TYPHOID FEVER. 
FOURTH PAPER, 
Read before the Ohio State Medical Society, with Clinical data. 
BY JOHN ELIOT WOODBRIDHE, 
Member and Ex-President Mahoning County, O., Medical Society; Member and 
Ex-Vice President Ohio State Medical Society; Member Mississippi Valley 
Medical Association; Member Ninth International Medical Congress; 
Member and Trustee American Medical Association, Etc. 
REPRINTED FROM 
THE TRANSACTIONS OHIO STATE MEDICAL SOCIETY. TYPHOID FEVER. 
John E. Woodbridge, M. D., Youngstown. 
The awful mortality from typhoid fever in Chicago, in 
Philadelphia, in Pittsburgh, in Washington, and in many 
other cities and in many rural districts throughout the 
-United States, and the recent outbreak of the disease in St. 
Louis, in Buffalo, in Northern Michigan, in North Dakota, 
and in many other places, coupled with the well-known fact 
that this malady manifests a marked preference for the 
young and vigorous of both sexes, fully attest the impor- 
tance of my subject. The interest of the medical profession 
in the subject is made clearly apparent by the enormous 
number of letters that have deluged my mail since the pub- 
lication of my first paper under the title " Can Typhoid 
Fever be Aborted ? " These letters, coming as they do from 
almost every part of the United States, and some from 
beyond its boundaries, indicate that this interest is general 
and widespread, while the dense ignorance of some of the 
simplest problems involved exhibited by the criticisms of 
some of those who have essayed the discussion of my papers, 
together with the contradictory theories and irreconcilable 
inconsistencies of the writings of different learned authori- 
ties, demonstrate the necessity of rewriting the entire litera- 
ture of typhoid fever. But it is yet too early to do that; we 
know too little of bacteriology to write a literature of this 
disease; we know, too, too many lessons that must be un- 
learned before we can study it properly and well, and those 
who have abundance of material and the best opportunities 
for observation in the great hospitals seem most loath to 2 
TYPHOID FEVER. 
give up the false theories that seem so dear to their hearts, 
as, for instance, "since typhoid fever, like a majority of 
specific infections, runs a course uninfluenced by any known 
medicines,"* is a statement which with unimportant modi- 
fications has been so long and so often repeated that it seems 
iconoclastic to attempt to break its force. Realizing fully 
what it means to question this statement, and thus attempt 
to convict all of the great teachers of having taught errors 
that have cost millions of lives, I have endeavored with the 
limited means at my disposal, to make my position impreg- 
nable. For this reason I have striven to avoid the discus- 
sion of scientific problems, and confined myself to statements 
of facts that have been proven or are easily susceptible of 
proof, believing that I shall accomplish the greatest good in 
the shortest time and ultimately benefit the greatest number 
by first demonstrating that typhoid fever can be aborted, 
and leaving the speculative discussion of unsettled scientific 
questions to the future. 
Since the early part of July, 1893, I have read three 
paper in my local society in which I gave the names and 
residences of a large number of cases of typhoid fever which 
I had treated during the preceding twelve years without a 
death, and showing an average duration of treatment of 
about ten days. In these papers I reminded the members 
of my society that in 1880 I had condemned all known 
methods of treatment of this disease, had given the society 
my idea of the correct treatment and foreshadowed its results ; 
that in 1882 I had declared in the society that hemorrhage 
of the bowels in typhoid fever would be unknown if the dis- 
ease were properly treated, and that in 1890 to emphasize 
my statement that typhoid fever could be aborted, I of- 
fered to recompense any member in the usual fee for every 
day that I had to visit a patient after the tenth day of treat- 
ment. With each of these papers I presented the history of 
my cases up to date, exhibiting the charts, and these charts 
*Johns Hopkins Hospital Reports, Vol. IV, No. 1, 1894, by 
William Osler, M. D. J. E. WOODBRIDGE, M. D. 
3 
having been exhibited, my statement that I had had no death 
from typhoid fever for twelve years made, and my claim 
that the disease can be aborted and that it should never cause 
death having been discussed in my local society, where 
several of the ablest members verified the charts of the cases 
they had seen and endorsed my statements of facts as far as 
they had come under their observation, can leave no doubt 
in the mind of any thinking physician that I have done 
and can do exactly what I claim. In one society, amongst 
entire strangers, my charts were severely criticised by a 
gentleman of undoubted ability, who said, " I have examined 
every one of them carefully,' and with four or five possible 
exceptions there is not a typhoid fever curve among them." 
Gentlemen, you are requested to examine these charts, 
with this explanation, which ought to have been given to 
the Association in which they were so harshly criticised : 
There are amongst them three or four charts of cases in 
which absolutely pathognomonic symptoms were not present. 
They are there, because they appeared amongst well-marked 
cases of typhoid fever, were so diagnosed, and the presump- 
tion is that had they not been seen early and properly 
treated, they would have developed characteristic symptoms 
of the disease. Most of the others have a small figure in the 
upper left corner showing the number of physicians, most of 
them members of this Society, who examined the patients, 
confirmed my diagnosis, watched the treatment, and are 
ready to verify its results. Every one of them is the peer 
of the gentleman who criticised the charts, and quite as 
competent as he would have been, had he been present, to 
make an exact diagnosis in typhoid fever. And when he 
said : " Not all of the State of Ohio could convince me that 
they are typhoid fever charts or that the temperature of a 
typhoid fever patient could be brought to normal in so short 
a time," he simply exposed his ignorance of the possibilities 
of antiseptic medicine and placed himself on record on the 
wrong side of the question. 
You are asked to examine them, and to accept them as 4 
TYPHOID FEVER. 
typhoid fever charts upon my diagnosis with the verification 
of these gentlemen ; and to study the temperature curve as 
a typhoid fever curve modified by treatment. Had the 
curves pleased my critics they would have lacked much of 
pleasing me. and had I been unable to modify the curve, no 
possible reason would have existed fortheir presentation to 
or indeed for my appearance before this distinguished 
audience. 
An analysis of these cases will show that many of them 
were put under treatment on the sixth, seventh or eighth 
day of sickness, and two or three on the tenth day or later, 
but a demonstration of the possibility of aborting typhoid 
fever as late as the eighth or tenth day of sickness must not 
be regarded as a claim that they can always be aborted at 
so late a date or as a justification of the dense ignorance, or 
criminal carelessness, or both, which are so often responsible 
for incorrect or inexact diagnosis. Nothing can justify the 
correction of a diagnosis from malarial fever or any other 
disease to typhoid fever, and still less the statement that any 
disease has run into typhoid fever. 
In order to make a just estimate of the value of my re- 
sults, you will please bear in mind that everything that the 
profession has regarded as essential to recovery from ty- 
phoid fever has been ignored. Very few of my private pa- 
tients have had the advantage of trained nurses. No bath- 
ing has been ordered in ordinary cases, in any case, except 
one that 1 took on the sixteenth day of sickness. No re- 
strictions as to exercise. My patients were allowed to sit up, 
walk about, and even go out of doors, if they felt able ; 
many of them have eaten solid food on the seventh or eighth 
day, and I am fast coming to the conclusion that no restric- 
tions whatever as to diet are necessary when patients are 
properly treated. 
With my last paper, read April 25th, 1894, I presented 
my charts up to date, including that of Case No. 71, dis- 
charged on that day, since which I have had but two cases 
(the charts of which I hand you, Nos. 72 and 75) which de- J. E. WOODBRIDGE, M. D. 
5 
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veloped absolutely pathognomonic symptoms of typhoid 
fever. They are the charts of the son and wife, respective- 
ly, of Mr. W. W., residing in the adjoining county of Trum- 
bull, and of especial interest because I had Cases Nos. 73 
and 74 (no charts), presenting tolerably well-marked symp- 
toms of the disease, in the houses on two sides of his resi- 
dence, and because he had previously lost a son and 
daughter from typhoid fever. Both of these cases present- 
ed all of the most characteristic symptoms of the disease: 
Intense headache, tympanitis, tenderness and gurgling in 
right iliac fossa, rose spots, bronchial catarrh, and in one 
nose-bleed and delirium. The charts show the result of 6 
TYPHOID FEVER. 
CaseN? . 
O ^/y|AGN0S*^? 
_..." 
Notes'afM/se 
Name $L. MF 
amw 
Nativity : 
Occupation 
"Residence ... 
Date oTadmisnon kJ 
Treatment 
Nestdt. 
treatment, which consisted of a No. 5 capsule of the formula 
given in my second paper, minus the podophyllin, viz.: 
IJ hydrarg. chlor, mite 3 i. 
guaiacol carb. REVI^I 
thymol ,jv. 
menthol 5;. 
sacch. alb - ii. 
eucalyptol as much as possible. 
every half hour the first day, every fifteen minutes the sec- 
ond day, and every hour the third day, followed by 
IJ eucalyptol AL x. 
guaiacol M. ii. J. E. WOODBRIDGE, M. D. 
7 
every three hours, in one case one day and in the 
other case two days, when a JNo. 5 capsule of the first mix- 
ture was given every hour in one case, and in the other 
every fifteen minutes for one day, when the eucalyptol- 
guaiacol mixture was given until the temperature was nor- 
mal. To Mrs. W., bowels having moved only once during 
her illness, a few doses of magnesia were given. To both 
were given a little ipecac, and Mrs. W. not having slept for 
four or five nights, her husband gave her a twenty-drop dose 
of tine, of opium. 
I regret that I am as yet unable to give any rule by 
which one may know when the desired object has been at- 
tained. I am in the habit of watching the symptoms very 
carefully, and when satisfied that they are steadily improv- 
ing, diminish the doses or stop treatment, striving to make 
up by extreme watchfulness what I lack in knowledge. 
There is no language strong enough to adequately con- 
demn the habit of making a mixed diagnosis, as is ordinarily 
practiced in many localities or as laid down in some other- 
wise very good text-books. It is not at all uncommon for 
practitioners to say that their patient has malarial fever, a 
few days later correct that diagnosis to typho-malarial fever, 
and when the patient has had hemorrhage of the bowels, or 
is dying of exhaustion, to say that it has run into typhoid 
fever - a practice justly condemned by Dr. Gustavus 
Eliot, of New Haven; equally to be condemned is the custom 
of those physicians who await the development of one or 
more of the pathognomonic symptoms, as enlargement of 
the spleen, rose spots, etc., before venturing an opinion or 
beginning any proper treatment. 
Since the course of treatment I have advised in typhoid 
fever is the best possible treatment for any disease for which 
it could be mistaken, and since a patient under this treat- 
ment need not go to bed, be restricted in diet, in social enjoy- 
ment, or even required to neglect his business, it is quite prop - 
er to treat every doubtful case as a case of typhoid fever. If 
future developments require a change in diagnosis and treat- 8 
TYPHOID FEVER. 
ment, the patient in any case will have profited by the mis- 
take ; and if the diagnosis prove to have been correct, his 
life will have been saved. 
I have been very severely criticised by some very emi- 
nent authorities for claiming so much on so few cases, while, 
on the other hand, during the discussion of my paper in my 
local society one member said that he thought Dr. Wood- 
bridge was responsible for a great many deaths for not hav- 
ing published a treatment capable of producing such results 
twelve years ago. To this I replied: "The gentleman will 
please remember that I gave my treatment to this society 
more than twelve years ago at a largely attended meeting at 
which the gentleman himself was present, and that every 
member who took part in the discussion condemned it." No ! 
The responsibility for deaths must not be charged to me. 
All of the great thinkers and teachers of the profession 
are, I believe, a unit, in teaching that typhoid fever cannot 
be aborted. They have a perfect right to their opinions, 
and so far as they are concerned they are probably correct. 
Mr. President, f speak thus plainly because of the per- 
sistent efforts of two or three " captious critics " to embar- 
rass my work, and because I wish to place the responsibil- 
ity exactly where it belongs. I wish to say that I am ready 
at any time to go wherever, in the whole world, typhoid 
fever claims a victim, and if I have a death from the dis- 
ease, challenge the publication of my failure, with the day 
of the disease at which I was called. 
The importance of this subject cannot be overestimated. 
Should cholera or small-pox cause a few hundred deaths the 
people would be up in arms against its inefficient health 
boards; but Dr. Victor C. Vaughn, than whom there is prob- 
ably no better authority, in an article published in the cur- 
rent issue of the Pharmaceutical Era, says : " About 50,000 
people die annually in the United States from typhoid fever, 
and more than ten times this number are sick with this dis- 
ease." He says further : " We have no foreign foe who 
could possibly inflict upon us the injury, suffering and death J. E. WOODBRIDGE, M. D. 
9 
which typhoid fever will cause during the next twelve 
months." 
Were this country threatened with an invasion of a for- 
eign enemy, capable of destroying the lives of 50,000 of her 
people, and prostrating half a million more for the average 
duration of an attack of typhoid fever, and were a military 
man to present the evidence of his ability to defeat that foe 
that I have given you of my ability to save the country the 
awful suffering and tremendous loss of life and time caused 
by typhoid fever, the entire resources of the nation would 
be placed at his disposal, and I ask you, does not the coun- 
try own me one Typhoid Fever Hospital in which to alleviate 
a little more suffering and save a few more lives than is 
possible in private practice, and in which to demonstrate to 
the profession that typhoid fever is really amenable to 
curative treatment; and if the medical profession and the 
people can be made to recognize this disease by its earliest 
symptoms and will send its victims to me as soon as they 
make their appearance, I make you this solemn promise, that 
I will return to you every one of them without a death from 
typhoid fever or its ordinary complications or sequelae, with 
much less than one-half of the usual loss of time and with 
little or no impairment of the constitution.