dr. Minor, one in ten. Dr. Thompson, three per cent. Dr. Knight, twenty-five per cent. Dr. Beach, ten per cent. Dr. Bidwell, "For short periods very fatal, now rarely so." Dr. Deming, "Small, but varies in different outbreaks."

It is very small in Wolcottville; scarcely ever fatal.

To question 5, Drs. Goodwin, Lyman, Thompson, and Minor answer fifty per cent. Drs. Derrickson and Beach, ten per cent. Dr. Knight, "none." Dr. Bidwell, three-quarters or more. Dr. Deming, "occasionally." Dr. Stevens, "in none." He attributes the disease to atmospheric influences, or imprudent exposure in the absence of direct contagion, added to the improper conditions as to drainage, etc.

I think a large proportion of our cases are caused by bad sewerage or drainage.

Question 6. Drs. Goodwin, Lyman, Derrickson, Knight, Beach, Deming, Brown, and myself answer, "constitutional." Dr. Minor, "both." Dr. Thompson, fifty per cent. arise from each cause in his experience.

Dr. Bidwell, Sometimes either, most dangerous when it begins with severe constitutional symptoms."

Dr. Stevens answers, "A zymotic disease is necessarily constitutional. It may be of any grade or type from simplex to maligna; with sometimes the local and sometimes the constitutional most marked and earliest developed."

Question 7. Drs. Knight, Beach, Deming, Brown, Goodwin, Lyman, and myself rely mainly on constitutional treatment.

Drs. Thompson and Derrickson use both, but lay particular stress on constitutional. Drs. Bidwell and Minor consider both equally necessary.

Dr. Stevens writes, "In a majority of cases local treatment is of the first importance; in mild cases, or those of moderate severity, it is the essential thing."

To question 8, Dr. Beach answers chlor. potass. gargle; Dr. Deming, turpentine, with steam from an atomizer; Dr. Goodwin, persulph. iron; Dr. Lyman, hyposulphite soda and chlorat. potassa; Dr. Bidwell, tannic and sulphuric acids; Dr. Minor, chlorat. and. nitrate potassa, argent. nitratis, carbolic acid, capsicum, tannic acid; externally poultices of poke root. Dr. Stevens, "of late I favor solution of carbolic acid, tinct. fer. chloride and glycerine;" Dr. Derrickson has no faith in purely local applications internally. Astringent poultices externally, if there is much swelling, and chlorate potass., with tr. iron internally, he considered useful, acting partly as a local remedy by contact with the diseased surface during the act of deglutition. Dr. Thompson uses tr. fer. chlor. two parts, glycerine one part, applied with a camel's hair brush. Also acid carbolic (saturated solution), ten minims, liquor calcis 3iv. to be thrown in the form of a spray; two or three grains of chlorate potassa on the tongue occasionally. Dr. Brown of Woodbury uses chlorate and bromide potass. equal parts, pulverized and allowed to dissolve on tongue at intervals of one half to three hours, in doses of three to five grains; also chlorate or bromide potass. with tr. fer. chlorid.; the latter with bromine and bromide potassa he considers almost a specific used both locally and constitutionally. Dr. Knight is "uncertain, changes frequently," an excellent resumé of all the answers received.

I have never used any local application except chlorate potassa allowed to dissolve on the tongue.

Question 9. Drs. Deming, Beach, Lyman, and myself, are of the opinion that it does not. Drs. Goodwin, Derrickson, Knight, and Stevens consider that the first cases are the most malignant, the succeeding ones being usually milder, although the feeble and poorly nourished suffer most severely. Drs. Brown and Bidwell think it does sometimes, but not always. Drs. Minor and Thompson answer that it does in their experience. Dr. Thompson recalls some cases which bear witness to this fact, and considers the prognosis more doubtful in these cases.

Question 10. Drs. Goodwin, Knight, Derrickson, Lyman, Beach,

Deming, Brown, and Thompson answer in the negative. Dr. Minor answers that it is. Dr. Bidwell considers it quite probable, and Dr. Stevens writes, "I accept the theory that with a combination of filth, crowding, impure air and the like, a malignant disease may be developed from a simple mild form by successive transmission." Very truly yours,

L. H. WOOD,

Reporter for Litchfield County.

TYPHOID FEVER.

W. J. BEACH, M.D., LITCHFIELD.

Case No. 1. Lizzie D., aged, 18, Irish parentage; stout healthy girl; never been sick before; out at service in the village. Was called to see her August 26, 1878; had been complaining of severe headache for eight days, but had not given up and was at the wash-tub when I was called to see her.

From 13th to 18th no record; the 18th, pulse 88, temperature normal and patient in every way convalescent. It may be noted that from Aug. 26 to Oct. 7, a period of six weeks, the pulse except in two instances was never below 130, and for a considerable part of this time was much above that. I would also state that for the first three or four weeks the patient was kept under the influence of tinct. aconite and tinct, digitalis in fair doses, so that it is fair to assume that there would have been still greater frequency of heart's action if not under the control of remedies.

The other symptoms were about as bad; for several weeks there was delirium, and involuntary and unconscious evacuation of urine, several bad sores, severe bronchitis, spells of diarrhoea, very great distention and tenderness of the abdomen, etc. With very few exceptions the patient's stomach tolerated food, medicine, and stimulants in large quantity. At one time, when there was great pain in the bowels, patient took forty-five grains of Squibb's powdered opium within twenty-four hours; patient usually took at least two quarts of milk in twenty-four hours. Patient was given about twelve grains of quinine with fair doses of sulphuric acid daily, and in addition to this was stimulated freely from the first. During the second, third, and fourth weeks of her sickness she took nearly a pint of brandy every twenty-four hours. She also had very frequent cold sponging, some days as frequently as every hour. I think the case is remarkable from the long continuance of a condition of things apparently hopeless, with final complete recovery.

MIDDLESEX COUNTY.

Answers to the questions contained in the circulars sent to the physicians of this county have been received from Drs. Burke and Cleaveland of Middletown, Hazen of Haddam, Grannis of Old Saybrook, Field of East Hampton, and Worthington of Middle Haddam.

In reply to question 1, Drs. Field and Grannis report an increase and the others less diphtheria in their respective localities than formerly.

Question 2. All reply that its type has not changed.

Question 3. Dr. Field has found it less and all the others more amenable to treatment.

Question 4. Dr. Field has found the ratio of deaths twenty per cent., and Dr. Worthington, practicing in the same town, three per

cent.

Question 5. Dr. Field traces twenty per cent. of his cases to bad sewerage and drainage, and Dr. Cleaveland has traced cases to bad water supply.

Question 6.

All agree that it begins as a constitutional disease. Question 7. All rely principally on constitutional treatment. Question 8. Drs. Cleaveland and Field use a solution of argent. nit. as a topical application, Drs. Burke, Grannis, and Hazen, tinct. ferri chlor. and solution potass. chlorat., and Dr. Worthington uses tinct. iodine diluted with solution iodide potash as a topical application with the spray of carbolic acid. Within the observation of the Reporter the disease has not increased; its type continues as for the last twelve years-mild, no deaths unless complicated with croup. It usually begins as a constitutional diseasegeneral symptoms precede the local for about twenty-four hours. The most of the remedies I use act both locally and constitutionally. I use the tinct. chloride of iron diluted with glycerine and water, a saturated solution of chlorate of potash in lime water with an addition of glycerine, and a solution of permanganate of potash in water alternately as often as every hour, following each dose with a spray from an atomizer of five minims carbolic acid in an ounce of lime water-the last is very agreeable to the patient, and I consider it very important; it acts also as a disinfectant. I also use the above solutions to the nose with a syringe when its cavities are involved. I use quinine. I insist on good nourishment, ventilation,